Is A Calorie Deficit All That Matters For Weight Loss? | The Truth of Energy Balance
Without a doubt, I am known as a Calorie Deficit advocate, and I am proud to be one.
I am a believer in the fact that to either gain weight or lose weight you need to understand the principle of Calories In vs Calories Out.
Science is irrefutable on the topic. [1,2]
But what goes into the make up of Calories In vs Calories Out needs far more context.
There are many people out there that simply think “Calories In vs Calories Out” is causing the problem in terms of Weight Gain and Obesity.
The Health At Every Size (HAES) movement, the Body Positive Movement which are both movements I support, would argue against the constant bombardment of the rhetoric of losing weight equals results and that you can’t be healthy unless you are thin, and the problems that are perpetuating in our society, and they aren’t wrong.
Problems that are leading so many people into very dark places with regards to the relationship with the self. And that is simply not good enough.
But they also think that anyone who utters the words “calorie deficit” is a proponent of everything they stand against — and that the two cannot co-exist.
There are many people who think that if you are overweight, you are simply lazy and lack willpower, an opinion that should be abhorrent to anyone who hears it and comes from a place of complete ignorance for what “The Truth Of Energy Balance” really is, combined with a complete lack of empathy for peoples humanity.
Because: “Science innit.”
And here I am.
Someone who loves helping people; someone who is on the side of both people being positive about themselves, and allowing them to work on Goals that they want to achieve. Someone who believes in the Science and a Personal Trainer that feels he is being crushed from both sides. Someone who wants to very much empower people to take responsibility for their health, whilst disarming those who simply place blame on people having never walked a day in their shoes.
Some people think that my approach to educating people on a Calorie Deficit isn’t right or fair for people's mental health and physical wellbeing.
Science says that a Calorie Deficit is required for weight loss.
Science also says that looking at why people eat excess calories is equally important in being able to help people with their weight.
The fitness industry is divided between these two…and I believe in both.
There is a bridge to be built — and if you can understand this bridge when it comes to Energy Balance you too will begin to understand why you may have struggled in the past so much for your fitness success, or why others struggle with it too. I’m not saying that you don’t have to take responsibility for your health, of course, you do.
But when you start looking at the context of what goes into Calories In and Calories Out you can start to work with your environment to help create that change and achieve your goals.
Table of Contents for: Is A Calorie Deficit All That Matters To Lose Weight? The Truth of Energy Balance”
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Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
What Is The Truth Behind Energy Balance?
There is the science which I touched on above.
The simple fact that Calories are units of measure of energy in food.
In the same way, a Mile is a unit of measure for distance. A calorie is a unit of measure for energy, and if we consume more energy than our body needs it will be stored somewhere.
In the same way that if you travel four miles down the road, you are indeed four miles further on from your starting point.
To adjust this storage of energy your body can indeed work these calories away and if you do this often enough and in enough quantity, you will then reduce the mass of your body.
Hence the energy balance equation of:
Calories In vs Calories Out
Or
“Eat Less, Move More” a phrase that is dogged and plagued with ignorance.
For more information on why Eat Less, Move More is an unhelpful term head here: https://www.thegymstarter.com/blog/2020/7/28/why-eat-less-move-more-is-causing-the-problem-not-curing-it
The energy balance equation is very simple and straightforward, and like with all things simple and straightforward it is going to be fraught with problems.
And this is the truth behind Energy Balance.
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
Calories In is not simply “how much you eat”
To view it thus is to oversimplify your human condition.
And Science supports us here too.
The factors that lend themselves to Calories In are the following:
Personal Economic Factors, Social Factors, Community Factors, Genetic Factors, Medical Factors, and Emotional Factors.
Personal Economic Factors
When the UK Government launched its new “Tackling Obesity: empowering adults and children to live healthier lives” plan there were many people on the telly box stating that:
“It's not more expensive to eat healthily”
Which is a falsehood.
In 2014 the University of East Anglia and the University of Cambridge teamed up with The British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust and produced a paper which looked at the growing price gap between healthy and unhealthy foods in the UK.
They concluded:
“Since 2002, more healthy foods and beverages have been consistently more expensive than less healthy ones, with a growing gap between them. This trend is likely to make healthier diets less affordable over time, which may have implications for individual food security and population health, and it may exacerbate social inequalities in health.” [3]
and the results found:
“In 2012 the average price of more healthy foods was about three times higher — £7.49 for 1,000kcal compared to £2.50 for 1,000kcal of less healthy foods” [4]
There are limitations to this study, namely that foods were judged per 1000kcal, and healthier foods are generally less calorie-dense.
Aside from this, I am writing this article at the end of 2020, which has been a year of great economic unrest and at a time where the poverty gap in most western societies is widening also.
I’ve said this before and I will say it again;
“When someone doesn’t know where their next meal is coming from, they aren’t going to worry about the quality of that meal…they are just going to be thankful they got to eat today”
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
Social Factors
This works both ways.
Having a very active social life can lead to a lack of control over your diet. I think we all find it hard to understand our calorie intake when we are eating out more and enjoying ourselves socially.
But the solution to that is simple in that you can choose to not go out as a way of balancing your caloric intake and the effect it might be having on your physical health.
There is however a flip side.
What if you don’t have the choice, to begin with? What if you never have the option to meet friends and go for dinner? What if you can’t afford dinner out? What if you don’t drive and don’t like getting public transport places? What if you have to stay home to look after the children? What if you are in a controlling domestic relationship and it's just not an option to enjoy yourself in that way because the consequences are too great?
Boredom is a key indicator as a cause of Obesity.
California State University (Edward E. Abramson et al, 1977) conducted a study where they took a group of Obese Individuals and people who are rated as “Normal” on the BMI scale. They were fed until satiated, then asked to complete an interesting and boring task…whilst the food was readily available to them. The results were:
“That the obese consumed significantly more food than normals, and that boredom markedly increases food consumption for both obese and normals” [5]
And then in 2012 another study titled: “Eating when bored: revision of the emotional eating scale with a focus on boredom” concluded the following:
“These results suggest that boredom is an important construct and that it should be considered a separate dimension of emotional eating” [6]
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
Community Factors
In the UK 10.2million or about 1/6th of the population live in a Food Desert.
Defined as the following: “Areas which are poorly served by food stores”
A report by the Social Marker Foundation, funded by Kellogs (make of that what you will), looked at “What are the barriers to eating healthily in the UK?” [7] and it found the following:
For those living in poverty, 15% of all household expenditure is spent on food, compared to 10% of those not living in poverty.
Just under a fifth (17%) of households surveyed as part of this research said groceries put a strain on their finances. For individuals with a household income of £10,000 or less, about two fifths (39%) said groceries were a strain on finances, as did about a quarter (23%) of those with a household income of between £10,000 and £20,000.
Some survey respondents stated that high and unaffordable food prices have led to a range of behavioral responses. Across all households one in ten (10%) said that they had cut back on their own level of food consumption so that others in their family (such as children) can eat. This figure stands at 14% among households with an income of less than £10,000.
A quarter of individuals (25%) said that they felt that healthy and nutritious food was unaffordable in the UK.
Access to food may be a barrier for individuals living in “food deserts” — areas that are poorly served by food stores. In these areas, individuals without a car or with disabilities that hinder mobility may find it difficult to easily access a wide range of healthy, affordable food products
These are just a few of their findings.
The truth of the barriers to eating healthily in the UK is simply terrifying, and I would encourage you to read the rest of the study here.
But Community means a lot more than just your location and access to food.
What about your education? The availability of work? The availability of being able to attend a Gym?
A study in Seoul, South Korea found the following:
“Lower socioeconomic status increases obesity. This is due to the intake of high-calorie and low-nutrition foods or environments that limit time and access to regular physical activities”
and a 2008 study, Frank et al, which was looking at “Walkability in neighborhoods” found the following:
“Male residents of more walkable neighborhoods were less likely to be obese or overweight”
and
“walking was consistently higher for all groups in the more walkable neighborhoods” [8]
Now imagine that for a second; you are more likely to be Obese simply because you don’t feel safe walking in your neighborhood, or your neighborhood isn’t accessible for walking for whatever reason.
This is before we even begin to look at things like education availability, public transport options, healthcare options, and public funding for areas to help with many of these factors.
Quite simply, where you are born and raised, through no fault of your own, could have a huge impact on your susceptibility to Obesity.
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
Genetic Factors
As it stands, you cannot be genetically obese.
Your risk factors towards obesity increase as you age if you have a high-risk variant of a gene called FTO. [9]
This gene exists in everyone, and there are some people in the population who have a high-risk version of the gene and the gene controls your impulsivity, and if you are a carrier of the high-risk version of FTO you might find high-fat food more enjoyable [9].
However, studies have also found that those with this variant of the FTO respond just as well to weight loss treatment as anyone else.
BUT (and its a big but) — carriers of this gene are more likely to store body fat because
“people with two copies of the variant weigh on average 3kg more and are 1.7 times more likely to be obese” [10]
So what does all this mean? Well, firstly it means that for some people, it just is harder to lose weight because the clock keeps ticking, and they are starting from a different place genetically.
But it doesn’t mean that you can’t necessarily take charge of your health and fitness — but aligning your goals to what the scale says might be a foolish way to go about it.
Of the people my cited research included just 20% of them had two copies of the FTO Gene, and 48% carried one copy. Therefore the likelihood of your genetic makeup affecting your bodyweight is the last place to look if you aren’t getting the results you desire.
It does however show that some people need more nuance in their understanding of why controlling calories in is so hard.
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
Hormonal Issues
Then again, there are many other metabolic conditions that might affect your ability to sustain a calorie deficit and therefore lose weight.
Conditions such as PCOS, Thyroid Issues, Hashimoto’s Disease, and Diabetes to name a few.
Again, these conditions are not a life sentence to forever gaining weight, but they do blur the lines for you.
In all the research I have done on Hypothyroidism in relation to weight loss I have found this conclusion:
“In general, 5–10 pounds of body weight may be attributable to the thyroid, depending on the severity of the hypothyroidism. Finally, if weight gain is the only symptom of hypothyroidism that is present, it is less likely that the weight gain is solely due to the thyroid.” [11]
I have personally helped many people with PCOS lose and sustain weight loss, but it certainly requires a different skillset from the client. In relation to Hashimotos, I have never personally worked with someone who has this, however, I am aware of many success stories in this field, as well as those who have Diabetes.
Hormonal issues ontop of everything else might make your weight loss journey a little slower and it might make it a little harder. But it by no means that it is not possible for you.
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
Medical Factors and Weight Stigmatisation in Society at Large
The sheer amount of medical conditions that might affect someone’s ability to stay in a Calorie Deficit is almost never-ending.
This also feeds into the other aspect of the energy balance equation which is Calories Out.
For example, someone who has Arthritis is far less likely to be able to engage in physical activity.
But the bigger issue in the field of Medical Factors is the constant Weight Stigmatisation that those with larger body mass face whenever they are seeing their Doctors.
The first two minutes of this TedTalk demonstrates this very powerfully.
Added to that in a 2015 study looked directly at this and they have stated the following:
“There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behavior, and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors, and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care.” [12]
The title of the study is: “Impact of weight bias and stigma on quality of care and outcomes for patients with obesity” [12]
In my opinion, that shouldn’t even have to exist as a study, but alas it does — I suppose Doctors are just human too.
You see this has an impact on the “Calories In” side of the equation because we know that when people are subjected to Weight Stigmatisation it leads to an increase in caloric consumption.
As the following Obesity Research Journal study found in 2011:
Overweight women who watched the stigmatizing video ate more than three times as many kilocalories as overweight women who watched the neutral video (302.82 vs. 89.00 kcal), and significantly more calories than the normal-weight individuals who watched either the stigmatizing or the neutral video
and
These findings suggest that among overweight women, exposure to weight stigmatizing material may lead to increased caloric consumption [16]
Weight sitgmatization happens everywhere. This particular study showed participants a video — and that was a contorlled environment. But it’s a lot harder to control this in the big wide world when you have no say in what you see on Billboards, TV ads, the Media Headlines, Social Media, and the sheer ignorant opinion of others who haven’t read an article like this and really looked at the Science beyond “Calories In vs Calories Out”.
That is a lot of exposure.
In a 2018 opinion article published on the BioMed Editorial Website, they looked at “How and why weight stigma drives the obesity ‘epidemic’ and harms health”
Researchers concluded the following:
“Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.” [13]
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
Emotional Factors and Disordered Eating
The direct link between Emotional Eating and weight gain is incredibly clear to see. The constant feed in our society of the binge and restrict cycle makes up the majority of my work and the sheer majority of my colleagues work in the Fitness Industry.
This is due to a problem that the Fitness Industry created for itself, in helping the media prioritize the “thin ideal” as a marker of health and we are now walking headfirst into issues such as Obesity as well as many Eating Disorders like Bulimia, Anorexia, and Binge Eating Disorders.
Combined with all of the factors that surround emotional eating and disordered eating you must also look at the past trauma of people who are obese.
For instance, some people use weight gain as a way of making themselves invisible and undesirable to the opposite sex as Justin Faden et al (2012) found that:
73% of patients undergoing psychiatric hospitalization following gastric bypass have a history of sexual abuse. [14]
Then let's look at Mental well-being in relation to Obesity.
A meta-analysis published in 2008 in the Journal of Health Psychology found that:
“Combining data from 16 studies the results confirmed that, after controlling for potential confounding variables, depressed compared to nondepressed people were at significantly higher risk for developing obesity. The risk among depressed people for later obesity was particularly high for adolescent females.” [15]
Which will then lead us to Social Media usage and the effect that can have on Calories In.
The International Journal of Eating Disorders published a study in 2019 and found that:
“A clear pattern of association was found between Social Media usage and Disordered Eating cognitions and behaviors with this exploratory study confirming that these relationships occur at younger‐age than previously investigated.[16]”
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
The conclusion to “Calories In”
I think thus far this article has made it very, very clear that the depth to Calories In is so deep and so great that simply understanding the Energy Balance Equation as “In vs Out” just isn’t enough.
And the terrifying part? I have picked just a few examples. The world is littered with many other aspects of what makes Calories In so complex too. This isn’t the whole picture of the equation. It is merely a snapshot that I can comprehend.
Yes, Calories In will need to be reduced for a successful weight loss journey, but when you view the spider web of what really goes into Calories In you begin to see that there is a whole world of social science and physical science that needs to be understood as well.
This understanding leads to one thing: empathy.
Empathy for the person you are working with and therefore building a bridge to the Calories In, side of the energy balance equation.
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
Calories Out is not simply “how much you burn”
On the other side of the Energy Balance equation, you have Calories Out.
And this is just as complex as Calories In.
The Factors that lead to Calories Out are the following:
Weight Sitgmatisaiton, Fat Phobic Attitudes, A Lack of Self Confidence, Inaccessible Gyms and Arresting Environments, Repeated Failure.
The age-old proverb of “you can take a horse to water but you can’t make it drink” is the overriding theme here.
I have already explored the relationship between poverty and obesity in this article, so let us assume that said person has the finances to join a gym in the first place.
They have the “motivation” to be at the gym and they are there primarily to try and get their weight down and to help with their Obesity.
What kind of experience do you think this person will have? How many other people do you think they will see in the Gym that they can relate to?
Plus the mirrors. Wicklund and Duval in 1971, put together a study upon which they found:
Viewing oneself via mirrors has been shown to increase levels of objective SA (situational awarenss) via self-evaluation, leading to increased awareness of the discrepancy between an individual’s current self and his or her “ideal” self [17]
The mirrors literally stop people from being motivated to workout.
Then there are the machines. I personally find some of the seats uncomfortable on these machines, and I am 6ft 4in and weigh 80kgs.
Then the marketing of the Gym. Everywhere you look there is a poster of a very fit person telling you to simply “get in shape in 12 weeks”.
Like it is that easy.
Add to that the attitudes of people within the Gym. The personal trainer someone might talk to about their goals, and then the very basic nutrition plan you receive that has no preference for food you actually like. Combined with the fact that if you want some more education and someone to show you the ropes, well, that's going to cost you extra on top of your membership.
In researching this article I came across the following study: “Obese persons’ physical activity experiences and motivations across weight changes: a qualitative exploratory study” [18]
This study has stories from people who are obese and have tried to exercise to help with their weight loss.
“I’d been on [another trip] maybe 15 years ago where the hiking club actually left me on a mountain because I couldn’t keep up, and [they] said you can sit here and wait for us to come down and get you, or you can go down by yourself. But you’re not coming with us; we’re not waiting for you anymore.” [18]
This is an actual person who was left on the side of a mountain by a Hiking Group.
Just let that sink in a little bit.
If that was you…how would you feel?
I’m not sure if you have ever seen me lift weights and the faces I pull…but it's not exactly attractive. This is the closest GIF I could find:
Now imagine you are someone who is already extremely self-conscious.
“… It’s kind of intimidating … you’re doing something that’s making your body move in all sorts of ways that is not attractive, and you feel like everyone’s going to see this.” [18]
This is a barrier to “Calories Out” that is very real and very true.
In this study they concluded the following:
“Finding an environment in which participants felt safe and encouraged to be active was extremely important, and instances of such inclusion had major ramifications on social wellbeing” [18]
But I personally think this sums it up the most:
“While participants had pleasure-related reasons for engaging in physical activity, this enjoyment could be overshadowed by the grip of caloric fear or dread of a demobilized future; a need for performative achievement or a thinner body; or the need to be a conspicuous exception to potentially stigmatizing anti-obesity messaging. Focusing on their health and fitness achievements and behaviors may have helped participants cope with their sizes in a stigmatizing climate. However, participants could still be overwhelmed by pressures to always be healthier or more active, and many participants had histories of disordered eating and activity practices.” [18]
Is A Calorie Deficit All That Matters For Weight Loss?
The Truth of Energy Balance
The Conclusion to “Calories Out”
Simply saying “exercise more” is base and unfair to say to humans who have panic attacks when they walk into a gym because of how arresting that environment is.
Telling them to just go for a run, when they already feel very self-aware isn’t helpful either — aside from the fact that running is an extremely hard form of exercise on your joints.
And added to that…listen to this story from Latoya Shauntay Snell who was heckled at mile 22 of a marathon by a man on the sidelines who shouted:
“It's going to take your fat ass forever”
Even people who aren’t struggling with their weight find it incredibly hard to find the motivation to workout and exercise. To simply reduce someone who is struggling as someone who is “just too lazy” is being a complete hypocrite towards your own struggles with being able to maintain a level of physical activity.
Just Do It; Just Don’t Cut It
In Conclusion
Quite simply…you can lose weight without exercise, and if you find exercise extremely triggering there are things you can do to still achieve weight loss goals without exercise.
That being said…I advise against losing weight without exercise.
I also advise against making weight loss the sole reason you want to exercise.
Caloric Control is required when it comes to your Diet in order to control your weight, but giving yourself more understanding and empathy for the context of what that truly means can actually give you a release from the constant wheel house of failure you seem to find yourself on.
What is most interesting in the study “Obese persons’ physical activity experiences and motivations across weight changes: a qualitative exploratory study” is that they identify two other reasons these people want to exercise:
Maintenance of functioning and mobility;
Pleasure derived from activity.
A Calorie Deficit clearly isn’t all that matters when it comes to exercise. The preservation of the self and finding movement as a means of enjoyment can mean so much to a person, far above and beyond what a weight loss success will give them.
The more I look, the more data I find that suggests that learning to fall in love with the movement of your body will make you so much happier than just worrying about losing weight.
“Stop foccusing on Re-duction of the body and start focussing on Pro-duction”
And finally;
These findings imply that to encourage physical activity among individuals with diverse weight histories and attitudes, physical activity messaging and programming may benefit from moving beyond a weight loss focus. Many participants in the present study found physical activity rewarding in itself. Disappointment in weight loss aims could be a disincentive to physical activity. Furthermore, physical activity messaging should feature a variety of bodies and abilities, as should activity venues and classes…An inclusive model of physical activity for people of all sizes would focus on enjoyment, pleasurable accomplishment, and social belonging emergent during physical activity, rather than focusing on possibly unachievable or ultimately exclusionary endpoints.
Personally I quite like that.
An inclusive model of physical activity.
If you put that at the heart of what you do clearly a calorie deficit is unequivocally not “all that matters”.
What’s Next?
I have plenty more articles about weight loss for females throughout this website.
Here is a selection I think would make great further reading for you:
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References:
Hall, K. D., Heymsfield, S. B., Kemnitz, J. W., Klein, S., Schoeller, D. A., & Speakman, J. R. (2012). Energy balance and its components: implications for body weight regulation. The American journal of clinical nutrition, 95(4), 989–994. https://doi.org/10.3945/ajcn.112.036350
Fleming, J.A., Kris-Etherton, P.M. Macronutrient Content of the Diet: What Do We Know About Energy Balance and Weight Maintenance?. Curr Obes Rep 5, 208–213 (2016). https://doi.org/10.1007/s13679-016-0209-8
Jones NRV, Conklin AI, Suhrcke M, Monsivais P (2014) The Growing Price Gap between More and Less Healthy Foods: Analysis of a Novel Longitudinal UK Dataset. PLoS ONE 9(10): e109343. https://doi.org/10.1371/journal.pone.0109343
nhs.uk. 2020. ‘Healthy Foods Expensive’ Claim Is Unrealistic. [online] Available at: <https://www.nhs.uk/news/food-and-diet/healthy-foods-expensive-claim-is-unrealistic/> [Accessed 22 November 2020].
Abramson, Edwaed E., Stinson Shawn G., (1977).
Boredom and eating in obese and non-obese individuals,
Addictive Behaviors, Volume 2, Issue 4, 1977, Pages 181–185 https://doi.org/10.1016/0306-4603(77)90015-6.Moynihan AB, van Tilburg WA, Igou ER, Wisman A, Donnelly AE, Mulcaire JB. Eaten up by boredom: consuming food to escape awareness of the bored self. Front Psychol. 2015;6:369. Published 2015 Apr 1. doi:10.3389/fpsyg.2015.00369
Social Market Foundation. 2020. What Are The Barriers To Eating Healthily In The UK? — Social Market Foundation. [online] Available at: <https://www.smf.co.uk/publications/barriers-eating-healthily-uk/> [Accessed 23 November 2020].
Frank LD, Kerr J, Sallis JF, Miles R, Chapman J. A hierarchy of sociodemographic and environmental correlates of walking and obesity. Prev Med. 2008 Aug;47(2):172–8. doi: 10.1016/j.ypmed.2008.04.004. Epub 2008 Apr 22. PMID: 18565576.
nhs.uk. 2020. FTO ‘Fat Gene’ May Make People More Impulsive. [online] Available at: <https://www.nhs.uk/news/genetics-and-stem-cells/fto-fat-gene-may-make-people-more-impulsive/> [Accessed 23 November 2020].
nhs.uk. 2020. People With ‘Obesity Gene’ Can Still Lose Weight. [online] Available at: <https://www.nhs.uk/news/obesity/people-with-obesity-gene-can-still-lose-weight/> [Accessed 23 November 2020].
British Thyroid Foundation. 2020. Thyroid And Weight — The Science. [online] Available at: <https://www.btf-thyroid.org/thyroid-and-weight-the-science> [Accessed 25 June 2020].
Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–326. doi:10.1111/obr.12266
Tomiyama, A., Carr, D., Granberg, E. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 16, 123 (2018). https://doi.org/10.1186/s12916-018-1116-5
Faden, J., Leonard, D., O’Reardon, J., & Hanson, R. (2013). Obesity as a defense mechanism. International journal of surgery case reports, 4(1), 127–129. https://doi.org/10.1016/j.ijscr.2012.10.011
Blaine B. Does depression cause obesity?: A meta-analysis of longitudinal studies of depression and weight control. J Health Psychol. 2008 Nov;13(8):1190–7. doi: 10.1177/1359105308095977. PMID: 18987092.
Schvey NA, Puhl RM, Brownell KD. The impact of weight stigma on caloric consumption. Obesity (Silver Spring). 2011 Oct;19(10):1957–62. doi: 10.1038/oby.2011.204. Epub 2011 Jul 14. PMID: 21760636.
Wicklund, RA, Duval, S (1971) Opinion change and performance facilitation as a result of objective self-awareness. Journal of Experimental Social Psychology 7: 319–342. https://journals.sagepub.com/doi/full/10.1177/2055102915598088#bibr54-2055102915598088
Bombak AE. Obese persons’ physical activity experiences and motivations across weight changes: a qualitative exploratory study. BMC Public Health. 2015;15:1129. Published 2015 Nov 14. doi:10.1186/s12889–015–2456–0