"Reach for a banana" -- Of course, if you are diabetic and limiting carbohydrates, a banana is a VERY poor snack choice. A snack for a diabetic should be about 15 g of carbohydrates, and an average-sized banana has 27 grams. A Mars Bar, in contrast, has . . . 27 grams!!! So in fact, reach for a Mars Bar OR a banana -- in terms of carbohydrate intake, it makes no difference.
I had the pleasure of this nonsense recently, when a doctor phoned me, told me she didn't know why she was phoning but she had a note to do so, then asked what my weight was, and proceeded, out of nowhere to tell me to eat only plain brown bread, lettuce, and grilled chicken or salmon as a treat.
Oh my gosh, and in other news, water is wet. Good grief. I'm really glad this was at least looked at, even if the study authors are hellbent on weight loss as a medical intervention. I worry they're going to find more creative ways to prescribe weight loss, and that companies like Novo Nordisk are going to sponsor even more CME's to keep weight loss in the back of doctors' minds.
also can I take a minute to address the absolute fuckery that is a doctor recommending gluten-free bread for weight loss? I have celiac disease and I was refused celiac testing when I requested it because "there's no way anyone your size has celiac disease," and then a couple years later I asked a new doctor for testing, and she ran one single blood test (not the recommended panel), it was right on the border of "we better do more tests," so she also just decided I couldn't possibly have celiac (and she was the most HAES-oriented doctor I'd ever seen). This delayed my actual diagnosis by several years, and cost me a lot of healthy years (and possibly permanent damage).
Meanwhile, there are doctors prescribing gluten-free diets as a form of weight loss? This causes harm in multiple ways! Not only is it garbage advice for weight loss, and not only might it encourage disordered eating in someone at risk for ED's, but it perpetuates the struggles people with Actual Celiac have with trying to exist in the world. If the advice is "switch to gf bread" or "bake with gf flour," now there's a doctor and a potential patient who think "yeah I can just avoid gluten sometimes and it's fine!" they go out to eat and get GF pizza with gluten beer and gluten dessert, and now the waitstaff and chef think it's okay to mix and match GF and gluten foods. Someone with actual celiac comes in and tries to stress how important it is that their pizza be GF, orders a GF beer, and skips dessert (because there's no GF option), and the waitstaff think the person with celiac is being dramatic or picky because they just served someone a gf pizza who didn't care about consuming other forms of gluten.
this is how we get restaurants that brag about their gf options but those gf options put celiacs in the hospital.
I digress.... basically, the gluten-free fad is dangerous as hell with doctors jumping on the bandwagon like this.
Thank you! As a diabetic, I get very exasperated with people (including way too many doctors) assuming that all fruits are always better choices than all "processed" snacks, under any circumstances. Some fruits make great snacks for diabetics (a small apple, a peach, blueberries) but bananas don't. I love bananas, and when I'm traveling I sometimes have a small banana and some almonds for breakfast--the protein in the almonds helps balance the carbohydrates in the banana, and I can have 40 g of carbohydrates per meal so the banana is fine. But not for a snack.
When my diabetes was diagnosed, I had several sessions with a trained nutritionist who helped me figure out what would work well for snacks and what wouldn't. She was very, very helpful, but as Ragen says, nutritionists have specific training in that area and far too many doctors don't. I was lucky that my PCP referred me to the nutritionist rather than just vaguely saying "watch your carbs."
Did you Ragen see the article The Economics of Thinness that just came out in the Economist? It talked a lot about fatphobia, quoting even Aubrey Gordon. The conclusion was rather sad, but expected. While the tolerance towards different races, sexual orientation etc. has increased by leaps in the past decades, the tolerance towards people with bigger bodies has gone backwards, with the attitudes being much more negative than they were in the 2000's or 1980's. Making matters worse is that the attitude towards bigger men is pretty much neutral - larger men make as much money as normal weight men, but for women the situation is so bad that being normal weight is the second most important thing a woman can do after getting a bachelor's degree if she wants to progress in her career/earn more money. This is something I've long suspected. Bigger men are treated as well as normal sized men, but bigger women are treated with so much hostility that they're almost pushed out of society. The article also mentions how trends like body acceptance has done nothing to reduce fatphobia, but instead has transferred the names of diets from things like Atkins to not eating sugar. I personally know many people who don't have celiac disease, but are nonetheless eating gluten-free. I myself have to be on a no-sugar diet, because I was diagnosed with fructose-induced non-alcoholic fatty liver disease, but find it strange how many other people I know who're now also avoiding all sugar. I can confirm the findings of lacking career progression, as I couldn't think of a single bigger woman who worked as a mid-level or higher executive in my line of work, but know a lot of thin women who're in that role.
No, I didn't feel attacked, but thanks for being concerned! I avoid "good" and "bad" food labels too, usually, and should have been more careful in the way I worded my original comment.
I completely agree about how terrible it is that taking insulin is surrounded with stigma; heck, I find that even taking Metformin gets stigma directed at it!!! I felt like a failure when I slid from "pre-diabetes" to "diabetes" -- I broke down in tears in my doctor's office and wailed "But I've tried SO HARD!!" She handed me a box of kleenex and said "You can't outrun genetics." But even knowing all I know about diet culture, I still genuinely thought I should be able to ward off diabetes if I just "tried hard enough."
The whole framing of diabetes as a moral issue is just madness, and so terribly harmful to so many people.
"It would remove the pressure for doctors to give weight loss advice that is not evidence-based and would allow doctors the opportunity to refer to practitioners for whom food and movement are areas of expertise."
What practitioners would you say actually are experts in the areas of food and movement? All I keep finding are people who are toxic with misinformation and prejudice against people in larger bodies. Thank you for all that you do, I'm learning so much valuable information from you
"Reach for a banana" -- Of course, if you are diabetic and limiting carbohydrates, a banana is a VERY poor snack choice. A snack for a diabetic should be about 15 g of carbohydrates, and an average-sized banana has 27 grams. A Mars Bar, in contrast, has . . . 27 grams!!! So in fact, reach for a Mars Bar OR a banana -- in terms of carbohydrate intake, it makes no difference.
I had the pleasure of this nonsense recently, when a doctor phoned me, told me she didn't know why she was phoning but she had a note to do so, then asked what my weight was, and proceeded, out of nowhere to tell me to eat only plain brown bread, lettuce, and grilled chicken or salmon as a treat.
Oh my gosh, and in other news, water is wet. Good grief. I'm really glad this was at least looked at, even if the study authors are hellbent on weight loss as a medical intervention. I worry they're going to find more creative ways to prescribe weight loss, and that companies like Novo Nordisk are going to sponsor even more CME's to keep weight loss in the back of doctors' minds.
also can I take a minute to address the absolute fuckery that is a doctor recommending gluten-free bread for weight loss? I have celiac disease and I was refused celiac testing when I requested it because "there's no way anyone your size has celiac disease," and then a couple years later I asked a new doctor for testing, and she ran one single blood test (not the recommended panel), it was right on the border of "we better do more tests," so she also just decided I couldn't possibly have celiac (and she was the most HAES-oriented doctor I'd ever seen). This delayed my actual diagnosis by several years, and cost me a lot of healthy years (and possibly permanent damage).
Meanwhile, there are doctors prescribing gluten-free diets as a form of weight loss? This causes harm in multiple ways! Not only is it garbage advice for weight loss, and not only might it encourage disordered eating in someone at risk for ED's, but it perpetuates the struggles people with Actual Celiac have with trying to exist in the world. If the advice is "switch to gf bread" or "bake with gf flour," now there's a doctor and a potential patient who think "yeah I can just avoid gluten sometimes and it's fine!" they go out to eat and get GF pizza with gluten beer and gluten dessert, and now the waitstaff and chef think it's okay to mix and match GF and gluten foods. Someone with actual celiac comes in and tries to stress how important it is that their pizza be GF, orders a GF beer, and skips dessert (because there's no GF option), and the waitstaff think the person with celiac is being dramatic or picky because they just served someone a gf pizza who didn't care about consuming other forms of gluten.
this is how we get restaurants that brag about their gf options but those gf options put celiacs in the hospital.
I digress.... basically, the gluten-free fad is dangerous as hell with doctors jumping on the bandwagon like this.
Thank you! As a diabetic, I get very exasperated with people (including way too many doctors) assuming that all fruits are always better choices than all "processed" snacks, under any circumstances. Some fruits make great snacks for diabetics (a small apple, a peach, blueberries) but bananas don't. I love bananas, and when I'm traveling I sometimes have a small banana and some almonds for breakfast--the protein in the almonds helps balance the carbohydrates in the banana, and I can have 40 g of carbohydrates per meal so the banana is fine. But not for a snack.
When my diabetes was diagnosed, I had several sessions with a trained nutritionist who helped me figure out what would work well for snacks and what wouldn't. She was very, very helpful, but as Ragen says, nutritionists have specific training in that area and far too many doctors don't. I was lucky that my PCP referred me to the nutritionist rather than just vaguely saying "watch your carbs."
Did you Ragen see the article The Economics of Thinness that just came out in the Economist? It talked a lot about fatphobia, quoting even Aubrey Gordon. The conclusion was rather sad, but expected. While the tolerance towards different races, sexual orientation etc. has increased by leaps in the past decades, the tolerance towards people with bigger bodies has gone backwards, with the attitudes being much more negative than they were in the 2000's or 1980's. Making matters worse is that the attitude towards bigger men is pretty much neutral - larger men make as much money as normal weight men, but for women the situation is so bad that being normal weight is the second most important thing a woman can do after getting a bachelor's degree if she wants to progress in her career/earn more money. This is something I've long suspected. Bigger men are treated as well as normal sized men, but bigger women are treated with so much hostility that they're almost pushed out of society. The article also mentions how trends like body acceptance has done nothing to reduce fatphobia, but instead has transferred the names of diets from things like Atkins to not eating sugar. I personally know many people who don't have celiac disease, but are nonetheless eating gluten-free. I myself have to be on a no-sugar diet, because I was diagnosed with fructose-induced non-alcoholic fatty liver disease, but find it strange how many other people I know who're now also avoiding all sugar. I can confirm the findings of lacking career progression, as I couldn't think of a single bigger woman who worked as a mid-level or higher executive in my line of work, but know a lot of thin women who're in that role.
Great article. Is there a link to the study?
No, I didn't feel attacked, but thanks for being concerned! I avoid "good" and "bad" food labels too, usually, and should have been more careful in the way I worded my original comment.
I completely agree about how terrible it is that taking insulin is surrounded with stigma; heck, I find that even taking Metformin gets stigma directed at it!!! I felt like a failure when I slid from "pre-diabetes" to "diabetes" -- I broke down in tears in my doctor's office and wailed "But I've tried SO HARD!!" She handed me a box of kleenex and said "You can't outrun genetics." But even knowing all I know about diet culture, I still genuinely thought I should be able to ward off diabetes if I just "tried hard enough."
The whole framing of diabetes as a moral issue is just madness, and so terribly harmful to so many people.
"It would remove the pressure for doctors to give weight loss advice that is not evidence-based and would allow doctors the opportunity to refer to practitioners for whom food and movement are areas of expertise."
What practitioners would you say actually are experts in the areas of food and movement? All I keep finding are people who are toxic with misinformation and prejudice against people in larger bodies. Thank you for all that you do, I'm learning so much valuable information from you