Episode 95: The History and Development of Obesity as a Disease
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Episode Description
In this episode of The Up-Beet Dietitians podcast, Emily and Hannah dive into the politics of obesity as a disease. The girls break down the history of when obesity was first defined as a disease. They also break down how the educational system has pushed the obesity epidemic ideology as well the effects of weight stigma. Lastly, the girls propose alternatives to weight-centric care.
*Disclaimer: Individuals in larger bodies should be at the center of this debate. Listen to the fat activists and their stories. Don’t just take our word for it.
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0:33
hello everyone welcome back to another episode of the upbeat dietitians podcast
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hey guys welcome back if you are here from last week's episode today is kind
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of a part two to that we discussed last week if intuitive eating could be used
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for weight loss and we kind of prefaced today's episode which is all about obesity as a disease and the Obesity
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epidemic is that really a thing we're gonna get into it we do want to start
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with some trigger warnings and disclaimers because obviously today is going to be a lot about weight so if
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that's going to be triggering for you by all means please skip today's episode we also want to make it very clear that
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we ourselves have not struggled with obesity and I guess kind of a part two
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to this disclaimer is if you're listening and not watching us on YouTube we're going to kind of use obesity in
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quotes um we'll kind of explain it more later but um obesity tends to be a pretty
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stigmatizing and also hard to Define word and so I myself know if I'm ever
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like writing it out like on like an Instagram post or like in a blog I usually put it in quotes
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um but anyway back to my original disclaimer Emily and I have not struggled with this ourselves and so we are approaching this
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from a medical professional standpoint and sharing stories from those that we've worked with who have
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that are in larger bodies and have dealt with maybe weight stigma and things like that so
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we meaning Emily and I should not be at the center of this obesity as a disease
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debate and we encourage you to listen to those who are in larger bodies to hear their stories and their side of things
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again we're just here today to talk about our side as medical professionals but not personal experience
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exactly that so let's just jump into it because Hannah and I have talked about how this is gonna be a really long
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episode so grab a snack grab a little beverage a little treat because we're
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gonna be here for a little bit and all good things to talk about so right off
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the bat let's just kind of talk about the big elephant in the room yeah yes
2:45
there's a len there's a lot of debate amongst Healthcare professionals if
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obesity is considered a disease in 1997 the
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World Health Organization who declared obesity in major public health
3:03
problem and a global epidemic so it's been now like over like 20 years but way back then they kind of publicly
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announced that and then later the National Institute of Health at the NIH
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declared obesity's a year later in 1998 and in 2008 the American obesity Society
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declared it a disease as well which is very it has the name in it so I'm like
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that's right it's like all who they know so yeah that's the whole thing there
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and then also the American Medical Association also kind of had a part in this in 2013 where they were going
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against the recommendations of their own committee about what classified obesity
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so there's like a lot of different organizations kind of putting out this announcement about whether it's a
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disease and then there's like conflicting data about it right into it but we'll get into all of that in a
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little bit specifically with AMA the American Medical Association though
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it was because the biggest controversy for why kind of their guidelines weren't
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lining up is because it was so difficult to Define and measure but
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AMA did it to benefit the drug companies and surgeons kind of especially in that
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weight loss side like throwback to our ozempic episode was it that one where we talked about no
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where was the one we talked about obesity oh or BMI we talk about this so much yeah where
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the criteria was changed a little bit so more individuals would be categorized as overweight or obese quote unquote
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according to BMI but there was there's questions about
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whether or not people in larger bodies were consulted in these recommendations
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or talked to um how these classifications would affect them there was kind of like with
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all of these guidelines being put forward and all these like public statements about being
5:09
a disease there was also a lot I don't know if there was a lot of question there's a lot of question of it now especially it was like who was being
5:15
consulted was it just a room of people in thin bodies
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or was it like who was it part of that conversation right so like basically the
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AMA was like yes obesity is definitely a disease even though like the committee
5:32
voted against that they were like we can't really measure obesity as a disease like all we've got is BMI to
5:38
measure that we know BMI really sucks but like the anime was like no we're still gonna do this because the drug
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companies Insurgent are going to benefit greatly from that so that's the biggest issue right off the bat with AMA
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classifying obesity as a disease I want to also get into the infamous obesity Maps you've definitely seen them
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we saw them constantly when we were when we were in our dietetics program
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um we were told that like okay I'll kind of explain it actually in case you don't know what I'm talking about basically they show the prevalence of
6:12
obesity which again is based on BMI and how it has progressed in each state it's
6:18
like a map of the United States and the different colors show the increasing rates like blue is like not severe than
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green or gets a little more severe than orange yellow whatever and then it's like the red states are just like
6:30
everyone there is obese everyone's going to die of obesity yada yada
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so we were showing these Maps a lot and it was used frequently to demonstrate like how the Obesity epidemic is a thing
6:44
and how obesity is an outbreak becoming very popular half the country is obese or maybe more than that I don't even
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know what the rates are um and these Maps when you see them they
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are very jarring like it might seem pretty impressive that you are making a very Grand Point of how
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obesity definitely is an epidemic but they're very misleading so first of all they use state borders
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as the boundaries for the shifting colors so like Alabama has its own data and Mississippi has its own data Indiana
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has its own data but this overstates the extent of obesity because the size of a state is
7:22
not relative to the size of the population so like for example California and Montana are very similar
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in land size but California has about 39 million people and Montana has like just over a million so they're not accurately
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showing like the rates of obesity like for the size of that state also when you look up the size or excuse
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me when we look at the states where obesity rates increase the most it is indicative of places that have larger
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rural rural and lower income populations so there's a lot of reasons why that
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might be true that weights are increasing in those certain areas but it's not because those people are lazy
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or I don't even know what excuses they might use these days but again the bottom line is that these maps
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are very misleading and they're don't they don't really paint a whole picture
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no it's I feel like the population is one of the biggest ones honestly it's just like
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population saturation is oftentimes wide maps at any time like
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with you just indicated color it's like let's think about how many people actually live in this state you can't
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just throw that up there be like look at these have the same rates when they're there's 38 million people
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differentiating between the two state population sizes and then
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the shifts and where people are moving to and what they have going on it's not as simple as just
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this state has a problem right like of course of course California is going to
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have less obesity prevalence than Montana when it has 39 times the people there
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yeah the ratio is a little bit different yeah exactly so let's
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since we've kind of gotten some of the background down to like all the organizations I've been involved with
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this and especially the Obesity Maps because I feel like that's one of the biggest things people always reference
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whenever it comes to the epidemic quote and out of the people's bodies are changing
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let's actually talk about like what obesity is or what maybe it's is classified in as
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in the medical field so the World Health Organization defined it
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as someone who is overweight or overweight
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in obesity are defined as abnormal or excessive fat accumulation that presents
9:50
a risk to health nowhere do they specify what is abnormal
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what is excessive or what is health it's kind of this very vague statement
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there's no specific like subjective criteria to what is
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abnormal or what is excessive like that's a very I said subjective I should have
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said objective yeah that's a very what they are doing is it's subjective it
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should be objective but like just saying those statements is there's a lot of
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gray area and a lot of up for interpretation it doesn't really mean anything and then also saying a risk to
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Hells doesn't sessify like say physical health mental health emotional health there's a
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lot of different aspects of Health like spiritual health as well what is a risk to health okay what's the
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risk even mean like yeah it's very vague and not very helpful
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but that's kind of the most standard definition out there of what obesity is something else people would often think
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of is BMI highly recommend listening to our BMI episode we spoiler alert we're not the biggest
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fan of BMI go listen to the episode or still like dive into the history of it
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specifically why we aren't the biggest fans but four obesity specifically with
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BMI what people think of is the three different classes there's like the BMI of 30 to 34.9 is class one 30 BMI 35
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39.9 is class 2 and everything above 40 is class 3 whereas
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with BMI it's a ratio of your height to your weight and there are these different classes in
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that is also what quote defines obesity
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also not a great measure because it's
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just listen to the BMI episode after this well tag it in the show notes so you can
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listen to it there but it's also not great between the very
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vague definition and these numerical ranges
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it's not off to a great start not off to a great start and also like how do we
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Define disease too so I pulled the Oxford dictionary definition in the
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Miriam Webster definition and I'll kind of read those off we can kind of do a little debriefing about it but right off the
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bat I feel like it's um not gonna really match
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when you hear disease you don't think of someone's body size or maybe you do if you're working on Obesity medicine but
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anyway the Oxford dish the Oxford dish tongue isn't working the
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Oxford dictionary defines disease as a disorder of structure or function in a
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human animal or plant especially one that produces specific symptoms or that affects a specific location and is not
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simply a direct result of physical injury okay so with that first of all
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specific symptoms we already talked about how it's so vague like
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I would not say that abnormal or excessive fat accumulation is a specific symptom so
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on that one um a specific location
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eh there were some people who will say like abdominal adiposity or like abdominal
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obesity or things like that kind of classifying like where the body fat is on a person's body and
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some will use like a waist measurement to kind of help Define or not Define to
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help classify obesity but it's technically not there aren't any specific guidelines that say like if you
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have this white circumference you are obese it's always based on BMI so I would say that doesn't really apply
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either and then of course the injury thing will disregard but I would say with the
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Oxford dictionary recommendation or definition it doesn't really fit with that especially the like also the disorder of
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structure or function it would the argument be like no
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self-control like a disorder of your mind right
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right no well speaking of that the the Merriam-Webster Dictionary I cannot say
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these words the Merriam-Webster Dictionary definition says a similar thing it says that a disease is an
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illness that affects a person animal or plant a condition that prevents the body or mind from working normally
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but once again like what is normal what's an illness like it's just so hard
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to say that's definitely a thing yeah it's very vague and then when you
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like try to utilize like the Obesity criteria that's also very vague so you
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can't really Define it there's a lot of holes in the logic that obesity is a disease
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and I don't know if I put this in the outline at all for this but something I hear a lot I actually think
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I heard this first one like the maintenance phase podcast episode on this topic but and I've seen it ever
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since like everywhere you look on like different obesity medicine websites they'll say that they are classifying
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obesity as a disease to reduce the stigma like that's their reasoning for making
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this a disease because it helps people who are in larger bodies and classified as obese feel as though it's not their fault that
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they're obese which great but like you are still telling them their body is wrong and tell them
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it should be changing it so I don't think that's reducing stigma if you are telling them that they need
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to change their entire body shape have you seen that
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I'm thinking specifically we talked about this in the ozempic episode where
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we discussed how like Weight Watchers has like partnered with sequence to be
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able to sell those epic through that Telehealth platform and on sequences website let's see if I can find it now
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and kind of quote it verbatim sequence says that they are all about reducing weight stigma
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but like they're a weight loss company the math is not mathing like
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what's the example that I heard on oh my gosh maintenance phase it was something that was like it was
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about like gay people and it was like we're trying to reduce the stigma around like gay people but also you shouldn't
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be gay or something like that I said it way better than I am but it's the same idea where like you're taking it this
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already stigmatized group and telling there's something wrong with that that makes sense
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of it so they can find it on sequence
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it's probably on the about us page oh here we go their mission oh my gosh
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so this is on sequence.com they say we're on a mission to help people feel confident they can control their weight
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while feeling good about how it fits into their lifestyle we provide a virtual Clinic that's free of weight
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bias and stigma but also let us help you change your
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body that is obviously Wrong by our definition they don't say that that's me I said
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that we're we're saying what's in between the lines yeah
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yeah it's so it was a little bit counter-intuitive yeah it's kind of like the whole intuitive eating thing where
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we said last week like people will Co-op the intuitive eating language and say we're gonna this is how I lost 30 pounds
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with intuitive eating like it's the same thing here like they are they know that weight stigma and fat activism and all
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that is being more talked about and so they are trying to throw those words in to make it seem like they're doing it
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the right way LOL
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it's it's nice when you're able to identify it but when you're on the receiving side
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of it and you are thinking that they would try to deceive you like that it's
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it's very easy to get caught up in the marketing unfortunately they're very good at marketing they always are so
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like you're so right like if I had seen that and I was trying to lose weight but
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I also knew that regular methods were telling me my body was wrong and I was being stigmatized like oh cool finally a
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program that's going to work for me maybe it will everyone's path of life is
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totally different but that's a red flag when a weight loss
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company or obesity medicine doctor which is who runs this thing you've likely see them on Instagram it's I don't know how
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to say his name Dr Spence or something um he's like the medical director of
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sequence but anyway when they say we're going to treat obesity as a
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disease without weight by us or weight Sigma we're going to change your body because it's wrong but without stigma
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though no Stigma there yeah it's not great impossible to do
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so that was kind of a side note I may have put it on the outline somewhere but I want to make sure I said
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that earlier before I forgot because pissed me right off
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yes so let's talk about who benefits from classifying obesity as a disease
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Eric Oliver wrote a book called fat politics which actually does a really good job of breaking down the politics
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behind obesity I have not read this book I know Hannah has read it with her book club I have a note about it I will say
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it does a really good job of breaking down like the politics of obesity like Emily had just said um but he does get a little bit into
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nutrition that I don't agree with so don't go past like chapter four or five because he like demonizes carbs and
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things like that so don't love that but he does it's it's kind of like like one of the
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members in my book club had said that it reminds them of like reading like a college
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like transcript it's like a really boring read I'm not gonna lie but it
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does again do a good job of kind of explaining what we're about to explain here like where did obesity's kind of
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come from and like how do they benefit from it so maybe check it out from a library and
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so you can read part of it but yeah when it gets to the nutrition Rex part Maybe
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deter blows the covers and hit return yeah
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so first and foremost one of the biggest beneficiaries
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obesity being a disease are the Health Care Systems and when more people are taking weight
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loss medications or getting bariatrical surgery
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the Health Care Systems are making more money and the more people that they can
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encap and like Encompass in these overweight and obesity categories the more they can Market these products to
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them and it's important to remember that oftentimes these methods
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don't work in the long term it's very it's very common for people to
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gain the weight back so especially when it's a medical professional promoting it it's tough to
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challenge them honestly like you don't want to challenge your doctor or especially if they're so ever doing it to reduce the
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stigma but whatever I'm past that but yes you're right yes you think like
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they should know they're talking about like they know what they're doing and they they likely aren't trying to do harm but
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we are trained in such a weight-centric way that of course yes their goal to
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help you with is treat this disease of obesity yes especially like it goes back into like the education Beyond it where
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when you are young and influential as we are old now in our old age in our
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mid-20s prefrontal cortex has fully developed so we are capable of thinking properly or
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thinking a little bit more critically I'm a different person than I was saying for
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pre-prefrontal cortex formation but
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it goes beyond that and even if like they have good intentions or maybe they
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have or if they've just been surrounded by this for so long the world of medicine is changing which
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is good um and where there's a lot more people being more weight inclusive especially
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medical professionals which is good but there's still a lot of work to be done so
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it's tough it's tough being in healthcare as being in healthcare but also it's tough when you don't feel as
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supported when you confined in your Healthcare professionals right I'll say from my
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experience as a medical professional working as an outpatient dietitian if someone has a BMI over 30 we bill for
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that like if you have come to see me as your dietitian and you looked at your we
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call it my chart which is like your like your records on your phone on the app you will see that I had to like
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diagnose you and Bill you for obesity if your BMI is over 30 which whenever I do
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it I'm like Ugh like vomiting as I put in the charge and then of course the hospital I work at gets a ton of money
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back for that because it's a big epidemic whatever so yeah we that's how they benefit is
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your body size if it fits in the Obesity categories can
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be billed for and the hospital gets money for that
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yes Insurance in the hospitals and Healthcare yeah this is our next part
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too similarly yeah the pharmaceutical companies also benefit so of course
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simply put they just get to sell more medications for weight loss like we talked about this in the ozempic
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episode that weight loss meds are not a new thing but they continue to grow and
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new ones are always being formulated and the reason they are able to do this is they get a ton of funding because
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obesity is classified as a disease if obesity wasn't a disease and it was not as big of a problem as it's made out
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to be they would not get as much funding to make these new medications to treat this disease
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so again pharmaceutical pharmaceutical companies make
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I mean big big bucks big bucks very big bucks
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I feel like you already alluded to this one as well as like the weight signs oh yeah researcher the ones like were
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pushing out the research articles funding those obesity studies and
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the effects of obesity on cardiovascular risk or
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cancer risk or whatever it is um the more prevalence there is in
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obesity in the population the more money there's going to be to fun studies
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which okay my next note on this I think this is all just so wacky and backwards
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because according to these obesity maps and all of these obesity associations
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like AMA and what was it like the Obesity American Association whatever
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yeah like according to all of these different people and organizations obesity rates are rapidly increasing yet
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our approach to fix it has not changed like we're still telling people to eat less move more take this medication get
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bariatric surgery but like the Obesity epidemic is just getting worse like more
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and more people according to their definitions are obese so like why do we keep doing the same approach oh wait to
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make money yeah it's been going on long enough
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that if the researchers were like finding changes and
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to accommodate this or whatnot something would have changed but it's
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all the exact same thing or like probably at least a century I don't know
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what they were doing like pre-1900 I don't really know either or if it was
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really documented that's what I was going to say I don't know how well they were documenting that or
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yeah it was collect storing that information or what you're even talking about it but it's been been going on for
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quite a while and it's all essentially the same yeah and we're gonna cover our
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proposition or our proposal for what the solution should be so we'll get
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to our chat on weight Centric Care in a minute here but again like something has to change like
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clearly the weight Centric eat less move more method is not working so why do we
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keep doing that hmm if money was not involved all right
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right if we stopped that the giant industry would just like take a beating
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which is great oh yeah but that would be just billions of dollars
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in the economy that plummet oh like probably a trillions if
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you think about like how many people are actually like I meant like insurance would get
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affected somehow Pharmaceuticals would get affected
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Healthcare Center systems like obesity medicine doctors would be obliterated
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yeah it'd be crazy yeah so
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all in all there's a lot of people that benefit from pushing the Obesity epidemic
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narrative so let's talk about specific let's get into the science and let's
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talk about correlation versus causation that's like one of our favorite phases
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phrases on here and like let's talk about the difference of these so last
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week we talked about what if I need to lose weight for health reasons and we're going to get into it right now this is
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what you've been waiting for welcome back we're glad you you're here so
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despite what Healthcare professionals and the popular media is telling you
29:08
there's no current research that states
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that having a higher weight or body fat percentage causes
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underlining causing that word what causes in bold in italics make it
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multiple fonts bigger causes disease like heart disease
29:34
cancer diabetes those tend to be like the big three that people like to talk
29:40
about oh yeah there's potentially a correlation
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underlining correlation where some people in larger bodies may have these
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diseases but the diseases are not caused by body size
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a common example is smoking cigarettes can cause yellow
30:04
teeth and smoking cigarettes can also cause lung cancer
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just because and I'll you may have yellow tea and also might have lung cancer but it
30:17
does not mean that the yellow teeth caused ear lung cancer
30:23
does that make does that example make sense like yes yes like there are
30:33
I can't think of words Finn just barks and threw me off yes so smoking cigarettes causes yellow
30:40
teeth it also causes lung cancer and so when you get lung cancer if it's due to
30:47
smoking you also have yellow teeth so it does not mean the yellow teeth is what caused the lung cancer it was the
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smoking so to take it back to obesity and body size
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let's see let's say genetics is what caused you to get type 2 diabetes you
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also happen to be in a larger body so people might say that because of your
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body size that is what caused your diabetes but it's actually because your dad has it your great grandma has it
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your great great aunt has diabetes so you were likely going to get it no matter what body size you had
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so all these things are correlated to each other but the cause was not directly the body size or body fat
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percentage or any of that yeah so genetics plays such a huge part and it's an invisible factor which I
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feel like that's why it gets neglected so much is because people don't see it so they don't think about it
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but also like environmental factors or environmental causes plays a huge part
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like what we eat physical activity levels weight stigma can also play a
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huge part in this as well I feel like I can speak most strongly in
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like the renal health field where the two biggest causes of well the two most
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common causes of kidney disease are diabetes and hypertension and I've had multiple conversations with
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people whenever they inevitably ask me about what I do and I'm I am not
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smart enough to lie about it I like to throw renal in front of it so
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they don't start asking me about what the best way to lose weight is
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[Music] um but I've had conversations with people where
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they're like oh so like oh were they here I work with like people with end stick with end-stage renal disease and
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they're like oh like you must do a lot of weight loss because a lot of them are like overweight and that like caught
32:54
like affected their kidney function and I'm like no actually
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the two most common causes are diabetes and hypertension and the large majority it's like why it
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led to kidney failure is because one they didn't have accessible
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like healthcare or they didn't have accessible like nutrition they were just kind of eating
33:22
whatever they could afford or genetics I've had so many patients and I'm not going to
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say like diabetes and height there are other causes besides diabetes and hypertension where they've had like other
33:34
very like interesting diagnosis instead of blood to kidney failure and they were like
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some of the most health focused people I've ever known to the point to a fault we'll say like to a folds are a little
33:47
bit too involved and their nutrition and physical activity and they still develop kidney failure yes and I'm like no it is
33:56
not their weight that led to this kidney failure and obviously
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I don't go through all that explanation because one I'm saving my energy for like
34:09
protect your peace girl yes but it's just
34:15
goes to show that there's so much more that disease
34:20
then body weight something that like one is not very well defined like obesity is
34:26
obviously not I'm very two the causation and correlation component
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played a huge role in this there are too many factors and also the lack of research is
34:40
is it's crazy for how many researchers are behind it
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there's a lot of correlation right not because they can't show that it causes it because it doesn't cause it
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in every case like it's impossible to prove and that's why it hasn't been
34:58
proved proven not proved wow I sound like a real scientist using bad grammar that's
35:05
why we are not in Academia it's we are
35:11
in the thick of it yeah plus I get in the fields get all jumbled oh
35:18
but it's just there isn't the causation there isn't
35:24
it's not there no and I know that we're gonna I am also speeching it as a research there's no
35:30
causation it's not there it's not there causation not there
35:38
lyrics I promise we are what's the word I don't even I can't
35:43
think of words either like in no like we can be trusted
35:48
uh now I can't we are to be trusted is what
35:53
I'm trying to say we are incredible credible yes I promise we're not
35:58
frauds even though we can't use basic words or apparently describe scientific
36:04
phenomenons and figures and such it's been a little bit
36:10
kids but the point is correlation does not equal causation and
36:15
there is no research that shows that body weight causes a chronic
36:21
condition let's let's share our piece so yeah we've talked about how
36:29
how obesity is defined who benefits from that
36:34
what the research is saying or not saying so what are our thoughts on all that now
36:42
that we've laid the base so right off the bat we've already
36:48
talked about this but there is no reliable way to diagnose obesity BMI is
36:54
incredibly flawed we hate it right like listen to our episode if you
37:00
can we beat it enough can we beat a dead record enough inside joke for Ted buds only
37:09
um yeah like with other conditions or other diseases like you think of like
37:14
type 2 diabetes is diagnosed with A1C you think of hypertension diagnosed with a blood pressure reading like other
37:21
diseases have a definite way of diagnosing it whereas obesity is just
37:26
BMI and like we've said and we've said in the entire episode of BMI that that's not a reliable measurement
37:33
of Health and it hasn't changed as well like and we said
37:38
that wasn't even like meant to be used to discuss body fatness like it was not
37:45
created for that purpose yet here we are using it for that purpose yeah okay yeah it seems silly
37:52
we've also said this too we've kind of already jumped the gun a little bit today as we typically do
37:57
um but a another argument that we have against classifying obesity as a disease is that higher BMI or fat Mass has not
38:04
always lead to poor health outcomes a lot of population-based Studies have
38:09
found that those in the overweight BMI category of 25 to 30 actually have the
38:14
lowest risk of mortality and chronic disease and then of course you get a little bit higher into the Obesity
38:20
categories and the risk does increase but it's still lower than those who are in the underweight category so actually
38:27
the ones who have the highest mortality risk is those in the underweight category which often is very shocking to
38:33
a lot of people goes against everything they're pushing out there yeah yeah
38:39
so we've also seen in a lot of studies too that many aspects of Health can
38:45
improve as a result of making healthy choices or we like to say Behavior changes and
38:52
what's on your bulletin board somewhere your weight is not a behavior um but making Behavior changes like
38:59
moving more sleeping better managing stress these are what is going to improve your health even if weight
39:05
doesn't change so if someone starts improving their health by eating more
39:11
vegetables and sleeping better and they're doing joyful movement but their weight doesn't budge a single pound or
39:16
maybe they even gain weight doing that their health likely still improved from those Behavior changes even the weight
39:22
didn't move and they still are classified as overweight or obese oh you are frozen
39:30
cool looks so creepy
39:37
it's like she's staring into my soul
39:43
oh I was trying to get a picture of that because you were like making the
39:49
creepiest scary face it was like you were staring into my soul
39:55
that was the longest phrase ever oh my gosh I freeze too
40:00
yeah oh my gosh it just kicked me out it kicked you out oh my gosh yeah
40:08
but I'm back well it probably got all that I said because I'm the one recording but I was talking about I had
40:16
a very scary face I was trying to get pictures I could show you later but yeah you were like it was so scary
40:26
to leave it in oh wait oh wait see it because if you edit this you'll see it well edit it yeah
40:32
okay I feel like you can just continue where you're at I'll just continue okay so our third argument against
40:40
classifying obesity as a disease sorry
40:48
how we're going to edit this but in case we don't edit this part out where we're giggling um there was a very scary moment where
40:54
our computers froze and Emily was making a very scary face we should like try to like include a screenshot in the video version of this well somehow
41:02
we do like a real or a tick tock it could just be cute
41:08
yeah I was like having a conversation you were just like it was so scary
41:14
we'll leave it in oh it was very scary the beauty of long
41:20
long distance recording I know we would not have this problem if we were in the same room we recorded but you know we do
41:26
what we can we're doing the best we okay back to Serious matters our third
41:33
two fingers for third apparently this is where we're at oh if you listen
41:39
to audio I'm sorry because there's a lot of visuals going on that you miss out on honestly go to YouTube We're wake funny
41:46
on YouTube you get the you get the hand gestures and the theatrics yeah
41:54
okay let's try this for the third time the third time
42:00
okay labeling a body this is actually a very serious matter so I shouldn't be giggling okay
42:07
labeling a body as diseased is like insanely stigmatizing and insulting
42:14
and we do know that weight stigma is related to poor health outcomes
42:19
actually a higher likely relation there than the
42:24
body weight being related to poor outcomes we as dietitians have heard countless
42:30
stories of people going to their doctor for like a cough or ear pain something totally unrelated and they left there
42:37
with like a handout on like a low FODMAP diet or a 1200 calorie diet or whatever
42:44
without any explanation of how or why or what
42:50
it just sucks I we should have a guest on that could explain this maybe more from their point
42:56
of view because like we said we can only really talk about this from our professional standpoint
43:01
but again we've heard so many stories and it's happening and it just like it really sucks it's very frustrating when
43:10
you go in for something and like we can't even imagine
43:15
it's it's frustrating when you know something's going on and it's not related to your weight but
43:22
oftentimes we've heard so many too many stories where people get
43:29
come in for something and go out being told they need to lose weight yeah we're going on a diet
43:35
too many stories so that in it a lot of it also like is in the
43:42
responsibility of like the healthcare professionals where we need to be having these discussions about weight stigma
43:49
less okay okay this is actually the part I did include it in the outline so that
43:54
was what I was saying earlier about how a lot of professionals will state that
44:01
calling obesity a disease is actually less stigmatizing because it takes away blaming it on like a lack of willpower
44:07
laziness whatever and like to what I said earlier that's fine like that's
44:12
actually you're you're halfway there like you're almost getting to the point where you get this but like you're still
44:19
like pathologizing is someone's entire body yeah exactly you're basically
44:25
saying like you are a walking disease like your body is a disease it's not reducing stigma in any way like
44:32
you're saying the solution for fat stigma to go away is for fat people to stop being fat
44:39
that's what it was on the maintenance maintenance based podcast I said the solution for
44:45
um how'd they say it like the solution for like homophobia to
44:52
like go away is for those who are gay to stop being gay
44:57
nope the the ball's in your form the ball is in your court homophobes like
45:03
you're the ones who got to figure your out and like yeah you fat phobic doctors like you're the ones who got to figure
45:09
it out not those who are just like walking in a body that's different than yours it's not on them
45:16
to change your mentality no and the the weight stigma is still gonna be there
45:24
even if they lose weight so yeah that's yeah
45:29
so yeah I can take a lot of systematic change yeah a little a little deeper than this podcast but at least we're
45:35
talking about it yes so I completely forgot what are we even
45:41
talking about um
45:47
I just groped a little bit I'm like we've been talking about this for a while I'm like what what is this category what's the category I know
45:54
um I know our last argument is pursuing intentional weight loss can be harmful I
46:02
feel like this is another one of our very common phrases on this podcast but
46:07
there's no good evidence or valid evidence that the majority of people can
46:13
lose weight and keep it off in the long term using diet and exercise oftentimes
46:18
people gain the way back or more after two years which leads to weight cycling where you gain a bunch of weight from
46:26
either stopping whatever extreme diet or exercise regimen you're following and
46:33
then you flip-flop to the other way where you're going back to that extreme and you lose the weight or you start a new diet or whatever it is
46:41
which weight cycling plays a huge part in risk for chronic conditions that
46:48
right no one likes to talk about that like it's like your body doesn't like change we talk about this quite often
46:55
and if you go up and down like 20 30 40 pounds that's a lot of change
47:03
for your body to ensure door from like a metabolism standpoint especially and
47:11
no one in the diet industry talks about weight cycling and it's a risk they just
47:17
talk about here's how you can lose weight and then if it doesn't work for you try
47:22
something else right like Weight Watchers just like keep counting points forever so you don't gain the weight
47:28
back oh wait you can't do that because it's not realistic that's your fault not our fault no
47:35
try again the amount like almost every single
47:41
person I have worked with like that talks about like their diet history always says like oh it worked so
47:49
well like I lost so much weight on this diet but then they inevitably inevitably
47:54
inevitably talk about how they gained it all right back like I have rarely seen a
48:00
person who has a an extensive dieting history that has like
48:05
saying and praise all the glories of how those diets work for them like and I
48:11
have a patients who have like done all the diets like I've had patients who have done 20 30 different diets and
48:17
they're still coming to see me because none of those things worked which sucks I'm glad they're talking to me and we
48:22
can finally figure it out but like it really sucks they had to go through all that
48:29
yeah so yeah bottom line intentional weight losses
48:36
and we said this last week too but that doesn't mean that Emily and I are anti-weight loss like
48:43
first of all we're also not anti-dieter so if you have the desire to lose weight
48:49
totally understandable that's the world we live in um but also we talked about last week
48:54
too how if you ditch the diets and you kind of get out of this weight cycling yo-yo thing you might end up losing
49:02
weight as you get towards your set point weight and I've been seeing on social media sometimes too like actually I've
49:08
gotten DMS people will say like oh I've like noticed that I'm losing weight as I adopt intuitive eating and I'm feeling
49:14
really guilty about that like I feel like I'm like dieting and I I totally get where that comes
49:20
from because we talk so much about how weight loss isn't the solution but it
49:26
does not mean that weight loss is always a bad thing either it's it's just nuanced guys like there's always going
49:31
to be a yes but to like whatever we have to say here so anyway if we said this last week too
49:39
but if you are losing weight as you are adopting intuitive eating
49:45
that could happen but it's not promised to happen the whole idea is just that
49:50
you're approaching that set point weight which is your body's best happy way it wants to be at
49:56
yeah we also have a episode on set point theory that we will tag in the show
50:01
notes but it's a lot about like the mentality behind it and the intention not
50:07
specifically what's happening outcome yeah exactly it's about the why
50:13
so let's talk about what changes we propose for this weight-centric care
50:20
world we live in and maybe one day we can propose this and changes will be
50:27
made but we're putting our two cents in here now so if this ever comes up Mark our words okay you can reference this
50:35
episode be like yes Hannah and Emily mentioned this right here and this is good
50:40
and maybe it'll change also like the the world changes all the time maybe we'll think of something better we'll we'll
50:46
keep you updated then yeah you'll be the first to know and we have a revolutionary idea yes so
50:56
the biggest change number one is shifting from a weight-centric approach
51:01
to a weight inclusive approach the main idea behind weight inclusive is
51:06
that health is not defined by someone's weight and people of all sizes should receive the same level and type of care
51:15
when it comes to medical the medical field
51:20
case in point if someone in a thinner body
51:27
came in for our cough and they were given antibiotics someone
51:33
in a larger body had the exact same symptoms
51:39
maybe like obviously no one's gonna have the same history but like exact same symptoms they should be treated
51:45
similarly and not given weight loss advice because
51:51
they wouldn't probably they don't wouldn't give it to the thinner person right so that weight stigma they they
51:57
see the weight and it's pushed on it so providing the same level of care is one
52:04
of the biggest things with weight includes just removing that weight aspect and not defining your health
52:10
healthy equals weight removing that exactly one of the biggest segments
52:16
and this doesn't mean that weight doesn't have an impact on health it absolutely has an impact on mental
52:22
levels because because weight is a very weight stigmatized
52:29
world and it can have an impact on physical health but we have to look at the bigger
52:36
picture it's not just focusing on this one piece of data and utilizing that to
52:42
decide how we treat someone and this doesn't mean that we also can't
52:48
discuss weight this is something that very much comes down to patients choice we need to look at if they have any
52:55
history of an eating disorder or disorder eating it's very important to be transparent with your patient about
53:01
this and know how comfortable they are discussing weight because you don't want
53:07
to just commonly spring it upon them and Trigger them into a binge episode or
53:12
restriction because all the time it's insane
53:17
like I hear from patients all the time their doctor will just like tell them to lose weight or like I'll read their notes and they went in something totally
53:23
unrelated and of course they gave them weight loss advice or my favorite is this is kind of a dis on me which is not
53:29
about me but when it says like recommend seeing a nutritionist or a dietitian
53:35
with the letter c they spell it wrong like they already are seeing someone that you just didn't like look in their note to even know if that was the case
53:40
you just assume that because they're fat but there's no way they're seeing a dietitian or working on their health
53:47
it's variant it's so insulting so insulting for the patient especially
53:52
it's just frustrating from my point of view to see that it's like hello
53:59
We Exist we're helping also this person is also helping themselves like they're trying to make changes you just don't
54:05
care to ask them about it all you want to say is here's your medication get out of here and also you're making a lot of
54:12
assumptions based on what their body is presenting as yeah it's an easy way out to just say lose
54:19
weight so it's an easy and lazy way out oh yeah in my humble opinion of being in
54:25
healthcare of two years it feels like it's been decades but I'm tired I'm I'm
54:32
aged I'm I'm so tired we need to get out I'm so tired
54:38
oh we're just fine we're fine we're fine we're fighting the good fight for you
54:43
guys we're trying to make changes from the inside we're maybe we're not we're just fine it's like it's like a David
54:49
and Goliath kind of thing like just little dietitians trying to fight against you know loads of doctors who
54:56
hate fat people it's fine yeah
55:03
oh oh okay so anyway let's continue to talk about winning inclusive care because
55:09
that's our big proposition so we talked about how
55:15
the big aspect is like not just utilizing weight as the main driving
55:20
factor for our making our decisions but we inclusive care is also good or has a
55:25
benefit because it acknowledges potential harm that can come from pursuing intentional weight loss this is
55:32
never talked about anytime I try bringing up that telling a patient that they need to lose weight could be very
55:37
triggering for them it could cause a lot of harm mentally especially doctors are like
55:43
uh what you're telling me that telling a patient that they need to be thinner is
55:49
like not helping them my whole point is I'm helping them they kind of like Gaslight me to thinking that their way
55:54
is the right way kind of thing I'm like let's see the other side of this where like maybe telling them that their body
56:01
is a problem is actually not super helpful it goes back to the whole thing I said earlier about how they're trying
56:06
to like reduce stigma but they're only making it worse like they truly could not see what they're doing is wrong and
56:11
I say they like very generally of course like there's plenty of doctors who are
56:17
not like that but more times than not that's what I see yeah it's oftentimes
56:24
the healthcare kind of system of how it's built up and those that follow it and don't
56:30
challenge it yeah but that's that's a good point too to just keep making this drown on for
56:37
longer like no one's ever brought it up to them like they were trained in medical school to help people who are in
56:44
larger bodies make their body smaller and no one's told them otherwise and the pushback or feedback I often get
56:51
too and I bring this up to people is well the research shows that
56:56
obesity is bad I'm like first of all is it really good research
57:02
second of all there's also research showing that intentional weight loss can be harmful and the method that you are
57:07
doing things is wrong like there's two sides to this coin here and you are only seeing one side hmm
57:15
yes hmm once again I am tired
57:21
it's fine we're fine but let's talk about the last thing we'll say about weight
57:28
inclusive care is really keep beating this dead record
57:34
you know they do call us the upbeat dietitians for a reason yes yeah
57:40
we're actually it's actually not about us being upbeat it's about us beating points till you're sick at them it took
57:47
us 95 episodes to finally to finally explain our our episode or our talk
57:53
it took us 95 episodes to explain where the name comes from but that's the truth behind the episode surprise this is
58:00
we are not very this is this is our truth this is our truth but they're
58:08
our Improvement improvements linked to incorporating weight inclusive camera
58:14
list these off so some that include like incorporating more healthful Behavior increased
58:21
movement and nutritious food choices improvements in blood
58:28
pressure cholesterol levels self-esteem and mood Body Image Weight stability eating behaviors especially like
58:34
reduction in disorder to eating and engagement levels with like lower Dropout rates
58:40
which people always like or people are not always like because no one to no one thinks about this people are not always
58:46
like that just us because it goes so much further
58:54
past just like surface level health
59:00
whatever that means One Way say like you're getting healthier from weight loss it's
59:06
there's a lot more involved than when you include or incorporate more that way inclusive care
59:11
it can lead to a lot of different benefits from all aspects of health because everything I just listed off is
59:17
not just physical health it's also emotional and mental health and also all those things definitely
59:22
could not correlate in some cases with weight loss and weight-centric Care like self-esteem and mood that could
59:29
absolutely not improve with weight loss body image could absolutely not improve weight stability eating Behavior
59:35
disordered eating like these things have been linked to weight inclusive care but
59:41
they absolutely they likely have been linked in some way too to weight central care but they
59:46
could also be the opposite and not happening that's what I usually see is they are not happening with the weight Centric
59:53
Care approach so all in all
59:59
way inclusive care is evidence-based
1:00:04
and also ethical no one talks about ethics have you seen
1:00:10
The Tick Tock of the sister and the brother who do the
1:00:15
Kardashian um impersonations it is not professional
1:00:20
and it is not ethical at weight Center Care yeah yeah
1:00:32
I love them it is yeah he has like a really good voice
1:00:38
yeah they really are they're also like very young I think they're like in high school like really wow I think so
1:00:47
what are we doing with our lives I know we should just wish we've been doing Kardashian yeah
1:00:52
we've really messed up somewhere along the line it goes around age 18 or so we've really messed it all up
1:00:59
I think yeah looking mad that's where we might make some changes
1:01:06
but that's that's okay we're here now took The Road Less Traveled
1:01:13
laughs I'm we gotta be optimistic because what else do we have this is our
1:01:20
therapy session we're like spiraling I think we always
1:01:25
do this we have like career crisis you guys get to hear about that they always do whenever we have like hard deep topics that's basically the opposite of
1:01:32
what we were taught in dietetics we're like what have we done this is a mistake
1:01:39
it's fine we're fine it's like you know the dog meme where everything's on fire I feel that every day I think this might
1:01:47
because I mean I'm fine yeah yeah that's
1:01:53
what it's like being in 08 Centric Healthcare field
1:02:00
unless you are a weight Central provider then it's great you're thriving like you're right it's like a red carpet
1:02:07
everywhere you go like everything's just ready for you and made for you but the rest of us who don't abide by that
1:02:13
approach we are struggling because we are like it's David and Goliath once again we are
1:02:18
just like fighting this big monster and he's kicking our ass
1:02:27
yeah let's wrap this up let's wrap you guys here for a little bit of time
1:02:33
so on both sides of the obesities argument
1:02:39
most Healthcare professionals can agree that the human body is complex
1:02:44
yeah body's shape and size is one spy of multitude of factors but no matter what
1:02:51
side you are on we have to consider who is impacted when we say obesity is a
1:02:59
disease because it's easy to just label this but we have
1:03:06
to look into it's a little it's not as surface level as
1:03:11
a little ratio that we call BMI and we want to reiterate that we are not
1:03:18
the ones that should be in the center of this debate people in larger bodies should be the
1:03:24
one at the center of this debate listen to the fat activists listen to the people driving the fat Liberation
1:03:31
movement listen to their stories and do not just take our word for it we have
1:03:37
seen it from a medical professional standpoint we have not lived these experiences so we lack that
1:03:44
component to this very complex issue so make sure you go follow them on
1:03:51
social media there are articles about it you can easily easily find articles
1:03:57
where people talk about their testimonials with like fat phobic providers
1:04:03
do your I say research Loosely
1:04:09
go search it's like do your searching
1:04:14
um but listen to what they have to say because it's very important that their voices are heard
1:04:20
and they're the ones being live listen to and driving this conversation so
1:04:27
and also our last thought is this is a question I don't know if it's a question for the government or who controls
1:04:35
Health Care Systems because I know unless some like government officials listening to this and
1:04:41
they have a lot of power and they also care a lot about
1:04:46
weight issues which yes who is that one person in government that cares about that that much
1:04:54
anyway whoever's listening this relates to listen close so what if instead of who or who or AMA
1:05:04
or nhi debating
1:05:09
obesity is a disease instead of that of whether it's a disease if they spent this time fighting the weight stigma
1:05:17
all those resources all that time towards the sweet stigma that has
1:05:27
is very prevalent and it's very obvious it's prevalent yeah yeah it's very neglected
1:05:35
how would this impact our health care System would it improve it it can't get worse
1:05:41
God forbid we improve our Health Care system can it get worse I don't know you
1:05:46
probably could I don't know what that's like though it probably could they could probably kick dietitians out
1:05:52
they could probably silence I mean we're this close like we're a dying field let's be honest we're not here much
1:05:58
longer oh I don't even want to think about that but let's let's think about where we're
1:06:03
putting our energy these giant organizations with tens and billions of dollars of research and resources what
1:06:10
would happen why don't we do this I know the why don't answer that don't answer that you
1:06:18
government official you don't even think about answering that yeah but
1:06:25
think about what a world we live in hmm and that's what we'll
1:06:31
leave you with in our to have your own existential crisis about join us we do this every day
1:06:41
so that's all we have let's talk about obesity disease we will include our fun
1:06:47
and upbeat bonus question in oh yeah that's why we're 18 segment
1:06:54
and the tud no the beat Deeds but become a tug bud and you'll have access to so
1:07:02
many more resources we're a little bit more fun and more light-hearted in that but we hope that you took something away
1:07:08
from today obesity as a disease is just such a
1:07:15
complicated conversation to have
1:07:20
and the impact it's had on I'm going to say our economy
1:07:26
because when it comes down to it money is always the driving factor in most
1:07:31
Corporate America decisions um it's
1:07:38
not as simple as eat less exercise more
1:07:44
shame fat people or say that you're not shaming them
1:07:50
but also their bodies are the problem [Music]
1:07:57
let's just dig a Little Deeper think about critical thought it all comes down to that every time just use some
1:08:03
critical thought yes please so thank you so much for listening today
1:08:11
thank you thank you so much for listening today guys we appreciate you
1:08:16
sticking it through and listening to us rant about this for a very long time let
1:08:23
us know I don't know any of your thoughts about this we always love hearing
1:08:29
well I don't know if I love hearing when people experience bat Bobby and the healthcare field but if you need event
1:08:37
or you need to just air it out let us you're free to DM us if you want to like comment and share
1:08:44
your story with other people you're also welcome to as well there's a lot of solidarity
1:08:50
in the way inclusive space I will note yes if we can't make a whole lot of
1:08:56
systemic change at least we can support each other yes
1:09:02
and stress about it together yeah all right guys
The Beet Deets Bonus Segment
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Welcome to the fifth installment of The Beet Deets Bonus Segment! Listeners of The Up-Beet Dietitians Podcast know that each episode ends with Hannah and Emily and guests having a (usually) friendly debate or answering a "would you rather" question. Well, we want to hear your opinions, too! By becoming a subscriber of The Beet Deets, you will have first dibs on future products as well as exclusive access to future ebooks and courses. We can't wait to keep growing this TUD Bud community!
What started off as an innocent question lead the girls down a deep, scary dive onto Urban dictionary... Tune into to hear about Emily's eye-opening Reddit experience and what Hannah stumbled upon in Urban Dictionary.
