Promoting Mental Health in the Workplace

[Content note: mental illness, including eating disorders]

This post was requested by Kate [not FtB!Kate], who donated to my conference fundraiser. She wanted to hear my opinion on mental health in the workplace and how employees and employers can foster a culture that values and promotes mental health. She had some of her own suggestions, which I’ve incorporated into this piece with her permission.

Work is often a concern for people who suffer from mental illnesses. They might worry, for instance, that their struggles will impact their work performance, that coworkers or employers will find out that they have a diagnosis and stigmatize (or even fire) them, or that offhand comments at work could trigger eating disorder symptoms.

I wrote about this topic much more generally in this piece, which was about how to prioritize and promote mental health in one’s community. Workplaces are particular types of communities, so a lot of this still applies. At the same time, workplaces present particular challenges to promoting mental health, as well as particular capabilities that might help.

Note that I’m writing this as a person with a mental illness, as a person who works, and as a person who observes human behavior. I’m not writing this as someone who’s ever been a manager or a supervisor, so while I can speak to what I would like to see from managers and supervisors, I don’t have firsthand knowledge of what it’s like to be one. If you have that experience and you’d like to weigh in in the comments, feel free to do so.

For employers/managers/supervisors

1. Ensure that the assignments you give your employees and the culture you foster in the office encourage and allow employees to take good care of themselves.

Every workplace that expects people to skip lunch or sleep less than 7 hours a night is a workplace that is detrimental not only to physical health, but mental health as well. Sleep deprivation can dangerously exacerbate many mental illnesses, and having to skip meals can cause people with eating disorders to relapse. Obviously this is unavoidable with certain jobs or when a big important project is nearing completion, but it’s avoidable with most jobs most of the time.

(At the same time, recognize that this is a problem with American culture at large, and companies feel pressure to pressure their employees in this way because if they don’t, a competitor will, and it’ll reap the profits.)

2. Make sure that new employees understand the health coverage they’re receiving under the company’s benefits plan, especially as it pertains to mental health.

Explain in as little legalese as possible what the coverage includes and doesn’t include, and where they can go to find more detailed information or look up specialists in their area. In my experience, many people are worried that if they see a mental health professional using their employer-provided insurance plan, their employer will somehow have access to their medical records. Emphasize that it’s none of your business as an employer what your employees do with their health insurance and that providers cannot disclose such information to you without a patient’s consent. For extra points, give a short overview of HIPAA.

Going over this information not only improves the odds that employees are able to get the mental healthcare they need, but it shows that you’re comfortable discussing mental health with employees and that your company thinks it’s important.

3. If you choose to have health-related contests at the office, focus them on fitness goals or healthy eating, not weight loss.

Personally, though, I’d avoid these altogether because many people consider health a personal matter and feel pretty uncomfortable about having to discuss it publicly and competitively. Even if the contest is optional, keep in mind that people will feel a strong social pressure to join in. Who wants to be the only person in the office who doesn’t seem to care about staying in shape?

In any case, framing weight loss as an intrinsically healthy and positive goal is harmful and counterproductive. You can weigh little and be very unhealthy, and if you lose weight in an unhealthy way, you’ll probably gain it back anyway. A better way to structure a health contest is by encouraging participants to achieve goals that are proven to be healthy and doable.

4. Make sure employees understand the policies and processes about taking time off for medical reasons (and remember that mental health is a medical issue).

It’s especially important to find a way to emphasize that mental health is just as important as physical health, and little gestures make a big difference. For example, you could say something like, “If you know in advance you’re going to need time off, like for a physical or a therapy appointment, you can submit the form to me at at least a week’s notice.” That provides important information while also implicitly conveying the fact that you consider therapy to be a legitimate reason to leave work an hour early.

For employees

1. Consider your own mental health when choosing responsibilities to take on at work.

It’s understandable, especially in this economy, to try to impress your boss by offering to do as much as possible and overworking yourself. However, good mental health should be seen as an investment. If you take good care of it, you’ll ultimately be more productive than if you neglect it and burn out.

This applies to all those little volunteer opportunities that aren’t directly job-related, either. If you have social anxiety, it might be a bad idea to offer to organize a social outing for the office. If you have an eating disorder that makes it really stressful to choose food to buy, it might be a bad idea to offer to bring snacks for a meeting. You know yourself best.

2. If you feel safe and comfortable, let your boss know about mental health issues that may affect your performance and how you plan to deal with them.

The “if you feel safe and comfortable” is the key part. I’m absolutely not suggesting that everyone can and should come out about their mental illness to their boss, since I know that in many cases that’s a really bad idea. (It shouldn’t be, but it is.) But personally, I know people who did this and found it really helpful because they were able to work collaboratively with their boss to make sure that they can get the time off they need and that they can fulfill their responsibilities rather than having to keep it a secret and try to solve potential problems on their own. Disclosing also makes it possible to receive any accommodations you may need, which brings me to:

3. Educate yourself about laws related to mental illness and the workplace.

The Americans with Disabilities Act (ADA) is obviously a major one, but so is HIPAA, which I mentioned earlier. The definition of “disability” in the ADA is intentionally quite general, but mental illnesses are included: depression, anxiety, PTSD, ADHD, and so on. Title I of the ADA concerns employment. There’s a lot of useful information in there; for instance, an employer cannot ask you in a job interview whether or not you’ve been treated for mental health problems, or which medications you’re taking. Keep in mind that the ADA only applies to businesses with 15 or more employees, however. Here’s another useful article about it.

For everyone

1. When someone asks you how you’re doing, be honest (within reason).

In the piece I linked to earlier, I wrote:

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

At work, there are obviously different standards than in other communities, or with friends and family. But even at work, there’s room for honesty and mutual support.

2. Be mindful of using language that relates to mental illness.

Casual usage of diagnostic terms (“That’s so OCD,” “You’re being delusional,” etc.) hurts people with mental illnesses by trivializing their conditions and turning them into the butt of a joke. It also makes it more difficult for people to disclose mental illnesses because it keeps people from taking them seriously. If “ADHD” is what you call it when you can’t focus on a boring project and someone tells you they have “ADHD,” you’re not going to think, “Oh, this person has a serious condition that makes it neurologically impossible for them to focus on a task unless they get treatment.” You’re going to think, “Oh, come on, they just need to close Facebook and get focused.”

3. Remember that talking about dieting and weight loss can be very triggering for people with past or current eating disorders.

Fat talk (as it’s called) is so ingrained in our culture and communication patterns that it’s hard to imagine that it could be such a serious issue for someone. But anecdotally, it seems that eating disorders in particular are very easily triggered by offhand remarks like “Ugh I need to work off this cupcake” or “My thighs are huge.” Even when not actually triggering, these comments encourage unhealthy behavior and create a social norm of dieting and preoccupation with weight loss.

I sometimes dread being around groups of women who are not my friends because more likely than not, I’m going to hear these comments. And it’s not like you can avoid your coworkers. So if you must do it, try not to do it to a captive audience.

4. Respect others’ privacy when it comes to mental health issues.

Just as you should never out an LGBT person without their permission, you shouldn’t discuss someone’s mental health with others at the office. Although I generally encourage people to be open about mental illness if they feel they can be, that has to be on their terms, not someone else’s. If you’re concerned that someone’s mental health problems are causing them to be unable to do their work, do the same thing you’d (probably) do anytime a coworker isn’t pulling their weight: talk to them about it in a kind and considerate way rather than going straight to the boss.

(An exception to this is if you’re worried that someone may harm themselves or someone else. In that case, please call 911. )

When it comes to structural issues like ableism and stigma, no community can be an island, unfortunately. There will not be stigma-free workplaces until there is a stigma-free society. But the more power you have in a workplace, the more influence yo have over its culture.

Thank you to Kate for her donation and for this prompt. 

~~~

Liked this post? Please consider donating so I can speak at conferences.

Some Evidence Against Shame and Stigma as Weight Loss Motivators

[Content note: weight/size stigma and discrimination]

It is considered self-evident by plenty of people that shaming fat people for being fat gets them to stop being fat. That’s why a common reaction to body/fat positivity campaigns is that they’re going to make people think it’s “okay” to be fat. As opposed to…not okay.

However, even if we begin with the presumption that it’s a net good for fat people to stop being fat, research evidence is rapidly piling up that suggests that shaming and stigmatizing them won’t work. In fact, it may have exactly the opposite effect.

In a paper recently accepted for publication in the Journal of Experimental Social Psychology, the authors provide this overview of research on this topic:

Media attention to obesity has increased dramatically (Saguy & Almeling, 2008), as has discrimination against overweight and obese individuals (Andreyeva, Puhl, & Brownell, 2008). Overweight individuals are often portrayed in the media as lazy, weak willed, and self-indulgent (Puhl & Heuer, 2009), and as a drain on the nation’s resources (Begley, 2012). Because stigma can be a potent source of social control (Phelan, Link, & Dovidio, 2008), some authors have suggested that stigmatizing obesity may encourage people to lose weight (Bayer, 2008, Callahan, 2013 and Heinberg et al., 2001), and policies that utilize potentially stigmatizing elements (e.g., BMI report cards) are becoming more prevalent (Vogel, 2011). Little evidence exists, however, that stigmatizing obesity promotes weight loss. In fact, among overweight individuals, experiencing weight-stigmatization is associated with greater reports of maladaptive eating behaviors (e.g., Haines et al., 2006 and Puhl and Brownell, 2006), increased motivation to avoid exercise (Vartanian & Novak, 2008; Vartanian & Shaprow, 2010), and poorer weight loss outcomes among adults in a weight-loss program (Wott & Carels, 2010; but see Latner, Wilson, Jackson, & Stunkard, 2009). Furthermore, experimentally activating weight stereotypes decreased overweight women’s self-efficacy for exercise and dietary control (Seacat & Mickelson, 2009). Collectively, these findings suggest that stigmatizing obesity has negative behavioral consequences that may increase, rather than decrease the weight of overweight individuals.

The paper also reviews research suggesting that the reason this happens is because of something called identity threat. When an individual has an identity that they know is stigmatized and something happens that triggers their awareness of that (such as a joke about the identity or a person who invokes negative stereotypes about it), the individual may experience negative effects. Some of these are physical, such as increased physiological stress response. Some are psychological, such as feelings of shame or anxiety. The person may try to act in ways that “compensate” for the flaws others may perceive in them or avoid situations in which people might think poorly of them (for an overweight person, this may include eating with people or going to the gym).

In theory, all this stress, anxiety, and effort depletes cognitive resources available for other activities that require what is known as executive function–mental tasks such as regulating emotions, setting goals, using short-term memory, and so on. Research has shown that when people of various stigmatized categories are reminded of those stigmas and stereotypes, their cognitive performance on a variety of tasks worsens.

The researchers in this study hypothesized that feeling identity threat would decrease participants’ ability to subsequently regulate their food intake. Specifically, they tested whether or not exposure to news articles about weight stigma would actually increase the amount of calories participants consumed. They believed that the participants who would be most affected would be those who believe themselves to be overweight, regardless of their actual weight, because they would be the ones who would feel identity threat when reminded that weight stigma exists.

The participants were 93 female college students (45% White, 24% Latina, 18% Asian/Pacific Islander, 3% African American, 10% other races). Prior to the study, they had filled out a survey that included a few questions about weight (the rest were just there to hide the purpose of the survey). When they arrived at the study, they were told that the purpose was “to examine correspondence among verbal, nonverbal, and physiological signals.”

They were randomly assigned to one of two conditions. In the test condition, they read an article called “Lose Weight or Lose Your Job,” which was compiled from actual news stories and described the discrimination that overweight people may face in the workplace. In the control condition, the participants read a nearly-identical article that was about smoking rather than weight.

Afterward, they were led to another room and asked to wait for the experimenter to return. The rooms had bowls of snacks that had been weighed prior to the study, and the participants had the opportunity to eat some of the snacks while they waited for 10 minutes. They were then asked to return to the previous room to complete a final questionnaire.

One of the measures on the questionnaire was called “self-efficacy for dietary control.” Self-efficacy refers to one’s sense of having the ability to do something and control one’s outcomes in that domain. This particular measure assessed the extent to which participants felt they could control their eating, avoid unhealthy foods, and so on. Various studies suggest that having a sense of self-efficacy is more important in terms of actual behavior than other factors, such as believing that the behavior is healthy or important. (For instance, here’s an example involving elderly people and exercise.)

The results were pronounced. In the weight stigma condition, women who perceived themselves to be overweight ate significantly more calories than those who did not perceive themselves as overweight. In the control condition, there was no significant difference:

The interaction between perceived weight and article type.

The interaction between perceived weight and article type.

Furthermore, women who perceived themselves as overweight had significantly lower self-efficacy for dietary control in the weight stigma condition than in the control condition, while women who did not perceive themselves as overweight actually had higher self-efficacy in the weight stigma condition than in the control condition.

This means that, within the context of this experiment, women who perceive themselves as overweight increase their food intake in response to hearing about stigma against overweight people and feel less capable of controlling their food intake. The very people being targeted by this information in ways many people think are helpful are actually being harmed by it, not only in the obvious emotional sense but even in their ability to control what they eat.

One really notable finding in this study is that actual weight did not correlate with either calories consumed or self-efficacy in either condition. Perceived weight was the relevant variable. I’ve often heard people argue against the body positivity movement because but if fat people don’t think they’re fat then how will they ever stop being fat?! Ironically, the women who did not perceive themselves as overweight had higher self-efficacy in the weight stigma condition than in the control condition.

One weakness of this study is that it is unclear whether or not the participants who increased their food intake did so consciously–or deliberately. If it was unconscious and not deliberate, then this finding may fit with previous findings about identity threat. If not, it’s still an important finding, but it’s probably easier to get people to change mental processes that are conscious and deliberate as opposed to those that are subconscious and unintentional. It’s also possible (though probably unlikely) that the women in the weight stigma condition purposefully ate more as a sort of symbolic protest. Oh, you’re going to fire me because of what I do with my own body? Well, fuck you, I’ll eat as much as I want.

Another limitation is that the type of stigmatization invoked in this experiment isn’t quite what overweight people might actually experience in their day-to-day lives. While articles like the one used in the study are common, the idea behind stigmatizing people so that they lose weight is usually more direct: for instance, telling them they need to lose weight, penalizing them for being overweight, and so on. Telling a study participant that they’re fat and ugly and need to lose weight would probably never pass an IRB review, but it would be a more naturalistic scenario, unfortunately.

While the sample used in this study is more racially diverse than many other samples in psychology studies, that really isn’t saying much. The researchers did not discuss any racial disparities in the data, but that would be an interesting direction for future studies. Also, all of the participants were young women, so it’s unclear how well this generalizes to older women and men of all ages.

With research like this, it’s important to remember that the findings should be interpreted much in the way that the statement “consent is sexy” should be interpreted. Namely, you should get consent because it’s the right thing to do, not because it’s “sexy.” Likewise, you should refrain from shaming and stigmatizing fat people because it’s the right thing to do, not because shaming and stigmatizing them doesn’t work anyway. Activists rightly criticize research like this for suggesting the implication that we should stop shaming fat people because it doesn’t get them to lose weight, rather than because it’s a shitty thing to do. That said, I don’t think that’s an implication that the researchers mean to give. We should conduct, support, and read research about how human motivation works (and how everything else works) because it’s important to know. This is just one piece of that puzzle.

It is my hope, though, that studies like this will work where “don’t be an asshole” won’t. The most important thing to me is for people to stop stigmatizing and discriminating against fat people, whatever the reason they stop doing it, because it’s harmful and needs to stop. Then maybe we can make these people understand why they were wrong to do it.

However, this research also opens up a lot of tricky questions. If shaming people who are overweight did actually help them lose weight, would more people think that this is an okay thing to do? If shaming people who do things that most of us would consider Definitely Bad, like rape or theft or even saying racist things, worked, would that be okay to do? Many would probably say yes to the latter but no to the former.

What is clear, though, is that human motivation (and reasoning in general) often works in ways that seem counterintuitive. You might think that people would respond to the stimulus of “being overweight can cost you your job” with “well I’d better stop being overweight, then!” But that’s not necessarily the case.

~~~

Major, B., Hunger, J.M., Bunyan, D.P., Miller, C.T. (2014). The ironic effects of weight stigma. Journal of Experimental Social Psychology, 51: 74-80.

Yahoo's New Female CEO Isn't a Feminist: Does it Matter?

Marissa Mayer is unquestionably a badass. But she’s wrong about feminism. (Photo credit: Giorgio Montersino)

This piece was also published on In Our Words.

Yahoo! has a new CEO. Her name is Marissa Mayer and she is 37 years old, making her the youngest CEO of a Fortune 500 company.

Mayer’s accomplishments in her career are incredible and she deserves credit for them. However, to some extent, so does feminism.

Mayer was born in 1975, as the women’s movement was really starting to take off. But at the time, it was still controversial for a woman to wear pants rather than a skirt, let alone to cohabit with a boyfriend, work outside the home after marriage, and so on. However, Mayer was able to benefit from the gains of feminism: she attended college (and not just any college, but Stanford University) and became Google’s first female engineer.

On the same day that Yahoo! announced Mayer as its new CEO, Mayer and her husband announced that they are expecting a baby. In a time when pregnancy-related workplace discrimination is still very real, this is momentous. And don’t think for a moment that this happened in a vacuum.

So, does Mayer identify with feminism, given all of her achievements? Nope:

I don’t think that I would consider myself a feminist. I think that I certainly believe in equal rights, I believe that women are just as capable, if not more so in a lot of different dimensions, but I don’t, I think have, sort of, the militant drive and the sort of, the chip on the shoulder that sometimes comes with that. And I think it’s too bad, but I do think that feminism has become in many ways a more negative word. You know, there are amazing opportunities all over the world for women, and I think that there is more good that comes out of positive energy around that than comes out of negative energy.

This viewpoint seems to be very common among successful women in the U.S. these days; I’ve heard it from many of my female peers at Northwestern. Yes, women can do anything men can do; yes, women should have equal rights, but do we really need to be all, like, negative about it?

First of all, there’s a certain amount of irony here. Feministing‘s Chloe writes, “Marissa, it is too bad that feminism has become a negative word. You know what’s also too bad? Your failure to acknowledge that without feminism, you could never have become the CEO of Yahoo.”

Second, what Mayer said that she believes is exactly what feminism is. Feminism is the idea that women and men should have equal rights, and that women and men are essentially capable of the same things, despite the physical differences that may exist between them.

Beyond that, everything’s up for debate. Different feminists believe entirely different things. Some very radical, separatist feminists believe that women should choose to be lesbians and to associate only with other women. Most don’t believe that. Many feminists see feminism as a place to address related issues, like racism, homophobia, and class issues. Others don’t. Some feminists supported the Equal Rights Amendment. Others didn’t. Some feminists are angry and bitter (and, often, rightfully so). Others are cheerful and friendly. Some feminists hate men. Others love them, and still others could take ‘em or leave ‘em. Some feminists are lesbians. Others are straight, bisexual, or something else. Many feminists are women. Some are men. Others don’t identify as either men or women.

Despite this incredible diversity of opinions, lifestyles, and identities, many people, including those who support equal rights for women, insist on distilling feminism only into its most unpleasant stereotype. This is a classic strawman fallacy, and, the way I see it, it’s an attempt (if an unconscious one) to avoid discussing the real issues. It’s unfortunate that Mayer has chosen this path.

However, as Amanda Marcotte points out in her post at Slate, Mayer’s refusal to identify as a feminist might be the only option for a woman who wants to get ahead in the corporate world:

Women are correct to believe that direct confrontations with sexism result in people turning on the “complainer” instead of blaming the person who acted sexist in the first place….Taking that on just isn’t for everyone, even for a powerful woman who is unquestionably willing to suffer for the ultimate success of her corporation. Someone who would rather do what’s right than what’s profitable simply isn’t going to climb very high on that corporate ladder.

I would agree. Not everybody has to be Super Social Justice Warrior (although I’d like to see more people at least not hold the movement back). Given Mayer’s career goals, it makes sense that she chooses not to align herself with feminism, and I can’t blame her as an individual.

That said, I do wish she wouldn’t promote the same tired stereotypes about feminists having “a chip on the shoulder” and “negative energy.” Are there feminists like that? Yes. Is feminism itself like that? Depends on who you’d ask. I would say no, because I’m involved in countless feminist circles online and in real life, and our discussions there are fun, productive, and extremely connecting experiences. It’s certainly more “positive” than sitting around and pretending everything’s fine with the world when you don’t really feel like it is.

Of course, there’s a good chance that Mayer already knows all of this. It’s quite possible that her statement about feminism was entirely a political one, something she said to make sure that the men she’ll be leading don’t feel too threatened.

I can’t blame her for making that choice, but she shouldn’t have had to make it–because our culture should not be so militantly averse to serious (and, sometimes, uncomfortable) discussions.

Fatism and Going to Extremes

Discrimination against fat people is a problem. People who are overweight are often judged to be less competent, less intelligent, and more lazy–not to mention less attractive–than people who are of a “normal” weight. They face discrimination in the workplace, and there are some jobs for which they are unlikely to ever be hired at all.

It’s only natural, then, that a movement has sprung up to combat “fatism”–and that’s awesome. What bothers me, however, is the tendency of anti-fatism activists to deny the fact that being severely overweight has negative effects on one’s health. I hear a lot of “weight has nothing to do with health” arguments these days, and this sort of denialism is simply dangerous. Obesity is a problem in America, and it does put you at increased risk for a lot of health problems, such as:

  • high blood pressure
  • heart disease
  • stroke
  • type 2 diabetes
  • sleep apnea
  • breast and colon cancer
  • osteoarthritis
Given that heart disease is the leading cause of death in the United States, I feel like its prevention is something that should be taken seriously.

Regardless, denying these health problems does not help anyone, and admitting that being obese is unhealthy is not tantamount to justifying discrimination against obese individuals. After all, one’s health is one’s own business, and not taking care of your body shouldn’t result in being discriminated against.

It worries me when social movements respond to a problem in society (such as fatism) by taking the extreme opposite view. This happens a lot with progressives. For instance, noticing that our society has pervasive and restrictive gender roles, some claim that gender is entirely socially constructed and has no basis in biology whatsoever. (Apparently these people never noticed that men and women do actually have at least one very noticeable biological difference.) Some note that homophobia is rampant in society, so they insist that heterosexuality is actually constructed and unnatural, and that same-sex relations are the only “genuine” ones. Similarly, some people think that because discrimination against fat people exists and discrimination is wrong, therefore, there is nothing whatsoever bad or unhealthy or in any way undesirable about being overweight.

But being fat isn’t the same as being part of other marginalized groups, such as being a woman, being gay, being transgender, or being Black. No reputable scientific study has ever found that being gay or transgender is in any way unhealthy or abnormal (except, of course, in the statistical sense). No reputable scientific study has ever found that women or African Americans are inferior in any way to men or Caucasians. But our entire body of medical evidence shows that being severely overweight comes with significant hazards to your health. This is something that is simply true. Regardless of whether you think BMI is a good measure of obesity, and regardless of how easy or difficult it is for you to lose weight, being obese is unhealthy. Does this mean that discrimination against fat people is okay? Hell no. But it does mean that obesity is something that should be discouraged.

Incidentally, some of the things that anti-fatism activists consider discrimination simply aren’t. For instance, when airlines ask obese people to buy two seats, guess what–it’s not because they just don’t like obese people. It’s because if your body requires more than one seat, then you should have more than one seat–in which case, it follows that you should pay for more than one seat, because it wouldn’t be fair to give some people a second seat for free. Furthermore, it would be unfair for a person who paid for a seat to effectively receive only half a seat because the person sitting next to them clearly requires part of theirs. Does it suck to have to pay more to fly if you’re fat? Yes. But in that case, lobby for airlines to make seats bigger, not to give you permission to use half of another customer’s seat.

Also, companies that provide incentives for their employees to exercise/get down to a healthy weight/whatever are not being fatist. They’re doing two things: 1) encouraging their employees to be healthier, and 2) saving themselves money by reducing lost productivity due to medical problems and by reducing the amount they have to pay as insurance. Fact: being healthier and not obese reduces medical expenditures. Similarly, doctors who recommend that their obese patients lose weight are not being fatist. They are being doctors. I am terrified of the day when doctors are prevented from dispensing sound, evidence-based medical advice for fear of offending someone.

Regardless, it is, in fact, quite possible to discourage obesity without promoting eating disorders, obsessive dieting and exercising, and holding oneself to an impossible standard of beauty, as the mass media does. Conflating  efforts to discourage obesity with efforts to promote unhealthy behaviors or stigmatize fat people is intellectually lazy. There is, for every issue, a solution that is healthy, reasonable, and benefits the greatest possible number of people. Just because that solution is extremely hard to find doesn’t mean it doesn’t exist. It’s there, and I can guarantee that it is almost never at one extreme or the other. It’s usually somewhere in the middle.