CNN ran a recent headline “Fat but fit’ is a myth when it comes to heart health, new study shows” and since then I’ve received a lot of requests to write about it, asking if that’s really what the study shows.

The short answer is that the headline and article are deeply misleading. For reference, in my recent workshop on The Truth About Weight And Health I used this headline, article, and study as my example of nearly every research and common media issue and research mistake that I had just talked about for the last hour.

In the CNN article (which I’m not linking to, they don’t get clicks from me) the study’s author, Alejandro Lucia who is a professor of exercise physiology, was quoted as saying “One cannot be ‘fat but healthy.’ This was the first nationwide analysis to show that being regularly active is not likely to eliminate the detrimental health effects of excess body fat“

Except that’s not remotely what his study showed, and not just because it was in no way designed to draw that kind of conclusion.

Let’s start with what the study actually did. It looked at self-reported activity data from 527,662 adults from Spain. They grouped the subjects based on BMI (and we already know the use of BMI reflects a lack of scientific rigor but we’ll move past that for now.) Then they classified activity level into three groups. No activity was considered “inactive,” less than 150 minutes of moderate or 75 minutes of vigorous activity per week was labeled “insufficiently active,” (a label that is unnecessarily judgmental and ableist, and doesn’t reflect the fact that studies have shown that small amounts of activity confer health benefits) and finally, 150 minutes of moderate or 75 minutes of vigorous activity per week or more was labeled “regularly active.”

The study’s goal was to look at the impact of exercise on risk factors for cardiovascular issues, including diabetes, high blood pressure, and high cholesterol. Note that they didn’t look at actual cardiac incidents (like heart attacks or strokes,) they just looked at factors that may raise the risk for such incidents.

So what did they find? Well, to quote their own paper

In summary, increasing PA [physical activity] levels appear to provide benefits in an overall dose-response manner (regularly active > insufficiently active > inactive for the risk of hypertension or diabetes) across BMI categories and should be a priority of health policies

Wait…what? You read that correctly – What they found was that activity provided health benefits to people of all sizes. (which is consistent with the findings of Wei et. al. and Matheson et. al, and Barry et. al. which found “Therefore, fit individuals who are overw*ight or obe*e are not automatically at a higher risk for all-cause mortality.” (And as always, a reminder that health is an amorphous concept, is not an obligation, barometer of worthiness, or entirely within our control)

So why are they claiming that you can’t be fat and fit? Well, because they found that fatter people’s risk factors were not mitigated to an equal level with thin people’s risk factors. Their (unsolicited) recommendation? “weight loss per se should remain a primary target for health policies aimed at reducing CVD risk in people with overw*ight/ob*sity.” (With a reminder that those are terms that were literally invented to medicalize and pathologize fat bodies and that person first language for fat people is a terrible idea and also excuse me while I bang my head on my desk for a couple minutes.)

This is where we see perhaps the most common mistake that is made in this type of research. They assume that if fat people have higher risk, then it must be due to their body size, and that making fat people look like thin people is the solution. This is the kind of mistake that would get you failed in freshman research methods class, but it consistently makes it past peer review in articles around weight and health.

In order to avoid making a correlation vs causation error (one of the most basic concepts in research methods) we have to, at the very least, ask ourselves if there are other things that could cause these different outcomes in fat people. And, as it turns out, there are.. Peter Muennig’s research found that the stress of constant weight stigma is associated with risk factors, and Bacon and Aphramor found that weight cycling (aka yo-yo dieting which is, by far, the most common outcome of more than one intentional weight loss attempt) is also associated with risk factors.

That means that when the study authors (whose language, especially in their intro paragraph, suggests that they are coming from a deeply fatphobic place) claim that exercise can’t fully mitigate the risk of being fat, what they very well could have actually found is that exercise can’t fully mitigate the risk of being constantly stigmatized and/or encouraged to diet repeatedly.

That makes their recommendation that “weight loss per se should remain a primary target for health policies” even worse that it originally seemed (and it originally seemed pretty bad..) First of all, they did not in any way study whether or not weight loss 1. is achievable or 2. lowers risk factors for cardiovascular incidents, so they have no basis in their own research on which to make that claim, and no basis in other research either.

It’s important to understand that these are, in fact, two different things. So in order to recommend weight loss as a health intervention you would need:

1. Research that shows that weight loss is likely to be achievable and maintainable long-term (if not then there’s no point in making it a recommendation regardless, it’s like recommending levitation to solve knee pain, it might take the pressure off the joint, but since it’s not likely to work, it’s not an ethical, evidence-based intervention)

2. Research that shows that weight loss has positive health impacts, including when measured against any risk associated with weight loss attempts

Let’s start with #1. They don’t have that. What we know from other research is that by far the most common outcome of intentional weight loss attempts (about 95%) is short-term weight loss followed by long-term weight gain, with up to two-thirds of people gaining back more than they lost. So they are using the platform of this research to recommend something that has the opposite of the intended effect the majority of the time. Not a good look.

Onto #2. They don’t have that. There is no study that compares those who have maintained weight loss to those who are fat to see if there are health outcome differences. Their recommendation is based on the assumption that if you make fat people look like thin people, they will have the same health outcomes, which ignores the possible impacts of weight stigma and weight cycling, and is roughly like saying that, since cis male pattern baldness is correlated with a higher risk of cardiovascular incidents, the solution is to figure out how to get all the bald folks to grow hair.

So does that study really mean you can’t be fit and fat? No, it doesn’t. That study means that, yet again, research that would have earned me a well-deserve F in freshman Research Methods class is instead getting CNN headlines, because when it comes to weight and health research any fatphobic nonsense will do.

If you want more information about the weight/health relationship and research, my workshop talk is available as a video with a pay-what-you-can option here.

UPCOMING ONLINE WORKSHOP:

The Role of Size Acceptance in Eating Disorders Prevention, Treatment, and Recovery

My March workshop is about the important of Size Acceptance, including Fat Acceptance specifically, in eating disorders prevention, treatment, and recovery. We’ll  discuss how using a framework of Size Acceptance and Health at Every Size prevents eating disorders and provides practical, realistic options to help those dealing with disordered eating and eating disorders, as well as anyone impacted by the damaging cultural messages we get about food, movement, and our bodies, to repair the damage these messages have done, and create strategies that support dealing with them moving forward, including through recovery journeys and beyond.

Plus an unlimited Q&A (I stay until all the questions are answered!) so you are guaranteed to get the information you came for!

Details and Registration: https://danceswithfat.org/monthly-online-workshops/
*This workshop is free for DancesWithFat members – login info is on the member page
Become a member here!
A recording is provided in case you can’t make it live on March 24, 5:30pm Pacific (or if you want to listen again!)

Like This Blog? If you appreciate the work that I do, you can support my ability to do more of it with a one-time tip or by becoming a member. (Members get special deals on fat-positive stuff, a monthly e-mail keeping them up to date on the work their membership supports, and the ability to ask me questions that I answer in a members-only monthly Q&A Video!)

Here’s more stuff you might like:

Wellness for All Bodies Program:A simple, step-by-step, super efficient guide to setting and reaching your health goals from a weight-neutral perspective.  This program can be used by individuals, or by groups, including as a workplace wellness program!

Price: $25.00 ($10 for DancesWithFat members – register on the member page)

Non-members Click here for all the details and to register!
Body Love Obstacle Course

This e-course that includes coaching videos, a study guide, and an ebook with the tools you need to create a rock-solid relationship with your body. Our relationships with our bodies don’t happen in a vacuum, so just learning to see our beauty isn’t going to cut it. The world throws obstacles in our way – obstacles that aren’t our fault, but become our problem. Over the course of this program, Ragen Chastain, Jeanette DePatie, and six incredible guest coaches will teach you practical, realistic, proven strategies to go above, around, and through the obstacles that the world puts in front of you when it comes to living an amazing life in the body you have now.
Price: $99.00 Click here to register
($79.00 for DancesWithFat members – register on the member page)

Love It! 234 Inspirations And Activities to Help You Love Your Body
This is filled with thoughtful advice from the authors Jeanette DePatie, Ragen Chastain, and Pia Sciavo-Campo as well as dozens of other notable names from the body love movement, the book is lovingly illustrated with diverse drawings from size-positive artist Toni Tails.
Price: $9.99 softcover, $7.99 Kindle, ($6.95 + free shipping for DancesWithFat Members)

Book Me!  I’d love to speak to your organization (and I can do it remotely!) You can get more information here or just e-mail me at ragen at danceswithfat dot org

Dr. Louise Metz, Tiana Dodson and I have been hard at work on this project and it is now officially launched! It’s called HAES Health Sheets and it’s a free online database of diagnosis-specific weight-neutral healthcare resources for patients, advocates, and practitioners available at www.HAESHealthSheets.com

It came about because it’s such a common occurrence that fat people (who were previously feeling solid in their fat acceptance and/or Health at Every Size journey) get shaken when they get a health diagnosis, at which point their bodies are often blamed and they are (mis)led to believe that weight loss is the only option, and now they aren’t sure where to turn or what to do.

So I partnered with Dr. Louise Metz and Tiana Dodson and together we created HAES Health Sheets so that people would be able to get information fast, and use them to advocate for themselves or others. They can also be used by practitioners who want to learn more about weight-neutral best practices (the site has been launched for less than 24 hours and I’ve already heard about them being shared with nursing students, physical therapists, and registered dietitians!)

There’s also a resources section that includes everything from self-advocacy cards to links to research.

I am grateful and lucky to get to work with Tiana and Louise, and while I wish it wasn’t necessary, I hope that this project can help people get the care they deserve!

Finally, I want to give a special shoutout to all of my DancesWithFat members. This project was partially grant-funded thanks to ASDAH, but I still did hours and hours of work that weren’t compensated and member support is what makes that, and so much of my activism, possible. Thanks y’all, I am eternally grateful!

UPCOMING ONLINE WORKSHOP:

The Role of Size Acceptance in Eating Disorders Prevention, Treatment, and Recovery

My March workshop is about the important of Size Acceptance, including Fat Acceptance specifically, in eating disorders prevention, treatment, and recovery. We’ll  discuss how using a framework of Size Acceptance and Health at Every Size prevents eating disorders and provides practical, realistic options to help those dealing with disordered eating and eating disorders, as well as anyone impacted by the damaging cultural messages we get about food, movement, and our bodies, to repair the damage these messages have done, and create strategies that support dealing with them moving forward, including through recovery journeys and beyond.

Plus an unlimited Q&A (I stay until all the questions are answered!) so you are guaranteed to get the information you came for!

Details and Registration: https://danceswithfat.org/monthly-online-workshops/
*This workshop is free for DancesWithFat members – login info is on the member page
Become a member here!
A recording is provided in case you can’t make it live on March 24, 5:30pm Pacific (or if you want to listen again!)

Like This Blog? If you appreciate the work that I do, you can support my ability to do more of it with a one-time tip or by becoming a member. (Members get special deals on fat-positive stuff, a monthly e-mail keeping them up to date on the work their membership supports, and the ability to ask me questions that I answer in a members-only monthly Q&A Video!)

Here’s more stuff you might like:

Wellness for All Bodies Program:A simple, step-by-step, super efficient guide to setting and reaching your health goals from a weight-neutral perspective.  This program can be used by individuals, or by groups, including as a workplace wellness program!

Price: $25.00 ($10 for DancesWithFat members – register on the member page)

Non-members Click here for all the details and to register!
Body Love Obstacle Course

This e-course that includes coaching videos, a study guide, and an ebook with the tools you need to create a rock-solid relationship with your body. Our relationships with our bodies don’t happen in a vacuum, so just learning to see our beauty isn’t going to cut it. The world throws obstacles in our way – obstacles that aren’t our fault, but become our problem. Over the course of this program, Ragen Chastain, Jeanette DePatie, and six incredible guest coaches will teach you practical, realistic, proven strategies to go above, around, and through the obstacles that the world puts in front of you when it comes to living an amazing life in the body you have now.
Price: $99.00 Click here to register
($79.00 for DancesWithFat members – register on the member page)

Love It! 234 Inspirations And Activities to Help You Love Your Body
This is filled with thoughtful advice from the authors Jeanette DePatie, Ragen Chastain, and Pia Sciavo-Campo as well as dozens of other notable names from the body love movement, the book is lovingly illustrated with diverse drawings from size-positive artist Toni Tails.
Price: $9.99 softcover, $7.99 Kindle, ($6.95 + free shipping for DancesWithFat Members)

Book Me!  I’d love to speak to your organization (and I can do it remotely!) You can get more information here or just e-mail me at ragen at danceswithfat dot org

I’ve received more than a hundred requests to write about a recent Guardian article with the headline “Pfizer vaccine may be less effective in people with ob*sity, says study” with the subtitle “Healthcare workers with ob*sity found to produce only about half the antibodies healthy people do”

The headline, subtitle, and article that follows are, at best, an example of the stunning scientific illiteracy that exists in mainstream reporting and, at worst an abandonment of journalistic ethics in the pursuit of the clicks that fatphobia always generates. (I’m not linking to the article, giving them additional clicks rewards their bad behavior and I’m not going to do that here.)

Just in summary, “fat people’ and “healthy people” are not two opposite, comparable categories (and “person first language” for fat people is a terrible idea.) Also, the study actually found that older people, cis men and fatter people had similar responses, but all we’re hearing about in this story (and every other one I’ve seen) is fat people. Huh, I wonder why that could be?

The study has not even been peer-reviewed yet, and there is literally no action that should be taken by the public based on its findings, so there is no reason (and certainly no rush) to publish it in a way that increases weight stigma, and possibly decreases fat people’s willingness to be vaccinated.

So the headlines are trash, but what about the actual study?

A content note before I start. The research around this is rife with the use of terms overw*ight and ob*se that were created for the sole purpose of medicalizing and pathologizing fat bodies in ways that are harmful on many levels. I’ll notate them as above as a reminder of that.

Alright, let’s go…

For some background, the study’s own authors explain that

A large clinical trial phase 2/3 with 44,000 people showed that a two-dose regimen of the vaccine BNT162b2, developed by BioNTech and Pfizer, has 95% efficacy in preventing symptomatic COVID-19.

I also want to add that (in a move that actually represents progress in medical weight stigma,) unlike vaccine development in the past, fat people were actually well represented in these trials (comprising 70% of the total subjects) and the vaccine was shown to be equally effective on fat people. (Research on this is available here (look as slides 42 and 43) and here, with a trigger warning on both for fatphobic language.)

To summarize, those were large-scale trials designed to test efficacy, and they showed 95% efficacy in preventing symptomatic COVID-19 including for fat people.

The study that The Guardian is discussing is a small study (248 people, all healthcare workers) whose goal is to look at a specific immune response in vaccinated people, and then compares that response between groups based on factors including age, gender (on a binary only, as is often the case there is a complete lack of trans and nonbinary representation here,) and BMI (which they admit is a “crude measurement” which is just scratching the surface in terms of the issue with using a measurement that has racist origins and fatphobic uses.)

When it comes to study design, this line is of particular interest:

Although the role of neutralizing antibodies to SARS-CoV-2 is under investigation, measurement of serum neutralizing activity has been demonstrated to correlate with protection for other respiratory viruses, such as influenza(3) or respiratory syncytial virus(8) and is commonly accepted to be a functional biomarker of in
vivo disease protection(9).

Which is to say that they aren’t sure if/how/to what degree the immune response that they are studying actually impacts COVID immunity.

So anyway, they administered both recommended doses of the vaccine, and then tested for specific antibody levels seven days after the booster dose.

As I mentioned before, their results found that cis men, older people, and fatter people all developed fewer antibodies than cis women, younger people, and thinner people (though there was a lot of overlap in the actual ranges.) And, just to reiterate, I can’t help but notice that all of the headlines I see when I google this ONLY talk about fat people.

Now, I want to be clear that it’s important that research like this happens. It is absolutely possible that different bodies have different immune responses and thus require different vaccine protocols (the “supershot” flu vaccine being created for older people whose response to the typical flu vaccine isn’t as robust is a good example of this. The fact that fat people also don’t respond as well to flu vaccine but that there is no alternate protocol developed for fat people is a good example of fatphobia in medicine, but that’s a topic for a different post.)

What we cannot scientifically and should not ethically do, is blame fat bodies for this issue, and what we should not do from a place of journalistic ethics is report on small, pilot studies as if they provide information that is immediately useful and relevant to the general public.

It’s also important to point out that, if the antibodies that they are testing do in fact provide immunity, the study authors have no idea what level of antibodies would be required to confer that immunity, so they don’t know if older people, cis men and fat people are producing enough antibodies or not, which is to say that the fact that they produce less may not have any impact on actual immunity.

What we do know is that in large-scale trials that included fat people, the Pfizer Vaccine was shown to be “95% effective in preventing symptomatic COVID-19”

I cannot stress enough that absolutely no conclusions can be drawn from the study that the Guardian and other outlets are “reporting” on. More research is needed and until it is completed this type of “reporting” is dangerous and inappropriate.

I wanted to check my work, so I reached out to Deb Burgard, PhD, who is a psychologist and expert in weight science, who added the following (and found the links to the original Pfizer data which were a much more direct, and less fatphobic, than the source that I was originally using)

I really just have one question, which is whether the use of the measured antibodies from the swab test on day 7 should be an operational definition of ability to fight the virus, especially when we have other studies that did not show a difference between BMI groups in the actual relevant outcomes like getting sick or being hospitalized or dying.

She also pointed other issues with the study:

There are other factors that can correlate with BMI among hospital workers – like Socioeconomic status (fewer fat doctors than nurses, fewer fat RNs than LVNs) – you have all kinds of possible confounding variables. It is even possible to posit that something about the physiology of thin and fat people could be different so that different snapshots might emerge on day 7 but it doesn’t make a difference in how people do after actual exposure. 

She concluded

I understand their wanting to know if they should tweak the dosages for higher or lower BMI but there really isn’t a shortcut to doing the science and seeing what happens in the real world.

So what does this study mean? To researchers – that more studies are necessary. To the general public – not a damn thing. It’s been recommended that everyone get vaccinated and then continue to take precautions, and that recommendation is unchanged for men, older people, and fat people regardless of the findings of this study.

What do all these headlines mean? My guess is they means that fatphobia sells and the Guardian, and other outlets that published similar headlines, are hoping that we are buying.

UPCOMING ONLINE WORKSHOP:

The Role of Size Acceptance in Eating Disorders Prevention, Treatment, and Recovery

My March workshop is about the important of Size Acceptance, including Fat Acceptance specifically, in eating disorders prevention, treatment, and recovery. We’ll  discuss how using a framework of Size Acceptance and Health at Every Size prevents eating disorders and provides practical, realistic options to help those dealing with disordered eating and eating disorders, as well as anyone impacted by the damaging cultural messages we get about food, movement, and our bodies, to repair the damage these messages have done, and create strategies that support dealing with them moving forward, including through recovery journeys and beyond.

Plus an unlimited Q&A (I stay until all the questions are answered!) so you are guaranteed to get the information you came for!

Details and Registration: https://danceswithfat.org/monthly-online-workshops/
*This workshop is free for DancesWithFat members – login info is on the member page
Become a member here!
A recording is provided in case you can’t make it live on March 24, 5:30pm Pacific (or if you want to listen again!)

Like This Blog? If you appreciate the work that I do, you can support my ability to do more of it with a one-time tip or by becoming a member. (Members get special deals on fat-positive stuff, a monthly e-mail keeping them up to date on the work their membership supports, and the ability to ask me questions that I answer in a members-only monthly Q&A Video!)

Here’s more stuff you might like:

Wellness for All Bodies Program:A simple, step-by-step, super efficient guide to setting and reaching your health goals from a weight-neutral perspective.  This program can be used by individuals, or by groups, including as a workplace wellness program!

Price: $25.00 ($10 for DancesWithFat members – register on the member page)

Non-members Click here for all the details and to register!
Body Love Obstacle Course

This e-course that includes coaching videos, a study guide, and an ebook with the tools you need to create a rock-solid relationship with your body. Our relationships with our bodies don’t happen in a vacuum, so just learning to see our beauty isn’t going to cut it. The world throws obstacles in our way – obstacles that aren’t our fault, but become our problem. Over the course of this program, Ragen Chastain, Jeanette DePatie, and six incredible guest coaches will teach you practical, realistic, proven strategies to go above, around, and through the obstacles that the world puts in front of you when it comes to living an amazing life in the body you have now.
Price: $99.00 Click here to register
($79.00 for DancesWithFat members – register on the member page)

Love It! 234 Inspirations And Activities to Help You Love Your Body
This is filled with thoughtful advice from the authors Jeanette DePatie, Ragen Chastain, and Pia Sciavo-Campo as well as dozens of other notable names from the body love movement, the book is lovingly illustrated with diverse drawings from size-positive artist Toni Tails.
Price: $9.99 softcover, $7.99 Kindle, ($6.95 + free shipping for DancesWithFat Members)

Book Me!  I’d love to speak to your organization (and I can do it remotely!) You can get more information here or just e-mail me at ragen at danceswithfat dot org