"I wouldn't want my kid to live like that"

An email from an ED colleague of mine (who shall remain anonymous) about the anti-obesity campaigns was just so spot-on and brilliant that I had to repost it here:

To me the most critical point is that weight is not a behavior. That's why anti-smoking campaigns are different from anti-obesity campaigns. Smoking is a very easily controlled behavior if you have not taken it up yet. You can most certainly decide not to start smoking but you can not simply decide not to be fat - you can do all the right things and still be fat. I have little nieces and nephews like that. They are active and energetic kids who eat healthy (more so than my kids!) so what else are they supposed to do? How does the message that they have the wrong kind of body that puts them at risk for health problems and earlier death serve them? To elaborate on Jon's point, should I raise my son to know that he is estimated to have a shorter lifespan than his sister? The only thing a kid needs to hear about his or her body is that it is precious and deserves good care.


Another thing that concerns me with our approach to obesity is that instead of normalizing behaviors, like we tend to do with other conditions, we push people into adopting abnormal lifestyles. When we see people with depression or anxiety or EDs, our goal is to normalize behaviors (e.g. that the person with depression be able to get out of bed and go to work, that a person with social phobia be able to go to social gatherings without distress, that a person with an ED be able to eat normally without compensatory behaviors). But in obesity treatment, our goal is to go beyond what we would consider normal. We want people to eat less than what a person who is not obese would eat, we want them to move more than we would expect of a person who is not obese, and we want them to be hypervigilant about their eating and weight - something that would concern us in a person who is not obese. Besides the obvious ethical questions involved in asking something of fat people that we would never ask of a thinner person, how many people are willing or able to go to such extremes?

From what we have seen, not many. The most optimistic reports of "long-term weight loss success" I have seen is around 20% ("long-term" defined as at least 1 y and "successful weight loss" defined as at least 10%). When we look at the behaviors of those successful at losing weight, described in the much-touted National Weight Control Registry, we see patterns resembling the habits of our patients: Low caloric intake, long hours of exercise, frequent weighings, and a constant vigilance - those who are most successful at maintaining their weight loss never stray from the dieting routine, no matter if it's Christmas, birthdays, vacations or what have you. I don't know about you but I wouldn't want my kid to live like that.

I wish more people wrote and thought like this!

posted under , , |

6 comments:

Jess said...

I completely agree!!!

FantasyGirl said...

well said

HikerRD said...

While I can't speak for the messages that other health professionals put out there, I can tell you that in my nutrition practice and those MDs that refer to me pediatric obesity is approached quite sensibly. I do not view high BMI as a disorder, but I do see it as a red flag when it shifts from the normal curve of that individual.

Unlike what your colleague stated, we do not hold overweight or obese kids to higher standards wrt exercise or eating. Rather, we attempt to change their behaviors that might ultimately lead to greater problems; for instance, if TV watching (and eating simultaneously) is excessive, that gets addressed. We work on small, realistic goals, just as we do with people dealing with anorexia and bulimia. Even more importantly, while the child might have been identified because of a climbing BMI, the family is targeted for change, vs isolating the child to be different, because generally, the family's patterns are at the very least, contributing factors.

For those of you who grew up overweight, you may recall that avoidance of the issue doesn't help self esteem or self acceptance. It doesn't just go away, and as younger kids are becoming more obese we are seeing more diabetes, and subsequently the consequences of long term diabetes.

So whether we like it or not, the pediatric obesity issue does need to be addressed. It just needs to be done appropriately and with a whole family approach.And a focus on the behaviors which the obesity may be a marker for.

howdidIgethere said...

In response to HikerRD's comment: "I do not view high BMI as a disorder, but I do see it as a red flag when it shifts from the normal curve of that individual."

And what about when it does NOT shift from the normal curve of that individual? When someone who has -- from birth -- been at average height, but above average weight? There were posters in my ped's office that showed a "slim" youngster (maybe 5 years old) and one that was bit "rounder" -- hardly fat, much less obese -- with the wording that the larger one was at higher risk for... [you name it -- everyone knows the drill]. I used to take a paper towel and cover it when my AN daughter was in for her weight check, especially because that "rounder" child looked exactly like my daughter did at that age!

"Unlike what your colleague stated, we do not hold overweight or obese kids to higher standards with exercise or eating."

Then why isn't the focus on HEALTH, not WEIGHT!???

"Rather, we attempt to change their behaviors that might ultimately lead to greater problems; for instance, if TV watching (and eating simultaneously) is excessive, that gets addressed."

Thin people also watch TV and eat simultaneously -- if that's unhealthy, shouldn't they, also have "... small, realistic goals"?

But, if they aren't "overweight", you don't even see them, so it must be OK for them to watch TV and eat. That, in itself, says that you and your colleagues are holding "overweight" kids to a higher standard.

"Even more importantly, while the child might have been identified because of a climbing BMI, the family is targeted for change, vs isolating the child to be different, because generally, the family's patterns are at the very least, contributing factors."
Sounds a lot like blaming the family for "contributing factors" whether or not the family follows healthful principles and strives for good health, if not for weight loss. Why could it not, just as easily, be a genetic predisposition?

"For those of you who grew up overweight, you may recall that avoidance of the issue doesn't help self esteem or self acceptance. It doesn't just go away..."

Nor does the memory of being told constantly that we needed to do X or Y to be at a more acceptable weight, when, even doing X and Y, didn't result in the promised weight loss, which we, no doubt, wanted for ourselves more than you did, since we were clearly not accepted at our higher weight! Thus we were introduced to yo-yo dieting, in spite of the evidence now that dieting doesn't work in the long run.

"... younger kids are becoming more obese we are seeing more diabetes, and subsequently the consequences of long term diabetes."

There is correlation in these two: diabetes and overweight children, but not necessarily causation. Or have I missed some research that proves, scientifically, that a higher weight causes diabetes? Or don't thin people get diabetes?

HikerRD said...

In response to howdidigetthere:

Maybe I'm the exception, but if a child shows up in my office as I described, having always been on the high side, but maintaining their usual %ile, I don't pathologize it. If there are behaviors to be addressed--by the child and the family, they are constructively addressed.

And no, it is not blaming the family, merely enllightening them as to how to be more mindful and have a healthier relationship with foods--yes, even for young kids.

And I couldn't agree with you more--this approach toward eating more mindfully, being more active, including balance and shifting away from categories of "good" and "bad" foods ought to be addressed with all kids, regardless of weight. Unfortunately, there is little health ed in schools, and most of what I hear at the upper grades I don't support. So I hear your frustration. But again, we do the best we can. If behaviors are appropriate and there is no need for change, that is exactly what the family hears.
As someone who also sees about 30-40 individuals/week with eating disorders, I am very sensitive to both what is said and what s heard.

As for diabetes and other chronic diseases associated with obesity, we can control the risk factors that are in our hands. People of all weights get diabetes--but the majority of individuals that get Type 2 Diabetes are overweight. But yes, there are exceptions to that rule as well.Generally the etiology is different. A good educator doesn't blame the pt or the family but encourages them to take control of the variables that are in their hands to change.
Lori Lieberman, RD, CDE, MPH, LDN

KL said...

God bless whoever wrote that e-mail. I spent YEARS. Seriously YEARS trying to get to my "ideal" [as determined my the medical establishment] weight. The only way I was able to get even close was to give up food entirely. I have to tell you, my body look "great" by conventional standards. I felt like if I had a flat tummy and slim hips then I would have everything. Truth was, when I had a tiny body I didn't have anything else.

Over the course of the past 16 years I have one by one rearranged my ideas about what my "ideal" body is supposed to be. I exercise is proportion. I eat well. I take good care of myself.

Today I have GREAT friends, a husband that is an absolute miracle in my life and 4 beautiful sons. I have a job that I love and a life that feels amazing. You know what else I have - a fat ass.

It's a trade off that i'm willing to make but sometimes I have to ask myself why. What is the issue? I have come to believe that the problem is not in how I live my life, but rather in the value that other ascribe to my body.

I'd love to be the cure little thing in size 6 jeans. But that's not my reality. Today I am a full figured woman and that's ok with me (most of the time).

Post a Comment

Newer Post Older Post Home

ED Bites on Facebook!

ED Bites is on Twitter!

Search ED Bites

About Me

My photo
I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

Drop me a line!

Have any questions or comments about this blog? Feel free to email me at carrie@edbites.com



nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote



Archives

Popular Posts

Followers


Recent Comments