The Big Bad VFHT

Bad DoctorWe haven’t talked about this on the blog recently, but it is something that happens all the time and is worth being aware of.  It’s the VFHT:  The Vague Future Health Threat. It sounds like this “Well, you may be healthy now, but it will catch up to you someday”  (“it” here having the meaning of “being fat.”)

I find this to be paternalist, ignorant, unsupported, and annoying for the following reasons:

1. The psychic friends network went out of business for a reason.  If we take a step back we soon realize that this whole mess is based on us believing that this person can predict the future.

2.  This seems to be designed to make sure that fat people never ever believe they’ve done “enough” for their health or healthcare which is neither helpful, nor evidence-based.

3.  Everyone is going to die. There is a 100% chance.  I just happen to live in a culture where if I die because a runaway truck drops 30,000 pounds of bananas on me – someone will blame it on my fat.  That doesn’t make it true.

4.  What if I changed the rules of the lottery so that if  you lost, you had to pay the lottery money as a penalty?  Now not only is your chance of winning infintesimmally small,  but there is a near 100% chance that you’ll end up with LESS money than you had after you bought the ticket.  Would you play?

Now imagine that this isn’t your money we’re talking about – it’s your long term health.  There is not a single study that shows that any weight loss method is effective long term, but there is some evidence that weight cycling (yo-yo dieting) may actually be dangerous to one’s health.  Since diets have such an abysmal failure rate, if I go on just 2 diets where I lose weight and gain it back (and I have a very high chance of doing just that both times), then I’ve likely damaged my current health and endangered my future health on a roll of the dice that was obviously a losing bet from the beginning.

The person VFHTing me is asking that I do something they can’t prove is possible, for a reason they can’t prove is valid, with a very high percentage that I’ll end up less healthy at the end.  I’ll pass. And that doesn’t even take into consideration the fact that health isn’t an obligation, a barometer of worthiness,or entirely within our control regardless of our size.

So what do you say to the VFHT?

Here are some possible responses broken down by category.

Quick and simple:

  • Please don’t make wild guesses about my health.
  • My health is not your business.   (If, at this point, they bring up tax payer dollars or health care costs, I ask them for an itemized list of things for which their local, state, and federal taxes pay, or health problems that people develop for which causation cannot be proven;  broken down into categories of things they are happy to pay for, and things they don’t want to pay for. If they don’t happen to have that list on hand, I let them know that I’ll be happy to discuss it once they do.)

More detailed/scientific

  • I don’t know of a single statistically significant, properly controlled scientific study that supports that statement.  So, either cite your research or I’m going to assume that I know more about this than you do and you are just talking without actually knowing what you’re talking about.  (Or “talking out of your ass”, depending on my mood).
  • You have no way to know that.  Cite your research or I will assume that you are putting my health at risk by talking about things for which you have no actual knowledge or qualifications.

The pointed response (feel free to mix and match questions/responses with boundary statements)

  • How dare you make assumptions about my health?  You may not discuss my health with me.
  • I find you completely unqualified to make that statement. Please keep your opinions about my health to yourself.
  • My health is not your business and you are not allowed to comment on it.
  • You will immediately stop making guesses and assumptions about my future health or this conversation is over.

The snarky responses (I don’t actually recommend these because I prefer some kind of productive conversation if possible, but it’s fun to think about)

  • I had no idea you could predict the future!   If you give me tomorrow’s lottery numbers ‘ll split the money with you.
  • I totally forgot that being thin makes me immortal – thank god you told me or I might have died some day.

To put it quite simply, the VFHT is BS.

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24 thoughts on “The Big Bad VFHT

  1. I like to ask the Dumb Question. You know, things like:

    So, do thin people not die? How does that work?

    If I starve myself to death, will that make me healthier?

    Mostly, though, I just tell them ain’t nobody getting out of here alive so I intend to enjoy my turn on the ride.

  2. I love your blog and and posting for the first time. I am having trouble finding some answers to my questions… I am new to intuitive eating after years of restricting. I am working with a wonderful therapist and dietitian, both whom are HAES advocates and assure me that I am on the right path. I am 6 months into this process of re-feeding myself and I went to the Dr. for my annual. My cholesterol is high – above the range of what is considered healthy (and my good Cholesterol is low). This is new and I am worried about me NOT being healthy, like you are. I feel like I would appreciate my new size more if I wasn’t worried about my health. That being said, I am fairly fit, exercise regularly, etc. But I am worried that my HEALTH (Cholesterol) is being compromised. Any suggestions? Am I the only one who is doing that does NOT seem to be healthy at my current size??

    1. Hi Rebecca,

      I’m really glad that you are finding a path that works for you. Here are my thoughts about this. There are some things to know about cholesterol (Of course I’m not a doctor so check with your healthcare providers). First of all, there is a lot of controversy about the way that we measure and treat cholesterol – a lot of the hype around it has been caused by marketing programs from pharmaceutical companies who sell drugs to treat high cholesterol (and get themselves appointed to medical panels that dictate policy). I would check out this article for a start (it’s not entirely HAES-based but it will give you an idea of some of the issues and the other opinions that are out there):

      Second,there are people of all sizes with high cholesterol – being thin is neither a sure preventative or a sure cure. You are also at the beginning of your journey – certainly talk to your dietician about this but it seems like you might want to wait until you’ve been at a stable place for a while to look at your numbers and decide if interventions are necessary.

      I hope that helps, let me know if you have other questions.


  3. I’m leaning more towards the more snarky comments. lol I get tired of people telling me that I’m going to suffer if I don’t lose weight. Funny thing is, I know plenty of skinny people who suffer, and I point that out to them.

  4. I’m freaking out because I possibly have an actual illness made worse/.caused by du du duh…obesity. God, I don’t want lectures and threats when I visit the neurologist in a few weeks. It also appears to be a hereditary disease and my sister assures me she got while young and thin. BTW, it’s pseudo tumor cerebri. I feel like my death fat bill has come due…

    1. This sounds like a really scary condition and I’m so sorry you are dealing with this. According to Mayo clinic it is more common in obese women over 44–but that does not mean it is CAUSED by obesity. Lots of things are associated with lots of other things, but that doesn’t tell you if one caused the other. It could even be that the pseudotumor cerebri causes the weight gain, they just don’t know! Wising you all kinds of hopeful news when you see neuro!

      1. Diane, thanks for pointing out the obvious! I just kept thinking causation not correlation! I just found a link where bariatric surgery was recommended for relief…

        1. Susie,

          There was a possibility I had this too, so I know I fair amount about it (turns out it was intractable migraines or hemicranina continua, we’re still looking for a diagnosis, but my CSF pressure just wasn’t high enough for psuedo tumor cereberi).

          Anyway, I was OBSESSED with my headache, and in between doctor visits played internet doctor and I was pretty convinced that it was going to be psuedo tumor because I’m fat, 40, and fertile. I knew the fat shaming was coming and I was terrified to see a neurologist because I just didn’t want to hear about how I had to change my body shape. Trust me, I felt every single emotion you are having about fat chickens coming home to roost. I remembered radical diet plans of my youth.

          My neuro was awesome, he only ever weighed me at my first doctor’s appointment, never since. He’s never said anything about my weight, other than rejecting the combo of steriods and antidepressants as a treatment option because they might make me the fattest woman in the world, which I’m not interested in. I will say, though, the ophthalmologist I saw to make sure the headaches hadn’t damaged my eyes was a freaking horror and all I got was a long, long, long lecture about weight loss surgery, and a $500 bill for the pleasure.

          As far as WLS surgery goes, and I say this as someone who was completely obsessed and read everything I could find, it had a cure rate of less than 50%, at least anecdotely. I’ll dig around see if I can find some studies I saw that back that up so you can go in armored with facts.

          I hope you feel better soon. Headaches suck.

          1. Thank you! I read the article Katie linked to and they presented WLS in the same way. I think anything with vision loss as a possible outcome is freaking me out most!

    2. I have this too. Don’t freak yet. My neuro has been really cool about my weight. I’m “obese,” but the only thing he asked at the beginning was if I had gained a lot of weight recently (“like 60 lbs in the last 6 months”). I told him that no, I hadn’t, and he hasn’t mentioned it since.

      Also, and this is SUPER important – this disease is not fatal. This link is, by far, the best thing I have read on the disease. It’s from an actual expert, it’s honest and serious, but it also really helped calm me down about some of the things I was super worried about.

      Good luck!

      1. Katie (hey that’s my name too!) thanks for that link. As obsessed as I was about condition, I never saw that page. I found so much on it interesting as it as it applies specifically to me (living in my hula hoop). So thanks for taking the time for the link.

        I think it’s good the page addresses the fact that weight loss is not always curative because that completely backs up what I read on various boards. (I know the plural of anecdote isn’t data, but having lived with a chronic disease for several years, there’s a lot doctors don’t know about living a condition, so I think anecdotal data is very important too.) Most of the time medical professionals just say lose weight and all your troubles will be gone forever.

        Anyway, thanks again for the link.

      2. Thank you so much, Katie. I read the article and looked up lots of unknown terms. It reassured me about the weight aspect. I’d love to hear more about your experiences with this.

        1. Happy to! Here’s the blog entry I wrote shortly after I was diagnosed:

          Since then, my optic nerve swelling has continued to come down, slowly but surely. I’m still on Diamox, (and potassium – make sure your doc is checking associated blood work regularly), but when I last saw my neuro and opt, they both wanted me to come back in 6 months, which will be about a year since the diagnosis.

          Things I have noticed: when I started the Diamox, my sinuses started draining like crazy. All of the crap that had been stuck up there for years finally drained out (sorry, gross, I know). My pressure is DEF higher before and during my period. If you take the Diamox with orange juice, it tends to keep the tingles away (or at least significantly less). As I wrote in the blog entry, I actually don’t have a lot of problems with headaches (also, I started getting my TMJ treated the week after my spinal tap, so it’s *really* hard to sort out what’s my insane jaw and what is the IIH), so I’m not worried about rebound headaches from OTC meds. That said, I get terrible cramps each month, so I do take ibuprofen or Tylenol. They are both okay with Diamox, but aspirin and anything containing aspirin is NOT. NOT NOT NOT. NO ASPIRIN.

          The key on Diamox is to *stay hydrated*. I found that I was drinking insane amounts of water (150-200 oz/day), and even though I was obviously “hydrated” (and peeing enough to prove it!), I still felt “dry” at a deeper level – my joints hurt, my lips were cracking, nosebleeds, that sort of thing. They actually brought my dose down a little, which helped, but I also just kind of got used to it over time. I was worried about drinking too much water (watch me be one of those people who dies from over-hydration, right?), but my pharmacist said I could drink as much as I want. These days I try to get in 120 oz/day, and add an extra 30oz water + a bottle of Powerade if I get to the gym. You’ll find what feels comfortable for you.

          Salt: Especially early on, but sometimes still, excessive salt gives me a headache. Diamox is already sucking the fluid out of you – and the salt wants to do the same thing. If I get all crave-y for Chinese food or salt and vinegar potato chips (don’t judge!), I make sure to add in plenty of water.

          Re: alcohol – I was really scared to drink alcohol on the medication, but people assured me it was okay, at least in small doses. Since alcohol is a dehydrating thing, it seems to pile on the effects. I don’t ever take the medication and drink alcohol at the same time – it doesn’t make me goofy, it makes my head hurt from dehydration…The night I sat out at the firepit inhaling smoke and drinking wine?…yeah, it will be a long time before I do *that* again…If I know I’m going to be drinking a lot of wine in an evening, I either quit early enough so I can take the meds when I get home, or take them early and pre-drink a ton of water. Either way, make sure you’re drinking plenty of water throughout the night.

          Hmm…that’s what I’m thinking about off the top of my head. If you have specific questions about something I haven’t mentioned, you can definitely ask! 🙂

          1. OMG, this sounds like me too! Saw the endocrinologist last week and of course there was the typical fat shaming due to the fact that I had gained 25 lbs in the last 4 years post gastric bypass and now have been suffering from daily constant headaches, edema under the eyes and vision changes and a horrible feeling of fatigue which to me is the worst of the symptoms. No one can figure me out and I’m scheduled to see the neurologist on Thursday but never even considered I’d have to deal with fat shaming there but now I’m at least prepared! Anyway I am also guilty of self diagnosing but if no one else can do it what else are we to do! Good luck to you and thanks for the info!!

    3. i absolutely have had ptc—in fact, if you look in the merck manual you will see w/in that ptc can be caused by an allergy to tetracycline. this is based in part on a paper that was written, years ago, about my case. if you start getting hassled & you are on tetracycline, you might bring that up. as far as i know, weight &/or tetracycline are the most common correlates, but there may be others—it would do you some good, i think, if you looked up one of the many ptc support groups available online. they didnt exist when i had it [i was around twelve & the internet, itself, hadnt yet even branched into the various BBSes], but i know such groups are out there.

      in addition to tetracycline, there is a possibility that ptc can be caused by an overabundance of different antibiotics, one on top of the other. this was considered in my case; i am unsure of the conclusion drawn by that consideration. tetracycline, btw, has many derivatives—one can be taking it & not know it. minocin, for example, is one. if you are, or have been, taking any antibiotics at all, you should definitely read up on this & bring it to the attention of yr doctor.

      otoh, this might help, i am not sure: when i had it i weighed around 150# [i’m little so this is not skinny, but it isnt obese]. as per: obesity cannot easily be ruled in as a causative factor, at least it wasnt for me [although i am in, & from, industry LA so, of course, my weight was mentioned. any woman over, oh, at most 120# in LA, particularly one attached to the entertainment industry, is thought obese]—at any rate, since it wasnt true for me, it very possibly is not true for anyone. it also may be more correlative than causative, i dont know, i wish i could tell you.

      it’s been a long time since i’ve looked up ptc & longer since i’ve had it [i had a really severe case but have never had a recurrence] so i dont know the new information. i do know, however, that since my illness there has been a voluminous amount of new research. when i had it they were completely stumped about what was wrong w/ me—ptc was not on anyone’s horizon years ago.

      check out whatever research you can find, dont go on a blind doctor date. before the profession was so worried over “dr google” & “disease[s] of the week,” one was taught to know as much about one’s illness as possible. this is still exceptional advice. do it, absolutely, but—& i despise having to say this—dont flaunt it. i would explain why i say this, but i have already written too much. just trust me: it is a good, if equally dreadful, idea to allow yr doctor to be assured s/he knows more than do you. even if it isnt true.

      anyway, i hope a little of the abovenoted helps, at least. try the support groups. i know they are there.

  5. Will you please write to HBO’s Bill Maher about fat? He is always making stupid jokes and comments about fat people & their health.

  6. While I think it’s ridiculous that so many people apparently seem to feel that other people’s health is their business, and that so much of this health dialogue is directed solely at fat people, I do understand the line of thinking to an extent. Yes, we are all going to die someday. But most of us would prefer it to be later rather than sooner. With that in mind, when you have such a strong societal misconception of disease being preventable through certain lifestyle habits (which to a limited extent, it might be, but certainly not to the extent we like to believe it is), and when there’s such a widespread misconception that fat equates to ill health, it makes sense that some people think that being fat puts you at higher risk of getting deadly diseases and sooner. I am by no means trying to suggest that anyone has the right to butt into somebody else’s health or comment on their weight. I am just trying to show the other side. And I know lots of people hate fat because they think it’s ugly or disgusting or it equates to laziness, tax dollars, whatever. But I also believe there are people who genuinely think fat is a health concern. There are people who think this who don’t hate fat people or assume they’re lazy, people who still account somewhat for body differences and metabolism and setting point, etc. who simply have learned that fat and “obesity” are components, or exacerbating factors, of poor health.
    Before I learned more about metabolism and setting point, and before I discovered fat acceptance, I was one of those people. I never hated fat people or assumed fat was the result of laziness. Now, I can’t honestly say I’ve never had my opinion if someone coloured by their weight, or that I’ve never felt contempt for a fat person. (We’re all human, we learn certain prejudices and we make judgements. Now that I’m an adult I try to redirect my automatic judgements so I can be more open and accepting.) But I never felt hatred or resentment toward fat people. When I was a teenager, I thought, “we’ve all got shit to deal with, no one’s any worse than anyone else. The shit just manifests itself in different ways, and unfortunately for fat people it manifests as food addiction and they get constant judgement simply because you can’t really hide fat, though you can hide a lot of other things.” Now I totally understand that this was a misconception, but I think that based on the (skewed) knowledge and understanding I had at the time, this was the fairest conclusion I could come to. I guess all I’m trying to say is, people can be ignorant to certain things and it doesn’t mean they lack compassion or are masking hate with a show of concern.

  7. Not to derail or anything, but I just received my “Ladies’ Home Journal” yesterday, and right up front was an article about a gal who had FINALLY accepted that her fat body was the way it was. And and and…she quotes studies showing that diets don’t work, the same ones Ragen has quoted over and over. Being LHJ, it’s a little fluffy, but it is the FIRST TIME I’ve seen a popular magazine publishing something like that. It seems like a victory to me.

    However…on the last page of the article was an advert for “slimming” jeans. Made me want to set things on fire.

  8. Do you have suggestions for what I might say to one of my closest friends, who is a nurse/fitness coach? I can’t say she doesn’t have qualifications, but she is absolutely convinced of the “deadly epidemic of obesity”. I’m sure that this issue will be the end of our friendship.

  9. I’m fat and I have health issues. The dysfunctional gallbladder being number one on the list at the moment. I went a few months with no attacks and now the attacks are back. I called my doctor who spent the entire time on the phone telling me to eat less fat. Wouldn’t listen when I tried explaining that I can barely eat anything, let alone anything fattening. But since I’m fat there’s no possible way I could be eating properly. I would love to find a new doctor.

  10. I love your responses to the VFHT! However, the #1 person I get VFHTs from is my doctor (who, after all the bloodwork and tests come in fine, still finds it necessary to VFHT me). Most of your responses are aimed at the general public, and I can’t really tell my doctor that my health isn’t any of her business, nor can I tell her that I know better than her. Maybe I will go in armed with science next time…

  11. Reblogged this on Sly Fawkes and commented:
    Aging kills us all eventually. These “diseases of obesity” are diseases that become more likely as we age. Damn old people driving the health care costs up! If they’d just stay young, we wouldn’t have these problems!

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