Tag Archives: obesity

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)

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

8 Replies

This 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.

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.

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.

Paradoxically(?!) Fatter Diabetics Live Longer

2 Replies

A few days ago a new study was released which indicates that of people living with type-2 diabetes, those in the overweight category live the longest. They even live longer than those in the “healthy weight” category. Newspaper articles like these (TRIGGER WARNING FOR UBIQUITOUS HEADLESS FATTY SHOT) are quick to cite this as another example of the “obesity paradox”. In case you are unfamiliar with this term, the obesity paradox refers to the fact that despite the fact scientists arbitrarily chose to name a lower weight category “healthy weight” or “normal weight”, the pesky fact remains that those of a higher weight on average live longer. And while people in the “overweight” category are more likely to contract certain diseases than those in the “healthy weight” category (such as cardiovascular disease) they are more likely to survive these diseases for a longer time. It’s vexing. Because, not only does this mess up the whole color scheme of the pretty BMI charts, it also means that we’ve been telling people to slim down to a weight that just might not be in their best interest.

One wonders how long the medical establishment is going to cling to this description of the “obesity paradox”, when the solution is so very simple. Change your labels. Change your definition of “healthy weight”. In fact stop saying “healthy weight” altogether. Because while certain weights have some advantages over others in some arenas, they are more dangerous than others. For example recent research indicates that the fattest people are the least likely to suffer from dementia at an early age.

The medical establishment and world at large are unlikely to change these labels any time soon however. The reason? Cash. Money. Cabbage. Moolah. Being able to charge over and over again for obesity treatments that don’t work is big money. Adding the word “obesity” to your research proposal increases the chances of getting funding and increases the amount of funding you are likely to get. Heck, as Harriet Brown’s excellent article in the Atlantic states–even mentioning the word “obesity” in a medical exam might mean you are able to collect more money for that patient. That’s why we classify obesity as a disease, even when expert panels in the medical establishment recommended against it.

I wonder when we are going to publicly accept the real obesity paradox. That we have a situation that occurs naturally in a certain segment of the population, that in some cases is potentially harmful and in some cases is potentially beneficial. Yet we label it a disease and focus billions of dollars towards trying (unsuccessfully) to change it, without any evidence that changing it will in fact, make people healthier, happier or live longer. That, to me, is the quintessential definition of a paradox.

Love,

Jeanette DePatie (AKA The Fat Chick)

Want to book me to speak at your event? Click HERE to learn more.

Study Proves “Not all Fat People are Unhappy”–Follow up to indicate Papal Affiliation With Catholicism

2 Replies

So I got a notice in my inbox this week that a study has been announced that indicates “Not All Fat People are Unhappy.” And honestly, my first thought was, “Duh.” I mean it seems quite obvious to me that not all Fat people are miserable, much as it seems obvious that the Pope is Catholic. But apparently the notion that not all fat people are sick, miserable, about to die and ready to throw in the towel is something we need to prove again and again.

But you know, before I cast to many aspersions on the study, I think maybe we really just need to look at the headline drawn from the study results. Because there are actually quite a few interesting things indicated by this piece of research. Let’s look at a few:

1. Your happiness seems to have a lot more to do with homogeneity than body size. If you are a fat person who lives in a town with lots of other fat people, you tend to be more happy than if you live somewhere with no other fatties.

2. The study creators speculate that being fat does not in itself make people unhappy. In the accompanying press release, study co-author Philip M. Pendergast states:

“In that light, obesity in and of itself, does not appear to be the main reason obese individuals tend to be less satisfied with their lives than their non-obese peers. Instead, it appears to be society’s response to or stigmatization of those that are different from what is seen as ‘normal’ that drives this relationship.”

3. Women tend to pay a higher emotional price for being fat than men do. The study creators speculate that this is because women face more social stigma based on body size then men do. In the press release Pendergast also says,

“Think about the advertising we see on television or in magazines—we are bombarded by images of thin women, and we are told that is the ideal,”

So here is yet another study that seems to indicate that how we feel about our size may have a lot more to do with our actual health and wellness outcomes than what we weigh. It follows on the heels of many other studies we’ve talked about on this blog regarding stigma and health outcomes like this one or this one. And all of these studies lead me to ask one very important question.

Even if we knew how to make people permanently thin (which we do not) should we ask them to change their body size to fit in? If being different leads to social stigma, and social stigma leads to poor health outcomes, should we encourage everybody to be the same for the sake of their health?

Even if we knew how to make people all be the same size (which we categorically do not) it seems to me that the answer is to deal with stigma rather than to make a completely homogeneous society to reduce stress on everyone involved. What if we actively worked to fight stigma based on body size? What if we actively worked to help people accept their own differences? What if we could feel better about our bodies? Might we be singing a song like this magnificent lady right here?

I mean just check these fabulous lyrics:

I looked in the mirror
What did I see a brand new image
Of the same old me ohhhh
But now I wonder why should I be surprised
I like the things about me that I once despised

There was a time
When I wished my hair was fine
And I can remember when
I wished my lips were thin

Makes no difference now y’all
How you may feel
I’ve done reached the point
Where I wanna be real
I’m tired of living living in disguise
I like the things about me that I once despised

Let’s face it, Mavis Staples has got it going ON! But she leads me back to my original question. Why can’t we take some of this time, money and energy that we are currently spending on stigma-inducing ineffective advertising that convinces people that they not only must be thin, but may easily obtain this state of grace by eating yogurt, and spend it on something that might actually help people feel better? It will help them feel better emotionally, and it will help them feel better physically. Why can’t we take some of the time, energy and money we are spending driving wedges into our society, by creating classes of otherness which we can blame for all our problems from the high cost of airplane tickets to soaring healthcare prices and spend it on something that teaches us to celebrate our differences. It will bring us together. It will help us live and breathe as a community rather than a simple pile of competitors in a winner-take-all, Victoria’s Secret model competition. When will we reach the obvious conclusions? Bears poo in the woods, stigma doesn’t help people, and yes, the Pope is indeed Catholic.

Call me captain obvious if you like. I’ve stopped spending on diets and weight loss schemes and self hatred because I like the things about me that I once despised.

Love, Jeanette DePatie (AKA The Fat Chick)

Join my mailing list and get free stuff! Get a boost! Have a Laugh! ;o)

Does Eating Margarine Cause Divorce? Correlation is not Causation.

On Golf, Waffle House and Becoming a Professional Hater

1 Reply

Recently, Bubba Watson won what is arguably the most important title in professional Golf–The Masters. He didn’t go to Disney World to celebrate. Nope, Watson celebrated his 1.6 Million dollar winnings by taking his family for a celebratory feast at a Waffle House restaurant. He tweeted the event to his 1 Million plus followers and the tweet went viral. The photo shows Bubba sitting next to his wife and best friend (Judah Smith, a pastor from Seattle). By and large the coverage was positive. Not only had Bubba managed to win the Masters for a second time, he had brought attention to an event that had primarily received coverage for the fact that Tiger Woods would NOT be attending. He managed to make a sport that is often seen as the exclusive playground of the rich seem more fun and less stuffy.

But not everyone was complimentary about Bubba’s trip to Waffle House for Grilled Cheese and Hash Browns. Apparently, self-appointed food policewoman, Katherine Tallmadge recently appeared on Neil Cavuto’s show on Fox recently–bashing Bubba for being a “poor example” of how athletes should eat–at least in public. Tallmadge fumed:

“Well, it would be great if celebrities and sports figures set a better example for our obese nation,” Katherine Tallmadge huffed to Fox TV host Neil Cavuto.

“There’s nothing wrong with the Waffle House if it’s an occasional splurge, but these gazillionaires love to show Americans that they’re one of you. And so, to win a popularity contest, they go to Waffle Houses, diners, steak places, when in reality, to be a great athlete or a celebrity in good shape, they don’t really eat like that.”

Okay, let’s break this apart, shall we? This guy won one of the highest titles in the land for one is arguably one of the most nerve-wracking sports on the planet but gets publicly scourged on a national level for eating some hash browns at Waffle House? Would it be better if he ate hash browns in secret where nobody could see. Is he failing to sport the fashionable eating disorder that should accompany any person receiving this much public attention.

And apparently, along with basic information about nutrition, registered dieticians receive training in clairvoyance and divination. Because although Tallmadge really doesn’t know Bubba or anything about his personal life, she feels she can safely comment on:

1. What Bubba eats on a regular basis.

2. Why Bubba took his family to Waffle House.

3. What all real sports stars eat on a regular basis.

4. Bubba’s general health status and physical condition.

Were Tallmadge ACTUALLY able to discern all of this about someone she’s probably never even met, she might warrant some of the media attention she’s recently received. Because, wow–MAGIC. Unfortunately, all Tallmadge is really able to do here is receive media attention by making self-righteous and unfounded assumptions about famous people that are just controversial enough to earn her some air time. Naturally Tallmadge has appeared often on television shilling her “nondiet eating plan for losing weight”. Forgive me if I don’t name her program or give it much credence. When people start talking about losing weight by eating right and not dieting, I tend to have trust issues.

Tallmadge’s web site is full of references to her multitudinous media appearances. And it all tends to remind me of another woman who appears a lot in the media–MeMe Roth. Ms. Roth has a degree in Journalism and had built a career working for top Public Relations companies. She also received a Health Counseling Certification from the Institute of Integrative Nutrition in 2008. The institute’s teachings and requirements have been called into question. But none of that stopped Roth from appearing in the media over and over again as an “Obesity Expert” (airquotes evident) who felt perfectly justified in telling fat people that they are ugly and useless and a scourge on society. Roth has made a media career out of being a professional hater. I’ve personally gone up against her brand of nastiness on the Dr. Drew show and have watched her scream and stomp and spit her way through many interviews since. She gets booked because she is a spectacle. She’s the train wreck that pulls the viewer over the commercial break. And her work on television would be laughable if it weren’t for the terrible damage she does to people of all sizes. She damages large people because she convinces them that they are ugly and worthless and unfit to join society at their current size. She damages smaller people by confirming for them that staying small is without question the most important thing they can do with their lives. While Tallmadge certainly sports somewhat better credentials–she seems to be headed along the same trajectory. She’s garnering massive media attention by serving as a professional food nanny–whether we’ve ordered one up or not.

I am often reminded of this clip from “Ratatouille”–one of my favorite movies ever. In this clip, the famous food critic waxes philosophical about his role as a critic and how it stacks up against the role of creator in his industry:

“In many ways, the work of a critic is easy. We risk very little yet enjoy a position over those who offer up their work and their selves to our judgment. We thrive on negative criticism, which is fun to write and to read. But the bitter truth we critics must face is that, in the grand scheme of things, the average piece of junk is more meaningful than our criticism designating it so..”

In that same way, I wonder about the work of a professional hater. They risk very little and create very little other than wagging their finger in a mildly entertaining way at the rest of us. Those of us who are writing books and inspiring others and winning international golf titles. I wonder if those of us who are winners and creators in the world might find a way to simply ignore these haters–like the unwelcome and uninvited house fly buzzing around our banquets. I wonder if we do this, if future employment opportunities for professional haters might be a little less rosy. But for now, if you’ll excuse me I’m headed out to eat some waffles.

Love,

Jeanette DePatie, AKA The Fat Chick

P.S. Wanna join my list and get free stuff? Subscribe already? It’s free and it’s fun!

Protecting your Heart from new Weight Loss Drugs

4 Replies

Well it’s that time of year again. The time of year that we talk about cupids and Valentines and love and stuff. And, as a good friend of mine on facebook pointed out, we’ve also reached the golden moment where post-Valentine’s day chocolate is 50% off. It’s the time of year when we think about our hearts.

So in this spirit, I thought I’d write about a new controversy brewing over two new weight loss drugs/combinations that have recently been approved by the FDA. In 2012, the Food and Drug Administration approved two new sets of magic beans, I mean “weight loss drugs” lolorcaserin hydrochloride (brand name Belviq, manufactured by Eisai Inc.) and phentermine-topiramate (brand name Qsymia, manufactured by Vivus, Inc.).

People have been pretty excited about these coming out, especially since a number of other “weight-loss” drugs have been taken off the market due to concerns over cardiac side-effects. Now one might think, in light of the fact that we put thousands of people at risk with the previous round of “weight loss” drugs, that the FDA might be extra careful not to release a new round of weight loss drugs with the same problems.

Not so fast, say a pair of doctors in an editorial recently published in the February 10, edition of JAMA. In this article, Steven Woloshin, MD, and Lisa M. Schwartz, MD, point out that these drugs were approved by the FDA despite an alarming number of side effects. In the abstract for the piece the doctors state:

The drugs have been associated with serious harms: Both drugs’ labels include warnings about memory, attention, or language problems and depression; for lorcaserin, the label also warns of valvular heart disease and euphoria; and for phentermine-topiramate, the label warns of metabolic acidosis, increased heart rate, anxiety, insomnia, and elevated creatinine levels. Neither medication is marketed in Europe because of safety concerns.

And as I read these words, all I can think is, “Here we go again!” The drugs were approved under the condition that the drug manufacturers would conduct studies looking into the drugs’ heart risks. According to the FDA, waiting until such studies were completed to approve the drugs would “delay effective therapy” for obesity. The post marketing trials that were required to begin 16 months ago, do not appear to have begun. And even once those trials begin, those studies are not scheduled to be finished for another four or five years. And in the meantime we’re prescribing drugs known to potentially cause memory, language, attention, mood and serious vascular and inflammatory problems because some trials have shown short-term weight loss improvements of 3 to 7 percent over placebo. There are no studies indicating long-term weight loss improvements in those who take these medications. Nor, as Doctors Woloshin and Schwartz point out, is there any proof that these medications prevent disease or help us live any longer.

In the meantime we play with people’s hearts both literally and figuratively. In a culture and a society where many of us are taught that being overweight is the worst possible situation, doctors are peddling hope in the form of these pills. And rather than rule out potential cardiac and other serious heart attacks before the drugs are prescribed, doctors prescribe these pills to hundreds of people and “expose a lot of people to it while sorting it out,” said Woloshin.

So we can hope that the “post marketing studies” will actually begin and show no serious, long-term side effects like the permanent heart-valve damage we’ve seen from similar drugs in the past. We can hope that we won’t market these drugs as the next great hope for people hoping to escape the pain of weight stigma in our society just to have to pull them off the market a short time later.

But I fear this is yet another page in the weight-loss-fantasy playbook likely to leave a string of broken hearts.

Love, Jeanette (AKA The Fat Chick)

Six Year Old Girl Dies–Diagnosed as Fat?

7 Replies

Sorry to start your week out with such a sad story, but I think it needs to be told. Late last week I became aware of the story of Claudialee, a six-year-old girl who passed away after being misdiagnosed with type 2 diabetes, when she actually had type 1 diabetes. There is a very detailed account of the story here.

I’m not going to go into every detail of this story, but I did want to point out a few things that stand out for me. One is that Claudialee has a family history of diabetes. Another is that the doctor diagnosed Claudialee as obese. It is clear that the doctor was deeply concerned about the young child’s weight–prescribing diet and exercise in an effort to get her to lose weight. It is also clear that the mother closely followed the doctor’s recommendations–carefully monitoring what Claudialee ate and making sure she got plenty of exercise.

What is not clear is why the doctor felt so strongly that this child had Type 2 Diabetes as opposed to Type 1. According to a source cited in the article (The National Institute of Health) at that age group, Type 1 Diabetes has an incidence of about 20 in every 100,000 kids, whereas Type 2 Diabetes has an incidence of .4 in every 100,000 kids or 1 in every 250,000 kids. What’s more, at that age, Type 1 Diabetes is a far more urgent problem than Type 2 Diabetes. So what led to the doctor’s misdiagnosis?

We may never know for sure. But it does invite one to speculate whether the child’s weight was a factor. Clearly, getting Claudialee’s weight down was a prime part of the prescription to the parent. And as the child’s weight went down, the doctor neglected to do some of the critical follow-up blood tests that would have indicated that something was drastically wrong.

The article states:

Because Mercado [the doctor] had locked in on type 2, she did not monitor her patient’s blood. She did not tell Irma [the child’s mother] to purchase a $20 blood sugar meter from the drugstore. She did not ask Irma about the frequency with which her daughter drank and urinated. And neither she nor Cabatic [another doctor] described to Irma the danger signs to look out for.

When asked in court, why the doctor seemed so certain that the child had type 2 diabetes when type 1 diabetes was so much more prevalent among children that age, she stood by her original diagnosis:

“How many type 2 infant diabetics have you treated?” a lawyer asked her.

“A lot,” she replied. “Maybe it’s geographical, because I work at Brooklyn as an assistant professor and also in wellness program where there are a lot of obese children, so we diagnose a lot of children with type 2 diabetes.”

Clearly there may have been other issues at play here. Claudialee was on Medicaid and doctors are paid significantly less for treating patients on Medicaid than they are for those with private insurance. The doctor was not board-certified, and the article points out that finding board certified physicians willing to work in clinics that take Medicaid can be difficult. And this is a single case where a single doctor has been convicted of malpractice. We will never know exactly what was in the doctor’s mind.

I but I personally found myself wondering if this doctor had ever previously considered that she may have a bias against fat patients–and maybe even fat children with low SES in particular. I wonder, had this doctor considered the potential for her own bias in this arena, would that child still be alive? Would Claudialee still be running around and playing today?

We certainly have plenty of evidence for a seeming “hysteria” around the issue of childhood Type 2 diabetes. A simple google search of “childhood diabetes epidemic” yields hundreds and hundreds of articles. This hysteria has spawned a number of shaming techniques aimed at children despite the fact that shame has been proven over and over again to be ineffective at treating obesity at any age, that shame is more likely to make kids engage in unhealthy behaviors, and that eating disorders are much, MUCH more prevalent among children than diabetes of any kind.

All I know for sure, is that stories like that of Claudialee get me even more fired up to fight against weight stigma in medicine. And that passion leads me to come to you with a plea. The Association for Size Diversity And Health and the Size Diversity Task force have embarked on a documentary film project to help doctors see and understand weight stigma and weight bias in medicine. This project is called the Resolved project. But this project needs a little bit of help from you. We are raising funds to finish the documentary on Go Fund Me here. Any help you can offer would be greatly appreciated. Even if you can only give a few dollars, that will help. And if you don’t have a few dollars to spend, would you consider sharing this with your friends and asking them to help? Let’s see if we can end weight stigma and weight bias in the healthcare industry for good. And maybe, just maybe we won’t have stories like Claudialee’s any more.

Love,

Jeanette (The Fat Chick)

P.S. Want to stay up to date on my projects and appearances? Just opt in RIGHT HERE!

Proof Please

1 Reply

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

Like my posts? You’ll love my stuff!

Buy my book: The Fat Chick Works Out! (Fitness that is Fun and Feasible for Folks of All Ages, Shapes Sizes and Abilities)–available in softcover and e-book versions

Buy my DVD: The Fat Chick Works Out! (A Safe, Easy and Fun Workout for Klutzes, Wimps and Absolute Beginners!)

Buy a book or a DVD for a friend and save $5! Just enter FRIENDBLFT in the discount code box!

Check out my Training Programs–both in person and via Skype (Starting at just $25!)

Book me to speak at your special event!

When doctors are wrong.

1 Reply

I recently watched this video–a TED talk–by Dr. Peter Attia. You may have seen it as it’s become quite a viral sensation over the last few weeks. But even if you have seen it, you might find it useful to watch again. So here it is:

While I don’t agree with absolutely everything Dr. Attia has to say, I do think he brings up a few important points. One issue is that some doctors, scientists, and other medical professionals are really starting to question the causal nature of the link between obesity and diabetes. I think this is an important area that will require a lot more study. And I think it is our job to continue to push for this continued study.

But one issue that I want to particularly want to highlight here is how hard it seems to be for doctors to admit they are wrong. Dr. Attia is clearly deeply moved. He feels a tremendous sense of remorse for how he treated that poor woman with diabetes. Once he realized the level to which he had allowed stigma to affect his treatment of this woman he was devastated.

Many of us would be quick to state, well he should be. He may have deeply hurt this woman. He may not have given her the best medical care. Many of us don’t go to the doctor because we are so afraid of being hurt just this way at the doctor’s office or the hospital. Some of us have died because of this.

To which I would respond, “Yes, that’s true.”

But I think it’s also important to see what this video has to teach us about doctors and what it might be like for them to understand that they were wrong about something. We look to doctors to fix everything. We ask them to make us well and to bring us back from the brink of death. It takes a certain amount of arrogance to hold a person’s beating heart in your hand and endeavor to fix it. And I imagine there is a certain amount of pain when you have to tell somebody or tell their family that you can’t fix it. You can’t make it all better. You are not god. And I’m not sure that the pain ever goes away.

Please understand. I am not making excuses for doctors who bully and stigmatize fat people. It is wrong, and it needs to stop. Now. That is why I am working so closely with the Size Diversity Task Force and the Association for Size Diversity And Health on the Resolved project. We need to share our stories. We need doctors and the public to understand that weight stigma is extremely damaging to fat people in medical settings and is sometimes even fatal. There was a period of years in my life when I was quite sick and might have died based on the assumptions that doctors had made about me. So I get it. This must change.

But I think, if we want our work to be effective, if we want things to change, we need to be perceptive and understand what it means to help doctors understand that they are wrong about this. We need to understand this–not so we can let them off the hook–not so we can let them down easy– so we can find the best path towards an actual solution, so we can understand why many doctors are so resistant, and so we can better understand why this is taking so long.

The issue of weight stigma in medicine is complex and nuanced. But I do know one thing. It will only change if a lot of us continue to work together to bring about change. I would love to hear your thoughts about this issue. And I would love to have your continued support to make the Resolved project a success! Click here for more information about how you can participate.

Love,

The Fat Chick

Like my posts? You’ll love my stuff!

Buy my book: The Fat Chick Works Out! (Fitness that is Fun and Feasible for Folks of All Ages, Shapes Sizes and Abilities)–available in softcover and e-book versions

Buy my DVD: The Fat Chick Works Out! (A Safe, Easy and Fun Workout for Klutzes, Wimps and Absolute Beginners!)

Buy a book or a DVD for a friend and save $5! Just enter FRIENDBLFT in the discount code box!

Check out my Training Programs–both in person and via Skype (Starting at just $25!)

Book me to speak at your special event!

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: