The Blame for Fat Shaming

The main reason why obesity is such an emotionally charged issue is simply that it has become entangled with all kinds of aspersions on a person’s willpower and character. It is completely different from almost every other disease because there is always the unspoken accusation that you did it to yourself. There is always the feeling that you could have done something about it if you weren’t such a weak willed glutton. Many physicians unconsciously engage in ‘fat shaming’ is that they believe that this gives patients extra ‘motivation’ to lose weight. As if the whole world was not reminding them every single day. So, who deserves the blame? The ‘Calories In Calories Out’ (CICO) crowd – those physicians and researchers who have strenuously and constantly cried that ‘A calorie is a calorie’ or ‘It’s all about calories’ or ‘Eat Less, Move More’. Because what they actually mean, but don’t say is ‘It’s all your fault’. The CICO crowd took the disease of obesity and instead of treating it with compassion and understanding infused it with personal shame. I’m here to tell you that it’s all just a huge pack of lies fed to us by their corporate backers.

If you develop breast cancer, for example, nobody secretly thinks that you should have done more to prevent it. Nobody condescendingly tells you to ‘get with the program’. If you have a heart attack, you simply don’t face those hidden accusations. Obesity has become a disease singularly unique in its association with shame. The CICOpaths imply that it’s all your fault and if you weren’t such a loser and just listened to them,  you, too could look like Brad Pitt or Julia Roberts. It’s not true. They’re really just trying to deflect the blame for the obesity epidemic from their own horrible dietary advice they’ve peddled for decades.

This CICO belief stems from a foundational error in logic. We have understood the problem of obesity as a fundamental imbalance of energy, calories. This is a crucial, crucial mistake. I’ve argued in my book, The Obesity Code that this obsessive fixation on calories is incorrect. Let’s think about this. Up until the 1970s, there was little obesity. Yet people had virtually no idea how many calories they ate. They also had virtually no idea how many calories they burn. Exercise was not something you did for fun. Yet, without effort people all around the world lived without obesity. They largely ate whatever they wanted when they were hungry, and didn’t eat when they weren’t.

If almost every single person in the world was able to avoid obesity without counting calories, then how is counting calories so fundamental to weight stability since 1980? People’s bodies were able avoid obesity for over 5000 years, but since 1980, we need calorie counters and step counters? Hardly.

There are two main changes in the American diet since the 1970s. First, we were advised to lower the fat in our diet and increase the amount of carbohydrates. This advice to eat more white bread and pasta turned out NOT to be particularly slimming. But there’s also another problem that had largely flown under the radar. The increase in meal frequency.

In the 1970s, people largely ate 3 times per day – breakfast, lunch and dinner. If you were not hungry, then it was perfectly acceptable to skip a meal. That was your body telling you that you didn’t need to eat, so you should listen to your body.

By 2004, the number of meals per day had increased closer to 6 per day – almost double. Now, snacking was not just an indulgence, it was encouraged as a healthy behavior. Meal skipping was heavily frowned upon. What kind of Bizarro world was this? You need to constantly shove food into your mouth to lose weight? Seriously? If you don’t eat, you’ll gain weight? Seriously? It sounds really stupid, because it is really stupid.

The admonishments against meal skipping were loud. Doctors and dieticians with the heavy backing of corporate $$$, told patients to never, ever skip a meal. They warned of dire consequences. Magazines blared out warnings of the problems of meal skipping. From a physiologic standpoint, what happens when you don’t eat that is really so bad? Let’s see. If you don’t eat your body will burn some body fat in order to get the energy it needs. That’s all. There’s nothing else. After all, that is the entire purpose the body carries fat in the first place. We store fat so that we can use it. So if we don’t eat, we’ll use the body fat.

As people gained more weight, the calls for people to eat more and more frequently grew louder. It didn’t actually work, but that was beside the point. As people became obese, doctors would say to cut calories and eat constantly – graze, like some dairy cow in a pasture.

But this horrible advice didn’t work. So there are two potential sources of the problem. Either the dietary advice for weight loss was bad, or the advice was good, but the person was not following it. On one hand, the problem was the doctor’s advice. On the other, it was a patient problem. Let’s break it down to the basics. Physicians and other nutritional authorities believe religiously that excess calories cause weight gain. They advise patients to eat fewer calories. Either:

  1. The ‘Eat Fewer Calories’ advice is wrong and doesn’t work
  2. The advice is good, but the patient could not follow it. The spirit is willing but the flesh is weak. You’ve got the dream but not the drive. Etc. Etc.

I believe that #1 is correct. Therefore, patients with obesity are victims of poor advice to eat more often, lower dietary fat in a desperate effort to reduce caloric intake. Their weight problems are a symptom of a failure to understand the disease of obesity. I do not believe they have low willpower or character. It is not different to me than treating a patient with cancer.

Many physicians and researchers believe option #2. They think the problem is not the advice. They believe the problem is the patients. Therefore, a healthy dose of fat shaming may give them the motivation to get healthy. It’s the ‘A Calorie is a Calorie’ people who are to blame for the phenomenon of fat shaming. They are blaming the victim because it exculpates their own failed understanding of weight gain. They believe that the obesity epidemic was the result of a worldwide collective simultaneous loss of willpower and character.

The name of this game is ‘Blame the Victim’. That way, doctors can go on believing that the advice they give is perfect. It was the patient’s fault. Does this make sense? Somewhere around 40% of the American adult population is classified as obese (BMI>30) and 70% are overweight or obese (BMI>25). Was this obesity crisis actually a crisis of weak will power?

Consider an analogy. Suppose a teacher has a class of 100 children. If one fails, that may certainly be the child’s fault. Perhaps they didn’t study. But if 70 children are failing, then is this more likely the children’s fault, or is it more likely the teacher’s fault? Obviously the teacher. In obesity medicine,  the problem was never with the patient. The problem was the faulty dietary advice patients were given. But the CICOpaths, in their denial have heaped the blame onto those obese patients that were the very victims of the doctors failure to understand obesity as a disease, and not a personal character failing.

This is why obesity is not only a disease with dire health consequences but comes with a huge slice of shame. It is a disease with dire psychological consequences. People blame themselves because everybody tells them it was their fault. Nutritional authorities throw around the euphemism ‘personal responsibility’ when what they really mean is ‘It’s your fault’. But it’s not.

The real problem is the acceptance of underlying assumption that obesity is all about ‘Calories In Calories Out’. This failed CICO mentality has pervaded our entire universe and the natural conclusion of this line of thinking is that if you are obese ‘It’s your fault’ that you ‘let yourself go’. You either failed to control your eating (low willpower, gluttony) or did not exercise enough (laziness, sloth). But it is not true. Obesity, as I’ve written about in The Obesity Code, is not a disorder of too many calories. It’s a hormonal imbalance of hyperinsulinemia. Cutting calories when the problem is insulin is not going to work. And guess what? It doesn’t.

Not only do people with weight problems suffer all the physical health issues – type 2 diabetes, joint problems, etc., but they also get the blame for it. Blame that is unfairly targeted toward them because the advice they received to lose weight had a 99% failure rate. Should people get angry about it? Absolutely. The next time some physician tells you that ‘It’s all about calories’ you have my permission to slug him/her.

 

2018-12-11T13:36:07-04:0023 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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MERY
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MERY

You are brilliant!!! Thank you

Steph
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Steph

Love it!

KanaBo
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KanaBo

Of course all of this can be true, the bad corrupt dietary advice, the victimization and fat shaming. Of course it also can be true that personal responsibility entails not appealing or deferring to so called authority or experts in the first place. Not just going along with the crowd or what some dummies pretend to profess so they can rip people off. Or placing blame with the deception rather than just learning not to be deceived. It can also be true that most of the time, by and large, obesity is an extremely unnecessary and self inflicted disease of… Read more »

AKP
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Ah. You think it is difficult to gain weight? Well, as someone who has needed to do both: I once weighed 190 and desperately tried to lose…and now weigh 130 (underweight) and am trying just as hard to add. Guess what? They are equally difficult. So, What I would say to you is: if you just had an ounce of willpower, if you would just make an effort, you could gain all the weight you wanted! Go ahead! Just eat more calories! Easy! You simply are not trying hard enough! JOKE OF COURSE–because… Honestly–it is exactly as difficult. Stuffing food… Read more »

KanaBo
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KanaBo

You’re assuming ive never been overweight or attempted to lose weight. And no, it’s not as difficult in the slightest. *Real* starvation and wasting diseases are not even in the same cosmos as the sensation of trying to lose excess visceral weight through restrictive diets, whether they be extreme, or intermediate fasting, or just very basic cardio or body fitness, CICO based, or low carb based. I’m surprised my comment was approved by moderation, kudos to the site, but you’re not making some grand point that i didnt consider or see some kind of hypocrisy on my part. The joke… Read more »

Valentina
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Valentina

My thoughts exactly! I admire Dr Fung, but I don’t get this article, either. It has become politically incorrect to hold people accountable for their behavior and to tell them that their health suffers from over-indulgence. Yes, overweight people may be victims of faulty medical advice and shopping malls blaring out advertisements, but they should also take responsibility for the choices they make. I’m 5.3 ft, 113 pounds most of my life ( I’m 56 years old), religiously follow Dr Fung’s advice and do everything by the book. Yet, for a long time I’ve been struggling hard to fight off… Read more »

Connie
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Connie

The problem with cico is that it works for a small % of excess weight. So people like you and doctors think it should work for all the excess weight. That’s not how the body works. The body is complex and is studied under biology not mathematics. When you artificially lower any input your body needs there are automatic processes that prevent you from dying. Try to live on less oxygen… Or less sleep.. When you eat less than your body wants it slows down your metabolism and it makes you cold and sleepy. Most chronic dieters can’t eat a… Read more »

Carlos
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Carlos

You are partially missing the point here. It is true we should not just believe what the so-called experts tell us, and it’s our responsibility to be critical and observant, but obesity is by and large not a self-inflicted malaise, as you picture it. To get closer to your standing point: Suppose your doctor notices you have slight gut problems. Suppose he proposes a treatment that is hard to follow and only provides temporary symptom respite while actually worsening the underlying disease. Now suppose every time you have a flare-up, your doctor tells you it’s your fault for not complying… Read more »

Patti A Johnson
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SUCH a FREAKIN’ FABULOUS post, Dr. Fung!! THANK YOU SOOO VERY MUCH, ONCE AGAIN, FOR YOUR HONESTY & BRINGING THE REAL TRUTH TO THE FOREFRONT OF DISCUSSIONS! Awesome. Simply awesome. YOU ROCK!!! #FungFan 🙂 <3

Michael
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Michael

There are many factors that play into obesity, some are physical (every body is different and there isn’t a fix all), some are cultural (how you were raised and the effects of capitalisum) some are emotional (mental health and coping skills) and some are just will power (the same as any other addiction, which have all the same factors as obesity).

Kay
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Kay

Excellent post, Dr Fung. I think another factor is the change in eating ‘etiquette’ over the last generation or two,probably influenced greatly by the graze/don’t-skip-a-meal advice. It used to be considered rude, if not outright forbidden, to eat in class, on public transit, etc. Now, everybody eats anywhere, any time. Students eat in class (I work at a post-secondary institution), and I can’t get on a bus without seeing people chowing down. It grosses me out. People even bust open snacks in grocery stores before they’ve paid for them! That one kills me. Corollary: food has to be for sale… Read more »

Katrina M Iannuzzi
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Katrina M Iannuzzi

Excellent

Amanda
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Amanda

Thank you Dr Fung, keep on getting the message out there, your doing a wonderful job. The tide is turning, slowly, but turning nevertheless. Thankfully, the internet has come at an opportune time so that the message can get to the masses.

mieg
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⭐🌟⭐🌟⭐

Carlos
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Carlos

Well, to a certain degree, it IS your fault: you blindly followed a ludicrous advice that you knew wasn’t going to work, and you didn’t look for better answers. I have been overweight for more than half of my life, slave to CICO and eat less, move more, and yoyoing like nobody’s business. Esporadic prednisone treatment did not help with this, and neither did my (very) low interest in moving (not moving MORE, just plain moving). Thus, being still reasonably youngish, I found myself carrying 60 extra pounds and not so much muscle mass to carry it, and decided that… Read more »

KanaBo
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KanaBo

If only.. what a different world that could be..

Susan
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Susan

CICOpaths! LOL!! I am no longer a CICOpath. Thanks Dr Fung. Life is so much easier (and less expensive) using a meal plan based on your work.

Kate
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Kate

Well you are not exactly correct in saying they do not use hidden shaming for people who have a heart attack…..they absolutely shame you about having a heart attack….they blame you for the risk factors, for your cholesterol, your weight, your lifestyle choices. They looooove to blame you for your own heart disease. And then your cardiologist loves to fat shame you, telling you you are just lazy, after all it is just calories in calories out. And move more. But this is entrenched in med school. Med school students who are overweight are fat shamed by other students and… Read more »

Arthur
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Arthur

I really like the “swim more, drown less” analogy! I had been a CICO follower for a long time. I lost weight, but always packed it back on. The combination of intermittent fasting, fasting and LCHF is easy and effective. The food is great and I stop eating when satiated. At 59 years old, I rarely exercise and I’m down 55 pounds with no loss in lean mass.

I have read “Then Obesity Code” and loved it. Thanks for all the great information.

Arthur

Melissa Halby
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Melissa Halby

Love this! Thanks so much. (sorry off topic) I’ve heard the Doctor mention in one of his previous videos that all people will lose weight after 6 months on any diet; However, what about tons of people who abiet are a bit older who are adhering to diet and exercise & that the weight doesn’t budge. It seems odd to me that IF is the only thing that seems to work. When and Where does Microbiology come into play? The “good microbes” & does IF just starve out the sugar eating bacterias? Should we be taking the pre-biotics?

sucre
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sucre

Yes many people have fallen victim to the CICO mentality, the carbohydrate-heavy “food pyramid”, poor advice about just “moving more” while eating low fat and high sugar processed foods. But really, I have a big problem with these calls to stop blaming people for their poor habits and lack of willpower. I am 50 years old and through much effort and self discipline, healthy weight and I have always been aware of the necessity to control myself, my diet, not indulge every time I want, exercise, restrict carbs, and fast. I never just binge or eat what I want, which… Read more »

Lisa
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Lisa

My dad was also overweight due to dietary choices. But knowing the kind of man he was (WWII hero, faithful father of 10, strong Christian, hard-working, generous), I do not doubt that he would’ve been able to maintain a healthy weight if he had a doctor who was more like Jason Fung and not like the CICOpaths. Unfortunately, my father got cancer and died at 60, leaving our whole family devastated.

Lisa
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Lisa

CICOpaths. LOL! You’re hilarious! I’ve really enjoyed reading your articles.

I can’t believe these numbers…40 percent of Americans are obese now and 70 percent are either overweight or obese. Unbelievable! There can’t be any other explanation except that we were sold a bill of goods.

Considering that most of us were raised on formula, then margarine, cereal, white bread, kool aid, pop, pop tarts, chips, pizza, and more…and many adults drink beer and hard liquors, it’s kind of remarkable that the stats aren’t 100 percent.