Fat Bias In Treatment

Researchers are looking at data on N1H1 flu to see how COVID-19 might go. For example, reviewing how fat people fare.

Results: We identified 22 articles enrolling 25,189 laboratory confirmed patients. The pooled estimates indicated obesity significantly increased the risk of fatal and critical complications of influenza A(H1N1)pdm09 infection (for fatal, OR = 1.81, 95% CI: 1.23-2.65; for critical complications, OR = 1.67, 95% CI: 1.13-2.47). However, we found significant interaction between early antiviral treatment and obesity (β = -0.28). After adjustment for early antiviral treatment, relationship between obesity and poor outcomes disappeared (OR = 1.14, 95% CI: 0.94-1.39).

Gee. Fat people didn’t get the same disease treatments as thin people, and didn’t recover as well thin people who were aggressively treated. It’s almost as if not treating diseases in fat people is a problem.

It’s unreasonable to wait for people to lose weight before treating diseases.

Quote of the Day

In dealing with the “encouragers” who want you to eat less, move more, and maybe have a few organs amputated to lose weight:

These fat hating types don’t know you and they don’t want to. They don’t care to know if you are or aren’t doing sit ups or exercising or what you really eat. And they don’t care. Their objective is to make you feel bad for being fat. It’s that simple. They’re sadists and nothing but suffering satisfies them.

These assholes will scream “why don’t you get on a treadmill fatty!” even if you’ve just gotten off one. They’ll just shout, “Stay on longer until you’re thin, lard ass!” They don’t care if you just found out you’re 25lbs lighter, even. So long as you are fat, they hate you and want you to suffer.

But when you figure that out, things can come into focus. You can start understanding that you’re not gonna argue your way to them being lesser douchewads than they were. They will never not hate you. That makes them the one with something deeply wrong about them, not you.

The winning move here is simple (but not easy): live the happiest and best life you can right this minute, as you are. Be good to others and yourself, try your hardest, and enjoy as much as you can about being on this Earth while you are here.

Sadists hate your happiness, so I suggest cultivating as much of it as you can, as you are, right this minute, as you are.

Madame Thursday

It Came From the Search Terms

Things people searched on to get to this site!

clothing for obese people

Yes, we wear clothing!  The types and sizes vary though.

seat belt extenders walmart

I’ve had better luck with car manufacturers & Amazon, myself.

im sore from girl dancing

I’m not sure what “girl dancing” is, anybody?

a guy got out of his car and yelled at me

That can be frightening.  It can be scary when they person yelling is in a car, but getting out is an aggressive move.  I hope that you’re OK.

fat acceptance

Check this out.

Why Isn’t Obesity Research Better Known?

CBC has an article on the part of obesity research that doesn’t always get talked about.

Tim Caulfield says his fellow obesity academics tend to tiptoe around the truth. “You go to these meetings and you talk to researchers, you get a sense there is almost a political correctness around it, that we don’t want this message to get out there,” he said.

“You’ll be in a room with very knowledgeable individuals, and everyone in the room will know what the data says and still the message doesn’t seem to get out.”

In part, that’s because it’s such a harsh message. “You have to be careful about the stigmatizing nature of that kind of image,” Caulfield says. “That’s one of the reasons why this myth of weight loss lives on.”

Stigmatizing.  How is it stigmatizing to know that being fat isn’t something that can be easily changed by anyone?  One theory: accepting that most fat people cannot permanently become thin implies that fat people aren’t fat “for now”. They may be fat forever.  For the fat people who are rationalizing “I’m fat but I’m losing weight,” the idea that they may not be able to fulfill their fantasy can unfortunately cause another round of self-hate.  Realizing that thinness may not be as controllable as they thought could be scary. But — my understanding is that most obesity researchers are thin. So let’s try another theory.

Researchers may not be fat, but they know fat people, and are probably influenced by implicit and explicit biases.  Adding awareness that fat people will probably stay fat — even the fat people you like, that might become friends?   That’s scary.  It implies that fat people may not actually be sabotaging their weight loss, may not be at fault for weight regain.  Why, fat people may not actually be deserving of hatred.  What, then, of your attitudes toward fat people?  What kind of person are you?

Or, y’know, it might be that researchers are just concerned that if they stop promoting weight loss they they’ll lose their jobs and funding.  In the book Health At Every Size: The Surprising Truth About Your WeightLinda Bacon discussed the funding for her HAES vs weight loss study.

[…S]tatistics clearly show that when industry funds research, the published results are much more likely to show beneficial effects than research conducted without industry funding.

[…] I follow a strict policy of never accepting research money from private industry. Not that private industry would have been interested in funding this research anyway—I mean, there’s no profit to be made if we show people getting healthier with lifestyle change, without worrying about weight loss, or if we show that weight isn’t the be-all and end-all when it comes to health.

Consequently, I’m limited to public funding […] Given that Congress shares the general perception that Americans need to lose weight, that’s where much of the nutrition money goes these days. Plus, many (all?) researchers who sit on the panels that review the grant requests are on industry’s payroll themselves. In fact, some in my field jokingly refer to a group of researchers from the Universities of Colorado and Pittsburgh and Columbia University as the “obesity mafia,” given their control over National Institutes of Health funding.

With my HAES study, I managed to wrangle a relatively small grant out of the NIH […] I’d like to believe we got the grant because of the outstanding proposal. But I’m not that naïve. The reality, I think, is that I took my name off the proposal as the primary investigator and substituted Dr. Stern’s, who is better connected to the mafiosi.

(emphasis added by me)

Others have also speculated that obesity researchers are afraid of losing funding.  To quote Melissa McEwan,  “Boy, it’d sure be sad if they lost funding. Almost as sad as if I lose my life [because] a deadly ailment is misdiagnosed as fat.”  The emphasis on thinness as a measure of health and the societal biases against fat people conspire to prevent fat people from getting proper healthcare.

And that, of course, brings the biggest reason this could be stigmatizing: If the “everyone can be thin” drumbeat is a lie, researchers are complicit in this lie.  You’re not just kowtowing to Weight Watchers, Congress or the NIH when you continue to encourage “just eat less and move more” — you’re a fraud.  That might, indeed, be stigmatizing.

Tell Me Again How It’s “For My Own Good”

Lara Frater wrote about this and I wanted to boost the signal.  The Rudd Center recently came out with a study (PDF link) showing that weight stigma affects the stress hormone cortisol.

Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.

It doesn’t require being fat to have this kind of reaction, by the way. Both the lean and overweight women “were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media.”

What’s cortisol? Some highlights from Wikipedia:

Cortisol, known more formally as hydrocortisone is a steroid hormone […] released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat, protein and carbohydrate  metabolism.  […] Cortisol counteracts insulin, contributes to hyperglycemia-causing hepaticgluconeogenesis and inhibits the peripheral utilization of glucose (insulin resistance). […] Cortisol can weaken the activity of the immune system.

Being fat (“excess weight”) is considered a cause of insulin resistance.  And it appears that weight stigma increases cortisol … which increases insulin resistance.  Which is the chicken? Which is the egg?

This isn’t necessarily new.  Weight stigma  has been tied to weight gain before.  What this study highlights is one mechanism.  There may be others.  We know that fat bias prevents fat people from getting jobs, from getting raises, and from getting proper healthcare treatment.   Fat people are also often paid less and harassed more than similar-qualified people who are thin.  None of this improves health.

So when I hear people saying that fat people just need more “tough talk” to lose weight “for their own good”? No, I don’t believe them.

Health At Every Size Principles

I sometimes post about Health At Every Size®, both the concept (which is trademarked by ASDAH) and the book Health at Every Size: The Surprising Truth about Your Weight, by Linda Bacon.  So I am pleased to see that ASDAH has updated its HAES® Principles to be more inclusive of different abilities and backgrounds. Weight bias and weight discrimination is explicitly called out.  Supporting individual choices is more explicitly encouraged. A brief framing of the Health At Every Size® Approach has been added, as well, noting that health is NOT “simply the absence of physical or mental illness, limitation, or disease.”  It also states that

[H]ealth exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.

I suggest you check the full statement on the ASDAH site.



[Content warning: criticism of fat shaming]

Melissa McEwan at Shakesville started the #fatmicroaggressions tag on Twitter.   (If you’re not familiar, “microaggression” is the concept that specific interactions between those of different races, cultures, or genders can be interpreted as small acts of mostly non-physical aggression; the term was coined byChester M. Pierce in 1970.  I am most familiar with microaggressions via http://www.microaggressions.com/.)

Melissa started with the old chestnut we’ve all probably heard too many times:

"You have such a pretty face."

“You have such a pretty face.”

Others included one I hope to never hear again while sick:

"There's nothing wrong with you that losing x pounds wouldn't solve."

“There’s nothing wrong with you that losing x pounds wouldn’t solve.”

…and one that seems to be declining as my age advances:

"Are you sure you should be eating that?"

“Are you sure you should be eating that?”

Others came fast & furious.

#fatmicroagressions "urrrgh, I feel fat" (said with fear/disgust/shame)

“urrrgh, I feel fat” (said with fear/disgust/shame)

"How do you wipe??"

“How do you wipe??”

Obviously reading this can be upsetting, in part because it reminds of when we’ve had these thrown at us.  But there’s camaraderie in sharing.  Some are common enough to be an in-joke.

"Have you tried dieting?"

“Have you tried dieting?”

Other things fit into less-common portions of the fat experience. Most fat women, for example, wear US women’s size 24 or below…but millions do not.

"We carry sizes to fit every body!" *stops at size 24*

“We carry sizes to fit every body!” *stops at size 24*

And most people probably do not think about who attends conferences on public health in regards to obesity, or why weight bias scholars are often thin and thus don’t have to face fat bias on their own.

No fat people speaking at the so-called "obesity" conference.

No fat people speaking at the so-called “obesity” conference.

Harassing women is depressingly common. Some people might think fat women get to avoid it. They’d be wrong.

Man at a club: "Hey baby, c'mon dance with me." Me: "No thanks." Him: "Whatever. Fat bitch. You're ugly anyway."

Man at a club: “Hey baby, c’mon dance with me.” Me: “No thanks.” Him: “Whatever. Fat bitch. You’re ugly anyway.”

Here the impression is that the fat hate might have been avoided if the writer had complied with his ask. However, when unhappy, he used “fat” as a go-to insult — along with “bitch” and “ugly”. It says something about what our culture does and doesn’t value.

"No one would rape someone as fat as you."

“No one would rape someone as fat as you.”

And here the anger is even uglier.  It asserts the myth that rape is about a man’s uncontrollable desire for an attractive woman.  It asserts that being “rapeable” is a standard to aspire to.  And it is a threat.  The person who states “No one would rape someone as fat as you” claims to know what rapists would do.  By doing this, that person claims to be a rapist.   Implied is also that “no one would believe you so I can do as I please”.  As Amadi notes, this also intersects with the concepts of rape culture and intersectionality. Fat does not exist in a vacuum. 

This is getting depressing, and I’ve barely skimmed the surface.  Feel free to check out the convo or post your own here.

Other posts:

Things to Read

You may have seen this poor as folk post on why poor people might not eat healthy.   There’s also a great post on why “healthy food vs junk food” infographics are inaccurate, misleading lies.

From Linda Bacon and Lucy Aphramor at the the Health At Every Size® Blog:

“Obesity-related” disease actually tracks your social status more than what size clothing you wear. In developed nations, data show, members of stigmatized groups, including those who are economically disadvantaged and people of color, are the most common victims of illnesses typically grouped under the “metabolic” umbrella. […] With social status comes control over one’s circumstances – success at work, fostering loved ones’ well-being, being able to plan for the future, or even next week. The absence of those, no matter how punctilious our lifestyle habits, stresses our systems in disease-promoting ways. In contrast, being able to exert an influence over what matters to us is health-promoting.

And astronaut Karen Nyberg created a stuffed dinosaur in space.

World Ending, Fat People’s Fault

It’s amazing what fat is used to justify. Besides the increased health risks associated with obesity, we’re told fat people harm national defense, make global warming worse, and decrease workplace productivity.*  The “Oh, but we need to do something about obesity!!!” is trotted out to sell organic foods, free range foods, Whole Foods, books, TV shows, spas, beauty products, workout systems, clothing, fat camps, school-based “interventions”, workplace “wellness” programs, and so on.

Now, some physical fitness instructors in Denver are upset that private property owners and city parks don’t want to have their open space used rent-free for fitness classes. And what is one of the justifications?

[I]n a country battling obesity and high rates of heart disease and diabetes, they say, governments should be doing everything possible to get people up and moving.

Note this dispute isn’t about a specific “anti-obesity” program.  This is about small businesses using public parks, or even privately owned areas open to the public, to offer private fitness classes.

Obesity isn’t the actual story.  The story is a clash between those who enjoy taking or offering open-air classes and those who’d like to enjoy the park without them.  It’s also about small businesses that want to offer classes  without having to rent space and the need for the parks to be available to all.*  The “but we need to fight obesity, heart disease & diabetes” is thrown in as an appeal to the public interest.   Why? Because being fat is assumed to be bad, to be wrong, to be against the public interest.

This is probably not how the writer intended it.  And yet.

*It’s assumed, of course, that all fat people get sick more often.  That said, it’s interesting to note that office equipment that fits the worker can improve productivity.

**”People will still be able to get together to play Frisbee or soccer. But if money changes hands, said Jeff Green, a Denver Parks spokesman, ‘you need to have a permit.'”

Why I Think Declaring Obesity A Disease is Harmful

It’s inaccurate:

It distracts from the real issues:

It’s a win for the weight cycling industry

Unfortunately, what’s good for the weight cycling industry isn’t necessarily good for patients: 

There is a Change.org petition on this – I’ve signed, have you?

Best (Worst?) Things I’ve Read Today

In the coverage of this fat-hating, scientifically inaccurate, harmful mess, I’ve seen a lot of variations on calling out Miller for hitting out the send button impulsively or failing to properly censor himself. But the problem isn’t that Miller broadcast this bigotry in a public venue. The problem is that he holds this bigoted view at all.

Melissa McEwan at Shakesville

Maybe Zimmerman should have saved the money donated to him for his defense to actually pay for his defense instead of using ~$213,000 of it to bail himself out of jail and live out of a hotel.

—  rhysande’s comment on ONTD-Political

My existence challenges everything that you’ve been told to believe about me, which makes you uncomfortable. And instead of getting to know me, you cast hate and anger at me. Hoping that your negativity will tell me to quit, hoping that I will amount to the nothing you desperately want me to be, and hoping that your negativity will give you a voice for a moment.

“On being a proud teen mom: I don’t hate myself  as much as you wish I did” by Gloria Malone

Believe it or not, getting rid of contraception and abortion isn’t going to lead to improved women’s health.

Libby Anne at Love, Joy, Feminism

Fat Bias Isn’t Just About Rapport

As noted on Twitter, the article Tara Parker-Pope wrote for the New York Times about a study in Obesity looking at how fat patients aren’t always welcomed by doctors. Not news, though I suppose it’s good to have quantitative research supporting it.

Really, though, this is just the tip of the iceberg.  Here’s some more.

For patient stories on health professionals, check out the crowdsourced http://fathealth.wordpress.com

ASDAH is collecting videos on weight bias in healthcare.

The Yale Rudd Center is not a fat-accepting organization, but they do research on weight bias and their publications page can be very useful.

Naafa on weight discrimination.

Typing “Fat People Are” into Google

I understand if anyone doesn’t want to read this.  But it says something about our society.

When typing “fit people are” into Google,* it helpfully tries to finish the thought for me, providing “more successful”, “happier”, “harder to kill”, and “smarter”.  The search results are similar.

Google for "fit people are"

Google for “fit people are”

Typing in “thin people are” shows options like “better”, “beautiful”, and “more successful”.  The top piece discusses the latest “moderately fat people live longer” study.**

Results for "thin people are"

Results for “thin people are”

Finally is the “fat people are” results: “gross”,” lazy”, and “stupid”.

Typing "fat people are" into Google

Typing “fat people are” into Google

Google doesn’t just index the web.  It also aggregates what other sites are linking to and what people are searching for — and what they navigate to.   The effort Google puts into making their search results find what people are looking for makes it also a somewhat accurate reflection of our society.

*Google does, over time, reflect what an individual has searched for in the past.  As I frequently search for fat-positive items, these screenshots were generated using a browser I rarely use, where I wasn’t logged into Google. I’d also cleared the browser cache.

**If Google is using IP addresses to adjust results this may be due to my usual fat-positive bias. Might be helpful to know if anyone else sees this.

UPDATE: Several other folks get the same or similar results.

Things to Read

A clear explanation of why  New York’s fat hatred is much more harmful than the soda ban from Melissa McEwan:

People do not die of “obesity.” Some fat people die from complications of what are commonly known as “obesity-related diseases,” like heart disease and diabetes, but those diseases have only been shown to be correlated with fat, not caused by fat. (Which is why thin people have them, too.) So it’s not even accurate to assert that obesity kills indirectly.

This, however, is a thing that is accurate to say: Fat hatred kills people all the time.

And speaking of correlation, an explanation of causation vs correlation at The New York Times makes use of a correlation between ads for junk food and fatness:

The problem is that their policy recommendations rest on a crucial but unjustified assumption: that any link between obesity and advertising occurs because more advertising causes higher rates of obesity. But the study at hand showed only an association: people living in areas with more food ads were more likely to be obese than people living in areas with fewer food ads. […] In fact, it is easy to imagine how the causation could run the opposite way (something the article did not mention): If food vendors believe obese people are more likely than non-obese people to buy their products, they will place more ads in areas where obese people already live. […]

This is not an arcane statistical point or a mere technical criticism of one academic article. Too often, relationships that are far from being understood are assumed to reflect a particular, strong causal connection, leading to no end of regulatory mistakes. 

(Emphasis added)

And from a woman’s story of getting fat after marriage:

I missed the husband who loved me no matter what, not the new anti-fat crusader he had changed into. But he felt the same way: he’d fallen in love with a plump-but-not-fat woman who wanted to be thin, and now he had a fat wife who’d “given up on herself.” And Ihad given up: given up on dieting, given up on the idea that my body needed to be fixed.

 I already wished I hadn’t spent so many years beating myself up for being fat; I wasn’t going to stay in a marriage where my husband did it for me.
The article is good, and bonus points for a photo of the author in scuba gear with the caption “Cage diving with great white sharks: more fun than dieting”.

Does It Matter?

Tonight I overheard some thin 20somethings discussing fat people as a group (nothing said about the 40ish couple at a nearby table). The terms and statements made were rather derogatory. There was laughter. Then their discussion moved to other topics.

Image courtesy of Stocky Bodies

Image courtesy of Stocky Bodies

This wasn’t pleasant. I tweeted about it. I then focused on dinner with the man of the house.


In the microcosm of this hour and this room, their comments did not necessarily have to affect me.  Their opinions did not cause me to lose my job or my home. And their finding fat people unsexy doesn’t undo what we did this morning. ;)

At the same time, however, the anti-fat views expressed by a group at a bar  encourages and reinforces anti-fat views at the societal level. Society’s view that anyone can lose weight, and that fat people are stupid or in denial or lazy to not be thin,  makes it less likely that I will be hired than a thin person with my qualifications. Or that I’ll be paid as well as a thin person. It’s also part of why medical professionals view fat people as non-compliant and deficient, since we are “willfully” avoiding thinness. Etcetera.

Does it matter to me what a random stranger thinks of fat people?  Individually, maybe not. But society’s view of fat people matters a great deal.

Five Things Make A Post

1) I am sooo looking forward to tomorrow morning, when Mark Reads will post the second-to-last chapter of Deadline.   Mark Reads reviews books a chapter at a time, progressing through books every other weekday, and it’s been building to this OMG HUGE second-to-last chapter for weeks.  (Need I say “spoilers”?) Some of the books he’s done this with in the past are the Harry Potter books, The HobbitThe Lord of the Rings,  and The Hunger Games.  Deadline is the middle book of the Newsflesh trilogy & Mark’s reading the whole thing, starting with the first chapter of Feed here.

2) I got myself a Fitbit Zip to help me be more consistently active — I use it as a pedometer that does built-in recordkeeping, so I can get a sense of how active I am in general, not just a single day. Since I got it I’ve found myself at work focusing deeply for one to two hours and then getting up to walk and get water or coffee or tea or something.  I’d quit feeling guilty about it because I found that a brief break to walk and stretch lets me focus better afterward.  This article helps me rationalize it more ;)

3) A year ago today I signed my father’s hospice paperwork as his medical power of attorney.  The anniversary was a bit freaky this week.  At the moment I’m at peace with it all, but I know my reactions will likely continue to change.

4) I’ve been posting on fat discrimination at http://fatdiscrimination.tumblr.com. It’s not a subject I want to dive into a lot, so posts are somewhat sporadic.

5) Like Paul Campos, I probably wouldn’t vote for Chris Christie.  But it’s not about his weight.

Quotes: Pretty

“You have such a pretty face. You should lose weight.”
— Relatives

“A pretty face and fine clothes do not make character”
— Anon

“Who cares about pretty? I’m going for noticeable.”
— Veronica Roth

“It has been said that a pretty face is a passport. But it’s not, it’s a visa, and it runs out fast.””
— Julie Burchill

“After all those years as a woman hearing ‘not thin enough, not pretty enough, not smart enough, not this enough, not that enough,’ almost overnight I woke up one morning and thought, ‘I’m enough.'”
— Anna Quindlen

“It suddenly struck me that that tiny pea, pretty and blue, was the Earth. I put up my thumb and shut one eye, and my thumb blotted out the planet Earth. I didn’t feel like a giant. I felt very, very small. ”
— Neil Armstrong