Research, the Media and Obesity – A Case Study

Reality and PerceptionIn a discussion about fatness and health that I was involved in on Facebook, someone posted an article called “Direct Link Between Obesity and Pancreatic Cancer” with the statement “there is an animal study that shows a direct, causal link between obesity and pancreatic cancer.”

This is a perfect example of how the media does a terrible job of reporting research around weight and health. I’m going to talk about this using just the contents of the article itself to demonstrate how poorly this was reported.

What the research actually studied was the effects of two different diets on signs of possible future cancer in mice.  They found that one diet led to higher body size and higher incidence of lesions that are often a precursor to cancer.   What the researchers actually found was correctly stated in the piece:  “These observations suggest that such a diet leads to weight gain, metabolism disturbances, pancreas inflammation and pancreas lesions that are precursors to cancer.” This is hardly proving causality between body size and cancer (note the use of the terms “such a diet” and  “suggest”), in fact, they are considering body size a possible side effect of diet, but are clear that this study is looking at diet, not body size.

The only fat mice they studied were fat mice who had been fed a specific high calorie, high fat diet.  They didn’t test low calorie high fat diets, high fat low calorie diets, diets that were high fat and calorie and included 5 servings of fruits and vegetables and 30 minutes of movement a day, nor did they have a group of mice of various sizes doing intuitive eating.  They studied only two specific diets – one high fat high calorie, the other low fat low calorie which limits the conclusions that they can draw about diet and cancer, and pretty much excludes any conclusions about general body size separate from diet.

The researcher said “These lesions take a long time to develop into cancer, so there is enough time for cancer preventive strategies, such as changing to a lower fat, lower calorie diet, to have a positive effect.”  Whether or not we agree with the conclusions (and let’s remember that they didn’t actually test these strategies to see if they worked in these mice), note that they do not recommend a change in body size, but rather a change in diet because, once again, this is a study of what the mice ate, not the body size of the mice.

The media is stating the correct facts and then drawing completely incorrect conclusions.   In order for there to be a “direct causal link” between obesity and cancer, they would have to study body size, not diet (because not all fat people/mice eat the same diet) and they would have to figure out the mechanism by which having a body with a specific ratio of weight and height (which is what “obesity” is) causes cancer (pro tip, assuming that all fat people eat a high calorie high fat diet is stereotyping, not science).  This study doesn’t even come close to doing that and so we’re back to correlation and we’ve talked about the many issues with that. The media has a pesky habit of reporting science in the context of the stereotypes and prejudices of our time, this story appeared on a website called Medical News Today so I can understand why people would take the headline at face value but, as we’ve so often seen, when it comes to the media and reporting on “obesity” and health, it’s always reader beware.

If you’re looking for more information about the issues with research and recommendations about “obesity” and health, I recommend this article http://www.nutritionj.com/content/10/1/9

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Obesity, Smoking, and Public Health

Public HealthIt seems like more and more often I’m seeing public health discussion in which fat is compared to smoking.  This is absolutely not an apt comparison and here is why.

The main difference is pretty simple.  Smoking in a behavior – every smoker smokes.  Being fat is a body size, being listed as “overweight” or “obese” in current medial science is a ratio of weight and height and it’s been changed over time, including at the request of companies that sell dieting.  Fat people are as varied in their habits and behaviors as any group of people who share one physical characteristic.

Now let’s talk about what a successful intervention looks like.  Smokers become non-smokers when they quit smoking – when they stop doing a single specific behavior. In order for  fat people to become not fat, they must change their body size.  There are no studies where more than a tiny fraction of fat people are able to become thin in the long term, with the behavioral solutions of “eat less and exercise more” failing just as often as what are considered fad diets.  Because being fat is a body size, not a behavior, there’s not a clear behavioral intervention.

For these reasons, even if someone believes that being fat requires public health intervention (and I don’t think it does) and even if someone believes that shaming smokers has been/is a good public health intervention (and I’m not suggesting that it is) they cannot logically draw the conclusion that shaming is an appropriate intervention for fat people.  Shaming smokers shames people for something that they do, shaming fat people shames them for who they are.  If smokers wish to avoid the shame and stigma they have the option to hide their behavior.  Fat people have no such option except to avoid ever going out in public.  It’s simply not the same thing.

Then there are issues with attempts and failures.  Even if we assume that smoking and weight loss have a similar failure rate (ie: the vast majority of people fail long term) the difference here is that a smoker is statistically healthier for every day they don’t smoke – even if they start smoking again.  Dieting does not work that way.  Each time we feed our body less food than it needs to survive in the hopes that it will eat itself and become smaller, we open ourselves up to health risks including those from weight cycling and from caloric deficit, as well as rebound weight gain.  If we think that being fat is unhealthy, then statistically a weight loss intervention is the worst possible recommendation since the majority of people who lose weight end up gaining it back plus more.

Smoking is causally related to health problems, obesity is correlationally related.  There is good research showing that quitting smoking improves health. In addition to a lack of evidence that significant long term weight loss is likely or even possible for most people, there is also no research showing that fat people who are able suppress their weight have health improvements because of the weight loss.  There is, in fact, research that suggests that they don’t.

Regardless of what you believe about smoking and “obesity”, they are simply not comparable from a public health perspective and continuing to treat them as if they are does a disservice to everyone involved.

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Fat People and Tax Dollars

“As long as my insurance and tax dollars continue to pay for there [sic] diabetes, and heart disease, I’ll continue to feel justified in telling every overweight person I see that they need to lose weight.  Shame is powerful and there [sic] fat is costing me real money”

So I read when I broke the cardinal rule of being fat on the internet and read the comments.

First of all, when someone brings this up I typically demand to see their list of things that their tax dollars pay for, broken down into things that they want to pay for and things that they don’t, and the interventions in which they are participating for each of the things they don’t want to pay for.  Nobody has ever produced such a list – I think that’s because this really doesn’t have anything to do with their tax dollars, it’s simply a convenient way to couch their size bigotry.

This argument is based on shaky claims that fat people are unhealthy and going to cost more money than thin people in healthcare.   I’m going to look at this two ways.  First the reality, and then as if those assumptions were true:

Reality:

Independent research has shown that the cost claims about fat people’s healthcare are seriously overblown (thanks to a world where people can say almost anything about fat people and it will be believed.)   The truth is, you cannot tell how healthy a person is by looking at them, you can only tell what size they are.  There is no such thing as a healthy weight.  Health is complicated, multidimensional, and not entirely within our control.  People make all kinds of choices that don’t prioritize their health, they are allowed to make those choices, and you can’t tell based on their size.

Also, research from Columbia has shown that shame and stigma can have negative affects on our health, so it’s possible that if their tax dollars are paying for fat people’s healthcare, they may  actually paying for the results of their fat shaming and bigotry. (We’ll never know the effects that shaming has on fat people until we stop shaming fat people.)

Fat people are targeted because we are easily identifiable by sight, and it’s never a good idea to take a group of people who can be identified by sight and suggest that they should be eradicated to make things cheaper for everyone else.  Not to mention that nobody making this argument can show a single method of weight loss that has been shown to work for more than a tiny fraction of people over the long term.

But let’s pretend that the assumption is true.  In that case:  I’m fat, so I’m unhealthy and may cost more money. But…

Fat people pay taxes too, and our taxes go to pay for the war on obesity – we are actually funding a war waged against us by our government for the purpose of our eradication.

I’ve never even smoked a cigarette.  And yet my tax dollars go to all the people who get health problems related to smoking.

I don’t drink.  I’ve never even been drunk. And yet my tax dollars pay for cirrhosis, drunk driving accidents and alcohol poisoning.

I’ve never done drugs.  And yet my tax dollars pay for people whose lives and bodies fall apart due to drug addiction.

I look both ways before I cross the street.  And yet I have to pay for people who get run over after failing to do so.

I don’t mountain climb, but my tax dollars pay for the healthcare costs of people whose attempts to do so are dramatically unsuccessful.

And well they should, because that’s how civilized societies behave. I would rather my tax dollars pay for antibiotics to cure bronchitis than pay for an ER visit and hospitalization for pneumonia.  And I’d rather my tax dollars pay for an ER visit and hospitalization for pneumonia than pay for a public funeral because someone didn’t have access to healthcare.  I think that a society where everyone has access to healthcare is better from every possible angle and so I’m interested in removing barriers to healthcare, not justifying them with an argument about my tax dollars.

Even if health was entirely within our control, I’d  rather my tax dollars go to the healthcare of people who make different choices than I do than live in a world where there is someone who gets to tell us all how we should live and I think that the people making the “fat people and my tax dollars” argument would agree.  I’ve also noticed that people who want to police my “health” (and by health I actually mean body size which is not the same thing) are never that excited to have other people police their health.  Should vegans only have to pay for the healthcare of other vegans if they believe that’s the healthiest lifestyle?  Should Christian Scientists taxes not have to pay for any healthcare at all?  Should people without cars not have to pay taxes for the road, should people without kids not have to pay taxes for schools?  Since I think that people who make this argument are bullies should I not have to pay for their healthcare since I don’t like bullies?

Marathoners drop dead of heart attacks.  People who do everything “right” (“right” here having the meaning of “what health concern trolls say we should do”) die of diseases to which they were genetically predisposed. Other people live their lives in ways with which we disagree, we live our lives in ways with which other people disagree, and all this “won’t somebody think of my tax dollars” hand wringing is nothing but thinly veiled fat bigotry.

If someone starts talking about their tax dollars, I tell them that I need to see the list of things their tax dollars pay for, broken down into things they do and don’t agree with, and the interventions they are involved in for everything they think makes their taxes too high. Otherwise, I’m going to assume that this is a bullshit excuse for engaging in weight bullying and this conversation is over.

Bottom line:

Even if they could prove that being fat makes me unhealthy (which they can’t). And even if they had a method that was scientifically proven to lead to successful long term weight loss  (which they don’t). And even if there was proof that losing weight would make me healthier (which there isn’t). And even if they were going to go around yelling at smokers, drinkers, jay walkers, and thin people who climb mountains (which they aren’t) this slope is still too slippery.  And that doesn’t take into account the reality that their premise is completely flawed, their assumptions are faulty, and their method of shaming people is utterly ineffective since they can’t make us hate ourselves healthy or thin.

So I think it would be dandy if they would just shut up.

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If my selling things on the blog makes you uncomfortable, you might want to check out this post.  Thanks for reading! ~Ragen

Fashion Bashing and Gabourey Sidibe

Gabourey Sidibe attended the Golden Globes and was criticized for her body, her dress, and how the dress fit her body. Although she shouldn’t have had to deal with it, her response was brilliant and, if it were possible for me to be more of a fan of her, this would do it:

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Obviously I think all of the fat bashing comments about her are complete bullshit.  But there is something else that’s been bugging me as well. Before I get into this I know that this blog is controversial and there are many who will disagree with me and that’s totally ok.  I want to be clear that people have every right to do the things that I’m about to discuss, I’m not the boss of anyone else’s underpants and I’m not trying to tell anyone else how to live. My goal is, as always, to give people something to consider, whether they agree or disagree.

I’ve never been much of a fatshionista.  Several times I’ve dipped my toe in the pool and every time I’ve found the water way too hot.  The first time I joined a fat fashion oriented community on a popular blogging site.  It was the kind of place where people post an OOTD (Outfit of the Day) and other people give them compliments.  I thought it was pretty cool and I was getting up my courage to post my own OOTD when, two days after I joined, I got an e-mail from someone in the community who knew me from the blog (and seriously misjudged my personality) inviting me to join a secret community that was created to make fun of people in the original community for their fashion choices. To be crystal clear, this cruel community was made up of fat women who were members of the original community.  I thought about publishing the information in the first community, but I didn’t want to be responsible for the kind of hurt it could cause.  Maybe I should have done it, I still don’t know. I do know that I found it, and still find it,  disgusting.

I’ve seen fashion used as a weapon over and over again to make some fat women feel better about themselves by putting other fat women down for what they wear, or making general statements that seem both pretentious and over-stepping (“Why anyone would leave the house in sweat pants, I will never know” –  in what seems to me to be exactly the same way I have seen being thin used as a weapon to make those thin women feel better about themselves at the expense of fat women.)  That’s not to say that everyone involved in fatshion, or every thin woman, has done this – I’m specifically talking about those who do.

I’ve seen so much advice about fashion given by fat people to fat people insisting that we should ALL use fatshion to look as thin and young as possible. Every time I’m told that I need to choose something “flattering to hide my problem areas, and not look too old” or am encouraged to buy something to try to squish my body into a more acceptable shape, I can’t help but feel that it is buying into and reinforcing  the social stereotypes that are already used to shame, stigmatize and oppress me every day.

Gabourey Sidibe is one of the very, very, very few fat people who have made any kind of traction in Hollywood.  She has publicly had to deal with health concern trolls and fat bashers every step of the way (not to mention the racism that she has to deal with as a Woman of Color in a racist world).  I don’t understand why other fat people can’t allow her to dress as she wants without negative comments and offering to be her stylist like she isn’t smart or savvy or fashionable enough to get the job done on her own – like the fact that she is talented and has succeeded despite the bullshit that she has had to deal with means that she owes every fat person their definition of fashionable or she deserves to have her choices picked apart and criticized publicly.  Y’all, could we not?

Fat people are told over an over again that our bodies are wrong and that we don’t deserve to have access to affordable clothing that we like to wear. For many fat people fatshion is activism – wearing clothes they love in a world that tells us that the only appropriate use of clothes is to make ourselves seem more invisible and/or closer to the stereotype of beauty, is activism.

If I were Underpants Overlord (and I am fully aware that I am not), people would treat fashion like they should treat health – where we are each allowed to make choices for ourselves, and other people’s choices aren’t our business unless they ask us to make it our businesses.  Maybe if we don’t like Gabourey’s dress we could take a pass on wearing it, but respect her choice. (EDIT:  Several people have suggested that this situation is different because other people assist her in choices and dressing – her designer, stylist etc. –  I don’t actually think that matters, she chose to go out in that dress and I choose to respect that, if she doesn’t like what her staff did then she can say something but I’m not interested in criticizing her look because  I don’t think you can criticize her outfit without criticizing her.)

I think it’s fine to comment on the way mainstream media treats fat people, and the clothing choices that exist for fat people.  I think it’s fine to comment on fashion trends and how they intersect with sizeism etc. I think that it’s possible to discuss all of these things without criticizing individual choices.  And maybe it would be cool if we could let fat people go out into the world wearing clothes they choose without fear of fashion bashing.

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A World Without Fat People

Nothing to proveIn a conversation on the Facebook Page Everyday Feminism I read this comment: “I don’t want to live in a world where being unhealthy and obese is the cultural norm. It speaks volumes about the decline of our social structure and our values.”

This, to me, actually speaks to the way that people confuse their right to live by their beliefs with their perceived right to a world where everyone lives by their beliefs.  (This is the kind of confusion that leads to people who disagree with same gender marriage to insist that two dudes getting married infringes on their civil rights. Um, no.  Their rights would be infringed on if they were forced to marry a same gender partner, not because other people have the right to do something with which they disagree.)

I talk a lot on this blog about the issues with conflating weight and health, and sometimes people get confused between the concepts of Health at Every Size and Size Acceptance.  I’ve said it before and I think it’s worth repeating:  Fat people have the right to exist, regardless of why we are fat, what being fat means, or if we could be thin by any means however easy or difficult. There are no other valid opinions about that.  Fat people have the right to exist in the world in fat bodies without stigmatizing, bullying, or oppression.

That is to say that even if every stereotype and hand-wringing statistic about fat people is true (and I, in no way, believe that they are), no matter what someone believes about fat people and health, they do not have a right to a world without fat people, nor do they have the right to bully, stigmatize, oppress, force medical treatment on, or impinge upon the rights of fat people, no matter how much good they think it will do for fat people specifically or society generally.

Nobody owes anybody else “health” or “aesthetically pleasing” by any definition. I think that the “decline of our social structure and values” occurs when people confuse their right to life, liberty and the pursuit of happiness with the delusion that they have a right to live in a world where everyone operates based on their beliefs.  Nobody has a right to world without fat people, fat people do have a right to a world without stigmatizing, bullying and oppression.

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If Fatty Can Do It, So Can I

Photo by Substantia Jones for the Adipositivity Project
Photo by Substantia Jones for the Adipositivity Project

There’s a phenomenon wherein people use fat people as fitness “inspiration” thinking, or even saying to a fat person,  “I saw you [accomplishing some fitness thing] and I just thought, if she can do it, so can I!”

That is not a compliment, and it’s not ok.  Fitness, like health, is multidimensional and not entirely within our control.  (Also, like health, someone prioritization and path to fitness are not a barometer of worthiness, not an obligation, and not anybody else’s business.)  There are genetic components, past behaviors/habits/injuries that can make things easier or harder, our current dis/abilities, what we prioritize and where we are currently on our fitness journey – and that’s for people of all sizes who are working on fitness. Fat people are not automatically the low bar when it comes to fitness and assuming that we are – just like any time we make guesses and judgments about people based on how they look – is stereotyping and bigotry.

Let me try to illustrate how ridiculous this idea is:  I can do the front splits – it took a shit ton of work but it is also because I’m genetically able to stretch in that way.  The fact that I can do it does not mean that anyone who weighs less than I do can also do it.  On the other hand, I cannot do the side splits.  I worked on them for an hour a day for a year and I went from tragically horrible to horrible – I was so far from the ground that you could drive a car under me – at that rate of improvement I was looking forward to celebrating my side splits with a senior-discounted meal. A Pilates instructor finally broke it to me that I simply don’t have the genetic capability to do it – it’s never going to happen.  It’s not because of my size and we can’t assume that because I can’t do it nobody who is bigger than I am can either.  Size does not equal fitness, or fitness capability.

I think that a lot of this comes from misinformation that gets spread (often by people who make their money promising to make people thin) that being thin makes you magically more fit/mobile and is, in fact, the only path to better fitness/mobility.  I’m always frustrated with people who insist that movement will be easier with the same muscle mass but less weight (typically ignoring the fact that weight loss causes muscle loss), but insist that it’s completely impossible that movement will be easier at the same weight but with more muscle mass and/or flexibility.  This leads to fat people getting horrible advice like “don’t lift weights because you don’t want to put anymore weight on.”  It also leads people to think that that they have the capability to do anything that someone larger than they are can do.

The idea that “if [whoever] can do it so can I” is a complete fallacy no matter what we’re discussing, but when applied to fitness – as in “If fatty can do it, so can I” – it becomes not just ridiculous, but insulting as well.

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The Fatty Whisperers

The jerk whispererFatty Whisperers are people who feel the need to give unsolicited advice to fat people (aka concern trolls). Recently  in the Rolls Not Trolls Facebook community Christine posted a perfect (ly horrible) example of someone being a Fatty Whisperer (reprinted here with her permission of course)

So I work at a pool as a lifeguard/swim instructor. I love it; I really do, but today one of our regular patrons came up and “encouraged” me to find exercise that I like. He introduced this by saying that he “has a bone to pick with me.” I’m just so upset and offended I could scream. What’s worse is that since I’m at work, I can’t simply tell him to “fuck off.” I just can’t deal with this today. My husband has been in the hospital all week, so I’m already at a breaking point, and I was just crying on the pool deck.

Let’s break this down into it’s absolutely awful parts (also, it’s going to be a heavy swearing day, you’ve been warned.)

Ok, admittedly these conversations can be hard to kick off. After all, it’s not easy to find a smooth opening line to a conversation that is completely inappropriate, based on stereotypes, serves to stigmatize the person who hasn’t asked to have the conversation, and is done completely in the service of the FW’s ego.  Still “I have a bone to pick with you” has got to be the blue ribbon loser opening line that I’ve ever heard to one of these conversations.

This phrase is typically used in situations where someone has done something to annoy or upset someone else.  The idea that fat people shouldn’t annoy this guy by existing is completely fucked up.  And if you’re going to try to use a conversation like this as your contribution to the “Save the Fatties” campaign then how about not starting it off in a combative way, as if the fat person has committed some egregious act against you.  This is off to a horrible start.

Next the idea that she should find exercise that she likes. This is wrong in about a hundred ways. Let’s start with the fact that other people’s prioritization and path to health are nobody else’s business.  Even if they were, it’s best not to make wild guesses about people based on how they look.  Finally if you want to say “hey, I’m a size bigot and as such I’d like you to stop being Fatty McFatterson mayor of Fatsville” then just say it, don’t do this backhanded “have you ever tried walking” bullshit.  Have you ever tried shutting the fuck up?

The Fatty Whisperer is almost always working off their stereotypes and bigotry in lieu of actual information, and in addition to not knowing anything about the fatty they’ve targeted, they also typically don’t have any information about the emotional state of their target fatty and how this will affect them, which makes this entire thing incredibly selfish.  I think that a lot of the time this is about the FW’s ego and not really about the fat person at all.

As always, each of us gets to decide how to deal with this.  If you want to believe that people who do this are well intentioned and that being well intentioned makes it ok then you are allowed to do that.  If you want to believe that it doesn’t matter why they are doing it they are going to receive a heaping helping of hatefire in return then you are allowed to do that.  If you want to take it case by case, that’s cool too.  Here are some ideas to get you started:

General Response

“WOW this is not any of your business!”

“Fuck off.”

Backhanded, ie:  “Have you thought about walking?“Answer the question completely wrong and change the subject;

“Not very much today,  I’ve mostly been thinking about getting a gerbil, they don’t walk so much but they do run on those wheels, I wonder if the wheels come in pink glitter.  I think I’m going to name the gerbil Fred.  Or Fredda if it’s a girl. Hey, do you know how to tell if a gerbil is a boy or a girl?”

Straight forward ie:”I think that you should lose weight”
Set a boundary and a consequence that you can follow through with.

“You can think whatever you want but I’m not interested in your opinion and you’ll need to keep it to yourself or we aren’t going to be able to talk anymore. ”

“I can’t imagine what would make you think this conversation is appropriate, I’m embarrassed for you.  How about you walk away, never do this again  and we’ll pretend this never happened.”

“I’m not accepting unsolicited opinions about my body so you can either change the conversation to an appropriate subject, or I’m going to go somewhere else.”

Fatty Whisperer who thinks they are a doctor ie “Don’t you know that  blah blah blah blah if you were thinner”

“Really, how do you justify that based on the findings of Matheson et. al., Wei et. al, and the Cooper Institute Longitudinal Studies?”

“I’m happy with my healthcare team and I’m not adding new members.”

Southern Style

If you are in a situation like Christine’s where the use of “fuck off” isn’t appropriate, ” may I suggest a Southern substitution.  You just say “bless your heart” whenever you want to say “fuck you”  – as in “Bless your heart, nobody ever taught you any manners.” Or  “You don’t know what is and isn’t your business, bless your heart,” or just “bless your heart”  accompanied by a pitying smile and maybe pat on the head and walk away.

Regardless, know that this behavior is just as wrong as if  a stranger came up to you and gave you sex advice.  You are fine, they are screwed up.  So whatever you say, may I suggest an inner monologue of “Fuck the Fatty Whisperers!”

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