Wednesday, April 21, 2010

Critical Obesity- Guest Post



I've been meaning to blog about 'critical obesity' forever- but just haven't been able to find time. However, a classmate of mine, Nicole Bergen, wrote a great article on the topic, for her journalism class. It's such a well-written piece that offers a great overview of the subject, and I'm so happy she gave me permission to post part of it for you to read.

Great job, Nicki!


Sara can hardly remember a time when she wasn’t concerned about her weight. Since the age of 16, she has experimented with Weight Watchers, appetite-suppressant pills, restrictive diets and arduous exercise routines. The now-24-year-old teacher consulted a number of medical doctors for weight advice, but grew increasingly disheartened with their approach. “They were putting it on me that I was lazy or that I got this way because I never exercise or have unhealthy habits, “ Sara said. “They told me what an optimal [weight] goal would be, but didn’t offer any new insight on how to get there.”

Dr. Arya Sharma, a Professor of Medicine and obesity researcher at the University of Alberta agrees that the medical profession may not be adequately prepared to offer constructive weight-loss advice. “Not all health care providers are trained to assess and treat obesity,” he said.

The current Canadian Clinical Practice Guidelines for Obesity define overweight and obese according to a patient’s height and weight, using a measurement known as BMI (body mass index). For most overweight patients, the guidelines emphasize weight loss through diet and exercise therapy. Sara said that she spent only about 10 minutes discussing healthy lifestyle choices with her doctor.

This type of approach is almost certain to fail as a weight-loss treatment. Studies from a variety of regions and populations repeatedly log success rates of less than five per cent. In a 2007 edition of the

Journal of the American Dietetic Association, the combined results from 80 scientific reports concluded that advice-based weight-loss attempts produced minimal results, both initially and in the long-term.

A little unsettling for a nation with no shortage of overweight and obese people trying to lose weight.

Lucy Aphramor, a dietitian and obesity researcher in the UK, questioned the ethics of recommending weight-loss treatments that have such resounding failure rates. In 2005 she wrote “The reality is that we do not have an effective weight-loss treatment to recommend.”

Societal demonization of fatness may be fuelling an obsession with thinness. Motivation to lose weight has extended beyond health concerns, to a pursuit for social acceptance. And, according to Sharma, this is an important distinction. It usually takes only a small amount of weight loss to see significant health benefits; the process of achieving a desired body type, however, requires more effort.

“Managing expectations is a big part of making weight goals,” Sharma said. “It is never a good idea to use optimism as motivation or set someone up for failure.”

When Sara’s doctor provided unhelpful advice, she joined a gym and began weekly sessions with a nutritionist and personal trainer. “They probably spent about three hours catering a diet to my specific needs,” she said. “I have polycystic ovarian syndrome, and when I first approached them they didn’t know a lot about it. They did some research and developed a good understanding.” Sara is confident in the advice that she receives at the gym, and has met some of her goals.

After working in the weight-loss industry, Mabel Pang-Bishop has changed her views about weight-loss treatment. Pang-Bishop sold meal supplements for a commercial weight-loss program for two years, and then realized that she had become part of the problem. “We marketed a program that was very restrictive and claimed to be a safer alternative,” she said. “But the program is structured for people to fail. There were some successes, but mostly yo-yoing. Our customers saw themselves as failures in their weight-loss goals and therefore failures in life.”

Now, Pang-Bishop is a graduate student at the Ryerson School of Nutrition, studying an emerging field she calls ‘critical obesity studies.’ A critical perspective on obesity promotes health at every size, and looks beyond diet and exercise to broader, social determinants of health and social justice. “I knew there was something more to weight loss than energy in and energy out,” she said. “Why do we accept ideas without questioning them? It is important to be aware that there’s more out there.”