Tag Archives: fat

New Study Suggests Obesity Doesn’t Make Joint Surgery Less Safe

BadKnees

Another media appearance for the bad knees.

I recently came across a recently published study that was published in The Journal of Arthroplasty regarding overweight and obese patients and joint surgery.  In particular, the study evaluates data from 900 hip surgeries and over 1,500 knee surgeries.  The data was evaluated in terms of weight, BMI, how often blood transfusions were necessary, complications from infections, and time spent under the knife (how long the surgeries took).

The study results were “counterintuitive” to many–meaning it failed to confirm some of their deeply held biases about hip and knee surgery and people who are fat.  The concern was that surgery on fat people would take longer than surgery conducted on thin people, and thus would increase the probability that a blood transfusion would be required.  This is of deep concern to doctors because blood transfusions can cause serious complications–with as many as 1 in 5 causing some sort of negative effect.

However, this assumption was not borne out by the research.  In fact, overweight and obese patients were less likely to require a transfusion than their thinner counterparts.  During hip surgery, on average 35 percent of the “normal weight’ patients required a transfusion compared to 28 percent of the “overweight”  patients and 22 percent of the “obese” patients.  During knee surgery, 17 percent of the “normal weight” patients needed transfusions compared to 11 percent of the “overweight” patients and 8 percent of the “obese” patients.

Furthermore, the study indicates that their research turned up no evidence that overweight or obese patients spend any more time under the knife than their thinner counterparts.  However, a slight uptick in complications from infection was noted for those in the overweight and obese categories.

A recent article in HealthDay turns to a surgeon from Los Angeles for a quote.  Dr. Alex Miric, an orthopaedic surgeon with Kaiser Permanente in Los Angeles stated:

“I agree that the results are counterintuitive,” Miric said. But he also agreed that conclusions “would need to be replicated with more surgeons and a larger and more current patient population before such a finding would gain traction in the orthopaedic community.”

Hmmm.  While surgeries for fat people might not take longer or be more dangerous than those for thin people, it seems pretty clear that surgeon bias against fat people is alive and well.  I have read many anecdotal accounts from people denied surgery–especially hip or knee replacement surgery because they were too fat.  People with diminished mobility and often severe pain are sent home to “lose enough weight” to be a candidate.  Those fat people determined to receive surgical relief often find themselves wandering a desert of medical red tape looking for a surgeon willing to take on their case.  And they suffer needlessly while they do.

The question of whether the mobility and pain outcomes are as successful for fat people as thin people is a topic for another post.  But in the meantime, I wonder how many studies will have to be done and how many cases will need to be reviewed before the “counterinituitive” nature (read physician weight-based bias) will be reversed.  And how many fat people will have to suffer for how long while we wait for that to happen.

Fired up?  Want to fight stigma and bias?  I’d love to recommend that you join Ragen Chastain, a huge group of additional talented speakers and I for the Fat Activism Conference THIS WEEKEND.  We start on Friday night, so if you don’t want to miss it, I suggest you register now!

Love,

Jeanette DePatie

AKA The Fat Chick

Advertisements

Bullying is Ugly, But we Need to Look at it with “A Brave Heart”

schoolHallwayThis ugly, UGLY picture was taken today of a poster that was taped to a wall at Northern High School in Calvert County, MD.  There’s a lot of argument about the poster–which we will get to in a minute.  But in the meantime, let me tell you just what interesting timing this poster has for me personally.

As I sat in the audience last night at a Producers Guild Pre-release screening of “A Brave Heart–The Lizzie Velasquez story” I heard the people around me gasp.  We had reached the part of Lizzie’s story where she recalled at age 17 finding an unauthorized video of herself posted on YouTube.  The video was captioned “The Ugliest Woman in the World” and had been seen over  4 million times.  And the comments–oh the comments.  People said things like , “Why didn’t her parents abort her?” and “Kill it with fire!!!” I heard people whisper things like, “oh my God!” and “I can’t believe it.”

I could believe it.  I haven’t lived Lizzie’s Velasquez’ story.  Nobody but Lizzie has lived that amazing life.  But I’ve lived with the hate.  I’ve read comments like that on my own blog and twitter feed and especially my YouTube account.  I’ve swapped stories with other fat activists about the death threats and the rape threats and the doxxing and all other forms of online harassment that so many of us experience on a daily basis.  And I thought how privileged some of the people in that audience were–that they didn’t really know that sort of online hate existed.  That they found it difficult to believe.

I was so proud of my husband, who stood up during the Q&A to relate that he had been completely ignorant of how bad the online climate was, of how unbelievably ugly it could be, until he started reading some of the comments that people have directed at his own wife.  He reiterated how important this movie was–how relevant it was–because adults need to understand just how bad it is out there.

The movie, directed by Sara Bordo also talked about how dire the consequences of bullying can be.  Lizzie arose triumphantly out of her bullying experience.  But Tina Meier’s daughter didn’t arise from the bullying at all.  After some particularly bad cyberbullying by her peers, Meier’s daughter committed suicide.  Tina and Lizzie have teamed up–working to get new federal antibullying legislation passed in the US.

Again, as the audience came to this point in the story, many gasped or covered their mouths in shock.  I simply nodded my head and cried.  Because I already knew Megan’s story.  I knew what had happened to her.  And I knew, just a little of what she felt.  Because as I told Lizzie and Sara after the screening and the Q&A, I could have been one of those kids.  I might have not made it out.  I was bullied relentlessly as a teenager.   I came home sobbing, vomiting and covered with hives from the stress of it.  At times I felt I could no longer take it.  But I got relief.  I didn’t have email or a Facebook account.  At the end of the day, I could escape at home to my loving family.  I had two whole days per week free of it.  Today’s kids do not.  Because of social media, these kids have to deal with this 24 hours per day and seven days a week.  Given that situation, I honestly don’t know if I would have made it.

Lizzie and Sara at the PGA screening.

Lizzie and Sara at the PGA screening.

But this is not a fun or easy or comfortable subject.  Many people who don’t have to deal with this sort of bullying would rather imagine that “it’s not really that bad” or “it’s not that big of a deal.”  Which leads me to the picture posted above.  A student took a photo of that poster.  The picture was posted online and has gone viral.  The original poster stated that the photographer believed that the poster had been taped up with the at least tacit permission of at least one teacher.  And the feathers are flying.  Many people are demanding answers.  Did a teacher know about this poster?  Did a teacher give permission or at least know it was being posted?  Who is the kid responsible for this thing?  And are they being disciplined?

Naturally the social media frenzy puts the school in a bad light.  But in a classic case of spin cycle, the Superintendent stated:

We are aware that a photo is being circulated on social media of a poster from NHS that makes a mean and inappropriate reference to obese students. That poster was not approved by any teacher or staff member and was up no longer than five minutes. The matter is being appropriately handled by the administration.

This is a good example to all of how a 5 minute bad idea can live forever on social media and be distributed with inaccurate references to good people. Rather than having a lifespan of 5 minutes, this poster (with the help of many well-meaning people) was effectively copied and posted in every hallway, classroom, and home. You can help put an end to the unfair reference to NHS staff and the continued distribution of this inappropriate message by deleting or, at the very least, refusing to pass it along. Thank you.

There is a certain amount of sense in choosing not to spread hate with wild abandon.  That’s why I didn’t link to Ms. Arbour’s nonsense and don’t give clicks to a lot of other ugly things out there.  But there are some problems with this response.  First of all 5 seconds in the eyes of a particularly vulnerable person are enough to do irrevocable harm.  5 minutes, in a high school hallway, is an eternity.  And while I respect the school’s right to deal with this problem according to its own policies, I have to vehemently disagree with the idea that simply not sharing this photo will make the problem go away.  (It won’t.) And I think that people need to be confronted with the level of nasty that truly exists before they are tempted to say they don’t have time to be “P.C.” that fat people are just whining and that fat shaming is an imaginary concept.  It is so very, very, very real.

That’s why I applaud Sara Bordo and Lizzie Velasquez for having the courage to show the bullying it all its true ugliness.  Refusing to censor Lizzie’s hate messages along with refusing to drop Megan’s suicide story resulted in the movie receiving a controversial PG13 rating.  This means that most schools won’t be able to screen the film because of the rating.  I find it fascinating that any kid old enough to move a mouse can be exposed to this online without warning and without context or support.  But a movie that explains how bad it is and gives kids and adults tools to discuss it is rated PG 13.

JeanetteAndLizzie

With Lizzie at the screening.

I really want to recommend that you and yours find a way to see this amazing film.  It is a stark look at the brutality of bullying.  It is also a warm, ultimately uplifting story about how bullying can be (sometimes) overcome.  It’s a great starting point for the deep conversations we need to be having about this topic–however more comfortable it might seem to simply walk (or run) away from it.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. I’d like to remind you that the Fat Activism conference is just a few short weeks away.  Ragen and the organizing committee and I have put together an absolutely amazing lineup of speakers who can help you figure out just exactly what can be done.
Register for the Fat Activism Conferenece!

Not Jolly and Not Sorry (Letting go my need to make everybody laugh…)

EnvironmentalAw1

I recently spoke at the Environmental Awards in Irwindale.  My speech was called No BODY Left Behind–Workplace Wellness for All. I talked about workplace wellness in terms of four “i-opening” words–information, incentive, invitation and inspiration.  I must give credit where it is due.  Jon Robison and Rosie Ward and their fabulous new book “How to Build a Thriving Culture at Work” helped to transform my thinking.

I shared a lot about what I thought was working and wasn’t working in workplace wellness.  I talked about how many wellness programs feel unfair because they ARE unfair.  They reward the already privileged in a way that is subsidized by the less privileged.  They only accommodate the needs of the folks that are in least need of the program.  They use shame and peer pressure to try to shove employees into a single vision of “health” which is largely driven by media-fueled unrealistic expectations and the personal bias of the program creators and managers.  They could be inviting.  They could be inclusive.  They could make every BODY feel welcome.  But they usually don’t.  And they often end up causing more problems than they solve.

I think I did a good job at the talk.  But it was weird.  As a speaker, I mostly give upbeat, Rah-Rah, body positive and funny speeches.  And this kind of speech is instantly rewarded.  People watching and hearing the speech cheer and laugh and clap.  People smile and have a good time.  It’s a pretty strong, emotionally positive feedback loop.  And I usually leave the stage feeling awesome.

This talk was different.  People were paying attention.  But people were thoughtful.  Listening carefully.  Letting my words sink in.  This talk was serious.  I had a positive takeaway.  There are ways we can do this better.  But this speech was not fun and it was not funny.

And as I walked off the stage, I wondered.  “Did I do okay?  Did I get through.  Did people hate it.  Did they learn something?”  I felt very insecure.  Sure, there was applause at the end, but no positive, laughing, feel-good feedback loop.

I always feel a little unsure when I release my need to entertain–to be funny–to be jolly.  But I’m always kind of amazed at the response when I do.  As I sat back at my table a woman immediately asked for my card.  Not because she wanted me to do a fun and jolly speech at her workplace (a local college).  But because her school has implemented a wellness program modeled after The Biggest Loser television show.  And my talk made her think that maybe it wasn’t such a good idea.  I’m hoping to speak with her soon.  So I could see a very positive result from straying outside of my comfort zone.

And this was a good reminder.  Being upbeat and positive and funny are great tools.  They are some of the colors with which I can paint.  But when communicating with others about size acceptance and body positivity and social justice for people of all sizes, it behooves me to use ALL the tools at my disposal and all the crayons in the box–even those that aren’t my normal favorites or the most comfortable ones to use.

Which leads me to this point.  I’d like to straight up invite you to attend the Fat Activism Conference.  Some of the people there will be taking a “fun and funny” approach to fat activism.  Some will be serious.  Some of the testimony may be full of pain and not so much fun to hear.  Some of it will be LOLROTF funny.  But what the conference allows you to do is hear a variety of voices coming from a wide range of perspectives all speaking on the topic of making the world better, safer and more inclusive for people of all sizes.  And frankly, today is the last day you’ll be able to get the lowest possible price to attend the conference.  Our super earlybird pricing ends tonight.  So if you’re up for hearing all different kinds of voices sharing using all the tools at their disposal and all the crayons in the box, while sharing ways to make the world better for Every BODY why not register now?

Love,

Jeanette DePatie (AKA The Fat Chick)
Register for the Fat Activism Conferenece!

PADS Saturday–Grandpa Pushes It Good!

As the nearby “Cabin Fire” has us coughing and staying inside, I thought I’d cheer myself (and you) up with a PADS Saturday.  What is a PADS Saturday you ask?  PADS Saturday is a semi regular Saturday-only blog feature which includes

Public

Acts of

Dancing

Spontaneously

I ran across this video and frankly love everything about it (except the comments of course).  This guy has got it going ON!  There is no questioning his commitment.  And this guy has got some incredibly strong hamstrings, quads and glutes.  Check it out when he goes down low.  And slides to the floor.  And, and, and!  His dancing partner has some great moves too.  But I have to say for inventiveness, for committing fully to getting his groove on and to rocking it out while not dropping his cell phone (note the clip) this guy wins the Internetz for today!

And I would be remiss if I didn’t invite you to collect just a little sumthin, sumthin from this guy’s mojo.  Where are you holding back?  Where are you making yourself smaller or less than?  And how can you get out there and PUSH IT–PUSH IT REAL GOOD?

Love,

Jeanette DePatie  (AKA The Fat Chick)

P.S. Today is the LAST DAY to submit to the fat fitness anthology.  Let us hear from YOU.

The 1% efficacy rate and weight loss as a prescription

Prescription

Talk to nearly any person over a size 12 and chances are, they have run into a doctor or medical professional who recommended that their health would improve if they would only lose weight.  Whether that person went to a podiatrist for help with their feet or a gyno for a pap smear or an optometrist to get an eye exam, chances are at least one of these medical professionals has stated that the solution for these health woes is that the patient simply lose weight.

Let’s take a look at that prescription for just a moment.  Just how likely is it that one of these people is going to lose any kind of significant weight (and keep it off for any period of time)?  A recent study, conducted by a team at King’s College suggests that this prescription is pretty unlikely to be successful.  For moderately fat people (BMI 30-35) the chances of returning to a “normal weight”  (heavy airquotes here) and staying there for a year is one in 124 for women and one in 210 for men.  For very fat people (BMI 40-45), the chances drop to 1 in 677 for women and 1 in 1290 for men.  The chances for losing only 5% of body fat were greater (one in 10 for women and one in 12 for men) however the majority of these folks gained the weight back within 5 years.

Keep in mind that there is no evidence that this very tiny percentage of people who had lost weight lived any longer or healthier than those who had not lost weight.  While there is some correlation of people who have always been thin and certain health benefits, there is virtually no statistical evidence that the microscopically small group of people who manage to maintain a significant amount of weight loss over the long term enjoy any health benefits at all over the people who don’t.

So, can we talk?  Can somebody tell me why, exactly, medical professionals are suggesting a “treatment goal” which in the very, very most optimistic scenarios can be achieved by 10 percent of those who try it and on the low end has a less than 1 in 1200 chance of being achieved?  And can anybody tell me why we recommend this strategy when there is virtually no evidence that in the rare case it will be achieved it will do any good?

Let’s talk about this in terms of a pill.  We tell the patient that they have somewhere between a 10%  and a .1% chance of even being able to ingest the pill.  And in the long term, so few people are able to keep this pill down long enough to test, that we don’t have really any convincing evidence that the pill does any good at all.  The side effects from even trying to take this pill range from frustration to eating disorders to weight gain, to poor nutrition to death.  So what on this God’s green earth is the point?

I think it’s time to recognize that weight loss is not a behavior–it’s a condition.  And that weight loss as a prescription is probably not worth the paper upon which it is printed.

Love,

Jeanette DePatie AKA The Fat Chick

P.S. Want me to come speak at your school, office, organization or group?  Learn more about my speaking at http://www.jeanettedepatie.com.

Diminishing Distress Dials Down Diabetes

First do no harm. Diabetes scare tactics just might kill you.

I recently ran across this article on Diabetes Hub which describes two important studies which correlate distress with poorer outcomes for people coping with diabetes.  The first of these studies involved a randomized trial of 150 women with uncontrolled diabetes.  What the study found is that those women in the study who were able to reduce their level of disease-related distress had significantly improved glycemic control.

Typical sources of disease related distress included fear of getting sicker and feelings of isolation or overwhelm in relation to disease management and treatment.  The EMPOWER study tested various forms of treatment interventions and found that regardless of treatment methodology, those people who were able to lower their distress were more compliant with treatment protocols:

HbA1c dropped much more substantially in those in whom distress was lowered, compared to those with whom distress was unchanged or increased,” Dr. Cummings said. “Medication adherence, self-care behaviors, and diabetes empowerment and self-efficacy were all substantially improved in the group with lower levels of distress at the end of the trial.

The doctors admit that they don’t quite know why lowering distress has such a significant effect on glycemic control among people with diabetes.  However it seems that working to lower distress among people with the disease is an important treatment goal.  According to Dr. Cummings:

We’re surprised at the number of these women caring for children, grandchildren, and other members of their families, often while working, and yet not finding time to care for themselves. It is clearly an important cultural phenomenon that we need to understand better.

The article went on to discuss data gathered from another important study: the national Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study.  Dr. Cummings noted that in this study which included 4,000 black and white adults 45 years and older with diabetes and nearly 18,000 adults without diabetes, those subjects with diabetes were more likely to suffer from depression or distress (26.7% vs. 23.2%, P < .001) or both (10.1% vs. 6.2%, P < .001), compared with those without diabetes.  Those people who had diabetes and also symptoms of distress or depression had higher risks for stroke and CV death than people with diabetes without depression or distress.

What all of this seems to make clear to me is the deep need for compassionate, blame-free, stigma-free, evidence-based health care for people coping with diabetes.  The notion of scaring people straight or using dire warnings to fuel completely unrealistic weight loss goals may be more than counterproductive–they might prove especially medically dangerous for this population.  Many forums for people with diabetes are filled with horror stories about how members were stigmatized, told their conditions were their fault and told that if they didn’t get thin, they wouldn’t live to see their children or grandchildren grow up.

But maybe what really needs to grow up is our approach to helping people with diabetes live better, longer and happier lives.  Maybe we need to spend a little less time pointing fingers and a little more time holding hands as we help people make small, incremental, manageable and realistic changes in their lives.  It’s just possible that fear tactics are doing more to harm people with diabetes than to help them.

That’s one of the reasons I’m so excited to be giving a presentation at the upcoming Take Control Of Your Diabetes Conference on September 26 in San Diego, CA  The event focuses on helping people with diabetes take positive, small and sustainable steps to better health.

Fitness is for ALL of Us

Ragen Chastain and I are so  very pleased to release our first video on our brand new YouTube Channel: Fitness for All of Us.  We’ve released our fight song to announce our intention to create a safe space where bodies of all shapes and sizes, ages and abilities can rejoice in joyful movement.  Here’s our first video:

For far too long, fitness has been a space relegated to those who have a certain body type or begrudgingly to those who are actively and seeking that body type.  Some have said that “Fit is the New Skinny!” without understanding that “fit” as defined by most is predominantly skinny.  It may include an extra pert rear and muscular legs.  It may include a six pack (or eight pack) and carefully-chiseled Michelle Obama biceps.  But the fit often referred to in the “fit is the new skinny” or even “strong is the new skinny” memes bounce right out of fitspiration with rock hard, totally toned, glistening, fitness model bodies.

But what about the rest of us?  Those of us who have bits that jiggle and flow?  Those of us with rolls and cellulite?  Those of us with big, bountiful bellies and big hips?  Those of us who are not exactly the slightly-upsized Barbie ideal of big boobs, tiny waist, swelling hips and tiny, pointed feet?  That is who this channel is for, it’s for ALL OF US who are interested in fitness in any capacity and at any level.

Because this is so much of what my work is and has always been about.  Fitness should be fun and encouraging and welcoming and physically and emotionally safe for all of us.  Fat and skinny, young and old, high powered athlete and folks who just want to walk their dogs.  Runners and walkers and boaters and swimmers and yogis and dancers and kickboxers and cyclers and multisport mavens.  Seasoned experts and frightened beginners.  Fitness should be for every BODY!

We should be able to get help when we ask for it and be left ALONE when we don’t.  We should be encouraged the same way as everyone else.  We should get a quiet thumbs up or even a shout of welcome for joining the posse for being part of the fitness community, not because somebody imagines that exercise is particularly difficult for us, or that we serve as some sort of weird inspiration for them and especially not because people imagine that we are forcing our bodies to comply to some ideal of shape, size, weight, or any other parameter.

Let us move.  Let us breathe.  Let us enjoy fitness on our own terms.  Above all, let us be.

Hope you like it!

Love, Jeanette DePatie (AKA The Fat Chick)

P.S.  Want to show us some special love?  Don’t forget to subscribe!