Session 4: Obesity



Session Readings

 

Background

The incidence of obesity has been steadily climbing, with the most recent report from the CDC showing that over 39% of adults and 19% of children in the United States are obese.  This is also a known readiness issue for the military, as demonstrated in the charts below:

 

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obesity-2015


To date, despite efforts on multiple fronts, treatment strategies to help people maintain a “healthy” Body Mass Index (BMI, a measure of weight for a given height) and decrease their risk for various associated 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 consequences that we don’t yet fully understand.

While obesity is known to be a complicated, multifactorial disease, both laypeople and medical personnel alike often demonstrate, in words and deeds, a strong bias against those who are obese.  In the medical setting, this undoubtedly affects the way we interact with, diagnose, and treat patients who are obese.  As Dr. Simon Auster astutely points out, “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.

This session offers each of us the opportunity to reflect on our own reactions to an individual’s body mass index, and to examine our biases and assumptions and how they might impact how we care for future patients.

Assignment: Prior to the small group discussion, bring notes that address the following:

  1. What are your reactions when you encounter someone who is overweight or obese. To what extent do the following impact that reaction:
    • 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. What are the sources of those reactions? These 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 related to 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, your 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).
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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