No Diet Day: Step Off the Scale

May 6, 2002 -- If you started off this morning counting calories, winning points or fat grams, you obviously do not know what day it is.

Today marks International No Diet Day.

A British diet book author and recovered anorexic started the little known holiday 10 years ago, and it is commemorated by people who want to advocate size acceptance and healthier approaches to dieting, body image, and eating disorders.

Among the messages of the day: Drop the strict eating regimen. Beauty and health are attainable at all weights, and "sizism" and fatphobia must end.

Discriminating against fat people is among the last acceptable forms of bias, say size acceptance activists, and even the medical community is not immune. Even though the U.S. surgeon general warns that fat is creeping up on smoking as the No. 1 cause of preventable death in the United States, size acceptance groups say doctors to readily blame obesity for myriad health problems.

"There are some biases that are ingrained," Allen Steadham, director of the International Size Acceptance Association, said. "They learn from medical school, if you have a patient who is physically overweight to tell them they have to drop weight."

Unfortunately, Steadham says, many doctors neither acknowledge that it is possible to be "fit and fat," nor that for most overweight people, keeping weight off long-term is often a losing battle.

"We've felt that there needs to be some diversity awareness training in the medical community," Steadham said. And some medical researchers agree with him.

'A Massive Epidemic'

For sure, the health risks of obesity are well-established, and you'd be hard-pressed to find a doctor who doesn't recognize the dangers of fat.

Medical literature shows that being overweight increases risks for Type 2 diabetes, coronary heart disease, sleep apnea, stroke, gallbladder disease, liver disease, arthritis and cancer.

"This is a massive epidemic," Harvard University nutrition and epidemiology professor Walter Willett said. "If it were an infectious disease we would be having a panic and taking emergency actions. It doesn't mean everyone is going to die of it … But you're putting yourself at high risk of having adverse consequences."

However, even some researchers say a blanket assessment of obesity's consequences is unjustified.

"You can be obese and quite healthy," said Rudolph Leibel, director of the division of molecular genetics at Columbia University's College of Physicians and Surgeons. "It's generally assumed they are somehow unhealthy as a result of being obese. In a statistical sense that's true."

When it comes to individuals, though, it is not necessarily true that obesity will lead to serious disease or death, Leibel said.

A study released last year found that obese people who exercise have half the death rate of those who are thin but unfit. Researchers at the Cooper Institute for Aerobics Research in Dallas said previous studies missed the importance of exercise and focused too much on weight loss.

Long-Term Effects Under Study

Why all the hype then about the obesity epidemic? Experts say it is critical to keep in mind exactly what researchers do and do not know about the dangers of being fat.

"There are clearly health risks of obesity," said Rena Wing, professor of psychiatry and human behavior at Brown University. "What I think is less clear is whether efforts to lose weight reduce … diseases."

There is clear evidence that if individuals at risk of developing diabetes lose weight, their diabetes risk drops. Patients who lost an average 7 percent of body weight and modestly increased activity decreased their diabetes risk by 58 percent, Wing said.

Weight loss also reduces cardiovascular risk factors, Wing said, although it is less clear whether dropping pounds cuts down on heart disease mortality or overall mortality.

There has been no randomized controlled study in this area.

However, Dr. Phil Ades, a University of Vermont College of Medicine cardiologist, says he sees clear benefits of losing weight in his own cardiac rehabilitation patients, 75 percent of whom are obese.

Even losing 15 pounds over four months has helped many patients reduce blood pressure, and triglyceride and insulin levels.

"It doesn't mean every single one will prevent a heart attack," Ades said. "You want to on average improve the health status of your patients."

Now, obesity researchers are striving to learn just what the long-term effects of obesity are on diseases and mortality.

Wing and her colleagues are conducting a 12-year study of 5,000 overweight people with Type 2 diabetes to see if they actually live longer if they slim down.

The population is exciting to study, Wing said, because diabetics are also at high-risk of developing heart disease.

Striving for Fitness, Not Thinness

Of course, for most overweight people, losing weight is a frustrating, quixotic effort.

Not only do most people eventually gain back lost pounds, dieting can slow down the metabolism, making it even more difficult to lose weight.

"Success is not promised to many. You have to be careful that way, and be circumspect about painting everyone with same brush," Leibel said.

Further, even if overweight individuals followed similar healthy eating patterns and rigorous exercise regimens, not everyone would see the same level of success in losing weight, experts say.

However, all will be healthier, Willett said.

"If they are seriously exercising on a daily basis, most people will tend to be lean," he said. "No matter who you are, staying on the lean side as much as possible and regular daily activity will be good."

Steadham of the size acceptance association says his group does not encourage weight gain or being unhealthy. Instead, he says he just hopes the medical community will eventually focus more on fitness and less on fatness.

"If you do things that make you more fit a lot of those things come under control," Steadham said. "We're trying to bring out some helpful information about how to be healthful and fit, and not just worry about dropping two dress sizes."