Health at Any Size?

[Emergent]

I just watched a video that discussed this movement. It is closely aligned with the fat acceptance movement.

I totally support body acceptance.  People should not feel shame about their appearance. But, the Health at Any Size movement is most definitely spreading misinformation about the health effects of obesity on ones health. Like many movements these days, online communities develop and people start talking in echo chambers.

Yes, there is a huge genetic component to who tends to gain weight and who doesn't. But, the Western diet of constant calorie intake in the form of high carbohydrate foods is hurting people's health. And the uptake in obesity is contributing to many chronic modern diseases.

Healthcare practitioners should be exhorting people to improve their diets. So many of our current health problems result from people just packing away too many donuts and soda pops. The food industry is a big problem. The school system also gets kids started on junkie school breakfasts and lunches Laden with sugar and empty calories. This is a public health crisis.

[JKL33]

klone said:

My opinion is there is a lot of validity to this program. The reading I have done on the research they've cited has shown that among individuals, it's more effective to look at specific issues like cholesterol levels, BP, A1c, cardiovascular health, etc, than WEIGHT when it comes to behavior modification. 

This is already my basic approach; if one cares about people and their traumas and their feelings and desires to have a respectful, long-term professional rapport with them, then it is really pretty natural to come at it from this approach just on a basic human decency level. But there are a couple of problems. First, since overweight affects all of those other things (and more), discussing weight in a kind and professional manner is basically part of one's duty to the patient and should not be conflated with fat shaming. What the research is saying is a more nuanced concept than what people want to hear and what they are then making of it. What they want to hear isn't that your provider shouldn't be focusing on weight but that they shouldn't be mentioning it because that is fat shaming. Your provider shouldn't even know your weight because that is fat shaming.

The second thing is that many, many people are not happy with their weight! They want to discuss it all the time and bring it up and want someone to do something about it and want all kinds of testing done to find out why they can't lose weight despite barely eating anything. And there are a fair amount of people who want to do something about it themselves and have a lot of questions about weight and dietary related lifestyle changes. 

I think a far more useful philosophical change for our society (than creating a furor about "fat shaming") or whatever would be that we must change our thinking on food and eating. It is imperative. Our media helps change other harmful attitudes and this should be on the agenda. Obnoxious food choices have become perfectly normal, like for almost all of us.  As an example, I was reading a recipe the other day thinking maybe I'd decide to make it. Got to the bottom and saw it was 800 cal/serving. For a single serving of ONE part of ONE meal of the day. Lots of high ratings/reviews; and of course we know a recipe is really good if everyone went back for seconds. We cannot eat this way.  Many patients who wish they could lose weight tell me they barely eat anything; a common example lunch I hear from this group is something like: sandwich with whole wheat bread (cause that is healthy), pretzels (healthy), yogurt with granola (healthy and healthy). That is easily approaching a 400-500+ calorie lunch before we figure what was put between the two pieces of bread (and what are the specifics on the yogurt and how much granola and pretzels are we talking). Many people's idea of exercise is simply not having a desk job, or doing some walking around at work. Many people who are trying quite hard to eat healthy and lose weight  and even logging calories then have regular "cheat days" where they can easily wipe out at least 2 weeks' worth of calorie deficit. And being able to "cheat" is a reward and part of being able to be normal for a day and eat like everyone else have a good time and is associated with all the good feelings. We are telling ourselves that we must cheat to feel joy/enjoy ourselves and that all the other [normal/healthy eating] days are not associated with this joy that comes with cheating.

By the way, we currently (also) love to SHAME and mock people whose lifestyle is limited to normal amounts of food, while at the same time assuming/pretending that people who are not overweight don't have to do a single thing to maintain their weight, because we love to hate that idea. 

It's all so very messed up and while I essentially agree with what the research is saying about behavior modification, the bottom line is that that we ARE still recommending that a behavior be modified--which is ultimately, when it gets right down to it, the part that a lot of people reject.

 

[JBMmom, MSN, NP]

JKL33 said:

if one cares about people and their traumas and their feelings and desires to have a respectful, long-term professional rapport with them, then it is really pretty natural to come at it from this approach just on a basic human decency level.

I think part of the problem is that many healthcare providers AREN'T approaching this with basic human decency. I have heard healthcare providers speaking to patients in the hospital that have a complaint/concern that is largely ignored because the provider focuses on weight as an underlying issue for everything the patient has going on. So people don't feel seen as a person and then they're not in a receptive state to start preparing to make changes. (Granted the ICU is not a spot to delve deep into many issues because most people are not well enough to participate)

I think the overall problem is that we're a reactive healthcare system/society and not proactive. But it's larger than the healthcare industry as you pointed out, it's the food industry, the supplements industry, the fitness equipment industry, it's practically setting people up to fail. I had a patient who was newly dosed as diabetic, had NO idea there was sugar in the yogurt they ate every day. It's yogurt so it's healthy, right? And when people are dealing with any kind of financial stresses, as many are, saving money on the food their eating is more of a priority than the health content. If that 800 calorie dish you saw on line could feed a family a meal for $10 that's going to happen. The problem is just so big and encompasses so many aspects of our society. In many ways progress has worked against us, when we were people in farming communities with laboring jobs, we were healthier in many ways. But progress happens. 

[Nurse...123]

"Prevalence of obesity (BMI > or = 30) in Japanese adults (aged 20 years and over) was 3.8% in males and 3.2% in females (National Health and Nutrition Survey, 2010), being quite low compared with other countries listed in the Global Database on Body Mass Index (WHO)."

This is a quote from a PubMed study.

Why? Diet and daily habits come first. Look at the pictures from 1970s. How many overweight people will you find there? Health system in the US is relyig n a steady manufacturing of heavy, depressed, unhealthy people. It is a very sad reality. Our role is to educate patients. One person at a time. Any other suggestions? In my opinion, food industry does not want to hear about the damage they cause to our health, government remains indifferent. 

... "appropriate body weight management has been prioritized in the national health programs". (oce again, this is in Japan)