Nick Galvin -Apr 8, 2012
Taken control ... Kath Read says her weight only stabilised once she gave up dieting. Photo: Michelle Smith
When Regina Benjamin was made US Surgeon-General in July 2009 she ran into a storm of criticism.
But it wasn't just the usual political point-scoring that any new appointee has to weather.
Many of the attacks on Benjamin were because she is overweight - by 20 kilograms or possibly more.
What message was the country's top health administrator sending, wondered her critics. And they were the polite ones. Even more bluntly, some asked, was she too fat for the job?
Benjamin, a formidable personality by all accounts, wasted little time returning fire. ''I exercise regularly, at least four days a week,'' she was reported as saying. ''I tend to stay on the elliptical as long as other people. I'm not out of breath. You can be healthy and fit at different sizes. The real message is that you don't want to limit yourself by your dress size.''
The furore around Benjamin's appointment brought into sharp relief a controversial approach being promoted by a small but growing group of doctors and academics, cheered on by ''fat acceptance'' activists.
It is possible to be fat and healthy, they say. Further, they believe that the constant focus on shedding weight and staying slim may actually be doing more harm than good.
Needless to say, this is a hugely controversial area - a potent stew of emotion, prejudice, guilt and politics. There is also a range of positions, from hardline ''fat pride'' activists through to doctors and other health professionals who, while they accept being overweight is often unhealthy, believe focusing exclusively on patients' weight can be counterproductive.
The official measure of whether a person is overweight is the Body Mass Index. If you have a BMI of 25 or more, you are overweight. Get up to a BMI of 30-plus and you are clinically obese.
(The BMI itself is a controversial tool, often criticised for producing anomalous results in all but the most ''average'' body types.)
Bureau of Statistics figures from 2007-08 show one in four adult Australians are obese and 37 per cent are overweight.
Anyone with a BMI of 25 or more who visits their GP will almost certainly be told to lose weight. They'll probably be given a diet sheet, counselling on exercise and may even be referred to a dietitian before being sent on their way.
And, while many of those patients will manage to lose some excess weight, most solid studies show the vast majority (up to 95 per cent) will regain all the weight they have lost within one to two years. Many will even ''overshoot'', ending up heavier than their starting weight.
Dr Rick Kausman is the author of a book called If Not Dieting, Then What? and widely recognised as a pioneer of healthy weight management without dieting.
''There is no question that weight-loss dieting does not work,'' he says. ''The way I define a weight-loss diet is anything that tells us what, when and/or how much to eat for the purpose of weight control.
''Weight-loss dieting also increases the risk of eating disorders and immune problems and physical health issues.'' Kausman says some doctors understand the complexities of the problem but don't have enough time to deal with it in ''a 10-minute consult'', and others ''just think it's a matter of telling people to eat less and exercise more and it's the person's fault that they are not able to do that''.
Regardless of individual doctors' reasoning, however, it has been pointed out that if any other treatment of ''intervention'' had a failure rate of up to 95 per cent, we'd almost certainly be looking for a different approach.
Dr Linda Bacon is an American physiologist and psychologist, and the main standard bearer for the ''health at every size'' (HAES) movement.
''HAES teaches people to rely on internal regulation, a process dubbed 'intuitive eating','' Bacon writes in a recent paper. ''HAES teaches people to make connections between what they eat and how they feel in the short and medium term, paying attention to food and mood, concentration, energy levels, fullness, ease of bowel movements, comfort eating, appetite, satiety, hunger and pleasure as guiding principles.''
And while Kausman tends to talk about individuals being at their ''most healthy weight'' rather than ''health at every size'' he shares Bacon's focus on mindful eating.
In particular, he says, it's important to ''check'' whether you are hungry before eating. ''Dieting makes it more difficult for people to know when they are hungry or full because dieting says, 'Don't trust your body, follow our rules and forget whether you are hungry or not','' he says. ''When I see people who have dieted on and off for 20 or 30 years, I'm almost retraining them to start trusting their body again.''
But activists such as Bacon go much further, asserting that promoting weight loss is counterproductive and it is possible to be fat and fit.
There is some research to show being fit is more important than being thin and that being overweight (though not obese) may actually offer some health benefits.
But both these points remain controversial, flying in the face of mainstream medical thinking.
Lyn Roberts, chief executive of the Heart Foundation, says it is dangerous to think that being overweight is OK. ''It's almost like we have normalised being overweight and obese in Australia,'' she says. ''That is a concern because of the very direct link between overweight and obesity and the fact that it increases your risk of heart disease. We also know it's a risk for diabetes and arthritis and some types of cancer as well.
''There are people who are overweight who may be very fit and who may not have high cholesterol and high blood pressure and who may not go on to develop diabetes, but there are a lot of people who are overweight who really do have a range of other problems.''
Heart Foundation research from last year suggests concern that being overweight is becoming normal in Australia is well founded.
The study showed that 30 per cent of overweight adults think their health is ''excellent or very good'' as do 18 per cent of those who had been told by their GP to lose weight.
Roberts admits losing weight is extraordinarily tough for most people, which is why the Heart Foundation also emphasises prevention. ''We really want to encourage people not to put on that weight in the first place because it is so much more difficult to lose it once it's on,'' she says.
''I have enormous sympathy and regard for people that are out there trying to lose weight because it is not an easy thing to do.''
Ask Kath Read how much she weighs and she'll tell you that she doesn't know.
She keeps a close eye on other indicators such as blood pressure, blood sugar and lung capacity, but as for the number on the bathroom scales, it's ''irrelevant''.
Read, a Brisbane IT librarian and health activist, says one of her earliest memories was being told she was a ''fatty''.
For 20 years from the age of 10 or 11, she battled her weight with a succession of weight-loss programs.
''I did all the textbook diets and the lifestyle changes,'' she says.
''I went to doctor after doctor who gave me pills and potions and eating plans and sent me to nutritionists. I remember looking at these things and thinking, 'But I know this - it's what I'm already doing.'''
It was in her early 30s that she found a doctor who, she says, didn't immediately give her diet advice.
In fact, it was only when she stopped dieting that her weight stabilised.
Now, she says she has taken control of her health. ''I never had an annual test until I stopped dieting,'' she says.
''Now I've stopped dieting I'm actually proactive about my health.''
And she refuses to exercise in the conventional gym/running sense, preferring what she calls ''joyful activity''.
''I hate the word exercise,'' she says. ''For me it equates to punishment. I only do things that feel good and which I enjoy. I have a bicycle and I tootle around at my own pace. I do yoga as well and I walk - I don't drive - and I like to swim. Anything that's fun.''
Read insists many of the health problems associated with being overweight are more a result of inactivity than body mass.
She also points out that the reaction overweight people get from others makes it far from easy for them to be seen out being active.
''When I walk down the street or ride my bike, guys yell out of cars, 'Keep pedalling, you fat bitch','' she says. ''Who's going to want to exercise if that is the way they are repaid?
''The morbidities are there but is it because of their weight or is it because they can't get out and exercise?''
In particular, Read is enraged when she sees fat people defined entirely in terms of their body shape.
''Society may see me as this amorphous blob of fat but they don't see that I have friends and a job and pay taxes and have hobbies and responsibilities … and a life,'' she says.
''Every single one of us is normal for ourselves. We are all humans.''
We teach our children not to use it, and it's not a word you'd expect adults to use in polite conversation, however, many activists make a point of reclaiming the word ''fat''.
Kath Read blogs as the ''Fat Heffalump'' and there are countless other bloggers labelling themselves ''fat'' or ''fatty'' in the so-called ''fatosphere''.
''For 30 years if you used that word in connection with me, I was devastated,'' Read says.
''And then I realised, even if I avoided that word altogether, there'll always be some dickhead walking down the street who is going to call me a 'fat bitch', or the first time I annoy someone they are going to say, 'Shut up, fatty'. I can't avoid it.
''There's nothing wrong, shameful or dirty about being a fat person. Some of us just are. That's how we came into this world and we don't deserve to walk through our lives with shame sitting on our shoulders.
''Identifying as fat is about reclaiming something that is terribly shamed.''
Rick Kausman is equally careful in the language he uses, however, to him, far from being empowering, words such as ''fat'' and ''obese'' are counterproductive.
''There's good research showing people don't find the words 'fat' and 'obese' very helpful - they find them judgmental and pejorative,'' he says.
''Unfortunately, many health professionals will call someone 'obese' to their face.''
Kausman prefers to use the phrase ''above their most healthy weight''.