Abstract
The recent article by Muntefering et al. (2023) promotes occupational therapy as a tool for the primary prevention of obesity. In this letter, the authors argue that the article is not only misguided but also potentially harmful.
The recent article by Muntefering et al. (2023) promotes occupational therapy as a tool for the primary prevention of obesity. In this letter, we argue that this article is not only misguided, but also potentially harmful.
First, the authors fail to acknowledge the historical flaws in the obesity literature. Body mass index (BMI) is the primary outcome for most weight-related research. BMI has significant flaws, in particular for racial and ethnic minorities and women, and the American Medical Association no longer supports the use of this metric on its own (Berg, 2023). The lack of a standard and reliable outcome measure makes the obesity literature even more equivocal. Indeed, findings from many studies linking obesity to negative health outcomes have been challenged because of methodological problems (Flegal et al., 2005; Gordon, 2023). More mechanistic research is needed to better understand the relationship between obesity and health before further intervention work is warranted.
Not only is the mechanism between obesity and health questioned, but also the effectiveness of known behavioral weight loss interventions is minimal. The vast majority of weight loss interventions conducted in real-world settings do not yield meaningful results in the long term (Dombrowski et al., 2014). For many, weight is similar to skin tone, a genetic inheritance with limited margin for change; social determinants of health also play a significant role in health outcomes regardless of weight (Hruby et al., 2016). Researchers and clinicians should use extreme caution before following a flawed historical precedence of associating health and body aesthetics.
Despite representing a profession that emphasizes the importance of contextual and systemic factors in creating impairment and disability, Muntefering et al. (2023) approached this phenomenon from a broader medical model that places the people with obesity at fault (Craddock, 1996). Specifically, the authors report that those with obesity have worse everyday task performance and quality of life. Fat activists argue, consistent with occupational therapy models, that these impairments are due not to the obesity but to the treatment of fat people in society (Gordon, 2023). For example, many physicians will refuse heath care procedures or engage in shaming language, leaving many fat people without access to the care they need and exposed to worse health and functional outcomes (Tomiyama et al., 2018).
Finally, the authors failed to consider the potential harms of weight loss interventions, in particular disordered eating. Diet and exercise regimens can be a gateway to eating disorders for many people (Golden et al., 2016). We must question whether it is ethical to promote weight loss interventions that could put people at risk for a serious mental health condition.
As occupational therapists, we should be committed to helping people live their best lives, regardless of their weight. This means promoting healthy behaviors in a way that is weight inclusive and nonjudgmental. It also means working to challenge the weight stigma and discrimination that are so prevalent in our society. We must do better.