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One Size Does Not Fit All!



by Susan Fekety, RN, MSN, CNM



The obesity epidemic is big news lately. Gastric bypass surgery is a growth industry and everyone's getting diabetes. Are we just a bunch of lazy slackers with a giant bag of donuts resting on our beer guts while we watch TV and practice denial? Guess what – there's more to it than that! Here are some pieces of the puzzle you might not have noticed.

First, our overall thinking about obesity needs serious updating. Medical science has historically not focused on nutrition and many practitioners were taught nothing about nutrition in their training.

What they did learn was provided courtesy of the agriculture and food marketing industries, and many of us are still playing those tapes. As a result, truisms like "a calorie is a calorie," "cut fat," and "eat less" are starting to look like simplistic nutritional fairy tales. Since we began our war on fat about 30 years ago, fat intake has decreased from 45 to 34 per cent of calories. American women consume around 1800 calories a day, though the recommended average is 2200 calories. So how can we be getting fatter?

Here's what I see – it's about quality. We're eating more processed and manufactured "empty calorie" foods than ever before. In the zeal to cut fat, we've loaded up on sugars, and are short on the essential fats our brains and hormone systems need. When we're missing fats, our clever body stockpiles them, just like it turns down our energy level when we don't eat enough to sustain activity.

Another disturbing trend is that fat discrimination in health facilities constitutes a health risk for people who are overweight. Yale researchers found that many health practitioners, especially those in weight-loss medicine (!), had very high disdain for fat people. Fat women tell me about rude comments being overheard, of needed treatments being deferred or ignored while a lecture about overweight was given, and about the inhospitable nature of many health facilities: flimsy chairs, improperly-sized equipment, too-small gowns, public weighing areas. I often wonder if this is the source of some of the health disparities we see for obese people. Projection about character flaws (fat people are lazy, stupid, lack willpower, etc.) perpetuates the cycle of shame that keeps fat people stuck and makes them avoid the health care system altogether. We would not tolerate this level of insensitivity towards a racial or religious group (would we?)

This especially matters because modern thinking about weight has finally recognized the role of emotional stress in body composition. Stress raises cortisol and other adrenal hormones which disrupt normal metabolism, make you store fat, decrease lean body mass and bone density, lower resistance to infection, and increase appetite. We have research that shows that calorie-restricted diets trigger production of stress hormones – it scares your body to starve it! Conventional weight-loss diets restrict calories to levels that would qualify as semi-starvation if it were the daily intake for someone in a third world country; we would be petitioning the UN to send supplemental food to anyone who had this little per day. Plus, so many diets make us children again: "good" and "bad" foods, "cheating" and "failure" come to mind. We recommend behavior to fat people (compulsive calorie counting, food journals, compensatory exercise, etc) that we would consider eating disordered in thinner ones: more stress.

It's the mind-body connection that most interests me in my work with women of size, because size discrimination comes from the inside and the outside. Tasty food, fun physical activity, self-expression, friends and loved ones are elements of a good life no matter what your body size. I often recommend food approaches that start with balancing food groups, not limiting quantities, having three meals and two snacks, and setting a lower threshold of calories not to go below. Sometimes it freaks women out to be given permission to eat. Aside from the stressful effects of feeling lousy about yourself, body hate and shame can make people stop exercising. But it looks like activity level is more important than weight in predicting how long you'll live – so anything that keeps you from moving is a health hazard. (Start small – go for a walk with a friend. Skip anything that involves spandex or someone yelling instructions at you.)

So here's a final thought: maybe people are supposed to be like flowers, or breeds of dogs, not figures on a weight chart. If you're supposed to have the body composition of a Saint Bernard, you'll make yourself sick trying to look like a whippet (and vice versa.) Give yourself permission to eat nutritious high-quality food, and see what makes you feel good. Practice weight neutrality – don't make compliments about body size, or make assumptions about personality based on body composition. Don't buy into magical thinking that life will be better when you're thin – you'll still be you. If you're looking for healthy approach to the obesity epidemic – feed your soul FIRST.




Article © Copyright 2004 by Susan Fekety. All rights reserved worldwide. Duplication or reprints only with express permission of the author or, for a nonprofit purpose, without consent so long as the author's name and contact information are included as follows: "Reproduced with permission from Susan Fekety," These articles are provided for informational purposes only. Their content is not meant to substitute for the advice provided by your own health care professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect you have a medical problem promptly contact your health care provider.




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