Tag Archives: study

More Evidence that Fat Stigma is Killing Us

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

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

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

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

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

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

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

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

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

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

Love,

Jeanette DePatie (AKA The Fat Chick)

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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

5-year-olds on a Diet

Sometimes people ask me why I do this.  I work in Hollywood.  Writing a blog doesn’t really pay all that well.  And it can be a solitary process at times without a lot of feedback.

But sometimes I come across something that reminds me why.  Like this study which talks about “dietary restraint” (the cognitive restriction of food intake for the purpose of controlling weight) among 5-year-old girls. Five. Years. Old.

At five kids should be coloring and tormenting their older siblings and screaming and playing and dressing up.  They should not be worrying about the size of their thighs.  They should not be counting carbs.  They should not be worrying about fitting into their skinny jeans.

But according to the study, nearly 35 percent of the 5-yr-old girls were displaying “dietary restraint”.  The study points out not only is dieting at age 5 distressing, it is also an important precursor or marker for eating disorders in the future.  And that future might not be very far away for a number of these girls.  The study states:

Despite eating disorders typically emerging during adolescence, cases have been reported in early elementary school children.

The study reviewed the influences that caused these girls to restrict their food intake.  While most of the girls were pretty happy with their body at the moment, over 50 percent showed some evidence that they had taken the “thin ideal” to heart.  And the girls who had clearly taken the thin ideal to heart, that had experienced more media that represented the thin ideal and had more discussions about appearance with their peers, were the girls more likely to be restricting their food intake.

Which leads me to ask some questions.  If we know that BMI report cards are ineffective, and we know that kids are learning behaviors that lead to eating disorders as early as age 5, why don’t we work harder to include body image education into the curriculum–the earlier the better?  Anorexia is deadly and notoriously difficult to treat.  Why don’t we put some real, sensible, research-based curriculum in place at the earliest possible age to help these kids not develop this problem?  And since adults who hate their bodies are fairly likely to project these feelings onto impressionable children, why don’t we require training for teachers and strongly encourage training for all adults who deal with kids?

We have an opportunity to make a world where girls don’t grow up hating their bodies and hating themselves.  That’s why I write this blog.  That’s what I do what I do.  I add my tiny voice to the growing chorus singing the song stating that we are beautiful, we are worthy of love, we are okay just the way we are.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want to hear me talk about body positive at your school?  Click HERE.

Extrapolating to Absurdity–Reporting on New Study Takes Things FAR OUT.

Extrapolating

I was driving around in my car yesterday, minding my own business, when a story came onto my local NPR station that caught my attention.  Kevin Hall PhD was on the air talking about his new study comparing how the body responds to low fat vs. low carb diets.  He was careful to state that the study compared people in carefully controlled environments as opposed to relying on food journals for information on food journals (because you KNOW us fat folks can’t be counted on to be honest about those things).  He said that the study participants were brought in for two, two-week inpatient hospital stays where every morsel of food was accounted for.  In fact, every person was fed the exact same breakfast, lunch and dinner every day for two weeks, were expected to eat all of it and were not allowed to have anything different.  (I think the study creators took their lives into their hands with this one, because if you fed me the exact same, low-calorie, diet crud for two weeks running, I’m quite sure I’d become pretty stabby.  And I don’t know what could possibly compel me to return for the second phase of that torturous crud.  But I digress.)

Kevin said all of the subjects “had obesity” which is a funny, disease-language sort of way to say they were fat.  But none of them had diabetes.  And according to Kevin, the study indicated that at a metabolic level there was very little difference in weight loss results from the low fat vs. the low carb diets.  Although, the low carb diet had a greater impact on blood glucose levels than the low fat diet.  And the low fat diet apparently led to slightly greater fat loss within the two week period than the low carb diet.  Okay.  Got it.

But then the report started to go off the rails for me.  Kevin suggested that based on this study we could extrapolate that the low-fat diet would lead to greater weight loss over the long term than the low-carb diet.  And that’s when I had to pull the car over because I was shouting at the radio.

“How can you extrapolate anything over the long term other than the notion that most of these people won’t keep the weight off or will even gain weight after this experiment,” I said.  “This study has a lot to do with metabolism but you can’t really expect to transfer the results of this study to real life!”  I tried to call in to express my opinion, but by time I got through the story was over.  So I resolved to hit the radio station website, find the study and take a look for myself.

I did just that.  And the data extrapolation situation was so much worse than I thought.  The study contained a grand total of 19 subjects.  During the first two-week stay, the subjects ate a eucaloric baseline diet for 5 days, followed by 6 days on either a reduced fat diet or a reduced carbohydrate diet.  Then there was a 2-4 week “washout period” when they went home.  After that, they returned and ate the eucaloric baseline diet for 5 days followed by a reduced fat or reduced carbohydrate diet.  Each subject switched diets for the second two week stretch. So if they did the low fat diet in the first stretch, they did the low carb diet in the second stretch and vice versa.

Okay.  So there’s some good stuff here.  The study carefully tries to control for various factors.  The food is the same each day, so there won’t be wild fluctuations there.  All subjects are, um, subjected to both diets so that helps eliminate some of the variables.  And everybody eats exactly the same thing.  Subjects spent a significant amount of time in a metabolic chamber to very carefully measure the way the calories were metabolized.  I see the point of needing this level of precision to control the variables of the experiment.

But my big, BIG problem came during the radio interview when Kevin started talking about how this could apply to real world fatties and what it would mean for them.  He suggested that over the long term (so far the study doesn’t even have 6 months worth of follow up data) the minute differences in weight loss from the two diets would accumulate and you would see significantly greater weight loss from the low-fat diet vs. the low carb diet.  This despite the overwhelming evidence outside of this study that indicates that over the true long term (2-5 years) the most likely outcome for the vast majority of the subjects is either insignificant weight loss or even weight gain.

Don’t get me wrong, I love it when science people are science-ing.  But when you extrapolate from 19 subjects over 22 days in an extremely controlled environment that is virtually impossible to replicate in the real world to what effect these diets will have over the long term in the real world, I’ve got a serious problem with that.  I have talked about it before, and I will talk about it again.  If you want to understand science, possibly the last thing on earth you should do is listen to science reporting in the mainstream media.

And I have to wonder about the millions of people who are going to hear this report and hop on the diet/shame/regain cycle all over again because science people say they should.  Because when you take science and simplify and stretch it beyond all limits in order to get a popular news story to help bump up your funding, you are behaving irresponsibly and people, especially fat people will wind up getting hurt.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want me to come and sort out some science reporting for your group?  Click here to learn more about hiring me as a speaker!

New study says weight stigma signficantly reduces Quality of Life–and water is wet.

Don’t get me wrong.  I am deeply glad that they are studying the negative effects of weight stigma.  But I am wondering when this will finally be considered obvious.  I am waiting for the moment when somebody says, “shaming fat people is bad” and the primary response is, “well, duh”.

I recently read this study which was released as an online precursor to publication in Obesity magazine.  The study seeks to understand the affect that weight stigma and discrimination on conditions like depression and overall quality of life.  As the study states:

Weight stigma is often cited as a potential mechanism leading from obesity to poorer psychological well-being [4, 5, 7, 9]. Prejudice against individuals with obesity is pervasive and rarely challenged in Western society [10]. As a result, many individuals with obesity, and particularly those with severe obesity, report being discriminated against because of their weight in their everyday lives [11, 12]. Given that weight stigma and discrimination have both been shown to have a negative impact on psychological health outcomes, including well-being [10], depression [13, 14], self-esteem and self-acceptance [13, 15], and body image dissatisfaction [13, 16], this might explain why people with obesity suffer psychologically.

You would think that this had been studied in depth before.  However, according to the introduction of the study, this hasn’t previously been explored in a lot of depth.  According to the study:

Only one study to our knowledge has tested the mediating effect of weight-related discrimination, showing a significant reduction in the association between obesity and self-acceptance after adjusting for perceived weight discrimination [15]. None have examined the role of discrimination in relation to more global indices of psychological well-being, such as quality of life or depression. The aim of the present study was therefore to investigate the extent to which perceived weight discrimination mediates associations between obesity and three markers of well-being: quality of life, life satisfaction, and depressive symptoms.

In other words, many studies have suggested that fat people experience a lesser Quality of Life (QOL) than thin people.  However, this study seeks to determine whether that reduction in Quality of Life is simply because of person’s body size or whether it is caused by the world’s reaction to their body size.  I won’t keep you hanging too long.  The study determines that 40% of the person’s reduction in QOL is from perceived discrimination.

We used mediation models with bootstrapping to test the proposition that associations between obesity and well-being are mediated by weight discrimination and found that approximately 40% of the total effect of obesity on psychological well-being could be explained by perceptions of weight discrimination.

This is I think an important distinction.  So much in the “War on Obesity” suggests that the solution is for all fat people to simply lose weight.  The study suggests that the reason fat people are depressed might be–in large part–the “War on Obesity”.  As Ragen Chastain frequently states in her blog, Dances with Fat, “The way to deal with oppression is not to remove people from the oppressed group.  The way to deal with oppression is to fight the oppression.”  And I have to wonder to what extent this 40 percent takes into account the internalized oppression experienced by people of size.

I hope that this, along with so many other studies regarding the harm caused by weight stigma will finally convince some of the folks in the Obesity War to consider the harm they are causing–the millions of lives ruined by “friendly fire” in this war that makes people sadder and sicker rather than healthier or happier.  And  I hope that those proponents of “tough love” and “the ends justify the means” will reconsider their stance.  Because in the case of weight stigma, love is indeed very tough to come by.  And when the ends are actually worse that the starts, it’s time to carefully consider some new means.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S.  Want to hear me speak about weight stigma at your school or organization?  Learn more about me here.

Weighing the Verdict–Punished in the Courtroom for Being Fat

PoundsFat

Recently I ran across this article in Scientific American about how certain stigmatized groups are more likely to elicit harsher punishments than other groups.  In particular, the article talks about a study where participants were asked to read a paragraph about people committing acts that are commonly considered to be “impure” like watching pornography, being sloppy or cursing.  The participants were then told that the people committing these acts in the story had various characteristics.  The study found that when the fictional characters were described as hippies, trailer trash or obese, the judgements of the study participants were much harsher.

Now I gotta put a trigger warning here, and say that the author of the article described those three categories in a way that wasn’t particularly positive.  You can skip on down to the last paragraph if you don’t want to read this part.  But the study and the author suggested that those groups elicited harsher judgements because they were more likely to elicit “disgust” in the minds and bodies of the participants.  The study (as well as a series of follow up studies) indicate that the study participants were also more likely to praise members of these groups for doing stuff perceived as more “pure”.  For example, if a member of the stigmatized groups (fat people, trailer trash and hippies) were described as keeping a neat cubicle, they were more likely to receive a virtual “pat on the head” from the study participants.  And in the study, when the  person described was committing a heinous act not related to “purity” like illegally parking or not tipping a waiter, the stigma they faced was far less likely to affect the judgement of the study participants.

“The assumption people have is that we draw on values that are universal and important,” says social psychologist E. J. Masicampo of Wake Forest University, who led the study, “but something like mentioning that a person is overweight can really push that judgment around. It’s triggering these gut-level emotions.”

After the study, the researchers went on to check the results against real world situations.  And to nobody’s surprise, the scales of justice were not balanced in favor of fat folks.  They looked at the records of all Police Patrol stops by the NY Police between 2003 and 2014.  If the stops were for a crime against “purity” (drugs, lewdness, prostitution) fat people were a lot more likely to be arrested.  In fact, for every point of increase in BMI was equal to a one percent greater likelihood of arrest or summons.

None of this is news to those of us who study weight stigma.  In fact, Sondra Solovay’s excellent book “Tipping the Scales of Justice” was a key work in helping us understand how fat people are treated by our justice system both on the streets and in the courtroom.  And while I’m a little disturbed by some of the wording used by the researchers, I’m a lot more disturbed by the reality of this injustice.  And I’m glad that this work is being done.  I can only hope that this work, in conjunction with so much other work being done about the effect that all sorts of stigma have on policing, judging and jailing actually leads to real significant change in how our policemen, judges and juries are trained.  It’s a big dream, but I think it’s worth having and pursuing.

Love,

Jeanette DePatie, AKA The Fat Chick

P.S. Want me to come talk to your group about size discrimination?  You can learn more about my speaking engagements here.  And you can contact me here to schedule a date!

Another study indicates fitness more important than fatness for longevity

Functional fitness kitty adds activities for daily living (ADLs).

Recently on one of the lists I was introduced to another study which suggests that one of the most important things we can do to have a longer life is to exercise–at least a little bit.  The study report begins by pointing out that in the past there has been an assumption that exercise helps people live longer indirectly because it helps them lose weight or change their body size.  However the paper goes on to state that recent evidence suggests that physical activity (including recreational activity and activity accumulated during work hours) seems to help people live longer regardless of whether or not there is a change in BMI or body size:

Whereas it could be hypothesized that PA exerts its influence on mortality indirectly through reducing adiposity, recent data from the European Prospective Investigation into Cancer and Nutrition (EPIC) suggest that PA is unrelated to change in body weight and inversely, albeit weakly, associated with change in WC (12). Thus, PA may interact differentially with BMI and WCin relation to all-cause mortality.

So the study went on to test this question.  Is it the change in body size or the activity itself that affects longevity?  And the answer seemed to be pretty clear that physical activity helps people live longer whether or not their was weight loss or a change in body size.  And furthermore, the test indicates that the biggest differences in longevity seem to be between the completely sedentary and the moderately inactive groups.  In other words, they hypothesized that the place where there is the greatest impact in longevity is moving people from the group that doesn’t do any exercise at all to the group that does a little bit of exercise.  More exercise helps a bit more.  But moving out of the completely sedentary group seems to have the most impact.

The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which suggests that efforts to encourage even small increases in activity in inactive individuals may be beneficial topublic health.
Am J Clin Nutr doi: 10.3945/ajcn.114.100065.

So what does this mean to us?  First of all, let me plainly state that nobody is  under any obligation to prioritize their health or engage in any activity if they don’t want to.  Your body is your own and you get to decide how you want to live.  But if you are somebody who is interested in living longer, perhaps one of the best things you can do (outside of being rich and born to parents with great genes) is to do at least a little bit of exercise.

So what does this mean to public health?  To me it suggests that if we really want people to live longer, we need to focus on helping them get more active.  Outside of the fact that most weight loss attempts fail, and about 1/3 of the time lead to people getting larger, outside of the fact that many of the more radical weight loss schemes (like surgery) can lead to life-altering side effects, is the simple fact that getting people to exercise even a little bit seems to have a more dramatic effect.  And getting people to exercise–provided they can do it in a safe environment–seems to be a lot less risky.

For so many reasons, I think it’s time to move outside of the weight loss rhetoric about the war on obesity and just move into an environment focused on making it physically, emotionally and financially safe, comfortable and accessible for all folks to integrate physical activity into their lives.  That is, if we are ready to stop worrying about making money upon broken dreams and start helping people actually have better lives.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. I’m setting my spring speaking schedule.  Want to book me to speak to your group or school?  Send an email to jeanette@thefatchick.com.  I can work to fit most programs and budgets.  You can read more HERE.