{"id":41097,"date":"2020-09-12T09:00:29","date_gmt":"2020-09-12T16:00:29","guid":{"rendered":"https:\/\/www.politicsplus.org\/blog\/?p=41097"},"modified":"2020-09-11T16:41:54","modified_gmt":"2020-09-11T23:41:54","slug":"everyday-erinyes-231-2","status":"publish","type":"post","link":"https:\/\/www.politicsplus.org\/blog\/2020\/09\/12\/everyday-erinyes-231-2\/","title":{"rendered":"Everyday Erinyes #231"},"content":{"rendered":"

Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto<\/span><\/strong>, Megaera<\/span><\/strong>, and Tisiphone<\/span><\/strong>. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”<\/p>\n

I feel the need to share this because, although unrelated to current events, it is profoundly accurate – and it is something I never expected to see, hear, read, in my lifetime. It is jaw-dropping.
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A doctor’s open apology to those fighting overweight and obesity<\/h1>\n
Doctors have told people who are overweight to exercise more and eat less, when in fact their overweight may be due to genetic or other factors that exercise won\u2019t change.
\nUConn Rudd Center for Food Policy & Obesity<\/a>, CC BY-SA<\/a><\/span><\/figcaption><\/figure>\n

J. David Prologo<\/a>, Emory University<\/a><\/em><\/p>\n

Obesity has emerged as a significant risk factor for poor outcomes<\/a> in patients infected with COVID-19. Based on how doctors and others in health care have previously treated patients with obesity or overweight conditions, my guess is that many will respond by declaring: \u201cWell, it\u2019s their own fault for being overweight!\u201d<\/p>\n

In the spirit of recognizing that people who struggle with weight loss include our family and friends, let me propose a different sentiment.<\/p>\n

To those who we have shamed for having excess body weight and\/or failing diets: \u201cYou were right, and we are sorry. After giving you undoable tasks, we ridiculed you. When you tried to tell us, we labeled you as weak and crazy. Because we didn\u2019t understand what you were experiencing, we looked down on you. We had never felt it ourselves. We did not know. And for that, we apologize.\u201d<\/p>\n

\"A
A nutritionist talks with a patient at an obesity clinic in Mulhouse, France.<\/span>
\nBSIP\/Universal Images Group via Getty Images<\/a><\/span><\/figcaption><\/figure>\n

\u2018Fat shaming\u2019 doesn\u2019t work<\/h2>\n

This is just one version of the apology we owe our fellow human beings whom we told to lose weight using diet and exercise. Then, when it didn\u2019t work, we blamed them for our treatment plan failures and smothered their feedback with prejudice and persecution.<\/p>\n

As a physician and researcher<\/a>, I have worked in this space for many years. I have witnessed firsthand the life-altering power of preexisting ideas, judgments and stereotypes. I have seen how unfounded, negative ideas are woven through virtually every interaction that those struggling with weight loss endure when seeking help.<\/p>\n

And there are tens of millions of them. The Centers for Disease Control and Prevention classifies more than 70% of U.S. adults as overweight<\/a>, and more than 40% as obese. Those numbers continue to climb, and even when some manage to lose weight, they almost always gain it back<\/a> over time.<\/p>\n

Rash judgments<\/h2>\n

To illustrate, imagine that I am your doctor. You have a body rash (which represents the condition of being overweight or obese), and you make an appointment with me to discuss a treatment plan.<\/p>\n

During your visit, my office staff uses stigmatizing language and nonverbal signals that make it clear we are annoyed at the idea of dealing with another rash person. We invoke a set of assumptions that dictate the tone of our relationship, including the notions that you are lazy or ignorant or both. You will sense my disgust, which will make you uncomfortable.<\/p>\n

Unfortunately, health care providers commonly treat patients who struggle with weight loss by assigning stereotypes, snap judgments and ingrained negative attributes \u2013 including laziness, noncompliance, weakness and dishonesty.<\/a><\/p>\n

After this uncomfortable exchange, I will prescribe a treatment program for your rash and explain that it\u2019s quite straightforward and easy to use. I will point you to several resources with pictures of smiling people with beautiful skin who never had a rash to emphasize how wonderful your outcome will be. \u201cIt\u2019s just a matter of sticking to it,\u201d I will say.<\/p>\n

Back at home, you are excited to start treatment. However, you quickly realize that putting on the cream is unbearable. It burns; your arms and legs feel like they\u2019re on fire shortly after you apply the treatment. You shower and wash off the cream.<\/p>\n

A dismal conversation<\/h2>\n

After a few days, you try again. Same result. Your body will not accept the cream without intolerable burning and itching. You return to my office, and we have the following conversation:<\/p>\n

You<\/strong>: Doctor, I cannot stick to this plan. My body cannot tolerate the cream.<\/p>\n

Me<\/strong>: This is exactly why doctors do not want to deal with rash people. I\u2019m giving you the treatment and you won\u2019t stick to it. I put the cream on myself every morning without an issue.<\/p>\n

You<\/strong>: But you don\u2019t have a rash! Putting this cream on when you have a rash is different than putting it on clear skin. I do want to get rid of my rash, but I cannot tolerate this cream.<\/p>\n

Me<\/strong>: If you don\u2019t want to follow the treatment, that\u2019s up to you. But it\u2019s not the cream that needs changing. It is your attitude toward sticking with it.<\/p>\n

This exchange illustrates prejudical behavior, bias and a disconnect between a provider\u2019s perceptions and a patient\u2019s experience.<\/p>\n

\"For
New approaches are needed for those trying to lose weight.<\/span>
\nJamie Grill\/JGI via Getty Images<\/a><\/span><\/figcaption><\/figure>\n

Prejudice and bias<\/h2>\n

For someone who wants to lose weight, the experience of a diet and exercise prescription is not the same as for a lean person on the same program. Perceiving another person\u2019s experience as the same as one\u2019s own when circumstances are different fuels prejudice and bias<\/a>.<\/p>\n

That night, though, you can\u2019t help but wonder: \u201cIs something wrong with me? Maybe my genes or thyroid or something? The cream seems so fun and easy for everyone else.\u201d<\/p>\n

At this point, the blame unconscionably lands on the patient. Despite an undeniable explosion of this rash, and abysmal treatment adherence rates while we have been touting the cream<\/a>, we stubbornly maintain it works. If the rash is expanding, and hundreds of millions of people are failing treatment or relapsing every day, well \u2013 it\u2019s their own fault!<\/p>\n

As time goes on, you feel increasingly discouraged and depressed because of this untenable situation. Frustration wears on your sense of optimism and chips away at your happy moments. You have this rash and you can\u2019t tolerate the treatment plan, but no one believes you. They judge you, and say you choose not to use the cream because you lack willpower and resolve. You overhear their conversations: \u201cIt\u2019s her own fault,\u201d they say. \u201cIf that were me, I would just use the d#$% cream.\u201d<\/p>\n

This is the very definition of prejudice: an opinion, often negative, directed toward someone and related to something that the individual does not control. Although it has been extensively demonstrated that the causes for overweight and obesity are multifactorial, the myth that it\u2019s the patient\u2019s fault is still widely accepted<\/a>. This perception of controllability leads to the assignment of derogatory stigma<\/a>.<\/p>\n

A setup for failure<\/h2>\n

That evening you sit alone. You think there\u2019s not a single person on the planet who believes your body won\u2019t tolerate this treatment. Society believes you brought this on yourself to begin with; there doesn\u2019t seem to be a way out.<\/p>\n

We have driven those with overweight and obesity conditions to this place far too many times. We have set them up to take the fall for our failed treatment approaches. When they came to us with the truth about tolerability, we loudly discredited them and said they were mentally weak, noncompliant or lazy.<\/p>\n

[Deep knowledge, daily.<\/em> Sign up for The Conversation\u2019s newsletter<\/a>.]<\/p>\n

So where do we go from here? If we agree to stop stigmatizing, stereotyping and blaming patients for our treatment failures, and we accept that our current nonsurgical paradigm is ineffective \u2013 what takes its place?<\/p>\n

For starters, we need a new approach, founded on respect and dignity for patients. A fresh lens of acceptance and suspended judgment will allow us to shift our focus toward treatments for the body, rather than \u201cmind over matter,\u201d which is a concept we use for no other medical condition. A perspective based in objectivity and equality will allow caregivers to escape the antiquated blaming approach and perceive those with overweight or obese conditions in the same light as those with other diseases. Only then will we finally shift the paradigm.\"The<\/p>\n

J. David Prologo<\/a>, Associate Professor, Emory University School of Medicine, Emory University<\/a><\/em><\/p>\n

This article is republished from The Conversation<\/a> under a Creative Commons license. Read the original article<\/a>.<\/p>\n

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\nAlecto<\/span><\/strong>, Megaera<\/span><\/strong>, and Tisiphone<\/span><\/strong>, I point out that The Conversation operates on a Creative Commons license (material is free to share, with attribution), and I hope everyone will feel free to share this. I wish someone would share it with Bill Maher (and then we would see how actually committed he is to science over prejudices, wouldn’t we.) You ladies can spread it too. Thanks.<\/p>\n

The Furies and I will be back.<\/p>\n","protected":false},"excerpt":{"rendered":"

Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, […]<\/a><\/p>\n","protected":false},"author":8,"featured_media":40592,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[3729,4103,4104],"class_list":["post-41097","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-politics","tag-furies","tag-health","tag-science","category-5-id","post-seq-1","post-parity-odd","meta-position-corners","fix"],"_links":{"self":[{"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/posts\/41097","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/comments?post=41097"}],"version-history":[{"count":0,"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/posts\/41097\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/media\/40592"}],"wp:attachment":[{"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/media?parent=41097"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/categories?post=41097"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.politicsplus.org\/blog\/wp-json\/wp\/v2\/tags?post=41097"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}