Martin Johnston talks to weight expert and battler Andrew Dickson about how the weight-loss industry exploits the anxieties of the obese
Dr Andrew Dickson knows that, at 105kg, he's a big guy. Obesity has been an obsession of Dickson's, personally and academically. A business lecturer at Massey University in Palmerston North, the 34-year-old wrote his doctoral thesis on the lucrative weight-loss industry and how it exploits "weight-anxiety" for profit.
Obesity is increasing in New Zealand and other developed countries. New Zealand's rate of adult obesity has more than doubled since 1977. In 2008, more than a quarter were obese; add in the overweight and you're talking about 65 per cent of the adult population. It's a big issue to researchers and in the public mind, but is it as big a risk to human health as it is often portrayed?
At his heaviest, Dickson grew to 130kg. His weight worries began in adolescence. He was athletic and still is, completing marathons and long, gruelling mountain-running events such as a run over his local Tararua Ranges.
"When I was 13, it became obvious that I was bigger than the other athletic members of my high school. I used to do this run-up to the long jump and the other kids used to line up each side and go 'boomba boomba boomba' as I was running down, even though I could jump.
"If you were a woman, that would be solely mocking; just a bitchy, nasty thing that they do. But there's a certain amount of respect you get as a man being large and so we call our big mates 'big man'. It's a term of affection as well as being an element of mocking. So I both enjoyed it but also suffered at the hands of it.
"I got to a point when I was at university, 18 or 19 years old, where I was probably 125 to 130kg and I was really starting to get angry at myself, starting to find myself disgusting. I hated going clothes shopping."
For 15 years his weight yo-yoed, in the pattern known to so many large people, as he tried different diets or exercise machines. He came to loathe his body and feel like a failure.
"Everyone else was thin or normal size and I was fat, because of my own useless inability to be able to maintain what everyone else could. There was something wrong with me."
For his thesis, he analysed how the language of obesity makes people absorb the message that through lack of education, lack of effort, they have become fat. You can see how that language paints them as immoral, undisciplined and lazy. It's an extremely painful way to live your life."
He argues that because obesity is not a top-line health risk, the disadvantages for society from weight anxiety outweigh any benefits.
"The types of neurotic behaviour we get as a result of many of the messages of the weight-loss industry, the yo-yo dieting, the incredibly disordered eating, the addiction to exercise - all these [are] painful effects - and probably the most common would be self-loathing, hating being in your own body, which is just a crap way of living.
"It just seems ludicrous that we would keep on going with the plan to try to get people to lose weight."
The accepted understanding is that obesity does matter because it is a risk factor for diabetes and both of these conditions are risk factors for cardiovascular disease, including heart-artery disease and stroke.
Diseased heart arteries and strokes cause nearly 30 per cent of deaths in New Zealand. Obesity has also been linked to an increased risk for various types of cancer.
Professor Rod Jackson, an University of Auckland epidemiologist, says there is a widespread misunderstanding among doctors, medical students and the public about obesity and the risk of diseased blood vessels.
When he gives talks about vascular health, he asks his audiences to rank the top five risk factors.
"Obesity and overweight almost always come in the top one or two and yet they should be in the bottom one or two."
He says the biggies are raised levels of bad cholesterol (associated with eating saturated fats, which predominate in butter, most meat fats, palm oil and coconut oil), elevated blood pressure (linked to excess salt intake), and smoking. Raised glucose levels comes fourth.
"Overweight is quite a long way down. It's not in the same category as those. How overweight would you need to be [to reach] the equivalent of smoking - smoking is the same as being 40 to 50kg overweight."
"The other reason why it is unlikely that obesity and being overweight are as important as the others is that vascular disease death rates have been plummeting from the 1960s and they continue to plummet. There's no evidence that the death rates are levelling off. That's despite an obesity epidemic. It's not that it's not a risk factor; it's not a major one. I think it's been over-rated as an individual risk factor."
"It's probably more important how you get fat than if you're fat," says Jackson, plugging for a diet rich in unprocessed foods and healthy oils.
Calorie for calorie, you'll get as big eating too much olive oil as too much butter or fatty lamb chops and this increases your risk of developing diabetes, but your vascular health will be better if you choose olive oil.
Losing weight can be pricey. Standard gym memberships can cost over $1200 a year. Jenny Craig meals can cost $170 a week. Weight Watchers charges $33 for registration and the regular weekly fee is $18.50.
Weight Watchers Australasia's New Zealand national manager, Carol Pinker, says the organisation "has helped millions of people lose weight and maintain a healthy lifestyle".
She points to a British study which found overweight and obese adults referred to Weight Watchers achieved significantly greater weight loss than the control group at their one-year follow-up.
Studies have found an average weight loss of 3.5 to 4kg after one year on a Weight Watchers programme. But the British study's wider findings after comparing various 12-week weight-loss programmes are illuminating. At one year, those who stuck with their allocated method lost just over half a kilogram after the end of their programme; those who switched to another method or stopped trying to lose weight gained 1.2kg.
Professor Elaine Rush, nutrition and obesity expert from Auckland University of Technology, says with adults "there is a set point that the body adjusts to. It is very hard to re-set that point."
The culture we've created doesn't help, with our preferences for car travel and cheap, unhealthy food, drinks and alcohol. But children are "more plastic", Rush says, citing the success of Project Energize, a school-based nutrition and physical activity programme in the Waikato backed by the district's health board and based on research she led.
For 10-year-olds in the scheme, the average waist measurement has shrunk 4cm, 15 per cent fewer are overweight or obese and they can run faster than the comparison group in the baseline research.
"These children will [become parents], so that's a very big bang for your buck, because their children will be healthier," Rush says.
Dickson didn't need to be told by Sir Bob Jones' sarcastic column that the fat are "heaving horrors", and self-made "human hippos".
"How we treat these people, the messages we send them - send me and others," he says, "is incredibly destructive psychologically. It certainly doesn't help you to lose weight.
"There is no evidence to suggest that education makes someone lose weight.
"Ninety-five per cent of people who attempt to lose weight fail," he says, citing a statistic accepted by Rush.
For Dickson, weight anxiety is something that won't ever go away, although he says that coming to understand it has helped him to manage it. He's clearly very fit and active but says he is now able to be a father, husband and teacher rather than constantly obsessing over what he looks like and planning the next 20km run.
He advises the weight-anxious to minimise their contact with the weight-loss industry.
"If you're anxious and think you need to lose weight to be happy, seek help from a therapist. A good analyst will explore what being happy actually means for you, and will help you disassociate your happiness from your weight."
A weighty obsession
In 2006, I lost around 40kg in four months. This was strange, as my weight loss attempts usually produced a small reduction, followed by putting it all back on again.
But in 2006, on my GP's advice, I took a weight-loss medication called Reductil (no longer available in New Zealand). I suddenly lost my appetite. My metabolism changed, making my body burn more energy for longer. The weight loss was dramatic: in the first month I lost about 20kg.
I was ludicrously happy. For the first time I could see the "real" me emerging from the fatness - to live among the "normal-sized" people. Everyone was joyful (except perhaps my still-fat friends and family) and anyone who knew the situation would tell me how much happier and healthier I must be.
Eventually I stopped the Reductil. My appetite slowly returned and I worried about my metabolism returning to the "old Andy" so I became vigilant. I counted every calorie, measured my exercise and balanced the books every day.
I weighed myself morning and evening and analysed the results. At least weekly I would exercise to the point of moderate dehydration and weigh myself to get the thrill of a low weight reading. The scales and calorie counters were my gospel.
Cracks began to appear. I was now an alcohol-free vegetarian and struggling to fit my new regime into everyday life. I avoided eating out if I could and began to starve myself before functions that I had to attend. My wife was frustrated that I was always out running or exercising and I was beginning to wear out my dogs.
My worst fear was weight gain.
My wife used to say "would it be so bad if you were to be a bit heavier?" This would send me into an anxious tailspin, though I couldn't explain why.
- Andrew Dickson