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Archive for February, 2011|Monthly archive page

Beginning to Weigh in on the Linda Bacon/Lucy Aphramor Paper

In Weight-Loss Maintenance on February 28, 2011 at 2:34 pm

The great thing about procrastination in blogville?  If you wait long enough other people do big chunks of your work for you.  I have, for some time now, wanted to post my impressions of the Linda Bacon/ Lucy Aphramor treatise, from January 24th of this year, Weight Science:  Evaluating the Evidence for a Paradigm Shift.  The shift they speak of, of course, is away from a weight-loss centered medical model to one of Health at Every Size, or HAES (trademark pending).  It is a densely referenced essay, with only eleven pages of narrative followed by 178 footnotes filling nine pages of their own.  Those footnotes deserve fair inspection and at least some random verification to make sure the authors are interpreting properly (a daunting task), and that has held me up some.  However, to critique such a treatise as this, it is only fair to start with a summary, and I thank others for coming through for me, brilliantly.

From the size acceptance community we have a lovely essay from Living 400lbs, and we have Big Fat Blog’s earlier quickie post on the topic. 

Since we can expect the size acceptance community to embrace a paper promoting HAES (which is rooted first in size acceptance), I found it more heartening to see that Canada’s preeminent obesity expert, Dr. Arya Sharma, not only posted a thoughtful summary of his own, but he ended by saying he is keeping an open mind on the topic.  This from a man whose bread and butter entails (where he deems appropriate and judicious) recommending bariatric surgery for his patients.  Unsurprisingly, he has a much rosier impression of the evidence-based benefits of bariatric surgery than Bacon and Aphramor or others from the size acceptance community who publish in journals.  (To my lay eyes, this debate is stuck in a state of limbo, these-scientists-say-X/but-these-others-say-Y.  And few scientists are creating studies that cover a significant time period, which should be required if they are to break the tie by the weight of their evidence, credentials or the consensus of their colleagues.)   Read the rest of this entry »

I Have Good News, and . . .

In Weight-Loss Maintenance on February 21, 2011 at 7:23 am

The year is 2050.   Two women with a BMI of 40 sit waiting to meet with their General Practitioner, Doctor Pense.  The nurse calls the first patient, and does not take height and weight.  The appointment takes place in the doctor’s office, not the exam room.  The initial exam and lab tests are done.  The Doctor speaks first.

“Well, Donna, I have good news for you, mostly, and some bad news.  The good news is that your type of obesity is one that is medically insignificant.  Your fat does not compromise your health.  You may, in the future, have some joint issues, arthritis.  You may need new knees or hips.  However, for now, there’s nothing medically indicated.  That means the bad news is that insurance won’t pay for further treatment at this time, and I know you were hoping for some help with weight loss.  Insurance will pay for those joints as you need them.” 

“Medically insignificant?” 

“Yes, your fat composition, disposition is not likely to create any more medical problems for you than if you were naturally trim.  Your life expectancy is the same as a naturally trim person’s of your age.  Your fat is cosmetic.  Did you find that pamphlet I gave you on hygiene and special care of the fat body helpful?”

“Sure, Doc.  It’s helpful.  Uh . . . I’m still . . .  Do you know why I’m fat?”

“That would require more testing.  All I can tell you now is that it’s benign.”

“So, you’re saying I have to live with this enormous butt?”

“Oh, Silly, you . . .”

“No, seriously, I’ve had to buy special furniture for my house.  This isn’t funny.  The trend recently has been for stick furniture, and it’s been a nightmare trying to find good, sturdy stuff.  And that’s just the beginning of . . .” 

“Yes, yes.  I’m sorry.  That’s an unfortunate trend.  But it is only fashion.  You know, back at the turn of the century, some doctors’ offices didn’t even have chairs to accommodate people of different sizes.   That wasn’t a fashion statement, it was ignorance.” Read the rest of this entry »

Arya! Arya! Arya!

In Weight-Loss Maintenance on February 19, 2011 at 9:29 am

Let me start by saying I don’t agree 100% with everything on Dr. Arya Sharma’s blog.  For example, I think his Best Weight Practical Guide to Office Based Obesity Management (which he co-authored with the venerable Yoni Freedhoff and from which he regularly draws material for reposts) is a gross oversimplification of what is required of doctors and patients if they really want to have an impact on weight.  In this most recent repost, for example, he suggests

“. . . it is safe to assume that a patient who is unable to commit to 30 minutes per day of combined dietary and fitness effort will be unlikely to succeed with weight management using a purely behavioural strategy. Asking patients whether they feel they can find 30 minutes a day for their weight management effort will help to assess their readiness and willingness to change.”

To that I gasp, THIRTY MINUTES?!  No wonder the mythology persists that it’s all just a zippy “lifestyle” change, when our wise doctors promote this kind of crap.  Thirty minutes devoted to a less toxic diet and some exercise may marginally improve someone’s health, but it is nowhere near enough time to have ANY permanent impact on weight.  

On the other hand, the man, Arya, on another day can be brilliant.  I’ll say it:  genius.   For example, on Friday he talked about the complexity of calorie intake as related to weight.

Clearly, he respects his own field of specialization, and yet he has not dropped the notion that General Practitioners can and should press patients to manage their weight.  He is disappointed that they are “unenthusiastic,” but maybe he should hear that as a clarion call.  His Practical Guide presses GPs to make behavioral prescriptions in the name of weight management (as opposed to mere health improvement), but the GPs know, intuitively, that those prescriptions are hollow, at best.  They may even be damaging, because their dismal results can foster disillusionment and depression.  To my thinking, asking GPs to help their patients with weight management is ludicrous.  You might as well suggest that the GPs should be performing routine brain surgeries too. Read the rest of this entry »

A “Meta” Post About This Blog

In Weight-Loss Maintenance on February 14, 2011 at 10:35 am

In addition to adapting the Rules of Engagement post for a “page,” and looking into how to get rid of the vulture advertisements as cheaply as possible, I have been making my way through the Linda Bacon/Lucy Aphramor paper supporting a Health at Every Size (HAES) approach to weight management.  I hope to post on it soon, but it’s turning out to be more challenging and time-consuming than I’d anticipated.  I am unable to breeze through it without checking at least some of the sources.  I mostly support its premise, and yet it makes me uncomfortable.  I think Barbara Berkeley touched on it in the comments at her own blog.  It reads as a manifesto, and that rubs me (and her) wrong.  It’s kinder and better sourced than Gary Taubes’s Why We Get Fat (also a manifesto), but the Bacon paper is a manifesto nonetheless.  And, as with Taubes’s book, I have no place in it, really, or at least my place is awkward.   Barbara’s ultimate response (in the comments) indicates she will return to her position of promoting weight loss, which is appropriate for her.  It’s her job, her life’s focus, and she does it with kindness and circumspection.  I will likely end up somewhere else, though I don’t know where that is yet.

The good news, the Bacon article isn’t messing with my weight, as Taubes’s book did.  As I read Why We Get Fat, I found myself falling into his regimen, compelled to decline counting calories, trusting my satiety to keep my weight in check (since I was increasing my fat intake).  My weight crept to the top of its range and hovered for days.  Then it went over my current range by a pound.  Ack.  And then another.  Ack.  Ack.  I’ve returned to my own tried-and-true regimen, and have some days seen a number in my range.   I think I’ll stick with what my body has prescribed for me.  Please accept that as my “final answer” and I will accept carb control or size acceptance as yours, and we’ll look at various topics with respect for our choices.  How wonderful that we ARE different, because we are much more likely to see something original between and amongst our experiences, rather than in a fray of dueling manifestos that blind us by calling up our own pig headedness. Read the rest of this entry »

Rules of Engagement

In Weight-Loss Maintenance on February 7, 2011 at 3:00 pm

In the comments section of my last post, it became apparent that I need to create a page, to appear with the Disclaimer and “About” pages, that establishes some rules.  Since we are a disparate community with two primary groups, weight-loss maintainers and size acceptance proponents, it is easy to see how something said by one may rub another wrong.   Actually, what I have found amazing is how we are on the same basic pages. 

 We agree that:    

  • Fat people, on average, are as smart and well informed as naturally trim people and people who are intentionally weight reduced.  
  • Diet culture has disappointed all of us, repeatedly. 
  • Science is incomplete and confusing, rife with arrogance and bias, and often does not advance health or well being, especially with regard to human body weight.  
  • The medical profession, which relies on science and is influenced by diet culture, does not give fat people equal regard to trim people.  Moreover, it has no idea what to do with body weight as it fits into the overall health picture, given its disease model, which promotes problem solving and fixing broken things, rather than nuanced lifetime strategies for dealing with issues that are not clearly broken.
  • Public policy has also been influenced negatively by incomplete and biased science, as well as diet culture.

This common ground has led to interesting discussions.  Perhaps these bullet points are the beginning of a set of site assumptions. 

Despite this common ground, our differences occasionally lead to inadvertent slights or well intentioned challenges that cross the line and become attacks.  Most of these kerfuffles, day to day, are manageable and can be gently set right.  They become more difficult when someone intrudes with an agenda that includes self-promotion.  Even self-promoters, however, can have good hearts and if they had a page to consult, they might not go so far astray. Read the rest of this entry »