Friday, May 13, 2011

Live Debate: Forks vs. Feet

Yesterday, readers may have observed a live debate organised by the CON-Student and New Professional (SNP) group at the University of Ottawa.

I, unfortunately missed it, but I know that the debaters were meant to debate the issue of whether diet or exercise is more important in preventing and managing obesity.

In the diet corner the CON-SNPSs had the CON members Dr. Yoni Freedhoff, Ottawa family doctor and Canada’s food ‘watch dog’ of Weighty-Matters fame; In the exercise corner they had Dr. Bob Ross, Professor of Kinesiology at Queen’s University, Kingston, Ontario, well known for his extensive work on exercise and visceral obesity.

Knowing both the passion and the immense knowledge base of both contestants, this is definitely a debate I will go back and watch.

But even without having seen the debate or having heard exactly what the discussants had to say, here are my own two cents on this whole topic: while both healthy diets and exercise are important to maintain good health, I always cringe, when these two topics are so directly linked to discussions on obesity and here is why:

Healthy eating and increased physical activity are recommendable for 100s of conditions that I can think of – everything from cancers to dementia, not to mention diabetes, heart disease, osteoporosis and almost every other chronic condition out there.

So, if promoting healthy diets and physical activity is as useful for preventing or managing any of these 100s of conditions, why focus any discussion on diet and exercise on obesity?

Thus, although eating healthier and exercising more reduces the risk or impact of countless health conditions, why is it only, when we talk about obesity, that diet and exercise suddenly become the central (and often only) topic of discussion?

Not only will readers recall my reservations about the limited efficacy of ‘Eat-Less-Move-More” (ELMM) approaches to weight management but also the fact that eating and activity are both behaviours that are driven by everything from genetics, psychosocial circumstances, cormorbidities, or medications.

In general, no diet or exercise plan that I have ever seen, really addresses the root causes of unhealthy diets or inactivity – they are just ‘prescriptions’ (and sometimes ‘gimmicks’) that seek to address, what I would call ‘symptoms’ of what’s really going on. Or, as I’ve said before, they address the “what” but not the “why” of these behaviours (which is probably why ELMM approaches tend to fail).

But there is another negative aspect of turning every discussion about obesity prevention or management into a discussion about healthy eating and exercise and that is the simple fact that such discussions (and recommendations) do little more than reinforce the widespread stereotypes of obesity being a condition solely attributable to unhealthy eating and lack of exercise (although this is by no means true) and that by simply eating healthy and exercising, anyone can achieve an ‘ideal’ weight (whatever that may be).

Not only is this a gross oversimplification of the actual etiological diversity and complexity of obesity but it also turns, what I see as a complex heterogeneous psycho-social-biomedical condition, into a simple issue of eating right and moving more, thereby squarely placing the ‘blame’ on the people, who already carry this burden (no one I have ever met is obese by ‘choice’ although many may have given up the struggle for good reasons of their own).

Thus, it may perhaps be time to completely cut all links between finding solutions to the obesity epidemic from any discussions about healthy eating and excercising.

Not because healthy eating and exercising are not as important for people with excess weight as they are for people of normal weight or people with 100s of other health conditions – but exactly for this reason! There is absolutely nothing ‘special’ that I can see about diet and exercise being any more important to prevent and manage obesity than for generally improving health and managing all those other conditions.

I therefore propose that we completely dissociate the discussion about improving population health by improving diet and physical activity from the necessary discussion about how we will tackle the obesity epidemic.

Linking diet and exercise exclusively to obesity (as if it were that simple) is a distraction to finding real solutions and will not solve the problem; if it increases weight bias and stigma, things can only get worse.

So, while I very much commend the efforts that the Ottawa CON-SNP groups went to in order to set up this debate (especially given the immensely busy schedules of both debaters) and very much look forward to eventually getting around to watching the recording of the debate (in which I am sure good points will be made on both sides) perhaps future debates will focus more on the ‘whys’ and less on the ‘whats’ of the obesity epidemic.

The debate will be posted on Obesity Panacea.

AMS
Regina, Saskatchewan

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9 Responses to “Live Debate: Forks vs. Feet”

  1. Razwell says:

    EXCELLENT article, Dr. Sharma. I like this article a lot, and will get the word out to people.

  2. Nathalie :D says:

    Thanks to expose, post after post, your views of this: “a complex heterogeneous psycho-social-biomedical condition”

  3. Rhonda says:

    All the media focus on diet and exercise in the context of obesity has led some people (including my husband) to believe that because they don’t have a weight problem they don’t need to worry about eating healthy and being active. This is a very unfortunate side effect, because good nutrition and a reasonable amount of exercise are important for EVERYONE’s long term health, no matter what their weight.

  4. Anonymous says:

    I hope scientists find the cure for obesity so we can eat what we want and never get fat. Like you say lots of things affect our weights. It will take years and years and a lot of money. It will be worth it to cure obesity. Our weight is not our fault. The best would be a pill to take so I can eat everything and eat all my favorite foods and not have to stop eating when I want to keep eating. Everybody can have Thanksgiving dinner with all the trimmings and any day, not just once a year. Everybody has the right to eat what they want not just some people who are born lucky.

  5. Rachel says:

    Wow! Radical. And I like it. The promotion of diet and exercise to lose weight has been ‘done to death’ over the decades. We are saturated with it, so its time to move the discussion on to new approaches. Something radical is required to move people from automatic thinking to conscious reasoning. There’s strong shock value in saying to someone “I’d love to discuss obesity with you but just for now, lets take diet and exercise off the table”. The result will almost certainly be stunned silence. That’s the time to bring up mind-opening ideas. I think it will work. Most reasonable people like an intellectual challenge.

  6. Lucy A. says:

    it is unfortunate that some of us–like myself can diet considerably easier that we can exersize that prescribe “moving more” is very self defeeting. My foot is bad enough that while on good days I wouldn’t mind going back to work but on bad days I am glad I can do T3 and go back to bed. A good exersize program needs planning something that with my depression and ADHD is somewhat hit and miss combined with the failure to follow through is even worse. While I have been using proper portion sizes to diet along with calorie counting I have found when I am eating emotionally versus for need.
    That is in itself a land mark and the food journal has helped plently now if I could figure out how not to eat emotionally before I eat it would even be better weight control. However, for now I will have to leave exersize on the shelf so to speak. Thank you

  7. HopefulandFree says:

    Thanks Dr. Sharma for clearing the air with this balanced post. After your “tongue in cheek” post earlier this week (comparing nicotine addiction and obesity), I was very concerned about that post’s potential to increase bias and “worsen stereotypes,” which you take care to avoid here. (Please warn readers in the future, dear doctor, if you post a parody. That intention was unclear, and very unsettling!)

    I look forward to reading more posts like this one, which applies a more critical lens to conventional wisdom (false assumptions.) Thank you again.

  8. DeeLeigh says:

    Dr. Sharma, I strongly agree with you on the “healthy eating and fitness are valuable in and of themselves” angle. People of all sizes can benefit from a balanced diet and regular movement. Tying them so closely to idea idea of weight loss tends to stigmatize them, if anything. People who are not labeled as overweight or obese don’t think they need to worry about healthy habits, and people who have only exercised and concentrated on nutrition during weight loss attempts come to associate them with grinding, joyless restriction. In reality, people of every size can benefit in many ways from being active and eating well.

  9. NewMe says:

    An excellent post. It’s nice to see the Dr. Sharma I though I knew back again.

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