October 2022

Reflections on Diet Culture

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No me gusta!

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George H. -

I agree that we should emphasize health more than appearance. I do not agree that we should normalize obesity. I think a causal link between obesity and diabetes is indisputable, as losing 10 - 15% body weight often reverses the diabetes. There are a multitude of other medical and orthopedic conditions strongly associated with obesity, as well as problems like not being able to get into a standard CT gantry, or even an airline seat. Dusty Narducci suggests that those of us who think these are serious problem really just don't like the way obese people look, and that we need to look at our own biases against fat people.
I did not hear diabetes mentioned once in the entire episode. This didn't sound much like a medical educational program. Should we also stop suggesting that smokers quit smoking? Should we normalize drug abuse?
That 90% of dieters regain their lost weight does not mean that we should just accept obesity as normal. Some studies of smokers show similar relapse rates.
I am open to alternative viewpoints on EM RAP. I also think that some alternative viewpoints need to be called out when they are not supported by evidence.
Thanks for listening,
George Hansen, MD

Heidi J., MD -

Hello and thanks for taking the time to listen to this piece and provide feedback. When we were creating this piece, we knew it would be a divisive one! We've covered aspects weight related health issues and weight management from an EBM perspective on the show many times in the past and will continue to do so in the future (agreed, it's important!) and realized it was time to include broader themes and perspectives on the topic, that while they might not lend themselves well to study, can and do (and should?) influence our practice. Family medicine is a particularly messy - and wonderful - mix of evidence meeting sociocultural influence and we felt exploring more of the latter was important. Dr. Narducci did include references and resources for this piece and I hope you'll find them helpful. On a personal note, I've recently started asking my patients about their interactions with healthcare providers (including me) regarding weight and weight management and how i has impacted them, and, oh my, it has been humbling...we can do so much emotional and psychological harm as we "encourage" our patients to lose weight. It's been motivating to check my own biases and to be mindful of patients overall wellbeing and not just their physical health. Thanks again for taking the time to connect - we truly appreciate your feedback.

David S. -

These piece sounded to me like, “accept the risks of obesity and fix what you can”. All fine and dandy, except that obesity is the biggest health crisis we face in medicine. I don’t understand why we simply cannot work towards positive relationships with our bodies and lose weight. They are not mutually exclusive. And while I do not condone diet culture, it is exceedingly clear that there are better ways to eat and move. Many being within people’s means to change. Even at that, a 10% chance of maintaining weight reduction is so, so much better than most things we do in medicine. Despite my frustrations with this piece, I enjoyed hearing it. If I can take away anything, I will now be more cognizant of approach.

Heidi J., MD -

Thanks for taking the time to listen and for keeping an open mind. This is certainly a novel approach to weight management!

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