Body Size and Eating Habits: STOP Judging!Please?

little-girl-1430293I saw an article this week on Twitter that really disturbed me. It was about “thin privilege”, and it showed a post with two pictures that went viral….one of a thin young woman getting ready to eat a gigantic burger and fries, and the other of a young (larger size) young lady on the beach. The comments were offensive, I don’t even want to repeat it. The bottom line was that the thin woman was found appealing because she was eating but the larger woman was insulted. It made me think about my own experiences with patients who have spent half their precious lives dealing with these issues.  Feeling embarrassed for eating in front of people, wondering what others thought of them as they ate.

If you have never had any issues with weight then you may not relate, but for those of you who have dieted, or had issues with weight, well, you will get it. We like to pretend all are created equal, but it unfortunately just is not true. In the past year the racists seem to have crept out of the woodwork, and we all understand racism. I am hoping most of us know that the color of our skin or our country of origin does not predict who we are. Even I know (although I like to joke about it) that all Italian women do not love to cook and feed people…just the ones I grew up with. It’s a stereotype. Well, the same thing happens with people depending on their size. We make judgments (out of our ignorance, just as racism is out of ignorance). Most people do not have a clue about how our bodies work and the physiology around body size and weight. We make assumptions about people depending on how they look.

If someone is very large and big we assume they overeat or stuff themselves, they have no willpower. People wonder why they would do something like that, and put their health in jeopardy. How awful.

And then there is that skinny person. They must have willpower to be that thin. They care about their health, they must eat lots of vegetables for sure, and exercise. We really look up to these thin, strong willed healthy people. We wish we could be like them and do that too. Or, we make assumptions about them. They must have an eating disorder, why else would they be that thin? They should just eat a cheeseburger, for heaven’s sake.

Well, guess what. It is all a bunch of baloney. That skinny person you are assuming is healthy might just be living on Coke and chips. Their blood pressure might be horrifying, and maybe they have high cholesterol. They might smoke a pack a day and be out of luck if they need to catch a bus because they can’t run more than 2 feet. Or, maybe their entire life they have tried to gain weight, but they take after dad’s side of the family, all tall and thin and no matter what they eat, they can’t gain weight. They get called names all their lives, made fun of for being too skinny, as if there is anything they can do to change it. They hide under clothes, layers of them so hopefully nobody will notice their skinny arms.

And that obese young woman you have sneered at and wondered why she doesn’t take care of herself? Well, she may have the blood pressure of a teenager, and the flexibility of a yoga teacher. She may eat more veggies in a week than you eat in a lifetime. She may eat less fast food than you. And, I am guessing, she has more willpower in her left pinky than you have in your entire body. Because, if she has experienced what most larger people have, she has dieted in her life. She (or he) probably have given in to the pressure to change. Have you ever tried to follow a diet? If you haven’t because you have been BLESSED with the metabolism and brain chemistry and genetics to be thin then I promise you, just like any human being you would not be able to do it….as long as most larger people have done it. Yes, they diet and lose some weight but BECAUSE IT IS NOT THEIR FAULT their bodies and brains fight against this. For a good article explaining why diets don’t work and what happens to some people’s metabolism after dieting check out:

TIME Magazine article “The Weight Loss Trap”    

So, unfortunately, when weight is lost quickly and then regained often our metabolism lowers and makes it even harder. So that person who originally wanted to lose a bit of weight finds her or himself after the diet with more weight than they started with. What often happens is that person tries to diet again, and the cycle begins. And the judgment from others is even worse. This makes me sad because the weightism from others leads people to diet, regain weight and then some, and then they are subject to even more of it.

I know there are a lot of people who will continue to judge. My hope is to help people be more empathetic by understanding that we are all different. For example, our brains and digestive system are connected by a complex system of neurochemicals that act as messengers or hormones to tell us what and how much to eat. For example, there is a messenger referred to a PYY that tells your brain you are full. Some people release it very quickly and want to stop eating even before they even finished a meal. You know those people, the ones who leave a quarter of a sandwich or who can’t finish their fries (what??!) This has NOTHING to do with willpower, they were born this way. Then there are those with less effective PYY and their brains just don’t get the message. They aren’t full. You wonder, “wow, how did they finish that?” It is not gluttony my friends, it is probably their chemistry. They were born with it. So stop judging. How would you like to walk around feeling starving all the time? It can’t be fun in this world we live in. And sometimes, some people have amazing willpower and have succeeded in ignoring their chemistry and have lost weight but the message eventually wins, and they give in. Think of a time when you really really really had to pee. Like when you are on a road trip in the middle of nowhere. If someone said to you, “you need to have some willpower and wait until tomorrow!” how would you feel? Well, that physiological signal that is telling your brain that you need to urinate is just as strong as the one that tells someone they need to eat something. It is not about willpower. It is about physiology. So we need to stop blaming.

If, like me, you don’t know much about “Thin Privilege” check out this website which I stumbled upon and liked (it is a feminist website, so if you are not of like-mind you may not like it but I hope you are):Thin Privilege

And next time you find yourself wondering how someone could eat that, or why on earth they can’t finish their meal…..just stop and focus on yourself. Just as I hope you look beyond skin color or race or nationality or sexual preference or religion or any other meaningless definition of someone’s goodness, I hope you look beyond someone’s body size and definitely beyond what someone is eating. Thank you.

More Than “Bedside Manner”: How Your Doctor Influences Your Health…or Not

medical-doctor-1236728Do you dread your yearly visit to the doctor? An acquaintance of mine recently shared how frustrated she gets with her physician. Her blood pressure is great, her labs are fine, she has energy galore and a healthy lifestyle, yet, the doctor insists on focusing on weight. The unbelievable part though is how little information this doctor actually gathered about my friend’s lifestyle. No, he did not ask about her concerns or her struggles. He had no idea she had been actively eating healthier, spending less time eating out and more time cooking healthy meals, was being more active and had decreased her stress level by changing jobs. No, he was making assumptions based on the number on the scale. Even though this friend had indeed lost some weight from some subtle changes in her lifestyle (not going on a diet, just making changes that resulted in normalizing her blood pressure, and the slight weight loss was coincidental). When my friend went to this visit she was actually very happy about her improvements in health parameters, but left feeling insulted and inadequate….like she was still doing something wrong.

It is a common scenario. Typical visits to the doctor often involve some type of health education and probably recommendations. Health professionals such as physicians, nurses, dietitians, and others have lots of knowledge in their heads, and they know what is best for us regarding what we need to do to be healthy. Typical advice:

  • You need to lose weight.
  • Cut down on sugar.
  • Cut down on fat.
  • Exercise more. At least 30 minutes a day.
  • Drink more water.
  • Drink less beer.

My question is: Do they REALLY think we don’t know what we are supposed to be doing? The problem is not in the “knowing”, the issue is with the “doing”, or the motivation to change. So the wise doctor or other health-promoter should probably consider focusing on how to assess motivation to change, how to identify the obstacles and how to help their patients to do what they need to do instead of simply telling them what to do and then scolding/judging them when they can’t do it.

Lo and behold, there actually is an approach to helping people change behavior called “Motivational Interviewing”, or MI.  This approach was originally used in the treatment of addictions, specifically alcoholism. But experts have learned that the empathetic and empowering approach of MI is also beneficial to many other fields where behavior change is key. Now, doctors, nurses, dietitians, therapists and others are getting trained because they want to help people achieve their behavior change goals, and they know from experience that the old-school approach (telling people what to do, shaming, scolding, etc) does not work.

Is your primary care physician trained in MI? Granted, some people are just naturally empathetic, and have the skills to motivate people to change. But, most of us use our instincts and do what comes naturally, and unfortunately, we are often wrong. What is wrong with emphasizing how forgetting your insulin is going to result in severe damage to your body? I know of one endocrinologist who threatened a young teen who had pre-diabetes that “if you don’t lose weight and get your blood sugar under control, we might have to chop off your foot!”. Do you really think that helped that kid leave with motivation to eat healthier? The opposite actually tends to occur. When we scold, shame and threaten, people actually become even more resistant. It doesn’t work. They don’t change. So if you leave your doctor’s office feeling shamed, guilty, bad or afraid, or even worse, you don’t want to ever return, well, chances are they may not be on top of their counseling skills.

Instead, when you leave your doctor’s office, you should feel heard. Your doctor ideally should be asking you some open-ended questions that require more than a yes-or-no answer. For example, instead of ” are you eating healthier?” a better question might be “tell me about the things you are doing to eat healthier, and what your obstacles are”. This type of open-ended question allows you to go through some details of what you have been doing or what your struggles are. Then, instead of the typical answer, or response of telling you what to do (“you need to eat more fruits and vegetables”), a more helpful response would be reflecting back what you said, and checking to be sure you were understood. For example, “so you have decreased eating out, but you still struggle with eating more fruits and vegetables because they are expensive and you don’t really like them, did I get that right?”. This type of reflective response shows empathy. There is some research demonstrating that patients who go to a doctor’s visit where they felt empathy actually leave and are more likely to be successful and compliant with recommendations verses those that were merely told what to do. We are all different, our issues are different, our lifestyles, and our readiness to change health behaviors, and being treated with empathy goes a long way to facilitate change.

So what does this mean to you? The most important thing in my opinion is to get regular health care.  When someone does not go back for follow up health care only because they were treated poorly, were shamed or blamed or otherwise disrespected, that is a tragedy. The repercussions can be great. Imagine developing hypertension and never being treated for it merely because you did not go back to your doctor.

If you can relate to being treated this way, I strongly recommend looking into finding a doctor who actually knows what motivational interviewing is. There is plenty of research involving the use of MI in a medical setting, and the benefits of treating patients with empathy. Talk to friends who love their physicians. Do some research into different practices, or just come out and ask directly. Don’t miss getting preventive care just because of the way you were treated. There are plenty of wonderful health care providers who have the skills to get you the help or support you need to be the healthiest you can be. Your health is too important to ignore. For more information on MI, check out the website: Motivational Interviewing