This post is also shared at The Ruminator.
Recently the New Zealand Medical Association (NZMA) released a report on “Tackling Obesity” in New Zealand. The Green Party has responded by saying that, if elected to government, they will commit to implementing all recommendations in the NZMA report. Inevitably, this has many people talking about obesity and public health strategies (or lack thereof).
There is a lot to say about obesity worldwide and locally. I am going to link you straight up to some very clever minds in the Health At Every Size community. Which is exactly what it says on the box; the concept that you can be healthy at every size.
This is firmly and unapologetically the camp I stand in, with my double E boobs and my size 16 waist and my penchant for sometimes walking 15kms in a day for shits and giggles. I am healthy. I am fat. (I also don’t think fat people have to justify their existence to you by outlining their health credentials). Weight can affect health. Health can affect weight. Weight can also become a sticking point leading some health professionals to do far more harm than good.
The BMI system, which decides how healthy someone can be with no other information other than kilograms and centimeters, is inherently flawed. And, often credited with mischaracterising the obesity “epidemic”.
But apparently we have one in New Zealand; an “epidemic”. A word that by definition means “a widespread occurrence of an infectious disease in a community at a particular time”, which weight is not. But hey let’s not get caught up in technical terms when talking about medical health.
Instead of meaningfully discussing the genesis of nutritional inequities among New Zealanders (like socio-economics, colonisation, urbanisation, racism, classism – small stuff like that) the report states the “Key drivers of obesity include the increased availability of cheap, palatable and energy-dense foods, persuasive and pervasive food marketing, and reduced physical activity.” So, not why this happens. Just that it happens.
The NZMA recommendations contain some commonsense general health measures, like teaching nutrition in schools and facilitating activity-friendly urban environments. It also contains surface-level tactics aimed at reducing advertising, moving fast food joints and taxing ‘unhealthy’ foods rather than improving socio-economic access to nutritional variety.
Fanta isn’t the devil. A capitalist system which allows time-poor families to earn so little that any cheap food is a blessing, is the devil. I give you this beautiful truth from The Onion as my cynical point in long form. Key part:
“I’m going to go out on a limb and say that our food budget might not be quite big enough to feed me seven nights a week, let alone three growing kids. So I can’t say these hard new truths about fast food have really been a deal-breaker for my family’s dietary habits.”
But the recommendation which takes the deadly death fatty fatty cake is the first one. It reads: “Health professionals should take every opportunity to engage sensitively with patients who are obese, providing them with advice for healthy living and directing them to exercise and nutrition programmes as appropriate. Recognising and acting on obesity in childhood is of particular importance.”
I am not going to explain to you why health professionals seeking every opportunity to engage patients about their weight is a bad idea. I am going to show you why. And let me be clear, if you wanna bring up your weight to your doctor, you go right ahead. But this ‘every opportunity’ thing? It’s already happening. And it is harmful:
I once had a doctor who told me that exercise induced asthma was normal and I should run through any attacks.
— Rachel Rayner (@RachelRayner) June 10, 2014
I left my last (low-income-area PHO-funded) clinic bc a locum GP laughed incredulously when I said actually I did exercise.
— petra jane (@petrajane) June 10, 2014
ugh my old doctor used to be like that. Sprained ankle? btw lose some weight. bad cramps? lose some weight. it was awful
— Lena (@superleeni) June 10, 2014
I stopped going to my doctor regularly because of this.
— Eamonn Marra (@yourjokesarebad) June 10, 2014
i didn’t seek medical help for depression for over a decade for two reasons. 1 depression, 2 knowing that I’d be told to lose weight, which made me anxious, feeling defeated and see reason 1.
— post-scott (@buzzandhum) June 10, 2014
last time I saw GP for a sporting injury, was told it was prob because I was fat & I should try exercising! & when I tried to get an OCD specialist referral I was told no, you’re actually just depressed, because fat
— petra jane (@petrajane) June 10, 2014
First time I went to the doc for depression & anxiety she saw me for 5 mins and decided it was indigestion due to size. I didn’t go back to a dr for another 3 months, until I started having full blown panic attacks
— Mighty Kites (@Regan_Gibbons) June 10, 2014
I went to dr because having trouble sleeping – dr spent whole appt talking bout weight & didn’t address sleep at all
— Ally Mullord (@Tarquin_Death) June 10, 2014
I was punched in the face and in the emergency room for stitches. The first thing I heard post-“Oh, that’s bad, we’ll fix that up” was “You need to exercise more”,
— Jon Lastnamé (@thelightisred) June 10, 2014
honourable mention to the GP I went to for acute anxiety who told me my weight meant I would die in ten years.
— Izzy Lomax, 23 (@izzyelle) June 10, 2014
I don’t go to the doctor because they always insist on, humiliatingly, weighing me. Even when what I was seeing them about had no conceivable connection to my weight. Even when I was just seeing them on mental health matters.
I was told to abort my son as I was too overweight. At a size 18. #Worstdayofmylife
— LatteJunkie (@LatteJunkieNZ) June 10, 2014
Normal GP wasn’t available. Substitute weighed me, tut-tutted, took my blood pressure and was visibly shocked it was normal.
— Stephanie Rodgers (@stephanierodgrs) June 10, 2014
Went in with the flu with full body muscle aches and was told maybe i’d found some muscles I didn’t know about..
— Sam (@littlelilybits) June 10, 2014
personal best: Dr who said “do you think you’re depressed because you’ve got low self esteem because you’re fat” five min in
– Spokesvagina @johubris (private account)
I presented with arthritis so bad I could not walk easily and was told was prolly weight & go for a run. turns out severe vitamin deficiencies from coeliac ! Nothing to do with weight.
— canllaith (@canllaith) June 10, 2014
Hey, I forgot the doctor in hospital who said I would die before my children grew up. AS I HELD A NEWBORN. #fattales
– dimsie (@dimsie) June 11, 2014
I don’t pretend that this is a representative cross-section of New Zealanders. In fact, this is a tiny portion of social media savvy, mostly white, mostly middle-class New Zealanders. Imagine the scale of these experiences by less privileged people throughout New Zealand.
If fat people want to raise weight as a health issue, that’s fine. It is possible for doctors to convey the importance of exercise and a balanced diet to all their patients without it being weight-specific. That is the whole Health At Every Size chestnut.
Pointing out that fat people are fat, and should really diet and exercise, is not a health strategy. It has already failed globally. Fat people know they’re fat. They know they’re supposedly undesirable and unhealthy, that sugary foods are bad and that exercise is good. They know they’re apparently ‘strains on society’, about to die literally any minute, and that headless stock footage of themselves running an errand could be used to accompany an “OBESITY EPIDEMIC!!!!!!1” piece on the news.
Any ‘strategy’ that prioritises limitations on chip shops, rather than limitations on systems which leave people with little options for their health, is doomed for failure. And this one holds huge potential for destructive shame and alienation on its way down.
I don’t expect the NZMA to fix the economy. But I expect them to work in away that acknowledges the realities of it. We need to increase community access to resources that enable wellbeing. And wellbeing is not a dress size.
This stuff is hard. Those tweets are heartbreaking. Feeling good about yourself in the face of an advertising industry built on making money from self hate, is one thing. Knowing your doctor’s office may be even less of a safe space for your body is another.
Here are some rad things to do after reading this, to refill your stores if you need it:
- write your body a late Valentine’s Day letter
- do something nice for your body – take a bath, give yourself a head massage, put on a nice smelling lotion
- take a babin’ selfie
- dance to your favourite song
- buy yourself something cute online
- look at ridiculous animal pictures online
- snuggle a nearby animal
- write down the best compliments you’ve ever received
- learn about mindfulness meditation (then give it a go)
- watch an episode of Full House, The Nanny, Friends or another blast from the past.