Prescribed To Fat People, Diagnosed In Thin People

ConcernOne of the things that always astounds me about the way that our society currently deals with weight and health leads to fat people being prescribed behaviors that would be diagnosed in thin people.

It’s no secret that The Biggest Loser is an abomination, even so Michelle Obama called the show’s contestants Role Models.” Really?  Role models? [tw:  potentially triggering eating disorder talk for the rest of this paragraph]  Consider for a moment if someone who wasn’t fat told their doctor that they were behaving like the contestants on TBL: -severely restricting calories, exercising 8 hours a day, eating large amounts of food that are “forbidden” on their current “diet” and then exercising all night to “make up for it”, and manipulating their weight for their weekly weigh in with dehydration.  I hope against hope that the doctor would not say “good for you, you’re a role model.”

Is it strange to anyone else that even with the big (and problematic in many ways) push toward locally grown whole foods, fat people are still encouraged, including by doctors, to go on Jenny Craig and/or Nutrisystem and microwave food that comes to them frozen in plastic baggies?  Or Medifast where you consume 5 reconstituted soy protein based “meals” a day? I’ve been to several farmer’s markets and never saw even one package of “parmesan puffs” made from reconstituted soy protein there. Again, I’m not arguing for any specific type of eating, I’m just trying to point out the ways that fat people and thin people are given very different messages.

I don’t believe that the same behavior is good for fat people but dangerous for thin people, I don’t think that we should diagnose and treat in some people what we recommend and prescribe to others.

Health is not an obligation or barometer of worthiness. It’s multidimensional and not entirely within our control. It’s not guaranteed under any circumstances. That said, it’s supremely annoying to me that that we have to fight to get decent information about health. But, just because so many other people aren’t using any common sense, and just because so many businesses put profit in front of health or truth doesn’t mean that we have to buy into it.

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22 thoughts on “Prescribed To Fat People, Diagnosed In Thin People

  1. I’ve long been of the opinion that most – if not all – of the ‘health risks’ associated with being fat are actually caused by the wildly unhealthy way we are ‘encouraged’ to lose the weight. After all, weight loss dieting is a deliberate attempt at starvation… which can damage all your major organs, your bones, your joints, and bring on heart attacks and strokes.

    Aren’t those the very things dieting is supposed to save us from?

    I’d rather base my food choices on other criteria, such as what I think tastes good, what I enjoy cooking, whether my body responds happily or un to a particular item, and the ever-popular budget (le sigh) than whether I think something will allow my body to consume itself to get slimmer on a temporary basis.

    My kitchen regularly includes both organic vegetables and highly processed sugary breakfast cereal, huge sacks of flour (I buy it 25lbs at a time from a restaurant supply that doesn’t check to see you have a restaurant) for baking from scratch and an emergency stash of frozen Stouffer’s entrees. This is how my kitchen and my life work. The only hard and fast food rule I have is that I don’t keep things in my kitchen that I don’t like to eat, except for a couple things Mr. Twistie likes that I don’t,

    Oh, and there’s that one other pesky rule: I do my best not to buy things with diet messaging on the package… but Mr. Twistie does use some artificially sweetened items since he has diabetes. It’s really more of a guideline.

  2. Can you briefly explain what you think is problematic about the push towards locally grown, whole foods? Not snarkiness, genuine curiosity. And I understand if it’s too big a topic to address it in the comments…in which case perhaps we can look forward to a future blog post on the subject? I

    1. She said nothing about it being problematic, just that it’s strange that it’s becoming popular in general to eat locally grown, whole foods, while AT THE SAME TIME fat people are prescribed processed foods to lose weight.

      1. That’s what I took away from her comments as well – the hypocrisy of telling one group the wonderful health benefits of locally grown, whole foods, while pushing another group towards heavily processed, preserved entrees supposedly also for their health.

        If the locally grown, whole foods are good and healthy for the thin, it would make sense that they would also be healthy for the fat. If the heavily processed, preserved entrees are healthy for the fat, they should also be healthy for the thin.

      2. No. She said outright that it was problematic and I think the question stands. I got (and mightily agree with) the point of the paragraph as the poster below summarizes it. But because I feel like those pushing towards local and whole foods are, for the most part, fighting the good fight on behalf of people of all sizes (even if they can be annoying in their approaches, and it’s all so damn expensive) I am very curious as to what the problem is. No snark here either as I think Ragen is the booooommmmb, I’d just be sad if we actually disagreed on something, however minor.

    2. I wondered about that as well. I see others have replied that it is the juxtaposition of whole food vs diet food, but that’s not how I read it since the comment in in parentheses right after “big”. The problems I see are access, cost, and moral baggage of the local-whole-organic food movement. I hope Ragen has the time to reply.

      1. Deenie, that’s what I was thinking, too. There’s a lot of hand-wringing in the whole food/slow food/locavore movement about how if we all just ate the right foods, there would be no fat people. They also tend to stay curiously mum on how poor people are supposed to be able to afford these foods, or else berate the poor for their silly whining that it costs more to buy local, organic, grass-fed foods grown/raised within 100 miles of where they live.

        As a poor, fat person I find myself regularly told that I have no place in the foods fight, as it were because clearly I am Doing It All Wrong.

        Pity, because I actually agree with a lot of the principles behind these movements.

        1. OK, I feel you on this. It REALLY pisses me off when people who live in cities on either coast say “there’s not such thing as not being able to afford to eat healthy”. They’ve clearly never been to a food desert, much less lived in one. I live in Texas and the only expensive food here is at health food stores. So yes, that part is highly problematic. True true. I do love seeing urban community gardening initiatives that seem to offer a low cost way to eat fresh produce, but I acknowledge these programs are probably not widespread yet.

          1. And there’s also the fact that while the high cost of LGWF is one problem, it is very far from being the only difficulty. Community gardening initiatives may lower cost for those who can participate in them, but a great many people do not the time or the physical capabilities to take part in a gardening program. People working two jobs, people with limited mobility, heck, even people with arthritis in their hands, are not going to find participation in a community-gardening initiative very feasible.

            1. True this. People tend to forget that a lot of the wholesome traditional recipes are for homemade pickles, baked goods, and stuff that has to be watched. And you have to cut it all up and trim it, and before that you have to go get it.

              I am facing the prospect that the small number of convenience meals that I can afford that will fill my family up and also provide a wide range of vitamins … may also be a migraine trigger for me. And I can’t “just” fill my freezer with precooked meals; I don’t have a separate freezer. And I already switched to making 80 percent of what we eat from scratch because money.

              I don’t like to cook anymore. I never thought that would happen.

    3. Hi Jen,

      Thanks for asking. Full disclosure, I do a lot of scratch cooking and a lot of Locally Grown Whole Foods purchasing, the movement often, but not always, fits my priorities and beliefs [Edit] and I am privileged to have easy access to food that is affordable to me. That said, I think the Locally Grown Whole Foods (LGWF) movement can be problematic in a number of ways – though of course I’m aware that not everyone in the movement engages in these behaviors:

      First cost – by its nature it can be expensive to eat locally grown whole foods and the cost is pushed up when people with money make it trendy and/or a status symbol. We already know that those who work full time at minimum wage (and even wages above minimum wage in many cases) aren’t earning the cost of living at the cheapest prices available, let alone for the cost of ultra-trendy small batch organic locally grown/raised food. Further stigmatizing that group of people with the message that they aren’t doing the best that they could for them, their children not ok.

      Second is availability. Even if people could afford it and did want to eat that way, there are plenty of places where LGWF are difficult and/or time consuming to find. Far too often I see people promoting the movement be completely dismissive of the issues that people raise in this regard – suggesting that they should just drive two hours each way to get to a farmers market, or take public transportation no matter how difficult or time consuming etc.

      Third is culture – people may live in areas where food that they would choose because of their culture is not locally grown and the suggestion that they should abandon their culture for the LGWF movement can end up being seriously problematic, including racist.

      Fourth – far too often people make this into an issue of food morality (using the age-old justification that they are right) which I think is always problematic.

      Finally is the messaging itself – too often for my taste based on belief instead of research, based on a specific set of priorities which its followers believe should be everyone’s priorities, overreaching promises (like that eating LGWF will make everyone thin, everyone healthy etc.), and marinated in a pretension that I personally find super annoying and off-putting. The messaging often sets people up for stigma and persecution if they don’t choose to eat this way or if they do but fail to live up to the “promises” of thin and healthy and are therefore treated like they don’t do it “right” (see the cautionary tale of the way that fat vegans are often treated by the vegan community).

      The tendency to respond to concerns and difficulties of eating this way dismissively and pretentiously insisting that “if people really want to do it they’ll find a way” creates an environment of stigma for those who can’t eat this way for the reasons stated above, or who choose to prioritize something else in their lives.

      Basically, as with everything, I think that if people believe that LGWF is the best way to eat then they are free to make choices for themselves based on that belief and to advocate for making it available and affordable for them. If they think it’s how others should eat then they should focus on making it available and affordable to every person, making sure that true unbiased information is available, and avoid creating messaging that engages in food morality or causes shame, stigma, bullying or oppression of any kind for those who make different choices or have different priorities.

      Hope that helps, I’ll monitor the thread and try to answer any questions that come up.


      1. Ragen, thank you for ALL of these points. I think the super-privileged wealthy people who sneer at the poor for not eating “healthy” food have probably never tried to live in a second-tier American city (by which I mean not NYC, Chicago, Boston, etc.) without a car. Quite apart from cost issues, if I get off work at 5:00 p.m., am I really going to take two buses, at rush hour when the buses are standing-room only, to a store where I can buy LGWF and then try to shove my way back onto those two buses *with* my bags of produce — thus adding an hour and a half to my commute time along with the extra stress — or am I going to buy whatever’s available at the smaller grocery store within walking distance of where I live? To me, the answer is obvious, and sneering at people for not doing “whatever it takes” to buy LGWF is a really obnoxious form of elitism. Thank you, as always, for pointing this kind of thing out.

  3. I am part of an online conspiracy chat room and message board. We talk about the 9/11 conspiracy, the JFK shooting, etc… Basically we brag that any and all conspiracies are fair game for us to discuss. But if I try to bring up that the fact that treatment of fat people vs thin has all the hallmarks of a conspiracy, then people will think I’m crazy. We as fat people are shamed for needing mobility devices (in fact a CREEP shot of me in my mobility device was posted to a notorious subreddit…I was horrified) but thin people with mobility issues are not judged at all–and in some cases lauded for being injured while doing a high risk activity like skydiving or rockclimbing.

    We are diagnosed on site by doctors, something that would never happen with thin people. We are denied surgery because doctors think its to risky (uh hello…isn’t dying from the issue the surgery would correct also you know…risky?). We aren’t allowed to be comfortable on airplanes, sporting events and even some churches. We are made to be uncomfortable in cars and the homes of our friends and family.

    I live all the above every day, and somehow I am supposed to believe that there is not a pervasive, dedicated and unified conspiracy against my very existence?

    Thanks again Ragen, we will get there in our lifetimes. I know it.

    1. My best friend has a serious health condition that doctors have not been able to find a definitive cause for (not faulting them there, it’s rare and even more so in women in their early 30s plus she has a number of other health problems) and they haven’t been able to adequately control it with medication. There is surgery that would help control those symptoms even though it would not solve the underlying condition. However at her weight her doctors don’t want to do the surgery and are trying every way to get out of it that they can. It’s absolutely infuriating to see them do this. If I was in the hospital 4 times in one month for a condition that surgery would relieve most of the symptoms of I’d probably have already been sent to the operating room months ago because I’m not “too fat” just fat enough to be nagged about losing weight despite being quite healthy.

      1. I wonder if that’s why it took them so long to send my daughter-in-law to a surgeon; when she finally did get there the surgeon was livid at it having taken so long for her to be sent to her – however, she wasn’t able to have it laparoscopically because of her weight – supposedly – although my husband did, hm…

  4. I want to address one thing you mentioned in particular… this comment: Or Medifast where you consume 5 reconstituted soy protein based “meals” a day?

    I know I have Hashimoto’s Disease. I’ve seen plenty of other fat people mention having thyroid issues, too. Soy is actually potentially contraindicated in people with thyroid dysfunction. There’s preliminary research to suggest it, which I learned when I was debating taking a soy supplement to try to help with my PCOS and ovulation. I did the research, and it was a good thing I did.

    Now, it’s not a huge body of evidence, but just the fact that it’s possibly a problem means it’s probably not ideal for a lot of the people that “food” is marketed to to be eating a diet comprised of a lot of soy! If the early research proves true, eating that food could actually make the problems that make losing weight for some people even harder than it already is! So you’re taking something already counter intuitive (prescribing weight loss when it’s repeatedly demonstrated to NOT work long term for the majority of people) and you’re “prescribing” a diet that may actually make it even WORSE than it already is. Talk about bad medicine!

  5. I’m not sure when they’d start diagnosing this behavior in thin people.

    When I first got my dentures and had a breakdown as my career ended just a few years after starting… I basically had trouble figuring out how to eat and was just letting myself starve as a passive suicide attempt.

    I was taken to see the doctor several times and they never noticed or cared that my weight was plummeting from well over 200lb to just under 120lb in less than a year. Like each time they weighed me at the start of the visit I’d lost several pounds even though I had more clothes on each time.

    And I’ve recently seen photos from the time and I look really emaciated. I was even wondering if I was developing anorexia as I was becoming motivated to keep hitting lower and lower weight thresholds. Like every ten pounds lost. Though it really was mostly about suicide and I like math and numbers….

    But basically everybody who was really close (except my mom who has been a life long dieter, she made a point of telling me gore good I looked..) was horrified by the rapid weight loss. But nobody else saw any issue with it. Especially medical professionals. Though they always made a point of talking about my weight when I’m fat. Emaciated and constantly feeling sick from not eating never made a blip on their radar.

    1. They most likely didn’t address it because you started out over two hundred pounds. There’s an attitude that anything a fat person does to lose weight is automatically “healthy” because it results in being thinner, never mind that there are some VERY unhealthy ways to lose weight (a few of which Ragen addressed in the post). But if you’d started at 120 AND told them you weren’t eating, the reaction most likely would have been different.

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