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Life After Emotional & Binge Eating

What if All Doctors Prescribed “Well-Being” over Weight Stigma?

Weight Stigma in the Doctor's OfficeI hear this all too often. I’ve thought it myself…

The last time I saw my doctor, he told me to lose weight. I’m heavier today than I was at that last visit. Now I have a medical problem that has nothing to do with my weight but I’m afraid to schedule an appointment because I know I’ll have to get weighed and he won’t be happy with me.

Weight stigmatization is bad for health, yet studies show many medical professionals practice it. Weight Stigma potentially puts everyone at risk; fat, thin, and everyone in between! Here’s why…

When people live at higher weights all sorts of assumptions are made about those people being “unhealthy”. When health issues are blamed on weight, true causes may be overlooked. In lower weight or “average” weight people, medical issues can be missed because it’s just assumed they’re healthy. “Oh, we don’t need to check you for diabetes, your weight looks great.”

But what if all healthcare providers prioritized well-being over weight, with every person?  What if they looked at our individual health, no matter what we happen to weigh, without any assumptions about our size?  That’s what my co-authors and I propose in our new Review Article, published today in the  Journal of Obesity, supported by a review of the latest research.

Based on research on the impact of weight bias, along with a comprehensive review of studies that show trying to get everyone to be a “normal weight” is not improving health for the majority of individuals, we propose a new model of care. It’s focused on health vs. weight. It fosters physical and psychological well-being in all patients, no matter what they weigh.  In an excerpt from our article, here’s what that might look like in the doctor’s office, when our patient Jasmine sees the doctor…

When Dr. Johnson greets her today, Jasmine seems anxious and tells Dr. Johnson, “I almost did not come in today knowing my weight is up from the last time I was here and you suggested a diet. I feel like such a failure. However, I need help for my migraines, so here I am.” Dr. Johnson and Jasmine look at each other, there is a beat of silence, and they both sigh.

Dr. Johnson says, “You know, Jasmine, I have been reading the research on weight loss interventions and weight-cycling and I’m realizing that if the same thing happens to almost everyone, it probably is not the fault of the person, it is probably more about the process itself. So, instead of focusing on weight loss, I’m encouraging my patients to think about what makes them feel better in their everyday lives; emotionally and physically. For example, do you feel better when you eat more fruits and vegetables, drink more water, take a walk with a friend, meditate to relieve stress, and get enough sleep? There’s good evidence that those behaviors are going to make you healthier and feel better even if your weight does not change.”

Jasmine is a bit surprised by Dr. Johnson’s shift and says, “Well, typically, when my weight loss slows down or stops completely, I stop doing any of those things you mentioned that would help me feel better and be healthier.” Dr. Johnson says, “I understand, but we’re going to turn the focus from your weight to your health. Because those behaviors are linked to health, why not do them anyway?”

Jasmine smiles at Dr. Johnson and says, “It sure would be easier to come back and see you the next time I’m supposed to if I did not have to lose weight first.”

Dr. Johnson replies, “I do not want anything to stand in the way of you getting your medical care, including worrying that I might scold you. Now that we have a better plan, I am going to have the nurse retake your blood pressure.” Jasmine and Dr. Johnson then discuss treatment options for Jasmine’s migraines.

Right before Dr. Johnson leaves the room, Jasmine shares one more quick concern, “I like the shift from weight to health, but there is this Weight Focusers group at work. If I do not go, I’ll get charged a higher premium for my health insurance.”

Dr. Johnson says, “Let me know if I can help with that. The Affordable Care Act is supposed to allow you to follow your doctor’s recommendation, and I have no evidence that Weight Focusers is going to make you healthier and lots of evidence that says that weight cycling is linked to poorer health.”

Jasmine leaves the doctor’s office feeling hopeful and understood.

As Dr. Johnson finishes the chart note, she realizes that her own body is relaxed, her jaw unclenched. She feels like she has made a better connection with Jasmine and developed a sustainable treatment plan she can follow. Dr. Johnson is curious and maybe even a little eager to see what happens next. However, she does wonder what will happen if the reviewers do not see weight loss in this patient, or a goal of weight loss in the treatment plan.

 To read the full Review Article in the Journal of Obesity, click here, The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss . PLEASE SHARE THE FULL ARTICLE WITH YOUR PHYSICIANS AND OTHER HEALTHCARE PROVIDERS!  You can download a PDF of the article and hand it to (or mail it to) your doctors…even anonymously, if that feels more comfortable.

We can reduce weight stigma in health care, in our lifetime! No matter what we happen to weight, all doctor’s can be educated, encouraged to be our ally; to look at actual medical issues and not be blinded by any prejudice or assumptions driven by weight stigma.

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Ellen Shuman is a pioneer in the field of binge eating disorder treatment; a Coach who specializes in helping people overcome binge eating, binge eating disorder, emotional eating, compulsive eating, and food addiction. She is the founder of A Weigh Out  Life Coaching & Members’ Circle, Acoria Binge Eating Disorder Treatment (1993-present). She is a Past President of the Binge Eating Disorder Association (2011/2012), and Co-Founder of the Academy for Eating Disorders Special Interest Group on “Health at Every Size”, ellen@aweighout.com, 513-321-4242.

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