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The Thin Doc’s Dilemma

Posted Jul 22 2009 11:14pm

By Barbara Berkeley

As a diet doc, it is my job to make people thin. It’s strange then that one of the most persistent obstacles I face in that task is being thin myself.

New patients will often sit through a 1-hour initial evaluation in seemingly rapt attention. We will discuss their ancient genetics, their struggling insulin systems, the importance of making changes that they can commit to permanently. Then, just as they get up from their chair and turn toward the door, they pause.

“But how can you understand any of this,” they say, “You’re thin.”

Of course I launch into a practiced and much-repeated speech. I am maintaining a 20-pound weight loss myself and would be vastly heavier if I had not reversed the process and put a permanent end to it. I live exactly the life and follow exactly the recommendations I make to my patients. In fact, you could even say I am the living lab for the program I preach.

Nevertheless, overweight people don’t trust thin people to “get” it. You may even find this to be true as a maintainer of larger amounts of weight, someone who was quite heavy for most of your life. Once you become thin, you seem to cross an invisible line. Like the rich, the thin are different.

In fact, there may be more of a parallel here than one might think. America is the land of opportunity and it is our fondest dream to accumulate wealth. But once we become wealthy in America, we’ve crossed a barrier. Politicians rail against “the rich” and talk about them as if they are some sort of enemy class.

Those who are still struggling to make it may see the rich as wasteful and uncaring. Achieving the success that we all crave leaves us open to envy and to a desire to tear us down. For people who are overweight, the thin tend to be viewed with similar suspicion.

My own weight and its stability prompts a lot of patient comments. “I’ll bet you never cheat.” “You really don’t have a problem with your weight do you?” “I can’t be like you.” I am a foreigner because I fall on the other side of the thin line.

But there is another facet to this issue. In this week’s NY Times, pediatrician Perri Klass writes about the dilemma she faces as an overweight doc. How does she help kids and their parents when she does not seem to have her own weight under control? She describes her discomfort in being asked by a family to deliver diet advice to their child, advice that she herself can’t follow.

Perhaps there is one positive in her situation: patients may be better able to identify with doctors who share their struggle. That said, it doesn’t instill confidence when the very person who is advising you is unable to follow the suggested guidelines. I have experienced this issue in my own practice. A number of years ago, I hired another doctor to share my workload. Although overweight, she was bright, kind, and seriously interested in working with our patients. Within a few weeks, our clients began to complain. They felt that they could not take this doctor’s advice; that she could not possibly help them. Ultimately, we had to let her go.

Awhile back, I wrote about the “pretzel phenomenon.” I had noticed that when I occasionally bought some pretzels while paying for my gas, the cashier always smiled and made conversation. This did not happen unless I was buying junk food. Being part of the overwhelming mass of America that eats mindlessly confers a certain feeling of guilty membership. When I bought the pretzels, I was a member. It’s not a club that I am part of most of the time, and when I experience one of those moments of welcome, I’m always struck by it.

Where does all of this leave us? Being thin puts us on the outside. Weight loss advice from thin people is suspect. The thin don’t understand and aren’t part of the club. On the other hand, overweight people can’t advise other overweight people because their answers can’t be trusted.

Clearly, in terms of giving weight loss support and guidance, it is maintainers who have the answers. But how to get the message across? I am left with the interesting thought that we need to de-stigmatize thinness. This is rather radical isn’t it? Who would think that the thin are stigmatized! We are always talking about taking the stigma out of being overweight. That’s a good idea. But there is a growing separation, a kind of weight-class warfare, between the fat and the lean. As successful maintainers, we see clearly what needs to be done to stay on the thin side of the line. We can be of enormous help to those who want to cross over. To do this, though, they have to be willing to abandon the club and enter an uncertain new fraternity. Hopefully, a greater emphasis on maintainers and on the joy of the lives they lead will make us less mysterious and more accessible. After all, it turns out that the thin are just like you and me.

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