- We've reacted to the topic of vaccines
on "Middle Ground" before,
but now it's time to react about the question
of whether or not being fat is a choice.
It's gonna be a worthwhile watch.
Let's get started.
- [Announcer] Being fat or skinny is a choice.
- This is a very polarizing question.
I think it's a false dichotomy.
I don't think you have to say it's one thing or another,
but their community seems to say that it's not a choice.
So that's interesting.
- Being skinny or being fat is about willpower.
Who you choose to associate with,
what sort of things you choose to listen to,
who you choose to kind of have as your friends around you
and support you.
All of those things are choices that you can make.
- Yeah, and you could easily point it in the other direction
and talk about the genetic components,
the importance of those who raised you,
and how they taught you to think about food,
the way that the frontal lobe developed
when you were a child.
Meaning that if you had higher exposure
to fatty foods growing up or unhealthy foods,
or ultra processed foods,
you may have a preference for that.
It's not as simple as just this choice,
- Even with the genetics that cause you to want to eat more,
the same solution is calories in, calories out.
- The calories in, calories out thing is true,
but then there needs to be a little bit of nuance here.
And that nuance is certain calories will lead you
to metabolize foods differently.
Certain calories will lead you to want to consume more
or less of a certain food.
And certain calories can be unhealthy for you,
for other reasons other than your weight.
This is why we're always against starvation diets,
or heavily restrictive diets on this channel,
because in many instances they actually create
more problems, like eating disorders, disordered eating,
unhealthy habits, et cetera.
- I was supposed to get blood tested,
probably when I was very, very young and I never did.
And they had mentioned that it could have been
because of my weight and how that connects with my thyroid.
And I never had like that leaning parent
to be like, go and get checked out.
Go and do this.
Like your weight is probably not your fault.
It was always like your weight is your fault,
so that's your issue.
- That's an unhealthy mindset.
If I have a patient that has not been worked up
for a thyroid condition,
for other reasons why someone may be carrying excess weight,
we absolutely would check those things.
If you have low thyroid hormone,
we can give you thyroid hormone to boost those levels up.
- I mean I also struggle with, you know,
thyroid in my own blood issues, I'm not quite sure,
but I do see an endocrinologist, and I go see a doctor.
- And that's not available to everyone in the United States,
especially those who don't have health insurance,
or are underinsured.
And some people are insured,
but don't have adequate transportation,
or they don't have day paid time off from work.
- As a disabled woman, I can't do a lot of the things,
that people say, calories in, calories out.
Oh, you gotta go work out and exert it.
I have to navigate weight differently.
I have to look at it differently.
My weight is the way it is because of medication,
because doctors put me in this position.
- This is why the false dichotomy pops up in my head.
If you're gonna be very stringent saying being overweight
is a choice, full on, you are neglecting
a significant part of the population who may be
having a side effect of a medication.
Because there's many medications
that we could put patients on to protect their health,
that has this unwanted side effect, they put on weight,
or they aren't able to lose weight as easily.
And then there's those with disabilities
that can't burn calories as easily as some
who are able-bodied.
So I think probably even a better conversation
to be had here is,
is obesity a disease?
The AMA and all the major organizations have made it
a disease process.
They've labeled it a disease.
The doctors who are saying that
that's not helpful are usually pointing out
that when a patient feels obesity is disease,
they feel powerless to make the change.
The way that I like to think about it is,
on a population level, it's certainly a disease,
because it affects our bodies negatively.
It's certainly contributing to a public health epidemic.
It's actually happening pandemic,
really across the world, obesity.
On an individual level,
we need to have providers who have good relationships
with their patients to make the call.
Is this something that I can present to my patient
as a choice that will get them motivated,
or is this something that we can help them navigate
through a medical perspective?
Where we can give them medications, surgeries,
maybe lifestyle modifications
if they are gonna be motivated to it
and make that call on an individual level.
But again, all medicine is practiced
on population-based information
and the research that we have there.
And then we as providers have to look at our patients
as individuals and apply that knowledge.
So I still think on a population level it is a disease
and then how we attribute it to each patient
and how we help each patient navigate their condition,
that's gonna be different and that's okay.
- [Announcer] I would rather be skinny than fat.
- I think there's a lot of different struggles,
when it comes to being a bit bigger.
I have a sister, she's 400 pounds and she struggles a lot.
She has lymphedema and to shower is really, really hard.
So I do think for like an overall happy life,
and like zero struggle, I think I'd rather be skinny.
- I think what we're pointing out here is something
that I frequently talk about this channel,
when people in the past have accused me of being fat phobic,
where I'm aiming to not just prolong my patient's life
and decrease their risk of disease,
but also improve their quality of life.
And that's exactly what she's talking about here.
Being able to be independent, being able to wash yourself,
have less strain on your knees, on your hips,
developing arthritis early,
which means that you can't exercise,
or move up and down on stairs in your home.
And I think saying I would rather be skinny than fat,
doesn't mean necessarily,
that you hate yourself if you are in fact plus size.
If you're seeking to improve
because you're constantly unhappy with yourself,
that might be an unhealthy coping mechanism.
But if you're seeking to improve
'cause you're seeking growth
and you see it from a positive aspect,
rather than a hate aspect,
then that could be a very healthy mechanism.
- I had the most body insecurities when I was small.
And rather than trying to control my body to avoid
that negative attention,
I would prefer to address the situation as a society,
we aren't feeling like I have to be a certain way
that's normal in order to be treated like a human being
and respected.
- One of the big takeaways from her sentence there,
is that she talks about how we need to address this
from a societal perspective.
That's absolutely true.
With the way our current society is fed,
with the food products that are allowed in our system.
The ultra processed foods being more readily available
and cheaper than true whole food, healthy products,
food deserts, areas where there's not enough access
to good quality foods.
All of those things matter.
Now the medical perspective has probably gotten
more of a highlight with medications like Ozempic
and the GLP-1 agonists,
because that is more of a financial incentivized way
of treating our obesity epidemic.
It's much better to create a medication
that you can make billions of dollars on,
than it is to create a sustainable change in our society
that will lead to people losing weight.
- I don't think skinny always equates to being healthy.
I don't know where I'd wanna lean
at a appropriate weight level,
but I think it's important to understand
for some skinny people, we're not living a great life
by any means.
And sometimes I feel like that's always kind of lost
in translation when they see someone who's really skinny.
- Well I think that goes to show that
no matter what a person looks like,
you can't know what they're going through.
This is why, as a doctor, you have to walk into a room
with a blank slate and not judge people,
but at the same time be able to
stereotype certain conditions in the sense of,
okay, you're having symptom X, Y, and Z,
that frequently stereotypically happens in condition X.
So I'm gonna try and rule out condition X.
So there is some stereotyping you're doing
in order to come to a diagnosis,
but then you don't wanna stereotype the person's behavior,
or their appearance.
And it's very important to distinguish
between positive stereotyping in healthcare
and negative stereotyping in healthcare.
Both truly exist.
- [Announcer] America has an obesity problem.
- I think we have a problem with how to treat obesity.
I think we have a problem with how to make it
so that it is not an epidemic,
but this is a systemic thing that we are in a society,
and in an environment that breeds this,
and we are doing it to ourselves,
we are doing it to our children
and our corporations and our industries are doing it to us.
And they aren't having to take responsibility.
- This is true.
The one thing that I have to point out,
is that this is a worldwide problem.
As we have more access to food
and food is driving our happiness,
and we are becoming more disconnected and more lonely,
we seek food for comfort.
And while companies certainly bear
some share of the responsibility for making sure
that they're not contributing to this problem,
which they absolutely are, ultimately it's not as simple
as saying, "hey company, don't sell this product."
It's easier said than done to villainize a corporation,
and then say at the same time, but it should be fair.
How do we make that fair, that villainization?
- And they're encouraging it with media.
- And the mukbangs, I was literally gonna bring that up,
you know the mukbangs,
and like all those videos that just come up
to trends for people- - Yeah it's insane.
- To do it as well.
- Not only the mukbangs, but also like Lizzo,
and other big like media...
- I don't think I agree with that.
Because Lizzo has been an example,
of not that we're celebrating that she has excess weight.
We're celebrating the fact that she's not allowing people
who are being negative to her about her weight
and still succeeding.
So we're celebrating her success,
not the fact that she's potentially carrying excess weight.
- She's dressing extremely scantily clad.
And then saying, if you don't think that it's normal
for a morbidly obese person to be wearing a G-string
in the middle of public, then you're the problem.
And they're trying to normalize society,
to this obese culture, which is extremely unhealthy.
- You do need to normalize it to some degree.
And I'll explain why.
We are here, we're not going back.
And there's a significant population in the United States
that does fall under the umbrella of obesity.
You can't neglect that population.
You can't be destructive to them,
and say that anyone who is overweight
should not be showing their body,
should be hiding themselves.
'Cause they're not a good example role model.
That is ineffective and that is what fat shaming is.
So instead we need to celebrate people for who they are.
Celebrate people for the actions they take.
If they serve as good role models, celebrate those people
as humans and respect them as humans.
And at the same time we can give them access
to potentially lose weight,
to make other changes in their lives,
that have nothing to do with weight
that can make them healthier.
But at the end of the day, like you can't judge someone
for choosing to wear a certain thing
because you don't vibe
with one part of their health journey.
Again, it's one part of their health journey.
- What is an obese culture?
- A culture which like
normalizes obesity. - I'm obese and I haven't
even heard that.
- Well, obesity's already normal, so...
- Well, I don't think it should be normalized.
- The problem is, when she says it shouldn't be normalized,
what you're doing is fat shaming.
You're telling people that they're abnormal.
No matter if you have good intentions with that statement
because you want people to be healthier, let's say,
that's not a valuable thing to say to the general public.
The way it needs to be done is with them
coming to a conclusion of,
"I need to be healthier.
I choose to be healthier."
And then society, the medical industry,
helping them reach their goals.
But to say that they're not normal,
you're not gonna make positive change by doing that.
- [Announcer] Diet culture has positive effects.
- Diet culture is about turning the word diet
from your overall eating into an activity
that takes place over a period of time.
A diet should not be something you do
from January until May of next year.
- Yeah, what you eat should be part of your lifestyle,
as opposed to like the activity you're doing right now.
I have to point out here,
the research that we have of carrying excess weight,
specifically excess fat,
shows that it shortens life, it increases risk of disease.
The disease is not just limited to our heart
and our brains, affects all our organs, our performance,
our quality of life, our chances for independence as we age,
even our fertility, cancer risk, all of those things.
So we absolutely need to approach this
from a societal level, a medical level, all of the above.
It's not a one size fits all answer.
And whether or not obesity is a choice,
is not as simple as saying yes and no.
It needs to be individualized to the person
sitting in front of you,
and the strategies to help that person
are gonna be different than the strategies
that are gonna be help another person,
or the strategies that we discuss on a systemic level.
And I think all of those things
need to be taken into consideration.
We shouldn't just seek systemic change
and forget about the medical perspective.
We need to do both.
We shouldn't just focus on the population-based changes
and forget about the individual strategies.
We need to be able to do both.
That's why at the end of the day,
having a good long-term relationship
with a primary care doctor
will go a long way to improving health outcomes.
And I think that's the biggest takeaway.
And the idea that the medical society
is fraught with bias and all that is true.
And that carrying excess weight is still unhealthy,
is also true.
And we need to be able to accept both of those as realities
and make changes we see fit.
(musical tone pulsing)
Let's watch our "Middle Ground" on vaccines
and hear my thoughts on that.
Click here, check it out.
As always, stay healthy and happy.
Happy and healthy.
But they both work.
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