What Mike Tyson Is Forgetting About Obesity

The ad featuring Mike Tyson that addressed obesity during last week’s Super Bowl was a tough watch. The spot may have been filmed in monochrome, but medically, obesity is anything but black and white. Both the messaging and messenger gave me pause — and I hope people watching it felt similarly.

“My sister’s name was Denise,” Tyson says.

I didn’t immediately know what the ad was for.

“She died of obesity at age 25. She had a heart attack.”

The commercial officially had this bariatric surgeon’s attention.

“I was so fat and nasty. I would eat anything,” Tyson continues. After citing his weight and describing his ice cream intake, he adds, “I had so much self-hate when I was like that. I just wanted to kill myself. We’re the most powerful country in the world and we have the most obese, fudgy people.”

What followed was a laugh that sounded more mocking than lighthearted, the dramatic crunch of an apple, and an all-caps banner across the screen: “Processed food kills.”

What I overwhelmingly heard in the first part of the commercial was simple, human grief. It’s terrifying when the people we love are in poor health. It’s tragic and traumatic to lose such a young person. I heard despair in Tyson’s admission that he wanted to take his own life when he got to a weight he didn’t want to be. It made the second part of the ad even more jarring.

“Fat.”

“Nasty.”

“Fudgy.”

These words are filled with shame — not just the shame Tyson felt about himself when he was obese, but the shame he seems to feel for those who are obese. It suggests that people struggling with their weight should feel ashamed.

I use none of these words when I’m trying to help patients understand the full extent of their health and supporting their weight and nutrition management. I’ve never read a study indicating that shame — or oversimplified explanations of the causes of obesity — improves patient outcomes.

If obesity were that easy, or a “calories in, calories out” problem solved by apples, my work would be very different. Like many medical conditions, obesity is multi-factorial, not simply a behavioral choice. While physicians and public health experts may be familiar with this concept, many members of the general public — the majority of those watching the ad — are not.

Sometimes my patients have illnesses or take medications that cause them to gain weight. Sometimes they have disabilities or conditions that make them unable to exercise, or they don’t live in safe, walkable neighborhoods that make it easy to move enough. Some live in food deserts where they don’t have access to nutritious food, and others can’t afford it. Those who work multiple jobs with difficult hours often don’t have time to prepare nutritious meals.

The picture is often different for professional athletes, like Tyson. Their job is to be strong, fast, and fit enough to compete successfully in sports. Presumably, they make enough money from competitions and endorsements to hire teams of professionals who decide their caloric and nutrient intake. And shop for their food. And prepare their meals.

The ad also points to the “processed” foods allegedly killing Americans. Some of those foods — for example, certain boxed breakfast cereals and yogurts — also may be keeping people alive. Many cereals contain added vitamins and minerals that are the best way for some children to meet their nutritional needs most days. And yogurt, even the sweetened kind that is considered “ultra-processed,” can be part of a balanced diet and offer greater health benefits than some alternatives. Moreover, not everyone has access to fresh foods. For some, their options are to eat processed foods or not eat at all.

If the ad was intended to be humorous, it missed the mark. If it was intended to provoke, it did so cruelly. If it was intended to inspire people to take charge of their own health, it’s unlikely to have achieved it, especially on the biggest game — and snack — day of the year.

The ad creators didn’t tell the stories I know.

They missed the sadness and frustration I hear as my patients step on a scale and don’t feel like themselves, or look in the mirror and don’t see the person they want to be. They missed how hard it can be to manage one’s own health and well-being while struggling to afford and prepare nutritious meals for their families. They missed the individual complexities of obesity and nutrition for each patient. And they overlooked the role that medical weight management experts play in helping patients get the best outcomes possible with evidence-based options — none of which include harsh language or shame.

What I saw in that ad was a choice to offer grief, sadness, shame, and fear to articulate a public health message about obesity. If the U.S. is the most powerful country in the world, we can afford to fix the message.

Andrea Bedrosian, MD, is a bariatric surgeon at Northwell Health.