Friday, April 29, 2011

Twittering, fat bashing, OB/GYN defends her sense of "humor"

A few days ago my friend and fellow blogger Travis Saunders from Obesity Panacea got into a Twitter fight with an obstetrician from Salt Lake City, Utah.

The obstetrician, Dr. Shelley Binkley, who tweets under the moniker @healthewoman, apparently doesn't appreciate having the misfortune of dealing with fat patients. Now that's unlikely to be a unique attitude, as anti-fat bias permeates society as a whole, (including doctors), but what was perhaps unique is that Dr. Binkley decided to take her bias and hate onto Twitter,

"A 5'2" woman weighing 254 pounds today told me she eats 'hardly anything'. I guess that might be true if 'anything' means the whole cow."
Travis took her to task, asking her among other things,
"Would you publicly denigrate patients with other chronic diseases"
And this led her to respond,
"Obesity is not a chronic disease; it's a behavioral problem: too much junk food, not enough exercise"
And therein lies the disconnect. Dr. Binkley believes obesity to be a part of a massive epidemic loss of will power. Especially I suppose among the children Dr. Binkley's bringing into this world, as childhood obesity rates are rising faster than adult. I suppose Dr. Binkley believes 7 year olds these days don't have the willpower they used to.

The fact is, people haven't changed over the course of the past 30 years. We haven't developed heightened hedonistic tendencies. Our environment has changed, and living freely in this environment causes the vast majority of the population to gain weight. Blaming individuals for their environment isn't helpful.

Less helpful?

Perpetuating anti-obesity bias under the guise of caring, which is precisely what Dr. Binkley has done.

The most telling part of Dr. Binkley's story?

In the newspaper article that came out of it Dr. Binkley talks of what she's learned from this experience. Sadly it wasn't that her attitudes demonstrated a hateful, ignorant, anti-fat bias. Instead it was that she's got to be more careful using, "humor" in her tweets, an attitude she's echoed on Twitter,
"Some people lack humor, can't laugh at themselves. I pity them for their lives must be sad"
Because what's funnier than making fun of your patients' medical conditions?

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  1. =(

    That is really quite sadening to have come from a doctor.

  2. Paulette7:26 am

    Frankly I pity her patients who have a bully for a Dr. A fairly typical bully response to criticism is to claim others have no sense of humour or they'd clearly understand it was all in jest. Come to think of it, I pity her as well. Must be hard to live in a world that doesn't appreciate her "humour"

  3. I don't agree with fat-bashing (or any other bashing) but I do think that there are some out there who really do need to take their lifestyle more seriously...likely the overweight woman doesn't eat much NOW but at some point, she likely did...while I do believe that food isn't what it used to be, there is certainly more of it now and children, especially, have access to it (and lots of non-food eating items) -- and partake without thinking. I know it's not as simple as calories in/calories out but neither do I believe that it's just our "environment", unless one considers that in our "environment" food is everywhere. My daughter works at a local fast food restaurant and she has had a family of 4 come in and order $75 worth of food - and then order more after that. This is 2 adults and 2 children! No one needs that much! I don't want to start some controvery but I do think that individuals and families need to take some responsibility for the matter also.

  4. That was actually hard to read. I received the same discrimination... exactly. That mom that that OB was talking about was "me"...

    People assume that because I am fat and think that it is because I must eat junk food and sit on my butt all day.

    @I will lay down my Idols: are you saying there are no thin people that go into your daughters work and order tons of food? There are probably many but that story wouldn't have the same impact would it?

    I admit, 12-13 years ago, I had a bad lifestyle, I was already big coming out of highschool (over 200lbs) but then I went to College and then University, I was out on my own for the first time without any experience in the kitchen, partying, ate too much out and too much convenience food in. I ended up weighing 260lbs. My husband, who was following the same diet and same lifestyle topped the scales at 140.

    I admit it, back then my weight was mostly my fault and I decided to change it.

    I went on WW and lost 50 lbs by eating never more than 900 cal a day and basically starving myself on low cal processed junk. I felt awful but at least I was losing weight.. right?

    I started plateauing at about 210lbs and then I got pregnant. I was then told that I was too fat by one of my midwives and that I should exercise more and not gain much weight so I kept eating the same way during my pregnancy... never more than those 18 points... still I was met with discrimination each time I saw a slight gain... a whopping 17lbs in all.

    Over the next few years I changed my diet to a quite healthy one (no processed food, all foods made from scratch, tons of fresh veggies and fruits) but had trouble getting around the fact that my calorie intake was too low especially because I was "allowing" myself to eat more because I was nursing... ~1400/ day...

    I had no energy, my metabolism was shot and I was on an eternal plateau. Over three more pregnancies I would gain a bit of weight and just keep on plateauing after. After 4 kids I ended back where I started in weight but the complete opposite in lifestyle.

    Finally I decided to start listening to the advice I had heard about BMR years ago but didn't think applied to me... I ignored my initial weight gain after allowing myself to eat 1900cal a day and then started to have more energy and then starting losing weight. Can you believe it? I had to eat more to start losing weight. The weight is now coming off slowly but steadily and I am eating more in a day than I have in years.

    So that Twiiter post:

    "A 5'2" woman weighing 254 pounds today told me she eats 'hardly anything'. I guess that might be true if 'anything' means the whole cow."

    could have been me...

    BTW.... the weight discrimination that I received in pregnancy and the way that iI was treated by the midwives and doctors was part of my decision to have two unassisted pregnancies and births.

  5. Bella9:49 am

    "believes obesity to be a part of a massive epidemic loss of will power"

    That, to me, is the best summary I have ever seen of the ridiculous view that people have of obesity. So neatly put, it so clearly shows just how far off the whole 'willpower' view really is, and how important it is to consider what other factors are contributing to the problem.

    For I Will Lay Down My Idols:
    Willpower and personal responsibility only go so far! I grew up being overweight my whole life. From childhood, when I had no control over what I ate, I was overweight. And my family was not one of those who ate fast food or takeaway every night, we ate homecooked meals for dinner, took packed lunch to school, and were, in general, quite normal as far as I could tell. But I was still overweight. And so was my mother. Because, despite eating pretty well, most of the time, there were still external factors that influenced our bodies and our weight. For my family, I think it was a lack of depth in food education - eating potatoes every night, even if they're home cooked and technically a vegetable, is not actually the best way to consume carbohydrates. Snacking on cookies, even if it's only 2 per day, or high sugar cereal bars, or salted nuts, is not a great choice of snack food. Drinking high sugar juice boxes every lunch time instead of water: also not a great idea. Little things, mixed in with a generally okay diet, do actually add up. Being a family that never exercised together and never made exercise fun for the kids probably didn't help much either, even though we played organised sports once or twice per week.

    As I got older, into my late teens particularly, I began to succumb to the messages I was receiving about food from outside of the home. I was young, susceptible, and hadn't learned any of the science of food and healthy eating. My eating became increasingly disordered, I started eating chips and chocolate and lollies, junk which I had never had as a child. Ironically, I recall starting to eat this things because I learned, from media and popular culture, that when I felt bad, food would make me feel better. I didn't have that view when I was a small child, emotional eating is something I learned from my environment. My weight increased further over about 5 years, though only by about 20kg. Not a huge weight gain, compared with what other people experience.

    Only as an adult, after years of struggle, trial and error, and self education, have I come to really understand food and exercise, and how I need to treat my body to be healthy. It's been a huge learning curve, that's gone way past what my parents knew about eating right when I was a child. It's moved far into my own psychology, studying and challenging learned behaviours and emotional responses. It's gone into analysis of the world around me, and the messages I receive, in an attempt to dissect the information that we are fed into what is useful and what is not.

    Just as people wouldn't automatically judge someone with an amputated leg as being a reckless risk taker, who probably caused themselves the harm by driving too fast, people shouldn't judge someone who is overweight as being a binge eating slob. No one can make any judgments about a person's attitudes, beliefs or 'seriousness' about their lifestyle based only their appearance. When it's an ordinary person on the street, it's sad. When it's a health professional, it's devastating.

  6. Anonymous10:38 am

    I was going to chime in a few times as I saw this story in a few places, but I didn't feel comfortable. People who want to believe that obese people are that way because they simply eat too much, won't listen.

    I grew up the "fat child" but looking back I was just on the heavy side of a healthy BMI. Because my sister and the kids at my school were on the thin side of it, I was deemed overweight, and put on a diet. I was nine. My food was severely restricted. I too was fed home made meals, and ate liver and vegetables, but I was constantly hungry and miserable. Not only with the lack of food, but the taunts and teasing from my class mates, and the complete lack of support from my parents (if you would just weigh less they wouldn't tease you) and the doctors.

    as an adult, I did not restrict myself, and when I was hungry I ate. Granted, it wasn't always broccoli, but I would often think that the scale never truely reflected what I ate compaired to others.

    Finally, at around 250lbs, I decided to "get serious" and I started on Nutrisystem. In total I lost 70 pounds, getting down to 179 for one day. the next day, despite no changes in my diet, my weight went up and it did not stop. My energy level is non existant, and often I am driven to distraction to eat. Will power is not an option as I can not focus on anything else.

    I've been under the care of a doctor for three years now trying to figure out WHY I am gaining weight. I am back up to 230, with very little change in my diet and exercise routine. I can not begin to express how excrutiatingly frustrating it is to eat 1400-1600 calories day in and day out, to deny my self the yummy foods everyone else around me is eating, and exercising daily for 40 minutes and to continue to gain.

    and to continue to hear people ignorantly talk about will power and choices, not having lived in the people's shoes that they are commenting on... well it is just a shame.

  7. Anonymous11:45 am

    I found the personal stories of the last three posters very moving. I suspect that sitting in judgment over other people's 'lack of will power' must comfort the judgers for some lack in their own selves. But especially if you are a young and vulnerable person, it's impossible to see that perspective. I think that so many of the women and men who struggle with their weight have exercised *more* will than those who haven't had to and are probably more impressive people as a result.

  8. Anonymous12:43 pm

    Well, I hate to stir the pot, but here goes. I partially agree with BOTH sides on this one. I used to be an extremely obese woman. I worked hard, sifted through bad nutritional information and challenged myself to learn about nutrition, what causes us to become fat and about exercise. It was the hardest thing I ever have done. But I came out the winner.

    I do agree that in most cases, obesity is caused by our behavior, namely poor food, poor lifestyle choices and a lack of interest in taking on the responsibility that is ours and ours alone. NOW, having said that, I will concede that there is a fraction of the population that is obese due to a medical condition or the meds that accompany it. This was not written nor aimed at you.

    On my quest to lose the fat, it was hard to change my bad behavior. When I was hungry (or bored, or mad, or sad or… fill in the blank), I ate whatever was in front of me or the closest drive thru. I didn’t know or care what I was doing to myself. I have a functioning brain, so I knew that the Big Mac and milkshake was probably not a great “in between meal snack”. I had no interest in that… I chose to eat it anyway. Chose is the key term there. I knew that sitting on the couch was not helping. Again, I chose to stay there.

    That is my side of the story. But what about the other side?? How are we supposed to know what to eat when we are constantly being told by advertisements, government agencies, our doctors (sorry, Yoni) and by big diet companies to eat the wrong foods?? Every time you turn on the TV, there is an ad telling us to eat sugary breakfast cereal because it will “lower our cholesterol”. Or, how about the ads for gummy, white processed bread in which the name implies that it is the “Smart” thing to eat?

    The Internet is a great source of information too, and the truth is on the web as well. Only problem is, you have to sift through digital reams of garbage, like the HCG Diet, the cabbage soup diet, the Shangri-La Diet, along with all the rest of the diet hype from weight loss companies big and small. You have to learn to recognize the gold nuggets from the filings. That in itself was the hardest part of my journey.

    But, it seems as though this instant oatmeal, drive thru salad, vending machine society has also bred the “It’s not my fault.” mentality, as well as the “It’s in my genes, so I can’t help it.” school of thought.

    People need to:
    1. Stop confusing behavioral obesity with a medical condition,
    2. Start using their functioning brains. Does it make sense that a breakfast cereal containing 30g of sugar in a small serving is a HEALTHY choice?? Really?
    3. Start searching for the truth, and begin to understand that our health now and in the future is ultimately OUR responsibility. TV advertisers don’t give a rat about your weight, your LDL or your happiness. They want your cash.
    4. Stop falling for the fad diets that are temporary in nature, or involve a healthy person being injected with vitamins or hormones. Again with the functioning brain… THIS will almost always guarantee a fatter future for you. If a diet sounds too good to be true or promises “easy, fast, permanent” weight loss… walk away. Weight loss that is easy and fast will likely NEVER be permanent. I know… I tried all of those diets too…
    5. Worth repeating… take responsibility!!! Overcome your own attitude.

    No doubt this post will infuriate some. So be it. Back in the day when I was helplessly drowning in my own willfully created lipid bath, the straight truth would have infuriated me too. I had the excuses all lined up. I have all of the morbidly obese relatives, every second one being diabetic. So, my obesity could not have been my fault, but rather, seemed to be my birthright.


    I turned it around for me, as a matter of fact, I went from an obese woman complete with all of the health issues, attitudes and emotional baggage to becoming a Nutritionist. Now, I pound the truth home to people. It doesn’t always soak in, but when it does, a life changes.

  9. This is so well-written. I think you hit the nail on the head with the point that about "living freely" in this environment. And there are so many other things at play, as well. But if we do not make some drastic strides in education of physicians and other health consultants as well as the general public, we are doomed to get bigger and bigger. In fact, it may be that the time for education is passed and some other systemic solutions will be required.

  10. Thank you for bringing attention to this. It is so sad it's making me delurk. As if overweight and obese women don't have a hard enough time with the medical system now? How many of us have had complaints ignored because the doctor assumes that our only medical problem is being fat? How many of us have suffered with gynecological problems because we were too embarrassed to be seen naked by a doctor?

    It's just unbelievably inappropriate for ANY doctor to make fun of ANY patient in a public forum, but having an OB-GYN make fun of obese women just adds that extra twist of cruelty.

    Whether or not someone is fat is not the issue. The issue is that someone who is supposed to guard the health of women is belittling and mocking them around an issue that is already so sensitive and emotionally fraught.

    I am disgusted that any health professional could say things like that about any patient.

  11. I think Ms. Doctor does not understand the problem, I went right over her head. Overeating is natural for some of us. We have to overcome our nature to be of normal weight.

    Many of my fellow overweight companions eat very little some days, then down 10000 C in a few hours. That is the way some of us live, and the way I lived, but my binges were typically only 2-4000 C. Once we start, we do not stop until all the food is gone. Yes it is a behavior problem but so is life.

    It is a behavior problem, and the solution is ELCMM but that goes against my nature, so value is the opinion of the ignorant.

  12. I used to be incredibly hurt when I heard things like that. Or when the weigher at my Weight Watchers meeting insisted that I had eaten things that I had not written down because I hadn't lost in months.

    Now I know that their opinion is irrelevant because I know what I have eaten and what I have not. And their disapproval is unwarranted and uninformed.

    I don't need to convince I will lay down my idols or Anonymous, because I cannot convince them of my background and my experience. I have not tried to lose weight in 5 years and my weight has not gone up. I think dieting causes weight gain.

  13. Re "people shouldn't judge someone who is overweight as being a binge eating slob" ... as a member of the binge eating slob community, I don't think you should judge even then!

    In fact, I'd advocate for even more compassion, because unless these "slobs" are card-carrying NAAFA or HAES members, they are probably beating themselves up every damn day about their weight.

    So no matter what, we really don't need our medical professionals making fun of fat folks privately or publicly.

  14. Anonymous9:01 pm

    What I don’t understand is that if a doctor tweeted about an alcoholic’s drinking there would be so few people that understood the humour or perhaps looks at the issue from both sides of the issue. Why, well because it is accepted that an alcoholic has a disease and ultimately must seek help in order to work through that disease. It takes a lot of work, time and a life time commitment since the disease never really goes away… but when the person is fat we are somehow allowed to be joked about.

    It hurts to the core to think that all those negative thoughts that pass through my head about what the doctor is thinking about me are warranted. Why don’t we just stay home, locked up in our homes hiding from the world? Oh wait, we are already doing that and yet even when seeking help we are ridiculed, and then put down again for not thinking it is funny.


  15. Anonymous10:53 pm

    omg stop defending the fat people.
    You're enabling them by giving them excuses for their condition.
    And it sounds like the OB/GYN was actually making fun of the patient for being stupid, not fat.

    1. Anonymous8:55 am

      The point is a medical professional should act like a professional and not be making fun of her patients at all. Especially since as her Dr. she may be missing clues about the womans health, such as a thyroid issue or PCOS. The fat could be a symptom, not a cause.

      The Dr was acting crassly and in an unprofessional manner. So the patient is overweight. Doesn't mean they deserve less care and respect. Unprofessional behaviour

  16. I used to have a doctor like this who lectured me about my weight to my face but never actually helped me. I stopped seeing her and got a new family doctor who directed me to Dr. Freedhoff who actually helped me. I found that this new family doctor was a better all-around doctor, because he sticks to facts and fully explains everything without getting emotional. If you are letting your emotions and personal issues be a part of your work, you are not going to do as good a job as someone who has a clear mind and is focused on the facts. This nightmare doctor is telling people to eat 1200-1500 calories per day. What if that's not enough for someone? What if they're hungry all the time with that? What if a person doesn't know the right foods to choose to achieve maximum fullness within those calories? You actually expect someone to be hungry for the rest of their life? Not going to happen. But since that wasn't even put into consideration with her "prescription", this is evidence that Ms. Doctor Nightmare doesn't really care about her patients, or at least the obese ones, enough to give them proper medical treatment for their health concerns.

    1. Anonymous9:00 am

      I had a similar problem. The sad part is I went to the Dr in the first place to get help with PCOS (weight gain is a symptom - I gained 60 lbs in one year without major changes in diet or activity) All I got was a pointless lecture and bad advice such as a low fat hi carb diet (the opposite of what a PCOS patient needs) and to stop drinking so much soda (I don't drink it or like it) and eating red meat.

      I did what you did - got a better Dr.

      Listening and empathy are important diagnostic tools. This woman is bad at her job.

  17. Anonymous2:49 am

    I think this article makes a few errors such as lumping childhood obesity with adult obesity in reference to willpower.
    For childhood obesity the willpower is placed on the parents.

    Another error is implying that the obese person has no responsibility for their condition by blaming it on their environment.

    The statement should read :
    "Our environment has changed, and living freely in this environment [that was created by the people living in it] causes the vast majority of the population to gain weight."

    I'm not saying what the Doctor did was right at all, I found it particularly inappropriate.
    But there is a reason why it is classified as a 'preventable' disease like smoking.

  18. Nonesuch9:24 pm

    That last Anonymous post about making fun of the patient for being stupid? No, that's not it. The fact of the matter is, a person's recent dietary habits are rarely reflected in their waistline. If you're overweight and begin eating a restricted diet, you aren't suddenly going to be a skinny-mini. You're still going to be fat. Even after you've been eating a restricted diet for a couple of months, you could still be fat. A 270-pound woman could have weighed 325 pounds six months ago! There's this idea in society (and, as this article highlights, in the medical community) that if you're fat, you MUST BE OVEREATING AND LAZY, and if you say differently then you must be lying about your habits. This is insulting, it's demeaning, it's demoralizing, it's dehumanizing, it's judgmental, it's prejudicial, it's inappropriate, and it's often completely and utterly false.

    To someone who has been overeating for a significant part of their life, eating what you might consider "normal" feels like you're not eating much at all. Trust me, it isn't pleasant to feel so very hungry and then look back and think "Damn, I still ate about 175% of the recommended daily caloric intake..." So it's also a matter of perception. Maybe she isn't eating barely anything, but it still feels that way to her. So what? Why demean her publicly? That is inappropriate and shows a severe lack of professionalism.