The End of Overeating but not of Fat-Shaming

On NPR's Tell Me More last night, I listened to Celeste Headlee interview David Kessler about the AMA's recent decision to classify obesity as a disease. David Kessler is an MD who served as commissioner of the US Food and Drug Administration under George H.W. Bush and Bill Clinton. I've read his book The End of Overeating, which does a very good job of explaining how fat, sugar, and salt in foods trigger us to eat more fat, sugar, and salt. Unfortunately, as can be heard in his interview, he overlooks the fact that even when people do change their habits, they usually will still gain back lost weight. You can listen to the interview here: http://www.npr.org/templates/story/story.php?storyId=194239969&sc=tw&cc=share

Frustrated, I sent the following email to the show:

I listened with great interest to Celeste Headlee's conversation with David Kessler. I've read The End of Overeating and appreciate the work that he has done. However, I feel that in regards to the AMA's decision to classify obesity as a disease, he misses the point. The notion that most people gain back weight after dieting because they don't change their habits is debatable. While it's not true of everyone, people often do indeed change their eating and exercise habits (and perhaps their neuro-circuitry), but their bodies do not cooperate with their intentions. There is a growing body (no pun intended) of evidence that some people are prone to keeping on weight, and that dieting can even compound the problem by making the body think it's experiencing a famine and fighting even harder to hold on to the pounds. Simple genetics may play a part as well. It is too simplistic to say that people gain back weight because of their habits, especially when the numbers of those who do are so high.

Another point overlooked is that researchers have been finding that those considered overweight (according to the BMI) have a lower mortality rate than those in the "normal" range. I worry that those in the heavier categories will simply be told to lose weight when they show up to the doctor's office with the same diseases (diabetes, for example) as thinner people, who will be actually treated for the same diseases. Besides, who is healthier? A thin, sedentary person who is not careful about what they eat, or a heavier, active person who is? More and more we are learning that the diseases correlated with being fat are not actually fat people diseases. In fact, it seems that only the extreme obese (as well as those who are drastically underweight) are the ones in danger.

A heavy person is not necessarily a diseased person - and often is not. I find the AMA's decision to classify obesity as a disease to be a very misguided one and, in fact, the Council on Science and Public Health advised them against it. I fear that the diet and pharmaceutical companies will now jump on this to market unnecessary and even harmful weight loss interventions. But maybe more importantly, the AMA's decision takes us all a step further away from the day when heavier people will cease to be made to feel ashamed for living in a body, usually against their best efforts, that is not considered acceptable by today's rigid standards.

There's an elephant in the room..

Is it OK to eat wheat? meat? dairy? gluten? grains? Paleo is the answer! Veganism is the answer! Why aren't I losing weight? Does my BMI matter? There's an elephant in the room and it has an eating disorder!

Letter to Dr. Fat-Shamer

It's been years since I've touched this blog. I have recently been toying with the idea of starting a new blog that touches on issues of body weight and society. In the mean time, here is a letter I wrote to a gastroenterologist who I saw last December. The term "fat-shaming" is new to me, but has been on my mind a lot lately. I have been feeling a strong urge to fight out against the stigma of having body fat, largely (ha!) inspired by this particular doctor.

Dear Dr. ____,

 I saw you as a patient on December 11, 2012, because of stomach pains and tests showing that I had a slightly enlarged liver. While discussing causes with you, I mentioned that I had been taking (prescribed medication)since 2007. We discussed my medical history (recent bilateral pneumonia and two surgeries in the last few years).

I also shared with you I had been struggling with my weight. You strongly urged me to lose weight, which I took to heart. You even told me to “keep your mouth shut,” half-jokingly, I am sure. You sent me off for another blood panel and told me to have another in a month or so after I was to lose 20 lbs. Although I felt stung with shame, I tried to take your words as inspiration. But despite my efforts, I haven’t lost weight, and in fact have gained a few more pounds. So I haven’t returned for the comparative blood test.

Recently, I have been coming to understand some things about weight. Mainly, that as much as I wish it weren’t so, I seem to be genetically predisposed to being heavy. You would recognize this immediately if you saw my family. Although the females in my family have a variety of eating habits, we are all quite short and round. Until recently, I held on to the hope that this fact was an obstacle that I could overcome. I’ve lost 30-40 on Weight Watchers several times, even reaching “Lifetime Member” status at one point. But the thing is, I’ve never been able to maintain the loss. This is in spite of my very healthy eating habits, my love of walking, hiking, and my regular yoga practice.

More recently, I have lost 30 lbs. on (meal replacement program), what I now believe was a crash diet that I went on out of desperation. I’m not sure if there is a connection, but I contracted pneumonia at my thinnest. That weight did not stay off either. Last fall, I tried the very restrictive (30 day paleo-inspired) diet, which felt an awful lot like an eating disorder. I did lose 6 lbs. but put those back on as soon as I completed the 30 days. On a normal day, I eat healthy non-processed whole foods, mindfully, on smaller plates. Yet my body is holding on to the weight. I am coming to understand that for my own sanity, I may need to move on from my lifelong dream of being thin. Make no mistake; it’s not for a lack of resolve. Worse yet, my repeated attempts at losing weight may even be the culprit, I’m learning. I’m now trying to accept my body in a society which stigmatizes my size.

Lately I’ve been reading reports stating the BMI is perhaps a poor indicator of health. Studies seem to be pointing to the fact that those in “normal” range may have a higher death rate than those in the “overweight” category. Only those who are morbidly obese or extremely underweight are truly in danger.

Looking back on our meeting, I’m wondering if your comments, while well-intentioned, did more harm than good. In regards to my liver, I’m wondering what advice you would have given me if my weight was not the issue. What would you have told a thin person who came to you with my same symptoms? Perhaps it may be (prescribed medication)related? I’m not convinced that my weight is necessarily the cause.

Also, is it possible that my enlarged liver may be contributing to my difficulty losing weight, rather than the other way around?

I look forward to your response.

Sincerely,