People come into my office all the time complaining they’ve put on pounds and feeling bad about themselves. I feel for these patients who are constantly worrying about their weight when there are so many other factors that are important for health. Our weight-focused society has spent billions of dollars convincing people who don’t look like supermodels that they’re unhealthy, and need supplements, weight loss gizmos, and fad diets.
But despite all this focus on weight, there’s little evidence that the medical community has any clear solutions. The medical model has persistently focused on getting people to just eat better and exercise more. This has yielded minimal success. Why? The best evidence shows that weight gain is much more complicated than just people eating too much.
The food environment of the United States is such that we’re constantly bombarded with messages to eat more. Food is everywhere and our bodies are programmed to eat food when it’s available. Plus, studies show that a lot of weight is preset by birth.
All of this research should lead us to our first point: Don’t feel bad about your weight.
The first step in dealing with this “problem” is realizing that your weight is largely out of your control. It’s only a symptom, not the root problem.
What is obesity?
The medical community often talks about obesity in terms of body mass index (BMI). This is just a ratio of your height to weight. According to the Centers for Disease Control and Prevention (CDC), you’re overweight if your BMI is >25 and obese if it is >30. (These cutoffs are slightly lower for those of Asian heritage, at 23 and 27.5.) BMI is used because it’s easy to measure and correlates fairly well with abdominal fat, one key risk factor for heart disease and cancer. However, BMI is not perfect. Some people with a high BMI just have a lot of muscle or more dense bones. Others with a normal BMI can have a lot of abdominal fat. So while BMI is one risk factor for disease, it is only one of many.
What really matters is how much intra-abdominal fat you have. This is the fat that surrounds the inner organs of the abdomen. This is hard to measure, but it’s the only really good measure of risk for future disease. Still, abdominal fat is just ONE risk factor out of thousands that we could measure. So it’s important to put abdominal fat in context with other risk factors: family history, blood sugar, cholesterol, and lifestyle.
What really causes people to be overweight?
For years, the medical community, as well as the food industry, have perpetuated a calories-in/calories-out approach. We’ve been told that all you have to do is eat less and everything will be fine.
But the truth is much more complicated than that. First, there’s a large genetic component to abdominal fat. We’re learning more about how many factors, from the uterine environment before you were born to your microbiome (the bacteria that live in your gut), start you on a trajectory for your adult weight. Second, we know that many popular foods, such as sweet soda and salty chips, are actually addictive and take advantage of our innate propensity to eat food when it’s available — which helps us gain weight. Third, many studies have found that much of eating is unconsciously controlled. For instance, obesity tends to “spread” between individuals — that’s why married couples sometimes have the same shape. It’s also very easy to get people to eat more calories without them noticing. For instance, studies show that altering the lighting, music, and the order of dishes on restaurant menus can get people to eat more (or less). This creates a picture of how we fall into unhealthy eating: we have genetic programming that sets us up to store as many calories as possible and we have an environment that’s constantly signalling the unconscious centers in our brains to eat more and more.
So don’t blame yourself; blame a food environment that’s set up to help gain weight. Paired with modern offices and jobs, where people spend hours commuting in the car and sitting at desks all day and 24/7 availability of on-demand entertainment, it’s no wonder so many people struggle with their weight.
So why does my weight matter?
The reason medical providers like to talk about weight is because it’s one visible sign that you might not be eating the healthiest foods, and it is also associated with diabetes and fatty liver disease. Instead of focusing on weight, reframe it by focusing on what you’re eating. We know that eating a typical American diet, full of fast food, extra sugar, simple carbohydrates and hydrogenated oils, is associated with higher rates of heart disease and cancer.
So instead of having a goal of looking like a supermodel, we suggest a better goal is eating a diet that will reduce your risk of chronic disease, and focusing on that.
How do I eat to cut my risk of chronic diseases (and maybe lose weight in the process)?
Most people approach healthy eating by looking for a quick fix to figure out what they’re doing wrong and correct it. Many people also think they’re eating healthy, even though they aren’t.
If we realize that we live in a food environment that’s toxic for our health, we will realize that we can’t just pick a diet book or an app to fix the problem. Think about it this way: If you lived in a developing country and all the water was contaminated, would you go around blaming yourself for getting sick? Would we all buy water filters and carry them around everywhere in case we wanted a drink? Or would we all ask for a water-filtering station to purify our water? In our challenging food landscape, we sure could use a food filter, but no such thing exists.
The only way to eat for health and lose weight is to set up an environment where unhealthy food cannot tempt us. We need to make our homes and work environments into safe places, free of unhealthy food. We can’t control what’s served in restaurants, but we can control the food environments of our homes and offices.
In Your Guide to Eating Healthier, we’ll share some common pitfalls that make it difficult to eat for your health and strategies you can use to get on track.
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.
Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.