The mysterious case of the public health guideline that is (almost) entirely ignored: call for a research agenda on the causes of the extreme avoidance of physical activity in obesity

P Ekkekakis, S Vazou, W R Bixby, E Georgiadis

Physical activity and exercise guidelines for weight management call for at least 60 min of daily activity. However, these documents fail to acknowledge that almost no obese adults meet this target and that non-adherence and dropout are even higher among obese individuals than the general population. The reasons for this level of activity avoidance among obese individuals remain poorly understood, and there are no evidence-based methods for addressing the problem. Opinions among exercise scientists are polarized. Some advocate moderate intensity and long duration, whereas others call for high intensity and shorter duration. The latter approach attributes the inactivity and high dropout to limited discretionary time and the slow accrual of visible benefits. However, higher intensity has been associated with non-adherence and dropout, whereas longer duration has not. A conceptual model is then proposed, according to which obesity interacts with intensity, causing physical activity and exercise to be associated with reduced pleasure among obese individuals. We theorize that, in turn, repeated experiences of reduced pleasure lead to avoidance. On this basis, we call for a research agenda aimed at identifying the causes of activity-associated and exercise-associated displeasure in obesity and, by extension, the causes of the extreme physical inactivity among obese individuals.