The Vision Chart Effect

So here’s a blurb on a new study, courtesy of Washington Post’s “The Checkup.” It opens:

Women, want to enjoy good health in your golden years?

Ooh! I know this one! [thinks] YES.

Lose weight. Now.

Oh. Wow, that’s… um, directive. Not one to slice the bologna too thin, eh, WaPo? Attention ALL WOMEN! What? Yes, even YOU, the one whose BMI puts you in the underweight range. Want to be healthy when you’re old, woman? Lose weight. Now. It’s What Women Do, see.

Look, I don’t want prematurely to pile on Jennifer LaRue Huget, whom I don’t know from Eve. (I will note that a quick Google search suggests that she’s written two children’s books that miiiiiiiight just tap into the old mothers-are-the-ones-who-bear-total-responsibility-for-the-kids-and-I-can’t-therefore-fathom-why-they’re-so-UPTIGHT-laff-laff-chortle thing. But perhaps if I read the books I’d be pleasantly surprised. It’s happened before.) She was writing, probably under a deadline, on a study that was uploaded to the BMJ website LAST NIGHT. Plus, who knows what changes her editor made?

In any case, one can’t expect a short, punchy WaPo blurb to contain as much nuance as this analysis of the same study, which appeared today on… ummm… Washington Post’s “The Checkup,” and was reported by a Jennifer LaRue Huget:

The study controlled for socioeconomic status and for smoking, diet and other lifestyle behaviors that could affect physical and mental health. One caveat: Most of the women studied were white, so researchers aren’t sure their findings extend broadly across the general population.

Oh. The heck you say. Well, no, that’s really okay, because we’re all pretty sure that white women count for all women, right? So the opening command to lose weight probably still holds. Plus: look, it’s a WaPo blog. If one wanted in-depth and even-handed analysis like this:

Still, the study adds new fodder to the often-heated debate about how closely body weight correlates to health. While the common wisdom is that being overweight puts people at increased risk of life-shortening diseases such as cancer, diabetes and cardiovascular disease, others say no such cause-and-effect relationship has been scientifically established and that people can be very healthy even if they’re overweight or even obese. The new research is the first, according to its authors, to examine the role of overweight and obesity in overall health among women who survive to older ages.

…one would need to look here, in the coverage by WaPo’s “The Checkup,” by Jennifer LaRue Huget.

Okay, okay, I’m having a little joke. It’s ALL the same article! Ha! But seriously. [Puts on serious face]. Shapelings, I point this out as an example of a phenomenon I see in health reporting and advertising. I call it the Vision Chart Effect. The principle runs thus: In messages about fat, the text at the top is big, bold, and brief. Read down and it gets smaller and smaller, and lengthier and lengthier. Just like an eye chart! Witness:

UR FAT!

LOSE WEIGHT FOR HEALTH!

Look at these ladies! They’re thin!* And therefore healthier than you!**

*Not that we actually know any good way for YOU to get thin. Results not typical and so on.***

***-Incidentally, you maybe should know that this might not have fuck-all to do with overall health.

** – And by “you” I mean “white lady.” Frankly, if you’re not white we’re probably not talking about you in the first place.

Because I know that people who show a concern for “health” always have everyone’s best interests at heart, it is my studied opinion that the mainstream media provides this effect as a SERVICE. A service to FAT PEOPLE. Isn’t that nice? Because apparently some fat people experience prejudice at the doctor’s office. To the point that they avoid going and getting regular checkups for things like vision. (A fact which could not POSSIBLY have any effect on overall health as one enters one’s golden years.)

Posted in Fat

96 thoughts on “The Vision Chart Effect

  1. My last eye doctor actually credited my slightly improved eyesight with my weight loss due to mono. That doesn’t make much sense to me… but then he was very small.

    Also Love

  2. Currently trying to gain weight and somewhat hypersensitive to this; I just realised that my apparent sneaking up over the 8st measure might just be period bloating and spent a while in tears. Perhaps I should lose some weight so I can live longer. How long do people live at a BMI of 18, again?

  3. Isn’t this from the same data set that showed that over several years, women in an intervention/”healthy diet” group neither lost weight nor had better health outcomes than the control group?

  4. Well, so far this year, WaPo has memorably brought us
    - Robin Givhan (hating on the President’s Dad-jeans and Justice Sotomayor’s failure to wear nothing but suits to her confirmation hearings) and
    - Charlotte Allen (hating on all women of all colors, equal-opportunity style).

    So my guess is she’s just having what they’re having. Like all women should!
    *is ill*

    “That doesn’t make much sense to me… but then he was very small. “
    *nearly chokes laughing*

  5. (((((Ailbhe)))))) Without meaning to pry, can I ask what the 8st measure means?

    Hey, you know what I just thought of on the way home from work? “Warning: do not attempt to view this chart through a feminist lens or it will appear distorted.” Well, I amuse myself.

  6. Gaaa! Even before I learned about FA, I remember seeing lots of studies that showed that extra weight is beneficial in old age.

  7. Astrobabe is right about the 14lb part but sooooo not a Brit. Though my children are.

    8st to me is the lowest I can weigh without being cold and tired and ill; 9st is better. My metabolism hates me and likes me to be cold and tired and ill. I lost weight with flu over the summer and can’t afford to face winter this underweight – I wouldn’t stand up to a cold like this, nevermind norovirus.

    When I got down to 7st once, I fainted several times a day. People at work used to congratulate me.

    Now I’m just angry that my daughters will likely get the same thing, one from each end of the scale.

  8. A Sarah: more succinctly, it means that although I am a very small person, and underweight by all sensible measures, my BMI is in the middle of the “normal” range.

  9. This is how Jezebel reported the same story (I think):
    “According to a study funded by the U.S. National Institutes of Health and the Boston Obesity Nutrition Research Center, every one point increase in a woman’s B.M.I. decreases her chances of surviving until age 70 by 12%. The study examined more than 17,000 female nurses over the course of 30 years.”

    um, WTF?

  10. “According to a study funded by the U.S. National Institutes of Health and the Boston Obesity Nutrition Research Center, every one point increase in a woman’s B.M.I. decreases her chances of surviving until age 70 by 12%.

    So I guess all those fat old women I create medical records for don’t actually exist. Come to think of it, I’m 46 now, so I might not either.

    For the luvva peatmoss, people. Don’t the people who write those stories know any actual senior citizens who aren’t Jack LaLanne? If they did, they’d know that wasting illnesses that cost people dozens of pounds are extremely common in people over 70. A thin 75- or 80-year-old person may well have been a fatass just a few years ago, before liver failure or cancer or a massive staph infection (possibly hospital-acquired!) got a hold of them. That’s your LOSE WEIGHT NOW, right there. Personally, I’d skip the massive staph infection even if I had to drop dead at 70, but that’s just me.

  11. I always heard that in addition to helping one survive cancer or other life threatening illnesses, the fat and extra lbs help maintain bone density and reduce the risk of breakign a hip.
    As for me, I’m not that old but have definately noticed that I catch a lot more colds when I’m at the low end of my weight range than when I’m in the middle, even though my BMI is >25 at both levels.

  12. And there are probably estrogenic effects from fat, that while possibly detrimental to breast cancer risk, which is 1 in 8 for the population at large, or something like that, but probably helpful to heart health, and heart disease is the number one killer of women……but then again, I’m not an epidemiologist, just a reader of media.

    Mostly I love the eye chart. I figure I have only the illusion of more control over my weight than I do over my height, and being extra tall (5’10″) isn’t correlated with great health on a lot of measures either. Why aren’t we reading about the need for people to get to a healthy height?

    Also being wealthier seems to help, too. Let’s get rich, now!

  13. As a black woman, I found this little disclaimer hilarious: “– And by “you” I mean “white lady.” Frankly, if you’re not white we’re probably not talking about you in the first place.” Most of the time, I ignore anything geared towards women because 9 times out of 10, they’re not really talking about me.

    The Vision Chart Effect, I like that. Is it trademarked?

  14. How horrible is it that I had to re-read Ailbhe’s first post 3 times before I actually read, “trying to GAIN weight,” and not, “trying to LOSE weight” ?

    This blog is so good for me, if only (and definitely NOT only) because it seemed so out of place for someone to be lamenting the difficulty of losing weight on here that it drew my attention. Anywhere else I probably never would have noticed.

  15. For some reason, the fact that she sort of referenced the current gaping hole in obesity studies without really actually looking at it pissed me off more than all the “get off the couch fatty” stories out there; it’s trivializing of the problems inherent in the statement “Lose weight. Now.” but acknowledges those problems exist.

    In fact, this pissed me off so much it took me a little while to notice that she acknowledged those problems exist.

    Fuckin’ A. The rethinking thin questions are now being included; minimized, trivialized, but they’re THERE.

    (Also, hilarious, A Sarah.)

  16. I need to read this blog right before bed more often . Many chortles + well-turned sarcasm = sweet dreams. Thank you in advance :)

  17. BrooklynShoeBabe, as far as I know I made it up. Then again, when I was four I thought I’d invented the word “Nicaragua” and the people on the news had somehow copied me. So take that for what it’s worth.

  18. “According to a study funded by the U.S. National Institutes of Health and the Boston Obesity Nutrition Research Center, every one point increase in a woman’s B.M.I. decreases her chances of surviving until age 70 by 12%.

    So wait, a 9-point increase puts your chances of surviving until 70 at -8%?

  19. According to that formula, my Mom should have expired about 8 years ago. I guess she didn’t get the memo.

  20. This is how Jezebel reported the same story (I think)… um, WTF?

    Right with you on the WTF, but in (very small, very mild) defense of whoever wrote that (I haven’t caught up on reading Jez today, because I was too busy writing for it), I can tell you that if it was just that text and a link, not an actual post, the person had to summarize the article in 40 words. If I had gotten that topic, I would have made it a whole post much like this one, only not as funny (love it, A Sarah), but having written several “quicklinks” over there now, I can attest that it is incredibly difficult to fit nuance into 40 words.

    That text was still bullshit, mind you. But it’s bullshit I can sympathize with more now than I could have a month ago.

  21. A Sarah, you are teh brillz. That eye chart is cracking me up.

    Oh, and this:
    Hey, you know what I just thought of on the way home from work? “Warning: do not attempt to view this chart through a feminist lens or it will appear distorted.” Well, I amuse myself.

    ROFLOL! You amuse me as well!

  22. Then again, when I was four I thought I’d invented the word “Nicaragua” and the people on the news had somehow copied me.

    HILARIOUS.

  23. So, while I haven’t yet read the study, it purports to say that being obese in middle age decreases your chances of being in that 9% of women (again read: white women) who make it to 70 without having one of the 11 most common chronic illnesses of old age.

    I mentioned this to one of my colleagues (a nurse), and her response was, “I think they’ve over calculated the amount of women who don’t have a chronic condition over 70.”

    I’m sort of in the clear…I already have one of those common chronic conditions….no waiting for 70 for me.

  24. Hmm. My BMI has greatly increased since I was 18. And every day I am getting older…OMG! It must be my BMI bringing me nearer to DEATH! And I’m a white lady, so it must be true.

  25. I needed a term for this. Thanks!

    Since I’m not entirely white, I reckon I must soon be a sort of pied monster, as my assorted parts suffer and wither and die at divers rates. And since fat is catching, soon, like La Mumia, I will lurch along the streets with one hand outstretched, felling passersby with a rotten-fingered touch, and mumbling along with the hero of an old horror comic: ‘I would’ve got here sooner, dear, but pieces of me kept falling off.’

    And now that I’ve given myself a good case of the mordant blues, I think I’ll pour myself a drink and re-read The Lament of the Makers.

  26. @ Shinobi – Seriously? Eyesight has what to do with weight, now?

    (My rather skinny Mom and her bottlestop bifocals that she had from when she was an underweight teenager would like to disagree with your doctor, please)

    On the article in general, here’s the thing – apparently they’re assuming that everyone reading is currently in the “overweight” or “obese” BMI categories? Because even if you ignore the fact that there’s evidence that being in the “normal” category isn’t a predictor of better health, even the most obesity panic-prone people generally admit that moving from “normal” to “underweight” isn’t good for one’s health, right? So the way the article is written only makes sense if the writer is assuming everyone reading is “overweight” or “obese”.

    Or she could just be a shitty writer with shitty editors. Unless we’re about to move, as a society, to openly suggesting that being “underweight” is better for your health than being “normal”, which honestly wouldn’t surprise me at this point.

  27. “Currently trying to gain weight and somewhat hypersensitive to this; I just realised that my apparent sneaking up over the 8st measure might just be period bloating and spent a while in tears. Perhaps I should lose some weight so I can live longer. How long do people live at a BMI of 18, again?”

    I’m with you, Ailbhe. I’ve had about two years of /not/ being diagnosed with Celiac Disease (because I’m teh wimmins, don’cha know, therefore getting skinnier and skinnier and having stomach pains must ‘just’ be stress. Or menses.), and have been steadily losing weight the whole time. I’d just about started gaining (and stopped fainting) on a gluten-free diet, and then my doctor tells me to do a ‘wheat-challenge’ for a blood test to make sure. Two weeks later, I’m back under 53kg, having my limbs and face go numb if I sit still for too long, and am addicted to flour-based food again. *cries*

    I just noticed today (having not long moved into a house with a mirror in the shower room) that I can count my ribs with little effort. It’s scary and I hate it.

  28. “Of the women who survived until at least age 70, 1686 (9.9%) met our criteria for healthy survival.”

    So. Of 17 065 women who survived until at least the age of 70, who SELF REPORTED (“provided”) information on their own occurrence of chronic disease, cognitive function, physical function, and mental health at older ages; AND who were free from major chronic diseases at mid-life (which I guess means 50…though how 50 is “Mid-Life” if you’re only aiming for surviving until 70 is beyond me); only 1,689 managed to get that “Clear Pass of Health” which met The Researchers’ “criteria” for healthy survival. Wow. I’d love to see the phrasing on that freaking questionnaire.

    I’d also love to see how they measured “having no substantial cognitive, physical, or mental limitations.” And why no red flag going up for these researchers if indeed the highest correlation with increased mortality is NOT with the obese but with the “just” overweight?? Are they pushing forward these results without fully examining them in the hopes of cutting away at the previously established recent research showing that those in the overweight range are have the lowest mortality??

    Then again…I take this “research” with a salt-lick sized grain of sodium because if they start the intro with “there has been a steady increase in overweight and obesity; in 2003-4, 66.3% of American adults were overweight or obese compared with 14.5% in 1976.” without ANY mention of the freaking line-drops in the BMI categories to which they are referring; then I have little hope for an un-biased study here.

    Geesh. Maybe I need to rub my eyes and try that eye chart again…not sure I’m getting this article’s full intent yet! ;)

  29. When I was pregnant with my younger son, I was considered “obese” (I was about 200 lbs and 5’10″. Not thin, mind you, but very fit as I had prior to my pregnancy done kick-boxing three nights a week. My doctor could speak of nothing else. He wanted me to have a “zero weight gain pregnancy” which he said was a “real thing”. In the meantime, I had a high-risk pregnancy with my first child, and was told that during any subsequent pregnancies I would be followed as a high-risk case and monitored appropriately so that we would catch anything early on. My doctor’s take on this? Well, I was fat so if I wanted to avoid any complications, I should lose weight. During pregnancy. Seriously. Anyhow, I put up with this nonsense for months, but around the time I was 36 weeks pregnant I knew something wasn’t right. I voiced my concerns to my doctor, who again fell back on the fat theory. I finally had enough and insisted on a new doctor. This was a huge issue, since I went to a military hospital and once you were assigned you pretty much were tracked with that doctor. I literally screamed and yelled in the patient advocate office. I went to see another doctor that day, who diagnosed that I had almost no amniotic fluid due to a faulty uterine lining. This was something that could have been easily diagnosed just with the tape measurement they take at the beginnning of each exam, or with the monitoring that I should have been having due to the high-risk status of my first pregnancy but that my doctor refused to do. They induced me that day, and I gave birth to a healthy baby boy. Later I was told that if I had waited even a day or two longer, I could have lost my baby. All because this guy was disgusted by my weight. I still am horrified when I think of it. My son is now 7.

  30. So wait, a 9-point increase puts your chances of surviving until 70 at -8%?

    Don’t try and bring rational thought into this arguement.

  31. @katmakai – Ummmm… wow. That doctor is an ass. I’m sure I could think of other “not so nice” words for him, but that’s the first that came to mind.

    I’m 5’10″ or so and 260 lbs as of last weighing a month ago. Getting me down to 200 lbs would make me look sick (it happened 5 years ago).

    As for the pregnancy thing… I hope you at least reported that doctor for what he did.

  32. Katmakai–love love love your story, although I’m sorry that you had that scary experience (and that you had to deal with d-bag ob/gyn throughout the pregnancy!) It bothers me no end when doctors Pronounce Stuff, since doctor’s appointments are nothing more nor less than a meeting of two experts: one who specializes in disease and treatment, and one who specializes in the condition of her own body. When I go to the doctor because something’s wrong, something’s wrong. I am the world’s leading expert in the way MY body functions, and the only person in the world qualified to say with certainty that the way it’s functioning now is not the way it used to or ought to function. I’ve had some great doctors who got that, and some horrible doctors who just didn’t. Your son is incredibly lucky to have a mom experienced enough to raise hell when things went wrong.

  33. Yes, I definitely reported him. He was an absolute ass. I never did hear if anything was done to him, due to confidentiality and all. I’m sure he got in trouble, since in fact there was an actual problem. I hate to think, though, that if there wasn’t an actual problem, that my feeling that something wrong had been wrong, that he wouldn’t have gotten in trouble. You know, that calling me fat and tailoring my care (or lack thereof) around my fatness was okay as long as there were no bad outcomes. I am also really glad that this happened in my 2nd pregnancy, after I had learned through experience how to better advocate for myself.

  34. @c.shuy — yea, me as 5’10″ and 200 lbs — I feel very thin at that weight. Just right in fact. BMI charts be damned. It is a great weight for me.

  35. Oh, dear God thank you for posting about this. I read it the other day and wanted to shoot myself. I’m 54 years old. My mother is fat and is a 20-year lung cancer survivor. She is 82. My father is fat and sedentary. He has a lymphoma so indolent he only has to go for checkups every six months. He is 84 and he and his overweight 70-year-old wife got back recently from a Mediterranean cruise.

    Now what was that again?

    I am 4’10″ tall and a women’s size 16. I do not eat fast food. I do not eat donuts. No, I don’t exercise as much as I should, but when I did, back in 1983, while on a 300-calorie-a-day diet, I lost a grand total of 13 pounds in 4 months. The minute I started eating actual food again it all came back — and then some.

    I had to change gynecologists after 20 years because my doctor decided that I should go on the extra-low-calorie diet she went on to look good at her high school reunion. My current gyno suggested I “try to lose weight”. I do not have an internist because I am afraid of the diet talk. There is an integrative doctor I want to try but I am still afraid. Today I am going for a pre-colonoscopy checkup and I’m afraid I’ll be told to come back after I lose some weight.

    My employer has Weight Watchers groups on site and I refuse to join. If Weight Watchers were so successful, why

    If I knew a way to get to even 145 pounds and stay there I would do it. But with a history of nothing but abject failure, why would I want to try?

    I am so sick and tired of being told that I am a glutton (I’m not), that I’m lazy (I’ve been working 80 hours a week since June), that I pig out on fast food (which I never eat), that I should not get health care because I don’t “take care of myself”, I could just cry. I have been dealing with this for nearly a half-century, and it just keeps getting worse all the time. The medical establishment refuses to acknowledge that some of us are just not able to be thin. Even when we see research that backs this up, we’re told “You just have to work harder at it than other people.” What does that even mean? Do you know how many hours a day I would have to spend in a gym to “work harder than everyone else”? I work long hours and have no life as it is? When the heck am I supposed to do this?

  36. The research paper behind all this hoopla can be found here :

    http://www.bmj.com/cgi/content/full/339/sep29_1/b3796

    At the bottom found something interesting :

    “QS wrote the first draft of the manuscript.” AND THEN “QS is supported by a postdoctoral fellowship from the Unilever Corporate Research.”

    On the Unilever Global website there is a section called “Diet, health, and the fight against obesity.” Go figure.

    ALSO

    @April P : Check out this line in the report : “As there is no standard definition of healthy survival, and as the criteria we used for some of our outcomes (such as physical function) might be considered somewhat arbitrary…”

  37. “As there is no standard definition of healthy survival, and as the criteria we used for some of our outcomes (such as physical function) might be considered somewhat arbitrary…”

    ACK. Arbitrary, my arse.

    As for weight and health, my 81 year old grandmother worked her entire life to be thin and now in her later years, she can’t keep weight on and it’s her number one health issue. No cancer, no disease, but she cannot gain weight and she’s very thin and frail. Her old doctor used to congratulate her on her abnormal weight loss. Her new doctor is very concerned about it and never coaches his language in a fat/not fat way. It’s just that she’s too frail, too cold all the time, and weak.

    So, now, every time my mother berates my for my (stable, normal for me) fat body, my grandmother pipes in that “she might need that someday! Leave her alone!”

  38. A Sarah, you are fucking brilliant.

    I just noticed an example of this the other day in an H & M print ad….giant letters said “SALE,” with an asterisk leading to tiny tiny fine print saying “none of the items shown are included in the sale.” SO MESSED UP.

  39. Still, the study adds new fodder to the often-heated debate about how closely body weight correlates to health.

    Honestly, can some people stop abusing this word into meaninglessness. A debate is when two or more sides exchange thoughts, it is not the way the truth and the light, seeing off the infidels.

    So why aren’t I dead yet?

    Are you sure, I mean, have you really checked, maybe you’re just deluding yourself!!

  40. The thing that confounds me is how convincing these reports are. Over the last year I’ve read too many to count and they all SEEM solid, reasonable, and rational.

    The chinks in their armor seem to be the way they define things and how they look at the numbers. Like in this study, there is no mention of how family history plays a part but the statistics they provide seem to suggest that family history is an important part of the picture.

    In some of the other studies there seems to be this issue of definition, where they lump together exercise and nutrition to equal weight, so they don’t look at exercise and nutrition independently of weight.

    It’s a debate because the information we have is not clear cut. And anyone telling you that the issue is clear cut, is lying.

  41. Honestly, can some people stop abusing this word into meaninglessness. A debate is when two or more sides exchange thoughts, it is not the way the truth and the light, seeing off the infidels.

    This is actually part of a weird phenomenon that has crept up more and more in the media. The idea that all stories, all things, all facts, are open to debate. I think in America it’s somehow a twisted version of our political system. All votes count and everyone gets a say, so therefore that should apply everywhere. Since we give candidates equal air time, we should give crap research funded by diet companies the same ‘air time’ as actual, you know, science. It is not anti-democratic to say that some opinions are just wrong if they are in conflict with reality. Just letting anyone with an opinion or an agenda spout off is apparently what now passes for ‘objective’ journalism.

  42. I’m with BrooklynShoeBabe on this. Unless they explicitly mention POCs in a study, I assume they’re not talking about me…or talkingto me, either. Especially since I come from a gene pool that regularly produces old, fat black women that develop conditions not (cor)related to weight at all.

  43. This is awesome, A Sarah! You and all the Shapely Prose folks have such a gift for drawing our attention to these things in a fun, enlightening way. Thank you!

  44. “there has been a steady increase in overweight and obesity; in 2003-4, 66.3% of American adults were overweight or obese compared with 14.5% in 1976.”

    Isn’t this also factually wrong? I might be the one who’s wrong, but I thought the 14.5% number in 1976 was only for obese adults, not overweight AND obese adults.

  45. Elizebeth Turnquist. Just wow on that last line indeed “As there is no standard definition of healthy survival, and as the criteria we used for some of our outcomes (such as physical function) might be considered somewhat arbitrary…”

    I want to know what sort of number tweaking HAS gone on there. “Well, we don’t think that anything related to malnourishment counts as un-healthy so keep all those people in the “healthy” figures….” Just imagining such a scenario makes me fervently wish it wasn’t even possible. And yet…

  46. Lori – I believe it is wrong, yes.

    Also they changed the definition of what qualified as overweight and obese in 1998 so the numbers shot up because they lowered the threshold to be put into that group down to a BMI of 25, so you can’t compare the stats from different years on either side of the definition change without adjustment (which nobody does).

    Plus the whole “the average age of the population has gone up significantly since the 1970s because all the damn boomers are getting older” issue nobody ever seems to take into account in screaming panicked media articles on this.

    Rar!

    DRST

  47. A Sarah, you just made me laugh until tears came to my eyes. Thank you!

    (And a big smushy group hug to all the wonderful writers and commenters at this blog – you’re the only reason i haven’t set fire to the internet.)

  48. Let me just reemphasize this quote from the study put in by @Elizebeth Turnquist upthread:

    “As there is no standard definition of healthy survival, and as the criteria we used for some of our outcomes (such as physical function) might be considered somewhat arbitrary…”

    How about the vision chart start with this:
    SOMEWHAT ARBITRARY SCIENCE SHOWS THAT UR FAT IZ KILLING U

  49. I had a horrible experience at a doctor’s appointment on Tuesday. I have been seeing this doctor for 7 years – he treated me for endometrial cancer twice. Now I’m 3 years post-radiation therapy and I’m fine. Fat (335 lbs) but fine (and 41). He was in the middle of the exam and said “so have you spoken to anyone about bariatric surgery?” I said “you have got to be kidding me!” This was mostly due to the fact that I was not wearing pants and he was not looking at my face when he asked this question. He persisted with the weight loss thing and was a complete concern troll. I said “I think you need to accept that I’m just fat. I work out with a trainer twice a week, I walk, I eat a healthy diet. I’m just fat.” He persisted with “I’m worried about your heart and your knees.” I said “they are fine.” “We have proven that the cancer you had was hormonally based” Ok, I’ll basically buy the argument that endometrial cancer is generally hormonally based as the endometrium is hormone sensitive. What I won’t buy is that my case was based on my “excess fat” as no testing was ever done on my hormone levels. He then made it clear that he doesn’t believe me that I work out, walk, and eat a healthy diet and if I do I must have some metabolic problem that is making me fat. Mind you, no one has ever found me to have a metabolic problem. I also told him I was tired of hearing this from him.

    He has mentioned losing weight before but this was the absolute worst. I will not go back. Now I remember why I skipped going to the GYN for 10 years until I was in such pain and bleeding so much that I had no choice and voila, cancer.

    So you ask why am I blathering on about this? Until a few years ago when I started reading this site I would have just tolerated his comments (and probably thought I deserved it because I was fat and everybody knows that everything wrong with me was because of my death fatz). I wouldn’t have spoken up and I certainly wouldn’t have even considered changing doctors. I will even write him a letter to tell him why I am leaving his practice.

    But it’s going to take a few more days for me to stop screaming about it.

  50. I just wanted to comment on the quote
    “As there is no standard definition of healthy survival, and as the criteria we used for some of our outcomes (such as physical function) might be considered somewhat arbitrary…”
    that sounds bad if you haven’t read the original paper, but they are actually trying in good faith to represent the choices that they had to make in order to be able to get this data. They go on to explain their definition pretty well and I actually think it isn’t bad as a population based definition of wellness (of course it isn’t generalizable to individuals, but we need to have some sort of grouping set up to be able to do statistics) this particular definition takes into account lack of chronic disease, cognitive state, physical fucntion (ability to perform moderate tasks such as walking up a single flight of stairs ect..) and mental well being.

  51. I’m sorry to hear that katmakai and iron lesbian.

    I’m sick of doctors not listening to me at all. One told me I had high blood pressure – I think it was just that I hated him and was stressed at his office. I’ve had my blood pressure checked at another doctors office and the grocery store a couple of times since, and it’s never been high except for my last two visits with HIM. Asshole doctor makes you wait forever to see him, and then comes in and doesn’t even listen to what I’m saying…no wonder I get stressed. He said “oh you seem stressed, here’s a prescription for Xanax”…I wanted to slap him.

  52. Tamar:

    Sorry to hear about the Celiac…and having to go on a wheat challenge. I went undiagnosed with it for about a year because I was a fat girl who did not lose weight (although I’ve had the neuropathy you described, headaches, horrible stomach pains and nausea).

    Good luck with the journey and check out Celiac.com, if you haven’t already. They have a ton of info about what’s safe and what’s not.

  53. Wow! To live a long life, we should lose weight? I’ll give my 91-year-old grandma a call right now and tell her that. Having been fat the vast majority of her adult life, I’m sure she’s totes ready for a change….. snort.

  54. In Canada, news stories about political opinion polls are required by law to include information about who paid for the poll, its basic methodology, the sample size and the margin of error. They also have to include instructions on how to find more detailed information about the methodology. I’m starting to think that we need similar legislation for stories about medical studies. I wonder how many different bits of information the law would have to require the stories to include in order to tip readers off to the most common forms of medical number-spinning?

  55. @emmaja: For me, anyway, it isn’t that I want to ridicule the scientists for having to use “somewhat arbitrary” standards. It’s that the news story doesn’t lead with, “Somewhat arbitrary standards have led scientists to conclude XYZ…” It starts with inflammatory language to get people’s attention and then puts the more detailed information (such as it is) so far down in the article that most people have stopped reading by then.

    Most people just retain, “FAT IS BAD.” Not, “we’re working on a way to quantify what ‘health’ is.”

  56. “there has been a steady increase in overweight and obesity; in 2003-4, 66.3% of American adults were overweight or obese compared with 14.5% in 1976.”

    I thought the 14.5% number in 1976 was only for obese adults, not overweight AND obese adults.

    The CDC has produced a table using current BMI values for this data. It says that in 1976 15% of adults were obese (using BMI > 30) and 47% were overweight or obese.

  57. So wait, a 9-point increase puts your chances of surviving until 70 at -8%?

    Does that mean you become undead of some description? Zombie fats? Vampire fats? Is this some kind of Herbert West, Obesity Researcher thing?

  58. @atiton I agree that the news article is written badly, in fact the vast majority of science articles on almost all subjects tend to be, which annoys the hell out of me as a scientist. I just wanted to explain what was quoted ( I thought that the “arbitrary” quote was pulled from the original paper rather than being part of the news piece) in the proper context, as bad reporting and the rather confusing nature of scientific writing can end up confusing the issue.
    I did read the article in full and a lot of the problems that people are bringing up in the thread were addressed. Interpreting the results of the paper is complex and of course should not be reduced to “fat is bad” for a lot of reasons, but on first read their data gathering and statistical methods seemed sound.

  59. Re: BMI and aging, I just thought of something that I’ve never seen mentioned anywhere before, but if someone else has already said exactly this, then never mind.

    But older women are at risk for osteoporosis, right? And osteoporosis can do what it’s done to my mom, even if it’s not severe, which is: cause you to shrink in height by an inch or two.

    But you’re probably not going to lose a proportionate amount of actual weight.

    So your BMI will go up even if you stay the same size, because you got shorter.

    Anyway. Hey, my BMI has gone up by about 6 points while I’ve been on birth control for the past three or four years. I’m gonna dieeeeee D:

  60. One factor they seem to have overlooked in this study: Anti-fat prejudice, as everyone here knows anecdatally (is that a word?), and as has been proven by not a few good studies, can have a considerable effect on mental and physical health. Not only do women start experiencing poor treatment on the grounds of their weight and size at a much lower weight than men of the same age, but these study subjects were nurses. If doctors mistreat fat patients, as they do, I wouldn’t think they treat fat medical staff any better.

    Sugared Harpy, you remind me of what happened with my mother. She was thin most of her adult life, put on a tiny bit of baby weight after my brother and me, but lost it all back, as it were, after about age 60. By the time she went into a nursing home, in her 70s, she was emaciated, but she was actually proud of it – kept boasting about how she weighed the same as on her wedding day, over 50 years previously – and it was impossible for any of the family or her doctor to convince her that she needed to try and keep her weight up, as far as possible, for the sake of her health. (She had parkinsonism, her coordination was poor, and she was injuring herself badly when she bumped against furniture and walls because she literally had no padding on her body.)

    It’s a cliché that ‘fat women die young, that’s why we’re left with little old ladies’, but from what I see, an awful lot of normal to fat middle-aged folks do seem to waste away in old age. I wonder if it’s not another of those natural life stages that involve putting on weight, like baby weight gain prior to starting toddling, and pre-teen weight gain prior to the growth spurt at puberty. I bet nobody’s actually looked into that.

  61. @Iron Lesbian 2 – About 10 years back, during a breast exam instigated by the fact that I found what I thought was a lump, the doctor told me very sternly that my weight was putting me more at risk for breast cancer (huh? is there ANY reputable study that’s claimed this?) and that also I needed to lose weight immediately because my being so fat would make it harder for me to find lumps and for them to be investigated (again, huh?). The total OMG you’re going to die if you don’t lose weight speech. She also visibly sneered. I so wish that I’d had access to some of the actual reasearch on fat and health back then so I could have thrown it in her face. Sadly, at the time I just cringed and felt awful, and let her berate me. Kudos to you for not doing that.

    (BTW, at the time I got the OMG you’re so fat we won’t be able to find breast lumps if you don’t lose weight speech? Sz 12 or 14, about 160-170 pounds. Doctors are insane when it comes to weight. Also internalised sexism for the win – part of the sneer was “well maybe if you lost weight your breasts wouldn’t be so large” while making a disgusted face.)

  62. On the arbitary thing –

    I think it’s fair enough for that ‘arbitrary assumptions’ phrase to set off alarms for us, as there are loads of supposedly scientific studies on fat which do make absolutely appalling, ridiculous assumptions to get their conclusions.

    I’ve just been reading a couple of articles (don’t have the links with me at work, but they’re from 2008, I think) arguing that obesity causes global warming, and their assumptions are so arbitrary it takes my breath away.

    For example: did you know that fat people cause more greenhouse gas emissions from transport than anyone else? No? Well, if you assume that all ‘normal’ size people drive small cars with small engines, and all fat people drive large cars with large engines (cause they have to fit all the fat in, obv), then you can study the difference in emissions between small cars and large cars and voila – fat people in destroying the planet shock!

    The other article did the exact same thing with food. It went something like – Junk food is bad for the planet. There is no evidence that fat people eat more junk food than thin people, but we really want to get this article published, so what we’ll do is, we’ll do a not very impressive estimate of greenhouse gas emissions from junk food production and attribute that all to fat people anyway! Just because we can! No one will read past the abstract anyway!

    And to think I used to have arts-person inferiority complex when reading science.

  63. @ Cassi – Blame the idea that everything is a matter of opinion on Fox News. It’s crept into everything like some sort of virulent weed, and now people think that “well that’s just your opinion!” is a valid rebuttal of everything up to and including “the sky is blue”. I do music journalism and my favorite recent example was the kid who quite earnestly argued that it wasn’t fair to say a particular dude was singing out of key because “well that’s a matter of opinion”. Um, no, sir, it is not.

  64. The idea that all stories, all things, all facts, are open to debate.

    It’s like that here too in the UK which is why I was always amazed at how many times on TV they would get a fat hating doctor, a fat hating ‘obesity professional’ and a fat hating nutritionist all saying the same thing. They had the cheek to present this as a debate/discussion about obesity.

    I sometimes wonder how much this has hurt us because people think, hell, if FA style views hardly appear in the media, they must be bordering on the psychotic, far beyond the pale of the outlandish nonsense that gets more of an airing.

    Are the nonsensical views there to lull us into a bit of a false sense of security about how open minded the media really is, and what else is not getting a fair hearing whilst they feature harmless eccentricity instead?

  65. @Cassandra: I got told that I should consider losing weight because of my elevated breast cancer risk, too. Looking back, the suggestion was more about the fact that my mom had just gone through her second (successful, thank god) premenopausal breast cancer treatment and I was clearly at a higher risk and there wasn’t much idea how to lower that. So, hey, maybe weight loss! I later read that higher weight was correlated with reduced risk of premenopausal breast cancer, not higher. So apparently “lose weight” is what doctors say when they really mean “I don’t know.” Between not being “overweight” at the time and being at a very body positive college where dieting and body hate were just not accepted, I think her comment became much more clearly about grasping at something she couldn’t really affect (my breast cancer risk) than any actual medical advice.

  66. Yeah, I am not a fan of the “well, why not lose weight?” advice from doctors. It’s worthless. I had one doctor suggest it last year for an ulnar tunnel nerve issue, and my response was, essentially, “How would you suggest I do that?”

    “Well, there’s always diet and exercise.”

    “No, I meant something that has actually worked, in your experience. If obesity’s a medical condition, where’s the treatment?”

    After some discussion–nutritionist? Meridia? small animal sacrifice?–she admitted that there were no actual medical treatments for obesity short of bariatric surgery, a bizarre oversight if it truly is teh deth fatz. I mean, with the numbers they give us, you’d think people would be up in arms, screaming for better research or a cure for obesity, wouldn’t you? No one has ever asked me to contribute a buck at the checkout counter to find a cure for teh deth fatz. No one seems unduly concerned that we’re still doing the Lord Byron version of weight loss two hundred years later. When they came up with “the reducing diet”, doctors were still bleeding patients, for crying out loud! Yet the medical establishment sticks with it, despite overwhelming anecdotal, personal and statistical evidence that it doesn’t work.

    Yet more evidence that this booga booga epidemic is really just a convenient way for everyone to give their inner judgmental Puritan an airing.

  67. Doctors are insane when it comes to weight.

    I saw this blog post this morning and got a laugh out of it. The author of the blog just returned to the US after living in China for years, and as a throwaway observation on repatriation, mentioned that there weren’t as many fat people as he’d expected.

    That comment touched off the predictable storm of letters, and in the post I linked, he got a letter from a fourth-year med student about why med students weren’t fat. The student said “maybe 5 people in my med-school class were ‘overweight’”, and went on to state hir height/weight as 6’2″ and 200 lbs… giving hir an overweight BMI of 25.7.

    (I did send the blog author an email suggesting that BMI cognitive dissonance may be at work, complete with a recommendation for the BMI project.)

  68. also I needed to lose weight immediately because my being so fat would make it harder for me to find lumps and for them to be investigated (again, huh?)

    Well, if it’s something in the center of your breast it will be a bit harder to feel if there’s more tissue in the way, but that’s what mammograms are for. What I’ve been told is that I’m at more risk than you are for misreads on mammograms and things because I have smaller breasts that are mostly mammary tissue, not fat, and thus are full of all sorts of inconveniently complicated tissue and are less squishy, making unusual lumps more difficult to distinguish.

    See, they can find something to blame in everyone :-b

  69. “As a black woman, I found this little disclaimer hilarious: “– And by “you” I mean “white lady.” Frankly, if you’re not white we’re probably not talking about you in the first place.” Most of the time, I ignore anything geared towards women because 9 times out of 10, they’re not really talking about me.”

    QFT.

  70. After some discussion–nutritionist? Meridia? small animal sacrifice?–she admitted that there were no actual medical treatments for obesity short of bariatric surgery, a bizarre oversight if it truly is teh deth fatz. I mean, with the numbers they give us, you’d think people would be up in arms, screaming for better research or a cure for obesity, wouldn’t you? No one has ever asked me to contribute a buck at the checkout counter to find a cure for teh deth fatz. No one seems unduly concerned that we’re still doing the Lord Byron version of weight loss two hundred years later. When they came up with “the reducing diet”, doctors were still bleeding patients, for crying out loud! Yet the medical establishment sticks with it, despite overwhelming anecdotal, personal and statistical evidence that it doesn’t work./

    This.

    And thanks Living400Pounds for showing that the CDC itself shows overweight and obesity have increased by only 4% – while underweight has been halved. People are getting *enough* food, not too much.

  71. @ starling — you’re lucky the doctor actually admitted that there was no medical treatment to “cure” obesity. Not all doctors are honest. It has taken me until last month to find a doctor I can trust. When the nurse rolled in the cart to take my blood pressure, I saw that there were three different size cuffs in the cart, and I actually teared up, I was so relieved.

    A Sarah, I’m sending your chart to my 83 year old overweight grandma, after she’s done hiking in Washington State with her two new knees (cleared by her doctor, who said she’s had the fastest recover of any of his patients). Thank you so much.

  72. @Starling,

    Brilliant. Everything you said!

    Is it just me or is the desire to bleed the demons out of a human body linked in some way to the desire to ‘bleed’ fat cells out of the humnan body?

    It’s struck me that the sheer aggression against the body to purge the body of fat(ness), is in keeping with the four humours theory of medicine and just as civilised;

    The four humors were identified as black bile, yellow bile, phlegm, and blood….. medical establishments that adopted and adapted classical medical philosophy, believed that each of these humors would wax and wane in the body, depending on diet and activity.

    Humourism.

  73. I always heard that in addition to helping one survive cancer or other life threatening illnesses, the fat and extra lbs help maintain bone density and reduce the risk of breakign a hip.

    Yep. My maternal grandmother had, shall we say, quite a bit of extra padding. She fell down a full flight of stairs at age 80 and suffered nothing more than a lot of bruising- no breaks. Her bones were strong and the fat cushioned her fall. She ate well, took many vitamin supplements, and walked a lot. She outlived both of her husbands and nursed the second one through the last three bedridden years of his life. In fact, until she was nearly 85, her only real health problem was a mild case of Type 2 diabetes- because she was old and so was her pancreas. She suffered a stroke not long before 85, and was recovered well enough six months later to get all dressed up for my wedding and walk down the aisle with no problems. She died almost exactly a year later, but for most of that year, she was in reasonably good health.

    But hey, she wore plus sizes. So she probably didn’t really exist, since one can’t be old and fat, right?

  74. Sorry I came late to the party. I noticed a while ago that all my older relatives seem to shrink and lose weight. Initially, I chalked this up to the stupid low fat diets they seem to be following, but after more reflection, I am not so sure. Maybe in my family we do just shrink and lose weight when we begin elder aging. Most of my male relatives were never fat to begin with, but almost all of us females are fat or were fat. And so even if we lose quite a bit of weight, we are still likely to be somewhat fat old ladies. While the menfolk all look a bit emaciated. And I really feel bad about that. It makes me worry about them. Having spent most of my life around older people, I can say without doubt that for various reasons it becomes increasingly more challenging to remain well nourished as we age. And illness takes a much heavier toll, because our bodies don’t as readily repair themselves. So being fat on the way in to elder hood doesn’t really seem to me to be a bad thing at all.

  75. I-Geek – Yeah, this is sort of what I’m thinking too. My Mom died of breast cancer and, other than one period of 5 or so years when she was clinically depressed (also I think a bit of post partum) she was pretty thin. As a kid, really thin, by the time she got sick, middle aged in shape but still thin. Her mom, my grandma? The healthiest 80+ person I’ve ever encountered, and has always been fat. I think the worst health problem she’s ever had has been a mild case of the flu. My dad’s sister, who also got breast cancer, recovered and is still alive more than 30 years later. And she’s fat.

    It really troubles me that people are making the suggestion that being thin can prevent cancer because not only am I not seeing any evidence to support that claim, if you’ve seen anyone go through the treatment process, it tends to lead to massive weight loss if chemo is involved. Surely anyone who starts out fat would actually be at an advantage there? I mean I still think what eventually killed my mom was starvation, not the cancer.

    (Just recently had a revelation that watching that happen was what snapped me out of my teenage anorexia. Nothing like watching someone you love get really skinny because they’re dying to put the desire to be skinny in a different perspective.)

  76. “Warning: do not attempt to view this chart through a feminist lens or it will appear distorted.” Well, I amuse myself.

    IMO it’s pretty clear here you amuse way more than yourself.
    WaPo should give you the column. :-)
    I’m pretty sick of their current columnist roster (not that I’ve ranted about that here, or anything).

  77. @CassandraSays, I’m so sorry about your mom.

    My mom is a survivor, and even though her doctors didn’t start telling her to lose weight until much much later — interestingly, when pounding one’s patients about “a healthy weight” became increasingly EnVogued — I’m sure, damn sure, her ‘extra’ weight helped her through chemo, because she had it to lose.

    Also get it about how it relates to the “another perspective on anorexia” thing. Hugs if you want them.

  78. My mom is a survivor, and even though her doctors didn’t start telling her to lose weight until much much later — interestingly, when pounding one’s patients about “a healthy weight” became increasingly EnVogued — I’m sure, damn sure, her ‘extra’ weight helped her through chemo, because she had it to lose.

    You know, I keep seeing people comment on studies showing overweight people have a longer life expectancies/lower death rates from certain diseases by saying “Yeah, but that’s because they have more weight to lose in treatment; it’s not that fat is healthy!” It makes me wonder what definition of “healthy” these people are working off of.

  79. LilahMorgan,

    It makes me wonder what definition of “healthy” these people are working off of.

    Answer: A mythical one.

  80. @littlem – Thanks, hugs always welcome. I actually do think the fact that my aunt was fat when she went into chemo helped a lot – like my Mom, even the smell of food was intolerable to her for a while, but she made it through that period, and I’m not sure if she would have if she’d started out at the same (about 40 0r 50 pounds lighter) weight my Mom did.

    And yeah, isn’t it a wierd feeling to realise that seeing something like that might have snapped you out of a different potentially fatal illness? I mean not that anyone is ever completely cured of anorexia – I think of it as more like being in remission – but forming a mental association between massive weight loss and death sure does lend a different subconscious perspective.

    I think this is why the idea of weight loss surgery has alarmed me ever since I heard about it. And I’m not criticising the decisions of anyone who chooses to do it – I know this is my personal issue – but for me, seeing anyone suddenly lose a lot of weight in a short period of time will probably always trigger worry and protective instincts.

    @LilahMorgan – Call me crazy here, but “alive” has always been rather a strong component of my personal definition of “healthy”. Also health is always a relative concept, so if you survive something like cancer? You are, relatively speaking, a lot healthier than you otherwise could have been. It’s good enough.

  81. @wriggles: Yeah, I think there’s a deep-rooted ascetic impulse that shows up in all societies–the practice of bleeding was one of its consequences. As we’ve more or less abandoned a cultural embrace of religion, it’s had to pop up all sorts of other places. I don’t think it’s an accident that our cultural obsession with dieting started around the same time that sexual mores were significantly loosened. We’re no longer ascetic about sexual appetites–we are encouraged to embrace sexuality as healthy and individual–so the self-denial has moved to food appetites, and shame and social condemnation has come with it.

    You notice that the burden of asceticism tends to hit the women of a culture? We get to be the great beacons of self-control, while the men eat Cheetos or have non-marital sex (depending on whether you live in 2009 or 1959) without condemnation. Essentially, culturally-imposed asceticism is a way for the powerful to control the less powerful. Jane Eyre has a great example in the family of Rev. Brocklehurst inspecting Jane’s school: the charity pupils had to be models of the kind of modesty, thrift and industry that the powerful would never dream of imposing on themselves. Likewise, the fat are held to a standard that the majority would never dream of imposing on themselves. (“OMG, a fat person at Chili’s! Obvs total self-control fail obesity deathfat health care costs aaauuughh!” Because the observer was totally at Chili’s just to drink Diet Coke and observe fat people, right?)

    Of course, this makes the disconnect between perceived and “technical” obesity problematic: if everyone is part of the Shameful Other, then who gets to do the shaming? Uh-oh! So we get headless fatties and the perpetual “You’re not fat” comments. And it makes HAES anathema to people who have bought in, because if diets really don’t work, and it’s really not just that fat people are eating lard by the bucketful, then maybe chocolate cake isn’t sinful and we can’t use appearance to condemn the moral character of people we don’t even know.

    And where’s the fun in that?

  82. I have been fortunate in that I myself have not been hurt by a doctor and fat prejudice (although I’m sure it’s just a matter of time), but my best friend was.

    I finally nagged her into going to see a doctor because she had been having abnormal menstrual bleeding and bleeding between periods. She goes to the clinic, and a nurse practitioner sees her (although she did see an actual doctor a couple of times). What diagnosis did she walk out of the clinic with? Pre-diabetes, high blood pressure and high cholesterol (WITHOUT glucose tolerance testing or a lipid panel) – because she was fat, fifty, and female. Regarding the abnormal bleeding – “Oh, it’s just menopause. Let’s wait 3 months and see.”

    AAAGGGGHHHH!!! Of course, I couldn’t convince my friend to do something about that because her father was dying and she had to deal with that before herself. This started in June. In OCTOBER, the practitioner said, “Oh, you’re still bleeding? Let’s do a endometrial biopsy.” Which they promptly did badly, so they didn’t really see any “abnormalities.” Their response: “Let’s wait another 3 months.”

    By this time, my friend’s father had passed away, so she demanded a second opinion, and had the biopsy results sent to the oncologic gynecologist surgeon (a gynecologic surgeon specializing in female cancers), who was so disgusted with those results he asked my friend to undergo a D&C. And THAT’s when he found the ENDOMETRIAL CANCER.

    So in December, my friend had a total hysterectomy, with a final diagnosis of Stage I, Phase II endometrial cancer (which means it was completely localized and had just started penetrating the uterine wall). Fortunately, all the abdominal washes and lymph node biopsies were clear, so surgery was all she needed. But she came SO CLOSE to having that metasize, all because a medical practitioner was more obsessed with her weight than with the blood coming out of her coochie!!!

    Yeah, I’m still pissed off as hell about it, although my friend has moved on and made a full recovery. Would that nurse practitioner have made different choices if my friend had been fifty, female, and THIN? I think so.

    Here’s the kicker: a mutual friend of ours went to the same clinic. She is also fat, fifty, and female. She got the SAME DIAGNOSES (pre-diabetes, high blood pressure, high cholesterol). Only she waited the additional 3 months. Now she’s undergoing chemo and radiation for the SAME DIAGNOSIS (endometrial cancer) because it had metasized to the lymph nodes.

    Needless to say, I tell every woman I know to NEVER go to this clinic for female care. It will get you killed.

  83. Starling,

    As we’ve more or less abandoned a cultural embrace of religion, it’s had to pop up all sorts of other places.

    Oooh, take that Ditchkens!

    Don’t get me wrong, I’m not a theist, but it annoys me when this is overlooked.

    the charity pupils had to be models of the kind of modesty, thrift and industry that the powerful would never dream of imposing on themselves.

    Yes, it’s as if controlling others is both a way of us controlling ourselves in a more pleasant way, and the reason we seek to control others.

    We control others to hide from ourselves who we really are. And vice versa, if we hide too much from who we are, we seek to control others.

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