Physicians Won’t be the Ones to Help You Lose Weight

Surprise! Your doctor may not be the best person to get you to lose weight – and it seems that it’s largely because they are averse to talking about it at all. A recent article from NPR breaks down some of the troubling reasons behind why this relationship isn’t making real significant strides in this public health fight.

78 million Americans are obese. There are 164,000 primary care doctors that are able to treat them. That’s a daunting division as it is, but when you think about the average amount of time a physician sees a patient – maybe 20 minutes, it seems impossible to achieve the task of vastly reducing the prevalence of obesity. The kind of personalized information that is needed for each patient would take longer than 20 minutes to gather, and creating a personalized subsequent behavior change and nutrition plan takes even longer. Interestingly, the NPR pieces cites the American Association of Family Physicians in reporting that not even 50% of primary care providers calculate a patient’s BMI (there are a lot of problems with BMI as a measure, and they’ve been widely discussed – how they don’t take into account muscle mass, for example – but for some obese patients, they can be a reasonable crude measure of where the individual is in terms of major health risks and how to initiate a weight loss program). But physicians who know the history of a patient and have tracked their health for years are in the best position in terms of knowing how risky an individual’s weight is.

Of course that’s not all that needs to be considered – I actually don’t think it’s even the most pressing or pertinent issue as to why physicians aren’t able to tackle the obesity epidemic. As the NPR article says, the psychologist in charge of the University of South Carolina’s weight management center calls the topic of weight loss and obesity a “mine field.” There can be resistance in going to the doctor for any number of reasons – shame or embarrassment, frustration, avoidance or denial, and even the very real fear of what a physician might tell them. And, importantly, deep concern and worry about not having the means – financially, mentally, community or family-wise, to tackle what seems like insurmountable changes in lifestyle. On the other side, doctors claim that some patients react defensively if they suggest that weight loss needs to be in their future.

This is a complicated dance, and I can’t help but draw parallels in these kinds of responses to the relationship between eating disorder patients and their physicians, psychologists, and nutritionists. Weight is so inextricably tied to identity, personally and culturally, for so many people, that the mere suggestion of a necessary change – either gaining or losing weight – can feel like an assault on the person’s actual self. How do we best navigate this? These conversations, first of all, can’t be brief. They just can’t. They require a meaningful relationship between those negotiating solutions, and for the individual who is in a precarious health position – whether it be due to restricting and bingeing and purging, or due to inactivity and unbalanced diets and genetic factors – it requires the sense that the person ostensibly helping them knows them personally, what their fears and concerns are, is patient, and most of all, is able to be consistently present and supportive through the successes and inevitable failures of the journey. And those relationships can be mighty hard to come by.

Looking for More Attention? Drop Some lbs.

At least that’s what Skinny Water is promising in their latest advertisement, which I spotted yesterday. The ad shows a woman facing a throng of cameramen snapping her picture, elegant earrings dropping to the top of the headline which says: “Skinny Always Gets the Attention.” Take a look:

Thinspiration, thanks to Skinny Water

A close-up, to see all the text:

Close-up, for good measure.

Below the headline and photo of the various flavors, it also says “Zero calories, Zeor sugar, Zero Carbs, Zero Guilt.” With all that’s not in this water, you might wonder what it does offer. The website tells me that depending on the flavor of water, they’ve added vitamins B3, B5, B6, B12, C, A, and E. They’ve also thrown in magnesium, folic acid, calcium and/or potassium.

Despite trying to market itself as healthy, Skinny Water is instead perpetrating the cultural message that the best – nay, only – way to ensure that you get attention is by being skinny. This of course positions them well to try to push their product on those women who have been pulled into this lie. This ad tells us that the best way to skinny is not through healthy food choices and exercise and an understanding of what “skinny” means for our particular body type and shape, but essentially through fasting – which is what zero calorie drinks are the equivalent of.

In fact, Skinny Water is doing precisely the opposite of what a health-conscious company and product should be doing. Promoting the idea that those who are skinny deserve attention more than those who are not creates communities that support harmful diet-related behaviors and disordered eating for the goal of a wispy appearance . Not to mention reinforcing the ever-present undercurrent of disapproval of those who are overweight – or even normal weight! – and do not bow to the hierarchy of beauty that says those who are thin are the best. It’s just one more item in the laundry list of products that tell women their size and appearance are what is most important and will attract loyal friends and fans.

In defiance of that, let’s use our brains to remind ourselves why Skinny Water is wrong. While the website details the added vitamins and dietary minerals of each drink, it’s far better to get your needed supplements through a healthy diet rich in cruciferous  and dark and leafy vegetables, fruits, whole grain and lean proteins. Washed down, in fact, by regular old water that keeps you hydrated and helps your body process and absorb nutrients. Skinny Water is telling its buyers that by adding these vitamins and minerals to their product, one can cut out food entirely and survive on a calorie-free but vitamin-rich manipulated water diet. Don’t be fooled! (I know you aren’t. Hopefully, you’re equally horrified.) For example, the“Power,” “Sport” and “Fit” drinks are all fortified with calcium, magnesium, and potassium – to help activate metabolic enzymes, keep your blood regulated, and support strong bones and teeth. Do you know what else can do that?  Bananas, yogurt, kale, almonds and cashews, and quinoa. Frankly, there seems to be little difference between the “Power,” “Sport” and “Fit” drinks despite the claim that they each support different ”goals” of the drinker - which lends support to the conclusion that these are madly marketed products that don’t substitute a healthy, well-rounded diet and instead are capitalizing on the now-entrenched notion that women care more about being skinny than anything else.

I Still Don’t Think Yoplait Gets It.

I wrote about the Yoplait commercial that was pulled from the air a few weeks ago in a post that had some hope for a change of tune for the company. It seemed that given the outcry – from media critics to the National Eating Disorder Association – Yoplait understood that their presentation of an anxious and panicked woman weighing whether or not she was “good” enough to eat a piece of cake and how many pieces of celery she would punish herself with in return for this ghastly ingestion was both triggering and normalizing. Triggering for people who may have experienced battles with eating disorders in the past, and normalizing for those who may be on the cusp of such a struggle, ensuring them that their mental calculations and rewards were right on par with the rest of America’s women. I also saw the danger in the potential of the commercial subtly instructing young women that this kind of anguish over food was what they had to expect and look forward to in their future, thereby setting them up for young failure. (I want to note that I am not excluding this commercial’s impact on the men who suffer from eating disorders, I am emphasizing women here because of the construct of the commercial and the genders of those who were featured in it.) I’ve also discussed advertising’s effect on behavior elsewhere, and I think this post addresses some of my previously articulated concerns.

However. I fear I wrote with hope a bit too soon. Another of Yoplait’s popular commercials smacks me between the eyes every couple of days, and while it’s certainly not as yougottabekiddingme as the one with the celery champion, there is still a real issue here:

Classifying some foods as “good” and vilifying others as “bad” sets one up for failure in a most beautifully orchestrated series of events.  Certain foods may be healthier for you than others, but like most things, foods do not carry with them an innate characteristic of innocence or evil. In giving foods these kind of descriptions, they take on anthropomorphic identities that make it easy for one to associate with themselves. If cake = bad, and I consume cake, then I have consumed bad, ergo me = bad. Cake isn’t “bad.” It’s sweet. Sometimes sugary, sometimes tart. Sometimes in cup form. It isn’t “bad.”

And of course, you will eat cake at some point. Or a cookie, a brownie, a pie, pick your pleasure. If you don’t like sweets but are trying to calorie cut like a pageant contestant, perhaps it will be bread, or all carbs, or any drink other than water. Trying to eliminate the consumption of something either enjoyable (cake) or necessary (you know, food in general), the abstinence of which upon you have hinged your self-worth, leads you down a dark path resulting in you equating yourself with a monster when all you did was have some dessert.

While I noted above that men also suffer from eating disorders (they comprise about 10% of eating disorder cases), this commercial also does nothing to fight and everything to reiterate one of our oldest gender stereotypes. A woman obsessing over food and calorie counts and thinking herself to be deserving of punishment if she fails the arbitrary, socially sanctioned test of true character – resisting cake and losing weight! The fact that someone as talented as Jennifer Hudson recently articulated that her weight loss was more of an accomplishment than her Oscar shows just how far the socialization of this absurd test of character has gone for women and girls. Making the resistance of a slice of sheet cake the high point of one’s day (or the accomplishment of your life) really diminishes the much more astonishing achievements one is capable of.

Losing weight can be a healthy goal for a lot of people if they are at risk for complications like diabetes, heart disease, or high blood-pressure. But it isn’t everything – which is what most media messages seem to think it should be. If you’re trying to lose weight, talk to your physician about nutritional guidelines and an exercise plan. And first, clarify if you need to lose weight at all. I suspect that many of you don’t, but have been informed by a bear sheriff that you do not meet the specifications of his ideal woman.