Pub. 7 2023 Issue 2

are immediately perceived as an indictment of themselves. The worse outcomes for people of heavier size almost disappear when correcting for microaggressions and social determinants of health.31,32,34-40 Health is not a function of your size. Hypertension is a disease. Diabetes is a disease. Anorexia is a disease whose risk of mortality is based on the degree of disordered behaviors, not weight. Medical training and the healthcare community have taught us that being at a higher weight is a disease. Let’s recognize that last statement as being part of the 50% that gets later proven wrong. Let’s treat our patients as people deserving of care, no matter what their demographics. Sara is a HAES-aligned family- and sports-medicine physician who practices at her clinic, The PEAAC, in Millcreek, UT. She specializes in treating people with eating disorders and performing artists/athletes/ musicians. She serves as a Team U.S.A. doctor for U.S. Figure Skating, U.S.A. Gymnastics and U.S.A. Archery. You can reach Sara at sara@thepeaac.com or www.thepeaac.com. References 1. Nuttall FQ. “Body Mass Index: Obesity, BMI, and Health: A Critical Review.” Nutr Today. 2015. 50(3): 117-128. 2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). 2013. 3. Harrop EN, Hutcheson R, Harner V, Mensinger JL, Lindhorst T. “’You Don’t Look Anorexic’: Atypical anorexia patient experiences of weight stigma in medical care.” 2023. 46: 48-61. 4. National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report, 1998. 5. Andres R. “Beautiful Hypotheses and Ugly Facts: The BMI-Mortality Association.” Obes Res. 1999. 7(4): 417-19. 6. Troiano RP et al. “The Relationship between Body Weight and Mortality: A Quantitative Analysis of Combined Information.” Int J Obes Relat Metab Disord. 1996. 20: 63-75. 7. Ernsberger P, Koletsky RJ. “Weight Cycling.” JAMA. 1995. 273(13): 998-99. 8. National Institutes of Health National Task Force on the Prevention and Treatment of Obesity. “Long-Term Pharmacotherapy in the Management of Obesity.” JAMA. 1996. 276(23): 1907-15. 9. Pasarica M et al. “Human Adenovirus Ad-36 Induces Adiposity, Increases Insulin Sensitivity, and Alters Hypothalamic Monoamines in Rats.” Obesity (Silver Spring). 2006. 14(11): 1905-13. 10. Dhurandhar NV et al. “Human Adenovirus Ad-36 Promotes Weight Gain in Male Rhesus and Marmoset Monkeys.” J Nutr. 2002. 10: 3155-60. 11. Mokdad AH et al. “Actual Causes of Death in the United States, 2000.” JAMA. 2004. 291: 1238-45. 12. Flegal KM et al. “Excess Deaths Associated with Underweight, Overweight, and Obesity.” JAMA. 2005. 293(15): 1861-67. 13. Wooley S, Wooley OW. “Should Obesity Be Treated At All?” Eating and Its Disorders, eds. Stunkard AJ, Stellar, EJ. New York: Raven, 1984. 14. Garrow, JS. Energy Balance and Obesity in Man. New York: Elsevier, 1974. 15. Braitman LE, Adlin EV, Stanton, Jr JL. “Obesity and Caloric Intake: The National Health and Nutrition Examination Survey of 1971-1975 (HANES 1).” J Chronic Dis. 1985. 38(9): 727-32. 16. National Resource Council (National Academy of Sciences). “Diet and Health: Implications for Reducing Chronic Disease.” Ed. Committee of Diet and Health (Food and Nutrition Board/Commission on Life Sciences): National Academy Press, 1999. 17. Coakley EH et al. “Predictors of Weight Change in Men: Results from the Health Professionals Follow-Up Study.” Int J Obes Relat Metab Disord. 1998. 22: 89-96. 18. Bild DE et al. “Correlates and Predictors of Weight Loss in Young Adults: The CARDIA study.” Int J Obes Rel Metab Dis. 1996. 20(1): 47-55. 19. French SA et al. “Predictors of weight change over two years among a population of working adults: The Healthy Worker Project.” Int J Obes Relat Metab Disord. 1994. 18: 145-54. 20. Korkeila M et al. “Weight-loss attempts and risk of major weight gain.” Am J Clin Nutr. 1999. 70: 965-73. 21. Stice E et al. “Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents.” J Consult Clin Psych. 1999. 67: 967-74. 22. Shunk JA, Birch LL. “Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years.” J Am Diet Assoc. 2004. 104(7): 1120‑26. 23. Stice E, Presnell K, Shaw H. “Psychological and Behavioral Risk Factors for Obesity Onset in Adolescent Girls: A Prospective Study.” J Consult Clin Psych. 2005. 73(5): 195-202. 24. Wolf N. The Beauty Myth: How Images of Beauty Are Used Against Women. HarperPerennial: 2002. 25. Bacon L et al. “Evaluating a “Non-diet” Wellness Intervention for Improvement of Metabolic Fitness, Psychological Well-Being and Eating and Activity Behaviors.” Int J Obes. 2002. 26(6): 854-865. 26. Bacon L. Health at Every Size: The Surprising Truth About Your Weight. Dallas: Benbella Books, Inc. 2008. 27. Schwartz MW. “Brain Pathways Controlling Food Intake and Body Weight.” Exp Bio Med. 2001. 226(11): 978-81. 28. Leibel RL, Rosenbaum M, Hirsch J. “Changes in Energy Expenditure Resulting from Altered Body Weight,” NEJM. 1995. 332: 621-28. 29. “MI Weight Discrimination Claims.” Harvard T.H. Chan School of Public Health. https://www.hsph.harvard.edu/wp-content/uploads/sites/1267/2022/02/MIWeight-Discrimination-Claims-4.pdf 30. Picker L. “Why Obesity Lowers Wages.” Nat Bureau Econ Res. 2005. https:// www.nber.org/digest/aug05/why-obesity-lowers-wages#:~:text=Prior%20 studies%20generally%20have%20found,face%20significant%20labor%20 market%20discrimination. 31. Puhl R, Brownell K. “Bias, discrimination and obesity.” Obes Res. 2001. 9(12): 788-805. 32. Puhl RM, Heuer CA. “The stigma of obesity: a review and update.” Obesity (Silver Spring). 2009. 17(5): 941-64. 33. Puhl RM, Andreyeva T, Brownell KD. “Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America.” Int J Obes. Mar 4 2008. 34. Fontaine KR et al. “Body Weight and Health Care among Women in the General Population.” Arch Fam Med. 1998. 7(4): 381-84. 35. Olson CL, Schumaker HD, Yawn BP. “Overweight Women Delay Medical Care.” Arch Fam Med. 1994. 3(10): 888-92. 36. Amy N, Aalborg A, Lyons P, Keranen L. “Barriers to routine gynecological cancer screening for White and African-American obese women.” Int J Obes Relat Metab Disord. 2006. 30(1): 147-155. 37. Flegal KM et al. “Overweight and Obesity in the United States: Prevalence and Trends, 1960-1994. Int J Obes. 1998. 22: 39-47. 38. Brook RD. “Is Air Pollution a Cause of Cardiovascular Disease? Updated Review and Controversies.” Rev Environ Health. 2007. 22(2): 115-37. 39. McEwen BS. “Protective and damaging effects of stress mediators.” NEJM. 1998. 338(3): 171-79. 40. O’Neill EA, Trout K, Winter VR. “Relationships between experiencing anti-fat microaggressions, body appreciation, and perceived physical and mental health.” J Health Psych. 2022. 28(2). 41. “Obesity Trends in the U.S.” Harvard T.H. Chan School of Public Health. https:// www.hsph.harvard.edu/obesity-prevention-source/us-obesity-trends-map/ 25 |

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