Tag Archives: Health At Every Size

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I have to thank my colleague Michelle May, M.D., CSP for recently posting links to two articles that I had missed in the past. Both were very interesting. But what I found really fascinating was the way they worked together.

The first article she posted was in the BMJ (formerly the British Medical Journal). It was an editorial article written by Emma Lewis entitled “Why there’s not point in telling me to lose weight”. In this poignant piece, Emma talks about how no matter what she goes to the doctor for, she’s told she needs to lose weight. She talks about the fact that her health markers are good and how she exercises regularly and strenuously. She talks about the fact that doctors often tell her to start exercising, without even asking if she is exercising already.

Emma also talks about how her doctor’s “one-size-fits-all-fatties” approach to wellness makes her feel alienated, unheard, and shamed. And she talks about how it keeps her away from doctors–how she hasn’t been to see her GP in a while, how she’s not doing routine diagnostic stuff.

This article is in a section of the BMJ called “Practice: What Your Patient is Thinking”. I applaud BMJ for running this piece. But I have to fight despair when I read the comments.

The comments are not uniformly bad. There are a few doctors that get it. But lordy, lordy, LORD there are quite a few that don’t. I’ll summarize some of it so you don’t have to waste the sanity points reading the comments yourself. But most of them go something like this:

1. The Super Snarker: Well if the fatties don’t WANT to change, then she’s right–there’s no point telling them to lose weight.

2. The Concern-Trolling Hand Wringer: But it would be irresponsible for me as a DOCTOR to not bring it up. Maybe they don’t know they are fat. Maybe they don’t think fat is bad.

3. The Food Policer: Well yeah, she exercises. But exercise doesn’t make people lose weight. She just has too much hunger.

4. The Math Guy: Well of course she can lose weight. Energy in vs. energy out! Look it worked in concentration camps and lands with famine so it’s just math.

5. The Apocalypser: Obesity is bad. Everybody Panic! Cuz’ FAT!

Like I said, there are some that point out that Emma has a point. There are some that get the fact that she feels unheard and disrespected and that this is a problem. But virtually everybody who commented seems to believe that Emma’s main problem with weight loss is a problem of will. If she wanted to, she could be skinny.

Except the evidence is not in favor of this hypothesis.

We simply don’t know any way of helping any but a very small percentage of people to lose a significant amount of weight and keep it off. We just don’t. And for any weight loss intervention we undertake, a very small percentage of people lose some weight and keep it off, the vast majority of the people gain all the weight back and a significant percentage of those people end up bigger than when they started. And a whole lot of people end up facing serious negative financial, social, medical and psychological side effects from the whole process.

And we simply don’t have enough evidence from the very small percentage of people who lost the weight and kept it off to determine, if even that tiny percentage of people end up healthier because they lost weight. We know that most people who exercise and eat better experience health benefits regardless of whether or not they lose weight. But we don’t know if fat people who become skinnier are healthier in the long run.

So all five of the commenter types above are missing a few very important points:

1. There is no intervention that you can offer Emma that offers her any kind of reasonable chance for significant, long-term weight loss. In fact, statistically, just about any kind of intervention you offer is statistically more likely to make Emma bigger in the long run than to make her smaller.

2. Any intervention that you offer Emma is likely to have negative side effects. These negative side effects include physical, social, financial, emotional, relational, and physical problems.

3. You can offer no reliable evidence that, should Emma be one of the very few people to achieve long-term, significant weight loss, she will experience health benefits from the weight loss that she would not achieve from far less invasive wellness efforts with far fewer side effects.

Cue the second blog post shared by Michelle May.

This post called “Let’s Talk About Intentional Weight Loss and Evidence-Based Medicine” is found in the blog entitled Worse for the Fishes by Anna G. Mirer, M.P.H. In this wonderful post, she talks about all of those wonderful interventions available to the five classes of point-missing commenters above. She talks about how they don’t work. She talks about how they cause more problems than they solve. She talks about how there’s no real evidence that they help anybody. And she provides lots of links to back this up.

I’m sure that this will all be refuted by another special kind of commenter:

The Research Refuter: Despite the fact that there is massive amounts of evidence supporting what you say–amounting to hundreds of peer-reviewed studies in reputable journals, I don’t like your evidence. Therefore I will accuse you of cherry-picking your articles.

Again, I have to thank Michelle for bringing these two articles together in my world at the same time. It so perfectly illustrates how we as a society are perceiving the wrong things as the problem and thus suggesting the wrong solution.

To me the solution is simple:

1. Everybody benefits from eating well and exercising, along with managing stress, sleeping well, and having strong social relationships.

2. So medical professionals just ask if people need any support with eating well, exercising, managing stress, sleeping well and having strong social relationships.

3. If people say no, then stop. If people ask for help on any of those specific behaviors, offer help with those behaviors.

The End.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want me to come and talk to your group about evidence-based medicine and wellness? Send me an email at jeanette at the fat chick dot com.

P.S.S. You can learn more HERE.

Talking to Kids About their Bodies

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I am sad to say that September is Childhood Obesity Awareness Month. I cannot see the need for this particular marker. I don’t know a single adult who isn’t aware that there are fat children in the world. And the vast majority of them are wringing their hands and worrying about what we should do about it. Schools are still sending kids home with BMI report cards despite significant evidence that this practice is not only not helpful but is often actively harmful. And most doctors still tell parents to put kids on a diet when kids vary even slightly from the statistical norms.

And it’s not as if kids are unaware of “the childhood obesity crisis”. Hospitalizations for eating disorders are up 119 percent among children under 12 years of age. 80 percent of all 10-year-olds are afraid of being fat and 42 percent of all 1st through third grade girls want to be thinner. Just who is it that remains unaware of a societal desire for kids to be thin? The whole thing is so deeply depressing I didn’t know how I was going to write about it. That is until I came across an article somebody posted to Fit Fatties yesterday about a dance teacher working to change the language she uses to talk to kids about their bodies.

Worried about how her words as a dance teacher were affecting the body image of the girls taking ballet lessons, dance teacher Amanda Trusty took several weeks off to work on the language she used in her classes. Trusty noted that many of the traditional commands from dance class like “tuck in” or “suck in your belly” or “pull in the butt” were not only imprecise, but tended to confirm a societal notion that kids bodies should be smaller and tummies and tushes should disappear.

In her article Amanda says,

I realize now where all my insecurities started. They started in first position at age seven at the barre.

And now here I am, 20 years later, catching myself doing the same things to my own seven year old students.

Oh, but I refuse. Nuh-uh. No way. I’m a body love advocate. How can I tell my ballerinas to suck it in and tuck it under, knowing how much that shaped my childhood?

So Amanda consciously and thoughtfully worked to change the language with her students. The new language was not only more imaginative and precise, but also managed to remove body judgement from the equation. Now rather than telling them to tuck the butt under, she asks the students to imagine they have beautiful tail feathers. And she asks the students to send their tail feathers down rather than out. Instead of asking kids to lift their chins, she tells them to imagine they are wearing a beautiful necklace and she asks them to display the necklace to everyone else.

Kids are perfectly well aware that many, many grownups are freaked out beyond all reason that their bodies are not thin enough. We don’t need a month dedicated to getting adults more freaked out about childhood obesity. And we don’t need a month dedicated to convincing fat kids that they should not exist, that there is a worldwide movement to eradicate them from the planet. What we need is a month dedicated to thinking about how we talk to kids about their bodies. We all need to take a time out like Amanda did, to figure out ways to communicate health and wellness to kids in a way that isn’t damaging to their body image and doesn’t send them charging down the road towards a life of eating disorders. Now that’s a month I could get behind.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want to hear me speak with YOUR group about how to teach fitness to kids in a way that isn’t damaging to them? Book me to speak!

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Powerful new Resource Helps Medical Professionals Understand HAES.

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I am very excited to tell you about an epic new article that has appeared in the Journal of Obesity. This article called, “The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss” reviews much of the available literature on doctors and weight loss and comes to a very firm conclusion: our medical obsession with weight loss is not making us any healthier. The article defines the difference between the Weight Inclusive and Weight Normative approaches this way:

In this paper, we review evidence that challenges the weight-normative approach for health promotion and offer evidence to support a weight-inclusive approach for health promotion. Instead of imagining that well-being is only possible at a specific weight, a weight-inclusive approach considers empirically supported practices that enhance people’s health in patient care and public health settings regardless of where they fall on the weight spectrum [1, 2, 22]. These approaches differ in the emphasis each one places on weight. While health care professionals using either approach may share some commonalities (e.g., recommending similar self-care practices), they contrast in the relative importance they place on body weight in the context of health and medical treatment, their perceptions of the malleability of weight, and how they respond to patients based on their weight.

The article is very long and rich and cites hundreds of sources. But I thought I’d pull out

10 things you can learn about weight-focused healthcare in this article:

1. Recommending weight loss is actually a less conservative approach than recommending HAES because there are negative consequences associated with weight loss attempts. Thus prescribing weight loss can go against the edict to “first do no harm”.

2. The data do not support the notion that higher BMI causes poor health outcomes.

3. Prescribing weight loss supports the notion that permanent weight loss is largely under a person’s control, and that fat people cost society more money. Neither of these notions are supported by the data.

4. Weight bias not only exists, but is common in clinical environments. This is a part of the general increase in weight stigma in the wider world, and weight stigma is dangerous to your health.

5. Not only does weight loss not work on a permanent basis, but weight cycling (the common result of repeated weight loss attempts) is dangerous for your body.

6. Obsession with weight loss has led to an increase in eating disorders.

7. But there is another way. The weight inclusive approach focuses on weight as a simple data point in a much larger view on health and focuses on positive behaviors.

8. The basic principles of the weight inclusive approach are these:

1)Do no harm.

(2)Appreciate that bodies naturally come in a variety of shapes and sizes, and ensure optimal health and well-being is provided to everyone, regardless of their weight.

(3)Given that health is multidimensional, maintain a holistic focus (i.e., examine a number of behavioral and modifiable health indices rather than a predominant focus on weight/weight loss).

(4)Encourage a process-focus (rather than end-goals) for day-to-day quality of life. For example, people can notice what makes their bodies rested and energetic today and incorporate that into future behavior, but also notice if it changes; they realize that well-being is dynamic rather than fixed. They keep adjusting what they know about their changing bodies.

(5)Critically evaluate the empirical evidence for weight loss treatments and incorporate sustainable, empirically supported practices into prevention and treatment efforts, calling for more research where the evidence is weak or absent.

(6)Create healthful, individualized practices and environments that are sustainable (e.g., regular pleasurable exercise, regular intake of foods high in nutrients, adequate sleep and rest, adequate hydration). Where possible, work with families, schools, and communities to provide safe physical activity resources and ways to improve access to nutrient-dense foods.

(7)Where possible, work to increase health access, autonomy, and social justice for all individuals along the entire weight spectrum. Trust that people move toward greater health when given access to stigma-free health care and opportunities (e.g., gyms with equipment for people of all sizes; trainers who focus on increments in strength, flexibility, V02 Max, and pleasure rather than weight and weight loss).

9. Along with the data that shows the weight normalization (weight-loss focused) approach is ineffective and harmful, is significant data showing the weight inclusive (HAES-oriented) approach is more successful, and that it does not share the negative side effects of the weight normalization approach.

10. With these thoughts in mind, it makes sense to move to a weight inclusive approach in both personal and public health and actively work to reduce stigma both within and outside of the world of medicine.

I urge you to take some time to work your way through this epic piece of work. And I urge you to print a copy and bookmark this for sharing at a later date. Maybe you could take this along to your next doctor appointment. Maybe you have a friend that is struggling with health care that can use the data to his advantage. In any case, I’m very, very excited about this and couldn’t wait to share it with you.

Love,

Jeanette DePatie (AKA The Fat Chick)

BACK (sorta)

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Hello my dear readers. As you may have noticed, I’ve been gone for a while. Fortunately I had the opportunity to meet and speak with over 400 schoolteachers this past week and share the word about shame-free fitness and Health At Every Size for children. It was wonderful, engaging and fun. It was also a set of 7 grueling days with a very intense schedule. Nevertheless I planned to continue blogging while away.

Alas, the universe had a different plan. Shortly after I started at the conference, I reached for a piece of paper in my bag and something in the region of my lower back and right hip went completely out of whack. My friends at the conference insist that it makes a better story that I hurt myself busting a move, that the limbo initiated my lumbago or SOMETHING. But the truth is, I was sitting in a chair reaching for something in my bag, and I had that MOMENT. There’s a moment when time stops and that surprising pain comes and all you can think is “WHOOOOOOAAAAA, that can’t be good!”.

I managed to fulfill all my obligations at the conference and even have some fun. But sitting aggravated my pain the most and I simply couldn’t bring myself to blog last week. Sorry about that. But I thought I would take this moment to share a few thoughts with you about my back experience.

1. Sometimes poop occurs. It just does. I could make myself crazy wondering if it was tension or a posture problem or lack of sleep or the size of my hips or the tilt of the universe that caused that pain. But at the moment that the pain occurs I need not to focus on that. I just need to deal with it.

2. Dealing with it means that sometimes your plans have to change. When pain or a serious setback happens, it’s time to reorganize priorities. Some stuff will not get done. You can either triage and choose which things you can do, or you can try to do everything and end up able to do nothing. You wanna know how I know? Experience. So many times, I’ve been in denial about the fact that I can’t do everything. So many times I’ve ended up at that point, in pain, completely spent, where I can’t do anything. I really don’t want to do that any more.

3. Pain is a sign that something is out of whack. It could be posture. It could be schedule. It could simply mean something in my body isn’t working properly. As I am healing this week, I will start, very gently to figure out what is out of whack. I’ll see my doctor and start reviewing things in my life to see if I can figure it out. But I may have to accept that the discovery process may be long and challenging. And I may have to accept that I can never figure out exactly what caused this episode.

The good news is that hundreds of school teachers, councilors, administrators, and other employees were exposed to the notion of shame-free exercise and the Health At Every Size(TM) approach to wellness–many for the first time. So I’m going to take an aspirin and take my leave glad for a job well (if shakily) done.

Love, Jeanette DePatie, AKA The Fat Chick

P.S. Don’t forget about the Fat Activism Conference coming up soon. Click here to register for the Fat Activism Conference!

P.P.S. Get access to free stuff! Join my mailing list HERE.

Study Proves “Not all Fat People are Unhappy”–Follow up to indicate Papal Affiliation With Catholicism

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So I got a notice in my inbox this week that a study has been announced that indicates “Not All Fat People are Unhappy.” And honestly, my first thought was, “Duh.” I mean it seems quite obvious to me that not all Fat people are miserable, much as it seems obvious that the Pope is Catholic. But apparently the notion that not all fat people are sick, miserable, about to die and ready to throw in the towel is something we need to prove again and again.

But you know, before I cast to many aspersions on the study, I think maybe we really just need to look at the headline drawn from the study results. Because there are actually quite a few interesting things indicated by this piece of research. Let’s look at a few:

1. Your happiness seems to have a lot more to do with homogeneity than body size. If you are a fat person who lives in a town with lots of other fat people, you tend to be more happy than if you live somewhere with no other fatties.

2. The study creators speculate that being fat does not in itself make people unhappy. In the accompanying press release, study co-author Philip M. Pendergast states:

“In that light, obesity in and of itself, does not appear to be the main reason obese individuals tend to be less satisfied with their lives than their non-obese peers. Instead, it appears to be society’s response to or stigmatization of those that are different from what is seen as ‘normal’ that drives this relationship.”

3. Women tend to pay a higher emotional price for being fat than men do. The study creators speculate that this is because women face more social stigma based on body size then men do. In the press release Pendergast also says,

“Think about the advertising we see on television or in magazines—we are bombarded by images of thin women, and we are told that is the ideal,”

So here is yet another study that seems to indicate that how we feel about our size may have a lot more to do with our actual health and wellness outcomes than what we weigh. It follows on the heels of many other studies we’ve talked about on this blog regarding stigma and health outcomes like this one or this one. And all of these studies lead me to ask one very important question.

Even if we knew how to make people permanently thin (which we do not) should we ask them to change their body size to fit in? If being different leads to social stigma, and social stigma leads to poor health outcomes, should we encourage everybody to be the same for the sake of their health?

Even if we knew how to make people all be the same size (which we categorically do not) it seems to me that the answer is to deal with stigma rather than to make a completely homogeneous society to reduce stress on everyone involved. What if we actively worked to fight stigma based on body size? What if we actively worked to help people accept their own differences? What if we could feel better about our bodies? Might we be singing a song like this magnificent lady right here?

I mean just check these fabulous lyrics:

I looked in the mirror
What did I see a brand new image
Of the same old me ohhhh
But now I wonder why should I be surprised
I like the things about me that I once despised

There was a time
When I wished my hair was fine
And I can remember when
I wished my lips were thin

Makes no difference now y’all
How you may feel
I’ve done reached the point
Where I wanna be real
I’m tired of living living in disguise
I like the things about me that I once despised

Let’s face it, Mavis Staples has got it going ON! But she leads me back to my original question. Why can’t we take some of this time, money and energy that we are currently spending on stigma-inducing ineffective advertising that convinces people that they not only must be thin, but may easily obtain this state of grace by eating yogurt, and spend it on something that might actually help people feel better? It will help them feel better emotionally, and it will help them feel better physically. Why can’t we take some of the time, energy and money we are spending driving wedges into our society, by creating classes of otherness which we can blame for all our problems from the high cost of airplane tickets to soaring healthcare prices and spend it on something that teaches us to celebrate our differences. It will bring us together. It will help us live and breathe as a community rather than a simple pile of competitors in a winner-take-all, Victoria’s Secret model competition. When will we reach the obvious conclusions? Bears poo in the woods, stigma doesn’t help people, and yes, the Pope is indeed Catholic.

Call me captain obvious if you like. I’ve stopped spending on diets and weight loss schemes and self hatred because I like the things about me that I once despised.

Love, Jeanette DePatie (AKA The Fat Chick)

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Friday Dance Break

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It’s been a tough week for me and in many ways a tough week for our country. So I thought for today’s blog I would post a FRIDAY DANCE BREAK!

Whatever else you may have to say about this week, it has been a great week for dancing. Here’s just a few of the things that have popped on my feed this week.

First, I ran across this wonderful piece of a plus-sized pole dancer on Britain’s Got Talent. I braced myself for Simon to be a total tool, but (spoiler alert) aside from some eye rolling, he managed to keep it together and be a gentleman. And perhaps the best news is that the comments are disabled on this YouTube clip so I don’t even have to tell you not to go there! Sweet!

And then there was this fabulous clip. This is a group called Company and they took SECOND place in the Vibe Dance competition. Props for the fabulous dancing and at least a teeny, tiny bit of body diversity. There were definitely some khaki’s above a size 00 out there. And this group is tight. And SO much fun to watch. Check it out!

There’s another version of the video with more closeups available here. This gives you a better chance to see the different bodies that are rocking it out.

And last but not least, this week, I ran across this adorable dancing kid on my Facebook feed. I mean how cool is she? Seriously?

Werk it girl. WERK IT! And it just goes to show, that when you get on our there and shake your thing, other people will want to join the fun. It takes the little guy a while to get with the program, but he does eventually get to steppin.

So there you have it. Not a lot of thought or philosophy. Just chock full of wiggling, jiggling bodies of all ages, shapes and sizes. You’re welcome!

Love, Jeanette (AKA The Fat Chick)

In EPIC Wardrobe Malfunction, Target Creates Thigh Gap by Removing Young Woman’s Lady Bits

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Close up of gruesome wardrobe malfunction. EEEK!

In it’s quest to ensure that all its models are sporting an appropriate thigh-gap, Target PhotoShop artists appear to have removed a junior model’s vagina altogether. The image was pointed out by several watchdog groups and blogs not only for it’s garish wardrobe malfunction, but also for the fact that it appears the junior model in question may have also been mutated into an alien creature with a very long torso and very long arms, best seen in the larger version of the photo here:

The photographic evidence of Target’s tampering have since gone viral and Target has issued an “apology” stating:

“In response to your query about the swimsuit image on Target.com, this was an unfortunate error on our part and we apologize. We have removed the image from our Web site,” a company spokesman said. Asked how the mistake occurred, “It was the result of a photo editing error on our part.”

Which leaves me with a few things to say to our friends at Target. First of all, in your “apology” I have to say that I don’t think that word means what you think it means. Sure, your PhotoShop guy or gal messed up. I can certainly understand how that happened. I doubt that it’s some sort of malicious protest on the part of the graphic designer as some have suggested. I really don’t imagine that some designer wanted to point out the brutality inherent in the system of PhotoShopping images by blatantly messing up and releasing a picture. I’ve produced websites and games and DVDs. I understand that stuff slips through the cracks. That poor graphic artist is probably not being paid less per hour than your minimum wage checkers and is probably working 80 hours per week on “salary” in a web sweat shop somewhere. And the junior manager or producer doing Quality Control on those images is probably working just as hard and not getting paid very well either. And if anybody gets fired over this whole mess, it will probably be them.

Apology? Hmmm. Maybe not.

But I’m sorry to say Target, that you apologized for the wrong thing. Don’t apologize to me that a graphic artist messed up and released a photo that makes it blatantly obvious that you drastically altered a young woman’s body to convince 12-year old girls that they need to be seven feet-tall, size 00 and have a thigh gap that could hold a soccer ball. Don’t apologize to me that you got caught. Apologize to me for feeling the need to PhotoShop these images this way in the first place. Apologize to me for altering photos to create impossible beauty ideals to products aimed at 12-year-old girls in an environment where hospitalizations for eating disorders in kids under 12 are up 119% (see Pinhas et. al.) Apologize to me for being so certain that your model needs to sport a thigh gap, a trendy body trait that is nearly impossible to maintain for all but a microscopic percentage of the human race, that you were willing to graphically stretch her on the rack and excise critical bits of her anatomy to accomplish it. (You could consider the techniques shown in the video below. These are kinda cool actually.)

Target, you make me sad. I adore your wide, bright aisles and fun POP displays. I love your colorful and fun, yet generally affordable housewares, camping gear and sporting goods. But this has GOT to stop. It’s time for you to retract your fake apology and give us a real one. Then tell us how you are going to stop digitally dissecting the already beautiful bodies of your models to sell us a dose of unreality we just shouldn’t have to swallow.

Love,

Jeanette DePatie (AKA The Fat Chick)

Don’t miss out on another day of body loving, booty shaking fun! Join me here.

…Dances, Rants, Raves and Generally Steals the Show

Tag Archives: Health At Every Size

Asking for help.

New Video and a New Plan

Fitness is for ALL of Us

When Docs don’t listen…

Talking to Kids About their Bodies

Powerful new Resource Helps Medical Professionals Understand HAES.

BACK (sorta)

Friday Dance Break

In EPIC Wardrobe Malfunction, Target Creates Thigh Gap by Removing Young Woman’s Lady Bits

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