I wrote a piece about the issues with fatphobia, fat people and our knees (and the problems that we have in receiving any kind of competent healthcare when we have knee issues.) It was shared by a reader on Facebook who received this response:
I agree that often the problems are tightness in the muscles and that should always be addressed if it’s an issue. But there is also a lot of research about the pure physics of having more force exerted on joints and feet that cause more wear and tear and lead to more arthritis. Is that research wrong? Is there counter-research being done? If you know of it, can you direct me to it? Thanks.
That’s not actually the most important question, but I’ll answer it anyway because it’s so very misunderstood.
To clarify, for this discussion when I talk about arthritis, I’ll be talking about osteoarthritis. And it’s way more complicated than just larger body = greater risk, first because so many factors are involved (everything from access to supportive footwear to participation in athletics at various ages, to the knowledge of coaches and trainers if one does participate etc.)
Research shows a correlation between larger bodies and greater risk, but that’s far from showing causation. Before the cause could be attributed to body size alone, there would have to be studies that control for the many variables that impact fat people.
To name just a few:
Fat people’s inability to get competent healthcare for joint pain (especially early joint pain,) Instead, we are typically being prescribed weight loss – which causes additional issues:
The effects of weight-cycling (ie: yo-yo dieting) on long-term joint health since most diets end in weight regain, and most fat people are put on multiple diets, thus experiencing weight cycling.
The effects of exercising while purposefully giving your body less fuel than it needs (which is typically suggested to fat people as a “weight loss intervention”) on joint health.
The effects of stigma including the impact of stigma on fat people seeking out care at the same rate and level of injury/pain that thin people do, on fat people participating in physical activities that might mitigate their risk for arthritis etc.
These are just a few of the issues with research around weight and health. The truth is that, because of weight stigma, fat people experience the world differently than thin people do, and these differences impact our health – including our joint health – and all of that must be accounted for before we attribute health issues to fat bodies.
But like I said, that’s not the most important question. In fact, it doesn’t really matter because even if fat bodies were proven to cause arthritis, the advice/treatment given to fat people should not change.
There’s not a single study in which more than a tiny fraction of the participants succeed at significant long-term weight loss. In the vast majority of weight loss attempts, people lose weight short term, then gain it all back in a few years.
Even knowing these odds many doctors still prescribe weight loss under the “logic” that, while it almost never works it would, in theory, be great if it did. This is roughly the same as prescribing flying to patients with joint issues. I mean, if you jump off your garage and flap your arms really hard you probably won’t fly, but think of the joint pain relief you would feel if it worked and your feet never had to touch the ground!
Beyond that, the majority of dieters actually gain back more weight than they lost, so if someone believes that larger bodies are at greater risk for arthritis, a recommendation of intentional weight loss is the worst thing they could suggest, since the most common long-term outcome is of weight loss attempts is weight gain. (And of course more dangerous solutions – like dangerous diet drugs and stomach amputation surgeries – risk fat people’s lives and quality of life for outcomes that could be achieved through far less dangerous means.)
If the medical establishment wants to improve fat people’s health, a good first step would be to actually care about our health, rather than refusing to give us good healthcare unless and until we become thin people.
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I have a friend whose doctor insisted that she lose 100 pounds before she could get knee surgery. She did lose the weight (it took her over a year) & has had the surgery but to me, that’s just bullying on a medical level. Why should she have to weight for necessary surgery? & if the surgery could wait until she lost the weight, just how necessary was it? Our health system is really F’d
Yeah, my friend had to lose weight before she could get knee surgery too. Stupid medical system. She managed to do it and has had both her knees done, but what bullshit!
Like you, when I was younger, was a fat athlete. I played tennis at least three times a week a long with other sports. When I was in my later 40’s, I started to have issues with my back, feet and ankles. The doctors insisted it was due to my weight. . They had me on heavy doses of prescribed Advil for the pain all that time. When my hands began to turn into claws, they finally tested me….. two years later. I was diagnosed with severe Psoriatic Arthritis. There is permanent damage to my feet and ankle because of the delay of getting on the proper medication. And the Advil and other medications caused my kidneys to crash.
Good news is that I just got a chance to teach at a conference for 2nd year med students and told my story and about Health at Any Size.” Hopefully it made an impact.
I really hope you made a good impact with your teaching. And maybe you can teach more.
Is this type of fat hate in all medical systems?
It may be even worse in some places. I have a friend in Australia who has shared some horror stories.
I’m 55 years old and a bit over 300 pounds. My knees are fine now that I’m no longer working a job where I have to climb numerous flights of stairs every night. I also no longer get nightly leg cramps. I do have problems with my back caused by working very strenuous physical jobs for most of my working life.