body image · equality · fitness · inclusiveness · Martha's Musings · stereotypes · training · weight stigma

Weight bias and obesity interventions: no easy answers

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A person wearing a black swim dress and pink flip flops gets ready to swim.

By MarthaFitat55

A while ago I had reason to consult with an anaesthetist. We went through the risk assessment and had a chat. The clinic nurse had told me the team might have some questions because of my weight.

Fair enough. I could hardly fault them given what’s involved in going under, so to speak. But I was cautious because context is so often missing when numbers are thrown around, especially numbers relating to the Body Mass Index (BMI).

According to that scale, one originally developed by insurance companies, I am obese. Anaesthetists aren’t fond of having to deal with obese people. So we had a chat and it was actually quite good.

Here’s the thing: I eat reasonably well, with almost all the required fruits and veggies, high fibre foods, lower fat choices, more fish and legumes, and less red meat and alcohol, our health system deems the better diet to follow.

I’m also pretty active. At the time of the chat, I was weight training twice a week, swimming two to three times a week, taking a trail walk lasting more than an hour weekly, and looking to get my steps in on a daily basis.

The doctor asked me about the weight training, and I ran through the numbers: bench was around 48kg, deadlift was around 105kg, and squat was 97.5 kg. So those numbers tipped the deal. If I could do all that, then I wouldn’t have any trouble, they concluded.

It made me think though. For the past ten years, I have acted on the guideline about eating less junk and focusing more on whole foods while being more more mindful about how active I am.

Truth is, I’m not prepared to starve nor am I prepared to add any more hours of activity (in fact I am at or past the threshold for the recommended 150 to 300 minutes of moderate to vigorous activity per week already).

At the back of my mind, I always believe I should be able to do more, and yet I can’t. It bugs me when I hear facile comments repeated in every weight loss inspiration story shared by the media. We all make choices, but some times even the good choices don’t make that much difference.

When SamB shared an article about how such tag lines like “Eat less, move more” contribute to weight bias, I was intrigued.

And I felt vindicated. Despite all my efforts in the gym, in the kitchen and yes, in my own mind, when I ran up against health professionals, who looked at numbers like BMI as reliable indicators of health, I felt my work was not enough, nor good enough, to make the difference society expected in my body shape.

Nor am I the only one. Canadian Obesity Network researcher Ximena Ramos Salas looked at obesity prevention policies and messages. She tested the messages with people living with obesity and what she heard was illuminating.

The short form is those messages don’t work. They are neither helpful nor accurate.

“Saying obesity is simply an issue of diet and exercise trivializes the disease. It makes those living with obesity feel like it is a lifestyle or behavioural choice, and therefore their fault. This causes them to feel judged and shamed, and to internalize the stigma of weight bias.”

Ramos Salas also reported “People told me that the public health messages were not relevant to their experiences. They didn’t relate to the messaging, they felt it didn’t consider other factors that contribute to their obesity that are unique to them, like genetics, mental health, medications and so on. It did not reflect the challenges that they faced while trying to manage their weight on a daily basis.”

I think these are two useful insights that should get more attention. But the best message arising from the research Ramos Salas is engaged in is this: “Not everyone who is big has obesity. People come in different shapes and sizes, so the idea that we categorize people based on their size as ‘healthy’ or ‘unhealthy’ is not accurate.”

I was fortunate I met with a health professional who was open to hearing about my numbers intead of relying on a flawed indicator to make a decision about my health status. Too many people though do not and some actually close that door themselves because they are not confident they will get the care they need.

For me, my conversation with the anaesthetist helped validate my choices about the fitness path I am on even though assumptions about weight and health by others may have forced the issue. I may never meet the biased image for health and fitness such weight stigma imposes, but I know I am doing the best I can given my circumstances. To suggest otherwise is limiting and dismissive.

— Martha is a writer and powerlifter in St. John’s.

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