"Health At Every Size": Social activism at odds with proper medical care?

[BlueLabel]

I stumbled across this blog just now, and while it is noble to encourage people not to shame others just because of the shape of their bodies, I have to draw the line when this kind of activism dares to challenge the sound medical opinion of healthcare professionals.

In the particular post below, the author decries the judgmental "shaming" perpetrated against heavier folks by their evil doctors, who according to her are so blinded by fat-prejudice they are no longer capable of adhering to the standard of care, evidence-based medicine, or the Hippocratic oath. I've attached below two cards that the author says people who worry about their weight should give/say to their physicians so that they can practice "Health At Every Size". Some of the lines are truly astonishing: "don't prescribe weight loss as a health intervention" (presumably under any circumstances? Seriously?).

Look, I am all for a more tolerant, understanding, and inclusive society. But before that I am for a healthy society. I see no reason why social activism should for any reason impinge upon the execution of best practices by healthcare professionals.

What do you think, SDN?


http://danceswithfat.wordpress.com/2013/04/01/what-to-say-at-the-doctors-office/

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[Reckoner]

1. Dances With Fat is seriously the best name they could come up with???

2. Sounds like a great way to ensure you get subpar care from your pissed off doctor.

 

[joonage]

"I ain't got no health problem!"

(I think she's actually working out to .... The irony.)

 

[QuinnTheEskimo]

The stuff you posted is bizarre and I agree it's ultimately detrimental. Fat is a proven health risk. I have "big-boned" friends who claim their blood pressure/cholesterol is normal, and I smile and nod...that's all well and good, but they never mention the strain they are putting on their joints. Early arthritis, anyone?

That being said, I think that some doctors can be rude when it comes to patients and weight. Personally I would probably shy away from chastising a patient who is ~10-40 lbs overweight. They know they are fat and are probably ashamed/working on it. Morbidly obese is a different story. But, it requires A LOT of sensitivity to talk about this issue with patients, because you risk shaming them, which results in them avoiding the doctor's office altogether.

 

[Mad Jack]

Anyone who thinks losing weight is impossible and that long term health and obesity can coexist really needs to be forced to sit through a semester of biochemistry and a basic nutrition course.

 

[Reckoner]

But, it requires A LOT of sensitivity to talk about this issue with patients, because you risk shaming them, which results in them avoiding the doctor's office altogether.

Agree with this. You definitely don't want to ridicule someone in a vulnerable situation.

I was eating while reading this and started laugh-choking.

Ass

 

[Pacna]

All I can say is that I expect the pay rates of hip/knee orthos to keep on going up and up and up and up...

 

[3838]

sorry its fuzzy. Basically this graph shows that all cause mortality can be reduced in obese and overweight individuals by ensuring that they are living healthy lifestyles. The study shows individuals who adopted 0,1,2,3,or all 4 of the following lifestyle choices: exercise, eating fruit and veg, not smoking, and drinking in moderation. The study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/22218619 The graph was designed by Sandra Aamodt. (The original chart created by the researchers can also be found in the above link) In other words, I think that what this woman is saying is misguided, I do agree that physicians shouldn't prescribe weight loss per say. They should prescribe a healthy lifestyle involving daily physical activity and healthy eating rather than weight loss. There have been studies done (and god I wish I could cite them off of the top of my head) that show that an intervention focusing on a weight maintenance program with African American women rather than a weight loss program actually helped these women achieve weight loss in a culturally acceptable way. Looking at the physiology of obesity and high adipose content is important too. It is impossible to decrease the size of adipose cells. As you gain weight, they acquire a new "set point" and it's extremely difficult for a person to change that set point to a lower level. It's a constant struggle. Obesity is a chronic illness; as such it needs to be managed that way.

Before prescribing weightloss, physicians should think about whether or not their patients will actually follow through with their prescription. A healthy lifestyle is an easier thing to follow than weight loss. It's less overwhelming and it's more evidence based.

 

[Mad Jack]

View attachment 178038
sorry its fuzzy. Basically this graph shows that all cause mortality can be reduced in obese and overweight individuals by ensuring that they are living healthy lifestyles. The study shows individuals who adopted 0,1,2,3,or all 4 of the following lifestyle choices: exercise, eating fruit and veg, not smoking, and drinking in moderation. The study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/22218619 The graph was designed by Sandra Aamodt. (The original chart created by the researchers can also be found in the above link) In other words, I think that what this woman is saying is misguided, I do agree that physicians shouldn't prescribe weight loss per say. They should prescribe a healthy lifestyle involving daily physical activity and healthy eating rather than weight loss. There have been studies done (and god I wish I could cite them off of the top of my head) that show that an intervention focusing on a weight maintenance program with African American women rather than a weight loss program actually helped these women achieve weight loss in a culturally acceptable way. Looking at the physiology of obesity and high adipose content is important too. It is impossible to decrease the size of adipose cells. As you gain weight, they acquire a new "set point" and it's extremely difficult for a person to change that set point to a lower level. It's a constant struggle. Obesity is a chronic illness; as such it needs to be managed that way.

Before prescribing weightloss, physicians should think about whether or not their patients will actually follow through with their prescription. A healthy lifestyle is an easier thing to follow than weight loss. It's less overwhelming and it's more evidence based.

A healthy lifestyle is generally going to lead to weight loss. And adipocytes readily reduce their size- it is their number that stays constant, and screws with your adiponectin, leptin, and insulin levels, among other things. Yeah, it makes it harder to lose weight, but that doesn't mean it is impossible. Proper diet and exercise will eventually bring a person's weight down, it is just a longer and more painful process if you are overweight to begin with.

 

[Reckoner]

exercise, eating fruit and veg, not smoking, and drinking in moderation.

Unless I'm missing something here, don't all of these things generally lead to weight loss in obese people?

I don't think "prescribing weight loss" means recommending a starvation diet...

ETA: looks like Mad Jack was typing faster than me and beat me to it. Didn't mean to steal your thunder brah

 

[gettheleadout]

People will go to extreme lengths to preserve their ignorance and lack of self-discipline.

 

[gettheleadout]

View attachment 178038
sorry its fuzzy. Basically this graph shows that all cause mortality can be reduced in obese and overweight individuals by ensuring that they are living healthy lifestyles. The study shows individuals who adopted 0,1,2,3,or all 4 of the following lifestyle choices: exercise, eating fruit and veg, not smoking, and drinking in moderation. The study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/22218619 The graph was designed by Sandra Aamodt. (The original chart created by the researchers can also be found in the above link) In other words, I think that what this woman is saying is misguided, I do agree that physicians shouldn't prescribe weight loss per say. They should prescribe a healthy lifestyle involving daily physical activity and healthy eating rather than weight loss. There have been studies done (and god I wish I could cite them off of the top of my head) that show that an intervention focusing on a weight maintenance program with African American women rather than a weight loss program actually helped these women achieve weight loss in a culturally acceptable way. Looking at the physiology of obesity and high adipose content is important too. It is impossible to decrease the size of adipose cells. As you gain weight, they acquire a new "set point" and it's extremely difficult for a person to change that set point to a lower level. It's a constant struggle. Obesity is a chronic illness; as such it needs to be managed that way.

Before prescribing weightloss, physicians should think about whether or not their patients will actually follow through with their prescription. A healthy lifestyle is an easier thing to follow than weight loss. It's less overwhelming and it's more evidence based.

It is not impossible to decrease the size of adipocytes, it's difficult to change their number. Set points are a range and not a defined value, and are not set in stone, which is actually congruent with your example of increasing set point with maintained overweight.

 

[BlueLabel]

View attachment 178038
sorry its fuzzy. Basically this graph shows that all cause mortality can be reduced in obese and overweight individuals by ensuring that they are living healthy lifestyles. The study shows individuals who adopted 0,1,2,3,or all 4 of the following lifestyle choices: exercise, eating fruit and veg, not smoking, and drinking in moderation. The study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/22218619 The graph was designed by Sandra Aamodt. (The original chart created by the researchers can also be found in the above link) In other words, I think that what this woman is saying is misguided, I do agree that physicians shouldn't prescribe weight loss per say. They should prescribe a healthy lifestyle involving daily physical activity and healthy eating rather than weight loss. There have been studies done (and god I wish I could cite them off of the top of my head) that show that an intervention focusing on a weight maintenance program with African American women rather than a weight loss program actually helped these women achieve weight loss in a culturally acceptable way. Looking at the physiology of obesity and high adipose content is important too. It is impossible to decrease the size of adipose cells. As you gain weight, they acquire a new "set point" and it's extremely difficult for a person to change that set point to a lower level. It's a constant struggle. Obesity is a chronic illness; as such it needs to be managed that way.

Before prescribing weightloss, physicians should think about whether or not their patients will actually follow through with their prescription. A healthy lifestyle is an easier thing to follow than weight loss. It's less overwhelming and it's more evidence based.

Another issue with this that hasn't been mentioned is the study strictly looks at mortality. It says nothing about quality of life, or the extent of medical care, time, and money that obese people need to invest in their bodies in order to keep them working.

Furthermore, if you read through the discussion, the authors are absolutely NOT trying to argue for the acceptability of high BMI; indeed, they point out that "obesity increases the risk of illnesses such as coronary artery disease, diabetes mellitus, hypertension, sleep apnea, and several types of cancer". In fact, the authors' conclusion was to urge patients and healthcare providers to stress the importance of healthy lifestyle habits regardless of BMI, i.e. just because you aren't overweight doesn't mean it's okay to get blackout 24/7 and smoke 2 packs a day. I don't know why exactly you took away from this study that they were dismissing the health risks of obesity, that's a very poor reading.

Other posters have already raised my other objections to your post.

 

[touchpause13]

Yes there are many health risks associated with obesity. But i think overweight people tend to have a rough time. Fat shaming patients is a recorded phenomenon and I would encourage future providers to treat overweight patients with respect and dignity and attempt to treat their health needs without being a jerk.

Here is a study showing that doctors overwhelming rated overweight patients as more awkward, and less complaint than thin patients, regardless of their actions. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0048448

 

[gettheleadout]

A healthy lifestyle is generally going to lead to weight loss. And adipocytes readily reduce their size- it is their number that stays constant, and screws with your adiponectin, leptin, and insulin levels, among other things. Yeah, it makes it harder to lose weight, but that doesn't mean it is impossible. Proper diet and exercise will eventually bring a person's weight down, it is just a longer and more painful process if you are overweight to begin with.

I'm clearly not as articulate at the moment as MJ here but I want to give my support for this. Relative to the number of obese people in the US, very few are actually suffering from metabolic conditions which prevent them from attaining a healthy body composition. In those cases obviously medical intervention is appropriate, but for nearly everyone else it's a matter of not maintaining any sort of proper diet, sedentary lifestyle, and lack of effort. It's not something these people want to hear from their doctors or anyone else, but it's as much their fault that they're fat as it is the fault of smokers that they got emphysema or cancer or whatever. The idea that the HAES movement is accepted by any substantial fraction of society says so much about our cultural abdication of responsibility...

Doctors are obligated to be conscious of patients' feelings not only out of simple respect and decency but in order to ensure successful care. No respectable doctor would set out to shame their obese patient, and the fact that some such patients likely feel that way is sad. However, this is a case of misplaced retaliation. Fat patients feel ashamed of themselves when their doctors address the issue? Too bad. It needs to be addressed for their sake, even if they're too uninformed or in denial about it to care. That's the responsibility doctors have. To me, what the HAES movement, and specifically the content quoted in the OP says is outright insulting. You don't want to hear that your lifestyle is causing you harm? You don't want to hear that its your fault you have hypertension/increased CV disease risk/back pain/whatever? Sorry, it IS your fault. You think you know better than your doctor? Why are you at the appointment then? Bringing scripted lines implying that you know better how to manage your health than your physician is the height of arrogance.

Yes there are many health risks associated with obesity. But i think overweight people tend to have a rough time. Fat shaming patients is a recorded phenomenon and I would encourage future providers to treat overweight patients with respect and dignity and attempt to treat their health needs without being a jerk.

Here is a study showing that doctors overwhelming rated overweight patients as more awkward, and less complaint than thin patients, regardless of their actions. http://www.plosone.org/article/infooi/10.1371/journal.pone.0048448

Obviously shaming fat patients isn't anyone's goal and fixing this is in everyone's best interests. However, I feel like HAES is an inappropriate and counterproductive response to society's fat shaming in general. See what I said about "misplaced retaliation" above.

 

[touchpause13]

I'm just more of the killing flies with honey approach. Telling a patient, suck it up fatty we gotta talk about this is probably not going to lend the best results. That's not to say that fat patients don't need a come to Jesus talk, becaue they certainly might. I'm just saying try to hold back on whatever personal bias you or anyone else (myself included) might hold against fat people when dealing with patients.

 

[BlueLabel]

I'm just more of the killing flies with honey approach. Telling a patient, suck it up fatty we gotta talk about this is probably not going to lend the best results. That's not to say that fat patients don't need a come to Jesus talk, becaue they certainly might. I'm just saying try to hold back on whatever personal bias you or anyone else (myself included) might hold against fat people when dealing with patients.

I think we're mostly on the same page here (except for @3838 ). Obviously we want the best possible outcome, and I have no doubt that like a good joke, in some cases sound medical advice is all about the delivery.

 

[darkjedi]

Here's a study that shows even overweight people who are metabolically 'healthy' are still at increased risk for adverse outcomes.
http://www.ncbi.nlm.nih.gov/pubmed/?term=24297192

The real question is how physicians can produce the best outcomes in these types of patients. It is difficult to treat the health issues if the patient is not onboard with you. It's also an issue that tough to tackle from the relatively narrow window of care that a physician can provide. There are social and cultural issues that run very deep as well.

 

[gumdrops]

lol, @3838 was endorsing telling patients to do everything to lose weight without actually telling them to lose weight. Kind of like the old "slipping a pill into applesauce" trick.

 

[Lya]

Here's a study that shows even overweight people who are metabolically 'healthy' are still at increased risk for adverse outcomes.
http://www.ncbi.nlm.nih.gov/pubmed/?term=24297192

The real question is how physicians can produce the best outcomes in these types of patients. It is difficult to treat the health issues if the patient is not onboard with you. It's also an issue that tough to tackle from the relatively narrow window of care that a physician can provide. There are social and cultural issues that run very deep as well.

There is a documentary called, "Escape Fire," during which it briefly discusses the work by Dr. Ornish, a professor at UCSF. I know there are numerous physicians addressing lifestyle interventions, but he is the only one I could think of off top of my head.

http://www.ornishspectrum.com/proven-program/the-research/

A year-long lifestyle intervention program that he developed is, if I remember correctly, covered by Medicare (he lobbied/advocated for 16 years) and other insurance companies, having demonstrated firsthand that quite a few diseases like heart diseases can be reversible with consistent lifestyle changes. I am certain that results may vary depending on patients, their backgrounds and other sociocultural aspects. However, at least we can influence and improve some people, if not all.


EDIT: Oops, my comments are not pertinent to your question at all. Never mind.

 

[Ace-Co-A]

View attachment 178038 ... It is impossible to decrease the size of adipose cells. As you gain weight, they acquire a new "set point" and it's extremely difficult for a person to change that set point to a lower level. It's a constant struggle. Obesity is a chronic illness; as such it needs to be managed that way.

Before prescribing weightloss, physicians should think about whether or not their patients will actually follow through with their prescription. A healthy lifestyle is an easier thing to follow than weight loss. It's less overwhelming and it's more evidence based.

It is not impossible to decrease the size of adipocytes, it's difficult to change their number. Set points are a range and not a defined value, and are not set in stone, which is actually congruent with your example of increasing set point with maintained overweight.

@3838 The bolded portion of your post is problematic, as others have pointed out. Although it may be that you have 'misspoken' here, because I have never seen such a claim about the lack of plasticity in adipocyte size. An explanation is required if you maintain this assertion. Some evidence for @gettheleadout 's refutation about changes in adipocyte size (albeit in the rat) may be found here.

A healthy lifestyle is generally going to lead to weight loss. And adipocytes readily reduce their size- it is their number that stays constant, and screws with your adiponectin, leptin, and insulin levels, among other things. Yeah, it makes it harder to lose weight, but that doesn't mean it is impossible. Proper diet and exercise will eventually bring a person's weight down, it is just a longer and more painful process if you are overweight to begin with.

... the authors are absolutely NOT trying to argue for the acceptability of high BMI; indeed, they point out that "obesity increases the risk of illnesses such as coronary artery disease, diabetes mellitus, hypertension, sleep apnea, and several types of cancer". In fact, the authors' conclusion was to urge patients and healthcare providers to stress the importance of healthy lifestyle habits regardless of BMI, i.e. just because you aren't overweight doesn't mean it's okay to get blackout 24/7 and smoke 2 packs a day. I don't know why exactly you took away from this study that they were dismissing the health risks of obesity, that's a very poor reading. ...

I think you both (@Mad Jack and @BlueLabel ) are putting up something of a straw man here. I may misunderstand the post, but I don't think @3838 is arguing that patients should not be told to lose weight, just that there are more prudent ways to actually achieve this goal without 'shoving it down their throat' [i.e., by recommending that the patient engage in activities associated with "healthy living" that will lead to weight loss without making this the focus of the treatment plan; @3838 said: "In other words, I think that what this woman is saying is misguided, I do agree that physicians shouldn't prescribe weight loss per say." (italics mine)]. If I have indeed captured the gist of what @3838 was getting at, then I think the argument about her post should have been focused on whether the physician is just in concealing the intentions of the course of treatment (i.e., that weight loss is the ultimate goal of the "healthy living" prescription, but that we are not calling it "weight loss"). I'll address each of your posts below individually:

@Mad Jack ... "Yeah, it makes it harder to lose weight, but that doesn't mean it is impossible." I disagree that this was stated or implied in @3838 's post. @3838 states that "it's extremely difficult for a person to change that set point to a lower level. It's a constant struggle. Obesity is a chronic illness; as such it needs to be managed that way." This does not suggest that weight loss is impossible, but only that it is difficult. @Mad Jack , you seem to have overstated your point.

@BlueLabel ... You say that "authors are absolutely NOT trying to argue for the acceptability of high BMI." Neither is @3838 , unless I'm sorely mistaken. You go on to say that "I don't know why exactly you took away from this study that they were dismissing the health risks of obesity, that's a very poor reading." You missed the boat here, completely. At no point does @3838 dismiss the health risks of obesity. Her post states that obesity is "a chronic illness" and assumes, fundamentally, that obesity is the problem.

If I have mischaracterized your post, @3838 , then an explanation of your understanding of the article as well as the viewpoint you defend is requested.

 

[3838]

Sorry guys. I misspoke about the adipocytes. Haven't had Physiology in a year now. A little rusty.

 

[3838]

lol, @3838 was endorsing telling patients to do everything to lose weight without actually telling them to lose weight. Kind of like the old "slipping a pill into applesauce" trick.

This is exactly what I was saying. Thanks.

 

[3838]

Another issue with this that hasn't been mentioned is the study strictly looks at mortality. It says nothing about quality of life, or the extent of medical care, time, and money that obese people need to invest in their bodies in order to keep them working.

Furthermore, if you read through the discussion, the authors are absolutely NOT trying to argue for the acceptability of high BMI; indeed, they point out that "obesity increases the risk of illnesses such as coronary artery disease, diabetes mellitus, hypertension, sleep apnea, and several types of cancer". In fact, the authors' conclusion was to urge patients and healthcare providers to stress the importance of healthy lifestyle habits regardless of BMI, i.e. just because you aren't overweight doesn't mean it's okay to get blackout 24/7 and smoke 2 packs a day. I don't know why exactly you took away from this study that they were dismissing the health risks of obesity, that's a very poor reading.

Other posters have already raised my other objections to your post.

I didn't say that a high BMI is healthy, but physicians have to consider the adherence of a patient to his or her treatment plan. Instituting lifestyle changes and telling patients to focus on that rather than the number on the machine will be more effective. They will be able to implement lifestyle changes immediately and feel more accomplished than if they look at their weight (that will go down much more slowly.) For many people healthy lifestyle change and weight maintenance is the first step to weight loss.

 

[deleted407021]

I think it's unfortunate that these people feel like they need to go on the defensive when it comes to their weight, and have some kind of social anxiety every time they come into contact with someone who might have something to say about how heavy they are. It's also unfortunate that this "Dancer, Choreographer, Writer, Speaker, Fat Person" feels that they have the medical expertise to rule out an unhealthy lifestyle as having a detrimental impact on people's biological well-being and is just fine in telling people that they can be perfectly healthy the way they are without any efforts aimed at reducing their BMIs. She obviously represents a group of people who have been conditioned, (probably through a combination of personality and upbringing in responding to societal stressors) that they should be defensive of their physique and thus, develop some kind of guarded pride in themselves. It is definitely a denial/rationalization defense mechanism aimed against a society which has a history of treating overweight/obese people poorly, through media, mostly. However, in denying that being overweight is medically hazardous for the majority of people, this individual is entering the realm of delusion and is taking others with her. She also seems to be aggressive toward "thin people", which probably arises from her perception (probably true, but exaggerated in her mind) that they are treated better within society. She's playing the "fat card".

I don't know if they do or not, but a physician shouldn't just prescribe "weight loss". That would be like giving a new seizure patient #90 Depakote 500mg and not telling them when and how to take it. At the clinic I work for, the percentage of our patients who are overweight is ≈65%, with quite a large number being obese. We don't just tell them to loose weight, we also host classes for them on a monthly basis and our doctors always advise them at every visit. You must provide people with the information they need to meet those expectations, but like the Depakote Rx, you can't take/do it for them.

Overall, I don't think that anyone should be ridiculed about their bodies/minds/anything, and certainly not by those who are supposed to be leading them to better health. This is just discouraging and humiliating. However, I don't think they should be told that their current physical state is fine and good, either, because it isn't. There needs to be an adjustment of sensitivity for all parties; doctors/others need to be aware of the feelings and individualities of the overweight people and the latter group needs to understand that everyone isn't out to hurt their feelings and demoralize them. Their doctors are there to help.

 

[3838]

I think it's unfortunate that these people feel like they need to go on the defensive when it comes to their weight, and have some kind of social anxiety every time they come into contact with someone who might have something to say about how heavy they are. It's also unfortunate that this "Dancer, Choreographer, Writer, Speaker, Fat Person" feels that they have the medical expertise to rule out an unhealthy lifestyle as having a detrimental impact on people's biological well-being and is just fine in telling people that they can be perfectly healthy the way they are without any efforts aimed at reducing their BMIs. She obviously represents a group of people who have been conditioned, (probably through a combination of personality and upbringing in responding to societal stressors) that they should be defensive of their physique and thus, develop some kind of guarded pride in themselves. It is definitely a denial/rationalization defense mechanism aimed against a society which has a history of treating overweight/obese people poorly, through media, mostly. However, in denying that being overweight is medically hazardous for the majority of people, this individual is entering the realm of delusion and is taking others with her. She also seems to be aggressive toward "thin people", which probably arises from her perception (probably true, but exaggerated in her mind) that they are treated better within society. She's playing the "fat card".

I don't know if they do or not, but a physician shouldn't just prescribe "weight loss". That would be like giving a new seizure patient #90 Depakote 500mg and not telling them when and how to take it. At the clinic I work for, the percentage of our patients who are overweight is ≈65%, with quite a large number being obese. We don't just tell them to loose weight, we also host classes for them on a monthly basis and our doctors always advise them at every visit. You must provide people with the information they need to meet those expectations, but like the Depakote Rx, you can't take/do it for them.

Overall, I don't think that anyone should be ridiculed about their bodies/minds/anything, and certainly not by those who are supposed to be leading them to better health. This is just discouraging and humiliating. However, I don't think they should be told that their current physical state is fine and good, either, because it isn't. Their needs to be an adjustment of sensitivity for all parties; doctors/others need to be aware of the feelings and individualities of the overweight people and the latter group needs to understand that everyone isn't out to hurt their feelings and demoralize them. Their doctors are there to help.

So, rather than telling my patient that his or her current physical state isn't acceptable, I will tell them that their lifestyle is unacceptable. Telling them their physical state is unacceptable will produce feelings of self disdain, self-disgust or on the other end of the spectrum will close them off and make them defensive. Telling them their lifestyle is unacceptable won't elicit quite the same emotions. A lifestyle can be changed as quickly as the next day. A physical state can't. Additionally, lifestyles are viewed by people as alterable; your physical state is,to a greater extent a part of your sense of self. I don't want to attack their sense of self. That's creating mental ill-health, IMO. I want them to be mentally and physically healthy.

 

[3838]

@3838 The bolded portion of your post is problematic, as others have pointed out. Although it may be that you have 'misspoken' here, because I have never seen such a claim about the lack of plasticity in adipocyte size. An explanation is required if you maintain this assertion. Some evidence for @gettheleadout 's refutation about changes in adipocyte size (albeit in the rat) may be found here.





I think you both (@Mad Jack and @BlueLabel ) are putting up something of a straw man here. I may misunderstand the post, but I don't think @3838 is arguing that patients should not be told to lose weight, just that there are more prudent ways to actually achieve this goal without 'shoving it down their throat' [i.e., by recommending that the patient engage in activities associated with "healthy living" that will lead to weight loss without making this the focus of the treatment plan; @3838 said: "In other words, I think that what this woman is saying is misguided, I do agree that physicians shouldn't prescribe weight loss per say." (italics mine)]. If I have indeed captured the gist of what @3838 was getting at, then I think the argument about her post should have been focused on whether the physician is just in concealing the intentions of the course of treatment (i.e., that weight loss is the ultimate goal of the "healthy living" prescription, but that we are not calling it "weight loss"). I'll address each of your posts below individually:

@Mad Jack ... "Yeah, it makes it harder to lose weight, but that doesn't mean it is impossible." I disagree that this was stated or implied in @3838 's post. @3838 states that "it's extremely difficult for a person to change that set point to a lower level. It's a constant struggle. Obesity is a chronic illness; as such it needs to be managed that way." This does not suggest that weight loss is impossible, but only that it is difficult. @Mad Jack , you seem to have overstated your point.

@BlueLabel ... You say that "authors are absolutely NOT trying to argue for the acceptability of high BMI." Neither is @3838 , unless I'm sorely mistaken. You go on to say that "I don't know why exactly you took away from this study that they were dismissing the health risks of obesity, that's a very poor reading." You missed the boat here, completely. At no point does @3838 dismiss the health risks of obesity. Her post states that obesity is "a chronic illness" and assumes, fundamentally, that obesity is the problem.

If I have mischaracterized your post, @3838 , then an explanation of your understanding of the article as well as the viewpoint you defend is requested.

No mis-characterization. 🙂

 

[gumdrops]

I completely agree with @3838 and @BrainsIsCool. People are made to feel such levels of shame and guilt over being overweight by society that they slip into denial or get very defensive. This reminds me of a close friend, who is currently clinically obese. She's very pretty, crazy-smart, conscientious, everything that overweight people are made to believe they're not. Yet she was still so embarrassed over even having this problem that she didn't address it for years. Now she's on track and losing weight quickly but needed support and empathy, not shaming.

Obesity is often not a matter of people being lazy or unaware of how unhealthy it is. It's the same way people smoke in spite of knowing it's unhealthy. It just takes a lot of strength and effort to publicly acknowledge the problem and fix it.

 

[SunsFun]

Here's a study that shows even overweight people who are metabolically 'healthy' are still at increased risk for adverse outcomes.
http://www.ncbi.nlm.nih.gov/pubmed/?term=24297192

The real question is how physicians can produce the best outcomes in these types of patients. It is difficult to treat the health issues if the patient is not onboard with you. It's also an issue that tough to tackle from the relatively narrow window of care that a physician can provide. There are social and cultural issues that run very deep as well.

I've been beating this dead horse for a while now. Physicians quite often have a very limited locus of control and as we know short "interventions" are not that effective. Unfortunately some doctors adopt a notion that the patients need to exercise personal responsibility and being obese is their fault. I am not going to argue with that because vast majority of average Americans will take the path of least resistance and pick short reward over long-term goals. This is just human nature. Some will become obese in the process because they didn't get the genes to be able to intake tons of calories and remain slim.

The way to deal with this problem is mostly on the level of community structure and urban design. As I have said before, if we permanently move all our obese Americans into the environment like Japan - they will lose weight.

 

[deleted407021]

So, rather than telling my patient that his or her current physical state isn't acceptable, I will tell them that their lifestyle is unacceptable. Telling them their physical state is unacceptable will produce feelings of self disdain, self-disgust or on the other end of the spectrum will close them off and make them defensive. Telling them their lifestyle is unacceptable won't elicit quite the same emotions. A lifestyle can be changed as quickly as the next day. A physical state can't. Additionally, lifestyles are viewed by people as alterable; your physical state is,to a greater extent a part of your sense of self. I don't want to attack their sense of self. That's creating mental ill-health, IMO. I want them to be mentally and physically healthy.

Targeting the lifestyle is the key. They know they're fat, sick and nearly dead. They have been told that before. Now, they must be made aware of all the things they could be doing better. The classes we provide let folks work together to achieve these nutritional and exercise goals and they quite enjoy it. When you take "my body is gross" and replace it with "the things I eat are gross" you can completely change how people view the situation.

 

[QuinnTheEskimo]

Targeting the lifestyle is the key. They know they're fat, sick and nearly dead. They have been told that before. Now, they must be made aware of all the things they could be doing better. The classes we provide let folks work together to achieve these nutritional and exercise goals and they quite enjoy it. When you take "my body is gross" and replace it with "the things I eat are gross" you can completely change how people view the situation.

I think the problem is that, in the past, people had to "exercise" and eat well out of necessity. They ate a certain way because they had no other choice, there was no canned soda or packaged chips. Even housework was more strenuous, as there were less technological developments in that area. In our grandparents' generation (or even our parents' generation), nobody was hitting the treadmill on a daily basis. Today, we basically have to ask patients to go against every visceral desire they have, in order to lose weight.

I hate to say it, but I am very pessimistic about the obesity crisis in America. The best we can do as doctors is counsel patients on the dangers of obesity, encourage them, and refer them to nutritionists and/or weight loss clinics.

 

[3838]

I completely agree with @3838 and @BrainsIsCool. People are made to feel such levels of shame and guilt over being overweight by society that they slip into denial or get very defensive. This reminds me of a close friend, who is currently clinically obese. She's very pretty, crazy-smart, conscientious, everything that overweight people are made to believe they're not. Yet she was still so embarrassed over even having this problem that she didn't address it for years. Now she's on track and losing weight quickly but needed support and empathy, not shaming.

Obesity is often not a matter of people being lazy or unaware of how unhealthy it is. It's the same way people smoke in spite of knowing it's unhealthy. It just takes a lot of strength and effort to publicly acknowledge the problem and fix it.

Many health problems are this way. Humans are humans. They make mistakes. Teens pick at their acne and make it worse. People let cancer get out of hand. The snookis of the world go to tanning beds and get melanoma. People smoke and do drugs. College students get their livers shot. So what? I want to help all of these people and I'm not going to beat them up for making mistakes. I'm going to help them deal with the consequences. Without judging them. Obesity can be the result of many factors, and you know what? It might not be completely their fault. I could never look a working single mother (who may barely have time to work, cook, and put her kids to bed) in the face and tell her that it's her fault that she's fat.

Also, personally, I would make sure to speak about having a healthy lifestyle to every single person who walks through the doors of my clinic, whether he/she is skinny or fat. How do I know that the healthy looking girl isn't eating oreos for lunch and dinner everyday and sits and watches TV 8 hours a day? How do I know that the body builder isn't jacking himself up on steroids? I want to stress a healthy mind and body to all my patients, not just those that are overweight and obese.

 

[sourdoughllama]

She also seems to be aggressive toward "thin people", which probably arises from her perception (probably true, but exaggerated in her mind) that they are treated better within society. She's playing the "fat card".

I dislike Health at every size as much as everyone else on this thread. I just wanted to say, though, that as a former fatty, I think being thin has led me to be treated significantly better.

 

[3838]

I think the problem is that, in the past, people had to "exercise" and eat well out of necessity. They ate a certain way because they had no other choice, there was no canned soda or packaged chips. Even housework was more strenuous, as there were less technological developments in that area. In our grandparents' generation (or even our parents' generation), nobody was hitting the treadmill on a daily basis. Today, we basically have to ask patients to go against every visceral desire they have, in order to lose weight.

I hate to say it, but I am very pessimistic about the obesity crisis in America. The best we can do as doctors is counsel patients on the dangers of obesity, encourage them, and refer them to nutritionists and/or weight loss clinics.

If humankind can invent computers, we can figure out a way to invest in and construct a public health infrastructure that can fight obesity.

 

[gumdrops]

I dislike Health at every size as much as everyone else on this thread. I just wanted to say, though, that as a former fatty, I think being thin has led me to be treated significantly better.

Sigh, same.

 

[BlueLabel]

@Ace-Co-A, @3838 : Fair enough. The impression that I got from the post was "these mortality statistics indicate that weight loss isn't important, only healthy lifestyle is". Subsequent posters made the explicit connection between healthy lifestyle and weight loss (not just equivalent mortality statistics); although this may have been implicit in the post I didn't pick up on it and felt the way the statistics were presented was misleading, particularly because the incorrect remarks regarding the physiology of obesity implied that it was an unrealistic objective to attempt to reduce the patients BMI.

I'm all for crafting appropriate interventions designed to achieve the best outcome; slip the pill in the applesauce. I just think it is important to reinforce that obesity itself carries significant health risks. In other words, equivalent mortality stats do not mean that one can truly be "healthy at every size".

 

[3838]

Can I just make it clear that I take issue with almost every statement in HAES? In case that wasn't clear in my post? I think she's misguided. But, I think that MANY patients have the same thoughts and emotions as her. They may feel overwhelmed or intimidated by being asked to lose weight. They may shut down as soon as you mention it. That's why I would target lifestyle changes, which in the case of patients like this, would be more effective.

 

[NontradCA]

I don't get the OP and blogs you listed..someone on the interwebz(a blog of all places) wrote something you disagreed with. You wanted to make a thread to feed your ego and make fun of fat people? Please tell us about your all empowering pre-med knowledge of all things health. Why not just say lets talk about fat people thread. Oh SDN, The doucheyness within you grows daily.

 

[deleted407021]

I think the problem is that, in the past, people had to "exercise" and eat well out of necessity. They ate a certain way because they had no other choice, there was no canned soda or packaged chips. Even housework was more strenuous, as there were less technological developments in that area. In our grandparents' generation (or even our parents' generation), nobody was hitting the treadmill on a daily basis. .

In the US and other western nations, namely the UK, fast food and factor farming has provided those of us who eat the filth, with a unique feature in human natural history. We can now take in way more calories on a regular basis than any other time in history. In addition to this, we now, more than any other time, have little need to exert ourselves on a regular basis, so you generate the issues we see today. On top of all that, many of us are starving on a biomolecular level. Fast food has enormous levels of fat, sugar and highly refined carbs but little else. This is a condition called the "hidden hunger", a broad micronutrient deficiency that used to only arise in underdeveloped nations. Not only are we consuming many more calories than we need, we are receiving them from very bad sources that contain very little of what our bodies need to function properly.

You end up with things like this:

(non traumatic)

 

[touchpause13]

What's the tongue thing about?

 

[3838]

.

 

[Reckoner]

So, rather than telling my patient that his or her current physical state isn't acceptable, I will tell them that their lifestyle is unacceptable. Telling them their physical state is unacceptable will produce feelings of self disdain, self-disgust or on the other end of the spectrum will close them off and make them defensive. Telling them their lifestyle is unacceptable won't elicit quite the same emotions. A lifestyle can be changed as quickly as the next day. A physical state can't. Additionally, lifestyles are viewed by people as alterable; your physical state is,to a greater extent a part of your sense of self. I don't want to attack their sense of self. That's creating mental ill-health, IMO. I want them to be mentally and physically healthy.

I agree with what you're saying now that I know what you meant with that first post, but this seems a little bit starry-eyed. Anyone who has ever dealt with a drug addict (not obesity, I know, but there are many similarities in terms of behavior and stigma) knows that telling them "their lifestyle is unacceptable" is often completely ineffective.

Not saying this isn't a better approach than attacking someone's appearance, but lifestyle interventions usually fail as well.

 

[3838]

okay dude. acne is not caused by the food that you eat. I had acne and I am one of the biggest health freaks I know. You know what my snack of choice is? Toasted double fiber bread, sliced apples, and low sodium organic peanut butter with flax seeds. My acne was caused by stress, lack of sleep, hormonal problems, and genetics.

 

[gumdrops]

(non traumatic)

[/quote]

THAT TONGUE

 

[sourdoughllama]

I don't get the OP and blogs you listed..someone on the interwebz(a blog of all places) wrote something you disagreed with. You wanted to make a thread to feed your ego and make fun of fat people? Please tell us about your all empowering pre-med knowledge of all things health. Why not just say lets talk about fat people thread. Oh SDN, The doucheyness within you grows daily.

Just FYI this blog is part of a bigger movement called Fat Acceptance with many people blogging and even going on news interviews. There's even a society called national association to advance fat acceptance (NAAFA). YouTube it! It's real

 

[deleted407021]

okay dude. acne is not caused by the food that you eat. I had acne and I am one of the biggest health freaks I know. You know what my snack of choice is? Toasted double fiber bread, sliced apples, and low sodium organic peanut butter with flax seeds. My acne was caused by stress, lack of sleep, hormonal problems, and genetics.

There are lots of causes and aggravators of acne. http://www.news-medical.net/health/Obesity-and-skin-problems.aspx

There's lots of other information about which foods can cause acne to arise.
I'm a vegetarian and I juice daily (≈6 apples, 10 carrots, 1 beat, 1 kale sprig, 2 oranges and anything else I may like). I've never had bad pimples but those I did have completely vanished when I started taking in dense nutrients. What I am consuming is significantly more nutrient rich (although lacking in protein and carbs) than the portion you cited. But I imagine you eat more variety than that. Acne has many sources.

 

[QuinnTheEskimo]

okay dude. acne is not caused by the food that you eat. I had acne and I am one of the biggest health freaks I know. You know what my snack of choice is? Toasted double fiber bread, sliced apples, and low sodium organic peanut butter with flax seeds. My acne was caused by stress, lack of sleep, hormonal problems, and genetics.

This. People have had acne since ancient times.

 

[Ace-Co-A]

@Ace-Co-A, @3838 : Fair enough. The impression that I got from the post was "these mortality statistics indicate that weight loss isn't important, only healthy lifestyle is". Subsequent posters made the explicit connection between healthy lifestyle and weight loss (not just equivalent mortality statistics); although this may have been implicit in the post I didn't pick up on it and felt the way the statistics were presented was misleading, particularly because the incorrect remarks regarding the physiology of obesity implied that it was an unrealistic objective to attempt to reduce the patients BMI.

I'm all for crafting appropriate interventions designed to achieve the best outcome; slip the pill in the applesauce. I just think it is important to reinforce that obesity itself carries significant health risks. In other words, equivalent mortality stats do not mean that one can truly be "healthy at every size".

 

[3838]

There are lots of causes and aggravators of acne. http://www.news-medical.net/health/Obesity-and-skin-problems.aspx

Most people with acne will do ANYTHING ANYTHING to get rid of it. As a high schooler, I tried cutting out milk, sugar, refined carbs, I've drunk carrot juice until my hands turned yellow, I drank raw turmeric (do you know how GROSS that is?). Most people's acne is NOT caused by food. there is very little evidence for that. Drinking too much milk might possibly screw with your hormone levels. that's about it. I've done so much research on acne, combing through journal article after journal article, there's nothing you could tell me about acne that I don't already know. I know how all the medications I use work. I know the pH's at which they are optimal.

 

[BlueLabel]

I don't get the OP and blogs you listed..you wanted to make a thread to feed your ego and make fun of fat people? Why not just say lets talk about fat people thread. Oh SDN.

I PRESENT TO YOU THE SPITEFUL REMARKS OF A CRUEL, EGOTISTICAL SADIST WHOSE ONLY CONCERN IS THE HUMILIATION OF FAT PEOPLE:

"Look, I am all for a more tolerant, understanding, and inclusive society. But before that I am for a healthy society. I see no reason why social activism should for any reason impinge upon the execution of best practices by healthcare professionals."


Read the OP again, I'm sure you will pick up on where I was going with this like every other person who read it.