Dr. Jessica Alleva,

I reported on Dr. Muttarak's study and understood the study to be a preliminary one. I also understood that she was putting forward a possible hypothesis for further research. I understood that the relationship between increased acceptance of overweight/obesity and misperception of weight is a correlation. Preliminary studies typically do not look for the causal relationship; that is for future research.

I am also aware that Dr. Muttarak's work joins a growing body of research on weight perception, and how our perception of our own weight and the weight of others (even our own children) can be skewed by many behavioural and societal factors. Her work is not the first to wonder about the possible detrimental effects of body positivity.

In a world where a large and ever-increasing percentage of the population is suffering due to being overweight and obese (the stats are very clear on the health risks), and where an increasing number of small children and youth are also struggling with being overweight and obese, we absolutely have to find ways to address the problem. This includes looking at all possible contributing factors, including the movements in society that, on their surface, might seem innocuous or even wholly positive.

Here is a quote from Professor Kersbergen's review:

"We examined peer‐reviewed literature published between 1991 and 2017 and found strong evidence to suggest perceived overweight was associated with a higher likelihood of trying to lose weight and moderate evidence to suggest perceived overweight was associated with greater use of both healthy and unhealthy weight control strategies. However, those weight loss attempts and strategies did not appear to be translated into healthy weight‐related behaviours. ... The most consistent evidence to emerge from this review was that perceived overweight was associated with attempting to lose weight. This was the case regardless of participant weight status, age group and gender."

The research is not yet at the level to tease apart the causal factors for why they are gaining more weight even after trying to lose weight. It's also important to note that "Half of included studies were conducted on adolescent samples or a combination of children and adolescents, with the remainder on adults or a combination of adults and other ages, or only young adults (aged 18–25)."

For anyone who has lost weight on purpose, it is done because of a perception of being at a weight that the individual believes to be not ideal and/or unhealthy. This weight loss, to be permanent, requires an adjustment on many levels, with many experts saying that it does not require a mere diet and exercise plan, but a permanent lifestyle change. Without the proper societal, familial, and medical supports, said lifestyle changes are close to impossible.

And what may be a mediating factor for those who are unable to lose weight, is overeating as food addiction. See "Food addiction as a new piece of the obesity framework" by Jose Manuel Lerma-Cabrera et al.

As with any addiction, simply knowing there is a problem is usually insufficient for making lasting changes to reverse the problem.

And I want to make it clear that I am not suggesting that all overweight or obese people are addicted to food, since I know that there are many other factors at play, including systemic problems in the food industry, unaddressed health issues, and unaddressed socioeconomic inequalities, etc. But the research indicating that a significant percentage of obese individuals may suffer from food addiction is convincing and should not be ignored.

Kristen Hovet

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