wshaffer

So, the AMA has declared obesity a disease, which I guess means I have an extra diseases that I didn't have last week. Funny, I don't feel sick.

I've seen a number of folks applaud this decision by saying, "Well, at least now fat people can get the treatment they desperately want/need."

Which baffles me. Because for most of my adult life, my doctors have insisted on treating my fatness whether I wanted them to or not, often at the expense of what were arguably more urgent medical problems.

And the thing is, most doctors are pretty crap at treating obesity. Which in part is not their fault, because we don't have any good scientifically-validated ways of reliably getting more than a tiny percentage of people to lose weight and keep it off. Most doctors don't seem to be terribly aware of that.

Here are some of my favorite ways that doctors have tried to get me to lose weight:
* Threatening to withhold prescriptions for birth control pills unless I lost weight. (Because fat people don't deserve to have sex anyway? Interestingly and possibly non-coincidentally, they stopped pulling this shit on me after I got married.)
* Telling me to "drink more water" (Not horrible advice in and of itself, but at the time I would have had to lose 100 pounds to be "normal" on the BMI chart, so the idea that a couple extra glasses of water a day were going to get me there was pretty laughable.)
* Instructing me sternly not to butter my toast at breakfast. (Without bothering to inquire whether I ate toast, or even breakfast. At the time I habitually partook of neither. This was merely the most hilariously memorable of a general pattern of doctors telling me to eliminate certain foods or categories of foods, usually without bothering to check if I actually ate them. Notice that you can tell that this example was from the 1990s, because the dietary bugbear du jour was saturated fat. If the same thing had happened 10 years ago, the doctor might have been just as likely to tell me to skip the toast and eat the butter.)

Lest I tar the entire medical profession with the same brush, I should mention the rather wonderful nutritionist I worked with when I was in graduate school, who introduced me to the revolutionary concept that it was perfectly okay to eat when I was hungry, and who encouraged me to look at foods from the perspective of their total nutrients and overall effect on my health or mood rather than just calories. I didn't lose a lot of weight working with her, and it took several more years of going 'round the weightloss merry-go-round before I was able to fully incorporate everything she taught me into my daily life, but she actually gave me sane, practical advice.

So, this rant was touched off by a blog post that I ultimately decided not to link to. Partly because the author of the post was clearly speaking the truth about her own experience, and I didn't want to seem to be attacking her for doing that. And partly because she's hardly the first or the last person to put forth the idea that triggered this rant: The notion that extremely overweight people are using food as a way to deal with emotional pain. This idea is usually expressed as something along the lines of, "No one gets to be a hundred pounds overweight just because they like to eat."

Actually some of us do. I did. Though to be fair, it went a bit beyond "liking to eat." It was more along the lines of, "when I eat highly-processed high-carbohydrate foods, my appetite regulation goes haywire and I'm constantly hungry, causing me to eat more highly-processed high-carbohydrate foods." When I cut back on the highly-processed high-carbohydrate foods, I stopped being hungry all the damn time, and I lost quite a bit of weight. (More significantly, I got back all the time I used to spend wondering if gnawing on the corner of my desk would somehow help me deal with the fact that I was ravenous despite having eaten an hour ago. Being constantly hungry sucks.) I didn't need to confront my emotional issues. I just needed more protein and fiber.*

Now, I'm not trying to deny that there are people who struggle with emotional eating, and that some of those people are fat. But every time someone makes a blog post like this, well-meaning commenters announce their intention to reach out to their fat loved ones and help them confront the emotional demons that they are battling with food. Wanting to help a loved one is commendable; trying to help a loved one with the attitude that you understand what the problem is better than they do is...well, "unlikely to work" is the kindest thing I can say.

*You have no idea how uncomfortable writing that paragraph made me feel. I think because it feels like such a conventional piece of weight-loss narrative. I practically expect it to wind up with, "And if I did it, you can do it to!" Maybe you can do it too; maybe you can't; maybe you don't want to. I use myself as an example because I think I have a pretty good understanding of what made me gain and lose weight, and so I think I can speak fairly authoritatively when I say that deep-seated emotional issues were not involved.

So, I came perilously close to dispensing weight-loss advice to someone yesterday, and I still feel kind of dirty. I guess this post is my penance.

I'm not categorically against the idea of pursuing weight-loss. It just seems hard for most people to do it without a) getting hung up on unrealistic standards for what their bodies should look like and b) falling prey to people peddling weird diets backed by dubious science that promise to provide that missing link that explains why just eating less and moving more didn't do much for them. (As indeed it doesn't for many people.)

I'm constantly struck, lately, by how often I hear something roughly along the lines of, "I want to be healthy, so I'm going on a diet." And it always throws me, because there's a huge logical leap happening between the two halves of that sentence, and we're so culturally conditioned to equate thinness with health that most of us don't even notice that leap. I'm still trying to come up with a way to say, "If you want to be healthy, how about doing something that actually promotes health?" without totally harshing people's squee.

I'm either the world's best or world's worst advocate for a health-first approach: I've been overweight my entire life, and throughout my twenties, I sporadically dieted in an effort to avoid various weight-related health problems that I was assured were headed my way. Basically, I'd lose twenty pounds and then gain them back, along with twenty of their friends. At some point in my early thirties, having dieted myself all the way up to being morbidly obese, I was sitting in my doctor's office, looking at a particularly dispiriting set of lab test results, and I thought, "You know, this weight-loss thing has kind of been a bust. How about we just focus on being healthy?"

So, I did. And within a couple of months, my lab test results had gone from being nearly universally crappy to being normal to excellent. And then over the course of the next year, I lost about a third of my body weight.

Which is where I become a bad advocate, because when I talk about this, people understandably find the whole "third of my body weight" thing rather arresting, and then we're having a weight-loss conversation again. Except that this time it's "If you really want to lose weight, you have to focus on health instead of on losing weight." Which is sort of interestingly Zen, but is it an improvement?

I don't know. I still think the best advice is: If you want to keep up with your kids, or climb stairs without getting winded, do some aerobic exercise. If you want to be strong, pick up heavy things repeatedly. If your cholesterol is bad, eat more fiber and less saturated fat. If your blood pressure is high, eat more fruits and vegetables and less salt. If you want to stop falling asleep at your desk mid-afternoon, consider whether you can balance what you eat at lunch so that it doesn't make your blood sugar spike and crash. Doing any or all of these things might also result in your wearing a smaller pants size, but setting out to wear a smaller pants size might not get you anything but smaller pants. If that.

A few interesting links I wanted to share:

• Via Mary Anne Mohanraj: A blog post on getting things done by creating rituals. I seem to have developed a very effective bedtime ritual that involves meditating, brushing and flossing my teeth while dancing around to silly pop music, and then choosing a podcast to listen to while falling asleep. I think I need to find more ways to incorporate ritual into my work, though. It would probably help me get certain routine but annoying things done more quickly.


• Via Big Fat Blog: When Your Doctor Makes You Feel Fat. The experiences I've had with weight bias in health care are pretty mild compared to some of what's described in this article, but I can definitely relate. Unfortunately, although the article promises "Here's how to make sure you get the health care - and the respect - you deserve," it doesn't offer much beyond "If you feel you are experiencing weight bias, tell your doctor so. And if you don't like the response you get, find another doctor." Some of the most obnoxious fat-shaming I've ever experienced was during an emergency room visit - how do you find another doctor when you're in the ER?


• I'm not sure how I missed out on Susan Schorn's Bitchslap column over at Timothy McSweeny's up until now. Both this recent one on princesses and gender roles and this early one on the rules for women who get a black eye during karate class are brilliant. As soon as I get a chance, I'm going back and reading through the whole archive.


• Via Stumptuous.com: Weightlifting could change your life on why women should lift weights. The point the author makes about noticing a big difference in every day activities is a good one. I've seen noticeable benefits from aerobic training as well, most notably in the ability to keep up with my longer-legged spouse without getting winded. But strength training makes a surprising difference, not only for things like slinging your luggage around, but for things that you don't really think of as requiring strength, like sitting up straight in a chair or shaking your hips when you're dancing to silly pop music while brushing your teeth.