RP101 – Obesity (June 2018)



Session Readings

 

Objectives:

By the end of the Reflective Practice session on Obesity, as stimulated by panelist narratives and supplemental resources, students will:

  1. Identify one’s reaction to those who are obese and/or those who struggle with weight in other ways, and consider what factors impact this reaction, to include but not be limited to:
    • the cause of their obesity
    • co-morbid health conditions
    • the age and/or socioeconomic status of the individual
    • personal relationship of the individual to you
  2. Reflect on the source(s) of those reactions, including:
    • your own experiences with those who struggle with weight
    • your beliefs about the causes of and treatment for obesity
    • your own emotions around food, eating, and exercising
    • the assumptions you have about the motivations of those who are obese, or who struggle with disorder eating.
    • how you perceive obesity to be viewed in the family/community in which you grew up
    • how you perceive obesity to be viewed in the medical and/or military community.
  3. Identify how those reactions might influence, both positively and negatively, one’s care of a patient who is obese or struggling with weight.
  4. Reflect on what you’ve learned about yourself in this process, and consider future actions around enhancing the positive and mitigating the negative implications of your reaction(s).

Background

The incidence of obesity has been steadily climbing, with the most recent report from the CDC showing that over 35% of adults and 18% of children in the United States are obese.  This is also a known readiness issue for the military, as demonstrated in the chart below (and this is only for those who are seen for a visit and are diagnosed as being obese):

w-fatarmy

To date, despite efforts on multiple fronts, treatment strategies to help people maintain a “healthy” BMI and decrease their risk for co-morbid illnesses has been largely unsuccessful, and in some cases, counter-productive.  Meanwhile a hyperintense focus on weight and body image pushes some to more extreme dieting or exercise measures, resulting in extreme weight loss or fluctuating weight patterns which may pose long-term metabolic consequences that we don’t yet fully understand.

While obesity is known to be a complicated, multifactorial disease, this recognition has not translated into a generally compassionate view of those who are obese. Both lay people and medical personnel alike often demonstrate, in words and deeds, a strong bias against  obesity. In the medical setting, this undoubtedly affects the way we interact with, diagnose, and treat patients who are obese.  As Dr. Simon Auster astutely pointed out during this session in 2012, “Obesity is [one of] the last socially acceptable prejudices in this country.” Conversely, clinicians often see patients struggling with being underweight as people deserving of their help, concern, and protection.

The military adds another element of judgment around weight, requiring certain bodyweight standards that seem to take precedence over one’s ability to perform his/her job, or one’s contribution to the services.  The military also asks for fitness, but seems to punish for a body shape/size even if someone can pass the exertional and strength components, yet not pass the tape test. This, in my mind, adds an element of shame and an overtone of failure to an issue deeply seeded in both.

This session offers each of us the opportunity to reflect on our own reactions to weight and influence of the military on each, and to examine our biases and assumptions and how they might impact how we care for our patients.


Panelists:

  1. Jack Rumbaugh, CAPT (ret), USN, MSC, is a former brigade commander at USU, and currently works as Health Care Inspector for the Department of Veterans Affairs.
  2. Marion Tanofsky-Kraff, PhD, is a professor in the department of Medical and Clinical Psychology. Her research revolves around eating disorders and obesity.
  3. Patcho Santiago, CDR, MC, USN is the current program director for the NCR Psychiatry residency.

Assignment (R.S.I.P. paper)

  • Reaction: Identify 2 or more reactions to panelists or to the supplemental materials as they pertain to the topic of obesity and weight.
  • Sources: For each of your reactions, identify the sources of that reaction.  Be specific when identifying these sources, describing the experiences that formed your personal context. Note: Many find that the most effective way to do this is to reflect on experiences sequentially through your life – starting with the norms and lessons you learned in your family of origin and the community in which you grew up, then those you had in your teenage years, and then those in your adult lifetime.  In most cases, we have a number of sources for a given reaction.  For this session, sources may include:
    • your own experiences with those who struggle with weight
    • your beliefs about the causes of and treatment for obesity
    • your own emotions around food, eating, and exercising
    • the assumptions you have about the motivations of those who are obese, or who struggle with disorder eating.
    • how you perceive obesity to be viewed in the family/community in which you grew up
    • how you perceive obesity to be viewed in the medical and/or military community
  • Implications: For each of your reactions, analyze the positive and negative implications of your reactions for patient care – how might they impact the care you deliver to your patients?
  • (Review and) plan:  I want you to reflect on what you’ve discovered about yourself and the topic at hand and summarize this in a sentence or two. If it’s easier, answer the questions specifically: What have I learned about myself and this topic? What do I think I need to be mindful of or actively work to change?
    • Lastly, I want you to come up with one question you’d like to bring to the group discussion that might help you further your introspection on this topic or help you see another perspective. Make that the last thing you write down…for example:  “The question I’d like to see the group discuss is: how do I approach a patient whose problems I think are specifically due to their weight, and it seems like previous interventions haven’t made a difference?” 
TEDxTEDMED 2013: Is the Obesity Crisis Hiding a Bigger Problem? By Peter Attia Dr. Attia’s perspective on obesity changed when he started to question his own anti-fat bias and assumptions. He now asks, and researches the answer to the question, “Is obesity the cause of insulin resistance or is it a symptom of a deeper problem?”
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this american life logoTell Me I'm Fat Let's change our perspective on how we view being fat.
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ESPNYou Can’t Quit Cold Turkey by Tommy Tomlinson Jared Lorenzen set the record for passing touchdowns at the University of Kentucky and later won a Super Bowl ring with the New York Giants. His last stop was with the Western Kentucky River Monsters, where at well over 320 pounds, he played quarterback. In this story and video, he shares his perspective on his challenges with weight.
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The Problem with Skinny Shaming A look at the difference between the bias against people who are "too skinny" vs those who are obese. They are not the same thing.
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Obesity and the US Military a look at the obesity crisis as it affects military members and military families
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medium_logo_detailThe Problem with Skinny Men a look at weight from a man who has difficulty keeping weight on, and how the weight debate for women affects men and their self esteem
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Session originally created by: Adam Saperstein | Uniformed Services University | Admissions Medical Officer, USNA | Assoc Prof. Family Medicine