Tell me again about how it’s fat that’ll kill you?

Back up the Duh Truck: Researchers at the University of Alabama have discovered that if you treat the patient you have, instead of the one you think might be prettier, you end up with better outcomes. In other news, fat asses can’t fit in a size 4 pant, that and 25 cents will no longer get you a cup of coffee, square pegs are unsuited to round holes, and ten pounds of shit doesn’t go in a five-pound bag.

Yeah, folks, apparently giving women with ovarian cancer chemotherapy dosages based on their actual weight, rather than their ideal weight, leads to increased survival rates, effectively eliminating any significant difference between the survival rates of fat and non-fat women. Of course, fat women are still going to be more likely to die of cervical, breast, and colorectal cancer, because for some WHOLLY MYSTERIOUS reason they’re less likely to get screened. But if they can manage to get diagnosed with ovarian cancer, thank god for these great strides in medical science that have shown we should give them the amount of treatment they actually need. And when we do that, I’ll be blowed — that survival difference we’d been putting down to “fat killz” somehow just goes away. (But remember, “research also shows obese women are more likely to have other health problems, such as diabetes and cardiovascular disease that may affect cancer treatment”! That research is surely completely valid and not affected by any confounding factors whatsoever! Also, this is no license to go around stealing other people’s cancer and surgically inserting it into your body!)

Did you have any idea that chemo dosing is “often” calculated based on ideal body weight? I guess that semi-mandatory weigh-in every visit really is just so they can decide whether to give you adequate medical treatment or not. Here I was thinking that it was because MEDICATION WORKS PROPERLY WHEN IT’S PRESCRIBED FOR THE BODY YOU HAVE, NOT THE ONE YOUR DOCTOR WISHES YOU HAD. For sure, chemo is the kind of shit you don’t want to overdose on. But it is also the kind of thing that you DO NOT WANT TO UNDERDOSE ON OMFG. And prescribing based on ideal weight is the medical equivalent of “there’s a thin person in you trying to get out” — it’s predicated on the idea that you have a real body that’s the same size and composition, give or take 20 pounds, as the body of anyone else your height, and then a bunch of extra non-functional tissue that doesn’t count. Those of us who’ve dieted and puked our way through adolescence and never hit “normal” already know that that’s absurd, as do those of us who are still considered overweight when thin. In the tradition of being grateful for the few crumbs medical science throws our way, I’m glad they’re catching on that there’s a difference between a fat person and Tyra Banks in a latex suit.

Kate covered this at Broadsheet too (I don’t have to tell y’all never to read Broadsheet comments, right? They have ironically some of the most antifeminist readers on the web, but unlike here, they pay), but we thought this one was sputter-worthy enough to merit a two-pronged attack.

Postscript: Since this is my second post about scientific studies in a row, I want to preemptively direct you back in the archives to this post on cherry-picking. You’re damn right we at SP give credit to the studies we find reasonable and question the ones we don’t — it’s called “educated analysis of available data.” You can’t build your scientific paradigm on any single study — you have to look at the full scope of evidence with an understanding that all will be to some degree biased or incomplete, and make your best educated guesses based on what you see. That’s what we do, and we do it a damn sight better than the media most of the time. Are the studies that support our hypothesis perfect? Like hell; the perfect experiment is a mythical beast. But they don’t suck any worse than the ones that support the opposing hypothesis, and often they suck a whole lot less. Studies like this one don’t prove beyond a shadow of a doubt that fat is health-neutral, but they — or at least the sheer number of them — sure as shit prove that we haven’t proved that it isn’t. No matter what the internet says.

99 thoughts on “Tell me again about how it’s fat that’ll kill you?

  1. but they — or at least the sheer number of them — sure as shit prove that we haven’t proved that it isn’t.

    *head explodes*

  2. Holy flaming crap on a pogo stick!!!!!!!!

    Doctors have really been basing medication on what they THINK sick people should weigh???????

    I shouldn’t be this surprised, I know, but I keep having this bizarre fantasy that going to that many years of school should have fucking taught them something.

    Then again, one of the stupidest people I’ve ever known has an MA.

  3. For sure, chemo is the kind of shit you don’t want to overdose on.

    Can I just say, I cut a whole paragraph from the Broadsheet piece in which I acknowledged that, because I realized I was writing only to head off criticism in the comments I don’t read anyway. (I know someone will be all, “But past a certain point, you’re so fat that an appropriate dose would KILL A HORSE! Put down the fork, chubs!”) I figure the whole “don’t want to OD” thing really should be obvious — but maybe I should have addressed it, because of course everyone who’s not fat pictures “obese” as “unusually enormous.” Whereas I just thought, “Well, I’m plenty obese at 200 lbs., and they wouldn’t give a 200-lb. man the same dose as a 135-lb. woman [the top end of my ‘ideal’ range], so that’s a big duh.”

    Also, on a semi-related topic, we’ve got a guest post coming up from my cousin, in part about how she probably survived esophageal cancer because she started out Death Fat. The extra 200 lbs. came in handy when she had most of her stomach and esophagus removed and started losing weight hand over fist.

  4. Well, it’s only the thin person inside who deserves to survive, y’see. Just like it’s only the thin person inside who deserves to have enough to eat.

  5. Well, it’s only the thin person inside who deserves to survive, y’see. Just like it’s only the thin person inside who deserves to have enough to eat.

    This is one of the most mordantly brilliant things I’ve ever read.

  6. Well, it’s only the thin person inside who deserves to survive, y’see. Just like it’s only the thin person inside who deserves to have enough to eat.

    Have I mentioned you and I will wed?

  7. You know, I want to take back my knee-jerk too-flip comment from a minute ago. Those were lost months, maybe years, that a sick person could have had to spend with her loved ones and find peace. I was trying to be clever and wise-cracking, because the real implications made me want to scream and cry.

  8. Er… I mean, I feel silly because we were commenting at the same time.

    Sorry, I’m having one of those days where I can’t seem to say what I mean, ever. Combination of Benadryl and caffeine.

  9. A Sarah, I think it’s very obvious that you’re making angry wisecracks at the expense of the doctors and diet-pushers, not making light of what happens to people who are mistreated by the medical profession. And you really struck right at the heart.

  10. A Sarah, we’re all doing our best not to scream, cry, and break out the pitchforks at the implications of this study. We need some good gallows humor to pull us through, and you provided it beautifully.

  11. Can I just say, I cut a whole paragraph from the Broadsheet piece in which I acknowledged that, because I realized I was writing only to head off criticism in the comments I don’t read anyway.

    Also, I should have followed it up with “but it is also the kind of thing you DO NOT WANT TO UNDERDOSE ON OMFG.”

    In fact, I think I’m going to edit to that effect.

  12. So basically, it wasn’t them being fat that killed them. It was their doctors being total fucking morons that killed them.

    Does that go down as as doctor caused death statistic? I’m guessing “no”.

  13. not that the general point isn’t well taken, but:

    According to a friend of mine whose dad is going through cancer treatment, (so, nondoctor, grain of salt), they use the ideal weight as a proxy for lean body mass. Some drugs, and apparently this is definitely true of chemo drugs, aren’t absorbed by fat much at all. The extra fat was thought not to make a difference to how much of the drug made it to the cancer. Treating a fat person just by weight, then, was thought to run the risk of an overdose.

    So the thinking was not “you should be thin, therefore we give you this much chemo”, but “fat doesn’t absorb the drug, so we need to scale the dosage appropriately.” And that makes sense. A 5’0”, 160 pound woman is going to have a different body composition than a 5’9”, 160 pound man, most likely; giving her the drugs that would make sense for him would be an overdose.

    I mention this because it wouldn’t surprise me that if this study is borne out, that there will be a different calculation, but one that is still based on lean body mass rather than ideal weight. (And it wouldn’t surprise me if another part of the problem is that drugs react differently in women, and they’re still not good at getting women into studies, and that women were systematically being underdosed.) Come to think of it, that would be the sensible thing to test.

  14. Don’t you love how they gloss over the fact that in their study the obese women lived an average of 47 months after treatment, while the thin ones lived 40 months? They’re perfectly correct that the study is too small to make that a statistically significant difference; but I would bet that if it had been the other way around we’d be seeing headlines that even with equivelent body weight adjusted medicine obese women survive only 80% as long as thin women. Perhaps I’m too cynical….

    And I think we’ll have to be known collectively as A Sarah’s Harem rather than Shapelings. Break out the gauze and the embroidered pillows. Who wants a spa installed?

  15. HOLY SHIT. I had no idea about the dosages on that. Although Dana’s comment makes sense, but even with that factored in . . . HOLY SHIT.

    Seriously, there are no words.

  16. A 5′0”, 160 pound woman is going to have a different body composition than a 5′9”, 160 pound man, most likely; giving her the drugs that would make sense for him would be an overdose.

    My point about Tyra in a fat suit is that a 5’0″, 160 pound woman ALSO has a different body composition than the 5’0″, 100 pound woman whose medication she’s getting.

  17. Every now and then, I read something which is just so unbelievable that I have to go back and read it again, and I still don’t believe it, and then I go and check the source (you guys are awesome in re:sourcing), and I am horrified to learn that yes, it really is true. Uhm, HOLY CRAP. Isn’t the whole point of providing dosage guidelines by weight to ensure that people get the right amount of a medication?

  18. Sure, fillyjonk. But given that fat tissue doesn’t absorb the drug well, it might be that she needs the meds of a 5’0”, 130lb person. (You know what I mean.)

    I wouldn’t be surprised if “prescribe to the ideal weight” works as a rule of thumb for *overweight* patients (especially since “overweight” can mean 5-10lbs); the real scandal here to me seems not that they prescribed based on a different weight than the patient has, but that they hadn’t considered that it might be a bad proxy outside a fairly narrow range, or that they should test for lean body mass or something that’s a better proxy.

  19. *sigh* My mother was an overweight/obese woman who had ovarian cancer and died of it when I was fourteen. I really hope this didn’t happen to her. This makes me sick.

    Dana, if that is the case shouldn’t they be measuring your fat percentage rather than making some airy fairy calculation out of “ideal weight”

    Hi by the way, I have finally de-lurked.

  20. we’ve got a guest post coming up from my cousin, in part about how she probably survived esophageal cancer because she started out Death Fat. The extra 200 lbs. came in handy when she had most of her stomach and esophagus removed and started losing weight hand over fist.

    I almost hate to say this, but I loved working in head and neck cancer (briefly, in the summer) because I actually got to tell patients to eat as much as possible and avoid losing weight at all costs, for this very reason.

    And I also assumed the near-constant weighing of chemo (and even radiation) patients was something related to dosage — but perhaps all this time it’s just been to monitor for malnutrition?? I have to admit, that is rather scary. I had no idea they based dosages on “ideal” body weight. The dietitians I work with don’t even base caloric needs on IBW alone, and that shit’s a whole lot less precise (and less potentially deadly) than chemo drugs.

  21. dana, that was my first thought after reading your comment: if the dosage is dependent on lean body mass, then why are they guessing at it? Why aren’t they measuring the individual patient’s lean body mass for the individual dose that this patient requires? There are methods to do so, and they’re not even all that inconvenient.

    I know…because that would be work and it’s SO much easier to look up a number on a chart.

  22. At first I was just happy that they were studying this phenomenon at all (treating patients you have vs. those you wish you had), but then the implications of this particular topic struck me and I’m furious. dana’s point makes a lot of sense, but the assumption on the part of doctors that “ideal weight” is a reasonable proxy for lean mass is ridiculous and in its own way fatphobic (if someone is overweight, this paradigm assumes, then every single pound of that “overage” must be made of fat, because there is no reason whatsoever for anyone to be outside one standard deviation of the weight norm–or not even the norm, the “ideal”–other than that they ate and lazed themselves up there). If it’s that dangerous then they should do an accurate body fat % measurement and use that to estimate. Similarly, you have a lot of thin people who have lower or higher body fat than usual–what if you get a bodybuilder in there who weighs 175 lbs. with unusually high muscle mass and give her a 130-lb. dose? Or what if you get someone who is very thin but doesn’t have a lot of muscle and overdose her? A lot of this seems like a failure to consider the individual needs of the patient, which is totally not surprising and especially not when it concerns fat patients.

    Leaving this specific topic aside, I really wish there would be a lot more studies on outcomes (which my initial read of the first couple of sentences led me to hope this would be) when treating fat people “as-is” vs. wholly or partially withholding treatment until they lose weight. I mean, when you type it out like that it sounds criminal, but obviously doctors and other providers do exactly this every single day. “Go on this diet and see if x resolves.” “I’ll give you this painkiller for the symptoms but you’re going to have to lose 50 lbs. to really fix the condition”–when if the patient was thin they would have taken a different tack.

    (dana–I’m totally not trying to attack you–it’s the doctors who make those assumptions who are pissing me off. So in case it wasn’t clear, I really appreciate your clarification of why “ideal weight” would be used in the first place, and 100% agree that the true correct dosage is probably somewhere in between BMI-normal weight and actual weight for most people. At least based on the info here, which is about all I know because I’m not a medical professional, but it definitely makes sense.)

  23. I did read the comments at Broadsheet, and while they were indeed mostly critical of the post, the majority were along the lines described by dana above.

  24. Dana wrote: I wouldn’t be surprised if “prescribe to the ideal weight” works as a rule of thumb for *overweight* patients (especially since “overweight” can mean 5-10lbs); the real scandal here to me seems not that they prescribed based on a different weight than the patient has, but that they hadn’t considered that it might be a bad proxy outside a fairly narrow range, or that they should test for lean body mass or something that’s a better proxy.

    I’ve not even sure how correct bioelectronic impedance is for someone who’s really large. I’ve read that ultrasound is more accurate and underwater weighing is “best”, but don’t know the exact numbers.

    I DO know that a pro football player may be about my weight but probably has more lean body mass. :)

  25. ugh. this is so, so horrendous.

    And even with the added data-thanks dana-there are gross differences in lean body mass that is under the fat-for instance I’m carrying more fat and less lean muscle since having my mobility impaired even though I weigh about the same. There MUST be a better way.

  26. Did you have any idea that chemo dosing is “often” calculated based on ideal body weight?

    I think I speak for everyone on earth when I say JESUS FUCKING CHRIST.

  27. @ dana: I wouldn’t be surprised if “prescribe to the ideal weight” works as a rule of thumb for *overweight* patients (especially since “overweight” can mean 5-10lbs); the real scandal here to me seems not that they prescribed based on a different weight than the patient has, but that they hadn’t considered that it might be a bad proxy outside a fairly narrow range, or that they should test for lean body mass or something that’s a better proxy.

    Thanks for explaining the rationale behind the “usual” dosage calculation. I wonder if part of the issue is that they fear patients would feel insulted or upset by having their lean body mass measured, which is a more involved procedure than simply standing on the scale.

    Your point above about men vs. women in clinical trials is an important one. Since women naturally have a higher body fat percentage than men, it may very well be that the dosage calculations should be made differently. And as a total aside, I wonder how often we are getting the right dosage of many medications, when people of all sizes are given the same amount – for some drugs it may not matter, but for others, like hormonal birth control, I would think it does.

  28. I read them too, and they immediately got snarky at Kate; and while they mostly did make the point about lean mass and fat metabolizing things differently (and wasn’t it interesting that all of them assumed fat was some sort of inert storage tissue rather than the metabolically active substance it is) they did so in an uncivil manner; and they also assumed that fat was simply added on or taken away from an ideal lean mass, which as posters above have pointed out is incorrect. I suspect the lean people (there were a couple of them worried on Broadsheet, with good reason, about being overdosed) have less muscle than “ideal” people who in turn have less muscle than fat people.

  29. I wonder if part of the issue is that they fear patients would feel insulted or upset by having their lean body mass measured, which is a more involved procedure than simply standing on the scale.

    But if they’re just prescribing based on “ideal” weight per height and gender, why weigh patients at all?

    I mean, this makes no sense. Even a rough measurement of lean body mass would be better than what they’re doing.

  30. I work in cancer pharma. Last year, in a previous job, I conducted a small round of calls with leading oncologists in an effort to gather data on this very issue. Only a few calls but enough to say, yes, it happens. And not seldom. Most of them won’t dose beyond an arbitrary cutoff point. And they can’t give you a strong reason why not. It’s just that gut “omg enough to kill a horse no wai” thing. Some of them will average the “ideal weight” dose and the actual calculated dose and split the difference — it could not be more arbitrary. (Chemo is generally given not by weight but by body surface area. But it works out similarly. You calculate body surface area by a crude BMI-like equation.)

    I am not sure about the fat absorption issue. No one we spoke to brought that up. You’d think they’d know. I’ll try and look into it.

    For what it’s worth, my gut feeling arising out of those conversations is that, like so many things, it’s on a spectrum. The 160-pound patient is probably generally getting the right dose, although if you’re a five-foot woman, vigilance is certainly a good idea. The 300- or 400-pound patient is maybe more likely than not to be underdosed.

    I would absolutely be all over this like white on rice if it were me or a loved one in the infusion chair. I hate that we need to be such strong advocates for ourselves, but better we know than not.

    Studies like this one urgently need to be done for other tumor types besides ovarian. The chemo makers have an obvious interest in the proper dosing of heavier patients (and some of them really do care — my old client was very earnest on the patients’ behalf) but they can’t really touch the issue without robust prospective validated analyses specific to their particular meds. We had to pretty much let it go, last year. I was helluva pist. It doesn’t necessarily require its very own study. I could be worked into other prospective studies as a secondary analysis. IMO the oncology research community needs to wake up to the problem. Er, end rant in inappropriate forum.

  31. or that they should test for lean body mass or something that’s a better proxy.

    Yeah, that. (Also, what spacedcowgirl said.) I had one of those electrical impedance tests about 10 years ago, when I weighed about what I do now, and they said my lean mass alone was above my ideal body weight by about 5 to 15 pounds depending on what yardstick of “ideal” you use. That’s me without ANY body fat AT ALL (and I’m also pretty sure that many women fatter than I am at the same height have a lot more lean body mass too — it makes sense for muscle mass to increase along with fat, unless you gain a lot of weight extremely quickly).

    It would have been absolutely ludicrous, were I to need chemo, to dose me any lower than my lean mass weight, regardless of how poorly fat absorbs the stuff. While I’m sure that almost all body-fat measuring tests become progressively less exact the fatter the patient is, they would probably at least be an improvement over what’s being done now. And fat women survive cancer better even DESPITE this?

    And A Sarah, if I join your harem, will you teach me to be as witty as you are? I make pretty good latkes.

  32. This ranks right up there with the time I learned that scientists concluded that men and women should be treated differently for heart disease. YA THINK?

  33. This pisses me off like whoah. I’m going to wave this in the face of anyone who brings up a stupid, “Fat people die earlier” study. Apparantly, fat people die earlier because FAT PEOPLE AREN’T BEING TREATED CORRECTLY. WTF?

    I get that fatty tissue doesn’t absorb drugs the way lean tissue does, but it doesn’t make any sense that, say, U.S. Olympic weightlifter Cheryl Haworth would get the same drugs as me, who’s the same height and like 100 lbs lighter, even though she definitely has more lean muscle mass than I do?

  34. Quick follow-up to prev post: just looked up the fat absorption issue, like I should have done before, and it very much depends on the class of chemotherapy. There are lots of different kinds that work in different ways. What’s relevant for a taxane isn’t relevant for a platinum.

    Also, the undertreatment per body weight issue isn’t unique. A hell of a lot of medicine needs to be better tailored to the body at hand. Oncologists are much less ageist about treating non-frail, non-comorbid, otherwise healthy elderly patients than they used to be, and I think there is hope for increased awareness on this and other fronts as well.

  35. To add to Dana’s point: Medications are also metabolized and eliminated from the body by the liver/ kidneys, and concentration of an agent in the body at a given point will not just depend on body mass/ lean body mass/ blood volume etc. but also on how fast it is metabolized (something that will probably not differ much between fat and thin people). Still, while I get while optimal dosage would not be linearly dependent on body weight I really don’t get while it took so long for a study to be conducted that takes a look at the appropriate doses for different weights – it seems a rather straight forward question to ask.

  36. I read them too, and they immediately got snarky at Kate; and while they mostly did make the point about lean mass and fat metabolizing things differently (and wasn’t it interesting that all of them assumed fat was some sort of inert storage tissue rather than the metabolically active substance it is) they did so in an uncivil manner;

    Yeah, this is entirely typical. Not just on my posts, or posts about fat — every single Broadsheet post gets a load of, “Here’s why you’re wrong, you stupid bitch.” Sometimes, it’s based on a good point, which the lean muscle mass thing is (though again, they should be testing for that, rather than estimating it — I don’t necessarily just have the frame of a 130-lb. woman plus 70 lbs. of fat), but it’s always so hateful and ridiculous, it’s not worth discussing. Which is why I don’t read comments there or recommend that other people do.

  37. Thanks, Dana, for shedding some light on this. I suspected there had to be something else at play here, though you’re right that there’s still an underlying problem.

    As others have said, I don’t think the underlying problem is just about fat people either. Fat bodies react differently than thin bodies. Female bodies react differently than male bodies. Adults vs. children, etc. There’s a long and storied history in medicine of running a study on adult males and assuming the results apply to everyone. It’s only been relatively recently that researchers have started to look critically at the differences. I remember when the news story came out that although the classic “pain in the left arm” symptom of a heart attack was right for men, women frequently had very different symptoms and because that male symptom was so well known, women wouldn’t recognize they were having a heart attack at all.

    It’s frustrating to see stories like this, but at the same time, at least the acknowledgments are starting to be made. Small steps, right direction.

    Now can we do something about the nutjobs giving statins to children? *headdesk*

    DRST

  38. … and concerning the commenters at Broadsheet: Yes, some of them have some valid points. But in addition to the clear fat-phobia of a lot of them I am really tired of the “doctors went to med school and are the most educated people of all – they even took organic chemistry” argument.

    I happened to get my undergraduate degree together with a lot of people who later went off to med school. They were not all geniuses. I have since then realized that compared to most doctors I have met I am actually better educated in research methods and statistics – which is not surprising since my field is more or less purely research oriented while the same is not true (and should not be true of medicine). And please, it’s time to get over the idea that organic chemistry is extremly hard. If this idea would not be still floating around in people’s heads more students might actually realize that it is quite fun to do.

  39. As the joke goes, what do you call someone who graduated at the bottom of his med school class? Doctor.

    And of course, there are plenty of links in this very post for anyone (I’m talking to the person whose comment, asking for a “correction,” didn’t make it through moderation — yeah, I’ll get right on amending this post to properly grovel to the medical profession) who thinks doctors and other medical professionals are unfailingly empirical, even-handed, and without personal bias.

    That said — when we say “don’t read the comments” or “Sanity Watchers warning,” it’s really not an invitation to go read the comments and come back with the Readers Digest version. This isn’t directed at you particularly, sannanina, but “don’t read the comments” means “these are either career misogynists (in the case of Broadsheet) or ill-informed drive-by asshats (in the case of most other stuff), and nobody will gain by reading these comments.” Not “please read the comments for us, we don’t want to.”

  40. I remember when the news story came out that although the classic “pain in the left arm” symptom of a heart attack was right for men, women frequently had very different symptoms and because that male symptom was so well known, women wouldn’t recognize they were having a heart attack at all.

    Yeah, I didn’t learn about that until my mom was in the hospital, dying from a massive heart attack, after having several that went undetected because they didn’t present “normally,” i.e., like they would in a guy.

    It took a long time for them to figure out that what works for men might not work for women. And this study (as well as others — this isn’t the first time I’ve read about fat people getting underdosed) certainly suggests that what works for thin people might not work for fat people. Just as women aren’t men minus a dick, fatties aren’t skinnies + X lbs. of blubber. But as long as one type of body is considered the default human being, progress is slow — especially when other kinds of bodies are considered inherently less desirable/interesting/healthy/worth saving.

    Problem is, until someone does the studies that show the difference, individual docs are just guessing and covering their asses.

  41. Just as women aren’t men minus a dick, fatties aren’t skinnies + X lbs. of blubber. But as long as one type of body is considered the default human being, progress is slow — especially when other kinds of bodies are considered inherently less desirable/interesting/healthy/worth saving.

    YES EXACTLY

  42. I’m trying to facepalm and headdesk at this at the same time. Medication should be appropriately prescribed according to body weight, and this is some recent great discovery? REALLY?

    It should be common knowledge especially for medical professionals that medication dosages could or should be relevant to body weight. Small kids get smaller dosages, so why wouldn’t fat people get bigger dosages? Dur?

    I have epilepsy, and whilst my current medication is not dosaged according to body weight (it’s recommended to use the lowest effective dosage possible to minimize side-effects), my previous medication was calculated according to my weight. (It also caused massive weight gain – but hey, I am fat because I am lazy, sloppy and out of control – certainly not because of prescribed medication!)

    There are some good points in the comments though, as well. Essentially I believe medication should be prescribed to fit the situation of the *patient* – not just whether they’re fat or skinny, male or female. Good medical practice would have the treatment fit the patient no matter who or what they’re like.
    But good medical practice is a rare find, apparently, and it is easier and cheaper to generalize.

  43. Yeah, I think maybe we shouldn’t hate on doctors so much. I know that it seems like the point made in the study is obvious, and that “they should know better after all that book-learnin’,” but the truth is that science (and therefore medicine) is tough, complicated, tricky, and all sorts of other confounded adjectives. And the truth is–prepare yourself for this one, folks–doctors usually know more about medicine than we do. Their education is undoubtedly colored by the paternalistic fat-hating society we live in, but you know, *my* personal views are colored by the paternalistic fat-hating society we live in. So I give credit to the ones who are willing to learn and change their views.

    Don’t we love how I’m talking about doctors as one big group, as if they’re all the same? Especially since my point is that we shouldn’t act like they’re all part of one big fatty-hating group? Oh irony.

    Also, just want to say: love this blog, love the posters. Thanks all for your wit, intellect, and careful punctuation.

  44. (I’m talking to the person whose comment, asking for a “correction,” didn’t make it through moderation — yeah, I’ll get right on amending this post to properly grovel to the medical profession)

    Um, yeah. Can I just remind everyone that, while discussing the details of why fat people are dosed the way they are is enlightening and fascinating (seriously!), the whole convo’s taking place because of a study that found that when fat women with cancer get higher doses of chemo, they live longer. We didn’t just pull that part out of our humanities-trained asses.

    It’s interesting to hear why dosing based on “ideal weight” is the norm, but the whole point here is that that doesn’t seem as effective — at least within the scope of this small study — as dosing based on actual weight. And that comes off as a big fucking DUH to those of us who are actually fat, and know we’re not actually just carrying 100 extra lbs. in a backpack. It’s as though people are dismissing the point here precisely because it DOES make intuitive sense — as though, if it’s something that might occur to a layperson, it couldn’t possibly have merit. (Note: this is directed at reports of Broadsheet comments and those in our mod queue, not Dana.)

    It’s not hard to grok that different drugs have different effects on different tissues. Two Advil will still kill a headache for me now, just like they did when I weighed 115 — but at the same time, it takes more booze to get me drunk. And that right there is enough to suggest that if fat people are responding poorly to a given treatment at levels that work for thin people, one obvious question to ask is whether they’re getting enough. Instead, the typical response is to chalk it up as one more health issue caused by fat. If you get cancer as a fatass, it’s your funeral, because you’re fat, period — not because they haven’t done enough studies to see if fat people need more drugs than thin ones.

    So I stand by my outrage.

  45. kateharding said: “Just as women aren’t men minus a dick, fatties aren’t skinnies + X lbs. of blubber. But as long as one type of body is considered the default human being, progress is slow — especially when other kinds of bodies are considered inherently less desirable/interesting/healthy/worth saving.”

    AHA! That just became my new email sig (replacing “ask your doctor if medical advice from a television commercial is right for you.”)

    As for the medical study: /me bangs my head against wall. Over and over. This stuff makes me scream. And cry.

  46. “Research also shows obese women are more likely to have other health problems, such as diabetes and cardiovascular disease that may affect cancer treatment.”

    I think this should read “research also shows that anyone unhealthy is more likely to have other health problems…”

    As the population ages it would make more sense that other health problems are present. My pre-op included a perfect blood pressure score and full capacity lungs (even for a smoker). My ECG was so good that the nurse doing my pre-op remarked that if she hadn’t seen my CAT scan she would not have even guessed that I was in any way sick.

  47. The entirety of my previous point: don’t get pissed at a whole group of people just because some of them are sexist fat-hating assholes.

    I know a lot of doctors who have treated me with the utmost care and respect, despite the fact that I’m overweight. And I’ve had doctors treat me like a lazy ass (my dad, for one) because I’m “obese.” I’m outraged, too, but it’s hard for me to just chalk it up to “oh, doctors are all idiots who think they’re smarter than they are.” I suspect it has a lot more to do with being immersed in a society with fucked-up values (not that that makes it any better, just more complex than we’re giving it credit for).

    That is ALL I’m saying, along with things like “this is an interesting study” and “I love this blog, it changed my life.”

    I tried to keep my comment professional and unoffensive, but if I missed the ball on that one, I’ll try harder next time…

  48. Yes, thank you, I read it and found it disgusting and horrible. It made me want to cry and thank God that I’ve never had a doctor like that.

  49. “oh, doctors are all idiots who think they’re smarter than they are.”

    Where do you see anyone saying this?

    Reading tip: questioning the infallibility of a particular group is not actually the same as saying they’re all idiots.

  50. And the thing is, not only is nobody saying all doctors are idiots who think they’re smarter than they are, it IS important to keep repeating out loud that SOME doctors are idiots who think they’re smarter than they are, i.e. that the mere fact that someone is a doctor doesn’t mean that their opinion is beyond reproach. Because most of our cultural messages are to the contrary. This is especially true since doctors so often seem to communicate (not always, but often) in a way that implies that what they’re communicating is a factual certainty the patient has no choice but to accept as true. I’ve heard it termed as “MDeity speak” which seems to sum it up to me.

  51. it IS important to keep repeating out loud that SOME doctors are idiots who think they’re smarter than they are, i.e. that the mere fact that someone is a doctor doesn’t mean that their opinion is beyond reproach. Because most of our cultural messages are to the contrary.

    Yes yes yes.

  52. Yeah, lets not hurt the poow widdwe doctows feewers. I mean, they are such a persecuted group, all that money and respect. How dare we expect them to be more than sheeple when it comes to treating patients.

    Doctors are only dumb when they do dumb things, if they are basing the calculation fo life saving and fucked up medication on something other than actual measurements of an actual patients body composition, they are doing something dumb.

    I do math in a really stupid, and relatively frivolous industry. We work with retail stores, and one of the main things we tell our retail clients is never assume that one store is going to be just like another store. It probably isn’t, and if you aren’t each store individually then you’re missing out on some information about that store.

    Why the fuck would someone as smart as a fucking doctor do any differently with people when the answers save lives?

    I can only assume it is because they aren’t very smart at all.

  53. Ok. I’m really sorry all this got misinterpreted. I was trying to keep the tone light so things like “oh, doctors are all idiots who think they’re smarter than they are” would be seen as the obvious, silly simplification of an attitude that I (mistakenly) thought I saw here. What LilahMorgan said is what I was trying to say, but it didn’t come out right.

    All I can say is I’m really sorry for offending anybody… this is why I don’t comment on blogs… I end up feeling like an idiot… yeesh.

  54. Soooo… I guess let’s take it as encouraging that someone’s actually doing the studies to show the difference? :P

    Constructive criticism for Kate: Your Broadsheet post would be something I’d forward around to all my friends if you had gotten the info Dana presented before writing it and incorporated it into your reaction. All the points you’re bringing up now about how they should have calculated lean mass in a less half-assed way, and how they should have figured out earlier whether to take fat mass into account as well as lean mass, are good ones! And the point about how medicine tends to default their assumptions to a standard-sized male Caucasian adult cannot be pointed out enough times.

    Of course, the original article’s author should ALSO have found and presented this info, and didn’t. It’s weird that he didn’t think, “why on Earth would they have been doing it that way?!?!” himself.

    I have learned the hard way that when I have an urge to title something “WTF?” it is a good signal to hold off on hitting send to all my friends or posting it anywhere until I research WTF they were in fact thinking. Or at least wait until the fury has worn off a bit. It makes me seem more credible and makes my arguments better targeted.

    It’s still a good post, I’m glad to have heard about all this! It just could have been a better post.

  55. God, I am sitting here weeping for the women who went through the torture of chemo and didn’t get the RIGHT DOSE oh my fucking god.

    Oh, and you know? I’ve had a few good doctors. The rest of them have been all too busy to blame any malady on my fat ass, rather than the actual problem. When I stop seeing that, I’ll give the profession some respect.

  56. Again, with the Andrea and other people making my points better than me… I guess this is my night for just making an ass of myself…

  57. There still isn’t a lot of information but according to the study’s release on the UAB’s website:

    UAB’s chemo dosing formula includes actual weight, body mass index (BMI) and other factors, Mathews said. Obesity is defined as a BMI (BMI: kg/m2) of 30 or more.

    They say nothing about lean body mass, which, would be relevant for non-obese patients as well I imagine. It sounds to me like there is an actual formula, into which one would input an individuals weight. And instead of doing that, they are using a number from a chart.

    I’m half tempted to e-mail the researchers.

  58. You’re not an idiot, it’s just mainly what LilahMorgan said… a la “what about the menz?” postings on feminist blogs, the answer is just “if you want to see the medical profession lionized, go anywhere else.” Obviously we don’t think all doctors are idiots — in fact several of my friends and relatives are doctors, but you know, I can’t think of anyone who’d be more likely to agree that some doctors are idiots of the first water. And that’s something that gets elided by people like the Broadsheet commenters (if we take them at face value, vs. assuming they’re just trying to twit Kate) who want everyone to assume that doctors are unassailably brilliant. Yeah, you know, sometimes the medical profession is fundamentally, abidingly Doin It Rong.

  59. I have to come to this website for the first time and see who this woman is “with an agenda.”

    You have a subversive agenda, Kate! Oh my. Dangerous. A large woman without repentance.

    Like Harvey Milk, are you recruiting for obesity or something? Are you going to take their dear children and make them eat three squares a day? Make. More. Large. People. ….At this point, some people are in a ball on the floor, rocking themselves to the horror that would be unleashed if we didn’t have that societal moral hate. Why…cats and dogs would mate in the street. What will be our yardstick for righteousness? How will we know if a woman deserves good and a man if not by the scale? World gone to the end times.

    What would happen if we accepted people!? Horrors. What if women didn’t hate their bodies for not being Paltrow?

    Like you could recruit…. Geeze. People chill.

    I kid.

    I cannot believe spewers on Salon.

    Now, I can actually believe the “go away you fat …whatever” graffiti artists who post from their parents basement.

    But the second camp of “liberal” logical posters who have to return, return, return to a subtle logic that obese women bring it on themselves. And between the lines the logic is that they do not deserve the same survival rates as those who “try” to live….morally. I suppose.

    I see a parallel with those who believe AIDS treatments or contraception encourages the breakdown of society – because – after all – there SHOULD be consequences. The new liberal puritans.

    Actually, the moral high ground is:

    What if health care gets better for everyone? What if….

  60. Like Harvey Milk, are you recruiting for obesity or something?

    Ok, Broadsheet just redeemed itself by bringing us CindyLu. :)

    The new liberal puritans.

    Word.

    (I am a little embarrassed that the only link I could quickly find for that is mine… I think other people have made the connection better.)

  61. I have learned the hard way that when I have an urge to title something “WTF?” it is a good signal to hold off on hitting send to all my friends or posting it anywhere until I research WTF they were in fact thinking. Or at least wait until the fury has worn off a bit. It makes me seem more credible and makes my arguments better targeted.

    Of course, when you’re sending something to all your friends, you’re not working on a strict deadline and word limit.

  62. Of course, when you’re sending something to all your friends, you’re not working on a strict deadline and word limit.

    True.

    I know I’m not a pro blogger. But I love seeing Kate’s posts pop up in Broadsheet and I love that she is getting so much attention for the sane point of view on weight. I just posted what I did in hopes that it might help her be an even more effective advocate.

  63. On heart attacks, I learned a couple of years ago in Emergency that in a woman they can feel like a large phantom cat sitting on your chest. Mind, I didn’t have a heart attack — I had, and have, gastro-esphogeal reflux disease, which can feel like this too — but I was told by the kind doctor that if I ever felt that again I should absolutely treat it as a possible heart attack and not dismiss it as heartburn.

    I mention it, even though it’s off-topic, because so far I’ve not seen a list of symptoms of heart attacks in women that includes something along these lines — like, say, ‘sensation of weight and pressure on chest’ — and yet I gathered it’s not all that uncommon an early symptom.

  64. The corollary to this discussion is antibiotic dosing for fat people.

    Now, it depends on the antibiotic used and how it acts in the body……but most antibiotic usage in adults is NOT weight-based. Some are, but many are not.

    So in many cases a 400 lb adult gets the same antibiotic dosage as a 100 lb adult.

    Doesn’t it make sense that the same dosage might be less effective in a 400 lb person? Shouldn’t this be something that’s studied in more detail?

    I know it’s complicated because different antibiotics work in different ways in the body, and I acknowledge there ARE some studies now beginning to look at wt-based dosing with antibiotics.

    Still, by now you’d think there would have been far more study of this very important topic. You have to wonder how many fat people are being chronically under-treated for infections. I also wonder if it adds to the problems of antibiotic resistance, which have population-wide implications.

    Just thinking out loud…..

  65. Also, the undertreatment per body weight issue isn’t unique.

    Oral contraceptives are dosed assuming a 150-lb maximum. The failure rate (controlled for consistent usage, or at least _reported_ consistent usage) doubles if you’re over 200 lbs.

    I was in the 180-lb range the year I used them, and the doctor told me this straight-out. Not in a “you need to lose weight” way, but in a “by the way, you should know this” way. I’m surprised by how many women don’t know it.

  66. I also wonder if it adds to the problems of antibiotic resistance, which have population-wide implications.

    It definitely could contribute to antibiotic resistance. Although I would guess that antibiotic overuse and use of wrong antibiotics (i.e., use of an antibiotic a given bacterium is not very sensisitve to to begin with, or use of an antibiotic that does not penetrate the respective side of infection well) is a stronger contributor to the problem. (Improper use of antibiotics is incidentally also a very good example of how doctors are NOT all all knowing – I did my research internship for my BSc on antibiotic resistance mechanisms and my boss who actually was an MD himself frequently ranted about the lack of knowledge the average doctor has concerning the use of antibiotics.)

    Oral contraceptives are dosed assuming a 150-lb maximum. The failure rate (controlled for consistent usage, or at least _reported_ consistent usage) doubles if you’re over 200 lbs.

    150 lb, seriously?! I knew that oral contraceptives have a higher failure rate for fat women, but I always thought that was only due to the changes in hormones that come with having more fat cells. 150 lb seems incredibly low considering that it is actually right in the middle of the ridiculous narrow “normal” range of BMI for me, and I am not that tall.

    PS: I guess I should add that I don’t blame doctors for not being all knowing – there is a staggering amount of knowledge in the medical field and even more things about the human body that are yet unknown. What I am pissed off with is that so many doctors behave as if they are all-knowing, or at least as if they always know everything better than their patients. And while this is certainly not true for every doctor I think it is something that is somehow fostered by the current system.

  67. dana, if that’s the case, then instead of operating with “ideal” weight (ideal for whom, exactly?) they need to do a complete body composition analysis and calculate it using your fat free mass. I hadn’t thought about fat vs water soluble drugs.

    CindyLu, you’re welcome to run screaming into our open arms here. Open, flabby arms, dammit.

  68. I think I must be the luckiest person in the world when it comes to health care. My chiropractor does little mini-rants about how unhealthfully skinny the beauty standard is now and how crazy it is, and my gyno is so considerate that the nurses there don’t tell me my weight when I get on the scale at their office, because they know that’s sometimes a trigger for me into disordered eating.

    Then again, my gyno also gives me a huge hug when I leave and tells me she loves me.

    Hmmm. We could be on to something there. Pity they can’t bottle Love and figure out how to profit from it. We wouldn’t cure teh fat but maybe we’d cure the fat hate.

    Then again, love’s complicated. My family are some of the worst at triggering me and making me feel downright awful about my body.

    WELL SHOOT. ALMOST HAD IT.

    Back to the drawing board!

    *puts on lab coat and picks up marker, only to find that instead of equations I have drawn kittens and dragons all over the board*

    I guess I’ll leave the hard maths to my assistant. *gives marker to cat, who bats it under the table*

    EUREKA!

  69. Little Robin, it happens. I have made a complete ass of myself several times here because what I meant to say came out completely and totally wrong. It’d frequently the result of sleep deprivation, alcohol or a thought concept more complex than my speaking skillz.

  70. Y’know, about cutting the doctors a break? To be completely honest, you have to admit that medical students and practicing doctors are presented with just as much if not more propaganda about how obesity causes every disease known to humankind than the regular person on the street.

    In a way, we’ve got a better shot at finding this stuff for our doctors because we don’t have to know as much about everything else medical.

  71. Oral contraceptives are dosed assuming a 150-lb maximum. The failure rate (controlled for consistent usage, or at least _reported_ consistent usage) doubles if you’re over 200 lbs.

    Y’know, I never really trusted the pill. I didn’t get preggers on it, but considering how much it lowered my sex drive, I’m not sure how useful a statistic that is….

  72. Oral contraceptives are dosed assuming a 150-lb maximum. The failure rate (controlled for consistent usage, or at least _reported_ consistent usage) doubles if you’re over 200 lbs

    I wonder what the implications of that are for women with PCOS like me, who are taking the Pill to treat it. I have noticed some improvements but my period is still not regular. Argh.

    DRST

  73. I should stress again; not a doctor, this is based on a conversation with my friend about his dad’s treatment where the issue of dosing (along with everything else about his dad’s chemo) happened to come up. Basically in the context of how chemo’s essentially poison (which probably makes them underestimate more.)

    And kate et. al. are absolutely right in any case that one can’t treat a fat person as if they are skinny person + X iron plates tacked on.

    But there’s so many ways bias can creep in. The heart attack thing is one example, but the other thing is how many drug trials are done on young men, 18-25. This makes sense — they tend to be near universities and not on the pill or potentially pregnant, making them good test subjects. And it probably means the drug that passes will be safe, but maybe not as effective.

    The birth control effectiveness thing is another one, though it seemed to be something that midwives and ob/gyns were aware of before it made the papers. (I’ve heard 180lb, fwiw. And that’s for the low-dose pills. The regular strength pills should be good. I think.)

  74. It’s just a lack of willpower in the fatty population, I think.

    After all, you doubtless can target your meds the same way skinny people Target Their Calories… You just WILL them to distribute over the appropriate systems, bypassing those stubborn or unruly areas.

    I read about it in a book once. One that promised visualizations and affirmations would make me a size two – and if I wasn’t, it’s cuz I didn’t want it bad enough.

  75. Oh the people you’ll see and the places they won’t go on Salon! And that place is the most dangerous place of all to them. A world where the “obese” could have a similar success rate as the smaller in cancer treatment. A glimpse. A hope. Blows the mind.

    There is a pervasive, sneaky idea that people with cancer had it a comin’ by some new age thinkers and some who believe all health is diet and exercise and possibly no animal products. If you are large – some say even as much as a size 12 or 14, you had it a comin compared to the pious size 6 who lived a tidy life. I don’t speak from experience, knock wood, but I’ve seen it with others with various health issues. Ironically, all of the women I know that have had breast cancer have been slim. Ironically to conventional wisdom.

    It’s interesting that people are flaming on the scientologists today for withholding medical treatment for things they believe are in the mind.

    Yet a woman is large and sick because of a thousand morality violations, and we don’t want to encourage largeness by advocating for better treatment and study of…largeness. That’s the subtext with some. That it is for any is appalling, and I have to wonder about the Salon “editor’s choice” symbol by some of the names.

    Would support for better health care for large people encourage wonton enjoyment of life by people of all sizes?

    We don’t want to encourage that sort of thing around here with certain women of appetite. THOSE kind of people just can’t contain themselves in proper company. Oh my, I’m getting the vapors. And don’t get me started on their excess estrogen and their carbon footprints… and…their elastic pants …apparently on Jezebel.com today.

    A thousand “yes-buts” light up the boards about how bad obesity is and don’t you know? And god forbid you say that the new priests, the doctors, that they may not know everything and some may be biased.

    I say, God forbid you fall under the care of a doctor or nurse that carries a hatred for you just because of some extra cells. There you are, vulnerable, and they hate you like some untouchable in a caste system. And the moral self-righteousness of the attitude of these folks who try to make themselves clean by referring to “don’t you know facts” about how on every measure, large people are appalling.

    God forbid the large are able to live healthy and be very successful. And sexual, even. And surviving the cancer and all.

    I am stuck by the hatred ground into some people.

    People like that should cut themselves free. They are the uptight victorians, the crazy religious folk that don’t believe in drinking the alcohol, playing cards, dancin’ and other roads to iniquity.

    Then Kate Harding comes in and writes about large women getting cancer treatment in accordance with their size and all these Salonistas with their 100% cotton Lucky Lotus wear are clutching their pearls and fanning themselves while some are shooting their guns up in the air like some redneck Yosemite Sam. The world’s most dangerous proposition. And how dare she say mi doctor or nurse is teh stupid.

    I guess they don’t have a need to read teh new studies.

    Of course they do read them …and they don’t do all things as they did even 10 years ago. To paraphrase Oprah, when they know better, they do better. Or should.

    So…we’d say we know everything there is to know now….no need for dangerously provocative medical studies that could upset the whole natural order as we know it? No possibly of learning something new?

  76. It’s a little late in the day and low on the page to be commenting on this, but, ASarah, I didn’t think your first comment (“it’s only the thin person inside who deserves to survive, y’see”) was flip at all… or whatever it was you said after you wrote it… I thought it was poignant and sad and a true and tragic (though ironic) expression of blindness and ignorance that is itself like cancer. Oh, now I feel like I’m trying to be poetic like you, but being wordy instead. Anyway, that comment was brilliant.

    About this whole issue.. well, I must admit, it made SOME difference to how I felt when I read dana’s explanation of the rationale behind it. Yes, it did… I rationalized along the lines of “ohhh-kay, so maybe doctors are really doing their best to get the right dosage to the patient, and it’s not really fatphobia, it’s just science that hasn’t been perfected, based on estimates.. blah blah blah blah BLAH”, and then graduallllly, I realized that that rationalization, when it is substituted for fact in a place where it has the power to save or forfeit someone’s LIFE, is just such complete.. dangerous.. bullshit.

    Okay, so, maybe the estimate based on ideal weight IS all that science knows to do. And maybe it has nothing at all to do with how anyone wants us to look, and how deserving of survival the fat v. the thin are.

    It’s still bullshit, because of the questions and unknowns that notion of ‘ideal’ is masking, and the ignorance of taking that fictional number as fact, and not bothering to look for anything more factual,and the reason for that has GOT to be something akin to complete bloody arrogance.

    It’s like… if I’m a hair stylist, and I use some sort of .. let’s say, hair color that works at a certain concentration on my fine, light light brown hair. And then a woman with black hair walks in and I calculate the amount of hair color she probably needs based on some totally fictional supposition of what she WOULD need if she too had light brown or blonde hair like me. Except, throw in a life/death component…. like, if I fail to give her enough hair color she could DIE, but for some dumbass reason I still feel it’s better and more scientific to calculate the amount based on me than based on her.

    It’s kind of like that, isn’t it? I hope I’m making some kind of sense. It’s been a long day and my brain feels kind of over-taxed.

  77. I’m a vet, and when I’m prescribing medication for a dog, I weigh it, about 90% of the time. This is because the right dose for a 3kg Chihuahua is going to vary from the right dose for a 60 kg Great Dane. It also means that different dogs of the same breed may get different doses of medicine, if their weights are very different. This is not rocket science. I have always marvelled that the same is not true of human medicine – other than paediatric doses, it’s all one standard dose for most things, as someone said upthread. And even with paediatric doses, at least here in the UK the dosage guidelines are by age rather than weight, which makes no allowance for the variation on size between children of the same age. I bought some ibuprofen in France last week, and I was impressed to see that the dosage recommendations included a minimum weight as well as a minimum age – far more sensible.

  78. My friend Kathleen died of ovarian cancer.

    She was fat (according to the BMI charts).

    Now I will always wonder if she might have lived.

    Enough said.

    –Andy Jo–

  79. Whoa, wouldn’t that fall under the common sense category? I’m not a doctor or even a vet, but even I know you dose medications based on weight. At least, when I’m giving horses their dewormer or pain meds. It seems like a no brainer, and I’m completely astounded that the medical community might have just figured this out in regards to chemo. wow.

  80. Holy Jesus. I’m 5’9″–were doctors only planning on treating the “average” 5’4″ of me if I ever got sick? Because those extra 5 inches that reside above my shoulders would get mad. And then file a lawsuit. Sheesh.

    When I first went on birth control, I used the patch. I remember there was a 200ish pound weight limit for that, so it makes sense that weight would be factored in for different body sizes in other drugs. I’m kind of shocked it’s news that different bodies require different dosages. So incredibly sad.

    That said, I cannot be the only person who refuses to get weighed at the doctor’s office. I have a history of anorexia, so I have no desire (or need, at this point) to know my weight. I guess if it were actually important to know for calculating drug dosages I would be more inclined to comply.

  81. Even if lean mass metabolizes chemo differently than fat, should the results of this study and its implications be any less appalling? Sheesh.

    Excuse me while I throw something across the room.

  82. Thank you , Fillyjonk, I was afraid I wouldn’t get my morning laugh in.

    How they prescribe medication always made me wonder about weight. How could they give the same amount to me when I got sick than they do to my husband, who weighs 80 pounds more than me? And in that case, who’s the “ideal” one they’re basing it on– am I getting too much or is he getting to little– or a bit of both?

    What are they going to think of next– that one size really DOESN’T fit all????

    That one about square pegs is new…I’ll keep that in mind.

  83. Off-topic (but I didn’t know where else to mention it) I just noticed a Radio Times blurb for a program tonight:

    “Claire embarks on a nutritional experiment – she will eat whatever she wants, whenever she wants, for six weeks. But what effect will her abandoning of self-control have on her weight, size and blood pressure? The film examines how her changing physique and body image affect her personal and professional relationships as well as her emotional well-being.”

    … How is “eating when you want to” for six weeks meant to cause drastic changes in her physique and her relationships? I find this somewhat baffling. (Maybe because I’ve never really been either a binger or a crash dieter, so I can’t imagine managing to cause huge weight shifts in that time frame…)

  84. I think I also just object to the notion of “my” ideal weight. That they call it that, I mean.

    How, exactly, is it “mine”?

    It’s not an amount I weigh.
    It’s not an amount I aspire to weigh.
    It’s not a number that I personally selected because I find it ideal-sounding.
    In fact, it doesn’t have anything to do with me or how I see myself or what I want for myself.

    So how, exactly, is it ‘MY’ ideal weight?
    I think the use of that personal pronoun is designed to make the person feel like they have some stake in the whole supposed ideal-ness of the theoretical weight.

    “Your ideal weight” is only a whisper away from “your target weight” or “your goal weight”, rhetorically speaking.

    How can someone tell me what MY ‘ideal’ is, without me having any say in it?

    What if you went to the bank and they started prattling on about “your ideal income”? Or what if we were taxed according to our “ideal income”? And only allowed to buy bras for our “ideal cup size”?

    We would just tell them to Sod Off, wouldn’t we? I hope.

    Well, if any medical professional ever tries talking to me about my ‘ideal weight’, I’m going to play dumb. I’m going to bat my eyes and look all confused and say “… but.. but… I don’t remember choosing an ‘ideal’!? So I think I must not have one? Maybe you have my chart mixed up with someone else’s?” I will just play so perfectly dumb that I will force them to acknowledge that it’s not MY ideal weight. It’s a coordinate on some chart. And that is all.

    And then I’ll explain to them that I’ve been that weight, and in my opinion it was not ideal at all, so I moved on to bigger and better things.

  85. This need to weight dose appropriately has been known for YEARS with respect to breast cancer. A cancer, I might add, that exists mostly in fat tissue. Even if muscle absorption vs. fat absorption differ, an ignorant guess/assumption that fat does not absorb chemo meds at all is uncalled for. Medical people continue to insist, despite controlled, double blinded research showing that mis-dosing of chemo is both killing fat people and leading to the assumption that being fat, and not malpractice, is why high weight is linked to cancer deaths.

    And practicing medicine without basing it on sound existing science IS malpractice. Yet most med schools teach next to nothing about research and interpretation of it. The “science” classes involve identification of structure and function, a rote memorization of information, which has little to do with the complete scientific method.

    RANT WARNING!

    When training doctors are taught science at all. it is epidemiology, which can NEVER establish anything more than a *chance* that there might be a statistically significant correlation between one thing and another. Correlation can never establish causation at all (Did you know that over 80% of child rapists drink water?! See what I mean? Correlation never implies causation.) This is the kind of study all over the news that makes people think that eggs are a wonder food one decade and a Silent Killer the next. BTW, when the correlation is lower that 200%, it means there is no relationship between the studied factors that is better than chance.

    So, “Men who ate kiwi fruit more than twice a month were 130% more likely to have their penises shrivel up and fall off.” means exactly the same thing as “Men who ate kiwi fruit more than twice a month were no more likely than other men to have their penises shrivel up and fall off.” So feel free to ignore any such “proof” that there is a magic food or diet. There isn’t. We’re omnivores who have lived on every possible type and range of foods. Actual malnutrition syndromes like beri beri or scurvy, and toxic exposures as with lead poisoning from food storage jars painted inside with lead based pigments are the exception, not the rule.

    Epidemiology is a perfectly sound scientific method: it identifies out of the endless range of possibilities which correlations *might* actually have a causal relationship, and warrant a true scientific test with controlled diverse populations, double blinded so neither researchers nor participants know who gets what. And even when a cause and effect relationship is established, the direction of cause and effect is not established. To do so we must do another true test with proper methods.

    There are many things we truly do not know, and it’s not malpractice to do your best to treat people with illnesses based on existing observations, even if they are technically guesses and hunches. Qualitative research is just as important as the above quantitative methods, because they can yield important “your mileage may vary” case evidence about individual differences and group differences that can’t be quantitatively captured. Quant research can only reflect populations and are biased toward the average – evidence for outliers or any other individuals can’t be adequately captured.

    Studies linking BMI to cancer in populations can’t yield any information at all about an individual’s risk of getting cancer based on her BMI. Medical practice is not currently scientfiically based for the most part, even when there’s good evidence.

    For example, in reproductive medicine there would be essentially no episiotomies or circumcisions performed in hospitals if medical practice were truly scientifically based. Episiotomies CAUSE vaginal/labial/anal tears 90% of the time and worsen them when cut after a tear starts, while outcomes for the babies are just as good for the the mothers without episiotomies, meaning that episiotomies aren’t “saving babies’ lives”. Circumcision has no scientifically significant health benefit at all, it’s basically just a cultural genital mutilation ritual. (Which is admittedly up to the parents, many of whom don’t regard it in this light.) Some obstetricians simply won’t believe the science on either common practice because their approach to medicine uses faith based thinking rather than scientific thinking. (Faith based thinking is wonderful in the proper context, of course!)

  86. “And please, it’s time to get over the idea that organic chemistry is extremly hard. If this idea would not be still floating around in people’s heads more students might actually realize that it is quite fun to do.”

    Well that’s all well and good for YOU, but, I prided myself on being a good student, who studied until she got it, but I had to take organic twice, and only got a D the 2nd time around. And I took it during the summer, it was the only thing I did besides work. And since the F and the D went towards my GPA, it was destroyed. Sorry we’re all not brilliant like you… I’ll tuck my OC bitterness away now.

    “Yeah, I think maybe we shouldn’t hate on doctors so much…..”

    Hmm…not so much, because they get paid way more than I do because they have a hard job. Not just because they have an MD at the end of their name. I know that part has all been said and done, but, to add to it, if we’re going to say, oh their job is so hard, and the human body is so complex, then they shouldn’t be going around saying that they’ve got obesity all figured out and this epidemic would be in the bag if those lazy, undisciplined people would get it together. Again, that’s already been said, but doctors in general (not the small amount of decent, nice ones) piss me off.

  87. I have to add a more minor “me too.”
    When my overweight husband went for LASIK, they just gave him the usual dose of Valium. Not enough; he flinched; they permanently damaged his cornea. So it’s not just for chemo.

  88. Ugh. This is just appalling.

    Maybe the medical community needs to seem self-assured, or people would be rioting.. But even if you are pretending you have it all figured out, you shouldn’t believe your lies to the point that you make people pay with their lives.. or health, physical or emotional. There is so much gray area left in the diagnosis and treatment of the human body! Not to mention metabolism is still almost a complete mystery.. why can’t we just admit we aren’t sure how it works yet?

    This is also personally worrying, as someone who is ‘abnormally’ light. I honestly had no idea – I am familiar with animal medicine and don’t really go to the doctor myself, I just assumed that most meds were dosed by current weight just like at the vet.

    As for dosing by lean body mass.. that tends to stay pretty darn constant, from what I’ve experienced myself and heard from other people, and doctors. Despite being officially ‘underweight’, I have an average proportion of lean body mass to body fat, as do most people I know (few of them within ‘ideal’ BMI ranges) who’ve had the testing done (the only truly accurate test is a full-immersion in the multi-million dollar machine at the hospital – calipers are somewhat accurate – those vibrating scales they sell are pure snake oil).
    Even if you gain a fair deal in a short time by eating more, and aren’t active, you still put on at least 1/3 of what you gain as muscle. So, as has been said before, ‘overweight’ people are not a thin frame with proportionate muscle, covered with many superflous pounds of fat – most people classed as overweight or obese, are proportioned just like ‘normal’ weight people, if we’re talking %s.

  89. I love the comment on BS that haughtily points out that this isn’t a “women’s issue” because “obese men would surely be affected too!”

    …I mean, really, what ABOUT all the mens who get ovarian cancer? Why does nobody care about THEM? So unfair.

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