Obesity and Fat Acceptance in Medicine – Meeting Notes

The body positivity (#bopo) movement swept through instagram and tumblr and now seems to be finding a place in mainstream media. With plus size models gracing the cover of Sports Illustrated, and a fat, active women getting her own show on TLC, it seems like embracing one’s body, no matter the size, is slowly becoming more accepted. This of course has many connections to healthcare and the physician-patient relationship. Can patients be overweight and healthy? What does healthy really mean? How can you approach a patient about weight loss in a body positive way? Physicians are often looked to as health role models, and have a important role in determining “health” – and yet,  weight bias is rampant among health care professionals , which calls into question if mental health is factored into a physician’s view of “health”.

We recently explored many of these concepts in our Obesity and Body Positivity in Medicine Session. Typically, Medlit sessions are based around a series of readings. Themes are chosen by the club execs (although we are open to suggestions!), and facilitated discussions are held to highlight various themes in the readings. We plan to use this blog as an account of these meetings and provide our discussion prompts for those looking to analyze the material but cannot attend. Readings are underlined  and discussion prompts follow!

Tell me I’m fat – This American Life Podcast  Click here to listen

The way people talk about being fat is shifting. With one-third of Americans classified as overweight, and another third as obese, and almost none of us losing weight and keeping it off, maybe it’s time to rethink the way we see being fat. A show inspired by Lindy West’s book Shrill.

This American Life  Questions:

  • In the opening segment, Lindy West states “its like no one accepts being fat as a permanent state of being, fat people are just failing at being thin”. Do you think physicians contribute to this idea? How?
  • Elna Baker describes how she found as a fat woman she had to be kinder, work harder and overall put in more effort to be valued in society than she does now that she is thin. This is often referred to as weight bias- thin people get things just because theyre thin. Can you think of ways that weight bias is reinforced by physicians?
  • The other side to weight bias is thin privilege. It has been proposed ( What’s wrong with fat, book by Abigail Saguy) that the intense hatred of fat people is a reflection of thin privilege- thin people want to believe that they are better and earned their thinness through good habits. This can only be true if being fat is “bad”. Do you think physicians are awarded thin privilege due to their status as health professionals?
  • Health Trolls – One of the most common retorts by fat phobics/anti fat acceptance proponents is “as long as youre healthy”. Ira glass refers to this as the third rail when speaking with Roxane Gay. How is health viewed as a currency in society?
    • What do you think this says about the importance of mental health and its validity as an illness in society? E.g Elna Baker is actually addicted to speed, but shes skinny, so shes seen as “healthy?
    • Do you think its possible for a physician to recommend a diet without endorsing an eating disorder? How?
  • Elna Baker played a recording of a conversation with her husband in which he admits that he would not have been attracted to her if she was still fat. This highlights that beauty standards for women play such a huge role in the course of their lives, and revolve much of the time around the physical body.
    • Do you think feminism plays a part into the fat acceptance movement?
    • Are there beauty and weight standards for other groups that could be affected by weight bias?
  • Ira Glass pointed out that we don’t even know how to treat obesity effectively, citing a study that followed a quarter of a million people over nine years which found only 5% maintained weight loss (Note: this study was not cited, but it could be this one ). There is evidence that backs this up- LOOK AHEAD study in NEJM 2013 found that losing weight did not change risk of developing type 2 diabetes or cardiovascular risks. 
    • What are the ethics to recommending treatments that are not fully understood? E.g recommending bariatric surgery when it may not treat root cause of weight gain and has many side effects? 

The Weight Inclusive vs Weight Normative Approach: Evaluating the Evidence 

A review of evidence surrounding weight inclusive and weight normative approaches to weight management. Pro-weight inclusive, with an emphasis on the Health At Every Size (HAES) movement. 

Click here

  • How is the role of physicians in confronting overweight patients different from confronting other patients with unhealthy habits (e.g smoking, alcohol abuse)? How is it the same?
  • The article challenges this idea by citing a study that indicated weight stigma itself may be attributed to weight gain- did you think this idea was well supported?
  • Do you think there would be a backlash against doctors who promoted a “weight inclusive” approach?
  • 2.4 Heightened Weight Stigma: The article states that “suggesting a diet to a patient that came in with a complaint unrelated to their weight” is a microaggression. This is, however, a practice that is recommended by the college of family physicians (all patients with a BMI over 30 should be counselled on nutrition/weight loss). What do you think?
    • A popular idea in the ‘weight normative’ approach is that weight stigma puts pressure on people to lose weight. What are some of the ethical issues with this idea if the stigma comes from a medical professional?
  • HAES/Weight inclusive approach: what are some of the pros and cons of adopting this approach in medicine?

Chicago Tribune Article: Can you be overweight and healthy? Click here

Fitness expert and bodyforwife blogger James Fell debates the merits of the HAES movement, focusing specifically on its aversion to weight loss. Interviews with obesity doctors included. 

  • What did you think of James Fell’s argument? What about the evidence used?
  • Is there a compromise somewhere between HAES and our current practices of recommending weight loss?
  • Does this highlight the confusing nature of obesity medicine

Follow up articles   Click here and here 

In the supplementary articles, Linda Bacon criticized James Fell and stated he took her words out of context to skew against HAES. He responded and wrote a follow up entry in his blog criticizing the HAES movement predominantly for its focus on not losing weight. Dr Yoni Freedhoff also wrote on his blog that he was walking away from HAES for the same reason.

  • How does this article challenge the previous reading? 

Please comment if you have any thoughts or feedback on our readings and prompts. Thanks for reading!

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