Review on Amazon
How our well-meant attempts to address the health implications of our increasing body fat are making the problem even worse.
This is a very well
written and uniquely informative book in a field glutted with opinions and weak
and conflicting advice. It is not a how-to book on losing weight, although it
has a few solid behavioral suggestions for making modest healthy changes. This
is primarily an interpretation of much of the available evidence regarding
obesity and health by psychologist who runs an eating lab at the University of
Minnesota and publishes a lot of scholarly peer reviewed work in the field.
Although she is a
researcher, Dr. Mann takes pains to distinguish herself from obesity
researchers with a public health focus who are motivated to warn people about
the dangers of increasing body fat. Her interpretation of the data is often the
opposite in some ways from theirs, she sees the growing incidence of body fat
and she sees the growing incidence of adult onset diabetes, but she reports
that the link between body fat and health problems is far weaker than is
implied by the rhetoric of most obesity researchers and much weaker than the
popular impression has become. In addition, our efforts to fight obesity have,
she concludes, actually become counter-productive because of the manner in
which we typically attempt to fight our own biology by restricting calories and
exercising in ways that increase our stresses and increase our preoccupation
with food, and that both of these things feed back into exacerbating the
original problem.
The book starts off
ripping into both the commercial diet industry and the focus of a lot of
articles by doctors and obesity researchers by announcing that their "3
pillars" are all simply false:
1. That some diets
work for losing weight
2. That some diets
are healthy for losing weight
3. That obesity
itself is deadly
Among the central
and most compelling aspects of this book is where Mann observes that our ideal
body image often tends to be outside of the range that we can reasonably
sustain. And this becomes confused with health concerns and fed by commercial
interests. We could transform our bodies potentially through diet and exercise,
but at the cost of altering or entire lives in the service of that goal and
experiencing extended self-denial and obsession with food.
And the clincher for
her argument is that all this self-denial and obsession would be mostly serving
our aesthetic ideal rather than actually improving health. She finds that
according to best available evidence upon close inspection mortality is not significantly
improved by losing weight, unless you are already extremely obese and still
have a long life ahead of you. The population in that category is far smaller
than the one targeted by both the diet and fitness industries and most obesity
researchers.
Mann finds that
diets consistently fail in two ways: (1) only a tiny percentage of dieters
retain their weight loss, regardless of which diet it is, and (2) even when
people lose enough weight to satisfy the goals of improving their risk profile,
they rarely lose enough to satisfy their aesthetic preference. This means that
according to the person themselves, their diet failed even when for health
purposes it succeeds. Our aesthetic goals trump our health goals for the
purpose of satisfaction with the diet.
If we should want to
attempt small changes that help us regulate our own eating so we can maintain a
sustainably lower body weight, Mann offers several well-tested behavioral
suggestions along the lines of "nudges" that help us avoid being triggered
to eat excessively.
I think her
principles seem sound and her use of evidence is compelling. I do have one
criticism of her otherwise superb and unique exposition though. She argues for
a set point model of body weight regulation that maintains our weight within a
fairly narrow range but she doesn't really address the obvious question of why
people are statistically getting fatter if we are so consistent at maintaining
our weight in such a narrow range.
She puts most of her focus on obesity not
being as deadly as it appears except at the extreme, and she explains why
people can't simply diet away unwanted body fat, but she doesn't at all dive
into the reasons for our growing bodies. That's a big topic and it isn't her
area of research so I can understand leaving it to others to try to explain,
but for me it left a logical hole in her argument that begs to be filled and
should have been addressed with at least some general thoughts.
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