She runs down a set of research demonstrating that dieters rarely manage to keep pounds off over the long haul, and those who do must tend to eating and exercising like it’s their full-time job. (They also learn to endure “intrusive thoughts and food preoccupations.”) She also notes that weight loss isn’t necessarily linked to lower incidence of disease; that typical health markers and size don’t go together; and that what you eat might be more important for health than what you weigh. Brown also points to one of the more baffling puzzles around obesity: “[S]ince 2002, study after study has turned up what researchers call the ‘obesity paradox’: Obese patients with heart disease, heart failure, diabetes, kidney disease, pneumonia, and many other chronic diseases fare better and live longer than those of normal weight.”
Brown delves into our national sense of shame about weight—the idea that fat people are lazy or disgusting—and blames that attitude for keeping the medical community from seeing and addressing what we actually know about diets and obesity: “Why do doctors keep prescribing treatments that don’t work for a condition that’s often benign? I suspect one reason lies in the fanaticism that often seems to drive the public debate around weight.”
So what is the solution? The short answer is there isn’t one. The long answer is that people who practice “eating competence”—paying attention to their body’s cues, eating when they’re hungry and not when they’re not—”score better on cardiovascular risk markers like total cholesterol, blood pressure, and triglycerides than non-competent eaters.”
But practicing eating competence takes a certain leap of faith. You eat what you want, when you want it. You buy clothes when you need them, rather than restricting your food intake to squeeze into your old jeans. It’s a radical idea, sure. But what have we got to lose?