“The Weight of the Nation” – Part 3

Posted By elissa on May 23, 2012 | 1 comment

I finally got the chance to view Part 3 of “The Weight of the Nation”… well, most of Part 3. I missed the last 10 minutes when my server connection froze. After multiple attempts to reconnect, I decided to hang it up – I think I saw enough of it to render an opinion, anyway. 😉

Ok, like Parts 1 and 2, it was good… in much the same ways (i.e., solid production values, sympathetic subjects, authoritative experts). I thought Part 3 was an improvement over Part 2 in that it examined the complexity of childhood obesity. Part 2 was pretty much all about personal responsibility, whereas Part 3 took a broader view that included the influences of school (poor food + limited gym), food/beverage advertising and technology (TV, computer, video games) that encourages sedentary behavior.

FWIW, the documentary did such a great job of exposing industry efforts to derail serious reform and outlining the constraints that schools are under, that I was left rather frustrated… what are we to do about all this? Thanks to the dropped connection, it’s possible that I missed some action items at the end, but the bulk of the program seemed content with simply pointing out the legislative and administrative roadblocks. A perfect example of this was the interview with Texas Comptroller Susan Combs, who – on her own initiative – set up a grant program, “Texas Fitness Now,” which funded 30 minutes of daily PE for 500 middle schools in the state. Despite the clear success of the program, pro-PE state legislators still weren’t able to get a comprehensive PE requirement passed for Texas schools. Another example was the discussion of the mass-produced, pre-packaged school lunches in Madison, WI. The administrators know the lunches suck (even the kids don’t like them very much), but can’t do much about them: to improve the food, they’d have to take money away from academic programs.

Nothing like being caught between a rock and a hard place! Grrrr…

Which brings us back to personal responsibility – the discussion of which had the same issues I ID’d in Part 2. All the kids and parents interviewed were great – all the parents were concerned and sought expert advice for their kids; and all the experts responded with warmth, attention and sympathy… and programs to help the kids become better educated and active. Not surprisingly, those kids made progress, and were happier and healthier as a result.

But… and here’s the big “but” – the kids whose stories were highlighted were from middle class, two-parent families, with access to medical care (and nearby pediatric obesity programs). Basically it was a tacit admission that – the higher up your family is on the food chain – the more resources you have to help your kids acquire healthier habits. It’s rather telling that this fact – “Only 10% of parents seek medical help for their obese children” – was shown on the screen, then just left dangling. The documentary was curiously incurious about why this might be so. Off the top of my head, I can think of a few (potential) reasons:

1. lack of health insurance or cash to pay for medical care
2. lack of time and/or resources (think single parents living in areas with limited free/low-cost pediatric services; parents living in rural areas, etc.)
3. lack of sympathetic, non-judgmental medical care.

That last one is a bigger deal than you might imagine. “The Weight of the Nation” clearly showed the best face of medical care available: kind, non-judgmental, patient, sophisticated. Great stuff. But that’s not what seeing a doctor is like for many obese people  – as sites like “First Do No Harm – Real Stories of Fat Prejudice in Medical Care” reveal. As this 2010 New York Times article pointed out:

Some of the most blatant fat discrimination comes from medical professionals. Rebecca Puhl, a clinical psychologist and director of research at the Rudd Center for Food Policy and Obesity at Yale, has been studying the stigma of obesity for more than a decade. More than half of the 620 primary care doctors questioned for one study described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment.” (This last is significant, because doctors who think patients won’t follow their instructions treat and prescribe for them differently.)

Dr. Puhl said she was especially disturbed at how openly the doctors expressed their biases. “If I was trying to study gender or racial bias, I couldn’t use the assessment tools I’m using, because people wouldn’t be truthful,” she said. “They’d want to be more politically correct.”

Despite the abundance of research showing that most people are unable to make significant long-term changes in their weight, it’s clear that doctors tend to view obesity as a matter of personal responsibility. Perhaps they see shame and stigma as a health care strategy.

This prejudice on the part of many medical professionals helps explain the reluctance of some parents to seek help for obese kids – they’re afraid that they’ll be blamed and/or the practitioner’s attitude will hurt the child’s self-esteem. As noted obesity researcher/author Dr. Arya Sharma wrote:

…there is no doubt often parental ‘denial’ about the potential impact of excess weight on their offspring.

Yet, even amongst those, who do recognize the issue, there appears to be a widespread reluctance to seek advise from their family doctors or other health professionals.

The possible reasons for this, from the perspective of parents, was explored by Katrina Turner and colleagues from the University of Bristol, UK, in a paper just published in Family Practice.

The researchers conducted in-depth interviews with 15 parents of obese children aged 5-10 years, to explore their views and experiences of primary care childhood obesity management.

Although parents clearly saw primary care as an appropriate setting in which to treat childhood obesity, they were reluctant to consult their family doctor due to a fear of being blamed for their child’s weight and a concern about the impact of raising this issue on their child’s mental well-being.

In addition, the parents had considerable doubts as to whether practitioners had the knowledge, time and resources to effectively manage childhood obesity.

…Explicit in these findings, is how much of this parental concern leads back directly to the issue of weight bias and the culture of ‘blame and shame’ that health professionals (and everyone else) often perpetuate, largely due to their poor understanding of the complex psychosocial and biological drivers of excess weight and their inability to provide professional advise that goes beyond ‘eat-less-move-more’ platitudes.

In “The Weight of the Nation,” doctors are clearly the good guys – as they should be! But when it comes to obese kids and their parents, this is not always the case… a situation that the documentary has yet to mention.

At any rate… part 4 tomorrow (and a summing up)!