Wednesday, November 5, 2008

Obesity Guidelines

I was recently looking through the Canadian Guidelines on Obesity Management. This is a monster of a document: 24 chapters and over 100 pages. It's also infuriating. A few choice quotes:

"In addition, the medical profession is failing to counsel young, disease-free adults and those in lower socioeconomic groups" [to lose weight]. Because if you haven't yelled at healthy fat people, you just aren't doing your job!

"Overweight and obese people, especially those with binge-eating disorder, lack self-efficacy. Self-efficacy refers to confidence in one's ability to do what is required to produce the desired outcome." I was pretty angry when I read this. Just because I'm fat doesn't mean I am lacking in the ability to Get Things Done. So I went and looked at the abstracts for the three articles they use to reference this statement (1, 2, 3).

The first two articles refer specifically and only to weight self-efficacy -- which, apparently, is confidence in one's ability to do what is required in order to get to a socially-sanctioned weight. That is, fat people are pretty sure that they can't diet to become permanently thin. I would describe that as "fat people have a good grasp on reality" rather than "fat people have low self-efficacy".

The third article is the only one that refers to self-efficacy in general, and it finds that fat individuals with binge-eating disorder have lower self-efficacy than fat individuals without binge-eating disorder. Which, obviously, says nothing about fat people as a group.

6 comments:

spacedcowgirl said...

I would describe that as "fat people have a good grasp on reality" rather than "fat people have low self-efficacy".

Ha! No kidding. Thank you for your commitment to HAES. I have no doubt you will be of untold help to the health of fat people in your practice, and it is a great comfort to me that you are in the medical field.

wriggles said...

"Overweight and obese people, especially those with binge-eating disorder, lack self-efficacy. Self-efficacy refers to confidence in one's ability to do what is required to produce the desired outcome."

What else are they going to say, that fat people have been one of the greatest success stories in participating in a public health experiment possibly of all time.

Unfortunately, their continuing fatness shows that these health messages whilst possibly of some benefit, are far more unlikely to bring about permanent weight loss, than we imagined.

It's now back to the drawing board for the scientists to come up with something effective, and let's hope they match the sterling efforts fat people have made.

Ashley said...

I would describe that as "fat people have a good grasp on reality" rather than "fat people have low self-efficacy".

This, a lot. I'm currently 10 weeks pregnant and have morning sickness of doom. I've pretty much barely eaten in the past month, and most of what I eat comes right back up. I haven't been weighed in 2 weeks, but between week 6 and week 8 I lost 3 pounds.

If I have to cut my food intake by 1/2 and throw up most of that to lose 3 measley pounds, fuck that I'm staying fat!

sannanina said...

The third article is the only one that refers to self-efficacy in general, and it finds that fat individuals with binge-eating disorder have lower self-efficacy than fat individuals without binge-eating disorder. Which, obviously, says nothing about fat people as a group.

Also, the finding that people with BED have low self-efficacy itself is not terribly meaningful - in particular it does not show how these two variables (BED and self-efficacy) are related. For example, people with eating disorders are often depressed and depression tends to go hand in hand with low self-efficacy, so it is possible that people with BED have on average low self-efficacy because they tend to be depressed.And then of course you still don't know how depression and self-efficacy are related. I for my part am pretty sure that while low self-efficacy can probably play a part in becoming/ staying depressed being depressed (and therefore not having the energy to do as many things as one was used to do) also can decrease feelings of self-efficacy, and this decrease might actually be partially based on observation of reality.

In addition, high self-efficacy is not always rooted in reality - people with high self-efficacy are not always as successful as they think.

Piffle said...

*Cheers*

You said it so well, I have nothing useful to add.

living400lbs said...

That is, fat people are pretty sure that they can't diet to become permanently thin. I would describe that as "fat people have a good grasp on reality" rather than "fat people have low self-efficacy".

Yes. This.

Thank you for this blog. :)