What is Fat?

I was going to start on what I saw as the potential imbalances that might cause someone to be fat but being thorough, I wanted to define fat before doing so.

I started with Giovanni Maciocia’s Foundations of Chinese Medicine (yeah, really the older one).  In the index, there is no reference to the words,”fat”, “overweight”, or “obesity”. So I read through the organ systems, paying particular attention to the spleen and stomach areas. No reference to fat. I recall reading somewhere that fat was dampness so I also paid particular attention to any damp related pathology as well as triple warmer. Nothing on “fat”.

Next, I looked through the pathologies of each organ, once again paying particular attention to spleen and stomach. Not one pathology references “fatness” or “obesity” as a symptom.

Finally I got to his chapter on the five constitutional types.  Earth types were drawn as being rather heavy and in fact, it talks about earth types as having a large stomach (looks “fat” in the drawing) as well as large muscles. Water too appears to carry some extra weight all over and is considered a constitutional type. There is no mention of defining this person as fat or treating a water type for being fat.  This is considered a constitutional type that is built this way, unlike the wood type that does look naturally slender.

I also looked in Maciocia’s Practice of Chinese Medicine. Again there is no listing for “fat” or “obesity” in  any of the syndromes or in the index. He does talk about the excess dampness under the skin being oedema but that is different from “fat”.

Of course, overeating is mentioned and the distention of the stomach and fullness that can cause illness when one overeats. Again, this is different from being fat given that the vast majority of fat people did not get there because they ate too much.

This leads me to wonder what people are reading when they talk about Chinese Medicine and obesity. I talked to a friend who is very well versed in Classical Chinese Medicine. His response was that he doesn’t recall reading anything about fat. The ancient Chinese were much more likely to have starvation and famine and underweight was probably a bigger problem. As to treating fat, well you’d go by the imbalances and once in balance the body would find it’s own normal weight (whatever that is).

There is discussion of dampness residing in the muscles, but I’m not sure that it manifests as fat so much as it manifests as that early morning muscle stiffness.  After all, colds often start out that way as well.  It could also be referring, as Maciocia did, to oedema under the skin.

That means that any acupuncture  practitioner who is determining if someone is fat is doing so by modern standards.  So that leads us to BMI, which of course really doesn’t mean anything. BMI is as arbitrary and inaccurate as height/weight charts.  In fact, in 1998, the BMI charts changed so that people in the normal range suddenly became overweight because the classification changed, not because they gained any weight.  Additionally there are a variety of recommendations for different BMI classifications as to what is normal versus overweight.

The other option is the waist/hip ratio. This is great for those of us who gain weight on our hips and thighs. However, if like most earth and water types, one puts on weight around the belly, one will still be considered fat even if it is normal for the person’s constitutional type. I’m not sure what I am. I have a BMI of 33 and a normal hip/waist ratio so do I split the difference and come out “overweight”? Slightly fat?

Even using modern standards, there are no set standards for the point at which a normal person becomes fat. Like beauty, fat, for the most part appears to be a cultural manifestation.  Now I haven’t had the time to look through everything in terms of defining fat to see if there is some objective standard. However, I’ve done as more or more research into this than the vast majority of people who claim to treat “fat”.  For me, this offers a level of concern over why any acupuncture practitioner, who is treating the whole person, would want to treat someone for being fat, when no one has asked what is too much. After all, everyone has some fat, that’s normal.  The question becomes when it is it abnormal from a health perspective versus abnormal from a cultural sense of what is beautiful? That’s not something we can tell by looking at someone and I’m not sure there is anything in the classics that offers me a place to start.


My Big Fat Rant

Recently there was a discussion on Facebook about acupuncturists treating people for obesity. I’d like to point out that treating someone for obesity is not treating someone for a health condition. People argue about this point but it’s true. Fat people can be healthy. Imagine.  They can also be fit. So the idea of bringing in people who are otherwise healthy for health care seems rather unethical to me.

Now, I and a few others who were pro-size-acceptance were asked to stay off the thread so that those who wanted to could learn what other practitioners found to be  effective for working with weight loss. Apparently pointing out that obesity was not a health problem and that we needed to treat the person rather than the “weight” was not considered a useful tip.

The fact is, fat people do go to acupuncturists. Some of my patients were fat. Some of them were not. Many of the fat and thin people had the same health issues. Many of them had the same overlapping constellation of disease patterns, that may have manifested in slightly varied symptoms. If I didn’t need to weigh my thin patient, why should I weigh my fat one?

Several practitioners talked about obesity as if it in and of itself was the problem.

They talked about gathering BMI measurements and taking weight measurements to help them assist the client in promoting better health. However, obesity is not in and of itself a problem. It is often correlated with other problems. Helping those other issues that may go in tandem with obesity is great if the patient comes to you for those issues. If you are actually treating the root cause, rather than focusing on the symptom, you might end up having a person who loses weight on your watch and maybe they even keep some of it off. To say that a fat person is unhealthy just because they have a large BMI is not true.

Practitioners were often quick to point out to the size acceptance people that we were wrong.

There was no scientific evidence used to back up the claims that we were wrong. It was only “common wisdom” that was used and everybody knows “that”. That’s  not an effective argument. Please point out the science behind what you think is wrong. Until then, I’m going to say they’re right. My links have science behind them and they quote it.

I am particularly disappointed that such arguments came from acupuncturists, because “everybody knows” acupuncture has no science behind it.

There were many suggestions on the thread about lifestyle changes, mainly diet and exercise.

Diets don’t work. Neither does adding exercise. Do I really need another link to Shapely Prose?  It’s healthier to maintain a stable weight than it is to lose a lot of weight only to regain it a few years later. That should be obvious to practitioners who are about balance. However, let’s remember balance is not static, it is something that fluctuates from time to time. The most stable systems can adjust and re-adjust on a regular basis. These systems, however, make small adjustments. That means that small weight fluctuations, like one or two or five pounds that get gained and lost are far healthier than fifteen or fifty pounds that get lost and then gained.

There were a few suggestions about measuring BMI.

Apparently, the BMI is “objective” and because of that, taking it and reporting it isn’t a judgement but merely a fact and therefore patients will hear the news that they are fat and will do something about it.

First, BMI measurements are an arbitrary measurement. They’ve been changed overnight so that many normal weight people became overweight, just because someone decided to change the categories.

Second of all, fat people know they’re fat. You don’t have to give them an objective reading. This will not be motivating. Trust me, all fat people are motivated to lose weight and if you actually have an unmotivated fat person sitting in your office, that person isn’t motivated because they’ve failed so many times they don’t want to get their hopes up again.

Or you may have a fat activist in your office, in which case you might actually learn something if you listen to them.

There is an insistence that there is a general consensus that being overweight or obese leads to health issues.

This is not true. At all. Except among people who sell diet products. As to the other side of that argument, please refer back to Kate Harding’s site.

One person suggested that obese people don’t want to change.

Well, maybe. Not everyone does. They may already be aware that those changes you want them to make don’t work. They may have tried things you’ve never considered and they are still fat. So why should they change? Additionally, if they are there for health reasons, maybe dealing with the illness is not the best time for major lifestyle change. It may be that they’re expending all their energy just to exist and get to their various doctor’s appointments.

Now, let’s consider that during the thread a number of people talked about how diets don’t work (see above) and that weight loss may not be as easy as you’ve tried to make it sound, and yet you refuse to comment on any of the great links offered. Can I suggest that perhaps you don’t want to change either?

In order to help a sick person, acupuncturists need to address diet and lifestyle.

I don’t disagree with that in general. I do disagree with suggesting people need to eat less or eat lower calorie foods. In fact, I suspect many of my fat patients actually need to eat more. As to how much change needs to be made, perhaps you need to start working on the acupuncture side of that and making small suggestions after finding out about the current lifestyle first rather than looking at someone and deciding what their lifestyle must be.

According to one person, acupuncture can help people get to a mental and spiritual place to make the “needed changes” in lifestyle.

I have no words. For this I consulted Ragan Chastain at Dances with Fat and  who said, “This is problematic on a number of levels, first of all, if you think that you can tell from someone’s body size that they need to make spiritual changes, in fact if you are under the impression that body size gives you any information other than the size of the body and your personal attitudes about bodies that size, then I urge you to refer your fat patients to another practitioner until you are able to properly address your prejudices and stereotypes around fat bodies.

“People are many different sizes for many different reasons, there are healthy and unhealthy people of every shape and size, and healthy habits and spiritual balance are not different for different body sizes.  If you run an evidence-based practice you already know that there is no weight loss technique shown to work for more than a tiny fraction of participants. ”

I am troubled by the lack of size acceptance among many practitioners because as acupuncturists we are uniquely suited to help all people get healthy.  It’s  a medicine that insists we treat the root cause. The root cause of  a fat person’s health problems is not being fat. Fat is a symptom. Consider that most women, and even some men (and the percentage of those men is growing) have been dieting off and on for years. In addition to pure caloric starvation, the body is also getting a lot of low calorie fake foods that have minimal nutrition and lots of chemicals that may actually exacerbate the problem. The diabetes and heart disease and hypertension may have less to do with the excess weight and more to do with the excess dieting.

I have information about my own health that I’m willing to share, but that may need to come in another post, because to see me, a fat-ish woman and tell me to eat less would be exactly the opposite of what my doctor told me. And yeah, we did blood work and plenty of tests. Oh and did I mention my doctor is a naturopath? I will talk more about that in a related post. I would also like to address the energetics of being fat in our world, which is a lot more complex than addressing just the spleen. But that’s yet another post. In fact, the combination of all of my commentary might end up being a book.

I’ll leave you with more words from Ragan. “If you want to work appropriately and effectively with fat patients, then I encourage you to think of them exactly like your thin patients, only bigger.  Explain that you can help them have their best possible health, and that health and body size are not the same thing.  Encourage them to pursue healthy habits and allow their body size to settle where it will, rather than attempting to manipulate their body size through food, exercise and acupuncture.

“The only changes you need to make are to your practice – make sure that you have chairs without arms, oversized tables and/or wings to make them wider to accommodate broad-shouldered and fat patients, and work on identifying and eradicating any prejudice that you might have against people of a certain size.  Finally, help your patients see that the social stigma to which they are currently subjected, which is of course horrible for their health, is not deserved and that the solution to social stigma is not weight loss, but ending social stigma and the problem lies not with their bodies, but with a society that has developed prejudice against it.”

And if you want to know more, in addition to her blog, which is a great read, Ragan does speaking engagements. This could be a great learning experience for a group of local healthcare providers who want to better serve their clients of size.

Latency in Acupuncture

I just read a fascinating piece in Acupuncture Today entitled The Curious Concept of Latency: The Luo Vessels.   I found myself inspired by the thought and explanation into a deep and complicated part of the medicine.   I think it’s one of the most intriguing theory pieces I have seen from Acupuncture Today in a long time.   It’s a recommended read for any acupuncturist (but allow some time, it’s long and you’ll want to pause to digest the ideas).

On Dieting

We live in a world that’s hungry for a diet to end all diets. Two out of five women and one out of five men would trade three to five years of their life to achieve their weight goals. Young girls are more afraid of becoming fat than they are of nuclear war, cancer, or losing their parents.

Michael Snyder, MD

It’s amazing to me that the idea of being fat is worse than cancer or nuclear war. I think this says something about the emphasis we place on the way we look rather than how we feel. Snyder has a full article talking about his new book here.

Perception or Actuality: Does it Matter?

This weekend I was out of town. I tried to minimize going off my GAPS diet but wasn’t able to be perfect. In fact, I was far from perfect and ate more stuff that I shouldn’t than I had hoped I would.

I’m surprised at how horrible I feel.

My question becomes, do I really feel worse than I did when I ate this all the time or am I just so used to feeling better than that? Are these new symptoms things I was just so used to that I ignored them or do I have new symptoms that I didn’t have before?

As I ask these questions, I realize that it doesn’t matter whether I really am worse than I was or if I just think I am due to feeling better in the last month, my reality is that I don’t feel well any longer. I wasn’t feeling perfect before but a lot of my low energy symptoms were easing. I knew I was on the right track. Now I have had a set back and I feel worse. Worse than I ever did or just worse than I had been. My perception is just that I don’t feel as good. I think that’s enough.

I am off to the kitchen to eat some more of my lovely Fab Ferments Kimchi, which I love! Maybe that will help me feel better. And maybe when Valentine’s Day rolls around and I go out to dinner with my husband I’ll remember this set back and make better choices (although I reserve the right to eat Creme Brulee!)

My Liver, the Couch Potato

Mark O’Donnell, who is a professional health and fitness coach has a wonderful article over at the Fitness Spotlight called Speed Up Your Metabolism-Fatty Liver Disease.

The article is important because it shows the importance of the liver in weight loss. Additionally, even if you aren’t over weight but don’t feel your best, there’s a good chance, in our culture that the liver is involved.

One thing Mark does leave out in his article is the effect of emotional stress on the liver. Emotional stress is anything that causes a stressed feeling in the body. It can be worry about work, feeling overwhelmed or being frustrated that you aren’t where you are in your life. These are all stressful things. Moving is a stress, as is planning a wedding or getting a divorce. Change in general is stressful. These add to the burdens that the liver has to deal with in it’s daily life.

From the paradigm of an acupuncturist, one of the main functions of the liver is to keep the body’s energy system moving. Emotions are energy. We are all familiar with them. When we are constantly stuck with one emotion or desperately trying not to feel a particular emotion (often fear), we don’t allow our liver to function fully. Things come to a stop. We end up in endless frustration. We move from one worry to another and are never able to move through the spectrum of appropriate emotions.

Like our emotional state, our body finds it harder to move. Our metabolism slows down because nothing is moving. Our digestion might slow. We put on more weight.

Treating your liver well and keeping it moving, through detoxifying it when appropriate, or at least being aware of the work it is doing is a good place to start keeping the liver working. Next time you think that store purchased chocolate cake will make you feel better, consider what the high fructose corn syrup is dong to your liver. You might choose to have it anyway, but make a plan to work with your liver after to keep it happy.

If you need ideas on how to keep your liver happy or if you want to read more about fatty liver disease, check out the article linked above. It’s packed with a lot of excellent information.

The Root and Branch of Healing

As an acupuncture student we learned about the root and the branch of illness. The branch of illness generally included the symptom that brought your patient to you in the first place. The root was generally the underlying problem that caused the imbalance manifesting in the set of symptoms in the first place.

To use the example of a cold, the cold itself may be the branch “symptom” that I am treating. This is particularly true of those who always get a cold when the kids first go back to school. Certainly there are many factors going on but while the branch may be the cold, the root may require dealing with boosting the immune system so they are less likely to get sick (or as sick) when their kids go back to school and bring home their own colds and flus.

In such a case, in the first treatment I might focus 90% of my attention on the branch of the problem. In subsequent treatments I may focus as much as 90% of my treatment on the root of the problem. The symptoms after the first treatment are likely much reduced and treating the root will help the body as much as anything to rid the rest of the symptoms.

Each illness is different in terms of how the percentages break down.

In general it is often fairly easy to make short term changes in the branch of a problem and make people feel better. It takes longer to make changes in the root of the problem, which is what keeps the problem from returning again and again.

Lifestyle changes can be looked at in the same manner. Some changes are big and require a lot of effort to make those changes. These might be the ones that make the most profound difference in the long run. These changes might mean giving up all gluten or stopping smoking or exercising regularly.

Other changes may encourage us to work towards our larger changes. Cutting back on smoking may not offer the same long term benefits of giving it up but consciously cutting back and becoming aware of smoking may make a larger change easier in the long run. Cutting back on food allergies and eating lower on the totem pole even once a week can be a good step towards bigger lifestyle changes. They should be looked as a step towards better health and these steps shouldn’t be minimized, particularly when people who are sick are making changes.

No one loves making changes in their lives. It takes effort. Small changes can feel like running a marathon to someone who is sick. Stop minimizing the efforts. Everyone has a lot of pressure to be perfect. We need to step back from that perfection and realize that sometimes good enough is. As people heal, even one day away from food allergens may make a huge difference in energy and cascade into the ability to make bigger and farther reaching changes.

Life is not about the goal. It is the path to get there.

Thinking about the 90% Rule

This last week was very hot. That meant eating out a lot more. Even as it cooled off, I found myself craving some ice cream, which meant eating something else I try and avoid. I was thinking about my 90% rule. I certainly wasn’t 90% this last week. I’m not sure how much closer I’ll be this week either, although I hope it’s at 90% or more.

However, there have been weeks when I’ve been able to stick to my food convictions 95% of the time rather than 90% of the time. I have to remind myself not to go around nit picking everything. Yes, I probably ate within my diet guidelines 40% of the time this time. I have this sense that I want to go and check up for the next few weeks until I work off that “drop” in my compliance. I am forcing myself not to think too much about it.

90% needs to be most of the time–for life. Not just today or this week or this month. It means that there will be weeks like this for me that I am not able to be so compliant. I am sure other weeks will challenge me as well. I need to understand that I should work at being as compliant as I can be as often as I can be and be content with being compliant, most of the time.

Undervalued Rest

As a society, we really undervalue rest. Everyone must always be busy. This doesn’t matter if you are sick or well. This doesn’t matter who you are, you must always have something to do. Resting, really resting and just taking a break isn’t considered productive.

From a health care provider’s perspective, rest is one of the most important things you can do. Rest allows your body to heal after the assaults of a busy day or busy week. Rest can help heal stress. Rest is important. After a good diet, rest can be the most important and loving thing you can do for your body.

Find time to just do nothing for awhile. Read a book you’ve been thinking you wanted to read. Watch the birds. Enjoy.

No Time

One of the big issues as an acupuncturist is seeing a patient who is living a life that is contributing to their lack of well being. Discussing this issue with patients, they are often overwhelmed at the thought of making a change. A big change most patients could make is to eat better quality foods. However, most patients will tell me that they don’t have time to eat better or to eat at home more often than not.

There have been several posts around the blogosphere that discuss a study that shows that convenience foods save an average of ten minutes a day. For myself and for a number of my patients the bigger difficulty is not in finding those ten minutes a day, it’s in planning for cooking and eating.

The vast majority of people find that they are reacting to circumstances rather than planning for things. They constantly feel overwhelmed by all that needs to be done and planning ahead for eating or for exercise is just one more item. Additionally going out often feels like a treat because then you don’t even have to clean up the kitchen.

I would love to see more people out there who can help these same people with their planning skills. They can plan to exercise (and make note of those things that interfere with their plans or not). They can plan to eat at home and make sure they purchase their foods on other days. Making one larger meal with left overs is a great way to cook once and eat it twice.

While learning to cook may also be an issue for some people, learning planning may be a more important skill. Such a skill crosses over from the kitchen to daily life in a way that can create places for rest and relaxation that are sadly lacking for so many people.

I have recently been trying to eat all food cooked or baked in my own kitchen. I have a few exceptions and I haven’t quite gotten to making my own condiments (too many in the kitchen to just toss out). I find that I am constantly obsessed with food–planning when I can make this or that or thinking about what I have so that I can plan a good lunch or dinner for myself and my husband. I know on Saturday by the time I get back from the Farmer’s Market what I am going to be eating that week. We have a small kitchen garden that supplements vegetables to the items I purchase at the Market. I can also easily run to PCC (a large food cooperative in the Seattle area) or if I don’t want to go quite so far, Whole Foods.

All of these trips require planning in a way I never bothered with before, but I find that my health is better. I also find that there are far worse things to obsess about than what am I going to do with all those leftovers?