August 13, 2010

Reader Poll Update :: The "F" Word

by Ashley Solomon

Did you get a chance to “weigh-in” (pun intended!) in on the debate about the “f” word? If not, check it out here.

I was totally in love with all of the comments offered in the debate. It’s what I love about the world of social media – it opens us up to enriching discussions where we can learn so much from disparate views.

So, as promised, I wanted to offer my own thoughts on this topic. Like many of you, my reactions and opinions shifted somewhat as I thought about the various aspects of this argument. However, the psychologist training in me won out and my opinion came down to answering the question, “What works?”

The problem with providers using the term “fat” to scare people into losing weight to me isn’t as much of an issue of the word, though I’ll get to that in a moment. What it ultimately boils down to for me is that using this word is an attempt to shame individual into losing weight, and we know that shame-based interventions do not work. Unfortunately, the idea of shaming people into action appears on the surface to be fairly easy and effective. However, major behavioral changes, whether individual or cultural, do not develop due to shame. As some of you pointed out, shaming others often leads them to further into a behavior – because shame generates fear and fear makes us retract in the behaviors that we know. Just look at how ineffective scare tactics are at reducing things like teen pregnancy or drug use, for instance. So if shame techniques don’t work, there’s no reason for a medical provider to use them.

Now on to the more heartfelt part of my argument. I believe that words have incredible power. While some argue that a word is just a word, I think that most of us can acknowledge that words have immense influence over our thoughts, our feelings, and our conceptualizations of the world. In fact, research on various therapies (there goes my empiricism again, damnit.), such as Acceptance and Commitment Therapy and Narrative Therapy, show us that words help shape our realities. Further, words cannot easily be separated from one another – they are inextricably linked by the connotations in our minds. Regardless of your own lack of biases, the word “fat” has taken on the connotation of “lazy”, “indulgent”, and even “stupid” in our culture. As hard as we may try, we cannot separate the word from the meaning that resonates in our minds. And thus when a provider calls a patient “fat”, (s)he also calls the patient all of these other things. Which is unprofessional, hurtful, and once again, not useful in accomplishing the ultimate goal of pushing the patient toward health.

One more point: A patient may be over what is considered his or her ideal body weight, but that does not necessarily mean the person is unhealthy. A (small) percentage of individuals considered “obese” can be considered metabolically healthy. While it’s likely that someone who is overweight does face medical issues, it’s important to consider the individual in providing care. If the person does face increased risk, then providers should bring up those health concerns. Focusing on weight, rather than health, often leads to “dieting” rather than lifestyle changes, and we know DIETING DOESN’T WORK!

So those are my thoughts. Thanks to everyone for weighing in, and please continue to do so below. Disagree with me, please! I’d love to hear more on this…

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August 13, 2010

Reader Poll Update :: The “F” Word

by Ashley Solomon

Did you get a chance to “weigh-in” (pun intended!) in on the debate about the “f” word? If not, check it out here.

I was totally in love with all of the comments offered in the debate. It’s what I love about the world of social media – it opens us up to enriching discussions where we can learn so much from disparate views.

So, as promised, I wanted to offer my own thoughts on this topic. Like many of you, my reactions and opinions shifted somewhat as I thought about the various aspects of this argument. However, the psychologist training in me won out and my opinion came down to answering the question, “What works?”

The problem with providers using the term “fat” to scare people into losing weight to me isn’t as much of an issue of the word, though I’ll get to that in a moment. What it ultimately boils down to for me is that using this word is an attempt to shame individual into losing weight, and we know that shame-based interventions do not work. Unfortunately, the idea of shaming people into action appears on the surface to be fairly easy and effective. However, major behavioral changes, whether individual or cultural, do not develop due to shame. As some of you pointed out, shaming others often leads them to further into a behavior – because shame generates fear and fear makes us retract in the behaviors that we know. Just look at how ineffective scare tactics are at reducing things like teen pregnancy or drug use, for instance. So if shame techniques don’t work, there’s no reason for a medical provider to use them.

Now on to the more heartfelt part of my argument. I believe that words have incredible power. While some argue that a word is just a word, I think that most of us can acknowledge that words have immense influence over our thoughts, our feelings, and our conceptualizations of the world. In fact, research on various therapies (there goes my empiricism again, damnit.), such as Acceptance and Commitment Therapy and Narrative Therapy, show us that words help shape our realities. Further, words cannot easily be separated from one another – they are inextricably linked by the connotations in our minds. Regardless of your own lack of biases, the word “fat” has taken on the connotation of “lazy”, “indulgent”, and even “stupid” in our culture. As hard as we may try, we cannot separate the word from the meaning that resonates in our minds. And thus when a provider calls a patient “fat”, (s)he also calls the patient all of these other things. Which is unprofessional, hurtful, and once again, not useful in accomplishing the ultimate goal of pushing the patient toward health.

One more point: A patient may be over what is considered his or her ideal body weight, but that does not necessarily mean the person is unhealthy. A (small) percentage of individuals considered “obese” can be considered metabolically healthy. While it’s likely that someone who is overweight does face medical issues, it’s important to consider the individual in providing care. If the person does face increased risk, then providers should bring up those health concerns. Focusing on weight, rather than health, often leads to “dieting” rather than lifestyle changes, and we know DIETING DOESN’T WORK!

So those are my thoughts. Thanks to everyone for weighing in, and please continue to do so below. Disagree with me, please! I’d love to hear more on this…

August 12, 2010

Reader Poll :: The "F" Word

by Ashley Solomon

Wow, this is a somewhat unusual week on this blog! Guest posting, my “regular” posts, and now a poll!

Quick and dirty reader polls are something I’ve considered doing on this blog, but haven’t put into action up to this point. However, a post came across the Academy of Eating Disorders listserv this morning, causing a lot of ruckus (AED members are a feisty bunch!), and I think you’ll see why. I knew it was the time to start the polling…

I’m posting here just the beginning of a longer article by Daniel Martin of the Britain’s The Daily Mail:

Doctors should stop mincing their words and tell the overweight they are fat, the public health minister has said.

Anne Milton called on the NHS to ban terms such as ‘obese’, because they do not have the same emotional impact.

The former nurse said larger people were less likely to bother to try to lose weight if they were told they were obese or overweight than if the doctor was blunt and said they were ‘fat’. But health experts argued against such plain speaking because they fear it could stigmatise overweight people.

You can read more here, but share you own opinion first!

Unlike my usual posts in which I offer to my readers my at times boisterous opinion,  in a Reader Poll I’d like to get your opinion (while I stealthily formulate mine in the background!). But don’t worry – you can count on me to offer mine as well! I would just like to hear your thoughts without my “loud” influence. Hopefully this will generate not just very unscientific survey results, but a discussion on some controversial issues.

So here’s the poll:


But don’t stop there! Make sure you leave your thoughts and reactions below in the comments section. I know that some of you have something to say on this!

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