With the “obesity epidemic” in the United States seeing no real end in sight, the government is starting to look at potential health solutions that will put the issue of weight and size even more in the spotlight.
Obesity has been linked to many health issues, and it is now the recommendation of the U.S. Preventive Services Task Force to screen for obesity and provide weight loss programs for people with a body mass index (BMI) over 30. An article in the Los Angeles Times suggests that health insurance plans would be required to fully cover the screening and resulting weight loss programs.
While screening for obesity and potential referrals to weight loss programs could be a wake-up call for many Americans, it is uncertain how this focus on obesity could affect other aspects of health, such as mental health and the growing stigma against overweight people.
The recommendation statement from the task force even considers that as a result of obesity detection and intervention, there is potentially “an increased risk for eating disorders.” However, trials for weight loss interventions found no evidence associating the interventions with increased risk for eating disorders and depression. Other experts have additional concerns in regard to obesity screening and resulting weight loss programs.
Judith Matz, a licensed clinical social worker, director of the Chicago Center for Overcoming Overeating, and co-author of the book The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-Care, said in an email that obesity screening and resulting weight loss programs can lead to further stigma and discrimination against overweight and obese people.
“This type of program … will increase weight stigmatization by promoting the myths that all fat people are unhealthy and that anyone can lose weight,” Matz said. “The scientific literature says otherwise, but beliefs about thin and fat run so deep that they are often ignored. Unfortunately, weight discrimination negatively affects both physical and mental health.”
She suggested that there should be less of a focus on weight and more of a focus on a healthy lifestyle. “The Health At Every Size paradigm offers an excellent alternative by focusing on wellness rather than weight so that people can achieve optimal health,” Matz said. In addition, the task force recommends screening based on the BMI, which she states is generally ineffective. “These obesity programs potentially hurt the very people they are trying to help,” Matz said. “Research shows that when using body mass index as a proxy for health, there will be a significant percentage of people who fall in the obese category but are actually healthy, and there will be a significant percentage of people who fall in the normal weight category but are actually unhealthy.”
“Therefore, the solution is to make any referrals to counseling based on an individual’s health status rather than using BMI and then to focus on sustainable behaviors that support health, such as physical activity, attuned eating (eating according to physical hunger and choosing from a wide variety of foods), lowering stress, good sleep patterns, etc. rather than focusing on weight,” she added.
Even the weight loss intervention programs suggested by the task force for people with a BMI over 30 are mostly ineffective in the long run and could increase an already unhealthy relationship with food. “Counseling for weight loss is ineffective; while most weight loss plans and programs result in short-term weight loss, research shows that approximately 95 percent of people will gain back the weight and two-thirds [will end] up heavier than their pre-diet weight,” Matz said. “People who diet are at greater risk for eating disorders, depression, [and] poorer health as the result of yo-yo dieting and are likely to experience shame when their diet inevitably fails.”
Jessica Setnick, a registered dietician and the author of the American Dietetic Association Pocket Guide to Eating Disorders, said in an email that the recommendation by the task force could possibly benefit obese Americans more than their current options. “It is better than what is happening now – doctors tell their patients that they are overweight but then give them textbook advice to diet and exercise that is useless in the majority of cases and occasionally causes serious mental health issues like depression and eating disorders,” Setnick said.
“As someone who has treated overlarge individuals, it is a much more detailed process, slower and longer and harder than anyone gives them credit for,” she added. “The only way for most people to get the help they need from dietitians and counselors is if it is covered by insurance. Appropriate insurance coverage would ensure that the mental health causes of overweight and consequences of being overweight in a weight-phobic society could be addressed.”
She said that weight can be linked to mental health in many ways, and although weight loss can be beneficial in some cases, it’s not the final solution. “It is very depressing to be overweight in a weight-obsessed culture,” Setnick said. “However, weight loss is not the only answer to mental health issues. Often mental health issues predate weight gain and then also prevent weight loss. It is a vicious cycle that can only be broken with both kinds of care—nutritional and psychological.”
She has one major suggestion for the type of intervention that would be most useful for Americans who are struggling with weight and health issues. “Stop wasting time screening people based on the almost useless criteria of weight and instead offer every man, woman, and child in America three visits with a counselor and a dietitian to evaluate their current eating behaviors and their current and future problems,” Setnick said. “This is going to require individual and personalized intervention.”
She added that doctors will have to give more attention to potential eating disorders while they do the obesity screening. “Many individuals who seek medical care for weight loss have an eating disorder,” Setnick said. “They will receive many options for temporary weight loss that will not last, and most will not receive treatment for their eating disorder. Other individuals who are normal weight but have severe eating disorders are not seen as having a problem.”
“Our medical community and our insurance community need to get on board with better eating disorder education (for themselves) so that they know what to look for and how to refer those in need onward to eating disorder experts,” she added. “I can’t even begin to summarize the damage that well-meaning doctors have done to my patients with eating disorders, both over and underweight, in making it seem like nutrition and eating is a simple task.”
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