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