Lose weight? It's not what you think.

38% of adults and 17% of children in the United States meet the criteria for Obesity. 

​- Healthy People 2020

This week Angel Mathis is stepping in with a post about weight, putting on her hat as a health care provider, and trying to provide some advice about how to deal with a topic that's both important and complicated from both a health and outdoor perspective.

The topic of weight, body size, and the outdoors is something that storytellers at our events are talking about, and I want to talk about it too. But I don’t want to reinforce the common idea that to be an outdoor enthusiast you have to be a certain size or shape. I want to help make room for people who frequently don’t feel welcome in the outdoor community - and that includes people of size - to use Jenny Bruso’s term. But I also want to celebrate people's stories like Demetri Zouboukos in Episode 63 of the Boldly Went Podcast, where weight loss was a major part of the process in overcoming barriers to accomplishing adventure goals. So it's complicated. 

Weight is a topic that I’ve dealt with professionally for years, because I’m a healthcare provider by training - a nurse practitioner. I want to help people be healthy not just because I want them to be able to experience the outdoors (which I love), but because it’s my original vocation. There are plenty of great things about that, but my experience as a healthcare provider has also been an experience of what’s wrong about the way we approach weight.

​We health care providers are paid to make objective judgments about people's weight. And there's a basic system we follow to do it. If a person's BMI is higher than 25, 30, or 35, then we slap the label 'overweight', or 'obese', or (ugh, do I have to say it) 'morbidly obese' on their chart.

Then, after accurately 'diagnosing' the problem, our job is to get to work applying an intervention - which is medical jargon meaning to use the 30 seconds to 2 minutes you might have to "counsel" a person about how to lose weight. Of course there are many ways of providing counseling, some more effective than others, but the one that insurance companies pay you for is giving advice about a healthy diet and exercise.

The problem with this approach is that it's counterproductive, because:

1. It applies a label to a person.
2. The label induces shame.
3. Shame triggers the release of cortisol, especially in the most vulnerable subsets of the population.
4. Cortisol inhibits weight loss and increases the risk of chronic diseases like heart disease - undermining your goal as a healthcare provider to improve your patient's well-being.
5. The intervention is minimally effective. Whose life is changed dramatically by a 2 minute lecture about how they should eat a healthier diet? And who hasn’t heard that before?
6. Despite this, all of this is considered to be a minimum standard for providing excellent health care.
7. And my personal effectiveness as a health care provider is measured based on the numbers of people who I've applied the label to, and who I've provided counseling for. And insurance payment (i.e. my livelihood) may be tied to this process.

Maybe the biggest problem with this model is that weight is simply a much more complex issue than the diagnose and intervene process implies.

My public health training taught me that weight is so much more complicated than nutritious food choices and exercising heartily. If it weren't, then we wouldn’t see (for instance) a disproportionate number of higher BMIs in lower education groups, lower income groups, and minority groups, and adults born in the U.S. wouldn’t have a much higher likelihood of being fat (36%) than adults born outside of the U.S. (See Healthy People 2020).

In the real world, things are more complicated than fat = bad and thin = good. A healthy diet and exercise don’t produce the same size and shape results for everyone, and body size isn’t directly correlated with the decisions we make. It’s a reflection of the fact that most of us relate to weight in outdated ways. The idea that having a big body is a moral failing is so 20th Century, so can we stop now?

From the perspective of an informed health care provider, weight isn’t just about willpower. It’s about stress, shame, cortisol, and the environmental factors that lead to a person who feels a lower self worth.   

Another big issue with the way we tend to approach weight, as Demetri's story points out, is that “losing weight” isn’t the goal anyway. Living the life you want and being happy is the goal.

Demetri courageously shared a personal account of living in an environment that wasn't healthy for him, and talked about how he didn't even realize he had lost his fitness or ability to ski until he took a trip to Tahoe and despite being an experienced skier, couldn’t keep up with a friend who was learning for the first time. That experience eventually led him to move to the Tahoe area, where he has changed his lifestyle and is now regularly skiing with his new friends, who inspire him to be better and take on more difficult challenges. 

In the process he lost 200 pounds, but the weight wasn’t the point. The point was that he regained the ability to do something he loves, and even progressed beyond what he had thought was possible. Weight loss was a side effect.

This is a reason that I think his story is important, and why I want to celebrate it - it’s a story that involves losing 200 pounds, but that’s not what it’s about. It’s about figuring out how to do more of what you love. As a healthcare provider and an outdoor enthusiast, this is the point of talking about weight - helping people figure out how to deal with barriers to living the lives they want, and achieving things they thought were impossible. And I can identify with that, even though weight wasn’t the personal barrier I fought through in order to spend more time outside. It’s universal.

Lessons for people managing their weight.

Another reason I want to celebrate Demetri’s story (and those like them) is that I think it will be helpful for people who are trying to do amazing things, but feel like they’re out of reach because of weight or other physical issues. As a healthcare provider, for people who feel their weight is a barrier to living the life they want, I think there’s a lot to take from this beyond the standard “eat right and exercise more” advice that I can bill insurance companies to tell you. Here are some suggestions:

1. Let yourself not stress about your weight. Seriously. Don't mention it. Throw away the scales. If you go to a gym with a scale don't ever go back. Haha, ok, probably not that part, but definitely keep a 10 foot radius between you and that scale.
2. Don't read or endorse things promoting weightloss as the goal.
3. Focus on the goals that you care about - the things that you want to do and the things that will make you happy.
4. Demetri’s last point is that he set a goal of climbing all of California’s 14ers. Let yourself believe things that seem impossible are possible. Other people do it. You can do it!
5. Celebrate what your body has done for you! One of my favorite examples of this is when Katie Mullinax shared a story with us in Seattle about a first hike she went on. When reaching the top of a climb, she was thrilled and said, "Hey this fat body got me here." I love that statement. Here's a longer version of how to celebrate what your body can do regardless of size by VO2 Inspirational Athlete of 2017 by Melissa Kegler, a marathon swimmer who successfully swam the English Channel.
6. Following Demetri’s point about moving to Tahoe, don't be afraid to change your life situation - whether that’s your location, your job, or whatever. That's a super hard step but if you need some help, our friends Carly Wynn (also featured in Episode 63!) and Rob Zimmerman (episode 57), are both coaches whose lives center on outdoor adventure and who specialize in helping people create the life they want.
7. Minimize drugs and alcohol. (Note: If drugs or alcohol are interfering with your ability to go and do the things you like or want to do then that's a sign that you may need to seek professional help. If you aren't sure where to start, you can message me and I'll put my nurse practitioner hat on and help get you on the right path.)
8. And surround yourself with friends who support and inspire you! 
   
   

Lessons for the outdoor community.

When you start to dig into this stuff, and the factors that prevent people from enjoying the outdoors, you end up recognizing that just like healthcare providers need to think about the effectiveness of our interventions (or lack thereof), the outdoor community needs to think about the way our culture impacts the people in it. 

All of us need to be honest that a reason many people don’t pursue outdoor activities is because they don’t feel welcome, and that people who don't fit the mold in terms of body shape are frequently made to feel out of place.

I think we in the outdoors community need to think about our relationship with weight and our reaction to other people's weight and how those things can actually trigger shame and the cascade of events I talked about above. 

This article in Outside Magazine by Jenny Bruso, a "self-identified fat, femme, queer, writer" from Portland was really helpful for me in thinking about these kinds of issues. If you're what she calls a “straight-sized” outdoors person, the article provides a guide for mindful ways to share the trail with people who aren’t. Some key things I took away were that well-intentioned comments that are intended to be encouraging can actually come off as demeaning, and that it’s annoying that so many people seem to assume that large people outside are there with the goal of changing their shape. If people are outside, it’s probably because they love being outside.

Support the adventure and the person - don’t fixate on their weight. Who cares? (And anyway, there are plenty of daily reminders that people think weight is a problem. You don’t have to worry about communicating that.)

Support funding for conservation efforts and park land. It's so hard to have an impact on this at the individual level. Unfortunately funding for health care is way beyond the funding for getting people outside so it's an uphill battle, but prioritize keeping public lands public and accessible. This is fodder for a future post.

Conclusion: 

Life’s not about size or any other measure of what you look like. Definitely not life in the outdoor community. It’s about figuring out how to support each other in the goals we’re pursuing. The reason Demetri’s story is so universal is that we can all identify with overcoming barriers, and the point is to celebrate that he showed it’s possible. Size and shape is a thing that impacts your life, but it’s not the point. Focusing on weight loss or body shape as a requirement for entry to the outdoors is outdated and bad for everyone, and we can do better.

If you like what we're doing at Boldly Went and want to help make sure it keeps happening, consider supporting us on Patreon!

Become a Patron!