health · stereotypes · weight loss · weight stigma

6 things Sam hates about seeing doctors, as a larger person

None of this is true about my current set of health practitioners. But they took awhile to find. Right now I’m halfway between jobs and cities and I’m looking for a new family doctor to start. It’s tough. And here’s why!

1. They believe ridiculous things about me. See this article about doctors and bias against larger patient. “Much research has shown that clinicians have biases related to overweight and obesity, conditions that affect more than two-thirds of U.S. adults, Dr. Gudzune said. “[With] the magnitude of the effect of obesity in our country, a substantial number of people are experiencing health care disparities as a result,” she said. Studies have consistently shown that physicians associate obesity with such negative attributes as poor hygiene, nonadherence, hostility, and dishonesty, Dr. Gudzune said. “These types of attitudes are pervasive. It’s not just in the U.S. … [but] physicians across the world as well: Australian, Israeli, European physicians. … These attitudes have been documented as far back as 1969, and they continue to persist up until today,” she said. In surveys of primary care physicians, more than 50% view patients with obesity as awkward, unattractive, and ugly, Dr. Gudzune said. “They have less respect for patients with obesity. They also believe that heavier patients are less likely to follow medical advice, benefit from counseling, or adhere to medications, which are some of the things that are really critical in thinking about managing obesity,” she said. She added that these attitudes may extend to other health professionals, such as medical students, nurses, and nutritionists.” Not fun.

2. They prescribe weight loss for everything. The evidence bar is very low. If there’s even a small chance that weight makes a difference, they mention it.

3. They don’t believe my attempts at trying to lose weight. I just haven’t tried hard enough apparently. It’s as if once a have a serious medical reason, like putting off knee replacement surgery, I’ll snap to it, get down to business, and the pounds will just melt away.

4. They don’t have anything useful to say about how to lose weight. See this post on unwanted weight loss advice. “Why do doctors weigh patients and offer weight loss advice? Other than “eat less and move more” which is kind of like the weight loss equivalent of “buy low and sell high,” what recommendations do they make and why?”

5. But they recommend diets anyway even though the most likely outcome is that the patient weighs more at the end. In this post I wonder if doctors would do that with any other “likely to fail spectacularly” treatment. See Well intentioned lies, doctors, and the diet industry: If weight loss is impossible, ctors-and-the-diet-industry-if-weight-loss-impossible-then-what/

6. They never believe my blood pressure readings or my cholesterol levels. I’ve had a complete work up with a endocrinologist who gave me a clean bill of fat health but still, it’s an uphill battle being seen. See this post and this one.

I know Catherine and Nat have blogged here about issues with doctors. I often think, hey we’re all strong feminists with serious amounts of post secondary education and some good attitudes, we’re white, English speaking, able bodied, if we have problems with doctors what’s it like for other women who don’t share our bundle of privileges? If you’re a larger person, what’s the medical world like for you. We want to know.

fitness · weight loss

Weight-loss surgery for teens: a disturbing trend

We bloggers and readers been writing and talking amongst ourselves lately about children, weight, fat shaming, and concerns about policing and medicalizing kids’ bodies. Once you start down this path, it’s really hard to stop. And where does this lead? To increased health and fitness, an end to worries about body appearance and function and social acceptability? Not if you read the studies.

The recent news (and blog posts like this, this, and this) about Weight Watchers targeting children with their new teen diet programs has been a hot topic around here. I wrote here about what I don’t like about diets for children even when they’re informed by extensive research. In short, I don’t like weight loss programs that set up kids with possibly unattainable goals that also may not be necessary for them to live healthy and long lives.

But in the realm of kid weight problem concerns, nothing worries me like the increasing push to use both weight-loss drugs and bariatric surgery on children.

Let me repeat this last part: bariatric surgery on children.

What?

No, really, this is a thing now. Here’s Columbia University’s Center for Metabolic and Weight Loss Surgery’s take on age minimums:

Our consensus is that adolescence is really the boundary for performing weight loss surgery, and the World Health Organization defines adolescence as starting at age ten. However, aside from age, we look at other physiological factors such as sexual maturity and bone age growth when deciding whether or not bariatric surgery is appropriate in adolescents. With all these factors taken into consideration, the average age of adolescents undergoing surgery in our program is 16 years old.

Okay, ignoring the horrifying idea that a 10-year-old child is considered both an adolescent and potential candidate for this surgery, what’s so bad about this idea? That is, what makes this kind of surgery so worrisome for teens?

You asked (well I actually asked myself), so I deliver– here’s a short list:

Nutritional risks: teenage children are still developing, and weight loss surgery permanent compromises their ability to absorb nutrients. In particular, bone density and skeletal development may be (and have been shown in some studies) to be adversely affected. Deficiencies in levels of calcium, vitamin D, iron, B12, are common, so patients have to take supplements and be screened.

No real informed consent: in order to be able to perform any surgery, health care professionals are required to get informed consent from patients. This means explaining the nature of the procedure, possible and likely outcomes, side effects, and other important features of what life will be like afterwards. Teenagers are demonstrably not developed enough cognitively/neurologically to engage in long-term complex decision-making on this kind of scale. It seems to me grossly unfair to ask them to make such a life-changing decision at this point in their lives unless they are in extremis.

Pregnancy risks: yes, you read that right. In one study, the rate of pregnancy in a post-surgery cohort was twice that of the regular adolescent population. That’s not enough to conclude this with confidence, but it is enough for the American Society of Metabolic and Bariatric Surgery site to post this about that study:

This finding suggests that the risk of pregnancy in adolescents undergoing bariatric surgery might be increased. All female adolescents should be informed about increased fertility after weight loss and that pregnancy during the first 18 months after bariatric surgery has possible risks. These patients should be counseled to avoid pregnancy during this period and offered contraception.

In short, what are some things to worry about here? They are the usual worries about teenagers:

  • Teenagers can be short-sighted and lack perspective about long-term effects of actions.
  • Teenagers aren’t well-known for planning carefully against potential negative outcomes of actions.
  • Teenagers don’t excel at being perfectly compliant with rigid dietary or other behavioral regimens imposed on them.
  • Teenagers aren’t equipped to understand and process information to make the best decision about complex and emotionally fraught situations that they’re in the middle of.

That’s okay– this is part of what it means to be a teenager, and the rest of us are here to help them get through it. But putting them in a position to go through and deal with the outcomes from gastric bypass means exposing them to enormous risks and experiences they’re not equipped to handle and certainly will not want.

Tonight I’m going to this talk by a medical researcher who works with adolescents who get bariatric surgery. She’s going to talk about the complexity of weight and weight loss. I’ll report back later this week. Hope there’s a Q&A– I have a few questions for her…

fitness · weight loss · weight stigma

Weight watchers is not kid stuff; what about other programs?

Since Weight Watches announced its program targeting teenagers, there’s been a flurry of posts here, chock-full of information and perspective.

One of Sam’s recent posts has (among other things) pointed to research on fat shaming. There are severely harmful physical and psychological effects of identifying children as fat (calling them fat or overweight, treating them as fat, subjecting them to dieting, etc.)   Enrolling a child in Weight Watchers is a guaranteed way to label them as fat.

While we’re talking about studies, the data on the long-term effectiveness of Weight Watchers (or any commercial diet program) is not promising.  A 2015 systematic review  of commercial diet programs suggests that, in the very short term (3-12 months, mostly 3—6 months), Weight Watchers might produce a slightly higher incidence of >5% body weight loss in some populations (all adult) than self-directed dieting, but in the longer term (>12 months), we either have no data, or the data show weight regains (and then some).

Tracy’s post on dieting and magical thinking really gets at the psychological pitfalls of yearning for some way to transform our and our children’s bodies into shapes and sizes that conform to medical guidelines and BMI charts.  It’s an illusion, one that does us and our children much harm.

So, taking Sam’s challenge to heart—if not weight watchers for children, then what?—I decided to look around town to see what programs were on offer.

As some of you know, I live in Boston, which is a very good place to be sick; we have highly-rated hospitals to treat whatever ails you.  I found out from my friend Janet, who’s a health care provider, about the Optimal Weight for Life program at Children’s Hospital.  It’s associated with (and I assume partly funded by) New Balance  (the athletic shoe manufacturer), which has a named Obesity Prevention Center and also sponsors the OWL program at Boston area community health centers.

The OWL program is for families who are worried about their children’s weight and risks for type 2 diabetes, or who have children with type 2 diabetes.  After doing a bunch of medical tests, the treatment services focus on nutritional counseling and individual behavior modification.  Some group therapy is offered, and follow up is required for at least 6 months.  They tend to favor a low-glycemic index diet (one of their directors is David Ludwig, who leads research investigating and has written popular books promoting low-glycemic index diets; look here  for research and here for popular books).

I have to say, I really like the approach they use in the OWL programs at community health centers.  Here’s what they do:

10-week comprehensive program that introduces families to healthful eating and supports them in making changes to benefit their entire family.  The program offers group and individual counseling and is led by a dietitian and psychologist from the OWL clinic.  Group discussions and interactive activities allow for peer support, skill building and knowledge sharing. 

The first six weeks are spent in a group format.  For the groups, parents and youth are separated and both groups discuss the same educational topic.  Following the educational intervention, the groups unite for a healthy meal and a question and answer session.  Each class concludes with a hands-on activity to reinforce the main messages.  Upon completion of the groups participants attend 2-4 weeks of individual counseling with the dietitian and psychologist to develop behavior change strategies to support individual goals. 

Through the program, patients learn:

  • How to shop for and prepare balanced meals and snacks
  • How sleep and screen time impact health
  • How small changes can be implemented to benefit the entire family
  • How to address body image and bullying

All of this sounds reasonable, comprehensive and evidence-based.  By the way, what’s good for the goslings is also good for those of us on the spectrum from geese to ganders—that is, adults can also use support around shopping, screens, sleep, small changes, body images and fat shaming/bullying/harassment.

But I don’t like the name of the program—Optimal Weight for Life.  Yeah, it’s cool to have OWL as your acronym.  You could give away T-shirts with owls on them, or maybe even have an owl-petting room at the hospital.  It’s already been done in Japan at this café, and I hear it’s popular.

Here are my three problems with the name OWL– Optimal Weight for Life:

1.Optimal.  Why do we have to be optimal? That’s a pretty high bar to set.  There are lots of reasons and causes for a child to be of non-optimal weight.  Maybe it’s not an optimal time in a kid’s development to be optimal.  I’m not a parent, but I have observed my niece’s and nephews’ growth patterns over time, and their sizes and shapes and heights don’t increase in perfect synchrony. It’s just not the way human growth works (as Sam pointed out about her own kids). Sometimes they are shorter and wider, and sometimes longer and narrower, and this varies over time and across people.

Also, who says that optimality should be the goal?  We know from epidemiological studies (and by looking around in the world) that there’s a range of body weights, shapes, sizes, influenced by a host of factors, many of which we have no control over.  What makes “optimal” optimal is presumably association of a class of body weights with lowered risk factors for disease; otherwise, this is just a matter of aesthetics/conventions, right?  When we dive deep into that data vortex, I argue that, given both the intractability of long-term weight loss and the small or nonexistent shifts in relative risk profiles that come with some weight changes, setting “optimal” weight as a general patient goal is both unrealistic and unnecessary.

2. Weight. Why do we have to focus on weight? Why not health? There are lots of metrics that track health quite well, and weight is arguably not one of them. Yes, this is a contested position, but it’s held by lots of medical and public health experts.  Physical activity happens to be one of those metrics.  See here for results of a very large European study showing strong association between even small increases in physical activity and lowered all-cause mortality risk.

3. For Life. That sounds scary to me. Why?  Because it seems controlling, demanding, and not understanding about the ups and downs of our experiences through the life trajectory.  There are going to be times in every child’s life when their physical state will be non-optimal.  This is not a cause for panic, and it may not even indicate that anything is wrong. So, setting people up with this humongous and unrealistic (yes, I said that before—it’s still true) goal is not very nice and not, uh, well, realistic.

We’ve got a lot to learn about how to help people identify, move toward and find some stability around health-according-to-them.  Owls are a great symbol, but how about we go with more variation, in keeping with our own glorious variation?  I have something like this in mind, but need help with names/acronyms.  Any thoughts?

Animated brightly colored animals of all types, shapes and sizes.

 

body image · diets · eating · fat · fitness · weight loss · weight stigma

The new health target of the century: kids

The news made the rounds of the health at every size (HAES) contacts I have in my social networks. I shouldn’t have been surprised to learn that Weight Watchers was offering free six-week memberships to 13 year olds, and yet I was.

Shortly after that, I learned the makers of FitBit were launching a fitness tracker for children. According to TechCrunch, the makers of FitBit are targetting the eight- to 13-year-old market because as the Telegraph noted, we need to do something about getting “couch potato kids” off the couch and into the gym.

Because child obesity y’all. (Insert eye roll here.)

I’ll admit I’ve been on diets, and I also have used a FitBit (see this post for how I use mine). I went on my first diet with WW when I was 14 and I needed my mom to sign for me. I can’t say it was a success because despite an endless variety of diet plans, I have continued to be my own fun-sized self and not the one society said I should be.

I stopped dieting when I reached my 40s. I read the literature, I looked at the research, and I considered the methodology of the studies. These days I try to eat most of my fruits and veggies every day, be moderate about my meat consumption, and add more whole grains, beans, pulses, and fish to my plate.

I still eat chocolate, potato chips and ice cream treats on occasion, but I am more mindful about my daily choices. And when I really, really want the chocolate bar, I go for the good stuff and thoroughly enjoy it.

Diets are all about deprivation, regardless of how they are marketed. And they don’t work. The problem with marketing to teens, especially teen girls, is they already have a decade of misdirection on what a female body is supposed to look like behind them. All those messages have been accumulating and Weight Watchers is stepping up to take advantage of the anxiety-fertilized soil to grow their market.

Ultimately, the only thing the plan will do is teach girls deprivation is the norm, their bodies at 13 are unacceptable, and it is on them to change their bodies rather than society change its expectations for the form expected for women.

At first blush, there shouldn’t really be an issue with creating a tool for kids. However, there are many people who see the number of steps reached as tacit permission to indulge. Weight Watchers for awhile had an exercise component that allowed users to collect food points through exercise and then spend them on either more, or fun type foods.

Many of these exercise tools track not only steps or other types of activities but also calories and weight. If you want off the diet train and onto the gym track, it can be very hard to find a gadget or tool that doesn’t link weight and fitness. In fact, it is one of the reasons I and my trainer make a point to track personal records that are strength based instead of scale based.

Whatever your size, age and body type, we are, at least in North America, a more sedentary society. Television, junk foods and in house gaming systems are factors in the higher weights we are seeing. But the problem with marketing fitness gadgets to kids is that after awhile the appeal is going to fade. While gamification of anything works effectively in the short term for setting goals, once kids and youth get where they want to be, there isn’t a point to doing it anymore and it stops being fun.

A co-blogger on this site shared with me some thoughts she and her sister had about the Fitbit and they echo mine: “My experience with fitbits with grown ups is they don’t understand the correlation between steps and food so it almost gives them more ‘permission’ to eat that piece of cake or whatever. I only know two people who use it in the way it was designed (make sure I get in my steps to stay fit) and they are both people who would be fit anyway. For kids, it’s a good awareness raiser and a ‘game’ but if it becomes the gadget it kind of loses its function.”

My co-blogger’s sister also made an important point that links to unpacking, resisting, or creating a new culture around fitness: “Fitness especially in kids comes from values, habits, home discussions, role modelling, fun activities, and doing things that don’t seem like fitness to the kid.”

Doing things that don’t seem like fitness are often more fun when you don’t have the “must” factor. Even I think it is more useful to say to myself: “It’s a gorgeous day out — let’s go for a walk!” instead of “I need to get 2500 more steps in to meet my time for today’s fitness.”

While I think the offer from WW for 13-year-olds is more problematic than FitBit’s plan to extend its market share by focusing on kids, I do believe we need to think carefully about how we look to change the behaviour of children when it comes to eating and moving.

Because in some respects is not how we change the behaviour, but why we feel it is necessary in the first place.

— Martha enjoys getting her fit on with powerlifting, swimming, and trail walking.

weight loss

You are exercising to lose weight and you aren’t losing any, what now?

Image description: A photo of a winding road in Iceland with lupins by the roadside
Image description: A photo of a winding road in Iceland with lupins by the roadside. Photo from Unsplash.

So maybe you set out to do things differently in 2018. Your plan was to go to the gym, tidy up your diet, drop a dress size or two. Suppose though that instead you went to the gym, and maybe even cut out the cookies and the chips, and didn’t lose any weight. It’s a common story. It’s my story usually.

So what now?

Should you just quit trying? Quit exercising?

There are dozens of lists on this topic, reasons to keep exercising that aren’t about weight loss.

Here’s my favorite because it’s the longest. It’s 45 reasons to exercise that have nothing to do with weight loss.

There are lots of good reasons for severing the tie between exercise and weight loss. For lots of us it just doesn’t happen. See my post on plus size endurance athletes.

Also I worry it sends the wrong message to thin people.

So here are my favorite reasons for working out that have nothing to do with dropping a dress size.

1. The immediate thing is that it feels good. I always feel better after.

2. For me, exercise is usually social. It’s fun. It’s friends. Sometimes it’s family too. Often dogs are involved.

3. The health benefits of exercise go far beyond weight loss.

4. Even the looks related benefits go beyond weight loss. I may not lose weight but I like building muscle. Exercise makes my posture better too.

5. Then there’s the not so immediate things like sports performance, everyday functional fitness.

6. And then there are the distant goals. I want to still be hiking in my 80s.

How about you? Why do you exercise? What non weight related goals motivate you?

diets · eating · fitness · Throwback Thursday · weight loss

Let’s Talk about the Myth of the Skinny Vegan Bitch #tbt

Here’s a #tbt for you from four years ago. Though I would venture that veganism is more popular now than it was then, and is gaining followers all the time, myths still abound. And one of them is that you’ll get skinny real fast if you opt to eat a thoroughly plant-based diet. You won’t necessarily lose weight at all. But that’s not a reason not to try it. Another myth is that you can’t possibly retain muscle if you’re vegan. You can! I’ll write about that sometime next month. Meanwhile, enjoy this old post. I’m vegan, but I’m neither skinny nor a bitch (or so I like to think anyway)!
Tracy

FIT IS A FEMINIST ISSUE

vegan-food-cc-300x400Here’s how the first installment in the Skinny Bitch series (authors Rory Freedman and Kim Barnouin) starts:

Are you sick and tired of being fat?  Good. If you can’t take one more day of self-loathing, you’re ready to get skinny...

This is not a diet. This is a way of life. A way to enjoy food. A way to feel healthy, clean, energized and pure. It’s time to reclaim your mind and body. It’s time to strut your skinny ass down the street liek you’re in an episode of Charlie’s Angels with some really cool song playing in the background. It’s time to prance around in a thong like you rule the world. It’s time to get skinny.

It sounds almost empowering.  Almost.

The first red flag?  If you’re full of self-loathing then…wait for it…getting skinny is the answer!  If that’s not clear from the introduction, it is made…

View original post 656 more words

body image · fitness · weight loss

My new scale doesn’t tell me what I weigh, and I like it that way

I really hate scales.  I think I’m not alone here.  There are loads of comic strips with scale jokes, but I will spare you because they all seem to presuppose that the scale is an authoritative judge and we are the irrational defendants whose weight is a crime.

And with respect to this scale hatred narrative, you’re damned if you do and damned if you don’t.  If you weigh yourself, then you’re generally appalled or ashamed or enraged or depressed.  If you don’t weigh yourself, then you’re avoiding your responsibility, which is to confront the reality which is the numerical judgment of your total worth.

Okay, maybe that sounds a bit dramatic, but this is the story that whispers in our ears from time to time.

I went to a conference in the Netherlands in June, and the keynote speaker was a behavioral economist named Dan Ariely.  He works on lots of ways to better understand why we behave in various ways, and to figure out some ways to help us achieve some of our goals that we have trouble with (e.g. saving money, losing weight, etc.) .

In this talk, Ariely mentioned a study his group did in which they tested out a hypothesis:  that weighing yourself every day helps you focus on health goals, and may help with weight loss.  This is something lots of medical experts also believe, but it hasn’t been tested.  The problem is:  people hate weighing themselves.  Why?  Well, if you weigh yourself, says Ariely, one of three things will happen:

  1. You’ve gained weight, in which case you’re depressed.
  2. You’re the same, in which case you’re not happy (because you haven’t lost weight).
  3. You’ve lost weight, in which case you become anxious about the next time you have to weigh yourself, worrying that you might regain some of what you lost.

When you put it that way, it sounds unpleasant all around.

Part of the problem with scales is that they register changes all the time because our bodies are changing in weight all the time.    Body weight has very high variance– we can fluctuate up or down 2kg or more in any given day, and it doesn’t mean anything.  There are scales on the market now that register one-tenth of a pound change.  This is really irritating to me, as there’s nothing good about this information– it’s just part of the noise of the variance, but it has the power to make me feel really bad.

Of course there’s a really simple solution to this problem:  don’t weigh yourself.  That’s a perfectly fine option.  Lots of folks who write for this blog and who read this blog do (or rather, don’t do) exactly that.  I say huzzah to that.

But for me, I can’t seem to leave this scale thing alone.  This is because I do want to track my weight changes over time and because I do have health goals that involve weight loss if possible (yeah, these things are complicated; you all know this as well as I do).

Enter the scale that doesn’t tell me what I weigh.  Here it is:

The Shapa scale, a bright orange disc on my bathroom floor with a white S in the middle.
The Shapa scale, a bright orange disc on my bathroom floor with a white S in the middle.

Ariely and his team had an idea:  we don’t really need to know how much we weigh.  What we need to know over time is whether our weight is the same, up a little, down a little, up a little more, or down a little more.  So they developed this scale, called Shapa, that does just that.  It comes bluetooth enabled, with an app on your phone.  Part of the screen looks like this:

A screenshot from the Shapa app, with daily weigh in info (when you weighed yourself) and an optional mission for some activity or cooking.
A screenshot from the Shapa app, with daily weigh in info (when you weighed yourself) and an optional mission for some activity or cooking.

You bring your phone with you to where the scale is, and weigh yourself.  It takes a few weeks for Shapa to calibrate what your average weight is, and what your weight variance is over time.  Once it does that (and it won’t tell you those weights even if you ask nicely!), then when you weigh yourself, it will give you a message and a color.  Mine today looked like this:

A screenshot of the results of my weighing myself- I'm blue, which means "good", which means my weight is the same.
A screenshot of the results of my weighing myself- I’m blue, which means “good”, which means my weight is the same.

The scale keeps the weight variance to itself, and just tells you whether you’re the same, up (one or two standard deviations from the mean) or down (one or two standard deviations from the mean).  Though it says this in a more encouraging and colorful way.

I love this.  What I want to know is how my weight is responding to any changes in my activity or eating, and this scale tells me that without the burden of all those fluctuations which just vex me.  Of course, our clothes and mirrors and partners and selves and other cues can tell us about our bodies.  But I really do like this.  I like the daily attention to myself, and it’s offering me an occasion to think more about what sorts of changes I can or want to make to see if I can effect weight change over time.  And it is also telling me that weight isn’t the only thing that matters.  My weight has stayed the same over the past 6 weeks since I got the Shapa scale, but I feel like my clothes are a little looser.  This is probably because I’m in better physical shape (thank you Bike Rally for motivating me!).

That’s interesting information for me, too– that I can feel better, do more of what I ask of my body, and feel better in my clothes in the face of silence on the part of my scale.  Maybe I like that best of all.

What about y’all, dear readers?  Do you have a relationship with scales?  What is it?  What do you think about this crazy idea of a scale that refuses to tell you what you weigh?  I’d love to hear from you.