First of all, thanks again to Dr. Sharma for hooking us in to the private world of obesity research where the erudite players who affect our lives talk about us. Specifically, today he linked us to the Canadian Obesity Network Presentation Portal for the Second Annual Obesity Summit held in Montreal April 28 – May 1 of this year.
Let’s give these CON-RCO people kudos for facility and detail. If you click on the presentations, you receive a split screen with the speaker, in focus and centered, on the left and his or her Power Point Notes on the right. How inviting! Whatever trouble that took, please know it is appreciated! Hooray.
I scrolled through the selections to find some interesting conversation fodder, and my heels came to a screeching halt on page two, where speakers were talking about weight discrimination and bias. I first was drawn in by this title: So I am Biased, Now What Do I Do? Michael Vallis, the co-director of the Capital Health Behaviour Change Institute and Associate Professor at Dalhousie University spoke well, and we may want to talk about him another day, especially how he seems to ice skate between talking about solving bias/discrimination and solving obesity – interesting and discomfiting. He also talks about Motivational Interviewing, which we have talked about some in these pages’ comments. As I listened to him I wore Hopefulandfree’s filter: is this just sophisticated manipulation? I don’t think he intends it to be, but I can see how it goes there.
But I digress. TODAY, I want to talk about Diane Finegood’s talk, Weight bias and discrimination through a complex-systems lens. About 22 minutes into the 26-minute speech, she presents us with a question, and with an earnestness that I think calls for reply. I think we might be able to help her.
Diane Finegood is a professor at Simon Fraser University and Executive Director of the CAPTURE Project (CAnadian Platform To increase Usage of Real-world Evidence). She’s also a radical weight-loss maintainer.
Her presentation, in simple terms: It ain’t easy to change a paradigm on a complex system, such as obesity bias as it relates to health care. You’ll want to watch the whole thing, as she starts with a complex map of the issue and then reduces the problem downward several times to arrive at five steps. The most important: shifting the stinking paradigm. This has to be done by attacking lower level issues – structural elements, goals, etc. But at the very top is that paradigm, or root assumption. She makes a stab at one-sentence statement to express what that paradigm should become, but she’s clearly uncomfortable. Even her Powerpoint notes have a question mark. Her attempt at a statement:
? “Obese people are no different because of their size.”
Is that the assumption we want our health professionals (and media, etc.) to start from? I understand her discomfort, because the answer is no (there are differences that come with size), and yet I arrived at respect for her dilemma when I paused the video and tried to come up with my own statement. (I use “fat” instead of obese for all the reasons that those of us in the Size Acceptance movement choose that word , but I imagine a scientist would have to use “obese.”)
Try #1: Fat people are different but equal . . . NO! Sounds like a throwback to the 60s: “separate but equal” is not equal.
Try #2: Fat people are not inferior to trim people . . . NO! Defines using a negative.
Try #3: Fat people should be defined by as many attributes as trim people, beyond weight.
Too complicated, but I think I’m in the ball park. We’re trying, after all to get professionals to look at their patients in a weight-neutral way.
Try #4: “Fat people are as multi-faceted as people of other sizes.”
That’s my final answer, but maybe I’m too closed into Diane’s box and the question needs to be shaken apart and addressed from an entirely different vantage point. I know that you all are good at hearing the unsaid and identifying those issues not considered. Perhaps you have better ideas.
In more than one past post I have called for the scientific community (or, more specifically, the scientists of the National Weight Control Registry) to throw their assumptions on the table and examine them. It seems that Diane Finegood is trying to do just that. I applaud her. Now, let’s consider her dilemma and email her the link.