healthateverysizeblog

September 27, 2011

the HAES files: when health speech is hate speech

by healthateverysizeblog

Can you support people’s health while rejecting their bodies?

The public health authorities seem to think so. Calls for the “prevention and elimination” of “obesity” are coming at us at unprecedented rates. Fatness – that is, fat people – are being blamed for just about everything vexing about modern life. Even the public health programs that acknowledge weight stigma don’t acknowledge their own stigmatizing messages. Fat people are told to solve the problem of weight bias, bullying, discrimination, and violence by disappearing.

And many fat people are trying to disappear. In fact, people of all sizes are trying to disappear. The quest for a body that can disappear – disappear from the view of the stigmatizers – fuels a $60 billion weight loss industry. Americans are spending more money every year on trying to disappear than we spend on college. It must be pretty damned important to us.

But no, the public health authorities protest, we are not trying to get rid of you, we are trying to get rid of your disease. You know, your FAT.

Ah, but there is the problem, isn’t it? Because fat is not a germ, fat is not a tumor, fat is not a parasite. Fat is an intrinsic and essential part of our human bodies.

But no, the public health authorities protest, we are not trying to get rid of all of your fat, just the “too muchness.”

Ah, but there is another problem, isn’t it? Because we can’t decide how much is too much. The public health authorities can decide on an arbitrary BMI, but it fails to predict who will be sick or well. It fails to predict longevity. It even fails to predict how much fat tissue someone has.

But no, the public health authorities protest, it’s fine then to just try to minimize it.

Ah, but there is another problem, isn’t it? Because people who are trying to minimize their fat are actually dying. Their treatment is so expensive that insurers try every tactic not to pay for it. So there really is a “too little” fat problem that begs the question, how much is the right amount? When there are people sick and dying of “too little” and “too much” fat at a wide range of weights, maybe there isn’t a global “right amount” of weight. Maybe it is an individual thing, inherited by each of us from our ancestors who survived a dazzling range of environmental challenges. Maybe we are supposed to be a diverse range of sizes!

BMI is clearly a terrible proxy for health, but is there an “ideal” BMI that keeps a person safe from weight stigma? How much is the right amount of disappearing to keep from being a target of hate? How much of you has to disappear to qualify for insurance without being forced to participate in Weight Watchers at work? To keep you from being called a fatty during “Childhood Obesity Awareness Month”? To prevent a weight loss lecture when you go in to see your doctor for a strep throat? To keep you from being the one the other kids blame because there are no more cupcakes allowed at school? How much of you has to disappear to make sure you can get a knee replacement without having to first mutilate your stomach? To keep your school from sending your parents a failing “BMI report card”? To keep you from worrying that the state will remove your children from your custody?

Disappearing is the road to death, not health. But it can seem like a good idea when your body is a target for the haters. And it is particularly difficult to untangle when the haters claim to be asking you to disappear “for your health.” Not only do people feel the hate, they feel the prohibition on naming it as hate, because it is delivered in the guise of something that is supposed to be good.

Let us remember that we do not talk about “having” fat, we talk about “being” fat. We identify with our bodies, even more than our homes or cars or jobs. When there is a rejection of our bodies, we experience it as the most profound rejection, because we understand that no matter how much weight we lose or plastic surgery we get, we still identify with those original body images. Even weight loss surgery does not reliably make fat people thin people (rather than temporarily-less-fat people), and even while people are thinner they realize they are the same person as before. Listen to the language of the makeover and you hear the relentless drumbeat of, “I am a whole new person!” because in fact, makeovers are fairy tales and we all understand that. “I disappeared myself!” is a fairy tale, not a solution. Disappearing is a death – in fact, a murder.

It is critical for the public health authorities to understand this psychological truth. When you hate fat, you hate a part of a person that they identify with. As a fat person, it is impossible not to perceive the hate in these messages. It is not a health-promoting sentiment. It is a violence that is being done, not just to fat people, but to anyone who has a part of themselves that identifies with fatness. That’s pretty much everyone these days, since fat is loaded with meaning in our culture.

Fat is supposed to represent being ugly, needy, out of control, depressed, vulnerable and so on. Our culture teaches us to relegate these all-too-human feelings to the shadows of our psyches, to strive to be everything that “fat” is not. So people work very hard at not being “fat” - all those virtuous meals and workouts and sacrifices are designed to hold the things we fear at bay. But of course even if today you do not feel ugly, needy, out of control, depressed, and so on, there is still the lurking threat of those feelings emerging tomorrow. And here is the kicker: You are very likely to feel one of those feelings if someone stigmatizes you. You are very likely to “feel fat” if someone rejects or shames you.

So the cycle continues – people being mean to other people, who translate the meanness into a problem with their bodies and blame their bodies. The problem, people, is meanness. The problem is hate.

If you are a public health authority, you have power and you have responsibility. Even if it is the norm for all of us to hate and fear the feelings that are associated with fatness, even if it is the norm to feel pride in a thin body, you need more insight into your own professional and personal beliefs and how they are organized by the cultural and economic forces of your time. You need to understand these beliefs so you will do no harm.

I ask you to stop running from or attacking what you fear. Listen to your public health messages with the ears of your fat loved ones and colleagues. Let them help you to understand how it feels to be hated and threatened. Can you really believe this is healthy for anyone? When you stop trying to make fat people disappear, you might be able to actually have a wonderful conversation about health.

The Health at Every Size® model teases out the hate speech from the health speech. It protests asking people to disappear in the name of “health.” It asserts that people become healthier when they stop living in fear, when they have environments free of hatred, when they can use the energy that was going into the effort to disappear to instead care for the body they were taught to starve, imprison, surgically restrict, or run into the ground. It asserts that people become healthier when they SHOW UP.

It is time for us all to refuse to disappear. Refuse the path of death. Care about, and care for, those who have felt rejected, inside you and outside of you. At any size, at every size, we are worthy. May we all SHOW UP and take our place at the table.

Posted in Deb Burgard | 13 Comments »

September 20, 2011

the HAES files: the cockroach effect

by healthateverysizeblog

by Jon Robison, PhD, MS

In my 25 or so years of being involved in the health field I have witnessed the comings and goings of a multitude of highly acclaimed scientific findings. Over and over again, a new piece of data, often something related to the risk of death or disease will appear in the scientific literature and instantaneously saturate the global media. And over and over again, often not far down the road from the initial announcement, will come another study or number of studies convincingly refuting the original findings. Somehow however, these new studies rarely garner even a fraction of the attention paid to the original, whose conclusions continue to be presented as indisputable fact.

Those of us who have been involved with the Health At Every Size® model over the years are all too familiar with this phenomenon. Remember the 300,000 people killed by obesity statistic that first surfaced in the prestigious (but not infallible) New England Journal of Medicine (NEJM) in 1996? The claim was dredged up incorrectly from a study published a few years earlier in the Journal of The American Medical Association (JAMA). In fact, the authors of this JAMA article published a response to the NEJM article protesting the bogus claim. In addition, the 300,000 number was formally debunked in 2005 by epidemiologists from the CDC. Yet to this day, some 7 years later, this bogus, fear laden statistic is commonly bandied about (and rarely challenged) in the media and at health-related conferences.

And who can forget the our children will be the first generation not to live as long as their parents because of obesity claim made by Olshanski and Ludwig again in the NEJM in 2005. Confronted about the origins and accuracy of their frightening claim just a few months later in an expose in Scientific American the authors responded with “these are just back of the envelope plausible scenarios. We never meant for them to be portrayed as precise.” In spite of this and even though the World Health Organization and The U.S. Social Security Administration have projected that life expectancy will continue to rise in the foreseeable future, this scary piece of non-science is commonly repeated today by health professionals and the lay public as if it were an ”evidence-based” fact of life.

I call this unfortunate and all too common phenomenon The Cockroach Effect. Cockroaches are amazingly resilient little creatures. They can continue to be active after not eating for 30 days. They can survive without air for 45 minutes and they have been known to recover after being underwater for 30 minutes! If you have ever tried to kill a cockroach or get rid of an infestation you know it is no easy task. Neither is trying to erase attention grabbing but faulty health-related claims once they have made their appearance.

The “Cockroach Effect” is certainly not limited to weight-related research. Dr. John Ioannidis has spent his career challenging his peers by exposing the personal biases, economic pressures and downright bad science that plague the medical profession. In a seminal paper in PLoS Medicine online in 2005 he presented a model which predicted correctly that 80% of non-randomized studies, 25% of randomized trials and 10% of large randomized trials were typically refuted by later research. While we expect contradictions as part of science, Ioannidis also found that even when faulty research was debunked, its conclusions typically persisted for years or even decades. The details of his fascinating findings are explored in an article entitled “Lies, Damned Lies and Medical Science” which appeared in the Atlantic Magazine in November 2010.

Sometimes the lingering of these faulty claims is fairly benign. It probably doesn’t hurt to drink 8 glasses of water a day; even though the scientific basis of this recommendation is elusive at best (I am guessing it may have originated with the promotion of drinking more water as a weight loss technique). Sometimes, after enough years have passed and sufficient conflicting evidence has accumulated, the faulty claims actually get laid to rest. This may finally have happened with the if you don’t exercise for at least 30 minutes it won’t do you any good mantra.

But when it comes to issues like weight and health, where there is so much deeply rooted socio-cultural and economic investment in the status quo, it can be quite a different story. We see all too clearly the heartbreaking consequences in the billions of dollars spent on fruitless and sometimes dangerous weight loss schemes and scams and the lives torn apart by disordered eating and weight stigma. My recommendation is that we stay vigilant and be wary of The Cockroach Effect – faulty data that will not die!

Posted in Jon Robison | 4 Comments »

September 13, 2011

the HAES files: put up your dukes – how HAES fought its way to the ADA platform

by healthateverysizeblog

by Linda Bacon, PhD

The American Dietetic Association’s annual Food & Nutrition Conference & Expo—scheduled in San Diego this month—has wide influence on U.S. nutrition education and practices, so you might naturally expect to learn about Health at Every Size® there. To date, though, HAES^SMhas never been the primary topic of an ADA FNCE session. That’s why it comes as major news that conference-goers on September 25 will hear obesity researcher John Foreyt debate HAES advocate Linda Bacon in a session called, “The War on Obesity: A Battle Worth Fighting?” [See a press release about it here. And be sure to forward to your media contacts.]

Some people wonder why HAES suddenly makes an ADA appearance this year. Others ask if Foreyt and Bacon are far enough apart in outlook to make this a “real” debate. Bacon, an ASDAH member, offers answers, along with the backstory to this groundbreaking event:

It wasn’t how I imagined I would finally debut at the ADA FNCE, but I can’t wait to debate Dr. John Foreyt in San Diego on September 25. What an audience! For starters, ADA members are influential, dedicated professionals on the front lines of the weight wars. And my rival? I hear Dr. Foreyt is a nice guy and great to talk to. He’s also a four-star general in the Obesity Wars, as a veteran of government obesity panels and large-scale weight loss studies, both corporate- and government-funded.

Until recently, it was hard to get anyone in the traditional “weight control” community to even acknowledge HAES, let alone debate its merits. So the chance to have HAES on the ADA conference agenda? Well, it’s unprecedented.

Literally unprecedented, in fact. The reason I know that ADA conference planners repeatedly turned down HAES presentation proposals is that most of them came from me. I am a professor, recipient of U.S. government research grants, and a multiply credentialed scientist with credits in peer-reviewed journals, as well as an accomplished and sought-after speaker. I say this not to toot my own horn, but to show why I assume something other than my resume was at issue in these rejections. The fact that my work challenges the scientific credibility of the ADA’s official position on weight management? That may have had something to do with it.

This year, though, ADA members demanded HAES representation: Dawn Clifford, member of both ADA and ASDAH, launched a letter-writing campaign to insist on a HAES forum at the FNCE. Others with joint ADA-ASDAH memberships (Dayle Hayes, Joanne Ikeda, and Michelle Morris, among them), joined the outcry. And there was a different outcome. Not only did I receive an invitation, but I even heard from conference committee members that they are fans of my work.

Imagine how my excitement deflated, then, when I read the fine print. Unlike every other FNCE panel, mine was required to take the form of a point/counterpoint debate, with a speaker presenting the “other side.”

I did appreciate the irony. As ASDAH member Deb Burgard expressed it, the full weight of ADA history, its years of voluminous presentations on obesity, and every other presenter on weight-related issues would not suffice to counterbalance my presentation. Deb advised me to take it as a compliment, and I do!

If it was a debate they wanted, I figured the bigger the name I went up against, the better. But those in the anti-obesity camp proved less eager. [Note: some names have been removed to respect concern that it may impact the ADA’s future speaking requests.] The ADA first approached a medical school professor who co-founded a weight control registry and helped develop NIH guidelines to “treat” obesity. His secretary said he was available. Then she said he wasn’t.

TV personality and surgeon Mehmet (“Dr. Oz”) Oz was considered. His speaking fee? $75,000—not an option. And no nonprofit discounts, either. As someone who dedicates much of her labor and income to gratis and non-profit advocacy (it’s all in my financial disclosure statement), I found this, well, disappointing.

In turn, the ADA also approached a prominent professor of medicine and public health at Harvard; another prominent professor who was co-founder of a weight control registry; and the director of a center for obesity research and education and former president of the Obesity Society. All routinely give talks at similar conferences. All declined.

I do understand that people are busy. Maybe busy enough to be booked six months out for a Sunday in September. But do I also detect a whiff of fear in the air?

That’s why I congratulate Dr. Foreyt, who teaches and directs the Behavioral Medicine Research Center at Baylor College of Medicine, for stepping up to the plate. He is a highly respected, credentialed and experienced researcher with numerous (17!) books and 300+ articles to his credit, and a worthy opponent. And he has devoted his career to seeking ways to help people who struggle with cardiovascular disease and other health problems, so his dedication is obvious.

Dr. Foreyt’s name might have come up even sooner in the ADA search, however, committee members feared we hold views too similar to allow for robust debate. They needn’t have worried. Dr. Foreyt’s feet are firmly planted in the anti-obesity/pro-diet world, and, like his fellow Obesity Warriors, he is well-supported by corporate interests.

As an example, he served on the NIH panel that, with a swipe of the pen in 1998, played a role in 29 million Americans becoming “fat” overnight, by suddenly lowering the nation’s BMI standards. In my book and elsewhere, I have described this reset as unsupported by data.

Dr. Foreyt is also representative of his colleagues in an obesity research field that is rife with conflicts of interest: Like them, he has been compensated by and received grants from a slew of diet and food industry behemoths. For instance, according to information from the Center for Science in the Public Interest [enter “Foreyt” in the search line], he has been a paid advisor to Slimfast. He has even made a personal testimonial about incorporating Slimfast shakes into his diet and appeared in Coca Cola ads. Not just pro-diet, Dr. Foreyt has also supported—and been supported by—purveyors of pharmaceuticals and weight-loss surgery, consulting for and/or receiving grants from a long list of drug firms that includes Sanofi Aventis, Roche Pharmaceuticals, Abbott Laboratories, GlaxoSmithKline, and Regeneron Pharmaceuticals, and from Orexigen, a manufacturer of bariatric surgery equipment. Contrast this with my commitment not to accept money from any food, diet or pharmaceutical company.

By naming this, I am not suggesting that Dr. Foreyt is personally dishonest or part of a conspiracy. Indeed, I believe he – and most obesity researchers – is well-intentioned. But that doesn’t mean he is uninfluenced. Think of the penalty he would pay for questioning obesity myths. And research confirms that industry-sponsored research yields more favorable results than independent research.

As I wrote in Health at Every Size, “My concern is that obesity researchers are highly vulnerable to accepting cultural assumptions—even more so than the general public—because their status, reputation, and livelihood are in large part determined by how well they promote the diet and pharmaceutical industries. Career opportunities are limited if they choose not to participate, resulting in little incentive to question the status quo. …

“Public/private conflicts of interest… [are] not conducive to being open-minded about new ideas or making sure important research gets conducted or reported, or that the best information directs public policy and gets out to the general public.”

If John Foreyt and I stand on common ground, it is our mutual desire to improve Americans’ health. I trust his good intentions. And that’s a great basis for moving the discussion forward.

Kudos to the American Dietetic Association for opening the floodgates and airing the debate. The organization may never be the same!

Posted in LInda Bacon | 10 Comments »

September 6, 2011

the HAES files: time to own it

by healthateverysizeblog

by Deb Lemire, President of the Association for Size Diversity and Health, adapted from the opening welcome for the ASDAH’s 2011 Conference

Those of you who know me, or have seen my recent talk at the Endangered Species: Women’s Summit, know my daughter is the foundation of my activism, my work and my desire to make change in the world. She hears my conversations on ASDAH Board and committee conference calls, phone interviews, counseling friends on the Health At Every Size® model, she has helped me with workshops; she really knows no other way of feeding herself. Not that she gets it perfectly right all the time, neither do I. Not that she doesn’t struggle at times; but dieting is not something she would ever consider because it doesn’t make sense to her. She claims the Health At Every Size way of life as her own. There has never been any other way for her. It is simply how things are.

Rachel likes to sit on the hill of our front yard and just watch the traffic, think, play her guitar. She is 14 yrs old. A couple of weeks ago, Rach was sitting out front. After she was there for about a half an hour she comes bursting into the house and says to me “Well …I was just sitting there in my own yard, minding my own business, when this jerk drives by and yells out the window to me ‘go on a diet fat ass.’ In MY OWN YARD!“

Now if that were me at 14, I would have been devastated. I would have come in the house, told NO ONE, especially not my mother, and crawled into my closet and ate a bag of Hershey bars.

But because Rach has had the HAES inoculation, she was mad more than anything else. I gave her a hug and said I was sorry someone was such a jerk to her. She said, “yeah, he’s just a dick.” OOOOkay well that was interesting….never really heard her say that before… but I thought given the circumstances, we’re gonna let that go. So in my best cool mom voice I was like, “yeah… he is!” We spent the next hour making dinner and of course going over all the things she could have said in response, you know how that is….but it didn’t last long.

Just to make sure she was going to be okay, I went for a booster shot and we watched the Body Positive’s new dvd for teens. Of course I didn’t want to be too obvious so I told her I needed to see it to give feedback, and it was for teens so I needed her input. She tried to pretend that I wasn’t so obvious and that she wasn’t that interested, I did mention she was 14, right? When it was over I asked what she thought. She said it was good. I asked if she thought this would be a good thing in schools. She thought for a moment and then said “yes, but I think it should be on TV at the same time all around the word and everyone should be made to sit down and watch it.” Immunization secure! While for me the experience would have shredded my sense of self, destroyed my ability to live fully, as many similar experiences had done; the HAES thought process protected Rach’s self esteem , capacity to love herself, literally saving her ability to live fully in her body.

That is the power of owning the Health At Every Size mindset for yourself. That is the power we can imbue on our clients and colleagues. That is the gift we can bring to our communities.

It is time to own it. ASDAH has secured the trademark on behalf of ALL Health At Every Size practitioners and advocates, whether members of ASDAH or not, so it literally belongs to us all. But it will mean nothing unless we fully embrace the knowledge that we are standing on the side of truth, standing on the side of science, standing on the side of health, standing on the side of love.

Posted in Deb Lemire | 5 Comments »

Tags: diet, discrimination, diversity, eating disorders, fat, HAES, health, Health At Every Size, health promotion, nourish, nutrition, obesity, stigma, weight, wellness, World HealthOrganization

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