What They Never Consider

Everybody knowsI’ve heard about studies linking fat to everything from diseases to lower cognitive function. There are any number of issues with these studies – from sample sizes so small that everyone in the study would fit in an efficiency apartment, to correlation vs. causation mistakes that would make a first semester statistics student blush.  But there’s a much larger issue:  They often try to control for variables like age, smoking, socioeconomic status etc.  But there are a couple of variables that they  never control for:  the stress of being under near constant stigma and oppression and the effects of dieting.

It’s not a small thing – the diseases that are correlated with obesity are also independently correlated with being under a high level of stress over long period of time.  Like, for example, the stress of having your government declare war on you for how you look. So in order to even start to prove that fat causes diseases, there would at least need to be a control group of fat people who have not suffered a lifetime of stigma to see if their disease incidence was the same as the first group.

When they find (in a tiny study) that fat kids perform worse in math, in order for them to even suggest that the fat causes the poor math performance they would need to test a group of fat children who did not constantly see diet commercials, hear the message that fat means your bad, lazy, sick, stupid etc., and who aren’t having war waged on them by the government. Because it’s entirely possible that being constantly stigmatized, bullied, and called lazy, ugly, dumb etc. could affect your performance in school. I imagine they don’t have these control groups because no such group of fat people exists in this culture.

This society MUST stop acting like the best thing that we can do for public health is tell 60% of the population that they should hate their bodies and see them as a sign of their physical and moral failings, insisting that everyone will just hate themselves thin and healthy (and acting like they are the same thing), then asking if we’re “doing enough” about obesity.  Not only is it not helping anyone’s health – it’s possible that it’s having the opposite effect.  When we hear about how our fat is linked to swine flu, the plague, hangnails or whatever the hell it is today, remember that it is entirely possible that they are caused by the stress of being under constant stigma and oppression which, as I’ve said before, I believe are  the real public health threat.  And that doesn’t even touch upon the effects of a life of dieting (especially in a world where we are putting fetuses on diets) but that’s a whole other blog.  We don’t know what effect ending the constant shaming and stigma of fat people will have on our health, but I would certainly like to find out.

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11 thoughts on “What They Never Consider

  1. Try having your best cognitive function when you are desperately hungry… as most people on diets are for much of the time, especially if they are children. Plus every time a fat person gets a hangnail or strep throat or a broken bone, it’s put down as a side-effect of being fat. If a thin person gets any of those health issues, it’s put down to falling out of a tree or getting an infection or washing dishes by hand without wearing gloves. And that just piles on more stress from dealing with not only more prejudice, but really shitty medical ‘care’ to boot.

    Also, many of the same diseases that correlate with being fat also correlate strongly with – you guessed it! – yoyo dieting, which is, of course, over ninety percent of all weight loss dieting. Back in the seventies I remember it being fairly common knowledge that people who go on lots of diets wind up with more hypertension, insulin resistance, heart disease, and half a dozen other unpleasant things that are now considered to be all the fault of the fat rather than of how we ‘treat’ the fat.

    When are we going to accept that every body is simply different? When will we believe that engaging in healthful behaviors (eating a varied, sufficient amount of food; getting moderate regular exercise appropriate to one’s level of mobility and fitness; getting adequate sleep and mental rest, etc) are far more likely to lead to healthy outcomes than bullying people into doing something that has never been proven to be either successful or even simply Not Harmful possibly can? When are we going to accept that each individual person has the right to choose whether or not to prioritize health in their own way according to their own preferences?

    My body, my choice. Your body, your choice.

    See how easy that is?

    1. Thank you for saying what I was going to say about the fact that most fat kids are on a diet which means they’re hungry and even if they aren’t really hungry, they’re probably not getting the nutrition they need!

  2. But Ragen, does this mean my ear infections, ankle pain from many many sprains as a child, very bad PMS, etc, etc, etc wouldn’t all be cured if I magically woke up @ BMI>25 tomorrow morning???

    And add in the extra stress and hassle every time I go to see a new doctor, waiting for the Weight Talk (like I don’t know I’m fat!!)

    I’d love to see a study like that – but as you say, finding someone whose life hasn’t been influenced by the Obesity Paranoia problem would be extremely difficult!!

  3. The other thing they don’t control for is exposure to toxins in the environment, our homes, and personal care products. These things effect everyone differently. But endocrine disrupting compounds could be causing weight regulation systems to go a bit haywire in some of us, but not others. Plus exposure to toxins is greater for people of lower socioeconomic status … Which is also correlated with????? Higher rates of fatness. It could be that these studies are measuring, among other things, the effects of pollution. Of course it doesn’t matter why we are fat, we all deserve respect no matter what. But I think it would be very hard to control for all factors, particularly when some might be environmental, making almost all “obesity” research suspect.

    1. There’s also increasing evidence about a correlation between certain bacteria in the gut and obesity (there was an excellent article about this in the New Yorker, October 22, 2012). It’s way too soon to claim that having (or lacking) particular bacteria CAUSES obesity, but the correlation is interesting. It looks to be yet another indication that the reasons some bodies are fat and some are thin are way, way, way more complex than the old “Calories in/calories out” model. Whatever the correlative or causative relationship between gut bacteria and weight turns out to be, it’s pretty clear that hating myself for my gut bacteria is not going to be a very useful or productive attitude.

  4. Thank you for another fantastic article! It really covers so much ground and I even had a chance to jump over and read the article about correlation vs. causation that you gave a link to, and loved that article too. I also learned much about a subject I knew very little about- statistics. Thank you Ragen for a beautifully informed, creative and dynamite article! (actually both articles)!

  5. How many of the premature deaths and nasty illnesses attributed the to obesity are caused by everything being put down to ones BMI by the medical profession, which allows the doctor to abrogate responsibility to fully investigate any issue, and the completely understandable reluctance of an obese patient to seek medical help because of the shame inducing crap they tend to receive when they do? I would say rather a lot, wouldn’t you?

    1. This. If a thin patient and a fat patient both go to the doctor with a life-threatening infection, and the thin patient is given an antibiotic/antifungal cocktail while the fat patient is given a flier for the South Beach Diet, the fat patient is more likely to succumb to the infection. It isn’t because they’re fat. It’s because they were given second-rate, phoned-in, weight-and-stereotype-based “care.”

  6. With regard to Maths abilities in children (I teach secondary school maths) a major contributor to maths achievement is attendance. Often bigger kids have poor attendance (they stay away because of bullying, particularly on days when they have sports). Correlation vs. causation. Being fat does not make you bad at maths, not attending school makes you bad at maths.

    1. Also a very good point. Shockingly enough, if you put a child in a place where they are made to feel desperately unsafe, they will not want to stay there.

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