Diet Rejection
Rethinking the Obesity Epidemic
It would take a world-class powerlifter to pick up a 700-pound person. If you saw the show My 600 Lb Life, you would know it often takes 4 to 6 grown men to lift up a 600 to 700 lb person.
Most of the USA is overweight and over a third are classified as obese- thank you captain obvious. But how do we solve this issue?
Most people point fingers using whatever and whoever to blame something for this issue rather than solving it.
"Sugar makes people fat."
"Seed oils are causing obesity."
"No, fructose caused the obesity epidemic."
But none of these statements are necessarily helpful or true. Blaming a food group, food ingredient, or nutrient doesn't help those afflicted with obesity.
We could also point to the other obvious fact that obesity is a function of overconsuming calories over time. Yet, this obvious fact does not solve the situation at hand.
How do we help people with obesity?
I think this question comes with a number of assumptions. The first assumption is we HAVE to help people with obesity. The second assumption is that these individuals want to be helped. Finally, we have a major assumption it is their fault they deal with obesity.
I will start with the science and move on to the psychological and philosophical pieces.
Current evidence seems to suggest the reason individuals deal with obesity is due to a combination of genetics, environment, and the brain. The hypothalamus is largely responsible for regulating body weight.
However, when an individual has dysfunction related to the hypothalamus, such as leptin resistance, they're more likely to become obese.
Certain people more than others have the genetic propensity to undergo dysfunction of the hypothalamus. This isn't helped by one’s environment where poverty in developed nations, fast food corporations, and socioeconomic factors can lead one more likely to deal with obesity.
Diet Rejection
It’s not a surprise most dieting interventions are unsuccessful or individuals gain back at least some of their weight. It could be argued weight regain is the exception rather than the rule.
While the fitness industry wants to argue over calories, diets, and whether obesity is a choice… we want to understand the deeper nuances.
Why do people become non-adherent to dietary interventions? What causes this diet rejection to begin with?
In my experience, fitness professionals are too concerned with the biological explanation, promoting “discipline”, or harping on about habits. However, the reason why people reject diets or undergo diet rejection isn’t merely due to biology or habits but overall psychology.
Specifically, we are talking about emotions related to eating behavior.
Emotional eating can be defined as the tendency to overeat in response to negative emotions.
Emotional Eating and Weight
Emotional eaters are more likely to consume foods higher in fat, sugar, and calories when they experience negative emotions. Emotional eaters also struggle to lose weight and maintain that weight loss.
From both a longitudinal and intervention study context, emotional eating is associated with weight gain and less weight loss.
But if emotional eating is such a hindrance to weight loss and weight loss maintenance, why is it not talked about more?
The fitness industry seems behind when it comes to psychosocial factors impeding body weight. If you go to any book store and then go to the fitness section you will see plenty of books related to fad diets. Look into Instagram or Tik Tok hashtags related to diet, nutrition, or fitness you are bound to see a ton of misinformation and disinformation online.
Okay, we know emotional eating is a problem and can be one of the reasons for diet rejection, but what can we do about it?
Emotional Eating Interventions
There is some good news, we have interventions to help people navigate emotional eating. These interventions typically deal with mindfulness or specific therapy formats like acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), and dialectic behavioral therapy (DBT).
Mindful eating protocols seem to target binge eating, disinhibition when eating, and depression, but these constructs are closely related. Even if the emphasis of the intervention is weight loss, mindful eating protocols tend to help increase levels of weight loss.
The other interventions have to do with typical therapeutic approaches to behavior and cognition.
These therapeutic theories and approaches do focus on better emotional regulation and behavior. This would in theory make them ideal for dealing with emotional eating. But let's look at their track record.
One intervention looked at the impact of CBT and DBT on emotional eating. The DBT group lost more weight and tended to feel less emotional distress, but this was a case series that is limited to applying to general emotional eaters. The main approach for CBT is behavioral (operant conditioning) and the emphasis on maladaptive thoughts (cognitive).
On the other hand, ACT deals with accepting emotions and working towards dealing with them. In this respect, ACT leads to more weight loss than standard behavioral therapy, as well as longer weight loss maintenance via 6-month follow-up.
Finally, DBT is a bit different as its intended focus is for patients with a borderline personality disorder but it has shown effective for other mental afflictions. One pilot study found those undergoing the DBT treatment decreased scores on emotional eating and their weight.
Nevertheless, the fundamental issue with these interventions is a lack of longitudinal follow-up (beyond 6 months) to see if weight loss persisted, these trials are often small, are in controlled environments, and target mainly obese individuals with known mental disorders. Additionally, the construct of “emotional eating” is often not differentiated from other maladaptive eating behaviors such as binge eating and disinhibition.
We lack larger, externally valid trials to on individuals specifically dealing with emotional eating.
Emotional Regulation and Coping
It shouldn't be entirely surprising to see individuals who have problems regulating their emotions tend to turn to food for comfort.
Women who were sexually assaulted are more likely to be obese. Individuals who deal with mood disorders are more likely to be obese. Children who are bullied are also more likely to be obese when they get older.
Overconsumption of food as a release or coping strategy for these emotions seems commonplace.
This was the case for me as well. As someone who went through intense physical and emotional abuse, my one coping strategy was food. It would give me temporary relief from the reality I was facing. It’s part of the reason that I, Jae, am an emotional eater as well.
On top of that, dealing with the stigma obesity places on top of whatever emotions a person is facing might exaggerate the issue.
Weight Stigma and Weight
We often assume fat people are lazy, goofy, dumb, and morally bankrupt. What are these assumptions based on?
Well, if you watch The Simpsons or Family Guy you would notice the main characters are classified as morbidly obese and are stereotyped as lazy, dumb, and selfish characters.
These stereotypes about people with obesity lead to stigma. Stigma is akin to a mark of shame, so weight stigma is this mark of shame for one’s weight. These negative attitudes and stereotypes about those dealing with overweight or obesity can have negative physical and mental outcomes.
Bullying, obesity-related and otherwise, was shown to be associated with later life mental disorders and physical disease. Weight stigma is also associated with binge eating and other problematic eating behaviors. Ironically, weight stigma can lead people to overconsume foods regardless of BMI. Weight stigma also increases the overall odds of being obese and leads individuals to increase sedentary behaviors.
To recap, weight stigma increases the risk of obesity overall by leading to increase calorie consumption, decreased physical activity, and a greater likelihood of engaging in problematic eating behavior.
TLDR; The Recap and Insights
Obesity is pretty complicated, there are definitely biopsychosocial components to it.
It is in my opinion, the fitness industry is too focused on the biological aspects but neglects the psychological and social aspects of obesity.
When it comes to interventions, diet rejection aka non-adherence is high amongst those dealing with obesity.
Diet rejection might be a result of psychological factors such as emotional eating.
Emotional eating is positively correlated with weight gain and obesity.
We have some potential interventions for emotional eating but the current literature is limited.
Emotional eating gets at something deeper psychologically for many people and the stigma against obesity does not help.
What does this mean for fitness professionals?
Fitness professionals should understand the greater sociological and psychological factors leading to obesity.
Professionals should be aware of emotional eating and its constituents.
Fitness professionals should become acquainted with psychological concepts in CBT, mindful eating, ACT, and DBT.
If a client is going through emotional distress they should be referred to qualified mental health professionals.
Make sure to keep mental health professionals as part of your network and be aware of these factors.