FAT DOCTORS

Here is a study out of Johns Hopkins that says fat doctors are not as likely to diagnose their fat patients as “normal” weight doctors:

http://www.nature.com/oby/journal/vaop/ncurrent/full/oby2011402a.html?cid=xrs_rss-nd

Here are two articles, both of which parrot the party line that it must be bad that fat doctors are less likely to offer diet tips, but are otherwise very different. The first (a short paragraph in the middle of a one-pager at nytimes.com) adds some skeptical snarkiness, while the second adds an extra helping of fat hate, horrifyingly advocating that all fat doctors should lose their jobs.

http://www.nytimes.com/interactive/2012/03/18/magazine/the-one-page-magazine.html

http://technorati.com/lifestyle/article/fat-doctors-less-likely-to-help/

First, I HATE it when people with a certain BMI are described as “normal”.  To me it smells of bias.  It just triggers my skepticism for the rest of it.

What I find disturbing in the research abstract is this:

A higher percentage of normal BMI physicians believed that overweight/obese patients would be less likely to trust weight loss advice from overweight/obese doctors (80% vs. 69%, P = 0.02). Physicians in the normal BMI category were more likely to believe that physicians should model healthy weight-related behaviors—maintaining a healthy weight (72% vs. 56%, P = 0.002) and exercising regularly (73% vs. 57%, P = 0.001).

In other words, the thinner doctors have a prejudice against fat doctors.   (And gee, do you think those prejudices carry over to their treatment of fat patients?)

If nothing else, wouldn’t you think doctors might want to listen to what fat doctors have to say about being fat?  You know, professionals that have the actual experience?  Maybe thin doctors don’t trust the advice of fat doctors, but as a patient, I certainly would rather discuss being fat with someone who knows that there is no way to turn a fat person into a thin person.  And maybe fat doctors have a better (personal) understanding that fat people can also be healthy people.

The study shows that fat doctors are less likely to diagnose a patient who weighs the same or less than themselves as “obese” and less likely to discuss weight loss treatment.  What the study does not appear to show is whether or not fat doctors discuss healthy behavior that is not weight focused.

I’m not saying that fat doctors are all great – I have personally had my experience with a fat healthcare professional who clearly hated her own fat body.  (see My Fat Ass and RNP from Hell, http://wp.me/pB0rE-7o).  And I currently have a thin doctor who is not perfect but is willing to listen and allows me to participate in my healthcare decisions.

But I think this study shows less about the medical treatment one receives from fat doctors and more about the prejudices of thinner doctors; and those prejudices are what needs to be studied and addressed.

Filed under: health, Science, Size Acceptance

Even If They’re Right . . .

Think about this. Let’s suppose for a minute that those who believe in the “obesity” epidemic are right. That we fatties are eating more than we need to make up for sadness elsewhere in our lives. Or perhaps we are self-medicating for depression. In any case we’re making ourselves fatter and happier, and we could choose to be thinner and healthier (by some measures), but less happy.

My answer is, “so what?” There are two points here: (1) all medicines have side effects, and (2) mental health is as important as any other type of health. People are prescribed anti-depression drugs even though weight gain is a common side effect because the disease is so crippling that it’s an acceptable tradeoff.

There might be some fat folks who eat more because they’re self-medicating. That is, they’re cutting out the middleman, so to speak, and rather than take anti-depressants, just eating more to feel better. To me, that’s also an acceptable tradeoff. Why is the weight gain acceptable in one case and not the other?

Filed under: health, Science, Size Acceptance, Size Discrimination

DIETING MAKES YOU (LITERALLY) FATTER

I’ve been saying this for years.

Okay.  A study looks at how when older women diet and they regain the weight (as we know they are going to do), what is it that they are losing and what is it that they are regaining.  And the answer is:

Specifically, for every 1 kg fat lost during the weight-loss intervention, 0.26 kg lean tissue was lost; for every 1 kg fat regained over the following year, only 0.12 kg lean tissue was regained.

Get it?  You lose fat and lean tissue.  When you regain, you end up literally fatter and with less lean tissue, even if you don’t weigh more than when you started the diet.  (And they don’t even get into the fact that fat cells are forever – unlike lean tissue cells, fat cells do not go away – they simply “deflate”, unless you physically remove them – and even then, there is evidence that your body will create more fat cells to replace those your removed.).

And while there are a lot of new studies out there talking about the protective nature of fat as we get older, loss of muscle and bone is detrimental, especially to older people.

Now want to go crazy? Here is what the lead author of the study had to say about weight loss for older women:

“But despite the great likelihood that people will gain it back and the suggestion that it will have an unfavorable impact on their lean-tissue-to-fat composition, ‘I think there are huge benefits to losing weight,’ she says. When older obese people deliberately slim down, their osteoarthritis improves, Nicklas says. They can get up out of chairs and climb stairs more easily. Even if they eventually regain all of the weight, she says, it usually takes a few years to do it.”

Except the study showed that 80% of the women had regained the weight within one year!  And I’m pretty sure in order to get out of chairs and climb stairs you need muscle (i.e. lean tissue).

So this doctor ADMITS that dieting will ultimately have an unfavorable impact on most of her patients, and yet she is still pushing for dieting.  Talk about drinking the Koolaid.

http://www.webmd.com/menopause/news/20111216/weight-regained-in-later-years-has-more-fat

http://www.ajcn.org/content/94/3/767.abstract

 

Filed under: health, Science

ROUND IS A SHAPE

Lorenzo Santiago, a former Olympic athlete and author of a study to see why fat and fit people don’t lose weight through exercise, believes that fat people are “out of shape and they have some sort of respiratory limitation”, even though his study shows that fat people are not “grossly deconditioned” (showing that you don’t have to be a certain shape to be “in shape”) and the cardiorespiratory fitness of nonobese subjects may be slightly higher, depending on the prediction equation utilized (in other words, even if you fiddle with the data to get results to suit your personal bias, fat people are only slightly less fit).

Mr. Santiago thinks the key is in the respiratory system (possibly because his own study showed that fat fit people are “in shape”), which he thinks works more efficiently in the fat and fit population.  So a fat athlete’s more efficient respiratory system is a problem?  Has he considered that this may be why fat people are able to be fit?

Mr. Santiago claims he is doing all of this so he can help regular fat people – not so regular fat people can become fat and fit people, but to fight “this epidemic of obesity.”  Well, fuck you very much.

You would think that a former Olympic athlete might appreciate that being fit is more important than being a certain size or weight; that he would be interested on how to encourage more people to enjoy exercise no matter what size they are (and what size they end up).  But no.  Mr. Santiago obviously has a problem with the idea that fat people can exercise, become fit and still be fat.

Attitudes like Mr. Santiago’s make it hard to convince people that there is any reason for exercise other than for weight loss; that if weight loss doesn’t accompany exercise, there is no purpose to the exercise.

This attitude is harmful because:

1) It leads to fat people giving up on exercise if they don’t lose weight, thinking either

(a) The exercise failed or

(b) They have “failed” in some way;

2) It leads people to believe the fat people they see either

(a) Need to exercise or

(b) Do not exercise.

3) It leads people who see fat people exercise to assume that the reason for the exercise is weight loss.

As Whaliam so succinctly summarized it:  Even though Santiago’s own data show that you can be fat and fit, he still sees fatness as a bad thing.  Fat people who are in shape and stay fat must still be somehow “out of shape”.  This circular reasoning causes Santiago to circle back and plant his own head up his ass.

http://www.kens5.com/news/health/Texas-study-looks-at-why-some-who-are-overweight-arent-restricted-in-exercise-135894573.html

http://chestjournal.chestpubs.org/content/early/2011/09/21/chest.11-1147.short

 

Filed under: Body image, health, Science

FEAR OF FAT BABIES

A study out of Harvard University claims that babies who gain weight quickly during their first months of life are more likely to become obese later in life.

The lead author, Dr. Elsie Taveras said the study should be used to raise awareness about potential risks but is not a reason to put babies on a diet.

Okay, that seems fair.

Other doctors point out that babies often grow in spurts.  Dr. Michelle Lample (director of Emory University’s Center for the Study of Human Health) is afraid the guide could be used to feed infants less and could prompt feeding patterns that could lead to obesity later.

Lample also pointed out that while many infants crossed at least two key points on the growth charts, only 12% were obese at age 5 and slightly more at age 10.  The National average for obese preschoolers is 10% and about 19% by age 11.  Showing that this “predictor” is not very good at predicting.

What scares me is that with fat-phobia being so common place in the healthcare professions, anything that would lead to labeling an infant as (horrors) fat (or heaven forbid, possibly becoming fat) puts that infant at the mercy of other people’s fat phobia at the time when brain, muscle, and bone development are dependent on good nutrition.

Dr. Joanna Lewis (a pediatrician in Park Ridge, Illinois) seems to me to be a prime example.  She supports the idea that infancy is not too young to start thinking about obesity.  She emphasized that rapid growth in infancy doesn’t mean babies are DOOMED (yes, doomed) to become obese.  “It’s not a life sentence.”  Oh boy.

http://www.slate.com/blogs/xx_factor/2011/11/09/baby_obesity_study_is_just_link_bait.html

http://finance.yahoo.com/news/babies-obesity-path-sign-may-132732172.html

http://archpedi.ama-assn.org/cgi/content/abstract/165/11/993

Scary enough for you?

Now look at the story coming out of Appleton, Wisconsin where parents are facing jail time for starving their infant daughter because the father was afraid she’d become fat.

http://lacrossetribune.com/news/state-and-regional/wi/appleton-parents-charged-with-starving-baby/article_571bfad4-1142-11e1-9464-001cc4c03286.html

In fairness, the healthcare professionals and social workers urged this couple to feed their child more – and the parents continued to starve their child to the point where she had no subcutaneous fat.

Well, new parents don’t always know what they are doing, right?  Except Christopher Sultze is 35 and his wife Mary is 36 and they have three other children.  Mary’s attorney isn’t sure there was any criminal activity or just misguided parenting intentions.

http://lacrossetribune.com/news/state-and-regional/wi/appleton-parents-charged-with-starving-baby/article_571bfad4-1142-11e1-9464-001cc4c03286.html#ixzz1eBrVTV6D

Obviously, this is an extreme case, but it shows what can happen when people become convinced that being fat is the worst thing that can happen.  And people become convinced when that is the message they are constantly getting from healthcare professionals, the media and the government.

“Consequences are unpitying.”  George Eliot

 

Filed under: Body image, health, Science

It Is Okay to Say,”I Don’t Know”

 Some researchers did a study of other studies to try to determine what effect exercise has in reducing the risk of chronic disease in fat people.  I will admit, I am not going to pay to read the full research paper. 

 In the abstract summary, the researchers say that exercise offers only a modest reduction in chronic disease risk for fat people. 

 I found that confusing because I believe that recently there has been quite a bit of research to the contrary.  So first, I have to wonder what studies were these guys looking at.  Recently may be part of the problem because part of the researchers’ criteria was to use studies dating before March 2010. 

 Other criteria included that the trials had to be randomized, at least 10 weeks duration, with a sample mean body mass index of greater or equal than 30, and the study had to report on things like blood pressure, blood lipids, glucose/insulin or C-reactive protein.  Note – the study had to report on at least one of those factors, not all of them. 

 The researchers admit that there was a great “heterogeneity” (consisting of dissimilar elements or part) in responses to risk factors across the studies and the types of exercise used was heterogenous across the different studies.  So lots of different kinds of exercise and lots of different responses. 

 And there was a problem in differentiating the effect of the physical activity independent of weight loss.  In other words, what was causing the effect – losing weight or the physical activity? 

 The abstract summary concludes with:  “The degree to which physical activity is effective at lowering risk factor levels among high-risk obese individuals is not known.”

 Seems pretty clear.  Basically they are saying “I don’t know.”

 I don’t find that surprising, considering how many variables they were dealing with in looking at 44 different studies conducted by different researchers for different purposes.

 How do you get from “Overall, physical activity had no more than a modest effect on chronic disease risk factors in obese individuals” to “The degree to which physical activity is effective at lowering risk factor levels among high-risk obese individuals is not known.”  These statements seem to be contradictory. 

 ”I don’t know” is a perfectly acceptable answer. 

 If you know, to recognize that you know.  If you don’t know, to realize that you don’t know: That is knowledge.” Confucius

 

http://www.doctorslounge.com/index.php/news/pb/23691

http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2011.00933.x/abstract

Filed under: health, Science

AT LAST THE ANSWER TO FAT

 The Los Angeles County Department of Public Health has started a new campaign against sugary drinks.  The ad says “You wouldn’t eat 22 packets of sugar, why are you drinking them?”

Okay.  I don’t have a problem with that.  It’s informative, and consuming 22 packets of sugar may not be a good choice for some people (not that it’s anyone else’s business).  I like to think that most people (especially fat people) are already hyper-aware of what they are putting into their bodies.  It’s only been beaten into us from school, TV, newspapers, etc. since we’ve been kids.  But I can see where some people may not realize that some sports and energy drinks are loaded with sugar.  So thank you.  This information is noted.

But the reason they don’t want you to consume those drinks is because:

1)  It makes you fat; and

2)  Fat is unhealthy.

Gee whiz, thank you.  Finally, someone has found the reason why fat people are fat.  Yes, indeedy.  Fat people just needed someone to tell them that sodas, sports and energy drinks are full of sugar and that is why they are fat. 

Do I drink at least one soda or sweetened drink a day?  No.

Am I fat?  Bet your butt.

Am I healthy?  Reasonably so.

 The campaign cites “too many people are fat” statistics and “too many people are going to be fat” statistics, and then says fatties drain $6 billion (yes billion) from the economy of Los Angeles County a year! 

 How do they get that amount?  I believe they use something called the Gallup-Healthways Well-Being Index.  “The Gallup is able to calculate the incremental cost of healthcare per year for each of these cities by multiplying the estimated additional direct annual healthcare costs for an obese person ($1,429 per person per year) by the population, then multiplying that by the obesity rate. A city of 100,000 citizens with a 20% obesity rate, for example, will have an incremental healthcare cost of $28,580,000 ($1,429 X 100,000 X 0.20 =$28,580,000).”  (Gallup Management Journal, January 7, 2011, The Cost of Obesity to U.S. Cities).  

 In other words, it’s based on statistics – and we all know that statistics can be used to prove pretty much whatever you have decided you want to prove. 

 This “health” campaign makes a target out of fat people; and also singles out poor people and certain ethnic groups – again, implying that if only these people would stop ingesting sugary drinks so many of them wouldn’t be fat – genetics and socio-economics be damned.

 There is a lot of overlapping of the groups (for example, a large proportion of the residents of East LA are Latino), and the data set is people who drink at least one soda or sweetened drink (Koolaid is a sweetened drink) a day. 

 So despite all the studies coming out that show that telling people how many calories they are ingesting makes little or no difference in the choices people make; even though people are fat for all kinds of reasons, even though there is no way to achieve significant long term weight loss for most people, and even though there appears to be a socio-economic link to fatness, LA County Department of Health seems to believe its money is well spent warning people of the insidious dangers of ingesting one soda or sweetened drink a day. 

 Well that makes me want a drink – preferably one with an umbrella in it.

 http://laist.com/2011/10/05/renew_la_county_campaign_to_combat_obesity.php

 

Filed under: health, Science

FAT STIGMA

I have another hero -Health Sociologist Dr. Samantha Thomas, Senior Research Fellow at Monash University’s Department of Marketing.

Dr. Thomas’ most recent research focuses on the stigma fat people face and the physical and mental effects of that stigma.

 This is information that needs to get out there.  Stigmatizing a group of people has consequences.  Real consequences.  Everyone keeps talking about how fat people are driving up health costs.  Well what about the costs that are related to fat stigma-induced problems?  It’s not the fat that’s the problem – it’s how the fat person is treated. 

 She has found that fat people avoid situations where they may feel stigmatized, which means they are avoiding activities that might improve their physical and mental health.  How’s that for a vicious cycle?

 One of the saddest things that has come out in Dr. Thomas’ research – most fat people don’t challenge the stigma they face because they believe they deserve it. 

 And she recognizes that doing something about fat stigma is going to be very complex because weight bias is everywhere and “inherent in the contemporary war on obesity.” 

 Dr. Thomas gets it. 

 Here is a link to an article about one of Dr. Thomas’ studies (for once, you will LOVE the photo that accompanies the article), and links to some of her research abstracts.

 http://www.healthcanal.com/metabolic-problems/21148-The-stigma-obesity.html

http://www.sciencedirect.com/science/article/pii/S0277953611005284

http://qhr.sagepub.com/content/early/2011/07/31/1049732311417728.abstract

http://www.ingentaconnect.com/content/png/ajhb/2011/00000035/00000004/art00008

 

Filed under: health, Science, Size Acceptance, Size Discrimination

ASDAH CONFERENCE ROCKS

ASDAH is the Association for Size Diversity and Health.  The voting members are healthcare professionals (doctors, nurses, therapists, dietitians, nutritionists, researchers, academicians – a very wide spectrum of healthcare professionals) who support the Health at Every SizeÒ (HAES™) approach and research. 

ASDAH is the group that is on the front lines helping to fight all the junk science regarding fat and health.  The HAES approach is that health is not the number on your scale or yourBMI.  Health is something that all people, thin, fat and in between, can work towards without changing their weight. 

I had thought that ASDAH was for healthcare professionals and science researcher “brainiacs”.  And while I knew I benefited from the work ASDAH does, I thought I would not be able to relate to or understand what they would be discussing.  I am not a healthcare professional or in academia.

Well, I went to my first ASDAH conference this past weekend and  I loved it.  I had to ask some questions, because like any area of work, there are certain terms that have specific meaning within that area of expertise.  

I can’t speak to what ASDAH has done at its past conferences, but at this one, on the first day various professionals made presentations regarding their work and/or research.  Lots of good science debunking of junk science; and lots of good talk by the people who are literally putting their careers on the line trying to change the healthcare paradigm of a world that ignores the science and keeps claiming fat equals unhealthy and thin equals healthy. 

I learned about the battles a HAES practitioner has to fight.  I got some suggestions on dealing with health practitioners who just want to talk about weight.  And probably most interesting (for me) I got to hear some of the reasons why it is so hard for some healthcare professionals to let go of the “old way”.  I came away with pages and pages of notes on information I want to follow-up on, blog ideas, things to think about and maybe apply to my own life. 

We did not stay for all of the second day of the conference.  We heard the committee reports, financial reports, and specific requests for members to participate in the various committees.  I found ASDAH to be totally open and candid with its members about the organization, where it is, what it is doing, and where it hopes to go.  When we left, the group was preparing to do break into groups to brainstorm.  I probably would have had a lot of fun doing that – but I had a bad headache (didn’t sleep well at the hotel) and just really wanted to get home to my own bed (and cats). 

I urge you to go to the ASDAH website and check them out. 

http://sizediversityandhealth.org/

 

Filed under: Fat Activism, Fat Rights Organizations, health, Science, Size Acceptance, Size Discrimination

MY OLD ASS IS DRIVING UP HEALTHCARE COSTS

 David Stipp thinks that my fat ass is what is driving the increase in healthcare costs.  But he’s wrong – it’s my old ass that’s doing it.

 http://www.miller-mccune.com/health/obesity-aging-cause-ballooning-health-care-costs-31879/

 It is clear that Mr. Stipp doesn’t like fat people – to the point where he doesn’t even see the irony in his own article.  In one paragraph he tells us that more than a third of the US population is “obese”.  In the very next paragraph he tells us that the CDC attributes $147 billion in US medical costs to obesity – and he tells us, that’s 9% of all medical healthcare costs.

 So wait.  We comprise 30%+ of the population, but only 9% of all medical healthcare costs are attributable to our “condition”.  Fuck, yeah.  We must be a pretty healthy bunch.  So much for the ideas that if you’re fat you must be unhealthy and that fat is a disease that must be treated.  

 Mr. Stipp is all in favor of “healthy” (i.e., thin) people living long lives, but he seems to feel keeping the old fatty alive is just a waste of money and resources.  After all, what kind of quality of life could we have?  Never mind that his ideas for living longer include long term dieting and use of diabetes drugs by non-diabetics. 

 Well first of all, if you aren’t meant to be thin, we pretty much know how dieting ends up.  And second of all, I consider the pleasure of eating as part of my quality of life.  I also would not be happy with a life that entails a disordered relationship with food, where I count every calorie and weight each morsel, etc.  No thank you.  Not my idea of a good time – especially not if it’s a life sentence. 

 Again, we all die, sooner or later.  Longevity (much like fatness) appears to be tied more to genetics, environment, and socio-economic status. 

 Mr. Stipp says the proof of what he is saying can be found in a 2003 study published in The New England Journal of Medicine. 

 What Mr.Stippfails to say is that a 2010 CDC study (http://www.cdc.gov/nchs/data/nhsr/nhsr024.pdf) refutes what he is saying.  The CDC report shows that older men and women have, on average, the same number of hospital admissions and doctor visits regardless of size. 

 In trying to find the study to which Mr. Stipp refers, I went to the NEJM website, and searched through the 2003 issues for the term, “medicare”.  I got dozens and dozens of results – articles, book reviews, editorials, and correspondence.  So then I searched for “medicare”, “obesity”, and “age” and I think I found the study to which Mr. Stipp refers – Health, Life Expectancy, and Health Care Spending Among the Elderly.

Only the Abstract is available for free – but this is the conclusion for the study:

 ”The expected cumulative health expenditures for healthier elderly persons, despite their greater longevity, were similar to those for less healthy persons. Health-promotion efforts aimed at persons under 65 years of age may improve the health and longevity of the elderly without increasing health expenditures.”

 http://www.nejm.org/doi/full/10.1056/NEJMsa020614

 Looks to me, live long and healthy or live short and unhealthy – the healthcare costs balance each other out.  Am I missing something here?

 No wonderMr.Stipp did not include the cite for the study, since its conclusion does not prove what he is saying at all.

 And once again, this is why we need to be informed fatties, and not take for granted what we are told by the fat-haters.

Filed under: Fat Activism, health, Science, Size Acceptance