When it comes to weight and health, our society has a tendency to get a little bit of information and then jump to conclusions that only seem obvious based on our stereotypes and myths about weight and health. Let’s look at some examples:
According to studies from the Albert Einstein School of Medicine, about 50% of overweight people and 30% of obese people are metabolically healthy. These fat healthy people are called a “paradox” and are ignored in discussions about health and weight. According to basically every weight loss study since 1959, about 5% of people successfully maintain weight loss (and there is no guarantee that they are healthy). They are seen as proof that weight loss works, as successes, and great effort is being made to study them to see how to make us all thin. So we ignore 50% and 30% to study 5%.
There are all kinds of articles out talking about a study that found that fat doctors don’t talk to their patients about their weight (thanks to reader Lyn for sending this along). Everyone jumps to the conclusion that this is a bad thing and that the doctors aren’t discussing weight loss because they are embarrassed of their size. But what about the possibility that these doctors are living the abysmal success rate of weight loss. Consider that doctors who don’t recommend weight loss are the only ones who are practicing evidence-based medicine. You see, when it comes to weight loss there is not a shred of evidence that would lead those doctors who are pushing it to believe that it would work. But hey, let’s jump to conclusions and criticize fat doctors for not giving people a prescription that fails 95% of the time?
Another one we hear a lot is how many fat people have type 2 diabetes. What they don’t tell you is that doctors test fat people early and often for diabetes based on diagnostic criteria that have been recently lowered. On the other side, thin people are not tested until they have severe symptoms and some doctors even mistakenly think that it’s not possible for thin people to get type 2 diabetes. So, if Group A gets tested for a health issue very earlier and very often, and group B doesn’t get tested unless they have severe advanced symptoms, how is it news that more people in group A are diagnosed with the health issues.
We have to rise above “everybody knows” and the way to do that is to question the status quo (in the wise words of Dr. Horrible, “the status is not…quo.”) The thing that makes great thinkers great is their ability to look at the world with a fresh eye. We all have capability to do that – to look at the evidence and consider everything that it might be suggesting rather than just jumping to conclusions.
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Dances With Fat 
There is a paradigm shift required here. Folks like you are leading the way towards this shift. I have been lucky to connect with a few amazing doctors that do understand the futility of prescribed weight loss. This has blessed me with medical attention that deals with my ailments and doesn’t blame everything on my weight. I have to work on my own self image and self judgement that is based in the culture of hatred of people who are my size
In terms of fat people and type 2 diabetes, while it’s probable that fat people are diagnosed earlier and more often than thin people, there is also an underlying relationship between the genetic propensity to develop diabetes and the genetic propensity to be fatter. My thinking is that it’s not so much that being fatter causes diabetes, as it’s often portrayed, but that some people have genes that predispose them to developing diabetes (not everyone has these genes) and that those same genes make gaining weight easier than it is for people without those genes. So, if a doctor looks at a fat person and thinks, hmmm, I wonder if they have diabetes, I think that’s a good thing, because they may not have it, but they are more likely to have it than someone who is thin, because of the genetic connection between the ability to be fat and the ability to develop type 2 diabetes. If the test results show that a fat person doesn’t have diabetes, then the doctor can move right along. Knowing you have diabetes and getting treatment early can head off serious complications that could otherwise be avoided — there are many actions that have nothing to do with losing weight, such as being more physically active, that can help head off complications.
Sorry for the rant — I’m just wanting to clarify that there is a connection between fatness and type 2 diabetes, but it’s not that fatness itself is the cause of diabetes. And most fat people will never develop diabetes.
There are quite a few researchers who are working from the principle that weight gain in adulthood and Type 2 diabetes can both be symptoms of the same underlying metabolic issue, so it’s not that weight gain leads to Type 2 diabetes, but that both can be a physiological response to that issue.
Hi! I love your blog… read every post… recommend your blog to others… but have never commented. I’ve realized that I have trouble defending/supporting the fact that you can be fat and healthy to people, so thanks for providing these studies in this blog. One question: what does it mean to be “metabolically healthy?” Thanks!
Hi Laura,
Wow, thanks for all the support and for passing the blog along, I’m flattered! Metabolically healthy as I understand it refers to being in the “healthy” range for metabolic health markers such as blood glucose, blood pressure, risk for heart disease etc.
Hope that helps!
~Ragen
Thanks, Ragen! It does help! Sorry I didn’t notice your reply till now!
Omg, the jump to conclusions mat!!!! LOVE XD ❤
I think it's always good to look at context when talking about "epidemics" of increasing prevalence. It is said a lot of illness, both physical and mental, are increasing when you have to consider that 50 years ago nobody would have tested for it, testing wasn't as refined, nobody tested below certain ages, etc. So while there might be increases in prevalence of some diseases and indeed causes for it, the hysteria that we're all getting fatter and sicker and life expectancy is about to plummet is really quite ridiculous…
“Omg, the jump to conclusions mat!!!! LOVE XD <3"
Yes. Except using "loose" when "lose" is the correct word just drives me nuts! :p
Whenever I see a glaring mistake such as this, I try to make sense of this as though the sentence is correct as is, and respond accordingly, if only to give myself a laugh rather than getting mad. In this case, “Loose one turn.” Doesn’t make much sense, unless you add some punctuation. “Loose one, turn.” Then whoever lands on that square is a “loose one” for the rest of the game, and must turn around whenever anyone lands on that square.
“There are all kinds of articles out talking about a study that found that fat doctors don’t talk to their patients about their weight (thanks to reader Lyn for sending this along).”
Our fat vet constantly talked to us about one of our cats needing to lose weight. He even suggested depriving him (and therefore all the other cats too) of food, and feeding only very limited amounts of “diet” cat food. Needless to say, we did not try this.
The vet lost his weight, and (surprise!) soon gained it all back and then some.
The cat passed away a couple of months shy of his 20th birthday (that’s pretty good for a cat!).
So… yeah.
“Did you just use the Jump to Conclusions Mat? Go sit in the corner and think about what you just did.” XD
Thank you, I wish this blog could go on billboards all over the nation. You are chicken soup for my soul.
It Is such insanity that we believe the 5% studies carry more truth than the other studies.
I was thinking this morning how depression is correlated with poor health and that many who are bigger sized most likely were encouraged to diet and try to control their size since they were young.
They most likely had poor self esteem which can relate depression.
Poor self care is involved with depression as well. People who are ashamed of their weight generally do not take good care of themselves.
Health at every size makes so much more sense. Taking weight out of the conversation leaves us free practice healthly lifestyle where and how we can with where we are at. So glad Ragan is showing us that one can be healthy and a bigger bodied person.
OMG how much do I love that you have the Jump to Conclusions mat AND a Dr Horrible reference in the same blog? Awesome.
Please understand, this is normal. The reason the female brain was ignored until fairly recently is because it was too variable and complex to understand thus was considered “abnormal” and not factorable in their studied of the brain. I suggest reading the book “The Female Brain”. It not only gives a wake up call as to what is likely happening in your head at different times in your life (developmentally/hormonally/etc.) but gives an indication as to where to look for these sorts of “studies”.
Basically, anytime science comes up against a variable they don’t understand, they ignore that which they don’t understand in favour of that which is simplistic and then report their findings. It’s not too surprising that they also don’t *report* about the stuff they didn’t understand.
It’s only been since finally getting around to the female brain that they’ve made sense of a lot in the male brain in proper context. Studying the female brain changed everything they knew about the brain! d’uh!
So I will patiently wait until they finally study that 30-50% before making any judgements as to what is actually unhealthy for shape. As far as I am concerned, if you are eating healthy (as in *generally* avoiding additives and highly processed foods, eating lots of fruits/veggies), at least walking everyday, and managing any extra health concerns in a constructive manner, you are healthy!
Oh, an any larger ladies, I highly recommend looking at getting some good supportive corsets, properly fitted. I had a larger friend struggling with a thyroid issue. I made her a corset for an event and brought it to her there. She took it into the bathroom to change. Understand that when she went in, the extra frontal weight (especially bossum) forced her to slouch (bras just pulled down on her shoulders) and give the effect of her head hanging. When she came out, because all the body mass was not just centralized but firmly supported by her back and core, her shoulders were back, her head was up and she was able to walk straight and proud. Let me tell ya! Some of the guys she walked past damned near got whiplash from the double take and attraction.
Sometimes, because of our shapes, we end up giving off mixed signals due to the assumption that a certain walk/slouch is due to attitude, not body physics. By bringing my friend’s shoulders up, her bossum being supported from underneath instead of pulling down on a bra, she was able to express her attitude and mood more fully!
I’m not saying corsets are for everyone, but certainly, if the bras aren’t helping the way you express yourself with your body, a corset might be the answer (I know it is for me, too. heheh). Sometimes I think that the main reason people are down on “fat” people is because the clothes they are forced to wear are not for their shape at all! Get the right cut and it doesn’t matter what your shape/size is, you look hawt!
Reblogged this on Mindful Consideration and commented:
Thanks to Ragen Chastain for writing this smart article.
How do I love thee Ragen? So many, many ways. Thanks for again bringing this discussion forward.
I’m lucky to (mostly) find physicians who are willing to treat me as a whole person.
Had a doozy of an experience with a Specialist jumping to conclusions this week! Waiting for my thin (and chronically ill) husband to come out of an outpatient procedure for his broken vertebrae this week. As he is leaving, the SPINE specialist asks him if he has a ride home. Hubs replies-yes, the fat woman with curly hair in the waiting room is my wife.
Dr. Presumptious replies—Don’t SAY FAT! That’s your wife! to which hubs retorts—-and that’s what she likes to call herself. M.D. then, having only passed me in the hall, offered to refer me to a physician for ….GASTRIC STAPLING. Uh, what rock did Mr. Specialist crawl out from under? I live in a part of CA that is abundant with Lap Band billboards. Sheesh. So glad he can diagnose AND inform me so quickly, even when I am not his patient.
Nice however, to see hubs laugh coming out from under the drugs, so not a total loss.
Yep. Jumping to conclusions for fun and profit!
The cynic in me wonders if he gets a kickback for every patient the lap band clinic gets from him.
I absolutely LOATHE it when doctors (or other healthcare providers) push WLS like this. For heaven’s sake, you weren’t even his patient! That just boils down to harassment.
If I feel charitable, then the doctor is doing it because he thinks it’s a cure-all and is trying to do you a favor in his mind.
But unfortunately, the cynic in me wonders if there is an informal kickback system for referrals.
On Fareed Zakaria’s show, GPS, they were talking about the US’s ranking in curing disease that is curable. We rank 29th out of the 29 richest countries. We have the worst rate of infant mortality in the industrialized world.
But our breast cancer survival rate is amazing!
I wonder why we can’t make the moral decision to fix the problems that need fixing. It’s mind boggling!
I wish I could articulate just how much I love what you write and how you write it without sounding trite and nonchalant because what you do here is groundbreaking. You distill stereotypes and fears and discourse about weight, health, size (and everything that goes along with them) and make poignant arguments for the practicality of the Health At Every Size® approach and for evidence-based healthcare. Your blogs should be required reading in medical schools, government health policy departments and … well … everywhere. I should print a thousand copies of this blog post and plaster it all over my city…starting with my gym.
Thank you Ragen.
While I am happy that more people are being diagnosed with Type 2 diabetes early before life-threatening symptoms manifest, I also think that this is a glaring example of “thin/average sized people losing out on healthcare because of weight bias.”
On one hand, you have fat people being given the Type 2 diagnosis of DOOM early on (and now, apparently, telling someone that they have Type 2 Diabetes is supposed to come with a heavy heaping of SHAME AND DEPRESSION, because ya know, “they brought it on themselves by being fat”) but on the other hand, you have thin or average sized people being told they’re “fine” until they’re at death’s door.
In my first pregnancy, I developed Gestational Diabetes during my second trimester. I have PCOS and a good amount of Native American history, and I am a little over 200 pounds. My doctors freaked the heck out about it, yet I was able to control the disorder with dietary changes and exercise as well as daily blood sugar checks. I didn’t like controlling my dietary behaviors so much but it was for my baby, and I am super needle-phobic, so the idea of injecting insulin scared the crap out of me (also the fact that injecting insulin can sometimes lead to hypoglycemia which otherwise never happens in GD).
One of the things that really bothered me about the nutritionists I encountered (and the doctors and the nurses, etc) was that they expected me to be an idiot about my body, and not know what the hell was going on with me. They always seemed at least mildly surprised when I pulled out my food log and my blood sugar log and everything looked in order and I *didn’t* have to inject insulin. Ditto on the surprise when I told them about my exercise habits.
The GD resolved after my pregnancy ended, but my body did go into hormonal shock and that caused my thyroid to die so now I’m Hashimoto’s as well as PCOS.
During my pregnancy, I was alarmed that I lost about 40-50 pounds and didn’t start gaining any weight until the last trimester. Even then, I ended the pregnancy with a full term fetus and all the pregnancy junk at 20 pounds lighter than I started. The doctors, on the other hand “praised me” for losing the weight and friends/acquaintances regaled me with “well you’re probably just eating healthier since you’re pregnant’ stories. I HATED it. I was kind of freaking out about the weight loss but since I wasn’t spilling ketones (which you can sometimes spill if you don’t eat enough carbs when you have GD) and the baby appeared otherwise normal, I relaxed more about it eventually and simply accepted that this is what my body hormonally does while pregnant.
And now I’m pregnant again. This is (hopefully) my last pregnancy, but already, the doctor is telling me that I need to check my blood sugar several times a day and go to the nutritionist (I am dreading it, ugh), even though my A1c was perfect in February and so far my fasting and post prandials in the morning are also normal, even with carb loading (cereal for breakfast without added protein).
I *know* I don’t have Type 2 Diabetes (yet), but the doctors are already treating me like I have Gestational Diabetes, and since my insurance is different than last time, I’m very worried and wary about being treated as an automatic C-section or some other BS because of my weight or my hormonal issues.
But do you know what? The doctors have you over a barrel when you are pregnant, even more-so than when you’re not. Because all they have to do is say the magic words “Your baby could die……” and trail off looking serious, and it’s like no-contest, of COURSE you don’t want your baby to die, so you’ll do whatever they say.
I mean, if a doctor says, “you could die,” I am much more likely to have an idea of whether or not I’m on death’s door. But when it comes to that little wiggly person growing inside of my womb, it’s almost impossible to tell….and I don’t want to be responsible for harming my little one. 😦