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?

In The News

The AMA has endorsed the idea that “obesity” is a disease, not a “condition”.  (Personally I consider it a characteristic.)  Forbes states that this is “a move member physicians hope will spur better reimbursement for treating overweight Americans and create better health outcomes.”  Exactly how it’s supposed to “create better health outcomes” when commonly prescribed treatments do not work long-term or create good health outcomes is not addressed.

In good things, Shakesville’s Fatsronauts 101 series continues to hit it out of the park.

The NY Times does a piece on Melissa McCarthy that doesn’t focus on her weight.  That’s allowed?

The NY Times also reminds people go get some sleep.

I Read This And It Changed My Life

Readers like to talk about books they’ve read.  And one thing you’ll hear about sometimes is “this book changed my life.”   Maybe it was a book that made you feel less alone, or changed how you see the world, or inspired you.

But sometimes they’re more mundane than that.

Dealing with my father’s finances reinforced for me how differently I deal with finances than my parents did.  And a big reason why is that I read Personal Finance For Dummies by Eric Tyson shortly after I graduated college.   There are probably other books that could’ve done the job, but this was the one I found and that worked for me.  It was accessible, practical, and yes, inspiring.  This book encouraged me to reduce and track my spending, to pay off my college loans early, and to live differently than my parents had shown me.

It may not be what most people mean by “this book changed my life.” But I no longer get daily phone calls from creditors. That’s a big enough thing to me.

Job requirements

“Put this all together and it means the IRS needs tens of thousands of people who are (a) smart, (b) willing to do really tedious work, (c) for moderate wages, (d) while working for a soul-crushing bureaucracy, and (e) being loathed by all right-thinking people. Does this sound to you like a recipe for disaster? Me too.”

Mother Jones

Wow…to a certain extent this sounds a bit like working in child care, or elder care, or Microsoft tech support.  (To name a few jobs I’ve done that were exacting and received little respect or pay.) But the IRS is probably worse.

Things to Read

By way of Slacktivist comes a piece on recognizing silencing techniques.  Some are definitely too familiar.

Security guards do not always improve the learning environment.  Art teachers might be better.

Petition to drop the charges against Keira Wilmot for a science experiment gone wrong and re-enroll her in school has over 36000 signatures — does it have yours?

From an article on mammograms, and why they haven’t dropped the incidence of metastatic breast cancer: 

Mammograms, it turns out, are not so great at detecting the most lethal forms of [breast cancers] a treatable phase. Aggressive tumors progress too quickly, often cropping up between mammograms. Even catching them “early,” while they are still small, can be too late: they have already metastasized. That may explain why there has been no decrease in the incidence of metastatic cancer since the introduction of screening.

At the other end of the spectrum, mammography readily finds tumors that could be equally treatable if found later by a woman or her doctor; it also finds those that are so slow-moving they might never metastasize. As improbable as it sounds, studies have suggested that about a quarter of screening-detected cancers might have gone away on their own.

 It’s a long article, but worth reading. 

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.

“Big data” and hiring

Having job-hunted recently I found this article in The Economist interesting:

Evolv mines mountains of data. If a client operates call centres, for example, Evolv keeps daily tabs on such things as how long each employee takes to answer a customer’s query. It then relates actual performance to traits that were visible during recruitment.
Some insights are counter-intuitive. For instance, firms routinely cull job candidates with a criminal record. Yet the data suggest that for certain jobs there is no correlation with work performance. Indeed, for customer-support calls, people with a criminal background actually perform a bit better.

Also are observations about trying to gauge honesty and that folks with higher “honesty” scores often aren’t as good at sales.  Ahem?

I was amused at the assumption that folks who use a non-default browser to fill out job applications are better candidates.  I can’t count the number of times a job application form would crash in non-IE browsers!

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”.

Exercise Takes Time? Really?

Reading yet another piece on an exercise study, this one with older (60-74 years) sedentary women, I giggled at this observation:

“They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.

Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.

As noted in the study abstract, the groups working out twice or four times a week (half strength training and half aerobics) had about the same physical improvement as the group working out six times a week, and became a bit less active overall than the other 2 groups.   And, of course, this is about averages and older women, and individuals vary.  But it’s nice to see recognition that you don’t have to work out every day to have useful strength or endurance results.  Or that people might have things to do besides exercise.

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.

Weight Loss Myths

Shakesville posted about this Gina Kolata NY Times piece already, but I wanted to highlight this:

David B. Allison, who directs the Nutrition Obesity Research Center at the University of Alabama at Birmingham […] sought to establish what is known to be unequivocally true about obesity and weight loss.

His first thought was that, of course, weighing oneself daily helped control weight. He checked for the conclusive studies he knew must exist. They did not.

“My goodness, after 50-plus years of studying obesity in earnest and all the public wringing of hands, why don’t we know this answer?” Dr. Allison asked. “What’s striking is how easy it would be to check. Take a couple of thousand people and randomly assign them to weigh themselves every day or not.”

Yet it has not been done.

And, in the meantime, you have parents, doctors, families, and friends advising people to follow these myths. You have weight-loss companies making money from these myths.  And they don’t work. Or, they work for some people. Or, they work temporarily before all the weight comes back (plus more).  Feel like hitting one of the lying liars who lie and mislead people into putting all that time and energy and work and money into eventually gaining even more weight yet?

From Allison’s study abstract: 

Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.

What sort of myths?  Back to Gina Kolata, here’s some weight loss ideas that have been proven to not work, yet are commonly preached to people everywhere:

  • Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.
  • Set a realistic goal to lose a modest amount.
  • People who are too ambitious will get frustrated and give up.
  • You have to be mentally ready to diet or you will never succeed.
  • Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Kolata also highlights some ideas that have not yet been proven true OR false:

  • Habits in childhood set the stage for the rest of life.
  • Add lots of fruits and vegetables to your diet to lose weight or not gain as much.
  • Yo-yo diets lead to increased death rates.
  • People who snack gain weight and get fat.
  • If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

…and yet, again, these are in diet books, diet programs, and in the last, calls to change how cities are laid out.  (Not to say that bike paths, jogging trails, sidewalks or parks are bad. Just that they won’t automagically make people thin.)

Why is this?  Doctors believe that being fat is terribly, horribly bad.  They want to give people something concrete to do.  And, often, doctors aren’t educated about nutrition or obesity research.  We end up with these myths being repeated over and over, endlessly, and people blame themselves when they don’t work or don’t work long-term. Or they figure it probably works for most people, just not me.   Even the list of “Facts – Good Evidence to Support”, which starts with “Heredity is important but is not destiny”, makes me wonder how much of it suffers from the “must hold out hope of weight loss!” bias.  Especially when the article notes that losing 10% of their weight is typical, and very few lose more.

Overall, the NEJM paper is a call to improve the research.  Even so, they’re not tackling the big “weight loss improves health” idea, or how much of its support comes from short-term studies that include exercise as a component (and never mind that exercise can improve health on its own, independent of weight loss).  Even the reference to most weight loss being in the 10% range will likely not burst the FOBT.

As Liss notes, “What a different culture it would be if fat people weren’t a problem to be solved.

QotD: Inauguration

“It is now our generation’s task to carry on what those pioneers began.  For our journey is not complete until our wives, our mothers and daughters can earn a living equal to their efforts. Our journey is not complete until our gay brothers and sisters are treated like anyone else under the law for if we are truly created equal, then surely the love we commit to one another must be equal as well. Our journey is not complete until no citizen is forced to wait for hours to exercise the right to vote. Our journey is not complete until we find a better way to welcome the striving, hopeful immigrants who still see America as a land of opportunity until bright young students and engineers are enlisted in our workforce rather than expelled from our country. Our journey is not complete until all our children, from the streets of Detroit to the hills of Appalachia, to the quiet lanes of Newtown, know that they are cared for and cherished and always safe from harm.”

— President Obama, in his second inaugural address

The US is so behind in so many ways. But this feels hopeful.

Harriet Brown on Weight Bullying by Parents

Image courtesy of Stocky Bodies

Image courtesy of Stocky Bodies

[Discussion of bullying and weight punishments; feel free to skip.]

Harriet Brown has a piece in the New York Times Well blog on “Feeling Bullied by Parents About Weight“:

Parents and other adults who are “only trying to help” may do harm rather than good, as a recent study from the journal Pediatrics makes clear.

It is a good discussion and I’m glad to see it.  At the same time, it can be upsetting to see things you’ve lived with discussed dispassionately. Dr Rebecca Puhl, from the fat-phobic Rudd Center, appears, as does Ellyn Satter.

“There still remains the widespread perception that a little stigma can be a good thing, that it might motivate weight loss,” said Dr. Puhl, a clinical psychologist. (Medical doctors, too, fall prey to this misconception.) But research done at the Rudd Center and elsewhere has shown that even well-intentioned commentary from parents and other adults can trigger disordered eating, use of laxatives and other dangerous weight-control practices, and depression.

Hells yes, y’all, parents can bully their fat children.  Or maybe you don’t want to call it “bullying.”  Maybe you want to call it teasing, belittling, or harassing.  Oh, here’s one: providing incentive.  Maybe buying your kids clothes that “will fit when you lose weight” instead of now, or pointing out that the fat kid gets different (less) food than the rest of the family, is just something that “has to be done” too.  No, it’s not.  It is abusive. And you should not be surprised if the kids you reject for being fat reject you in turn.

Kudos to Harriet for broaching a topic that many parents like to pretend doesn’t exist.  Also for common sense suggestions, including

¶ Don’t blame your child for his weight. […]

¶ Don’t engage in “fat talk,” complaining about weight and appearance, whether it’s your own, your child’s or a celebrity’s. [….]

¶ Don’t promise your child that if only he lost weight, he wouldn’t be bullied or teased. […]

¶ Don’t treat your child as if he has — or is — a problem that needs remedying. “This will make him feel flawed and inferior,” says Ellyn Satter, a dietitian and therapist in Madison, Wis., and author of “Your Child’s Weight: Helping Without Harming.” Instead, she suggests, focus on a child’s other good qualities, and encourage traits like common sense, character and problem-solving skills.

I would strongly recommend NOT reading the comments in the Times. 

Conflating Dieting with Eating Healthy

[Feel free to skip if you don’t want to think about dieting right now.]

Image courtesy of the Rudd Center Image Gallery

Image courtesy of the Rudd Center Image Gallery

It’s January and there is the usual plethora of diet commercials extolling weight loss. Google “dieting” and up comes Special K’s “Healthy Eating Plan”!

That said, it is a bit refreshing to see someone write:

As a lifelong dieter, let me tell you from experience: A diet need have nothing to do with “eating healthy.”

[…] It’s possible to lose weight by eating more healthily. But losing weight and eating more healthily can also be two totally different goals.

The cultural conflation of “eating healthy” and “dieting” has a lot of built-in assumptions.

There’s certainly more (and I haven’t even gotten into all the debate over what “healthy eating” means).

One result of the end-of-year crunch at work is that I haven’t been eating lunch regularly.  I’m going to work on permission to eat what I want, and eating at regular intervals.  But I am still avoiding diet commercials.

Today in Don’t Read The Comments

Marilyn Wann takes on weight bias in healthcare in “Big deal: You can be fat and fit” on CNN.COM:

…People are telling their stories of weight bias in medical care on websites like First, Do No Harm, This Is Thin Privilege and Obesity Surgery Gone Wrong. The National Association to Advance Fat Acceptance has been speaking out on behalf of fat people’s civil rights since its founding in 1969.

Health professionals of good conscience are joining this effort in increasing numbers. They’ve developed an approach called Health At Every Size that is proving to be better for people’s health than weight-loss attempts. The Health At Every Size professional organization,Association of Size Diversity and Health, this week launched the project Resolved, a response to New Year’s weight-loss resolutions. It invites people to share stories about weight discrimination in health care and opinions about what needs to change.

Weight bias has been documented among doctors, nurses, fitness instructors and other professionals on whom a fat person might need to rely for help. Last year, researchers who themselves are part of an anti-“obesity” institution (Yale’s Rudd Institute) surveyed medical professionals who specialize in caring for fat people and found that they had high levels of weight bias, viewing us as “lazy, stupid, and worthless.”

Image courtesy of the Rudd Center Image Gallery

Image courtesy of the Rudd Center Image Gallery

Paul Campos uses the latest “obesity paradox” study with “Our Absurd Fear of Fat” in The New York Times to argue that policing fat is worthless:

The study, by Katherine M. Flegal and her associates at the C.D.C. and the National Institutes of Health, found that all adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals. If the government were to redefine normal weight as one that doesn’t increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.

[…]

Now, if we were to employ the logic of our public health authorities, who treat any correlation between weight and increased mortality risk as a good reason to encourage people to try to modify their weight, we ought to be telling the 75 million American adults currently occupying the government’s “healthy weight” category to put on some pounds, so they can move into the lower risk, higher-weight categories.

In reality, of course, it would be nonsensical to tell so-called normal-weight people to try to become heavier to lower their mortality risk.  […T]iny variations in relative risk in observational studies provide no scientific basis for concluding either that those variations are causally related to the variable in question or that this risk would change if the variable were altered.

Both articles are well worth reading, but I would skip the comments on those sites. If you must discuss with someone, chat about it here ;)

Happy New Year!

Image of a fat woman talking on the phone in an office setting.

Image courtesy of the Rudd Center Image Gallery

Hello and welcome!  I’m back at work with my new cartoon-a-day calendar (New Yorker cartoons) and new wall calendar (Pacific Northwest landscapes).  I even cut off some of the photos from last year’s wall calendar to decorate my cube.  Ready to work!  (Yes, I know it’s Wednesday, but today feels like Monday to me.  Yay four-day weekends! )

I adjusted the layout, let me know if you can’t find things.  Also, let me know if you have additional topics or questions you’d like me to write about.

As for resolutions, well, there’s resolve and then there’s Resolve the carpet cleaner, (Two Lumps).  There’s also ASDAH’s Resolved: Addressing Weight Bias in Health Care Project, collecting health care stories in video or written form.  Please see their site to see what they are asking for and the submission methods.

 

In the meantime, some things to read / discuss if you wish – warning for fat hate:

People are living longer! I thought this would be a good thing. Oops! As Fatties United discusses, some people aren’t happy with this.

Since so many fat people have had the audacity to keep on living instead of dropping dead on schedule, Dr. Mokdad is predicting that all these fat folks will be old sick fat folks and require lots and lots of medical treatment.

Study results show that “normal weight” folks don’t live longer than overweight folks? (Again?) Oh noes, must include lots of fat panic in the news coverage!

Charlotte Cooper writes about The UK Royal College of Physicians and their concerned about obesity!  Oh dear.

Reading the report is like a journey into Opposite Land. The work is well-meaning, but it exists with a framework that is profoundly problematic. For example, it is hard to disagree that current service delivery for fat people is really poor, particularly for those who undergo weight loss surgery, and that there needs to be proper auditing, quality control and monitoring of all obesity treatments.

But the report, as is typical in a medicalised discourse of fat, is entrenched in a view that regards weight loss as the universal solution to the problem of fat people and health. The authors throw about “severe complex obesity,” a term they’re obviously pretty proud of, coming soon to a healthcare provider near you, and bound to further medicalise and stigmatise fat people. They make the crucial mistake of failing to question the effectiveness of weight loss at all, so it’s not weight loss surgery that ruins fat people’s health, it’s the fact that the care pathways surrounding the surgery need tweaking. This ties them up in all kinds of knots, looking for answers in the wrong places, for example suggesting that the UK needs a Michelle Obama figure to galvanise the population against obesity, even though her crusade in the US has been disastrous in re-stigmatising fat kids, and even though we’ve already seen Jamie Oliver screw things up over here.

Anyway, let’s be careful out there. Now, I’m going for a walk.