- Obesity is due to an individual’s choices, lack of willpower, laziness, or another factor within the control of the individual.3
Obesity is a chronic, multifactorial disease. Some of the factors contributing to it are within the control of the individual, but many are not. Amongst these are
- Lack of access to healthy food
- Evolutionary tendency for the human body to increase hunger hormones/decrease metabolic rate in the face of weight loss
- Food industry/availability of highly processed foods
- Structural brain problems
- Environmental chemicals
- Body Mass Index tells the whole story.
We know that BMI does not necessarily reflect body fat in people who have high muscle mass or those who hold on to a lot of fluid. Many muscular athletes have a body mass index that is 1-5 points higher than it would be if they had less muscle. The average BMI of all 2008 NFL quarterbacks was 28. The average BMI of 2016 Olympic female weightlifters was 26.4.
However, BMI is an easy-to-measure vital sign that can be used as a starting point to assess risks from body weight. Many muscular athletes have a body mass index that is 1-5 points higher than it would be if they had less muscle. If you feel BMI is an inaccurate indicator of your body weight/risk, consider measuring your waist circumference to provide an alternative indicator of the most dangerous type of fat, visceral fat.
- Exercise will make you lose weight.
Exercise is good for your heart, brain, lungs, muscles, mood, and longevity, so it definitely recommended. But it does not typically help you lose weight (unless you are exercising more than 4-6 hours a day).
Exercise is extremely important in maintaining weight loss. The most successful maintainers exercise on average 60 minutes daily.4
- In patients with obesity, weight is the cause of all of their health problems.
Many patients experience weight stigma when health care providers and others tell them that all of their other problems will go away if they simply lose weight. We have data that many health problems improve with weight loss, but there are many others that won’t (infectious diseases, cancers, etc.).
It is important to do a standard-of-care workup for any health problems that exist in a patient who has obesity, to ensure that alternative causes of pathology are not being missed.
- People who carry extra weight are all going to have bad health outcomes.
There are lots of people who carry extra weight who don’t seem to get many weight-related problems, like Diabetes and High Blood Pressure (metabolic problems from the chemical activity of fat). If one avoids the metabolic problems, there are still risks: problems like osteoarthritis and obstructive sleep apnea (problems related to the physical weight of fat) seem to increase as weight goes up.
- You can have obesity and be healthy (Health at Every Size Approach).
We know that people who have Obesity and are regularly physically active (cardiovascular fit), get enough sleep, address their mental health, and eat nutritive foods are healthier and generally live longer than other people with similar weights who are not. That’s the key point. If you have obesity, but weight loss is not a focus of yours at this point, or weight loss has been unsuccessful, you can improve your health by taking care of your body in all of these other ways.
- I am eating too little, and that is why I can’t lose weight.
Laws of thermodynamics tell us that if your body is taking in less energy than it is burning, you will lose weight. Therefore, if you decrease food enough, you will eventually hit a threshold where you are losing. The question is: can you live like that? What we know is when the body feels restricted, hunger hormones are upregulated, and you end up taking in an almost imperceptibly increased amounts of food. From professional experience, when patients feel hungry, weight loss stalls. Therefore, if you are taking in too little calories and always feeling hungry, it’s likely time to try a different strategy.
- Breakfast is the most important meal of the day.5
We know that people who are most successful in maintaining weight loss do tend to eat breakfast, but when we ask people to add breakfast to their days (if they are not natural breakfast eaters), this does not promote additional weight loss.
- Smaller more frequent meals are better than three larger meals.6
This has not been demonstrated consistently in studies. What seems to matter more is that individuals are eating in a pattern that prevents them from getting very hungry and then overeating. This may be different for different people.
- I’m not drinking enough water.7
Studies have not shown a consistent benefit of drinking a lot of water to induce weight loss. But if drinking water helps you feel better or fuller, by all means proceed!
- Artificially sweetened beverages are better than sugar-sweetened beverages.8
If you have diabetes, this is definitely true (sugar sweetened beverages acutely elevate your blood sugar whereas artificially sweetened beverages do not).
If you don’t have diabetes, regular consumption of both artificially sweetened beverages and sugar sweetened beverages is associated with a higher risk of diabetes compared to those who don’t consume sweetened beverages. People who regularly drink artificially sweetened beverages tend to weigh more, but it is uncertain if this is causal. Regardless, there is suggestion that sweetened beverages of any type may promote weight gain/retention (through taste bud programming, priming the brain to consume more calories, and changes in gut microbiota and hormone release) that it makes sense to try a break from sweetened beverages to see if this promotes weight loss.
- I need to get back down to my high school weight to be healthy.
There is ongoing research in this area. Once you have reached a high weight, it is hypothesized that you can get a “metabolic reset” by losing as little as 5-10% of your body weight. We are unsure of how much additional benefit one gets by losing more and more weight (i.e., down to your high school weight or a “normal” body mass index)
- I need to lose weight “on my own”.
Try it and see! We know that some people can lose weight successfully on their own and maintain the weight loss. We also know that statistically, many people don’t lose as much as they wanted to or regain after losing. If you have not been successful with your weight loss goals, you can place at least some of the blame on evolution!The drive to eat comes from the primitive portion of your brain (hypothalamus), not the part that is responsive to rational choice (frontal lobe). If a medication can help overcome this drive, great! There’s no shame in using a medication to help you reduce weight if it facilitates improvements in your health. Isn’t that what medicines are for?
- Bariatric surgery is either a “drastic step” or “the easy way out”.
Bariatric surgery is the most efficacious and durable tool for weight loss that currently exists. Yes, it is a surgery, but many surgeries are minimally invasive (done laparoscopically) and reversible. Many surgeries take less than 3 hours, and many patients spend just one night in the hospital after surgery. For people who are eligible, this is a very reasonable tool. This would be particularly recommended for people who have not had success with other weight loss options, and those who are having trouble controlling weight-related comorbidities (like Diabetes).
The people who have the most success with surgery will do months of preparation (learning about how they will use their new anatomy and physiology) and need to follow several rules after surgery, so it is not “easy”.
- I can get obesity medications at the health food store.
Many products sold in the supplement aisle will claim to help you lose weight. Generally, these supplements have been shown to induce 1-5 lbs. of weight loss, but are not considered “clinically significant.”
- I can lose weight, then add back calories.
Try it and see, perhaps this could work for you. However according to professional experience, many people regain weight when moving into the “maintenance” phase of a diet that permits adding back calories. You are more likely to be successful making a permanent lifestyle change with any dietary strategy.
Important Myths and Controversies for patients to understand9 [View Website] >>
3. Bays, Harold Edward, Angela Golden, and Justin Tondt. "Thirty obesity myths, misunderstandings, and/or oversimplifications: an obesity medicine association (OMA) clinical practice statement (CPS) 2022." Obesity Pillars 3 (2022): 100034.
4. McGuire, Maureen T., Rena R. Wing, Mary L. Klem, and James O. Hillf. "Behavioral strategies of individuals who have maintained long‐term weight losses." Obesity research 7, no. 4 (1999): 334-341.
5. Sievert, Katherine, Sultana Monira Hussain, Matthew J. Page, Yuanyuan Wang, Harrison J. Hughes, Mary Malek, and Flavia M. Cicuttini. "Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials." bmj 364 (2019): l42.
6. Kahleova, Hana, Lenka Belinova, Hana Malinska, Olena Oliyarnyk, Jaroslava Trnovska, Vojtech Skop, Ludmila Kazdova et al. "Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study
7. Stookey, Jodi JD. "Negative, null and beneficial effects of drinking water on energy intake, energy expenditure, fat oxidation and weight change in randomized trials: a qualitative review." Nutrients 8, no. 1 (2016): 19.
8. Greenwodd, DC Threapleton DE, Evans, CE, Cleghorn CL, Nykjaer C, Woodehead C, Burley VJ. Associate between sugar-sweetened and artificially sweetened soft drinks and Type 2 Diabetes: systematic review and dose-response meta-analysis of prospective studies. Br J Nutr 2014;112725-34
9. Harold Edward Bays, Angela Golden, Justin Tondt. Thirty Obesity Myths, Misunderstandings, and/or Oversimplifications: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022, Obesity Pillars, Volume 3, 2022, 100034, ISSN 2667-3681, https://doi.org/10.1016/j.obpill.2022.100034.