“The power of intuitive understanding will protect you from harm until the end of your days.” – Lao Tzu

Posted on February 17, 2012

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Guest Post on  Obesity Panacea

Iatrogenesis or Good Intentions? Why do Health Care Practitioners Continue to Ignore the Health At Every Size Philosophy?

Note from Travis: Today’s guest post comes from Registered Dietitian Julie Rochefort, in response to my post last week titled “Time to Watch My Weight“?  More information on Julie can be found at the bottom of this post.  On a personal note, I should add that I don’t believe that weight loss isalways a bad goal, but nor do I think it’s the solution for all individuals.  Enjoy the post!

PS. For those interested in the Health at Every Size Movement and the treatment of obesity, we will be hosting a debate in Ottawa in June of this year on the topic “Is Obesity a Disease?”, with two prominent speakers looking at the pros and cons of the medicalization of obesity, among other things.  More details on that event coming soon.

The Problem

As a frequent flyer within the twitterverse (@julie_rochefort; @shift_the_focus), I came across Travis’s tweet which indentified a       very pressing and ethical issue facing health care practice today: weight bias.

“my bmi is <25. at my physical, the nurse [asked] me to “watch my weight”, lest it should eventually increase to 25″

The Issue

Subsequently in his post, Travis questions why his nurse focused on his weight rather than other relevant health behaviours such as, food intake and physical activity.  While I cannot speak from a nursing perspective (albeit, there are many commonalities among health care professions); I argue that the way in which obesity is framed and discussed within healthcare professional education may help to explain the maintenance of the acceptable weight=health mentality.

The Dietitians’ View

During my professional development in dietetics, dietitians were identified as a key player in the national fight against obesity; which in turn defined our role as weight loss “experts”. Accordingly, during my education and training, I was taught and mastered, how to calculate the BMI and, appropriately classify individuals into their respective weight categories. Normal. Overweight. Obese. Obese Class I, II, III.  Once classified, I was expected to ensure those in the normal category maintained their weight and the fat people lost weight. Failure to keep individuals within the supposedly safe BMI range of 18.5-24.9 would question my duties as a professional and put my patient’s health at risk.

While research continues to demonstrate that obese individuals can improve metabolic indicators (e.g. high blood pressure, high cholesterol, insulin resistance and glucose intolerance) independent of weight loss (Bacon and Aphramor, 2011), why is there still such a focus on weight at the clinical level?

Critical Obesity Studies

The weight-centered approach to health was a singular focus of my professional education and training. I wasn’t introduced to an alternative way of interpreting the weight/weight-loss imperative until my second semester of graduate school. Why was this alternative view not incorporated as part of my professional education? Perhaps dietetic educators can help shed some light on that question.

The overstated associations between weight and the risk of disease have given us permission to correct and pose shame onto the fat body defined by a BMI >25.  While Travis was able to overlook the well-intended warnings from the nurse, unfortunately this is likely not the norm.

While clinicians often practice with the best of intentions, a shift away from promoting weight-loss needs to occur if we are to truly commit to our ethical responsibility to ‘do no harm”.

The Next Steps

Incorporating alternative views of fatness is imperative to promoting the health and well being of the population.  I am not sure how this shift will take place. A good way to start this shift is by questioning our traditional approaches to body weight and engaging in dialogue with all members of the health care team, including the patient.

 

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