Tuesday, October 09, 2007

Food for Thought...

A few weeks ago Sanjay Gupta wrote a piece for TIME about doctors' apparent unwillingness to tell their patients that they need to lose weight. It seems that even physicians get a little squeamish about telling their patients that they're overweight:

"Researchers at the Mayo Clinic in Rochester, Minn., recently released the results of a survey of more than 2,500 obese patients who went to their doctor for a regular checkup over the course of a year. The investigators found that the charts of only 1 in 5 of those people listed them as obese. What isn't on the charts is probably not communicated between doctor and patient either, and that means trouble. Those in the study who got the diagnosis were more than twice as likely to have developed a weight-management plan with their doctor than were the other obese patients."

Absurd, isn't it? A 300-pound man walks into a doctor's office, the doctor pokes and prods and shines light into his orifices, they'll talk acid reflux and flatulance, erectile dysfunction and rectal polyps, but not word one about the elephant--as it were--in the room: that our guy is, in the immortal words of David Brent, "a bit of a bloater."

So what's the deal here?

Talking to other people about their physical health or habits is always dicey, but certain habits seem to have tipped in the direction of "okay to talk about:" just about everyone who smokes, for instance, knows it's bad for them and has either tried or are currently trying to quit. As a result, although I've never smoked, I feel completely at ease razzing my close friends who do about their habit; I feel less comfortable addressing what appear to be drinking problems in my friends, but I've certainly brought it up with people I care about. And I don't really lose sleep over it, either; I see my mini-interventions as expressions of love, and I imagine that most people reading this feel the same way.

But obesity? I just don't go there. And I'm in the fitness field.

I suppose it has to do with the pervasive feeling that being fat reflects a kind of moral failing on the part of the fat person, not simply an unfortunate health condition that the sufferer should take steps to address. Calling a person fat, in so many words, be he your friend or your patient or your own child, is dangerous territory, no matter the terms it which it's couched, or the intention behind them. One risks sounding preachy, insensitive and God-awfully un-P.C.

And, just to go ahead and BE un-P.C. for a moment, here, to some extent being heavy DOES reflect on the self-discipline and physical habits of the fat person. It's NOT just an unfortunate, inherited condition; both nature and nurture are involved. Lou Schuler recently cited and neatly undid the most recent study suggesting that exercise DOESN'T affect weight loss--such studies pop up periodically, presumably in an effort to combat the pervasive association of being heavy with being lazy. But in spite of the occasional dissenting voice to the contrary, we're talking about a problem that reflects on the whole person, the thousands of tiny choices they make over the course of their average day, from what and when they eat, to how much they sleep, to how they spend their free time, to the priority they place on their careers and families, to say nothing of their personal attractiveness sex appeal.

No wonder it's hard to talk about, even for the health professionals we depend on to tell it like it is.

As a partial solution, Gupta cites adolescent-medicine specialist Dr. Mark Jacobson, who says that

"...doctors must discuss the topic. One way to do so gently, he says, is to avoid the word obese and instead say the child has a weight problem. Doctors may also tell kids that their weight is a couple of years ahead of their age. Then, Jacobson says, he focuses the discussion more on the behaviors that could help improve the situation--like watching less TV and playing outside more--instead of concentrating principally on shape."

Now, telling a kid that his weight is "a couple of years ahead of his age" is about the most laughably spineless way of telling a budding Eric Cartman to lay off the Cheezy Poofs that I can imagine. It's such doublespeak that kids and their parents might even interpret it as an indicator of good health. You're telling a parent that little Bobby is fat by saying...that he's ADVANCED at something. Tell a parent that and they'll probably want it printed up on a bumper sticker.

But truly, Jacobson's well-meaning advice is only further evidence of how hard it is to talk about weight problems with anyone.

The solution, though, in so far as there is one, is implied by Jacobson's second piece of advice: that focusing not on 'shape'--or appearance--but on activity and performance is the best way to affect change. The people I've known who have managed to radically shift ingrained habits tend to be trying to accomplish a specific task: they want to do a major hike, or run a marathon, or lift a certain amount of weight, or lift their grandchildren, or make a school team, or compete in a bodybuilding show, or do a triathlon. A couple of years ago my sister cut out a whole host of long-standing unhealthy behaviors because she was trying to get pregnant. Boxers trying to make weight often think nothing of losing five to ten pounds over the course of a few days. They don't often lose the weight in a very healthy way, but they manage to do it, I wager, because they passionately want to box. How many of us have been carrying around ten or more extra pounds for ten years or more, resigned that it's stuck on there forever?

Borrowing a page from the thespian's handbook, it's nearly impossible to play what acting teachers call a "negative objective." That is to say, It's much harder to go through your days trying NOT to do something than it is to orient yourself towards the accomplishment of some positive and specific task, even if the behaviors required for both goals are virtually identical.

Got weight to lose? Choose a performance goal: something measurable, tangible, possible, and challenging--and you'll be well on the way to making it happen.


Anonymous said...

Hey, try telling your wife she's fat...even if it's only 10 or 15 pounds she needs to drop. "Yes honey your butt looks huge in those pants." Now where is that couch, I will be sleeping on.

Actually, I think performance goals are a great solution. I have used various races as goals in the past. Over the last year the wife and I used Crossfit workouts and those have something of a competitive edge to them. Now we have added Martial Arts classes to the Crossfit stuff, so the goal becomes working for the next belt. So far the results are good.


Andrew said...

Performance goals take the value judgment out of the equation: forget whether you look fat in your jeans, can you pass the belt test or not? Can you make it through the Crossfit class or not? If you work towards being able to do something you weren't able to accomplish before--you're in better shape, and the dress sizes, the scale readings, the compliments on your looks follow.

Thanks for the comment, JD.