A recent Facebook post from a fellow physician triggered such an emotional response from me, I felt compelled to share my thoughts with you as I was yet again reminded how pervasive weight discrimination and fat shaming is in our culture, even within medical circles.
Her post stated that “40% of Americans are considered obese” and in the caption she talked about how she learned this statistic while doing some continuing medical education. Horrified at reading this, I want to take the opportunity today to highlight the harmful implications of using such labels, and not allowing for health at every size. I am also examining my own personal feelings about my place in this in the hope I can strive for more courage in addressing such beliefs amongst my colleagues.
The harmful impact of BMI
Obesity is most probably being defined here by BMI because that is how we define it in the medical world. I have previously highlighted the issues with using BMI as a determinant of health, and in recent weeks, the American Medical Association even released a statement encouraging physicians to reconsider how they’re using BMI because of its history and the racial implications involved.
In 1998, the U.S. National Institutes of Health brought U.S. definitions in line with World Health Organization guidelines, lowering the normal/overweight cut-off from a BMI of 27.8 (men) and 27.3 (women) to a BMI of 25. So thousands of people went to bed with a normal weight one day and woke up overweight the next. This is a perfect example of just how arbitrary this number actually is, and yet this is how we classify people according to their weight.
Now someone has decided that 40% of Americans and North Americans are obese according to this particular measurement.
Are implications of having a label like this harmful? Yes. Here’s why:
- Particularly in terms of the medical system, there are some implicit biases at play when it comes to healthcare providers. We know from studies that have interviewed healthcare providers about their perceptions of people who are obese, that they believe they are lazy, unmotivated, undisciplined, etc. And so your healthcare providers are already unfairly characterizing you based on your BMI classification.
- Sometimes medical procedures and surgeries will be withheld from people who are classified as obese because they think that the complication rate will be higher. Or there may be other perceived negative associations with this, even if the science shows that it’s not there. We know that it is very pervasive in medical culture. A study published in the last few weeks showed that people who are overweight and obese do not have any worse outcomes after orthopedic surgeries, yet many people with obesity are denied hip replacements, knee replacements etc. on the basis of their BMI.
Prescribing weight loss as an intervention
It has been shown that that yo-yo dieting or diet cycling as we call it in medical terms, where you go through repeated cycles of losing weight and gaining weight, is actually more detrimental to your health and more associated with the chronic diseases that we traditionally associate with obesity (diabetes, cardiovascular disease, certain cancers, dementia, etc.).
Despite this, the vast majority of the studies done do not take that into consideration. Therefore what we see is an association between apparent obesity and risk for these diseases, but no causation. And when you tease out the details a little further, we don’t see that it is your weight that carries the risk, rather the weight cycling.
And so if we know that prescribing weight loss as an intervention is most likely to fail, that means we’re going to contribute to weight cycling and actually put patients at higher risk because of it. This is one of the biggest reasons why I am so fundamentally opposed to prescribing weight loss as an intervention.
Weight does also not necessarily predict how healthy you are. Peter Attia recently revealed that up to a third of people who meet the BMI criteria for obesity are metabolically healthy and their life expectancy is the same as a lean person.
Just a year ago I was coaching weight loss and actually contributing to the problem by encouraging women to lose weight. I was just doing it all wrapped up in lifestyle changes – but the goal of it was to shrink people’s bodies so that they could have all of these other things that they wanted for themselves. Because of that, I know exactly where the physician who posted this was coming from, as well as all of the physicians who responded to her.
Therefore I do have some empathy here because the sad fact is that doctors, including myself, are educated, trained, and raised in the same diet culture that everybody else. And so we get the same messages through media, social media, friends, and family as everyone else. Plus, we also get the messages inside diet culture within the medical curriculum as well. That means we’re not immune to any of this, but it is our responsibility to think critically about this topic, to examine the literature on our own, and to not just automatically believe what everybody tells us.
I hope through sharing my point of view, I can encourage other physicians to at least think twice about this issue, read the literature on their own, and inform some of their own opinions around the topic of obesity.
Are you interested in discovering the 3-step process that helps women escape diet culture and find health, joy and confidence at ANY size? Check out the Food Freedom Formula in my FREE online masterclass here.