In which case, definitions of "normal" may evolve.

My wife serves a lower income population. She often has to dance delicately around words. She sees a large number of "morbidly obese" patients who want X, Y, or Z (like to get pregnant, but they're not cycling). When she tells them they are "overweight" they often resist even that non-precise term, thinking that their body mass index of 54 is just right.

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tells them they are "overweight" they often resist even that non-precise term

Yeah, this is hard... I get the body-positive stuff and the call for being accepting of different body types. I have a very overweight friend who talks about fat discrimination. And I have no doubt that that is a very real thing, and it should be addressed.

But, she's very, very overweight, and everything we know from medical science says that this is bad for her health. But I can't imagine any doctor would be able to talk with her about it in a way she could accept.

Doctors can tell people to stop smoking, so it seems like there ought to be a way for them to talk about losing weight in the context of health without it triggering these other concerns... I know, it's so much more complicated though. Because, you can't just tell someone "stop being fat."

Doctors do have a variety of ways (or weighs!) to introduce weight control, and sensible physicians don't say, "you're too fat and you should eat lots of broccoli and stay out of McDonalds." But it's really hard to initiate a conversation with people who don't want to recognize their own condition, and where the social norm against obesity has ... melted away.

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it's really hard to initiate a conversation with people who don't want to recognize their own condition

Yes to this, and at the same time:

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where the social norm against obesity has ... melted away

I don't think this is accurate. I think there is a fair amount of discrimination against fat people, and so some of their resistance to "health talk" related to losing weight comes from a place of self-preservation, or at least I think some people see it this way.

When I was a kid, my father managed to lose a lot of weight.
After he regained the weight, my grandmother's housekeeper said, "I am so glad you got your health back."

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Originally posted by CHAS:
When I was a kid, my father managed to lose a lot of weight.
After he regained the weight, my grandmother's housekeeper said, "I am so glad you got your health back."

Precisely the point. Many lower-income people still have a 19th century relationship with weight. Heavy = healthy.

I think there's also an awful lot more of "don't shame me for who I am" than there used to be.

In many ways, that's very healthy. No one should be shamed for being gay, or being short, or being an intovert.

However, it's gone too far, in some respects, when commentary on morbid obesity by a medical professional is viewed as inappropriate body shaming.

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Originally posted by Piano*Dad:

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Originally posted by CHAS:
When I was a kid, my father managed to lose a lot of weight.
After he regained the weight, my grandmother's housekeeper said, "I am so glad you got your health back."

Precisely the point. Many lower-income people still have a 19th century relationship with weight. Heavy = healthy.

I think that comes from a time when being fat was a sign of having plenty to eat and showing it.

"You can never be too thin, or too rich." Wallis Simpson gets credit for saying that. I have read that it goes back to one of the Astor family women.

When I used to visit Turkey courtesy of being married to a Turk, I got used to hearing, "Amanda - pek cok zaif" with shaken heads. Literally, Amanda, poor miserable thing, the word "zaif" meaning simultaneously thin and pitiful.

Over time, the Turks got more influenced by Western media and noticeably slimmed down and appreciated slenderness.

Still remember my ex pointing out the ubitquitous stalls in outdoor markets selling women's underwear. They used to advertise by hoisting the largest size on poles. They'd fly in the breeze about the size of a small sail!

The other factor that's playing into all of this (and is not without a racial element) is the glorification of, um, large posteriors and the popularity of hip hop culture. The term now isn't "fat girl," it's "curvy girl," and if you listen to a lot of shows like Project Runway (OK, so shoot me, I love that show), you'll hear the judges saying things like, "That designer knows how to really show off her curves." That's not anything you hear them say about a slim girl. Then, they'll say something like, "That designer knows how to design for a woman's body." It's very annoying.

There's a pendulum that's always swinging. I think it's good that we seem to have stepped past the notion that the prototype for female beauty most closely represents an adolescent boy (and there's a lot to read into that, as well). But I also agree that we've perhaps gone too far the other way. But weight is one of the last areas where bullies are given a lot of leeway, at least in school, and anything to lessen that is a good thing.

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Originally posted by Piano*Dad:

quote:

Originally posted by CHAS:
When I was a kid, my father managed to lose a lot of weight.
After he regained the weight, my grandmother's housekeeper said, "I am so glad you got your health back."

Precisely the point. Many lower-income people still have a 19th century relationship with weight. Heavy = healthy.

I disagree.

Many lower-income people lack the financial means to eat healthy or get exercise. The income disparity that causes this predicament is a 21st century phenomenon.

I mean, why would it be better to make lower-income people feel bad for being heavy when we as a country seem to have done everything we can in public policy to make them poor and keep them poor?

I think celebrating the backside or curves is a great and long overdue thing.

Some racial groups are built to be more straight and angular, and some are built to be more curvy. The only reason one body type was considered the ideal or the norm was racism.

The fact that curves and backsides are in is the best news I've had in quite a while.

Yes, poverty is highly correlated with poor health and poor health behaviors. And poverty has deep roots that create habits ... culture ... that persists over time, even when the initial poverty begins to abate. But until you spend lots of time working with the medicaid community, I don't think you fully understand that preferences and choices are very powerful, even if you think poverty has helped shape those preferences.

These people have agency. It's really hard to get many of them to stop behaviors that are expensive, like smoking, and to realize that low cost eating choices that they DO have available to them would help them achieve better health outcomes. The fact that some low-income people live in food deserts doesn't mean that all do. Many others who have a wide set of options tend to CHOOSE poor foods. Kitchens go unused. Fast food predominates in the diet. This is not a racial thing. It's a set of choices that crosses racial boundaries.

Also, in years past lower-income people had jobs (mostly in farming) that consumed immense numbers of calories. That work style is largely gone. But the habits of eating 4K calorie diets persists, with much of that intake in the form of simple carbs and fatty foods/oils. This is an immense challenge going forward, and the medical profession is ill equipped to deal with it. Doctors have no training as psychologists, counselors, and dietitians. But they can't do much for patients who want certain outcomes, but who resist information about how their choices are creating their issues.

And my wife has encountered many obese patients ... I mean morbidly obese, not "curvy" ... who think they are perfectly healthy, despite the obvious medical evidence that they are not, and who accuse my wife of trying to harm them when she suggests avenues for changing basic behaviors.

I have no issue with the notion of celebrating someone who isn't a size 00. I just think that we need to be careful about drawing a distinction between body shaming, health, and obesity. Everyone's body is different, and it's about time we acknowledge that there are different standards of beauty.