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.

fitness · weight stigma

Is the end in sight for headless fatty photos? Here’s a glimmer of hope

We see them all the time:  media depictions of fat people minus their heads, commonly called the “headless fatty” photo.  I won’t post any, but you can see a google images collection of them here.

What’s the problem with these pictures?  They portray fat people not as people, but as objects– objects of ridicule, disgust, pity and contempt.  These are strong words, but apt.

And, it turns out, a recent article from the Lancet agrees with me (thanks, Sam, for sending it).   The authors call out popular media outlets for publishing articles with derogatory and inaccurate content about body weight and those with larger bodies:

The media portrayal of obesity—often stigmatising and inaccurate… is influential, and insidious to popular belief. Yet publishers and editors rarely challenge this media content, and so a stream of derogatory articles floods into mainstream media.

They cite a number of articles as examples of what they consider irresponsible journalism, some with mocking and hate-mongering tones.  We’ve all seen these sorts of stories– again, I won’t link to or quote any, but they engage in criticism of larger bodies and also make judgments about what the responsibilities of larger-bodied persons are (namely to lose weight as fast as possible to ease the burdens they create for society).

Yes, yes, we know all this.  But what can be done about it?  Here are their suggestions:

  • Adhere to the national journalism societies such as the Society of Professional Journalists code of ethics,10 which states that journalists should avoid stereotyping and examine the ways in which their values might shape their reporting, and the National Union of Journalists code of conduct,11 which emphasises that journalists should not produce material likely to lead to hatred or discrimination;
  • Accurately portray obesity;
  • Refrain from publishing articles that stigmatise and discriminate against people with obesity;
  • Use non-stigmatising images when reporting on obesity;
  • Take the opportunity—where stigma and discrimination are reported—to condemn such behaviour, as has been done for other topics (eg, mental health).

These proposed guidelines do a very good job of making this clear: many stories and articles about health, illness and body weight are written in ways that do the following:

  • they stigmatize larger bodies (I no longer use the o-word if I can avoid it);
  • they are used to perpetuate discrimination against and condescension towards those with larger bodies;
  • they use images of parts of bodies, disconnected from people or contexts in which they live, for shock and amusement;
  • this type of reporting promotes hatred of fat people.

Hatred– this is a very strong word, too.  I’ve been thinking lately about fat-shaming and fat-stigmatizing and its connections to hate speech.  Hate speech is not an area I know much about academically, but I’m starting work on a project with a friend investigating the relationships between the forms of weight stigmatizing speech and more traditional forms of hate speech.  I’ll be reporting on our progress here, and will welcome your responses, as always.

I’m heartened by this article, which calls weight stigmatizing articles as they see them:  discriminatory, inaccurate, and hateful.  Thanks, authors.  Thanks, Lancet, for publishing it.  And thanks, readers, for reading.