Obesity Public Policy Requires a Foundation

In Weight-Loss Maintenance on April 27, 2011 at 1:36 pm

There I was, noodling around in Science Daily, trying to take a break from contemplating why Dr. Sharma and his friends have lost their minds, when I happened upon this article on how discrimination makes you fat, which is no less depressing.  Sigh. The researchers excluded people who perceived themselves as victims of fat discrimination, nevertheless, we know that fat carries as much stigma and suffers as much discrimination as any other “negative” attribute, even among health professionals who should know better.  What is one to conclude?  Being fat, which leads to discrimination, will make you fatter.  Oh, that cortisol.  How we love it!

Now, what drives fat discrimination?

Oh, damn, here I am again, thinking about Dr. Sharma losing his mind.  

If you haven’t been following his blog lately, this election cycle in Canada has somehow prompted Dr. Sharma to use his authority to advance hysteria, which feeds discrimination (and will make us fatter), though that isn’t his intent.  He and his partners in politics are bamboozled, in fact, that some of us have suggested they are employing “scare tactics,” since their treatments (in practice) are nuanced.  And yet, how will these words from the Canadian Obesity Network call to action ring in the ears of people who are inclined to discriminate and stigmatize?

“Obesity is the nation’s top contributor to disease, death, loss of productivity and costs to our health systems,” says Dr. Arya M. Sharma,  . . . “One in 10 premature deaths among Canadian adults aged 20–64 years is directly attributable to excess weight, and 60% of adults and 25% of kids are overweight or obese.”

Huh?  Confusing causation with association is the tactic of weight-loss profiteers and other fatphobes.  That statement is followed by hysterical statements about the multimillion-dollar costs of obesity based on studies that are far from flawless.

Obviously, Dr. Sharma and crew are hoping to drum up a sense of urgency, but that’s not at issue.  Everyone’s panties are bunched over obesity.  The call to action itself makes the point that “37% of Canadian adults and 35% of youths identified obesity as the number-one health issue affecting Canadians.”  The problem is not a lack of urgency but a lack of understanding – people aren’t on the same page regarding what to do about obesity. That’s the reason it’s not in the public debate, and rightly so.  Politicians’ positions, at this time, are unlikely to be measured, educated or prudent.  If they do pledge public $upport for addressing obesity, Dr. Sharma and crew may not be the parties who profit.

This campaign for “attention” is frighteningly premature.  Armed with hysteria and lacking good, clear direction, the best one might hope for is an Eat-Less-Move-More corporate sponsored campaign along the lines of Michelle Obama’s “Let’s Move.”  At worst, however, we may see certain politicians adopt a simplistic vote-getting “tough on fat” or “war on obesity” campaign, in the spirit of “tough on crime” or “war on drugs.”  These campaigns, in the states, have been driven largely by the American Legislative Exchange Council (ALEC), a pro-corporate, limited government think tank composed of legislators and corporate executives who draft model legislation to benefit “the free market.” Maybe in Canada, unlike the US, companies like Allergan are NOT setting the standards for when weight-loss surgery is appropriate.  And maybe in Canada corporations don’t write legislation through their membership in think tanks such as ALEC and don’t buy politicians through campaign contributions the way they do down here.  Maybe this campaign for “attention” is harmless and no opportunistic corporation will jump in and hijack it.  I can hope.

I’ll be the first one to debunk the idea that you can’t solve problems by throwing money at them (often, that’s the ONLY way to solve certain problems), but you must have a clear target.  The onus is on Dr. Sharma, Dr. Freedhoff, the two Obesity Panacea guys and other bona fide experts who “get” nuance to come up with a clear vision statement (free of hysteria), and that’s going to take time and patience.  COACH is trying.  This is good, but it needs to gel into a clear plan of action, and then politicians can be encouraged to adopt it.  In the meantime, asking for political “attention” now, on hysterical grounds, is like calling on the politicians of the 1800s to respond to the epidemic of “bad humors.”  We are likely to get simple solutions, like bloodletting, that don’t advance our health.  I found it interesting in this article from the Museum of Quackery that other popular ancient “cures,” lumped in with bloodletting, were “purging, starving and vomiting.”  Wow.  Anorexia, dieting, bulimia.  Do people ever change?

Are we taking bets?  Will our Canadian blogger friends find and reclaim their minds once this damned election is over on May 3rd?  Please reassure me.

(Sorry, gang.  It looks like my “allow comments” button got unchecked for some reason for a day.  Corrected!  Thanks NewMe, for the alert!)

  1. The Canadian triad (Sharma, Freedhoff and the Obesity Panacea guys) had my knickers in a BIG tizzy last week with their joint post. I was furious. I basically used up all my blogging fury responding to them.

    If you’ll allow, I would like to repost my responses here. The first one was basically my response to Freedhoff (and his virus metaphor) with a few extras for the OP hotties. Then I talked about the power of words in a response to OP Travis and finally, again in response to a question by Travis, I further waxed poetic on the issue in general:

    FIRST RESPONSE: So let’s say this horrible virus, which you’ve described in great detail in your post, does exist.

    We’ve tried appealing to people’s amour-propre (“the virus makes you really ugly and unappealing”), we’ve tried telling people that they are simply morally weak and could beat the virus if they only really tried (“why don’t you have enough willpower, you lazy, gluttonous slob?”), we’ve tried slicing and dicing their bodies in an effort to turn around the virus’s effects (aka “weight loss surgery”) and for the past few years we’ve been trying to frighten people into curing themselves of the virus (“you will die a horrible, early death if you don’t do something drastic NOW”).

    None of this works, at least in 95% of cases. It’s a pretty dismal success rate, I’m sure you’ll agree.

    So what tactics are we implementing to turn this ship around? All of the above, with a special emphasis on fear-mongering.

    Add to the mix the fact that repeated dieting actually often exacerbates weight gain and, as they say, “look at the fine mess we’re in now”.

    There has got to be another paradigm. A completely different paradigm. Otherwise, nothing will change. Can I hope against hope that your conference in Montreal (which I would dearly love to attend, but can’t) will look at “health at every size”? Even for just a minute or two?

    And I now add: So far, obesity has shown itself to be an intractable problem–treatable???? with a 95% failure rate??? Surely you jest.

    During our federal election, I agree that we should be talking a lot about health, health promotion and the social determinants of health–these are the issues that are going to improve our health and NOT screaming that we are in the midst of an obesity epidemic and that the only answer is to LOSE WEIGHT NOW.

    Unless you know of a magic formula that people can follow without driving themselves crazy in the process, without making dieting and exercise into a part-time (or even full-time) job, without causing even more cases of disordered eating, medical disasters (what’s the complication rate for weight loss surgery? pretty high, I believe) and further stigmatization to those who don’t look like the two of you (yes, that’s a compliment, you’re two handsome young men who have probably never in your lives agonized over having an extra slice of bread, or a handful of nuts, or god forbid a chocolate sundae just once a year), for goodness sake, please stop concentrating on weight and start thinking about overall health, which is possible even if your BMI is over 25.

    […]a linguistic analysis of your post (which is essentially the same as those of Drs. Freedhoff and Sharma) would show that it is replete with words meant to shock, appall and incite fear and loathing: “the obesity crisis”, “pretty shocking”, a “particularly nasty” virus, “challenging”, “difficulty”, “a whole slew of other medical conditions”, “visible affliction”, “top health issue facing the country”, “the most prevalent disease”…

    As a fat person who eats healthily and exercises to the best of her (handicapped) abilities, words like these sting, insult and rob me of any sense that I am doing the best I can. I am simply part of a visible crisis, a person who is looked down upon by the general population for my gluttony and laziness.

    Yes, Travis, words are amazing weapons and the longer we keep crying “crisis-epidemic”, the more the general public and even people who seem to have an academic background such as Rob above, will further stigmatize and isolate the fat amongst us, decrying our evident lack of willpower and personal responsibility.

    I’ve been blogging about these issues for the past two + years. It’s hugely complicated.

    First, the mainstream is solidly in the camp of personal responsibility/stigmatization. Even most weight loss bloggers hate (truly hate) fat people. They hate themselves or at very least, they believe that the fault is theirs and theirs alone. It’s going to be very, very difficult to turn this juggernaut around. Certainly, the kinds of words being bandied about (see the selection I pulled out of your post) by health care “experts” are not helping the situation at all.

    Next, yes, we have to look at our children and our youth. As long as phys ed in the schools is reserved for the athletically gifted, most kids are going to hate it. I’m 54 and still remember the sting of being chosen last for every team, or being barely able to jump the lowest hurdle. We must make phys ed mandatory throughout primary and high school, but as a purely pass/fail course, based on participation. If kids who are good in sports want to score 90s on their report cards, give them advanced classes (a little along the lines of gifted programs).

    Nutrition is also a complicated issue. One person’s super food can be another’s ticket to weight gain, heart disease, etc. But I think we can all agree that candy and fast food (especially due to horrifically high salt content) are just not good for you. At very least, we should take all commercials for sugary cereals, the various hamburger and fries emporiums and soft drinks off the air. Nor should vending machines selling this dreck be allowed in the schools. Junk food should be treated the way we treat tobacco today: yes, it’s still legal, but the Marlboro man is long gone from our TVs. We should do the same with R. McD.

    Public health campaigns should focus first and foremost on health at every size. How many people give up doing any exercise or making even small changes to diet (let’s say just cutting out soft drinks in favour of drinking more water), because the results in terms of weight loss are usually negligeable? Why are we not telling people about the many tangible benefits of physical activity that have nothing to do with weight loss? We must make a conscious effort to decouple physical activity from weight loss. Physical activity is extremely beneficial, but people don’t persevere because they don’t see the results on the scale.

    The word “diet”–except as it applies to people who must, due to severe medical conditions, avoid certain foods (i.e. peanut allergies)–should be banned. The only thing dieting does is create fear and the inability to think for oneself when it comes to food choices. Intuitive (or mindful) eating is a step in a much healthier direction. And need I remind us all of how many people end up much fatter after years of “dieting”?

    OK, so the medical profession has to do something about conditions that are associated with overweight and obesity (though causal relationships are not necessarily that clear). Doctors are, for the most part, woefully uneducated when it comes to weight management. They make the same assumptions as the general population: you’re fat because you eat too much and spend too much time in front of the computer or the TV. Doctors have to learn about health at every size and mindful eating and promote both concepts at every occasion; they have to be aware of what kind of resources are available in the community to help people nourish themselves and their families more successfully and encourage people to enjoy moderate physical activity (i.e. even just taking a 15 minute walk in the evening, if at all possible.)

    I have also observed that a lot of weight loss bloggers live seriously disordered lives. They binge because they are deeply unhappy. This is not a food issue, it’s a mental health issue. How about the doctor asking that mom stuck at home with three screaming kids what it would take to stop her from downing a tub of ice cream? Maybe she needs to get out of the house. This may be a facile example, but there’s a lot of pain out there. I read about it every day. Sadly, many of these people (in particular, women) continue to hate and blame themselves and see their only salvation in weight loss.

    Well, those were just a few ideas off the top of my head. And I’m just a little, fat, middle-aged lay person. But believe me, I’ve thought a lot about this over the past two years.

    • For a few minutes, NewMe, I was mute. You appeal to these folks as if they can grasp your logic. At first it hurts to realize that the professionals are more in the dark than you and I. It’s sobering (and not in a pleasant way.) We want real heroes to exist, people who understand complexity and who value human beings for no other reason than we are human.

      Something that came to me recently, and which I am reminded of again by your post(s) NewMe and Debra: we have to be our own heroes. We must listen to our intuition, love ourselves, form support groups if necessary–not to lose weight, that’s been done to death, the attempts anyway, no, I mean to support each other’s wisdom when it stares us in the face. What a contrast, your wisdom, to their bullsh*t…to their blah blah blah… 🙂

      And yet, they’re human too. I’m sure they try.

      O, btw, I love you, Debra and NewMe, and etc.

      • Hopeful, you are right. I so appreciate the support I’ve found here: launching my thoughts and receiving so many broad perspectives in return that are held together by a basic sense of respect and an understanding that fat has nothing to do with character. I may not qualify as my own hero, but my spine has grown stronger as a result of this community. Love you too. You execute my mission better than I do: Tell a truth; advance compassion. That’s what you do, and with poetry. Love this community. And NewMe, you do get points in heaven for trying so hard to get through to the Canadian trifecta.

    • @ NewMe: HAES and size acceptance 101. From your lips to their ears and hearts. I especially appreciated your isolating the language that promotes horror and hate.

      And, might I add, you have a very young face for 54. I wouldn’t have guessed.

    • NewMe, that’s absolutely brilliant.

  2. To hopefulandfree, Debra, and the whole tight-knit group that has formed around this blog:

    I love you too! You are my oasis of support and sanity in an otherwise unbelievably frustrating, stupid world.

  3. Recall a book, 1990 or thereabouts, called “The Madness of Hunger”, in which the author reports on areas in Brazil where people are chronically hungry due to socio-economic conditions of inequality. The people who subsist on inadequate nutrition, many of whom simply slowly starve to death, believe that they are “nervous” types, prone to weakness and various nervous conditions that result in rage, mood swings, insomnia, dizziness, and so forth–when, in fact, they are chronically hungry. They do not see their lives that way because the doctors and other professionals share a consensus reality; thus, the hungry are able to obtain sleep medications and drugs to calm their “nerves” but not given food they need to live. Are the doctors who participate in this social construction of sickness evil? I doubt it. But there is rarely any critical theory applied to social phenomenon, critical theory which asks: whose needs are being met in this situation.

    Watching noted doctors who might normally retain a more critical mindset succumb to the *professional* consensus reality about obesity (and what “needs” to happen to find a remedy) reminded me of this sad book about hunger–and the simplistic ways in which doctors and other intellectuals interpreted what THEY NEEDED to see into what they were certain they were seeing. Still, they were of course wrong. And the hungry people continued believing they, themselves, were deeply flawed or simply experiencing the inevitable consequences of the lives they had *chosen* for themselves.

    Sigh. (Sorry I don’t have a link. Shouldn’t be too hard to track down, but I must warn: it breaks your heart…)

  4. Here’s a link to an article about the book I noted in my previous comment:

    The last 5 paragraphs of the article reveal the ways that professionals medicalize social conditions related to, indeed caused by, oppressive economic and social conditions of inequality. Many of the illnesses supposedly “caused” by obesity are far more strongly correlated with inequality (and various forms of stress directly related to oppressive conditions) but the medical professionals continue to medicalize obesity as the cause, and patient noncompliance as the source of obesity…like blaming starvation on “weak nerves” and poor choices, the ideology of professional medicine supports the blaming of individuals for diseases that are products of social inequality and oppression…then to make matters worse, they suggest that additional oppression is necessary (weight loss dieting, enforced exercise, body mutilation, etc.–with little or no required economic/social supports in place to implement their extreme expectations for change). The fact that a small percentage of people are *successful* in losing weight is all the proof they need. This is what passes for evidence-based knowledge, evidence based medicine?

    And these are the folks watching out for our health *care* needs.

  5. Wow, Hopeful, what a thought-provoking article. It’s going to haunt me.

  6. “Next, yes, we have to look at our children and our youth. As long as phys ed in the schools is reserved for the athletically gifted, most kids are going to hate it. I’m 54 and still remember the sting of being chosen last for every team, or being barely able to jump the lowest hurdle. We must make phys ed mandatory throughout primary and high school, but as a purely pass/fail course, based on participation. If kids who are good in sports want to score 90s on their report cards, give them advanced classes (a little along the lines of gifted programs).

    This is *brilliant*. How do we make this happen?

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