Myths and Misconceptions About Obesity
Today is World Obesity Day, i.e. an excellent opportunity to discuss something that is very important to me. At the moment I am in my third year of a PhD programme investigating the intersections of childhood obesity, identity and disadvantage. Throughout my time of research, I have come across several misconceptions about people living with obesity, both children and adults. I have had more than one shocking moment of a health professional or academic relaying these myths to me. On this World Obesity Day, I would like to address just a few of the myths and misconceptions about obesity that I sometimes still hear from others or read online. Please note that I will be using people-first language when talking about obesity. This means I will say phrases such as "people with obesity" or "a person with more weight" instead of saying "obese people". This is in line with multiple obesity organisations in an effort to reduce stigmatisation for children and adults with obesity. I will also aim to avoid using crude or stigmatising imagery. In doing so, I am encouraging any other writers, academics, twitter-goers etc. to do the same.
1. Childhood obesity is child abuse... FALSE
I have actually had someone in the clinical psychology field say this to me before. When it occurred I was simply floored that a clinical professional could not understand why they were wrong. This perspective has become a big pet peeve of mine. This misconception is a misconception because it is not supported by evidence or common sense. Firstly, there are several research studies that suggest some parents underestimate their child's weight and weight status. They may be unaware that their child is considered overweight until their primary care doctor suggests so. This difficulty of recognising when their child has more weight than peers is likely linked to problems with health literacy. In many families, food and treats are used as rewards for children and opportunities for physical activity are less available. There are very few cases when childhood obesity is a result of serious, irresponsible neglect on behalf of a caregiver. Obesity does not happen in a vacuum and is a result of several factors in multiple areas of our life. Secondly, there are many genetic disorders that can contribute to a severe and early onset of obesity that have absolutely nothing to do with parenting and everything to do with genetic mutations. These disorders are rare and of course, have nothing to do with parenting.
2. People with obesity don't eat healthily or exercise... FALSE
Someone's body size or appearance is not an indicator of how frequently they are physically active or how well they eat. For example, with my BMI, I would not be considered overweight or obese. However, I can assure you that I am not very good at making time for physical activity. I haven't been to the gym in weeks and I am a sucker for every unhealthy food that is out there. There are people out there who would be considered obese by a medical professional that can run for longer and faster than me. You simply cannot tell whether a person exercises a lot or eats 7 fruits/veggies a day by looking at them. A recent example of this misconception showing itself comes from some remarks that personal trainer and tv person Jillian Michaels came out with. Jillian questioned why Lizzo's body should be celebrated in addition to her music, and made an assumption about Lizzo's health, stating "it isn’t going to be awesome if she gets diabetes". Jillian made an assumption about Lizzo's health just by looking at her body size and this is inappropriate. Have you seen Lizzo twerk? Have you seen her run around a stage while also playing the flute?? In recent years, obesity research has taken a turn in how obesity is even defined. More and more research tells us that obesity is a disease and should be defined as such. Last May I attended the annual conference put on by the Association for the Study of Obesity in Ireland. At the conference, there was a lot of discussion about how obesity is defined and how more researchers should be evaluating patients with obesity differently by using a staging system to classify the condition. Obesity is a disease and the environment (i.e. the obesogenic environment) is a cause.
3. The body-positive movement promotes "unhealthy lifestyles"... FALSE
The body-positive movement is about promoting self-love and respect for oneself regardless of what body shape, size or appearance you have. It is about being kind to the body you currently have; taking care of it, loving it, keeping it strong, and appreciating what it can do. In recent years, we are seeing more and more diversity in visual media in regards to body size and appearances and this is important. There is a lot of evidence suggesting that people with obesity experience weight stigmatisation which can contribute to other mental health difficulties such as depression. Some people with overweight feel shame. This is heartbreaking. Life is far too short and no one should ever feel that they are less-than because of their weight for even just a moment. If you are someone who thinks that the body positive movement is problematic, I recommend you take a quick look at a recent photography project from Abbie Trayler-Smith that documented the experiences of people living with obesity in Ireland and the UK. If you think I am exaggerating about the stigmatisation that occurs to people with obesity, just go on Twitter today. It is completely not okay.
4. People wouldn't have obesity if they just ate less and moved more... FALSE
Increasing physical activity and changing your diet is certainly part of lifestyle treatments for the management of obesity. But it isn't a cure. Moving more and eating less is about preventing overweight and obesity. Obesity will go away when our world becomes a world in which opportunities for moving more and eating better is accessible to everybody and easy to do. This myth completely erases several other determinants of obesity. Some of the more researched determinants include socioeconomic disadvantage, education, general health inequalities and the food environment. Evidence demonstrates that in many western countries, there are very apparent gradients in society regarding health. Families who have less education and come from disadvantage circumstances are more likely to have obesity. More recently, there has been a lot of very interesting research coming out about the role of marketing to children and the role of "treats" in a family culture. Even my own research demonstrates that childhood obesity is much more complicated than just what young people eat and do.
There are so many myths and misconceptions about obesity and it would take me all day to keep up with the comments and stigmatising remarks that are thrown around. I just hope that even a quick read such as this one can make a little bit of a difference. Please find some interesting and important references for further reading below. If anyone has any questions about obesity, I am always available and open to an educated and informed discussion.
So what is the take-home message? Obesity is a disease. It is caused by multiple factors, some of which are out of our control.
Eckstein, K. C., Mikhail, L. M., Ariza, A. J., Thomson, J. S., Millard, S. C., & Binns, H. J. (2006). Parents' perceptions of their child's weight and health. Pediatrics, 117(3), 681-690.
De La O, A., Jordan, K. C., Ortiz, K., Moyer-Mileur, L. J., Stoddard, G., Friedrichs, M., ... & Mihalopoulos, N. L. (2009). Do parents accurately perceive their child's weight status?. Journal of Pediatric Health Care, 23(4), 216-221.
Stevens, S. D., Herbozo, S., Morrell, H. E., Schaefer, L. M., & Thompson, J. K. (2017). Adult and childhood weight influence body image and depression through weight stigmatization. Journal of health psychology, 22(8), 1084-1093.
Puhl, R. M., Moss-Racusin, C. A., Schwartz, M. B., & Brownell, K. D. (2008). Weight stigmatization and bias reduction: perspectives of overweight and obese adults. Health education research, 23(2), 347-358.
Wanniarachchi, V. U., Mathrani, A., Susnjak, T., & Scogings, C. (2020). A systematic literature review: What is the current stance towards weight stigmatization in social media platforms?. International Journal of Human-Computer Studies, 135, 102371.
Friedman, K. E., Reichmann, S. K., Costanzo, P. R., Zelli, A., Ashmore, J. A., & Musante, G. J. (2005). Weight stigmatization and ideological beliefs: relation to psychological functioning in obese adults. Obesity research, 13(5), 907-916.
Rubino, F., Puhl, R.M., Cummings, D.E. et al. Joint international consensus statement for ending stigma of obesity. Nat Med (2020). https://doi.org/10.1038/s41591-020-0803-x
Jastreboff, A.M., Kotz, C.M., Kahan, S., Kelly, A.S. and Heymsfield, S.B. (2019), Obesity as a Disease: The Obesity Society 2018 Position Statement. Obesity, 27: 7-9. doi:10.1002/oby.22378
Stamatakis, E., Wardle, J., & Cole, T. J. (2010). Childhood obesity and overweight prevalence trends in England: evidence for growing socioeconomic disparities. International journal of obesity, 34(1), 41-47.
Marmot, M., & Wilkinson, R. (Eds.). (2005). Social determinants of health. OUP Oxford.
Harris, J. L., Pomeranz, J. L., Lobstein, T., & Brownell, K. D. (2009). A crisis in the marketplace: how food marketing contributes to childhood obesity and what can be done. Annual review of public health, 30, 211-225.
Kunkel, D. L., Castonguay, J. S., & Filer, C. R. (2015). Evaluating industry self-regulation of food marketing to children. American Journal of Preventive Medicine, 49(2), 181-187.
McCafferty, C., Shan, L. C., Mooney, R., O'Rourke, C., Pourshahidi, K., Livingstone, B., ... & Murrin, C. (2019). How do adults define the treats they give to children? A thematic analysis. Appetite, 133, 115-122.