For many overweight and obese people, getting in shape can feel like an act that is meant to be publicly announced and privately executed. Consider NBC’s The Biggest Loser, which has consistently drawn in millions of viewers over the last 10 years by showcasing the spectacle of rapid physical transformation. Sure, the contestants’ dedication to improving their health might be inspiring, but more alluring is the promise of watching a sweaty, shout-filled struggle, with a Big Reveal at the end of the season.
In non-reality show reality, being gawped and sneered at by their fit peers has actually led heavier gym-goers to become members of facilities like Downsize Fitness in Forth Worth that cater exclusively to bigger clientele. There’s a sense that no one will be singled out for the state of her health but, instead, welcomed as part of a community with a shared goal. Emphasizing the importance of community to curtail the prevalence of obesity is the goal of Drs. Walter Willett and Malissa Wood, the co-authors of Thinfluence: the powerful and surprising effect friends, family, work, and environment have on weight.
Dr. Willett is a professor of epidemiology and nutrition, and chairman of the department of nutrition at the Harvard School of Public Health, whose research helped to instate modifications to the USDA Food Pyramid. Dr. Wood, a clinical cardiologist and staff physician at Massachusetts General Hospital in Boston, is co-director of the Corrigan Women’s Health Program and an assistant professor of clinical medicine at Harvard Medical School. As lead investigator of the HAPPY Heart Program, she researched the impact that community-based programs might have on the health of low-income and minority women in a Boston suburb.
Jointly, the two hope to counter the notion that getting in shape is a solitary pursuit and the sole responsibility of the obese. I spoke with the pair about the influence of friends, family, and public policy on weight loss.
Thinfluence’s subtitle states that the book is about the “powerful and surprising effect” that friends, family, work, and the environment have on weight. Why is it important for people to understand the significance of these networks?
Willett: If you look around the world at wealthy countries like the United States, you see very different rates of obesity. In Japanese women, prevalence of obesity is under 5 percent; in Swedish women it’s about 6 or 7 percent. In the U.S., it’s between 35 and 40 percent—and we know that when people come from these countries to live in the United States, they fatten up. That’s a clue that there is something pretty important going on that’s related to where we live, and that there are very important factors operating [outside of us as individuals].
We’ve started to understand some of these; they’re often complex but it’s a clue that Americans aren’t simply completely irresponsible people. And looking at kids, too, their obesity rates have about tripled over the last four years, or quadrupled among some groups. It’s not that kids have become massively irresponsible in such a short time, but that there are obviously factors outside the kids’ inner-selves that are operating here.
So much of what people have been told is that weight is just about individual change. We’re not saying that there is no such thing as individual responsibility, but sometimes even very responsible people can have a hard time making the choice that’s in their best interest if there are a lot of barriers in their daily life and environment. Most diet books just focus on what we should or shouldn’t be putting in our mouths [without] looking really comprehensively at all of the factors around us.
One of the ways you try to categorize the impact of different areas of people’s lives is through a “circle of influence” graph. What are the most important areas to focus on, at least in the beginning of a weight-loss or healthy-eating initiative?
Willett: The closer-in factors will probably be the first things that people pay attention to, because that’s usually where you can make a difference the fastest. You have more control over things like yourself and your relationships, and as you go farther out you have less and less control—but not zero. A lot of people, for example, live in a place where healthy foods are relatively unavailable or very expensive, and often there are small convenience stores that don’t have many healthy choices. Those more distant factors are possible to change but it takes active individuals in groups to make it happen, and change often happens over a period of years, not weeks or months. So you may be working on these bigger factors more for your kids, perhaps, than for yourself.
In terms of the circles of influence, you parse through various internal and external factors that impact weight and unhealthy eating habits. What is the dividing line between those sides?
Wood: Internal factors are important because we don’t give enough credence to the fact that stress, anxiety, and depression are really driving a lot of overeating; those drivers are behind this unhealthy relationship with food that a lot of people have. Many people take an internal struggle and try to solve it by getting comfort from something that’s attainable. What we try to point out is that the links between those factors—stress, depression, anxiety, and obesity—are so strong that addressing the inherent cause of some of those things can have a benefit downstream.
That’s exactly what we did at HAPPY Heart. We recognized that those women had stress and anxiety that were off the charts, and we tried to address the major source of their angst, whether it was, “I don’t know how to balance my checkbook,” or “I’m worried about my home being foreclosed on.” Then, we gave them a forum to really discuss these things and get support from their friends to ameliorate some of the stress in their lives. In this book, we’re trying to do the same by helping people address some of these internal factors that they can manage—and obviously a chemical kind of depression would need to be managed by a professional—so that they can take steps to climb out of that dark space that overeating becomes a part of.
We feel very strongly that there has been so much guilt associated with being overweight or obese as a personal failure, that we want to open it up and say, number one, recognize that your choices reflect a web around you of many environmental factors, which are very important. Second, understand that some of those things you can change and some you can’t, and learn to recognize what you can. It’s harder to change that unless you really help them to see that this is something they have control over.
Thinfluence isn’t only geared toward people who want to become healthier, but to the family members and friends of people who want to lose weight. What is the best way to be supportive but still realistic about a friend or relative’s state of health without badgering them or shaming them? Is that even your job at all?