Why Everything You've Been Told About Weight May Be Wrong
Photo credit: Perryn Ford
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Whenever we go to the doctor's office - be it for an annual checkup or a sore throat - one of the first things we do is step on a scale. It's a tense moment for some of us: will the number be higher or lower than last time? How will we feel about it? And especially people with larger bodies might be wondering: what will my doctor think about this?
In a paper published in 2014, researchers found that 21% of patients with BMIs in the “overweight” and “obesity” range felt that their doctor “judged them by their weight” - and therefore placed significantly less trust in theirs Return to doctor or even for follow-up care. And research shows that lack of confidence is justified: Doctors are more likely to be biased towards high BMI patients, and this affects the quality of medical care.
After analyzing audio recordings of 208 patient encounters by 39 GPs, scientists found that doctors develop less emotional relationships with their heavier patients, according to a 2013 study published in the journal Obesity. Other studies have found that because of this lack of relationship, doctors are more likely to classify a heavily weight patient as “non-compliant” or “difficult”, often before the test has even started. And for women, gender-nonconforming people, people of color, and people of low socioeconomic status, a doctor's weight bias can overlap with other prejudices and potentially make the situation worse.
Medical weight stigma can have dire consequences. When patients delay health care because they fear discrimination, they miss regular checkups and are likely to be much sicker when seen by doctors. This is one of the reasons some people assume that everyone in a larger body is unhealthy and observe correlations (but not causalities) between higher body weight and chronic health conditions that benefit from good health care provision.
At the same time, provider bias can lead doctors to under-treat or misdiagnose their larger patients in a variety of ways. Patients with larger bodies with eating disorders tend to struggle longer and be sicker when they finally get treatment because doctors can ignore their symptoms - or even praise their eating disorders if they result in weight loss. The weight stigma also causes doctors to overlook non-weight issues. For example, in May 2018, a Canadian named Ellen Maud Bennett died just days after being diagnosed with terminal cancer; In her obituary, her family wrote that Bennett had sought medical help for her symptoms for years but only received weight loss advice.
With this growing evidence on the health consequences of medical anti-fat bias, some providers are beginning to shift their medical practice to what is known as the "Health at Every Size" approach, which is aimed at taking the focus off of the person and looking at weight instead their overall health holistically. Of course, many doctors still use scales and prescribe weight loss. But the “Health at Every Size” movement can be a model for health and wellbeing that you can adopt for yourself as well.
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So what is health at each size?
Most doctors today approach health through what is known as the "weight-centered" model, which sees weight as one of, if not the most important, health indicator. In the weight-centered model, when the patient is in a larger body, many conditions are treated primarily by prescribing weight loss. Health at Every Size, commonly known as HAES (pronounced “hays”), is an alternative approach, sometimes referred to as the “weight inclusive” health model.
HAES originated in the fat acceptance movement and was best known by Lindo Bacon, Ph.D., a weight researcher and associate nutritionist at the University of California, Davis, who wrote the book Health At Every Size: The Surprising Truth About Your Weight. wrote in 2010 and hosts the HAES community website. “Health at Every Size is the new peace movement,” writes Bacon. “It is an inclusive movement that recognizes that our social characteristics such as our size, race, national origin, sexuality, gender, disability status and other traits are advantages and recognizes and questions the structural and systemic forces that affect a good life represents. It also helps people of all sizes adopt healthy behaviors. ”(If you are interested, please contact the Association for Size Diversity and Health for more information on the history and philosophy of HAES.)
HAES-informed physicians do not routinely weigh patients or use the weight to determine how healthy a person is. Instead, they look at other biomarkers like blood pressure and cholesterol levels to assess physiological health. And they take into account how various social, economic, and environmental factors in a person's life affect their ability to pursue health. Translation: Instead of assuming that you are lazy or uninformed when you are not exercising or eating vegetables, a HAES-focused doctor will ask about your schedule, responsibilities, and priorities to see what obstacles you face in establishing a regular Training program. And they take into account whether you live near a grocery store, have time to cook, or otherwise have easy access to healthier foods.
This does not mean that a HAES provider will never encourage you to be more active or change your eating habits; This means that they only recommend changes that are achievable and realistic for you. And most importantly, they are not going to tell you to do these things in order to lose weight. In the HAES model, weight loss is never a treatment goal because your body is never seen as a problem to be solved. You have the right to track the health of your own body instead of waiting for that body to change to be considered healthy.
But isn't it unhealthy to be fat?
Contrary to popular belief, being fat isn't inherently unhealthy. Research shows that the relationship between weight and health is much less clear than we are often told. Weight can be a correlating factor in health conditions such as diabetes and heart disease, but scientists have failed to prove that high body weight causes such diseases. In some cases it may help, or it may simply be another symptom of another cause. (Think about how smoking can cause both lung cancer and yellow teeth - but nobody thinks yellow teeth cause lung cancer.)
In fact, weighing more can protect you from certain health problems, including osteoporosis and some cancers. Cardiac surgery patients with higher BMI also tend to have better survival rates than their thinner counterparts. The fact that high body weight actually helps survive serious illnesses could explain why overweight and obese BMIs have the lowest overall risk of death compared to other weight categories, according to data, first published in 2005 by the Centers for Disease Control and Prevention In short, it is absolutely possible to be fat and fit.
Even if you live in a larger body and have health issues that are often thought to be related to weight, there is good evidence that you can treat these issues and improve your health without aiming for weight loss. In a 2012 analysis of nearly 12,000 adults, the researchers found that lifestyle habits were a better predictor of mortality than BMI, since people, regardless of their weight class, lived longer if they practiced healthy habits, such as walking and eating. For example, do not smoke, drink alcohol in moderation, eat five or more servings of fruit and vegetables daily, and exercise at least 12 times a month.
This is good news because, despite the frequency with which doctors prescribe it, we don't have a safe and permanent way for most people to lose significant amounts of weight. That's because our bodies are programmed to fight weight loss for our own good. According to an evidence review of popular commercial weight loss protocols first published in 2007 and later updated in 2013: People lose some weight in the first nine to twelve months of each diet, but gain it all back over the next two to five years, but an average of 2, 1 pound. And dieting and “weight cycling” that way can increase your risk of eating disorders and other health problems.
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How do I practice HAES - and how do I get my doctor on board?
Practicing health of any size looks different for everyone because that is part of their beauty: you can determine your own health priorities and focus on goals that are accessible and realistic for your life, rather than one "one size fits all" one Doctor's to follow all “health concept. But there is one universal principle: your weight is no longer part of the conversation. That could mean giving up your scales, stopping dieting and exercising for weight loss, exploring intuitive eating and joyful exercise - or all of the above.
But while awareness of HAES is growing in the medical community, it is not the standard approach in most health agencies. To find doctors or other practitioners in your area who identify themselves as HAES Compliant, you can first check the HAES provider directory. But if not, it may be possible to have a productive conversation with your current doctor about why you want to take the focus off your weight. An easy way to set this limit is to decline the tradeoff at the start of the visit.
You may be concerned that the doctor's office won't allow you to skip the routine weighing, but you have the right to refuse the weighing, says Dana Sturtevent, RD, a nutritionist and co-founder of Be Nourished, a Portland nonprofit, Oregon, which offers workshops, retreats, and e-courses for health care providers to provide trauma-informed, weight-inclusive care. "This can be a very real and potentially vulnerable step towards self-care," she says. If your doctor has objections, you can ask, “How is this information used?” There are times when a weight is medically necessary, such as when it is necessary to determine the correct dosage of certain medications. If so, you can request to be weighed with your back to the scales so you cannot see the number. But if you're told it's routine, or just need to write it down for insurance reasons, you can ask them to write "patient refused" instead.
It may also be helpful to point out to your doctor that you prefer not to talk about weight or weight loss at your appointment. If you're scared of bringing this up in the exam room, you can download this letter, created by HAES providers Louise Metz, MD, and Anna Lutz, RD, to mail or give to the nurse who is yours The appointment takes the vital signs at the beginning. Dr. Metz also worked with health trainers Ragen Chastain and Tiana Dodson to create the HAES Health Sheets Library, which contains downloadable fact sheets on treating conditions that are often associated with weight from a HAES perspective.
If your doctor continues to focus on weight in your treatment, remember that you have the right to switch providers. But more importantly, "Remember, you don't have to be a certain weight to be worth love, respect, belonging, or decent medical care," says Sturttevent. "Your body is your body."
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