10/23/2012 03:06 pm ET Updated Dec 23, 2012

Weightism: The Real Reason We Are Failing at Weight Loss

Recently, an agent called to see if I wanted to be a guest expert on childhood obesity for a new TV show. I had a lot of fun during TV segments while on book tour, so my first impulse is always to say "yes." This time, I murmured my regrets. There are two reasons I hate talking about obesity. One, unless you are selling a new berry or iguana extract that some vague study found lasers off the extra pounds, there is nothing exciting to say. These products do not work unless you cut down on food intake and/or dramatically increase your activity level. Oops, I said it again: the same old, same old regarding weight loss.

Secondly, people have emotionally volatile views about excess weight, so it is hard to address the issue effectively. The distorted thinking bounces between people not acknowledging they are obese to self-hatred when they face reality to being very nasty to people with weight issues. In one study, only 22 percent of overweight women and 7 percent of men correctly identified themselves as obese. So about half of the 33 percent of those who are obese do not realize it. (Obesity is defined as 30 percent or more above ideal weight.) Another study found 25 percent of overweight women misperceived their weight, viewing themselves as normal weight.

This issue is particularly prickly in children where parents, especially if they struggle with weight themselves, are unlikely to recognize obesity.

In my experience, pediatricians tread lightly or hint at weight issues, lest they alienate parents or for fear of triggering a future eating disorder. (Technically, they should be more concerned about the overeating disorder right in front of them.) The first step to solving a problem is figuring out you have a problem, but there are excellent reasons for people to live in denial.

A most excellent reason to stay in denial is to avoid feeling bad about yourself, as carrying around extra weight is inexorably linked to body image issues and shame. A woman in my practice had not seen a doctor for years because stepping on the scale is too humiliating to her. I begged her to go because results of old blood tests, added to her symptoms, screamed, "See a doctor!" But even my offer to call a physician of her choice and insist she not be put on a scale would not sway her. "After I lose 20 pounds," she promised unconvincingly.

If you can hang on to your self-esteem, other people will help beat it out of you. Weightism, the prejudice against those who carry around extra weight, is pandemic. How discrimination affects earning opportunities and advancement is unclear. Certainly, people with weight problems report discrimination.

What is clear to me is we are not very nice to the overweight. The slurs and nasty comments I have personally heard could rival the cruelest racist remarks. People who in my experience are otherwise thoughtful consider the obese fair game. "I could never let myself get like that," or "Don't they have any pride?" or "That's disgusting," sound like the same old hatred that has fueled every other us-vs.-them excuse for mistreating others.

The conversation I would like to have about obesity is about acceptance and being kind to each other. Gaining weight is a part of our modern life. All sorts of things happen that turn thin people into chubby people. That fat person you view with disdain today could be you tomorrow. We all know the hundred cultural reasons that induce us to overeat. Since supersizing was introduced a few decades ago, for example, our portion sizes have increased across the board. We all try to blame the food companies, but our waistbands expand anyway. Enhancing food flavors to induce us to eat more is playing dirty, but educating people about food is not solving the obesity epidemic, either.

Yes, obesity is a health problem, and I am not saying we should all simply accept being overweight and damn the consequences. By all means, make a commitment to better health by attaining ideal weight if you can, but leave the self- and other-loathing at the refrigerator door. It turns out that Richard Simmons was right -- shame does not help you lose weight, whether you are beating up on yourself or someone else. The strategies and task force recommendations of the best medical minds has not helped our waistlines reduce a centimeter. Maybe it is time to try a little kindness.

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