Category Archives: Medicine

Fat is contagious again

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Several of you have alerted us to news about a study of an “obesity virus” that, when caught, appears to increase the number of fat cells in the body. (Long-time readers may remember that fat was already contagious through the power of magical thinking.) Now, I haven’t read the original study; I have no idea how much credence to give it. But what I can attest to is the oh so familiar treatment of this idea in the news. No article is complete without a headless fatty, of course (though this one went for the next best thing: the dreaded scale!).

The headless fatty pics set the tone for the freakout to come. The venerable BBC asks:

So if we want to remain slim, should we be shunning fat people?

Yes, that is an actual quote from a news article. Not from a person quoted in the article, mind you; that is just what the reporter asked the doctor who ran the study. You may find yourself wondering who this “we” is who wants to shun fat people, given that the graphic RIGHT NEXT TO THIS SENTENCE says that almost a third of Britons are obese. I’m guessing that Diane Roberts, BBC news health reporter, meant to file this under “Confidential: Thin people only” but messed up the html tags.

This article from the UK Daily Express site makes sure to include quotes from skeptics who just want us all to get off the damn couch, even if you have some stupid virus. In fact, the last several paragraphs in this article are a master lesson in cognitive dissonance:

Dr Shahrad Taheri, clinical director for obesity at the Birmingham Heartlands Hospital, said: “Most people believe obesity is caused by environmental factors.

“But there is a lot of information about how things like the furring up of arteries could be linked to infections. It is not beyond reason to think about various different factors, including infections, adding into the mix about what causes obesity.”

Tony Barnett, professor of medicine at the University of Birmingham, said: “These associations may give some clues but they detract from the basic message that we all need to take more exercise and eat a bit less.

“This kind of research needs to go on but we have to be cautious.”

Dr Colin Waine, chairman of the National Obesity Forum, said: “We must acknowledge it is a contribution to the research but it doesn’t alter the management of obesity.”

The documentary also reveals research which claims to explain why those on diets feel permanently hungry, even when overweight.

A US study found that people have a “natural body weight” and respond to losing a few pounds in the same way as if they were starving.

The findings suggest that overweight people who diet will always suffer hunger pangs, even if they become lean and healthy.

Let’s break this down a bit. Dr T says fat is caused by a mix of many different factors and that we don’t know how they all go together. Then Dr B says we should be “cautious” about studying the causes of fat because he is not going to change his prescription no matter what is found: have you tried diet and exercise, you stupid fatties? Dr W backs him up on the “management” of fat, virus or no. Then we not-so-seamlessly transition into the idea of natural set points and the hellishness of dieting.

So, the takeaway from this article is that you’re fat for a whole lot of reasons including that you maybe caught a virus way back when that magically made your fat cells multiply, but that’s no license to not diet even though you will literally feel like you’re starving. Fat is contagious, but it’s all your fault. Probably some other fat person sneezed on you when you were at Chili’s a while back, so now you lie around all day eating baby donuts and making all your friends fatter. Why don’t you hit the gym if you’re so susceptible to viruses and everything? Just wash those infectious hands before you touch any equipment.

Achoo!

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

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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.

Reality Check: Why Don’t Fat Women Get Checked for Cancer of the Nasty Bits?

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The Rotund points out a recent Reuters article about how clinically obese women are less likely to be screened for cervical, breast, and colorectal cancer. And of course, researchers and journalists just can’t imagine why.

It’s not certain why obese women are less likely to get these screening tests, as few studies have been designed to look at the underlying reasons

Well, here’s one: Stigma and Discrimination in Weight Management and Obesity, by Kelly Brownell and Rebecca Pugh. A few highlights (with my emphasis):

24% of nurses said they are ‘repulsed’ by obese persons

Numerous studies2-6 document explicit negative attitudes about obesity among physicians, nurses, dieticians, and medical students. These attitudes include: obese people lack self-control and are lazy, obesity is caused by character flaws, and failure to lose weight is due only to noncompliance.

Among physicians, 17% reported reluctance to provide pelvic exams to very obese women, and 83% indicated reluctance to provide a pelvic exam if the patient herself was hesitant.12 Given that overweight women may hesitate to obtain exams and that physicians are reluctant to perform exams on obese or reluctant women, many overweight women may not receive necessary preventive care.

Efforts to reduce bias toward obese people have been limited. One intervention study17 attempted to reduce stigma toward obese patients among medical students. Before random assignment to a control group or an education intervention using videos, written materials, and role-playing exercises, the majority of medical students in the study characterized obese individuals as lazy, sloppy, and lacking in self-control, despite the students indicating that they had an accurate understanding of obesity’s cause. After the intervention, students demonstrated significantly improved attitudes and beliefs about obesity compared with the control group. One year later, the effectiveness of the intervention was still evident.17

Here’s another one: Barriers to routine gynelogical cancer screening for White and African-American obese women, by Amy, Aalborg, Lyons and Keranen.

The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women’s BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were ‘moderately’ or ‘very concerned’ about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them.

I find that bit about having been on weight loss programs five or more times fascinating. Because the logical conclusion is, these are women who know bloody well that diets won’t work for them–and also know bloody well that no matter what they see their doctors for, including a fucking pap smear, they’ll be told to go on yet another diet.

24% of nurses are repulsed by fat people. 17% of doctors don’t want to put a speculum up a fat woman’s vagina. (Do they enjoy giving pelvics to thin women? ‘Cause, ew.) A majority of medical students think fat people are “lazy, sloppy, and lacking in self-control.”

Yeah, it’s a total fucking mystery why fat women don’t want to have their most vulnerable body parts, the ones culturally designated as most shameful, poked and prodded by medical professionals. How could we ever begin to figure that one out?

Quick hit: WaPo on fat prejudice in medicine

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Roni Caryn Rabin is quickly becoming the fatosphere’s new best friend, perhaps the more wired-in version of Gina Kolata. On the heels of the fatosphere article, Rabin linked to SP/F-word side project First, Do No Harm in a Washington Post article on fat prejudice in medicine and the assumptions that doctors make about their fat patients.

Two studies in the journal Obesity Research in 2003 found that many physicians harbor negative attitudes toward fat people: A University of Pennsylvania study of 620 primary care physicians found that more than half reported viewing obese patients as “awkward,” “unattractive,” “ugly” and “noncompliant”; a Yale study reported that health professionals strongly associated being overweight with being “lazy” and “stupid.”

Such negative views, some experts charge, may be helping to drive patients away: These experts point to a 2000 study of 11,425 women, which found heavy women less likely to obtain cancer screenings such as Pap smears and mammograms even though they’re at higher risk of dying from cervical cancer and breast cancer. Newer research has produced similar findings: A 2006 study of 498 women, published in the International Journal of Obesity, found that obese women delayed cancer screenings more than other women. Negative attitudes of health-care providers and disrespectful treatment were among the reasons cited for postponing care.

This is a subject that I honestly think almost nobody has written about but us bloggers — Thorn in her incredibly affecting series of guest posts, and our contributors at First, Do No Harm. Fear of the medical establishment brought on by systematic mistreatment may be one of the biggest contributors to the correlation between fat and ill health, but it’s almost never called out — with the result that many people who experience it think that they’re the ones doing something wrong. Rabin deserves kudos for helping to expose a dirty little medical secret. She’s shown herself to be uncommonly good at maintaining equilibrium in the face of undoubtedly strong editorial pressure to pass more judgment on fat, so I hope she stays on the beat for a while.

I do wish she’d been able to insinuate a little more about the real causes of the “obesity crisis” (so, you say fat people can’t get equal medical treatment, either corrective or prophylactic? And you say that being fat is associated with health problems? Well gee, I can’t for the life of me see how those are connected). But it’s pretty radical to envision any cause for obesity-correlated health risks beyond “fat kills,” and I can’t really expect the world.

What do you think? And what’s your experience with the medical profession? (Mine’s been pretty fortunate, aside from the GYN who told me I was having pain during sex because I “sweated too much” and the doctor who sent me a note saying “EXERCISE AND LOOSE WEIGHT AND AVOID FRIED FOODS ,EAT A LOT OF VEGETABLE.” If you know anything about my habits, the second one is particularly absurd.)

Edit: If you’ve had a good experience with your doctor, please consider adding him or her to the Fat-Friendly Health Professionals list!

Edit 2: And if you’ve had a bad one, consider filing a complaint.

First, Do No Harm

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The response to Thorn’s beautiful series of guest posts was overwhelming. I’ve rarely gotten so many comments on a Shapely Prose post as I did on her first post, outlining how a doctor’s callous words led to the death of Thorn’s mother.

So when I was about 11 years old, and Mom went to see her doctor because of some problem she was having, and he scathingly told her that her problem was she was fat, and not to come back to him until she’d lost 50 pounds? Yeah. It hurt her. It hurt her bad. But she believed in the rules. And so she tried to ignore how hurt she was and focused on trying extra-hard to get back to following those rules…

Having been unable to meet her doctor’s demand that she lose 50 pounds, she followed the only part of his stated rule that she could: she didn’t go back.

From that point on, whenever she got sick or injured and someone suggested she go see a doctor, she brushed them off. “Oh, they’re just going to tell me I’m too fat. Don’t worry, it’s just a cold/a sprain/a whatever. I’ll be fine.”

If you haven’t read the whole post yet, go do that now.

And if you haven’t read the comments, which are full of heartbreaking stories about the way doctors treat fat people, I’ve collected some of the highlights here.

Continue reading →

Fat Hatred Kills, Part One

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[Note from Kate: I can't believe I think there might be a need to say this, but there might be... This is a personal essay that Thorn is sharing with us because I asked her to. It's intimate stuff about her mother's recent death. It is not a freakin' polemic. So if anybody comes in here and starts arguing about where the blame for her mother's death really lies, or trying to tell her she's wrong about things she's said in this personal essay, the comment will be deleted, and the author will be banned. I will be compulsively checking e-mail while I'm away, even if I'm not posting. Don't try it.]

Guest post by Thorn

My mother died on May 1st of this year. A little more than two months ago.

It’s very difficult for me, on a lot of levels. She and I had a very difficult relationship, for a long time, and so while we weren’t fighting when she died, it’s mostly because we weren’t exactly on speaking terms, either.

That’s difficult for me to cope with.

But people understand that. People get that. And so a lot of people have been very kind and reassuring, reminding me that even if we never could seem to just talk to each other, she knew I loved her just as I knew she loved me.

What’s more difficult for me to cope with is the anger.

It’s hard to even know where to begin, to express this white-hot rage I carry.

And what’s extra-hard about it is that I can’t really talk to many people about it. I’ve tried, but most of the responses I’ve gotten only serve to piss me off more.

See, this is what I’m pissed off about: my mom is dead not because she was fat, but because of how she was treated for being fat.

Continue reading →