HBO's Weight of the Nation: Shedding Light on Obesity

HBO’s Weight of the Nation is a great reminder of all the things we know about obesity and how incredibly hard it is to treat but that it is possible.  Research over the past 30 years has shown us that “diets” don’t work long term, and that obesity prevention is so much more effective than treatment.  It’s also clear that the best long term health outcomes happen when people focus on eating healthfully and moving more, rather than focusing solely on weight loss.   Finally, physical activity is helpful during weight loss,  but it is most effective in keeping weight off. 

Ultimately, the treatment is not a pill or even a set protocol:  anyone who wants to lose weight has to find the methods that work best for them.  

As a registered dietitian (RD) for the past 22 years, I’ve watched the nation gradually put on weight.  My first real “job” as an RD was working for the Duke University Diet and Fitness Center, a residential, comprehensive obesity treatment program that provided the meals, fitness programs, nutrition education programs, and psychological therapy.  One of the most frustrating things I experienced as a clinician was realizing that while the program provided all the best approaches and worked well, once patients returned home, very few were successful at maintaining their weight loss or continuing their weight loss. 

While certainly we are each individually responsible for what we eat, we are also influenced by the choices available around us.  If fruits and vegetables and whole grains are easily available (and affordable), we eat those.  If foods with lots of calories, fat, salt and sugar are available, then we’ll reach for those.  There’s plenty of blame to go around in terms of who or what is responsible for the obesity crisis.  And, there are a number of solutions that will have to be implemented simultaneously for the crisis to abate. 

As registered dietitians, I think we can help our patients best when we teach them the tricks that we personally use to eat healthfully and manage weight.   I know that I have a set of “food rules” that I stick to. Some of mine include:

• No eating in front of the television
• No eating in the car
• When eating out, immediately cut the portion in half and take the rest home
• Eat salads, vegetables and whole grains first, then eat the other foods
• Never grocery shop when hungry

Ultimately, obesity comes down to an issue of too many calories and too little activity.  Each of us, in the context of our busy lives, has to come up with our own set of “rules” that works for us.  No one likes being told what to do and rules that are imposed can seem restrictive.  That’s why as dietitians, we are in the unique position of guiding patients and clients to explore what rules might work best for them. 

We know that when kids help prepare dinner, they are much more likely to eat the meal.  Similarly, when people create their own guidelines for how to manage their food choices, portions and activity patterns, they are much more likely to stick with them. We also need to acknowledge that not everyone has access to healthful foods or safe places to exercise and help people devise strategies even with these challenges.

Most people know  how much they should eat and that they “should” exercise more.  Perhaps it is time to shift our focus a bit so we can help people create their own “rules” for exactly how to manage the food and exercise challenges in their stressful lives.

Michele M. Tuttle, MPH, RD