Amy, What About That Ted Talk?

I’ve had a bunch of people ask me about this video.  Peter Attia talks about fat stigma, diabetes, and alternate theories of why people are fat.

There is pretty good science about the idea that there are reasons that lead to obesity other than the “two whole cakes” theory, which states (approximately) that all fat people are somehow sneaking two whole cakes daily. He talked about one of those suggested reasons. The idea is that insulin resistance causes obesity, not the other way around. This is promising. I love that people are looking at their preconceived notions about fat people and talking about them publicly.

I also support the fact that he pointed out that there are a good number of obese people that are metabolically healthy, and thin people with metabolic syndrome. These are often tied to diet and exercise, hence why I follow a HAES® mentality for those that WANT to improve their health. 
Those messages I support.

However, for those people who are fat and metabolically healthy- that means that they aren’t showing signs of insulin resistance. I think that needed to be more than a passing note in his lecture, because if they aren’t showing symptoms of insulin resistance, then why are they fat? I fall into this category. 

I have trouble with his messages of “I eat like this, and I lost a bunch of weight,” and the idea thinner is tacitly better, and realistically achievable. Not everyone loses weight with improved diet and/or activity. I also think that health is multi-dimensional, and sometimes the best thing for someones overall well-being isn’t improving their physical health at the expense of their social, emotional, and/or spiritual health.  This approach does not so much fix the stigma fat people face, but changing the bar by which we judge fat people-  if they’re insulin-resistant, and doctors say it is ok, then they’re not terrible people?  But those other fat people…

I don’t agree with a moving target for stigma.

Back from the HAES® Training

The training was amazing.  Linda Bacon and Lucy Aphramor were brilliant.   There were over 50 people at the training, and about half of them were dietitians.  There were people from as far away as Australia.  Everyone in the room believe that fat people have the same health goals as thin people. We covered a few things I have thought about before in conjunction with Health at Every Size®, but never quite connected in the same way.

We talked about how health is multi-dimensional- there is physical health, emotional health, spiritual health, social health- you can’t hold one above the others and expect to feel well.

I mentioned First, Do No Harm in my previous post.  I’ve talked in classes before about the futility of prescribing weight loss to patients, as it almost inevitably results in weight rebounding and worse health than just being fat.  I’ve talked about how our current medical model creates a barrier to treatment.  However, Linda and Lucy clarified and condensed these issues.  These are all issues of medical ethics.  Providers, by and by large, get into the business to help people.  But when providers are taught to prescribe weight loss, and that weight is a result of laziness and a lack of willpower, they are harming the vast majority of their patients.  That is simply unethical. If providers knew and shared the facts about long term weight loss attempt results, we wouldn’t recommend it anymore, and more and more, people wouldn’t consent to trying it.

In the next few months, I’m setting up a forum to create a conversation between fat patients in Denver and Denver care providers.  Hopefully we can address some of these barriers to quality care.

We talked about the fact that being fat can exacerbate some conditions.  Being fat can impact joint pain, diabetes, and heart disease.  However, is weight loss necessary? Experiencing one of these conditions doesn’t make weight loss any more reasonable of a goal.  Also, there are things that you can do for any condition that doesn’t include such drastic measures with such poor results.  While it is clear that eating a varied, enjoyable, quality diet and physical activity can improve diabetes and heart disease regardless of weight loss, joint pain is harder to assess.  Eating low-inflammatory foods and getting enough sleep can improve joint pain, and sometimes physical therapy can improve symptoms, without weight loss.   Thin people with diabetes, heart disease, and joint pain are given suggestions to improve their health that don’t include weight loss.

The last thing that I took away from this training a reminder of the community available to me.  I was reminded of the HAES Community, where you can find researches, authors, activists, care providers, and more in your community.  I heard more about ASDAH, who actually owns the HAES trademark.  They have another listing of health professionals that work within a HAES mentality.   They hold annual conferences, do lots of work in the community, and have excellent educational resources on their site. I heard of local HAES activists, and left having met many many awesome people.

Headed to Health at Every Size® Training!

Today I start the Health at Every Size® fascilitator training, and I am super excited about it.  I’ll spend a week learning how to best teach people in my community (that means you!) about the concepts of HAES.   Until then, here is an overview.

The HAES concept doesn’t erase that people of different size may face different health concerns.  It does acknowledge that long term weight loss is nearly impossible, and we need to address health concerns with people where they are, not when they reach an ideal body.  There are people who lose significant amounts of weight and keep it off, but that is a very, very small minority of people; different studies show no more than 2-5% of dieters are able to keep off significant amounts of weight for five years.  There is no weight loss method that has a decent success rate (which explains why nobody publicizes their results).  Weight loss attempts usually lead to regain, and often lead to weight gain above and beyond the loss.  This weight cycling is more damaging than just being fat.  In a culture where people often start trying to lose weight in childhood, it means that they are weight cycling again and again and again.

The obesity epidemic panic also does a disservice to thin folks.  Culturally, we assume that thin people are healthy, and don’t talk about how being inactive can impact their health, or that thin people need to be screened for the diseases and conditions that we associate with obesity, like high blood pressure, heart disease, and diabetes.   When we teach assumptions about what kind of people get these diseases, we harm those outside of that demographic by reducing their awareness of their own personal risks.  These assumptions are also found in health care providers, reducing the quality of care that both fat and thin people recieve.

Better than focusing on weight, what we can do is focus on health. While changing eating habits and exercising may not impact weight, they clearly impact health.  If we focus on changing eating habits, and creating opportunities for enjoyable movement, we see that regardless of weight, health markers improve.  This means lipid levels, blood pressure, resting and exercising pulse rate, blood sugar levels, blood insulin levels- all markers of physical health.  This is an approach that works for thin and fat people.

A big part of this approach is self-acceptance.  There is a lot of stress associated with thinking that you’re failing at losing weight.  That stress, combined with other life stresses, snowball into a lot of the diseases we currently consider ‘weight-related’*.

Many people have dieted and exercised in ways that have moved them out of touch with their bodies.  I have dieted and exercised in ways that got me way out of touch with my body.  But understanding what your body needs doesn’t go away entirely, it just gets shouted over so much it is hard to hear.

HAES promotes intuitive eating, the idea that when you remove foods from being off-limits, and pay attention to how foods make you feel, you will make far more healthy choices than when we are stuck in a good food/bad food dieting denial loop.   I know what foods make me feel good, what foods don’t, and when I want a little ice cream, I don’t finish off the carton because I’m afraid of my diet tomorrow, and that I’ll never again remember what it tastes like.

HAES also promotes enjoyable activity.  Find something you like doing, because movement, however you define it, benefits health.  Physical activity, whether difficult or easy, improves mood, sleep, and all the other health markers talked about earlier.

*See Robert Sapolsky’s book, Why Zebras Don’t Get Ulcers.