When it comes to being fat, we’re simply too polite

North Americans are heavier than ever. If our doctors aren’t calling us on it, who will?



Two years ago my doctor told me I was overweight—not in a Karl Lagerfeld to Adele sort of way—but in the privacy of his office, during an annual physical, and in a sensitive manner. The result? After calling him terrible names in my head, I lost 20 lbs over the course of five months. And the next year, I weighed in just about right. It’s been the most effective weight-loss tool I’ve ever encountered because every year I know I have to get back on that medical scale, and I don’t want to disappoint the doctor, or myself.

But recent results from a national survey published in the journal Chronic Diseases and Injuries in Canada show that few of our doctors (one in three) are advising obese patients to lose weight. But if 59 per cent of Canadians are either overweight or obese, and being fat causes God knows how many health problems, and our doctors aren’t measuring waistlines (fewer than one in five of the survey’s participants, the journal reports) and 40 per cent of overweight or obese Canadians describe themselves as just, “about right,” than that’s a fat problem. If we can’t count on our doctors to call the kettle fat, then who can we count on?

 It’s a touchy topic, one that the U.S., in particular, is having a hard time framing. Recent American health campaigns aimed at bringing the problem of  childhood obesity to the floor have been lambasted for being too critical of fat kids. And in late February Disney shut down an interactive anti-childhood obesity exhibit after critics said its fat, villainous characters, such as “The Snacker,” were insensitive to overweight youngsters. Those chubby children could be stigmatized, or worse, bullied. And that would be terrible. But the problem remains that 40 per cent of children in the U.S. are overweight and obese, more than in any other of the 32 countries polled in a 2010 obesity study by the Organization for Economic Cooperation and Development. Whose job is it to keep our ballooning waistlines in check?

The report I mentioned above suggests that our timid doctors are “a further indication of the widely held societal view that obesity is an issue of personal responsibility rather than a medical problem.” Maybe it’s a bit of both.

I just had my annual physical yesterday. I knew I’d gained about five of those 20 lbs. back. I also knew why; I’d stopped running regularly (I run so I can eat more without gaining weight, not for the health benefits, but those are great side effects), and I’d had more dinners of Dr. Oetker’s frozen pizza polished off with a half container of Häagen-Dazs pralines and cream than I care to admit (including the very night before the doctor’s appointment.) The important thing is, I think, that I know what I have to do to lose that last five, and that my doctor gave me a bit of stink eye for gaining it.


When it comes to being fat, we’re simply too polite

  1. “…. that 40 per cent of children in the U.S. are overweight and obese …”

    Slate ~ Leave Fat Kids Alone:

    Let’s get one thing straight: I wasn’t a fat kid; I was husky. At least that’s what it said on the labels of my pants. Maybe not the navy sweats I wore to school three times a week, but the other pants—the slacks, the dungarees, the husky dungarees.

    This idea—that we’ve gone soft in more ways than one—has come up again and again in Slate’s effort to crowd source a remedy for overweight children. “Schools should actively stigmatize being fat,” writes one member of the Hive; “few things are more terrifying to a kid than being an outcast.” Another declares, “We need to stop telling children to ‘love themselves the way they are.'” A third suggests that the government take custody of any child with obese parents, as a way to “get both parents and children motivated to exercise and eat healthy.”

    These proposals are so plainly ill-advised, so thoroughly at odds with the available evidence on the causes of obesity, and so utterly detrimental to the welfare of our children, that I can only indulge in the fantasy that they’re meant as satire. Let’s be realistic, though: They’re not.

  2. The Atlantic ~ Interview with Paul Campos:

    Q) Over the last five years or so, I’ve noticed that public health efforts about obesity are not just amping up the volume, but exploring increasingly coercive methods to induce weight loss: taxes on junk food, lawsuits against fast food companies (which are basically a tax on junk food), and so forth. Does that match your analysis?

    A) It’s the classic pattern of moral panics. As public concern about the damage being done to the fabric of society by the folk devils increases, increasingly intense demands are made on public officials to “do something” about the crisis, usually by eliminating the folk devils. That of course is the strategy for this crisis. If fat people are the problem, then the solution is to get rid of them, by making them thin people. The most amazing aspect of this whole thing, for me, has always been the imperviouusness of policy makers, and even more so people who consider themselves serious academics and scientists, to the overwhelming evidence that there’s no way to do this. 

    I mean, there’s no better established empirical proposition in medical science that we don’t know how to make people thinner. But apparently this proposition is too disturbing to consider, even though it’s about as well established as that cigarettes cause lung cancer. So all these proposals about improving public health by making people thinner are completely crazy. They are as non-sensical as anything being proposed by public officials in our culture right now, which is saying something. 

    It’s conceivable that through some massive policy interventions you might be able to reduce the population’s average BMI from 27 to 25 or something like that. But what would be the point? There aren’t any health differences to speak of for people between BMIs of about 20 and 35, so undertaking the public health equivalent of the Apollo program to reduce the populace’s average BMI by a unit or two (and again I will emphasize that we don’t actually know if we could do even that) is an incredible waste of public health resources

    • U.S farm bill policy that corrects the distortions to food production, i.e. low priced subsidized commodity crops, etc. that make up the basis of junk and processed foods would not be a massive undertaking. It would change th nature of farming help people in developing countries to feed themselves and without reworking taxes it would raise the price on junk food making it less  profitable and therefor less ubiquitous. 

      To lose weight you have to fight against the structure of our food system and the advertising from the most powerful ocorporations in the world – not gonna happen. This author lost 20 lbs but she’s young. She’ll put those pounds back on in the next ten  years and then some.

  3. Like all moral panics, there is a strong dose of truth and a whole lot of fiction. I think North America knows well enough that there is a weight problem afoot. We are, after all, reminded on a daily basis and on a social level, Fat-Shaming has been both remarkably common and remarkably ineffective at solving the problem. This is because shame is a great way to make people hide behaviours, not change them.

    For what it’s worth, I think that doctors should mention getting to a healthy weight in the event that the problem being taken care of relates to being overweight in some way. Should doctors whose patients’ complaints or problems have no correlation with weight be put on a “you’re too fat” notice? I don’t really think so. Otherwise, it’s just getting them in on the moral panic.

    I say this as someone who has had dangerous highs, dangerous lows, and took a long time to find and remain at a healthy spot. 

  4. I have a simple way of tracking whether my levels of food intake and exercise are appropriate. My pants. If my pants are consistently tight, it means I should probably ease up a little. If they are loose, perhaps not. My waist size has remained roughly the same over the past decade – which is good, because I’m pretty cheap when it comes to buying pants (I have gained weight, but remain in the normal BMI range). 

    I say this because I think the author’s obsession over 5 pounds is indicative of how stupid the public health community’s decision to preference BMI was. Ms. Allen, although 5 lbs moves you from one category to another, its effect on your health will be negligible. Hell, it might even be beneficial. The effects of BMI are not that great when you control for hip:waist ratio, and some studies have found that overweight people have longer life expectancy than normal (aka. the bottom third in the US) weight people. Plus, BMI lets a lot of unhealthy skinny people off the hook.  

    •  The problem though is that clothes are cheap– pants too tight? Buy new, only slightly larger pants. Do this over the course of 10 years and you’re obese without noticing how you go there. I was a scrawny scrawny rake until about age 21– at which point, having the free time of an arts student LOL, I hit the gym religiously 5 times a week and was in killer shape, bulging biceps and pecs and all, until the age of about
      27, at which point I got busy with life (and food is a small but
      ever-present comfort when you’re busy) and now 9+ years later my waist
      size is at least 3 inches larger than it really should be. I don’t feel too bad knowing I’m fatter than I should be, but I know I am.
      My doctor couches it in terms of cholesterol and things like that, but I
      feel at even my slightly overweight weight, I’m more self-aware about
      it than most people. There has to be a happy medium between being
      bullied for being overweight and being oblivious to the fact one is.
      Where that medium is, I don’t know…

  5. I am a person that has lost a lot of weight.  I have written a book about it with my formerly overweight psychologist friend and normal weight but works at it dietitian friend.  From this project, i have learned that there is a huge difference between obese and overweight, a huge difference in the way our brains work.  I have also learned that guilt or stink-eye or bad feelings are what create the weight in obese people, and what is required is self love in order to gain the strength to work through this battle that I feel is very similar to (if not actual) addiction.  I think the most important thing to remember is that one person’s journey does not the story make.  I am happy you found a way to deal with your issues (though it seems not to have worked this year, if you’re five pounds up), but don’t think that will work for everyone, or that everyone has exactly your problem.  
    Deborah Nicholson

  6. I am very disappointed in you Jessica Allen. I do understand this is a commentary about your experience with a few added pounds on the scale, but has nothing to do with our National Obesity epidemic, and when I say nothing I mean nothing. I would recommend reading the following bloggers to educate yourself on this issue so your articles on this topic are from an educated perspective.
    You can also read Dr. Sharma’s blog http://networkedblogs.com/vltpf
      Both individuals offer medically sound perspectives on what is helpful and what is not .
    Your articles falls in the latter.

  7. you cannot rely on the FDA, when it comes to healthy eating, the garbage that they put on our supermarket shelves is disgusting, they don’t care about you, they care about their wallets, corn is cheap, soy is cheap, and makes you unhealthy, it is very sad. Animals have better food choices than we do