Dealing with overweight. Part 2: Unfortunate cultural stereotypes

There is a stereotype in the US that everyone who is overweight is an over-eater.  The more overweight a person is, the more of a glutton he or she is judged to be.  While I see this as pervasive in this country, I have reason to believe this is also an accurate portrayal of the attitudes within most modern societies.  I say this is a stereotype because is just isn’t accurate.  Of course, it is true that there are folks who do consistently eat very large meals, and as a consequence, they can become quite large.  The problem is that our culture has adopted an attitude that carries over to everyone who is overweight, even though it is only a small minority that actually fit this stereotype.  The stereotype is clearly in play when an overweight person’s problems are being discussed by others and someone chimes in with a  thinly veiled criticism/comment like:  “His only problem is learning to push away from the table.”   I cringe when I hear this kind of statement.

Even within the medical community, where you would expect at least a somewhat enlightened attitude, the stereotype is also common.  The criticism is more scholarly sounding in this circle, though:  “It is simply a matter of calories in compared to calories out.”  Not only is it very difficult for the overweight person to find a medical environment where they are treated respectfully, I frequently witness terrible medical care that results from this attitude.  Just about any medical problem a victim of this attitude may seek help for can be met with: “You just need to lose weight.”  (The “Now get out of my office” part is usually just implied.)

I can tell you from an extensive experience with treating this problem that it is much more complex and difficult than the “calories in versus calories out” and “pushing away” analysis would lead you to believe.  If it were this simple, there would hardly be anyone overweight, ever.  There are just too many social, physical, emotional and health problems that result to take it less than very, very seriously.  When I evaluate a patient with significant overweight problems and find he is an over-eater for some reason, or he just doesn’t understand good nutritional guidelines, I consider myself lucky, because I know he will likely have very good success with minimal work on my part, and I will look very good as a therapist.  The vast majority of people with weight problems, though, require every skill I have to help them over an extended period of time and I know I will not always be successful, even if they are highly motivated and compliant with my directions.

If you look carefully at the research you will get some powerful clues why weight problems are usually so hard to treat.  For instance, careful studies that have recorded actual food intake for months at a time show that most overweight people eat less than their normal weight counterparts.  Furthermore, metabolic studies show that people with excessive body weight have abnormal metabolic responses and appetite responses to periods of both excessive caloric intake and of inadequate caloric intake when compared to normal weight people.  What is particularly enlightening, even when the massively overweight folks are able to be brought all the way down to a normal body composition through some effective strategy, their abnormal metabolism and appetite patterns do not just go away.  Once out of the highly artificial research environment, they usually start regaining the excessive weight despite their best intentions and efforts.  No one knows why this abnormal regulation occurs nor is it easy to demonstrate outside of sophisticated research programs.  What is clear is that it creates a very difficult medical problem.

This is not to say that the situation is hopeless for most people with these problems, just that it is quite difficult and requires a lot of knowledge to help them.  Over the years I have learned how to help most of the folks who seek treatment to bring their weight down to healthier levels and keep it there, as long as they will make a reasonable effort and can continue to follow through.  This is actually what usually determines long term success or failure: whether they continue their treatment long enough to get to the root of their problem and learn all they need to know.  This is in line with what researchers report about the long term outcomes of people trying to lose weight.  What correlates best with long term success is whether the person in the study continues to follow up with knowledgeable therapists on a long term basis.

While I am on the topic of stereotypes, let me mention two important consequences.  The first is the human suffering that results.  Imagine the overweight child and the criticism he receives from classmates.  Consider the overweight adolescent who sits at home while others kids her age are out on dates.  Among adults, who do you think is often last hired?  The list can go on and on.  Beyond this, the emotional toll of these attitudes can easy result in chronic depression.  I would estimate that about 80% of the folks I treat are depressed when I first meet and evaluate them.  It can easily become a vicious cycle: quite often depression causes weight gain which further aggravates the depression.   I have learned that I must eliminate the depression before weight control is a reasonable possibility.

In the next installment of this series, I will cover some easy solutions that I sometimes see for people who are struggling with their weight.  Such easy solutions aren’t real common, but they do happen.  It is important to understand them and keep them in mind.

I am estimating there will be about another eight or nine articles in this series.  If you want to follow it easily, you might want to select an email subscription or RSS feed available in the column to the right.

Chuck

About Chuck Gebhardt

I am a physician specializing in internal medicine. I sub-specialize in nutritional medicine. I am very interested in all areas of healing research, not necessarily limited to traditional medicine topics.
Gallery | This entry was posted in Dealing with overweight and tagged , , , , , . Bookmark the permalink.

17 Responses to Dealing with overweight. Part 2: Unfortunate cultural stereotypes

  1. Emilia says:

    I am not an expert, but I have come to “observe” empirically that calories are a myth. Human beings are much more complex than heating radiators. “Mens sana in corpore sano” used to say the latins ( a wealthy mind in a wealthy body), they knew the relation between the two ( as the Ayurveda did ).

  2. Emilia says:

    Of course it is a “healthy mind in a healthy body”.

    • I really like this sentiment: “a healthy mind in a healthy body,” but there is something really catchy about “a wealthy mind in a wealthy body” too ;-)

      I didn’t get into much detail in my article, but there are some really mysterious things discovered by careful research. For instance, a number of studies have found that when you put certain massively overweight people in a tightly controlled environment for weeks at a time and carefully measure their changes in body composition in relationship to their energy expenditure (carefully measured) and their nutrient intakes (also very carefully measured), you do not get the calculations to add up for certain subjects. Sometimes caloric restriction far below their me4asured metabolic expenditures, for prolonged time periods, does not result in body composition changes predicted by conservation of energy expectations. Not even close. This is only one example of the enormous complexity of what happens to real human bodies when people try to lose weight.

      Thanks, Emilia, for your helpful comments,

      Chuck

  3. Dr. Chuck, while what you and Emilia say here is also true, my unbiased observation is that overweight people (and I’m one) eat too much. Yes, there may be skinny people who can eat all they want and be skinny. Most of the skinny people I know don’t eat all that much, and they watch what they eat.

    • Gloria, I think your observation is very compatible with what I am saying in this article. I think the difference is that I am referring to people who are very overweight, and have significant medical problems as a consequence, and who are highly motivated to lose weight. For many folks in this circumstance, it is a much more complex problem than just pushing away from the table more quickly. I will be getting into this explanation in more detail as this series goes on.

      For people who are slightly to moderately overweight. The problem is often that their food choices are poor and their lifestyle is such that their hunger is out of control. They struggle to fight this but often end up moderately overweight in response to overeating. Just pushing away from the table also doesn’t work well for them, because they stay constantly hungry as a consequence. Not a very pleasant way to live. The overeating is driven by excessive appetite and excessive food cravings and the ready availability of the foods they love. These different situations are at opposite ends of the same spectrum. There are effective strategies to help with both of these kinds of problems, but the massively overweight person is the one who creates the stereotypic social prejudice and also often has the much more difficult problem (frequently due to derangements in their regulatory systems more fundamental than just their lifestyle and poor diet).

      Thanks for your observation, Gloria, and for providing the opportunity for me to clarify this important distinction.

      Chuck

  4. Jochen says:

    It seems to me that however much we may comment on known and agreed-upon medical, social and psychological factors, there will be no escaping the fact that what we are talking about is voodoo and nothing else – the way getting sick from smoking or sleepless from coffee and every other seeming causality are 100% voodoo. Sure, it would be cruel to spring that news on someone struggling with severe weight problems or any problem at all since we are all deeply conditioned to believe in them as something real. But wouldn’t it be wonderful to be able to lovingly assist each other in slowly slowly re-believing our lives?

    • Jochen, if I understand what you are saying, you are using the word “voodoo” to mean the power of our minds to influence our experience. I would certainly agree that our mind is very powerful and that it can potentially over-ride anything we see as physical factors. The problem is, from my way of thinking, that many of us are not able to effectively mobilize this power. Until we can, we must do our best to use what we have: our physical factors. Perhaps we disagree with this assessment, but that is fine from my point of view.

      Lovingly assisting each other, to me is what life is all about. Part of the ultimate goal I hold for this blog site is to be a means that we can use to help each other re-believe in our selves.

      • Jochen says:

        Chuck, using “our physical factors” is not something we disagree on. In fact, I have expressly argued for it earlier.

        My use of the word “voodoo” does not imply power. It doesn’t really say anything. I just like to use it for its spectacular sound and slightly chilling nature. What I am saying, following Heavenletters, is that expectation or belief IS perception: I see as I believe, it is pure projection, and there is nothing there really, no cars, no warts, no broken bones or hale ones. There are no powers at work, nothing is changed “according to” belief or whatever, there are quite literally no causes and no effects. Everything is instant. What I see now when I look around is what I believe has to be there. There is nothing, nowhere, nothing at all. My seeing does not create anything, it’s just a seeing with nothing “really” being there. Oneness imagines, it even imagines Jochen seeing a world from a certain perspective, seeing it as bright or as gloomy, seeing health, disease, youth, old age, poverty, affluence, male, female … when there is only Oneness and something that is called love but is really, at least on your way back to where you cam from, a huge and helpless joyful amazement at the rediscovery of the fact that all of it all of it all of it is you.

        I think we have already covered the “medical” application of this.

  5. Emilia says:

    All healing practices, from surgery to meditation, are based on our beliefs and work in the measure we give credit to them. They are equivalent per se, trust makes the difference. Some believe in “physical factors” and Chuck give them what they want, some other believe in “mental factors” and there are psychologists or psychiatrists for them, others believe in “spiritual factors” and they have gurus. I do believe in Swiss Chocolate and guess what? I do not gain weight and feel wonderful. I am waiting to mature a bit and come to believe in nothing, which is the ultimate freedom.

  6. Jochen says:

    Someone commented on an older Heavenletter today (#2317 of March 2007), and when I read it, there was that sense again of hearing the last word on health or any problem at all:

    “What the facts are is irrelevant. Facts are to ignore because they are only there to surmount and not to be lodged in. Facts are insignificant. That’s a fact.”

    Personally I feel there is something that’s coming closer, dangerously close. I feel like my hands will finally sink one of these days. More and more often I feel like saying, “Okay, You take the wheel. Have it all. Make all the decisions big and small.”

    Some more from Heavenletter #2317:

    “Perhaps you don’t have to kick [obstacles] or shove them out of your way. Perhaps you leap over them. Perhaps you find they are nothing at all, just a mote in your eye. Perhaps they are not made of stone. Perhaps they are made of thought. Change the constituents of your thoughts. Change the configuration. Leap, beloveds, leap.”

    http://www.heavenletters.org/the-secret.html
     
    I’m not overweight, but at 65 and smoking I may be hypertonic or something, depending on my conditioning and ingrained beliefs. Since I haven’t seen a doctor in decades, I don’t know. I may die tomorrow, stroke or whatever. But what an adventure to try leaving facts and obstacles behind and allow yourself to sink into the immediacy of oneness dead or alive. What an exiting thing to know that as soon as you remember, truly remember, the oneness that you and brother God are, there will be no obstacle whatsoever left in your life. And if you die of cancer or diabetes or old age before you remember, does that mean you failed?

    Mind you, life and death, health and sickness are big issues! But in the end, at least for me, all those regimens and repairs look so strangely unsuitable for a child of God. More and more, I feel silly when I catch myself struggling for anything a child of God is meant to simply take from God’s table.

    • Jochen, my friend, as I read your words it makes my think along certain lines of thought that are very interesting. One line goes like this. With all the effort we expend trying to do things like control our weight and protect our health, what are we really trying to accomplish? What difference does it make how we look, how long we live and how comfortable we are in that process? Can anyone answer these questions, besides each one of us individually for ourselves?

      I think raising such questions does us a service. These are useful questions to consider and can result in profound changes, (at least this is how I see it). But we are all in different spots in our lives as far as what is important to us and what we find to be worthwhile goals. My inclination is to accept everyone’s goals in their lives as legitimate and do what I can to assist. As I think is demonstrated by the eclectic nature of the material on this blog, I think the frame of reference everyone is in their individual moment should be honored. If someone’s main goal in life is to be a model of the best health possible, let’s go for it! If someone else thinks that finding a nice comfortable cave to focus on prayer and meditation is just the ticket, then I also say go for it!

      I think we may differ in judgment when you find being concerned about “life and death, health and sickness” to be “strangely unsuitable for a child of God.” I take this to mean this is where you are at at this moment. I am not there myself, but this is all fine. There is room for all, and all ways of living, in this wide world.

      Chuck

  7. Jochen says:

    There is only one answer possible to what you say, Chuck: Yes.

    Mentioning a sense of “unsuitable” is not meant to be a general suggestion. It fells like something that has been lingering somewhere in my heart and mind all along and is now brought into stark outline by Heavenletters. I recognize it as being what I came here for this time. Apart from that, in what looks like my daily life, my conditioned belief in the physical and everything that apparently needs to be done to keep it going is probably as strong as anyone else’s.

    On the other hand, Heavenletters’ call to remember Oneness is clearly for all of us. I don’t think they are advising to first drop everything else and then reach for Oneness. They suggest reaching for Oneness under all circumstances. And they say that taking circumstances less seriously helps.

  8. Jochen says:

    There is the same effect today I experienced recently when reading the day’s Heavenletter after posting here. I seem to start forgetting to read the new HL first thing in the morning, can you imagine?! Anyway, when I read it now, there was an immediate sense of “Good riddance, what are we talking about?” This is the Heavenletter I’ve been dreaming of and longing for, waiting for. I understand very well when God says I have written it. It’s true. But I write it while I read it, I wouldn’t know how to do it before that moment. Well, following Heavenletters, there may not be a before. My private title for this Heavenletter will be “From Now On”.

    But what are the implications of today’s Heavenletter #3931 for health and healing and all the things that seem to make up our life in the world? I have no idea any more!

    One quote: “You make boundaries which are judgments and do not even grasp the magnitude of the game you are playing that is called Life on Earth.”

    Yes, we do that and even try to find all kinds of noble names for it since boundaries are painful even to the one who draws them. But since we love being where less of it is done, this is one of the things that “will right themselves” (another quote). Until then, thanks, Chuck, for providing a space where one can speak and breathe freely.

  9. Emilia says:

    I have read somewhere that breathing is very healthy ( I try to stop it now and then since I do not like routine, but, invariably, after two minutes I star feeling very bad), while breathing freely is considered to be quite dangerous by the Welfare.

    • Jochen, I sense a dichotomy between what you experience in your daily life and what you experience as Heavenletter’s “call to Oneness.” I get this distinct impression as I read the words in your comments. I like the sound of “reaching for Oneness under all circumstances.” This very much fits what I see as how the world actually is and what its purpose is. In my view of the world, everything is intimately connected to everything else. I see everything that exists or that happens as purposeful and under the guidance of a supreme intelligence that created it all and is responsible for the inter-connection.

      I do not come to this view wily-nily. This view grows out of what I see as the cutting edge of a rapidly growing and diverse body of scientific work. (Readers who do not know what I am referring to here may want to read a little about a book I am writing that explains what I am finding from this research. http://chuckgebhardtmd.com/2011/07/19/whats-it-all-about-alfie/) On the one hand I feel literally forced into this view from this research. On the other hand, this view is a very peasant and life-affirming and congenial one.

      What are the implications of Heavenletter #3931 for health and healing? (here is the link to this letter: http://www.heavenletters.org/for-one-moment-of-eternity.html ) I feel about what this Heavenletter is saying the same way I feel about what Jesus says in the New Testament, something to the effect: “Everything I do, you can do also and more.” I believe he is telling us profound truth, but I’ll be darned if I know how to heal a blind man’s vision with a little mud, though I think we will all be able to someday.

      Yes, as this letter says, I believe we do not grasp the magnitude of the game we are all playing on earth. My heart tells me there is much, much more for me to learn to see more clearly. I feel I know this just as firmly as I know I have two arms and two legs. I think the remembering and the re-learning are exciting. Not only is the remembering a great thrill in itself, the power that the remembering opens up for us is an even greater joy.

      I am happy, Jochen, that you appreciate the availability of this space for your use. It is my great pleasure to help provide it for you and for anyone else who wants to use it. I think one of the things we need much more of is the completely unrestricted ability to say whatever is in our heart waiting to be said.

      Emilia, you can breathe freely here. You and I well know we need not care in the least what anyone else thinks about it, either.

      Chuck

  10. Jochen says:

    Quite a few things, none of them important, come to mind that I might want to write about in reply, Chuck. But since vacation preparations want my attention and since todays wonderful Heavenletter seems to imply it would be soliloquy anyway, I will simply congratulate you on one of the most heart-warming sentences (outside of Heavenletters) I have heard in a long time: “I think one of the things we need much more of is the completely unrestricted ability to say whatever is in our heart waiting to be said.”

  11. Pingback: The State of the Bog | Dr. Chuck's Chat

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s