Fat and Fit
Fat and Fit, Featured, Issues — By Administrator on January 26, 2011 at 12:01 am
POINT:Sizing up Healthby Catherine Kraus M.Ed, RD, CHES. |
COUNTERPOINT:Health at Every Sizeby Michelle Allison |
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How many times have you heard someone say, “I have a weight problem because I have a slow metabolism?” People blame their weight on all sorts of things, and it is true that diet, exercise, genetics, and environment all play a role in a person’s ability to manage weight. Understanding obesity is a complex issue that we will not solve overnight. But the truth is the obesity epidemic is a serious public health problem in America, one we cannot afford to ignore.
Before we can discuss the implications of weight, we have to understand that obesity is defined as having a BMI of >30, whereas the “overweight” category covers BMIs between 25 and 29.9. The terms are not interchangeable. There are many exclusively obesity-related co-morbidities, including diabetes, hypertension, sleep apnea, heart disease, joint pain, and acid reflux. But these aren’t the only difficulties facing the obese. As a dietitian working in a weight management setting, I see and hear about the struggles my patients experience on a regular basis. People of average weight might never think to worry about seat belt extenders for cars and planes, a chair’s ability to withstand their weight, discrimination in the workplace, inability to find clothing in any department store, crossing their legs when they sit or difficulty with bathing, dressing, and chores. Many obese people, however, must confront these difficulties daily. These are serious problems, and they affect a large slice of the population. According to the CDC, the prevalence of obesity in the United States is 32.2% among adult men and 35.5% among adult women. Childhood obesity is also on the rise: 17 percent of children ages 2-19 in the United States are obese. Many pediatricians and parents shy away from using the term “obese” when referring to children, but parents may not take their child’s health seriously if the pediatrician sugar-coats the situation with statements like “your child is a little overweight.” Children face the same health risks as adults as well as many psychosocial issues such as bullying and low self-esteem. These obese children often grow up to become obese adults, and the vicious cycle continues. It is essential that we break this cycle. Motivation, or lack thereof, can affect a person’s ability to make changes in their lifestyle. But, at a fundamental level, weight gain is linked to excessive calorie intake. The diets of individuals with limited resources or limited access to healthy food tend to consist largely of refined carbohydrates, saturated fat, and sodium. All of these promote diabetes, hypertension, dental caries—and, of course, obesity. Some of the best ways to improve a poor diet include increasing fiber intake via fruits and vegetables, decreasing overall calorie intake, choosing non-sweetened beverages, and making healthy choices while dining out. But individual diet choices alone aren’t the answer. So, what is the solution? Many people believe we should invest in preventative programs. However, this would require either 1) all insurance companies to cover these programs (an unlikely prospect) or 2) all participants to pay for these programs out of pocket. Given the medical costs associated with adult obesity ($2.9 billion in 2003) and the current state Michigan’s economy, the latter is not really an option for most individuals. Obese individuals should also avoid non-surgical weight loss programs that guarantee drastic weight loss in a short amount of time. A safe, healthy rate of weight loss for an adult is about 1-2 pounds per week, and for children that number can be 0.5 pounds or less. People can achieve these goals by reducing their daily caloric intake by 500-1,000 calories while increasing energy expenditure. Pharmacotherapy can supplement these practices in some cases, and bariatric surgery is an option for adolescents and adults who qualify based on the requirements of their insurance company—typically, having a BMI of greater than 40 and at the presence of serious weight-related illnesses. But even those who undergo surgery must still change their lifestyle significantly. Obesity is a serious health care issue, and we must take concrete measures to address it. Most people probably recognize that it is not healthy to be obese, but they may not know what steps to take in order to lose weight. Though healthcare providers ought to be sensitive when discussing a patient’s weight, they have an obligation to educate their patients about the consequences of obesity and effective ways to improve their health. Working with a multidisciplinary team (dietitian, physician, exercise specialist, therapist, pharmacist) provides the most well-rounded approach by addressing all areas of the patient’s life. Trying to change several behaviors at once can also feel overwhelming, and initially, patients can change their habits in small ways, such as consuming a high calorie beverage every other day instead of daily. Long-term clinical follow-up may also be necessary to ensure weight maintenance. But these steps do lead to successful and lasting weight loss, and if patients continue to develop and solidify positive lifestyle habits, they can go on to lead healthier and happier lives. back to top
Read the counterpoint...
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Edited by: Aaron Bekemeyer and Leslie Horwitz
Authors:
herine Kraus is an LSA senior majoring in Communications and Linguistics. Perry is a lifelong Michigan fan and laments the fact that his four years at UM have been some of the worst four years in Michigan football history.
Michelle Allison is a sophomore at the University of Michigan majoring in history and anthropology.
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Tags: food, Health, obesity
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19 Comments
I’ve just been looking at the website of Michelle Allison, who calls herself “The Fat Nutritionist”.
She’s 5’4″, weighs around 260 pounds (which puts her BMI at 44.6, well into the morbidly obese category) and for only $1,200 (12 sessions at $100 a pop) she will tell you how to eat.
Really.
http://www.fatnutritionist.com/index.php/online-nutritionist/
I’ve read it as well after reading these editorials.
It appears to promote a rational and healthy approach to food, as well as mindful eating. As someone who treats multiple patients with eating disorders, and has to address the unfortunate medical and psychiatric sequelae of the darker side of WLS, I’ve just bookmarked it for further review and probably some patient education linking. For the patients I work with who do overeat, being able to accept / recognize their behavior and get out of the trap of ‘good’/'bad’ food, recognize the way the food influences them, etc., is crucial to behavior change. Her website appears to address that very well, and it doesn’t scold or shame the reader.
Realistically, Canada and the US are obesogenic societies – see the works of Brian Wansink and David Kessler, for example. Personally, I can’t wait until WLS is a thing of the past – and I suspect it will fall out of favor again within 10 years, except for the most extreme situations. The failure and complication rates are too high, and the outcomes really aren’t that good on a population basis. What’s more concerning is that the US at least (haven’t been tracking Canada as closely) is also a very inactive society. The folks at Obesity Panacea routinely recommend small social changes that can have influence on activity level, for children and adults, at just a day to day, almost imperceptible level. Obesity does NOT equal inactivity. (And activity does not equate to slenderness at all.)
I agree with Ms. Allison that one can be healthy and obese; many of my patients are. I don’t agree with HAES (sorry, folks, don’t kick me too hard.) I have treated patients weighing greater than 700#; there have been major health issues present. By the same token, I have treated adult patients weighing 80#; there have been major health issues present. Unsurprisingly to any rational person, I’ve treated “normal weight” people with really severe medical problems. Blah blah blah. I *do* believe in Health at a Wide Range of Sizes, however, and the right to be treated with dignity and competence whether one is fat, cachectic, or anywhere in between.
Oh. By the way. Was there a point to your comment about Ms. Allison’s height and weight? I can’t imagine that it was intended as an ad hominem attack, because this isn’t 8th grade, and Ms. Allison’s BMI is completely incidental here. Relevance, please?
I think Michelle is bang on correct. I am overweight by BMI standards, on the edge of obese. I wear size 14 or 16. I am vegan and gluten free. I eat organic food. I eat low-fat. I eat when I’m hungry, and don’t when I’m not. I’ll never be “normal”. I am healthy. But I do not get treated that way. And OMG, if I dare to eat a bag of chips in public, the crap I take for it is epic. Michelle’s way of thinking needs to make strides into society. We can be healthy at any weight.
Just how fat does the first author think these people are!!! She says “People of average weight might never think to worry about seat belt extenders for cars and planes, a chair’s ability to withstand their weight, discrimination in the workplace, inability to find clothing in any department store, crossing their legs when they sit or difficulty with bathing, dressing, and chores. Many obese people, however, must confront these difficulties daily.” This is basically ridiculous. “Most” obese people are in the BMI 30-35 range, do not need seat belt extenders, do not break chairs when they sit down, can easily cross their legs, can find clothese anywhere, and have no problems with bathing, dressing or chores. The first author is describing problems that might happen to a small minority of obese people with BMIs in the40 or 45+ range, NOT problems that most obese people in the US have.
It is true that some (though not a majority of) fat people struggle with physical accessibility. I’m fat myself, and certain places or seatbelts can be a tight squeeze. I just really don’t think that the answer to accessibility problems is for people to change their bodies in potentially dangerous, and most likely ineffective, ways in order to fit into the man-made world. Chairs, clothes, etc. are made to accommodate human bodies; not the other way around.
While there’s some truth in your statement that chairs, clothes and so on are (should be?) made to accommodate human bodies, not the other way around, I notice you didn’t address the other obesity-related accessibility problems Caroline Kraus references. What about discrimination in the workplace, being able to cross your legs when you sit, or difficulty with bathing, dressing and chores?
Well, my BMI is 41. As far as I can tell I have yet to be discriminated against in the workplace, and I have absolutely NO problems what so ever with:
–crossing my legs when I sit (as in lady-style, where I can lay the back of my knee over my other leg)
–difficulty with bathing, dressing or chores
–so far have never required a seat belt extender, nor have I broken a chair, or hung over the side of one, unless you count the chairs at my nephews kid sized play table
Perhaps Michelle doesn’t suffer some these issues either…..?
Discrimination in the workplace is something that is real, yes, and needs to be addressed by society, not by people losing weight to escape discrimination.
Mobility issues, debilitating as they can be, are not always directly related to weight. Even when they are, their existence does not make permanent, safe, sustainable weight loss any more likely to happen for those people. Physical therapy and increasing physical fitness, without focussing on weight loss, is likely a much more effective alternative.
Gina, are you suggesting that discrimination in the workplace is the fault not of the discriminator but of the target? Should i recommend then that my friends who are discriminated againt should, say, straighten their hair and bleach their skin? At a BMI of 60+ I had no trouble bathing, dressing, or doing chores. At a BMI of 22 I can’t cross my legs. So what?
I have to question this statement by Ms Kraus: “There are many exclusively obesity-related co-morbidities, including diabetes, hypertension, sleep apnea, heart disease, joint pain, and acid reflux.” Am I reading this right? You’re claiming that only obese people suffer from these conditions? That can’t possibly be true. My father has had severe sleep apnea his entire adult life, and he’s never been overweight. Ever.
Are there any endocrinologists or cardiologist out there who can verify whether all their patients with diabetes, hypertension and heart disease are obese? I’m betting they see plenty of normal weight patients with unhealthy habits and/or lousy genes.
Given the context of the paragraph, I think what she meant to say was “specifically obesity-related co-morbidities,” i.e., co-morbidities associated with obesity but not overweight. I’m sure Ms. Kraus is aware that people of average weight suffer from these disorders as well.
There’s a new journal article out (full text is free to all!) that explains the issue much more clearly than I ever could — those who are interested in further reading on the topic should check it out:
Weight Science: Evaluating the Evidence for a Paradigm Shift
http://www.nutritionj.com/content/pdf/1475-2891-10-9.pdf
Linda Bacon and Lucy Aphramor
Nutrition Journal 2011, 10:9 (BioMed Central)
While there are ties between obesity and health problems, it cannot be ignored how often the news stories show images of overweight Americans rather than health related issues. While watching Saturday morning infomercials not a word is mentioned about blood pressure or heart rates. These things being said there is still a problem with health and programs that help with proper dieting and exercise throughout life should be supported.
Similar: http://consideronline.org/2009/10/13/is-a-fat-tax-fair/
I think it’s pretty interesting comparing the tone between these four authors. Could this possibly describe the public outlook on obesity since ’09 to now?