Obesity: We're doing it wrong

For 60 years, doctors and researchers have known two things that could have improved, or even saved, millions of lives. The first is that diets do not work. … 95 to 98 percent of attempts to lose weight fail and … two-thirds of dieters gain back more than they lost. The reasons are biological and irreversible. …. Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.

The second big lesson the medical establishment has learned and rejected over and over again is that weight and health are not perfect synonyms. … anywhere from one-third to three-quarters of people classified as obese are metabolically healthy. …. Meanwhile, about a quarter of non-overweight people are what epidemiologists call “the lean unhealthy.” …

Lesley Williams, a family medicine doctor in Phoenix, tells me she gets an alert from her electronic health records software every time she’s about to see a patient who is above the “overweight” threshold. The reason for this is that physicians are often required, in writing, to prove to hospital administrators and insurance providers that they have brought up their patient’s weight and formulated a plan to bring it down—regardless of whether that patient came in with arthritis or a broken arm or a bad sunburn. Failing to do that could result in poor performance reviews, low ratings from insurance companies or being denied reimbursement if they refer patients to specialized care. …

“A lot of my job is helping people heal from the trauma of interacting with the medical system,” says Ginette Lenham, a counselor who specializes in obesity. The rest of it, she says, is helping them heal from the trauma of interacting with everyone else. …

“These findings suggest the possibility that the stigma associated with being overweight,” the study concluded, “is more harmful than actually being overweight.” …

Diet is the leading cause of death in the United States …

All of our biological systems for regulating energy, hunger and satiety get thrown off by eating foods that are high in sugar, low in fiber and injected with additives. And which now, shockingly, make up 60 percent of the calories we eat. …

Participants who got more than 12 sessions with a dietician saw significant reductions in their rates of prediabetes and cardiovascular risk. Those who got less personalized care showed almost no improvement at all. …

The United States spends $1.5 billion on nutrition research every year compared to around $60 billion on drug research. Just 4 percent of agricultural subsidies go to fruits and vegetables. No wonder that the healthiest foods can cost up to eight times more, calorie for calorie, than the unhealthiest …

The most effective health interventions aren’t actually health interventions—they are policies that ease the hardship of poverty and free up time for movement and play and parenting.

—Michael Hobbes, Huffington Post Highline[^1]