Obesity, we are told, is a personal failing that strains our health care system, shrinks our GDP and saps our military strength. It is also an excuse to bully fat people in one sentence and then inform them in the next that you are doing it for their own good. Nearly half of 3- to 6- year old girls say they worry about being fat. The emotional costs are incalculable. I have never written a story where so many of my sources cried during interviews, where they double- and triple-checked that I would not reveal their names, where they shook with anger describing their interactions with doctors and strangers and their own families.
My interest in this issue is slightly more than journalistic. Last year, for the first time, we talked about her weight in detail. For 60 years, doctors and researchers have known two things that could have improved, or even saved, millions of lives. The first is that diets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets. Since , research has shown that 95 to 98 percent of attempts to lose weight fail and that two-thirds of dieters gain back more than they lost.
The reasons are biological and irreversible. As early as , research showed that losing just 3 percent of your body weight resulted in a 17 percent slowdown in your metabolism—a body-wide starvation response that blasts you with hunger hormones and drops your internal temperature until you rise back to your highest weight.
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The second big lesson the medical establishment has learned and rejected over and over again is that weight and health are not perfect synonyms. Yes, nearly every population-level study finds that fat people have worse cardiovascular health than thin people. But individuals are not averages: Studies have found that anywhere from one-third to three-quarters of people classified as obese are metabolically healthy. They show no signs of elevated blood pressure, insulin resistance or high cholesterol.
Habits, no matter your size, are what really matter. But we still have a chance to become a healthier one. This is Corissa Enneking at her lightest: She wakes up, showers and smokes a cigarette to keep her appetite down. She drives to her job at a furniture store, she stands in four-inch heels all day, she eats a cup of yogurt alone in her car on her lunch break. After work, lightheaded, her feet throbbing, she counts out three Ritz crackers, eats them at her kitchen counter and writes down the calories in her food journal. Or not. Some days she comes home and goes straight to bed, exhausted and dizzy from hunger, shivering in the Kansas heat.
She rouses herself around dinnertime and drinks some orange juice or eats half a granola bar. The last time she lived like this, a few years ago, her mother marched her to the hospital. Crew, still got unsolicited diet advice from colleagues and customers. She was hungry all the time, but she was learning to like it. When she did eat, she got panic attacks. Her boss was starting to notice her erratic behavior. She could add a few hundred calories to her diet. Her period would come back. She would stay small, but without as much effort. And my doctor was congratulating me. But for fat people, they are a source of unique and persistent trauma.
This phenomenon is not merely anecdotal. Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. In one study , researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice.
Some of these doctors are simply applying the same presumptions as the society around them. Other physicians sincerely believe that shaming fat people is the best way to motivate them to lose weight. In a journal article , bioethicist Daniel Callahan argued for more stigma against fat people. Shame helped him kick his cigarette habit, he argues, so it should work for obesity too.
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This belief is cartoonishly out of step with a generation of research into obesity and human behavior. Plus, rather obviously, smoking is a behavior; being fat is not. Jody Dushay, an endocrinologist and obesity specialist at Beth Israel Deaconess Medical Center in Boston, says most of her patients have tried dozens of diets and have lost and regained hundreds of pounds before they come to her. Telling them to try again, but in harsher terms, only sets them up to fail and then blame themselves. Not all physicians set out to denigrate their fat patients, of course; some of them do damage because of subtler, more unconscious biases.
According to several studies , thin doctors are more confident in their recommendations, expect their patients to lose more weight and are more likely to think dieting is easy. Sarah not her real name , a tech CEO in New England, once told her doctor that she was having trouble eating less throughout the day.
Then there are the glaring cultural differences. When Joy Cox, an academic in New Jersey, was 16, she went to the hospital with stomach pains. Many of the financial and administrative structures doctors work within help reinforce this bad behavior. The problem starts in medical school, where, according to a survey , students receive an average of just 19 hours of nutrition education over four years of instruction—five hours fewer than they got in Then the trouble compounds once doctors get into daily practice.
Primary care physicians only get 15 minutes for each appointment, barely enough time to ask patients what they ate today, much less during all the years leading up to it. Failing to do that could result in poor performance reviews, low ratings from insurance companies or being denied reimbursement if they refer patients to specialized care.
Another issue, says Kimberly Gudzune, an obesity specialist at Johns Hopkins, is that many doctors, no matter their specialty, think weight falls under their authority. Gudzune often spends months working with patients to set realistic goals—playing with their grandkids longer, going off a cholesterol medication—only to have other doctors threaten it all. One of her patients was making significant progress until she went to a cardiologist who told her to lose pounds. And so, working within a system that neither trains nor encourages them to meaningfully engage with their higher-weight patients, doctors fall back on recommending fad diets and delivering bland motivational platitudes.
Ron Kirk, an electrician in Boston, says that for years, his doctor's first resort was to put him on some diet he couldn't maintain for more than a few weeks. In a study that recorded interactions with doctors, only 13 percent of patients got any specific plan for diet or exercise and only 5 percent got help arranging a follow-up visit. Should he go on a low-fat diet? Become a vegetarian? Should he do Crossfit?
Should he buy a fucking ThighMaster? Instead of a conversation, I got a sound bite. It felt like shaming me was the entire purpose. All of this makes higher-weight patients more likely to avoid doctors.
Three separate studies have found that fat women are more likely to die from breast and cervical cancers than non-fat women, a result partially attributed to their reluctance to see doctors and get screenings. Erin Harrop, a researcher at the University of Washington, studies higher-weight women with anorexia, who, contrary to the size-zero stereotype of most media depictions, are twice as likely to report vomiting, using laxatives and abusing diet pills.
Thin women, Harrop discovered, take around three years to get into treatment, while her participants spent an average of 13 and a half years waiting for their disorders to be addressed. The rest of it, she says, is helping them heal from the trauma of interacting with everyone else. If Sonya ever forgets that she is fat, the world will remind her. Rintrah , 20 October UTC. The article is becoming a work of self-indulgence by female gender rights activism. It is already 3 times the length of the Man article and is full of connotation and innuendo which stretches credibility of the article and its neutrality.
Case in point: "It is commonly accepted that the reason both men and women have breasts is that the rudimentary form of animals was female for millions of years. It is a broad claim on gender origins on the entire Kingdom of Animalia, lacking scientific pretext. Furthermore, the quality of both articles is very poor, with statements such as "the breast is an enlarged sweat gland" working to degrade the quality of the woman article.
The majority of the article is unneccesary and focuses on arguments of sexism, which, while an important side note for the article - is not the main focus of the article itself. Furthermore, I would like to point out to whomever added these ridiculous, unscientific and biased claims: you are suggesting that males evolved from females as a standard.
This implies that males are more evolved, is that your true belief? Perhaps that illustrates the need to remain objective and scientific here, despite all your beliefs and urges to the contrary. You do yourselves a disservice by detracting from the credibility and value of this article. C00kiemnstr , 31 October UTC.
Why don't you try to improve the article? Complaining about it won't make it any better and I'm interested to see what you could contribute.
Already have , 1 November Since the disscussion page directly bears on the content and future actions taken upon the article, me writing my concerns here should help to improve the article, at least indirectly. Thanks for complaining about my complaints though. C00kiemnstr , 3 November UTC. I agree, much of this article is terible. I have replaced "and today, using the word, girl, to refer to grown women in most social settings and the workplace as in office girl typically is considered inappropriate and denigrating in the United States and United Kingdom because it implies a view of women as infantile, having a parallel in the use of the term "boy" for black men to deny their adult status in racist communities.
It is sometimes stated that the use remains commonplace in several other English-speaking countries, without such implications, but research regarding that is lacking.
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This shows an incredible application of double standards, re need for research or citations not to mention an at best spurious parallel.