The last area of medicine where we prescribe tough love
September 19, 2018 1:58 PM Subscribe
The terrible irony is that for 60 years, we’ve approached the obesity epidemic like a fad dieter: If we just try the exact same thing one more time, we'll get a different result. And so it’s time for a paradigm shift. We’re not going to become a skinnier country. But we still have a chance to become a healthier one.
tw for discussion of eating disorders, fatphobia, and racism
tw for discussion of eating disorders, fatphobia, and racism
This post was deleted for the following reason: Poster's Request -- frimble
I agree, the article was excellent but it was the photographs that really moved me. I would love so much to see a whole series of those, they felt so honest. I looked at that hero picture for a long time.
I stopped talking to a friend of mine because of his insistence that losing weight is just a matter of "calories and willpower", when he was a man in his twenties who was never really overweight and just wanted to lose a few pounds to look fitter, AND YET was convinced his success means that weight loss is actually simple for everyone.
Actually it wasn't just because of that, it was because of a whole series of opinions like that, but that one was pretty emblematic.
posted by stillnocturnal at 2:52 PM on September 19, 2018 [8 favorites]
I stopped talking to a friend of mine because of his insistence that losing weight is just a matter of "calories and willpower", when he was a man in his twenties who was never really overweight and just wanted to lose a few pounds to look fitter, AND YET was convinced his success means that weight loss is actually simple for everyone.
Actually it wasn't just because of that, it was because of a whole series of opinions like that, but that one was pretty emblematic.
posted by stillnocturnal at 2:52 PM on September 19, 2018 [8 favorites]
In a few minutes, someone will probably come into this thread with the intention of posting: "but it's just calories in vs. calories out; it's just MATH!"
I hope they do not after they read the following two sentences. You can sometimes, sort of calculate calories in. You cannot calculate calories out.
posted by capricorn at 3:04 PM on September 19, 2018 [44 favorites]
I hope they do not after they read the following two sentences. You can sometimes, sort of calculate calories in. You cannot calculate calories out.
posted by capricorn at 3:04 PM on September 19, 2018 [44 favorites]
I..feel a lot of complicated feelings about this article as a fat lady.
I am a fat lady who desperately needs to lose weight - not because I don't think I'm beautiful (I do!) but because my husband - not even me!- has a fertility issue, and we need a fertility treatment in order for me to get pregnant. And my fertility doctors refuse to allow us to have that treatment unless I lose 50 pounds.
And is that bullshit? Probably. I don't know. There are probably real health complications to having a baby at the weight I am currently. I have really bad back issues that would be exacerbated by carrying a pregnancy. My legs are prone to swelling. All this stuff is real.
But also I still need to lose that weight or they won't let me have a baby. And so this article just made me sad, desperately sad, because it seems to be saying nothing I can do healthily will work. And because I am desperate, to-the-point-of-tears-desperate, for a baby. And I would prefer not to take up bulimia again? So like - is this article just saying there's no hope?
posted by corb at 3:04 PM on September 19, 2018 [38 favorites]
I am a fat lady who desperately needs to lose weight - not because I don't think I'm beautiful (I do!) but because my husband - not even me!- has a fertility issue, and we need a fertility treatment in order for me to get pregnant. And my fertility doctors refuse to allow us to have that treatment unless I lose 50 pounds.
And is that bullshit? Probably. I don't know. There are probably real health complications to having a baby at the weight I am currently. I have really bad back issues that would be exacerbated by carrying a pregnancy. My legs are prone to swelling. All this stuff is real.
But also I still need to lose that weight or they won't let me have a baby. And so this article just made me sad, desperately sad, because it seems to be saying nothing I can do healthily will work. And because I am desperate, to-the-point-of-tears-desperate, for a baby. And I would prefer not to take up bulimia again? So like - is this article just saying there's no hope?
posted by corb at 3:04 PM on September 19, 2018 [38 favorites]
Anyway, that aside, this is a fantastic article. Not a lot in here that is surprising, because ask anyone who is female and she'll tell you she already knows it all, but it's wonderful to see it all laid out this way. And I agree, great photographs.
posted by capricorn at 3:06 PM on September 19, 2018
posted by capricorn at 3:06 PM on September 19, 2018
Man, stuff like this bums me out because I was 270 lbs until 4 years ago and have held steady at about 90-100 lbs down and yeah, I've been working hard at it, but I really don't want to lose the progress I made.
Maybe I'm one of the lucky ones, I don't know. But it is a daily, daily struggle for my wife and I
posted by drewbage1847 at 3:09 PM on September 19, 2018 [10 favorites]
Maybe I'm one of the lucky ones, I don't know. But it is a daily, daily struggle for my wife and I
posted by drewbage1847 at 3:09 PM on September 19, 2018 [10 favorites]
*sings* and don’t...read...the comments!
Because some people are so small and petty that the low-hanging point continues to hover directly over their nasty little heads.
posted by angeline at 3:12 PM on September 19, 2018 [8 favorites]
Because some people are so small and petty that the low-hanging point continues to hover directly over their nasty little heads.
posted by angeline at 3:12 PM on September 19, 2018 [8 favorites]
One of the things I've been coming around to philosophically is that there are no permanent solutions. We know that a temporary adjusment to behaviors and patterns of food consumption does not result in permanent weight loss. Much like Allie Brosh cleaning all the things, I live in cycles of effort, result, obersvation, readjustment, effort and outcome, an absurd struggle against entropy.
What I learned about weight loss from spending a day inside a metabolic chamber
posted by the man of twists and turns at 3:28 PM on September 19, 2018 [4 favorites]
What I learned about weight loss from spending a day inside a metabolic chamber
posted by the man of twists and turns at 3:28 PM on September 19, 2018 [4 favorites]
Weight loss is certainly not a permanent solution. It's not even a temporary solution. We know that dieting fails in almost all cases, and usually results in additional weight gain, which results in more stigma, which results in poorer health. The temptation to say "yes, we know diets don't work, but this is a lifestyle change, this is health intervention, obviously you would be healthier at a smaller weight" falls within the cultural narrative about weight that we know is wrong, that we can prove is wrong, but the narrative just blithely rolls on. Yes, of course, diets don't work, stigma is bad for your health, but fat people are weak and you should lose weight. It's infuriating.
posted by misfish at 3:38 PM on September 19, 2018 [12 favorites]
posted by misfish at 3:38 PM on September 19, 2018 [12 favorites]
I mean, it might also be great if the post didn't populate a ton of "but I lost tons of weight!" comments.
posted by TwoStride at 3:48 PM on September 19, 2018 [24 favorites]
posted by TwoStride at 3:48 PM on September 19, 2018 [24 favorites]
I have two family members who, after years of trying lots of things, decided to get bariatric surgery to reduce their weight. In the most recent case, as I was trying to figure out ways to support my cousin, I did some research - and i was surprised to learn that unlike all other interventions for obesity, bariatric surgery actually resets the body's metabolism at a new, lower weight.
And knowing how much health care and public health plug behavior change as the one true way - if only those dang patients were disciplined and compliant! - it struck me as a tragedy that these surgeries are seen by some as a shameful last resort instead of as a fucking miracle that can give people so much.
posted by entropone at 3:56 PM on September 19, 2018 [17 favorites]
And knowing how much health care and public health plug behavior change as the one true way - if only those dang patients were disciplined and compliant! - it struck me as a tragedy that these surgeries are seen by some as a shameful last resort instead of as a fucking miracle that can give people so much.
posted by entropone at 3:56 PM on September 19, 2018 [17 favorites]
I have not read the article yet, however I was thinking bitterly the other day how the refrain of "lose weight" is just neverending even from doctors and yet my health insurance, which is pretty good on average I think?...does not cover ANY weight loss discussion, either between me and a primary doctor or me and a nutritionist, or any other health care provider. I think they said it was because nothing had provable outcomes, but it sure is weird given how much the health care narrative insists on people losing weight. Like "do this huge thing, and shame on you for not being successful, but we're not going to give you any possible tools or support, and also it really really affects your health." Something doesn't add up.
posted by Rufous-headed Towhee heehee at 4:00 PM on September 19, 2018 [28 favorites]
posted by Rufous-headed Towhee heehee at 4:00 PM on September 19, 2018 [28 favorites]
7400 words and they don't get around to mentioning the food industry until they're 5700 words in. And then it's just
Draining this poison from our trillion-dollar food system is not going to happen quickly or easily. Every link in the chain, from factory farms to school lunches, is dominated by a Mars or a Monsanto or a McDonald’s, each working tirelessly to lower its costs and raise its profits. But that’s still no reason to despair. There’s a lot we can do right now to improve fat people’s lives—to shift our focus for the first time from weight to health and from shame to support.
That's it. How about shifting our focus to getting rid of this poison instead?
You know, so maybe our grandchildren aren't also poisoned for "raising profits".
Fat shaming needs to disappear, completely agree - but 'accepting' obesity gives the industry a free pass to continue poisoning us.
posted by cfraenkel at 4:06 PM on September 19, 2018 [31 favorites]
Draining this poison from our trillion-dollar food system is not going to happen quickly or easily. Every link in the chain, from factory farms to school lunches, is dominated by a Mars or a Monsanto or a McDonald’s, each working tirelessly to lower its costs and raise its profits. But that’s still no reason to despair. There’s a lot we can do right now to improve fat people’s lives—to shift our focus for the first time from weight to health and from shame to support.
That's it. How about shifting our focus to getting rid of this poison instead?
You know, so maybe our grandchildren aren't also poisoned for "raising profits".
Fat shaming needs to disappear, completely agree - but 'accepting' obesity gives the industry a free pass to continue poisoning us.
posted by cfraenkel at 4:06 PM on September 19, 2018 [31 favorites]
I was glad to see this impeccably well-researched and empathetically reported piece. I'm a public health professional and I've seen my field just continue to lurch toward this disaster in continuing to believe that individual-level behavior change can address the obesity epidemic - and I've seen it rest on ideology masquerading as science.
For example, the CDC is very careful to not say that obesity causes the myriad of health issues with which it is associated; Cochrane Reviews point out that there are few if any effective interventions for obesity (yet as Hobbes points out in TFA, our approach is "if we try the exact same thing one more time, maybe it will work out.").
As the title of the piece handily points out, so much that we think we know about obesity - the knowledge that "everybody knows," that we take for granted - is just incorrect. And yet it keeps guiding several key health fields. It alienates people from health care, contributes to poor treatment, and creates a really significant amount of mental and emotional trauma.
We're really fucking up here, big time.
posted by entropone at 4:08 PM on September 19, 2018 [26 favorites]
For example, the CDC is very careful to not say that obesity causes the myriad of health issues with which it is associated; Cochrane Reviews point out that there are few if any effective interventions for obesity (yet as Hobbes points out in TFA, our approach is "if we try the exact same thing one more time, maybe it will work out.").
As the title of the piece handily points out, so much that we think we know about obesity - the knowledge that "everybody knows," that we take for granted - is just incorrect. And yet it keeps guiding several key health fields. It alienates people from health care, contributes to poor treatment, and creates a really significant amount of mental and emotional trauma.
We're really fucking up here, big time.
posted by entropone at 4:08 PM on September 19, 2018 [26 favorites]
That was a great article. The photos are fantastic. I really hope we can avoid what most other fpps on this subject became, which is a long list of concern-trolling and stories about successful dieting
posted by rtha at 4:23 PM on September 19, 2018 [20 favorites]
posted by rtha at 4:23 PM on September 19, 2018 [20 favorites]
Fat shaming needs to disappear, completely agree - but 'accepting' obesity gives the industry a free pass to continue poisoning us.
So, we should keep shaming fat people or else capitalism will continue to exist?
How would "not accepting 'obesity' but not shaming fat people" even work?
posted by misfish at 4:53 PM on September 19, 2018 [16 favorites]
So, we should keep shaming fat people or else capitalism will continue to exist?
How would "not accepting 'obesity' but not shaming fat people" even work?
posted by misfish at 4:53 PM on September 19, 2018 [16 favorites]
This reminds me that I need to find a new doctor. I've put it off for a long time. The practice he works in has shifted towards "lifestyle interventions", which means I can't do anything without a lecture on my weight.
It terrifies me because I'm not healthy fat. But my anxiety and allergies were constant before I became fat, and made it more likely for me to become both fat and unhealthy. I'm the same age my mom was when she was diagnosed with cancer, but no doctor feels the need to do any screening about that. After most doctor appointments, I have a serious debate with myself if I need to get bariatric surgery. I'm only barely eligible under my insurance guidelines as obese with 2 related conditions. It's possible that my symptoms are related to an underlying endocrine disorder, which bariatric surgery can alleviate. But more likely it would just exist to give doctors a skinny body to diagnose, and maybe that would make me visible to the medical community.
Jumping through the hoops and taking serious time off work has kept it an anxiety fueled daydream. But the thing that ultimately stops me is this worry it would permanently brand myself a fat woman. That I wouldn't be a 'real' skinny woman, and any continuing symptoms would still be attributable to the lifestyle they imagine fat women have.
I'm lucky to have a psychiatrist I trust. So at least I'm working on the anxiety, and I think it shows that I don't have a total aversion to health care in principal and being "too sensitive". But at some point I know that I need to be getting regular physicals. I need someone to track my many abnormal labs and actually know when it needs to be researched and escalated.
That's something the majority of the medical system is not able to provide for me, and more importantly, the millions of people with a similar medical profile as me.
posted by politikitty at 4:57 PM on September 19, 2018 [8 favorites]
It terrifies me because I'm not healthy fat. But my anxiety and allergies were constant before I became fat, and made it more likely for me to become both fat and unhealthy. I'm the same age my mom was when she was diagnosed with cancer, but no doctor feels the need to do any screening about that. After most doctor appointments, I have a serious debate with myself if I need to get bariatric surgery. I'm only barely eligible under my insurance guidelines as obese with 2 related conditions. It's possible that my symptoms are related to an underlying endocrine disorder, which bariatric surgery can alleviate. But more likely it would just exist to give doctors a skinny body to diagnose, and maybe that would make me visible to the medical community.
Jumping through the hoops and taking serious time off work has kept it an anxiety fueled daydream. But the thing that ultimately stops me is this worry it would permanently brand myself a fat woman. That I wouldn't be a 'real' skinny woman, and any continuing symptoms would still be attributable to the lifestyle they imagine fat women have.
I'm lucky to have a psychiatrist I trust. So at least I'm working on the anxiety, and I think it shows that I don't have a total aversion to health care in principal and being "too sensitive". But at some point I know that I need to be getting regular physicals. I need someone to track my many abnormal labs and actually know when it needs to be researched and escalated.
That's something the majority of the medical system is not able to provide for me, and more importantly, the millions of people with a similar medical profile as me.
posted by politikitty at 4:57 PM on September 19, 2018 [8 favorites]
I'm a fat dude. My current doctor has talked at me about weight loss every appointment we've had, going on 3 years. He has never once asked me if weight loss is a priority for me (it is not). He has never once asked me about my lifestyle or diet (I cook most nights and eat fairly healthy but probably eat too much ice cream). I can literally predict the script ahead of time - calories in, calories out, and insulting examples always about chicken wings.
This is basically par for the course for my adult life.
posted by tocts at 5:05 PM on September 19, 2018 [10 favorites]
This is basically par for the course for my adult life.
posted by tocts at 5:05 PM on September 19, 2018 [10 favorites]
Terrific article.
Since 1980, the obesity rate has doubled in 73 countries and increased in 113 others. And in all that time, no nation has reduced its obesity rate. Not one.
1980 marks the election of Ronald Reagan and the consequent rollback of governmental regulation of all kinds in the US, but especially regulation of industrial chemicals (with knock on effects in the rest of the world), many of which are lipid soluble and/or endocrine disruptors.
When I was doing some research for a Metafilter comment about one of the most ubiquitous of all chemical pollutants, PFOA (perfluoro octanoic acid), the Wikipedia article pointed out that PFOA levels in pregnant women have been associated with subsequent obesity in daughters, but not sons.
posted by jamjam at 5:27 PM on September 19, 2018 [23 favorites]
Since 1980, the obesity rate has doubled in 73 countries and increased in 113 others. And in all that time, no nation has reduced its obesity rate. Not one.
1980 marks the election of Ronald Reagan and the consequent rollback of governmental regulation of all kinds in the US, but especially regulation of industrial chemicals (with knock on effects in the rest of the world), many of which are lipid soluble and/or endocrine disruptors.
When I was doing some research for a Metafilter comment about one of the most ubiquitous of all chemical pollutants, PFOA (perfluoro octanoic acid), the Wikipedia article pointed out that PFOA levels in pregnant women have been associated with subsequent obesity in daughters, but not sons.
posted by jamjam at 5:27 PM on September 19, 2018 [23 favorites]
I once spent years -- years! -- screwing up my courage to go to the doctor for help managing debilitating panic attacks, which were starting to turn into genuine agoraphobia. My doctor was a tiny blonde woman, who told me about the food pyramid and gave me a brochure about low fat diets and government-recommended forms of exercise.
I went on my first diet when I was 11 years old. I still remember tearing that brochure into tiny, tiny pieces and scattering them in the parking lot.
posted by Basil Stag Hare at 5:33 PM on September 19, 2018 [22 favorites]
I went on my first diet when I was 11 years old. I still remember tearing that brochure into tiny, tiny pieces and scattering them in the parking lot.
posted by Basil Stag Hare at 5:33 PM on September 19, 2018 [22 favorites]
An entire article about obesity and the idea that dietitians work only comes near the end of the article?! Of course, you don't go to a doctor expecting them to do a dietitian's job. It's the same reason why you don't go to doctors expecting them to do any sort of physical rehab. You go to a physical or occupational therapist for that.
The education for becoming an registered dietitian (full disclosure, I'm doing a RD program right now) covers not only nutritional therapy but also a ridiculous amount of biochemistry and some serious training on motivational interviewing and other behavior change techniques. I've been trained to be non-judgmental and to consider pretty much every aspect of people's lives.
My internship this summer was out in rural Appalachia, and I helped my supervisor with counseling sessions. Holy crap were they detailed. I saw her work with a long-haul truck driver for over 2 hours to help him figure out how to fit his meals and eating around his long driving hours. So many of her clients were on fixed incomes, yet she was still able to help them build new eating habits that helped them control blood sugar for diabetes, lower cholesterol for metabolic syndrome, and overall help them with sustainable habits. It's totally possible if only more people go to see professionals who spend YEARS learning how to do this!
Articles like this make me so mad and want to scream to everyone I meet, "Doctors don't have time to spend on this, but dietitians do!! And it works!!!"
posted by astapasta24 at 5:36 PM on September 19, 2018 [44 favorites]
The education for becoming an registered dietitian (full disclosure, I'm doing a RD program right now) covers not only nutritional therapy but also a ridiculous amount of biochemistry and some serious training on motivational interviewing and other behavior change techniques. I've been trained to be non-judgmental and to consider pretty much every aspect of people's lives.
My internship this summer was out in rural Appalachia, and I helped my supervisor with counseling sessions. Holy crap were they detailed. I saw her work with a long-haul truck driver for over 2 hours to help him figure out how to fit his meals and eating around his long driving hours. So many of her clients were on fixed incomes, yet she was still able to help them build new eating habits that helped them control blood sugar for diabetes, lower cholesterol for metabolic syndrome, and overall help them with sustainable habits. It's totally possible if only more people go to see professionals who spend YEARS learning how to do this!
Articles like this make me so mad and want to scream to everyone I meet, "Doctors don't have time to spend on this, but dietitians do!! And it works!!!"
posted by astapasta24 at 5:36 PM on September 19, 2018 [44 favorites]
I went on my first diet when I was 11 years old.
My mom dragged me to Weight Watchers when I was 9. It was horrific and I'm certain it contributed to my later disordered eating and suicidal ideation. It took DECADES for me to learn enough about HAES and fat acceptance to be able to pick a good doctor and then basically further train her out of haranguing me about my weight. I refuse to be weighed at the doctor's outside of my annual physical (so, like, when I go in because I sprained my wrist or because of a weird mole on my back, there's no fucking need to get on the scale); now there must be a note in my file because the nurses don't even read out my weight at the annual and the doctor doesn't mention it directly. She basically limits herself to one brief, "Do you want any referrals?" and "Are you happy with your activity levels?" and leaves it at that.
I wish so many more of you on this thread could have a doctor who's as willing to treat their patients with decency.
posted by TwoStride at 5:39 PM on September 19, 2018 [9 favorites]
My mom dragged me to Weight Watchers when I was 9. It was horrific and I'm certain it contributed to my later disordered eating and suicidal ideation. It took DECADES for me to learn enough about HAES and fat acceptance to be able to pick a good doctor and then basically further train her out of haranguing me about my weight. I refuse to be weighed at the doctor's outside of my annual physical (so, like, when I go in because I sprained my wrist or because of a weird mole on my back, there's no fucking need to get on the scale); now there must be a note in my file because the nurses don't even read out my weight at the annual and the doctor doesn't mention it directly. She basically limits herself to one brief, "Do you want any referrals?" and "Are you happy with your activity levels?" and leaves it at that.
I wish so many more of you on this thread could have a doctor who's as willing to treat their patients with decency.
posted by TwoStride at 5:39 PM on September 19, 2018 [9 favorites]
It's totally possible if only more people go to see professionals who spend YEARS learning how to do this!
How many people have health insurance that covers such a visit?
posted by palomar at 5:39 PM on September 19, 2018 [19 favorites]
How many people have health insurance that covers such a visit?
posted by palomar at 5:39 PM on September 19, 2018 [19 favorites]
As early as 1969, research showed that losing just 3 percent of your body weight resulted in a 17 percent slowdown in your metabolism—a body-wide starvation response that blasts you with hunger hormones and drops your internal temperature until you rise back to your highest weight. Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.
Knowing that, and knowing how most doctors react to my weight, is part of what keeps me from going to doctors more than once every two or three years. The last time I went in, there was one of those BMI charts pinned to the corkboard, and it took serious effort to not ask the doctor, "this says the 'healthy' weight for my height means I should lose at least 75 lbs. How quickly do you think I should plan to do that?"
The link I keep handy to remind myself that a two-year starvation diet is a bad idea: The Tyranny of ‘the Normal’: Why the BMI has always been a hot ton of oppressive bullshit
posted by ErisLordFreedom at 5:43 PM on September 19, 2018 [9 favorites]
Knowing that, and knowing how most doctors react to my weight, is part of what keeps me from going to doctors more than once every two or three years. The last time I went in, there was one of those BMI charts pinned to the corkboard, and it took serious effort to not ask the doctor, "this says the 'healthy' weight for my height means I should lose at least 75 lbs. How quickly do you think I should plan to do that?"
The link I keep handy to remind myself that a two-year starvation diet is a bad idea: The Tyranny of ‘the Normal’: Why the BMI has always been a hot ton of oppressive bullshit
posted by ErisLordFreedom at 5:43 PM on September 19, 2018 [9 favorites]
I just looked at my own health insurance coverage and dietary/nutritional services are not covered. I mean, if I get diagnosed with diabetes and I meet their qualifications I can get some nutritional services, or if I had a child on the autism spectrum with severe enough symptoms, they could get some nutritional help (mostly in the form of supplements, though, not actually working with a RD). But no visits to a RD. Gotta pay out of pocket for that.
Weight loss surgery is 80% covered, though. And membership in the Naturally Slim program is at least partially covered if you meet certain criteria.
And I work for a pretty large company with offices all over the country, and we have what's considered to be pretty good health insurance. I'm sure that visiting a dietician would be beneficial for just about everyone, the same way that going to therapy would be beneficial for just about everyone... but there's another crucial part of healthcare that's rarely covered by insurance in an actually helpful way.
posted by palomar at 5:52 PM on September 19, 2018 [3 favorites]
Weight loss surgery is 80% covered, though. And membership in the Naturally Slim program is at least partially covered if you meet certain criteria.
And I work for a pretty large company with offices all over the country, and we have what's considered to be pretty good health insurance. I'm sure that visiting a dietician would be beneficial for just about everyone, the same way that going to therapy would be beneficial for just about everyone... but there's another crucial part of healthcare that's rarely covered by insurance in an actually helpful way.
posted by palomar at 5:52 PM on September 19, 2018 [3 favorites]
How would "not accepting 'obesity' but not shaming fat people" even work?
We've walked this road with plenty of other formerly stigmatized diseases and mental health conditions, including cancer, HIV, and tobacco addiction to a lesser extent. Multiple diseases have been greatly reduced or eliminated by addressing environmental factors.
This would mean challenging three of the larger industrial systems in the United States: sugar, automotive, and construction. But we've done that before with urban coal, and we have other incentives to make those changes.
posted by GenderNullPointerException at 6:00 PM on September 19, 2018 [20 favorites]
We've walked this road with plenty of other formerly stigmatized diseases and mental health conditions, including cancer, HIV, and tobacco addiction to a lesser extent. Multiple diseases have been greatly reduced or eliminated by addressing environmental factors.
This would mean challenging three of the larger industrial systems in the United States: sugar, automotive, and construction. But we've done that before with urban coal, and we have other incentives to make those changes.
posted by GenderNullPointerException at 6:00 PM on September 19, 2018 [20 favorites]
You're suggesting that being fat is like having cancer or smoking, but it isn't. It's not a disease, it's a body size. While you frame the issue around 'obesity' and not around health, you are stigmatising a body size. A war on obesity is a war on fat people, and you can't give up fat shaming while maintaining the obesity rhetoric.
posted by misfish at 6:16 PM on September 19, 2018 [27 favorites]
posted by misfish at 6:16 PM on September 19, 2018 [27 favorites]
This just makes me hate myself even more for having MDD, because if I want to keep myself from at best staying in bed for months at a time and at worst actively pursuing ways to end my life or living on a locked ward, I have to keep taking medications that, when I was 28 years old, changed me from a 115-pound woman to a 200-pound self-shame generator.
Yay.
posted by tzikeh at 6:38 PM on September 19, 2018 [9 favorites]
Yay.
posted by tzikeh at 6:38 PM on September 19, 2018 [9 favorites]
I had bariatric surgery last year. It probably saved, or at the very least substantially lengthened my life. If anyone wants to ask about that, just MeMail me.
posted by DirtyOldTown at 6:50 PM on September 19, 2018 [5 favorites]
posted by DirtyOldTown at 6:50 PM on September 19, 2018 [5 favorites]
How many people have health insurance that covers such a visit?
Unfortunately this varies. :( :( And this makes me also very sad.
posted by astapasta24 at 7:08 PM on September 19, 2018 [2 favorites]
Unfortunately this varies. :( :( And this makes me also very sad.
posted by astapasta24 at 7:08 PM on September 19, 2018 [2 favorites]
I read this hoping there would be some discussion of gut biome and its effect on obesity.
Weight and obesity have little to do with conforming to societal norms for me. If I were able to lose and keep off weight my blood pressure would go down. Changing my diet would be instrumental in doing this, but my body literally craves carbs.
And medicine offers no solutions other than "eat less, exercise more". It's not so easy...
posted by JamesBay at 7:23 PM on September 19, 2018 [2 favorites]
Weight and obesity have little to do with conforming to societal norms for me. If I were able to lose and keep off weight my blood pressure would go down. Changing my diet would be instrumental in doing this, but my body literally craves carbs.
And medicine offers no solutions other than "eat less, exercise more". It's not so easy...
posted by JamesBay at 7:23 PM on September 19, 2018 [2 favorites]
There is zero actual difficulty in addressing the environmental factors that cause some obesity while not shaming people.
It is not shaming people to say that the cheapest and most available foods are profoundly unhealthy, and that is a problem.
It is not shaming people to say that the US has an infrastructure that is actively hostile to what would be considered normal activity in most other nations, and that is a problem.
It is not shaming people to point to corporations choosing to create actively hostile environments for people as a problem.
It is not shaming people to investigate family and genetic history as it relates to our modern food system.
It is not specifically singling out obesity as universal victims of these problems, as literally everyone suffers because of them, and some obese people suffer less from them than skinnier people. Lots of people are in terrible health for these exact reasons and are as skinny as twigs.
There is a way to have this conversation that doesn't posit body size as either the most important factor for health, or as one completely removed from health as a concern, because neither is completely true.
posted by neonrev at 7:33 PM on September 19, 2018 [33 favorites]
It is not shaming people to say that the cheapest and most available foods are profoundly unhealthy, and that is a problem.
It is not shaming people to say that the US has an infrastructure that is actively hostile to what would be considered normal activity in most other nations, and that is a problem.
It is not shaming people to point to corporations choosing to create actively hostile environments for people as a problem.
It is not shaming people to investigate family and genetic history as it relates to our modern food system.
It is not specifically singling out obesity as universal victims of these problems, as literally everyone suffers because of them, and some obese people suffer less from them than skinnier people. Lots of people are in terrible health for these exact reasons and are as skinny as twigs.
There is a way to have this conversation that doesn't posit body size as either the most important factor for health, or as one completely removed from health as a concern, because neither is completely true.
posted by neonrev at 7:33 PM on September 19, 2018 [33 favorites]
I loved the pictures too. Especially the superheroes.
posted by Emmy Rae at 7:38 PM on September 19, 2018 [6 favorites]
posted by Emmy Rae at 7:38 PM on September 19, 2018 [6 favorites]
the trouble is too many of those conversations will then cite negative health outcomes that categorises obesity as one of them. i think we have to consciously pull away from making that connection there are obviously more apparent health outcomes that needs addressing that's been a result of poor environmental factors.
posted by cendawanita at 7:38 PM on September 19, 2018 [7 favorites]
posted by cendawanita at 7:38 PM on September 19, 2018 [7 favorites]
If anyone is interested in digging deeper into how and why fat shaming doesn't work, Fat Shame: Stigma and the Fat Body in American Culture is an excellent history.
posted by rogerrogerwhatsyourrvectorvicto at 7:51 PM on September 19, 2018 [8 favorites]
posted by rogerrogerwhatsyourrvectorvicto at 7:51 PM on September 19, 2018 [8 favorites]
There is zero actual difficulty in addressing the environmental factors that cause some obesity while not shaming people.
It is not shaming people to say that the cheapest and most available foods are profoundly unhealthy, and that is a problem.
I think we ought to consider the broader context here. Several people began this thread asking that the conversation not follow similar lines of "I lost weight, so it is possible, yay!" That's because this isn't a brand new conversation. To me it is worthwhile to say less about the connections between weight and health (even if we think those comments are not stigmatizing) to avoid falling into conversational grooves that will reopen wounds that have already been opened many times on this topic.
There is plenty of information out in the world about the relationship between weight and health. One of the points of this article is that improving health can be fairly straightforward, but losing weight is often impossible, and one of the factors that prevents people from getting healthier is weight stigma. Reinforcing the connection between obesity and poor health is not new, and is unlikely to be helpful anyone here. It does have the potential to make this thread unpleasant for people who found this article to be a welcome relief from the mainstream narrative on the topic, however.
posted by Emmy Rae at 8:00 PM on September 19, 2018 [19 favorites]
It is not shaming people to say that the cheapest and most available foods are profoundly unhealthy, and that is a problem.
I think we ought to consider the broader context here. Several people began this thread asking that the conversation not follow similar lines of "I lost weight, so it is possible, yay!" That's because this isn't a brand new conversation. To me it is worthwhile to say less about the connections between weight and health (even if we think those comments are not stigmatizing) to avoid falling into conversational grooves that will reopen wounds that have already been opened many times on this topic.
There is plenty of information out in the world about the relationship between weight and health. One of the points of this article is that improving health can be fairly straightforward, but losing weight is often impossible, and one of the factors that prevents people from getting healthier is weight stigma. Reinforcing the connection between obesity and poor health is not new, and is unlikely to be helpful anyone here. It does have the potential to make this thread unpleasant for people who found this article to be a welcome relief from the mainstream narrative on the topic, however.
posted by Emmy Rae at 8:00 PM on September 19, 2018 [19 favorites]
Some of us in this discussion have lost loved ones where fat-shaming was a contributing cause. Some of us are still fucking mad about that to the point where we can't see straight to type this. Maybe take a breath and think about that before you make assumptions about our "conversational grooves."
posted by GenderNullPointerException at 8:27 PM on September 19, 2018 [8 favorites]
posted by GenderNullPointerException at 8:27 PM on September 19, 2018 [8 favorites]
I am also confused by the bariatric mini-bandwagon. I know seven different people--different heights, weights, ages, ethnicities, genders, etc., who had bariatric surgery, and all gained the weight back (sometimes plus more) within five years, no matter how many hours they spent at the gym, or how small their portions of boiled skinless chicken and a side of cucumber slices were. I've never heard of a long-term bariatric success story. Not to mention that it's a very high-risk surgery to begin with--a full 15% of all bariatric surgeries have major complications that require second surgeries to fix things that didn't work the first time. Plus osteoporosis as a fun side benefit? Seizures? Fucking total renal failure?
I 10000% understand the desperate, tears-of-rage desire to "get back to" the body I used to have (I miss it so much), and I hate how shamed I feel all the time, and I hate how I feel! I hate what my body feels like! I hate how uncomfortable I am. I hate that my feet hurt all the time, and that I have to *use my hands to move parts of my body around in order to roll over in bed*. But what we are willing to do to ourselves to "fix" it is just fucking horrific.
posted by tzikeh at 8:29 PM on September 19, 2018 [19 favorites]
I 10000% understand the desperate, tears-of-rage desire to "get back to" the body I used to have (I miss it so much), and I hate how shamed I feel all the time, and I hate how I feel! I hate what my body feels like! I hate how uncomfortable I am. I hate that my feet hurt all the time, and that I have to *use my hands to move parts of my body around in order to roll over in bed*. But what we are willing to do to ourselves to "fix" it is just fucking horrific.
posted by tzikeh at 8:29 PM on September 19, 2018 [19 favorites]
While I overall enjoyed this article and think it's message extremely important - that cannot be understated truly. People suffer and die regularly due to fat shaming. But I also feel that some of the language veered into "... as long as you're healthy" territory.
That is a message that many fat and disabled (and fat while disabled) activists that I follow really hate. As a disabled woman it's frustrating. I hope their overall message is that we need better education, food, resources, for the overall welfare of people in general. But "health" is very nuanced in a way that didn't seem fully apparent in the article. (Beyond some comparisons of risks of health conditions across types of bodies.)
posted by Crystalinne at 8:38 PM on September 19, 2018 [22 favorites]
That is a message that many fat and disabled (and fat while disabled) activists that I follow really hate. As a disabled woman it's frustrating. I hope their overall message is that we need better education, food, resources, for the overall welfare of people in general. But "health" is very nuanced in a way that didn't seem fully apparent in the article. (Beyond some comparisons of risks of health conditions across types of bodies.)
There’s a lot we can do right now to improve fat people’s lives—to shift our focus for the first time from weight to health and from shame to support.Everyone is deserving of respect and help from society - especially doctors - whatever their health status EVEN IF some of that health status is potentially within the person's control. The article has the word "health" 28 times and as a Sick Person it makes me cringe a little bit as a catch-all term for body wellness that is within control/choice/access versus body status that is out of our control.
posted by Crystalinne at 8:38 PM on September 19, 2018 [22 favorites]
Yeah, I have a close family member who had bariatric surgery and while the first two years the results were amazing, nearly 10 years later the weight has crept back up. I mentioned this to my doctor when she asked if I was interested in bariatric surgery, and she confirmed that the long-term results are mixed and that avoiding surgery whenever possible is the likely the healthier option at this point in my life.
posted by TwoStride at 8:40 PM on September 19, 2018 [4 favorites]
posted by TwoStride at 8:40 PM on September 19, 2018 [4 favorites]
Prejudice is a pretty clear health risk as far as I'm concerned, even if you factor out both the disparities in hate crimes and socio-economic status.
posted by GenderNullPointerException at 8:45 PM on September 19, 2018 [3 favorites]
posted by GenderNullPointerException at 8:45 PM on September 19, 2018 [3 favorites]
Yep, I only know one person who had bariatric surgery, and 5 or so years later they had gained most of the weight back.
I find it troubling that people go so far as to suggest that doctors should never weigh patients or mention the patient's weight or suggest weight loss to a patient. I had a doctor who did not bother to correct me when my real weight was significantly higher than what I expected/believed (I assumed it was the same as the last time I had weighed myself several years prior).
He didn't tell me my weight ,or that I was in the overweight category, or that losing weight would be helpful for some of my physical problems. I didn't own a scale or a full length mirror and came from a slender family; it didn't even occur to me that I could become overweight.
If he had said something sooner, a lot of the physical issues that trouble me now with my gut and joints might have been less severe or not become issues, and I might not have the permanent loose skin, stretch marks, and painful varicose veins that I do.
There needs to be some kind of balance between haranguing people and keeping them totally in the dark. I would rather he had hurt my feelings than have these concerns for the rest of my life.
posted by windykites at 8:56 PM on September 19, 2018 [6 favorites]
I find it troubling that people go so far as to suggest that doctors should never weigh patients or mention the patient's weight or suggest weight loss to a patient. I had a doctor who did not bother to correct me when my real weight was significantly higher than what I expected/believed (I assumed it was the same as the last time I had weighed myself several years prior).
He didn't tell me my weight ,or that I was in the overweight category, or that losing weight would be helpful for some of my physical problems. I didn't own a scale or a full length mirror and came from a slender family; it didn't even occur to me that I could become overweight.
If he had said something sooner, a lot of the physical issues that trouble me now with my gut and joints might have been less severe or not become issues, and I might not have the permanent loose skin, stretch marks, and painful varicose veins that I do.
There needs to be some kind of balance between haranguing people and keeping them totally in the dark. I would rather he had hurt my feelings than have these concerns for the rest of my life.
posted by windykites at 8:56 PM on September 19, 2018 [6 favorites]
If anyone's not already familiar, MeFi's own Avery Edison has been talking a bunch about this issue lately on twitter. Usual trolls in the replies ofc but she's been talking a lot about these dominant ideas about body weight and health, how they're often both wrong and unhelpful, a lot of the good stuff people have been talking about here.
Plus, she's really funny.
posted by AnhydrousLove at 9:13 PM on September 19, 2018 [1 favorite]
Plus, she's really funny.
posted by AnhydrousLove at 9:13 PM on September 19, 2018 [1 favorite]
regarding BS:
posted by standardasparagus at 10:12 PM on September 19, 2018 [8 favorites]
… two landmark studies that were previously published in the Journal address the long-term efficacy of bariatric surgery. The Swedish Obese Subjects (SOS) study prospectively followed 2010 patients undergoing bariatric surgery and 2037 contemporaneously matched patients receiving conventional obesity treatments. After 10 to 15 years, the surgical patients had reduced development of and improved recovery from diabetes and cardiovascular risk factors and a 23.7% reduction in mortality, as compared with the control subjects. In a retrospective cohort study involving 7925 patients who underwent gastric bypass and matched controls, Adams and colleagues found that mortality was reduced by 40% in the patients who underwent gastric bypass.Malcolm K. Robinson, “Surgical Treatment of Obesity — Weighing the Facts,” New England Journal of Medicine 361, no. 5 (July 30, 2009): 520–21, https://doi.org/10.1056/NEJMe0904837.
posted by standardasparagus at 10:12 PM on September 19, 2018 [8 favorites]
Fun thing: when a doctor doesn't knee-jerk kick you out with weightloss advice but takes the time to diagnose, they may find a reason for the extra weight.
I just started working with a wonderful endocrinologist who took my refusing the weigh-in in stride, took the time, and when discussing probable weight-loss effects of treating my wonky thyroid and liver, said I could keep up the treatment until I reach a weight I'm satisfied with. No targets, no preaching, nothing but types of foods and an exercise schedule and medication. This was several weeks ago and I'm still in freaking shock.
posted by I claim sanctuary at 10:48 PM on September 19, 2018 [9 favorites]
I just started working with a wonderful endocrinologist who took my refusing the weigh-in in stride, took the time, and when discussing probable weight-loss effects of treating my wonky thyroid and liver, said I could keep up the treatment until I reach a weight I'm satisfied with. No targets, no preaching, nothing but types of foods and an exercise schedule and medication. This was several weeks ago and I'm still in freaking shock.
posted by I claim sanctuary at 10:48 PM on September 19, 2018 [9 favorites]
re: bariatric - I brought it up, so comments here have made me realize I've got some further learning to do. The experience people in my life have had with it have been pretty positive; Cochrane Reviews suggests a pretty wide range of outcomes (reop rates ranging from 2% to 13%) - it's not clear but i'd wager that factors include type of surgery (there are several) - and does point out that the studies it reviewed are not long-term studies but stop after 1-2 years.
posted by entropone at 5:23 AM on September 20, 2018
posted by entropone at 5:23 AM on September 20, 2018
This is a great article, and I loved the photos.
Someone I work with is getting bariatric surgery. I hope it works out well for them because they have been dealing with increasingly serious health issues over a long time, but it is serious, major surgery and the outcomes are not guaranteed. It's a measure of how desperate people can be for a way to effect change that they would take such risks.
One of the ways that reading Metafilter over the years has changed me is around the question of weight and health. Listening to people who frankly know way more about this than I do and who have been living this for a long time was transformative to how I understand the issue and made clear how inappropriate it is to give simplistic answers ("eat less!") or to assume that if other people would only do what you do that they would have the same results, as well as recognizing moments of conscious or unconscious judgment and bias.
So I've mostly stopped commenting in these threads, but I wanted to say how much I appreciate them and appreciate the care and thought that goes into many of the comments.
posted by Dip Flash at 6:46 AM on September 20, 2018 [13 favorites]
Someone I work with is getting bariatric surgery. I hope it works out well for them because they have been dealing with increasingly serious health issues over a long time, but it is serious, major surgery and the outcomes are not guaranteed. It's a measure of how desperate people can be for a way to effect change that they would take such risks.
One of the ways that reading Metafilter over the years has changed me is around the question of weight and health. Listening to people who frankly know way more about this than I do and who have been living this for a long time was transformative to how I understand the issue and made clear how inappropriate it is to give simplistic answers ("eat less!") or to assume that if other people would only do what you do that they would have the same results, as well as recognizing moments of conscious or unconscious judgment and bias.
So I've mostly stopped commenting in these threads, but I wanted to say how much I appreciate them and appreciate the care and thought that goes into many of the comments.
posted by Dip Flash at 6:46 AM on September 20, 2018 [13 favorites]
A few years ago my friend and I each had similar back problems (disk collapse) within a year of each other.
One of us got diagnostic tests quickly, excellent pain relief (percocet, pre-opioid crisis but both of us were in that timeframe), a physiotherapy referral, an offer of a doctor's note for any workplace effects that needed to be accommodated, and suggestions for things like supportive back cushions and a list of where to get them at lower than average cost.
One of us had to see the doctor three times before getting the tests that spotted the collapsed disk, minimal pain relief (Tylenol/Advil/over-the-counter back medication, nothing stronger at any point in the process), a grudgingly signed referral for massage, and a recommendation for a _800 calorie a day_ diet and to go for walks. That person had to go back twice to get a letter for her workplace.
I'm sure you can spot the overweight person's care in this story.
posted by warriorqueen at 7:11 AM on September 20, 2018 [15 favorites]
One of us got diagnostic tests quickly, excellent pain relief (percocet, pre-opioid crisis but both of us were in that timeframe), a physiotherapy referral, an offer of a doctor's note for any workplace effects that needed to be accommodated, and suggestions for things like supportive back cushions and a list of where to get them at lower than average cost.
One of us had to see the doctor three times before getting the tests that spotted the collapsed disk, minimal pain relief (Tylenol/Advil/over-the-counter back medication, nothing stronger at any point in the process), a grudgingly signed referral for massage, and a recommendation for a _800 calorie a day_ diet and to go for walks. That person had to go back twice to get a letter for her workplace.
I'm sure you can spot the overweight person's care in this story.
posted by warriorqueen at 7:11 AM on September 20, 2018 [15 favorites]
Another bariatric surgery success story here--5 years out, and the weight is still mostly gone. The results are vastly different for different types of surgeries, and while I'm biased toward the surgery I selected (duodenal switch), the commonly share wisdom among people who chose the DS is that it is the gold standard of bariatric procedures as far as long-term results go.
When I signed my informed consent documentation at the surgeon's office, there were two of us meeting with the team that day; the other patient was getting a Roux-en-Y anastomosis (a far more common procedure). I would guess that most of the people you're all thinking of that gained the weight back from "gastric bypass" had a Roux-en-Y. And in fact, when you say "gastric bypass" that's what most people are talking about. The nurse practitioner read off a list of disclosures to each of us and had us each sign on the dotted line. The disclosure for the other patient included a statement that said something like: "At five years post-op, 35% of patients have maintained 85% excess weight loss." The same statement for my surgery was 88% of patients at 85% EWL. I wondered at the time why she didn't stop and say "What's she having? I want that one!" because the discrepancy was so profound.
The ugly side of it all is that I had to appeal to my insurance company three times to cover it, even though one $40,000 surgery was significantly less money than all of the insulin, insulin pump supplies, doctor's visits, and retinopathy treatments that the surgery would resolve. In the end, even though I had a whole team of medical professionals petitioning the insurance board on my behalf, I still had to gain 10 pounds to qualify for the surgery. I had to take weeks off of work for the recovery, which not everyone would have been able to afford to do. And I still have to advocate for myself with all kinds of medical professionals because my surgery is not common and doctors don't understand why it's different from a Roux-en-Y, or how that changes my treatment options for all sorts of things.
Surgery comes with trade-offs, too. It wasn't the easy way. But I've maintained a loss of 130 pounds. I traded my insulin pump with diabetes STILL threatening blindness at age 30 for vitamin supplementation and an HgA1C of 4.9. I have one child and another on the way. I'm off blood pressure medication and insulin completely. I don't shop for plus-sizes anymore. I'm not casually judged for my size. Seatbelts fit. My feet and back and joints don't hurt constantly. I'm not nervous at amusement parks. Nobody judges me for eating a cookie. When people meet me, they're shocked that I used to be so overweight.
My mom had the same surgery 18 years ago, with similar levels of success. We don't treat it like a shameful secret. It shouldn't have to be the last resort. If I had done it sooner, my eyesight would have never been threatened, but I didn't want to "give up." It seemed so drastic.
If you have a busted knee, we do surgery to fix it. If you have a messed up heart, we do surgery to fix it. Obesity is a busted metabolism, and we can do surgery to fix it. But we spend so much time and energy making it into a moral failing that people don't feel like they can get the help they need without hitting rock bottom first. It's a shame.
posted by terilou at 10:09 AM on September 20, 2018 [10 favorites]
When I signed my informed consent documentation at the surgeon's office, there were two of us meeting with the team that day; the other patient was getting a Roux-en-Y anastomosis (a far more common procedure). I would guess that most of the people you're all thinking of that gained the weight back from "gastric bypass" had a Roux-en-Y. And in fact, when you say "gastric bypass" that's what most people are talking about. The nurse practitioner read off a list of disclosures to each of us and had us each sign on the dotted line. The disclosure for the other patient included a statement that said something like: "At five years post-op, 35% of patients have maintained 85% excess weight loss." The same statement for my surgery was 88% of patients at 85% EWL. I wondered at the time why she didn't stop and say "What's she having? I want that one!" because the discrepancy was so profound.
The ugly side of it all is that I had to appeal to my insurance company three times to cover it, even though one $40,000 surgery was significantly less money than all of the insulin, insulin pump supplies, doctor's visits, and retinopathy treatments that the surgery would resolve. In the end, even though I had a whole team of medical professionals petitioning the insurance board on my behalf, I still had to gain 10 pounds to qualify for the surgery. I had to take weeks off of work for the recovery, which not everyone would have been able to afford to do. And I still have to advocate for myself with all kinds of medical professionals because my surgery is not common and doctors don't understand why it's different from a Roux-en-Y, or how that changes my treatment options for all sorts of things.
Surgery comes with trade-offs, too. It wasn't the easy way. But I've maintained a loss of 130 pounds. I traded my insulin pump with diabetes STILL threatening blindness at age 30 for vitamin supplementation and an HgA1C of 4.9. I have one child and another on the way. I'm off blood pressure medication and insulin completely. I don't shop for plus-sizes anymore. I'm not casually judged for my size. Seatbelts fit. My feet and back and joints don't hurt constantly. I'm not nervous at amusement parks. Nobody judges me for eating a cookie. When people meet me, they're shocked that I used to be so overweight.
My mom had the same surgery 18 years ago, with similar levels of success. We don't treat it like a shameful secret. It shouldn't have to be the last resort. If I had done it sooner, my eyesight would have never been threatened, but I didn't want to "give up." It seemed so drastic.
If you have a busted knee, we do surgery to fix it. If you have a messed up heart, we do surgery to fix it. Obesity is a busted metabolism, and we can do surgery to fix it. But we spend so much time and energy making it into a moral failing that people don't feel like they can get the help they need without hitting rock bottom first. It's a shame.
posted by terilou at 10:09 AM on September 20, 2018 [10 favorites]
Obesity is only a 'busted metabolism' if you assume that all bodies should be thin.
posted by twilightlost at 10:12 AM on September 20, 2018 [7 favorites]
posted by twilightlost at 10:12 AM on September 20, 2018 [7 favorites]
Obesity is only a 'busted metabolism' if you assume that all bodies should be thin.
I understand your point. Perhaps it's better to say diabetes is a busted metabolism? MY bariatric surgery fixed MY health problems, and I avoided it for too long because I'd been told I could do better if I tried harder.
posted by terilou at 10:18 AM on September 20, 2018 [6 favorites]
I understand your point. Perhaps it's better to say diabetes is a busted metabolism? MY bariatric surgery fixed MY health problems, and I avoided it for too long because I'd been told I could do better if I tried harder.
posted by terilou at 10:18 AM on September 20, 2018 [6 favorites]
I've been a large woman all my adult life, and I have multiple chronic health issues that complicate both exercise (asthma and allergies) and food (exhaustion, stretches of time with significant nausea, stretches of time where migraines make food and food prep really difficult.)
I have been so fortunate in my current doctor (and the practice in general). They do a weight check but are very clear they check because major changes either up or down are an important symptom. (My thyroid diagnosis involved losing 35 pounds in about 3 months without changing anything in my food or activity and my doctor at the time thinking it was good, not a sign of a problem.)
I see a nutritionist every 4 months. This is the first nutritionist who has read my file (and she's always up to date on the latest stuff), who remembers what we talked about, and who's been able to work with me no just on the stuff you can get from any general advice, but on the specific stuff I need help with. (She's covered by my insurance.)
My weight hasn't gone down noticeably, but my quality of life has gotten better, I get colds and other minor stuff less, and we've been able to stabilise a lot of the chronic stuff, and work on improving other things. (I had have a summer of medical appointments basically every week because we managed to get down to dealing with second tier 'this is not urgent, but could be improved' stuff. Which is exhausting, but I'm seeing improvements.) My overall health measurements (blood work, blood pressure, pulse, etc.) have all stayed good or improved.
I started with my current doctor 3 years ago. It takes time to dig out from the years of doctors who didn't listen, who made assumptions, and all the effects of treating things sub-optimally. And a big part of why I go see her, on time, is that I know she won't either shame me or ignore the stuff we can fix or improve (or push me to do things I can't sustain and that would be worse for me long-term.)
posted by jenettsilver at 10:22 AM on September 20, 2018 [4 favorites]
I have been so fortunate in my current doctor (and the practice in general). They do a weight check but are very clear they check because major changes either up or down are an important symptom. (My thyroid diagnosis involved losing 35 pounds in about 3 months without changing anything in my food or activity and my doctor at the time thinking it was good, not a sign of a problem.)
I see a nutritionist every 4 months. This is the first nutritionist who has read my file (and she's always up to date on the latest stuff), who remembers what we talked about, and who's been able to work with me no just on the stuff you can get from any general advice, but on the specific stuff I need help with. (She's covered by my insurance.)
My weight hasn't gone down noticeably, but my quality of life has gotten better, I get colds and other minor stuff less, and we've been able to stabilise a lot of the chronic stuff, and work on improving other things. (I had have a summer of medical appointments basically every week because we managed to get down to dealing with second tier 'this is not urgent, but could be improved' stuff. Which is exhausting, but I'm seeing improvements.) My overall health measurements (blood work, blood pressure, pulse, etc.) have all stayed good or improved.
I started with my current doctor 3 years ago. It takes time to dig out from the years of doctors who didn't listen, who made assumptions, and all the effects of treating things sub-optimally. And a big part of why I go see her, on time, is that I know she won't either shame me or ignore the stuff we can fix or improve (or push me to do things I can't sustain and that would be worse for me long-term.)
posted by jenettsilver at 10:22 AM on September 20, 2018 [4 favorites]
The Venn diagram between people who say things like "Extensive studies show that traditional dieting does not work, because when you analyze large samples..." and people who say things like, "I know this person from my office who got bariatric surgery and they gained all the weight back, so..." has a curious overlap.
posted by DirtyOldTown at 10:51 AM on September 20, 2018 [7 favorites]
posted by DirtyOldTown at 10:51 AM on September 20, 2018 [7 favorites]
I feel a bit guilty in accidentally feeding the bariatric surgery drift of the conversation.
It's absolutely ridiculous how much the duodenal switch actually changes the endocrine system. The metabolic changes are completely independent of the weight loss, despite the fact that the surgery does accomplish both.
But I think that's the thing we gloss over which makes bariatric surgery both underprescribed and overprescribed.
For people with chronic endocrine issues, the duodenal switch is a life-changing surgery that should be suggested when diabetes or x is not well-controlled. We should be recommending it independent of their weight, and the current guidelines are denying people treatment because we expect them to be fatter if they're so sick.
For people who are simply fat, it is overprescribed as an incredibly invasive surgery to mitigate societal prejudices. And I don't think the people doing it are making the wrong choice. Roxane Gay's article about choosing bariatric surgery was heartbreaking. It highlights something wrong about our society that dangerous invasive surgery is necessary to our survival. It is cosmetic, in the sense that we do it to appear closer to society's expectation of us. But it's also life-saving because it means suffering less discrimination and self-loathing (which is tied higher mortality rates) and being able to participate in the medical system.
Within a year, my step-grandfather and aunt both suffered heart attacks. My grandfather is incredibly thin and known for eating all right things. My aunt has always been overweight, but always astonished her doctors with healthy vital signs. As soon as he suffered chest pains, he knew to take it seriously. He called an ambulance, and they took it seriously. He was promptly sent to emergency surgery to have stents put in place. My aunt ignored her heart attack. She called my mom to take her to urgent care 36 hours later for vertigo. By the time a doctor saw her, her organs were failing and she needed to be rushed to a hospital. With all that time wasted, she died 48 hours after her heart attack.
He had a major heart attack and lived, she had a mild heart attack and died. The culmination of fairly ordinary decisions that all fell along line of privilege. Doctors ostracized her so she wasn't getting regular care. Healthy self-care routines were irretrievably linked to self-loathing and difficult for her. Society understands the heart attack symptoms of men, so women's disparate symptoms are not recognized. Women are trained to ignore pain, so delay care and go to centers ill-equipped to handle their emergencies.
posted by politikitty at 12:44 PM on September 20, 2018 [15 favorites]
It's absolutely ridiculous how much the duodenal switch actually changes the endocrine system. The metabolic changes are completely independent of the weight loss, despite the fact that the surgery does accomplish both.
But I think that's the thing we gloss over which makes bariatric surgery both underprescribed and overprescribed.
For people with chronic endocrine issues, the duodenal switch is a life-changing surgery that should be suggested when diabetes or x is not well-controlled. We should be recommending it independent of their weight, and the current guidelines are denying people treatment because we expect them to be fatter if they're so sick.
For people who are simply fat, it is overprescribed as an incredibly invasive surgery to mitigate societal prejudices. And I don't think the people doing it are making the wrong choice. Roxane Gay's article about choosing bariatric surgery was heartbreaking. It highlights something wrong about our society that dangerous invasive surgery is necessary to our survival. It is cosmetic, in the sense that we do it to appear closer to society's expectation of us. But it's also life-saving because it means suffering less discrimination and self-loathing (which is tied higher mortality rates) and being able to participate in the medical system.
Within a year, my step-grandfather and aunt both suffered heart attacks. My grandfather is incredibly thin and known for eating all right things. My aunt has always been overweight, but always astonished her doctors with healthy vital signs. As soon as he suffered chest pains, he knew to take it seriously. He called an ambulance, and they took it seriously. He was promptly sent to emergency surgery to have stents put in place. My aunt ignored her heart attack. She called my mom to take her to urgent care 36 hours later for vertigo. By the time a doctor saw her, her organs were failing and she needed to be rushed to a hospital. With all that time wasted, she died 48 hours after her heart attack.
He had a major heart attack and lived, she had a mild heart attack and died. The culmination of fairly ordinary decisions that all fell along line of privilege. Doctors ostracized her so she wasn't getting regular care. Healthy self-care routines were irretrievably linked to self-loathing and difficult for her. Society understands the heart attack symptoms of men, so women's disparate symptoms are not recognized. Women are trained to ignore pain, so delay care and go to centers ill-equipped to handle their emergencies.
posted by politikitty at 12:44 PM on September 20, 2018 [15 favorites]
I've had successful bariatric surgery, which is relevant but not what I dropped in to say.
I read this article with a little superstitious dread - I think everyone who has had successful bariatric surgery knows that some percentage of people gain some percentage of weight back, and therefore devotes some percentage of their available cortisol to worrying it might happen to them. I never expected to read a heartfelt and compassionate article about fat people in my lifetime, so I was super surprised to find that this was both.
The way these people described their experiences hit very close to home. I've had a doctor refuse to x-ray a painful joint because "there's nothing I can do to help you until you've lost some weight." I've had people get up and change seats on buses rather than sit next to me. I've had the humiliation of asking for a seatbelt extender on a plane ("YOU NEED A WHAT, HONEY? COULD YOU SPEAK UP?") and I've had a toddler point at me on an elevator and say, "Mommy, she's BIG." These and a thousand other indignities, major and minor, my entire life - and yet there's still always some asshole who thinks you aren't QUITE ashamed enough of yourself, who has to say something loud and public and vicious to make sure you really get how disgusting you are.
I'm at a normal weight now, and a normal size. Let me tell you, if you don't already know - normal is different. At a normal weight, people meet my eyes on the elevator and say hello. People ask me how my day was, or what I'm planning for the weekend. Doctors actually listen to my symptoms, and don't shy away from looking at or touching my body. I don't have to raise my voice or interrupt to make a point in a meeting. People smile at me and move their purse or bag when I get on the train. People smile at me. Sales people come up to me and ask if they can help me. When I'm walking in the park, the other walkers say hello. There is an entire range of casual human-to-human interaction that I witnessed but was never invited into, because people were too disgusted or too pitying to acknowledge me before. I felt, a lot of the time, like I had no personhood.
And the worst part is, a lot of the time? I was grateful for that. I didn't want to be noticed. I knew what happened when somebody noticed a fat woman, and it was never anything good.
This is something so deep in our society that I don't know if anything can change it. It's hurtful and offensive, and even decent people do it. To a fat person, it doesn't matter whether the reaction is "ugh, a fat person" or "oh, poor fat person" - it's still not "oh, a person," which is what most of us want and will never get. And it's in fat people, too. As a fat person, I was always checking to see - am I the fattest person in the room? Which means inevitably I'm looking at the person who is - and then I'm the chick staring at the fat person rather than seeing a person, and I'm the problem.
Whether my bariatric surgery is successful for the long haul remains to be seen, but I'll just say this - being a thin person, even if it turns out to be temporary, has opened my eyes to what I've been missing. And it's not cool clothes, or guys hitting on me; it's being a person in the world who is allowed to just be a person.
If someone had told me before surgery, "Hey, there's a chance you'll end up gaining all the weight back, but for a few years, you'll get to see what it's like to be treated like a real human person" -- I'd have made that bargain in a heartbeat.
posted by invincible summer at 1:23 PM on September 20, 2018 [46 favorites]
I read this article with a little superstitious dread - I think everyone who has had successful bariatric surgery knows that some percentage of people gain some percentage of weight back, and therefore devotes some percentage of their available cortisol to worrying it might happen to them. I never expected to read a heartfelt and compassionate article about fat people in my lifetime, so I was super surprised to find that this was both.
The way these people described their experiences hit very close to home. I've had a doctor refuse to x-ray a painful joint because "there's nothing I can do to help you until you've lost some weight." I've had people get up and change seats on buses rather than sit next to me. I've had the humiliation of asking for a seatbelt extender on a plane ("YOU NEED A WHAT, HONEY? COULD YOU SPEAK UP?") and I've had a toddler point at me on an elevator and say, "Mommy, she's BIG." These and a thousand other indignities, major and minor, my entire life - and yet there's still always some asshole who thinks you aren't QUITE ashamed enough of yourself, who has to say something loud and public and vicious to make sure you really get how disgusting you are.
I'm at a normal weight now, and a normal size. Let me tell you, if you don't already know - normal is different. At a normal weight, people meet my eyes on the elevator and say hello. People ask me how my day was, or what I'm planning for the weekend. Doctors actually listen to my symptoms, and don't shy away from looking at or touching my body. I don't have to raise my voice or interrupt to make a point in a meeting. People smile at me and move their purse or bag when I get on the train. People smile at me. Sales people come up to me and ask if they can help me. When I'm walking in the park, the other walkers say hello. There is an entire range of casual human-to-human interaction that I witnessed but was never invited into, because people were too disgusted or too pitying to acknowledge me before. I felt, a lot of the time, like I had no personhood.
And the worst part is, a lot of the time? I was grateful for that. I didn't want to be noticed. I knew what happened when somebody noticed a fat woman, and it was never anything good.
This is something so deep in our society that I don't know if anything can change it. It's hurtful and offensive, and even decent people do it. To a fat person, it doesn't matter whether the reaction is "ugh, a fat person" or "oh, poor fat person" - it's still not "oh, a person," which is what most of us want and will never get. And it's in fat people, too. As a fat person, I was always checking to see - am I the fattest person in the room? Which means inevitably I'm looking at the person who is - and then I'm the chick staring at the fat person rather than seeing a person, and I'm the problem.
Whether my bariatric surgery is successful for the long haul remains to be seen, but I'll just say this - being a thin person, even if it turns out to be temporary, has opened my eyes to what I've been missing. And it's not cool clothes, or guys hitting on me; it's being a person in the world who is allowed to just be a person.
If someone had told me before surgery, "Hey, there's a chance you'll end up gaining all the weight back, but for a few years, you'll get to see what it's like to be treated like a real human person" -- I'd have made that bargain in a heartbeat.
posted by invincible summer at 1:23 PM on September 20, 2018 [46 favorites]
I thought the essay was very informative and clear in presenting the countereffective tactics of fat-shaming and healthcare-thru-weightloss. Really eye-opening (for me) in laying out that, yes, being overweight is bad for your health, but primarily because of how it affects other peoples perceptions of you, including medical professionals. I also loved the stark factoid
Since 1980, the obesity rate has doubled in 73 countries and increased in 113 others. And in all that time, no nation has reduced its obesity rate. Not one.
as well as
Americans actually consume fewer calories now than we did in 2003.
...which is just incredible and should be conclusive evidence that obesity has nothing to do with individual willpower, a myth which permeates. It's not as though in 1980 humanity collectively lost their ability to exert personal control over they body-fat-percentage.
I will admit that upon finishing the essay I was at first at a loss as to what the point was. Raising awareness that obesity leads to poor medical care, sure...but the essay seemed to veer between claiming obesity isn't a worldwide health problem and claiming that it definitely is. After some reflection, it became clear to me that the essay is saying obesity is a problem, but not the primary problem. It is a tertiary problem; far smaller, in terms of health, than the stigma against it, and than the decline of nutritional quality of modern food. From a sidebar:
60% of the calories Americans consume come from “ultra-processed foods”
SOURCE: BRITISH MEDICAL JOURNAL, 2016
I sincerely hope the vitriol directed toward the victims of substandard nutrition (all of us, in some way) can be re-directed with a vengeance against the food industry that creates and aggressively markets these slow-working poisons; profitable only by externalizing the cost of human health. In other industries the chemicals with long-term adverse health effects are regulated with safeguards to keep them away from humans, while in food they are made palatable (irresistible!) and sold to us explicitly to be ingested.
posted by smokysunday at 1:24 PM on September 21, 2018 [4 favorites]
Since 1980, the obesity rate has doubled in 73 countries and increased in 113 others. And in all that time, no nation has reduced its obesity rate. Not one.
as well as
Americans actually consume fewer calories now than we did in 2003.
...which is just incredible and should be conclusive evidence that obesity has nothing to do with individual willpower, a myth which permeates. It's not as though in 1980 humanity collectively lost their ability to exert personal control over they body-fat-percentage.
I will admit that upon finishing the essay I was at first at a loss as to what the point was. Raising awareness that obesity leads to poor medical care, sure...but the essay seemed to veer between claiming obesity isn't a worldwide health problem and claiming that it definitely is. After some reflection, it became clear to me that the essay is saying obesity is a problem, but not the primary problem. It is a tertiary problem; far smaller, in terms of health, than the stigma against it, and than the decline of nutritional quality of modern food. From a sidebar:
60% of the calories Americans consume come from “ultra-processed foods”
SOURCE: BRITISH MEDICAL JOURNAL, 2016
I sincerely hope the vitriol directed toward the victims of substandard nutrition (all of us, in some way) can be re-directed with a vengeance against the food industry that creates and aggressively markets these slow-working poisons; profitable only by externalizing the cost of human health. In other industries the chemicals with long-term adverse health effects are regulated with safeguards to keep them away from humans, while in food they are made palatable (irresistible!) and sold to us explicitly to be ingested.
posted by smokysunday at 1:24 PM on September 21, 2018 [4 favorites]
I recently heard a food addiction specialist suggest that as a society, we should treat unhealthy food the way we do cigarettes. I still don't know how I feel about that.
posted by bq at 1:44 PM on September 21, 2018
posted by bq at 1:44 PM on September 21, 2018
I think that's a ridiculous suggestion and is the kind of overreach that makes people not take dietary advice seriously. A slice of cake, an order of fries, a pot of fondue — none of these is in any way equivalent to a cigarette in terms of negative health effects.
Unless something is actually poisonous, it's unhelpful and probably counterproductive to try to describe foods as if they're things like cigarettes or drugs.
posted by Lexica at 3:31 PM on September 21, 2018 [6 favorites]
Unless something is actually poisonous, it's unhelpful and probably counterproductive to try to describe foods as if they're things like cigarettes or drugs.
posted by Lexica at 3:31 PM on September 21, 2018 [6 favorites]
Gay people like other gay people; Mormons root for other Mormons. Surveys of higher-weight people, however, reveal that they hold many of the same biases as the people discriminating against them.
Lol at that first part -- the first analogy that came to my mind for the second sentence was internalized homophobia. It took me a lot of work to even get me to a state where I was really happy being gay, where that in and of itself didn't feel gross and shameful, and I still trip over pockets of shitty beliefs every once in a while that I'm only even able to recognize because of therapy.
This is not to disagree with the general point at all, just to say that sadly I'm not the slightest bit surprised that a stigmatized group would internalize negative stereotypes about themselves and people like them. It's exactly what I would expect to happen.
posted by en forme de poire at 9:19 PM on September 21, 2018 [5 favorites]
Lol at that first part -- the first analogy that came to my mind for the second sentence was internalized homophobia. It took me a lot of work to even get me to a state where I was really happy being gay, where that in and of itself didn't feel gross and shameful, and I still trip over pockets of shitty beliefs every once in a while that I'm only even able to recognize because of therapy.
This is not to disagree with the general point at all, just to say that sadly I'm not the slightest bit surprised that a stigmatized group would internalize negative stereotypes about themselves and people like them. It's exactly what I would expect to happen.
posted by en forme de poire at 9:19 PM on September 21, 2018 [5 favorites]
I recently heard a food addiction specialist suggest that as a society, we should treat unhealthy food the way we do cigarettes. I still don't know how I feel about that.
The UK is already doing it.
I think it depends on what you define "healthy" food as. And paternalistic social engineering is not really democratic anyway.
posted by JamesBay at 6:23 PM on September 23, 2018
The UK is already doing it.
I think it depends on what you define "healthy" food as. And paternalistic social engineering is not really democratic anyway.
posted by JamesBay at 6:23 PM on September 23, 2018
You know, reading through this thread, I get it, I really do, but I think that dismissing people who lost X kg by doing Y, as a few comments above have done, is a pretty shitty thing to do, given what a painful journey it will have been for many of us.
Are people who have lost a bunch of weight, or are in the midst of losing a bunch of weight, or are working hard maintaining their new lower weight, not "real" obese, just like science fiction writers aren't "real" authors?
I'll also note that a chorus of "diet is a temporary solution" and "oh you'll put the weight back on and more" or even "diets don't work" is a shitty chorus for those people who have been lucky enough to find a formula that works and has been sustainable for them.
Given the particular psychologies of the long term obese, and given how easy it is to find a slippery slope when it comes to dieting and exercise, I agree that ex-obese or for-now-non-obese or "normals" or whatever we might decide we want to call them should perhaps be a little less-quick to share their stories of transient or permanent success...but I'll also submit that the "diets are bullshit" and "weight loss isn't something I'm interested in anyway" commentary might be tempered a little as well.
I won't go so far as to say that the presently-obese chiding or diminishing the previously-obese is a form of body shaming, but I think it's certainly in orbit around it an this particular previously-obese certainly doesn't appreciate it. It smacks of "your struggles weren't real struggles like my struggles are".
posted by turbid dahlia at 9:02 PM on September 23, 2018 [6 favorites]
Are people who have lost a bunch of weight, or are in the midst of losing a bunch of weight, or are working hard maintaining their new lower weight, not "real" obese, just like science fiction writers aren't "real" authors?
I'll also note that a chorus of "diet is a temporary solution" and "oh you'll put the weight back on and more" or even "diets don't work" is a shitty chorus for those people who have been lucky enough to find a formula that works and has been sustainable for them.
Given the particular psychologies of the long term obese, and given how easy it is to find a slippery slope when it comes to dieting and exercise, I agree that ex-obese or for-now-non-obese or "normals" or whatever we might decide we want to call them should perhaps be a little less-quick to share their stories of transient or permanent success...but I'll also submit that the "diets are bullshit" and "weight loss isn't something I'm interested in anyway" commentary might be tempered a little as well.
I won't go so far as to say that the presently-obese chiding or diminishing the previously-obese is a form of body shaming, but I think it's certainly in orbit around it an this particular previously-obese certainly doesn't appreciate it. It smacks of "your struggles weren't real struggles like my struggles are".
posted by turbid dahlia at 9:02 PM on September 23, 2018 [6 favorites]
Where here do people say that those who have lost weight aren't real??
Perhaps it's because this thread is about an article focusing on the currently-and-likely-always obese. Perhaps that is the space being championed. The formerly-obese may have different current needs and spaces.
posted by TwoStride at 5:34 AM on September 24, 2018 [4 favorites]
Perhaps it's because this thread is about an article focusing on the currently-and-likely-always obese. Perhaps that is the space being championed. The formerly-obese may have different current needs and spaces.
posted by TwoStride at 5:34 AM on September 24, 2018 [4 favorites]
Are people who have lost a bunch of weight, or are in the midst of losing a bunch of weight, or are working hard maintaining their new lower weight, not "real" obese, just like science fiction writers aren't "real" authors?
They are real obese. However, those who keep the weight off for more than three years are 3% of dieters, and there's no indication that "hard work" is what puts them in that 3%.
The article and comments are relevant to the 97% of dieters who were lied to - who were told, "do this to lose weight" as if that were a plan instead of a roll of the dice - and the ones who resist dieting because they know that the odds are strong against them.
All the research now points to the fact that diets are bullshit. For some people, a drastic, permanent change in diet, combined with drastic, permanent changes in activity levels, can lose weight and keep it off; for most, however, the body has a size it's trying to be. This is often based on both genetics and childhood habits that a person doesn't get to choose, and exacerbated by any disabilities or medications a person needs.
It smacks of "your struggles weren't real struggles like my struggles are".
The struggles of someone who can stay under 150 lbs by keeping their calories under 2000 and exercising a half-hour ever day, are not the same as as the struggles of someone who tried that lifestyle and discovered that it made her exhausted, cranky, prone to illness... and not a bit skinnier, as her body works hard to maintain those calories instead of converting them to usable energy.
This isn't denigrating the struggles of someone who manages to lose weight and keep it off; it's pushing hard against the common narrative of, "I know one person who did that, so you should be able to as well."
posted by ErisLordFreedom at 4:47 PM on September 24, 2018 [12 favorites]
They are real obese. However, those who keep the weight off for more than three years are 3% of dieters, and there's no indication that "hard work" is what puts them in that 3%.
The article and comments are relevant to the 97% of dieters who were lied to - who were told, "do this to lose weight" as if that were a plan instead of a roll of the dice - and the ones who resist dieting because they know that the odds are strong against them.
All the research now points to the fact that diets are bullshit. For some people, a drastic, permanent change in diet, combined with drastic, permanent changes in activity levels, can lose weight and keep it off; for most, however, the body has a size it's trying to be. This is often based on both genetics and childhood habits that a person doesn't get to choose, and exacerbated by any disabilities or medications a person needs.
It smacks of "your struggles weren't real struggles like my struggles are".
The struggles of someone who can stay under 150 lbs by keeping their calories under 2000 and exercising a half-hour ever day, are not the same as as the struggles of someone who tried that lifestyle and discovered that it made her exhausted, cranky, prone to illness... and not a bit skinnier, as her body works hard to maintain those calories instead of converting them to usable energy.
This isn't denigrating the struggles of someone who manages to lose weight and keep it off; it's pushing hard against the common narrative of, "I know one person who did that, so you should be able to as well."
posted by ErisLordFreedom at 4:47 PM on September 24, 2018 [12 favorites]
The struggles of someone who can stay under 150 lbs by keeping their calories under 2000 and exercising a half-hour ever day, are not the same as as the struggles of someone who tried that lifestyle and discovered that it made her exhausted, cranky, prone to illness.
In many cases, they absolutely are. Eating at a deficit and exercising makes pretty much everyone hungry, tired, cranky. That's what makes it a struggle.
posted by windykites at 9:18 AM on September 25, 2018 [2 favorites]
In many cases, they absolutely are. Eating at a deficit and exercising makes pretty much everyone hungry, tired, cranky. That's what makes it a struggle.
posted by windykites at 9:18 AM on September 25, 2018 [2 favorites]
Perhaps it's because this thread is about an article focusing on the currently-and-likely-always obese.
When for some of us, if that is true, it means the death of really important things to us, it kind of doesn't feel great to have fellow heavy folks saying things like this. I get that it may feel empowering to some, but to others, it's more like an incitement to active despair.
posted by corb at 10:15 AM on September 25, 2018 [3 favorites]
When for some of us, if that is true, it means the death of really important things to us, it kind of doesn't feel great to have fellow heavy folks saying things like this. I get that it may feel empowering to some, but to others, it's more like an incitement to active despair.
posted by corb at 10:15 AM on September 25, 2018 [3 favorites]
In many cases, they absolutely are. Eating at a deficit and exercising makes pretty much everyone hungry, tired, cranky. That's what makes it a struggle.Just as everyone feels sad sometimes, but not everyone goes through what clinically depressed people go through, lots of people put real effort and worry into balancing their their caloric intake and exercise without having the vaguest inkling of what obese people struggle with.
posted by DirtyOldTown at 10:36 AM on September 25, 2018 [2 favorites]
They published an addendum, following up with the folks pictured and interviewed in the initial piece.
The various reactions and receptions were in a lot of ways as diverse as the stories in the initial profile, but i couldnt help feel sorry for Erin Harrop the researcher depicted in her pride shirt and superhero garb:
“I haven’t told my mother or my sister about it even coming out. They are still entrenched in a diet paradigm. I’m pretty sure they would be a bit upset by my photo being featured with the title ‘Everything You Know About Obesity Is Wrong’ in capital letters across my image. They would definitely be embarrassed that I chose to wear a pride shirt. It is striking to me that I haven’t been able to show some of the people I’m closest to, and that I fear their reaction so much more than the 10,000 internet trolls that I know will attack this. As the article states, one of the worst parts about weight stigma is that it usually comes from those you love, too, not just the world. So the people that should help protect you from that stigma might actually perpetuate it.
I wish I could tell my mom about this, because it certainly has been a weird, surreal experience. And maybe I will at some point. I just feel a little too vulnerable right now. Having so much of me “out there” (mostly referring to the photo) is hard to hold, knowing how cruel many folks are. But I’m also surprised by the humanity I’m seeing, and the human empathy that seems to have been evoked by this piece.”
posted by Exceptional_Hubris at 1:43 PM on September 25, 2018 [6 favorites]
The various reactions and receptions were in a lot of ways as diverse as the stories in the initial profile, but i couldnt help feel sorry for Erin Harrop the researcher depicted in her pride shirt and superhero garb:
“I haven’t told my mother or my sister about it even coming out. They are still entrenched in a diet paradigm. I’m pretty sure they would be a bit upset by my photo being featured with the title ‘Everything You Know About Obesity Is Wrong’ in capital letters across my image. They would definitely be embarrassed that I chose to wear a pride shirt. It is striking to me that I haven’t been able to show some of the people I’m closest to, and that I fear their reaction so much more than the 10,000 internet trolls that I know will attack this. As the article states, one of the worst parts about weight stigma is that it usually comes from those you love, too, not just the world. So the people that should help protect you from that stigma might actually perpetuate it.
I wish I could tell my mom about this, because it certainly has been a weird, surreal experience. And maybe I will at some point. I just feel a little too vulnerable right now. Having so much of me “out there” (mostly referring to the photo) is hard to hold, knowing how cruel many folks are. But I’m also surprised by the humanity I’m seeing, and the human empathy that seems to have been evoked by this piece.”
posted by Exceptional_Hubris at 1:43 PM on September 25, 2018 [6 favorites]
I do t see how losing weight is any different from passing. Maybe that’s just because my grandmother did it so successfully, I am often accused of faking my latinx identity.
She did real violence to herself and her kids, giving up her identity to seem possibly Italian or Jewish. She hurt the people around her who couldn’t pass, by isolating them and denying them solidarity.
It’s understandable but also problematic. You should recognize that there is privilege at play that you could play the system, and that there’s something ugly about being held up as a model minority to justify oppression of others
posted by politikitty at 2:30 PM on September 25, 2018
She did real violence to herself and her kids, giving up her identity to seem possibly Italian or Jewish. She hurt the people around her who couldn’t pass, by isolating them and denying them solidarity.
It’s understandable but also problematic. You should recognize that there is privilege at play that you could play the system, and that there’s something ugly about being held up as a model minority to justify oppression of others
posted by politikitty at 2:30 PM on September 25, 2018
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This thread has been archived and is closed to new comments
So many images you see in articles about obesity strip fat people of their strength and personality. According to a recent study, only 11 percent of large people depicted in news reports were wearing professional clothing. Nearly 60 percent were headless torsos. So, we asked our interview subjects to take full creative control of the photos in this piece. This is how they want to present themselves to the world.
I loved the photos.
posted by TwoStride at 2:20 PM on September 19, 2018 [56 favorites]