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As you try to approach weight issues in a new way, you may find yourself
fielding questions about how you can be trying to just accept your body
size rather than lose weight. How could you handle the following
Frequently Asked Questions?
?
I
see fat people eating junk food and buying ice cream, so how can you say
they don�t overeat?
Don�t
fat people just lack the will power to keep the weight off?
What
about the studies that showed fat people are more likely to eat for
�external� reasons like the time of day or because there�s food in
front of them?
Key Size Acceptance Points:
Fat
People Eat the Same as Thin People
The
research shows that fat people don�t eat differently from thin
people:
-
There
are fat people who binge, but there are also thin people who binge.
-
Overall,
researchers have had a heck of time trying to find any differences, in
overall quantity, or the type or composition of diet.
-
If
anyone, of any size, has an eating disorder they would like to get
help with, that is usually treatable.
But the person's weight may or may
not change with treatment.
-
The
residue of attitudes and behaviors after dieting/restricting (tendency
to binge on the foods which were forbidden on the diet, tendency
to eat when not hungry or past the point of fullness - "dieting
detox" as I call it) is
not the same as an eating disorder.
Related
arguments:
Maybe
we are like breeds of dogs (setpoint
theory).
Can't
generalize to healthy fat people (people with problems do not
represent the general population).
Current
treatments can cause health problems, e.g., dieters are more likely to
binge; weight cyclers are more likely to develop hypertension; as a
population, the more we diet, the fatter we get (iatrogenic issue).
back to top
?
I
can go along with what you say for plus-size people but isn�t there a
really high weight where it is too dangerous not to try to lose weight?
Don�t
fat people just lack the will power to keep the weight off?
What
about the studies that showed fat people are more likely to eat for
�external� reasons like the time of day or because there�s food in
front of them?
Key Size Acceptance Points:
Current
treatments can cause health problems, e.g., dieters are more
likely to binge; weight cyclers are more likely to develop hypertension;
as a population, the more we diet, the fatter we get.
-
The
treatments we have been prescribing for fat people may in fact be
making their problems worse, and may in fact be causing some of their
problems.
-
It
turns out that fatness is not the best predictor of binging; rather,
dieting/restricting is (see Herman/Polivy).
-
Dieting
teaches you how to ignore your internal appetite/satiety cues,
undermining the very mechanism that helps people eat normally.
-
In
populations where people diet less, even when they are heavier than
the "ideal" their health and longevity is better than
populations which are dieting more, though it is hard to tell what the
causal mechanisms are (because they are likely to suffer less
discrimination based on body size which leads people to diet) (see
Roseta Study).
-
Healthcare
providers are supposed to DO NO HARM.
If their own research says that 95% of the time their
intervention will fail, and if it does fail, the
person will feel worse (physically and emotionally), then how can they
justify it?
Related
arguments:
No
proven treatment to change weight permanently: SHOW ME THE DATA!
We
shouldn�t �prescribe� for fat people what we diagnose as eating
disordered in thin people
Individual
health risks vary
back to top
?
But
isn�t being fat unhealthy?
I
can go along with what you say for plus-size people but isn�t there a
weight where it really is dangerous?
Doesn�t
being fat cause people to get depressed?
Wouldn�t
it solve the problems fat people face from discrimination if they just
lost weight?
Aren�t
you being too permissive with fat people?
Isn�t it like trying to �accept� that you�ll always be a
smoker?
I
know someone who lost 100 pounds by dieting (or weight loss surgery, or
exercise) and she feels great.
I
know someone who lost 100 pounds by dieting (or weight loss surgery, or
exercise) and she kept it off 6 years and she feels great.
All
I know is that when I eat less and exercise I lose weight so why can�t
fat people?
Don�t
fat people just lack the will power to keep the weight off?
Don�t
fat people have problems they should get therapy for?
What
can I say if someone is unhappy with their weight and wants to lose
weight?
Key Size Acceptance Points:
No
proven treatment to change weight permanently:
SHOW ME THE DATA!
The
1992 National Institutes of Health (NIH) Technology Conference published a
list of recommendations for consumers considering weight loss programs. They
were not aware of any programs which could answer these criteria, nor have
any programs complied since. The
report states: "In
evaluating a weight loss method or program, one should not be distracted
by anectodal 'success' stories or by advertising claims. The information
that should be obtained includes:
- The percentage of
all participants who complete it.
- The percentage of
those completing the program who achieve various degrees of weight
loss.
- The proportion of
that loss that is maintained at 1,3 and 5 years.
- The number of
participants who experienced negative medical effects as well as their
kind and severity."
If we
do not have a treatment that works, then what we prescribe is all
experimental and should be labelled as such.
In
the few number of people for whom weightloss is maintained, people do not
necessarily live longer anyway and there is some evidence they die earlier
than people of a higher, stable weight.
If we
do not have a treatment that works, it really doesn't make sense to go on
blaming the victim. Why do
scientists/clinicians keep doing the same intervention expecting different
results? Say it were somehow
true that fat people lacked will power, would it make sense to expect them
to diet for the rest of their lives?
The healthcare community's responsibility is to come up with
interventions that work that make fat people's lives better.
Related
arguments:
Current
treatments can cause health problems, e.g., dieters are more
likely to binge; weight cyclers are more likely to develop hypertension;
as a population, the more we diet, the fatter we get (iatrogenic issue).
Fitness
is more important than weight
Individual
health risks vary
We
shouldn�t �prescribe� for fat people what we diagnose as eating
disordered in thin people
�Success�
is taking care of your body
back to top
?
If
we can�t help fat people get thinner then what should I do to help them?
What
should I do if someone has lost weight and expects me to compliment her?
What can I say if someone is unhappy with their
weight and wants to lose weight?
Key Size Acceptance Points:
�Success�
is taking care of your body
Stop
reading someone's "success" from their weight.
How many thin, smoking, sedentary, junk-food-eaters get harrassed
about their health?
We
don't have a weight loss intervention that works, so how do we help make
fat people's lives better?
-
Focus
on the day-to-day decisions to get good, tasty fuel and fun physical
activity, have friends, express yourself.
These are the elements of a good life no matter what a person's
body size. People of all
sizes do it and should be recognized for it.
-
Notice
how people are feeling and the quality of their lives rather than
their weight.
-
Practice
"weight neutrality" - focus on what you would focus on if
weight was not an issue (in the culture, or to the person), whether
you are a therapist, a friend, a clinician, or family member.
-
Work
to change the discrimination and weight preoccupation in our culture
Related
arguments:
Fitness
is more important than weight
Medical
discrimination causes health problems
Social
discrimination causes health problems
We
shouldn�t �prescribe� for fat people what we diagnose as eating
disordered in thin people
back to top
?
Doesn�t
being fat cause people to get depressed?
Don�t
fat people just lack the will power to keep the weight off?
Don�t
fat people have problems they should get therapy for?
What
can I say if someone is unhappy with their weight and wants to lose
weight?
Key Size Acceptance Points:
Fat
people do not have more emotional problems than thin people
-
Studies
which have tried to find psychological differences in fat populations
have failed.
-
The
few studies which have found differences are often of clinical
populations (people who are self-selected because they already have
problems) and are thus not representative of the general fat
population.
-
There
are no "obese" personality types/traits
-
There
are people who have problems with body image who are fat but there is
an equal number who are thin - it is not about body size
-
It
is remarkable that there is not a higher incidence of depression, etc.
because fat people are members of a stigmatized group. We should be
studying why they are not depressed, i.e., how they are
psychologically resilient.
Related arguments:
Can't
generalize to healthy fat people (people with problems do not
represent the general population).
Fat
People Eat the Same as Thin People
Social
discrimination causes health problems
back to top
?
Wouldn�t
it solve the problems fat people face from discrimination if they just
lost weight?
Even
if fat people maintain a higher body weight and don�t eat more,
shouldn�t they eat as little as they need to to be thin?
Maybe they shouldn�t eat like normal people.
What can I say if someone is unhappy with their
weight and wants to lose weight?
Key Size Acceptance Points:
We
shouldn�t �prescribe� for fat people what we diagnose as eating
disordered in thin people
If
keeping track of everything you eat, having rigid categories of
"good" and "bad" foods, not eating in response to body
cues, having your mood/feeling of control/"success" depend on
the number on the scale, etc., is bad for thin people, why do we recommend
it for fat people?
-
Look at the descriptions of the "maintainance
strategies" of the 3% "successful" weight loss
maintainers and in many respects it is difficult to distinguish them
from the practices and preoccupations of eating disorder patients.
-
Therapists
usually challenge the magical thinking associated with weight
("My life will be so much better if I can lose weight") when
a thin person displays it, but agree with it when a fat person
expresses it.
-
We
need to practice "weight neutrality" - looking at people as
individuals rather than having their weight dictate our actions.
Related
arguments:
Maybe
we are like breeds of dogs
(setpoint theory).
Medical
discrimination causes health problems
Fat
people do not have more
emotional problems than thin people
back to top
?
But
isn�t being fat unhealthy?
I
can go along with what you say for plus-size people but isn�t there a
weight where it really is dangerous?
Key Size Acceptance Points:
Individual
health risks vary: The argument about
the health risks of obesity is much more controversial than is typically
portrayed.
- Correlations
are there for certain health problems at higher weights, but let's
remember that correlation is not causality. There are also some health
advantages to weighing more, including less likelihood of
osteoporosis.
- For any given individual, fat may
be a health problem or not. Maybe we're like breeds of dogs.
St. Bernards are never going to be greyhounds, even if starve
themselves. And maybe they don't live as long, but we seem to be able
to let dogs have their breeds and not shoehorn them all into an
"ideal" height and weight or BMI chart. If you're a
chihauhau who is 5 pounds over your genetic weight, maybe that is
health-threatening. If you are a Rottweiler, who can even tell?
Medical
discrimination causes health problems
-
More
fat people are poor (fat women make the same amount less than thin
women as short men vs. tall men), and more of them do not have any
medical insurance at all because the insurance companies won't cover
them, or charge exorbitant rates to cover them.
-
Research
is currently underway to document the avoidance of medical care
by fat people who don't believe that they'll be treated for their
problems without a weight-loss lecture, so their problems may be more
advanced by the time they see a doctor.
Social
discrimination causes health problems
-
The
stigma against fat people is profound and stressful, and the same
diseases that are associated with being in other oppressed groups
(high blood pressure, for example) may be caused by social
discrimination.
-
In
the Roseta study, an Italian-American community where fatness was not
a bad thing, people had lower incidences of the health problems
usually correlated with fatness.
Related
arguments:
Current
treatments can cause health problems, e.g., dieters are more
likely to binge; weight cyclers are more likely to develop hypertension;
as a population, the more we diet, the fatter we get (iatrogenic issue).
back to top
?
But
isn�t being fat unhealthy?
If
we can�t help fat people get thinner then what should I do to help them?
What
can I say if someone is unhappy with their weight and wants to lose
weight?
Key Size Acceptance Points:
Fitness
is more important
than weight
-
See
Steven Blair's work and the other long-term, massive studies from the
Cooper aerobics center. Fat,
active men lived longer and were healthier
than thin, sedentary men.
-
If
we helped people of all sizes integrate more pleasurable
physical activity into their lives we would do everyone a favor.
-
By
focusing on exercise for weight loss we set people up to give up if
they don't become thin.
Related
arguments:
Current
treatments can cause health problems, e.g., dieters are more
likely to binge; weight cyclers are more likely to develop hypertension;
as a population, the more we diet, the fatter we get (iatrogenic issue).
No
proven treatment to change weight permanently: SHOW ME THE DATA!
�Success�
is taking care of your body
back to top
?
Doesn�t
being fat cause people to get depressed?
I
see fat people eating junk food and buying ice cream, so how can you say
they don�t overeat?
Don�t
fat people have problems they should get therapy for?
What about the studies that showed fat people are
more likely to eat for �external� reasons like the time of day or
because there�s food in front of them?
Key Size Acceptance Points:
Can't
generalize to healthy fat people (people with problems do not
represent the general population).
-
Studies
of people seeking help, or examples of people with problems, do not
tell you about the general population. The �clinical� population
of fat people (those that seek mental health services) is not
representative of the general population, just as thin people who seek
help are not representative of all thin people.
-
The
general population of fat people has no associated personality type or
trait, no higher incidence of depression or mental health problems
(which is rather extraordinary given the discrimination they face).
Related
arguments:
Fat
People Eat the Same as Thin People
Fat
people do not
have more emotional problems than thin people
back to top
?
Aren�t
you being too permissive with fat people?
Isn�t it like trying to �accept� that you�ll always be a
smoker?
I
know someone who lost 100 pounds by dieting (or weight loss surgery, or
exercise) and she feels great.
I
know someone who lost 100 pounds by dieting (or weight loss surgery, or
exercise) and she kept it off 6 years and she feels great.
All
I know is that when I eat less and exercise I lose weight so why can�t
fat people?
Even
if fat people maintain a higher body weight and don�t eat more,
shouldn�t they eat as little as they need to to be thin?
Maybe they shouldn�t eat like normal people.
What
about the studies that say being fat is a killer disease?
Key Size Acceptance Points:
Maybe we are like
breeds of dogs
(setpoint theory).
-
For
any given individual, fat may be a health problem or
not.
-
Maybe
we're like breeds of dogs. St. Bernards are never going
to be greyhounds, even if starve themselves. And maybe they don't live
as long, but we seem to be able to let dogs have their breeds and not
shoehorn them all into an "ideal" height and weight or BMI
chart. If you're a chihauhau who is 5 pounds over your genetic weight,
maybe that is health-threatening. If you are a Rottweiler, who can
even tell?
-
What
may be more relevant to health is not someone's absolute weight, but
rather their weight relative to their own genetic destiny. This
would explain the wide disparity in findings among some studies, a few
of which show health problems with very little "overweight"
and others which show no major problems for a wide range of weights,
or more problems with being too thin.
Related
arguments:
Individual
health risks vary
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