"Lifestyle Change" is the New "Diet"
Yet another story about how willpower isn't the key to taking care of the "obesity epidemic" from Dr. Barron H. Lerner; this one caught my attention because it was linked (favorably) on digg.
This doctor thinks weight is a genetic issue. The first 4/5ths of the article is pretty standard pro-diet, pro-weight loss jive until he hits this:
So maybe it is time for health professionals to stop reflexively assuming that personal sacrifice will lead to weight loss. But this will not be easy.
Right here I thought, "What? Maybe he's going to condone... health at any size?" But no.
For one thing, there certainly are success stories of people who have dropped dozens of pounds by drastically altering their lifestyles. Moreover, watching one's diet can have beneficial health effects beyond losing weight.
Ah, yes, lifestyle changes - the code-word for "diet". Really. It's a bummer because he comes really close to condoning HAES. But then... yeah... this:
And I just cannot conceive of a session with an overweight patient that does not involve a discussion of being careful at holiday meals, controlling portion size, avoiding bedtime snacks, and trying to exercise three times a week. Somehow it still seems to me that part of a doctor's job is to push patients to try harder. Just call me old-fashioned.
I have other terms for you.
This is the conundrum: he tries to pin the cause of fat on genetics, environment, and eating simultaneously. The fact that Dr. Lerner "cannot conceive" of treating a fat person as a person instead of fat is the biggest problem here.
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Posted by paul on July 18, 2007
And I just cannot conceive of a session with an overweight patient that does not involve a discussion of being careful at holiday meals, controlling portion size, avoiding bedtime snacks, and trying to exercise three times a week. Somehow it still seems to me that part of a doctor's job is to push patients to try harder. Just call me old-fashioned.
Right, because as we all know, fat people are fat simply because they eat too much and don't exercise. If that was the case, what with all the barrage of diets currently out there, we'd have a nation of skinny people.
For one thing, there certainly are success stories of people who have dropped dozens of pounds by drastically altering their lifestyles.
Yeah, I drastically altered my lifestyle and dropped 175 pounds in a year. But in my case, doctors call it anorexia and bulimia. But according to Dr. Lerner's - and most of society's - definition of "success" (i.e. not fat), then I guess mine would be considered a success story.
it's too bad that the way he phrased it wasn't a clue to himself: HE CAN'T CONCEIVE of doing it that way because the quandary lies in HIS CONCEPTION (perception) of the situation.
that would require an openness to re-examining the paradigm, though.
"lifestyle" has been substituted for "diet" for decades now, i think, by a particular school of people: the ones who acknowledge the dangers of diet drugs and unbalanced crash diets but still believe that fatness is caused by overeating.
I read the same article on the NY Times website yesterday. They also have readers' comments (http://news.blogs.nytimes.com/2007/07/10/is-willpower-obsolete/) for this one and those comments are simply disheartening. Very little fat-bashing if any as far as I could see but plenty of "I did it so can you". Yeah, right, ever considered that I "did it" about four times in my life, but unfortunately I just as the great majority of people was not able to keep the weight down in the long term? And then there are of course plenty of diet tips all of which are not new and some which have been proven to be wrong. For example, one person writes you should consume more than the recommended dose of vitamins. However, recent studies actually show that taking large doses of vitamins in forms of pills is unhealthy. Whatever.
Huh. A doctor who did that with me would no longer be my doctor, or at the very least I wouldn't see him/her except in the outer extremities of need. My NP doesn't even mention it anymore, and last time I saw her she gave me the choice of being weighed or not weighed. I chose not.
On the other hand, if the doctor does that with ALL patients (since a doctor should encourage patients towards healthy behavior) I can get behind that. If the doctor encourages everyone to exercise and eat a variety of foods and get proper nutrition, etc., that's doing their job. It's just useless to couch it in weight-loss and therefore to assume that if a patient has a BMI within "normal" range then they are already eating healthily and exercising enough. That does a disservice to all patients.
The "careful at holiday meals" remark is what really bugs me. If a doctor said it to me - even if he or she intended it in the most neutral way possible - what I would HEAR is "You're fat, so you don't deserve to enjoy food - even at holidays that occur once a year."
I totally agree on the "lifestyle change" is the new code-word for "diet."
To paraphrase the old, old New Yorker cartoon: "It's 'lifestyle change,' dear" - "well, I say it's 'diet,' and to hell with it."
(Original reference here: http://en.wikipedia.org/wiki/The_New_Yorker#Cartoons)
I frankly hesitate to ask this (I imagine pissed off BFB-ers jumping up and down on me!
), but is it FA "political correctness" to deny that eating and fat aren't connected? Why?
Paul's comments said: "This is the conundrum: he tries to pin the cause of fat on genetics, environment, and eating simultaneously."
I think that is precisely the combination of factors that frequently results in fat, and, in the vast majority of people's inability to keep weight off. My mother was fat. Her mother and sister were fat. Her father wasn't particularly heavy but many of his relatives were extremely fat. I was an average-weight kid until I hit puberty, then I inflated. Clearly, genetics play a big role in my size.
My mother was white/Jewish and my father was black/West Indian. Eating -- for pleasure, for comfort, for congeniality -- is a big part of both cultures and the joy, indeed the imperative, to be constantly surrounded by large portions of wonderful food defined my world from Day One. My grandmother (maternal) was a professional cook. My grandfather (paternal) worked in the Chunky candy factory all the years I knew him. Clearly, environment played a big role in my size.
When I was in elementary school, I went home after school to my maternal grandparents, who provided childcare services for my working mother. One of my most frequent after-school snacks, courtesy of Zayda [Yiddish for grandfather], was three large chocolate-covered custard donuts. This was just to tide me over until dinner, which always consisted of very large amounts of whatever was on the evening's menu. And dinner held me until my mother came home, when I had a snack while she had dinner. During my 20s, when I was a working girl still living at home with the folks, I used to stop at a deli just outside the subway to buy that night's Entenmann's [local NYC baked goods -- yum!]. This went on for years, along with other high-volume eating. (When I was in Overeaters Anonymous, I called myself "an Entenmann's-a-day compulsive eater.") Clearly, eating has always played a big role in my size.
Like most people who are extra large, I've lost substantial amounts of weight (70 -100 lbs.) on several occasions, and always gained it back -- thanks to (1) genetics, (2) my idea of what makes life worth living (GREAT FOOD!!! ), and (3) my tendency to eat very large amounts of food. It seems to me there wouldn't be a multi-billion-dollar diet industry if the "solution" to fat were not very complicated, multi-faceted, and greatly misunderstood.
If I had had my druthers early on, I would not have chosen to be fat. It was hard being fat. It still is and I'm pushing 60. In general, I eat much less than I did when I was younger, but I still eat a lot. And I don't exercise. I do believe it is possible to be fit / healthy at any size, but it takes a level of effort I've never been willing or able to maintain.
As I've said in previous posts, I'm not ashamed of being fat and I'm both angered and disturbed by all forms of fat-hate and the hostile climate of anti-fat propoganda that grows around us. But how does it serve fat acceptance efforts to deny any of the factors that produce obesity? I'd really value feedback on this subject.
I don't think anyone's denying it's possible that fat people can be fat because of eating. The problem arises when lazy people, like the good doctor, make the assumptions that eating ("too much", presumably) causes people to be fat and that fat people eat "too much".
Truth is, there are as many reasons for why we're fat as there are fat people.
"...to deny that eating and fat ARE connected"
Sorry `bout that...
Does this guy think it's really those holiday meals a few times a year that really just push fatties like me over the mark of acceptable sizes? And if so, does he also counsel thin patients to be vigilant, lest they too become faaaat?
And he'd better learn to "conceive" of a conversation absent the lectures and ridicule if he ever finds me as his patient! I mean, wow, what's he gonna do when he finds out that I DO exercise at least three times a week and DO control my portions? Would his head just kinda melt into a little puddle? And if so, could I charge an admission fee?
"I mean, wow, what's he gonna do when he finds out that I DO exercise at least three times a week and DO control my portions? Would his head just kinda melt into a little puddle?"
Rebelle,
I've known doctors like this. He would simply believe you're lying to him because of his prejudice against fat people.
MizB, there is an association between eating and weight but the relationship is not causal. There are thin people who eat as you describe do (did), and fat people who don't. No one is denying a relationship between the two factors, it's the assumption not only that fat people are voluminous eaters AND that thin people aren't which is wrong, as well as just plain annoying.
Jennifer Portnick
Personal Trainer (who is fat)
San Francisco, CA
MizB: Yes, there are people who eat themselves fatter than they would otherwise be. However, many of us do not. And you can't tell which is which just by looking. And why is it OK for people to "overeat" if they're thin, but not if they're fat? Or, for that matter, to consume alcohol (other than sacrosanct tiny glasses of wine), which has significant calories and virtually no nutritive value?
What people are really saying is, "Fat people have to live lives of privation in order to have any chance of being accepted, while thin people can consume whatever they like." I find this just as objectionable as someone saying, "Married heterosexual people who are trying to create babies can enjoy sex, while everyone else has to abstain."
Thanks to Paul and jportnick for your input. I'm going to think about what you've said and check out some of the newest literature on weight, as well. I understand that for a combination of physiological reasons there are thin people who can chow down without consequence and fat people who can starve and still gain weight. But the idea that the relationship between fat and eating is not causal feels ingenuous to me and doesn't jive with my experience (of myself and many others).
I know the fat-haters like to play the glutton card and dismiss us as voluntary hogs, but my response to that is: screw you and the skinny horse you rode in on! Apparently, people can engage in any other kind of excessive behavior -- greed, dishonesty, sexual impropriety -- and not even raise an eyebrow in many circles. But show them a fat person eating a cookie and they lose their minds.
I think that taking the position that fat folks shouldn't be hated because they can't help being fat misses the point. Fat people shouldn't be hated because body size should not be grounds for treating people like sick, stupid, lazy-ass, second-class citizens.
The dynamics of obesity are still one of science's least-understood human conditions and perhaps we are beginning to realize that overeating = fat is too limited and simplistic an equation. But I doubt that we can ever honestly take eating a lot out of that equation, nor should we try to.
You know, I'm not trying to strike a discordant note on the what-causes-fat question. I'm very grateful that a fat acceptance movement exists to counter our anti-fat culture, and I appreciate that a critical component of this movement is learning to view fat and food in new ways, to spread the word re: new scientific understandings about fat and food, and to shut-up the fat haters by having new factual information to lob back to them in response to their hateful, superior, pig-ignorant attitudes.
I'm just an old veteran of assorted political campaigns and I know how easy it can be for a struggle to get sidetracked by defensive arguements that don't always make sense; sincere communists in the 30s tried very hard to justify Stalin's pact with Hitler. I'm NOT equating that stupidity with the fat/food issue. I'm just saying that 40 years of social/political involvement have taught me to question the party line. But I'm still learning and I'm keeping an open mind.
My thanks to all other BFBers for creating this community/platform for an exchange of information and expression of ideas.
rebelle:
"I mean, wow, what's he gonna do when he finds out that I DO exercise at least three times a week and DO control my portions? Would his head just kinda melt into a little puddle? And if so, could I charge an admission fee?"
I hate to say it but in some instances he might accuse you of lying or overestimating amount of exercise/undestimating calories consumed. I've seen it happen.
(There was some show on TLC, which I clicked off of IMMEDIATELY that had a doctor saying, about an obese patient who reported that he followed portion control: "Well, we know ALL fat people lie about how much they eat." Real helpful, doc.)
I would also observe that hating fat people is wrong because fat people are, you know, PEOPLE. I was taught growing up that all people were children of God (or substitute whatever idiom you want here if you don't do the God-thing) and so, all people deserved at least a basic level of respect and kindness. I never got the "don't make fun of the Black kids" lecture (I went to an almost lily-white school) or the "don't make fun of the developmentally disabled kids" lecture - all I got was "Everyone you run into every day is a person just like you, and they deserve to be treated the way you'd like to be treated."
It's a simple rule but a good one. Sadly, doesn't seem to be adhered to much in our society.
"I think that taking the position that fat folks shouldn't be hated because they can't help being fat misses the point. Fat people shouldn't be hated because body size should not be grounds for treating people like sick, stupid, lazy-ass, second-class citizens."
Well said, Miz B! You are exactly right, and so is beakergirl, who said: " I would also observe that hating fat people is wrong because fat people are, you know, PEOPLE."