I will warn you but I will not apologize... this blog may be rip through your comfort zone and everything you have ever known. You may even decide to stop following me at this point. And guess what... I am ok with that! But I hope these words ring through your ears for years to come and may help at least one person make one small shift that will ripple through this world that we all co-exist in together. I also trust that you will likely be back when you are ready to take off the rose colored glasses to view the world as it actually is and to see the damage we have done to ourselves, our children, and our world.
We have all been experiencing a global pandemic. It has been our faces. None of us like it but we all know it is here, regardless of how we feel about it. We all want to be done with it. We want to wake up and have it gone. We want to return to our previous normal life (as if that is a possibility). COVID has killed loved ones, destroyed many businesses, and has really had us taking a look at our life and even more so our health. Whether we have had COVID or had family with COVID, we have ALL been impacted (100%) in one way or another. What if I told you there is another pandemic circling, raising its ugly head even more right now and it has been around for decades, but we have only shifted its impact minimally, in the grand scheme of things and not everyone is aware of it?
It is the global pandemic of "Fat Phobia causing Weight Stigma". If you are questioning wether this is really a global problem, stop and think... Have you ever met anyone who doesn't care about their weight? Or who has not been indoctrinated into judging what their body looks like? Why aren't we talking about that? This is causing massive harm to our communities and individuals ALL OVER THE WORLD! This is not just happening in your little town or city. I am going to be as brave to say... "Fat phobia literally has or is currently impacting every single one of us 7.9 billion people in this world". We all walk around constantly fearing weight gain or trying to lose weight (except the few of us that have learned to rise above this, but even then, we were impacted at one point). This concern of our weight just lives with us because let's face it... it has been there since we were young, likely hundreds of little messages that have supported our thinking in this manner and as we continue to age there are just more, which silently influence how we think about ourselves.
As this so called obesity epidemic has spread... We have become so morbidly obsessed with controlling our bodies, which controls our thoughts and then our overall well-being! We have been led to believe that in order to not only be "good enough" as participating human in this society , we have also been taught that to be healthy is to be the "perfect weight". However, what the heck is that?! And who is dictating what makes us the weight that we need to be? How has our body become not the expert of our body? Our brains, hearts, lungs, digestive center, etc work in beautiful synergistic way without us thinking it through, but yet for some reason our metabolism and body shape seems to be something we are supposed to "control".
Have we come to this because of that pesky completely invalidated BMI tool that was created by a mathematician/sociologist to "identify the perfect man" for evaluation against studies; however, he couldn't figure it out, so he had to square everything and force his formula to make it work? Oh and don't get me started on how he was only looking at European white men to make his equation, which again he forced his data. How in the world are we evaluating our self-worth against something that had forced data? Is that sound science? And how are we evaluating our medical care when the pseudo-science was looking at only one gender and one ethnic background? I am not going to go into that full answer in this blog as there numerous resources out there that have already uncovered this (see resources). But I will say... follow the money! It is a HUGE problem that medical providers get paid more when they mark that they are treating someone with obesity. Yes, you read that right... medical providers get higher rates of reimbursement when they code "obesity" and they just have to spend 4 minutes of their time on "diet & exercise" counseling, because yeah... counseling in 4 minutes can really help someone.
We are evaluating our self-worth and body against something that was never intended to be used for health evaluation. But hey, the insurance companies need something to drive their coverages off of (and I am not just talking health insurance as this also includes life insurance). Did you know people pay a higher premium for life insurance based on the size of their body? What would it look like if we screened for health (equally) based other known determinants of health such as food access, skills to prepare food, how we eat our foods, our relationship with food, if we have people to share meals with, number of times cycling has occurred, the number of restrictive diets followed, the thoughts we have about our body, our bodies abilities to complete day to day tasks, lean muscle mass, and our abilities/skills to work on increasing muscle mass, etc.
To be clear, I am not faulting medical providers, insurance companies, policy makers, etc as all of these categories of people are simply just people and they were indoctrinated from diet culture just like the rest of us. This is how our systems and education are set up, mine included. As health care providers, we often learn what sick care looks like and we learn that overweight and obesity is the driving force of problems. However, we are struggling students just trying to make it through our schooling while still participating in life, so most of us do not stop and evaluate the research behind what is being told to us. We do not realize that what is being taught to us is based on correlation studies and studies that do not control for weight stigma, weight cycling, or a whole other host of variables such as socioeconomic status, access to food, skills for food preparation, mental health variables and so much more.
When we look at correlation graphs and follow the thinking that if this X% of people could lose weight then that would reduce X disease by this much. Seems like a completely plausible public health initiative that we have invested millions of dollars towards; however, we have not yet solved this "problem". We are only going the other direction. Have you ever asked yourself why? Or looked at the countless studies that just may explain this?
The answer can be boiled down to weight stigma! This is one of the biggest causations of so many of our problems today. WEIGHT STIGMA CAN CAUSE:
Mental health challenges and disorders including disordered eating and eating disorders
Malnutrition, reduction of lean muscle mass
Physiological health problems and worsened disease states
Poor metabolic health and increased weight gain
All of this is basically HARM. Medical providers are taught to "First do no harm" and they sign an oath to follow this. Ironically, this is the name of the 1997 American made-for-television drama film about a boy whose severe epilepsy, unresponsive to medications with terrible side effects, is controlled by the ketogenic diet. The ketogenic diet can have it's place under medical supervision, but was never intended to be used for controlling one's body size or to go on and off of, essentially causing harm. Again, I reiterate, can we really control our bodies? Our bodies often have a genetic set point, which epidemiology is showing that DNA transcription from our ancestors can go back 7 generations.
And to be clear... I get this may be a completely new of thinking and you may ask questions like... what about weight loss for medical reasons, such as joint pain. Wouldn't people need to lose weight to help their joints? Well I ask you... what if someone were having joint pain that did not live a larger body? What would the recommendations be? Would you tell them to restrict their nutrition intake and start potentially unsafe exercises in order to control their body before providing other medical treatment? Does someone have to prove themselves through weight loss before receiving other medical care? And I would also ask... what could someone (anyone) do to improve the strength of their joints? Wouldn't it fell less resistant to think about this? I am not a physical therapist or even someone who will pretend to have knowledge in this area, but I believe the initiation of strength building exercise can help someone to actually start building strength today versus "waiting for the indefinite, unachievable weight loss". 97% of people who diet "fail". But really it is not people failing diet, it is diet culture failing that person. In a medical setting, people need to be supported for what they come in for, otherwise, they likely will not return for medical care and this is a result of weight stigma in of itself.
Most medical providers get into the medical field to help people. This needs to include having compassion for all bodies. We need to get away from assumption healthcare, which is assuming something about someone based on their body. There have been countless studies showing medical provider biases based off of someone's body size and often times those providers have thin or health privileges that those they are treating simply do not.
So if you are a medical provider and are curious if you promote weight stigma, ask yourself these questions:
Do I make diagnoses or treatment plans based on the size of someone's body?
Do I promote or encourage weight loss? (and I would lean further into this... if your patient's want weight loss, is it ethical to have them pay you for it knowing it does more harm than good in more than one way?)
Do I have biases about people based on their weight?
Do I succumb to the requirement from insurance companies to weigh every person even though it does not change my care plan for them that day?
Do I weigh every patient I see without even thinking about it?
If you are wondering if you have been a victim of weight stigma...
Are you living your life to the fullest or do you put life events on hold based on your weight?
Do you think "will this make me lose weight or gain weight" at each decision intersection of your life?
Do you make choices based on controlling your body or are you making choices that feel so good in your body?
Do you look in the mirror and judge your body shape? Or do you avoid mirrors at all costs?
Do avoid seeking medical care unless absolutely necessary?
If you answered yes to any of the questions above, it is ok! You are here now and you can make small intentional shifts. There are a ton of resources out there to support you and quite a few practitioners that have signed on to support people becoming their healthiest at any size. Check out the "Healthy at Every Size" movement and so much more. I am also here to support others throw out this old way of thinking and lean into this concept, which can help providers serve their patients with their patient as the focus and can help others really start to live their life in a way that feels good to them!
Association for Size Diversity and Health (ASDAH): www.sizediversityandhealth.org
Body Image Health: www.bodyimagehealth.org
Body Positive: www.bodypositive.com
Council on Size and Weight Discrimination (CSWD): www.cswd.org
The Body Positive: www.thebodypositive.org
Eating Disorders Awareness and Prevention (EDAP) www.edap.org
Healthy At Every Size: https://haescommunity.com/
Healthy Weight Network: www.healthyweight.net
Intuitive Eating www.intuitiveeating.org
National Association to Advance Fat Acceptance (NAAFA): www.naafa.org
Obesity Action Coalition: www.obestityaction.org
Weight Inclusive Nutrition & Dietetics https://weightinclusivenutrition.com/
And be sure to our join our free Facebook Group: Love your Food, Love Yourself where you will receive free journal prompts every week to help you with this transformation at https://bit.ly/lovefoodloveyourself