Tackling a weight problem is often viewed as a personal responsibility that requires making healthier choices. The latest research, however, shows that external factors—from family and friendships to advertising and the workplace environment—make an equal, if not greater, contribution. Just look at the stats: A person's chance of becoming obese increases by 57 percent if a close friend is obese, 40 percent if a sibling is obese, and 37 percent if a spouse is obese.
That's where Thinfluence comes in. Through a research-based examination of various social, environmental, and policy-based issues, renowned Harvard researchers Dr. Walter Willett and Dr. Malissa Wood examine how relationships, workplace, media, and other factors are affecting readers' weights. Thinfluence doesn't tell readers to ditch their friends and family, change jobs, or move to another state. It offers a clear three-step action plan—analyze, act, influence—for readers to identify hidden factors affecting weight, develop a personal toolbox to combat external effects, and become positive influences on others around them.
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About the Author
WALTER WILLETT, MD, DrPH, is a professor of epidemiology and nutrition and chairman of the department of nutrition at Harvard School of Public Health and a professor of medicine at Harvard Medical School. His bestselling book Eat, Drink, and Be Healthy helped change the USDA Food Pyramid. He lives in Cambridge, MA.
MALISSA WOOD, MD, is a clinical cardiologist and staff physician at Massachusetts General Hospital in Boston, codirector of the Corrigan Women's Health Program, assistant professor of clinical medicine at Harvard Medical School, and the lead investigator of the HAPPY Heart trial. She lives in Concord, MA.
DAN CHILDS is the managing editor of medical coverage for ABC News. He lives in New York City.
Read an Excerpt
What Is Thinfluence?
Young, thin, and healthy. Gabriela remembers this version of herself well from when she grew up in sunny Colombia, where she lived until she was thirty-three. Back then, she weighed 137 pounds. It may have been one of the last times she could remember being at a healthy weight for her five-foot, five-inch frame.
Indeed, many things were different when Gabriela lived in Colombia. When she recalls the tropical weather there, the balmy temperatures and the friendly layout of her community come to mindthe things that made her own two feet the ideal vehicle for getting from place to place. "I walked everywhere," she says, adding that she also owed some of her previous health to a good diet. "A lot of fruits, like pineapples, papaya, and vegetables. Everything was available at the market or from a cart."
Ultimately a job opportunity caused her to leave her home. And while the move would fulfill her dream of living in another country, she knew she'd have to make some adjustments. The climate was different, and so was the language. Feeling homesick, trying to make new friendsthese changes were easy to anticipate. But alongside these expected challenges came alterations in her routine.
In Boston there were fewer opportunities for outdoor activities and exercise, particularly in winter. The fruits and vegetables with which she had been so familiar in Colombia and that had been a staple of her former diet were not as plentiful in Boston, and those that were available were more expensive. So, like the nearly imperceptible shifts in the New England seasons she now experienced, she gradually adopted a lifestyle that involved commuting instead of walking and pizza and fast food instead of fresh produce.
Not all of the adjustments were so difficult, and perhaps the most pleasant surprise Gabriela encountered was Rod. Unlike Gabriela, Rod had lived in the United States his entire life. He started smoking at an early age, but one day in 1997 he took his last drag on a cigarette and quit cold turkey. It was an important step for his health, and to this day Rod acknowledges kicking the smoking habit as a no-brainer. But for him, it was also the point at which his weight gain began.
"My average weight had been 152 pounds," he noted of his earlier years. "After I stopped smoking, I put on the weight and just kept eating."
It wouldn't seem like Rod and Gabriela would have much in common. But when she started working as a temp for his company in December 1999, they quickly grew close.
"It may have been love at first sight," he said with a laugh. "I can't remember. I just knew that I loved being around her."
Before long, their lives and their lifestyles had intertwined. For ten years they did everything togethershared meals, watched movies, spent time doing what they loved. And they also gradually gained weight together. By 2009, Rod tipped the scales at 242 poundsofficially obese. Gabriela weighed 158, which made her overweight for her height. Both were taking prescription medicines for high blood pressure and cholesterol by this time. Rod admitted that he showed up at the doctor's office "quite a bit" for chest pains, a very concerning sign.
"I did nothing," Rod recalls. "I just ate, lay on my bed looking at computers, and I stuffed my face with potato chips all day."
Like many couples in America today, both Rod and Gabriela needed a change. Indeed, their lives may have depended on it.
This change came first for Gabriela, after a particularly sobering checkup with her primary care physician. He referred her to the well-known HAPPY Heart program at Massachusetts General Hospital, which was designed to help women make healthy lifestyle changes. This is when she met Malissa, who headed the program. Looking back, Gabriela says the counseling and support she received through HAPPY Heart was the wakeup call that roused her from a routine that was slowly killing her.
It was not just a diet, nor was it simply an exercise program. It was a completely new kind of lifestyle. Gabriela began to eat more healthily. She started engaging in more physical activity. And after three years in the program, she was four pounds lightera modest amount of weight, but a difference nonetheless. And many of the positive effects were not ones that showed up on the scale. She lost fat and gained lean muscle mass, evidenced by the fact that her waist size dropped by more than four inches. Other measures of health, including her blood pressure and cholesterol, also improved. She found that she was able to cut back on some of her medications. Ask her today and she will tell youemphaticallythat she simply feels healthier.
But what about Rod? He joined no such program, and he didn't receive any special counseling or group support. And yet, for some reason, he, too, got bettermuch better.
In the same three years that Gabriela got lighter and healthier, Rod dropped a whopping seventy pounds. And in February 2012, he did something that just a few years might have seemed impossible to him and those who knew him well: He completed his first-ever 10-K race.
While all this was happening, another interesting transformation was occurring that, at first glance, would seem tangential at best to Rod's story. This transformation involved Rod's colleague, Larry, who happened to be in worse shape than Rod had been during his computer-and-potato-chip days. At his heaviest, Larry weighed almost four hundred pounds. These days, however, he is considerably lighter and can do something he has never been able to do before: He can join Rod on his regular jogs.
"Now that he's running with me," Rod says with a grin, "he looks like a different person."
These stories are separate and independent instances of three people's lives and lifestyles changing over the course of three yearsor at least that is what our conventional views about weight loss would tell us. For years, the mantra of weight management has been one of self-discipline, of overcoming individual challenges. Sure, it is possible for us to view these changes in isolation. What would be the first thing you would say if these people were your friends or colleagues? It would likely be, "Wow, Larry looks so much better since he decided to make a change" or "Rod sure has taken it upon himself to improve his health."
Yet of these three people, Gabriela was the one whose healthy actions preceded those of the people connected to her in some way. So given that everyone lost weight in this story, we have two choices as to how to interpret exactly what happened. On the one hand, we could chalk it all up to happy coincidence. But while this is possible, it does not seem terribly likely. So on the other hand, we could venture that something else is going on herethat the actions of one person somehow influenced the actions of those she knew, and even those she did not know, for the better.
This "domino effect" of healthy behaviors has made headlines in recent years, almost always with a negative connotation. You might even remember some of them: "Your Friends Are Making You Fat," "Obesity Is Contagious, Study Finds," and "Can You Fight the Fat Flu?" among others. Many of these were spurred by the research of Nicholas Christakis, MD, PhD, of Harvard University and James Fowler, PhD, of the University of California, San Diego,1 which found that if your sibling, spouse, or best friend is overweight, you are more likely to be overweight yourself. Specifically, the research showed that a person's chance of becoming obese increases by 57 percent if a close friend is obese, by 40 percent if a sibling is, and by 37 percent if their spouse is obese. This idea is broadly known as social contagion, and it goes a long way in explaining how habits, beliefs, and behaviors can spread throughout a group of connected individuals.
Perhaps the "contagion" part of this term makes us want to run away and wash our hands. It's not a word that we normally associate with good things. Yet follow-up research has shown us that it's not just negative health aspects that can be spread in this way. Take one 2011 study,2 for instance, which found that individuals had greater intention to lose weight when one of their social contacts was trying to lose weight. Social contagion, it turns out, can be a vehicle for positive behaviors as well.
So for better or for worse, when scientists have examined how social connections relate to real-world outcomes like weight and obesity, they have found that the decisions we appear to make just for ourselves can ripple through the web of our social connections. They can influence those we know, and they can spread beyond our social circles, perhaps even beyond our communities, potentially influencing people to whom we may never be introduced.
Weight Loss: It's No Longer Just Personal
This clashes, of course, with much of what we've been conditioned to believe about our weight. It is no great leap to say that personal responsibility is perhaps the overriding theme in the arena of weight. On a daily basis, we hear an awful lot about our choices, our self-discipline, our need to slim down and get healthy. Even the most common phrases used to describe weight and weight loss usually lead us to believe that weight is an isolated, individual issue. Consider the following oft-heard statements:
"I'm never going to lose these extra pounds."
"She has put on so much weight."
"Wow, did I ever let myself go!"
The truth is, however, that the notion that we are somehow islands when it comes to our weight simply isn't true. We have even begun to shift intuitively to understand this. Why else, for instance, would we be calling it an obesity "epidemic"? Think about it enough, and it soon becomes ironic that the issue of weight is so often framed as one in which we are "going it alone."
Not that anything is necessarily wrong with taking personal responsibility for adopting a healthier, more weight-friendly lifestyle. Few would argue that individual motivation and self-encouragement is a bad thing. Yet the language of personal responsibility when it comes to weight, all too often, is not at all encouraging. It is usually a language of blame. Being overweight has come to be viewed as a personal failure, a sign of weakness and vice. It is hardly the right foot to start from when devising broad strategies to solve the country's weight problem, and is far from constructive on the individual level, too.
Clearly it's time for a fresh start.
This fresh start is the principle behind Thinfluence, and the first step is realizing that the personal choices you make are enmeshed within a web of interconnected factors that reach far beyond simply what is on your plate or how long you spend on the treadmill. Once you recognize these various factors as what they are, you will be able to turn them in your favor. This is what sets Thinfluence apart from everything you think you know about the reasons you have put on weight, why your past efforts to lose weight have failed, and how you can move forward with real, sustainable strategies to improve.
Your Weight Is Not Your Fault
You have probably heard the following mathematical equation many times in the past: Calories consumed minus calories expended equals the deficit that you need to achieve your weight goals. Technically speaking, this is absolutely trueif you burn more than you take in, you will lose weight, and if you burn less than you take in, you will gain it. It's simple math.
The problem is this: Few, if any, of us live our lives like a mathematical equation. While certain situations may make it easy for us to count calories in and calories out, this strategy becomes much harder to follow during holiday visits to the in-laws, where second helpings at the Thanksgiving table are de rigueur, or when a late evening at the office means skipping the gym and going in with your colleagues on delivery pizza.
Other factors beyond diet and exercise make it more difficult for us to exert control over our weight. Start by taking a look at the elements of your environment. Consider your kitchen pantry or fridge. When you open either of them, are you presented with healthy yet satisfying options for meals and snacks? Or are you more likely to find bottles of sugary soda staring back at you? Notice how close your television is to the area where you eat your meals. Is it positioned in a way that fosters TV watching while you eat, a distraction that can lead you to eat more than you intended? Look out your living room window. Do you see a sidewalk? A busy thoroughfare? How far is it to the nearest grocery store? The answers to these questions may be more impactful to your weight and health than you realize.
Many other things that hold sway over your weight may be even more surprising. These could include your paycheck, the politics of your local and national government, and other seemingly external factors. And there is science to prove it. For example, in a landmark study published in the New England Journal of Medicine,3 researchers demonstrated for the first time that simply moving out of a neighborhood with a high level of poverty into one with a lower level of poverty was linked to a 13 percent reduction in the risk of moderate-risk obesityin other words, having a body mass index greater than 35.
We encounter influences like these and more every day. They are often so commonplace and subtle, they have become invisibleuntil they hit our waistlines, that is. These "blind spots" affect our efforts to lose or maintain our weight. And their impact is considerable.
The good news is this: By realizing that these spots exist, you are halfway toward bending them in your favor. Think about itwhat would you be able to achieve in terms of your weight, your appearance, and your health if your family and close friends reinforced what you were doing? Or if your workplace became conducive to exercise? Or if you were routinely able to cut calories from your diet before entering the grocery store checkout line?
These approaches may not come to your mind first in terms of improving your weight. But they are vital to consider, and they're exactly the types of things we will be discussing in the chapters to come.
Can You Be an Influence for Weight Change?
As we discuss these oft-overlooked factors that impact weight, it may have already occurred to you that many of them are the very things that link us to the people we work with, know, and love. What this tells us is clear: Not only are we on the receiving end of the influence, but we, too, can have a positive effect on those around us.
Table of Contents
Chapter 1 What Is Thinfluence? 1
Chapter 2 Know Thyself: Internal Factors That Affect Your Weight… and How External Factors Influence Them 21
Chapter 3 Family Matters: How Your Closest Relationships Affect Your Weight 43
Chapter 4 How Your Friends Can Make-or Break-Your Weight Success 67
Chapter 5 Your Workplace and Your Waistline 93
Chapter 6 Your Food Environment and How It Influences Your Weight 116
Chapter 7 How Your Physical Environment and Surroundings Affect Your Weight 135
Chapter 8 Your Media "Diet": The Impact of Information and Advertising 159
Chapter 9 Policy: What Is It? And How Does It Affect Your Weight? 183
Chapter 10 Thinfluence: Putting It All Together 209