More about ECOG 2014

Amizade

Childhood Obesity News has already discussed some aspects of the 24th Congress of the European Childhood Obesity Group, or ECOG 2014, at which Dr. Pretlow presented the address “Treatment of Child/Adolescent Obesity Using the Addiction Model.”

Everyone acknowledges that obesity treatment must begin with prevention, which must begin with identifying the underlying cause or causes. This is where agreement starts to fall apart. What are the underlying causes? Many people take it for granted that one answer is “poor lifestyle choices.”

Dr. Pretlow asks if it were that simple, wouldn’t obese people make the choice that feels better – the choice to weigh less and experience improved health? The cause and effect relationship between obesity and, for instance, sugar-sweetened beverages, is blatantly, almost insultingly clear. So, why don’t people make the choice to expunge SSBs from their lives? As Dr. Pretlow says, “Obviously something else is going on.”

What’s in a Name?

That elusive something is what we have been calling “food addiction,” a term that Dr. Pretlow now suggests may not be the most accurate. Even “eating addiction” does not seem quite apropos, since obesity is 99% a psychological problem. “Overeating addiction” seems more descriptive, and the addiction seems to be behavioral.

While the “feelgood” foods that inspire insatiable cravings are pretty much junk, and many natural ingredients and additives seem able to “hook” consumers, there is still something else going on. Many people snack just to be doing something, and might as well be twirling their hair or biting their nails – except that food brings in more calories.

Options

In Salzburg, various speakers told the assembled health professionals about the available treatment options. Even weight-loss surgery does not produce impressive long-term results. With all due respect to fellow physicians, Dr. Pretlow would prefer that kids not experience surgery.

Residential immersion programs mainly involve forced food withdrawal and cognitive behavioral therapy, and are fairly successful. But of course, such institutional programs are prohibitively expensive and beyond the realm of possibility for the large majority of obese children or adults. And even the people who can afford them can’t stay forever. Going back into the real world must always imply a certain degree of challenge.

In the case of an obese child, part of the challenge, always, is getting the family on board. Parents need to be convinced of the importance of keeping snack foods out of the home, and of avoiding outside meals. Determined parents can always provide a much more healthful diet – and it is rather socially awkward to weigh servings of foods in a restaurant.

W8Loss2Go

Regarding the most recent study of the W8Loss2Go approach, it is possible that some listeners were surprised to know how readily most of the participants took to weighing the servings they ate at home. This good and useful habit is hard to maintain in public, but it is one of the techniques that led to improvements in self-esteem and control over food. As Dr. Pretlow told his colleagues, the smartphone app helped this group of youngsters to decrease their use of eating as a stress-alleviating coping mechanism.

Exciting Note:

Dr. Pretlow’s paper “Treatment of child/adolescent obesity using the addiction model: A smartphone app pilot study” was accepted for publication by the journal Childhood Obesity.

Your responses and feedback are welcome!

Source: 24th ECOG, October 2014
Image by Douglas Iuri Medeiros Cabral

 

Fat Acceptance Can Hurt

Size Comparison Photo frontways

It would be difficult to estimate how many people have been harmfully influenced by the idea that obesity is not such a big deal after all. It seems as if a lot of the “health at every size” rhetoric aims to convince people to give up – and that “fat acceptance” is just shorthand for “fatalistic acceptance.”

The Reddit discussion website is an unfailing source of cautionary tales.  A young woman, only 5’5,” who once weighed 200 pounds, writes that the people who “revel in denial” make her doubt herself – despite her success in losing enough weight to achieve an 8-10 dress size. She says:

I can only imagine that a lot of people on the cusp of making changes to their lives choose not to because they are convinced by the FA movement that they are doomed to fail… The FA movement pushes people over the edge, back toward obesity, poor health, and even death…

Rather than fighting for the oppressed, the FA movement fights to oppress and marginalize anyone who might prove their central premise, that weight is outside of an individual’s control, wrong.

On another page, where people ‘fess up about the fat-logic nonsense they previously bought into, a contributor remembers believing that if he just ate whatever his body seemed to want, everything would automatically sort itself out. Allegedly, his appetite would gradually match up with the body’s actual energy needs, and his weight would “stabilize at its natural ‘set point.’”

This turned out not to be a workable solution, so he abandoned the theory and eventually became a calorie counter with such success that people assume he is a naturally thin person with an efficient metabolism who can eat whatever he wants. Of course that is not true either, but it’s a myth that a lot of people cling to.

Strange Byways

Individual attempts to grapple with the idea of fat acceptance can lead down some unusual pathways. In Saturday Night Live’s ancient past, Nora Dunn sometimes played a therapist whose one piece of advice, no matter what the client’s problem, was “Look at yourself.”

11 Years is a book by photographer Jen Davis, an obese woman who realized in 2002 that, “I need to look at myself.” After many years of self-portraits that won artistic acclaim, she realized that just looking was not enough, and opted for lap-band surgery. The more recent pictures in the book were taken after a 110-pound weight loss. The entire project is an exploration of the societal ideals of beauty, love, and intimacy – and insecurity. Davis wrote,

In the work what I kept returning to is: What is love? Am I loveable? Can someone find me attractive?

This piece of video comes with a warning – the language is salty and explicit. But it is an interesting peek into the life and thoughts of a frequent Reddit contributor with the handle Boogie 2988. Speaking knowledgeably about obesity and the fat-logic trap, he tells both fat-acceptance advocates and opponents that he loves them.

Your responses and feedback are welcome!

Source: “My Internal Battle Against the FA Movement” reddit.com, 03/02/14
Source: “What Fatlogic Did You Believe in the Past?,” Reddit.com, 11/05/14
Source: “Woman who spent 11 years photographing her overweight body to try to love herself but in the end resorted to gastric band surgery,” dailymail.co.uk, 05/20/14
Source: “Fat Logic and Fat Hate,” YouTube.com, 10/28/13
Image by thepeachpeddler

 

The Futility of Shame and Blame

diversity in the carrot patch

Claire Goodwin, a contestant in the Great British Bake-off, had never been a target of fat-shaming  before she was on television. From that experience, she came away with the belief that negatively addressing a person’s weight can trigger behaviors that result in even more weight gain. She also cites a study performed by Cancer Research UK and written up in the journal Obesity that proves the same thing. Goodwin writes,

I am fat due to a whole range of issues. I haven’t always been fat, I wasn’t a particularly fat child. But I have always been very emotional. I believe the two are linked for me, particularly at this stage in my life. But my weight is my business.

Sharon Begley reported for Reuters.com on how the perception of being fat-shamed  can cause people who need plenty of exercise to get even less of it, because they don’t want the neighbors to laugh at the sight of them trying to walk off a few pounds. She writes:

Targets of stigma often fall into depression or withdraw socially. Both make overeating, binge eating, and a sedentary existence more likely, studies show.

A University of California study confirms that girls who are called “too fat” by relatives, friends, classmates or teachers, will likely become obese teenagers. The study itself, which started with 10-year-olds and followed them for 9 years, had previously been completed, but two researchers re-examined the data in the light of their own concerns. Senior author A. Janet Tomiyama notes that the worst effects occur when the girls are labeled or stigmatized by family members. The results were remarked on by Yale University’s Dr. Rebecca Puhl who said,

This study suggests that negative weight labels may contribute to these experiences and have a lasting and potentially damaging impact for girls.

Another authority, Dr. April Herndon, author of Fat Blame: How the War on Obesity Victimizes Women and Children, finds fat-blaming counterproductive because it turns a confused and unhappy overweight child into “the problem.” As therapists know, any time a child or a grownup is made to feel like “the problem,” trouble ensues. Like the “identified patient” singled out from within a totally dysfunctional family, this individual will probably end up feeling more like a sacrificial lamb than like a person receiving needed help.

The worst thing about the shame/blame game is that it can so easily kick off a vicious cycle, as described in Slide 19 of Dr. Pretlow’s invited keynote talk, “Treatment of Child/Adolescent Obesity Using the Addiction Model” at the Dr. Pretlow and ECOG 2014 before the European Childhood Obesity Group.

For more information on this phenomenon, see “Cycle of Bias and Obesity,” which starts at Slide #31 of “Clinical Implications of Obesity Stigma,” written by the aforementioned Dr. Puhl. A mistaken notion about “tough love” turns out to be an ineffective weight loss tool. Aside from human decency and a few other factors, the main thing to know about fat-shaming and fat-blaming is, they don’t work. That’s really all we need to know.

Reactions?

Source: “’Fat is something you have, not something you are’,” Telegraph.co.uk, 09/11/14
Source: “Insight: America’s hatred of fat hurts obesity fight,” Reuters.com, 05/11/12
Source: “Calling girls ‘fat’ may result in weight gain,” FoxNews.com, 04/29/14
Source: “WSU professor’s ‘Fat Blame’ book challenges war on obesity,” winonadailynews.com, 04/03/14
Source: “Clinical Implications of Obesity Stigma,” YaleRuddCenter,org, 06/27/13
Image by woodleywonderworks

 

Conscientious Objectors vs. the War on Obesity

Big is Beautiful

Big is Beautiful

“Health at Every Size” proclaims itself a new peace movement, and that the “war” on obesity is already lost. But like an army preparing for war, HAES wants people to enlist and sign a pledge. The homepage says:

Fighting fat hasn’t made the fat go away. And being thinner, even if we knew how to successfully accomplish it, will not necessarily make us healthier or happier. The war on obesity has taken its toll. Extensive “collateral damage” has resulted: Food and body preoccupation, self-hatred, eating disorders, discrimination, poor health….

Another group, the Council on Size and Weight Discrimination, has a director of medical advocacy, Lynn McAfee, who weighs around 500 pounds. She points out that in every state but Michigan, it is legal to discriminate on the basis of weight. In practical terms, this means employers and landlords can, with impunity, deprive obese people of jobs and apartment leases. Paradoxically, it appears that thin people are not the worst practitioners of “thin privilege.” McAfee mentions another interesting fact:

Studies show that fat people are even more prejudiced against fat people.

Yale University’s Rudd Center has found substantial evidence of weight-based bias from both fat and thin people in the areas of employment, education, the media, health care, and interpersonal relationships.

The discussion website Reddit offers a Body Acceptance sector, replete with such slogans as “Confidence Always Fits.” The moderators shun the notion of the ideal body, and believe that everyone deserves to feel good about herself or himself. The index page displays a roster of enticing headlines, including these:

‘Thigh Gap’ Trend Creating Dangerous Consequences
Student Sent To Principal’s Office After Refusing To Be Weighed
Five things that are perfectly acceptable to say to fat women
How can I become an effective size acceptance activist?

Authority on Their Side

HAES proponents have some authorities in their corner, including April Herndon, PhD, author of Fat Blame: How the War on Obesity Victimizes Women and Children. A formerly obese person herself, she is uneasy about the focus on childhood obesity h and critical of medical certainty. Herndon is not convinced that the ties between obesity and diseases such as diabetes and heart disease are sufficiently well-established. She believes that everyone should be conscious of the need to keep moving and eat wisely, and says:

Weight loss is often conflated with being healthy. I don’t think obesity in and of itself is a health problem.

Your responses and feedback are welcome!

Source: “Health at Every Size,” www.haescommunity.org
Source: “Insight: America’s hatred of fat hurts obesity fight,” Reuters.com, 05/11/12
Source: “Clinical Implications of Obesity Stigma,” 06/27/13
Source: “http://www.reddit.com/r/BodyAcceptance/, Body Acceptance
Source: “WSU professor’s ‘Fat Blame’ book challenges war on obesity,” winonadailynews.com, 04/03/14
Image by Paul Stein

Dr. Pretlow and ECOG 2014

Salzburg

The European Childhood Obesity Group (ECOG) brings together professionals from all over the world, including but not limited to “paediatricians [sic], psychologists, nutritionists, geneticists, physical activity experts, [and] economists….” Founded more than two decades ago, it maintains headquarters in Belgium. This year’s mid-November gathering was convened in Salzburg, Austria, in the state-of-the-art auditorium of Paracelsus Medical University. The schedule was divided into five sessions:

Critical window: Pregnancy
Critical window: Infancy
Critical window: Early childhood
Novel ideas and perspectives
Comorbidities

Session 4 included Dr. Pretlow’s invited keynote talk, “Treatment of Child/Adolescent Obesity Using the Addiction Model.” The presentation begins with the shocking statement that not a single country has curbed its obesity rate over the last 30 years. Here is the one of the most interesting parts, from Slide #17:

With a few exceptions, withdrawal from problem foods and snacking was associated with minimal withdrawal symptoms. However, withdrawal from excessive food amounts was associated with significant withdrawal symptoms consisting of nagging urges, agitation, even anger, but rarely real hunger. Nevertheless, the participants interpreted food withdrawal symptoms as “hunger.”

The kids even admitted to sneaking food because of what they termed hunger. But if they ignored it, the feeling went away – which real hunger does not tend to do. The bottom line is, in many ways, “We are failing our young people.” The principles are elaborated on in text and graphic form in the poster, “A Smartphone App/Server Platform for Investigation of the Addiction Treatment Approach for Child/Adolescent Obesity,” which attracted a lot of attention.

The long-awaited new edition of the Diagnostic and Statistical Manual of Mental Disorders is strangely unhelpful on the topic. It lists plenty of things a clinician should look for when diagnosing a disorder. And millions of people’s relationship with food meets those criteria. Yet the authors of DSM-5 stopped short of including food along with alcohol, opiates, and stimulants as substances capable of inducing such a disorder. For this and other reasons, and although in general medical opinion has shifted somewhat, it is still difficult to convince doctors to view the obesity epidemic through the addiction lens.

Not the First

This was only the most recent of many trans-oceanic trips. The reader will enjoy Dr. Pretlow’s account of his experiences at the 2009 ECOG scientific meeting, where he conducted a plenary session and introduced the idea that the childhood obesity epidemic is caused by emotionally driven comfort eating which often results in addiction. This idea is based, he says, “on the anonymous posts of thousands of overweight and obese kids on my open-access website over the past 10 years.”

Other European appearances included Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal, and another at the 2012 European Congress on Obesity, and yet another at the 2013 European Congress on Obesity in Liverpool, UK.

Your responses and feedback are welcome!

Source: “European Childhood Obesity Group,” undated
Source: “24th ECOG, October 2014
Image by Serge Bystro

 

The Day After Thanksgiving

Tux goes to town

The day that follows a big holiday blowout is perfect for good intentions, and most of us formulate resolutions with ease. We decide to take the high road, to do everything right from here on out. But how?

The advice for the day after Thanksgiving is the same as for any other day of the year. There are some obvious issues that we already know even if we pretend ignorance. For instance, cut out the fizzy beverages, and take a close look at whatever energy drinks and fruit juices your child may be consuming. Another major precept is “Lead by example.” The maintenance of a healthy normal weight also depends on numerous small decisions and habits, many of which are just common sense. Parents can find a generous array of tips. Here is one from registered dietician Maryann Jacobsen:

Be smart about sweets: When parents reward kids with sweets, take them away for punishment, provide them to make kids feel better or overly restrict or provide too much access them, they make these foods even more desirable to kids. Instead, parents can serve them in a frequency that makes sense for their family, utilize structure and teach kids how to sensibly fit these foods fit into a balanced diet.

Think outside the box – the one on cables that goes up and down. If there is a choice between an elevator or stairs, take the stairs – within reason, of course. (That is where the common sense part comes in.) Taking a child to a 10th floor doctor’s office, ride on up. But after the appointment, why not walk down the stairs? It counts as exercise, it burns up calories and gives a workout to muscles that are not much used.

Create an Adventure

Make it interesting. Voices sound different in stairwells, and so does tapping a pen on a railing. If you don’t want to hear a bunch of yodeling, suggest whispering all the way down. You could count the steps; or count the steps in one flight and count the flights, and teach an impromptu multiplication lesson. If your child is unfamiliar with the word “descend,” it’s also an English lesson.

How many different ways can your child describe the activity of walking downstairs? Who might have a really hard time walking downstairs? A person with a broken leg? A baby? A grandma or grandpa? Someone with no shoes? A very overweight person?

It could be a fascinating discussion and an opportunity to develop some real empathy. In general, children learn through their bodies and need sensory experiences to match up with things they see. For a child who has experienced a long descent on foot, a movie in which the heroine flees down steps hewn from stone, or a hero runs down the stairs of a lighthouse, will have an extra dimension. For a parent, it is possible to turn a chore into an adventure, and an opportunity for exercise. What’s not to like?

Your responses and feedback are welcome!

Source: “15 of the All-Time Best Strategies for Raising Healthy Eaters,” RaiseHealthyEaters.com, 02/07/14
Image by Ilovebutter

It’s Official! Fat Can Be Fit

Kidney Center

The headline, “America rejoice! Being fat may actually make you healthier,” can brighten up one’s day, but the claim needs careful investigation. That particular headline appeared in the New York Post over Susannah Calahan’s review of cardiologist Carl J. Lavie’s book The Obesity Paradox. One of Lavie’s main arguments is that although one-fourth of obese adults have disordered metabolisms, so do approximately the same proportion of normal-weight women and men.

Metabolic abnormalities include insulin resistance, diabetes, abnormal blood levels of glucose or lipids, and high blood pressure. Knowing that lean folk share the same organic problems, some overweight people might get the notion that having a wacky metabolism is no big deal.

The Possible Exceptions

According to some researchers, there is a subgroup of obese people in whom no signs of disordered metabolism are present. That group is large: research suggests that about 75% of obese people do not suffer from any metabolic abnormality in conjunction with their overweight condition. That may be an unrealistically optimistic number: Lavie and his colleagues acknowledge that when it comes to the morbidly obese, all bets are off. The paradox applies only to less severe categories.

The title The Obesity Paradox is an homage to the phrase first spoken by Dr. Luis Gruberg more than a decade ago at the Cardiovascular Research Institute in Washington, D.C. He and others noticed a trend among overweight surgical patients whose arteries were unblocked by angioplasty: compared to normal-weight patients undergoing the same procedure, obese patients experienced fewer complications, and more of them survived to the one-year mark.

But That’s Not All

Way back in 1982, Prof. Patrice Degoulet found that obese dialysis patients had better survival odds than normal-weight ones. Other studies have produced equally counterintuitive results. That is the trouble with intuition. Sometime what seems deeply, naturally true is just confirmation bias. The majority of Americans hold a cultural assumption that thin is always better than fat. The received wisdom is that every large person should try to be smaller, for his or her own sake, and for the general improvement of humankind.

What emerges here is that weight loss, to use a hackneyed but strangely appropriate analogy, is not a “one-size-fits-all” panacea. For at least one category of patients, reducing appears to be hazardous: those who already have cardiovascular disease, especially if they are morbidly obese. Rodney Steadman, author of Active Aging: Hiking, Health, and Healing, notes:

…a couple of long-term studies suggest that weight loss increases mortality in overweight and obese individuals. Therefore, weight loss may be more of a detriment than a benefit in obese patients with CV diseases.

Yes, morbid obesity (BMI ≥40 kg/m2) is a major risk factor toward developing cardiovascular disease. But once that illness has taken hold, losing weight will not help, and will probably speed the patient’s demise.

Or maybe not. Under some circumstances, with some medical conditions, having a highish (but not too high) BMI might be advantageous to some patients, for reasons no one quite understands. But only if they are adults. For younger patients, the opposite applies, and a higher BMI translates to an increased mortality risk.

Your responses and feedback are welcome!

Source: “America rejoice! Being fat may actually make you healthier,” NYPost.com, 04/05/14
Source: “Absurd, but True?,” WordPress.com, 07/15/14
Image by Daniel Oines

 

Fat-Shaming by Proxy

Made Me Reconsider

Even worse than a bigot is a bigot who goads, persuades, or shames others into bigotry. Fat-shaming by proxy, or second-hand fat-shaming, occurs when a nosy friend or relative tries to force-feed someone with their own personal preferences.

For instance, a boy likes a hefty girl and wants to ask her out – but his family objects. He is being fat-shamed, and he’s not even plump! If the prospective girlfriend had facial piercings, he might say “Go ahead, disown me,” and some friends would no doubt view him as a hero. But a fat girl? Not worth fighting for. He bows to the elders’ superior wisdom, and forgets the whole thing.

Angel or Devil?

Are such family members dictatorial or caring? That young man’s mother might say, “Don’t get me wrong, I myself have nothing against the obese. But you know how cruel people can be. If they see him with such an overweight girl, they won’t respect him. He’ll be a laughingstock. He’s my son, I don’t want him to get hurt. And who needs tubby grandchildren? For heaven’s sake, it’s just as easy to fall in love with a girl who has a nice figure.”

To members of other excluded groups, the justifications are old news. They have heard all the excuses from families that closed ranks and rejected an outsider who was “wrong” because of race, age, religion, economic status, previous divorce, etc. Too many people grant themselves veto power in the lives of friends and family members. Consequently, the characters in that scenario are typical of the unnumbered casualties, the collateral damage from the war on obesity.

Anecdotal Evidence

It is obvious, and scientifically provable, that individuals often reject potential partners who are overweight. However unfortunate this may be, it is a personal preference, and people are allowed to have those. But what about when other voices chime in? The social environment will always contain busybodies who appoint themselves Defenders of Correctness.

This facet of fat-shaming is hard to measure with surveys or studies, which is why we hear about these situations in online forums and discussion groups, where issues can be unpacked and examined in a much more nuanced way.

The Paradox

What turns people into fat-shamers? Here is one answer from a Reddit commenter:

It’s sad to watch someone eat themselves to death but my pity runs dry when they have access to all the information they need and refuse to listen to reason.

That judgmental critic assumes a lot, especially the part about refusing to listen to reason. If, as Dr. Pretlow believes, food can be addictive and people can be addicted to food, then reason is totally irrelevant. Drug addicts are notorious for being unable to think sensibly about the monkeys on their backs.

Also, returning to the quotation, it depends on what is meant by “all the information they need.” As Dr. Pretlow learned from asking his Weigh2Rock website participants, it is true that young people claim to have all the information they need – about diet and exercise, at any rate.

What they do not receive, in school or anywhere, is information about how to stop wanting to eat the harmful, nutrition-void substances they know darn well they should leave alone. How do we eliminate cravings?  How do we even resist them? Those are the questions kids ask, and that is the education they need.

Your responses and feedback are welcome!

Source: “Dismantling fat logic makes me an “ignorant prick”,” Reddit.com, 09/23/14
Image by Tony Alter

 

 

Put the Thanks Back into Thanksgiving

Thanksgiving at the Trolls

A few days from now, many Americans will face an annual celebratory gathering of family and/or friends that should be pure pleasure. Instead, Thanksgiving too often provides traumatic difficulties for anyone who wants to exercise sovereignty over substance intake. The issues around food can be enormous. The temptation to drink too much is a separate but potentially related problem, because that much relaxation can impair judgment.

As Childhood Obesity News previously mentioned, Alex Brecher is a lap-band surgery patient who lost more than 100 pounds ten years ago without regaining weight in the interim. One reason for his success is a canny expertise in the area of fatlogic, the wacky philosophy cobbled together from often-absurd excuses for counterproductive and self-defeating behavior. He offers practical suggestions to meet holiday challenges.

He advises people to abandon the “I only get to eat this once a year” fallacy. When a cousin says “Aunt Hilda makes a bacon and pumpkin pie to die for,” it could be literally true. Not that the pie alone would be responsible, but it could provide the tiny push that sends a weight-conscious person careening down a slippery slope.

Maybe Aunt Hilda says, “I made it just for you, because I remembered how much you liked it last year.” You don’t want to offend anybody, and you don’t want your spurning of the pie to become the topic of family gossip throughout the new year. Is it possible to talk your way out of this trap?

You want to acknowledge how special the treat is, and how much you appreciate the work that went into making it, and the cook’s thoughtfulness in remembering your fondness for it. “I really look forward to having some later” is a ploy that might work. Here is a brilliantly flattering suggestion from Brecher:

Thanks, but I can’t eat that any more. The sugar could make me sick, and I’d rather stay healthy and get to spend the afternoon with you instead of in bed.

Or just blame a professional. “Oh, bummer! Pie is on my no-go list, and my doctor hooks me up to a lie detector every appointment. I’d never get away with it.” The important thing to remember is, it’s okay to say no. In some cases, it’s also okay to have one (1) slice of Aunt Hilda’s bacon and pumpkin pie. As Brecher says:

Serve yourself one small portion, and savor every bite. Think about the taste of the food, how it feels in your mouth, and what memories it brings to mind. Then think about how good it feels to be in control of yourself… Even if you only get the chance to eat the dish once a year, you’re not going to make it last any longer by cramming in more servings.

Dr. J. Renae Norton, who treats eating disorders, also offers holiday survival advice.  One suggestion is to eat the day’s preliminary meals as usual, rather than skipping breakfast and/or lunch in favor of the large dinner. If the special meal you plan to attend is a pot-luck, bring something on your own list of acceptable foods. That way, you will be sure there is at least one thing you can enjoy without repercussions.

For anyone who belongs to a support group, or who has a good friend also caught in the same family-awkwardness dilemma, role-playing can be a tremendous help. Take turns acting the part of Aunt Hilda and the guest who will refuse all dangerous foods. Practice saying no with perfect politeness and implacable firmness. And if all else fails, bail. Dr. Norton says:

Have an “emergency plan” in case you find yourself in a stressful situation. Get some fresh air, go to another room and practice some relaxation or deep breathing exercises, arrange for a close friend to be “on-call” in case you need someone to talk to.

Your responses and feedback are welcome!

Source: ““I’m Cleaning My Plate Because Children Are Starving in Africa…” and Other Terrible Excuses to Overeat,” BariatricPal.com, 10/23/14
Source: “Eating Disorder Treatment: Tips to Reduce Stress During the Holiday Season,”
EatingDisorderPro.com, 11/22/13
Image by martha_chapa95

What is Fat-Shaming?

Shame  (yellow paint)

Fat-shaming is trying to make someone feel guilty and “less than” because of their weight. It can include many implications and shades of meaning, like “Aren’t you ashamed to have health conditions that will cost the taxpayers a fortune?” and “How dare you wear an outfit that only a normal person should wear?”

It is all too easy to sound like a fat-shamer. Perfectly nice people say things that seem, to them, to be common sense. They are amazed to discover how offensive their words can be to others, especially people in the Health At Every Size (HAES) movement whose ears are hypersensitive to anything that might be construed as blaming or shaming.

When considering matters that should or should not be anyone else’s business, HAES proponents see weight as a personal choice, equivalent to hair color. Is this valid? In a debate, an opponent could say that hair color should not be compared with obesity. One person’s hair color does not impact another’s tax bill or insurance rates – but the cost of conditions caused by obesity eventually becomes everyone’s problem.

In the HAES universe, body size and physical health are two totally separate realms. Quite rationally, people of this belief system encourage everyone, of every size, to practice healthful behaviors. And of course there are larger people whose current health seems fine. HAES-minded individuals point to their own within-normal-limits vital signs and excellent lab test results as proof that all is well. But all is far from well. As one citizen put it,

The issue isn’t whether you have health complications now, it’s that you’re statistically much more likely to develop health problems down the road that may kill you before you would have died otherwise.

No matter how healthy an overweight person seems now, quite possibly the worst effects of obesity have not shown up yet, and it is only a matter of time. To point out such an obvious possibility – is that fat-shaming?

True Puzzlement

A lot of people are immobilized or confined by physical circumstances they can’t control.  Almost everybody knows someone who has fought courageously to walk, or endured many surgeries, or has simply become too old to do the things they want and need to do. The sight of a person disabled by 600 pounds of fat is likely to inspire bafflement and even anger. How could anyone do that to themselves, when they could so easily NOT do it? Here’s a congenitally disabled person in a wheelchair who will never walk, and there’s a mountain of flesh with a potentially healthy and able human buried underneath. Where is the justice? To ask the question out loud – is that fat-shaming?

Claire Goodwin, who appeared on TV as a contestant in the Great British Bake Off, received some unkind remarks through social media, and told Telegraph readers how this was the first time she had ever been fat-shamed. Her meditations on fat discrimination include the realization that some workers, like Emergency Service personnel, need to be in excellent physical condition. But should anyone care if a chef is overweight? She disagrees with the knee-jerk assumption that an obese person is lazy, greedy, weak, or any other negative quality, and says,

Fat is something you have, not something you are. To make someone feel unworthy and ashamed because of an aspect of their appearance, and assume things about their personality and behaviors due to this is frankly absurd.

Your responses and feedback are welcome!

Source: “Dismantling fat logic makes me an “ignorant prick”,” Reddit.com, 09/23/14
Source: “’Fat is something you have, not something you are’,” Telegraph.co.uk, 09/11/14
Image by Anthony Easton

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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