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.