Author Archives: drdeaun
Maybe it is the new year, but I have been reading article after article, even a video, about how someone did X healthy thing for themselves, lost weight, and is now healthier and happier! Whee!
While I am very glad that these people have found things that make them feel good physically, even mentally and emotionally, I have an issue with the fact that they 1) lay most or all of their improvement on weight loss and 2) that their individual solution is THE solution. This assumes that weight loss is the only solution to a myriad of issues. It assumes that there is only one solution for health and that that solution will also lead to weight loss. It assumes that weight loss and good health are equated.
These assumptions are just that, assumptions. Health and weight are not the same thing. There is not only one solution to health issues and weight loss certainly is not it either.
I understand the desire to have a simple, single solution. “If I eat this way (with specific rules), exercise this way, take this vitamin, and spin around 3 times every morning, I will live to an old age without any infirmity or illness!” Whew! That does sound nice doesn’t it? To not have to think too much as you follow the rules. To know that there is a guarantee.
Well, I have some bad news, there is no one solution. Health is individualized and it usually requires listening to your own body, mind, and heart. There certainly are general things that help the majority of people, sleep, decreased stress, nutritionally dense food, body movement, laughter, strong social bonds, clean water, etc, but even these things must be adjusted for the individual. For example, some people must be very careful with their water intake, which is generally the first “healthy” tip that is thrown out there, even among health care providers.
On the other hand, a lack of a simple, generalized health guarantee may be good news actually. It means that each person can create a life of good health for themselves that is tailor made for their preferences, schedules, and abilities. It allows for a freedom self knowledge that one cannot get from someone else, though having a guide and a support person is often very helpful.
One of the articles I read was distressing because the author, someone I know personally, talked about the path that lead to that person’s health and weight loss. We have a mutual friend who also followed that path and, while it improved the second person’s health for a long while, that person’s health deteriorated for reasons beyond reasonable control. Did the second person do something “wrong” because that person’s health results were not the same, long term, as the first? Or, did the first person do something “right” that the second person missed? I would say no. Will the first person, who currently has a high state of health, stay that way forever and live a really long, active life? I certainly hope so! However, no one knows for sure, and if I did, I would be likely be a very wealthy woman.
Weight stigma certainly makes many of us want to be thin, even the thin folks, regardless of how it affects our health. I’d love to believe that most of us, in our heart of hearts, would prefer to be healthy and as able as our bodies allow. To enjoy the time we have on the Earth. To be able to appreciate the people and experiences around us. To be allowed to live the lives we choose to live and not be ashamed to be the people that we are. However, we often seem preoccupied with being thin at almost any cost.
Maybe we can focus our efforts on supporting one another rather than assuming anything about the people around us.
Personally, my focus is to love and appreciate the body I have right at this moment for what it is. Every moment it does amazing things to keep me alive. My body may change over time. It may get closer to the health it seeks or further away. It may change sizes. It may stick with me and allow me to be active until old age. It may experience some issues that significantly change how I interact with the world. All I can do is to be the best steward of this amazing body as possible. I can also spread that love and appreciation to others, to help them see their bodies as the amazing bodies that they are!
This is a rather long video, but to understand some of what I am talking about, I recommend watching the whole thing. I will, of course, explain certain things I got from the video.
Up front, this video is specifically about race and my intention is not to diminish the importance of racial inequities. The reason I am using this lecture to bring up the idea of fat peoples’ experience is that, as I watched it, it seemed very applicable. I have no desire to jump into the Oppression Olympics.
During the video, the teacher is conducting an exercise to demonstrate the issues that people of color face every day merely because of the color of their skin. A white student has issues with the lesson, she seems to feel as though she is not being properly heard, and ultimately leaves the room. The teacher points out that she has the ability to leave the discussion, an action that is not afforded to people of color, the discussion never truly ends for them.
It occurred to me that fat people also do not have the opportunity to leave the discussion about our bodies in public discourse. We cannot prevent the assumptions that are made of us because of how we look. At this point, some will counter that fat people can just lose weight and, tada, they can walk out of the discussion (at least, ostensibly, the fat discussion…if they are a person of color, they still have a whole other discussion going on). The problem with that is that 95% of the fat population cannot effectively become thin enough or stay thin enough to leave the conversation for good and even those who leave the conversation temporarily are significantly affected by it.
The thing that I appreciated most about this woman and her lesson, was her acknowledgement that we are all different and we all have different experiences. These experiences make us who we are and create the vibrant tapestry that is humanity.
A quote from the video:
“We live in different realities and when you deny what this person is going through, and what this person is going through, you deny their reality. We are as different on the inside as we are on the outside and we have the right to be so. People, don’t deny differences. Accept them, appreciate them, recognize them and cherish them, they are extremely important.”
To deny the reality of entire groups of people is akin to taking a colorful, textured piece of art and making it monochrome and flat. The art ceases to be. Maybe another example is going to an art gallery with a blindfold on. What is the point?
In acknowledging the differences in people, we create space for them to exist. In really seeing a person of color, a white person can hear what they may have to say about their experience, rather than dismissing that experience because they want to be “color blind”. In seeing the roundness of a fat person, a thin person can recognize the space that might be needed to help that person move through the world more comfortably. This can help to create compassion toward others by truly seeing them and actually listening to their experience, instead of being so frightened to acknowledge any difference that one ends up forcing others into boxes where they do not fit.
So, next time you see a fat person, a person of color, a female, someone who has a different level of physical ability than you do, or anyone else who is different than you are, be willing to ask them about their reality and then listen to what they have to tell you. Don’t make assumptions about an individual based on experiences you have had with someone who might share a similar trait. Also don’t assume that that person is speaking for everyone else in the world that has that trait. They are not because they are not all of those people, they are just themselves.
Many of us have privileges as well as oppressions. Recognizing our privilege allows us to move through the world with contentiousness. Ways we are in the minority of society allow us to understand how it feels to be unwittingly or purposefully oppressed by others.
Active listening and not being “blind” to differences allows each of us to see the incredibly beautiful interweaving of the strands of humanity into an incredible, unique work of constantly shifting art. Why would we want to miss out on that?
For my first post on Prism Natural Health Center’s blog, I have decided to discuss blood pressure and I cross-posted it here.
First, a little definition of what blood pressure is measuring and what that can mean. Blood pressure is a measurement of the pressure of the blood against the walls of the blood vessels as it is pumped through the body by the heart. When this pressure is too high, it can contribute to significant health issues including strokes, cardiovascular disease, chronic kidney disease, and, if it gets very bad, it can be life threatening. These health issues are why your doctor wants to be very proactive when it comes to reducing blood pressure.
When blood pressure is too low, it can lead to dizziness, which can lead to fainting and falling. In emergency situations, bleeding leads to low blood pressure which can lead to shock or even death, though generally your doctor is not worried about that extreme during an office visit!
Now that we know what blood pressure is, I want to talk about how it should be taken to be as accurate as possible.
For people who fit into the standard sizes of blood pressure cuffs designed for the upper arm, this is the most accurate way to take blood pressure. According to Uptodate, the proper cuff sizes are as follows:
- Arm circumference 22 to 26 cm (8.5 to 10 inches), “small adult” cuff, 12 x 22 cm (4.7 x 8.5 inches)
- Arm circumference 27 to 34 cm (10.5 to 13 inches), “adult” cuff, 16 x 30 cm (6 x 12 inches)
- Arm circumference 35 to 44 cm (13.5 to 17 inches), “large adult” cuff, 16 x 36 cm (6 x 14 inches)
- Arm circumference 45 to 52 cm (17.5 to 20 inches), “adult thigh” cuff, 16 x 42 cm (6 x 16.5 inches)
Regardless of arm size, it is important to use a cuff that is closes to the size of one’s arm. A cuff that is too big could show falsely low blood pressure and a cuff that is too tight could show falsely elevated blood pressure. It is important for people who have arms that are smaller or larger than normal to request an accurately sized cuff!
Sometimes arm cuffs are not safe or practical, such as after the removal of lymph nodes under the arms, the inflating of the cuff is too painful, or if one’s arm is larger than the available cuff sizes. In these case, it is possible to use a wrist cuff, you may have seen these at the dentist office, or take blood pressure with a smaller cuff on the forearm. The drawback of these two methods of taking blood pressure is that they tend to be inaccurate, usually reading higher.
Whatever method used to take blood pressure, it is important to follow some basic guidelines to get the most accurate reading:
- Be sure that you haven’t just run into the doctor’s office. If you are out of breath and anxious, request that they take your blood pressure at the end of the visit instead of the beginning. The beginning of the visit is often the preferred time to take blood pressure, but it can seem falsely elevated if you are anxious and hurried.
- Try not to eat or have caffeine within 30 minutes to an hour before having your blood pressure taken. Also, if you are a heavy smoker, you should mention that to your provider and tell him/her when you last had a cigarette, as that can affect your reading.
- Make sure you are sitting upright with your feet comfortably on the floor (or a step) with something to lean your back against. Do not cross your legs or arms and do your best to relax.
- Your health care professional should hold your arm at heart level (or rest it on a table that is at heart level). Allowing your arm to fall onto your practitioner’s arm or the table will create the relaxation you are looking to achieve.
- Do not talk, nor should your health care professional talk. It will not take much time!
- Above all, RELAX! Many of us get anxious at the doctor’s office. If you do, be sure to tell your doctor. Try to remember that most health care practitioners have your best interest at heart!
If you have a home blood pressure cuff, make sure that it is calibrated regularly. Also, make sure that you follow the guidelines above as well when you take your own blood pressure. Taking it at the same time every day to get a consistent reading.
Treating high blood pressure can be done with medication, exercise, healthful changes in diet, and even herbs.
I am going to write today about something that has been on my mind recently, the things I have noticed on my own journey through Health At Every Size® (HAES®).
I was first introduced to HAES® three years ago. While I was learning to be a naturopath, I noticed (and experienced) a great deal of worry from everyone in school about what to eat, how to eat, when to eat, etc. Everyone, regardless of size, was concerned about these things…occasionally obsessive. To say that the term Orthorexia was one that fit our campus culture may be an understatement. I was definitely sucked into that mindset. The fact that I not only didn’t get thinner, but I actually gained weight made it very demoralizing to be in school.
A teacher told me about Linda Bacon’s book, Health At Every Size®, and I read it during spring break of my third year. It was then that I decided to not worry about what was “right” or “wrong” to eat. I decided to not beat myself up if I didn’t take my 3-4 mile walks as regularly as I used to take them because I was worn out. I decided to relax and allow myself to do what I could do to care for myself and get through school. Often this involved sleep, laughter, water, and relaxation between bouts of studying. Unexpectedly, to me, I stopped gaining weight. I also stopped feeling guilty. I was able to expand my inner self to be able to handle all of the things that were thrown at me during my last year in school.
Now, as I recover from school, start my business, and improve my health, I definitely am considering how to increase the healthy habits in my life. Part of this is to not allow myself to begin to spend all of my time thinking about what I am eating, how much I am exercising, what supplements I am taking, how much I am sleeping, what my stress levels are…etc. In other words, to not obsess about my health and enjoy life. I certainly think about these things, but I am allowing myself to be human. To have chocolate cake without guilt. To have a spinach salad without feeling sanctimonious.
This journey continually forces me to challenge my assumptions about how individuals can be healthier. I certainly know that there are things that I can do to increase my health, but stressing out about those things seems as though it would reduce the very health that I am working to increase!
The thing is, I also find that I have less judgment about those who are still part of the diet/lifestyle changes to lose weight paradigm. I still sometimes want to shake people to get them to understand. I often felt this way when I started learning how to treat people naturopathically: “Why can’t everyone see how incredible this medicine is? Why can’t they understand the potential it has to improve the quality of our lives?” I relaxed on that when I realized that those very questions were the reason I was in school, to spread the medicine. It is also the reason I was shown to HAES®, to add another layer of improvement to the lives of the people I help. I can’t force anyone to believe I am right, but I can speak the truth that I experience and listen to the truth of others with an open mind.
The fatosphere has been alight this morning with the news that the AMA has officially made “Obesity” a diagnosis (at least the NY Times has a picture of fat kids running. The LA Times can’t seem to do anything beyond put headless fatties next to their story).
I wondered what it the world I could possibly say that would add to what they, and no doubt many others I haven’t read yet, have said. Then I realized, I can talk about how this may affect me as a doctor, and potentially my patients.
As far as how it will affect how I treat patients, well, it won’t. I will still encourage all of my patients, regardless of size, to pursue healthy habits. I will still weigh only when necessary. I will still discourage diets and weight loss for the sake of weight loss. My biggest concern is whether or not, as NDs become more widely seen as Primary Care Physicians (PCPs), as they are here in Oregon, if I will be forced to diagnose “obesity”. Considering that I am not part of the AMA, and I pray that my own national professional organization, the AANP, does not follow suit, it is possible my patients and I will not be faced with that. Regardless, I refuse to diagnose someone as “obese”.
As far as patient advocacy goes, this makes it even more clear to me that there needs to be an intervention at the practitioner level.
Naturopathic Medicine has long been scoffed at, until something we have been doing to treat various conditions for decades suddenly is “discovered” by the conventional medical establishment. I see “obesity” and the fight for equal medical treatment for fat people in the same way. At some point, everyone, including many naturopaths, will fully realize that not only are diets bad (most people are getting on board with that now), but that lifestyle changes don’t always lead to weight loss and that is not due to a lack of compliance on the part of patients! Becoming an ND has prepared me to “suffer the slings and arrows” of the modern thoughts on “obesity” and health. I embrace the Health at Every Size(R) as an idea ahead of it’s time and as more people (physicians and patients) come to embrace it, I predict that we will see an improvement in health, and maybe even general weight loss (though maybe not). At the least, we will see happier, healthier, more well adjusted people.
I encourage every fat person reading this to have frank discussions with your physician. Fire physicians who do not comply with your health goals (if you can). Find physicians who understand that you are a person, and that your size should not dictate the quality of the treatment that your receive. Don’t let the financial interests of the diet, drug, and surgery industries affect how you are treated. Encourage your doctor to read Health at Every Size by Linda Bacon and start a discussion. Patients will be a big push to get full equal treatment for fat people. Those of us who are already here are working toward it, but we are few and you are many. Plus you have money! Money speaks.
Questions and comments are welcome.
My “obese” cat has the same lifestyle as my thin cat.
Warning: May contain triggers for some people for disordered eating and fat shaming.
The other day, I was catching up on my podcasts and I saw there was one from Freakonomics radio entitled 100 Ways to Fight Obesity. Because Freakonomics is on NPR, my first reaction was one of hesitancy and a bit of nervousness. I love public radio, but NPR and it’s affiliates have a tendency to be stigmatizing, judgmental, and alarmist about the “obesity epidemic”. I was not incredibly hopeful.
However, Freakonomics, the book and the show, often have very interesting ways of looking at societal, economic, health, and many other issues, so I did have a glimmer of hope that they would point out some of the things that the size activism and Health at Every Size movements have seen over and over throughout the years.
Let’s just say that I had to listen to the podcast in chunks to save my sanity.
The beginning of the show was full of the typical stuff. Huge “obesity epidemic”. How ever will we curb the growing backsides of Americans. We’re all going to die if we don’t lose weight RIGHT NOW! Honestly, I like to pretend that people are running around frantically pulling at their hair somewhere behind the scenes. Maybe they are screaming,”Think of the children!!!” It makes me laugh inside every time and makes it easier for me not to lose my sanity. I like to think about this scenario whenever people are freaking out about something that really does not need to be freaked out about.
Finally, someone said something about how when people stop smoking they gain weight, and there was this huge drop in smoking over the past several decades. I got excited because I thought that maybe they were going to start exploring concepts besides gluttony for the increase in the weight of the population since the 1970’s. However, beyond mentioning that the decrease in smoking would only account for maybe 20% of the weight gain, there was no further discussion about why there has been a weight gain. What about the possibility that the increase in dieting may have increased weight? What about our chemical filled world affecting our metabolisms in a different way? Processed foods? GMOs? I think all of these things need to be seriously discussed. Even the social pressure to be thin at all costs may have a negative effect on weight gain.Nor did anyone mention the lowering of the BMI in 1998, which moved everyone further toward “overweight” and “obese”.
They did talk about how our societal preoccupation with fat has increased along with the incidences of eating disorders, which can lead to a great many health issues, including death. At this point, there was a discussion about how focusing on healthy habits instead of fat leads to increases in health and decreases in eating disorders. That was very exciting to hear!
Then there was a brainstorming session to find solutions to the “childhood obesity crisis” where no idea was considered too outlandish.
Some ideas seemed to be old hat. Shame parents into making their kids eat right and exercise. Use incentives in health insurance to encourage parents to have their children in a certain weight range. There was one suggestion to have standardized testing to determine a baseline for nutrition, exercise, and media literacy, then teach those things. As if the schools have so much extra time and resources.
Some of the ideas, I liked. As an ND, I can get behind getting rid of sucrose and High Fructose Corn Syrup. I can also get behind finding ways to not advertise nutritionally devoid foods to children. There was a great suggestion to make all advertising into “opt in” advertising, which I love because I dislike ads, but it is impractical.
My favorite suggestion was that we stop using “obesity” because it is a loaded word and not a good measurement of health. He suggested that we use malnutrition. Considering the rapidly declining nutritional quality of much of our modern, processed food, I love the idea of using this word. It applies to many of us who get sufficient calories, but not sufficient nutrition, as well as those of us who get neither. Increasing our nutritionally dense foods may change the weight of some, and not others, but we would all benefit.
The end of the podcast what what disturbed me the most. There was a discussion of a fantasy to have a parasite that would stop nutrients from being absorbed. People could then lose weight (by essentially starving) and eat what they want without gaining weight (bulimia anyone?). There was also a suggestion by one of the economists (well his father) to smell something horrible, like vomit, when one is hungry to stop being hungry. (Anorexia anyone?) The end of the podcast was so full of eating disorder behavior that I found it to be very disturbing.
All in all, the podcast threw out a few good ideas, but most of them were glossed over to perpetuate the fear and panic surrounding fat. They also generally encouraged shaming and disordered eating to encourage people to be thinner, though whether they would be healthier is debatable.
Now, if we could use some of the above ideas (not the shaming ones), but coming back to Health at Every Size (R), I think that we could make great strides in the health of our country. HUGE strides. (like that?) Whole foods, cut out GMOs, access to a variety of real food, fun exercise options. Why do we need to make all the solutions to our “obesity crisis”(which I would like to reframe as a malnutrition or health crisis) need to involve weight loss and not focus on health? I, for one, plan to keep pushing for health, not thinness.
Yes, I am a creative title writer.
This is mainly a sort of test post, but I will go ahead and give you a brief idea of what this blog will be about.
I am a licensed Naturopathic Physician in Portland, OR with a passion for Health at Every Size (R) and a weight neutral approach to health. The current climate of fat phobia and the “War on Obesity” have had a detrimental effect on the mental and physical health of people of all sizes, not the major reduction of obesity that has been hoped for when the “war” started. I am also a proponent of size/body acceptance. My focus tends to be on helping people who are fat navigate in a world that stigmatizes them daily, but I also see so many people ranging from very thin to very fat being affected by the push to have an unattainable, “perfect” body. Size/body acceptance affects us all.
This blog will be attached to my practice website and I will discuss health issues here, however, I intend for this to be a mix of health information and, most importantly, size activism.
Comments will be moderated because I want this to be a safe place for anyone to go and get good information. Reasonable, respectful comments that disagree with what I have said may be published, but that is entirely up to my discretion.