DebraSY

Why I Will Continue to Read Arya Sharma’s Blog

In Weight-Loss Maintenance on May 11, 2011 at 12:47 pm

In yesterday’s post, I was pretty hard on Dr. Sharma.  I also contacted him by email and let him know that he had provoked a munity among a chunk of the HAES community who read his blog and respect his opinion, if not always in full agreement.  He responded thoughtfully and at length. 

My thoughts: 

Blog’s are written quickly.  Dr. Sharma says he is often asked whether his is ghost written (as I did).  It is not.

Now, regarding his emails, he didn’t apologize for his posts of May 9th or 10th.  Following is the closest thing he offered to an apology (note that you are “they”):

Their anger, trauma, suffering, frustration, disillusionment with the medical ‘establishment’ is all very real and understandable – in short – I can fully see ‘where they are coming from’.

So while some of them may now be hurt, frustrated and disillusioned by my post (which, really was not a personal attack, but rather a reflection of the kind of ‘uncritical’ thinking and arguments that I see reflected in some of the comments left on my site), this is not really the audience that I write for or even see in my practice. I am not out to talk anyone out of HAES or Fat Acceptance or anything else that they are happy and comfortable with.

I primarily write for my colleagues, to try and help them keep up with the latest research in this fast moving field, and perhaps over time change their understanding of obesity and their attitudes to people with obesity, who may wander into their practice.

Now, while we aren’t his central audience, he isn’t completely unappreciative of us.   He says that people who come to his blog and (respectfully) disagree with him “represent an interesting and important view point, which although by some standards extreme, certainly serves as a reality check to me and other readers – a reminder that there are other opinions out there.”

So, what set him off?  If we aren’t his central audience, I don’t think it was us.  (Even though some of us have been less than entirely respectful.)  I think, and this is only speculation, that we were hit by the shrapnel of a bomb aimed mostly at Linda Bacon.  Admittedly, in my first email to him I singled her out:  “Some HAES commenters are prickly about you, including Linda Bacon herself, but most have appreciated that you’ve kept an open mind despite unknowable pressures from others in your field.”  So, while the following paragraph may be revealing, my words may have provoked it.  (Attempt to read it aloud at your own peril.)

When a Linda Bacon, whose work I have extensively followed and reviewed in great detail in a previous blog post, resorts to accusing me of ‘failure’ in promoting my “unscientific weight-loss ideology”, I can only roll my eyes and wonder about her own agenda and lack of insight and confess to feeling a deep sense of disappointment in her inability to chose her arguments carefully enough to still confer professional respect and cordiality, which I tend to extend to all my colleagues – even the ones I completely disagree with – never would I dare accuse them of being ‘unscientific’ – there are always more than one way to interpret any body of evidence as complex as that on weight management – any scientist should know that.

(You may now suck in a deep breath.  Whew.)  I may have hit the bug-a-bear by raising her specter or he may have only been trying to build common ground with me.  Nevertheless, he had noted her comments, and taken umbrage, and I agree with him.  Linda Bacon is “branding” herself as the mother of HAES (and chasing down the trademark for it), and she could stand to be more measured and politic with her language.  As I’ve said before, she speaks in manifesto.

Among his other comments to me, Dr. Sharma summarized some of his contributions toward a more HAES-friendly approach to medicine:

I developed the Edmonton Staging System specifically to stop health professionals from recommending weight loss to people who are essentially healthy, I developed a diagnostic framework that looks at all potential factors that may lead to excess weight in an individual, and have written extensively about the shortcomings of BMI and why it is clinically meaningless.

I single-handedly championed the first ever National Summit on weight bias that generated over 40 million media impressions and got this topic onto the front pages of national media and we are currently preparing a position paper that will call on all policy makers to test any policies on the potential risks for increasing weight bias and promoting body-size distortion, especially in the context of the childhood obesity strategy, which may in the end do more harm than good.

I am currently working to have BMI and ‘ideal’ weight eliminated as measurements of “success” in the Alberta provincial obesity strategy.

I co-authored the book and coined the term “Best Weight” where we present an entirely different way of looking at obesity and its management.

I am outspoken about the need for regulating the commercial weight loss industry and the fashion industry for the depiction and promotion of unrealistic weights and inducing millions of people to weight-cycle themselves into obesity.

I was the first to invite the Eating Disorder folks to the table and have been actively building a relationship to them (also- note that HAES was well represented at the Summit – perhaps not by the radical ideologists, who may have liked to be there, but by those who do have the scientific credentials to speak about the issues).

AND he offered an edited bibliography of what he sees as his blog posts “that challenge the conventions ‘biomedical’ establishment,” including:

Is Weight-Loss Advice Unethical?  (He says this post opened discussions among the professional, “mainstream” obesity community in Canada.)

Why I Don’t Like BMI 

Does Weight Matter? 

To Have is Not to Be 

Does the Focus on Obesity Prevention Promote Bias and Discrimination? 

Is Obesity a Question of Choice?  

Obesity Classification:  Time to Move Beyond BMI 

Preventing Weight Gain is the first step in Obesity Management 

Severe Obesity is not a Choice 

When Will Health Professionals Understand Obesity? 

While that’s an impressive list, he actually neglected to include my favorite HAES-friendly post:

Eating More Calories Increases Weight (In some People – Maybe – Sometimes)  

Bottom line:  I feel he took my email inquiry seriously.  I think his inflammatory posts of May 9th and 10th were unfortunate (as well as his uncritical post a couple of weeks ago on the Alberta study that portrays fat people as society’s financial pariahs, and his premature post demanding political attention for obesity, yet lacking a clear plan), but I’m going to forgive (if not forget). 

As for Linda Bacon, I don’t know what to think.

As a feminist during my journalism school days, I had an eye-opening experience.  A professor called me “completely nutty” because in my copy I used the words “utility hole cover” instead of “manhole cover.”  I also vocally supported the women professors in their action challenging the Dean’s office to attain equal pay. 

Later in the year, I was talking with a feminist friend about a “rally” that embarrassed me, where some of the sisters decided to protest a campus policy that allowed men to go shirtless (but not women) by staging a sit-in . . . sans shirts, of course.  I told my friend, “they make us look nutty.”  She said to me, “Oh, no.  We need them.  The pendulum will never swing to where we want without them providing the magnetic pull from where they are.” 

By the time I graduated, the J-school newsroom had adopted Miller and Swift’s Handbook of Nonsexist Writing and the women professors reached a new pay agreement with the Dean.  Did the shirtless protesters advance this progress by making these requests look reasonable?  I’ll never know.  Is Linda Bacon our shirtless protester?  If so, should she put her shirt on?  Perhaps she can leave her shirt off, but speak more judiciously?

As for Dr. Sharma, he’s doing a better job of moving the medical pendulum to a more compassionate place than most other doctors in his field, and they listen to him more than they do any of us.  That’s why I’ll keep reading and commenting, always with due understanding of and respect for his not-entirely-weight-neutral position, and maybe offering a little bit of magnetic pull.

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  1. Very interesting. I admit that I can’t stay away from Sharma. My own personal “good-bye” post to him was more my good-bye to the trust I had put in him as one of the most open-minded health professionals writing on the subject of weight today.

    I feel slightly ill at ease with his responses to you. I feel the arrogance of the doctor coming through: an underlying “I can’t apologize outright because doctors just don’t do that,” hidden in the text. And if he’s mainly writing for his colleagues, what kind of message did his last two posts in particular send to them? Do they have special doctors-only reading glasses that enable them to understand his “real” meaning?

    I still believe that something has changed in Dr. Sharma’s outlook in recent weeks. And I continue to suspect that it’s a combination of the conference’s full-fat immersion atmosphere and the stress of constantly dealing with obese, incapacitated people that is taking its toll on him.

    Yes, he has written some great, out of the box blog posts, and I found them thrilling reading (boy, it must not take much to send me over the moon, but I digress), but I’m feeling skittish now. What’s coming next?

    BTW, were you struck, as I was, by today’s incredibly bland post? Vitamins! Whoo-wee.

    As for Linda Bacon, I’m torn. On the one hand, I think she’s onto something really exciting. Perhaps, however, the strain of fighting the diet-industrial complex is taking its toll on *her* and making it harder for her to dialogue effectively with people whom she justly or unjustly feels represent weight-loss orthodoxy.

    So, as far as Sharma goes, to be continued…

  2. What a compelling argument you present here. You show compassion, wisdom, and empathy.

    I’ve met a lot of doctors, and I often come away with the sense that they have been strictly advised and persuaded against saying “I’m sorry.” (My own doctor, I believe, is a lovely exception.)

    In an ethics and jurisprudence class for nurses, in fact, I too was strongly advised: “Never tell a patient you are sorry. It implies you did something harmful.” (!!!) (Apologizing to doctors is a different matter.)

    Dr. S’s post (re: quitting tobacco, which he later said was intended in jest, to mimic a kind of extremism) was potentially harmful. Of course, I am not suggesting that he intentionally wrote something that he realized could be harmful. Even if it was a kind of intentional parody, though, it may have resulted in serious harm. We may never know. I didn’t take it personally, but I was very concerned about the potential damage his rhetoric (in that particular post) might cause. Rhetoric constructs our consensus realities and worldviews. It is powerful. When the rhetoric comes from the keyboard of a noted authority, a medical doctor who is viewed as an expert in fat knowledge, it’s power may be greatly amplified.

    I’m not sure he can understand the way his words may have encouraged (constructed) more discrimination and fat bias. I’m beginning to understand more than ever before just how severe the harm (physically, mentally, emotionally, financially, etc), which results from fat bias and discrimination, and how that discrimination contributes to, or even results in, the very forms of illness (made worse by stress and social inequities) that professionals often profess to be so deeply concerned about.

    He does seem to act, more often than not (based on posts you note here), with forethought and consideration. But. The culture of health care needs to re-learn the virtue of honesty when it comes to saying “I am sorry” or “I made a mistake.”

  3. I’ll continue to read his blog, but really, 11 posts that are fat-positive (or at least close to it) out of how many total posts that aren’t even close to fat-positive, some of which are downright blaming and shaming? And he still continues to advance diets/exercise/WLS as ways to change weight and improve health in the fattest of people, even though he knows that for the majority of those people, it’s not going to work long-term and could cause more harm than good.
    Reminds me of two sayings – “With friends like that, who needs enemies?” and “Keep your friends close, but keep your enemies closer.” When it comes to Dr Sharma, I think I’ll keep those two sayings very much in mind, thank you very much. He’s disillusioned me for the last time.

  4. Hopeful: Believe it or not, I had a surgeon apologize to me–repeatedly and with profound sincerity. He was (and still is) extremely respected in his field and many young surgeons come to him to learn from the master.

    In 2003, he performed a routine surgery on me, but he used a technique that was quite new to him (with my approval, of course). The surgery went badly and, though it was not immediately apparent, I ended up more handicapped than I had been originally. While five physio-therapists kept telling me over the course of a few months that I was just progressing more slowly than usual, when I saw my surgeon for a special consultation (I had become extremely depressed and the regular appointment was moved up several months), he immediately said he was sorry, that it was his fault (during the surgery, he realized that I was NOT a good candidate for minimally invasive surgery, but the damage had already been done), and that he would do all that he could to correct the damage. He performed the revision surgery and although I am not absolutely thrilled with the result–that’s another story–he definitely corrected the problem that he had caused and I can now walk again and indeed, I walk better than before the first surgery.

    I see my surgeon once a year for a check-up and he is always all smiles. He even told me how scared he had been and how relieved he was that things finally went right. In fact, at my 3-month appointment after the revision surgery, after I told him how well I was doing, he looked skyward and said, “Thank you, God”. He was not being facetious.

    I would not wish my experience on anyone, but I have to hand it to Dr. G.: he acted like a decent human being, contrary to many doctors.

  5. It’s a legal thing (the non-apologetic doctors) – an apology can be taken as an admission of guilt & therefore RESPONSIBILITY…

    Therefore it is true, we are advised NOT to say “I’m sorry”, but to find other ways & means to confer/interact w/clients & patients.

    Anyway, now I’ll tell you a funny story: today I saw the sneezing cat of an elderly couple, long-term clients as well as friends of mine who cannot medicate this beast! Generally we manage his chronic sinusitis by having them bring him in every other day for an antibiotic injection… However, they are going out of town so the idea struck me to give this kitty a dose of a long-acting antibiotic which I’ve used a great deal in rabbits (which are sensitive in a fatal sense to many antibiotics)… Anyway, long story shortened to say he had a bad reaction; I treated him & we all had a good (if nervous) laugh about learning a valuable lesson at my feline guinea pig’s expense.

    But I did apologize sincerely!

  6. I think that people I disagree with, so long as they’re arguing in good faith, are more interesting to talk to than people who consistently reinforce my paradigm.

    I don’t keep up with Sharma’s blog daily or weekly, but I see more good faith than bad faith in what I’ve read. The two posts discussed above are obvious exceptions, but he’s willing to question dogma even when he doesn’t dismiss it.

  7. I agree, Bobbini. I think that more often he’s operating from compassion and, for a doctor, he does and admirable job of keeping his ego/condescension in check. Recently, he’s had some notable exceptions, but they do seem to be exceptions.

  8. Well. Dr. Sharma’s blog post today is light years away from the one(s) that got us steamed. Gotta give him credit. Still. It’s a bit like being in The Twilight Zone over there this week. (I know. I’m dating myself.) 🙂

  9. Yes, hopefulandree, I’m feeling the same way. I think I’ve got whiplash from his 180 degree turns.

  10. Hey Debra, Thanks for the add on to your blog roll! Very much appreciated. I have an idea for a post for you, if you get in the mood…

    Very curious as to ways in which you may have changed because of your blog or because of other new experiences since you started your blog. I know I have a different perspective from, say, six months ago, much change based on your blog (and a couple others.) Also, do see change in the general social climate at large re “obesities”? Am I seeing more fat bias or has it always been this bad. If it is worse now, when did that worsening increase? (Okay, weird sentence.) I guess I’m just blown away when I even expose myself a bit to popular media assumptions about fatness. Obviously, I tend not to look if I can avoid, but even my husband and another friend, neither of whom are targets of fat bias, have commented about the general “discussions” and “news coverage” of “fighting obesity.”

    Well. Curious what you are seeing. I must be wanting a reality check. 🙂

    • Good post idea, Hopeful. My quickie thought is that fat hate runs in cycles. It may have more than one cycle, but definitely it has an annual cycle. We are in fat-hate season from roughly January 2nd to the end of June. Guilt over holiday weight gains (and popular media encouraging New-Year’s resolutions) fades into pre-swimsuit season and bridal bootcamp, which ends roughly on the 4th of July in the USA. Then we throw the brats on the grill and pop the tops on our beers, because we have tired of hating on ourselves, it’s too late for a bikini body, and we give ourselves permission to relax for a bit.

  11. I have so much to say about this but I’m feeling kind of stuck. I wish I could have lunch with you and Dr. Sharma and just get it all sorted out.
    Well, honestly, I would probably be self-conscious eating lunch with him. But maybe over coffee?

  12. I’ve just read his WLS posts and at this point, you know what? I don’t believe him when he says that he writes everything himself. But given the fact that he (at least) approves things, I am out of there. His world view is just so warped.

    To be charitable, it may be because of the type of patients he’s dealing with. He says as much. But, generalizing their experiences to all fat people? Completely inappropriate. His whole understanding of the population he specializes in treating is biased by the fact that the people who come to him are in a desperate place. “Fix me!” they scream. “I’m helpless! I have no control over anything!” And, I’m sure it’s true in some cases, maybe for most of the people he sees. But it’s not true for most fat people. Most of us can manage our health pretty well, and most of us aren’t steadily gaining weight.

    The people caught in that conundrum are the ones who follow doctors’ advice: diet, diet, diet. And then they go back to the doctors and say “Well, that didn’t work. Let’s butcher my digestive system. Anything to be thin.” and the doctors say “Yes, that’s a good idea. You’re much better off with permanent internal damage than you would be with a bit of extra energy storage. Let’s clear out every fat cell and every dollar you’ve put way for a rainy day, shall we?”

    That’ll turn them into fasting Buddas, you see; the flesh mortified and a vow of poverty, all stripped down and holy, contrite, penitent, forgiven for having diverse, imperfect human bodies. I’m sorry, but weight loss surgery sickens me.

    Those of us who don’t feel that there isn’t anything horribly, unmitigatedly wrong with our fat bodies wouldn’t go within a mile of someone like him, and he seems to think we’re not real or are incredibly rare. WRONG. We’re the rule, not the exception. We’re why he’s posted wondering why the vast majority of obese Canadians don’t ask for “help.”

  13. I got a personal answer from him on my comment yesterday, but it was less than satisfactory, as far as I’m concerned. According to him, the success my husband is having with not having complications with his type 2 diabetes is atypical. Supposedly, since Mike has had t2d for 17 years now, he should be ready for dialysis, should have retinopathy, neuropathy, and other co-morbidities of t2d, as those are inevitable, even if one has been using medication, diet, and exercise.
    I left another comment in response, we’ll see if he bothers to answer it. I’m getting rather fed up with his rah-rah attitude about WLS and how it’s such a life-saving alternative to remaining fat and finding other options. He acts like what happens to a very few fat people applies to all fat people. I asked what ever happened to “first, do no harm”? To my mind, WLS doesn’t fall in that category (been there done that, got the t-shirt, hat, poster, and keychain).

  14. Not sure about the Dr. S. stuff…I started reading his blog as a result of this blog.

    In terms of Dr. Bacon and the trademarking of HAES, I’m not sure that’s how it happened. I’m on the fatstudies email list, and it looked like it was ASDAH that pursued the trademarking of HAES. I don’t recall Dr. Bacon giving her opinion on this one way or the other on list. Other folks might know better than I do though (and I don’t have the time to dig through the archives for it, sorry!)

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