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« Moving as fast or as slow as you can. | Main | Fat positive news »

February 09, 2009

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When I was 11, I was enrolled in a program at a hospital called Shapedown, with the reasoning that it was for fat kids like me. It was supposed to make it better that all the kids there had "weight problems," even though my older, taller, thinner sister was also enrolled in the program and I knew I would never be able to get as thin as she was in a million years.

One especially laughable part of the program was an exercise in eating slowly and chewing carefully, prefaced by a little survey among the group about our binging habits. It wasn't "Do you ever binge?" It was, "When do you binge? By yourself or with others? Large binges or small binges?" We were all fat, so obviously we all had a problem with binge eating. I think I gained 15 pounds during the course of the program. (I was eleven and going through puberty. I had been skipping meals since the age of eight trying to lose weight. My family was going through a great deal of turmoil as my parents were separating. It was possibly the worst time in my life to have been enrolled in a diet program--not that there is ever really a good time.)

Medical professionals need to know that their attitudes cause problems. I agree that simply acknowledging the stigma doesn't go far enough. There is a stigma, it negatively affects our health care. What they need to be asking is, why is this stigma there, how is it affecting our patients, and what are we going to do to change it?

Sorry to be a double poster, here, but I read through the online course link you posted above, and I have to say... it's pathetic. Sure, it talks about weight bias, but the focus is on how to talk about losing weight so that fat people will actually want to do it. It encourages doctors to ask questions like, "How does your weight affect your daily life?" and "What was your life like before you gained weight?" Ridiculous, and not helpful. I would love to see a CME like this implemented by someone who actually believes in health at every size.

I read the course too, and I agree with Fantine. I thought it started out pretty well, trying to bring awareness to the kind of attitudes some fat people cop from their doctors, and trying to explain how this has a negative impact on it.

Unfortunately it was all a preface for "just try to be nice when you tell them to lose weight, it's not easy you know".

*sigh*

That is soooo not the point! Your post is spot on.

Why couldn't there be something like this course, except at the end instead of having the "sell them the diet nicely" crap it could have "here is the scientific evidence of why you should get over it already", just to reinforce the first parts.

I haven't checked out the online course, but I thought the videos were more positive than they were negative. In both, the center clearly stated that there are other factors beyond lifestyle that contribute to one's body weight. The center also does a lot of work in helping bring awareness to attendant issues of poverty and its correlation to body weight that I, someone who has worked with poverty-assistance groups and study as part of my graduate research, much appreciate. And I don't understand Rudd's emphasis to be on weight-loss so much as I understand it to be on the prevention of "obesity" (to use their word).

I don't identify as a fat acceptance activist -- I promote body acceptance (personal) and fat rights (political) -- so perhaps this is why my perception of Rudd differs from yours. I also tend to be more moderate in my overall activist approach. I don't support Rudd's positions wholeheartedly and I recognize that there are obvious contradictions in what they promote, but I appreciate that they see weight discrimination as a social injustice issue and are actively working to reduce it. In my experiences, I've found that I get more accomplished when I work with people/groups than when I work against them. Rudd has resources and a legitimacy that very few, if any, fat rights groups have. I prefer to use those assets to my advantage, while continuing to reject those I disagree with. All in all, I think Rudd represents a good meeting ground between anti-obesity proponents and fat rights activists and I think it does neither group any good to dismiss them altogether.

"What was your life like before you gained weight?"

Oh man, I deeply wish a doctor would ask me this. "Well, it was pretty good... we were learning multiplication and division in school, I read 'A Wrinkle in Time," and I got to play with my friends in the yard a lot. Never did get a puppy, though."

And Laura, you're absolutely right, of course -- removing the stigma of "obesity" just doesn't jibe with simultaneously telling patients to lose weight. That's not removing the stigma -- that's just expressing it in kinder tones.

Man I said Laura and I meant Lara, I am an asshole.

They keep emailing me to post about the class on my blog. They obviously haven't a clue who they are asking and haven't read very deeply into it. I usually just delete the email and ignore them. If they send another one I think I may have to reply, tho on my blog so then they might get a clue next time thru.

My name is Chelsea and I work at the Rudd Center. I've been following your posts about the Rudd Center and I feel compelled to respond to your comments and try to rectify any misperceptions about the Rudd Center’s work.

The Rudd Center has the dual mission of improving the world’s food environment to prevent obesity and reducing weight bias. I am aware that the integration of these two goals may seem contradictory. However, we believe that these goals are both compatible and complimentary.

In the past several decades, obesity has been addressed through a predominately individualized model where weight is seen as a matter of personal responsibility and individuals are blamed for their size. Unfortunately, this approach often fuels negative stereotypes and discrimination against overweight people.

In contrast, the Rudd Center’s work involves research and advocacy from a population perspective. We view the rise in obesity as a symptom of an unhealthy, even toxic, environment. Rather than encouraging weight loss, our goal is to improve the food environment for all individuals, regardless of weight. We also understand that people can be healthy and overweight at the same time.

Because of these values, our main focus is to create “optimal defaults.” That is to create conditions that promote the healthiest and most beneficial choices for everyone. Thanks to the unbridled influence of the food industry, our nation’s eating habits are currently driven by the worst defaults (to name a few: large portions, deceptive food marketing practices, schools selling unhealthy foods, and economic policies that make fruits and vegetables more expensive than calorie-dense processed foods).

If you were to take a look at some of our current initiatives, you would see that we focus on promoting a shift toward healthier defaults. We do not advocate weight loss, we know that diets do not work, we are opposed to the damaging myth of “personal responsibility,” and we certainly do not target fat people.

We are dedicated to eliminating weight stigma and discrimination not only because they are grave social injustices that are harmful to both individuals and public health, but because we believe our society’s focus on personal responsibility is a barrier to achieving real change.

As for the online course to which you referred, we worked very hard to create a tool that addresses the serious problem of weight bias in health care. This is the first resource of its kind designed to help health care providers understand the harmful consequences of weight bias and realize how their own personal biases may influence the way they treat their patients of size. Reading through some of the above comments, I realize now that some of our "tips" to health care providers on how to communicate with patients may be misconstrued. However, I assure you that our overall goal was to create a tool that would be both acceptable and helpful to health care providers.

I am aware that we may disagree about many things – from whether there is a need to address obesity at all to the terminology that should be used when discussing these issues. But I think we do agree that weight bias and discrimination are pervasive and wrong. Although we may choose different paths, I hope that we can respect one another’s efforts as genuine.

I make an effort to browse the size acceptance blogs regularly and I learn a great deal by doing so. I invite you to view our blog as well.

Chelsea, it makes absolutely no difference whether you place the blame for the existence of fat people on individual fat people or on an allegedly obesigenic environment. That you place blame inevitably means you see something wrong with the existence of fat people! And as long as you — and Rudd Center — conduct a witch hunt on people like me (aka, prevention of "obesity" [sic]), then you're making more work for the people who really do work to end weight-based prejudice and discrimination. (I.e., me and other rad fatties, like Lara, who does excellent work with this blog.)

Chelsea, I invite you to read about the Health At Every Size approach to public health and individual wellbeing. It manages to blow Brownell's usual weight-loss approach away (in terms of improved nutrition/exercise behaviors AND improved health numbers). The HAES approach also stands up for human rights where Brownell and Rudd are willing to trample them in order to get to the "obesity" funding trough.

I have a clear and accurate view of what the Rudd Center stands for. Your attempt at correcting that view only reinforces my opinion that Rudd and Brownell and everyone who works at Rudd is no colleague of mine.

@Chelsea - The Rudd Center wants to prevent my body. Please understand that when you place *any* blame for my body, whether it be personal actions or environment or something else, you devalue me and every other fat person. I just am. It doesn't matter how I came to be fat. The idea that there is something to blame for or there needs to be a reason for our bodies continues to perpetuate bias and myth and discrimination. I don't need people, particularly health care providers and various health authorities, looking at me and thinking "Oh, she's probably fat because of this terrible obesogenic environment we have, if only we could have got that woman access to fresh vegetables and make the restaurants in her town learn portion control, she might not have become so fat" any more than I need them looking at me and thinking "Oh, she's probably fat because she has no self control and has no idea what exercise is." You are merely adding pity to the hate.

I do not care whether getting people in need affordable access to a more balanced diet will make them thinner or stop some of them getting fat. I care whether getting people in need affordable access to a more balanced diet actually improves their lives in any meaningful way. Classism, sexism, racism, ablism, ageism; all these things are far more in need of alleviation and prevention than fat bodies. Address these issues at their root and people are going to be far healthier than if you prevented a few people from getting fat.

There is part of the Center's website talking about the health costs of "obesity". There are many that posit that a great deal of this associated cost would be reduced not if there were less fat people, but if fat people received proper preventative care and treatment. One of your videos on bias suggests a doctor ask "Can we talk about your weight?". I suggest a doctor do no such thing, as nearly every fat person will have already had a lifetime of talking about their weight. Instead limit talk about weight only to where it is directly relevant, such as weight-based medicine dosing, using the right equipment such as large blood pressure cuffs, and perhaps that unexpected or quick weight loss or gain *may* be a *symptom* of a health issue.

(You claim the Center doesn't target fat people, but they are right there in the name! How about the Rudd Center for Health for All, following the Health at Every size paradigm? I guess that wouldn't get much anti-obesity funding, though, like Marilyn said.)

Chelsea,

Perhaps it would be clearer if we used a different analogy. What if the public health response to the AIDS epidemic had been "homosexuality prevention"? Trying to prevent health problems that are more likely to occur in fat people by "preventing obesity" is the same logic. There are no health problems that only occur in fat people, just as AIDS is not limited to the gay male population. The same environments are problematic whether people are thin or fat. And if we all lived in perfectly pristine environments (whatever your definition of that is), there would still be fat people. Thank god! Having a biologically diverse ancestry where some people are gifted at making fat from food is one of the reasons you and I are here at all. It would be nice to show a little respect and appreciation. : )

from the Rudd center said: "The Rudd Center has the dual mission of improving the world’s food environment to prevent obesity and reducing weight bias."

That is comparable to some institution saying they have "the dual mission of improving the world’s environment by preventing dark skin and reducing race prejudice."

You cannot say an entire group of people should not exist AND then say you want to stop bias against them. That IS the bias against them!

Chelsea here again. Thanks to everyone for their comments. I do understand why many people feel the Rudd Center's mission is contradictory. The way I see it, personally, is despite clear ideological diffences between our two camps, the bottom line is that I feel that the Rudd Center is doing good work towards reducing weight stigma and discrimination. We do solid research that helps change people's minds about weight stigma and recently we've developed resources to reduce weight stigma (e.g. our CME, videos, and toolkits).
I can see that many of you don't feel that these resources are perfect, but I still think they are an important step and we've worked very hard to make them as useful as we can.
As for the work being done in other parts of the Rudd Center.... I just don't see how trying to improve the food served in schools, or working to improve access to fresh fruits and vegetables in neighborhoods that don't have them, or reducing junk food marketing to children, is in any way at all stigmatizing or placing blame on fat people.
I suppose we can't agree to disagree.

Chelsea,

You said: *We do not advocate weight loss, we know that diets do not work, we are opposed to the damaging myth of “personal responsibility,” and we certainly do not target fat people*

Does the Rudd Center acknowledge that some people are "naturally" fat? That just like there's a spectrum of body height, there's a spectrum of adiposity? And if so, how does that reconcile with a wish to reduce the number of fat people (aka "reduce obesity")?

I don't think anyone thinks that: **trying to improve the food served in schools, or working to improve access to fresh fruits and vegetables in neighborhoods that don't have them, or reducing junk food marketing to children** is a bad idea. It's doing these things to reduce the number of fat people that many people have a problem with.

I really hope you are still reading this post, and will answer my question about naturally fat people - I don't think I've ever seen this addressed by anyone from the Rudd Center.

Hi Lisa,
Yes, of course, the Rudd Center believes that there is a broad spectrum of adiposity and that some people are "naturally fat". We firmly believe that weight is determined by a complex interplay of genetic, biological, and environmental factors. One key point that we try to communicate to health care providers is that the ability to lose significant amounts of weight in the long-term is a myth. Studies shows that, if a person were to try to lose weight, the maximum amount they can lose and keep off is 10% of their body weight, which can mean important health benefits, but need not translate into a "non-obese" BMI. Meaning, we know that people can be both fat and fit, and we're not trying, as you say, "to reduce the number of fat people."

I fear that the main problem and source of disagreement here is the rhetoric that is being used, not the actual work that is being done. The Rudd Center's core initiatives center around making the food environment healthier, by doing the things I mentioned in my previous posts. I can see that people are objecting to the language in our mission "to prevent obesity," but those are just words we've chosen to use to communicate our purpose. Why aren't we being judged by our actions as opposed to a disagreement over terminology?

It really surprises me how much our work is misunderstood. I find it hard to understand why were are so often labeled as the enemy, when we've dedicated ourselves to reducing weight bias. For example, NAAFA features our research and tools on their website and in their new toolkit, however we are still vehemently criticized by some of NAAFA's constituents.

Thank you so much for such a quick response!

I am really, honestly, trying to understand your - and The Rudd Center's - position :) So, you have said:

We do not advocate weight loss
We know that diets do not work
We are opposed to the damaging myth of “personal responsibility,”
We certainly do not target fat people
Some people are "naturally fat".
We know that people can be both fat and fit.

And you have just said that you don't understand why people (like NAAFA constituents) take issue with some of the works/phrasing you use. But given that "obesity" is another way of saying "fatness", it's it obvious? Your rhetoric seems to completely contradict your actual message (as listed above), AND your rhetoric translates to the generally-uninformed public as fat = bad (or why else would you be trying to prevent it?)

It seems to me that TRC is twisting itself into a pretzel to continue to use language and labels (The Campaign to Prevent Obesity) that your own data and understanding are in opposition to. Why not lose the rhetoric, since it seems to be getting in the way and is apparently VERY misleading? Serious question, not being rhetorical.

Thanks for the dialogue.

"I fear that the main problem and source of disagreement here is the rhetoric that is being used, not the actual work that is being done. The Rudd Center's core initiatives center around making the food environment healthier, by doing the things I mentioned in my previous posts. I can see that people are objecting to the language in our mission 'to prevent obesity,' but those are just words we've chosen to use to communicate our purpose. Why aren't we being judged by our actions as opposed to a disagreement over terminology?"

Words and rhetoric ARE actions. And they are actions that have effects! I can't go around spreading rhetoric about ridding the world of a group of people ("preventing" their existence) but also doing nice things for those people and then say "Don't judge me by my words, judge me by my actions!" The terminology you use matters a LOT because it is what tells people how to think about me and my body. Your purpose, as you have communicated it, is to prevent people like me from existing. That tells others that my existence is something unacceptable. I will judge TRC by its words because spreading words is doing something, and it is doing something that is KILLING me and people like me (through the effects of stigma caused by people learning that my existence should be prevented).

Chelsea,

I do appreciate the fantastic scholarly work that Rudd is doing to document weight bias. And - I also feel that rhetoric not "harmless.' Are we back to "Sticks and stones can never hurt me"? Framing is an action too. Kelly Brownell has been candid in public about why he frames the nutritional arguments as "obesity prevention" and it has angered many of us. Being able to get grant money because the public's stigmatizing of fatness is at an all-time high is not innocent. It is not dismissable. If there was a public health effort to
"prevent" blondes, wouldn't you take it personally? People who are serious about focusing on health need to end their addiction to the weight loss money and get sober. It's not just words, and just words are bad enough.

Like Deb, I have high regard for much of the work of the Rudd Center. However, I have never been able to understand how scientists working on behalf of reducing weight stigma miss the contradiction inherent in the language of "obesity prevention." I will resist repeating the several good analogies and explanations already presented here that demonstrate why it is not possible to talk about "preventing" an entire category of people without stigmatizing that group. What part of this could possibly be unclear? I too have heard the argument that this is the language that is needed to obtain funding, but come on.

My suggestion is to change the language from "obesity prevention" to "prevention of a RISING RATE" of obesity. This at least carries the message that of course there will always be very fat people, just like there will always be, for example, "C" math students. Allow me to explain. As a widely respected and credentialed professional and author, despite my very best efforts, I was always a "C" math student (I even got a few "Ds"). I wasn't particularly thrilled about this, but it was just the way things were. I learned to live with this, got into graduate school anyway, and certainly never felt any stigma attached to it. That said, if across the nation we suddenly saw a significant rise in the number of "C" math students, I would be concerned about this right along with everyone else. A dramatic shift would no longer seem to reflect a normal distribution, and we would want to look into the causes. But if the powers that be responded to this concern with a call to "Prevent 'C' math students" —well, all of a sudden I would feel stigmatized! Now I'm no longer just a "C" math student, I'm "bad." I must be doing something "wrong." Now I should feel ashamed, like I should "do something about it," or at least that this is what everyone else would be thinking if they knew.

I would really like to see the Rudd Center respond to this perspective. Rhetoric is not benign. It will be a glorious day when leaders such as the Rudd Center take a stand in refusing to use rhetoric that contradicts their very mission.

Chelsea, there are so very many good reasons to encourage nutrition and physical activity across the weight spectrum and so very many reasons why attaching any sort of weight-based expectations to these healthful habits at all poses a threat both to the health and to the human rights of people of all sizes, that I can't understand why any scientist-y sort of person would still engage in a project that is so unethical and inhumane.

Rudd Center and Kelly Brownell are not being vilified nearly as much as their words and actions merit.

I occasionally cite Rudd's data on weight discrimination. I do so when I want to make a dual point: Look, here's data about the prevalence of fat hate. And ironically enough, the people who gathered adn published this data are so saturated in anti-fat thinking that they are conceptually unable to recognize their leading national and international role in justifying and encouraging weight discrimination. (Happily, I can also cite so many researchers of good conscience: Rothblum, Roehling, Crandall, etc., on weight discrimination, when I feel more hopeful.)

I imagine that NAAFA cites Rudd's data with the same sort of irony, perhaps implicit in their case. I hope you're aware that both NAAFA and I offer weight diversity trainings. So Rudd's toolkit not only contains content steeped in weight stigma, it's potentially offering an out for people who want to address the issue without making any real change. (Just as Rudd Center does!)

I would also remind you that NAAFA has never received any response from Rudd Center or from Kelly Brownell to its open letter of Oct. 6, 2006, published as an advertisement in the Yale Daily News.

Here's the full text of that letter...

* * *
An open letter to Yale University’s Rudd Center and its scholars:

In its mission statement, the Rudd Center lists preventing “obesity” and reducing weight stigma as two of its three main goals.

The board of the National Association to Advance Fat Acceptance represents the world's first and foremost civil rights organization for fat people. We, the leaders of the fat civil rights movement, speak from the combined experience of our more than 120 years dedicated to ending anti-fat prejudice and discrimination. We write to tell you this: Every time you talk about “preventing ‘obesity,’” you stigmatize and medicalize and dehumanize fat people.

Albert Einstein said, "You cannot simultaneously prevent and prepare for war." You also cannot reduce fat hatred while you fuel fat hatred.

There is a humane option: The Health At Every Size approach has been scientifically proven to improve the health of fat people while reducing weight stigma. It is possible to do good without doing harm.

That you insist on stigmatizing fat people—while pretending to do the opposite—is proof that fat people’s wellbeing is not your primary concern.

The National Association to Advance Fat Acceptance will sponsor a large and public celebration when the Rudd Center and its leading scholars stop promoting weight stigma on a national and international level.

Weight stigma is a recent development among humans. It will fall from popularity, with or without the help of the Rudd Center or its scholars. In the long history of our species, there have always been fat people. There are fat people now and there will always be fat people in the future. The hope—so often expressed in Rudd Center materials—of eradicating fat people is not okay; it is ominously close to eugenics.

Signed: the National Association to Advance Fat Acceptance
Co-signed: Jon Robison, PhD, co-editor of the Health At Every Size journal
* * *

Chelsea, you're not helping me. You're helping my enemy. I don't know your reasons; I suggest you reconsider, for the sake of your conscience (not for my sake!).

I thank everything that is good...I know what it feels like when someone (or some institution) genuinely cares about my health and my human rights, about the health and human rights of fat people in general, and people of all sizes. The feeling I get from Rudd Center? From Kelly Brownell? From you? It's not anything like that feeling.

By the way, every time you use the word "obesity," you put my life at risk. Because of that word alone, I am not allowed to purchase health insurance at all. My access to basic medical care is uncertain and expensive, thanks to the insistence of people like you on defining health in terms of weight. It doesn't matter how healthy I am, it only matters what I weigh, and I'm shut out in the cold, left to die. Thanks tons!

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