I know that we all want to clutch onto every piece of evidence we find that Trump is a despicable human, hold them close, let them keep us warm at night, and build bomb shelters from them. I also know that society and popular media have taught us that “fat people” are the villains. That they are lazy and gluttonous and deserving of scorn. It’s incredibly difficult to set aside these biases, especially when we want to believe these things of a person, but that’s exactly what we need to do. Trump has given us ample reasons to believe that he is a garbage human. His objectification of and assaults on women, his racist comments and travel bans, his mockery of people with disabilities, his complete and utter lack of diplomacy, and on and on. His weight is not one of them.
Thanks to Helen at Food & Nonsense starting the RD book club I finally got around to reading Linda Bacon’s Health at Every Size. Unfortunately, due to time differences, the tweet-up to discuss the book is taking place at 6 am on a Sunday morning for me. I’ve scheduled this post to go live at that time as my feeble attempt at participating in the discussion without waking up ;) If you’d like to check out the discussion just search for the #RDBookclub hashtag (was that redundant? Probably) on twitter.
Helen was also kind enough to post some discussion questions so here goes…
1. Do you agree with the HAES assertion that health not weight should be the focus of nutrition interventions?
Absolutely. The focus should be on health and well being, never on numbers on a scale. That being said, weight management is one of the main reasons that people seek out advice from dietitians. I don’t think that we can just ignore this fact. As health care professionals it’s our job to help people to understand that the numbers on a scale don’t necessarily matter all that much when it comes to health. That being said, weight is often inextricably intertwined with health and nutrition.
2. Is a health approach practical in todays aesthetic focused society?
This is an excellent question and one that I found myself thinking about quite a bit as I was reading the book. It’s all well and good that we know that people can be healthy at many different weights but how do you translate that into acceptance and understanding? As much as we tell someone that they are healthy at their current weight, if they’re unhappy with that weight should we help them to lose weight or help them to accept themselves as they are? Oftentimes, neither of these options is feasible.
3. Do you feel that the main concepts in the book were adequately backed up by the research presented?
For the mist part I did. Although I must confess that I didn’t take the time to seek out all of the research Bacon used to back-up her arguments. A couple of things did bother me: One, I didn’t like how much she mentioned that if you do this or that you’ll probably end-up losing weight. If your book is about being healthy no matter what your size, and you’re preaching fat acceptance, then I don’t think that weight loss should be a frequently touted benefit of your approach. Two, I’m not sure how credible her evidence to support that overweight and obese people generally live longer than their lower-weight counterparts is. Weight loss is an extremely common side effect of many serious diseases. Thus, thinner people may be more prone to dying than larger people as a result of an underlying illness causing weight loss, not as a result of being thin. If we’re talking health at every size we need to be careful not to tip the scale in the other direction. People who are overweight, obese, average, or underweight may all be healthy. Also, death is not the only thing to look at. Obese and overweight people may be living for longer but how many of them are healthy during these extended life spans? Health span may be a more important consideration than life span.
4. How should nutrition professionals use this information in their day to day practice?
I think that nutrition professionals should use this information to help themselves overcome their personal biases and to educate their clients that weight is not the be all and end all when it comes to health. We should also use it to help clients realise that our own weight is not an indication of our health nor of our ability to do our jobs well. I can’t tell you how many people I’ve had tell me that I’m a dietitian they might actually listen to because I’m slim, as though larger dietitians don’t have exactly the same knowledge and education as I do. As with any field, our weight is not an indication of our ability to perform our jobs well.
5. Were there any ideas in this book that you reject or find difficult to accept? Why?
I think I covered this in question three. Oops! I was also bothered with a very small point in which Bacon was advising people on how to choose whole grains (p.79). She says, “Look for the word “whole” in the ingredients list.” Not entirely accurate. This is the point where I pondered whether or not it was okay to write in a library book. You need to see the words “whole grain”. Unfortunately, “whole” on its own is not sufficient. Anyway… This is a very small quibble in the scheme of things.
I did also find it difficult to accept that there is no relationship between obesity and disease states. While I absolutely believe it’s possible to be healthy (and conversely unhealthy) at any weight I do still believe that there is increased risk of developing certain conditions such as heart disease, some cancers, type 2 diabetes when you’re obese.
6. What is the main thing you took from this book? How has it been helpful to you?
The main thing I took from this book is the importance of self-worth and acceptance. We all need to stop aspiring to look like other people and learn to be happy being ourselves. Many of us also need to step away from the scale and stop letting the numbers on it define us. I also really enjoyed the chapters on food and fat politics.
For some more interesting perspectives on the HAES movement check out the following links:
Sometimes I need a little time to percolate on a subject before I weigh in. This was one of those times. A couple of weeks ago the American Medical Association decided to classify obesity as a disease. This, of course, created quite an uproar. On one side, there are the people who are saying that this will lead to a decrease in personal responsibility for the condition as well as those who believe that it will mean those of us who are not obese will be footing the bill for surgeries and new obesity drugs (1). On the other side, there are those who believe that this will lead to increased efforts to curb rising obesity rates and may be beneficial to those who are suffering from obesity (2).
Personally, I’m not sure that calling obesity a disease will lead to any improvements in obesity rates but I certainly don’t see it causing any harm. Considering how well we’ve being doing reducing obesity rates thus far I figure that classifying obesity as a disease is worth a shot. While I agree with the point made in the Globe article that the current use of BMI to measure obesity is highly flawed I would also like to point out that there are other measurements of obesity being developed (e.g. the Edmonton Obesity Staging System) and perhaps the classification of obesity as a disease will lead to wider use of these more accurate tools.
I also take issue with the notion that classifying obesity as a disease will lead to people throwing up their hands and saying “not my fault, I have a disease” and then going for a big mac meal deal. When alcoholism was classified as a disease in 1956 did alcoholics cheer and say “now I have a licence to drink!”. No. The classification raised served to raise awareness that this was a serious medical condition and increased treatment availability and options.
Did anyone else notice the photos of headless obese bodies accompanying the news articles? I hope that this classification will lead to increased sensitivity toward those who are obese.
My concern is not with the classification of obesity as a disease (keep in mind that over weight is not the same thing as obese and that individuals who are over weight may indeed be healthier than their “healthy” weight counterparts but yes, I am concerned that this classification may detract from the notion of health at every size) it’s with our current medical model in North America. Our focus is on treatment when it should be on prevention. This goes for all diseases, not just obesity. In Canada, our system will cover many treatments once you’ve fallen ill but will not cover most preventative measures. We need to start covering (at least some of) the cost of things like dietitians, certified personal trainers, gym memberships, sports equipment, etc. regardless of disease state. In the long-run it would be a lot less costly to keep people healthy in the first place rather than waiting until they become ill to provide medical and professional supports.
Yes, there is much more than our medical system that needs to be involved in preventing and curing obesity. Our food systems, environment, and societal structure are major contributors to our current high levels of obesity. However, as we’re talking about the AMA classification today I wanted to focus on the medical side of the issue.
So, these are some of my thoughts on the subject. I’ve seen many other thoughts out there as well, mostly from medical professionals and the media. What I’d really like to see are thoughts from those who are most likely to be directly affected by the classification of obesity as a disease. If any of my readers, or anyone you know, is currently (or was ever) obese and would like to share your thoughts on the recent classification of obesity as a disease by the AMA I would love to hear your thoughts on this subject. Please email me at dmc555 [at] gmail [dot] com to let me know what your thoughts are. With your permission, I will share your thoughts in a future blog post.
A thought provoking question was recently posed by the Globe and Mail: Is it futile to treat obesity? The article quotes a doctor who thinks that because there is such limited success in treating obesity and such a negative emotional burden that comes along with weight loss efforts (and failures) that we should shift our focus to helping patients become more accepting of their size. Another doctor quoted in the article presents the opposing argument: doctors should still be trying to help their patients to become as healthy as possible even if it is often a battle in futility. I think that we need to incorporate both approaches and also treat the real cause of obesity which does not lie with the patient nor the doctor.
If a patient is experiencing negative health issues which can be ameliorated by weight loss then the doctor should clearly be suggesting that they should lose weight and providing them with necessary tools to do so. Now, as the article says, benefits from weight loss can be seen with as little as a 5% loss of body weight. We’re not saying everyone has to go out and lose 100 pounds and start doing fitness modelling. We’re just saying that if you can better manage your diabetes (or stave off development of diabetes), or cholesterol, or blood pressure, etc. then you should probably be advised on how to do so. Especially if the treatment doesn’t involve medications and involves such side effects as: improved mood, better sleep, increased energy, improved mental acuity, etc. At the same time, we need to be more accepting of the fact that health can come at many different sizes and we don’t all have to have washboard abs to be healthy.
That’s the role for the doctor, as I see it. I would also suggest that the tools they provide their patients for weight loss involve other health care professionals such as dietitians (of course!), psychologists, and fitness experts. But, to really treat obesity we need to change the world in which we live. We need to live close enough to our places of employment so that we can easily get to and from work using active transport (i.e. our feet, bikes, skateboards) or at least public transit. We need to stop relying on restaurants and meals “cooked” out of boxes. We need to redesign our environment so that the healthy choice is ALWAYS the easy choice.