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Wednesday, November 28, 2012

NHBPM #28: These Times Are A-Changin'

11:11 AM Posted by Tiffany Taft , , ,
I came across this story today about a department store using an obese mannequin and the subsequent discussion that took place online about this move.  Other than the mannequin having a freakishly small head, I had mixed reactions to this news.

One person cited said that she was happy to see this because the way clothing fits a smaller mannequin didn't accurately reflect how it would fit a plus-sized person.  I can understand that as being a positive.

Others decried our society's movement toward greater acceptance of obesity as a new norm, as being overweight is associated with poor health and skyrocketing healthcare costs.  I can understand this point of view as well.

Another stated that stigma toward obesity isn't the same as stigma toward race, gender, or sexual orientation.  Presumably because of the commonly-held  belief that being overweight is controllable and a result of poor choices.

Having worked with many obese people, I know it's a much more complex issue than simply blaming the person.  However, I do agree that there is a significant degree of personal responsibility in the development and maintenance of obesity.  My belief doesn't serve to blame a person for being overweight.  Rather I strongly believe that by accepting personal responsibility we empower ourselves to change.  We can blame the fast-food industry, our parents, the government, and the recurring cycle of fad-diets.  But at the end of the day, where does that leave the person struggling with their weight?

Resistance is Futile
We must acknowledge the role that mental health plays in the obesity epidemic.  Over-eating and under-exercising are behaviors, and our behaviors are influenced by our thoughts and our feelings.  Emotional eating is a huge part of this epidemic, and has been paralleled to addictions research on drugs and alcohol.  Unfortunately you cannot apply the AA abstinence model to food.

There's also a large educational component needed.  When I worked with veterans enrolled in the VA's weight management program I was astounded by how many lacked basic understanding of reading food labels and portion sizes, and how many under-estimate their caloric intake and over-estimate their caloric burn from exercise.

Actual conversation:

Me (Describing the calories in a high-fat meal on a veteran's food diary):  It looks like you took in about 1,200 calories at lunch on Monday.

Veteran:  Really?  That much?  But I exercised to burn some of it off.  I went for nice walk around the neighborhood.

Me:  That's great!  How far did you walk?

Veteran:  I went around the block twice.

Me:  Good.  How many calories do you think you burned with that?

Veteran:  Had to be at least 500 calories.  I was really huffin and puffin.

Me:  Well, we know that if you walk a mile someone your weight burns around 100 calories.  


For some, education was enough.  I'll never forget the veteran who drank a gallon of whole milk a day before he joined the program.  Think about that.  First off, he must have had a digestive system made of steel.  Second, a gallon of whole milk is about 2300 calories.  Times 7 is 16,000 calories.  He cut this from his diet and proceeded to lose 15 lbs in the 8 weeks I worked with him.

But for many, other factors hindered their ability to make lasting behavior changes including depression and socioeconomic factors.  I wish it were as simple as the milk guy, but it isn't.

So, should we embrace obese mannequins?  Or is this evidence of complacency and acceptance of a complex and expensive condition?