Thursday, October 18, 2007

Addressing obesity in a fat-phobic society

It's time to stop treating obesity as the problem of a lazy individual.

Yes, yes, and yes! This article (title of post is link) needs to read by all those doctors who think that if we just lost weight we'd be healthy and happy and our lives would magically improve. However, I do have a couple of reservations about it.
You would never look at a working class, single mother driving a jalopy with three kids crawling around in the back and say, "Gees, what's her problem? Why can't she drive the Lexus hybrid like me?" You understand that she doesn't have the means, and furthermore, probably doesn't have the peer influence that would make it seem like a viable option.

I really don't think this is a valid comparison (since when did peer influence make any difference in one's weight?). And most mothers don't let their kids crawl around in the backs of their vehicles, they don't need a ticket for no seatbelts/carseats for the kids.
Our judgmental, fat-phobic society seems even more ridiculous when you consider that there is a strong genetic component to weight. We now have ample scientific evidence suggesting that we are each born with a set point within which our metabolism will automatically adjust no matter how many calories we consume. It's like our working class mom could be dedicatedly saving up for that hybrid, but the money just keeps disappearing from her bank account.

Again, not a valid comparison. Most single, working class moms with 3 kids are too busy paying bills, providing food, clothing, and shelter for their kids to have any extra money to bank for that Lexus hybrid. Calorie consumption (and where those calories go) has nothing to do with banking money (and unless you are careless with your banking info, money just doesn't magically disappear from your bank account and you don't notice that it's gone).
Instead of vilifying fat people, this country needs to look long and hard at the roots of our obesity epidemic. While we can't change someone's genetics, we can work to change the institutional disparities that make maintaining a healthy weight difficult for people with less money. Encouraging supermarkets to open up in poor neighborhoods by adjusting zoning laws and creating tax-incentive programs is a start. More funding for public schools in low-income areas would translate into better quality food in the cafeterias and more nutrition and physical education.

Again, saying that being fat is not from laziness, but we need help maintaining a healthy weight? Who decides what is a healthy weight? And since diets don't work to get to that "healthy weight" and stay there, isn't that just a bit difficult to achieve? Supermarkets in poor neighborhoods are a good start, but they don't do much good if the people in those neighborhoods can't afford to buy the fresh produce sold there. Making fresh produce as available and affordable as processed food would be a good goal to go along with those supermarkets, I think. More funding for schools to provide better education would be another desirable goal, since the more and better education a person has, the better their job prospects are, and with that comes the opportunity to make more money, find a better place to live, and just possibly, better health.
It goes on to talk about soul-searching attitudes about fat, and separating the potential health risks of being fat from internalized stigmas about fat (potential health risks, this in spite of all the studies showing that those of us who fall into the "overweight" category live longer than the "normal" and "underweight" categories).
Whether you are a primary care provider, a nurse practitioner, a nutritionist, or a community health advocate, I urge you to treat your next patient like a living, breathing human being with complicated feelings, economic concerns, and cultural affiliations. Weight loss isn't the ultimate goal; economic equality, cultural diversity, wellness and happiness are.

In other words, respect us and don't automatically blame our illnesses/diseases on our fat. There might actually be another cause for it, and that should be looked for before useless WLDing is proposed.

1 comment:

  1. Okay, I'm enjoying reading back through your blog.

    I just have to say the comparison here made me laugh - but I mostly enjoyed this article.

    As a working single parent of three boys, who drives a 12 year old jalopy (and does, incidentally, wish for a hybrid, but not a Lexus hybrid), I laughed and laughed. I am trying to live a more health-conscious life, and indeed, it does require resources (and time) that an individual like me simply doesn't have. I didn't read the banking analogy as on par with calorie consumption. I think the reference was more that life is so hectic for the lower classes, who are just struggling to get by, that they can't "get ahead" when it comes to basic 'healthy' nutrition, time for exercise, etc. Hey, who can afford a gym membership on $5.75/hr? What single mother can find time to go when she's responsible for child pick-up and drop-off, homework help, dinners, etc? Why is fresh produce so expensive? Why is overprocessed food so cheap?

    I try to take advantage of every educational/free health/family benefit program I can out there - and really, it's still a struggle. In a sense I'd like to see the changes this article advocates - I don't think offering out public health education for low income families is a bad idea. The difficulty is in how the changes are presented - are they fatphobic , or promoting health? The article seems to call for a HAES approach on the second page...which I could get behind. Granted, the article does have the typical health/fat associations, which I understand your rant on.


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