Take Your Pick

I’m not sure which one of these recent stories infuriates me more:

  1. A new study says obese women shouldn’t necessarily gain weight while pregnant – and it’s even okay if they lose.
  2. We’re now supposed to be upset about obesity among people living with HIV – because it’s “overtaken ‘wasting syndrome‘ as the top concern.”

Seriously, you guys. We are now supposed to be worried about teh fat in pregnant women and people with HIV.

Sandy at Junkfood Science has covered both of these subjects in the last day, and Rachel at The F Word wrote an excellent post on the HIV story. I don’t really have much to add to their critiques of this bullshit, but that’s not gonna shut me up.

So, the study on pregnant women broke down the category “obese” into 3 subcategories: BMI 30-34.9, BMI 35-39.9, and BMI 40+. You’ll note, however, that the headlines do not take into account that breakdown — which actually shows that only those with a BMI over 40 gained any benefits (according to their criteria) from losing weight, and women in the lower BMI categories had the best outcomes when they gained weight.

About 3 percent of the population has a BMI over 40. That includes men. So even if we take this study at face value, the advice to lose or not gain weight applies only to a tiny, tiny fraction of the population at any given time. The headlines don’t tell us that. I have to get 11 paragraphs into the AP article to learn that for obese women in the same BMI range as me (i.e., most obese women), “the best outcomes came with a weight gain of 10 to 25 pounds.” Which, as far as I know, is consistent with the existing recommendations for obese women anyway — although interestingly, the American Pregnancy Association’s guidelines only address “underweight,” “normal,” and “overweight” women. We all know really fat chicks can’t get laid, so I guess it makes sense that they wouldn’t be included.

Anyway. What are these complications we’re supposed to avoid by eating for less than one instead of two? High blood pressure, Caesarean deliveries, and having something other than a “normal weight” baby. On that last point, they don’t tell us if that means the babies are too big or too small — but check this out:

The Missouri study found that the least-heavy obese women [again, that’s BMI 30-34.9] who lost weight were at somewhat higher risk to have a low birth-weight baby. However, they still benefited by having fewer other complications.

So most obese women (presuming the incidence of obesity among pregnant women reflects the general population) who lose weight during pregnancy are at a higher risk of low birth-weight babies, yet the thrust of this article is about how it’s okay for fatties to lose weight while pregnant? The risk of, say, delivering by C-section is still considered a noteworthy benefit in the face of a low birth-weight baby? Are you fucking kidding me?

And that refusal to acknowledge that being underweight is in fact far more dangerous, in both babies and adults, than being fat brings us to the HIV story.

People with HIV are now living much longer than ever before. Far fewer of them than ever before are suffering from wasting syndrome, an unexplained loss of 10 percent or more of one’s body weight — alongside super fun symptoms like diarrhea, fever, weakness, and increased susceptibility to illness. Which, you know, is kinda the last thing you want when you’ve got HIV.

And yet, somehow this is not perfectly awesome fucking news? Because why?

Because they’ve gone and turned into fatty boombahs.

Turns out, people with HIV now have rates of overweight and obesity similar to the general population. The general healthy population. This is a problem, evidently. Heaven forbid people with HIV start to look just like everyone else, instead of being unable to maintain a body weight high enough to keep their energy and resistance to illness up.

And what does this mean in terms of pounds gained, by the way?

When patients gained weight, they tended to put on an average of 13 pounds over a decade.

13 pounds over a decade. Among a group of people who used to be at risk of quite literally wasting away. I’m sorry, but WHY ARE WE NOT DANCING IN THE STREETS ABOUT THIS?

“It would be very sad to survive HIV and die of something else that was preventable,” said [Dr. John T.] Brooks of the CDC.

Oh, I see. Yes, I can imagine how surviving HIV and finding out you’re still mortal anyway would be a major bummer.

Also, don’t even get me fucking started on how the researchers blithely assume all these people gaining an average of 13 lbs. over a decade must be eating crap and never exercising. Because that’s the only possible explanation for gaining weight, ever. And don’t you love how the fact that people with HIV are now surviving long enough for their weight to be tracked over decades is just casually pushed aside, because ZOMG THEY’RE GETTING FAT?

And of course there’s absolutely no chance that the weight gain has anything to do with the increased survival rates. Here, for once, obesity researchers actually seem to remember that correlation doesn’t equal causation. So clearly, that’s not even worth looking into.

I don’t even know how to wrap this one up. All I can think to do is cry, “Where does it end?” or some shit like that. We are at the point where pregnant women and people with HIV are being told to lose weight. If you had any doubt that the obesity panic is indeed a panic, and that it’s way the fuck out of control, there you go.

44 thoughts on “Take Your Pick

  1. Pregnant women “need” to lose weight? WTF?

    My partner’s ex-wife looked her normal size from straight on during pregnancy, but sideways she looked like she was carrying a whole football team – her bump was huge, so it was no wonder she went up a good few clothes sizes and weighed more.

    Are these people mad, that suddenly the focus isn’t on the health of the mother and baby, but on “ZOMG – she’s FAT!!!”.

  2. These basically strike me dumb.

    At first I thought the HIV one infuriated me more, because something that is an unmitigated positive (HIV patients being able to hold onto weight, having longer lifespans, being at a weight that improves prospects including the effect of retrovirals according to Sandy, and basically living to see middle-age spread) is being spun as a menace because of fat panic and ONLY because of fat panic. The consequences if people take this seriously are (again according to Sandy, I haven’t verified this myself) potentially quite deadly. It is dangerous and insane.

    But then I thought, if pregnant women take the other study seriously? They’re not just being asked to hurt themselves, they’re being asked to endanger their fetus. Um, sorry, but isn’t omgbabykilling one of the OTHER major moral panics in this society? When are the Republicans going to swoop in and save these children from low birthweight and the associated risks?

    Also, I totally fail to see how you can have something weighing 7-9 lbs hanging out in your stomach and still lose 9 lbs, which is their recommendation if you have a BMI over 40. Because then you’re losing 18 lbs. And 18 lbs in 9 months is slow, but would still require a pretty restrictive diet for most people (esp if you’re pregnant and your mobility is constrained).

    ALSO, I love how they’re touting it as “the first study looking at different levels of obesity!” but then it’s reported as “obese pregnant women should not gain weight and also should lose some.” Um, no, apparently the findings were, you know, different for those different groups of obese women they were so proud of studying.

    Basically? I hate everything.

  3. …… uhh….. I got nothin’.

    Anyway, I wanted to say “Thanks” to Kate for the BMI slideshow. The timing couldn’t have been better. I was teaching my Psyc 120 class the chapter on stress, and of course obesity is listed under the problems that can result in behavior-related illnesses (OMG Heart Disease). While the text does give lip service to fat acceptance, and does not imply causation (he says obesity is “linked to” these problems), he really has bought into a lot of the “Fat Panic”, so this is one of the few areas where I contradict the text and teach mainly from notes.
    As the students were looking at the BMI chart in the text, and a few of them were saying, “well, this doesn’t look so bad” I pulled up the slideshow. By the end of it they were alternating between speechless and furious – “Where did they get these ratings?”
    From that formula right next to that chart. “Oh my God!”
    So I emphasized healthy eating, regular exercise, and a positive outlook. I said that if you go to your doctor and your blood sugar is good, your pulse, blood pressure, cholesterol, triglycerides are good, and if you can walk a mile or up the stairs w/o getting winded, don’t focus on the scale. Focus on being healthy.
    And I told them all about starvation diets (which the text did agree with at least) and how yo-yo-ing will cause more harm than doing nothing.

    Anyway, thanks again.

  4. I wish I knew where I read this but it’s one of those trivia bits that stuck in my mind. It was reported that when there is famine and pregnant women are starved then their children are more likely to be fat. So when we restrict weight gain in pregnant women by starving them(low cal diets) wouldn’t that do the same thing?

  5. When I got pregnant with my son I was around 260, and my doctor told me that the most I needed to gain was around 15 pounds. Yeah, that didn’t fly with me or my husband. I wasn’t going to endanger my baby’s health and not eat just because I was a bigger mom-to-be than most of the sticks in the OB/GYN office. Yeah, I gained 35 pounds instead and had a bouncing 9 pound 6 oz. baby boy, who is fine and healthy to this day.

  6. I saw the one about HIV late yesterday and exactly the same line about “preventable” shook me up the same way.

    You know, HIV is preventable, too. And yet, there it exists–new HIV patients come in every day. I really wonder if the prevention message is getting lost because of the new treatments. Even with the glaring failure of prevention in THAT arena, they still focus on prevention of fat. They never want to address if they are even asking the right question–can you truly prevent somebody from becoming fat?

    I also wonder if some of their medications for HIV contribute to the weight gain. Nothing like blaming the fatties for being lazy when it’s the life-saving medication that makes thinness impossible!

  7. I’m pretty sure I was “obese” when I got pregnant with Bacon (though I was 50 lbs. lighter then). I gained 50 lbs., had a Caesarian (which, IMO, was soooooo much better than labor), and gave birth to a normal weight-and-height baby who had the highest possible Apgars (a measure of health immediately after birth.). She’s never had more than a cold in almost 4 years.

    My mother weighed all of 100 lbs. (at 5’2″) for all of her pregnancies, and had to have four Caesarians – one for each of us.

    I’m not sure where they’re getting the correlation between fat and C-sections, but based on my completely unscientific study, it would seem that general pelvis size would be a more accurate indicator of the necessity for a C than being fat would. And frankly, it’s 2007. A C-section on a healthy woman has less risk of pelvic floor damage and future sexual dysfunction – not to mention, it comes with *great* pain meds.

    And as to the HIV study – W. T. F.

  8. These studies keep quoting “increased risk of C section” as though surgery is something that just spontaneously happens to pregnant women out of thin air.

    Obstetricians make decisions about C sections. The majority of C sections are not medically necessary, and obstetricians as a group tend to be _extremely_ prejudiced against obese women.

    The blood pressure stats are meaningless unless we know whether the appropriate sphygmo cuff sizes were used.

    So we’re back to bigger babies. In the absence of any actual adverse event, a big baby is not a “complication”, it’s a number. Somehow, people are surprised and horrified that larger women have larger babies. But – OMGTEHFAT! We must panic!

  9. it would seem that general pelvis size would be a more accurate indicator of the necessity for a C than being fat would.

    Care provider and bill payer seem to be the strongest predictor around here.

  10. Obstetricians make decisions about C sections. The majority of C sections are not medically necessary, and obstetricians as a group tend to be _extremely_ prejudiced against obese women.

    This is a superb point, lauredhel. In fact everyone is at increased risk of C-sections right now, compared to a decade ago. They’re not emergency procedures anymore, and they don’t reflect on the health of the mom or the baby. Sometimes it’s even just a matter of the mother’s choice; sometimes it’s about prejudice or money or convenience or speed. Not a good indicator of “complications.” Weren’t we up to like a third of births being C-sections?

  11. Actually FJ, it’s more than that. Here’s the breakdown of a 30 pound weight gain during pregnancy:
    Baby = 7-8 pounds
    Placenta = 1-2 pounds
    Amniotic fluid = 2 pounds
    Uterus = 2 pounds
    Maternal breast tissue = 2 pounds
    Maternal blood = 4 pounds
    Fluids in maternal tissue = 4 pounds
    Maternal fat and nutrient stores = 7 pounds
    23 pounds of that is necessary weight gain. So a pregnant woman who loses 9 pounds during pregancy is actually losing approximately 32 pounds of fat.

    I don’t know which story is worse! Encouraging pregnant women to diet instead of making sure their baby gets the nutrients it needs, or encouraging people with freaking HIV to diet instead of making sure their body has the fat reserves necessary to help them survive their illness. I just… what the hell?

    Also: Dear Dr. John T. Brooks, DEATH IS NOT PREVENTABLE. No matter how much you may wish it was possible to live forever as long as you “do everything right”? It is not.

  12. I have to say, I read both stories with horror, but especially the one about telling pregnant women to lose weight. When my mother was pregnant with me, she was sick all 9 months and lost weight instead of gaining it. But because she was fat, her obstetrician apparently thought nothing of it, even told her she “should be pregnant all the time”. End result, I was born at less than six pounds (small enough the doctor also thought they might have miscounted when I was conceived) and spent the first year of my life in and out of the hospital. Who knows if any of my later health problems are related. So just… no. It’s BS and I hope no one listens to this and endangers their fetus.

  13. Weren’t we up to like a third of births being C-sections?

    Above 34% here, and that rises to over 45% with a private payer, though they’re dealing with a healthier, more advantaged population.

    Add episiotomies, another operation done far more often out of poor judgement or impatience than out of medical need, and the surgical delivery rate is over 50%.

    Fewer than 25% of women labour and birth without induction, augmentation, forceps, vacuum, or C section. And the majority of those, in my experience, have other unnecessary interventions, like frequent vaginal examinations, coerced epidurals, forced inappropriate positioning and coached pushing, and so on. And birthrape, for some (statistics completely unavailable).

  14. Can we just put the Paid Media on massive group ignore already? I mean, do they really have anything to offer anymore? Anything? By that I don’t mean the blogosphere shouldn’t dissect what they say to little tiny pieces, of course you should, in fact it’s probably a must until people are convinced not to take them seriously on any level. I mean, what will it take to get the rest of society there, to realize that these people DO NOT CARE about them on any level and just want their money money money?

  15. I think this “journalism” about obesity in pregnancy straddles one of the last feminist frontiers: reproductive rights. Y’ever notice how “but it’s for the CHILDREN” is always a clarion call to action against…whatever? When less than a hundred years ago a low birth weight was a fucking death sentence, but now it’s Clearly Okay because you can throw the squirmy little shits into a NICU for two gazillion dollars a day, but GOD KNOWS you can’t save anyone from Teh Fat, except, well, a diet! Yes, let’s hook everyone up to Dr Atkins and…what were the risks again?

    I’m obviously so disturbed by this that I can’t think straight.

  16. I’m at 5’11, 290-300ish (yep, that’s morbidly obese!) and hubby and I are hoping to get me preggers in 2008. I’m getting more and more worried about the hysteria i’m going to be facing from doctors, etc. I swear, if anyone tries to put a damper on what I expect to be one of the best things to ever happen to me — they will get a big fat girl foot up their ass.

    by the way, this is my second day as a poster, not just a lurker. I’m still a relative newbie in the fat acceptance world, but I can’t even begin to explain the impact that all of you intelligent, amazing people have made in my life. It is just so damn refreshing to not hate myself.

  17. mrscracker, me too. I’m only “mildly obese” but I still worry… what if I can’t concieve and the doctors won’t help me because they assume the problem is just that I’m fat? And I can’t adopt either because I’m too fat for that too? It’s really scary. I know I would be a good mother and the thought that I may never get the chance because of my weight makes me want to cry and cry.

  18. Mrscracker, I’m glad you’ve joined the commentariat (as Lauredhel called it)! Thanks for the kind words.

    Speaking of Lauredhel, rock on with the C-section stats. Thank you.

  19. You know, I hate to use anecdotal evidence, but I remember hearing an HIV+ friend discussing another HIV+ friend and mentioning that they’d adjusted his meds recently and now he was gaining a lot of weight.

    So here are my hypotheses: 1.) There are newer HIV medications that make people gain weight. 2.) There are newer HIV medications that don’t force people to lose weight via wretched side effects. 3.) We’re identifying people infected with HIV earlier these days (rather than, say, in the 80s, which is probably where a lot of the old studies are coming from) so we can track weight over a longer period of time. 4.) Let’s flip it around: perhaps gaining a little weight slowly increases your likelihood of lasting longer with relatively few symptoms of HIV/AIDS (“surviving it”). Or being overweight in general. Why not? I don’t see any evidence to the contrary. If it helps in heart attacks . . .

  20. And thanks Becky for the weight gain during pregnancy stats… really puts it in perspective.

    I worry too, and I’m not even trying to get pregnant or necessarily planning to reproduce! But there are so many “what ifs” given the apparently prevalence of obstetrical brutality against fat women in particular. Weirdly, I’ve already encountered the opposite situation — more than one doctor has opined that there’s “no point” in trying to treat my PCOS unless I’m trying to conceive. WTF?

  21. Let’s not forget about the “labor clock” as a determining factor in c-sections. My sister had her labor augmented with Pitocin in 1986; she said, “well they HAD to, my water had been broken for 24 hours and infection can set in!”. The previous standard had been 36 hours.

    Fast forward to 2002 when I had my child. The guidance from my OB was that “your child will be born one way or the other within 12 hours of your water being broken because infection can set in!”.

    My prediction is that they are working on making the “clock” have only 6 hours on it before you get your c-section to prevent “infection from setting in!”.

    I wonder if the hospital committees that review the c-section rates will ever, ever make this connection. You get the clock low enough and nobody but those crowning in the parking lot will tie up the labor wards.

    In my experience, doctors and hospitals exist to make each other money. No way is any committee going to make decisions that result in LESS money.

  22. Hey Kate,

    I don’t want to be the perpetual gadfly, but…

    The real negative effects of gaining too much weight during pregnancy maybe on the baby…not so much the mother.

    At least according to Gary Taube’s new book (remember me?), there are some studies that demonstrate that a mother with overly high blood sugar (insulin, fat percentage) passes this along to her child. This is why so many children of diabetics are prone to be diabetic themselves.

    I’m not sure if you finished Gary’s book yet…so you may not have an opinion on this. But, it comes down to the same issue we discussed in another post…what are the negative effects of excess glucose/insulin on the mother and her child?

    If (big question), you are inclined to believe that excess glucose/insulin is bad, it may be scientifically correct to recommend that a woman pays attention to her carb intake (at least) during pregnancy.

  23. At least according to Gary Taube’s new book (remember me?), there are some studies that demonstrate that a mother with overly high blood sugar (insulin, fat percentage) passes this along to her child.

    Sure, gestational diabetes is one of the things pregnant women are tested for.

    Guess what though, Robert? Not only fat women get it. What you’re talking about is an effect of HIGH BLOOD SUGAR and INSULIN RESISTANCE (however temporary) on a fetus. Not weight.

  24. If (big question), you are inclined to believe that excess glucose/insulin is bad, it may be scientifically correct to recommend that a woman pays attention to her carb intake (at least) during pregnancy.

    But since A) we have no idea if any of these women have an unusually high carb intake, and B) recommending that women eat fewer carbs is entirely different from recommending that they lose weight, your point is still irrelevant to this article.

    there are some studies that demonstrate that a mother with overly high blood sugar (insulin, fat percentage) passes this along to her child. This is why so many children of diabetics are prone to be diabetic themselves.

    Um, yeah. Either that or it’s hereditary.

  25. “At least according to Gary Taube’s new book (remember me?), there are some studies that demonstrate that a mother with overly high blood sugar (insulin, fat percentage) passes this along to her child. This is why so many children of diabetics are prone to be diabetic themselves.”

    So, even women with controlled diabetes don’t have kids more likely to be diabetic? Where’s the data? (Great. Now we have to find the Diabetes gene to keep that from becoming even more of a Moral Panic issue.)

    And, we’re talking body weight, not diabetes or blood sugar levels during pregnancy. None of those three are interchangeable.

    And, controlling (something tells me you mean “limiting”) carb intake is not necessarily equivalent to controlling blood sugar levels (although some people may monitor carb intake to control blood sugar.)

    Give me a break. Or, better data.

  26. Okay, I’ve been waiting for the appropriate opportunity to post about something that happened to me this week, and this seems to be it. Warning: this will be long. I am not capable of conciseness. just not. never have been. It will, however, at least be somewhat on topic, though not entirely.

    Background: I’ve just fallen headlong into the world of FA the past week or two and it has been mind-blowing. I’ve been pretty much reading every word of every post here and all the replies as well as posts on some other blogs (but this is my favorite!) and generally feeling pretty good about this whole idea of FA/HAES, etc. and about myself and my body (other than the bit where I’m actually really out of shape right now, but this new outlook has given me the freedom to focus on “hmm, I’d really like to be exercising more so I can climb two flights of stairs without getting out of breath, etc.” WITHOUT worrying about whether or not it will cause me to lose weight!!! i.e. it’s a good thing to be getting the exercise, regardless of whether I lose weight or not! That part (the weight) simply isn’t what matters. This is incredibly freeing.)

    Okay, so along into this happy haze of body acceptance comes an envelope in the mail two days ago. I don’t recognize the return address, but got married a few months ago and have been hearing from assorted random relatives so I figured it was more of that. Oh no. It wasn’t.

    It was a photo-copy of an article titled “Obesity: a risk factor in pregnancy that’s weighing women down.” WHAT!?!? I say, wtf is this? Well, even finding out where the article came from was a little challenging b/c most of the places where a doctor’s name or hospital name appeared had been BLACKED OUT! again WTF? Except, well, they missed one or two, so I was able to track it down to being from the newsletter of the North Shore Long Island Jewish Health System (downloadable at: http://www.northshorelij.com/workfiles/newsletters/vitality.pdf)

    Here’s the article as it was sent to me: http://tinypic.com/view.php?pic=2qn4hlt&s=2 (hope the links work)

    It basically amounts to an advertisement for their “high risk obstetrics” department, and the whole thing is pretty much BS, with absolutely no evidence beyond quotes from doctors. (B/c we all know doctors are never wrong about anything *eyeroll*.) So pretty easy to debunk, but yes, it does end with saying “Many obese patients may need to focus on just maintaining — not gaining — weight during pregnancy.” So, yeah, the article in and of itself is pretty bad, but let me get back to the freaky part: THIS WAS SENT TO ME BY A COMPLETE STRANGER!!!!

    I have checked with my parents and grandparents and my partner and nobody knows who this person is. I don’t know anyone with this last name, nor particularly many people who live in Florida, where this was sent from.

    So, yeah, I’ve spent two days going WTF? Who the frack sent this and why??? and how did they get my name/address? (not that I don’t realize info like that is pretty easy to find online these days if you want to, but you do usually at least have to know who you’re looking for . . . ) This whole thing really threw me more than I’d like. I’d like to think that armed with my newfound knowledge and confidence thanks to FA I would just brush it off and ignore it, but, um, some stranger sent me a fat panic article. yeah. (Let’s no even get into the whole “pre-pregnant” assumption this seems to make about me . . .whole other issue there.) There’s something about that that just doesn’t sit so well with me.

    So, yeah, just felt like this story should be shared. Gold star if you made it to the end! sorry about the length.

  27. Dude. Type 2 diabetes has a large genetic component (type 1 does not). You can inherit it from either parent.

    And, no I don’t have “type 1″ and “type 2″ mixed up. Go to the American Diabetes Association website and look it up.

    This guy cracks me up. He tries to sound knowledgable, but he makes it all up as he goes along.

  28. monkey, that is SO scary and offensive. I hope you are able to move on from it somehow so it doesn’t impact your life too much longer. I don’t want to make this about me but my husband once received (turned out to be a prank from two of his “friends”) an email from his “future self” warning him not to marry me for various insulting reasons. Before I knew who sent it and was able to get some closure about it, I spent a whole weekend feeling sick about the fact that someone had inserted themselves into our lives for the sole purpose of being mean. So I think I can empathize (though I won’t say “I know how you feel”) a little with the feeling of violation that you describe and how upsetting it can be when a stranger pokes uninvited into your life like this.

  29. Sometimes I fucking hate people.

    But this pregnancy thing? Thirty years ago, it was what my people call a bubbameiser; an old wives’ tale. You don’t have to gain weight during pregnancy if you’re fat, you just convert the fat to baby by maintaining the same weight, then when the baby comes, voilá, thin! But it’s not true, it puts the baby at risk, and those recommendations were dumped over twenty years ago.

    Kate, having studied the medicalization of childbirth extensively, I gotta say that c-section is higher-risk, and scarier, than mildly low birth weight. You could do a whole blog on lies told about pregnancy and childbirth, media alarmism about the risks of pregnancy and childbirth, and social “everyone knows” falsehoods about pregnancy and childbirth, exactly as you do about obesity.

    This is the bullshit to end all bullshit. I want to strangle the doctors who wrote it, I really do.

  30. I was automatically put in the “high-risk” category for pregnancy because I am “obese”. Now, I have no doubt that I *would* have been at higher risk of having a cesarean or an induced labor (which would put me at higher risk for a premature, uh, I mean “low birth weight” baby) if I’d chosen an OB for a care provider, given that OBs (like the medical profession in general) tend to have hysterical and non-evidence-based biases against fat people. As it was, I had complication-free pregnancies and vaginal births and gained 35 pounds with each pregnancy, with all of my babies average size and healthy.

  31. “Dude. Type 2 diabetes has a large genetic component (type 1 does not). You can inherit it from either parent.”
    What would cause it then? Not saying that in a “you’re full of crap” way, but a “I’m curious” way. I have a friend with type 1, she’s had it since she was about 4. I think she had an uncle with type 2, and her mom has “pre-diabetes” or could possibly become type 2. n

    My mom is (and was) “normal weight” and she gained 60 lbs. in pregnancy with me. She had to have a C-Section and I was well over 9 lbs. Interestingly, my dad, whose BMI rivals the supermodels’, was also a big baby. I imagine his mom was on the thin side, but I can’t say for sure because she died (like all my biological grandparents) when I was really young. So: small women can have big babies (ouch :( my poor mom [and dad’s mom, actually]) and big babies can grow up to be thin people. And apparently big baby weight can be solely genetic? Dunno if it happens all that often, but there you go.

  32. What would cause it then? Not saying that in a “you’re full of crap” way, but a “I’m curious” way.

    I think the point was that it’s not necessarily hereditary — as in, it can show up even if there’s no family history — but there’s plenty of evidence that Type 2 is. (I don’t know the stats on that off the top of my head, btw, but that’s how I interpreted the comment.)

  33. Exactly. Nobody knows what causes type 1 diabetes.

    Type 2 diabetes runs in families, along with a predisposition to be unusually heavy. It’s likely that body size and the type 2 diabetes are related in some way (because they do correlate), but it’s not necessariy cause/effect.

  34. There are a couple of pretty valid theories about Type I diabetes being an autoimmune attack on the pancreas, sometimes caused by an in-utero or early childhood viral infection. Maybe there is a teeny tiny possibility of being genetically prone to this autoimmune error but it’s a small percentage of cases, I believe (trying to rack my brain for the source of that belief). Type II, on the other hand, has a strong genetic component and is frequently a *cause of*, not *because of*, excess adiposity. So pfththth to them, says I! :)

  35. I should clarify: there’s recent work showing that defective insulin receptors are responsible for the inability of cells to mobilize fatty acids for use in the body as fuel. It’s not a total cause and effect mechanism, but it’s closer than anything these fatphobic wingtards have come up with.

  36. The HIV thing is especially ridiculous because “lipodystrophy” is a known side-effect of the meds used to treat it. Basically your fat increases in some places and decreases in others — you get increased abdominal fat and the “buffalo hump” that someone with Cushing’s gets, but lose fat from your arms and legs and face.

    You also have other metabolic effects, like high cholesterol and hyperglycemia — but it’s an effect of the protease inhibitors, not of the patients becoming “just like everyone else in America” like they’re trying to spin it.

    Bah. If I know this as a med student, ID docs should definitely know it.

    http://www.emedicine.com/derm/topic877.htm

  37. Limiting weight gain in pregnant fat women is a media campaign by a segment of OBs who want to pressure the Institute of Medicine to re-do the wt gain guidelines. Guess what’s coming up for review soon by the IOM? What a co-inky-dink that all these press releases are happening now, eh?

    As for limiting wt gain in fat women, yes, famine in the Dutch during WW2 was linked to increased rates of obesity and disease in children exposed to the famine at the right point in pregnancy. It’s difficult to prove for sure that limiting wt gain in pregnant women today will cause a similar effect but it certainly is a real potential concern.

    What these doctors have done, once again, is confuse causality and correlation. The study showed that the obese women who gained less wt had less pre-eclampsia (BP issues), less cesareans, etc. It did NOT show that *deliberately* limiting wt gain is effective in preventing these problems. It was observational, not an intervention study.

    Now, why did the obese women in the study who gained less wt have less pre-eclampsia? Well, duh, one of the symptoms of pre-eclampsia (PE for short) is edema, retaining fluids. Many women who develop PE have higher wt gains than other women who don’t. It reflects the increased edema/water weight they gain. So isn’t it logical that the women in the study who had PE gained more? But that doesn’t necessarily mean that deliberately restricting calories and wt will prevent PE!

    In fact, being too restrictive is thought by some to *raise* the risk for PE, because it interferes with the body’s ability to expand its blood volume enough to maintain a healthy pregnancy. There’s more to it than that, but this is already long enough so I’ll stop there.

    I would also note that the prejudice in obstetrics against fat women is pretty extreme. In particular, they fear the combo of a fat woman who gains more wt in pregnancy than they approve of. So is it any wonder the c/s rate is higher in that group? This is the group they aggressively section and/or induce early, and induction is *strongly* related to risk of cesarean.

    Yes, the cesarean rate in this country is about 1 in 3 right now; the rates in fat women are between 30-50% for first-time moms, more for women who have had kids before. If you are supersized, the rates are even higher. This is insane because surgery carries more risks for the person of size.

    If you are a woman of size considering a pregnancy, my top hint is to NOT see an OB for your care. Go to a midwife. Don’t take for granted that a midwife is automatically size-friendly; there are fat-phobic ones there too. But as a group, their philosophy of care is much more likely to end with a normal vaginal birth, and infant outcomes are better with a midwife also (as per the CDC).

    There is so much more to say on this topic, but it’s too long already. For more info, visit http://www.plus-size-pregnancy.org, my website. I have lots of research and articles there, including hints about lowering your chances for an unnecessary cesarean. Lots of birth stories of big moms there too! Enjoy. kmom

  38. The pregnancy study really pissed me off.

    Right now, I’m about the size I was when I gave birth to my son in 2002. Oh yeah, *AT HOME*. He was a planned homebirth and it was awesome. My Midwife was amazing and so positive about my pregnancy and his birth–never once harping over my weight (though state mandated I had to the get “ok” from an OB because of my weight @@ WTFever) It was such a lovely difference from my daughter’s birth–with an OB (overweight himself) who was an ass about my weight.

    One of THE best resources I used the 2nd time around was http://www.plus-size-pregnancy.org/

  39. Robert,

    I think you’re looking for a complicated explanation when the obvious one is that doctors in general don’t like taking risk – in fact they put risk as a primary concern over patient welfare.

    I’ll probably botch this explanation, but here goes. The relative risk for complications during surgery is much greater for the obese. But the absolute risk is very close to what it would be for someone who’s thin. So when you hear that someone who is obese has a chance of complications that are 12 times greater than someone of normal weight, it sounds scary. But then you realize that the real chances are 2 in a thousand versus 24 in a thousand, so it’s really the difference between buying one lottery ticket or two – though your odds doubled, that doesn’t mean a whole lot.

    So if you’re fat, it’s not really that big a deal. Yeah, your odds of having complications are greater, but you’re talking about 0.1% vs 1.2% (hypothetical numbers!) so it’s nothing to get worked up over. Close to 99% chance of everything going smoothly in either case.

    But from the other end, it’s a different story. Treating 500 patients with those same odds, if all were thin the chances of complications on any case would be about 40%. But if all of them were fat the chances on any case would be 99.8% That’s a HUGE difference from the viewpoint of an insurance company doing numbers on a doctor’s results.

    So you have this paradox where risk from a patient’s viewpoint is psychologically very different from risk from a provider’s viewpoint. Of course, it goes without saying that the provider’s viewpoint is what will wind up being followed.

  40. Pingback: A WLS story, Part 1: “How the surgery changed–and didn’t change–her” « spacedcowgirl

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