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Who's Obese? Patients, Doctors Differ

Obesity Health Warnings Ignore Racial, Cultural Diversity

When Body Size Does Affect Health

Feeling good about not being pencil-thin is a good thing. It shows that a person has good self-esteem. But there's a point at which being too thick or too thin just isn't healthy. And these days, being too thick is much more prevalent.

Regardless of how we see ourselves, there's a point at which our body mass makes us ill. Obesity is directly related to problems that include -- but aren't limited to -- diabetes, heart disease, asthma, and some cancers.

"Being comfortable with your body, that is good for self-esteem," Biro says. "But suppose your body mass puts you in the category of being very obese. That is not a good thing. At very high body mass, you increase the risks to your health. So being more comfortable with a moderately overweight body size is probably good. But being comfortable with an obese body size is not a good thing for you, because you put yourself at much greater risk of adverse health outcomes."

Unfortunately, Davidson found, people aren't connecting what doctors call obesity with too-big body size.

"The hard part is, regardless of how you see yourself, you are going to hit a certain weight that leads to illnesses associated with too much weight," she says. "We have to get away from weight being about beauty and attractiveness and desirability. We have to stop talking about those things when it comes to health. What predominately white health care providers are saying to African-Americans doesn't have any meaning."

In her work with black families, Davis finds that when she talks about obesity, nobody listens. But when she talks about health, people not only listen -- they change their behavior.

Davis and colleagues interviewed obese children and their parents -- mostly mothers, nearly all of whom turned out to be obese. They asked the children, and then the parents, about their experiences and about how they saw things.

"When we began to share with parents the fact that their children were being teased about being obese, the parents made excuses," Davis says. "They said things like, 'It's in the genes,' and so on. They didn't seem to be concerned. But we noticed a big change in mood when talked about the health aspects of their children's body size. With no further provocation from us, the parents began to form groups to get together and exercise, and make healthier meals."

The lesson, Davidson says, is that health care providers have to sing a different tune.

"We know we are missing something. What is it?" she asks. "What I see clinically is people saying, 'What you are talking about doesn't apply to us.' But just because we can't get past the fact I am labeling you with a term you feel doesn't fit you doesn't mean we don't have a health problem here."

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