Nov. 18, 2016 "Do I look fat in this?": Today I found this article by Sharon Kirkey in the Edmonton Journal.
This is a good article about mental health mainly amongst women who talk about how fat they are even though they aren't. We should all stop talking about how fat and bad we feel about our bodies:
It’s something most women are guilty of. “I feel fat,” one will declare after a meal, no matter its size, to which her friend might reply, “God, if you think you’re fat, what about me?”
Fat talk, the everyday negative and body-disparaging comments and conversations between women about eating, weight and body shape (“I hate my thighs”, “She’s so thin!”) is fuelled by women who put more importance on physical appearance and attractiveness and who feel pressure to achieve the “perfect” body, suggests a new study exploring why women do it.
The findings shouldn’t be seen as any kind of judgment reaction, they and other researchers stress. It’s difficult, as a woman in this culture, to not be worried about how you look.
But fat talk has an extra element of perniciousness, because it feeds into the culture that creates it.
“Women who overhear others engage in fat talk are more likely to fat talk themselves and to experience heightened body dissatisfaction and guilt,” University of Ottawa researchers write in the most recent issue of the journal Body Image.
Fat talk occurs among women of all ages and all body types and women often engage in it to receive “validation or re-affirmation that their bodies are appealing,” they said.
“It’s done with the purpose of fishing, or trying to understand what people think of you, or perceive of you,” said co-author Luc Pelletier, a professor and social psychologist at the University of Ottawa.
In fact, “conversational shaming of the body” has become so pervasive, it’s “practically a ritual of womanhood (though men also engage in it),” Northwestern University psychologist Renee Engeln wrote last year in the New York Times.
That occurred after Facebook ditched its pillow-cheeked “feeling fat” emoticon when thousands signed an online petition posted by Endangeredbodies.org, an initiative that exists to “challenge all those merchants of body hatred who turn girls and women against their own bodies.”
Many women who engage in fat talk have internalized an “ideal” (usually ultra-thin) body image perpetuated by the media, Pelletier said. “Some women become vulnerable to the images that are portrayed, while others are able to resist them,” he said.
For their study, the Ottawa researchers applied the “self-determination theory,” a basic theory of human motivation. The theory holds that people are motivated by either intrinsic (personal growth) or extrinsic (popularity, physical attractiveness, social status) goals.
Intrinsic goals are associated with better health and wellbeing, while extrinsic goals have been tied to lower self-esteem, higher depression, anxiety and stringent exercising and dieting.
Their sample included 453 female undergrads aged 17 to 50 who completed an online questionnaire. According to their BMI, or body mass index, 69 per cent were in the normal range, while 20 per cent were overweight or obese (11 per cent were underweight).
Most said they sometimes engaged in fat talk, but women who were more motivated by extrinsic goals — to “be beautiful” or “be admired by many people” — were more likely to do it.
“Looking thin and looking good respond to those goals, compared to others’ goals of being healthy,” Pelletier said.
The fat talkers were also more “non-self-determined,” which Pelletier described as women “who don’t regulate their behaviours themselves, who feel pressured or coerced to do something” in order to please others.
They were also more likely to engage in unhealthy eating — focusing on calories to lose weight and be thin.
Self-determined women who are more likely to reject sociocultural pressures to pursue an idealist body image were less likely to engage in negative body talk, they found.
“Some women prefer conversing with other women who speak more positively about their bodies, compared to women who tend to self-degrade about their bodies,” they write.
Despite the link between fat talk and body dissatisfaction, other studies have found that fat talk, in a rather twisted way, can make women feel better.
In a study reported by Engeln and her colleagues in 2011, “The most common response to fat talk was denial that the friend was fat, most typically leading to a back-and-forth conversation where each of two healthy weight peers denies the other is fat while claiming to be fat themselves.”
In an interview, Engeln said the Ottawa study is consistent with what was known about the “objectification” of women, “which tells us the more we worry about how we look, the more we can have all sorts of negative outcomes.”
“Like it or not, we still live in a culture where women are taught that how they look matters more than anything else about them,” she said. “Which, in this culture, means being thin”
Talking about it with other people would normally be seen as a good coping strategy, she said. But fat talk is different.
“We have evidence fat talk makes it worse, not just for you but for people who hear you doing it. Because the more you hear it, the more you think about your body.”
Mar. 3, 2017 "Should obese teenagers get bariatric surgery?": Today I found this article by Gina Kolata in the Globe and Mail:
If all goes well, Aliayha Carrasco-Garcia will have an operation next month that will change her life. She will shed many of the 240 pounds that now burden her 5-foot-2 frame. Like many who have bariatric surgery, she has tried diets and exercise to no avail. Surgery is her last best hope.
But there is a difference between Aliayha and almost everyone else who has had this operation: She is only 15.
While the number of adolescents who are overweight or obese has leveled off in recent years, the number who are severely obese — heavy enough to qualify for bariatric surgery — has nearly doubled from 1999 to 2014, according to national data, going from 5.2 to 10.2 percent of all adolescents aged 12 to 19.
As a result, more and more doctors and parents are facing a difficult question:
Should very heavy teenagers have bariatric surgery, a radical operation that is the only treatment proved to produce lasting weight loss in severely obese people?
The very idea fills many parents and doctors with trepidation, and with good reason, said Aaron Kelly, a physiologist and specialist in pediatric obesity at the University of Minnesota.
“We’re at a point in this field where surgery is the only thing that works for these kids but we don’t know the long term outcomes.”
The best data are from two recently published small studies that so far have outcomes for just five years. Scientists say there’s an urgent need for more ambitious research.
The question for teens and their parents is:
Which is worse — accepting uncertainty about the long term health risks from surgery or the likelihood of serious health risks from remaining obese?
An estimated three to four million adolescents are heavy enough to meet the criteria for bariatric surgery, Dr. Kelly said. But only about 1,000 teenagers a year have the operation.
Many medical centers will not perform it on teenagers and many pediatricians never mention it to their heavy patients.
“It obviously is a controversial area,” said Dr. Marc P. Michalsky, the surgical director at the Center for Healthy Weight & Nutrition at Nationwide Children’s Hospital in Columbus, Ohio..
Yet insurers routinely turn down teenagers on the first request, doctors say, leaving surgeons to appeal, sometimes multiple times, before they can operate on an adolescent. Dr. Kirk W. Reichard, the clinical director of pediatric surgery at the Nemours Alfred I. duPont Hospital for Children where Aliayha is planning to undergo her operation, said Delaware’s Medicaid program had denied coverage for all patients under the age of 18 with one exception.
“We still struggle with acceptance in the adult population,” said Dr. John M. Morton, the chief of bariatric and minimally invasive surgery at Stanford. “Acceptance in the pediatric community is even worse.”
Some researchers worry that five years may not be long enough to understand the effect of the surgery on people who undergo it as an adolescent.
The operations alter brain signals that control weight and appetite and change hundreds of nerve and hormonal signals to the brain. What, researchers ask, are the consequences for still-developing brains and bones and bodies? Could low levels of vitamin D cause osteoporosis?
The procedure for teenagers is the same as for adults — either a sleeve gastrectomy, in which much of the stomach is cut away to form a small pouch, or a gastric bypass in which the stomach is made smaller and part of the small intestine is rerouted.
The operations are just as safe in teenagers as in adults, surgeons say: Mortality rates are around 0.1 percent, which makes them safer than gallbladder surgery or joint replacement.
Both operations require patients to follow detailed medical instructions, including taking supplements for the rest of their lives after surgery. Adolescents, though, are not always the most compliant patients.
Dr. Inge said that when he first started offering the surgery in 2004, several of his patients developed beriberi, a serious condition that can affect the heart and nervous system. It is caused by a lack of thiamine.
Of course the best option would be to prevent kids from becoming obese in the first place, but that is not so easy. There seems to be a strong genetic component that is not easily overridden.
Most of the teenagers who have the surgery have a parent who also is extremely obese, said Margaret H. Zeller, a professor of pediatrics and psychologist at Cincinnati Children’s Hospital whose research focuses on adolescents with severe obesity. Dr. Morton has operated on patients from three generations in some families.
But despite their qualms about possible medical problems with bones or other body systems in the future, many researchers and surgeons say those concerns are dwarfed by the consequences of being an obese teenager.
“I am less concerned about osteoporosis than that their lives will be completely destroyed if they don’t get some serious weight off,” said Dr. Lee M. Kaplan, the director of the weight center at Massachusetts General Hospital. By completely destroyed, he adds, he means “medically, socially and economically.”
In almost every aspect, life for very obese teenagers is “significantly impaired,” Dr. Zeller said.
These difficulties, Dr. Zeller noted, are piled onto the normal angst of adolescence.
“It’s not just that people make them feel uncomfortable,” she said. The physical effort of carrying the weight around can make simple tasks arduous, like walking from one area of a high school to another or sitting at desks too small for them. Many have sleep apnea, making it difficult to stay awake in class. And, she said, “inside, they are feeling ashamed.”
Although not every obese teenager feels isolated and friendless, many, including Aliayha, do. She asked to be home-schooled, but her mother, Cristina Carrasco, refused.
Aliayha was not alone in wanting to leave school. Overwhelmed by their struggles, as many as 10 percent of obese students in grades eight to 12 leave the classroom and are home-schooled or take online classes instead, Dr. Zeller and her colleagues have found. That is nearly three times the rate of home schooling in the general population in those grades, according to the Department of Education.
But some teenagers expect too much from the surgery. They are told they will lose a significant amount of weight, feel better and be healthier but that they are unlikely to reach a normal weight. They are told the surgery will not solve all their problems. Some, though, hold out unrealistic expectations.
“They see shows about bariatric surgery or YouTube. They have this idea about the before and afters,” Dr. Zeller said. But, she added, “the average person having bariatric surgery isn’t doing a YouTube video.”
Dr. Morton worries about what he calls social re-entry. “When they lose the weight, they are not always prepared,” he said.
Tiffany Hunter can attest to that. She had the surgery when she was 15 and weighed 350 pounds. Now, 27 and 5-foot-11, she weighs 190.
She added, “You think everyone will immediately like you because of how you look on the outside.”
Dr. Daniels went from being shocked to hear at a meeting in 2003 that doctors were considering bariatric surgery for adolescents to wondering if a bar of a B.M.I. of 40 or 50 is too high.
There was no real science behind those guidelines, he noted. He also worries about children who get fatter and fatter throughout childhood, reaching a level of obesity by adolescence that, even with surgery, will still leave them obese as they head into adulthood.
“We can only expect so much out of these operations,” Dr. Michalsky said. The longer the teenagers wait for the surgery and the fatter they get, the less likely they are to reach a normal weight.
But how young is too young? Should it be done on children?
Dr. Morton said the only place he knows where surgeons have done bariatric surgery on children is Saudi Arabia. He and others think it is best to wait until puberty to avoid interfering with physical, mental and emotional development.
“We get asked very often what is the lower age limit, but we really don’t know,” Dr. Michalsky said.
No comments:
Post a Comment