It's nice to occasionally have a HAES victory, even when it's small. I'm doing a rotation in a psychiatric ward this month, and in their examination room there was a huge BMI poster on the door. It was the same kind of poster you see everywhere with a graph to see how fat you are, and a table explaining that anything over a BMI of 25 means you need to lose weight.
BMI posters are incredibly irritating no matter where they are, but in a psychiatric ward it makes even less sense: People are already feeling pretty badly about themselves, let's berate them about their weight! And if they are in the psychiatric ward to treat an eating disorder, even better to remind them that they might be fat! So, I asked the individual in charge if it could be removed, and she took a look, agreed with me, and pulled the poster down.
One BMI poster less in the world is one of those small but very satisfying victories.
Thursday, August 20, 2009
Friday, May 1, 2009
Pediatrics
I am currently finishing up my pediatrics rotation. While I absolutely love working with kids, the constant focus on The Obesity Epidemic has been infuriating and exhausting. I gave a presentation to the department today, and while I usually talk directly about HAES in these contexts, I just couldn't cope with that kind of hostility after over a month of it. So I spoke about a related topic -- treatment of Anorexia Nervosa.
I spoke about Family Based Treatment, and how it is the only treatment for AN that has reasonable evidence behind it. I discussed how FBT works. I talked about the absence of evidence that families of teens with AN are themselves pathologic. Many of the audience members had a big problem with this. The argument that most families have pathology, particularly if you put a big microscope under them, so you shouldn't use anecdotal evidence to villify families of teens with AN was not convincing apparently. Plus, you know, the lack of evidence.
Anyways, that was all fine. I can deal with that. But then, just as I'm finishing, one of the pediatricians says, "You know, I bet that this behavioural approach would work really well for obesity as well. You schedule meals at particular times, you watch the kids, and you force them to normalize their eating." An argument followed where I stated that there is no evidence that kids who are fat eat worse than their thin peers. The pediatrician and several others were simply like, "You're wrong." Fine. Even that I can deal with!
But just before the pediatrician left, I was making the point that there is a huge difference between AN -- a severe mental illness with a high mortality and even higher morbidity -- and obesity -- a supposed risk factor for illness that describes one end of the normal spectrum of human variation. And the pediatrician said, very confidently, that he didn't think AN was worse than obesity in the long run. Nobody else seemed to understand how profoundly offensive, never mind ridiculous, that statement is.
Sigh. There are so many days where I feel like I'm living in a parallel world, and I start wondering whether I really am the crazy one. I'm ready for pediatrics to end.
I spoke about Family Based Treatment, and how it is the only treatment for AN that has reasonable evidence behind it. I discussed how FBT works. I talked about the absence of evidence that families of teens with AN are themselves pathologic. Many of the audience members had a big problem with this. The argument that most families have pathology, particularly if you put a big microscope under them, so you shouldn't use anecdotal evidence to villify families of teens with AN was not convincing apparently. Plus, you know, the lack of evidence.
Anyways, that was all fine. I can deal with that. But then, just as I'm finishing, one of the pediatricians says, "You know, I bet that this behavioural approach would work really well for obesity as well. You schedule meals at particular times, you watch the kids, and you force them to normalize their eating." An argument followed where I stated that there is no evidence that kids who are fat eat worse than their thin peers. The pediatrician and several others were simply like, "You're wrong." Fine. Even that I can deal with!
But just before the pediatrician left, I was making the point that there is a huge difference between AN -- a severe mental illness with a high mortality and even higher morbidity -- and obesity -- a supposed risk factor for illness that describes one end of the normal spectrum of human variation. And the pediatrician said, very confidently, that he didn't think AN was worse than obesity in the long run. Nobody else seemed to understand how profoundly offensive, never mind ridiculous, that statement is.
Sigh. There are so many days where I feel like I'm living in a parallel world, and I start wondering whether I really am the crazy one. I'm ready for pediatrics to end.
Tuesday, February 10, 2009
Not much to report from medical school lately. There's an interesting study described in the NYTimes about how "health scares reduce smoking but not obesity": http://www.nytimes.com/2009/02/11/health/11smoking.html. It's interesting how they ignore the obvious conclusion: smoking is a modifiable behaviour; weight isn't.
Sunday, November 23, 2008
Blobs of Fake Fat
Doctors in the UK are getting plastic models of fat blobs to show their patients. (Yes, seriously).
When I was 10 or so, I recall my family doctor showing me one of these plastic models. It was very hurtful. I really don't understand how the message can be anything other than "This is disgusting. This is part of you. Thus, you are disgusting." I already wanted to lose weight; it had been my New Year's Resolution for years, and part of my daily life for even longer. This experience just added more shame and more pain to being a fat child.
Experiences like these with doctors are a big part of why I chose to study medicine. There are better ways to motivate people, and better ways to promote health. One of my dreams is to one day open a multidisciplinary primary care health clinic based around Health at Every Size principles. Fake fat won't be allowed on the premises. :-)
When I was 10 or so, I recall my family doctor showing me one of these plastic models. It was very hurtful. I really don't understand how the message can be anything other than "This is disgusting. This is part of you. Thus, you are disgusting." I already wanted to lose weight; it had been my New Year's Resolution for years, and part of my daily life for even longer. This experience just added more shame and more pain to being a fat child.
Experiences like these with doctors are a big part of why I chose to study medicine. There are better ways to motivate people, and better ways to promote health. One of my dreams is to one day open a multidisciplinary primary care health clinic based around Health at Every Size principles. Fake fat won't be allowed on the premises. :-)
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.
"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.
Sunday, September 7, 2008
Good News, For Once!
First, apologies to anybody who is still reading this blog for my several-month-hiatus! Over that period, I gave two talks about HAES topics: one to my medical student peers, and one to some philosophy grad students. Both went over very well! It was nice to find a receptive audience for these ideas.
Third Day Back
We managed to get through two whole days of school this semester without mention of the Scary Obesity Epidemic. On the third day, our final lecture about health care spending and cost analysis was nearly over when the professor decided to use an example of how fat people are going to bankrupt us. After all, the obesity epidemic is no doubt going to cost a fortune because of diabetes and other necessary interventions. And just to make sure that our evidence-based-medicine week had some not-remotely-evidence-based comments, he added that exercise programs for kids that reduce obesity later are likely to have a great return on investment these days.
He really ought to read Junk Food Science occasionally, where he could learn things like childhood obesity prevention programs don't work, or that there's really no evidence that fat people are going to cost more, and being fat may actually save the health care system money.
He really ought to read Junk Food Science occasionally, where he could learn things like childhood obesity prevention programs don't work, or that there's really no evidence that fat people are going to cost more, and being fat may actually save the health care system money.
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