The Current

'It's not your fault': Changing the conversation about obesity

Millions of Canadian adults are classified as overweight or obese by the Body Mass Index. But according to some experts, the BMI is among many things that should be scrapped as the medical field changes how it looks at obesity.

Not blaming myself for my weight was something that was 'completely foreign to me,' says Theresa Babb

For years, Theresa Babb tried everything to lose weight, from commercial workout programs to fitness classes. But it was four words that changed her life: 'It's not your fault.' (Submitted by Theresa Babb)

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For years, Theresa Babb blamed herself for her obesity.

"It was always my fault," she told The Current. "Who else's fault would it be?"

She says she spent thousands of dollars trying to lose weight, even going so far as to try commercial weight-loss programs like Weight Watchers and Jenny Craig.

She also sought medical help from health-care providers, but she found some of them weren't willing to discuss her weight with her aside beyond uttering clichés about eating less or working out more.

"I don't understand why a health-care professional would be afraid of talking to somebody or be uncomfortable about talking with a patient about health," she said.

Nothing seemed to work for Babb, and she said she felt like a "failure" for not succeeding. 

That was until she met obesity specialist Dr. Laura Reardon two years ago.

"One of the very first things that Dr. Reardon said to me … was 'It's not your fault,'" she said. "And it was hearing those words for the first time in my life that changed everything for me."

A common story

According to Statistics Canada data from 2018, 7.3 million Canadian adults reported heights and weights classified as obese. Another 9.9 million Canadian adults were classified as overweight. 

Combined, these numbers represent 63.1 per cent of the Canadian adult population.

Reardon said Babb's journey is one shared with millions of Canadians.

"A lot of patients who come to see me probably have experiences like lots of the people out there, which is they've tried everything," she said. "They've gone to all these commercial weight loss programs. They've hired personal trainers. They've gone to the gym."

Dr. Laura Reardon says people's struggles with obesity stem from how society has negatively shaped perceptions of weight for decades. (Submitted by Dr. Laura Reardon)

According to Reardon, people's struggles with obesity stem from how society has shaped perceptions of weight for decades.

"[It's] this illusion — if you're living with extra weight — to eat less and exercise more. And if that doesn't work for you, then you need to try harder," she said. 

Dr. Ali Zentner, an internist who runs a public clinic specializing in obesity medication, said these perceptions negatively impact how people see obesity. 

"This idea [that] you're carrying increased weight, therefore you are fat, lazy, not really smart…. You're super unhealthy and you really don't care," she said. 

Babb says from her experience, doctors, particularly those who don't specialize in obesity, validate these myths by parroting them to patients like her.

"The bias that I came up against every single time was they either didn't want to talk about weight at all, or they would say 'fewer calories.' And that was it. That was the cure-all," she said.

Weight is not a behaviour; you cannot control weight. [And] BMI is not a measure of health, it's the measure of gravity.-Michael Vallis

Zentner likens these kinds of suggestions to "telling people with depression to cheer up." She said the onus should be on the doctor to do the work to help the patient address their obesity, not suggest vague one-size-fits-all methods that don't work for everyone.

"In fact, I'm baffled that this is the one area of medicine that we're … sort of comfortable with leaving it to the patients to treat [themselves], and yet every other area we really want to be involved," she said.

Zentner said doctors can offer medications that aid with weight loss, and even bariatric surgery, if needed.

"The fact that these options are available to those patients where their weight is impeding their quality of life ... makes a massive difference in how they continue to move through the world," she said.

Body Mass Index

Zentner says part of the medical perception of obesity has to do with the Body Mass Index — or as she calls it, the "Bull**** Medical Index."

"It was never intended to be used in clinical practice, and now it's been adopted into mainstream sort of nomenclature," she said.

Dr. Ali Zentner says cultural myths about weight are often negative; that people who are obese are "fat, lazy, not really smart…. super unhealthy and you really don't care." (Submitted by Dr. Ali Zentner)

The BMI, which was devised by Belgian astronomer and mathematician Adolphe Quetelet in the mid-19th century, is a value derived from the weight and height of a person. By dividing a person's weight by the square of their height, the BMI characterizes people into categories such as overweight and obese.

But because of its focus on height and weight, Zentner says there's potential for serious inaccuracies. 

"It doesn't account, for example, for gender," she said. "It doesn't calculate for the location of fat tissue, for muscle mass, for the metabolic nature of fat tissue, etc. It tells us nothing." 

According to Zentner, these inaccuracies raise doubts about the BMI's scientific validity.

"We're using a standard that had no business being used," she said. "We've already made this sort of diagnostic criteria ... just based on a number that doesn't have scientific validity."

'Weight is not a behaviour'

Michael Vallis is a psychologist and an associate professor of family medicine at Dalhousie University. He said the conversation about BMI and obesity in general needs to shift.

According to psychologist Michael Vallis, the conversation about BMI and obesity in general needs shifting. (Submitted by Michael Vallis)

"One of the things that I really like to emphasize is weight is not a behaviour; you cannot control weight," he said. "[And] BMI is not a measure of health; it's the measure of gravity."

Vallis trains the doctors of today and tomorrow on how to treat obesity. He says some health-care workers feel confused about how they should address weight-related topics.

"You hear this quite commonly. Providers will say, 'I don't want to offend the person that I'm working with…. I need to maintain my relationship, so I don't quite know what to say,'" he said.

But Vallis notes that many patients also fear being judged for their weight, especially if they're put on the spot by a medical professional.

"So what we're trying to do is really give the health provider … the responsibility to ask permission to have the conversation," he said. "'Would it be OK if we talked about your weight and help? Could I ask you some questions?'"

"It's critically important also that we accept body diversity; that bodies come in all shapes and sizes. We need to promote a self-esteem around a person."

Liberation

Babb has lost 150 lbs since she first consulted Dr. Reardon a couple of years ago.

More importantly, she's learned to love herself, insead of blame herself for her weight, she said.

"Those were things that were completely foreign to me, completely unfamiliar until Dr. Reardon liberated me by saying 'This is your chemical makeup, this is your body and we can help your body get healthy again." 

It's this point that makes both Dr. Zentner and Vallis hopeful for the future of this conversation.

"I'm optimistic for conversations like this one where I know that enlightening people really can be empowering in terms of how we change culture," Zentner said. "We're needing a reckoning on how we approach this patient population at all levels."

"In fact, I think we're beginning to see a revitalizing of the medical school curriculum and also health professionals," Vallis said. "So I'm actually fairly optimistic that the voice of individuals like Theresa will be accepted and heard."


Written by Mouhamad Rachini. Produced by Mary-Catherine McIntosh.

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