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Make War on Obesity – Not on Obese People!



Yesterday I blogged about how many folks with extra pounds do not see their excess weight as a health risk. Readers of these pages will also recall that I am the first to acknowledge how difficult it is to lose weight and keep it off or that successful weight management starts with stopping the gain and not with losing weight.

So yesterday, a regular reader pointed me to an article in the Globe and Mail by Edith Honan on the fat-acceptance movement which lobbies against weight discrimination and promotes the idea of being as healthy as possible at any weight rather than pursuing unrealistic (and according to some fat-acceptance advocates, unnecessary) weight-loss targets.

As Kate Harding, one of the most prolific fat-acceptance advocates is quoted, “Being fat doesn’t make me lazy or stupid or morally suspect”.

While many of the issues and arguments of the fat-acceptance folks are very real and sensible, I also have no doubt that when excess weight is, or threatens to become, a health problem, there are also very real benefits to effective weight management. In fact I have very rarely met patients, who after successful weight management would voluntarily go back to regaining their lost weight (that many do, is besides the point).

So while I am definitely not a militant weight-loss advocate, I am certainly an advocate for sensible obesity-management. I fully support the notion that weight discrimination is very real and unfair (e.g. the airline seat issue) and very much know that for many, successful weight management simply means not getting any heavier.

None of this, however, makes me an advocate for weight gain and I certainly would not promote the notion that excessive weight gain is OK as long as it makes you happy. I simply see too many patients in my clinic for whom the mental, mechanical, and metabolic health problems directly related to their excess weight are very real.

so, while I am all for fighting weight discrimination, I am also all for increasing access to evidence-based obesity treatments for those in whom excess weight is destroying their health and quality of life.

I fully agree with Yale University’s Rebecca Puhl, who in the article is quoted as saying, “We do need to fight obesity, but not obese people”.

AMS
Edmonton, Alberta

p.s. Hat Tip to regular reader Ann Hastings for pointing me to the G&M article

9 Comments

  1. Hi Dr. Sharma,
    I’ve never figured out how to do the trackback thing, but I did talk about your post on my blog.
    I don’t think the perspective of the fat acceptance movement can be summed up as:
    “excessive weight gain is OK as long as it makes you happy.”
    Whether you mean to or not, you do support many of the ideas of fat acceptance, which fundamentally advocates for fat people to be treated as people. If the writing on your blog is an indication, you demonstrate compassion, respect and caring for people who are often treated as less than.
    There needs to be more conversation between the “fat acceptance perspective” and people like yourself and the Rudd Center’s staff, because there is much common ground, and some real differences as well.

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  2. None of this, however, makes me an advocate for weight gain and I certainly would not promote the notion that excessive weight gain is OK as long as it makes you happy.

    You really don’t seem to understand the fat acceptance movement at all. Fat acceptance is not about “encouraging” weight gain. It’s about accepting oneself as a valuable human being regardless of weight-gain or weight-loss.

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  3. I also have no doubt that when excess weight is, or threatens to become, a health problem, there are also very real benefits to effective weight management.

    There aren’t any effective weight management strategies.

    In fact I have very rarely met patients, who after successful weight management would voluntarily go back to regaining their lost weight (that many do, is besides the point).

    Wrong.

    I simply see too many patients in my clinic for whom the mental, mechanical, and metabolic health problems directly related to their excess weight are very real.

    Nothing to do with efficacy.

    I fully agree with Yale University’s Rebecca Puhl, who in the article is quoted as saying, “We do need to fight obesity, but not obese people”.

    What you need , is to work out how to recruit the weight regulatory mechanism (or mechanisms) to lose weight with the same efficiency as it can gain it-when it wants to.

    You don’t need to ‘fight’ anything, just good old science will do.

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  4. I don’t know if the story you saw is the same one I read today in the online Chicago Tribune. It probably is, in that it sounds similar themes. I would agree that “fat acceptance” isn’t encouraging gaining weight, but rather accepting who you are and the number on the scale. The article mentions a book I’ve found enormously helpful, Health at Every Size by Linda Bacon. It’s an amazing book. It explains weight science with plenty of scientific detail, but actually turns it into fun reading. And it provides a lot of really practical advice. I’ve been on plenty of “diets,” but never found anything I could stick with for life. But this isn’t about finding a diet plan, this just makes eating natural and easy. It’s the first book that I really feel will transform my eating habits for the rest of my life. And I “accept” that most of all.

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  5. Fat acceptance isn’t about encouraging weight gain. What an funny idea; it hearkens back to the idea that the gay rights movement was about recruitment (toasters for new converts!) Very silly misconceptions, and I think mainly about fear.

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  6. Maybe this analogy will help.
    Being light skinned often means you’re at a greater risk for skin cancer. However, tanning until you’re dark 1) doesn’t stick long term – doesn’t make you darker skinned permanently, and 2) doesn’t help you stave off skin cancer. Actually, it’s a risk!

    If fat and thin are somewhat analogous, what fat acceptance suggests is going on is that you’ve got a whole generation of “white” people tanning and tanning and tanning to have their skin cancer rates go down. Which is beyond idiotic, of course; it’s making the problem worse.

    No one’s saying it’s bad to aim for positive health outcomes.

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  7. First, I really appreciate the work that you are doing, Dr. Sharma. And I think that you truly have your patients’ best interests at heart, which is a far cry from the experiences of so many fat people in medical care. I agree that for some people, weight does indeed play a role in overall health, although I think that often times weight is a symptom, and not the cause of many health issues. I am interested in hearing more about the “evidence-based obesity treatments” you mentioned in your post. What specific treatments are you referring to? We all know that diets are largely ineffective and many people who have weight loss surgeries also regain the weight or, at the most, become just less fat. Can you elaborate more on this, please?

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  8. You agreed with: “We do need to fight obesity, but not obese people”.

    But every time you fight against obesity, you *are* fighting against fat people. I am a fat person. I do not have the option of existing as a thin person without major damage to my health. Every time someone fights against obesity as not acceptable, they are fighting against my very existence.

    How can you possibly fight against obesity without fighting the person the fat is attached to? If you try and declare war on obesity you *are* declaring war on the fat attached to individual people, including me, and my fat is very very attached to me! You *are* attacking me! Please understand this! It is different from things like cancer. Cancer patients understand that when you try and fight the cancer, it is the cancer that you are fighting, not the patients. With obesity it is different. It is not some illness that has taken hold of my body, it is ME. Fat is my natural state of being. You are attacking ME if you are attacking obesity.

    I have three options:
    (a) I can choose to take good care of myself as a fat person.
    (b) I can choose to attempt to lose weight, and suffer the many negative consequences.
    (c) I can choose not to take care of myself at all.

    Doctors seem to assume I am choosing (c). What I’m actually doing is choosing (a). What they want me to do is (b), and they are greatly deluded in how effective any weight loss efforts would be and what side-effects there would be. (b) is the war on obesity route and doctors think they are suggesting something helpful, but they are really not.

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  9. I’m reading this post very belatedly and am pleased to see that people left some great comments regarding Size Acceptance NOT meaning “let’s all gain lots of weight because we believe it’s not harmful at all”. The Size Acceptance movement is largely about fighting the discrimination and social prejudice that fat people experience on a daily basis, not about bucking all medical advice and common sense. Advocates of Size Acceptance have created social action such as having size-discriminatory billboards advertising a fitness center removed from the top of a San Francisco building, and adding “size” to the list of ways that citizens may not be discriminated against in state human rights legislation.

    Anyway, what I really wanted to know was if that t-shirt that you used as the image for this blog entry actually exists…because I want one!!!! 🙂

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