(Reuters Health) - A growing share of overweight and obese Americans are not trying to shed excess pounds, and researchers think it's at least in part because more people see being fat as socially acceptable, if not healthy.
Over roughly the past three decades, the proportion of adults who are overweight and obese has surged from 53 percent to 66 percent, researchers report in JAMA.
Over that same period, the proportion of heavy adults trying to lose weight dropped from 56 percent to 49 percent.
Losing weight is hard, and keeping it off is even harder. This may explain at least some of the waning national interest in weight loss, said senior study author Dr. Jian Zhang, a public health researcher at Georgia Southern University in Statesboro.
"It's hard to drop pounds," Zhang said by email. "It's a life-long commitment and painful, and many of us have tried and failed, tried and failed, and finally failed to try anymore."
A lot of heavier adults are probably also seeing so many other overweight and obese people that they feel comfortable at their current size and don't feel social pressure to slim down.
"This might be explained, at least partially, by increasing evidence that adults who are overweight may live as long as and sometimes even longer than normal weight adults," Zhang said.
The decline in weight-loss efforts occurred mostly among adults who were overweight but not yet obese, Zhang added.
For the study, researchers analyzed data from a nationally representative health survey for three time periods: 1988 to 1994, 1999 to 2004 and 2009 to 2014.
Among other things, the survey asked overweight and obese adults if they had tried to lose weight during the past 12 months.
Black women experienced the steepest decline in weight loss efforts from the first study period to the last. In the late 1980s and early 90s, 66 percent of overweight and obese black women said they were trying to lose weight, but by the final study period this dropped to 55 percent.
At the same time, the proportion of obese and overweight black women surged much more than for white women, the study also found. By the end of the final study period, 79 percent of black women were overweight or obese, compared with 59 percent of white women.
Limitations of the study include its reliance on survey participants to accurately recall and report their weight and height to allow researchers to calculate whether they might be overweight or obese, the authors note.
It's also possible to see the results in a positive light, said Susan Roberts, a nutrition researcher at Tufts University in Boston who wasn't involved in the study. That's because despite the challenges, millions of Americans are still trying to lose weight.
"People haven't given up," Roberts said by email.
Losing weight is hard, and keeping it off is even harder. This may explain at least some of the waning national interest in weight loss, said senior study author Dr. Jian Zhang, a public health researcher at Georgia Southern University in Statesboro.
"It's hard to drop pounds," Zhang said by email. "It's a life-long commitment and painful, and many of us have tried and failed, tried and failed, and finally failed to try anymore."
A lot of heavier adults are probably also seeing so many other overweight and obese people that they feel comfortable at their current size and don't feel social pressure to slim down.
"This might be explained, at least partially, by increasing evidence that adults who are overweight may live as long as and sometimes even longer than normal weight adults," Zhang said.
The decline in weight-loss efforts occurred mostly among adults who were overweight but not yet obese, Zhang added.
For the study, researchers analyzed data from a nationally representative health survey for three time periods: 1988 to 1994, 1999 to 2004 and 2009 to 2014.
Among other things, the survey asked overweight and obese adults if they had tried to lose weight during the past 12 months.
Black women experienced the steepest decline in weight loss efforts from the first study period to the last. In the late 1980s and early 90s, 66 percent of overweight and obese black women said they were trying to lose weight, but by the final study period this dropped to 55 percent.
At the same time, the proportion of obese and overweight black women surged much more than for white women, the study also found. By the end of the final study period, 79 percent of black women were overweight or obese, compared with 59 percent of white women.
Limitations of the study include its reliance on survey participants to accurately recall and report their weight and height to allow researchers to calculate whether they might be overweight or obese, the authors note.
It's also possible to see the results in a positive light, said Susan Roberts, a nutrition researcher at Tufts University in Boston who wasn't involved in the study. That's because despite the challenges, millions of Americans are still trying to lose weight.
"People haven't given up," Roberts said by email.
For more of them to succeed, however, we may need to rethink what weight management means, Roberts added.
Things doctors have recommended to overweight patients for years like logging food in a diary, using willpower to resist overeating and getting 10,000 steps a day haven't worked.
"It doesn't address the basic neurobiology of how our brains think about food," Roberts added.
"It doesn't address the basic neurobiology of how our brains think about food," Roberts added.
"We can't use willpower to think ourselves out of hunger because willpower doesn't reach the unconscious brain."
The bathroom scale, however, is a simple tool that can work - especially for people who are overweight but not yet obese.
"I think a really important strategy is catching it quick," Roberts said.
The bathroom scale, however, is a simple tool that can work - especially for people who are overweight but not yet obese.
"I think a really important strategy is catching it quick," Roberts said.
"Buying a bathroom scale if you don’t have one and weighing yourself regularly is so important because it's not that hard to lose five pounds with almost any diet method, and if you have a line in the sand that if you go over it you eat carefully for a couple of weeks you can make a big difference."
Aug. 28, 2017 "Fat bias appears to start early in life": Today I found this article by Jane E. Brody in the Globe and Mail:
A Duke University study suggests implicit weight bias in children ages 9 to 11 is as common as implicit racial bias among adults.
A very slender friend recently admitted to me that she “can’t stand to be around fat people.” Her reaction is almost visceral and it prompts her to avoid social and professional contact with people who are seriously overweight.
Although she can’t pinpoint the source of her feelings, she said they go back as far as she can remember.
And she is hardly alone. Decades ago, researchers found that weight-based bias, which is often accompanied by overt discrimination and bullying, can date back to childhood, sometimes as early as the age of 3.
The prejudiced feelings may not be apparent to those who hold them, yet they can strongly influence someone’s behaviour. A study by researchers at Duke University, for example, found that “implicit weight bias” in children ages 9-11 was as common as “implicit racial bias” is among adults.
The study’s lead author, Asheley Skinner, a public-health researcher, said prejudices that people are unaware of may predict their biased behaviours even better than explicit prejudice.
She traced the origins of weight bias in young children and adolescents to the families they grow up in as well as society at large, which continues to project cultural ideals of ultra slimness and blames people for being fat.
“It’s pretty common for parents to comment on their own weight issues and tell their children they shouldn’t be eating certain foods or remark about how much weight they’re gaining,” Skinner said.
Explicit weight bias is well documented, as are its damaging effects on people who struggle with their weight.
Yet, implicit bias can also result in discrimination and socially undesirable behaviour that negatively affect people who are seriously overweight.
Weight bias is widespread in society, occurring in employment, education, the media, health care and even in relationships with family members, parents and teachers, according to Dr. Scott Kahan, director of the National Center for Weight and Wellness in Washington.
“Obesity has been called the last socially acceptable form of prejudice, and persons with obesity are considered acceptable targets of stigma,” Kahan wrote in a 2015 blog post.
He said that weight bias “occurs even in people who are otherwise fair-minded and non-judgmental – even in obesity specialists,” who may not realize that it “predisposes to unhealthier behaviors and more weight gain.”
Whether explicit or implicit, weight-based bias can be counterproductive, impairing the ability of overweight people to lose weight and keep it off. Studies by Rebecca Puhl and colleagues at the University of Connecticut Rudd Center for Food Policy and Obesity, among others, have found that overweight and obese people who experience weight based bias and who manage to lose weight are less able to maintain their weight loss.
Stigmatization is associated with more frequent binge eating and other “maladaptive eating patterns,” Puhl reported in a comprehensive review of the subject in the American Journal of Public Health.
“In a study of more than 2,400 overweight and obese women who belonged to a weight loss support organization,” she wrote, “79 per cent reported coping with weight stigma on multiple occasions by eating more food, and 75 per cent reported coping by refusing to diet.”
Furthermore, experiencing weight stigma can result in a poor self-image, depression and stress that, in turn, increases the risk of poor eating habits and difficulty losing weight and keeping it off.
People can internalize weight stigma, blaming themselves for their excess weight and the social discrimination they experience.
Even people who simply think they’re overweight – regardless of what they weigh – may be “at increased risk for weight gain and eating more in response to social threats,” Puhl wrote.
Three long term studies involving more than 14,000 adults in the United States and Britain showed that adults who thought of themselves as overweight were more likely to gain weight over time, regardless of what they originally weighed and whether their self-perception of being overweight was accurate.
When weight stigma is internalized, it significantly diminishes a person’s chances of maintaining weight loss over the long term, Puhl and colleagues confirmed in an online survey of 2,702 American adults.
A study by Robert Carels and colleagues at Bowling Green State University of 46 overweight and obese adults enrolled in a behavioural weight-loss program found that both explicit and implicit weight stigmatization was linked to greater caloric intake, less exercise and energy expenditure, less weight loss and a greater likelihood of dropping out of the program.
“There are very visible people in society making comments about people’s physical appearance in very inappropriate ways,” Puhl said in an interview. “Where are the voices saying that this is not acceptable? That silence communicates this is socially acceptable.”
Three states – New York, Maine and New Hampshire – have passed laws prohibiting discrimination against people based on their weight, Puhl said. And Congress has amended the Americans with Disabilities Act to protect those with “severe obesity” against discrimination in employment (although many people who are discriminated against because of their weight are not covered by this law).
There has also been a growing movement to improve affordable access to healthy foods in communities considered “food deserts” where obesity is often rampant.
Still, being overweight is one of the most, if not the most, common reason children are bullied, a problem sorely in need of intervention and prevention both in schools and organizations to head off self-image problems and eating disorders that result in lifelong weight struggles, Puhl said.
While the ideal solution to weight bias ultimately depends on education of both lay people and health professionals, people currently struggling with weight problems can’t wait for a society wide reformation that may help to absolve them of personal responsibility for their weight.
“With extreme thinness being so prevalent in the media,” Puhl said, “it’s hard to change societal attitudes.”
To compete with “all the well funded messages from the diet and fashion industries,” she recommends making a concerted effort at self-acceptance and engaging in “positive self-talk” that challenges stereotypes to help people with weight issues recognize that what really matters to self-worth is “character, intelligence, ambition, effort and contributions to society.”
“We all need to move away from the current appearance-focused culture and recognize that other things matter more than what a person looks like,” she said.
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