Entries Tagged 'doctors' ↓

Apparently, according to a survey by the Australian Heart Foundation. Kunoichi has a blog response here, and here’s my take. It was written as an email to send to friends who are not really into FA or sort of on the fence, so the framing is a little different to something I’d write to Advanced Fats.

The survey of 1200 people found one in four people who are considered obese using the body mass index (BMI) rate their health as being very good or excellent, and one in five believe their risk of getting heart disease is low to very low. The chief executive of the Heart Foundation, Lyn Roberts, said that despite years of public health messages, there was still an alarming lack of awareness about the cardiovascular risks of being overweight or obese.

Considering that the BMI is, frankly, a terrible indicator of one’s health, why is the Heart Foundation still using it? The man who invented it in the early 1800s, Belgian Adolphe Quetelet, never intended for it to be used as a measure of health, and a great many medical researchers agree that it is a poor way to measure overweight, obesity, and health risks, especially as epidemiological studies on the relationship between some health risks and BMI show only a correlation, not a causation, and that some health risks decrease with increasing BMI, such as osteoporosis and lung cancer. The same epidemiology continually shows that ‘overweight’ people have the highest life expectancy, ‘obese’ and ‘normal’ people the next best expectancy, ‘morbidly obese’ people rank third, and ‘underweight’ people, independent of illness which causes weight loss, have the worst life expectancy.

Thin people who are sedentary show just as much cardiovascular disease risk as fat people who are sedentary, and fat people who are active share the same reduced cardiac risk as slim people who are active. This was conclusively demonstrated by Drs Stephen Cooper and Glenn Gaesser in a comprehensive study, and has been shown further in yet more studies. How about we have a campaign encouraging healthy activity for all, not singling people out based on the flimsy BMI?

There is not one study that proves a causation between cardiovascular disease and larger amounts of adipose tissue on a body. There are, however, studies which show stress, stigma, discrimination, imposed low self-esteem, poor treatment by health professionals, low socio-economic status, repeated dieting and eating disorders are strongly correlated with and have some direct causation of obesity, all of which are known to contribute to poor cardiovascular health. There are well-known “obesity paradoxes” also, one of which is that obese people survive heart attacks far better than ‘normal weight’ people.

”As our waistlines expand, it appears that our perception of what is a healthy weight has also expanded, so many people who are overweight or obese do not actually see themselves in this way,” Dr Roberts said.

No, it’s that the BMI is rubbish and people know it. Have a look at Kate Harding’s BMI Project sometime and you can see photographs of what the various BMI categories actually look like. The vast majority of the ‘obese’ population are BMI 30-35, which, as photographs show, makes one look chubby at best. The headless fatties, unflatteringly photographed and used to illustrate obesity scare stories in the news, are of extremely fat people who represent about three percent of the Australian population. Surveys such as this one by the Heart Foundation also make no exception for people who are muscular and have solid frames. There’s no section after height and weight for people to write in their body composition and if they’re an athlete or not. A quick look at NRL player stats finds that Joel Clinton has a BMI of 29.1, Nathan Hindmarsh is BMI 28.3, and Wendell Sailor is obviously cause for concern at BMI 31, and most other players are Officially Overweight or Obese. One could claim that such people are not representative of everyone else with a BMI of more than 25, but I can’t seem to find any surveys of this kind which measure body composition and actual fitness levels as opposed to assuming that someone with a BMI of 31 is a couch potato. Assuming isn’t very scientific but it does get you good publicity! …And plenty of grant money, if I might be so cynical.

One in six who had a BMI of 30 or more believed their weight met health guidelines, compared to one in nine last year. The proportion of overweight people (those with a BMI between 25 and 29) who thought they were in the healthy range also increased,, from 51 to 57 per cent in 12 months.

Surely this should be taken as a measure of success, not despair. While “almost half of obese Australians had made no changes to their behaviour to reduce their risk of heart disease” this implies that the other half have, and have thus seen real measures of their health improve, such as decreased cholesterol and glucose levels, better mental health and exercise capacity. They may have lost a little weight (just 1%-5% of bodyweight lost is pushed by health authorities as improving health) but still remain in the ‘obese’ or ‘overweight’ BMI category, or remained the same weight but had body composition change to more muscle, less fat, or even not at all and just improved various actual health measures. There’s also some tricky wording here: believing one is in the official healthy weight ranges when you’re not and believing you’re healthy when you’re not are in fact different things.

The survey, which was jointly funded by the life insurance company Zurich,

Well, of course. Who better to fund a study proving fat people are walking time bombs, ignorant that they are about to die any moment now, than a company which has a vested interest in denying overweight and obese people insurance based on tenuous claims.

…found one in four obese people smoked, with most smoking daily, a proportion 70 per cent higher than people of ideal weight range.

Could it possibly be that they’re that desperate to lose weight that they’ll smoke to keep appetite down? Surveys have shown that young women would rather be blinded or lose two limbs than become fat. Hey, at least chemotherapy’s good for weight loss!

The tendency to judge ourselves against other people, rather than scientifically based weight guidelines, was ”normalising” obesity, said the Heart Foundation, which commissioned the survey.”

Oh yes, obesity is so normalised! Fat people can walk down the street and not have people sneer at them, small children point and stare, groups of teenagers snicker and throw things; fat kids can go to the beach and wear swimmers without their photographs being taken and exploited for anti-obesity articles; plus-size fashions are available at every designer boutique; Kyle Sandilands is telling Magda Szubanski to put those kilos right back on so she’ll be hot again; of course! Apparently Dr Roberts is living in a special magical fantasy world where fat people are not treated like a mysterious brown smear on the bottom of one’s shoe, and the BMI is a scientific measure. (Let’s remember high school maths: human bodies are three dimensional, and volume increases by the cube, not the square. BMI measured by the square: fail number one.)

What, exactly, is wrong with allowing fat people a little self-esteem? Psychiatrists and dieticians who work in the eating disorder wards know that good self-esteem and mental health is the foundation of good health. When Dr Roberts comes along and gets in a flap that even though you have taken to eating better and exercising you’re still a fatty and therefore all your positive health gains amount to nowt, and of course you must be completely ignorant of any of the anti-obesity messages which saturate our society, then it’s enough to make one feel like giving up. Perhaps that’s what they want. There are a lot of people whose entire careers depend on the moral panic that is obesity, and frankly it seems like some of these people get a sick little thrill about how they’re paid to bully fat people in public.

Wow, it’s been a while. A lot’s been going on, but at the same time nothing much, you know what I mean? I’ve been getting more and more tired and distracted and having some distressing memory problems, amongst other things.

After Rachel at The F Word posted a brilliant series of posts on hypothyroidism (Part 1, part 2, part 3, part 4, part 5, part 6), I finally got it together to compile a list of the symptoms I’ve been having (and blaming on various different things), and whaddya know, a match for hypothyroid. Except I can’t tell for 100% sure yet because the pathology lab is being an ass about actually testing my FT3 and FT4 levels despite my doctor telling them to do so, at my behest. Their reasoning? “As the TSH (Thyroid Stimulating Hormone) is normal, we see no benefit in testing the other stuff.” Frustrating. This lab uses an outdated range of 0.3-5.0, and in other countries the top end of the range is being lowered to 3.0 and even 1.5 for some. Even a rather conservative endocrinologist in this town, who has some of his lecture notes published on his website, states that a TSH of 2.0 or above is hypothyroid if symptoms are present. Which they are, and my TSH was 2.0 last time we checked. And thyroid antibodies are present, if a little under the lab range. And I came back alarmingly positive for thyroid inflammation. A bunch of other glandular stuff I got checked also came back with markers pointing to a thyroid and/or pituitary problem.

But my GP, while excellent in many respects, is not terribly cluey about thyroid problems and seems extremely dubious that I have anything wrong going on because my TSH is “normal”, despite all the other signs and symptoms. Reading around the web, this seems to be quite the problem amongst doctors – the sole reliance upon TSH as a diagnostic for thyroid problems – and is causing a lot of people to go undiagnosed or undertreated and have a resultant poor quality of life.

I encourage you to go read Rachel’s posts on hypothyroidism and do some further research, if you think you may have a thyroid problem. The symptoms are a pretty close match with all the things doctors love to blame on being fat, and especially on being a fat woman: being fat (duh); fatigue; depression and anxiety; wonky periods (if female); joint pain; foot pain (including plantar fascitis); disordered sleep/apnoea; abnormal blood sugar; high cholesterol, and many more. It can even be mis-diagnosed as chronic fatigue, fibromyalgia, diabetes, kidney failure, PCOS, irritable bowel syndrome, chronic mental illness [*], etc. Left untreated, hypothyroidism can cause some of those serious conditions, as well as heart problems. And the main culprit is lack of understanding about the TSH lab range and what it can and can’t signal. I’ve come across a case study from a psychiatrist who has on several occasions tested people in psychiatric wards with severe depression and several suicide attempts, running a full thyroid panel and finding that while the TSH was in range the FT3 and FT4 levels of these patients were severely deficient. They were well enough to go home after getting thyroid replacement therapy. OK, I don’t mean to scare anyone, really, just illustrate that this is something a lot of doctors seems to know jack shit about.

Diabetes is the popular kid with medical professionals these days, and I often wonder how many fat people have been misdiagnosed and are subsequently receiving only band-aid treatment for their real problem. According to the statistics, hypothyroidism is actually far more prevalent than diabetes and far more underdiagnosed. And I wonder just how much undiagnosed and undertreated thyroid conditions contribute to the correlation between “obesity” and poor health. (Or any other number of conditions that fat people don’t get treated for because some doctors are too busy telling them to lose weight and everything will be fine.)

There is a lot of information on hypothyroidism on the web, and it can be difficult to sort out. And honestly, I reckon the F Word posts are some of the best balanced and researched. Here are some other sites I’ve looked at and my comments:

• Thyroid.about.com – there’s some useful information here if you can ignore the weight loss crap that’s prominent on the front page.
• Stop the Thyroid Madness – it’s very pro-Armour/natural thyroid, but it does have some interesting information on conditions associated with hypothyroidism, such as adrenal fatigue, and explains more about why TSH alone is a poor diagnostic.
• Thyroid-Disease.co.uk – a lot of info specifically for UK people, and some “alternative” stuff I’d personally ignore, but there are a few papers with comprehensive bibliographies and references from peer-reviewed and respected publications, which might help convince some doctors
• Thyroid Patient Advocacy UK – See previous.
• Thyroid Australia – You have to become a member to see a lot of content, but you can get some good info.

Regarding Armour/natural thyroid, the most sensible information I’ve seen has come from pharmacists (as is often the case): Some people do well on the synthetic T4 alone, others need a T3/T4 combo, and others still do best with natural thyroid, and in all cases it’s what relieves your symptoms that should guide your treatment. And make sure the pharmacist educates you on how to store your medication properly.

—-

[*] And people with some of these conditions also often have a hard time convincing doctors there’s something wrong, too.

The Australian federal government has set up a Preventative Health Taskforce. It’s to make recommendations on preventative strategies to combat the ‘burden of chronic disease currently caused by obesity, tobacco and the excessive consumption of alcohol’.

It will allegedly ‘provide evidence-based advice’ on the above. Just putting fat next to smoking and binge drinking and it’s an EPIC FAIL right at the start. (see note at end for more on this)

The experts chosen to make up the Taskforce have short biographies available on the Taskforce website, but I’ve compiled some other important information the public might like to know:

Professor Rob Moodie – mostly involved with anti-drug and alcohol campaigns and global health. He is currently not a member of or involved with any organisation or company that’s notably or specifically with an anti-obesity focus (that I can find), but he has written articles like this one, Obesity – a market success, full of the usual OMG fat kids are reducing life expectancy! panic. As Chair of the Taskforce, he recently said “there should be five-yearly check-ups on Australians’ obesity rates, activity levels and nutrition”. WTF mate.

Professor Mike Daube – again previously mostly invovled with anti-drug and alcohol abuse policy, but also on the public record as getting all agitated about Too Many Fat People and thinking a ‘junk food tax’ will fix it.

Professor Paul Zimmet – involved currently and previously with a long list of think tanks and health policy organisations, etc, mainly to do with diabetes and obesity. Calls obesity an “insidious creeping pandemic” and “international scourge“. Pandemic. I do not think that word means what he thinks it means, what with it definitionally requiring a transmissible disease. More importantly, Professor Zimmet is also a currently a board member or scientific advisor for pharmaceutical companies that are developing obesity and diabetes drugs: ChemGenex, Apollo Life Sciences, and Dia-B. He is a member of Monash University’s Centre for Obesity Research and Education (which states ‘obesity’ is a disease) and several other organisations whose continued funding relies on the continuation of the idea that being fat is a horrible deadly disease.

Ms Kate Carnell – not much to add about Carnell beyond what’s on her bio there, but interestingly when she was CEO of the Australian Divisions of General Practice she stated the ADGP (now the AGPN) had decided that banning junk food advertising was not a practicable idea because the definition of ‘junk food’ was not clear. Has made general obesity-bad statements.

Dr Lyn Roberts – Can’t find any blatant commercial interests, but here’s an example of her (fairly standard, mainstream) stance on fat and health. I find it interesting the difference between the way she talks about fat and health compared to the dramatic language used by Zimmet: by no means fat-friendly but not using fearmongering as an argument technique.

Mr Shaun Ramsay – a senior manager at HCF, a private health insurance company. Previous to that, he was an executive for a large private hospital company. Is on the board of Research Australia, an organisation for strategic health research funding. RA is supported by a great deal of vested interests.

Professor Leonie Segal – A health economist. Not much to add, is on record with similar views as Dr Roberts above.

Dr Linda Selvey – a standard smattering of appointments to public health statutory bodies. Similar mainstream views on fat and health.

So there we have it. I suspect some people might say that well, pharmaceutical companies provide research funding! Where else are researchers supposed to get it? Sure, but it’d be nice if these interests were fully declared. And it would have been nice to see an eminently qualified researcher and academic on the Taskforce who was a proponent of Health at Every Size (yeah right, in your dreams) or at least had heard of it. They’re out there but they’re not one of the cool kids.

Not happy, Kevin and Nicola.

–

Note: Interestingly, people are all handwringing over a supposed epidemic of binge drinking (especially amongst young people) here. The available evidence on binge drinking shows that there’s been no real increase in binge drinking and alcohol-related violence is not rising. However, polls do show more people are worried about binge drinking and its effects and there’s been an epidemic of media sensationalism over those naughty naughty drunken teenagers, particularly those nasty slutty teenage girls/”ladettes” (how dare they try to have a good time). Sound familiar?

Also note: I don’t think that demonising smokers and heavy drinkers does any good. Teenagers drinking well beyond their limits on a regular basis even if it’s not an “epidemic” isn’t a great idea, but I think there are overarching societal problems that need fixing, not slapping taxes on alco-pops and various knee-jerk responses. You get the idea.

That’d be the laparoscopic adjustable gastric band, known by several brand names but commonly ‘lap band’, a weight loss surgery procedure whereby an adjustable band made of silicone is placed around the stomach to create a small pouch. The idea is that it’s a tool for portion control. The reality is that it’s a surgically-enforced eating disorder. Tiny portions, lots of chewing, vomiting, acid reflux, and bowel problems. ED or WLS? You decide!

There is currently a big push in Australia from the Australian Medical Association (AMA) and the various clinics that offer the procedure to have the costs covered by Medicare, Australia’s socialised (but pretty run-down) health system. At the moment, those wanting the procedure have to do it on their own dime, with or without private health insurance. [ETA: Apparently Medicare currently covers a tiny number of these surgeries - the waiting lists are years long.] The lap band pushers say, however, that by keeping it off Medicare, the government is being mean to fat people, apparently. They’re forcing fat people to spend their lives in misery. It’s safe! It’s reversible! It’s shiny! You’ll be surrounded by ponies! Fat people will die real soon now if they don’t have the surgery! This is the only thing that can cure teh diabeetus! You’re discriminating against fat people by denying them surgery!

Yes, the surgery is safer, less destructive, and has fewer serious side effects than the various forms of gastric bypass. It may be reversible, as long as the band doesn’t adhere to your stomach. But so freaking what? The problem is not fat people. The problem is society. Fat people who live their lives in misery so not do so because of some inherent fault with their body. They live in misery because society tells them that they’re worthless gluttons, lazy pigs and worse than terrorists. They face stigma and social isolation because the general public really believes that most fat people could lose weight if they wanted. They face discrimination because the same doctors that sell weight loss surgeries blame all their medical problems on their weight. They face poor health because of these fucked-up situations, not because their fat makes them diseased. The person whose problems are directly caused by their adipose tissue is pretty damned rare indeed.

The doctors pushing for fat people to get on board with lap band surgery count on fat people believing that they are failures and doomed to a life of disease and disability or dying young. Their professional and financial investments depend on the fantasy of being thin thriving. They say the cost of giving everybody with a BMI over 35 this surgery will be less than the cost of people staying fat. This is under the current societal model where fat people are ill non-humans, however, and only studies that support this idea are allowed to be considered when making health policy. I reckon the cost of implementing a health at every size-based health policy would be a lot less, but then you’d have to have certain medical professionals admitting that their entire careers are based on lies and on the suffering of fat people.

And there’s one big conflict in the pro-WLS arguments I’ve seen published recently in Australian newspapers: certain doctors want everyone of a BMI over 35 or 40 (choose your preferred option) to have the surgery judging by their statement that this will cost less than all the fatties getting heartattackitis, but then they say it should be reserved for the really fat fatty-boombahs who just can’t stop eating because they have leptin problems or some other condition that makes them extremely fat. Which is a tiny percentage of fat people, mind you, even the ‘morbidly obese’ ones. And, uh, I’m unclear on how a silicone band fixes a serious hormonal problem. It may mask the problem by forcing the person to eat tiny amounts, but that’s still not fixing the problem, for fuck’s sake. It’s certainly not going to fix binge eating or compulsive overating disorder, seeing as how those are mental health problems, not simply a lack of willpower.

[ETA: As for performing this surgery on children, see Rio Iriri's continuing series on Kids & WLS, Part 1, Part 2, and Part 3. I agree with her that it is inhumane to foist such restricted eating upon bodies that are still developing, no matter how fat, and no matter how safe or reversible the surgery.]

Fat people of Australia may face some…interesting…times ahead, seeing as how there’s this AMA push for anti-fat surgery, and the new Rudd government has declared that ‘obesity’ will be one of its main health focuses this year. There have been calls for anti-smoking or TAC (traffic accident)-style shocking ads to be put on TV showing the ‘horrors of obesity’, from doctors and medicos who are supposed to care for the health of fat people, no less. The new Minister for Health, Nicola Roxon, has so far seemed rather earnest in her efforts to be seen to be a Serious Cabinet Member, and being the person who will lead Australia out of the shame of being so fat (I’ve read some of her speeches on childhood obesity, good god) and into a gloriously golden future full of thin people.

Write to your local member, Senator, and the Minister expressing your concerns. The more people who do, the more notice they have to take. I hope.

BABble blog has pointed out this article:

Obese Patients Demand For Equal Chances For Elective Surgery

I certainly hope their demands are met.

However, there’s one particular thing that has rankled me for some time:

“But Dr. Timothy Bhattacharyya, spokesman for the American Academy of Orthopedic Surgeons, said the issue is hardly about financing the procedures. “In a hip replacement, if the patient is obese, the doctor might not be able to see everything he needs to see,” he said. He also noted logistical problems among obese patients are common, including correctly positioning the body at the operating table. Recovery periods are likewise longer.”

My response as commented at BABble, plus supplementary ranting:

Man, I am SICK of people that are supposed to care about and for ALL people’s health WHINGING that they might have to spend a little extra time getting a large body in the right position on the operating table, or take some extra care with surgical site treatment afterwards. People come in all shapes and sizes and, gasp, as a health professional you might have to treat some of those icky people that fall outside the average. GROW UP AND DO YOUR JOB. Sometimes jobs are hard! Maybe the doctor should have picked some other career if he wasn’t up to the challenge.

I should point out that doctors are denying joint replacement and other surgery (I’ve actually read that several British hospitals are denying hysterectomies to fat women, which is a whole other WTF) are going on BMI, the measurement we all know and love. Love to call bullshit on, I mean. So such massive fatties as the “obese” people in the BMI Project slideshow, for example, would be denied surgery because it’s “too hard” and has “logistical problems” and “a new joint is wasted on a fatty”.

Now, we know that that fat people have no worse outcomes from joint replacement surgery than slim people, as Sandy Szwarc has already pointed out.

But “logistical problems”? What in the hell is that supposed to mean? Medicine, treating the illnesses and conditions of human beings, is one whole massive logistical problem. So you’re a surgeon and you notice that standard surgery techniques are not working well for fat people, tiny people, people with whatever condition – you find a new way to do it! Complaining because the patient doesn’t fit the textbook procedure is just plain lazy. Now, not all doctors are like Dr Bhattacharyya; I’ve known quite a few that were actually competent, compassionate, and caring – they’ve managed to consider that yes, I’m fat, but I still deserve medical treatment, so they use the large blood pressure cuff without making a fuss, explain anaesthetic risks without blind anti-fat bias, find a modified position for an examination. They do their jobs in a proper, professional manner. Without making the patient feel humiliated or upset.

Which is how it should be for all people regardless of size, whether it’s believed their condition was self-inflicted or not. No judgement. Just care.

Doctors, nurses, and other health professionals who do otherwise are do a huge disservice to the profession and humanity.

A recent article in the Sydney Morning Herald tells us what we already know – obesity hysteria fuels eating disorders. Dr Jenny O’Dea, another of the (sadly small) handful of nutrition/health/obesity/etc experts who aren’t all OMG TEH FAT = EVIL!!!, points out that the moral panic over fat kids is helping create increased levels of disordered eating behaviours. Sandy Szwarc has written a response to the article, but there’s something else I want to address:

The executive officer of the Australasian Society for the Study of Obesity, Tim Gill, agreed there had been “some degree” of panic but said campaigns had been very sensitive.

Dr Gill said there had not been any emphasis on weight loss, but on such things as increased physical activity.

“There is a difference between clinical eating disorders and self-reported [eating-disordered] behaviour,” he said. The level of clinical eating disorders among girls was “very, very low and has been for some time”.

“The problem of obesity is of equal if not of greater concern … so it would be wrong to stop focusing on obesity for fear that it might increase eating disorders,” Dr Gill said.

Riiiiiight.

Harriet Brown has blogged about the problems with having eating disorders (EDs) diagnosed at a clinical level – for example, girls not being diagnosed with (and getting treatment for) anorexia nervosa because her body still menstruates despite the starvation.

Other problems of course include: many of these behaviours are given either blatant or tacit approval, especially if the young person in question is considered ‘overweight’; they could well be hiding the behaviour from parents and teachers; their parents may not recognise the behaviours and symptoms or know how to help. So, these kids are not being counted in the ‘official’ ED statistics and the likes of Dr Gill can dismiss the problem. “It would be wrong to stop focusing on obesity for fear it might increase eating disorders,” he says.

Wrong? Wrong to stop focusing on a goddamed BMI category that doesn’t actually have the alarmingly inflated health risks that the campaigns are based upon? Wrong to stop focusing on weight, a number on a scale, an aesthetic, even though kids in frikkin’ kindergarten are worried about their weight? So, it’s ok that more people will suffer and die from eating disorders (whether they have an official diagnosis or not) because we have to ‘fight’ the fat? Well, it bloody well is NOT. It is not acceptable to have these ‘casualties from the fat wars’.

Now, Dr Gill also says

“[But] there has been some moralising … even the Prime Minister and the Minister for Health have both moralised this issue, saying it’s a lack of self-control and a lack of will.”

Which is true, but what’s missing is that he’s not really making the connections between fat as an artificially-created health issue and the stigma fat people face – and the fear many people have of becoming ‘like them’. Also, I’ve heard too many ‘obesity experts’ claim they really do understand fat people, they know being fat isn’t the fault of gluttony and sloth – only to have it revealed that they need this position so they can peddle diet pharmaceuticals and bariatric surgery.

Then there’s the statement on anti-obesity campaigns from the Australian Government, that there hasn’t been “any emphasis on weight loss, but on such things as increased physical activity” – well, sure, but you don’t need to say it when your audience will fill in the blanks for you. The implication from “eat healthy and exercise more” is that this should result in weight loss, or “maintaining a healthy weight”, as this is what we’ve been told for decades. The follow-on from this is that if you don’t lose weight even if you’re eating well and getting regular exercise, you’re failing at being “healthy”. If the campaigns were truly about health, they’d admit that you can get health benefits from a balanced diet and exercise no matter if you lose or gain weight or stay the same. They’d admit that being fat is not actually a death sentence. The media sure ain’t helping – all those “reality” shows about weight loss, the “lifestyle” shows, the heath shows, they just reinforce the message. How about a Government health campaign that tells people to stop hating on the fat because that’s what’s really unhealthy? Didn’t think so.

The Rotund has pointed out this great post from Rio Iriri about thin privilege.

If you’ve built upon the privilege that comes with being thin, and someone suggests that it’s equally as valid to be fat, you stand to lose the things you’ve gained from that thinness.

Also, if you are a thin person who has built status by treating fat people like they are lesser beings, you’re going to have a great deal to answer for when they become recognized as equals.

Likewise, if you’ve built your career or profession or business upon the back of fat shame and fear and hatred, no matter how much you think or say you’re actually doing it for fat people’s “health”, it’s likely that you’re not going to be terribly happy with the possibility that fat people don’t actually need your diet plans or your surgery, pills, fat-free yoghurt, or your advice. Not only do you have an emotional investment to lose, but a professional and financial one. Thin privilege-fat hatred as commodity! Hooray!

Commenter Jackie pointed out to me this recent news item on how “fat kids face widespread stigma“. It’s yet another one to add to the “No kidding!” files.

It’s full of what we already know but now it’s out in a paper that reviews all the literature on fat bias over the past 40 years, published in Psychological Bulletin. The full article isn’t general access, but the abstract states:

The authors then review stigma-reduction efforts that have been tested to improve attitudes toward obese children, and they highlight complex questions about the role of weight bias in childhood obesity prevention.

With these literatures assembled, areas of research are outlined to guide efforts on weight stigma in youths, with an emphasis on the importance of studying the effect of weight stigma on physical health outcomes …

Now that last part’s very interesting indeed and I’ll have to try to get a hold of the full article to read about it. Weight stigma and bias can kill, as Kate Harding’s guest blogger Thorn tells in Fat hatred kills – about how her mother died as a result of the negative attitudes of doctors.

And if this is what happens with adults, the effect on children is very alarming indeed – they are dependent on the adults around them for their health care, and I don’t know that there are many children who can be truly assertive in demanding proper care. Unless their parents follow the ideals of size/fat acceptance and ‘health at every size’, they’re unlikely to be able to show their doctor an introductory letter stating how their weight is just fine thanks and be able to leave if the doctor starts in on the nearly inevitable weight loss lecture.

The child’s dependence on adults for care is made more dysfunctional when, as the the study authors say, one of the biggest sources of weight stigma comes from parents. This from the parents has been around since well before the Childhood Obesity Crisis! bandwagon rolled around, but Jackie made a good point in her comment – it’s unsurprising that parents will engage in ultimately destructive practices to do anything to make their child “normal” weight when we hear stories of child protection agencies removing children from their parents because they’re “too fat”. No parent wants that, and they may ‘do what it takes’ out of sheer desperation and fear.

And look what’s just come up on the BBC site via Google News: Obese girl taken into care because of her weight. She’s apparently eight, and 5’1″ (about 156cm) and a size 16 (US size 14). That she is EIGHT and already 5’1″ should be a big fucking clue that she could well have some hormonal issues, or possibly be naturally quite big.

And people wonder why I’m perpetually cranky.

Yo-yo effect in dieters who get counseling, too reports the New York Times.

Counseling-based weight-loss programs — those led by dietitians, nurses or doctors — produced an average weight loss of 6 percent of initial body weight, or about 11 pounds, at the end of one year. By the end of three years, participants had regained about half of that weight, and at the end of five years they had typically regained all of it.

Still, the lead author, Dr. Michael L. Dansinger, a physician with Tufts-New England Medical Center in Boston, said: “When it comes to long-term weight loss, the health care system wants an A-plus grade, but based on this report, I’d give it a C minus. Primary care doctors should take a more active role in seeing patients more regularly for lifestyle management.”

So … supervised and monitored weight loss programs don’t work either, so doctors should see patients more often to tell them to eat less and exercise more, again. That’s what I’m getting here. “It doesn’t work! Let’s do it more!” (Because we all know what “lifestyle management” really means.)

How bloody thickheaded do you have to be?

Problem: Childhood and adult anti-obesity programs don’t work.
Solution: Let’s have more, just in case we weren’t sure the first 292612 times around!

Also, the moon landing was faked and if you say “Candyman” five times while looking in the mirror you will instantly lose 3lbs, provided you crap yourself in fright.

I’ve been so busy at work I’ve not had much time to write anything blog-worthy. But there have been plenty of interesting posts from the Fatosphere, including Kate Harding who’s now a regular contributor over at Shakesville. I hope more progressive blogs will take Shakesville’s example and get right on the issue of fat and size acceptance.

Yesterday I had to have my “Pre-employment medical” (even though I’ve been working where I do for some time). Since my phobia of dentists and doctors is strong, and doesn’t actually have a lot to do with my weight, I managed to arrange it so my regular, trusted, doctor could fill in the paperwork. My doctor is a lovely woman who has never harangued me because of my weight, never even specifically mentioned it even – and has also pooh-poohed the suggestion of a certain specialist that tried to sell me lap band surgery as “I don’t think that kind of thing is a very good idea at all!” She believes me when I tell her I eat a balanced diet and get enjoyable exercise. I’m quite sure if she thought my size was a problem she’d bring it up in a rational and tactful way. If only all doctors would be like her. There was also a medical student in there that day, and I signed my permission for her to observe and participate in the exam because I hoped she’d see a happy fat person to counter the anti-fat messages given to med students these days.

Hanne Blank, author of Big Big Love and now Virgin: The Untouched History, has a letter she takes to any new doctor, explaining her stance on not wanting to be weighed, not needing to be lectured on weight loss, and things like that. I’ve written a modified version and given it to my doctor to have on file, just in case I have to see someone other than her or I move city and have a new doctor. I highly recommend giving a copy of a similar letter to your health care provider, especially if you are a bit shy or intimidated by medical situations. If your doctor reads the letter and still gives you the “Fat is eeeeevil and unhealthyyyyy!” lecture, find another one as soon as you can. I realise many people may be in a situation where they don’t have a choice of doctor, but if there’s any way you can find an alternate, your health and peace of mind is worth it. I think there are is a significant percentage of doctors who are as horrified by the obesity hysteria as we are, only that’s not a view that sells diet pharmaceuticals and surgery, so they tend to be drowned out. But they’re there, the ones who take “First do no harm” seriously. Also, do tell your doctor how much you appreciate her or him and their fat-friendly stance. Doctors need love too!