Super-Sized Denial?

My first reaction to the headline, Survey: Most Obese Claim to Eat Healthy, in the Boston Globe this morning, was 'they're in denial'. A number of headlines and articles seemed to concur with my first thoughts too:

• Are Obese Americans in Denial?
• Obese Americans in denial
• Fat People In Deep Denial About Obesity

I decided to think about this one before putting pen to paper (well, fingers to keyboard) and grabbed my coffee and headed outside to enjoy the cool morning air - something the recent heat wave deterred. One position I've maintained for years now is that you simply cannot have an entire population not "get" a message of what constitutes a healthful diet when it is repeated as often as it is in the United States.

For decades now that message has been clear - a diet, with the majority of calories from carbohydrate is optimal. And here we have a survey asking individuals what they weigh, how tall they are, and how well they eat each day. When the results are such that they find most people think they're eating a healthy diet even though the majority are overweight or obese, the researchers question whether those responding were truthful and suggest, perhaps they're in denial.

This is because it is difficult to escape the notion that if you eat healthy you are going to be a normal weight. It defies out sense of logic to consider the concept of an obese person eating what is defined as a healthy diet and still be obese.

So, let's first tackle the issue of honesty by those who participated in the survey. The survey was conducted by phone from January to March of this year. The researchers contacted 11,300 individuals and found:

• 37% were overweight (4,200)
• 27% were obese (3,100)
• 34% normal weight (3,800)
• 2% were under weight (200)

This demographic result - 64% overweight or obese - is close to the current estimate of 66% overweight or obese in the US. I point this out because the survey relied on those answering to be truthful in their responses. The result of the individual responses taken collectively indicate, as a group, those providing responses may be considered honest - the demographic results for overweight or obese is within 2% of the current estimates released by public health authorities in the US and the World Health Organization.

With this in mind, let's now go through the other findings:

Of those classed as obese,

• 75% reported they eat a healthy diet
• 40% reported they exercise "vigorously" at least three times a week
• 28% reported consuming snacks two or more times a day
• 19% reported always reading labels on food packages
• 29% reported eating out in restaurants three or more times a week

What the researchers failed to ask was what foods those responding considered "healthy," or what they ate on a daily basis. I'm not surprised these questions went unasked. Had they asked, the researchers may have uncovered the stark reality of how well the messages promoted about healthful eating have been adopted by the population in the United States.

Data on consumption trends in the United States betrays the notion that the average person eats a high-fat diet and too much protein. As a percentage of calories and in absolute grams, men in the US are consuming less fat than ever before; women are consuming less calories as fat as a percentage of their diet, but about the same in absolute grams. Protein intake over the last thirty years has remained fairly constant for both men and women.

The really radical change in our dietary habits is our consumption of carbohydrates - specifically sugars and grains; the former recommended for years as up to 25% of total calories, the latter promoted as the optimal foundation of a healthy diet. This shift in message, eat a carbohydrate-rich, low-fat diet, and change in consumption in the last thirty years has added more calories a day to the average person's diet with the average American now blamed for eating what they were told to eat...more grains without worry about the sugar, afterall, sugar is fat-free!

And now, we're told they're in denial about how they eat - they're not eating healthy, they're obese, they can't be eating healthy!

So here's my perspective on the findings - perhaps their obesity isn't simply the result of "denial" but is the reality we've set in motion with the messages over the past decades promoting the idea that an optimal diet is one low in fat and rich with carbohydrate!

Quite frankly, I've yet to meet an obese person who was totally unaware they were obese; some have tried for years to lose weight and have given up, some are currently struggling to follow the "rules" promoted by the powers that be to lose the weight, and some are just content and not going to change their habits.

I know I've watched in horror while eating out as an obese person at a table nearby chose to eat a meal that was anything but healthy; but I've also watched plenty of obese people make what they believe are good, healthy choices when they're dining out: a salad with low-fat dressing, the grilled chicken breast with pasta primavera tossed in the marinara on the side and allow themself just one piece of bread, sans any butter; a diet coke and the fruit cup for dessert. Is this an obese person in denial if they responded that they're eating healthy?

I've most certainly kept myself from saying anything as I watched an obese person pass by in the grocery store, their cart loaded to the brim with the worst foods possible; but I've also watched plenty of obese people place what they believe are healthy foods in their carts, the look of determination in their eyes - you know they're trying to watch what they eat and are trying to lose weight: whole grain bread, whole grain cereals, skim milk, fat-free yogurts, vegetables and fruits, fish and chicken, light margarine and one or two of the new "100-calorie" snack packs available, promoted as a good choice. Is this an obese person in denial if they responded they're eating healthy?

The reality is that some obese folks truly have no clue what it means to eat healthy, but I strongly believe that there are many more who truly believe they are trying to eat as healthy as they can, and do make their food selections on the message that's repeated again and again to the American public - they eat more plant-based foods (translation: eat more carbohydrates).

No matter how many times the "experts" have tweaked the message, it has remained "eat a carbohydrate-rich diet if you want to be healthy" - and the obese are doing just that.

That's not denial, that's reality folks.