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What to Say To a Doctor, when intro-ing anti-diet stuff

 

This episode’s sponsors are Juliette Sakasegawa – Your Empowered Life, and StitchFix (and my desire for as many $25 coupons I can get). More info on both all the way at the bottom 👇🏼

 

This week I had an appointment with a cardiologist because my dad has a heart condition that can be genetic, so I was being screened for it. Turns out I DON’T have it, but while I lay there getting the echocardiogram he asked me what I did, and I said that I was a writer.

“About what?”

Sigh, here we gooooo. “I write about diet culture.”

I don’t always know how to approach the subject with people in the medical field who I USUALLY assume will be extremely indoctrinated with food-fearing, weight centric beliefs. I usually tread lightly because I never know how people are going to respond. I said, “I think we have a blind spot when it comes to disordered eating. There’s nuance of course, but it is more rampant than we tend to think.”

He seemed open, and said was interested in hearing more about it, because he is often put in the position of telling people to make changes to their diet, but he knows it’s not his area of expertise. He also said he is rather “atheistic” about diets, and that he is aware that different things work for different people. Which all seemed like a good sign! So he said he may want to follow up with me on the subject so he could learn more.

So! I went home and figured out what I would want to say to best intro the subject to someone who is likely entrenched in diet culture already, and a weight-centric paradigm.

What I wrote:

First and foremost, we have a problematic way of approaching weight in the pursuit of health – or in the pursuit of improved health. There is an assumption that weight is just a simple calorie math equation, and that is inaccurate for lots of people who have naturally higher weight set ranges, genetically or because of underlying health issues- and that belief leads to a dysfunctional way of approaching weight and weigh loss, and often leads to a dysfunctional relationship with food, that will ironically lead to poorer health outcomes long term.

This hyper-focus on weight is a cultural issue first and foremost, but what we tend not to understand, is that health habits can and do change people’s overall health for the better, often without any change in weight. When there is a change in weight, longterm, thanks to better health habits, it’s usually because the dysfunctional relationship with dieting (and often bingeing in response to dieting) has been healed. 

There is a lot of talk about people having a “food addiction” or “sugar addiction” which doesn’t actually have data to back it up – in fact the studies that show food addiction actually starve and restrict the subjects (rats) beforehand, and then the rats act food addicted, and it lights up pleasure centers of the brain (that also light up with things like hugs and playing with puppies). So the “addiction” part is actually the consequence of the restriction. Simply… restriction leads to something that looks a lot like food addiction, and then often starts a viscous cycle.

Another issue is the lack of fluency around the social determinants of health, as well as how much weight cycling, not weight alone, accounts for a lot of health issues- and weight cycling is a direct results of attempted weight loss.

The following quotes are pulled from this article: Weight Science: Evaluating the Evidence for a Paradigm Shift, and if you want to find the references for the quotes below, they can all be found at that link above by going to the referenced study number below.

“Ob*se people who have had heart attacks, coronary bypass [50], angioplasty [51] or hemodialysis [52] live longer than thinner people with these histories [49]. In addition, obese senior citizens live longer than thinner senior citizens [53]. “

“Weight cycling can account for all of the excess mortality associated with obesity in both the Framingham Heart Study [69] and the National Health and Nutrition Examination Survey (NHANES) [70]. It may be, therefore, that the association between weight and health risk can be better attributed to weight cycling than adiposity itself [63].”

“Additionally, it is well documented that obese people with hypertension live significantly longer than thinner people with hypertension [43,86-88] and have a lower risk of heart attack, stroke, or early death [45]. Rather than identifying health risk, as it does in thinner people, hypertension in heavier people may simply be a requirement for pumping blood through their larger bodies [89]. “

“There is extensive research documenting the role of chronic stress in conditions conventionally described as obesity-associated, such as hypertension, diabetes and coronary heart disease [173]. These conditions are mediated through increased metabolic risk seen as raised cholesterol, raised blood pressure, raised triglycerides and insulin resistance. The increase in metabolic risk can in part be explained by a change in eating, exercise and drinking patterns attendant on coping with stress. However, changes in health behaviors do not fully account for the metabolic disturbances. Instead, stress itself alters metabolism independent of a person’s lifestyle habits [174]. Thus, it has been suggested that psychological distress is the antecedent of high metabolic risk [175], which indicates the need to ensure health promotion policies utilize strategies known to reduce, rather than increase, psychological stress.”

 

Again, all research can be found here: Weight Science: Evaluating the Evidence for a Paradigm Shift

 

“What do I say say to doctors when they get diet culture-y???”

“Please don’t talk about diets and weight with me. I’ve already dieted for years, and I developed disordered eating. (Whether this or true or not, you can say:) I’m working with an intuitive eating dietitian. If you’re interested in more info on how I’m approaching health, I have information I can send you, but it is not healthy for me right now to focus on weight or restricting food at all.”

 

Sponsors for this Episode:

Juliette Sakasegawa of Your Empowered Life

Juliette is a Certified Intuitive Eating Counselor and Empowerment Coach who works with her clients virtually, both individually and in groups. Juliette is passionate about helping her clients finally make peace with food and their bodies. She works from a body positive and Health at Every Size perspective to help you re-learn to trust and listen to your body. Juliette would love to join you on your journey of learning to nourish your relationship with food and exercise, discover your authentic self, and free yourself from diets forever! In addition to Intuitive Eating work, Juliette also offers self-care and relationship coaching. She can help you create a life of joy and fulfillment, reduce stress and overwhelm, discover more peace and calm, enhance your relationships, and move into the next chapter of your life smoothly and easily. You can follow her at @yourempoweredlifecoaching or visit her website at juliettesak.com or email her at juliette@juliettesak.com for more information about her coaching and Intuitive Eating services.

 

Stitch Fix

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