If You Are Fat and Sick

ShamelessOne of the consequences of rampant size bigotry, discrimination and bullying in society in general is that it bleeds over to healthcare providers and healthcare concepts. For example, a study concludes that “There are unacceptable levels of weight bias among UK students training to become nurses, doctors, nutritionists and dietitians.” [trigger warning:  this study is not necessarily Health at Every Size]

This leads to a number of issues, one of which is that the misinterpretation of correlational relationships as causational relationships means that people believe that being fat causes diseases.  The fact that the media has jumped on this band wagon means that even though the Congressional Budget Office is clear that obesity is NOT the reason for the increase in healthcare costs, people keep insisting that it is.

That means that when a fat person gets sick, they not only have to deal with whatever illness they have, but also with the shame of being a “bad fatty” who brought this on themselves, and is increasing everyone’s health insurance etc.  And that’s bullshit.  And here’s why:

First is the issue of correlation vs. causation.  My first semester of my first research methods class we had to say “correlation never ever, never ever, never ever implies causation” every day during class.  It’s the cornerstone of good research.  Correlation means that two things sometimes – but not necessarily always – happen at the same time.  Causation means that we can prove that one thing causes the other.

Let’s say that every August there are more murders and more ice cream is eaten. We cannot conclude that eating ice cream causes murders. If there are a rash of murders we cannot say that there is an ice cream epidemic. And we cannot conclude that taking ice cream off the shelves will cut the murder rate.  They could both be caused by a third factor (maybe heat makes people cranky and they either eat ice cream or commit murder) or they could be completely unrelated and the correlation could be a coincidence.  (More thorough explanation is here.)

The same diseases that are correlated with obesity are also correlated with being under a lot of stress for a long period of time.  Like, for example the stress of living under constant stigma with the government waging war on you for how you look.  Since no study can control for the effects of stigma on fat people, no study can claim to know that diseases are caused by being fat. Not to mention the fact that there are health issues that cause both weight gain and other diseases, and that both weight and many diseases have strong genetic components.  This issue is not nearly so cut and dried as media hacks and people making money from its perpetuation would have you believe.

But more importantly, there’s absolutely no point in speculating how someone got a health problem, or blaming someone for a health problem.  They are a person with a health problem, it’s time for them to make decisions about their treatment and have those decisions respected, including the decision of who to tell, by the way.  (Those wishing to make a “but my tax dollars” argument can head over to this post.)

There are no such things as “fat people” diseases. Thin people get all the diseases that fat people do. People get to make their own decisions about priority of health, path that they want to take to reach their goals etc.  In order to avoid being massive hypocrites, people either support the idea that other people get to make their own decisions about their bodies, health, and habits, and have those decisions respected; or those people must be willing to let anyone who thinks they know better (what will make us healthier, what will make us cheaper etc.) dictate what they eat and how they exercise.

Health is multi-dimensional and includes behaviors (past and present), environment, genetics, stress, access, and more.  Some of these components are within our control and some aren’t.  We cannot control the end result and if we develop a health issue we will probably never know for sure exactly why it happened.  More to the point, it doesn’t matter.  People of all sizes get sick for all kinds of reasons.  Once someone is sick it’s time to skip shame, blame, and bullshit and move to getting them the care they choose.  If you can’t help get them the care they want, or find another way to support them, then please feel very free to move silently on your way.

If you are fat and sick there is absolutely nothing to be ashamed of.   Nothing.  You deserve compassionate care of your choosing. You do not deserve any of the things that our culture’s stigmatization and oppression of fat people might create – that’s the result of bigotry, and you don’t deserve that either.

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34 thoughts on “If You Are Fat and Sick

  1. Reblogged this on Em's Way To Go and commented:
    “When a fat person gets sick, they not only have to deal with whatever illness they have, but also with the shame of being a “bad fatty” who brought this on themselves”. This post explores the bias some healthcare professionals have regarding size – often true, a friend’s girlfriend’s just been diagnosed as having asthma – previously overlooked, not least because her breathing difficulties were attributed to her being “big”.

  2. Let’s not forget that fat people are often prescribed weight loss in lieu of the actual, evidence-based medical intervention that is offered to thin patients. Then, when their (untreated) condition naturally worsens, the effect of this medical neglect typically gets blamed on… you guessed it, OBESITY.

    1. this has happened to me so many times that this time I have decided to try put up with my health problem,because I just can’t go through the doctor telling me if I loose weight the problem will go away, there was a program on the radio today with the presenter talking about the “obesity epidemic” and a doctor talking about how to let people know in a “caring way” they are to fat, several people came on and said they felt it was their duty to let people know they need to loose weight, I have to admit untill recently I believed all the things the doctor said, because they are after all, the people who should be giving us the right advise, it seems to me that if your fat, you have to fight to get the same treatment that other people get from health care professionals naturally.

      1. Yes, me too! Sometimes I wonder what the point of seeing a doctor about some health issues that I know have been correlated with weight, because what’s the point? They’ll prescribe a diet, I won’t do it, and nothing will change except I will have wasted time, money, and mental health on the doctor visit.

        Is this what the medical profession wants? Everyone just giving up and not trying to get their illnesses treated anymore because of the shame and abuse?

      2. Was this the Jeremy Vine Show on the BBC by any chance, Kerri? I was in the car when I heard him announce that this was the next item, and started raging instantly! It’s probably just as well that I got to my destination before the item started!

  3. “This issue is not nearly so cut and dried as media hacks and people making money from its perpetuation would have you believe.”

    And that’s so frustrating. There’s so much medical science doesn’t know about the endocrine system and weight regulation that *should* be investigated, but as long as we’re in a political climate that encourages… nay, obligates… researchers to waste their money, time, and brainpower trying to get rid of fat people, it never will be. We’re stuck in an endocrine dark age where the people who *should* be asking and answering those questions are more interested in silencing dissent and selling favor.

    1. Amazing just how many folks like to practice medicine without a license. And more amazing is how many of those folks think they are good at it!

      1. What’s even more shocking, is, as inept as they as they are at it, sometimes they are still more adept than some fully licensed MD’s! ((shudders))

    2. Exercise may release endorphins, but that really doesn’t re-balance your brain chemistry. And it doesn’t bring lost loved-ones back to life, re-get you your dream job, give you another shot at winning that race, or whatever it is you might justly be upset about. Telling someone who’s depressed, either with “the blues,” or with a clinical depression, or even just upset about a recent life event to just exercise and lose weight, and you’ll feel happy…

      GRRRRR. They know nothing, Jon Snow.

        1. I just stared at the screen, jaw open, for a full minute in my shock. WHAT?!

          OK, I note that you say you “thought” he had been murdered, which I am reading as “he wasn’t murdered, after all,” and I hope that includes, “he is still alive,” but WHAT THE HELL?!?! Who SAYS that?!

          1. Yes, after 2.5 yrs I discovered that he was still alive, and still alive now (2015), but those yrs were the worst of my life. And I couldn’t believe that the person who said that to me, said it.

  4. There’s one way to control _fairly_ adequately for discrimination-stress versus inherent effects of being fat, and it’s been done, in two studies back in (IIRC) the late ’70s. My copies were taken by a flood and I don’t recall journal titles or cite-deets, but I remember the content well:

    In American Samoa, the diet, workstyle and lifestyle are pretty thoroughly Americanized. The one big cultural difference is that in AS, people of size are (or were then) considered beautiful, healthy, marriageable, hireable, promotable and worthy of respect and admiration, while the thin folks get the ridicule, exclusion, abuse and general weightist bullshit accorded to fat people in the us.

    Guess who gets the heart attacks, strokes and other major stress diseases in Americn Samoa? And not by a small margin, either.

    1. Could this be the study?
      Stephen T. McGarvey & Paul T. Baker, The Effects of Modernization and Migration on Samoan Blood Pressures, Human Biology
      Vol. 51, No. 4 (December 1979), pp. 461-479, http://www.jstor.org/stable/41463157.
      I think McGarvey is the right researcher, even if this is not the right article.

  5. My doctor told me that I have PCOS and that I can improve it by losing weight. My mother and both sisters also have it but they are thin. I asked my doctor about this. Apparently they have “lean PCOS” which is somehow different and has actual causes besides fatness. Makes sense.

    1. Does this “lean PCOS” have a separate entry in the DMSV (whatever alphabet soup that book is – I can’t remember at the moment, but it lists all the different recognized diseases/syndromes/whatzits).

      Does “lean PCOS” have separate coding in medical records?

      Does “lean PCOS” have different treatment? Well, of course it does. The treatment for “lean PCOS” is actually effectual.

  6. This is so beautifully empowering. Thank you for honoring all of us with our differing levels of ability, activity, and “health.” We’re all amazing fatties!

  7. Being fat and chronically ill is such a strange experience at times. Especially with invisible illnesses. Fat is visible, and marked as “unhealthy”, and “unhealthy” is often used as code for “fat”. Yet my actual illnesses are pretty damn invisible. So people look at me and make judgments about my health based on being fat, that don’t match my actual health status, though my actual health status is chronically ill.
    And then there is the way that despite fat supposedly being “unhealthy”, the same people often act as though disability/chronic illness simply does not count unless you are thin. Fat is unhealthy but somehow at the same time discounts my actual poor health? o.0

    So in summary, being fat means I’m unhealthy, but because I’m fat I can’t be “legitimately” disabled by my illnesses.

    1. Right! Like if you are fat, and also need a wheelchair (maybe you got fat AFTER needing the wheelchair), but people think that they should just take that wheelchair away from you, because then you’ll be forced to walk, and get thin, and THEN they can respect your use of a wheelchair because both your legs are broken, and one was amputated at the knee, and you have cerebral palsy and polio and…

      This is maddening, and entirely too common.

      Remember that article Ragen posted about some sort of health conference that decided to encourage “health” by disabling the escalators and elevators? Because just EVERYONE can walk the stairs, right? Nobody has bone spurs on their knees, or severe asthma, or any of the other perfectly valid reason for a THIN person to be considered mobility challenged/disabled.

      I wonder, did they turn on the elevators/escalators, when a thin person with visible disabilities asked for it? Or did they give them the same treatment they give everyone with invisible disabilities, or whose visible disabilities are counter-acted by their fat?

      OK, I need to go do something zen, now. I’m too angry.

  8. This hits home very much for me right now. I’ve been dealing with chronic digestive issues for years and have just ignored it and dealt with the bouts where I can’t eat normally for a week and then moved on. This recent bout scared me because it was accompanied by severe pain in the middle of my stomach that kept me in bed for 3 days. I reluctantly went to the doctor 2 days ago and though he took me seriously and wants to run tests, he can’t give me any meds until he knows what’s going on. When I asked if there was anything he could give me so that I could eat properly, he said it was probably a good thing I wasn’t eating much right now because “Obviously you need to lose a lot of weight”. He said after the tests came back we “had to talk about my weight because that was most likely the problem” I didn’t cry or scream I just sat there stunned, took my lab orders and left. Then on the way home at the bus stop, two teenage girls decided to literally point at me and say “wow, look at that big fat whale of a woman” …Perfect. So 2 days later, I’m living off small amounts of soup and ginger tea and crippling pain. I’m feeling really disillusioned about living in a world where I am so blamed for being sick that I’m afraid to get the help I need so that I can live normally.

    1. Agh! Thin people have digestive issues all the freaking time. I’m so mad at your doctor and those stupid girls!!! Besides which, you need good nutrition in order to heal from whatever this is. I’m sorry this happened to you. They’re wrong. I hope you are able to find someone to help you.

      1. I wish you had my doctor. My doctor is great, and doesn’t do any of that fat-blaming stuff.

        Good doctors ARE out there, but it’s really hard to find them, especially because the good ones are usually full up, and not taking new patients, even if they are in your insurance network.

        I wish you well, and I wish your doctor gets his head screwed on straight, and gets you the help you really need.

        1. Recently I was looking up about the Alberta College of Physicians, and there was something in their Code of Conduct that …. It went something like this: If a patient seeks care from 2 or more doctors for the same ailment, the other doctors are required not to treat them, and to kick them out. So if Doctor #A doesn’t get to the bottom of it and you want a 2nd opinion, tough luck.

          My former GP has many negative reviews on ratemymds. One is detailed and says that he went in with elbow and arm pains, and basically his arm was out of commission. The doc said “if it hurts, don’t do it”, and sent him home. He ended up in Emergency later that day/week with worse condition, and his ulnar nerve (runs from the shoulder down the outside of the arm and into the pinky and half of the ring finger) was so badly damaged, he needed surgery. When they heard his treatment at the hands of the incompetent, they were shocked that a doctor could do that.

          But under the Code he would be sent home since it already been “treated”. Also, the Code allows doctors to “fire” their patients, and no part of the Hippocratic Oath is present. Harm is prescribed.

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