I didn't start this blog to engage in the war on obesity.
I'm not talking about healthy eating habits, fitness or weight loss. Remember? I'm a pathologist - I don't see patients and I don't give people health advice, especially not how to lose weight.
Why then am I writing this? I felt obliged to editorialize my own words from the summer of 2018, about the pannus - a specimen a pathologist deals with as part of surgery for endometrial cancer. A version of the post was even featured on KevinMD.
I'm writing this editorial because on Instagram I've seen physicians directly mock fat people.
Physicians who are selling themselves as weight loss doctors. And I see how my observations about specimens from the human body can be used to further shame people. If these same doctors use my pictures and frank discussion of handling human fat in the lab to mock people, I will feel sick.
As a pathologist I don't see patients. I see parts of patients. Because I handle parts of the human body every day, I respect the human body in a way few other people ever can. This is a unique perspective that isn't represented in popular discussions about health and disease. This is the perspective I want to continue to share. But people have funny ideas about their bodies and my frank discussions of what goes wrong inside of us can be misinterpreted to mean that I am shaming the person who is afflicted with the disease process.
Yes, disease can be physically disgusting. But guess what? So can the rest of us. And as someone who’s seen every part of our bodies (... yes all of it .... ...that part too) , I can say that all of it can be either disgusting or amazing. Your choice. Fat shouldn’t be singled out as something special to be disgusted by or shamed by.
Fat shaming has real consequences - patients go without treatment, essentially neglected by their doctors. Several stories really make it clear what the real problems are with health care and obesity.
I'm personally of two minds when it comes to even talking about overweight.
One part of me sees most everything from what I call the birds eye view - a biological and historical/societal perspective. In which case, the obesity epidemic is a crisis for public health and of excess food and farming, not a personal issue. It’s like a plague, brought about by industry-driven nutritional recommendations, trauma, sedentary entertainment and our winner-take-all world. This is the frame where I consider the unhealthy sequela of our modern world, of which excess calories are just one item, and how our conditions have dramatically departed from our evolutionary era of starvation.
The other part of me knows that informing people of their health risks doesn't help people modify their behavior, shaming people about their fatness doesn't help them improve their health and centering the problem as weight doesn't help anyone reduce their weight. Even if all of those things did work, the facts really show us that dieting doesn't work - metabolically or psychologically. Have you heard the joke?
"I'm going on a diet."
"Oh really? Well, how much weight do you want to gain?
There are great docs and nutritionists researching and talking about common sense approaches to health.* But they sure seem talked over by those hawking a weight-loss first approach. The evidence shows that restrictive eating just doesn't work. And talking about obesity and fat the way I see some of my physician colleagues do leads to counterproductive shame. Behavior modification does not happen through shaming, and it is not as simple as holding up your own shining example of a trim life.
As someone who survived diet culture** and got busy with my life, I'd ask simple questions - is it healthy? Are you able to focus on what matters in your life? Self acceptance means just that - this is where you and I are, how can we move forward? Intuitive eating, moderation of all foods and a life that has fulfillment and exercise. It is absolutely not easy, but it is the secret sauce. Even if these don’t result in weight loss.
I'm going to continue to share the pathologist perspective about our bodies. But I'm going to be increasingly mindful of how my impressions can be distorted. Those distortions are part of what I want to change.
* Some of the resources I'd recommend for healthy eating and approaches to food include:
Health at Every Size - prioritizes health over weight loss
Dr. Linda Bacon - yes, that name.
** What is 'Diet Culture'?
from the website https://christyharrison.com/:
-Promotes weight loss as a means of attaining higher status, which means you feel compelled to spend a massive amount of time, energy, and money trying to shrink your body, even though the research is very clear that almost no one can sustain intentional weight loss for more than a few years.
-Demonizes certain ways of eating while elevating others, which means you’re forced to be hyper-vigilant about your eating, ashamed of making certain food choices, and distracted from your pleasure, your purpose, and your power."