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Obesity: Why We Have It All Wrong

 

by Nicole Cruz, RD

First, let me say, I don't like the term obesity. I don't use it in my practice as a dietitian, or with my friends and family, unless it's such a major part of their vernacular it's the only way I can connect. If it's what I need to use to be on common ground or to make a point, I do. But in general, it's not a way I categorize bodies. People always have and always will come in different sized bodies. We don't diagnose someone's height and we shouldn’t diagnose their weight.

Today I had a few minutes to look through my stack of magazines. I get Today's Dietitian, a publication geared toward Registered Dietitian Nutritionists (RDNs). As RDNs we're required to keep up with a certain number of continuing education hours every five years, and this publication provides Continuing Education Units for reading specific articles and answering those questions. As I was scanning the magazine I came across the CPE Monthly: Childhood Obesity Prevention and Treatment.  I turned to the article and started reading. My heart immediately started to race. I felt sick thinking about these poor kids, the ways they are being stigmatized, and the things they are being told. They're being blamed for being in a larger body, told their bodies are all wrong, and sold ways to fix them by restricting their intake. Sadly, this article was a beautifully horrendous reminder as to why I'm starting an Intuitive Eating Group for Teens. The way we treat people in larger bodies is at its worst prejudiced and harmful and at the least, ineffective.

Medical professionals (dietitians included) continue to blame obesity for a myriad of symptoms and conditions, including hypertension, elevated cholesterol, sleep apnea, glucose intolerance, and diabetes, and now, in this article, mental health issues. The author states,

“Mental health consequences of obesity are also reported. These include a variety of eating disorders, ranging from generalized preoccupation with food and distorted body image to restrictive eating and bulimia nervosa, as well as depression."

Wait! You're telling me that obesity CAUSES eating disorders and depression. Does anybody else hear how absurd this is? I understand that obesity may be correlated with disordered eating and depression, but the size of someone's body does not CAUSE these conditions. The cause is the fat phobic society we live in telling kids their bodies are not ok and they need to change. It's the weight stigma they face for being in a bigger body and being shamed by their doctor. It's their peers bullying them. It's them being told to eat less, and trying so hard, but being hungry and sneaking food. It's them feeling guilty about the size of their body. It's them not finding clothes they like. It's them not getting appropriate care for their depression because they're being told to lose weight instead of assessed appropriately for mental health conditions. It's them being told to restrict all sugar and going to the birthday party and eating all the cake, because they feel so deprived and like they don't fit in watching all the other kids enjoy it. Yes, obesity is correlated with eating disorders and depression, but body size is not to blame.

This is true for the medical conditions mentioned as well. They may be correlated with being in a larger body, but we cannot say being obese causes diabetes, heart disease, or anything else. There are far too many factors in play to wheedle it down to a body size and a medical condition. We cannot remove the weight stigma people face, lack of medical care, socioeconomic status, and behaviors that may be present. People always have and always will inhabit larger bodies, and some people have these conditions and others don't. The body size does not CAUSE the condition.

When I take my kids to the pediatrician we always chat about weight and obesity. Last time I went I shared more about the problems with restriction and some research about weight stigma. And the pediatrician said, "But when I go to the American Pediatric Conference, they say, 'We have to fight the war on obesity'. When I asked him if telling kids to change their diet and exercise is working to make them lose weight, he said,

“No. And they keep telling us to fight the war on obesity, but they never really tell us how."

The medical institutions are so fat phobic themselves, they can't look past their own stigma and see what the research really says. This doesn't work. When we tell kids to restrict their intake, they don't lose weight. Instead, they develop eating disorders and gain more weight in the long term. Dieting as a teenager is correlated with a higher rate of eating disorders AND obesity. So, telling a teenager to lose weight actually perpetuates the very problem the medical community is calling a problem in the first place. Wake up! This isn't working. My pediatrician says, "but what else do we do?"

I don't blame him. I get it. All of their medical training is geared toward pathologizing bodies and blaming obesity, and the only thing they're ever told about fixing it is to restrict intake and exercise more. I imagine some of you reading this are saying, "I'm not saying to restrict, just make different choices", or "limit those foods to special occasions" or "just watch portions sizes", something along those lines. You think you're telling them to do it the healthy way. But anytime you say to choose something else or only have it "sometimes", or just don't have as much, THAT IS RESTRICTION. And this restriction is making children, teenagers, and all people in larger bodies, feel bad about themselves, ultimately gain more weight, and develop eating disorders. Limiting, restricting, providing guidelines and portion sizes IS NOT working.

That's why I'm starting my intuitive eating group for teenagers. Shaming someone never gets results, but compassion and understanding can create change. Regardless of their body size, I want them to be kind and find empathy for themselves. They need to hear there is an alternative. They need to hear their body is ok. They need to take the focus off their body being wrong and learn to live in it, and care for it, regardless of it's size. I want to teach them they don't have to diet or restrict food. I want to educate them on the principles of intuitive eating and give them tools to practice listening to their bodies. I want to provide support for them through this process and empower them to make behavioral changes regardless of their body size.

My teenage years were marked with dieting, judging my body, and not trusting myself with food. I wish someone had given me support, taught me to listen to my body, and told me that I was ok. And that is why I'm here.

If there is a teenager in your life that might benefit from this group, please send them my way! They can be in any body size and struggling with any type of food behavior or body issues, or maybe they're not struggling now but you don't want them to go down that road. They all need to hear this message, and I want them to find food freedom!

 

For more about Nicole, visit her website:

http://www.nicolecruzrd.com

For information about her new group for teens, click here:

http://www.nicolecruzrd.com/about-us/services/groups/