Dear Eye Doctor,
You are an excellent ophthalmologist. My cornea implant is helping me to see much more clearly.
You are also a caring doctor. That is why I thought you would like to know how I felt about the printed instructions you handed me after our last meeting. I was so enraged that I shredded the sheet into pieces.
The instructions tell me to exercise at least 30 minutes, 5 times a week. Well and good. Exercise is under my control. I have now increased my exercise from 17 minutes to 27 minutes, 7 days a week.
Then the instructions tell me, very presumptuously, how I should lose weight. I should quit drinking sugary drinks. (I have not had a sugary drink in over 50 years.) Furthermore, I should see a nutritionist or diet coach. (I eat an almost exclusively vegan diet. I cannot recall when I last had pizza or ice cream. No nutritionist knows as much as I about what will cause my body to gain weight. I have struggled with losing weight for 61 out of my 70 years.)
In fact, these instructions are not based on the current scientific knowledge about weight loss. I suggest that whoever typed these instructions into the random template ostensibly provided to all “obese or overweight” patients read articles about these facts:
- Bodies come in different sizes and shapes, largely defined by heredity. Dieting down to a so-called “healthy” weight will cause the body to defend its genetic setpoint. Metabolism is slowed and hunger hormones are released. One can maintain the weight only if he or she chooses to be hungry all the time. Personal anecdote: I achieved an “ideal” body weight several times in my life by being anorexic. My father says I have the body type of all the women in his family. He says I weigh much less than they, however, because I pay such attention to diet and exercise.
- Going on even one diet will cause metabolism to slow permanently. Being a chronic dieter like me causes metabolism to slow even more. Studies recently conducted show that people who lost a substantial amount of weight were burning hundreds of calories less per day than others their size. Personal anecdote: I was not allowed to have ice cream as a child. I brought a lunch of carrot sticks and celery sticks. I watched other children, the skinny ones, devour huge sandwiches and bags of chips. I stayed fat. I had a treat last night—a potato the size of a baseball with low fat yogurt–and gained a pound. Past experience tells me that it will take 5 days of salads with vinegar and oil to lose that pound.
- When women age, their muscle turns to fat, and their height shrinks. Automatically the holy grail of healthy body weight, the BMI, changes. Personal anecdote: After the age of 65 my height shrunk. My breasts grew huge and sagged. My belly fat expanded. Nothing I was eating had anything to do with these changes. My BMI went up as my height went down.
- BMI is a “one size fits all” measure that is irrelevant to many bodies. A BMI of 25 supposedly means one is not “overweight.” However, recent studies have shown that the people who live longest have BMIs of 27.3! Personal anecdote: At one point, through meticulously careful dieting, I reached the holy grail of 25 BMI. Then my height shrunk another inch. I am now 26.3. The printed instructions blithely demand a BMI of 24
You are a wonderful eye doctor. Your printed template, however, is based not on scientific evidence but on the last bias allowed in our culture: fattism. The template was provided without anyone asking me what I have done or am doing to keep my weight down. The template was provided, I suspect, by someone who has never been on a diet or had to struggle with weight—someone blessed by genetics with a body in the “normal” range as defined by our culture.
Yes, anyone can lose weight by starving enough. I know that hunger. During one period of anorexia, I was afraid to one eat peach in a space of 36 hours.
At the age of 70, I prefer to exercise and eat a healthy diet and not starve. I am still struggling to lose, but as the potato anecdote indicates, the slightest variation off my strict regimen sets me back. My father believes I am too obsessed about my weight. Your template did not help.
You are a wonderful eye doctor. I came to you for treatment of my eyes. Please stick to eye care. Please revisit the idea of your diet template. I feel sure I am not alone in being enraged and offended by its assumptions.
Bunny Paine-Clemes, Ph.D.
UPDATE: The eye doctor and his assistant were horrified that a weight-loss invective had been added to my care plan after my visit. Apparently the HMO had inserted the template without their knowledge. Comments included, “This is unscientific” and “This makes us look ridiculous.” My husband says the HMO is on a “healthy weight kick” and sent a similar newsletter out to his inbox. I got the newsletter also but deleted it without reading it.