“Obese people lack motivation.”
“Obese people just need to be motivated.”
“If you lost some weight you’d have less back/knee/hip pain.”
It’s important that we are honest with our patients.
- Yes. Obesity is harmful to your health. Full stop.
- Yes. Many conditions that obese individuals experience could be improved if they lost some weight. Full stop.
- Yes. There are things that you can do to improve your health even while remaining obese. Health is a spectrum. Full stop.
- BUT. It will always be better to be healthy and at a normal weight than healthy and obese. Full stop.
However, we need to stop perpetuating this belief that a lack of motivation is a primary cause of obesity. It’s not. Motivation is a factor to some degree but it’s much less than many of the other societal, environmental and psychological factors relating to obesity.
- Our preferences for food are developed during childhood.
- Perhaps even in utero.
- Our daily occupational physical activity has drastically changed over the past 50 years as we moved away from industrial jobs to commercial and office jobs.
- School programs for health/physical education and athletics have been cut.
- Individuals growing up with lower socioeconomic status have less access to green recreational places, and team sports.
- They might also be raised by grandparents or single parents where there may be difficulty in getting them involved in sports or fitness (this factor is controversial though).
That’s only a handful of these other factors. I haven’t even touched on portion size (which people tend to underestimate), health literacy, medical misinformation in the media, stigma, childhood exposure to trauma, food deserts, knowledge of exercise, transportation to fitness facilities, income/cost of healthy living programs, access to healthcare, and eating habits such as eating while watching TV, etc.
Let’s also not forget that obese individuals do attempt to lose weight fairly often (and in increasing numbers) but many fail, close to 70% annually.
(If you’re interested in a thorough review of factors relating to obesity and how to best address them read our open-access paper published in Progress in Cardiovascular Disease.)
Healthy living is a learned behavior.
Too often are obese individuals with various complaints also told to just lose weight. Back pain? Lose weight. Knee pain? Lose weight. Breathlessness? Lose weight.
Cool.
But what are you gonna do for them right now or in the meantime until they lose weight? People need tenable and actionable solutions. They don’t need someone just repeating the obvious or fixating on something that’s a long term goal for what is a much shorter-term problem. Again what are you going to do to help them now?
It takes time to lose weight, especially significant and meaningful amounts. Even 20lbs of body weight is a lot to lose and that’s probably not gonna happen in 1 month (without surgery), and quite honestly probably shouldn’t happen. Weight loss should be sustainable and with realistic goals. For those reasons, successful weight loss is often gradual. Quite often one of the reasons why people fail to lose weight is that they set unrealistic goals for weight loss and get quickly discouraged when they invariably fail to meet to said goals.
In summary, I agree that it’s important to be honest with our patients but let’s perpetuate honesty to our patients.
Physical Therapy Reviewer 