Thursday, July 17, 2008

Weighty Questions

This is from last week, but I rather liked it: the New York Times' Health section looks at a doctor's blog, and particularly what the doctor has to say about weight loss and shame. From the Times:
But I was particularly moved by a recent post, which was written after Dr. Rob’s encounter with an overweight patient who was clearly accustomed to being lectured about obesity. As Dr. Rob was about to discuss whether the man needed surgery for sciatica and back pain, the patient interrupted him, hanging his head in shame and blaming his weight for the problem. Dr. Rob writes:

This whole episode really bothered me. He was so used to being lectured about his obesity that he wanted to get to the guilt trip before I brought it to him. He was living in shame. Everything was due to his obesity, and his obesity was due to his lack of self-control and poor character. After all, losing weight is as simple as exercise and dietary restraint, right?

Perhaps I am too easy on people, but I don’t like to lecture people on things they already know. I don’t like to say the obvious: “You need to lose weight.” Obese people are rarely under the impression that it is perfectly fine that they are overweight. They rarely are surprised to hear a person saying that their weight is at the root of many of their problems. Obese people are the new pariahs in our culture; it used to be smokers, but now it is the overweight.

Dr. Rob says obese patients don’t need lectures.

Instead of patronizing obese patients with a lecture, I try sympathizing with them. Just because something is simple doesn’t make it easy. How do you quit smoking? You just stop smoking. We should just pull out of Iraq. There should be peace in the middle east. People should stop hurting each other and start being nice. All of these are good ideas, but the devil is in the details. Losing weight is a struggle, and it really helps to have people giving you a hand rather than knocking you down.

I really appreciate what Dr. Rob writes here, even though I'm merely overweight, not obese. I've seen lots of diet books, lectures, plans and approaches take, even in a subtle way, the negative tack: weight gain is your fault. You're a glutton; you're greedy. If you could just exercise a little willpower all your weight problems would just melt away.

I guess I was pondering all of this because it hit me the other day that I weigh about the same as I did a little over 12 years ago, when Kitten was born. I've yo-yo'ed a bit, gaining and losing the same five pounds over and over; once I did manage to lose almost 12 pounds, but then gained it all back rather quickly. But prior to Kitten's birth I always, always, always weighed between 115 and 120, from the day I graduated from the eighth grade until the day I got married, in my late twenties. And once I gained the extra 25 pounds with Kitten, lost a bit, gained it back with Bookgirl, lost a bit again, and gained it back with Hatchick, I've tended to weigh almost exactly 20 to 25 pounds more than I did before I ever had children.

And I've tried about every diet under the sun (the 12-pound loss was my "Atkins phase;" I lost the most, but it came back on really fast when I stopped avoiding all bread. Who can eat like that long term, anyway?). And I've had some successes and failures in the exercise realm, too, as most long-term dieters can relate to. But what it really comes down to for me is the frustration that I didn't gain weight through some kind of sneaky glutinous habits of too much snacking and endless second helpings; I gained weight by having babies--only when the babies exited my body, the weight decided to stick around. And over a decade later it's still here.

So it helps to know that there's someone out there who doesn't think it's all that helpful to scold and chide and lecture those of us who need to lose weight. Between sighing in frustration over the numbers on the scale and grudging myself just about every mouthful of food I eat, I do a pretty good job of that part all on my own. I think Dr. Rob may be on to something good: maybe if the medical community could quit spending so much energy on the whole "pointing the fingers of blame" aspect of weight loss and start helping their patients tackle all that complicated data about diet types and body types and metabolic types in order to design individual plans that will really work for their patients, the right kind of "losing" could finally start to happen, without expensive surgeries, chancy drugs, or new habits of deprivation that can be almost as addictive as the behaviors that caused the weight gain in the first place.


Irenaeus said...

an article of interest.

Melanie B said...

I hear the same story from almost every woman I know who has had children. I wonder sometimes whether those of us who gained weight in pregnancy and haven't been able to lose it are really overweight and unhealthy. So much of medical "science" is guesswork, so much of what was accepted wisdom for our parents' generation has since been disproved. What things that we accept as gospel now will seem equally silly to our children and our children's children?

I gained more than 30 pounds with my first pregnancy and have been pregnant, nursing or both ever since. Not only did I not lose all the weight I gained in my first pregnancy, I gained a little more weight with my second daughter. I expect that I'll probably be nursing my daughter when I get pregnant again and I seriously doubt the cycle will discontinue for some years to come. I don't think it's a good idea to go on a radical diet while nursing or pregnant. So I expect I will continue to be "overweight" for years to come as well. Much of the time I feel depressed about being overweight, at other times, I realize that I'm merely trying to eat healthily and do what is best for myself and my family.

I question, though, whether this rather natural weight gain is really all that unhealthy since it happens to so many women.
How do they determine what is a healthy weight? Is the standard based on women who haven't had children? Is this another example of childbearing being treated as not the norm, even as a disease, by the same medical establishment that assumes all women are using birth control and that a child should only be carried when it is "planned"?