Overcoming Pain

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The Myth of Benign Obesity

They really are beautiful, and sexy, those women in the Cacique ads. Nothing appears wrong with them: How can beautiful and sexy be unhealthy? Well, the bottom line is that being overweight is not healthy. As cute as she might be, that full-figured gal is in reality a femme fatale, whose inability to count (and control) calories may lead to an early death. Read More

Catalyst for change

Perhaps one of the most important factors in making a life change is acceptance, both by self and others. Hopefully this ad will inspire women who wear larger sizes to love themselves as they are and see their beauty. Then they may begin to treat their bodies with more care with regards to the American cultural expectation of healthy eating and exercise. Believe it or not, the choice between salad and French fries has more to do with comments made by doctors like you than an ad for a red bra. Then next time you write and editorial about the influence of media on compliance, please do, at the least, a quick literature review.

Exactly. I couldn't have said

Exactly. I couldn't have said it better myself. Encouraging someone to be healthy is completely different than shaming them about their body weight. I truly hope he does not speak to his patients in such a demeaning tone.

not obese

I'd be surprised if any of the plus-sized models in the Cacique ads are actually obese. I'd guess their BMIs are in the slightly overweight range of 25-28.

That was exactly my thought.

That was exactly my thought. How could someone call the model in the picture associated with this article obese? She's clearly not. I had hoped Dr. Borigini would provide some sort of description of what he considers obese--but at the end of the article, I was left with the impression that he has a black-and-white view of human body types--that everyone is either thin or obese, where obese is, in his mind, synonymous with low will power. That viewpoint is obviously mistaken.

I've noticed the word

I've noticed the word 'overweight' seems to have disappeared in the media, replaced by 'obese'. Like you go from a normal weight to Marlon Brando with nothing in between - the BMI skips from 25 to 30.

agreed

Good point. 'Obese' sounds more abnormal and scary, so naturally it's become the preferred term. There's a world of difference between having a slightly-overweight BMI of 26, where the person still has mobility, can fit into airplane seats and shop at Target, etc., and being morbidly obese.

I also think we're so used to seeing models with a BMI below 19, often as low as 16, that a picture of a normal-weight model looks weird.

My weight has been creeping

My weight has been creeping up over the past year (a bad combination of stress and just eating too damn much). I'm not huge, mind you, but I am overweight, and my BMI had just crept into the "obese" category.

This fall, I started having chest pains, which led to a trip to the doctor, where I found out I have high blood pressure, pre-diabetes, low iron and low vitamin D.

Since that time, I have been exercising and eating well, and have lost seven pounds. Already, I am feeling so much better than I was.

My doctor encouraged me to lose just TEN pounds because it would make such a big difference on my health. SKINNY isn't necessarily healthy, and a person doesn't need to be bone thin to be healthier.

I think the important message here is to love yourself enough to take care of yourself. I think when we dress nicely, it's part of caring for yourself. Which means I am worth more than the drive through at Mc Donalds. I am worth taking the time to prepare healthy meals and go to the gym.

And that is an important message. Nobody hated themselves skinny.

At least I haven't.

That's great that you are

That's great that you are taking the steps to make yourself healthier and not simply doing it to fit in a smaller dress size. We should all be focused on our health, not our waist circumference, and our doctors should be encouraging us to become healthier, not skinnier. I'm glad you have a doctor who recognizes that small steps, realistic advice, and most importantly support, are key to successful health behavior change. Shaming someone into losing weight is not an evidence-based strategy...at least, not last time I checked :)

thank you

Thank you, Caroline! Yes…shaming, whether it's coming from ourselves or another, simply doesn't work. I'm very grateful that my doctor has given me acceptance and support on this journey.

Horrendous

Not-dear Dr Borigini,

the hook to your article is, to put it simply, abhorrent.

1. You want to talk about obesity. So OF COURSE you choose a picture of a WOMAN, even though women are ALREADY the gender most self-conscious about their weight and shape. And at NO point in your article do you EVER counterbalance that first paragraph (which is ENTIRELY about shaming overweight women) with a symmetric specific criticism of overweight men. Thus, you single out women as your target - as if they needed more of this!

2. You take a picture of a woman who is most likely not obese at all, only overweight, to talk about obesity, thus reinforcing in women's minds the idea that ANY fat AT ALL is simply unacceptable.

3. You SPECIFICALLY borrow an image from a campaign aimed at making overweight women develop a better self-image - and then caption it with a paragraph detailing how this body-type is BAAAAAD.

4. And then you go on to specifically shame and psychologically torture these women:
- They are dangerous: "femme fatale" (which, by the way, doesn't mean what you seem to think it means);
- They are stupid and/or weak-minded: "whose inability to count (and control) calories", which couldn't be further from the truth for many, MANY overweight women, whose weight problems are DIRECTLY linked to the fact that they SPEND THEIR TIME counting calories!
- They are selfish: they might leave their "loved ones the direct and indirect victims of diabetes, arthritis, and heart disease".

Congratulations! Your article is EXACTLY the type of sermons that makes overweight women EAT EVEN MORE.

1. You tell them: Even if you obese women out there manage to become only overweight, and even if you become cute and sexy in that full-figured way, it STILL WON'T BE ENOUGH.
They conclude: Why even bother, then?

2. You tell them: Losing weight is about counting calories and controlling your food intake.
They conclude: Anorexia nervosa is the Perfect Way Of Life. For those who are "not lucky enough" to develop it naturally, then simulating it, by making themselves starve and/or purge, is the next best way to live.

3. You tell them: You're a horrible person for not thinking about what your weight will do to your loved ones.
They conclude: I'm a horrible person. I don't deserve anything good. Maybe I shouldn't even be alive. I.e. they go into depression. And do you know what is a very common cause for overeating? Right, depression.

So you demoralise overweight women, you shame them, and you send them into depression.

And then, what do you do? Do you offer help? Suggestions? Encouragement?

No.

"At least we know that there is no “benign obesity.” Now, what are we going to do about it?"

In other words: dear disgusting, weak, selfish overweight women, are you finally going to get off your huge butts and lose all that weight, on your own, simply through obvious starving!? What are you waiting for already, you disgusting, weak, selfish things!?

... Right now, Dr Borigini, I hate you very, very much.

PS: Please notice that I don't argue any of the scientific points of your article. I have no problem with accepting that overweight is not benign and can have major health consequences down the line. And you know what? Most of the overweight and obese women you psychologically harass already agreed with these conclusions long before you tried blowing their shaky self-esteem to smithereens. So you've done no good, and a lot of bad. Think about this, please, especially in the light of this being posted to a blog entitled "Overcoming Pain" (Hint: creating massive psychological pain DOES NOT help relieve physical pain, duh!)

That's a bit of rant

When one goes on a rant and uses words like "hate" I tend to tune out. But the poster does make a minor point. In my neck of the woods it's the men that are overweight, not the women. I do notice that when one talks about obesity the message is often directed at women who seem to be the gender most sensitive to their weight. As with most Psychology Today posts, this is directive to get healthy and do better is directed straight at women, and unhealthy fat men aren't discussed.

Yes, it was a rant, so?

I was angry. I was justifiably angry, since as you admitted, this article unfairly and pointedly attacks women. To you, this might be a "minor point", but to me it's a major pet peeve. I am sick and tired of men constantly picking on women (and especially on women's physical appearance), patronisingly putting them down and blithely shredding their self-esteem in the process, while never calling out other men for the very same sins they constantly criticise in women. It truly angers me. And when I'm angry for a good reason, I don't see any reason to hide this anger - on the contrary: I want it *known* that I am angry!

No.

One can be angry without raging. When one rages and rants they lose their integrity and people don't take them seriously.

I don't see the logic

Please explain how you go from:

A. one rages and rants

to

B. they lose their integrity?

Did anything I say in my rant was factually untrue? Not to my knowledge.
Did I demand at any point that I be believed just because I was angry? No.
Most importantly of all: would I have made the *exact same points* in a less ranty way if I had not been so angry? YES, absolutely.

So I fail to see in what way my integrity was compromised.

Quite frankly, if you can't be bothered to listen to people just because they are being angry about something which is dear to them, then I say the problem is with you, not with them.

Fatties gonna fat

Fatties gonna fat

Thank you for writing this

Thank you for writing this comment. You hit the nail on the head with your point by point critique. I don't hate the author of this article, although it is quite obvious from his language that he hates overweight and obese women. He basically calls overweight women selfish, horrible people who are"femme fatales." He is so nuts it's unbelievable he has a MD. Everyone already knows being overweight and obese is unhealthy, but the standard of what is a healthy weight and obese is skewed by the media and men, as demonstrated by the use of that pic for plus clothing when the models for plus size clothing are usually only a size 12, not overweight. People are overweight for many different reasons and as scientific study after study has shown, limiting calories and exercise doesn't have the same effect on each person's body due to different physiology, metabolism, bone structure, thyroid or other health issues or even emotional issues that are being dealt with by food. We are all humans, inperfect as we are trying our best with our resources to be best selves we can be and to morally judge others with such contempt under the guise of scientific support is immoral.

I don't hate him anymore...

... now that the anger has abated ;) That's why I said I hated him "right now": because I knew it was temporary.

My disgust at the article, however, has not diminished at all. And I rather agree with you that "to morally judge others with such contempt under the guise of scientific support is immoral." This article is the kind of ignorant and insensitive tripe I would expect from something written 15+ years ago, when we didn't know everything we've learned in the meantime about weight loss, and about the terribly destructive impact on women's self-esteem that the way society judges them on their appearance and especially their weight can have.

thank you!

thank you for standing up for all women!
I could not have said it better!
I too am very offended by this post, to the point that I think this post should not have appeared on psychologytoday...

Lose some weight already

Chill out you're freaking out about nothing. It doesn't matter if it's a picture of a fat girl or guy, you're just looking for excuses to get mad about nothing. You're making sound like it's everyone elses fault that you're overweight, it's your fault. No one elses, take responsibility for your actions and loose the weight. If you're so self conscious about how much you weight do something about it rather that sit on the internet to try to put others down because you feel shitty about yourself. Get over it.

Awww, so cute! *pets troll*

Why, good sir or madam, thank you so much for showing me the light :D ! I would never have figured things out on my own :)

*can't resist pinching troll's cheek and petting its hair* So cute!!!

I don't disagree with you

I don't disagree with you that being overweight is not healthy and that losing weight would improve one's health. However, your statements that overweight women (umm…what about men?) lack the "ability to count (and control) calories" and that overweight women (again…how about overweight men?) are not trying to lose weight, but rather are persisting "in pressing the snooze button when it comes to maintaining a healthy body weight" are honestly, extremely insulting and just the type of sentiment that contributes to low self-esteem, self-consciousness, and obesity stigma. I consider myself to be somewhat lucky because I have never had a weight problem, I grew up with very healthy parents who taught me good habits from a young age, and I have always been able to maintain a healthy body weight without a lot of effort. However, my mother became very ill several years ago and is now extremely limited in her mobility. She can barely walk, not to mention exercise. She has gained a significant amount of weight, and now meets the criteria for obesity. But, contrary to your suggestions, she certainly has the ability to count and control her calories, and she is struggling each and every day in her battle to keep her weight down. She keeps a food journal, she eats no more than 1,800 calories/day, and the majority of what she eats is fruits, vegetables, and low-fat dairy products. She is not "hitting the snooze button" and she knows that her weight is unhealthy, but her efforts have not led to significant results. This is the case with many people, and it is insulting and untrue to insinuate that overweight women simply don't care about their weight and are not trying to do anything about it. There is a difference between accepting your body vs. not caring about it.
If we are to encourage women (AND MEN) to try to reach and maintain a healthy body weight, a good place to start would be NOT shaming them about it.

Shaming vs. Sensitivity

I have a dear friend. She's a great person but I've known her for a really long time. Never has she controlled what she ate and now she is seriously overweight. Her obesity has compromised several existing medical conditions and now she is fully disabled and can barely walk. All this time, while she was eating unhealthy foods I ate healthy foods and exercised. Only after she spent several weeks in the hospital did I bring up the subject of her weight, and I did it ever so lightly.

Now her many medical doctors have told her that she absolutely must lose weight. My friend is asking me questions about my food choices and knowing how sensitive she is, I answer them very gingerly. It is so easy for an overweight person to misinterpret help for shaming. I could help my friend much more, but I am too afraid of her feeling insulted.

True, but

"It is so easy for an overweight person to misinterpret help for shaming."

I don't disagree with this in the general case, but there's no such confusion possible in the case of this article - since it simply doesn't offer ANY help*. In fact, it pointedly ends at the point where it would start tackling the very topic of "Here are some ways to lose weight."

* with the exception of "Count and control calories", which is far too vague to be any kind of help at all.

So this article is not a case of Helping being misread as Shaming. It's a straight case of Shaming - and Shaming only women too.

Why did Borigini write this article?

I think, perhaps, it would be a good idea for Dr. B to meet with a psychologist to find out why he has such strong reaction to this advertisement. His reaction was so strong that he posted an article like this, which is (hopefully) not well thought out, written off the cuff, with little thought, and most likely driven by emotions that were (again, hopefully) clouding his judgement. What would make him post such a thing using language like this? I am curious.

He wrote it because fat women

He wrote it because fat women repulse him, he just happens to have a medical license and is using that credential as a means to broadcast his contempt as a legitimate article on Psychology Today. The article is devoid of any helpful advice or insights to readers, but simply attaches moral contempt to all the women who are overweight or obese due to a higher probability of possible health issues.

His misuse of the term "femme

His misuse of the term "femme fatale" may be a genuine mistake, but it may also be telling. A femme fatale is a literary creature who lures a man in with her charming looks and personality before proceeding to suck the life out of him. From "obesity is unhealthy," Dr. Borgini seems to jump to "obese women are unhealthy" to "overweight women are unhealthy" to "overweight women are bad" to "overweight women are seducing, then sucking the life out of men."

Hmmm. That's a lot of jumps for the good doctor.

slip of the tongue ?

I would call that a Freudian slip for sure haha. Nice insight.

There is FAR more involved to weight loss than calorie-countingy

I was never able to lose weight before paying attention to my carbohydrate intake, not just calories. Different people will find that different means of weight loss/maintenance work for them.
Counting calories does not work for a lot of people. No matter how much you insist it does, for a lot of people IT DOES NOT WORK.
And the standard for overweight keeps shifting. In the 1950's being a size 14 was not considered overweight (the size Marilyn Monroe was), but now it is? When did it suddenly become unhealthy?

Sizes change

A size 14 in the 1950's fit a much smaller person than it does today. Back then, a 14 fit a woman with a 34 inch bust measurement, but now that woman would wear about a size 4.

There is no way a today's

There is no way a today's size 14 used to be a size 4, that is 5 sizes that the sizing scale would have had to jumped. I personally know at least 2 women today who are super petite due to a very tiny bone structure and super high metabolisms and they wear a size 0. It is unbelievable that 20, 50 or 100 years ago that more than 5% of women could be a smaller size than these women (they can fit into clothes made for 12 year olds). Based on your reasoning they would have worn a size 10 in the past, even though size 6 used to be considered the ideal size and then I guess 95% of the rest of women would have worn at least a size fourteen? That makes no sense. The sizing scale could not have jumped that much.

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Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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