Tag Archives: evidence

More Evidence that Fat Stigma is Killing Us

Today, I got an email pointing me towards some new research on fat stigma.  There has been an ever increasing pile of evidence indicating that weight stigma is making us miserable and sick.  We know that weight stigma makes us fatter,  increases inflammation, increases disease burden and decreases quality of life, increases the chances that we will engage in risky behaviors and may contribute significantly to diseases like diabetes and heart disease. We know that weight-based discrimination increases blood pressure and reduces our ability to think clearly. Now we have further proof that weight stigma is shortening our lives.

It has always been supremely frustrating to me that concern trolls are so ready to tell us that they beat us up about our weight because they are concerned for our health.  But as a person who has been on the end of concern trolling, I can tell  you that it doesn’t feel anything at all like genuine concern.  It feels like people relishing the fact they have an excuse to be a bully.  It feels like having a license that allows some people to spew hate under the micron-thick veneer of caring.  It feels like complete B.S.

And this new study indicates that the results of this hate can be profound and life-threatening.  The study states:

The ultimate cumulative effect of these hostile social interactions may be lower life expectancy. The present research examined whether the harmful effect of weight discrimination reached beyond morbidity to mortality and whether common comorbidities and health-risk behaviors accounted for this association. We also compared weight discrimination with other forms of discrimination (e.g., age, race, sex) to examine whether they share weight discrimination’s association with mortality risk. Finally, we examined whether the association between discrimination and mortality varied by sex, ethnicity, age, or body mass index (BMI). We tested these associations using data from two large longitudinal studies, the Health and Retirement Study (HRS) and Midlife in the United States (MIDUS).

After reviewing the data from both the HRS and the MIDUS, the study group came to some rather startling conclusions.  It appears that weight stigma can increase risk of mortality by a significant amount:

Weight discrimination was associated with an increase in mortality risk of nearly 60% in both HRS participants (hazard ratio = 1.57, 95% confidence interval = [1.34, 1.84]) and MIDUS participants (hazard ratio = 1.59, 95% confidence interval = [1.09, 2.31]). This increased risk was not accounted for by common physical and psychological risk factors. The association between mortality and weight discrimination was generally stronger than that between mortality and other attributions for discrimination. In addition to its association with poor health outcomes, weight discrimination may shorten life expectancy.

If people are truly worried about the health of fat people, they are going to have to give up on concern trolling.  Outside of the fact that you can’t hate someone for their own good (thank you Marilyn Wann), there is hard statistical evidence that it just may be your hate that is making fat people sick and giving them a shorter life.  Not to mention the horrible effect you have on their quality of life.  The study goes so far as to suggest that the harm of weight discrimination may be more harmful than any other effects of being overweight:

The present findings indicate that the harmful effect of unfair treatment that is attributable to body weight is not limited to psychological distress and morbidity: It also extends to risk of mortality. This association was apparent in two independent samples that covered different periods of the life span, and the association persisted after we accounted for behavioral and clinical risk factors. The effect of weight discrimination on mortality was generally stronger than that of other forms of discrimination but was comparable with that of other established risk factors, such as smoking history and disease burden. Moreover, the association between weight discrimination and mortality risk was in sharp contrast to the protective relation between some of the BMI categories and mortality risk. These findings suggest the possibility that the stigma associated with being overweight is more harmful than actually being overweight.

This type of research can have a profound effect on the lives of fat people around the world.  But just because it can doesn’t mean in necessarily will.  The media doesn’t jump to report these stories.  For many reasons, these articles aren’t popular with media outlets and are especially unpopular with advertisers.  If we want these studies to have an impact, we have to make sure that people in the world at large know about them.  We need activists.

That’s why I’m so excited that the Fat Activism Conference is starting tomorrow.  It’s not too late to get your tickets.  We have dozens of amazing speakers lined up ready to share ways that you can be an activist and an advocate for people of all sizes.  We’ve got speakers talking about activism and medicine and activism and art and activism and sex and many other topics.  I hope you’ll consider joining us for the conference.  This study indicates that activism against weight stigma may do more than just make us feel better and feel better about ourselves.  It just might help to save our lives.

Love,

Jeanette DePatie (AKA The Fat Chick)

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Docs Admit Diet and Exercise Don’t Equal Weight Loss, Then Jump to Wrong Conclusion

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An article hit my feed from LA Times today and it seemed to offer some refreshing news.  It seems 4 doctors, weight-loss specialists set out to say what so many of us have been saying for so long now.  They admit that for the vast majority of obese children and adults in this country, telling them to eat less and move more is a prescription for failure.

They acknowledge that once a fat body begins to lose weight, a whole lot of processes, hormonal and otherwise kick in.  Hormones increase hunger signals.  Metabolisms slow down.  The body struggles to maintain the weight.

Furthermore, the 4 weight loss experts admit that a body that has lost weight are biologically quite different from bodies that have never been fat.  One states:

“Few individuals ever truly recover from obesity,” the authors wrote. Those that do, they add, “still have ‘obesity in remission,’ and are biologically very different from individuals of the same age, sex and body weight who never had obesity.” They are constantly at war with their bodies’ efforts to return to their highest sustained weight.

So far, so good.  Many of us have been pointing out the studies that show these results for years.  So after this, those docs recommend a behavior-based approach where we focus on exercising and eating well for their own sakes (as both have been demonstrated to improve health regardless of whether or not they are accompanied by weight loss), right?  Right?

Well, as it turns out, no not so much.  The docs are suggesting that we simply increase awareness of other tools for weight loss (pills, potions, surgeries and devices) and turn to them sooner.  They suggest we increase fear mongering in the overweight to help keep them from becoming obese.  They suggest a greater focus on weight maintenance for those who have lost weight in order to help them keep it off.  (They somehow neglect to tell us how this is going to work or how it will help.)

The funny thing is, that the doctors see the stigma.  They see how telling patients to just eat less and move more is cruel, since it for the most part doesn’t work.  They see how stigmatizing fat patients and simply labeling them as non-compliant isn’t the answer.

But they simply substitute in another bad answer.  And this bad answer is likely to drag along much more devastating side effects than the original bad answer.  At least suggesting people move their bodies more and eat more nutrient-dense foods is likely to improve health, regardless of whether or not it leads to the holy grail of weight loss.  While pills and potions and surgeries and devices are slightly less ineffective than diet and exercise alone for weight loss, these methods can also carry significant dangers like increased heart rate, higher blood pressure, heart defects, permanent disfigurement, malnutrition, depression, suicide and death from other causes.  And there is not much evidence that in the long run, the few people who do sustain weight loss from the pills and potions and surgeries and devices end up any healthier than the people who stayed fat.

Meanwhile, there is ample evidence that eating well and exercising have a positive impact on health regardless of whether they are accompanied by weight loss.

So why on earth are we not just focusing on healthy behaviors here?  Why do we insist on focusing on weight loss at all?  Well these docs do label themselves as weight loss specialists and that may have a lot to do with it.  And as a society, we do love to blame fat people for stuff.  So I guess they took a few steps out into the light and then fell into a deep, dark hole.

Oh well.

I for one am going to continue my focus on living the best life I can in the gloriously wondrous body I have now.  So if you’ll excuse me, I’mma gonna get on with it.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want me to talk about evidence-based medicine and wellness at your school or organization?  Learn more HERE.

Proof Please

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So very often these days we hear that the world has deemed to help the portly because they so desperately need help and the world is being nice–and stuff.  Millions upon millions are invested in trying to prove that fat people are unhealthy, and if they would just eat a little less and move a little more, all their problems would be solved, everybody in the world would be healthy, and good, quality health insurance would cost everybody $1.  The fact that despite the millions of dollars spent, nobody has been able to prove these or demonstrate any way to make this magical weight loss happen on all but a fleeting and temporary basis doesn’t seem to deter anybody from testing this hypothesis again and again.

And even when the proof is not available, or indeed the available evidence says that your “weight intervention” causes negative effects and makes people fatter current policy seems to involve simply ignoring those pesky little facts.

Take the current practice of weighing and measuring kids at school and then sending home “BMI report cards”.  Despite showing again, and again and again that shame doesn’t make kids thinner or healthier, showing that shame causes kids to engage in more unhealthy behavior, that shame makes kids fatter, we still do this.  Why?  The National Eating Disorder Information Center issued the following statement regarding BMI testing in schools:

What the American Academy of Pediatrics (AAP) seems to be ignoring in its advocacy of weighing and measuring the height of schoolchildren is the risk it carries not just to increase body-based bullying from student’s teachers and peers, but the risk to children’s developing self-stigma and poor body image.

Body-based bullying continues to be the most common cause of bullying in youth. 29% of girls and 15% of boys are already teased about their weight at home. By grade seven, up to 30% of girls and 25% of boys are teased by other students. Poor body image has been found to stop youth from engaging in social, academic and physical opportunities. It limits willingness to express an opinion. In perpetuating focus on body shapes and sizes rather than on encouraging health providing attitudes and behaviours in children regardless of size, what are our schools (and public health) teaching?

However, it seems that plans to do BMI testing and BMI report cards in schools is continuing throughout North America.

This also reminds me of another recent situation I had recently reported.  Blue Care of Michigan is still touting the positive results of their “enforced march” walking program for fatties despite the fact that there is no evidence at all that those who participated either lost weight, or had any positive health outcomes associated with the program.  They apparently did nothing to track the original fitness level of the plus-sized participants and had no idea whether or not these folks were already active.  They just told these people that unless they wanted to pay an additional $2,000/year they had to participate.  They also forced those who participated to either be a member of Weight Watchers or wear a monitor which counted their steps during the day.  Just like a prisoner, they were forced to wear a physical implement on their bodies that told their insurance overlords what they were doing throughout the day.  Just because their BMI is over 30.  They declared this project a success even though nearly 1/3 of the 12 percent of participants who bothered to respond to the survey said they hated the program and found it coercive.  For more information, you may wish to read this article from my friend and colleague Jon Robison.

Throughout all this rhetoric about making fat people into “healthy thin people”.  Throughout all this spending on proving that fat people can become thin people on more than a very temporary basis and that making fat people into thin people will make them healthy there is one thing continually missing and that thing is proof.

When the available evidence points to the opposite of the fat people can become thin people, or fat people can’t be healthy people or fat kids just have ignorant parents rhetoric, the powers that be either request more money to re-test the hypothesis or simply ignore the inconvenient facts.

You may have heard of iatrogenic effects in medicine.  Dictionary.com defines them as: (of an illness or symptoms) induced in a patient as the result of a physician’s words or actions, esp as a consequence of taking a drug prescribed by the physician.

And good old Dictionary.com also defines iatrogenic as relates to social welfare: “(of a problem) induced by the means of treating a problem but ascribed to the continuing natural development of the problem being treated”.

Some experts have suggested that the “obesity crisis” is a textbook example of iatrogenic effects in both medicine and social welfare.  But I wonder if the “obesity crisis” isn’t responsible for iatrogenic effects in the economy as well.  If the response to the mounting pile of evidence that “diets don’t work” and “shame doesn’t work” and “fat people can be healthy” is always, “let’s pay for more tests” or “let’s do the weight loss junk but try harder this time” the obesity crisis will continue to be very, very expensive.

But I think the treatment for the economic effects of the hysteria surrounding the “obesity crisis” may be as simple as this.  Demand proof.  If your insurance company wants to put you on a walking program without doing an intake of any kind or presenting any data regarding the efficacy of the program, demand proof.  If your kid’s school wants to measure their BMI along with everybody else’s and send home a BMI report card, demand proof that this makes kids happier or healthier.  It’s not easy.  It’s not fun.  But the rights of fat people to enjoy life, liberty and the pursuit of happiness demands that we, the fierce fat folks, demand proof.

Love,

The Fat Chick

 

 

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