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.
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.)
Possibly more important than Dr. Sharma’s post itself, however, are the comments. Linda Bacon, herself, responds. Wow. Moreover, Dr. Barbara Berkeley jumps into the fray (as do a few of her supporters). And from the size acceptance community, we see the influential voices of Deb Lemire (President of the Association for Size Diversity and Health) and Bill Fabrey (founder of NAAFA and continuing size acceptance advocate).
I am disappointed that Dr. Sharma didn’t acknowledge the comments, and I hope he recognizes that while the post was important, synthesizing the important comments (and ignoring some of the others) may be more so. In as much as HAES v. Intentional Weight Management becomes a conversation, and not dueling manifestos, his post may be progress toward a broader, more dimensional understanding of human adiposity by influential people of differing vantage points.
HOORAY! I cheer! Let those of us in the peanut gallery bust open the champagne! (A fruit-based carb product, unlike that shady grain-based beer.)
Now that the summary is out of the way (no thanks to me), later this week (or at such time as I am not distracted) I will address a few of the strengths and weaknesses I see in the Bacon/Aphramor research. I will try to make sense of the pencil notes I wrote in the margins, and give my thoughts on some of the footnotes I chased down.