On That AMA Ruling…

So big news this past week in the world of obesity. Apparently it is now officially a disease according to the American Medical Association.

I wish I could eloquently write about this turn of events, but I’m not that good.

Mostly all I think about is the fact that the AMA apparently did this to decrease the stigma faced by obese people. I think they meant the discrimination doled out by health professionals; you know the stories of a person seeking medical attention with specific symptoms but being told by their doctor simply to lose weight.

But that’s of course just the obvious discrimination. Stigma can often be much more subtle than that; a look, a thought of judgement, the negative beliefs and prejudices we hold against fat people (lazy, gluttonous, and so on).

I wish I could say I believed that labelling something a disease would end the discrimination and stigma, but I doubt it will. After all, many diseases have had stigma associated with them (in the past, and sometimes to the present day). And many of these diseases weren’t visible to others; you didn’t have to tell anyone your HIV/AIDS status, or in the case of chronic diseases that you had diabetes or heart disease.

Prejudice doesn’t end with labels (especially the label “disease” which actually is at best quite vague, and hard to define), it takes a lot more than words to change people’s minds. We need education that teaches people empathy, compassion, and understanding. 

I could go on, tell some stories from life I’ve met with that describe the way (some, not all) health professionals judge people who are overweight or obese. But I think I’ll leave those for another post.

And because I am at best just writing a quick post to add my two cents, I’d like to send you to a couple great posts on the subject, by a couple of my favourite bloggers. Find them here and here; as always both are well thought out, share lots of great points and evidence and provide great food for thought.

It’s Not A Diet, it’s a Lifestyle

Heard this one before, have you?

I’ll admit I like this phrase. I used to really love it; yesssss, I would think when I read it; it is all about the lifestyle.

Sadly like many trends, it is now everywhere, and most stunningly (though not surprisingly) it is attached to a large number of what should be called diets.

A while ago I was eschewing diets with all the long term bad side effects that can happen (regaining the weight, increasing some medical problems substantial, poor quality of life, loss of connection to hunger signals, the list could go on) to a friend on facebook. She was a little surprised:

Me: love busting diet myths for people… did you know you end up eating more if you are “dieting” than if you are not?
Friend: huh, how does that happen? if you are dieting aren’t you watching what you are eating so therefore wouldn’t you be eating less?
Me: well that is the thing, how do you define dieting? and what does “watching what you eat” really mean?
Friend: i dunno eating no junk food, less fruits, more veggies and meat….less carbs
Me: and if you are going to define dieting then what is not dieting?
Friend: eating some of the other stuff occasionally once u are at the weight u want? lol i dunno

My friend’s definition of dieting is innocuous enough, and really this (somewhat vague) description might be what most people consider a diet. There are hundreds of different definitions of diet, and if so, what is the “real dieting” that leads to the studied negative (and somewhat ironic) outcomes?

Truthfully it’s the diets that cut out entire food groups. Or that have you eating very very few calories. Or has you eating all their packaged foods (as a nutritionist, all I can say is for optimal health real food is where it’s at; our body knows what real food is, it doesn’t recognize those unpronounceable words on the ingredient list either). I would go so far as to say if they are charging you money to attend their meetings/weigh in/lose weight it’s a diet.

I personally completely agree with Health At Every Size. I am glad to see that provinces in Canada, like New Brunswick and British Columbia are starting to focus on wellness rather than on weight loss being a goal of prevention initiatives. Even the Canadian Obesity Network believes that obesity management should be about attaining the Best Weight possible while living the healthiest lifestyle a person can maintain with enjoyment.

Still, wanting to lose weight is not always a bad thing, but sometimes focusing solely on the number on the scale, and focusing on it’s downward spiral at any cost is more detrimental to your health than simply allowing that number to get where it will with reasonable healthy eating and living.

I was thinking about giving a list of how to recognize if the “lifestyle” you’re looking at is actually a diet. But I figure there are a lot of those lists out there. There are many many different ways to eat healthy. And eating can change more than your weight, and it should be about more than your weight, especially if you are considering a “lifestyle change” (lifestyle does imply something beyond eating food, doesn’t it?).

I think I will draw this post to a close before it gets even more rambly than it already is.

One question I think you should ask yourself should be (before you start your next lifestyle change): if  this diet/lifestyle/health challenge/detox/cleanse didn’t promise me weight loss, would I eat like that?

The Danger of a Single {Medical} Story

Have you guys seen the Ted Talk, The Danger of a Single Story?

No? Well it’s awesome. Go watch it now.

A few weeks ago I was teaching a diabetes class, the topic was creating reasonable health goals. As an example I mentioned adding a couple pieces of fruit as a snack a day.

A rather outspoken woman looked towards me and said, “And why are you telling diabetics to eat fruit?” Her words were sharp and her eyes concentrated on me, “Diabetics can’t eat fruit.”

This was news to me and my colleague. We’d never heard that diabetics can’t eat fruit.

It turned out as the conversation progressed that when her husband (the diabetic in this case) ate fruit his blood sugars would shoot to 23 (very high for you who don’t know.). This is not the case for everyone. Diabetics can eat fruit. But for this gentleman, fruit might not be a good idea.

But for his wife, after being told fruit was probably not a good idea if his sugars went to 23, she assumed ALL diabetics could not eat fruit.

Assumptions. Stereotypes. Simply reading between the lines of our client’s diagnosis and assuming we then know their life. Yes, the woman in the the diabetes group is a client, but do we as health professionals really behave differently?

After all many health care professionals have personal experience with diseases, chronic or otherwise. Either ourselves, or a close loved one, or even a friend may have been diagnosed with x, y, z and beat it through careful monitoring of this or a lifestyle change of that.

The danger comes because sometimes the patient we’re seeing doesn’t need to change what your aunt changed to get her weight down, or her blood sugars in order. But because the patient fits, in looks, in diagnosis, with your aunt’s story of diabetes, you assume that’s what her problem is.

But all health conditions are made of myriad of factors. No two people live the exact same lives with the exact same results.

So it’s important to ask them the questions, even if you predict the answers correctly, about their life and their lifestyle, because simply basing your answers on your assumptions isn’t going to help them.

And really you might be surprised at how many times their answers surprise you. And getting the full story of their life outside of their diagnosis is the best way for you both to work together to help them get to the healthiest place they can.