In recent years, it has become painfully clear that most non-surgical interventions against being overweight/obese are ineffective. Extensive clinical trials show that the vast majority of people who undertake to lose weight initially lose substantial amounts, but they gain it back again (and some more) within three to five years. Over 95% of motivated patients cannot keep off significant amounts of weight loss.
A recent NYT article paints a vivid picture of people struggling with weight. Winners of the reality TV show “The Biggest Loser” lost hundreds of pounds, but almost all of them gained them back shortly after the show ended. The article is written in a voice that expresses an unsettling Cartesian disconnect between the obese body and the person who strives to be thin: “As long as you are below your initial weight, your body is going to try to get you back.” and, “dieters are at the mercy of their own bodies, which muster hormones and an altered metabolic rate to pull them back to their old weights”. Some former contenders in the show had a slowed basal metabolic rate, which led them to require 800 calories less than someone of their stature would normally need to consume.
A study in the 1990s looked at people who successfully lost weight through bariatric surgery (the only intervention that seems to have decent success rates in the medical fight against obesity). The abstract reads
Patients (n = 47) who lost 45 kg (100 lb) or more and who successfully maintained weight loss for at least three years following gastric restrictive surgery for morbid obesity viewed their previous morbidly obese state as having been extremely distressful. In spite of the strong proclivity for people to evaluate their own worst handicap as less disabling than other handicaps, patients said they would prefer to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind, very bad acne, heart disease, one leg amputated) than to be morbidly obese. All patients said they would rather be normal weight than a morbidly obese multi-millionaire.
What are we to make of this? Is being obese worse than a major disability?
It is difficult to assess for the formerly morbidly obese people in the study I just cited whether they’d be adjusting well to a disability such as blindness. Not everyone adjusts well to disability, as advocates of the mere-difference view agree. But they remember vividly the social stigma of being morbidly obese. Thus perhaps these patients underestimate the social stigma of having a major disability, preferring that to going back to the distressful state of being overweight.
The view that obesity could be a mere difference, like hair color, gender, or sexuality is not popular in the medical world. Ever since the medical community in the 1950s started medicalising obesity, measuring it, offering advice on how to stop it, they have (1) spectacularly failed to stem the tide of increasing obesity in most western countries, especially the US and (2) failed to provide unequivocal evidence that being obese always constitutes a harm.
On the mere-difference view of obesity, the harms of being obese are mainly social harms and if society were fully accommodating and non-prejudiced, the people in this study, or the winners from the Biggest Loser, would not dread to go back to their previous weight. Imagine a society where obese people were not discriminated against for jobs, where they could be regarded as truly physically attractive, where they could run and work out without having to worry about being stared at, wear a bikini, or eat a burger in public without being judged.
It is time to regard being obese as a mere-difference, just like gender, sexuality, hair color and the like: a stable characteristic of someone’s physical and mental make-up. In the past, and in conservative Christian and Mormon communities still today, there are so-called medical interventions to try to alter gay people’s sexual orientation, or to try to turn transgender kids into cisgender kids. It has become obvious that these interventions do not work, and people have rightly pointed out that the existence of such interventions is harmful as it leads to stigmatising gay and transgender people, or viewing their characteristics as something to be cured. Similarly, there’s overwhelming evidence that being obese cannot be cured through non-surgical interventions. Even bariatric surgery does not guarantee success and is risky.
Is obesity a mere difference (would it still be bad if we could take away the social stigma) or is it a bad difference, i.e., inherently reducing people's wellbeing? Studies have struggled to tease apart correlation and causation. Perhaps whatever stressors that cause people to become overweight, such as limited ability to exercise, limited exposure to green space, an unhealthy and unvaried diet cause both obesity and its associated ill health effects such as high blood pressure and heart disease. Moreover, some studies suggest a protective effect of being overweight/obese and recovery from stroke and other ailments (an effect that has refused to go away in spite of it running counter to the dominant medical narrative, hence called the obesity paradox). Obese people receive poorer medical care as a result of prejudice, which again makes it unclear if they are inherently worse off, health-wise.
Regarding being obese not as something to be cured, something that requires tough love, or a tragedy, but just a personal characteristic that is stable can be liberating. We can rejoice that exercising improves health and wellbeing in people of all sizes and shapes, for instance, rather than saying that you can’t exercise off a bad diet.