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.

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Bonnie

Bonnie Koenig has been a licensed acupuncturist since 1999. She is passionate about helping people find real healing and real health. In the process she keeps asking about our attitudes towards sickness and health. Only by being clear on what sickness is, can we ever find health.

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