New guidelines redefine 'obesity' to curb fat shaming
Is focusing solely on body mass index the best way for doctor to frame obesity?
- New guidelines published in the Canadian Medical Association Journal argue that obesity should be defined as a condition that involves high body mass index along with a corresponding physical or mental health condition.
- The guidelines note that classifying obesity by body mass index alone may lead to fat shaming or non-optimal treatments.
- The guidelines offer five steps for reframing the way doctors treat obesity.
Doctors determine obesity by dividing a patient's weight by their height, producing a measure called body mass index, or BMI. Patients with a BMI of 30 or higher are considered obese.
But is this the best way to frame obesity?
In new guidelines published in the Canadian Medical Association Journal, a group of doctors argue that, while knowing a patient's body mass index is useful, healthcare professionals should take a more holistic approach to treating obesity — one that doesn't overfocus on weight-loss through exercise and diet.
The authors say this new model could improve treatments and reduce weight stigma. After all, the old model typically frames obesity as a "self-inflicted condition" caused by a lack of personal responsibility, which may affect "the type of interventions and approaches that are implemented by governments or covered by health benefit plans."
"For the longest time, we blamed our patients, we blamed people living with obesity for the lack of willpower in terms of overeating, in terms of not being physically active," co-author Dr. David C.W. Lau of the University of Calgary's Julia MacFarlane Diabetes Research Centre, said in a podcast. "We now know this is a totally misperceived perception."
The new guidelines define obesity as "a prevalent, complex, progressive, and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity) that impairs health." Under this definition, someone would only be considered obese if they have a high body-mass index and a corresponding physical or mental health condition.
#Obesity management should focus on outcomes that patients consider to be important, not #weightloss alone, and inc… https://t.co/Qy3c9cisl0— CMAJ (@CMAJ)1596566367.0
The guidelines aren't arguing that weight isn't relevant to health. After all, there's no shortage of research showing that having a high body mass and excess body fat boosts your risks of developing many conditions, such as heart disease, diabetes, stroke, depression, respiratory problems and even certain cancers.
But one key complication is that obesity is caused by many factors. For example, the guidelines note that the condition is influenced by genetics, epigenetics, neurohormonal mechanisms, associated chronic diseases and obesogenic medications, sociocultural practices and beliefs, social determinants of health, built environment, individual life experiences like adverse childhood experiences, and a host of psychological factors.
As such, a straightforward "eat-less, move more" strategy might not work equally for everyone. The guidelines note that "obesity management should be about improved health and well-being, and not just weight loss."
A new 5-step system for treating obesity
To help primary care practitioners better treat obesity, the doctors outlined five steps:
- Recognition of obesity as a chronic disease by health care providers, who should ask the patient permission to offer advice and help treat this disease in an unbiased manner.
- Assessment of an individual living with obesity, using appropriate measurements, and identifying the root causes, complications and barriers to obesity treatment.
- Discussion of the core treatment options (medical nutrition therapy and physical activity) and adjunctive therapies that may be required, including psychological, pharmacologic and surgical interventions.
- Agreement with the person living with obesity regarding goals of therapy, focusing mainly on the value that the person derives from health-based interventions.
- Engagement by health care providers with the person with obesity in continued follow-up and reassessments, and encouragement of advocacy to improve care for this chronic disease.
Insider noted that some health professionals and body-positive advocates don't think the guidelines go far enough in reframing obesity treatment. The update still points "to individual bodies as the problem, not culture," registered dietitian Rebecca Scritchfield, told Insider.
But it's also possible to see how some health professionals may worry this new model could discourage patients from taking the initiative to tackle weight-loss on their own, through exercise and dieting.
In a 2020 opinion piece published in Frontiers in Nutrition, Dr. Elliot M. Berry argued that misplaced "medical and political correctness" may lead to the abrogation of the physician's responsibility to properly care for patients.
"For example, some doctors are now even reluctant to raise the issue of obesity lest they be accused of fat shaming by not accepting their patients' proportions (despite the quote at the head of this opinion piece), and thereby receive poor approval ratings in an atmosphere where popularity is equated with good healthcare."
Berry offers a list of nine steps that he thinks could help the healthcare industry better treat obesity, without shaming patients or falling prey to political correctness.
Berry concludes his piece:
"Parental and individual responsibility, choice and self-management clearly have a place near the center of the stage in the obesity tragedy. Otherwise, it is like going to see the play Hamlet and the Prince fails to make an appearance."
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Whether or not women think beards are sexy has to do with "moral disgust"
- A new study found that women perceive men with facial hair to be more attractive as well as physically and socially dominant.
- Women tend to associate more masculine faces with physical strength, social assertiveness, and formidability.
- Women who display higher levels of "moral disgust," or feelings of repugnance toward taboo behaviors, are more likely to prefer hairy faces.
Beards and perceptions of masculinity<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjU5OTg0MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NzkxMjM3N30.cH-GqNwP5GVqvstgJWAhBPn1B_lYpVEAI0I7iax7EQw/img.jpg?width=1245&coordinates=0%2C1900%2C0%2C849&height=700" id="caae6" class="rm-shortcode" data-rm-shortcode-id="cb0a355a4e8e1899789bc45f3f7aef56" data-rm-shortcode-name="rebelmouse-image" />
Photo Credit: Wikimedia<p>The study used 919 American (mostly white) women ages 18-70 who rated 30 pictures of men they were shown with various stages of facial hair growth. The photographs depicted men with faces that had been digitally altered to look more feminine or more masculine, with a beard and without a beard. The women rated the men according to perceived attractiveness for long-term and short-term relationships. The study found that the more facial hair the men had, the higher the men were rated on their attractiveness, particularly for their suitability for a long-term relationship.</p><p>Part of this might be attributed to facial masculinity — i.e. protruding brow ridge, wide cheekbones, thick jawline, and deeply set narrow eyes — which conveys information to a woman about a man's underlying health and formidability. Women tend to associate more masculine faces with physical strength and social assertiveness. It can also indicate a man with a superior immune response. The researchers suggested that their findings favoring bearded men could be due to the fact that facial hair enhances the masculine facial features on a man's face, like creating the illusion of a thicker jaw line. This could communicate direct benefits to women like resources and protection that would enhance survival among mothers and their infants. In other words, while a beard doesn't mean superior genetics in and of itself, it might be a primitive, ornamental way of saying, "Hey girl, I'm a testosterone-fueled lean, mean, pathogen fighting machine." <br></p><p>It could also be that a beard becomes its own destiny. The researchers in this study cite prior research that found that by growing a beard, men felt more masculine and had higher levels of serum testosterone, which was linked to a higher level of social dominance. They also tended to subscribe to more old-school beliefs about gender roles in their relationships with women as compared to men with clean-shaven faces.<span></span><br></p>
What does disgust have to do with beard preference?<p>Obviously, not all women dig beards. The researchers were particularly interested in what traits make a women prefer bearded men over clean-shaven faces. They looked into several factors including a woman's disgust levels on various concepts, her desire to become pregnant, and her exposure to facial hair in her personal life. </p><p>According to the study, women who were not into facial hair were turned-off by potential parasites or other critters they imagined could be in the hair or skin. Women ranking high on this "ectoparasite disgust" scale might have viewed beards as a sign of poor grooming habits. However, women who ranked higher in levels of "pathogen" did find the bearded men to be desirable, possibly because they perceived beards as a signal of good health and immune function. An intriguing discovery in the study was links to morality. Women who displayed higher levels of "moral disgust," or feelings of repugnance toward taboo behaviors, were more likely to prefer hairy faces. The authors opined that this could reflect a link between beardedness, politically conservative outlooks, and traditional views regarding performances of masculinity in heterosexual relationships.</p>
Additional findings<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjU5OTg1My9vcmlnaW4uZ2lmIiwiZXhwaXJlc19hdCI6MTYyNDI1NjUyOX0.P9B8WbmJR0q4nfzYZKbuNSA-2SAigVWJgrQE-_Gxlds/img.gif?width=980" id="49143" class="rm-shortcode" data-rm-shortcode-id="2ed3b1d6f20fc170bf2974646e565e8d" data-rm-shortcode-name="rebelmouse-image" />Giphy<p>The correlations that existed between married and single women's rating on the attractiveness of beards were not particularly clear, although the researchers noted that single and married women who wanted children tended to find beards more attractive than the women who didn't want children. They also found that women with bearded husbands found beards to be more attractive, which might indicate that social exposure to beards influences how desirable they are perceived of as being. Or it could be that men with wives who like beards grow beards.</p><p>It's important to note that culture plays a huge role in how attractive women perceive certain male characteristics as being. This study looked at a small, culturally specific group of American women, so no big, universal claims should be made about masculinity, facial hair, and male desirability to women. However, research like this is important in highlighting how human grooming decisions are driven by much more than fashion trends. Sociobiological, economic, and ecological factors all play a part in the way we choose to present ourselves.</p>
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