Tag Archives: overweight

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

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

The 1% efficacy rate and weight loss as a prescription

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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.

Paradoxically(?!) Fatter Diabetics Live Longer

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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)

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Wicked Witch Hands Fat Kids Shame-Filled Letter instead of Candy

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*Loud record scratch noise*

We interrupt our regularly scheduled blog to make this public service announcement. Apparently a woman in North Dakota called into a local radio station saying that she will hand trick-or-treaters that she deems too fat a letter along with their candy. The thin kids will just get candy. After the interview, she emailed a copy of the letter she plans to send along to the radio station.

Want to know what the letter will say? Here it is in all its glory:

Happy Halloween and Happy Holidays Neighbor! [Picture of a cute pumpkin]

You are probably wondering why your child has this note; have you ever heard the saying, “It takes a village to raise a child”? I am disappointed in “the village” of Fargo Moorhead, West Fargo.

Your child is in my opinion moderately obese and should not be consuming sugar and treats to the extent of some children this Halloween season.

My hope is that you will step up as a parent and ration candy this Halloween and not allow your child to continue these unhealthy eating habits.

Thanks!

Yup, apparently this woman called into a radio station (anonymously) and claimed she would be handing these letters out to the fat kids this year. She won’t tell us her full name or where her house is. There is no way for a parent to avoid this house with their kids because nobody [as yet] knows where she lives. But she says she’s going to do this, because, “It takes a village, people!”.

I guess nobody told her that she’s been designated the village idiot and thus probably won’t be put in charge of the welfare of the village children this year.

This whole thing is so appalling, I frankly had a hard time figuring out where to start. So I guess we’ll start at the beginning of this amazingly articulate missive. *Insert eye roll here.*

It begins “Happy Halloween and Happy Holidays Neighbor”. Because nothing says “happy holidays” quite like shaming your child in front of his peers and offering unsolicited and uninformed opinions on your parenting skills. But that’s okay because I’ve got crappy clip art of a jack o’ lantern here, see? And the jack o’ lantern is smiling so that means I’m being nice.

“You are probably wondering why you are receiving this note;” Yes indeed. I am wondering why you decided to send a judgmental and shame-filled letter home with any child. Since we all know that shame doesn’t make kids healthier, happier or thinner, I would really like to know why you thought it was okay to do that to a kid in front of her peers. Given the fact that shaming kids tends to lead to unhealthy behaviors including binge eating, drug use, alcohol abuse, smoking and eating disorders, I would really like to know what made you think this was okay.

The letter goes on, “have you ever heard the saying, “It takes a village to raise a child?” Yes I’ve heard this saying, but I’m pretty sure it means something different than you think it does.

Then the letter says, “I am disappointed in “the village” of Fargo Moorhead, West Fargo.” To which I would respond. Well I am too. If the village contains judgmental people like you who think that, based solely on a child’s appearance you have the right to shame that kid in front of his friends and send an anonymous letter to the parents telling them that they don’t know how to raise him, I think our “village” has a problem.

Okay, this next line makes me incandescent with rage. She says, “Your child is in my opinion moderately obese and should not be consuming sugar and treats to the extent of some children this Halloween season.” O.M.G. First of all, how exactly are you determining that the child tips the scales as “moderately obese”. Are you measuring height and weight and calculating B.M.I. on the fly? Are you pulling some skin calipers out of your “candy cauldron” and doing a little skin fold testing there on your front porch? Or are you basing your calculations on which kids are chubby in a way that insults your delicate sensibilities? Oh wait, I forgot. It says it’s your opinion. Did I ask your opinion? Did anyone? No? That my dear villager is a sign you should Just. Shut. Up.

But the last sentence of the letter is the real kicker. She closes by saying, “My hope is that you will step up as a parent and ration candy this Halloween and not allow your child to continue these unhealthy eating habits.” It is unbelievable how many unsubstantiated assumptions this woman is able to cram into one little sentence. It assumes that the parent is not doing their job. It assumes that the child has unhealthy eating habits. It assumes that the parents don’t ration candy. It assumes that the parent is unaware that the child is chubby and is somehow negligent as a parent. Does she know this because she knows the child and the family and the situation? Does she have a crystal ball that shows definitively, in each particular situation what is happening in that child and family’s life? Does she know if the kid is taking medications that make weight gain more likely? Does she know if the kid has a metabolic disorder? Does she know if the kid has just lost a parent or is coping with unbridled bullying at school? Or is she spewing hate all based on the fact that Tammy’s tutu is a little too tight?

And she closes with the word “Thanks”. Yes, and let me also offer my thanks.

Thanks for shaming kids in front of their friends. I’m sure that will make everything better.

Thanks for taking the one holiday of the year which is really about kids having fun and wrecking it for them.

Thanks for offering your completely unsolicited and unsubstantiated, bitchy and judgmental opinions on people’s parenting skills based on your personal prejudice.

Thanks for making kids cry.

Thanks for increasing the chances these kids will turn to drugs, alcohol, tobacco or an eating disorder, because everyone knows, a fun-sized Snickers bar is the worst thing in the world.

Thanks so much for staying anonymous while you are bullying kids. Because nothing says, “It takes a village” quite like putting on a mask and lobbing fireballs at children from behind a wall at a safe distance.

The kicker has to be the moment in the radio interview when asked by the hosts of the show why she didn’t give out toys or stickers instead of candy. Our protagonist, who identified herself only as Cheryl, said she didn’t want to be the “mean lady” in the neighborhood.

Um. I’m sorry. That’s not what you meant.

What you really meant is that you only wanted to be mean to the FAT kids, so that makes it okay.

Trick or Treat is supposed to mean give me a treat or I’ll play a trick on you. All I can say, is that if this woman actually follows through and hands out these letters, she is likely to face some pretty staunch retribution. #theVillageTPdYourHouse. I think she might find the village throwing eggs at her very fragile glass house.

Love,

Jeanette DePatie

AKA The Fat Chick

Should the Boy Scouts Add a “Weight Cycling” Badge?

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Proposed (by me) “Weight Cycling” patch

In the wake of my previous blog post about BMI and the Boy Scouts of America (BSOA), I’ve been reading some responses. And the responses I’ve been reading by various members and officials within the BSOA are troubling to say the very least. Let me give you some examples:

1. We haven’t turned anybody away because of BMI. In an article found in the Cleveland Plain Dealer, Adult leader Ron Blasak states, “there was no one in the Greater Cleveland Council who was turned away because of a BMI issue.” However, Blasak also admits that it’s possible “that someone read the requirements and shied away.” To which I reply, hmmm. Do you think so? Do you think that plastering BMI requirements all over the marketing materials and saying they will be strictly enforced just might make a kid fear that he will be shamed and ridiculed at this shindig? Do you find it surprising that your average 13-year-old might choose not to trap himself miles away from civilization with people who are convinced he can’t do anything?

2. We’re turning away kids with high BMI for their own good. In that same article, Blasak also states, “Overweight boys would have a tough time getting around and probably wouldn’t have much fun.” I have to wonder what evidence he is using to form this conclusion. BMI is a simple calculation based on height and weight. It doesn’t tell you anything about the fitness level of a potential participant. A Scout with a BMI in the “ideal” range may be very unfit and may be at greater risk than a stouter scout who exercises more and has greater functional fitness. Assuming that all the overweight kids will be miserable is just that, an assumption. And we all know what happens when you ASSuME.

We’ve given the scouts plenty of time to get thin. In many of the articles I’ve read, BSOA spokespeople are quick to point out that they released these health requirements two years in advance of the Jamboree, which should give the scouts plenty of time to get fit and achieve an acceptable BMI. In an article published by Fox News, BSOA spokesperson Deron Smith states:

“We published our height-weight requirements years in advance and many individuals began a health regimen to lose weight and attend the jamboree. But, for those who couldn’t, most self-selected and chose not to apply.”

To which I say, “You got it half right, but 50 percent is still a failing grade.” Over a two year period, it may be reasonable for a young person to make significant changes to their overall conditioning and fitness level. We know how to do that. What we don’t know how to do is make a fat kid into a thin kid–at least over the long term. We can make a fat kid into a thin kid temporarily. We might even get the timing right and make that fat kid thin at just the right moment to pass his physical and enjoy the Jamboree. But when we look at the statistics for that kid staying thin over the long haul, the success rates are dismal. So instead of teaching fat Scouts how to become thin scouts, we are teaching them the amazing, adult-level skill of weight cycling. This is the process of losing weight, gaining it all back plus a little more, losing weight, gaining it all back plus a little more and so on and so on. In fact, this process of BMI busting in order to make Jamboree weight seems ideally suited to the process of weight cycling. That’s what led me to suggest that maybe the BSOA should just make a “weight cycling” badge and be done with it. (Please see proposed badge design above.)

And what can I say about “self-selected and chose not to apply” other than “see point 1 of this blog”? Yup, if you tell pudgy kids and chubby kids and fat kids that they are not welcome in enough ways, with enough 14 point bold print on your website, they will ultimately get the message, “Don’t bother to apply, because we don’t want you.”

But the real story is not in the rhetoric that is flying back and forth on the airwaves and in cyberspace. The real story is the way that this policy will affect the lives of real kids. Kids like the one referenced in this recent NAAFA press release:

One mother reported to NAAFA in 2009 that her son was having issues attending Philmont High Adventure Boy Scout Camp in Cimmaron, NM. “Philmont has a weight standard and anyone over this standard is labeled unhealthy and cannot participate. I tried to explain to them that my son plays football, wrestles and runs relays, shot put, discus thrower, in track & field and a weight lifter. During the summer he swims, weightlifts and conditions for football. He has been conditioning for Philmont by hiking for 2-3 hours with a 50 pound pack on his back for the last 2 months. He weighs 261 lbs. and has been eating a 1200 – 1400 calorie diet trying to lose weight. Unfortunately he only lost 3 pounds… According to Philmont medical staff if he doesn’t weigh below 246, he will be sent home. It didn’t matter to them if he is active, only his weight number. I have watched my son condition for football and he can run circles around other players that are what society deems healthy.”

This is why this is such a big deal. We have kids who really want to go, who have put in the long hours of training required to be physically prepared for the challenge, who are probably in far better physical condition than many of their younger counterparts who are told, “go home fatty.” Given the rise in eating disorders among young men, I have a hard time understanding not only how this is considered reasonable, but also, how it can be considered responsible.

Maybe we need to help the BSOA along a little and propose some new HAES-friendly, body-positive awards. Got any ideas? I’d love to hear your proposals for new BSOA awards patches that are more likely to help young men accept and care for the bodies they already have and learn to feel comfortable in the skin they are in. Feel free to post your ideas in the comments below!

Love,

The Fat Chick

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