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Massachusetts Medical Society's Physician Focus

September 2016

The Misconceptions of Obesity


  • Despite enormous attention and multiple programs created to reduce obesity, the condition remains prevalent in the U.S. with more than a third of the population considered obese.
  • Conventional wisdom has thought of obesity as primarily a lifestyle issue, with people eating too much and not getting enough physical exercise.
  • New research, however, is discovering that obesity is much more complex than first thought, with many more factors contributing to obesity besides diet and exercise.

For more than a decade, obesity has been recognized as an epidemic in the United States, affecting all age groups. The numbers seem to justify the characterization: nearly 35 percent of adults have obesity along with almost 13 million children 2-19 years old.

The condition has put millions of Americans at risk of some of the leading causes of preventable death, such as heart disease, stroke, type 2 diabetes, and certain types of cancer.

While the prevailing view has been that obesity is a lifestyle issue – the failure of individuals to eat healthy foods and exercise regularly – new research is revealing that obesity is much more complex.

Over the last 25 to 30 years, says Fatima Cody Stanford, M.D., “our environment has become more ‘obesogenic.’ By that I mean we have more things in our environment that predispose us to having obesity.”

Dr. Stanford joins colleague Scott Butsch, M.D. as guests on the September edition of Physician Focus with the Massachusetts Medical Society to discuss the misconceptions surrounding obesity. Both are obesity physicians at the Massachusetts General Hospital Weight Center in Boston and members of the Medical Society’s Committee on Nutrition and Physical Activity. Hosting this edition is Dale Magee, M.D., a past president of the Society.

Diet and exercise are important, the physicians say, but they are quick to point out that reducing obesity entails much more than just eating less and moving more.

“I really think we have to look at many different components,” says Dr. Butsch, “diet being one of them. Diet should reflect changing what we eat and the types of foods we eat to healthful foods. It really isn’t all about calories. And that’s where I think we’ve gone wrong in telling people how to lose weight. We need to look at the content of the food. Nutrition facts on food labels can be hard to figure out if you don’t know what to look for.”

Similarly, says Dr. Stanford, some misconception exists about physical activity. “If we look at physical activity and its role in weight regulation,” she says, “we see that physical activity does a really good job of helping us maintain our weight.” But it’s not so good, she adds, in causing weight reduction.

Both physicians agree that individuals need to examine their diet and exercise more closely, but the factors contributing to obesity are many. The number of times we eat out at restaurants instead of cooking at home, the amount of processed food we eat, the amount and quality of sleep, the levels of stress, and even certain medications can lead to overweight and obesity.

While the health risks of obesity are many and well known, the physicians are concerned as well about the effects on an individual’s health from the stigma associated with obesity.

Weight stigma or discrimination against those based on their weight,” says Dr. Butsch, “exist in many different areas. The misconception is that obesity is a lifestyle problem, a characteristic flaw, and that why they’re overweight. People can be very judgmental and their judgment can impair someone’s health.”

Watch the above video for more discussion, including conversation about “gut bacteria” and its effect on weight control; the role of the body’s fat cells in obesity; and how antibiotics and other medications can lead to weight gain.

MMS/Richard Gulla

Massachusetts General Hospital Weight Center

U.S. Centers for Disease Control

The Obesity Society

Weight of the Nation - HBO

Time to Act on Obesity

Left to right; Dale Magee, M.D., Scott Butsch, M.D., Fatima Cody Stanford, M.D.
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