Mindset Makeover 1: Obesity is a Disease, not a Choice
In this series of posts, we’ll identify and discuss several hurdles that are typical in the ongoing mental and physical battles we fight as adults with chronic weight challenges. This post deals with considering what obesity is and is not. The bottom line is that obesity, especially in adulthood, is a disease. What it is not is a lifestyle choice made by lazy people who have no self-discipline. Those of us who’ve spent our lives dealing with our weight deeply understand that the latter is not the case, but for me anyway, it took some education, reflection, and effort to understand and internalize the former statement. Making that internal transition from self-blame and shame to understanding that obesity is a medical condition that, just like any other disease or illness can be understood and treated, has been very powerful for me. I am grateful for my new mindset around this every day; it has allowed me to unpack my baggage around weight and my body and get moving toward truly caring for myself and my health.
Before I go on, let me clarify something.
This post, this blog, and my practice are not about managing weight for cosmetic reasons- This is about health and survival. There are plenty of folks who carry extra weight and are active, vibrant, and do not have health issues related to their weight! Others, especially as we age, develop significant health problems and/or risks for major medical challenges that are directly or indirectly attributed to being overweight or obese. For most of us, it’s a lifetime of being heavy that has put our lives, literally, at risk if we do not find an effective and lasting way to live a healthier life through, among other things, achieving and maintaining a healthier bodyweight- I am one of those people, and that’s the focus here.
Before I go on, let me clarify something.
I don’t know about you, but I realize now that I first picked up my emotional, physical, and mental baggage around my weight as a child and it has been getting more cumbersome and heavier ever since. I don’t think I’m alone- the more folks I talk to about the traps we build for ourselves around being overweight the more common this experience seems to be. The mindset and internal dialogue we develop after years of negative messaging from society, the media, friends, family, strangers, physicians, and others is one of shame, self-criticism, defeat, and resignation that ultimately holds us back from looking at things in a new way.
Social media, the internet, television, all kinds of media, and advertising reinforce for us, either overtly or covertly, that being overweight is a result of a lack of personal commitment and discipline and that somehow we are less valuable, capable, and desirable as people. Admittedly, the body positive movement has been great in providing a counterpoint to all this negativity, but the same venom and cruelty shows up in the comments on posts, sites, groups, people, and organizations that focus on health rather than weight and/or appreciating all shapes and sizes of people. It doesn’t take much to see that the judgement and misunderstanding is alive and well, even when we work to connect with the fact that we are beautiful, capable, loving, successful people, despite our weight.
Do any of these statements sound familiar to you?
- “You could be a cute girl but you’re just too fat.” (This one from childhood)
- “You’d be so pretty/handsome/much more attractive if you’d just lose that extra weight!” (Adult version of the above)
- “All you have to do is eat less and move more! What’s the big deal?”
- “Being fat is a choice. You’re choosing to eat too much rather than choosing to be healthy.”
- “People who are overweight are just lazy.”
- “I’m not usually attracted to big women/men/people, but I like you even though you’re so big.”
- “If you’d just start cycling/running/working out/walking all that weight would just fall off!”
- “Yeah- I have problems with my weight too. There’s this 10 pounds I just can’t seem to get rid of, but I’ll just cut out the sugar for a few weeks and I’ll be back on track!”
Over time, we build a sort of emotional and mental fortress around our self-esteem to numb the impact of these kinds of statements. This “Avoidance Mindset” allows us to avoid the shame, pain, and frustration of the overt and covert negative messaging we receive as heavy people and get on with our lives. In many ways, this is a good thing as it is a protective mechanism, but at what cost? As we learn to compartmentalize the wear and tear of this kind of stuff, we also learn to compartmentalize the fact that, for some of us, being overweight (a term I will use to capture both “overweight” and “obese”) is threatening our health, well-being, and potentially, our lives. The fact is that for many of us, our self-talk about our bodies, our weight, our eating, our habits, and our struggles is at least as bad as what others may inflict upon us; what other say and do only reinforces the cruel ways in which we tear ourselves down as a result of years of dieting, regain, more dieting, gaining more, and eventually, believing, deep down, that we are powerless to make any lasting changes in our weight and habits that will create the heathy vibrant lives we desire. We end up buying, and deeply internalizing, the dogma that “You are only fat because you are weak and you are choosing to stay fat because of the choices you make and do not make- YOUR WEIGHT IS PURELY A RESULT OF YOUR OWN CHOICES AND LIFESTYLE.”
Don’t get me wrong- our choices do impact our weight (and every other aspect of our lives), but being chronically overweight is a result of a lot more than our own personal choices and behavior. Research is demonstrating over and over again that for those of us who have a lifetime of cycling between dieting and regain, obesity evolves into a diagnosable and treatable medical condition, not a choice. What does this mean?
Nearly 10 years ago, the American Medical Association (AMA) made headlines when they publicly recognized that obesity is a disease rather than merely a set of bad choices. Based on significant and ongoing research, clinicians and scientists have concluded that “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences”, and have developed a comprehensive set of diagnostic and treatment guidelines to better understand and manage obesity, which affects over 40% of the adult US population (The Obesity Algorithm, 2021).
Among the most useful aspects of The Obesity Algorithm, which can downloaded for personal educational use, is an extensive treatment of myths about obesity and clarification of what is true about this disease as we currently understand, study, and treat it. Although this document is designed for clinical professionals involved in treating overweight adults, there is a TON of good information and reference material that sheds, for me, a much brighter light on the variety of pathways to becoming healthier and, critically, describes the health benefits of developing a workable, consistent weight management strategy. A very important aspect of this resource, by the way, is that it is solidly grounded in real science and evidence-based practice, and is not an advertisement for any product, service, or approach; this resource is trustworthy and sound, so I encourage you to check it out.
I will be addressing several points raised in The Obesity Algorithm in coming posts, which may be helpful in your thinking. This information may also be useful in conversations you may have with your own physician or medical professional as you embrace the possibilities of finally effectively managing this chronic disease so you can get on your best life!