Wednesday, March 28, 2012

A Plea to Folks who Lose 20lbs to Stop Thinking They've Solved Obesity

I'm sure you've come across this phenomenon before. Some almost slim person who was just barely medically definable as overweight loses 20lbs and suddenly is an expert at preventative public health policies and obesity treatment and prevention. They take their n=1 experience with minor weight loss and decide that whatever worked for them ought to work for everyone, and that clearly the solution to society's weight woes is easy, because hey, if they can do it, so can anyone.

It's a strange and all too common phenomenon. It'd be like folks who just finished their first piano lesson preaching about what it takes to become a concert pianist, or for an Easy Bake baker to speak with authority about the intricacies of baking croissants, souffles and French macarons.

Take for example Jessica Allen. She's an associate editor with Maclean's magazine (Canada's answer to TIME), and she recently penned an opinion piece entitled,
"When it comes to being fat, we’re simply too polite"
In it she details how in response to her physician's, "stink eye", that she lost 20lbs over a 5 month period. And of course, because it worked for her she wonders,
"If we can’t count on our doctors to call the kettle fat, then who can we count on?"
Ms. Allen, I'm sure you mean well with your post, but if you truly believe that what's missing for those who struggle with weight is personal desire and a sense of personal responsibility, and that what's required to help those same people is name calling and shame, then sadly all it really demonstrates is that you don't in fact have a grasp on what it is to struggle with weight, nor an understanding of weight's complex etiology.

Yes, I know, if you eat less and exercise more you'll lose weight, and yes, in your case if you lay off your frozen dinners and get back to your running you may lose the 25% of weight you regained. That said, do you honestly believe that there's a deficit of desire among those with weight to lose, a desire whose flame is simply not being lit by their doctors who for some odd reason don't believe in negative reinforcement?

So forgive me Ms. Allen, if I don't practice my stink eye, for if guilt, shame and name calling were useful in the generalized real world, then the real world would most assuredly be one hell of a skinny place as it currently has no shortage of guilt, shame and name calling for those with obesity.

[Hat tip to friend and fellow blogger Travis Saunders from Obesity Panacea for sending the article my way]

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  1. Lolly7:49 am

    Thank you for all you do to get this message out there. If only there were a few more doctors like you around, we might actually get somewhere with this problem...

  2. Anonymous7:51 am

    Oh, my goodness, yes! I'm tired of skinny people saying how easy it is to lose weight! Getting fit is the hardest thing I've ever done--and that's a fact.

  3. It not about how much weight she did or didn't lose. She obviously has no empathy. If she lost 100 lbs. and said the same thing would what she said be more palatable? I think not.

  4. Anonymous8:09 am

    for Jessica:
    Honestly, why is it anybody else's business that I am fat??? Why does my extra 10-50 lbs upset you so much? What gives you the right to judge me and try to Bully me into losing weight so that you can feel better about your life!

    TV/media judges people constantly-too fat/too skinny/too old/clothing too showy/not showing enough.... and we play along with their judgments. We honestly have no rigt to do so!
    As long as I am happy about my weight and finally accepted the truth of my genetics it is honestly NONE of your business!

  5. Thank you thank you thank you thank you! Like if you're 100 pounds overweight, you need a doctor to tell you.

  6. Anonymous9:31 am

    Funny, reading the piece it sounded like she was making more of a point more along the lines how most physicians aren't talking to their patients about weight.
    "being fat causes God knows how many health problems, and our doctors aren’t measuring waistlines (fewer than one in five of the survey’s participants, the journal reports) and 40 per cent of overweight or obese Canadians describe themselves as just, “about right,” than that’s a fat problem". Not the first time this issue has been discussed i.e

    It also sounds like she appreciated her doctors approach and so I'm failing to understand why someone would have an issue with an approach that was both effective and the patient liked. Not to say that her doctor uses this same approach with everyone, after all this is only an n=1.

    Guess it just depends on what lens you read the article with.

    1. Anonymous11:19 am

      I agree. I lost 40 lbs myself and have kept it off for four years. And, in fact, for the vast majority of people the *formula* is easy. The implementation of the formula is the really really difficult part. If you are happy with your weight, why put yourself through that?? If you are unhappy with your weight then the work is worth it. When friends and colleagues ask about my weight loss I am happy to share my method because the result makes me feel really great. Why wouldn't I want to share that with my friends? But I am not about to rant to my heavier happy friends about their weight.

      I also find it interesting that people would be very critical of a doctor who does not encourage a smoker to quit their unhealthy habit, yet jump all over a doctor who points out this health issue. Yes, it's a sensitive issue and requires a sensitive approach. But it is neglect to ignore it.

    2. Anonymous12:03 pm

      The problem so often is that the focus is on weight, not habits. Years ago, I knew an exceptionally slender person that lived on canned ravioli, McDonald's and Pepsi. It's neglect to not ask if a person -- regardless of weight -- is eating a healthy, balanced diet and getting exercise. It's neglect to look at someone with the "correct" body size and say "Hey, keep doing what you're doing!" while assuming anyone over the magic number keeps a bucket of twinkies by the TV remote.

    3. Elizabeth Niederer12:08 pm

      Uh, no, the "formula," for a morbidly obese person, is frequently far more complex than most doctors make it out to be. Congratulations on your 40 pound loss. I'm sure it's significant to you. But you do not have the same issues that a person with 100 or 200 pounds to lose frequently has.

      Doctors SHOULD know and acknowledge this, but they don't. I'm reminded of the endocrinologist I fired in the mid 1990's. At my last meeting with him, I reported on my eating, exercise and diabetes control. Once again, despite careful adherence to an appropriate regimen, I had gained still more weight.

      He, of course, didn't believe my report and lectured me about portion size....When I had just shown him a month's record, perhaps more, of my intake with weighed and measured portions. When I asked him if something was wrong with me for this to be happening, he assured me that everything was fine and I just had to make my caloric output exceed my caloric intake.

      Thanks for propagating this same attitude, folks....And BLESS YOU Dr. Sharma for not believing it.

    4. Anonymous12:22 pm

      I'm not so sure the formula for morbidly obese folks isn't as simple as eat a lot less processed food and eat a lot less meals at restaurants. I used to be morbidly obese (150Kg/330LB) and dropped over a third of it with the main modification being to stop shopping in the center of the supermarket where all the boxed food was, and doing my shopping instead mostly at the produce, but also at the meat, and dairy cases.

      I think there is a very good reason that obesity is a big problem now and it wasn't 100 years ago, and I think it has a lot to do with the growth of the packaged food industry, and more people eating a higher percentage of their meals at restaurants.

      Relearning how to cook and eat was the best choice I've made for my health.

    5. I can see both sides of this story. On the one hand I agree with Yoni that the last thing we need is to shame overweight and obese people (e.g., the writers "stink-eye" comment). But on the other hand - as someone who has lost 80 pounds and kept it off for more than 10 years - there is a part of me that wishes that someone had said something to me or brought it to my attention sooner, so that I could have done something about it sooner.
      Granted, I'd "tried" (and failed) previously, and I needed to be in the right mental state to begin the process in earnest; but it still confounds me today why nobody who cared about me ever offered help, support or encouragement. They just sat back and watched me get heavier and heavier. AFTER I lost the weight, the comments finally came out. But that ticked me off even more because it angered me that they hadn' tried to intervene.

    6. Bobbini1:44 pm

      Whose job is it to maintain your body? Assuming you knew you were fat, what was there to tell you?

    7. Anonymous8:37 am

      Personally, I didn't actually realize that I was overweight since it happened gradually. I was really skinny and underweight in high school and picked up a few pounds here and there until I was nearly 200 pounds (and only 5'6" with next to no muscle) and none of my half a dozen doctors said a word about controlling my weight. Once I got diagnosed with a hiatal hernia, I decided to work out and control my diet because my insurance would barely cover the maintenance meds needed.

      After I started controlling my intake and exercising, I lost almost 40 pounds and 6-8 inches at the waist in a few months and kept it off for about a year so far (and with my unusual proportions and accounting for increased muscle mass, that seems to be enough to keep me trim and healthy) and I was able to wean myself off of most of my long term stomach and respiratory meds without any problems.

      This story is not going to be too helpful for people who are morbidly obese or who are overweight/obese due to specific medical conditions, but I think its very important for medical professionals to bring up weight control to their patients, even if it is uncomfortable for them or their patients to address the issue.

  7. Anonymous9:36 am

    I've had people give me diet advice all my life. It annoys me more than I can express in words. Even after my gastric bypass these same people were giving me advice on how to lose weight.

    I now find it amusing how everyone becomes an expert when someone's trying to lose weight. I have now learned to ignore people and their advice & decided to go back to school to become that expert myself! If I'm gonna listen to's gonna be me!

    1. Anonymous10:47 pm

      As a bariatric surgery patient who has lost 147 pounds (so far!), I find your attitude healthy and refreshing. I have never seen my own feelings so perfectly expressed.

  8. Anonymous9:39 am

    Excellent post!! I also notice people who have never had a weight problem assuming they are doing something that fat people aren't doing and therefore they also know the solution to obesity. Like my naturally slim sister (who is also a doctor) and truly thinks obese people are just lazy because she is slim and stays that way by "occasionally taking walks and not eating entire gallons of ice cream in one sitting." She has a pretty mediocre, processed food diet and is borderline sedentary so assumes that overweight people must have VERY bad habits. I've struggled with my weight my entire life and monitor my diet closely and compete in running and swimming events, but somehow, she has the answer.

    I liken it to asking someone without cancer how they prevented cancer and using those lessons to treat cancer patients.

    Until the medical community and society recognize that obesity is not a disease of gluttony and sloth we will never find a solution.

    1. I would also like to add that obesity can't be treated with a one-size-fits-all solution. We are not cookie cutter people and what works for one person won't necessarily work for another.

  9. Anonymous10:08 am

    Not to mention, she's only kept it off 2 years ... and she hasn't actually kept all of it off. When she maintains it for 5, she's beaten the odds. Many people find it easy to lose weight, but the body fights back, so few can keep it off. Invariably when I read "inspiring" weight loss stories in the popular media, 99% of those profiled haven't made the magic 5-year mark. When she gets there, then maybe she can talk.

    1. Anonymous10:36 am

      Yes - and she's already gained 5 pounds back. Welcome to the club.

  10. Anonymous10:45 am

    Yoni, You are amazing and I wish you had an article in the papers, or an even more public way of sharing your wonderful insight, important knowledge, and healthy cynicism that everyone should see. Straight up, I wish I could hug your brain.

  11. I particularly like the photo you have used. It looks like the same photo that the satirical UK magazine "Private Eye" uses for "our newest columnist" -- a spoof/parody column allegedly written by a baby always containing very niaive opinions !!!

  12. Anonymous11:30 am

    I like the topic of this post but I do have a problem with the title that you posted on Facebook. There is no need to generalize and assume that everyone who has lost a "tiny" bit of weight thinks that they have solved obesity.

  13. Anonymous12:06 pm

    Hallelujah - well said... you get'em Yoni!!!!

  14. Anonymous2:42 pm

    thank you for writing this. I constantly get told I'm "Too Fat!" and continue to get advice from my skinny friends on how to lose weight! I have a problem. it's not that I don't know I'm fat, or I don't know that eating less and exercising more is good. so I don't see how her article or anyone's criticisms are going to help me. I've stopped telling people around me that I'm on a diet, because I'm sick to death of them counting my calories for me.

  15. I have to agree w/ Mrs. Allen, but society as a whole us far too PC and even a doctor using the "O" word (obese) is too often frowned upon. Call a spade a spade and call fat fat.

    Also while there may be a lot of people with the "will" to loose weight until you translate that will into action it might as well be just a dream for all its worth.

    1. Please tell me what society you live in where people don't feel compelled to shame fat people. I'd like to move there.

  16. bravo, Dr. Freedhoff! this is the difference between a practitioner who helps a variety of patients handle a difficult condition, and all of the theoreticians out there.... "eat less and move more" doesn't cut it, for a surprising number of people.

  17. Alexie9:45 am

    I agree with the commenters who mention that people who lose weight in the public eye need to be told to wait five years before they get all self-congratulatory. If they've kept it off, they need to be honest about how they're doing it. I lose 55 pounds involuntarily (illness) and to maintain the loss, I've begun to follow the habits as outlined in the National Weight Registry Control research - daily weighing, calorie counting, lots of exercise etc etc. These are the same behaviours that are akin to an eating disorder. I'm not even sure how long I can keep it up. It's a dreary way to live - but if I stop self monitoring for even a day or so, the weight comes back on without fail.

    I think the only reason I can do it is that it's easier to maintain something than it is to create it. When you have something to defend, the motivation to continue is actually higher than when you're at base camp facing a climb up Everest. Similarly, it's much easier to have good money habits when you actually HAVE money, then when you have absolutely nothing and that bad-for-you treat is the difference between a bearable day and an unbearable one.

  18. Anonymous2:09 am

    I was very obese.
    My doctor's comments to me on my weight?
    I wish my doctor gave me the "stink eye".
    There are all sorts of ideas out there about weight -from " Fat is lethal" to " Fat doesn't matter if you're healthy".
    I thought if I really had a problem , my Doctor would tell me. I always figured if my Doctor didn't talk about my weight it wasn't a medical problem, just a cosmetic problem.
    Then, after years of being fat , but not sick, it all caught up with me and I did get sick.
    At that point, my Doctor told me to lose weight. When I asked him why he didn't tell me to do that before, he said he didn't think he needed to because "everybody knows it's unhealthy to be overweight".
    So, kudos to that doc for telling the patient to lose weight, and kudos to him for doing it early, before she had even more weight to lose.
    As someone above said, he seemed to use language that worked for her, even if other patients would be offended (maybe he knew her well enough to know it would be taken ok,)

  19. Anonymous7:47 pm

    As someone who's been obese for roughly 30 of his 39 years, I have mixed feelings about your message.

    To the part about how there's already enough guilt, shame, and name-calling for fat people, I say amen!

    However, as a lifelong fat person, I can also attest that I have often made excuses and wallowed in self-pity, instead of doing things that I *knew* would be effective in decreasing my weight.

    I've also spent decades in denial of the simple truth that, in most cases, eating fewer calories than you burn leads to weight loss.

    I'm not suggesting, as Ms. Allen seems to be, that that's all there is to it.

    Rather, I'm suggesting that, in many cases, but certainly not all cases, "eat less" is *exactly* what an overweight person needs to hear - not as a mean-spirited taunt, but rather as a friendly piece of helpful advice.

    More precisely, it's not that we fat people need to hear this from others - after all, what fat person hasn't already heard it a thousand times?. Rather, it's something that many of us need to recognize the basic "truthy-ness" of, and take it to heart once and for all, instead of continually ignoring/denying it.

    It's not a magic wand, and I'm not suggesting otherwise. Weight loss is difficult and often complex, no matter how determined you are. I think we can all agree on that point.

    But I think we'd be doing a disservice to the truth if we were to merely scoff at Ms. Allen as an ignorant fraud, and say nothing more beyond that. As simplistic and naive as Ms. Allen may be, there is at least a kernel of truth there that deserves not to be swept under the rug.

  20. Nice post. For a bit of light relief you might enjoy this cartoon about the food pyramid.