Why knowledge is not enough to manage obesity

I am a university professor. I teach in the school of Kinesiology which focuses on the science of human movement, anatomy, physiology, biomechanics and more.

In one of my courses, “Growth, Maturation and Physical Activity”, we learn about how physical activity intersects with human development and health.  An important concept I discuss with my students is “health literacy” – the ability to seek out, understand and implement health information in our lives.

In light of all the bogus information, fads and downright scary weight management advice that spreads like wildfire, having a high degree of health literacy would be useful. It would allow you to sift through the junk and understand what you really need to know. A very important aspect of obesity management and prevention.

But is that enough? Do we simply need to educate the masses and we solve the obesity puzzle? What happens when knowledge is not enough?

Most obesity interventions focus on prevention and do so through “education”. That is, teaching individuals about healthy eating and activity and trying to improve health through knowledge. If people have a higher degree of understanding, they would make better choices and the issue is fixed.

Now, I am all for increasing health literacy across the board, and I think everyone can benefit from learning more about eating well and activity. But there is a reason why this approach has had zero impact on obesity no matter how much we try to educate.

For one, it completely ignores the genetic, psychological, physiological, biological and environmental factors involved in obesity. Putting all our focus on prevention through education is essentially reinforcing what we know to be untrue and perpetuating false narratives about obesity: “If fat people were not so stupid, we wouldn’t have this problem.”

I should know. I live with obesity. Obesity nearly killed me. At my sickest I was well over 360 lbs, with hypertension and sleep apnea and the nagging feeling that the fat was sucking the life out of me.

I have been heavy most of my life, I have lost and gained weight numerous times. Now, if only I knew better, right? If only I was smart enough to fix this on my own. If only I had the health literacy around food and exercise I never would have gotten so sick. Right?

Wrong!

I am educated, more than most in fact. I have a PhD in Kinesiology which focussed on physical activity and obesity. I completed a 2-year postdoctoral fellowship in Obesity research as well. I am a registered Kinesiologist and Certified Exercise Physiologist – meaning I know more about activity, exercise and the body than most of your personal trainers. I have even taught nutrition courses at the college level.

My health literacy on this particular topic is manifestly through the roof, yet here I am, living with obesity. How does this happen?

Ironically, as I was preparing to defend my PhD thesis, at this pinnacle of knowledge, I was also at my sickest with obesity. I was going to international conferences, learning and speaking about the science of obesity while struggling with my own personal health.

Not only was it difficult for my ego to have a body that clearly did not reflect my advanced health knowledge. It was a total mess for my mental health.

I hated myself. I beat myself up. I was ashamed of who I was. I felt like a fraud. Who could take me seriously? I of all people should be able to fix this. And if I can’t even do that, what good am I at all?

That was until I shifted my mindset, until I fully embraced the fact that obesity is a chronic disease. That there was much more going on than simply not knowing better.

Think about any other chronic disease: cancer, hypertension, diabetes, etc. Is educational prevention the focus of any of their management? Is there any disease where we wipe our hands clean and say “you’re on your own, you just need to learn how to heal yourself”?

Imagine a doctor being diagnosed with hypertension. Is that doctor a failure because he got something he knows about? Would we expect him to cure himself by reviewing some of his books from med school?

Absolutely not, because chronic diseases are more complicated than that, and regardless of how smart you are, you still need chronic disease management.

So why on earth do we do this for obesity?

Policy makers and society at large have yet to catch up to the facts, that obesity is a chronic disease that requires a different approach than what we have been doing up until now.

I get it. Change is hard. We have been conditioned to believe that obesity is simple, that it’s the individual’s fault, but we have been wrong before.  Consider, for example, how not all that long ago, radioactive water was a popular treatment for mental illness, diarrhea, malaria and even aging.

We can and should do better when it comes to obesity. It is okay to be wrong, as long as we use it to get better.

We need to be open to learning more and eager to correct our mistakes.  As a society we need to improve our overall health literacy so we can shut down the spread of bogus and dangerous information.

We need to demand that policy makers and health systems get with the times and recognize obesity as a chronic disease and treat it as such.

But perhaps most importantly, we need to recognize that when it comes to obesity, we need an approach that addresses the complexity of the disease, and does not fall solely on prevention education. We need to understand that knowledge is not enough.