RP101 – Weight and Body Image (June 2020)



Session Readings

 

Objectives:

By the end of the Reflective Practice session on Weight & Body Image, students will:

  1. Identify their 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 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.” You can see evidence of that in billboards, advertisements, jokes, memes, and many other media forums – people joke about weight in ways they would never joke about race, gender, sexuality, or religion. 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.


Instructions:

–Watch this opening video by CDR Cimino

–Watch this video interview with 2dLt Steven Mowen, USU class of 2021.

–Watch this video interview with LtCol Elizabeth Pietralcyk, USU class of 2007, family medicine physician with obstetrics fellowship training, currently stationed as a flight surgeon at Joint Base Elemendorf-Richardson, Alaska.


Assignment: 

This session we’re trying something different.  We’re doing a discussion board with your small group BEFORE you meet. Please see this document for guidance on giving constructive peer feedback.

    1. Google Doc discussion board (the R.S.I. — Reactions/Sources/Implications)
    2. Personal/individual “Review” as a word document in Sakai (that your group facilitator will read)

    Instructions

    1. NLT 0800 on June 12 2020 ( I said 2359 on 11 June on the video, but this makes it easier for everyone):
      1. Post your initial R.S.I. comments in your groups’ GoogleDoc (see RSI prompt below)
      2. Post your personal “Review” as a Word Document in Sakai (see prompt below – and don’t forget to put your last name in the file name!)
    2. NLT 2359 on June 14th 2020 
      1. Read all the posts (add your initials to indicate that you’ve read the post)
      2. Respond to 2-3 group members

    Prompts

    1. Google Doc (RSI) prompt
      • 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.  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 for patient care – how might they impact the care you deliver to your patients?
    2. SAKAI Word Document prompt
      • Reflect on what you’ve discovered about yourself and the topic at hand and summarize that in a paragraph or two or three.  What is your bias around this topic?  How did my context influence that?  What do I think I need to be mindful of or actively work to change?
      • Write one question you’d like to bring to the group discussion that might help you further your introspection or help you see another perspective about obesity.
AtlanticThe Weight I Carry (10min read) The author shares an inside look on how he feels about the weight he carries, from the worry he has riding the subway to the way he plans which restaurants will have the right combination of tables and booths to seat him. He talks about what makes him eat and what makes him want to lose weight. It's gripping and honest. Worthwhile read.
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academic-medicine-logoAre medical students aware of their anti-obesity bias? Medical students have a significant implicit anti-fat bias and two-thirds of those with this bias are unaware it exists. How might this impact the care they, and others in the healthcare community, deliver?
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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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huffpostEverything you know about obesity is wrong 15min read - A description of obesity, weight bias, fat shaming, and a bunch of the consequences from it. A popular article, not a research article, but a comprehensive look at the topic.
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Session originally created by: Adam Saperstein | Uniformed Services University | Admissions Medical Officer, USNA | Assoc Prof. Family Medicine