Quote of the Day: Healthcare Providers and Expectations

From an article on healthcare providers stigmatizing fat patients:

Healthcare providers also need to readjust their expectations. Getting individuals who are obese down to a normal weight isn’t realistic: Research shows that most people can’t expect to lose more than 10% of their body weight and, more important, to maintain the weight loss over time. Instead of viewing that as a treatment failure and growing discouraged with patients, doctors and nurses need to recognize that even relatively small changes in weight represent real progress and can have very important implications for health.

I’ve written before that the US National Institutes of Health (NIH) guidelines for treating obesity recommends a 10% weight loss goal.  Not to diet down to “normal weight”, or even to just “overweight”.   Ten percent.    I also noted that I never had a medical professional (or parent or teacher) be satisfied with a 10% weight loss.   I was still fat, so obviously 10% wasn’t enough.

Just to be clear? If a 10% weight loss puts you in the “normal weight” category, you weren’t in the “obese” category.

Most readers know I disagree with the emphasis on weight loss; not only are most losses not  maintained in the long term, but dieting is associated with long-term weight gain.   I do believe in bodily autonomy, though, and that those who choose to diet should use resources like the NIH guidelines and the observations of others who are maintaining losses to maximize their chances.  And I get angry that someone could work hard to lose 10% of their body weight, could work hard to maintain that loss, and still have a healthcare provider berate them for being fat.  Or refuse to treat them, just because they’re fat.

Skip the fat shaming.  It doesn’t help anyone.

(Checking out Health At Every Size doesn’t hurt either.)

Applying “Pro-Choice” to Fat Acceptance

I came to fat acceptance by reading BBW magazine in college. Yes, fashion articles, but also articles on how weight cycling is bad for you and reporting on studies that show dieting tends to lead to weight gain in the long term. I knew that every time I had dieted to lose weight – which I’d done all through jr high and high school – I had regained all that I had lost, plus more … and I wondered, was I making things worse?

I called a “temporary halt” to dieting, selling it to my parents as “just while I’m in college”. My Bs and Cs turned into straight As. I remember feeling amazed that I could pour the energy I used to put into dieting into school and actually get results!  Maybe I wasn’t such a failure after all!  Maybe there were things I was good at!

I didn’t realize for another decade that the pervasive unhappiness and preoccupation with suicide while dieting in high school was actually my first depressive episode. I just knew getting good grades, being good at my job, and not worrying about my weight made me a lot happier.

This was a very intense, personal path into fat acceptance, where my overarching focus was “Leave me alone already!” I had an Enemy, too: Society’s pressure to diet – and my family’s pressure to diet, their accusations of “cheating”, their judgments over whether I was eating “good foods” or “bad foods”, their “suggestions” of diet programs and diet tips I could try, and general message of “You are NOT okay! You are fat! You must lose weight!”

But there are other paths into fat acceptance. One is to know people who are fat, who aren’t trying to lose weight, and being okay with their choice over their body. Maybe you’ve read about Health At Every Size and that you can be fat and fit and you’re thinking, hm, maybe you can’t tell how healthy someone is just by looking at them. Maybe you read statistics that show that dieting doesn’t work for most people or if you want to lose more than 5% of one’s starting body weight, but if you only want to lose about 5% anyway, well, that 5% can seem pretty doable.

This is a more external, live-and-let-live path, where it’s about respecting others’ choices, and much less about one’s own situation or one’s own body. Kind of a “pro-choice” kind of stance, where one deplores discrimination and pressuring people to diet, but is also okay with an individual who chooses to diet, too. It’s a different mindset, and one that usually doesn’t involve seeking out fat acceptance blogs, at least not until a friend starts one and has trouble discussing anything else because the fat blog has eaten her brain (*cough*). Continue reading