Last July, a survey published on the website of the magazine Scientific American caught our attention. The article titled What if doctors stopped prescribing weigh loss? questions the effects of the prescription of weight loss by doctors, based on the example of a clinic in North Carolina where scales are prohibited. This medical structure is home to health professionals who question a system of care based on weight measurement, without looking beyond it.
Reading this article, and since the results of the clinic seem conclusive (some patients describing the initiative as having "changed their lives"), we were led to ask ourselves the question:is a similar model possible for us, in France ? And how weight management by the medical profession affects the lives of patients?
Plunged into the heart of a utopia, ultimately perhaps not so unrealistic.
Having your weight monitored is something you inherit at birth. No sooner are we introduced to the world than we are put on a scale. And it's not without reason. "We do not monitor only the weight, but the weight and the height, and in particular in the child because we want to ensure that the growth of the latter is accompanied by a coherent weight gain", clarifies Dr. Faïza Bossy*, general practitioner specializing in vascular diseases in Nanterre.Video of the day:
Figures on the scale, weight curves and body mass index (BMI) calculations:these indicators then allow health professionals to monitor, in particular to anticipate excessive weight gain and loss, which could be indicators of pathologies or future diseases. “Standards” have thus been established in order to adapt care:an adult whose BMI exceeds 30 is considered obese, while a BMI of less than 17.5 shows underweight. Obesity, like anorexia, are considered chronic diseases.
"Of course when you are an adult and have reached your normal height, you are no longer measured, you are only weighed, because weight is an indicator that is easy to measure , to objectify, continues the doctor. It is also a reflection of our lifestyle, since it will fluctuate according to the latter."
According to Catherine Grangeard**, a psychoanalyst specializing in supporting overweight people, thinness is far from being synonymous with good health, it is even a "terrible confusion" .
Thus, the expert is formal:addressing the question of weight by being centered on the scale is a mistake . Especially since these repeated remarks, added to a society that rejects fat people, are not without consequences on the health, physical and mental, of the victims.
In his acclaimed documentary We finish the big ones well (adapted from her book We are not born fat ), journalist Gabrielle Deydier tells her story with the weight. A first diet at 16 which she describes as "the beginning of hell" changes her life. While before, she had "no particular problem with food", she consults her doctor after her mother was panicked by the size of her daughter's new jeans (a 42, nldr). "This diet was clearly not a good idea, I did it I weighed 65 kgs, I wanted to lose 10, the doctor told me to lose 20 and this diet completely messed up my relationship to weight loss. 'food', shares the author.
A consequence far from being isolated since, according to Catherine Grangeard, eating disorders can be fueled in this way. But physical consequences (other than weight gain) can also result from this desire to lose weight at all costs. Many cornered patients find it difficult to trust health professionals again and sometimes even refrain from going to consult, for fear of being judged.
"In the end it has the opposite effect because as they move away from the treatment, they isolate themselves more and more, which often reinforces the need to calm down by eating and it makes them regain weight. He has already been proven that people who are stigmatized for their obesity gain more weight than others," says Vanessa Folope***, endocrinologist.
"We idealize thinness a lot and thus, obese people are clearly stigmatized. There are a lot of prejudices in relation to weight gain which are as present in the general population as among health professionals", she explains. by even evoking a "societal problem".
Misconceptions which, according to an article published in the British Journal of Obesity in 2015, make some doctors see obese patients as less self-disciplined, less compliant and more annoying than others. A biased perception that leads in many cases to inappropriate prescriptions and a shortening of consultations.
"When we talk about grossophobia in the medical community, it's heresy, retorts Faïza Bossy. You have to know that we are in a relationship with the body which is very altered in the 21st century, more and more patients do not want to be fully examined. We come for a cough and 1/3 of cases no longer want to undress when asked because they consider that they only come for a cough. However, we, in medicine, l he clinical examination is global, we don't have to judge your measurements, what we want is to make a diagnosis, but if you prevent us from accessing the body, we will not be able to do it well and it's really very problematic."
However, the doctor recognizes that what may have been said during the interview may not have been taken in the same way on both sides. "Everything is subjective, it's a one-to-one relationship and I say very frankly to my patients 'you are overweight or obese, what do we do?'. Maybe it shocks them, my goal is not to make them feel guilty."
"It doesn't bother me that people worry about my weight, I'm aware of the problem, I like to tell myself that it's done in a benevolent way, testifies Alexia, what bothers me is that it becomes an excuse for everything, whatever the reason for my consultation, whatever the practitioner. Limit I come for cystitis, I am offered a diet like antibiotics." Obese, the 28-year-old young woman has been immersed in "medical judgment" since childhood.
And she is not the only one, on Twitter, the hashtag #BalancetonGrossophobe is full of similar testimonies, sweating with a fed up from patients exhausted by consultations centered on their overweight.
"Too often obese people are victims of speeches or attitudes on the part of fatphobic health personnel reducing all their health problems to weight. They often have hurtful words without realizing it and in their minds. for some, it is enough just to make an effort, to be less fat and everything will be resolved. They attribute this chronic disease to the person who suffers from it", supports Catherine Grangeard.
A confusion, which, still according to the psychoanalyst, leads to an "aberration":the prescription of diets galore. However, according to the 2010 ANSES survey****, in 80 to 95% of cases, weight-loss diets end in failure , which induces further weight gain.
"The results after a diet are negative in terms of loss but also in terms of self-image, because if you're not crazy about losing weight when your doctor tells you to do so, you're really very bad. You blame yourself, you feel guilty so you eat to console yourself, "continues the psychoanalyst.
But for Vanessa Folope, these are things that can change. And this is already going through the university:"We know very well that medical and paramedical students copy the behavior of older pros and therefore another model of behavior should be brought into the care units thanks to health professionals. formed that could give another image", she imagines.
Since 2015, Vanessa Folope has also been at the head of training at the Rouen University Hospital. Entitled "Obese Patients:From Changing Our Looks to Improving Our Practices" , the latter applies to change the way we look at the question of weight and to highlight the benevolence and empathy necessary for the care of patients in order to limit prejudice and grossophobia.
Thanks in particular to simulation exercises and in particular to a combination that mimics an obesity of 200 kilos, the message gets through. Role-playing games, a sequence on the manipulation of people using technical aids and the exposure of caregivers in a situation of massive obesity are included.
Over the past four years and more than 200 people trained, 94% of people said they had changed at least one practice, 68% succeeded in doing so within their team by spreading these good practices, while 70% said they had fewer prejudices . A marked profit even several years later.
On the side of Catherine Grangeard, we agree on the idea that it is high time to put an end to a system of prescription for weight loss. According to her, for successful care, you have to take care of people and not just their symptoms .
"Please look at why, what's behind it, who the person is… Why constantly have this reflex of going on a diet when if you listened to them, discussed it, that would change a lot of things?" asks the psychoanalyst.
She takes as an example a patient "coated" because she has experienced sexual violence. "By finding a solution in food, she wanted to get out of the body that was violated, of what she represented for her attacker and so this solution she is not going to get out of until she has solved everything else. J I saw who knows how many women who had lost thirty kilos and who regained the weight because they were not comfortable in the street because they became again this woman who had been assaulted", she illustrates.
She proposes to approach things differently and to democratize multidisciplinary work. "A person, we can take it from many angles. When you are a general practitioner, you can say to yourself, 'I with the obese I have trouble, so I will be satisfied with angina and then I will suggest going to see colleagues'. That's what will make the difference", indicates the psychoanalyst. Especially since she notes that people do not generally tell her the same things as their attending physician who sees children and spouses pass by.
Today in France, 17% of the population is obese, i.e. more than eight million people. And to Catherine Grangeard to conclude, "in fact, when you want to make people lose weight when you haven't understood that getting fat has been a solution to a problem, it's quite simply bullshit monumental".Read also:
*Dr Faiza Bossy , general practitioner in Nanterre
** Catherine Grangeard , psychoanalyst and author
*** Vanessa Folope, endocrinologist and program manager “ Obese Patients:From Changing Our Looks to Improving Our Practices "
**** Risk assessment of dietary weight-loss practices , ANSES, 2010