RP101 – Weight and Body Image (June 2021)



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.

The COVID-19 pandemic has exacerbated the obesity and weight problem. According to the CDC, 61% U.S. adults undesired weight changes since the beginning of the pandemic.  The APA surveyed 3,000 U.S. adults, 2/5 gained more weight than desired, an average weight gain was 29 pounds per person and 10% gained more than 50 pounds. This is attributed to stress, unhealthy eating, lack of exercise and increased alcohol consumption. All military services suspended fitness test and organized physical exercise with the expectation that service members would maintain fitness, height and weight standards on their own.

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 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: 

Please follow following instructions and the attached guide to complete this assignment. Refer to these emotional wheels to help you identify your reactions.

  • 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?
  • 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.
TEDxObesity is a National Security Issue: Lieutenant General Mark Hertling Lieutenant General Mark Hertling addresses the issue of obesity as a national security issue.
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military-comThe ACFT and the Problems with the Military's Cult of Physical Fitness
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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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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