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News, views, & musings from Peggy Elam, Ph.D. │ September 17, 2004 |
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A long habit of not thinking
a thing wrong gives it a superficial appearance |
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The Larger Picture I learned something disturbing recently: The city of Nashville, TN, where I live and work, promotes surgically induced eating disorders. Your city or town may, too. Nashville, along with dozens of other communities across America, is the site of the second annual “Walk from Obesity” this Saturday, September 18. Like many other such walks and races, it’s a fundraiser. But instead of raising money to fight breast cancer or multiple sclerosis or other illnesses, this fundraiser is designed to raise money to create a medical condition — the artificial condition resulting from bariatric surgery, commonly known as weight loss surgery (WLS). In these surgeries, healthy stomachs are amputated or sectioned off by banding, intestines are cut and portions are removed and re-routed. Those who undergo these surgeries can never eat normally again and cannot absorb enough nutrients from what they are able to eat, so nutritional supplements will always be necessary. Even with supplementation, nutritional deficiencies such as beri-beri — with its risk of permanent neurological damage — can and do occur. If bariatric surgery patients eat more than their surgically altered gastrointestinal tracts can handle, which means more than a few ounces at a time, or eat certain foods, they may vomit or have diarrhea. You think I’m being cynical in calling the outcome of WLS “surgically induced eating disorders?” Well, I first saw the term used proudly (or at least without embarrassment) by the physician inventor of one of these procedures. But that figures. In our culture, being fat is so reprehensible that “treating” it by encouraging eating disordered ideation and behavior (in the name of dieting and other preoccupation with food, eating, exercise, and weight) is seen as the lesser of two evils, when it’s seen as an evil at all. So why not go flat-out and intentionally create an eating disorder to get the desired outcome? Advocates of WLS will say that such procedures are done in the pursuit of health. They cite figures about “obesity” and mortality that have become a new urban (and scientific) myth: 300,000 people a year die “from obesity.” Wait, now it’s 400,000! Never mind that the studies and journal articles from which these figures are plucked have been criticized as flawed and their results misinterpreted (sometimes, interestingly, by the original researchers and authors themselves). See Glen Gaesser, Ph.D.’s Big Fat Lies: The Truth About Your Weight and Your Health and Paul Campos’s The Obesity Myth for good discussions of the problems with these statistics. And about that "pursuit of health": As a psychologist and psychotherapist who has worked with eating disordered individuals for many years, and as a woman — and girl — who spent decades viewing her own body fat as something to be exorcised, I can tell you from both personal and professional experience that many people would rather be dead than fat. Often, any risk is considered acceptable so long as the desired state of thinness (or less-fatness) is obtained even temporarily, as is so often the case. “Show me a woman who wants to lose weight for her health,” Boston Globe columnist Ellen Goodman wrote several years ago, “and I’ll show you a man who buys Playboy just to read the interview.” Weight loss surgery is being widely promoted to adults and adolescents even though the long-term effects are not known. What is known is that many of these surgical patients gain back some or all of the weight they lose, and 1 in 200 die either during or shortly after the surgery. I’ve heard death rates as high as 2 percent within 30 days. (For more information on the risks, and personal accounts of survivors of such surgeries, see The Other Side of Weight Loss, a webpage maintained by psychotherapist and fitness professional Kelly Bliss. She also maintains a companion page of Alternatives to Weight Loss Surgery.) Yes, it is true that some researchers have reported improvements in diabetes and other health risks in some WLS patients. But those improvements apparently come from the changes in diet forced by the surgery, as well as the recommended exercise and other physical training/rehabilitation, not from the weight (or fat) loss itself. Just removing fat from a body does not change its health status for the better, as a recent study has shown. When insulin sensitivity, blood glucose levels, blood pressure and other health indicators were measured in a small group of fat women (both with and without diabetes) before and after liposuction, the researchers found NO significant changes in health indicators as a result of the surgery. This, even though the cosmetic surgery resulted in an average 44 percent reduction in subcutaneous abdominal fat among the women without diabetes and a 28 percent reduction in the women with diabetes. (See the June 17, 2004 issue of The New England Journal of Medicine for the report of this study.) Losing weight (or fat, even particularly demonized subcutaneous abdominal fat), does not improve health. But good nutrition and exercise do. So why not skip the weight loss focus and simply encourage healthy behaviors independent of weight? That's the message in a growing movement among health professionals called "Health At Every Size." The organizations sponsoring the “Walk From Obesity,” including “Healthy Nashville 2010” and the mayor’s office, may actually believe that event is “designed to reduce disability, death, and discrimination of people who are obese by educating the public and healthcare professionals about effective treatments,” as the event’s website says. (I’m not going to give you the URL because I don’t want to promote the event any more than I already may be in writing about it.) But their stated intention makes about as much sense as a plan to reduce anti-Semitism by converting Jews to Christianity. These guys don’t even “get it” that the use of the word “obesity” itself perpetuates stigma by labeling fat people as abnormal, even diseased, simply because of their size, weight, mass, or body composition. Try inserting the name of another stigmatized group in the title of this event and see what message that evokes. “Walk from African Americans?” “Walk from Blackness?” “Walk from Hispanics?” “Walk from Brownness?” “Walk from Homosexuality?” “Walk from Jews?” Repeat those phrases in your mind and what do you see? A bunch of white supremacists who want everyone in America to look and think and believe like they do. The sponsors of and participants in the “Walk from Obesity” may think they’re promoting health, but what they’re really promoting is “thin supremacy,” and all the ugliness that implies. Weight loss and weight control have become a religion in America. The best-selling categories of books after the Bible are diet books and cookbooks, and there's often overlap between the latter two categories. Sometimes all three. But like many religions or cults, the messages are personally disempowering. They tend to keep people focused on the external rather than the internal — much less the eternal — by encouraging fear of social rejection, illness, and/or death if weight exceeds specified limits. The end result isn’t better health, but body dissatisfaction, eating disorders, yo-yo dieting and weight loss/regain (officially called “weight cycling,” more dangerous than maintaining a stable “over” weight). And, all too often, shame and despair at not living up to societal ideals that masquerade as medical prescriptions. There is a campaign underway that trumpets this religion with missionary zeal not only throughout America but, increasingly, the rest of the world. The immediate goal appears to be to convince people that they are sick because of their size, with the ultimate goal being to sell them “treatment” for that sickness in the form of diet products and programs, drugs, and surgery. Sometimes the message is tweaked to preach — and sell — “treatment” to prevent the “disease” from occurring, so they get you coming and going: Whether you’re fat now or not, you could be. Horrors. The campaign has a name: "The war on obesity." Many fat people I know (including, at times, me) feel the war is directed at their very being. How else to interpret the use of a word (“obesity”) that implies bodies are diseased simply because of their weight, mass, or composition, regardless of whether any true medical condition (high blood pressure, atherosclerosis, diabetes, etc.) exists in them? (By the way, did you know that there is no association between fat-clogged arteries and the amount of body fat a person has? See Gaesser's book for even more misconceptions and myth-busting about weight/fat and health.) Those who are most active in declaring "an epidemic of obesity" preach that this sickness can be treated with — my, my, how convenient — what they are selling: diet products and programs, drugs, and surgery. Perhaps less active but still instrumental in this campaign are the scientists and professionals in various fields whose funding and thus livelihood depend on their research into the supposed illness and its "cure." Never mind that weight-loss efforts usually don’t work in the long run (or, often, the short run) and can even make things worse. Americans have been dieting en masse for decades, and guess what? We are all, as a whole, even fatter. In large part, no doubt, because almost everyone who loses weight through dieting or other such efforts eventually gains it back, and often more. And, often, what’s regained is proportionately more fat than lean tissue. Among therapists there’s a tongue-in-cheek definition of “insanity” as the act of keeping on doing the same thing while expecting different results. With that in mind (and my own tongue in cheek), I ask anyone who still pursues or recommends weight loss: “Are you nuts?” Paul Campos, author of The Obesity Myth, has commented that P.T. Barnum must be spinning in his grave in frustration that he can’t get in on the weight-loss scam. Convince people they’re sick and socially deficient and sell them products or programs that will supposedly cure what ails them, or at least keep it in check. And when the products or programs don’t work or even backfire, blame the consumer, not the product! How delicious. The U.S. is currently trying to export its obsession with weight to the rest of the world through the World Health Organization by declaring a "global obesity" crisis. Most if not all of the "experts" behind this campaign, and its U.S. counterpart, are physicians and research scientists who run weight-loss clinics and conduct government- and pharmaceutical-industry-funded research on weight loss. Their solution to the so-called “obesity crisis” (which has largely been manufactured through statistical sleight-of-hand, misinterpretation of research, and media spin, not to mention the actual harmful effects of yo-yo-dieting/weight-loss-and-regain cycles) is, of course, diet programs and products, drugs, and surgery. The very things they sell or research. By the way, all the trumpeting about people becoming fat because we're sedentary and eat so much junk food might come as a surprise to the inhabitants of Burkina Faso, apparently one of the poorest — and fattest — countries in the world, where there is NOT a Seven-Eleven or its convenience-food equivalent on every street corner. Their "obesity" rate is more likely related to semi-starvation and poverty, including the long-term effects of maternal nutrition deprivation upon fetal development. Children whose mothers were not adequately nourished during their pregnancies have been found to be fatter, later in life, than children whose mothers were adequately nourished during pregnancy. The deprivation appears to "switch on" mechanisms in the fetus/children to become more efficient at making do with what nutritional fuel they receive. Kind of makes you wonder about all the pregnant women in America who have been encouraged by their physicians to only gain X amount of weight during pregnancy. And it may be one of the reasons poor people in America tend to be, as a whole, fatter than rich people. (That, and the fact that fat people tend to earn less, and are thus poorer, than thinner people — one of the costs of thin supremacy.) Many if not most fat people have tended to internalize the programming of the war on obesity, believing there is something inherently wrong and sick about their bodies because of their size or the amount of fat in them, even if they are otherwise healthy. Those who aren’t actually fat, or that fat, are encouraged to fear and stridently guard against becoming fat or fatter. The internalization of such messages has not only contributed to eating disorders and depression but, in some cases, to suicide: Some fat children have killed themselves because they could no longer face the teasing, bullying, and rejection of their peers. And yet some people see the solution to the pain and prejudice fat kids experience among thin supremacists as being boarding schools and camps for fat kids in which meals are monitored, eating is externally structured, and exercise is pushed for weight control rather than any intrinsic joy of movement. Hello? What can we do to counteract this madness? Fat activists in some cities have organized Sept. 18 protests against those whom they call “stomach thieves.” But whether you participate in a protest on that day, or another day, or not, let’s spend Sept. 18 and every other day celebrating the wondrous creations that are our bodies. Yes, go for a walk! Or dance, or garden, or swim, or skate, or work out, or play at any thing that gives you joy. Be active — moving, stretching and strengthening your body in a way you enjoy will help you feel better and have more energy and, yes, be healthier, no matter what you weigh. Eat well — good food and drink are your body’s fuel, but their enjoyment can nourish your spirit, too. Get enough sleep and rest and play — all ways in which our bodies and souls restore themselves. (There’s a reason it’s called recreation — play and leisure time provide opportunities to re-create ourselves.) Today, tomorrow, and all days, let’s walk, dance, work, and/or play to, not from, something: To real health — whole health and well-being, of mind, body and spirit. To respect — ourselves and others, including those who choose to pursue paths (toward weight loss or anything else) we disagree with or even find dangerous. And above all, to love — ourselves and our bodies, including any perceived flaws. After all, we take better care of what we love than what we hate. Peggy Elam, Ph.D |
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Imagine this:
The Thomas Paine quotation at the
beginning of this newsletter
is from Eileen Welsome’s 1999 book, |
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On the Whole is published by Pearlsong Press © 2004 Peggy Elam │ All Rights Reserved |
