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,

TMI? or not enough?

Yesterday I was reminded of a sad glitch in human compassion. Not many people are willing to acknowledge the suffering of a woman who has miscarried, unless they themselves have experienced one themselves.

This has put me in the highly unlikely position of defending former first lady Barbara Bush. The same Barbara Bush who said of hurricane Katrina victims who were being housed in the Houston Astrodome in abysmal conditions "What I'm hearing, which is sort of scary, is they all want to stay in Texas. Everyone is so overwhelmed by the hospitality. And so many of the people in the arena here, you know, were underprivileged anyway, so this is working very well for them." She also said on the war in Iraq "Why should we hear about body bags and deaths. Oh, I mean, it's not relevant. So why should I waste my beautiful mind on something like that?" Beautiful mind indeed..

Reluctantly, I find myself in a position where I do feel compelled to defend her. George W. Bush writes in his new book about how when he was a teen, he drove his mother to the hospital following a miscarriage that she had suffered. The fetus was in a jar which she showed to him. Hear me; Medical protocol, then and now, requires that a woman bring with her whatever "material" remains from a miscarriage. This is not a sign of anger, depression or character imbalance on the woman's (mother's?) part, but rather a common practice. It is usual to perform an examination both as to learn the cause of the miscarriage and to understand how much has been expelled so that the doctor can know how to further treat the woman who has miscarried.

I too am somewhat uncomfortable that Mrs. Bush showed her teenage son the remains as he drove her to the hospital. But it does not seem to be outside of the range of normal -- or worthy of the media's collective gagging. It was a specimen. Some people might be grossed out by that, some might not -- but when it comes down to it, it is kind of fascinating. From what I understand, it was stated in the book that it had not been kept as a keepsake, which I admit I indeed would have found disgusting. Then again, I also find morbid the thought of people keeping their loved ones' ashes on their mantle. But I would never ridicule someone for doing so, understanding that others find this practice completely acceptable.

So why this strong reaction. Is it merely the thought of human tissue and blood? Or is it that the story had been twisted enough to falsely imply that the fetus had been kept as a souvenir? Is this just a way of bullying the the Bushes because they suck? But what about those of us who suffered miscarriages who don't suck?

Also on the subject of miscarriage, why is it still so taboo to talk about? For the most part, I sensed pressure from those around me to suffer my miscarriages silently. I was told that at least it didn't happen later on when the fetuses were already babies -- but as far as I was concerned, they were. They were MY babies who were very much wanted. (I find it imperative here to mention that unlike the Bushes, I am very pro-choice -- even after having seen the fetus up close). Why was I told by more than one person that this was probably for the best? Even if that is true, what kind of thing is that to say to someone who has just suffered a loss? It is true that the pain usually does heal, (I love my Jonah to bits. Without having miscarried there would have been no Jonah). But I always ALWAYS do wonder who my other babies would have been, had they survived.

Since starting this blog I've been asking myself what I want to write about. I've realized that I would like to use this blog as a jumping off point just to see what comes out of me. If I sense a theme coming on, I will start a new blog. So for now, Peanut Butter Basquiat is a mosaic of whatever comes to me.

Last night I went to a writing workshop that a new friend (in my neighborhood!) hosted. What follows are some samples of what came out of me.

There is a deep sense of peace that I've found. It's been here all along, and I've known it, but somehow didn't trust it. Until my mother died. It's almost shameful to say, but at the same time it's absolutely not. I keep reminding myself of all the things I miss about her, and I DO miss her,but for all except the last year of my life, I've missed me.

And another sample..

The fog makes me feel extremely content. Especially (but not only) when I get to be home. Especially (but not only) on a weekend when it's morning and the house smells like pancakes and coffee and my kids and I are in our pajamas and in no hurry to get anywhere. I like to play with them, sip my coffee, look at the paper and giggle at the silly dance they've performed to get my attention. I love living in the hills when I look out the window, seeing nothing but trees and the mystical-seeming fog floating around and blocking out everything in the world that is not central to my love. The fog has a way of heightening my senses -- music sounds crisper, blankets feel cozier, breathing feels more nourishing.

One more..

There's an astronaut who lives in my house. He used to be a little bear, but that was another time. Though sometimes, when his curiosity has taken him out into the wasteland of rage, and he must negotiate the foliage of his fear, he must alone find his footprints that lead him back up the hillside to the place where again he can steady his pulse, and look in my eyes, and gently touch my eyelashes until again he's my little bear.

Hello, Dearie!

So here it is. The blog that I've been encouraged to create. Hello!  I have no clear idea of where I want to take this. I do like the idea of having my own little soapbox. I often have thoughts that begin "I wish I could just tell people that ....." But nothing is coming to me at the moment.

So, has anyone heard any good jokes lately?

Actually, this is reminding me of time in college. I was a theater major (but I spelled it "theatre" at the time), with an emphasis on acting. The roles that I preferred tended to be comedic. I was definitely not a musical theater person, but I was envious of those who were. I have mixed feelings about musical theater. I find it so cheesy -- and yet a good ensemble performance can actually evoke an unexpected tear from me. Something about good choreography and people unafraid to belt out a goofy song feels cathartic to me. (I assume many people feel the same way, thus the popularity of Glee, which I was sure I was going to dislike. I watch it for Sue, but I don't exactly turn it off when the numbers start.) Anyhow, I took a musical theater class in college. The only musical that I had ever been in was a children's theater production where I played the tortoise in The Tortoise and the Hare. I sang and danced but in my mind it didn't count. The other students in my class were mostly girls and were the big names in the theater department at my school. The ones who were automatically cast in every show and who seemed to live to sing and dance for an audience. I was sure that these girls felt disdain for me as much as I was envious of them. I dreaded that class. I especially dreaded one of our first assignments -- to rehearse a singing audition. I had not yet sung in front of this class. We had an assignment where we were to bring in a piece of music and properly hand it to a piano player, introduce ourselves (no up-speak!), introduce the number, nod our head to piano player to begin and then sing. Even as I am writing these words I can feel my stomach drop the same way it did when I heard the first note of So Long Dearie from Hello Dolly being played on the piano. But at that time, tears came to my eyes and I stood there -- not able to choke out one lyric.

Well, I'm not crying right now, but I do feel a bit vulnerable knowing that I'm about to publish this for anyone who happens to google the words "no up-speak!" to read.

Anyhow, despite my protests, I was asked to start over. My cheeks still burned, but I sang really well. And I got a standing ovation from the musical theater girls who ended up becoming my friends.