Discipline and the Obesity That No One Wants to See
Discipline – or the lack of it – is something that is sometimes offered up as an explanation for obesity. Public health professionals, employers, and physicians gathered at a medical forum in Baltimore last week to discuss obesity and how health plans can address this growing health concern. One physician who is medical director for a large health insurer asked at the end of a presentation on the physiology of obesity:
This is all very interesting, but isn’t obesity simply a matter of self-discipline? I mean the food might be available, but does that mean that you have to eat it all? Why do we pretend obesity is a medical issue?
As a matter of fact, complex physiology regulates how our bodies energy absorb, use, and store energy as fat. In obesity, that physiology causes the body to store fat in an unhealthy way. Obesity is no more a failure of discipline than high blood pressure is. It is a failure of physiology. It requires care, not blame.
Stereotypical thinking assumes that people with obesity are undisciplined or suffering from a number of other character flaws. It is well documented in studies of weight bias and stigma that many healthcare professionals harbour such attitudes. Such thinking is often used as an excuse for ignoring obesity and for neglecting the medical needs of people who have it.
A new editorial by Daniele Di Pauli in Eating and Weight Disorders points out that weight bias should not be overlooked:
As health professionals, and scientific societies, we cannot allow the stigma toward obesity to go unnoticed like happens to Icarus, in the painting by Pieter Bruegel the Elder, in which no one seems to notice the son of Daedalus fallen from the sky into the sea.
Unfortunately, bias against people living with obesity has been quietly overlooked for far too long. Health professionals who are inclined to blame people for their illness should reflect upon the purpose of their chosen profession.
Click here for the editorial by Di Pauli.
Order, photograph © A Not Very Creative Mind / flickr
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June 12, 2016
June 12, 2016 at 8:45 am, M said:
I suspect part of the issue is that doctors are being told “You have to address obesity with your patients!” There’s two parts here, I think. One is the bizarre idea that fat people don’t know they’re fat. (I suspect they’re confusing people who say “I am perfectly healthy otherwise. Who cares what I weigh?” with fat people thinking they’re skinny.) The other is the too common belief that “address” means bully and shame into restrictive dieting, instead of making sure the patient is eating well and regularly exercising – just as they should be doing for their thin patients, as well.
Studies show that doctors often think that fat people are non-compliant, likely from a belief that “If they cannot control what they eat how can we expect them to follow treatment?” The frightening truth of the “death by obesity” statistic is that doctors may have a role in those deaths.
June 12, 2016 at 4:33 pm, Ted said:
Unfortunately, much of what you say has been shown to be true in research on weight bias. This is a case where the “cure” is worse than the problem. It certainly makes the problem worse.
June 12, 2016 at 9:51 am, Stephen Phillips said:
The concept of obesity resulting from willful misconduct is as old as ignorance.
Stephen Phillips
American Association of Bariatric Counselors
June 12, 2016 at 10:10 am, Beth Bianca said:
Thank you for being an advocate for our community. Discipline is great if you have to lose 20 pounds. However, those of us who have tried using discipline over and over our entire lives and end up heavier are obviously dealing with something different.
I wrote an article last month that was published in the Huffington Post. It addressed the judgement against weight-loss surgery and how people do not think discipline is required for the results. Therefore, people looked at weight-loss surgery results as “not counting” as much as using “diet and exercise alone. Absolutely absurd.
June 12, 2016 at 4:30 pm, Ted said:
You are right, Beth. Thanks for speaking up!
June 13, 2016 at 5:30 am, Mary-Jo Overwater said:
I firmly believe in the importance of discipline in life. Exercising discipline to stay on task when one is distracted or wants to give up or to reign in impulsive behaviors can be character-building and really help one enjoy feelings of accomplishment and strength. People who are hard-wired to be naturally slim or self-regulators, but who have put on 10-25 lbs with age or change of lifestyle circumstances have better success when they exercise discipline because their bodies respond more efficiently to treatments and to any lifestyle changes to eat more healthfully/ balanced again and/or to exercise. Discipline is rewarded in these cases and affirms the argument for discipline.
But, when it comes to weight management in obesity, it is naïve and ignorant to assert it has a key role to solving the struggle with obesity. Most of my obese clients who struggle with their weight are, in fact, often MORE disciplined than people who don’t have the (patho)physiology of obesity. The amount and focus of self-control and dedication exhibited for long periods of time in keeping dietary intake either restricted or certainly much less than their bodies are hard-wired to ‘require’ and to sustain exercise regimes often much longer and more intense than non-obese individuals, takes incredible discipline Then, after all that effort, to see little or no change on the scale or in your clothes size, or even in your biomarkers — well, it’s soul-crushing.
So, people with obesity and people who treat obesity need the facts before any true assessments and/or decisions about courses of action can be made. In my case, as a person who is BOTH — I work with people who struggle with weight and I, myself, struggle with my weight. I know the reality that growing up obese and being obese for a good part of my early adulthood has set my body up to fight tremendous odds to get me at a certain ‘ideal’ weight. I exert tremendous discipline in pushing myself to exercise at least 5 times a week and in stopping eating when I know I’ve had enough. I am not hard-wired to stop. I do believe that discipline has kept me from being 50, maybe 100 lbs more than I am now.
But, believe me, it IS at times, soul-destroying. What makes it even worse is when other fellow-dietitians or anyone else, for that matter, make presumptive judgements. The reality of weight bias is extremely destructive. I could go for a bypass or pursue medical treatment and I may do so at some point. Right now, my labs and biomarkers are all good and I feel healthy and vital, despite being 40-50 lbs more than I have been at my lowest weight before my second pregnancy. Exercising discipline is important for me, but having a clear understanding of the limitations of discipline has been extremely uplifting and actually keeps me even more motivated to keep up with my healthier choices. 🙂
June 13, 2016 at 5:36 am, Ted said:
Beautifully well said, Mary-Jo. Thank you!
June 13, 2016 at 12:24 pm, Katherine Rivard said:
In even high-level corporate Health Coaching Companies, where boss women are heavy and at the top, the idea of a skinny subordinate is reason to limit their advancement.
So the flip side of “I am working on it” shows up in the numbers reflecting that weight is actually not managed because it is a human reason to suggest that people of managed weight don’t sit down enough to get their work done and are less devoted to the female boss. I have seen this unspoken and not addressed until the research came back showing that weight is least likely to change in the workplace neighborhood.
June 13, 2016 at 10:24 pm, ejh said:
Ted —
I find others have well described the personal dynamic of issues surrounding obesity — so I am grateful and feel no need to further discuss it.
HOWEVER — I would like to know what the response was to the physicians question about lack of discipline and blame the fat person mentality…. Did he listen? Do you think he LEARNED anything? Scares me that someone in his position would remain so ignorant. Ten years ago maybe I could see it…. so I am curious…
As always, thanks for your column.
Jean
June 14, 2016 at 4:44 am, Ted said:
Thanks for asking, Jean. The presenter responded that obesity has many causes and an undisciplined personality is not one of them. The presenter went on to describe the physiology of obesity, but my assessment was that the questioner was not listening. He left the room several times. At lunch, he tried to persuade another HCP, who was a bariatric surgery patient, that her problems with obesity since early childhood were due to emotional problems. He was not doing a lot of listening.
June 14, 2016 at 8:09 pm, John said:
The blog is a breath of fresh air. It’s so hard to find folk that understand this complex chronic disease. Yet the facts about the physiology are clear. We somehow allow this disorder of regulation to be treated differently to others like blood pressure, diabetes and cancer. It’s interesting diabetes and hypertension generate complications – obesity generates co-morbidities!
Come how this is different? Why?
But this blog is the exception. Other blogs that follow a little touch of the truth are condemned for their clear error in that “we all know it’s all about bad choices”!
But, we are not winning. Can you imagine the outcry if we just treated 1% of those with type 2 diabetes with effective care beyond lifestyle advice. I think the word is negligence.
John
June 15, 2016 at 5:44 am, Ted said:
Thanks, John. You make some excellent points. In particular, the comparison to the failure of regulating glucose, blood pressure, lipids, and cell growth will stick with me. Thanks!