The accepted wisdom is that there is no such thing as healthy obesity. Don’t believe it for a minute says dietician Jacqui Gingras.
“I came to ask questions about what we were telling people about weight when I was an intern. I would hear people say that they had tried all the advice we gave them and it didn’t work and left them feeling shameful, bad and guilty. That took me down a different path where I learned that people can be healthy at a wide range of weights,” she said.
“Society has made a moral issue of fatness for people of all sizes. Larger people have the weight stigma while thin ones fear gaining weight. This affects people of all ages, women and men, men more often as weight loss becomes more of an industry.”
Gingras is an associate professor at the School of Nutrition at Ryerson University, Harrison McCain Visiting Scholar at Acadia University, an educator of dieticians and speaks on health and weight issues in Canada, the U.K., the U.S. and Australia. She lives with her family in Falkland.
“When I started asking questions about weight and health in 1996, I found a lot of good research that conflicted with what I had been taught but that is largely ignored. It’s great to have the evidence. Now we have to change our message about health and body weight.”
Gingras talked to her peers first but found many health professionals resistant to look at health and weight in a new way.
“I see this as a social justice issue, an issue of health equity. No one should face any barriers to having the information they need to make health choices. The social weight stigma can stop people from expressing their needs and even lead to avoiding health care professionals and not getting health care. This inequality affects us all,” she said.
“I don’t believe there is an ‘obesity epidemic’ but there is a huge amount of morality that makes it hard to accept that people can be fat and healthy, and people of all shapes and sizes can be unhealthy.”
She calls the weight stigma part of healthism, the idea that there is only one perfect way for all people to be and that people need only make the right choices. If people do not meet the ideal, they are made to feel blame and shame. The effects of weight stigma can start in childhood where large children may be seen as less capable or not given opportunities. This can lead to fewer education and employment options.
“There is an intersection between health and social issues that includes education, income, social support, gender, access to health care and other factors. People can feel guilty and soothe themselves with food, alcohol, drugs, other things. We have to look at the root causes of poor health, why people need to soothe themselves.”
Gingras said Canada is ahead of many countries in that it has had a Charter of Health since 1987 but that the country is not doing what it should about issues like child poverty and access to safe housing and healthy food that are health determinants.
“There is an issue with the commodification of health and using weight as the ultimate measure of health,” she said.
She suggests three ways that people can be aware of their health and make good individual health choices.
The first is How We Eat.
“This is thinking about our relationship with food, how it is used to nourish or to soothe and how to know when to start eating and when to stop eating. The hunger meter can be imagined as a ruler from zero to 10, with zero as empty and lethargic and 10 as stuffed, uncomfortable and lethargic. The middle is five, satisfied.”
Some people like to never feel hungry, while others like to feel a little hungry. Others binge, then feel guilty and starve, never attuned to their own inner signals
“Food relationships can become distorted but we can learn to recognize our body’s signals,” said Gingras.
The second aspect of health is Physical Movement.
“We need to look at ways we can reclaim movement for the sake of pleasure, from jogging, swimming, walking to yoga. There are so many ways to move to get the right exercise. It is part of health equity that people with limited mobility have the opportunity to get the exercise they need. If mobility is limited because of weight, people need the support where they are,” she said.
“If people are told to lose weight for their health regardless of symptoms, they should say, ‘I want the same advice you would give to a thin person with this problem.” That is health equity.”
The third health consideration is Acceptance.
“That is the most difficult and challenging concept. It means that instead of giving up, show up. Say, ‘Today this is where I am, this is what I’m working with.’ Then people will be less likely to berate themselves, restrict eating, over-exercise to injury, stigmatize themselves or others. They will be more likely to act from a place of self compassion instead of self loathing and make choices that are more likely to be maintained and lead to healing and health.
“We have to make these choices and behaviours that are health-affirming every day. I’m not saying acceptance is easy but we are capable of creating conditions to be healthier. This shift of perspective is something that we can do. There is so much research to back up this new direction. Challenge those old messages.”
Gingras will give her presentation Ample Reason on health and obesity Jan. 8 at 6 p.m. at the Vernon library. Tickets are $10 at the door. For more information see criticaldieteticsblog@wordpress.com.
