Advocating weight diversity [MedicalXpress.com]

I can point back to several situations over the past 20 years of being a professional educator and learner where the information shared with me resulted in a true paradigm shift. One of those occurred when I read Dr. Vincent Felitti's (et al, 2010) article titled: Obesity: Problem, Solution, or both?    I was able to read the article and then interact with Dr. Felitti a short time later as he spoke in our region on this topic and the counter intuitive findings summarized in the article. 

The entire article is downloadable for free at the following link. 

http://www.thepermanentejourna...olution-or-both.html

For those reading this blog post on a move toward "weight inclusive" principles and practices, it will be helpful  to make a direct connection to the thinking of one of the world's most influential researchers on this topic. What Dr. Felitti and his colleagues share in the above article is that weight - while problematic in and of itself - is actually symptomatic. Weight gain is also highly protective in ways that might not occur to an ACE-unaware practitioner (in any field).  This is important to know if/as one thinks about the rationale for becoming more "weight inclusive" and welcoming of weight diversity. In reality, as this is done we simultaneously become more ACE-inclusive and demonstrate compassion toward others who may have used weight as a non-verbal method of conveying information about any number of other things (e.g. early childhood adversities, depression). 

When listening to Dr. Felitti share in our regional meeting, he shared the profound truth of what is also a poster that is affixed to the laboratory walls at Keiser-Pernanente:

"It's hard to get enough of something that almost works." 

As Dr. Felitti indicated, many turn to various forms of drugs both illicit, common (ie, beer/alcohol), or both. Again, the pursuit of these "almost works" self-prescriptions puts the individual in even further jeopardy of experiencing poor(er) health, sickness/disease, or premature death.

The world is full of so-called remedies that almost work - and many individuals in an earnest effort to mitigate psychological, physical, social, relational, or emotional pain - self-prescribe "food" as their "drug of choice" (Felitti).  It would be significant loss of scientific understanding if the conversation trafficked in mere verbiage or semantics, and not what Dr. Felitti and his colleagues have learned and shared. 

Simply put, everyone should take note when researchers at the forefront of the work around health, wellness and the correlation to weight/obesity have something to share about how counter-intuitive their findings are - even to them.  

While I embrace a societal and professional shift toward a more "weight inclusive" approach I am concerned that to the general public as well as any ACE-unaware professional this would only be a shift in semantics, not rooted in a scientific research-based understanding of how weight could be symptomatic of something else.  The ACE Study provides evidence as to what that "something else" might actually be.

We will all need to contend with the reality that improved semantics are no match for what really works. As shared by Dr. Felitti and his colleagues in the article (and elsewhere) is that what may medically/technically work when treating obesity may not be asking the right question, namely: "Why the obesity?"

I will end this long blog comment by including Dr. Felitti's (et al, 2010) own comment(s) which resonates with me to this day (note: All italics/bold emphases are my own, not the authors'): 

In actual fact, our task is to help the participants discover what they already know at some level, and then to use that discovery for their own benefit. To illustrate the process, some seemingly simple questions may be offered for our readers to try, understanding that this works best in small groups and initially will be stressful for the group leader:

1. Why (not how) do you think people get fat?

2. How old were you when you first began putting on weight? Why do you think it was then and not a few years earlier or later?

3. Sometimes people who lose a lot of weight regain it all, if not more. When that happens, why do you think it happens?

4. What are the advantages of being overweight?

Patients’ answers to these questions are staggeringly counter-intuitive to conventional thinking about obesity. Moreover, their answers have been consistent over the many years we have posed these questions in group sessions. For instance, answers to question 1 routinely are: "stress, depression, people leave you alone, men won’t bother you." There are of course occasional escapist responses like "I just like food." In that case, the following response to the answer given for question 2 is helpful: "Really? Can you tell us why you suddenly liked food more at 22 when you first began putting on weight?" Responses to question 3 always are versions of "If you don’t deal with the underlying issues, the weight will come back." About 60% of the time, someone in a group will also propose that regain occurs because major weight loss is threatening. Answers to question 4 repeatedly fall into three categories: obesity is sexually protective; it is physically protective (eg, "throwing your weight around"); and it is socially protective—people expect less from you.

Ultimately, we were forced to recognize that patients in a supportive setting speak of things that we ourselves may find it easier not to know. This embarrassing recognition exposes the tempting opportunity that a physician or group leader has to become part of the problem by authenticating as biomedical disease that which is actually the somatic inscription of life experience onto the human body and brain. The frequent reference to "the disease of obesity" is grossly in error, diagnostically destitute, and apparently made by those with little understanding of the antecedent lives of their patients. Obesity, like tachycardia or jaundice, is a physical sign, not a disease."