Thursday, January 31, 2013

Doctors, please don't tell fat people to lose weight

I seem to have taken a slide into weight and body issues on this blog. Oh, well. That's where my focus is these days. Food issues are a huge part of my self esteem building and I'm determined to spend my fifties in a lot less self-hatred than I spent my thirties (and every year before 30).

Shapely Prose is an archived blog that was maintained by Kate Harding between 2007 and 2010. The focus of the blog was to advocate for the acceptance of all bodies, no matter their size. It was a strong part of the fat acceptance movement and as an archive, it still is. Harding has moved on to other projects and the comments are closed on Shapely Prose, but I strongly recommend that anyone with body issues check it out. So I'm talking to pretty much every American woman alive today plus a lot of American men.

I particularly like Harding's post called Reality vs. Relativism. She asserts that since there's no method that safely and conveniently causes a fat person to become thin permanently, fat people with health conditions need medical advice other than "lose weight." Harding points out that the human body simply isn't designed to become skinnier over the long term: it's designed to maintain stasis or beome fatter. She writes that weight loss studies (whether for diets, exercise or weight loss surgery) rarely follow results for more than one or two years, while most weight loss reverses within five.

(I've learned that while weight loss surgery can cause dramatic results, the challenges of a post-surgery digestive system are more demanding than most of us know. And even if the person meets their nutritional needs, manages the pain and accommodates their stomach's reduced capabilities, the weight can come back eventually.)

Harding argues that we must stop telling fat people to improve their health through weight loss because it's simply not realistic. I agree. For a doctor to advise a fat person with bad knees to lose weight is stupid. If the patient could lose weight, she would have done it. Does the doctor not know that? Weight loss is terrible medical advice because even if the patient resolved to try it again, how is she supposed to get out of the building without pain? A doctor advising weight loss for an acute condition is cruel as well as ignorant. What about the person's symptoms today?

Given that -
- we're hooked on an American way of life that causes fatness
- weight loss surgery is difficult to live with, dangerous and sometimes fatal
- diets and "lifestyle changes" rarely maintain weight loss permanently
Then what else has the medical community got?

It better come up with new ideas because we've pretty much proven -- since the 1970s -- that weight loss as a public health solution isn't realistic. As long as doctors give fat patients impossible requirements like losing 50 pounds, fat people aren't going to get the medical help they need. Now please read Harding's excellent post on this subject because she says it way better than I do.

[P.S. Here's an eye-opening discussion of some possible results of bariatric surgery on the blog of a registered nurse with 30 years experience.]

1 comment:

Mick said...

Reading the headline of this post reminds me of the occupational nurse who used to do our annual works medicals. She told almost everyone they needed to lose weight yet she was far more overweight herself, always made me laugh.