Do You Stand Out on Family Pictures?Monday, April 1, 2013
As someone, who sees patients with obesity for a living, I fully recognize the importance of genetic predisposition.
This is indeed a far stronger determinant for shape and size than most people suspect (the heritability of body fat is about the same as that of body height!).
For clinicians, taking a good family history can often pose a problem, not least because of time limitations.
So this is how I ask my patients about their family history of obesity:
“If I brought your whole family together for a family photograph, would you stand out because of your size or would you fit right in there?”
No one has ever been offended by this question and the information is not only useful but opens a whole avenue of possible discussion.
Often, I will follow the question with, “Who else stands out?” and “Would this picture have looked different when you were younger?”
There are obviously a number of scenarios that emerge from such questions:
For example, my patient can respond that she definitely stands out, always has, as everyone else in her family is “skinny”.
Or, my patient can tell me that she not only fits in well (on her dad’s side) and in fact is not even the biggest (compared to her two sisters”).
My experience has taught me that there are often many subtle clues in how patients will answer these questions.
I have seen patients, who suffered through skinny moms, who were themselves paranoid about weight gain and deeply disappointed in the fact that they had an “obese” offspring – you can imagine what this does to self-esteem and eating behaviour in the kid.
I have seen patients, who had an obese father, who insisted that you always eat up and grow up to be “big and strong” – the “bigger” the “stronger”.
I have seen patients, who had obese older siblings and always feared that one day they would be that big – resulting in significantly pathological eating behaviour and a compulsive obsession about “healthy” eating.
Thus, discussing this imaginary family picture can open the discussion to many aspects – not just of genetics but discussions about family dynamics, eating behaviours, body image issues, and countless other topics that I need to understand in order to fully appreciate the context and belief system in which my patients makes decisions about their health behaviours and expectations.
Clearly, even just a mental picture can be worth a thousand words.
Tuesday, April 2, 2013
A favorite movie line—In “Romy and Michele’s High School Reunion” Janeane Garofalo steps out of a dressing room in an ill-fitting dress and announces “This dress exacerbates the genetic betrayal that is my legacy.”
If it were still possible to gather together all the women on my father’s side of the family—my aunts, my cousins, my grandmother—we all shared the very same body type. Ample hips, heavy thighs, thick ankles. My legs have been this same shape my entire life. I never fit into anything correctly. Uniforms for school and Girl Scouts; outfits required for events. My thick calves wouldn’t go into the boots that were part of a band uniform. And while I was just barely at the higher end of the weight range in elementary school, even fitting me in knee socks was a challenge.
Growing up with an exceptionally thin, petite mother has ended up having a benefit. I know she’s the way she is because it’s what’s natural for her. Now in her 70s, my mom is still a twig though now it worries me that as she ages, she’ll become fragile. I’m in my 50s and have spent my entire life having to fight with my weight. I’ve gotten the number on the scale to drop but I remain the same general shape to this day and I could never wear pumps.