Kweku’s Korner
By Dr. Sheriece Sadberry
Dr. Sheriece Sadberry
As a psychologist who works with clients with eating disorders, body image concerns, chronic medical conditions, and general mental health concerns, what do you see as some of the issues with weight loss drugs like Ozempic, Wegovy, and the like?
The anti-obesity, fatphobia, fat shaming, and thin is best mindset of this country and now, the worldwide perspective is driving the sale of these drugs and increasing the insecurities of people.
This is another systemic “-ism,” like racism, like sexism. Society treats people differently based on the size of their bodies.
My initial reaction to how I hear people talk about these drugs and the desire for thinness sounds like the Black and Brown communities’ pressure to meet Eurocentric standards of beauty. Curly hair – straighten it, etc. Society shames people in bigger bodies, society treats people differently when they are in bigger bodies, therefore “I must fit society’s ideals to feel better.” Trying to solve a societal issue by forcing ourselves to fit societal expectations.
Unfortunately, we have removed the psychological and sociological perspectives from the conversation.
There are also side effects to these medications. Most people will stop taking the medicines because of the side effects, but they don’t know how to report them to the FDA. So, the number of issues people are experiencing such as nausea, vomiting, diarrhea, constipation, stomach pain, fatigue, headaches, etc. go largely unnoticed.
What if someone says, “my doctor told me I am obese” or I have medical concerns because of my obesity?
What we see happening is a conversation about obesity. “Obesity as a disease.” I want to challenge some of this.
My first question when someone says they are being told they are obese is, based on what markers? If the doctor is using BMI to say someone is obese, this is entirely an incorrect use of BMI.
BMI is a simple calculation that was created by a mathematician, not a medical professional, trying to estimate the “socially ideal” or average European man. It didn’t take into account women, people of different ethnicities, age, athletes, and other factors. It doesn’t distinguish between fat and muscle.
It is appropriate for use in research when examining populations. It is not appropriate for assessing the health of individual people, despite so many medical professionals and organizations using it.
BMI does not tell you anything about health. So, if your doctor says you are obese, you need to lose weight because you are at risk of these health conditions, these are estimates and not actual evaluations of your health.
There are genetic, metabolic, and behavioral factors that are complex and all at play in different ways for different people that determine their body size and their health. So many factors in the environment, food quality or processed food, lack of sleep, etc. also impact health. The health concerns a doctor may be worried about, like high blood pressure or high cholesterol, are found in people of all shapes and sizes.
What about obesity being a disease?
Obesity is not a disease. What? I know that has been the language for the past decades. I want you to take notice that what they are calling a disease is your weight issue, this is rooted in the fatphobia of our society.
There is also debate within the medical community about whether or not this can be classified as a disease because there is no universal agreement on the medical issue being treated. Remember there are so many factors that contribute to someone’s health, the disease is not weight.
There is a very small percentage of people who have metabolic issues or dysfunctional regulatory systems or other underlying diseases that may need intervention, but that is not a weight issue, that is a health issue. Like thyroid disease, PCOS, or Melanocortin system dysfunction, these are not diagnosed via BMI nor should the intention of treatment be weight loss.
The reality is our bodies are designed to maintain weight and some people have a higher set point than others. We come in all beautiful shapes and sizes. I would caution people that if you have to go to extremes to lose weight and to maintain weight loss then that is not the body you are meant to have. Many people who have tried dieting will experience rebound effects as a result, where they regain weight and sometimes more. Your body doesn’t trust you anymore. This is not a failure; it is about acceptance and quieting the noise of fat shaming in our society.
This is also true for people with eating disorders such as anorexia or bulimia, disorders we don’t talk about much in the Black and Brown communities. These are still based on fear of weight gain. We are trying to control our bodies or control our emotions by controlling our bodies and trying to force our body into a space it doesn’t naturally want to go.
From a psychological perspective, how can someone focus on their health?
Overall, the most important way to improve health is stress management. Chronic stress has a greater negative impact on health than weight. That is achieved by:
1. Developing meaningful relationships.
2. Go outside for 20 minutes every day. We need sun and fresh air.
3. Move your body. A brisk walk is an exercise. We are too sedentary.
4. Eat what you like and add what you need. I tell people to cook at home more, save money, and know you are eating real ingredients. Don’t cut out food groups.
5. Resistance training to increase lean muscle for bone health.
6. Get 8-9 hours of sleep every night.
7. Pause for 5 minutes every day. Sit still and breathe deep slow breaths.
8. Reduce electronic and social media use.
9. Have hobbies, enjoy life, LAUGH, and smile more.
10. Love yourself, self-compassion, and grace.
11. Go to therapy. Go to Church. Wherever you feel supported and get the guidance you need in life.
At the end of the day, if these same people who are putting these medications out there cared about the well-being of their patients, they would be working to change greater issues in society. Society needs to remove barriers for people to feel safe in their neighborhoods, reduce biases, reduce poverty and the squeezing of the middle class, increase access to adequate medical treatment reduce the cost of medical treatment, etc.
There is only so much you can tell an individual to do to manage their stress when the world adds to it.