Are Lifestyle Zealots Promoting Weight Bias and Discrimination?

There are no doubt important benefits to be had from following a healthy lifestyle. A healthy diet, plenty of physical activity, restorative sleep, meditation, mindfulness, healthy relationships all contribute to maintaining good health and well-being. 

And yes, all of the above can and probably should be part of any management regimen for any chronic disease. 

However, the notion that these measures alone can constitute an effective and feasible treatment approach to obesity is neither supported by long-term randomised controlled studies nor by real-world experience of most individuals living with obesity, who have attempted controlling their weight with such measures. 

Obviously, there are some anecdotal cases of individuals who have apparently “conquered” their obesity by drastically changing their lifestyle, mostly following rather restrictive dietary regimens (of which there are many) together with a punishing dose of daily exercise – but these rather exceptional cases in fact constitute fine examples of just what it takes to lose and sustain significant weight loss and should readily explain why this approach will simply not appeal to or prove feasible for the vast majority of people living with obesity. 

Harping on about how lifestyle change is the real answer to obesity is simply promoting “fake news” and clearly implies that anyone who has tried lifestyle measures and failed, has simply not tried hard enough. 

Such a message can only lead to even greater internalised weight bias and does little more than to reinforce the notion with the rest of us, that people with obesity are simply too lazy, lack motivation or willpower and are perhaps just not smart enough to get it. 

Thus, every time another health zealot feels called upon to voice their opinion on how they may have personally conquered their obesity or have helped clients conquer theirs, I can only cringe at how my patients living with obesity perceive such messages. 

Rather than freely acknowledging that trying to manage your obesity with lifestyle measures alone means a lifetime of restrictions and ongoing efforts, healthy living enthusiasts promote notions that do little more than to promote weight bias and ultimately reinforce stigma and discrimination. 

Perhaps, even more importantly, now that we have effective medical treatments, their messages imply that anyone turning to these treatments is simply taking the “easy way out”, not willing to do the work and should probably be ashamed of themselves for failing to stick to the righteous path of living a clean and healthy life (perhaps with the addition of a super food or some magical dietary supplement) that can solve all their problems. 

This message neither reflects an understanding of the biology of energy homeostasis, the realities of living with obesity, nor evidence-based medicine and comes from a position of privilege that is nowhere near or relevant to most of my patients, who are simply trying to get through one day at a time. 

None of this speaks against the benefits of trying to live as healthy as possible – but please stop suggesting that all it takes to conquer obesity is motivation and willpower (and following whatever path has apparently worked for you or you happen to be selling)  – that is nothing less than an insult to people living with obesity. 

@DrSharma
Berlin, D

Disclaimer: I have received honoraria as an independent medical, research and/or educational consultant from various companies including Aidhere, Allurion, Boehringer Ingelheim, Currax, Eli-Lilly, Johnson & Johnson, Medscape, MDBriefcase, Novo Nordisk, Oviva and Xenobiosciences.