Back when my classmates were playing with blocks, I was stacking cartons. The glove compartment, as far as I know, might as well have been called the smokes compartment, because that’s all we kept in ours. I can visualize the plastic sealed, blanched white bodies, stacked in rows; I can still smell the unmistakeable insult of the ash that used to cling, like velcro on the lace of my shoes. He was going through two, three packs a day, habitually pounding cigarette after cigarette as if each puff was giving him life… when in fact, it was doing the opposite.
So, I’d draw family caricatures and bold, arching, colorful print that read something along the lines of “Please Stop Smoking DAD” and variations of. I’d sneak letters into his travel bag, and on the occasion I’d get to see him, I would beg him to quit. For us. For a healthier life. For, at only six years old, I was already afraid that the next time I’d see a plastic sealed, blanched white body, it’d be his.
What I had yet to learn was that the success of behavior change is determined by adherence, which can only be cultivated intrinsically. My father continued to smoke for many, many years, and despite positive behavior changes that renovated different aspects of his life, he could never fulfill the intricate web of physical, emotional, spiritual, intellectual, environmental, and social health. Because wellness is a cumulative interaction between these six dimensions of health, behavior change that hinders the maintenance of this balance may –in consequence– be fleeting, inefficient, and even detrimental.
The film, “Fat Chance,” portrays the journey of behavior change intended for weight loss that is later redirected to self acceptance. Rick Zakowich is first introduced, thirty pounds lighter but not much happier since the start of his plan to lose weight. Feeling pressured by cultural standards of beauty and acceptance, he uses appearance-based motivation to take on behavior change involving diet and exercise. It is no surprise, considering how heavily our society weighs the significance of body image, to hear a even medical professional deviate from motivational interviewing. The physician advises, “Best way to make yourself feel better about yourself… is to lose weight so that your blood pressure improves, so that you look better.” Inherent in modern American thinking is that looking better equates to happiness.
As Rick finds support from those who are content with their obesity, he adapts to a new perspective that directly antagonizes fat shaming culture; he ends the documentary by saying, “The way you are is fine. Walk through this world in that way.” On a superficial perspective, one could argue that Rick achieves a step towards wellness by coming to self acceptance, increasing his self confidence, and joining an empowered community. However, despite it being a step in the right direction, Rick fails to recognize the danger of extremes. By orienting behavior change strictly towards emotional and social health, he completely neglects the other essential components, such as physical health. There is no doubt that self love, in the right context, is deserving of praise, but the fact that he is happier does not eliminate the risks of being overweight. By the summer of 2008, my father ended up in the ICU. If he, then, had settled on self acceptance and placed another cigarette between his lips, would you have applauded him, too?
Fat shaming and fat acceptance fall on opposite ends of the spectrum, and through understanding the crucial interplay of the six components of wellness, we unveil the importance of moderation. Had the medical professional taken a different approach, like educating the benefits of exercise, rather than implying blame or demonizing Rick’s body image, perhaps Rick would not have fallen victim to an illusory state of happiness that is likely evanescent. Increasing studies now indicate that cardiorespiratory fitness and physical activity can improve multiple aspects of wellness and reduce the comorbidities tied to obesity, with or without weight loss (Dallow). This outlook on exercise may be a better approach towards positive behavior change, than one that is based on appearance. Furthermore, it would be of a greater benefit to implement behavior change that caters to both fitness, confidence, community, and other aspects of wellness. With Dr. Lerner’s medical knowledge and morale amongst Rick’s new connections, the support group could potentially be the perfect medium for a wellness program. With less emphasis on weight loss, they could tackle multiple obstacles at once and find a more permanent solution. In contrast of what they have been told by others –they can have their cake and eat it too.
To ensure safety, longevity, and efficacy of such program, professional advisement to promote adherence is crucial. Though the responsibility of wellness falls on the shoulders of each individual, it is equally important to have health care providers take the lead on public education. Patients are more likely to adhere to behavior change if they understand risk and the gravity of their conditions, so medical professionals can play a key role here (Stonerock). Proper motivational interviewing along with professional, objective, and evidence-based opinions is essential to assist others, particularly in the transition from earlier to later stages of the Transtheoretical Model. In “Fat Chance,” Dr. Moe Lerner highlights that obesity is caused by metabolism and dieting. Not once does he mention the importance of physical health. Despite his sensible attitude, his perspective holds a very narrow, almost defensive, focus to justify obesity. By relying on rationalizations and believing his physical state is not a problem, he, along with Rick and the others in the support group, regress and sink deeper into the precontemplative stage (Dallow).
In a society that strongly antagonizes fat and with a disproportionately increasing prevalence of obesity, there is a strong need for leadership towards fitness in all populations, especially obese individuals. The fact that Dr. Lerner’s personal stake in the issue does not take a backseat to his obligation to the public, and that another medical provider advises Rick “just do it” as a plan for losing weight reveal how the medical care system has ample room for improvement. Physical therapists, and all medical providers, can and should “provide key elements of effective behavioral change interventions” so that the general public can adhere to wholesome decisions about wellness (Rhodes). Even the most effective interventions whittle down to scraps, in the absence of patient adherence.
It is easy to believe a person is well when one aspect of wellness has been satisfied. One might say being fat and happy is better than being skinny and unhappy; one might argue the opposite. During an interview, supermodel Kate Moss was quoted saying, “Nothing tastes as good as skinny feels.” When we fall victim to such paradigms that cater to one aspect of wellness, such as emotional health, we neglect all else. The temporary contentment that follows blinds us from seeing the short-lived nature of it, and the resulting imbalance may put an us in a worse position than we started from. Fooling ourselves about our well-being is like sipping on a pina colada, floating comfortably above a circle of sharks. In shallow waters, it becomes more clear that a fool’s paradise –though paradise– thrives only in the minds of fools.
Bezner JR. Promoting health and wellness: implications for physical therapist practice. Phys Ther. 2015;95:1433-1444.
Dallow CB, Anderson J. Using self-efficacy and a transtheoretical model to develop a physical activity intervention for obese women. American Journal of Health Promotion, 2003;17(6):373-381.
Fat Chance. Dir. Jeff McKay. Perf. Rick Zakowich. YouTube. NFB, 17 May 2015. Web. 19 Apr. 2017.
Rhodes RE, Fiala B. Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence. Physiother Theory Pract. 2009;25:424- 441.
Stonerock GL., Blumenthal JA. Role of Counseling to Promote Adherence in Healthy Lifestyle Medicine: Strategies to Improve Exercise Adherence and Enhance Physical Activity. Prog Cardiovasc Dis (2016), http://dx.doi.org/10.1016/j.pcad.2016.09.003