New Thread: Weight issues in psychology

[wigflip]

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They did things like helping people develop time management and organizational skills, increase the effectiveness of their communication or politically savvy behaviors in difficult/hostile work environments, sometimes helping people with weight loss goals where there is no pre-existing or additional mental health issues....

It's funny; there was a previous thread on life coaching and someone made the same assertion there (multi-part list of specializations that included "weight loss goals"). I'll respond here in the same way I did there: "weight loss" doesn't belong on that list. I'm not taking issue with the facts (coaches do, in fact, work on weight goals with clients), but with the ethics of it. Time management (which seems like a fine domain for life coaching) isn't in the same ballpark as weight/body size issues. Weight loss related services constitute a multi-billion dollar industry precisely because the longterm outcomes are so dismal for people pursuing intentional weight loss. I'd regard any health/mental health practitioner specializing in weight loss as suspect.

 

[ClinPsychEnthus]

It's funny; there was a previous thread on life coaching and someone made the same assertion there (multi-part list of specializations that included "weight loss goals"). I'll respond here in the same way I did there: "weight loss" doesn't belong on that list. I'm not taking issue with the facts (coaches do, in fact, work on weight goals with clients), but with the ethics of it. Time management (which seems like a fine domain for life coaching) isn't in the same ballpark as weight/body size issues. Weight loss related services constitute a multi-billion dollar industry precisely because the longterm outcomes are so dismal for people pursuing intentional weight loss. I'd regard any health/mental health practitioner specializing in weight loss as suspect.

I'm not sure that is a fair statement to make, as I think it is very contextually bound. Sure, some people experience weight along with a myriad of self-esteem/self-identification issues and pathology (even sub-clinical) and would be inappropriate for work with someone who has no training in working with these things... but, what about people who simply lack knowledge? Who grew up in environs where portion sizes were off, exercise was de-emphasized, healthy eating wasn't taught or valued, or who don't understand some basics about body, nutrition and health?? Those people aren't pathological, per se... they are ignorant. They need knowledge. Once they gain the knowledge, then they can always be re-evaluated if they continue to struggle with behavior change or if other issues emerge.

It probably sounds silly, but if you've ever seen Jaime Oliver's Food Revolution you could get that picture in your head- many many of the people he helped lacked even basic knowledge about health, nutrition, etc. There were only a few people presented on the show that may possibly have needed psychological help. My only point is, save the psychologists' time for those people, and let the others learn their knowledge from someone CERTIFIED to teach them (I also really dislike the people out there who claim to be "personal trainers" and/or who claim they can teach people about nutrition without the proper education. Oh, the crap you can find on the interwebs nowadays...)😡

 

[Pragma]

Don't some health psychologists do weight loss work? Not like being a spotter, but psychoeducation and such?

 

[AcronymAllergy]

Don't some health psychologists do weight loss work? Not like being a spotter, but psychoeducation and such?

There's one at my current internship site who works in a weight management clinic (which is also staffed by a variety of other healthcare professionals) for children and adolescents, yep. And I know there are also health psychologists who do bariatric surgery-related evals and therapy.

 

[Pragma]

There's one at my current internship site who works in a weight management clinic (which is also staffed by a variety of other healthcare professionals) for children and adolescents, yep. And I know there are also health psychologists who do bariatric surgery-related evals and therapy.

Yeah I know some of those too. I'd imagine if they are doing interdisciplinary work with other professionals in a wieght-loss clinic, it could be a good team-based approach to helping someone lose weight. But I wonder if any go out and practice independently for helping people lose weight.

 

[wigflip]

The results are dismal because it is challenging to make lifestyle changes. People don't like to work. I think it's similar in cause to why people often prefer a pill to psychotherapy. It's easier.

Fact: You eat less calories than you burn, you lose weight.
Fact: You exercise properly and eat healthy, you decrease body fat weight and increase muscle weight.

What percentage of the population works out at moderate to high intensities regularly? What percentage of the population has a gym membership and uses it?

For some reason, people have a block about fitness. In my opinion, we should be educating people and physicians/psychs should be bringing up fitness and diet with everyone (including those who are in "healthy" BMIs). The impact of exercise on health outcomes across a large range of indicators is huge. But, people don't take advantage of it.

As to the OP, I agree, regulate that crap.

Oh no, not this again. Jon, if the science actually said it was that simple and uncomplicated, that people essentially endure oppressive stigma and discrimination because they're lazy, and undisciplined, you don't think the outcome data on longterm weight loss would look different?

Thanks for your sensitive and nuanced mansplaining. Now I know that research indicating that cortisol levels, medication, metabolism, genetics, a history of weight cycling, and other factors don't actually affect weight and body size. I'll just be over here with the other fatties, lolling about in a tub of cupcakes, wondering why I haven't magically become whatever size the smug, thin folks think is acceptable.

 

[Pragma]

Oh no, not this again. Jon, if the science actually said it was that simple and uncomplicated, that people essentially endure oppressive stigma and discrimination because they're lazy, and undisciplined, you don't think the outcome data on longterm weight loss would look different?

I have a related debate in my undergraduate courses sometimes, and it is usually lively. There tend to be some folks who approach America's growing obesity rates as a public health concern (given the high incidence of comorbidities and mortality rates), and some who approach it as a social stigma issue (citing, for example, hiring studies for overweight women).

Oftentimes I think that some of the folks who focus mostly on stigma may not recognize the public health issues to the extent they should. In my clinical experience, I have seen countless folks with amputations secondary to type II diabetes, dementias, and other severe health comorbidities involved with maintaining an unhealthy weight. Often these patients were not educated about the basics of what their medical condition (e.g., diabetes) was.

I think they are two completely separate issues. But one question I admit has popped into my head is: can you be oppressed when you are the majority (i.e., 68% of American adults are overweight or obese according to the most recent CDC data).

Yes, I know...major tangent. But I think it is important for us as psychologists to be able to be sensitive to body image and social consequences of obesity, while also acknowledging and acting on the importance of educating and motivating people to live at a healthier weight.

 

[Pragma]

One other thing about social stigma - I was a smoker. Gradually, smoking became more and more difficult to do as the costs went higher, physical barriers became greater, and probably most importantly, the social stigma became absolutely intense. I couldn't smoke a cigarette without getting dirty looks. People mock smokers at hospital meetings. Really, society is quite oppressive towards smokers these days.

Is that social stigma a good thing in this case? I am not entirely equating smoking as an unhealthy behavior to overeating as an unhealthy behavior, but they are worthy of comparison I think. Why can we oppress someone who wants to smoke a cigarette but not one who wants to eat two tubs of Ben and Jerry's per day? There are societal costs to both.

 

[paramour]

There's one at my current internship site who works in a weight management clinic (which is also staffed by a variety of other healthcare professionals) for children and adolescents, yep. And I know there are also health psychologists who do bariatric surgery-related evals and therapy.

Oh, geeze, don't get me started on the bariatric surgery evals. Person comes into office for an evaluation because they "need" surgery. Why? Because they "want" it? Why? Because they know someone, just recently heard about someone, or just watched someone on TV who had it. It worked wonders for them, so it will work wonders for this individual as well. So give it to me now! Person's never tried to lose weight, never made any attempt to change their diet, never made any attempt to exercise. They just want a quick & easy fix. And they don't intend to change anything until after surgery because "maybe" they'll gain some motivation to make those needed changes afterward. 🙄

In the meantime, you have folks who get fed up dealing with said clients, pass them back for surgery... And look-y here! They're right back where they started in half a dozen years or so when they've regained all that weight because they never discovered that motivation to actually do a damned thing. So now they're back and "need" another surgery.

But no one thinks to educate these folks re: the ongoing psychological & physical risks of these procedures... Even with the individuals who have tried to lose weight unsuccessfully. Yeah, there's that informed consent issue, but I suspect it's glossed over in a huge number of cases.

 

[Therapist4Chnge]

Thanks for your sensitive and nuanced mansplaining. Now I know that research indicating that cortisol levels, medication, metabolism, genetics, a history of weight cycling, and other factors don't actually affect weight and body size. I'll just be over here with the other fatties, lolling about in a tub of cupcakes, wondering why I haven't magically become whatever size the smug, thin folks think is acceptable.

...great wording.

Interestingly, the majority of the population is overweight and a growing % classified as morbidly obese, though fatism is alive and well. Louis C.K. has a great bit about being overweight and skinny people not understanding. He uses this very matter of fact somewhat snooty voice while saying, "Why don't you just have one donut and that is it?" and his reply is, "Because I CAN'T!!" He was doing it to be funny, but his bit touches on the reality that making the kind of lifestyle changes JS mentioned can be very hard to do.

 

[Qwerk]

But one question I admit has popped into my head is: can you be oppressed when you are the majority (i.e., 68% of American adults are overweight or obese according to the most recent CDC data).

Well...yes. That's kind of like saying, "Can people of color be oppressed when they're in the majority?" Clearly they can, and we've seen examples of this all over the world.

Is that social stigma a good thing in this case? I am not entirely equating smoking as an unhealthy behavior to overeating as an unhealthy behavior, but they are worthy of comparison I think. Why can we oppress someone who wants to smoke a cigarette but not one who wants to eat two tubs of Ben and Jerry's per day? There are societal costs to both.

I don't think hiring discrimination, mocking, sexism, body shaming, and stereotyping are helpful deterrents. (For the record, I don't think discrimination against smokers is wonderful either.) Have they worked so far?

I think you also need to make a distinction against public health statements (e.g. "people shouldn't eat this and that") and discrimination against overweight people (e.g. "fat people are disgusting").

 

[wigflip]

Jon, your statement to the effect that fatness is acceptable today would be laughable in its ignorance, but unfortunately there is a rich social psych/sociological literature detailing the many areas in which fat folks endure very tangible discrimination. Look it up.

Pragma, I appreciate your willingness to break from the pack and at least attempt a sensitive conversation on the topic. But I'm gonna drop out anyway. I'm going to resist noting, in any detail, the confounding variables present in a lot of the weight-and-health research (most notably weight cycling and sedentary lifestyle), the conclusions which diverge significantly from the results, the inflated/distorted epi numbers, the moral panic aspect, the fact that healthcare providers' biases (mental health not excluded) negatively impact fat people's likelihood of seeking medical assistance when needed. Past experience with this topic on this forum leads me to believe that a productive conversation on weight/body size, if even possible, would require way more effort to achieve than I'm willing to provide.

 

[Therapist4Chnge]

Have you ever compared fast food options? A Jimmy Johns tuna sandwhich and chips is more calories than a 2 cheeseburger combo from McDonalds. But, we see those Subway ads. There's a lot of misinformation out there. If people actually monitored their caloric intake they would be very surprised, in my opinion.

I treated myself to Buffalo Wild Wings last night (HR Derby on), and it was one of the few times I encountered a menu with the caloric intake listed for each item. It was crazy how many calories were in the "healthy" food (hint: their dressing is super fatty/caloric), but their typical food was even worse. To contrast the 'healthy' options, they were advertising a 12 wing combo: 6 boneless, 6 tradition, a side of fries & coleslaw. I don't know if they counted bleu cheese/ranch sauce..but IIRC it was 2200 calories. Add in a couple beers and a person is pushing 3000 calories...for one meal. I ate 6 wings (@100 cal ea. for Mango Habenero..yum!) w. some bleu cheese (200 cal. for partial serving), and 1/2 an order of small fries (130 cal., not bad!). Right there is almost 1,000 calories, and I tried to be mindful of my caloric intake. Unfortunately many people eat out quite frequently (I can't afford to), so they pack away hidden calories. Portion sizes are completely out of wack in the US. There has been some interesting research on what people think is a "normal" serving size. A good guesstimate is 1/2 to 1/3 of a meal at The Cheese Cake Factory is on the high side.

 

[Pragma]

Well...yes. That's kind of like saying, "Can people of color be oppressed when they're in the majority?" Clearly they can, and we've seen examples of this all over the world.

I agree that they can. It's just interesting to me that people can selectively select which majorities you can be a member of and be oppressed, and which ones you can't. I think it is obvious that anyone can be potentially oppressed, and some minority (and majority groups, for that matter) are oppressed more systemically.

I don't think hiring discrimination, mocking, sexism, body shaming, and stereotyping are helpful deterrents. (For the record, I don't think discrimination against smokers is wonderful either.) Have they worked so far?

Well no, discrimination is not a good thing. But get a group of people together united against something (a candidate, a behavior, etc), and you'll notice that they create outgroups in day-to-day life. Check out any political protest. In my case, the social stigma was probably my biggest reason to change my behavior (more than the $/policies).

I think you also need to make a distinction against public health statements (e.g. "people shouldn't eat this and that") and discrimination against overweight people (e.g. "fat people are disgusting").

Absolutely. But do you realize how much is in between those two things? That's what people argue about. Some people think that suggesting anyone eat differently is oppressive. Some people are very sensitive. You will encounter resistance whenever you try to urge people to change their behavior.

 

[wigflip]

Hiring discrimination given the burden of healthcare costs on companies, on the other hand, makes sense and also increased risks of sick days, etc. . .

Justifying discrimination? I'm sorry, but that is really offensive.

By that same logic, men should be hired neither as teachers nor any kind of mental health care job, since the prevalence of sexual abuse perpetrated by men is so much higher than by women. White folks should get stop-and-frisked, since they are more likely to have drugs on them than are people of color. We could simply go on forever.

But, I know, fat folks are special. We're discriminated against because "it's good for us." 😡

 

[Pragma]

Jon, your statement to the effect that fatness is acceptable today would be laughable in its ignorance, but unfortunately there is a rich social psych/sociological literature detailing the many areas in which fat folks endure very tangible discrimination. Look it up.

Pragma, I appreciate your willingness to break from the pack and at least attempt a sensitive conversation on the topic. But I'm gonna drop out anyway. I'm going to resist noting, in any detail, the confounding variables present in a lot of the weight-and-health research (most notably weight cycling and sedentary lifestyle), the conclusions which diverge significantly from the results, the inflated/distorted epi numbers, the moral panic aspect, the fact that healthcare providers' biases (mental health not excluded) negatively impact fat people's likelihood of seeking medical assistance when needed. Past experience with this topic on this forum leads me to believe that a productive conversation on weight/body size, if even possible, would require way more effort to achieve than I'm willing to provide.

Fair enough, but I certainly would be interested in learning more about your perspective sometime. I'm less aware of the methodoligical issues, and certainly biased by my experience with predominantly low SES clients in that I think lack of education is one of the primary problems.

 

[JeyRo]

One other thing about social stigma - I was a smoker. Gradually, smoking became more and more difficult to do as the costs went higher, physical barriers became greater, and probably most importantly, the social stigma became absolutely intense. I couldn't smoke a cigarette without getting dirty looks. People mock smokers at hospital meetings. Really, society is quite oppressive towards smokers these days.

Is that social stigma a good thing in this case? I am not entirely equating smoking as an unhealthy behavior to overeating as an unhealthy behavior, but they are worthy of comparison I think. Why can we oppress someone who wants to smoke a cigarette but not one who wants to eat two tubs of Ben and Jerry's per day? There are societal costs to both.

Social pressure is a highly preferable way to encourage positive health behaviors compared to coercion, fines / taxation, sanctions, prohibitions, just my opinion

 

[Therapist4Chnge]

No, it's not laughable at all, nor is it ignorant. You are clearly quite sensitive on this topic. And, that's fine. But, what Americans perceive as overweight and what is actually overweight are not the same things.

There are also HUGE (pardon the pun) differences in perception of healthy for someone who lives in an east coast city like NYC and someone who lives in Mobile, Alabama.

 

[Therapist4Chnge]

Fair enough, but I certainly would be interested in learning more about your perspective sometime. I'm less aware of the methodoligical issues, and certainly biased by my experience with predominantly low SES clients in that I think lack of education is one of the primary problems.

Lack of education is definitely a factor, though so is access to food. There has been some really interesting data on access to fresh produce in an urban setting. Add in cultural factors like "southern cooking" and economic limitations, and it is no surprise that the average american is overweight.

 

[paramour]

There are also HUGE (pardon the pun) differences in perception of healthy for someone who lives in an east coast city like NYC and someone who lives in Mobile, Alabama.

Hey, careful now, you're talking about a huge chunk of my family... 😛

 

[Pragma]

Social pressure is a highly preferable way to encourage positive health behaviors compared to coercion, fines / taxation, sanctions, prohibitions, just my opinion

When does social pressure become social stigma? Just curious. It certainly is effective.

 

[Therapist4Chnge]

Hey, careful now, you're talking about a huge chunk of my family... 😛

I was going to make up a city name (Anytown, USA), but Mobile was what I settled on instead. 😀 I spent some time training in a place where it was more likely to be on a BBQ Team than a softball team and being vegetarian was someone who ate pulled pork, chicken, etc...but not beef. I totally get where you are coming from. I attended more "[Produce name] Festivals" than you can shake a stick at! I didn't make any of the tractor pulls, though I did learn quite a bit about farm equipment! Joking aside, it is a very different approach to what is 'healthy' when you live in the South or the Midwest.

 

[paramour]

We make hiring discriminations on every decision on every candidate. But, my comment was more about the misplaced responsibility of healthcare on employers and also burdensome laws with respect to what employers can do when they have an employee who does not work effectively because of health issues and, then there is, of course, the bottomless pit that you can fall into if you do happen to become debilitatingly sick for an extended period of time. Awful situation.

So we should discriminate against any & all health issues, not just individuals with weight issues. Yes? Seems like they're (the overweight & obese) some of the few with their potential health complications viewable for their prospective employers, whereas others get a free pass as long as they don't mention it. This doesn't seem fair if we're going to make hiring decisions based on "potential" (or even known!) health issues.

 

[Pragma]

Lack of education is definitely a factor, though so is access to food. There has been some really interesting data on access to fresh produce in an urban setting. Add in cultural factors like "southern cooking" and economic limitations, and it is no surprise that the average american is overweight.

Absolutely cultural factors, familial norms, access. But there is certainly an element of convenience, and using food to feel good as well.

I've dabbled in academic research about eating disorders in various contexts. I know that we have a tendency to over-pathologize some things, which is why I think that discussing the various factors associated with weight IS important for people to do. Otherwise "Binge-eating disorder" could just become the next "ADHD"

 

[paramour]

I was going to make up a city name (Anytown, USA), but Mobile was what I settled on instead. 😀 I spent some time training in a place where it was more likely to be on a BBQ Team than a softball team and being vegetarian was someone who ate pulled pork, chicken, etc...but not beef. I totally get where you are coming from. I attended more "[Produce name] Festivals" than you can shake a stick at! I didn't make any of the tractor pulls, though I did learn quite a bit about farm equipment! Joking aside, it is a very different approach to what is 'healthy' when you live in the South or the Midwest.

Yeeah, the majority of my relatives are spread across various parts of the South. (We had folks who drove their tractors & riding lawn mowers to school... 😛) No big surprise that most of the relatives are overweight/obese and have a hx of high blood pressure, diabetes, cardiac issues, strokes, etc.

I moved just a smidgen north to the Midwest... and we still have Cornfest. There's even a Corn Princess! Even here in Chicagoland, there's a huge Southern influence on diet, which I suspect partially contributes to the prevalence of individuals who are overweight/obese (although you still typically see the South with the greatest rates and the first states to start increasing during periods of change before it expands outward... ).

 

[Therapist4Chnge]

So we should discriminate against any & all health issues, not just individuals with weight issues. Yes?

Should employers...no, do they...yes. JS has a point about pushing to owness on employers. People need to be more responsible for their own health and well being, but our healthcare system is not setup like that. It rewards high utilizers, punishes the healthy/young, and doesn't do much to encourage preventative care. There is no real incentive for most people to bother to get/stay healthy. Those of us who are young and healthy are footing an inordinate amount of the bill.

 

[Pragma]

I can't help but laugh at the title of this thread when I consider where we have ended up here.

 

[paramour]

<sigh> Ah, to be young & healthy again . . . 😛

I can't help but laugh at the title of this thread when I consider where we have ended up here.

I was thinking the same a few moments ago. I couldn't determine why I was responding to this thread (thought maybe I was in the wrong one) because the title didn't seem relevant...

 

[JeyRo]

When does social pressure become social stigma? Just curious. It certainly is effective.

Not sure. That seems like trying to discuss the objective difference between a freedom fighter or a terrorist, if you get my drift. Depends on your POV, I suppose.

 

[Pragma]

Not sure. That seems like trying to discuss the objective difference between a freedom fighter or a terrorist, if you get my drift. Depends on your POV, I suppose.

Well I'd hope we could operationalize stigma vs. social pressure, in that I'd imagine social pressure could be positive (encouragement, etc), or applied in a non-discriminatory way.

But I think the more effective social pressure tends to be the stuff motivates you via wanting to avoid embarassment/marginalization. It becomes harder to distinguish when the behavior becomes discriminatory, IMO.

 

[Therapist4Chnge]

It may be helpful to split this topic off...

I've dabbled in academic research about eating disorders in various contexts. I know that we have a tendency to over-pathologize some things, which is why I think that discussing the various factors associated with weight IS important for people to do. Otherwise "Binge-eating disorder" could just become the next "ADHD"

I actually started my research training looking at body image and associated ED risk factors (not exactly neuro 😀, but instead an extension of my undergrad work), so this issue was once near and dear to my heart. Anyhow...I think the generic term "eating disorder" is thrown around far too casually by laymen and professionals, though I believe the base rates for the various ED Dx's are not actually representative of the prevelance of disordered eating in Western culture. Disordered eating is widespread, and it isn't just with women who are 13-21...as is a common stereotype by the general public. I think "overeating" is probably more applicable than binge-eating disorder, as the latter is a very different construct (at least how I view it). IMHO, the DSM-IV-TR left a lot to be desired in how it quantified the various types of disordered eating that exist out there.

Hmm...now we are really off topic. I think there was a thread about EDs and the DSM-V if someone wants to bump a thread and discuss this further. 😀

 

[paramour]

It may be helpful to split this topic off...



I actually started my research training looking at body image and associated ED risk factors (not exactly neuro 😀, but instead an extension of my undergrad work), so this issue was once near and dear to my heart. Anyhow...I think the generic term "eating disorder" is thrown around far too casually by laymen and professionals, though I believe the base rates for the various ED Dx's are not actually representative of the prevelance of disordered eating in Western culture. Disordered eating is widespread, and it isn't just with women who are 13-21...as is a common stereotype by the general public. I think "overeating" is probably more applicable than binge-eating disorder, as the latter is a very different construct (at least how I view it). IMHO, the DSM-IV-TR left a lot to be desired in how it quantified the various types of disordered eating that exist out there.

Hmm...now we are really off topic. I think there was a thread about EDs and the DSM-V if someone wants to bump a thread and discuss this further. 😀

I've had folks tell me that being a "picky eater" is an ED. 🙄

And it seems EVERYONE has BED. We had a prof (who was teaching a Nutrition/ED course) who repeatedly told us very personal, explicit details of her life and why she thought she (and everyone else in the world) qualified for an ED. The prof had no idea what she was talking about most of the time, and I'm still not sure why she was "teaching" the class. I use "teaching" loosely as the students taught the entire semester, and she provided nothing but lots of gross mis-information to perpetuate the ignorance surrounding EDs. 👎

 

[Qwerk]

I've had folks tell me that being a "picky eater" is an ED. 🙄

Don't roll your eyes just yet -- Google around and you'll find online support groups for people who vomit if they eat anything other than French fries or angel food cake. A rare phenomenon, sure, and not well-researched, but these people seem sincere.

I read this WSJ article about it a while back: http://online.wsj.com/article/SB10001424052748704699604575343130457388718.html

Here's a link to the online questionnaire for the study they reference, which is apparently the first research conducted on adult picky eating. Sounds interesting. www.dukehealth.org/clinicaltrials/the_food_fad_study_finicky_eating_in_adults

 

[paramour]

Don't roll your eyes just yet -- Google around and you'll find online support groups for people who vomit if they eat anything other than French fries or angel food cake. A rare phenomenon, sure, and not well-researched, but these people seem sincere.

I read this WSJ article about it a while back: http://online.wsj.com/article/SB10001424052748704699604575343130457388718.html

Here's a link to the online questionnaire for the study they reference, which is apparently the first research conducted on adult picky eating. Sounds interesting. www.dukehealth.org/clinicaltrials/the_food_fad_study_finicky_eating_in_adults

Ah, yes, I've seen more of these "types" of "selective eaters" popping up in the news as of late. Kids only eating McD's diets since the age of 2 and the like. I think calling such individuals "picky" is a bit of an understatement. I know a number of picky/selective eaters who manage to eat more than a handful of items, not just french fries, chicken nuggets, & grilled cheese (good grief!), and they're not restricted to fast/junk food.

Interesting, yes, and I've seen it researched bit more in the sensory research with children previously--not so much in adults. But not everyone who limits/restricts their food intake has an ED, just as not everyone who overeats has BED. I can see the benefit of researching more into this area; I also can see it being received really poorly by individuals who think everyone who's picky has an eating disorder, must be distressed, and needs x, y, or z (oh, wait, this already happens).

 

[wigflip]

So we should discriminate against any & all health issues, not just individuals with weight issues. Yes? Seems like they're (the overweight & obese) some of the few with their potential health complications viewable for their prospective employers, whereas others get a free pass as long as they don't mention it. This doesn't seem fair if we're going to make hiring decisions based on "potential" (or even known!) health issues.

I'm surely going to regret jumping back into this.

I'm assuming that paramour's first sentence here is facetious, no? Still baffled that anyone here would favor hiring discrimination, or any other form of discrimination.

Paramour's key word above is "potential." Yeah, maybe Fatty is going to be out sick now and then. And so might that sylphlike size 0 waif that all the guys around the water cooler are drooling over. Or all the people who occupy many sizes in between. One of the top funded folks in my current program is a gym rat who openly boasts on facebook about cutting out of work.

It's a mistake to conflate thinness and fitness/health or to assume that all fat folks (and yes, those of us who are politicized prefer that terminology to "overweight" or "obese") are either ill or on their way to catastrophic illness. There are plenty of people who are fat and fit, with good cardiovascular fitness, strength, flexibility, and all the other markers of health (healthy BP, low cholesterol, etc.).

I'm probably fatter than a lot of folks here. But I guarantee you that if we strap on our backpacks, I'll get to the top of the mountain first.

 

[Therapist4Chnge]

From what I can tell, there's no such thing as fit and fat. The data appear to be relying on BMI ratings.

I think this is one of the primary limiting factors to some of the older research from the 90s and early 00s, as BMI isn't horrible as a quick and dirty measure, but it is limited (in my opinion) because it lacks the kind of specificity I'd want in a study.

 

[Pragma]

I think this is one of the primary limiting factors to some of the older research from the 90s and early 00s, as BMI isn't horrible as a quick and dirty measure, but it is limited (in my opinion) because it lacks the kind of specificity I'd want in a study.

Are you suggesting that the the BMI I was assigned by my Wii Fit is somehow not fully reliable or valid? 😱

 

[BlackSkirtTetra]

There's no reason we (as a society) can't accept obesity and hate it at the same time.

I actually think that's the case.

The obese are sick and deserve compassion, not fat jokes. Those who advocate for "fat acceptance" have always confused me. I've never seen "diabetes acceptance" or "scurvy acceptance" movements. I think of obesity as a real physical health issue on par with those things.

 

[Qwerk]

Are you suggesting that the the BMI I was assigned by my Wii Fit is somehow not fully reliable or valid? 😱

Irrelevant anecdote from my partner's family:

At a family gathering, partner's uncle gets on the Wii Fit and it tells him that he's obese. Various family members start to tease him about it because, y'know, they're like that. Uncle's little daughter is later found under a table, looking sad. Partner asks her what's wrong.

"They said my dad's a beast. But he's really not!"

 

[roubs]

I don't think anyone set out to be obese. A culture that teaches/encourages blaming one's self for obesity is contributing to the problem. Gradually gaining one pound a year is enough to get someone obese. Without regular measurement and substantial attention to intake/expenditure, anyone could end up with excess weight.

At the same time I think it's plain as day that anyone will keep their original joints waay longer if they run up the mountains with a minimum of adipose tissue. Acceptance of how obesity happened should not have to equate to acceptance of continued excess diabetes-inducing belly fat. It should be okay that extra weight arrived and okay that it needs to depart.

If ~zero people actually make obesity a goal for themselves or their loved ones, why should they defend that they got it like some overpriced useless Sharper Image purchase? I'd be like "Thanks [sales dude/my body], but on second thought I don't really need this!"

 

[ClinPsychEnthus]

I don't think anyone set out to be obese. A culture that teaches/encourages blaming one's self for obesity is contributing to the problem. Gradually gaining one pound a year is enough to get someone obese. Without regular measurement and substantial attention to intake/expenditure, anyone could end up with excess weight.

I think this is a key point, and is another one that separates issues of weight from issues of mental health at times...

I continue to think about this as I interact with or even see pictures of some phenomenal psychologists... who happen to be overweight or even obese. If you google various names, you will find that some of them have significant weight issues, yet are clearly psychologically healthy.

Having known and met some of those people, I can't help but recognize that sometimes there are reasons why this is. Sometimes, these psychologists travel a LOT to conduct or disseminate their research. Sometimes, their schedules are so busy that, when push comes to shove, they don't choose to use their time preparing healthier meals and exercising. Its a choice they are entitled to make. And some, in light of other perspectives and priorities, don't see it as a big deal. Arguably, in light of the traumas and tragedies experienced by some clients, you could see why working out isn't a priority to some (again, psychologically healthy) clinical psychologists.

That's when I'd argue that a life coach could be really helpful. Not necessarily a personal trainer who's going to take the "No excuses!" route... Let's be honest- psychologists who work with really significant problems could see that as a total lack of understanding about the real problems in the real world (i.e. "...people are suffering and dying around the world, and this PT is telling me I have no excuse to not work out 5 days a week? gimme a break...")

However, IMO personally (anecdotally) find that I cope better and experience the problems of my clients better when I am refreshed and energized. Lately for me that has come to mean that I am always seeking to get the nutrition that I need, and if I have to take shortcuts on one of the 2, I'll take the shortcut on exercising.

Clearly we continue to see what a complicated topic this actually is, even for ourselves. Therefore, I reiterate that I do take issue with the idea that weight issues are equal to mental health issues. Sometimes, yes... always? No.

 

[BlackSkirtTetra]

You're all going to think I've jumped off the deep end for knowing this, but there are actually people who set out to become obese.

Some are the BBW (Big, Beautiful, Women) fetish community and some call themselves feeders/feedees, where they have a partner who (literally) spoon-feeds them until they reach gargantuan sizes.

Granted, these folks seem to be the extreme minority, but they do exist. For them, giant sizes in the range of 600-800 pounds are the desired goal.

 

[futureapppsy2]

At the same time I think it's plain as day that anyone will keep their original joints waay longer if they run up the mountains with a minimum of adipose tissue

Huh? I thought hardcore running was generally really hard on people's joints in the long-run (and even in the not-so-long-run). 😕

 

[futureapppsy2]

Hi, guys,

I made this its own discussion separate from the LMFT scope of practice thread and moved the relevant posts over here. Please continue the discussion here and not in the original thread.

Thanks. 🙂

 

[Ollie123]

Huh? I thought hardcore running was generally really hard on people's joints in the long-run (and even in the not-so-long-run). 😕

Depends how "hardcore" but its a common myth that typical recreational running is bad for the joints. I don't know that there is a definitive answer yet, but there is evidence in both directions (causes problems/is protective) and effects seem relatively small regardless, suggesting its probably not a big deal either way. Overall, health benefits seem to vastly outweigh any risks of running for the general population. There are, of course, certain individuals for whom it could cause problems and thus is contraindicated.

 

[Doctor Eliza]

Having known and met some of those people, I can't help but recognize that sometimes there are reasons why this is. Sometimes, these psychologists travel a LOT to conduct or disseminate their research. Sometimes, their schedules are so busy that, when push comes to shove, they don't choose to use their time preparing healthier meals and exercising. Its a choice they are entitled to make. And some, in light of other perspectives and priorities, don't see it as a big deal. Arguably, in light of the traumas and tragedies experienced by some clients, you could see why working out isn't a priority to some (again, psychologically healthy) clinical No.

(Sorry, the last few words there got jumbled. It's hard to do some of this on an iPad).

While, I agree with a lot of what you have to say, I think that you are missing one important factor: genetics. There are certainly some people out there that can abuse their bodies like crazy, not eating right, never exercising, etc. and still be super-skinny. Just because one person is heavier than another, you cannot assume that the heavy person doesn't take care of themselves and the skinny person does.

One thing I always tell my clients who are down on themselves about weight issues is that "We're not all given the same deck of cards". It is truly a different battle for everyone. We get into trouble when we assume that there is a simple answer that fits everyone.

Dr. E

 

[JeyRo]

Depends how "hardcore" but its a common myth that typical recreational running is bad for the joints. I don't know that there is a definitive answer yet, but there is evidence in both directions (causes problems/is protective) and effects seem relatively small regardless, suggesting its probably not a big deal either way. Overall, health benefits seem to vastly outweigh any risks of running for the general population. There are, of course, certain individuals for whom it could cause problems and thus is contraindicated.

Yes, I'm citing "Time Magazine," so sue me: http://www.time.com/time/health/article/0,8599,1948208,00.html

 

[ClinPsychEnthus]

(Sorry, the last few words there got jumbled. It's hard to do some of this on an iPad).

While, I agree with a lot of what you have to say, I think that you are missing one important factor: genetics. There are certainly some people out there that can abuse their bodies like crazy, not eating right, never exercising, etc. and still be super-skinny. Just because one person is heavier than another, you cannot assume that the heavy person doesn't take care of themselves and the skinny person does.

One thing I always tell my clients who are down on themselves about weight issues is that "We're not all given the same deck of cards". It is truly a different battle for everyone. We get into trouble when we assume that there is a simple answer that fits everyone.

Dr. E

I COMPLETELY agree with you. That is another factor that I see as important when it comes to conceptualizing weight issues... and another reason why I think that it is unfair to equate obesity with pathology. Sorry if not giving this as an example implied that I didn't include it in my list of confounds 🙂

 

[Pragma]

Yes, I'm citing "Time Magazine," so sue me: http://www.time.com/time/health/article/0,8599,1948208,00.html

Thanks! I am a runner but not hardcore. This was a good read.

 

[psychRA]

Oh, geeze, don't get me started on the bariatric surgery evals. Person comes into office for an evaluation because they "need" surgery. Why? Because they "want" it? Why? Because they know someone, just recently heard about someone, or just watched someone on TV who had it. It worked wonders for them, so it will work wonders for this individual as well. So give it to me now! Person's never tried to lose weight, never made any attempt to change their diet, never made any attempt to exercise. They just want a quick & easy fix. And they don't intend to change anything until after surgery because "maybe" they'll gain some motivation to make those needed changes afterward. 🙄

This is a bit off topic, but have you done bariatric surgery evals, or worked in a setting where they were done?

I'm not trying to be snarky or argumentative, but I would like to provide some information from the standpoint of someone who has worked in such a setting. Granted, this was several years ago, but I can speak to my own experience.

Gastric bypass surgery is not an "easy fix." Not by any stretch of the imagination. It requires major, lifelong modifications in eating behaviors. Any reputable surgical center provides extensive education about this (at my center, this included several months of weekly classes), and does not allow surgery to be scheduled until it is clear that the patient is willing and able to make these changes, both before and after surgery.

I have to disagree with your assumption that patients just up and decide to pursue bariatric surgery without having tried to lose weight by any other means. In my experience, this just doesn't happen - ever. The overhwhelming majority of patients seen at my center had tried every weight loss strategy imaginable, often multiple times, over the course of years or even decades. Diets, exercise programs, pills, herbal supplements, self-help books, support groups, hypnosis...you name it, they'd tried it. Did our patients sometimes benefit from some basic education about nutrition and physical activity? Yes. Were they lazy individuals who'd just never bothered to try losing weight before? No. Like I said, that just didn't happen. In fact, insurance companies generally won't approve surgery unless the patient has made serious, long-term attempts to lose weight in the past under medical supervision.

Contrary to popular belief, people do not just sit around getting fat for years under the assumption that they'll just pop into surgery when they hit a certain point.