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.