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…
There are things we want to be true but aren’t. One of those things–for me– is working out causing weight loss.
Why do I even care about weight loss? The reasons are boring and hard. I want to go faster up hills. That’s the physics of it. I want to look like the athletic person I am and have people recognize me as such. That’s the vanity of it. But absolutely the most important reason is knee replacement surgery and increasing the odds of a better recovery. It’s my left knee now, but soon it will be both. Mostly I keep weight loss talk off the blog with the exception of my monthly updates where I talk about it in the context of my knee.
Now, for me, the exercise connection isn’t the usual one. I’m not exercising now to lose weight. Rather movement and physical activity, mostly cycling but also hiking and dog walking and skiing, are big and important sources of pleasure and joy in my life. I need total knee replacement surgery to keep doing those things. I need to lose weight to better my odds of a good surgical outcome. I’m not exercising to lose weight. I’m trying to lose weight to keep physical activity in my life.
I’ve struggled with weight loss my whole life and I am bored with the issue. So bored. I’ve written so very much about the impossibility of weight loss. See here and here. I’ve written lots about weight loss myths, like the idea that everyone likes that slow steady weight loss is better than speedy. It’s not. Neither has good long term success but the former sounds better.
That said my eyes still light up when I see weight loss linked to exercise in the headlines.
Last month the media got all excited over a study showing that the right amount of exercise, if weight loss is your goal, is 300 minutes a week.
First, that’s an awful lot of exercise for someone who doesn’t work out now. Here on the blog we always tell people trying to establish a fitness routine to start small. 300 minutes isn’t small. And if you already do work out that much now and aren’t losing weight as a result, why expect a change?
Second, there also people (ME!) who do exercise vigorously more than 300 minutes a week. I ride or race my bike on Zwift at least 6 hours a week, or 360 minutes. I also lift weights. I do yoga. I walk Cheddar. As my son might say, 300 minutes is baby food.
Third, I worry that people who start exercising to lose weight and who don’t lose weight, will quit exercising and miss out on all the other health benefits of working out. Exercising is the single biggest positive change you can make for your health. But if you think it’s about weight loss, you are very likely to be disappointed. Don’t blame exercise and don’t blame yourself. It’s just the way bodies work.
Fourth, if we start to think of exercise as tied to weight loss, then what about the thin people? Doesn’t this inadvertently exclude thin people from hearing the right message about how important and good and valuable exercise is?
Many years ago I saw a physiotherapist who started talking to me about how he wished his wife would exercise, for her health and well-being. The problem is that she’s naturally thin and doesn’t think she needs to. She’s not athletic, finds sports boring, and has lots of other things in her life that interest her more than exercise. He told me his wife’s doctor has never once mentioned to her that exercise would be good or asked about how much she works out now. She looks like she works out (code for ‘she’s thin’) and so no one asks about exercise or recommends it.
(This is out of my wheelhouse, and I didn’t go look at the actual study, but it also seems to me to be short term weight loss and pretty small numbers in terms of study participants. Catherine Womack is our public health policy blogger who frequently reads the studies behind the headlines and explains them to our community. Maybe she’ll go look!)
For more commentary follow Yoni Freedhoff on Twitter about this study.
You might also want to watch his talk on rebranding exercise.
The answer, not surprisingly, then and now, is that it’s complicated.
Catherine concluded, “I don’t work in medicine, but I do know that there is a humongous evidence gap between what’s happening clinically in a particular hospital and its patients (each with their own complex medical and other histories), and what is true about everyone with higher BMIs in the US (not to mention other countries) with respect to risks related to COVID-19. Right now we can’t say much of anything. So maybe we shouldn’t. Which means the answer to my blog title question is, “we don’t have evidence right now to answer this question”. It doesn’t make for exciting news copy, but it’s the closest thing to the truth right now.”
But nevermind the fact that it’s complicated get in the way of a feel-good media campaign. Britain’s Prime Minister Boris Johnson plans an anti-obesity/anti-COVID-19 campaign, with bicycles front and center.
I have lots of complicated thoughts about all of this. And it’s not helped by all of the cycling advocacy groups which make up a good chunk of my social media newsfeed sharing news of the plan enthusiastically. Treehugger proclaims, Miracle Pill Found for Fighting COVID-19: The Bicycle.
First, it’s not at all clear that if you had to pick one thing to work on to improve COVID-19 control in the United Kingdom it’s weight loss. How about mask wearing? Contract tracing? Or speedy testing? There are many areas in which the UK’s COVID-19 response is lacking. I wouldn’t start by blaming individual citizens for their excess pounds.
Second, it’s not clear that there is a shred of evidence that ‘eat less, move more’ public health campaigns do anything other than shame fat people.
Here’s an obesity doctor’s assessment, “I find it impossible to fathom that anyone with even an ounce of knowledge of the complex, multifactorial, chronic, and often progressive nature of obesity should in this day and age still fail to understand that the proposed plan, which includes the usual talk of changing the food environment (largely by appealing to personal responsibility) and a 12-week weight loss plan app [sic], focussed on healthy living (read, “eat-less-move-more”), is about as likely to noticeably reduce obesity in the UK population, as taking out a full page ad in The Sunday Times stating that “Obesity is bad!”.”
But here he is, a committed, regular, everyday cyclist out there pushing bike riding for weight loss.
Note we’re different kinds of cyclists but neither of us is thin.
I love bikes but I hate to hear them promoted as weight loss tools.
Because, they’re not.
I love to ride my bike. I’m on track to ride 5000 km this year, or about a 100 km a week. You can follow me on Strava, here. On ZwiftPower I’m here. I’ve been doing this for years and I can assure you it’s not making me any smaller.
And I worry that if people start riding to lose weight, and they don’t lose weight, they’ll quit and miss out on all the other benefits of moving through life on two wheels. For example, cyclists are the happiest of commuters.
In my post on reasons to ride I give some of my reasons for riding a bike, “There are lots and lots of reasons to ride bikes. Some are health related. It’s also a terrific stress relief, and it’s good for the environment. It’s an easy way to incorporate exercise into your day. It’s good to spend more time outside. As well, it’s a sensible financial move. Driving, once you add up the costs of car payments, parking, insurance, and gas is an expensive way to get around. And I agree with all of these reasons but on their own they might not be enough to get me out the door and on my bike. What does it then? The sheer joy of cycling. On my bike I feel like I’m 12 again. Whee, zoom!”
I wasn’t going to blog about this because when I mentioned it on my FB timeline, more than one person commented something along the lines of “people have different senses of humour and we all need outlets in these difficult times.” But if there is one thing that I can’t stand, it’s “jokes” about self-isolation weight gain. Isolation / shelter-in-place weight gain (“the covid 19,” riffing off of the “freshman 15”) has become a hot topic, as people are confined to their homes, possibly moving less and eating more, routines thrown off. There are articles about how to prevent it (with the usual advice, like all the usual advice). There are even quarantine diets.
That’s all fat phobic, fat-shaming, perpetuating harmful diet culture, and triggering for people recovering or recovered from or in the throes of eating disorders. They buy into harmful social ideologies that vilify fat and weight gain.
Jokes and memes take it to another level. They take it seriously as a thing, even a thing to fear. And they make light at the same time. The “humourous” edge makes it more difficult to take issue.
If you don’t find them funny, you are dismissed yet again as a feminist killjoy. Sometimes reprimanded for wanting to deprive others of their sense of humour (the old “just scroll past” rejoinder).
This Allure article, “Can I Socially Distance Myself from These Terrible Jokes about Gaining Weight While in Quarantine?” does a great job of explaining the harm. The most obvious issue is that “gaining weight is framed as an inherently bad thing–an idea that steeped in fat phobia.” When we frame weight gain as a bad consequence of being in quarantine, self-isolation, or shelter-in-place, we add a further layer onto an already difficult situation that calls for kindness to ourselves, not judgment and self-flagellation.
That kind of thinking can drive people into diet mode, or trigger feelings of self-loathing that come up in chronic dieters or people with eating disorders. As if living in isolation during a global pandemic isn’t challenging enough, bringing with it all sorts of fears grounded in the rapid pace at which our lives have changed, coupled with uncertainty about what awaits us in the future, how long we are going to need to live this way, in this shrunken version of our previous lives.
We do not need another demon. We do not need to shame ourselves for wanting treats. And we do not need to shame ourselves for gaining weight. We are trying to survive an unprecedented global situation. Surely that is task enough right now?
I am well aware that people have different senses of humour. And that people need occasions to laugh in the midst of this pandemic. I am also well aware that some jokes perpetuate social harm. Racist and sexist jokes do that. And jokes about the covid 19 do too. They are fat phobic and shaming. I’m sure we can find other things to joke about and lift our spirits.
From the Independent: “Over the last few years, the theory that walking 10,000 steps a day has become popularised as the key to health and weight loss. However, according to a new study, walking 10,000 steps a day won’t actually prevent weight gain, or lead to weight loss.”
I don’t have a lot to say about this start to the story, except….
WHO WOULD HAVE THOUGHT THERE WAS A CONNECTION BETWEEN WALKING LOTS AND LOSING WEIGHT?
More on the study: The study took 120 first year university students, all women, and had them walk either 10, 12 or 15,000 steps a day, 6 days a week, for 24 weeks. They also tracked their weights and their calories consumed. On average, no matter what group they were in, the students had all gained 3.5 lbs which is the average amount of weight students typically gain during their first semester of school.
Again, my reaction….
But here is the bit they don’t mention until the end of the story.
“However, the researchers did note that the increased steps meant an overall positive impact on students’ “physical activity patterns,” which they stated “may have other emotional and health benefits””
Why isn’t that the headline? It’s good news. Students struggle with stress and anxiety and all sorts of emotional and mental health issues when beginning university. Why isn’t that the focus rather than the 3.5 lbs they typically gain when confronted with stress and cafeteria style eating?
Probably my biggest complaint about health and exercise reporting is the emphasis on weight loss. If people do it for reasons of weight loss and then don’t lose weight, they quit. And then they miss out on all the real health benefits of physical activity.
I’m with Yoni Freedhoff (again): Exercise is the world’s best drug. It’s just not a weight-loss drug.
Let’s talk about the other benefits of walking lots. I’ve got a post in our drafts folder about the wonders of walking.
Before I begin my irate list, let me say thanks to Samantha for pointing out the great blog post by Yoni Freedhof about this just-published study, and of course thanks to Yoni Freedhof for writing said blog post, from which I’m drawing both info and inspiration for my list.
Also before I begin listing, here’s a brief blurb about a hot-off-the-presses study in the International Journal of Obesity, testing the relationship between an additional 15-minute-per-day walk/run (called The Daily Mile program) for kids and changes in their BMI (body mass index) after 12 months. The idea was this: schools in the intervention group would have teachers take their students outside to walk around the school grounds, maybe combining it with some other educational activity. The control group didn’t implement the Daily Mile program. Result: nothing. There wasn’t any statistically significant change in BMI in the intervention group. Which is entirely unsurprising, and also wasn’t the goal of the Daily Mile program to begin with. Here’s Yoni Freedhof on the subject:
It’s an odd study in that we’re talking about 15 minutes of running per day which literally no one should expect to have a marked effect on childhood obesity given both math (15 mins of children running, jogging, or walking a mile probably doesn’t even burn the calories of a single Oreo) and the fact that multiple meta-analyses have shown that even far more involved school based PE initiatives don’t have an impact on childhood obesity.
So, courtesy of Yoni, wrong thing #1:
Who thought an additional 15 minutes a day of traversing a mile would result in kids losing weight?
He goes on to make another important critical observation about the study:
And it’s a problematic study in that consequent to the wholly predictable non-exciting outcome, it’s the sort of study that might be used as a means to discourage the program’s continuation.
Thanks, Yoni, for giving us wrong thing #2:
So you’re telling me someone did a study to show how a perfectly nice school program like The Daily Mile is actually a failure at something it was never designed to succeed at? Great.
The researchers did have other plans for their study in addition to measuring effects of the Daily Mile on kid BMI. They also planned on measuring some quality of life outcomes, including “child-reported quality of life, child-wellbeing and teacher-rated academic attainment (overall attainment and attainment in maths, reading and writing)”.
However, 56% of their daily life outcomes were missing. Why? They have an answer:
This was attributable to the time commitment required to collect these data by schools. Research staff obtained anthropometric measures, whereas fitness, academic attainment and wellbeing measures were administered by school staff.
Here we go, now, with wrong thing #3: Who thought primary and middle-school teachers would have time to conduct testing of student quality of life and wellbeing in addition to their copious other work duties? Were they trained to do this? Were they paid extra? Well?
Angry bird has a point. Of course data will be missing under these circumstances. In addition, the researcher also confess the following:
The schools were provided with minimal training and advised to implement The Daily Mile… interviews with school staff indicated that The Daily Mile was largely not conducted daily, and implementation fluctuated depending on competing demands during the school year.
Thus we reach wrong thing #4: You mean to tell me that, in addition to minimal staff training, they didn’t even implement the Daily Mile on a Daily basis? Why even bother crunching this data, such as it is?
Both Yoni are in agreement with Angry Bird. First, Yoni:
As I’ve said many times, dumbing down exercise to weight management shortchanges both the benefits of exercise and the realities of weight management.
I couldn’t agree more. Physical activity is good for body and soul, and weight management is excruciatingly complex at best. They are different things. Let’s not talk about them in the same study, especially one set up like this one.
Which leads us to wrong thing #5: Can we just torpedo this wrong idea that physical activity will lead to weight loss? It leads to many good things, just not that particular one. Got it?
I have some thin friends who say that they just watch it for a joke. They’re looking forward to new episodes. It’s so bad, it’s good they say. I’m not a “it’s so bad it’s good” kind of person.
I said, just stop. It’s not funny. It’s abusive. It doesn’t work. It hurts people. But also, it affects your attitudes towards fat people. Did you know that?
“A 2012 study published in the journal Obesity found that people who watched just one episode of the show exhibited higher levels of explicit bias against fat people. “Participants who had lower BMIs and were not trying to lose weight had significantly higher levels of dislike of overweight individuals following exposure to The Biggest Loser compared to similar participants in the control condition,”the researchers found. Just one hour of watching the show left thinner people with an even greater personal dislike of fat people.” From Jillian Michaels and the Alarming Legacy of the Biggest Loser.
What do you think? We know that my sense of humour about the treatment of large bodied people by the media is running low. You might have read my very very cranky review of Brittany Runs a Marathon.
You can’t miss the announcements: “The all-new Biggest Loser | Premieres January 28th.” But you don’t have to watch the show.
We’ve written about the show before. Lots. As you can guess we don’t much like it.
Catherine wrote a blog post about Brittany Runs a Marathon without watching it. That was definitely the wiser choice. See her commentary here.
She writes, “So why I am writing about a movie I haven’t seen? Because I think the movie/advertising/fashion/fitness industries have (sort of) taken in the message that it’s not okay to blatantly fat-shame people or overtly identify lower body weights with fitness, success and happiness in life. Notice, I said “overtly” and “blatantly”.”
Catherine goes on to identify “some strong fitspo messages buried (not too deeply) in this film:
Health problems should first be addressed by losing weight
Weight loss is possible to achieve through physical activity
Weight loss makes physical activity possible and easier and better and more fun
Some deep-seated emotional problems will resolve through weight loss and physical activity”
So why did I end up watching it? I sometimes watch “bad” TV or fluffy shows while cleaning. Easy to follow rom-coms? Sign me up! I hadn’t seen the floor of my room in weeks. There were Christmas gifts I still hadn’t put away, clean laundry, bags of gym clothes, yoga mats etc all over the floor, the bed needed making, the socks needed sorting and so on. I needed something longer than a regular half hour show to deal with all of the mess. I needed a movie length thing at least. I thought I could handle the fat shaming and enjoy BRAM for its redeeming features. The trailer looked, as a friend put it, cute. The Guardian called it a fluffy feel good flick. It is not that. By the end, I did not feel good at all.
Friends, it was not mostly cute with a side of fat shaming, which I expected. Instead it was a dumpster fire of stereotypes and it was also super sex shaming. All of this was lumped into criticism of Brittany’s self-destructive lifestyle. At one point in the movie someone opines–in a line that was supposed to save the movie, “Brittany, it was never about the weight.” Instead, “weight” is just a stand in for all of Brittany’s problems. Before fat-Brittany is taking drugs and giving men blow jobs in night clubs and by the end of the movie, thin Brittany isn’t just thin. She’s also turning down casual sex. The friends-with-benefits/boyfriend proposes. There was way too much moralizing about sex and drugs. And I say that as someone who is no fan of drugs or alcohol and is often accused of moralizing in this area.
This happens because Brittany isn’t just a fat girl. She’s a fat girl with low self -esteem. She could have just gotten some self-esteem. But no, she gets thin and then gets self-esteem. She could have gotten self-esteem and demanded equal pleasure in the casual sex. She could have started using drugs and alcohol in a responsible manner. Instead, no. She gets self-esteem, says no to drugs, and holds out for a real relationship.
Not surprisingly, it doesn’t manage the weight-loss plot line well at all.
The Guardian reviewer writes, “The film struggles to square its protagonist’s weight loss with the pressure to present a body-positive position and ensure it doesn’t alienate the very female audience it courts. One minute it’s wryly poking fun at the expense and inaccessibility of gyms, the next it’s fetishistically cataloguing the shrinking number on Brittany’s scales. Indeed, as her body transforms, so does her life. She finds a new job, and supportive friends in her running club; men begin to notice her. Yet Brittany still battles with her body issues, unable to shed her identity as “a fat girl”. There’s a note of truth in Bell’s finely tuned performance as a character whose insecurities have calcified over the years, hardening her to genuine goodwill, which she frequently misreads as pity.”
For the record, fat Brittany is smaller than me. She starts out weighing 197 pounds. Her goal weight is 167. And we can track it because never in movie history has a person stepped on a scale so often.
(A blog reader pointed out a more charitable interpretation of why we see her stepping on the scale so often: “She steps on the scale a lot because she trades in her addictions to drugs and alcohol for an addiction to scale weight loss, which the movie portrays as an unhealthy obsession. What starts out as a good “oh look, I lost this many pounds now!” thing quickly escalates into a dangerous “go for a run, jump on the scale, dislike the number displayed, so go back out to run in the mistaken belief that it will make the number change” cycle. That’s why she steps on a scale so often. Because it’s NOT good that she does it.)
Forget the weight loss and the sex, even the running themes aren’t handled well. Friends tease Brittany when she first starts running because she isn’t a real runner. The longest she’s run is 5 km. Rather than tackling the “real runner” thing head on instead the film has Brittany run a marathon and become a real runner by the friend’s standards. Even her triumphant marathon finish is marred by Brittany’s continuing to run on her (spoiler alert) injured and possibly still stress fractured leg. We don’t know that but we do know she’s holding her leg and crying, running and not able to put much weight on it, and her first attempt to run the marathon was derailed by a stress fracture.
There is nothing to love here. Nothing cute or funny or feel good or fluffy.
I’m back inside riding. Why hello Zwift! It’s been awhile. So much fun.
I’m also continuing the path to become an indoor cycling instructor. I wrote the test yesterday. Scary. It won’t be graded for a few weeks. I’ll let you know. Next up, playing apprentice instructor in a few classes.
But I’m still trying to go for short outside rides too. I’m commuting by bike and I’m looking forward to playing in the snow with bikes. I even blogged about my transition to being an all season rider. That makes fall less sad. But so too do plans to go riding in January in Florida
And before that I was in Munich for a conference on Neglected Relationships talking about chosen family. What a big month!
So dark! And getting darker still next weekend. Pretty soon I’ll be getting up in the dark, riding to work in the dark, and riding home in the dark too. I’ve got my warm, reflective gear ready along with all the lights for my bike out and fully charged.
I’ve also decided to order some full spectrum lights to help with the season of darkness. Do you do that? Does it help?
My knee pain continues. I’m not able to walk very far without my knee brace but even with the knee brace it’s limited. I’ve pretty much cut out long walks which is hard. I didn’t see much of Munich. I miss walking Cheddar!
I’m losing weight still and still conflicted about all of that. I’m at the stage of needing to replace some clothes. On the upside I can now fit into my smaller jeans again.
I’m trying to avoid the internalized version of you’ve lost weight, you look great. That’s a little bit too easy of a trap to fall into if I try being body positive about my slightly smaller body. Body positivity is easier for me at smaller sizes. No surprise. And it feels mean to my former size. Given that I know the odds of never seeing that size again aren’t great, I’m trying to avoid all of that.
Instead I’ve been trying out Tracy’s body neutrality attitude. This is a good body. So too was my larger body. It’s just that the larger body wasn’t such a good match for my aging arthritic joints. It was better for some things and this body is better for others.
September is the big back to school month for many of us here on the blog. I’m teaching for the first time in awhile. My class is three hours on Tuesday afternoon and that often means I’m doing the reading, grading, etc on Sunday afternoon. I also have days of solid back to back meetings, followed by events most evenings. My max this year was three evening events. A meet the new grad students thing, followed by a gallery opening, followed by a dinner with some new faculty members. Don’t get me wrong. I love my job. But September is hard work. There’s a lot going on!
I’m also trying some new things. One scary new thing is cycle instructor training. It’s a goal I announced as part of the fittest by fifty challenge but it didn’t get done. This year when the university announced they were offering training, I jumped in.
I’ve completed the full day class. Next up is the exam. After that there’s an instructor mentoring program and then for my final test, I plan and teach a class on my own.
I also tried a new thing that I thought I might hate but actually really enjoyed: golf. Friends, you can let the teasing commence.
Another good thing in September? Camping with Sarah in Killarney park. We had lots of fun paddling and we weren’t eaten by bears. I’m planning on more paddling trips next summer. I love my canoe.
I’m coping with my usual September/October sadness. I definitely need to spend more time on my bike. But it’s getting dark early in the evenings so that’s going to be just a weekend thing or an indoor thing from now on. Oh, September.
Pretty soon I’m moving my bike training indoors. Back to the Back Shed! See you soon on Zwift!
On the mixed feelings side there’s weight loss. I’m not even sure really how to to talk about it and it’s a thing people love to talk about. I’ve invested a lot of effort in, and spilled a lot of virtual ink about, loving my larger body. But I need to lose weight for knee replacement surgery and I’m doing it.
Most people are excited and happy that I’m losing weight. I’m mostly “meh” about it except that my knee hurts less and that’s a fabulous thing. All of a sudden people are noticing and complimenting me. Mostly I shift the focus pretty quickly to my upcoming knee surgery.
In my heart of hearts, I’m with Carly B, the “cheerful chubster.” I need to remind myself that even at my smallest I’m still “overweight.” I don’t even aspire to be in the normal weight zone. I’m trying to make peace with changing size by telling myself that as much as I like my larger body my injured and aging knee can’t take it.