Bitty Kitty

Rather than focusing on losing weight in 2019, let’s think about what we can gain. What can you add to your life to make it more satisfying? What new practices would make you happier and feel better? Consider some of these healthy resolutions for the new year:

Get more quality sleep

Eat vegetables at every meal

Wash your bed sheets regularly

Meditate

Spend more time outside

Actually eat your fruit before it goes bad

Get back in touch with old friends

Bring your own bags when grocery shopping

Don’t watch tv or use the computer during meals

Support local farms and food producers

Take vitamins

Learn to knit or sew

Stretch and improve your flexibility

Volunteer to register voters

Concentrate on improving your posture

Make doctor and dentist appointments regularly

Cook and prepare lunch instead of relying on processed foods

Replace your toothbrush

Clean your kitchen and dishes after each meal

Stop biting your nails

Compliment someone every day

Regularly donate unworn and ill-fitting clothing to a local shelter

Wear sunscreen every day you’re outside

Clean your pantry and throw out expired food each month

Quit smoking

Explore local museums and parks

Put your laundry away

Get an eye exam and update your prescription

Cut down on the amount of plastic you use each day

Re-try foods that you hate, but haven’t eaten in years

Delete a social media account

Moisturize and remove your makeup before going to bed

Attend town hall meetings

Keep a journal

Floss

By this I mean that your body is brilliant at compensating. If you’re weak in a particular area, your body will find other, stronger muscles to complete a given task. Let’s say that your hamstrings are weak. In a deadlift, your body might opt to preferentially recruit the lower back (multifidi) rather than the hamstrings. Your hamstrings might be working a little bit, but not as much as you’d assumed. This actually happens quite often. 

To the naked eye, someone’s technique looks perfect, but their bodies are actually using accessory muscles as prime movers. Take notice of the muscles that you feel working during a given movement. Yeah, you might be doing a “core” exercise, but maybe your hip flexors are actually doing most of the work, or even your neck flexors! It’s possible that your shoulders are working way too hard during a push-up because your pecs aren’t firing properly.

 If you contribute to an environment where they feel judged, ridiculed and unwelcome, then you are a big part of the reason why so many Resolutioners fail to continue exercising throughout the year.

I don’t care if they’re using your favorite squat rack.

I don’t care if you have to wait for a while before getting a treadmill.

I don’t care if you think that they socialize and rest more than they actually workout.

I got a new primary care doctor so I went in for my first appointment to establish care. The doctor orders a mass of blood tests, for every single reason he stated it was due to my obesity. (I’m 5'6" and 280lbs)

He kept making comments about how my A1C is probably in the diabetic range, how my cholesterol is probably high, my sodium is probably too high, ect. When I came in the nurse has taken my blood pressure and when he took a look at it he made a side comment of “your blood pressure is surprisingly good, I’m impressed.” Literally no one is trying to impress you, that’s just how my blood pressure has always been: normal.

I got the results back and I wish I could have seen the doctor’s face when he read them but instead he had a nurse call me to go over the results. Everything was fine. I am not diabetic, my cholesterol is fine, my sodium is fine, even my thyroid levels were good. Literally the only thing wrong was my vitamin D levels. Normal is 30-100 and I was hitting 18. So a vitamin D supplement is all I need.

Source: https://academic.oup.com/jcem/article/98/10/E1610/2833484

If you dig further, you find another study (https://bmcendocrdisord.biomedcentral.com/articles/10.1186/1472-6823-14-9) showing between 24 to 65% of obese women and 43 to 78% of obese men are metabolically healthy.

One of the main reasons that the percentages above varies widely is that doctors can’t decide on a standard definition of metabolically healthy obesity. http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70062-7/abstract

In particular it will fuck your antidepressants and birth control right up.

Ofttimes it’s used to induce vomiting. If you’re super duper lucky, it’ll cause a blockage in your intestines.

It’s used MEDICINALLY to treat poisonings. Not to make something ~aesthetic~

We’re starting our “metabolism” module at med school this week, and I’m dreading it with every fibre of my being. You see, I am going to be a doctor, and I am fat.

I’m not the type of fat you feel after you’ve had a big lunch, and your usually flat belly is protesting against the waistband of your jeans. I’m the real kind. My BMI hovers a couple of points below “morbidly obese”.

I worry a lot about what people will think of me as a fat doctor. For the smartarses among you, of course I’ve tried to be non-fat, it goes without saying. The thing is though, bodies don’t really like weighing less all of a sudden and are pretty good at reversing things in the long run. Mostly my body settles back to the same size 18 shape eventually.

I am always aware of my fatness, but perhaps more so here at medical school. We are training to work with bodies, and mine is a type of body we warn our patients not to have. It is the first thing described in every list of ‘modifiable risk factors’. A colleague suggests “just don’t let yourself get too fat” as we talk about preventing a certain type of cancer. A final exam question asks us to list four poor health outcomes associated with obesity. I sit through lectures with slides that have sniggering titles like “how BIG is the problem?”

make fun of fat people dancing

make fun of fat people wearing exercisey clothes

go ‘ew gross’ at fat people in swimwear

make fun of fat people exercising

be grossed out by fat people swimming

be judgy about fat people getting out of breath 

be grossed out by fat people sweating

be grossed out by fat people leaving the house

make fun of fat people in sports bras

go ‘ew gross’ at fat people exercising in a way that involves jiggling

make fun of fat people doing yoga                                                            

There is no permanent and safe way to intentionally lose weight. This is true.  

And that means that if you want to truly live a fulfilling and meaningful life, you will need to let go of the fantasy of being thin. You will need to do the difficult self-work needed to unlearn your internalized fat phobia. You may also need to learn how to eat normally without restriction and shame. All of this is difficult. But a lifetime of self-hate, restriction, repeated cycles of weight gains and weight losses, and declining health from the damage caused by under-nourishing your body is far far worse. 

Over fifty years of research conclusively demonstrates that virtually everyone who intentionally loses weight by manipulating their eating and exercise habits will regain the weight they lost within three to five years. And the vast majority will actually regain more weight than they lost. [sources]

In fact, the results of a 10-year study of over 275000 people revealed that the annual odds of a fat person attaining a so-called “normal” weight and maintaining that for five years is approximately 1 in 1000. [source]

Nope. One individual’s experiences do not negate 50 years of scientific research with thousands and thousands of people.

“Just change your *lifestyle* by doing blah blah blah and then anyone can lose weight!”

Nope. Any attempts to intentionally lose weight by manipulating food intake and exercise have the same result. Scientists have tried it all! The result it always the same. Weight regain. 

No. A systematic review of research using the doubly-labeled water method to assess people’s energy needs revealed that healthy adults over age 25 need between 2500 and 3000 kilocalories per day on average. People under the age of 25 need about 500 calories more per day than their adult counterparts. People who are bigger than average (including fat people) also need more energy than average to thrive, as do people who are very physically active. [source] [source] 

“Buuuut the nutrition guidelines say we only need 2000 kilocalories per day!”

Did you know that in post-mortem examinations there is zero correlation between weight and levels of arteriosclerosis and related diseases found?

Did you know that people with an overweight BMI have the longest life expectancy, that those with an “ideal” and an “obese” have about the same life expectancy, and that being “underweight” raises mortality rates more than being “morbidly obese”?

Did you know that losing weight and then gaining it back is worse for your heart than remaining at the weight you started consistently?

Did you know that 95% of people who lose weight do gain it back, and there has never been a single documented weight loss program that has been demonstrated to keep the weight off for five years or more in the majority or even a significant minority of people? Like, telling people to lose weight isn’t much use if we don’t know HOW to make that happen.

Like I have read The Obesity Myth by Paul Campos and Rethinking Thin by Gina Kolata and Big Fat Lies by Glenn A Gaesser (Ph.D!) And Fat!So? and several other books that I don’t own and so don’t remember all of their names I spent like four years reading every single study coming out and looking at the methodology and noting which ones had huge holes or terrible methods and which didn’t (the holes were almost always in the pro-weight-loss studies) and like

Big Fat Lies has 27 pages of bibliography. 27 pages worth of scientific citation. The book content itself is only 197 pages. That’s a page of references for every 7 pages of book. Reading the book is just reference after reference and study after study. Most of these doctors (like Linda Bacon, author of Health at Every Size) started out the same way. They wanted to use the scientific method to find a real weight loss program or health solution that worked and could be proven to work, and so studied everything they could about weight and fitness only to find out that we didn’t need weight loss in the first place. That all the studies calling for it were lacking or nonexistent. That weight and underlying metabolic health have very little relation. That the history of our relationship with health and obesity has little basis in fact and a LOT of basis in capitalism, politics, and fashion. No, really, the association between weight and health was first proposed by insurance companies looking for ways to charge people more by claiming risk. They also charged tall and short people more. And people with different skin colors. When they got in trouble for charging people for things they had no control over and had no bearing on their health, they set out to prove that weight was controllable and that fat was unhealthy to make money. 

These are also a lot of the same people who went on to invent the President’s fitness program, so if you went to public school you probably already hate them. 

People are clapping back against the doctor who body-shamed two researchers at a medical obesity conference

Obesity Week, a major conference for obesity researchers, is being held this week in New Orleans. But one attendee’s tweet suggests that some doctors have a lot left to learn about our society’s pervasive biases on these topics.

I’m about to finish my second week of medial school tomorrow and I’ve already noticed a trend. Occasionally, we have physicians come and talk to us about different topics that will affect us when we practice.

We had one about the shortage of primary care providers and today we had one about helping patients change behaviors. In both of these lectures, the physicians teaching had a very clear bias, in my opinion, toward overweight and fat patients….making jokes, oversimplifying obesity, and accepting the fact that overweight and fat patients have worse outcomes because they are fat and not because those patients are more likely to avoid going to the doctor for serious health problems (or having those health issues ignored when they DO go to the doctor and being told that losing weight will fix all their problems…the physicians even showed us all a chart demonstrating this almost magical phenomenon of 100% cured diseases after weight loss) because they have been ignored or made to feel ashamed or embarrassed by doctors in the past about their bodies.

Today was no different but it added to my disappointment. Today, we discussed how to implement behavioral changes and the overarching theme of the lecture was that we should all implement changes because doctors should be healthy and no patient will take us seriously if we’re overweight and prescribing weight loss to them. I have several problems with this.

1. This idea that physicians must be healthy in order to give advice to patients about their health perpetuates this idea that if you have a mental illness or a disability, you can’t be a doctor, when in reality having physicians who live with a disease and understand it make them better, more understanding doctors.

2. Having a physician who openly admitted to never having struggled with weight loss talk about how simple it was and make jokes about fat doctors was alienating to the medical students she was talking to who were overweight because it basically told them that they can’t and won’t be taken seriously as physicians years before they even get to work with a patient, take a USMLE step exam, or before we’ve even had a midterm.

and 3. Telling medical students that getting healthy = weight loss is incredibly oversimplified and just plain dumb. There are a lot of metabolic diseases that make it nearly impossible for patients to lose weight, telling a woman with PCOS to drop 40 pounds is setting her up for failure. Especially when more and more studies on obesity and weight loss are showing that significant weight loss is unsustainable in the overwhelmingly majority of people who manage to do it, they end up gaining the weight back within five years even when they maintain their activity levels and a well-rounded diet.

I hate this idea that doctors should be prescribing weight loss because the reality is that losing weight doesn’t actually have an impact on overall health, it’s the fitness of exercising that does, the weight loss is merely a side effect of increased fitness levels. I don’t believe that being fat is a disease state and I don’t believe that it must automatically mean that person needs to drop a bunch of weight. Everyone can benefit from an increase in their fitness levels and eating better, the weight loss is merely a side of that, it should not be the goal. 

I want to see a doctor counsel a patient on their health and instead of setting a goal to be “lose X amount of pounds” I want to see them say, “walking around the block 3 nights a week after dinner”. I hate that the idea that we should be targeting overweight patients with this counsel, too, when there are plenty of people within “healthy” weight parameters that lead sedentary lifestyles, drink like fish, and haven’t eaten a vegetable in ten years. But the urgency with which we are taught to counsel overweight patients on losing weight is very obvious and absolutely no discussion was had today on counseling thin patients to begin an exercise regiment, regardless of their medical history. So basically, if they don’t look fat, we’re to assume that their medical conditions are treatable with medication or medical procedures, but if the patient is fat, we need to insist they lose weight to fix their medical problems even for the same medical conditions! Medications are for thin patients, exercise is for fat patients; that was certainly the overall theme for today.

And I hate the idea that fat patients are meant to be the butt of a joke for all of us medical students while we are supposed to be learning how to help our patients implement healthy changes to their lives. Odds are, overweight patients are anxious about seeing a doctor, they are not unaware of their size, and it’s not the first time they’ve had someone tell them they need to lose weight for their health (plenty of randos on the internet do that for them already…and then take surreptitious photos of them working out at the gym because lol look at the fatty on the treadmill guyz!). It’s also probably not the first time that patient has tried to lose weight through diet and exercise or through really unhealthy ways. 

I love it when I see other medblrs blogging about the struggles that fat people face.

Actually taking fat people’s signs and symptoms seriously instead of diagnosing them with “fat.”