Objectives:

By the end of the Reflective Practice session on Weight, 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):

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 hyper-intense 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 body weight 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. Dr. Maureen Petersen, COL, Army, is a Pediatric Allergist and Director of Graduate Medical Education and Graduate Dental Education at Walter Reed.
2. Dr. Tamara Worlton, CDR, Navy, is chief of the division of minimally invasive and bariatric surgery and co-director of the global surgery division at Walter Reed,  and a USU class of 2003 graduate.
3. Dr. Jonathan Scott, PhD, is a registered dietitian and assistant professor in the Department of Military and Emergency medicine.

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