Disordered Eating--- and how we perpetuate it.
“We often prescribe for the overweight what we would diagnose in the underweight”
** Trigger Warning: this post may be triggering for those who have been labeled underweight, anorexic, obese, or have been on restrictive diets before.
** This post is targeted at healthcare professionals.
This quote (I don’t know if it is verbatim or even who to attribute it to) has stuck with me every day since I heard it. And every time it pops back in to my head, I reevaluate my words and actions, especially in my workspace. It plainly describes how we demonize, criticize, and diagnose all who don’t fit a very narrow definition of normal. I see patients on all sides of this argument daily:
the “underweight” or overrestricted or potentially mal or undernourished
the “obese” or fat or over nourished
the barely “overweight” but desperate to change
What I see is that these lines blur - I see women who are labelled obese, who are so desperate to lose weight that they underconsume so much, they end of with muscle wasting and still only lose 5 pounds.
I have seen underweight men who are so desperate to gain weight that they eat themselves into diabetes and heart disease. All without a history of restrictive eating or diagnosis of eating disorder or family history of hyperlipidemia.
We need to stop shaming, blaming, and labeling people. We need to stop analyzing the size and shape of people’s bodies - especially when there are no objective numbers to back it up. AND there are NO objective numbers when you take into account changes in biochemistry.
We, as a medical community, blame, shame, and ignore complaints of those who are in different sized bodies most of the time, so much so that larger bodied individuals leave our offices in one of twos states. One: feeling powerless and blamed for any ache, pain, or change in energy. Or two, pissed off. Pissed that they came to you, a professional, and you dismissed their months’ long ordeal as a weight problem. Yes, weight may be an exacerbating factor, but it did not cause their problem overnight. Losing weight, especially quickly, unhealthily, and unsustainably, is certainly not going to fix it overnight. SO, while we might bring up the subject of stress on the body over time, it does NO good to blame and shame and ignore the issue. If we catch it early, really press for lifestyle adjustment and REFER out to someone who can walk by their side through those changes. If we catch it later, blame and shame still has no place, we focus on how we move forward and really impress that we can reverse or at least halt progression of most lifestyle related conditions.
And for all that is good, DO NOT blame and shame someone for a condition that is hereditary. Even diseases worsened by lifestyle (I am looking at you diabetes and hyperlipidemia) because how we grow up is how we live if we are not given the tools to change it. There is no room for questioning a person's weight or habits, especially if we have not given them the chance and the tools to change them.
We allow ourselves, society, and our own patients to feel so poorly about themselves that they feel powerless and give up on their goals, or worse, give them some shoddy advice and allow them to overrestrict their intake to the point of illness.
What does it take for us to take responsibility for the actions we take that allow for the perpetuation of BMI as the standard of health?
We can, gently, guide our patients toward their goals, including weight loss if so desired, by providing weight neutral, sound advice and resources that allow for a slow, steady change in health status. Looking instead of at weight, at blood pressure, blood sugar, lipid levels, and fitness. A patient’s ability to do all the things they want to do in life should be the gold standard, not their weight.