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The Inside Story: 'Just eat less, exercise more...'

November 19, 2018


The predominant societal mindset about overweight and obese people is that they should have the self-discipline to eat healthy and exercise regularly. And if they’d done this in the first place, they wouldn’t be in this situation—and society wouldn’t be facing skyrocketing obesity rates. However, research is increasingly revealing that managing obesity isn’t as simple as “just eat less, exercise more.” The complex nature of managing obesity can also lead to pitfalls: the feeling that obesity management is a lost cause, that it’s a waste of time. Or worse, that it’s completely out of our personal control. Fortunately, the opposite is the case…

Understanding the complexity of obesity opens up a whole new approach to managing it—an approach that focuses on health, not size. An approach that doesn’t simply label people as either villains—who are the sole causes of their obesity—or victims at the mercy of their environments.1 And more good news, this evidence-based approach to managing obesity also sheds light on prevention. Here’s the lowdown…

Defining obesity

Obesity is at epidemic levels around the world—and Canada is no exception. With 25.8% of Canadians over 15 years old considered obese, Canada has one of the highest obesity rates among OECD countries. Only the United States, Mexico, the United Kingdom, South Africa, Australia, New Zealand, and Hungary have higher rates.2

And the problem is getting worse in Canada, with today’s obesity rates twice as high as in 1978-79.7 Plus, when statistics include overweight Canadians, the percentage of overweight or obese rises to 61.3% for 2015.8 And the prevalence of obesity is predicted to continue to rise. In fact estimates include that by 2025 there will be 2.7 billion overweight and obese people in the world—a third of Earth’s population.9 But what technically is overweight and obesity?

The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that may impair health.10 Traditionally, overweight and obesity is most commonly assessed using a simple measure that has been around since the 19th century called the body mass index (BMI).11 BMI is calculated by dividing a person’s weight in kilograms by his or her height in metres squared. The WHO defines overweight for an adult man or woman as a BMI greater or equal to 25 and obesity for an adult man or woman as a BMI greater than or equal to 30.12 In addition to BMI, waist circumference is another assessment tool: it measures the area above the hip bone and below the rib cage. A waist circumference of 35 inches or greater for women and 40 inches for men is considered unhealthy.13 However, BMI and waist circumference are now widely recognized as having many limitations. Keep reading…

Moving from size-focused to health-focused

Not only do BMI and weight circumference not determine a person’s actual percentage of body fat, they do not reflect the presence of potential underlying health issues. In addition, they don’t capture other common consequences of overweight and obesity such as reduced quality of life and decreased functional abilities such as limited mobility. These tools just measure size not health or quality of life.

Accordingly, experts like the Canadian Medical Association advise that tools like BMI and waist circumference alone should not be used to clinically diagnose obesity.14 Instead, additional tests and measures are necessary. For example, newer assessment approaches complement BMI and waist circumference by also investigating the medical, mental, and functional impact of overweight and obesity on an individual basis. In addition, for each individual, these new methods also explore the specific root causes that are contributing to their weight gain, as well as barriers impeding their weight loss. These root causes and barriers are often overlapping and can be one and the same.15

Not solely about individual responsibility

A growing body of scientific evidence reveals that a number of different and often overlapping root causes and barriers determine the weight our bodies settle on. Accordingly, the prevailing misconception—the blame game that overweight and obesity is solely an individual responsibility—is being replaced by a broader, more accurate, perspective—one that recognizes that numerous environmental and socioeconomic factors are working against weight management efforts.

Researchers continue to assess what is known as the obesogenicity of environments: “The sum of influences that the surroundings, opportunities, or conditions of life have on promoting obesity in individuals or populations.”17 The goal is to identify the contributors to obesogenic environments and then develop strategies to combat them.

Case in point: Sugary drinks have become deeply entrenched in Mexican culture in a large part due to deliberate marketing in the 1980s and 1990s promoting pop as a cheap way to get energy and to hydrate. Very appealing given Mexico’s high poverty level, poor supply of drinkable water, and hot climate. Essentially, pop soon replaced water, with estimates that Mexico drinks more pop per capita than any other country. More than 70% of the Mexican population is overweight or obese with more than 70% of the added sugar in the diet coming from sugary drinks. To help combat this trend, on January 1, 2014, Mexico became the first country to impose a national pop tax. The result? Declining consumption: sugary drink sales fell by an average of 7.6% over a two-year period. It’s too soon to tell, but hopefully the tax will continue to decrease consumption and in turn, translate into lower rates of overweight and obesity and associated health consequences.19

To reflect this more in-depth understanding of the nature of obesity, the WHO, the Canadian Medical Association, the American Medical Association, and Obesity Canada now categorize obesity as a complex chronic condition like hypertension and diabetes.20 And like other chronic conditions, managing obesity is now recognized as a lifelong process.

‘Battling the bulge’ is an ongoing process

A main reason managing overweight and obesity is such a struggle is the way the body reacts to weight loss. A reduction in body weight of five to 10% can actually reduce resting metabolic rate by as much as 20%.21 Resting metabolic rate is the number of calories the body needs to carry out basic functions like breathing, circulating blood, adjusting hormone levels, and growing and repairing cells. When someone loses weight, they are likely to regain the weight because their energy requirement (the amount of food they need) has decreased. As a result, although many people think that if they could just lose weight, they will be able to maintain the lower weight with less effort, the opposite is the case. Typically, the minute they relax their efforts, the weight simply comes back. Think yo-yo. Think rollercoaster.

That’s why diets—as in “I’ll eat healthy until I drop the weight and then stop”— don’t work. Accordingly, the scientific director of Obesity Canada stresses that a fundamental principle of obesity management is “do not do things to lose weight that you are unlikely to continue doing to keep the weight off.”22 

It’s time to ditch “diets” and unrealistic numbers on the scales that set up failure. Instead, the success of obesity management should be measured in terms of improvements in health and well-being rather than the amount of weight lost. As described by Obesity Canada: “Obesity management is about improving health and well-being and not simply reducing numbers on the scale. The success of obesity management should be measured by improvements in health and well-being rather than in the amount of weight lost. For many patients, even a modest reduction in body weight can lead to significant improvements in health and well-being.”23

In fact, central to the categorization of obesity as a chronic condition is that good health is possible over a wide range of body weights. For example, although metabolism often slows down with weight loss, people with obesity who lose as little as 5% of their body weight can reduce the risk of developing type 2 diabetes and heart disease if they can just keep the weight off while battling a slower metabolism.24

Obesity management provides lessons learned
for prevention…

Maybe prevention of overweight and obesity starts with youth—and the sooner the better as not only are obesity rates on the rise for Canadian adults, rates of obesity among Canadian children and youth have also nearly tripled in the last 30 years.26 Between 1978/79 and 2004, the combined prevalence of overweight and obesity among children age two to 17 years old increased from 15% to 26% with increases highest for children age 12 to 17 years. And here’s the kicker: most adolescents do not outgrow this problem—in fact, many continue to gain excess weight.27

The government of Canada recognizes that “addressing the factors that contribute to obesity early in a person’s life helps to reduce the likelihood of being overweight or obese in adolescence and adulthood.”28 Accordingly a range of initiatives are underway across Canada to reach children where they live, learn, and play to address obesogenic environments. This is all part of an official federal/provincial/territorial framework on curbing childhood obesity and achieving healthy weights. Initiatives include everything from healthy school food guidelines to promoting physical activity among youth after school and both urban and rural planning that focuses on designs that promote activity. 29 In addition, in 2016 top health officials from Canada, Mexico, and the United States met to discuss their joint commitment to addressing childhood obesity. The three countries  continue to share information on innovative policies and programs as best practices to prevent overweight and obesity.30

Make the mind shift

Clearly there is no single or simple solution to overweight and obesity. It’s a complex problem that requires a supportive environment that promotes health not only at home and school, but also at work. For instance, GSC is helping support plan members through the Change4Life® health management portal as well as offering health coaching programs. Here’s to gaining health!

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