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The Long-term Consequences of WLS - Rich & Heather's Story

My name is Rich, but I may be better known to some of you as richie79 of the UK who used to post prolifically here on Big Fat Blog and elsewhere in the Fatosphere for many years. Don't know if any of the old faces are still around but I wanted to share my wife Heather's story and felt this was maybe as good as any a place do it. If you believe otherwise, please let me know and I'll remove it.

In February 2005 a pretty girl with big brown eyes by the screen name of 'sweetheather86' sent me a 'smile' through a plus-size dating website of which we were both members. At the time I was at a low point following the failure of a previous long-term relationship. Heather and I hit it off almost immediately despite her being in the US and at 18, almost 7 years younger than I. Looking forward to daily emails from one another quickly progressed to a first nervous long-distance phonecall, nightly 4-hour chat sessions on MSN and before either of us knew it I'd booked a ticket to Boston. Two incredible weeks on from our first shy meeting at Logan Airport I knew this was the one person I wanted to spend the rest of my life with.

The only cloud on the horizon was the gastric bypass Heather underwent just two weeks after we first made contact. Even then I knew of the horrendous risks of these operations but although I had already fallen for her, didn't feel i knew her well enough to ask her to delay or reconsider it. She came from a long line of big women and had herself been fat throughout childhood, resulting in numerous failed diets and all the bullying and self-loathing that accompanies being a fat child / teen. At the time the media was full of stories of this 'magic bullet' and several of her family members had undergone the surgery with dramatic initial results. She told me that she wanted it done so that she could have all the things in life she had been convinced were not available to people of her size - someone to love her, a home and a family, access to nice clothes, and not to be abused and harassed in public. Tragically she later told me that she opted for the bypass as unlike the lap-band it was irreversible (the stomach is cut in two and 18" of small intestine removed and discarded) and therefore offered no opportunity to back out at a later stage.

Our relationship continued to blossom even as her health began to deteriorate. Each of us crossed the Atlantic to spend long periods together in one another's countries and during this time we crammed in as many activities, visits etc as many couples do in a lifetime. In September 2007 I proposed to her and she accepted tearfully and without hesitation; we were married two years later almost to the day and having obtained a spousal visa, in July 2010 she finally moved to Leeds in the UK to live with me full-time. By this point she had lost around 200lb and gained back almost 100lb of that. She was on a cocktail of drugs, could eat very little, suffered from constant dumping syndrome and was developing problems with joint pain, blood sugar and constant fatigue, all of which were exacerbated by a revision to the original surgery to repair the staples but which further reduced the range of foods she was able to eat.

In October 2010 Heather gave me the news that she was pregnant. Our joy at this was tempered only by concerns about her deteriorating health. Fortunately apart from having to be artificially rehydrated several times (she suffered from such debilitating nausea throughout the pregnancy that she was at times unable to keep down fluids) her pregnancy passed largely without serious incident. Our son Ben was born in June the following year; despite several attempts to induce her at term plus two weeks she never progressed to active labour and had to undergo an emergency Caesarean section on one of the hottest days of the year in an overwhelmed Leeds General Infirmary where she was treated like an inconvenience by several of the medical staff.

Her surgeon in the US had recommended a UK counterpart in our city who might have been able to help but NHS rules decreed she would first have to see a dietician. As was often the case I went along with her as she was rightly worried that this would be used as yet another opportunity to shame her about her weight; predictably the dietician told her that on her sub-1000 caloric intake it was 'impossible' for her to be maintaining at 320lb and that there must be something she wasn't telling her (because *everyone knows* that fat people always lie about their eating habits). This was followed up by a barium swallow which suggested she may be suffering from a stricture (narrowing) of the digestive tract and the prospect of further investigation, though subsequent events meant this never ultimately took place.

On the weekend of 8th February 2013 I went to visit friends in another city an hour away from home. Heather had encouraged this rare weekend away, as we took it in turns to give one another breaks from the stresses of young parenthood when possible. She waved me off at the train station with hugs and kisses and called to tell me goodnight later that evening. That would be the last time I ever heard from her. My attempts to contact via text and phone throughout Saturday went unanswered and, knowing how out of character this was, my friend drove me home. Unable to gain access to the house, which she'd locked from within the previous night, I frantically called the police, who broke in through our basement and found her collapsed in our bathroom. I was told that she'd been gone for some hours. Our little one was fortunately still upstairs in his crib and none the worse but for need of a clean diaper, a good feed and a cuddle.

Initially we thought the cause may have been related to a persistent headache she'd been complaining of but which her doctor had failed to take seriously. The results of the post-mortem however showed the truth to be far worse. Unbeknown to anyone she'd developed a fistula at the site of the gastric bypass surgery. This had suddenly ruptured causing, as the report put it 'destruction of chest cavity and diaphragm through discharge of gastric material'. I don't even want to imagine the discomfort my poor sweet girl likely suffered in her last hours, or to think that the surgery on which she'd once pinned her hopes of acceptance (and subsequently come to regret when she realised that her happiness was not weight-dependent) had been a ticking timebomb from the very outset of our relationship.

Heather was without a doubt one of the sweetest, kindest, most loving people I have ever had the privilege to know. In a world beset with so much cruelty and unpleasantness she was a revelation of tolerance and humanity. For the first time in my 33 years she made me comfortable in my own skin, gave me confidence to be myself and become a stronger person through my recent diagnosis with Asperger's Syndrome, a strength that only left me two Saturdays ago. Our long-distance relationship was forged in patience and anticipation of better days ahead, giving us a depth of connection that is all too rare and making us soul mates in every sense of the word. Heather loved me for my differences and quirks rather than despite them, as I loved hers and trusted her implicitly. In turn she told me that my unconditional love for her had finally given her the contentment and safety she craved when so much of her life had been marked by pain and unhappiness. She often said 'I'll always be your girl', over the years it became our little refrain that she would add to the bottom of cards and emails and tell me last thing at night. My life, Ben's life, those of all who knew her and the world at large will be all the poorer for her absence from them. Rest in peace forever sweetheart, know no more pain or torment, and I'll be counting the days till I'm back at your side.

(Cross-posted as 'Rich & Heather - Love Can Bridge an Ocean' to 'First Do No Harm' blog at www.fathealth.wordpress.com, WLS Uncensored Yahoo group and my personal FB page).

NWSA 2013 Fat Studies Interest Group Call for Papers

NWSA 2013 Fat Studies Interest Group Call for Papers
November 7-10, 2013, Cincinnati, OH.
Papers on any topic at the intersection of women's studies/ feminism/ womanism/ gender/ sexuality and fat studies will be considered.


At minimum, your submission should fall under one of the following themes for NWSA 2013:


* The Sacred and the Profane
*Borders and Margins
*Futures of the Feminist Past
*Body Politics
*Practices of Effecting Change


For more information on the themes, visit: http://www.nwsa.org/


While this is an open call, topic suggestions from last year's meeting include:


-Defining and Refining Fat Studies
-Fatness and Beauty Ideals/Beauty Privilege
-Women of Color and Body Size/Fatness
-Fat Intersections (including race, nationality, disability, sexuality, appearance/beauty)
-Teaching Fat Studies (professorial bodies, student bodies, resistance)
-Fat Feminist Research Methods (including role of the researcher body)
-Fat Feminists Theorizing the Body
-Fatopias/Fat Utopias
-Transnational Fat Bodies (immigration, globalization)
-Knowledge-sharing/de-colonizing
-Fat Performance/Performing Fatness/Fat Icons
-Fat Activism & Feminism/Fatosphere


If you are interested in being a part of the 2013 Fat Studies panels at NWSA, please send the following info by February 13, 2013 to NWSA Fat Studies Interest Group Co-Chairs Michaela A. Nowell and Candice Buss: (michaela.nowell@uwc.edu and cdbuss@uncg.edu). Please make sure one of us confirms receipt of your submission.


Your submission should include your:
*Name, Institutional Affiliation, Snail Mail, Email, Phone.
*NWSA Theme your paper fits under (and fat studies topic area/s if yours fits any of the above).
*Title for your talk, a one-page, double-spaced abstract in which you lay out your topic and its relevance to this session.
*AND a 100 word truncated abstract (NWSA requirement).


Each person will speak for around 15 minutes, and we will leave time for Q&A. In order to present with your name in the program, you must become a member of NWSA in addition to registering for the conference.
_____________________________________________________________________
If you submit a fat studies related paper or panel, you can tag it with the keyword 'fat feminisms,' and likewise search the program for 'fat feminisms' to find relevant panels. If you submit a paper or panel on your own, we encourage you to use this keyword if your paper or panel fits the bill. We thank NWSA for adding a keyword that helps conference attendees locate fat studies panels.

Conflicting research on fat kids and their health

I have three articles for y'all today, all of them about children's health, and all of them seem to be conflicting with each other (but then, what else is new with obesity research in general, right?).
The first article is Overweight Teens Typically Eat Less Than Normal-Weight Peers. This one seems like a no-brainer to me, since it's also true of "overweight/obese" adults and studies have proved that time and time again. The thing that's infuriating about the article is that it's blaming these teens for being fat in the first place because - wait for it - they overate as toddlers/young children. What it doesn't take into consideration is that maybe, just maybe, these teens are eating less than their peers because of the bullying they face for being fat, the blame and shame they face every day from every source there is because they don't fit society's "ideal" body shape, or the blame and shame they get from their doctors who ignore their metabolic health in favor of that dreaded number on the scale.
The second article is Taste Buds Less Sensitive In Obese Kids. This study has all kinds of problems with it, that I can see, anyway. First of all, 85% of the fat kids were from lower socioeconomic classes, they didn't control for gender differences, and the only thing they really did control for was whether the kids were fat or "normal-weight". The conclusion they reached was that fat kids have trouble identifying the intensity of sweet and salty until something is either very sweet or very salty (ergo, that's why fat kids eat too many sweets or too many salty snacks and are fat, I guess).
All of these kids were between the ages of 6 and 18, so I'm wondering how many of them had been on diets (and since they all came from the hospital's pediatric obesity center, you can almost guarantee that most of them have dieted at least once. So did the researchers take into consideration how that affects one's sense of taste? Did they take into consideration what the children normally ate on a daily basis? That can affect one's sense of taste. There are just too many variables to know if this study has any value.
The third article is More Exercise Cuts Kids' Diabetes Risk. The problem I have with this study is that they're saying that 28% of these kids were pre-diabetic and the aerobic exercise lowered their insulin AUC by "2.96 mU/mL relative to control in the low-dose exercise group and by 3.56 mU/mL versus control in the high-dose group". Without knowing what they considered pre-diabetic (the starting diagnostic for insulin AUC), I'm not sure I'd consider that a significant drop (going from 100 to 97 isn't a big deal with a fasting blood sugar, and if 95 is the number at which they say you're not pre-diabetic, is this really a big deal after all?). And one semester of activity, with no follow-up? WTF? Are they really aiming to improve these kids' health, or are they just using them as guinea pigs to prove a point? Because if the activity isn't continued, the improvements aren't going to be maintained, and where does that leave these kids, health-wise? Sure, their insulin AUC improved for a while, and they lost some visceral fat, and improved their aerobic fitness, but if they don't continue the activity sponsored by the research, all of those improvements could be lost. I really don't see a school continuing a sports program where movement for movement's sake is the goal, rather than winning at any cost, do you? And that was the carrot to get these kids moving - participate in the sport whether they were good at it or not, have fun with it, and who cared about winning or losing as long as they played. That's not the way schools do sports.

Man fired because of his size wins lawsuit

The Houston Chronicle reports that a man who was fired from his job solely because of his size (his performance reviews were excellent) has been awarded compensation by the local district court. The July 25th article, Fired obese worker will get $55,000, details the court case and the circumstances surrounding it.

It's good to know that larger Americans can turn to the court system when they are discriminated against by employers. However, Mr. Kratz hasn't found a new job since being fired in 2009. I hope that the sum he's been awarded by the courts helps him out, but this just underlines how pervasive size-based discrimination is in employment.

Talking Fat now available

Talking Fat: Health vs. Persuasion in the War on our Bodies is now available from Pearlsong Press, Amazon and Barnes and Noble online. Amazon says temporarily out of stock because the book is print on demand. If you order it now, you should receive it in a timely manner (depending on Amazon).

I will be at the NAAFA conference. I will not be selling books there. However, if you get a book beforehand, find me, and I’ll gladly sign it for you. Feel free to come up and introduce yourself – I’d love to meet some of our readers! (Look for the tall, fat blonde with a long nose and a Texas accent.)

See you at NAAFA!

Study: Weight isn't the real issue

Big Liberty has already covered this on her blog, but I wanted to add a note about it here, too.

HAES advocates keep saying over and over again that weight isn't the real issue. If you have an issue with cardiac risk factors, then it's best to address those risk factors by tweaking your habits and, if necessary, using drugs. The same is true if you have an issue with high blood sugar. Control the blood sugar, and let your weight do whatever it's going to do in response to any changes you make. The number on the scale isn't the main issue.

Now, there's a study that strongly supports that view. It's a high quality analysis of population level data.

Anthony Jerant, Peter Franks. “Body Mass Index, Diabetes, Hypertension, and Short-Term Mortality: A Population-Based Observational Study, 2000–2006″ J Am Board Fam Med July-August 2012 vol. 25 no. 4 422-431

If you follow the link above, you'll find that the entire text of the study is available for free.

In analyses not adjusted for diabetes or hypertension, only severe obesity was associated with mortality (adjusted hazard ratio, 1.26; 95% confidence interval, 1.00–1.59). After adjusting for diabetes and hypertension, severe obesity was no longer associated with mortality, and milder obesity (BMI 30-<35) was associated with decreased mortality (adjusted hazard ratio, 0.81; 95% confidence interval, 0.68–0.97). There was a significant interaction between diabetes (but not hypertension) and BMI (F [4, 235] = 2.71; P = .03), such that the mortality risk of diabetes was lower among mildly and severely obese persons than among those in lower BMI categories.

Yes, not only were even the highest BMIs only weakly associated with excess mortality, fat diabetics are less likely to die than thin diabetics. This study also found that people with BMIs under 35 do not have an elevated mortality risk at all, not even when diabetes and heart disease aren't controlled for.

Interesting stuff.

Pre-diabetes: a fake disease?

Once again, I'm just putting this out there.

Diabetes, real diabetes, is a health condition that needs to be carefully monitored and controlled. The repercussions of not doing so can be pretty horrific.

However, what the hell is "prediabetes," and does it really mean anything? Is it just a way for the drug companies to make basically healthy people into patients and increase profits? It has to be asked.

Phamawatch Canada is asking, in "Manufacturing Diabetes":

The diagnosis of pre-diabetes is bad news for patients and their families, most of whom have no idea about all the drama in the background. But it’s also bad news for society as a whole because of the enormous costs associated with treating millions of people who do not have a medical condition. But for the pharmaceutical and diagnostic industries, it’s a great turn of events — and there’s little doubt that Big Pharma has influenced the lower thresholds that have been put in place.

Health News Review printed this follow-up which contains links to other articles that are exploring the question.

Diabetes is a chronic disease that should be taken seriously, but slightly elevated blood sugar doesn't have the same effects on health as full blown diabetes - and slightly elevated blood sugar levels do not necessarily continue to rise until they hit diabetic levels. Is pre-diabetes simply a conservative approach to diagnosis, or is it just a cynical strategy being used by drug companies to create more customers?

Debate: 'Is obesity a disease'

I haven't had time to watch this yet, but I'm just putting it out there for discussion. It should be interesting.

Dr. Jacqui Gingras is a HAES advocate and Dr. Arya Sharma is Alberta's leading expert on obesity. I think it's fair to say that Dr. Sharma is somewhat less enmeshed in the size=health paradigm and in social prejudice than many others in his field. I'm hoping that it's going to be a sane and reasonable discussion.

Joseph Abdulnour initially posted this on Obesity Panacea.

The YouTube intro:

Dr Arya Sharma and Dr Jacqui Gingras debate whether obesity should be viewed as a disease in Ottawa, Ontario on June 7, 2012. The event was moderated by Dr Mark Tremblay, and was supported by a Café Scientifique grant from the Canadian Institutes of Health Research as well as an event grant from the Canadian Obesity Network and in-kind support from the Healthy Active Living and Obesity Research Group at the Children's Hospital of Eastern Ontario Research Institute. To download the audio of the debate, visit http://blogs.plos.org/obesitypanacea/2012/06/13/is-obesity-a-disease-debate-r.... Video by Joseph Abdulnour.

WLS Surgeon Faked Data in Medical Studies

From Retraction Watch: Three more retractions for weight loss surgeon Edward Shang for making up data.

Edward Shang, the weight loss surgeon who lost his job at the University of Leipzig in May after it was revealed that he had made up most, if not all, of the patients in his research studies at the University of Mannheim, has retracted three more papers...

The authors of the above articles have requested their withdrawal, notifying the Journal that the clinical trials described in the articles were not conducted as written in the article. The Editor-in-Chief, the American Society for Parenteral and Enteral Nutrition, and the Publisher have determined to retract the articles.

The first paper has been cited three times, according to Thomson Scientific’s Web of Knowledge, while the third one has been cited 32 times.

Shang has already retracted a study in Surgery for Obesity and Related Diseases, and one in Obesity Surgery. A May 9 University of Leipzig press release refers to a total of six retractions, so there is apparently one more on the way.

Here are the three latest studies in question:

  • Pump-assisted versus gravity-controlled enteral nutrition in long-term percutaneous endoscopic gastrostomy patients: a prospective controlled trial. Journal of Parenteral and Enteral Nutrition, 2003;27:216-219.
  • Pump-assisted enteral nutrition can prevent aspiration in bedridden percutaneous endoscopic gastrostomy patients. Journal of Parenteral and Enteral Nutrition 2004;28:180-183.
  • The Influence of early supplementation of parenteral nutrition on quality of life and body composition in patients with advanced cancer. Journal of Parenteral and Enteral Nutrition, 2006;30:222-230.

UK Government criticises obesity epi-panic

Just by way of an update, the All-Party Parliamentary Group into body image has now published the report of the inquiry discussed above. Considering this a Government document there's some really good, groundbreaking stuff in there, including acknowledgement of the limitations of the BMI, the role of constant media discussion of the obesity epidemic as being key to fuelling fear of fat in children, the prevalence and effects of weight stigma, the potential harm being caused by the National Child Measurement Programme, the need to re-frame the emphasis of public health messages away from the current focus of weight and obesity and even (and perhaps most controversially) the potential for legislative action against discrimination and prejudice based on appearance, effectively making weight a protected class in terms of access to employment, housing, goods and services.

On the downside (and not entirely surprisingly) the recommendations place a disproportionate focus on the role of the media over and above that of central / local Government and their often ill-advised NHS / Education Department campaigns which deliberately target children and problematise fat at an increasingly younger stage. They also take claims that there is an obesity epidemic or multiple crises of public health for granted and avoid examination of the evidence base for these, instead regurgitating the 'accepted wisdom'. Some of the language also leaves much to be desired. But all in all, it's a good start.

However as the group's primary targets the mainstream media, has unfortunately and almost without exception attempted to downplay, dismiss and put a negative spin on the group's findings in a thoroughly spiteful and apparently co-ordinated attempt to ensure that after a flurry of animosity toward fat people the report ends up being quietly forgotten about. The worst culprits were (as usual) good old Auntie Beeb with a piece which focused exclusively on the recommendation that public health messages be presented in weight-neutral language and twisted it into being about 'banning' the use of the 'overweight' and 'obese' labels (again).

Of course all these articles have comments enabled and if one were to take the balance of opinion expressed within at face value (which I long ago learned never to do) you'd be mistaken for thinking that denying the great British Public their right to bully and shame fat people was up there with ID cards and road pricing in the list of unpopular Government suggestions; as such expect to hear little more about it. When the UK press and media bare their teeth, woe betide anyone who resists.

"What is right is not always popular and what is popular is not always right" - Albert Einstein

Loving Your Body

A very interesting conversation has been going on in the tumblrverse about the meme of loving your body. Marianne Kirby argues that this meme can be problematic. Kirby explained her issues with the concept on her tumblr page:

It’s very much coming from a place where people want to feel good about themselves and to help other people feel good about themselves, too.

But it homogenizes bodily experience and feeling - basically it dictates the One True Way people are “supposed” to feel about their bodies. And that skeeves me. Because there are lots of reasons people have complicated relationships with their bodies - from trans identity to disability to body dysmorphia in general and so on.

 
I also think that for someone just coming off dieting or an eating disorder, loving the body is far too tall of an order. I found loving my body to be unfathomable at first and not something I could force. Feeling love for the body can be incredibly challenging, and really is not necessary in my experience.

However, I found that accepting my body is very important. For me, the ideas expressed in the Serenity Prayer, popular in recovery circles, are applicable in this situation:

Grant me the serenity to accept the things I cannot change, to change the things I can and the wisdom to know the difference.

I spent many years hating my body and not accepting it as it was. I did myself a great deal of emotional and physical damage with that state of mind.

So, I had to make acceptance important. I could change some things such as becoming stronger or flexible. However, after 30 years of trying, I had to accept my weight as it was.

Additionally, I must accept my body as it is before I can make any improvements. I have to accept my current level of fitness before I can make progress, or I wind up injured and in worse shape. I have to accept my health where it is before I can address any issues, before I try to make it better.

To me feeling love for the body is not as important as accepting it and honoring it. Yet, I think accepting and honoring are forms of love – love the verb. We tend to think of love as a feeling – that ooey-gooey feeling we usually associate with the term. That feeling is wonderful, but fleeting even in the best of relationships or situations.

What is not fleeting is the choice to act lovingly, whether it be to ourselves or others. I can always choose to act lovingly towards my body, no matter how I feel about it. I can always choose to connect with my body. I can always choose to feed it and exercise it according to its needs. I cannot control how I feel about it.

So, in my viewpoint, trying to feel love for my body really isn’t important. Choosing to treat my body with respect and honor, to act lovingly towards it, is vital.

Marilyn Wann's two cents on Weight of the Nation

Weight of the Nation. It's the toxic new HBO documentary on how all of the disgusting and out of control fat people are going to bring down western society. Fuck you very much, HBO!

Marilyn Wann is on it in her latest SF Weekly column, Weight of the Nation Serves Up More Fat-Shaming. Marilyn reminds us:

I attended the first, government-sponsored Weight of the Nation conference in 2009. I didn't pay or anything self-defeating like that. I just walked in (with a brave friend or two) and delivered plastic-wrapped fortune cookies to the fancy luncheon tables where major stakeholders were about to chew on the alleged "obesity" problem. If the professional food scolds took a cookie, they got messages like these:

  • The war on "obesity" is a war on PEOPLE!
  • The No. 1 threat to fat people? Your unexamined prejudice.
  • What's the word for science that serves bigotry? Hint: It starts with "you."
  • If you can't imagine fat people being healthy...that's YOUR pathology!
  • Tell people to lose weight if you want to endanger public health AND civil rights!
  • How many fat people must you starve, poison, slice up? Celebrate weight diversity now!

AND she includes this nice video from the Association for Size Diversity and Health (ASDAH):

But don't stop here. Check out the whole article.

There's a new issue of Vol•Up•2 online!

I wrote a BFB post on the first issue of Velvet L'Amore's incredible web magazine Vol•up•2, so it's only fair to give all of you a heads-up. A new issue is available! Even better, I've figured out how to embed it in this post.

However, WARNING, this is not safe for work. It contains artistic nudes.

So without further ado...

Chewing the Fat in the UK

So spring is in the air and our old friend Jamie Oliver is back to his usual rabble-rousing with demands that academy schools must be subject to the same draconian school meals standards as LEA-controlled ones and the launch of a campaign, backed by an alliance of celebrities, footballers and obesity campaigners for compulsory healthy cookery lessons in schools. The second may be a laudible objective in its own right but of course he justifies it in the context of fighting what he describes in typically potty-mouthed fashion as the ‘biggest f**king obesity epidemic ever’. Ironically, the School Food Trust, a taxpayer-funded organisation set up to implement improvements’ to school dinners in the wake of Oliver’s first campaign in 2005, is now warning that many children are at risk of malnutrition as a result of inadequate portion sizes driven by requirements to reduce calorie contents, lack of cafeteria time and fear of weight gain.

Whilst a survey of British doctors and the claims that a majority support restricting healthcare to smokers, drinkers and fat people has been receiving a lot of attention from Fatosphere bloggers, another story involving doctors passed largely un-noticed. The Academy of Royal Medical Colleges, which claims to represent every doctor in the UK, has united in a ‘crusade’ against obesity, which it claims in predictably Chicken Little-esque fashion to be the biggest single issue facing Britain. According to its spokesman Prof Terence Stephenson the project will spend three months reviewing the evidence for different types of obesity interventions and strategies but the striking thing about this is how much has already been taken for granted; that obesity is a problem requiring intervention is never questioned and the familiar alarmist urgency of language abounds. Whilst it is pointed out that the recommendations are not final, the proposed inquiry seems to be something of a window-dressing exercise and I’ll bet my house there’s no mention of HAES or the counterproductivity of some of the more extreme proposals being mooted anywhere in the final report.

Meanwhile the latest salvo in Peta’s anti-obesity crusade has not been well received. A billboard depicting a coffin-shaped meat pie with the tagline ‘fight obesity, go vegan’ has invoked the ire of local people (the location was apparently chosen due to the opening of new crematoria capable of dealing with 50st cadavers) and, interestingly, Tam Fry of the National Obesity Forum. The hoarding was later defaced by vandals who tore away the ‘obesity’ section revealing a previous advertisement for McCain home fries. With food advertising next on the list of fat police ban targets, it seems that irony is rarely without a sense of humour.

Once again the language of the crisis has made the news. In an apparent rejection of a 2009 suggestion by the then opposition party that the word ‘fat’ should be used to shock and shame patients in preference to the more clinical ‘obese’ , a new NICE paper on fighting obesity in deprived communities advises against the use of the stigmatising O-word in favour of the (equally problematic from a FA perspective) phrase ‘healthier weight’. Woe betide any who suggest that fat people should be entitled to the use of respectful language, with the usual ‘antis’ dominating what passed for a debate in the mainstream media. British fat activist Kathryn Szrodecki pointed out on the BBC’s notoriously fat-phobic Breakfast show that whilst language is important in influencing attitudes, fighting the fat stigma that keeps fat people in their houses and avoiding the doctor should be even more of a priority, but was quickly drowned out with a rant from the obligatory ‘expert’. The Guardian’s take was typically puerile, with the implication that it was an instance of ‘PC gone mad’ more fitting of the Daily Mail, but even my city’s local newspaper covered the story, and with an uncharacteristically balanced piece.

Also in the Guardian ‘body image’ campaigner Suzie Orbach discusses the(really quite horrifying) findings of a British study into levels of weight-based discrimination in the workplace, Kevin Smith talks about his vilification and ridicule at the hands of the media following the Southworst sizism incident of 2010, and there’s a truly frightening demonstration of how fat hatred and rising levels of disability prejudice intersect over the issue of mobility scooters (or ‘obesicles’ as several commenters refer to them) and whether fat people without a specific diagnosis of a disability should now be prohibited from using them.

Elsewhere, rising rates of premature births and arthritis are the latest health crises to be blamed on weight, whilst a BBC report on a course for ‘fat food workers’ aimed at teaching them to cook healthier meals is also framed in terms of fighting obesity. There’s criticism of the sponsorship of the London Olympics by Coca-Cola and McDonald’s, renewed demands to replace the GDA method of labelling foods with a traffic-light system of ‘good’ and ‘bad’ items, another propaganda piece promoting WLS for kids and a study linking reduced testosterone levels to male obesity.

Oh, and yet another Channel 4 series, starts this week, this time claiming to tackle ‘Britain’s big fat problem’ with ‘secret eaters’ by subjecting ‘obese’ families to 24-hour surveillance in a chilling echo of the tactics employed by Social Services in the recent Dundee child protection case.

Whew. Now enjoy what’s left of the weekend...

Stories I've seen lately in my MedPage Today

I subscribe to MedPage Today and the following are some of the headlines I've seen in the last week:
Co-Sleeping May Protect Children from Weight Gain This one says

"The results may suggest that elements of parental social support or other types of positive psychosocial responses of being allowed to enter parents' bed during the night may protect against overweight, whereas types of negative psychosocial responses such as feelings of rejection when not being allowed to enter parents' bed may lead to overweight," Olsen said in a statement.

Not sure how I feel about that one, think more studies need to be done.

FDA Panel Gives Nod to New Diet Drug Lorcaserin hydrochloride, another drug that they don't know if it has any cardiovascular side effects yet, and has minimal effects on weight loss (3.3% difference between lorcaserin group and placebo group).

Big Midsection May Up Risk of Dying Suddenly Not sure what this is trying to say - are they talking heart attacks? If so, I thought they said fat people had a better chance of surviving heart attacks than thinner people. Seems contradictory to me, and in need of more study.

Program May Hold Promise for Teen Weight Control

A school-based anti-obesity program for adolescent girls from low-income communities cut down the time they spent glued to the TV or computer screen, researchers reported.
But although changes in body composition moved in the right direction, they did not differ significantly from those of girls in the control group, nor were there significant changes in physical activity, according to David Lubans, PhD, of the University of Newcastle in Australia.

The gist of the article is that BMI didn't change much (less than .2%) but the girls were more active and spent less time in front of the TV/computer. I'm assuming their health improved even though their weight didn't go down, so it seems to me that would be good, but the focus is still on weight loss instead of improving health. *headdesk*

IOM: Society Must Rally to Fight Obesity

"The costs [of obesity] have the potential to become catastrophic and unaffordable unless all sectors of society take the need for obesity prevention seriously and act responsibly," Daniel Glickman, JD, chair of the IOM's Committee on Accelerating Progress in Obesity Prevention, wrote in the 478-page report's preface.

Do I really have to dissect this? When are they going to admit that personal responsibility hasn't worked so far? If personal responsibility for being fat worked, all of those fucking diets that fat people have spent $60,000,000,000 on in the last year would have worked to make us permanently thin and there would be no fat people for them to get their knickers in a knot over.

Shedding Pounds May Hike Success of Fertility Tx And again, the problem with prescribing weight loss as a solution to a problem is that there is no way to guarantee that the weight loss can be maintained for long enough to do any good for the majority of people.

New Model Sees Smaller Uptick in Obesity Rates Methinks the CDC needs to get its act together - didn't they say obesity rates have been level for the last 8 or 9 years or so? Now they're predicting a smaller rise than was originally predicted? Which is it? Rates are either staying level or they're slowly rising - can't have it both ways, no matter how much you might want it.

Moms Often Blind to Toddler's Weight This one, well, this one is just outrageous fear-mongering as far as I'm concerned. Most mothers know very well if their kids are fat. Could it be that they know better than anyone how their children eat and how active they are and whether their weight is something about which to be concerned?

So that's the fat news round-up, have at it in comments.

HAES vs. Weight Management

An interesting thing has been happening lately. Some prominent doctors have started (at least occasionally) sounding like...

us?

I go back and forth on my opinion of this. Is our message being co-opted and twisted by the medical establishment, or are attitudes changing for the better? Is the weight centered paradigm finally shifting?

Here's something very HAES-like from Dr. Rick Kausman.

Dr Rick Kausman is a medical doctor who is recognised as the Australian
pioneer of the person-centred approach to healthy weight management. Rick
has written two books including the award-winning 'If Not Dieting, Then
What?', he is the creator of a number of other resources, and has had
several articles on healthy weight management published in peer-reviewed
journals. Dr Rick is a Director of the Butterfly Foundation and a Fellow of
the Australian College of Psychological Medicine.

He talks about "everyday foods" and "sometimes foods." He talks about "weight management" rather than "weight loss" (or HAES, for that matter). Part of me is really suspicious of that terminology, but I have to admit that it would be easy to frame the same behaviors I would call HAES as weight management, since for me, a fairly stable weight - over decades - has been a side effect of HAES. And to be completely honest, yeah. There are foods that I enjoy but don't eat very often or only eat in small quantites because my body doesn't feel good when I eat them or because they're very heavy. I guess those could be framed as 'sometimes foods.'

Anyway, this HAES/weight management thing seems like it might be worth discussing. The relationship between fat acceptance and weight management is complicated. I'm pretty sure that a significant number of people in the fat acceptance movement have been below their maximum weights for quite a while, but are still fat. There are many of us that sorta kinda manage our weight the way we'd be expected to if we were thin - just listening to our bodies and striking a balance. I call it HAES and I try not focus on weight or size, but I have to admit that it's convenient to have a stable weight and I'm glad it's a side effect of HAES for me.

In the end, the difference between HAES and "weight management" can be in the intent and the focus. The two can look very similar from outside. HAES is meant to be 100% weight-neutral, but in this society, 100% weight-neutrality is difficult. Is HAES-like behavior that's conceptualized as weight management really so different? Maybe it's not complete weight neutrality that's the most important; maybe it's simply the removal of weight or BMI-based goals. If mental health, energy levels, and medical numbers other than BMI are priortized and if the goal is not to reach a certain prescribed weight, then damn. It is indeed very close to HAES, and it might help a lot of people make peace with their bodies and find ways to feel better, both physically and mentally.

Then I remind myself that "health" is a social construct that's being used as a bludgeon in our society, and that maybe the people on the fat acceptance side who have an ideological problem with HAES ("Health At Every Size") have it for exactly this reason - that it can intersect with the softer side of the medicalization of fat bodies.

What do you think?

Feeding tubes? Really?

Google "feeding tube diet" or Ketogenic Enteral Nutrition (KEN) Diet. There are a whole bunch of neutral to positive, freak show style news items. Take your pick.

Done?

You may have noticed that this weight loss diet is so incredibly embarrassing and moronic that a Google search will turn up several negative articles on the first page of results.

  • Canadian obesity specialist Yoni Freedhoff, who is a bit of a nutritional puritan but who helped nix the Epcot Center's crap Habit Heroes exhibition, thinks it's medical malpractice. He skewers it in a post called "Church booked? Check. Flowers? Check. Feeding Tube? Check?" Well, yeah. Sounds like medical malpractice to me too. Thanks for pointing that out.

  • Google News has an item called "Feeding Tube Diet? Irresponsible Doctors Condone Anorexia". The fun thing about this article is that the author clearly finds the whole thing problematic - but only when it's used by people who aren't 'morbidly obese.' For very fat people, she thinks it sounds like an excellent weight loss option.

Much as I think that Freedhoff is an okay guy for a diet doctor, I've got to say that the Yahoo article is less hypocritical than his. Don't get me wrong. I agree with everything he says about the feeding tube diet. But, this is someone who is not terribly critical of weight loss surgery. A feeding tube is less invasive than weight loss surgery and it can be removed at any time. It seems likely that the only advantage that weight loss surgery has over a permanently installed feeding tube is that it's invisible. The fact that you're tampering with your body in order to physically enforce a starvation diet isn't apparent to every single person who looks at you. But really, it's not that different. In fact, the feeding tube is not nearly as extreme and risky. It is easily reversible and does not involve the ol' slice and dice.

The feeding tube diet is marketed as a quick and easy way to lose weight. Apparently it provides 800 calories a day with no carbs, and they claim that people don't get hungry. It would be nice for the dieters if that were true, because it physically prevents them from eating. Side effects may include bad breath, constipation, dizziness, acid reflux, and nausea.

In a society that thinks weight loss surgery is a good idea, why would anyone be surprised that people want a doctor to stick a feeding tube up their noses and down their throats to provide a minimum amount of nutrition and prevent them from eating? It makes perfect sense. Not-so-fat people who love the idea of weight loss surgery but aren't eligible for it must be delighted by this new option.


I'm not surprised by it, but it is still hard for me to understand (emotionally) why someone would do this to themselves. The old "easy way out" trope doesn't fit any better than it does with weight loss surgery. This is public. It is humiliating. It is physically unpleasant and disempowering. It seems to come from a place of deep frustration and an antagonistic mind-body relationship. I keep slipping into thoughts of masochism, penance, and the mortification of the flesh. It's a self destructive (or at least risk embracing) form of self punishment. The same human impulses have found a home in religion in the past. What are those impulses acting in service of here, and why are they such a persistent part of human nature? I obviously haven't thought this all the way through, but I'm putting it out there.

A few other thoughts...

As far as I can tell, there is currently only one American doctor who is willing to insert feeding tubes for weight loss. However, this is all over the North American news. It occurs to me that:

1. All of this news coverage is free publicity for this dumb idea and it will probably spread the word to every greedy and ethically impaired doctor in North America. Coming soon: a feeding tube diet doctor in your area!

2. The news coverage sure does support the "young women are stupid, lazy and vain" trope.

Study: the Biggest Loser increases weight bias

In January's issue of the Journal Obesity, a Bowling Green Department of Psychology study: The Effects of Reality Television on Weight Bias: An Examination of The Biggest Loser.

From the abstract:

Weight-loss reality shows, a popular form of television programming, portray obese individuals and their struggles to lose weight. While the media is believed to reinforce obesity stereotypes and contribute to weight stigma, it is not yet known whether weight-loss reality shows have any effect on weight bias. The goal of this investigation was to examine how exposure to 40-min of The Biggest Loser impacted participants' levels of weight bias. Fifty-nine participants (majority of whom were white females) were randomly assigned to either an experimental (one episode of The Biggest Loser) or control (one episode of a nature reality show) condition... Participants in The Biggest Loser condition had significantly higher levels of dislike of overweight individuals and more strongly believed that weight is controllable after the exposure... Exploratory analyses examining moderation of the condition effect by BMI and intention to lose weight indicated that participants who had lower BMIs and were not trying to lose weight had significantly higher levels of dislike of overweight individuals following exposure to The Biggest Loser compared to similar participants in the control condition. These results indicate that anti-fat attitudes increase after brief exposure to weight-loss reality television.

The Biggest Loser increases weight bias, especially among thin people. No big surprise.

And Michelle Obama is appearing on the show! I really want to think that Mrs. Obama means well. I want to think that she's a decent person, if a bit misguided. But the study above has been available for months, and even without it, isn't it obvious that The Biggest Loser is horrible? That the contestants are bullied? That the methods used to make them lose weight are unsustainable?

In the Huff Post, back in 2010: Michelle Obama On Bullying: Adults Need To Set Example. I guess she's changed her mind. If fat people are the targets, she thinks bullying is a-okay. What a disappointment.

More armchair quarterbacking

There been a lot of discussion of race and the Atlanta billboard campaign in the fatophere lately. I can't say that most of it seems to me as if it would be useful to someone struggling with the issue of how to be inclusive.

I've read the original thread that caused all the fuss, and in that thread, Atchka asks a few questions about what, exactly, he should have done or should do to include people of color in the fat activism surrounding the Georgia billboards. As far as I can tell, he has never gotten an answer from anyone.

So, although I'm probably the least qualified person to try to answer that question, I do think that it's sincere and that it really should be explored, so I'll give it a shot. I hope that others will also contribute their comments and ideas. Also, I'm pretty sure that at least some of this did go on behind the scenes, but I don't know the whole story.

But First...

I want to start by saying that this whole effort has been absolutely amazing and that I am blown away by what has been accomplished. Even though it may not have been textbook perfect (and what kind of grassroots project being done for the first time would be?) it has been well managed and effective beyond anyone's expectations. Sometimes when you see that something needs to be done, you just do it. I have become very cynical about human nature over the years, and this campaign has really lifted my spirits.

I also want to make it clear that I know I'm being an armchair quarterback. I knew about the anti-billboard campaigns from pretty early on, and I could have volunteered for a role doing what I'm about to describe. However, it just didn't occur to me at the time. The fact that we were non-local and were taking action on an issue that was local to Atlanta had occurred to me, but the full implications of it really didn't hit me, as I didn't give enough thought to the demographics. However, that's a poor excuse, because what we probably should have done first is...

1. Figure out exactly where the billboards are and who lives there.

When the effort to do something about the Georgia billboards first began to gel, there was an issue of context that (as far as I know) was never fully explored. This campaign is in Atlanta, Georgia. The majority of the children in the negative stereotype-based, fatphobic Strong4Life advertisements were either Black or Hispanic. In fact, according to Wikipedia, Atlanta is approximately 55% Black, 35% White and 5% Hispanic. In Georgia as a whole, the population is approximately 60% White, 30% Black and 5% Hispanic. These are the demographics of the people whose neighbourhoods are being polluted by the negative ads.

We could have made a map of the ad locations and then figured out the ethnic and economic demographics of the specific areas that were targeted.

In reality, I think there was some awareness of this issue, especially after the first of the "stage one" billboards were removed and Children's Healthcare of Atlanta began really obviously targeting poor Black neighborhoods. However, it may not have been acted upon strongly enough.

2. Look for links into Georgia-based, activist, African American and Hispanic social networks.

Some of this could have been done through our social networks. There are size positive bloggers and commentators who may be from Atlanta or have Atlanta connections - particularly activist, African American connections. Even a general call-out for volunteers may have drawn out people who could have helped link the fatophere campaigns to local Georgians, particularly African Americans, who were concerned about the effect of the billboards on their children.

I seem to remember that an Atlanta newpaper columnist wrote a piece that was critical of the campaign, early on. It would have been a good idea to get in touch and to see if there was anything they could do to help.

3. Seek out community groups local to the billboards

After reaching out with our social networks, the next thing we could have done was seek out local Atlanta groups who are already fat positive: the local NAAFA chapter (I think Marilyn Wann may actually have done that), local BBW groups, the local plus sized fashion community. Body image activists, feminists, and eating disorders groups share common ground with the fat acceptance movement and are often based in universities and colleges. I'd look specifically for educational institutions in and near the targeted neighborhoods, with diverse faculties and student bodies. We could even have looked for privately owned plus sized and big-and-tall shops and enlisted the owners' help.

We could have tracked down community groups and cold called (or e-mailed) them. Local chapters of civil rights organizations? Volunteer-oriented churches? People in those types of organizations are going to be just as likely to be fat-phobic as they are to be sympathetic to our cause. However, it's hard to believe that the Strong4Life billboards won't have offended people involved in social justice. If we'd taken the right approach (HAES and an acknowledgement of the racist aspects of the Strong4Life ad campaign), we'd have had a chance to win some allies there and to support people in those organizations who may have already been concerned about the billboards and thinking about taking action.

4. Listen to - and amplify the messages from - local people

We could have tried to find out what the people who saw the billboards every day were thinking about them; what effects they were having. We strongly suspect that the billboards are psychologically harmful and probably counterproductive as well. We could have strengthened that argument with real examples - written, audio and video testimonials from real local people, not actors with a message someone else wrote. Then we could have plugged the hell out of these messages on our blogs and social networks.

5. Partner with concerned organizations and individuals

"Do you think something should be done about those billboards? Have you got anything is mind? Is there anything we can do to help, or can we plan something together?"

And from there on in, hopefully the fatophere's efforts could have meshed with actions taken by local groups that reflected local demographics.

The Issue of Timing
Now, I want to emphasize that this is difficult stuff. It isn't "just Google it." There's social risk involved, there's the possibility of substantial delays, however...

The billboards had been up since May, 2011. Fatophere bloggers had been aware of the campaign for a long time. I remember that someone linked to this this April 2011 article on Sociological Images right after it was posted. However the fatophere campaign didn't start until January 2012.

It's true that all of the things I describe above would have slowed down the response. The fact is, we did it at the last minute anyway. There was no organized response from the fat acceptance community for the first seven months of the Strong4Life Campaign. If we'd been on top of the issue from the beginning, there would have been time to build a coalition.

I'm not blaming anyone, because I'd have to blame myself too. I wasn't a leader in the campaign, even at the rather late time it emerged. I just photoshopped a bunch of "I Stand" posters. That was my contribution. It's just how things worked out.

The fact that we accomplished something so solid and that so many people (of all backgrounds and physical descriptions!) were ready to put their money and their pictures behind it tells me that it was needed and that it was a good idea. The fact that it got done by a group of volunteers with absolutely no grants, public or private - only individual contributions - is incredible. I don't think we should be too hard on ourselves. BUT, if it had been organized sooner, there would have been more time to build alliances.

The Issue of Distance

There's also the question of whether or not it was appropriate to get involved in someone else's local issue. In this context, we were "people from the internet," an amorphous group of size acceptance activists with no particular tie to Atlanta, Georgia, taking action from a distance. I asked a good friend who isn't involved in fat acceptance (okay, my husband) what he thought. He said "Do you think it was wrong for people outside of South Africa to take action on Apartheid or people from outside Afghanistan to criticize the Taliban for how they treat women?" And he's right. When you can clearly see that something's wrong, then how is it wrong to speak out about it and take action against it? The thing is, doing it from a distance and in relative isolation was probably not the optimal way to go about it.

On the other hand, I do see the negative Stand4Life campaign as primarily sizest and secondarily racist. The size issue is what's right out front. It was definitely not an inappropriate issue for fat acceptance activists to take a leadership role on. Some people might disagree, arguing that the ads are primarily racist because associating fatness with minority groups reflects badly on the minority groups (presumably because fat people really are - insert negative stereotype here). As someone who sees fatness as a neutral physical characteristic and fat people as a group that's in need of social justice, I am not on board with that, although I can certainly see how many people would view it that way.

In Conclusion

I think that what we did - especially what Regan Chastain, Marilyn Wann and Shannon Russell (Atchka) did, was spectacular and that it was absolutely a positive and worthwhile thing to do, even though sure, it could have been done better.

But maybe what we can start here is a list of ideas for how, specifically to establish partnerships with other community and social justice groups. And maybe the best way to reach out to people who aren't exactly like us but who share similar values right now so that we can share social networks and give each other help and support when it's needed.

Next

I think that for my next post, I'm going to start the work I talked about above, just to see how long it takes and how difficult it is. For example, is there an easy way to find out the locations of the Strong4Life billboards when you're not actually in Atlanta?

British police and press confuse BMI with fitness

It sounds like straightforward weight discrimination, right? British cops being fired or docked pay because of their BMIs?

No. That's not it at all. They're instituting an annual fitness test, and police officers that fail it three times in a row could have their pay lowered.

The problem here is that the press in the UK (and the US) think that being classified as "overweight" or "obese" is exactly the same thing as being physically unfit. The link between "being out of shape" and "overweight and obesity" is so strong in their minds that they are using the two concepts interchangeably in headlines.

The root cause: Reuter's inaccurately titled article, Obese UK police officers face pay cuts. Reuter's is one of the world's biggest news services, and many newspapers copy their articles without any further research, if not word-for-word. If you look up this story now, some of the headlines are a bit more rational. However, when this story first turned up on my newsfeed yesterday, the headlines were consistently as idiotic as the ones above. This is probably because the earlier articles were more heavily dependant on Reuters.

Based on these headlines, it seems that most members of the press don't understand what "overweight" and "obese" mean. "Overweight" is defined as a BMI between 25 and 30 and "obese" is defined as a BMI over 30. A 5'-8" tall person who weighs 165 (11 stone) is overweight. A 5'-8" tall person who weighs 200 pounds (14 stone) is obese.

There are plenty of people who fall into those categories who are very fit; not only strong, but capable of running fast over long distances. And guess what? People whose BMIs fall into the "normal" range and especially the "underweight" range can be very unfit. So, this isn't about being overweight or obese at all. It will (presumably) hit unfit, thin police officers just as hard as unfit, fat officers.

Now, I don't know the details of this fitness test. I hope that it takes more than just distance running into consideration, because let's be honest. Heavier people do tend to be stronger while lighter people tend to be faster, and both of those characteristics can be useful to a police officer. Fight and flight, right?

I also hope that they're taking age, experience, and the type of work these officers do into consideration. Some older officers may be less physically fit but have better judgement; better mental and emotional fitness for the job. Some officers may have old injuries that limit their performance on the fitness test, or they may have a physical disability. They may be working desk jobs rather than walking a beat. Officers need to be fit for their particular role.

More importantly, being a perfect physical specimen doesn't make up for being a dumbass, having poor judgement under pressure, being lazy on the job, being a bully, being a racist, or any of the other major flaws that have occasionally been observed in officers of the law. In fact, if the idea is to turn the British Police Services into an Order of Modern Supermen* then perhaps these issues should be even higher priority than physical fitness?

ANYWAY...

Having a regular fitness test for cops is not a crazy idea, as long as it's used appropriately and with common sense.

However, for Christsakes, people. Overweight/obese ≠ out of shape. The categories "overweight" and "obese" are based on weight/height ratios, not level of fitness.

*used in the generic, inclusive sense, of course.

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