feckalyn: (Default)
[personal profile] feckalyn
A nursing journal article echoing the theories in the book Health at Every Size by Linda Bacon. It's a bit lengthy, but if you've struggled with your own weight or decided that fat people should just diet and exercise and shut up about it, this is for you!



Every semester, in nursing programs across the country, Health Promotion students write proposals to combat obesity. In an effort to address Healthy People 2010’s health goal of reducing obesity, they develop weight loss interventions in the schools, in the local health clinics, and in assisted living settings. These nursing students map out programs that measure body mass indices and teach participants about food quality and portion size. Their programs provide recipes for “healthier,” lower-calorie meals. They design support systems to help participants avoid unhealthy choices and stay on the straight and narrow. They spend significant amounts of time and energy trying to determine how to help participants “lose weight".
At the same time, in the same institutions, nursing students are taught that nursing is “holistic.” They learn that nursing rejects reductionism because nursing views a person as more than just a sum of his or her parts. Nursing students bask in the knowledge that their discipline values the human as a spiritual, emotional, and physical being. They may even write articles describing the connection between holism and homeostasis.
When applying the concept of holism to weight loss, perhaps a few of these students question the wisdom of using food deprivation as a means to control weight. It is possible that some of these students have been on and off diets for most of their adult lives, only to find that they weigh more now than they did before their first diet. Maybe some of them do not feel the joy of honoring physical, emotional, and spiritual needs when they are cutting back on calories and obsessing about food at least once every waking hour.

CASE STUDY I
Barbara is a 35-year-old mother of two, who has a successful homeopathic business. She freely admits that she avoids mirrors so that she does not have to see her “huge butt” that, she says, has grown disproportionately as she steadily gained 60+ pounds since pregnant with her 8-year-old. At 5' 10" she says she weighs about 220 lb. When talking to her about her relationship with weight and food throughout her life, she states she began to watch her weight at the age of 9. She recounts feeling “big” from early childhood, having inherited her father’s big bones. She always marveled at her petite mother who was able to stay a size 6 her whole life, skimping and going without. She knows her mom was always worried about her daughter’s weight and started cutting back on Barbara’s portions when she was 9. Although “watching her weight,” Barbara thought of herself as “chubby” until she got married, losing and gaining the same 15 lb over and over again. She was able to lose 40 lb before her wedding so she could fit into a size 10 dress, but when she got pregnant a year later, she had already regained almost all the weight lost, and with the pregnancy, she says the pounds just “flew on.”
She finds herself thinking about shopping for food, preparing food, or eating food all the time. At the same time she “beats herself up” every time she has one of these thoughts. Her eating behavior reveals that she ate cereal for breakfast “I wasn’t really that hungry,” but couldn’t make it to lunch (seven hours later) so she ate a banana and a handful of nuts. At lunch she only had a bowl of soup because “I wasn’t that hungry and I felt guilty for eating a snack.” She skipped dinner in an effort to keep her calories down, but “ate basically nonstop” from 8:30 PM until she went to bed at 11:00 PM.
Barbara despairs over her “lack of discipline” and wishes she could be as successful as her mom is in controlling her weight but worries that she is destined to continue “packing on the weight.” She knows she is missing out on much of her life because of her obsession with food and her feelings of failure.
Barbara has been using restraint and deprivation to control her weight for the last 24 years. It has resulted in a steady climb to obesity and serious emotional and spiritual distress. Barbara is not alone; over 70% of American women have dieted in the last 4 years.1 Why are so many women dieting with seemingly no success? To answer this question, it might be helpful to look at the belief in an overly simplistic formula that encourages deprivation. A reductionist view of weight control derives body weight by measuring calories in minus calories out. Reductionism views an organism as separate individual parts. This is not a holistic view and has a damaging effect on Americans’ somas and psyches.
Homeostasis leads to an understanding of weight that is holistic.2 As more of the homeostatic mechanisms of weight control are understood, the clearer it becomes that weight cannot be reduced to the simplistic formula, calories in minus calories out.1,3 Restraint-based weight loss strategies also cannot be holistic by definition because they disrupt homeostasis. Restraint includes a spectrum of eating behaviors from “counting calories” to anorexia. Furthermore, because of the disruption in homeostasis, deprivation-based weight loss strategies are doomed for failure, and in some part to blame for the obesity epidemic. The objective of this article is to present the argument that intuitive eating, or, in other words, tuning into body-based cues of “hunger” to guide us when to eat, and “fullness” to guide us as to how much to eat is a holistic and effective way to achieving a healthy weight. To support this objective, it will show that:
1. holistic care requires support of homeostatic processes;
2. weight homeostasis is resistant to interventions aimed at decreasing energy stores;
3. restrained and deprived eating behaviors disrupt homeostasis;
4. deprivation does not lead to healthy weight;
5. deprivation and restraint are damaging physiologically and psychologically; and
6. nursing care is most holistic and effective when size acceptance is promoted and intuitive eating is encouraged.

HOMEOSTASIS IS A CORNERSTONE OF HOLISTIC CARE
Homeostasis is derived from the Greek words “homeo,” meaning same and “stasis” meaning “to remain.”4 Homeostasis involves all those activities that help maintain a stable internal milieu despite internal and external challenges.5 In weight control, there are primarily internal challenges to maintaining homeostasis. As macro and micro nutrients are used, they must be replaced. There are many internal forces that may change the rate at which these resources are used. Fever and hormonal increases are just 2 examples. While not as common, external challenges of heat or cold weather could increase the need for energy as well. From a holistic perspective, “best health” can be achieved only when homeostasis is maintained.2
Weight homeostasis involves a dynamic interaction between hormones, proteins, and neurotransmitters from the gut, liver, brain, and fat cells. The human body is not a simple container of calories that can be added and subtracted. With internal changes in energy, a multitude of biochemical changes occur. Each biochemical communicates and influences other proteins and hormones. Caloric changes bring about extremely complex physiologic responses.6–9
Besides energy homeostasis, blood volume, body temperature, acid-base balance, and blood glucose are just some of the other conditions under homeostatic control.10 If Barbara were extremely cold, as holistic nurses or practitioners, we would give her warm blankets. We would do this with the understanding that these would be comforting physically and reassuring psychologically. Barbara no doubt feels distress when hungry, but because she “feels fat” she will continue to go hungry. In homeostatic terms she is meeting decreased energy stores with even greater decreases. It would be analogous to putting ice packs on someone who was shivering. The best health occurs when homeostatic signals are honored. By encouraging “eating when hungry” holistic nursing facilitates internal well-being. To quote our holistic founder, Florence Nightingale, nursing’s aims are “To put the patient in the best condition for nature to act upon him.”11

“YOU CANNOT FOOL MOTHER NATURE”
What we know about appetite regulation has increased dramatically in the last 20 years. Interestingly, it is the search for a “diet pill” that has spurred a majority of this research.12 Early on it was assumed that there were peripheral hunger and fullness signals that sent information to the hypothalamus.13 Recently, enough of these biochemicals were identified to understand some of the intricacies of weight homeostasis.6,14 Ghrelin was identified as a primary orexigenic or “hunger” hormone.15 Produced in the gut, it sends hunger signals to the hypothalamus.16 The hypothalamus then sends powerful hunger signals into bloodstream.17 A significant amount of research went into finding out how to decrease ghrelin levels and therefore decrease weight.6,16 One discovery was that ghrelin levels were low in patients who had had gastric bypass.18 Apparently in removing part of the gut, the cells that produced ghrelin were also removed. However, another discovery was that ghrelin was more than just a hunger stimulator. Ghrelin helps people sleep more deeply and improves cardiac health.19,20 Because ghrelin promotes restorative sleep and cardiac function, the negative effects of reducing ghrelin may outweigh the positive effects of reduced weight.21
Other studies focused on leptin, an anorexigenic hormone. Leptin is produced by adipose tissue. Leptin levels increase with extra fat cells and decrease when weight is lost. Scientists tried making the body think there was excess fat by injecting subjects with leptin. Leptin suppresses appetite in part by decreasing orexigenic levels of hunger hormones like ghrelin.22 Unfortunately, simply increasing leptin levels does not lead to sustained weight loss because individuals develop resistance to leptin. This finding has led researchers to conclude that leptin exists to prevent starvation, not to lose weight.14,23 This finding also underscores the complexity of weight homeostasis and supports the adage, “you cannot fool mother nature.”

RESTRAINT DISRUPTS HOMEOSTASIS
An important finding in the fullness and hunger hormone studies was that leptin and ghrelin presumably helped keep lean subjects lean. Those who ignored hunger and fullness cues became resistant to leptin.9,24 Ignoring hunger cues is a feature of restrained eating, and restrained eating may be responsible for both undereating and overeating.25–27 Whether causal or coincidental, restrained eaters also have higher levels of ghrelin than their unrestrained counterparts.28
Barbara thought she had a “lack of discipline” when she ate continuously from 8:30 PM to 11:00 PM.
It is more likely that she was responding to an overwhelming cascade of hunger chemicals. Her late-night eating marathon was similar to gasping for breath after swimming under water the length of a pool. Her ability to exert cognitive control over eating probably resulted in her eating less than 600 kcal worth of food over a 21-hour period. Because over 80% of the day she ate less than 20% of needed calories—she was essentially on starvation rations. To her body, this was like swimming underwater the length of an Olympic-sized pool. Cognitive control can only last so long before homeostatic forces become so strong that they are irresistible.
While health policy makers do not recommend severe calorie restriction, the advice still remains to “make healthy choices.”29,30 Although this advice may seem healthful, if the individual believes he or she should lose weight, this advice usually results in “dieting” behavior. Because Barbara sees herself as fat, making healthy choices turn into “I can’t eat if I want my fat to go away.” If the goal is to lose weight, it is easy for the client to conclude that eating less is better. Believing this, they end up going hungry or not getting full enough. Her central nervous system gets bombarded with signals of energy depletion and responds with a “May Day” cascade of chemicals to stop fat loss. In simple terms, not eating when hungry disrupts homeostasis.

DIETING MAY ACTUALLY LEAD TO OBESITY

Overriding hunger may be partly responsible for the failure of dieting to lead to sustained weight loss. As holistic beings, our minds and bodies are connected. Perhaps the human psyche, like the body, senses a disturbance of homeostasis. For a psyche that is under restraint, eventually “disinhibition” takes over. Once restraint is lifted, overeating and binging begins.31 In fact, when restrained eaters are compared with unrestrained eaters, the most likely group to eat unhealthy food are the restrained eaters deprived of the forbidden food.27 This psychological phenomenon of disinhibition also helps explain the “dieting paradox.”
The fact that more people are dieting in the United States than ever before, while simultaneously more people are overweight than ever before has created a “dieting paradox.”32,33 There is a growing consensus that restraint leads to weight gain.34,35 Whether it is the psyche resisting “can’t” or the body flooding the system with hunger hormones, weight gain appears to continue for years after severe dieting.36,37
While there are plenty of studies showing diets work in the short term,38,39 these losses are generally not sustained.40–42 Some researchers have suggested that the only question is how fast the weight will return, not whether the weight will return.43 Several long-term studies looking at the effects of “diet only” found follow-up weights significantly higher than rediet weights.44 Based on long-term, controlled studies, dieting becomes a major risk factor for future weight gain.34,36,45

DIETING HARMS BODY, MIND, AND SPIRIT
Going hungry causes physiologic damage in at least 1 of 2 ways. It can cause homeostatic disruption leading to weight gain. Dieting may also actually damage body chemicals, tissues, and organs. As mentioned earlier, hunger floods the system with chemicals bent on preventing starvation. going hungry causes an increase in ghrelin, an increase in brain hunger chemicals, probable leptin resistance, and metabolism to slow down.24,28,46–48 All of these changes have been implicated in overweight and obesity.7,9
Damage to the body also occurs because the chemicals released to prevent starvation can harm cells. Fasting can cause inflammation of liver cells.12 It also lowers blood glucose levels enough to cause overgrowth of Helicobacter pylori in the gut.49 This, in turn, is a risk factor for gastric cancer.50,51 Also, decreasing carbohydrates in favor of proteins as a weight-control strategy may also lead to negative health effects including osteoporosis, renal damage, hypertension, decreased aerobic capacity, and heart arrhythmias.52
Reasons for psychological and emotional harm are also varied. Like physiologic distress, emotional distress can result from a disruption in homeostasis. For example, in hospitalized adult, neonatal, and animal literatures, hunger is seen as a distressor.53–55 There is a consensus among researchers of these populations that disruptors of homeostasis are distressing to the organism.56 The list of disruptors includes pain, thirst, hypothermia, and hunger. One study found that infants cry more intensely when hungry than when in pain.54 Unfortunately, there appear to be few studies of healthy adults that address the connection between hunger and emotional distress. However, the fact that fasting is often followed by feasting, splurging, or binging would argue that going hungry is more unpleasant than the negative physical and emotional consequences that occur by overeating.
Recent studies show that chronic dieters are emotionally distressed. Some of the reasons stem from feelings of shame and guilt that arise when they are unable to sustain dieting or weight loss.57–59 Feelings of failure and hopelessness abound in the life of the overweight client who has often lost significant amounts of weight throughout his or her life but who may ultimately lose the battle to the powerful forces of homeostasis bent on preventing starvation.60
For example, Barbara felt “completely devastated” every time she “gave in” to hunger. The emotions most devastating to her were feelings of powerlessness, hopelessness, shame, and worthlessness whenever she would overeat after going hungry for many hours. In her case, starving and splurging took a large toll on the psyche.

INTUITIVE EATING IS A HOLISTIC ALTERNATIVE TO DIETING
The holistic alternative to dieting and restrictive eating advice is to promote health at any size and encourage eating that is motivated by internal cues. If the goal is to eat when hungry, then size acceptance is critical.61,62 As previously discussed, homeostasis explained how restrained eating increased hunger hormones and led to disinhibition. A vicious circle is created when weight loss remains a goal. If an individual wants to get thinner, his or her default belief system says “eat less.” This restraint, in turn, sabotages weight loss. On the other hand, people who naturally eat intuitively are slimmer than those who diet.57,62
The goal of intuitive eating is to master the process, not focus on the outcome of weight loss.63 For example, babies are completely focused on the process of eating and have no interest in the outcome. Ideally, if they are hungry, they cry until they are fed and they will eat until satisfied. In order for adults to eat intuitively, a variety of healthy and delicious food must be available when ideal hunger sets in. Adults must allow themselves to eat until they are satisfied but not stuffed. For long-term dieters who have inured themselves to hunger, this simple advice is very difficult to follow. They may not even be aware of what ideal hunger feels like. It may take time and practice to reconnect with those bodily sensations.
For Barbara, this intuitive approach to eating was very difficult. For most of her life, hunger was the “enemy.” She filled her schedule with many activities that would distract her from hunger and allow her to go without eating for as long as possible. She found it extremely difficult to tune into the bodily sensation of hunger. Sometimes she would not even know she was hungry until she was sitting in the parking lot of McDonald’s wolfing down a Big Mac and a super-sized order of fries. It was especially difficult for her to make sure she had meals available 5 or so hours after the last time she ate. In the beginning, she would make excuses for why she had only almonds on hand or a banana. “I was in my clinic,” “I was driving my son to soccer practice.” It took a number of sessions before she realized that she had created a lifestyle that promoted chaotic eating. Once she committed to eating delicious, healthful, and satisfying meals on a regular basis, she admitted being surprised that she actually ate less in a 24-hour period than when she was “trying to lose weight.”
Intuitive eating is holistic because it promotes the greatest degree of physical and psychological well-being. The goal of intuitive eating is to help the individual regain trust in the ability to recognize how much food the body actually needs.64,65 Physically basing when and how much to eat on internal cues avoids many problems that occur when homeostasis is disrupted. Intuitive eaters, therefore, are likely to maintain a healthy weight over time and with precision.13
Psychologically, it is satisfying to be able to honor the internal cues of hunger and satiety.59 Much like it is psychologically satisfying to drink water when thirsty, get warm when cold, or breathe after diving 25 ft to the ocean floor. Unlike the negative recommendations of restrictive eating, the primary goal of intuitive eating is positive, “eat when hungry until completely satisfied.” This positive dictate makes meeting a basic physiologic need a purely positive experience. Trust in a homeostatic process leads to a relationship with food that is free of hunger, fear, and guilt. The positive recommendation to honor hunger and satiety cues is perceived by the mind, body, and spirit as supportive and nurturing. It allows for a full enjoyment of food and connects us to the spiritually satisfying world of life’s simple pleasures.57
Barbara could not believe how much her spirit had suffered while she was punishing her body. She thought she was “so evolved” but realized that by wanting to lose weight she was inadvertently making her body feel like it was “fighting to survive.” “It’s hard to be spiritual when you’re so obsessed and miserable.”

HOLISTIC EATING: SIMPLE BUT NOT EASY
For many people who have responded to the internal cues of hunger and fullness since birth, eating intuitively is easy. Eating when hungry until completely satisfied is something that almost all mammals are wired to do from birth.13 For humans who have veered from intuitive eating, by dieting or using food for emotional reasons, it may be simple, but it is not easy.

CASE STUDY II
Doreen came from a long line of body controllers. Both her mother and grandmother dieted on and off their whole lives. Doreen’s grandmother stayed more or less a size 8, while her mother was a yo-yo dieter. At times her mother was so wildly successful that she modeled lingerie. At other times, she was so big she had to buy clothes from Plus Size catalogs. Doreen “never knew when we were eating” as kids (perhaps Doreen’s mother suffered from the same chaotic dieting strategy employed by Barbara). At the age of 13, Doreen started believing she should not eat much if she wanted to stay slim, and began controlling her weight. Using exercise and never quite allowing herself to get full, she was able to stay a size 6 or 8 for more than 30 years. What she could not understand then and still cannot understand now was why she ate half of what her best friend ate and weighed the same.
Then, at the age of 38, a back injury forced her to stop exercising for a while, and the pounds crept on. Completely “freaked out” she became even more rigid with her eating, and joined Food Addicts Anonymous, a group that forbade more than 4 oz of meat 3 times a day, and 6 portions of vegetables daily. She was able to lose 20 lb but it seemed “impossible” to resume her previous size 6. Completely frustrated, she turns to an intuitive eating program.
Doreen is attracted to the program for a couple of reasons. First, she states she is “sick of strategizing.” She admits she would not be able to name a single day over the last 30+ years she was not thinking about how to eat as little as possible without feeling hungry. She is “so through with that.” Second, she believes herself to be very spiritual and feels that a process that “honors the body instead of punishing it,” is more in tune with her sensibilities.
For the first 2 weeks she is very diligent about tracking her food, she writes down how long after waking she eats, how hungry she is when she does eat, and how full she gets. She notices these same things for each snack and meal. What strikes the evaluator is that Doreen is eating 6 or 7 times a day. She begins breakfast, goes to a Pilates class, and finishes her breakfast an hour and half later. She agrees that she is eating about the same number of times a day as when she was on the severe food restriction of Food Addicts Anonymous. However, now this grazing behavior has taken her from deprivation to surplus. She recognizes she is not eating intuitively. She never feels hungry and always feels slightly full.
Intuitive eating requires that she be “ideally” hungry when she eats. Eating 6 or more meals a day prevents her from ever getting ideally hungry. Now that the meals have increased in calories, she hovers over “kind of full” instead of “not at all full.” Her old strategy is hard to break. The taboo of ideal fullness is not completely gone. To get her to eat more intuitively, she is asked to do something that “completely wigs [her] out.” She is asked to eat until she is ideally full. It is hard to allow herself to get full when she knows she is already eating an excess amount of food. Through one of the sessions, she comes to understand that it is her old beliefs and fears that are spurring her to eat excess food. One belief is that if she wants to be slim, she should never get full. Her other fear is of getting hungry. These “dieting” thoughts are keeping her in “Surplus Grazing” behavior.
Four weeks into the program she had actually gained a few pounds. At week 5, Doreen is “getting panicky.” Because her mother had “lost the weight battle,” ballooning to a size 18, at the same time she was diagnosed with cardiomyopathy. While her mother’s rapidly fatal version had nothing to do with obesity, these 2 events became linked in Doreen’s mind. She sees her mother’s excess flesh as the cause of her death. She says she knows there is not necessarily a correlation, but she just cannot shake the dread that comes with extra pounds. While Doreen recognizes that she had been a “body punisher” and acknowledges the spiritual superiority of intuitive eating, she often starts her sessions “pleading” for permission to start dieting again. She will state, “I just don’t feel comfortable this heavy,” or “It’s not about looks, I just don’t like the feeling of my thighs rubbing together.” When asked, what she would like to do to “solve” this problem, she just sighs. Seven weeks into the program, she starts eating like a vegan and actually loses 3 pounds over a 10-day period. While she is cautioned that deprivation can lead to rebound weight gain and then some, at the beginning of this dietary change, she states that she “just feels charmed to it.”
By week 10 she has given up eating like a vegan and is noticing her appetite is “huge.” Two weeks after her vegan experiment, she has gained back the 3 lb she lost and an extra 6. She now weighs about 12 lb more than when she started. She complains that her clothes do not fit, “not even my ‘big’ ones” but she cannot go shopping. The last trip to the mall had her in tears for the rest of the day. When queried about what makes her sad, she says looking at herself in the mirror, wearing clothes that used to look good, all she sees is her fat and she is afraid she is “going to die alone.” At the same time she says this she realizes intellectually that her size probably has nothing to do with finding lasting love, as she married and divorced 2 husbands at a size 6.
At this time she also begins to discuss her unpleasant feelings at family gatherings that began when she hit puberty. She remembers feeling simultaneously ashamed and pleased at an uncle’s unnatural attention. She was the recipient of some substantial gifts from this well-off uncle, which contributed to her confusion. When her body was “attractive” she felt a certain power, and she notices how this parallels her mother’s experience. When her mother was heavy, she could barely make ends meet, but when she was smaller, she modeled lingerie allowing her to make her own money and attract wealthy boyfriends. Doreen begins to see how her desire for power might drive her to deprive herself, while her desire for safety drives her to overeat.
By week 16 Doreen is “close to” giving up the outcome of “being attractive.” She is close to turning her food intake over to her body. She has found that when she eats a substantial breakfast (all at once), she does not get hungry for more than 5 hours. She notices she is eating 3 meals and 1 snack a day. Doreen still worries that her years of deprivation may have “permanently ruined” her, but she has moved to a spiritual conclusion that maybe her weight is there to teach her something. She is focusing on spiritual and emotional intimacy, before becoming physically intimate, a behavior that makes her feel safe and comfortable. She has purchased the makings of a new wardrobe, including clothes that she thinks are “cute.”
By week 20, Doreen is consistently eating 3 and a half meals a day. She believes she is eating only when ideally hungry and stopping when ideally full. She says she is closer than ever to finally “taking the need to control” her eating “off the table.” She does Pilates 6–7 times a week and feels strong and fit.

IMPLICATIONS FOR HOLISTIC PRACTICE
Struggling with weight is often a profoundly difficult, terrifying, humiliating, and frustrating activity for many people in the United States and around the world. When beliefs about weight and worth steer an individual off his or her intuitive approach to eating, the holistic, homeopathic guides that maintain healthy weight are disrupted. As holistic practitioners, we need to support homeostatic processes. We need to understand that dieting and controlling food intake may actually lead to greater weight gain because the human body appears “programmed” to prevent starvation. In other words, homeostatic mechanisms counter weight loss with antistarvation responses, including increased hunger, and decreased metabolism.16 Finally, as holistic nurses and practitioners, we need to understand the harm that fighting natural forces might have on an individual’s mind, body, and spirit.
Hopefully in the future, nursing students will integrate their holistic tradition with healthy goals and design programs that encourage their patients to “Eat for Hunger.”65 Twenty-four-hour recalls can help both nurse and client/patient understand how hungry the client was when he or she ate, and how full he or she got when they finished eating. Focusing on health outcomes versus weight outcomes will be healthy and reassuring. Perhaps these students will explore their patients’ beliefs about their weight and how it relates to worthiness, nurturance, and safety. Clients should be counseled to have a variety of healthy and delicious food available whenever they get hungry. Linking clients to vital lay resources can also be immensely helpful.66–68
Maybe many years from now we will wonder how we could, as holistic advocates, have embraced restraint over a physiologic need as an approach to health and weight. Maybe part of the answer is that we have been influenced by the simplicity of “lifestyle” changes. Maybe shoddy evidence misled us to believe that deprivation could lead to a “healthy weight.”Whatever the reason for advocating conscious control over promoting homeostasis, concern for body, mind, and spirit should urge us to promote intuitive eating. Whether we are nurse educators who are training tomorrow’s holistic practitioners, nurse administrators, or patient educators, we have a role in sharing a holistic perspective on weight. By focusing on fitness, saying “yes” to hunger, and promoting well-being of the body, mind, and spirit, one by one, healing can occur.

References available upon request

Date: 2010-03-05 01:38 am (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
It's unfortunate that one must resort to "spiritual damage" because psychological and physiological impacts are not sinister enough.

Date: 2010-03-05 01:57 am (UTC)
From: [identity profile] feckalyn.livejournal.com
It is a journal focusing on holism...

But yeah, I didn't really like that part either.

Date: 2010-03-05 02:04 am (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
I love that nurses tend to be more interested in patient care. I hate that they tend to be so prone to such fluff.

Date: 2010-03-05 02:17 am (UTC)
From: [identity profile] feckalyn.livejournal.com
Well, I don't think the article is that 'fluffy' overall. And HAES isn't fluff; it's well scientifically backed up.
And I haven't met many nurses who buy into fluff over science (I've met a bunch who don't give a shit about anything though...)

Date: 2010-03-05 02:18 am (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
Not HAES, being fluff, but other things.

Date: 2010-03-05 02:24 am (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
Spiritualism, prayer, herbals, I've had more nurses recommend chiropractic than anyone else I've met... ordinary stuff, really, to anyone but me. I generally just ignore it, but it makes it hard to know when to trust them about stuff I don't know enough about.

Date: 2010-03-05 02:32 am (UTC)
From: [identity profile] feckalyn.livejournal.com
Interesting. That has not been my experience with nurses (as a nurse or a patient) at all.

Date: 2010-03-05 02:47 am (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
I live in the Bible Belt. I'm sure it's peculiar to my experience.

Date: 2010-03-05 03:59 am (UTC)
From: [identity profile] feckalyn.livejournal.com
I live on the fringe of said Belt these days myself. I've seen more "You should just pray and then you won't be depressed anymore!" type sentiment than woo. Both have the potential to suck, IMO.

Date: 2010-03-05 02:29 pm (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
Yeah. It's so stupid. But, I guess I consider prayer suggestions to be woo when given in a medical environment.

Date: 2010-03-05 06:14 pm (UTC)
From: [identity profile] auntysocial.livejournal.com
What do you mean? I wouldn't put chiropractic in the same category as prayer.

Date: 2010-03-05 06:17 pm (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
You're right. Prayer won't cause strokes.

But I don't want to hear either suggestion from a medical professional.

Date: 2010-03-06 02:47 am (UTC)
From: [identity profile] auntysocial.livejournal.com
I was waiting around for my HMO doctor to take an interest in my back pain when I found a chiropractor. By the time the HMO doctor got around to noticing my complaints, I was already getting good results from chiropractic. It didn't give me a stroke. Neither did I have to live with side effects of prescribed drugs. Unfortunately, when my chiropractor moved to another city, I didn't find another I liked as well. The indifference of my medical doctor to my back pain broke my trust in the medical system. While I consult an MD for other conditions, I've never even mentioned the upper back pain that plagued me years ago.

I'm sure it's unprofessional for a nurse to suggest chiropractic, but its nice for a patient to have some hope.

Date: 2010-03-06 02:51 am (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
I'm sorry you had a bad doctor.

Date: 2010-03-06 06:33 pm (UTC)
From: [identity profile] auntysocial.livejournal.com
It may have been my HMO rather than my doctor that was poor. They were geared toward efficiency, not patient care. They thought your treatment was successful when you stopped complaining rather than when you felt better. They made it so hard to see a doctor, that you stopped complaining rather quickly. I paid my chiropractor out of pocket, not through insurance. Just what the insurance company wanted.

Date: 2010-03-06 04:02 am (UTC)
From: [identity profile] feckalyn.livejournal.com
I have my personal doubts about Chiropractors (because I saw one who had anti-vax stuff in his office, gave me no relief from the pain I was experiencing after weeks of visits, AND tried to defraud my insurance with double billing). I wouldn't refer a patient to see one because I think many of them are 'snake oil salesmen' and it's hard to know which ones are reputable but I wouldn't argue with someone who was seeing one and getting relief.

I think patients can get hope from a variety of different places that nurses may not routinely recommend. It's a challenge to know what to do for each patient in each situation but I hope that more medical professionals make more of an effort so you (and people like you) don't feel ignored :/

Date: 2010-03-06 06:28 pm (UTC)
From: [identity profile] auntysocial.livejournal.com
Wow, my chiropractor was just the opposite of yours. She had a great social conscience as well as a personal conscience. She was not connected with an insurance company. She kept her fees low so people could afford treatment. It was only $15 back in the early 1980's. She didn't let you out of her office until you felt at least a little better.

Date: 2010-03-05 06:16 pm (UTC)
From: [identity profile] auntysocial.livejournal.com
Hooray for Linda Bacon!

Date: 2010-03-05 07:02 pm (UTC)
From: [identity profile] feckalyn.livejournal.com
Did you know about her from before HAES?

Date: 2010-03-06 02:49 am (UTC)
From: [identity profile] auntysocial.livejournal.com
I don't know how long I've known about her. I've met her at NAAFA conferences, before her book was published.

Date: 2010-03-06 03:51 am (UTC)
From: [identity profile] feckalyn.livejournal.com
Is she a pleasant person to talk to?

Date: 2010-03-06 07:05 pm (UTC)
From: [identity profile] auntysocial.livejournal.com
I didn't actually converse with her, just attended a workshop she led. At a NAAFA conference, she stands out as being very small. She gave a keynote speech at another conference which I didn't attend, where she talked about the difference her own size makes in her credibility. She talked about the discrimination faced by nutritionists of size.

Date: 2010-03-06 07:30 pm (UTC)
From: [identity profile] feckalyn.livejournal.com
I would think she'd be embraced for her outstanding work in furthering fat acceptance irrelevant of her size :(

Was she presenting as if she'd personally experienced fat discrimination?

Date: 2010-03-07 05:01 pm (UTC)
From: [identity profile] auntysocial.livejournal.com
She is! and no, she wasn't presenting as if she had experienced discrimination. On the contrary, she was talking about how she found herself taken more seriously because she isn't fat. She was talking about the struggles of a fat colleague, who didn't get a promotion probably because of her weight.

The funny thing about NAAFA conferences is how the eyes get used to seeing fat people in the majority. That makes the thin ones stand out. It's quite an experience!

Date: 2010-03-08 12:21 am (UTC)
From: [identity profile] feckalyn.livejournal.com
I'd love to attend some NAAFA functions :)

Date: 2010-03-09 01:16 am (UTC)
From: [identity profile] auntysocial.livejournal.com
There's a conference this summer in the San Francisco Bay Area. I wish I could go, but I've run out of money.

Date: 2010-03-05 08:42 pm (UTC)
From: [identity profile] kuh.livejournal.com
Wooo this is a long one. Note to self to come back and read when not at work :)

Date: 2010-03-05 08:46 pm (UTC)
From: [identity profile] feckalyn.livejournal.com
It's got some good stuff. At least serious skim-worthy IMO :)

Profile

feckalyn: (Default)
feckalyn

April 2017

S M T W T F S
      1
2345678
9101112 131415
16171819202122
23242526272829
30      

Style Credit

Expand Cut Tags

No cut tags
Page generated Jul. 25th, 2017 08:46 am
Powered by Dreamwidth Studios