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How Medical Studies Affect Us

This article,“How to Read Articles about Health,” by Dr Alicia White,, is an important caveat to my previous post on the Atlantic Monthly article. I'd originally added it on there, but I was worried that it might not get noticed. MichMurphy sent me the link (thanks!), and It offers advice on how to get some idea of the reliability of studies with nothing but a news article to work with.

I wanted to add something else, too.

As someone with very analytical mindset and a deep respect for the scientific method, the reporting on obesity-is-unhealthy medical studies has done more to make me question my understanding of my body and my commitment to self acceptance than anything else.

On the other hand, the reporting on these studies has bothered me ever since I became conscious of it as a young teenager. The inflammatory language they use, the constant blaming, the nasty little digs embedded in the language... it feels like bullying. And, I guess a defensive reaction to that (and the fact that none of it matched my personal experience) was what made me open to questioning the science behind obesity-as-a-disease. Sociology clearly influences how the science is interpreted.

But, I'm getting all abstract again. Frankly, I feel clearly that the way obesity-related scientific studies are interpreted and reported is not neutral. It is harmful. And, BFB commentators, I need your help to explain how that works, because I'm not particularly good at analyzing and explaining emotional and psychological stuff. What are your thoughts?

Medical Studies: For Entertainment Purposes Only?




The Atlantic Monthly has published an interesting article in it's November issue: Lies, Damned Lies, and Medical Science. It's part of a series called Brave Thinkers, 2010 and it features an interview with Dr. John Ioannidis, who leads a team that specializes in critiquing medical studies, both qualitatively and quantitatively.

“Maybe sometimes it’s the questions that are biased, not the answers,” he said, flashing a friendly smile...


That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed.

We've discussed poorly designed studies before on Big Fat Blog. Studies and surveys in the social sciences are especially sensitive to design bias and data manipulation, and medical studies aren't far behind. They may have biases built into their design, and their data may be manipulated and interpreted to support the conclusion that will make continued funding most likely. Glenn Gaesser's Big Fat Lies and Paul Campos's The Obesity Myth (or the Diet Myth) do an excellent job of exploring how this has happened in the study of obesity, in particular. The dodginess of obesity research is referred to somewhat obliquely in the Atlantic article as well:

On the relatively rare occasions when a study does go on long enough to track mortality, the findings frequently upend those of the shorter studies. (For example, though the vast majority of studies of overweight individuals link excess weight to ill health, the longest of them haven’t convincingly shown that overweight people are likely to die sooner, and a few of them have seemingly demonstrated that moderately overweight people are likely to live longer.) And these problems are aside from ubiquitous measurement errors (for example, people habitually misreport their diets in studies), routine misanalysis (researchers rely on complex software capable of juggling results in ways they don’t always understand), and the less common, but serious, problem of outright fraud (which has been revealed, in confidential surveys, to be much more widespread than scientists like to acknowledge).

Now, Dr. Ioannidis's assertion that up to 90% of medical studies produce flawed conclusions seems very dire indeed, and I'm not sure what to think about it. I wonder about the details of his methods and about the scope of the analysis. Is he talking about a particularly error-prone subset of studies? Where does he draw the line between medical research and hard science?


I like data and believe that collecting and analyzing it is useful. I believe that the scientific method - hypothesis to experimentation and observation to theory- is the best way we have of understanding the universe, our world, and our biology. But Dr. Ioannidis's work really illuminates the way science can be warped by economics, by biased assumptions and methods, and by individual egos.


When journalists cover scientific studies they usually serve them up uncritically, based on press releases, often with a dash of sensationalism. And, they bring their biases to the table as well. Qualified scientific and medical journalists that look deeper, like Sandy Szwarc of Junkfood Science (currently on hiatus, but still well worth exploring) are rare and valuable. Science, especially medical science as reflected in the press, is far from infallible. It is always wise to look closely at the studies that concern you most, and at their context.



...and here's a great post on how to do the best you can with nothing but a news article to work with. Thanks, MichMurphy!

Apparently Killing a Fat Person Isn't so Bad

Doctor Spared Jail Despite Road Death
The Herald, Wednesday 17.11.2010, page 9 News

A doctor who killed a morbidly obese woman on his way to a medical team bonding course has been fined his entire savings of £5000 and banned from driving for three years.

Dr. Benjamin Kendrick was fined by a sheriff, who ruled out community service because he was already serving the community through his work as a surgeon.

At Perth Sheriff Court, Sheriff Michael Fletcher also ruled out jailing Kendrick because his 29-stone victim could have survived the crash had she been of "average fitness."

Kendrick, of Chesham, admitted driving carelessly and killing Joan Johnston, of Scarborough, and injuring her husband and three of his colleagues as they drove on the A93 road on May 6 last year.

The orthopaedic surgeon - described as an "exceptional" talent - lost control of his rented people carrier and smashed into a vehicle, causing the death of Mrs. Johnston.

Sheriff Fletcher said "Your contribution to society in your everyday work is extensive. At the time of the accident you employed your medical skills to help the injured."

"If the person had been of average fitness they might have survived the injuries. A custodial sentence is not appropriate. The appropriate penalty is a sunstantial monetary penalty."

I saw this short article in the Glasgow Herald yesterday, and haven't found it reprinted on their webpage. So, I retyped it for the benefit of the Fatosphere.

This story has also been covered by STV and The Daily Record.

This incident stinks of the Old Boy's Network; £5000 to a surgeon is a slap on the wrist. Given the fact that he admits to careless driving... I don't even have words. Joan Johnston's life was obviously worth considerably less to the doctor and to the court than the life of a thin person. They came right out and said it.

Scam Alert!

Just an FYI, if you get approached by a company called moredigital.com to buy ad space on BFB, delete delete delete! We have no plans, now or in the future, to run ads here, and we are not affiliated with that company in any way, shape or form. Let me know if you see any other scammy activity and I'll set the record straight.

Roundly yours,
Carrie

Introducing Elizabeth Patch



Artwork used with permission of Elizabeth Patch


Elizabeth Patch is an art teacher who has seen too many young women struggle with body image. When one of her students died of anorexia in the 1990s, she found herself drawing pictures of beautiful, happy fat women.

Eventually, she gathered them into a book.

Elizabeth has an active website with a blog that's full of cheerful art and positive reinforcement. She's also on Facebook and Twitter.

Elizabeth's aesthetic is all about curves and pastels and femininity. These drawings are very mainstream in a lot of ways, and they remind me a bit of a type of twentieth century vernacular art that I'm pretty sure I'm supposed to be snotty about: the cute, old-fashioned fat people who were never completely exiled from greeting card pictures, christmas ornaments, and figurines; the twentieth century echo of the old nineteenth century ideal.

The strength of this work is that it really does present a cohesive alternative standard of beauty, if only in cartoon form. And, because of their association with the twentieth century venacular, these images are profoundly unthreatening. The accessibility of the drawings tends to mask the fact that they're doing a damned good job subverting the current beauty standard.

There's a 2-part interview with Elizabeth Patch here and here on the Weightless Blog, and she tells more of her story in her blog's about section.

Reading Elizabeth's personal story reminded me of how much the anti-fat bias in our society hurts (and I'm tempted to say "diminishes") everyone, not just fat people.

BFB's Virtual Kiss-In!!!

Last updated November 3, 2010.


Kiss this, Marie Claire!!! 


Mmmm, Maura Kelly, fat kisses and love and existence!!!!



I present to you BFB's Virtual Kiss-In!!!!!!!!!  Thanks to everyone who has submitted photos!
Keep on sending them to withoutscene at gmail dot com, and I will keep on updating them! XOXO




Stef and Sarah

Awww, fat love!

Stef_Sarah



Nichole and Roy

"Here's a picture of my husband and I kissing. That lady at M.C. would cringe to see us in person! I wish we could be in NYC - we'd be front and center!!"

Nichole_Roy



SurferKM with her wife and son


"(fat! *gasp* lesbian! *faint*). We kissed before and after the shots, so I figure it counts."

SurferKM_wife_son



withoutscene

Virtual kiss-it!

Gif Created on Make A Gif



withoutscene and Chris

Fat lovin!

Mychii_Chris



Shannon Campos and Anthony M.


"I want it to be known that I am fat and I have no regrets and it should be shown that fat people live... and live happily."

ShannonCampos_Anthony H.



Michele


Smooches!

michele



Michele and Chris

XOXOXO

michele_partner



Buffpuff


Kiss-kiss!

BuffPuff



Jenna from AxisofFat with her little brother


"Am I too fat to kiss or be kissed in public? My bro didnt think so!"

Jenna_axisoffat_littlebro



Claudia and Shelley in San Francisco


Livin and public kissin!

claudia_shelley_sf



G and J

"Two fatties, deeply in love, and sharing a chocolate shake! Not
kissing in this scene, but it happened right afterwards ;)"

gretchen_partner



nettaP and seanP

At NYC Big Fat Kiss-In! nettaP has a video on her blog which includes some footage of the kiss-in.




Beth and Luke


"We're newlyweds and we'll kiss and hug wherever we like, thank you very much."

beth_luke


Marilyn and her squeeze


Photo credit: Kathy Barron.

Marilyn_Sqeeze



Regina and her partner

"I wanted to submit my own rolls and rolls of fat kissing picture for your blog!"

regina_partner


Jamie and Josh

"This was taken after we had spent the day snorkeling, hiking, and kayaking around the island. (Yes, Marie Claire- my fat ass did all these things...in a swimsuit no less! You would have been super offended by my rolls that day!)"

Jamie_Josh



Katie with Jordan and River

"This is me and my sister and her two foster daughters."

katie_jordan_river

Tami and River

Look at that smile!

Tami_River



SunflowerP and JFPBookworm


So sweet!

SunflowerP_JFPBookworm



Buttercup and her husband

"Here's my husband and I at our wedding, kissing and being fat, with cake, no less!"
102_0239_1

Brie

"How could I resist a kiss for that cute face?"

Brie



Jeanette and her husband

Awwwww!!

jeanette_partner




Substantia Jones documented the NYC Big Fat Kiss In with her madd photo skills.



Lesley Kinzel is also turning the Museum of Fat Love into a Tumblr, so check it out and submit your love there too!

Virtual Kiss-In

If you can't make it to any of the Kiss-Ins today (NYC, Philly, SF--any others?), you can send photos of your kisses, hugs, smiles, puckered lips, and/or existence, etc. to withoutscene at gmail dot com! I will then post a virtual kiss-in!

Big Fat Kiss-In

So, no doubt you've heard about the Marie Claire fiasco, or as Lesley Kinzel calls it, the "EWWW, FATTIES!" debacle.



Stacy Bias had the incredible idea of doing a kiss-in in front of Marie Claire in NY. But since Stacy isn't in New York for a few more weeks, someone else took up the task of organizing it. As Substantia Jones said, IT'S ON!!!!!!!!



If you are anywhere near NYC and can manage, DON'T MISS THE BIG FAT KISS-IN!!!! The more people, the better.



How incredible that this will happen! It is sure to be a fantastic, empowering event.




If you can't go, kiss anyway! Send me your kisses to withoutscene at gmail dot com. (Addendum: I want to stress that you do not have to have a partner/s to submit a kiss. Air kisses, dog kisses, platonic kisses, hugs, and well, pictures of you walking and/or existing will do since it's the existing, just not the kissing that's 'bothersome.') Received a few already!



And I hear rumblings of future events as well. Global fat events....yup, here we come!




UPDATE!!!


And there's ANOTHER BIG FAT KISS IN in Philly!!! And ANOTHER BIG FAT KISS IN in San Fran!!!!!



If you are holding a kiss-in in your town, please leave a comment! And remember to send me your kisses to post on BFB!






Also, I thought I'd add a little something that I made up, which goes to the tune of Cee Lo's "Fuck You"



I see your ignorant shit on Marie Claire's blog & I'm like, Fuck you! Oo, oo, ooo.

Seein fat people kissin must be real tough. I'm like, Fuck you! And fuck Marie Claire too!



(Fuck you can alternatively be "Boo Hoo")

Traveling While Fat

Check out this article in the New York Times.

This brave soul wrote about his experience and how he manages his air travel. As could be predicted, he got SLAMMED. To be fair, there are some good comments. One woman praised the man for his travels, and she told the story of her large friend who, while traveling through Thailand, would sit in the square of the villages where he arrived and would allow children to touch him for good luck (apparently touching the Buddha is considered lucky and children tend to touch fat people because of it). She said it made him happy to make so many people happy. Talk about making lemonade!!!

A plurality of the negative comments fall into the predictable categories:

  • Category 1 -- Largest -- Fatties don't know/don't want to know/don't care what is their impact on the rest of the non-fat world around them. I bought my seat, don't take over half.
  • Category 2 -- Fatties as the new "Ugly American" ( these comments are particularly odious)
  • Category 3 -- Next Largest -- The concern trolling "for your health" and its corollary "you are raising my health care costs"
  • Category 4 -- Mixed bag of awful:
    • Subcategory 4A -- "Fat people are Ugly/smelly/_____" (fill in desired adjective)
    • Subcategory 4B -- Just plain, astonishingly, unbelievably offensive and low. My PERSONAL favorite douchebag of the day wrote that he/she would come up with a business to get fatties to pay her to live in a third world country, live in huts, be exposed to diseases, and grow local food which would be the only thing they would have to eat. They would absolutely lose weight that way. Let's not forget infectious diseases as a weight loss strategy.
    • Subcategory 4C -- Just plain huh? One commenter referenced her chemotherapy in a way that was most confusing. Chemo as a weight-loss plan? I hope not. A couple of others pointed out that, no, the Buddha was not fat -- the Chinese just depict him that way.

Check it out folks. Help balance out the fat hate in my hometown paper. I continue my comment campaign against the trolls who hang out at Tara Parker Pope's blog in the Times, but here are a few more who got their fresh meat.


WARNING -- Some of the comments could be triggering to some.

Body Love Attack!!!!


This is a call to action, a fun & feisty project, and a way for me to connect my activist and academic endeavors.

So, I humbly invite you:

Have a body love attack on Wednesday, for Love Your Body Day.

 

First, A Note on Love Your Body Day

If nothing else, LYBD is a day to promote respect for body diversity and awareness of body oppression—OF ALL KINDS. We should be raising awareness of different bodies which are ‘othered’ or different physical features which are devalued. We can think about body diversity and oppression terms of race, class, gender (including transgender), disability, body size, body shape, and beyond—and we should be thinking broadly.

 

Also, remember that LYBD should not be used as a way to make people feel shame about not loving their body or struggling to do so. It’s not a prescription or a moral imperative. Some people love their bodies more than others, but pretty much no one loves their bodies completely, all the time. In our culture, that’s really not possible. This project aims to fight the culture of body hate, not the people who experience body shame or have a difficult experience with their bodies. People are at different places with their bodies and our relationships with our bodies are constantly in flux—and that’s okay. But trying to feel better in your skin, or helping others to see that they can, is a valid option and worth exploring.

 

Okay, I get it…so what is a body love attack?

The idea of a body love attack is a humorous response to body hate. We are constantly attacked by a barrage of messages encouraging us to hate our bodies. But we can fight back—with love—and draw attention to the fact that body hate is so prevalent that body love seems counter-intuitive, so embedded in how we live that people often BOND by hating on their bodies and the bodies of others.

 

Can anyone have a body love attack?

Of course! Everyone has the right to love their body! People of all kinds are subject to body shame. We all need a body love attack! At the same time, you don’t have to be chock full of body love to participate, spread body love to others, or recognize the harm that body hate causes.

 

But what is a body love attack, in practice?

A body love attack can be acted out in any number of ways.

 


·         A body love attack might be a parody of a heart attack, acted out instead as a joyous proclamation of body love. You love your body so much you can’t stand it! Grab your chest, groan, and then scream it to the mountaintops! Marilyn Wann envisions “holding my hand to my chest in mock drama and pulling away a previously palmed red heart piece of paper with some sort of rad fatty slogan on it and handing that to a passerby.”

 

·         A body love attack can also be interactive. Stand in public and “attack” people with body love by complimenting them! And then hand them some body positive messages! This one was my boyfriend’s idea.

 

·         Marilyn Wann had a funny idea for a ‘Body Love Attack Movie:’ Turn a body love attack into a romantic comedy, using that formula to explore our back and forth relationships with our bodies as a “love affair where you fall in love with your body.”

 

·         According to Marilyn, A body love attack could be a video game where you fight body hate, or in real time (for example, for LYBD) it can be made into a life-size pinball game “cobbled-together-from-bits-of-wood-from-street-find-furniture-and-old-coffee-cans-and-spraypaint…mounted on a rolling table tennis table. To play, people have to hand over 2 tokens that symbolize body-hate experiences they've had. Via the rock-opera alchemy of pinball, they'll turn into just a little bit of body love. I can totally imagine the string of battery-powered sparkly lights (Sparkle is the new black.) outlining the pinball game's name: Body Love Attack! And who wouldn't want to try to go tilt at that endeavor?”

 

·         After hearing Marilyn’s idea, I thought also that it might be cathartic set up a table where people could write down and then throw away body-hate experiences or thoughts in exchange for some body-love affirmations. Or set up a table where people can make body-positive art or body positive posters (see ideas below), think Wil from Huge and her “stop body fascism” poster, the fat lib classic “Riots not diets!!!!” or a poster about the way beauty ideals have changed over time.

 

·         Notblueatall, who will be working at her café all day, plans to attach body positive sayings to tree branches outside for people to take.

 

Where to have a body love attack?

Do it anywhere, but do it in PUBLIC for Love Your Body Day! A body love attack can be done in private, as a personal reminder and celebration of one’s body (my body love attacks are usually in the form of spontaneous one-person dance parties). But Body Love Attacks that are public can be powerful in a different way, both personally and as a form of activism. Proclaiming body love is a way to subvert the powerful messages of body hate embedded in our culture. So have a public body love attack on Wednesday--at the office, at a park, on campus, at the mall, at restaurant, at a rally or public meeting, on your favorite city block. Do it all by yourself or with a group! If you want to raise awareness with your body love attack, take along some information to hand out to onlookers. This will give them something to take away from the experience…beyond the awesome spectacle that is a Body Love Attack.

 

What can I hand out on LYBD to raise awareness about body diversity, body love, and body oppression?

So glad you asked! Here are some slogans/resources you might use:

 

“I respect body diversity.” or “Body diversity is hotttt.”

 “Celebrate weight diversity!” or “You look fabulous!” or "Love your body, change the world!"

 “Welcome! Weight diversity is celebrated here. Kindly refrain from diet talk, body disparagement, and other unpleasantries. Thank you!”

 You might also create a handout which on one side says “Celebrate with us on Love Your Body Day” with a list of body diversity/body oppression related Google search terms.

 

Here are some links to bookmarks, brochures, etc.:

Love Your Body Day! Detroit signs, courtesy of Amanda Levitt of Fat Waitress  

NAAFA Brochure on Size Discrimination, h/t Fatties United! 

“This Book Lies” anti-dieting bookmarks by Adrienne Hill and Sheana Director. Made to be inserted into diet books, this bookmark can be adapted for LYBD purposes. Front. Back.

Lesleigh Owen also has some great anti-dieting/body love bookmarks.

There’s, of course, the always fabulous Fat Liberation Manifesto

And here’s Patti Thomas’ “I Take Up Space Manifesto”




Share your Body Love Attack!

Tell us all about it! Please, oh, please share your ideas below and tell us if you do a body love attack for Love Your Body Day! Fight back against body hate!

 

Where did you get the idea for Body Love Attack?

I’ve been brainstorming similar ideas for a long time, but the other day I heard the song “Walking on the Sun” by Smashmouth, which may sound corny…but listening, I remembered why I liked that song so much. It was a call to action. In the song, they mention a “love attack.” This was something I’d heard about before, but hadn’t thought too much about. Since I am a fat activist obsessed with body love, I instantly envisioned a “body love attack.”

 

Body Love Attack, especially as a form of fat activism, turns body hate on its head. Fat people are considered a threat especially in Western countries. Our mass, it is thought, might topple our entire civilization. In addition, we are considered an assault on aesthetic sensibilities—that is, according to many, we are not so “easy on the eyes.” Because of the unquestioned fear of fat, body love is also a seen as a threat. Government officials are concerned when women of color continue to love their bodies at higher weights than fat white women do. Loving your fat body is a threat. It is an attack on a culture that would have you hate your body at all costs.

 

Body Love Attack is also rejection of the way our bodies are medicalized and pathologized, purposefully invoking the imagery of the fat person having a heart attack. To have an ‘attack’ is usually to be subject to physical or psychological distress. For anyone, let alone a fat person, to have a body love attack is counter-cultural. Instead of body distress, it is radical, joyful embodiment!

 

Special Thanks to everyone who contributed ideas or resources to the development of this project. You know who you are, and you rock!

 

 

An Epidemic of Scapegoating

Lately, the press and government in the U.S., the U.K., and Australia have been suffering from a virulent epidemic of obesity scapegoating. Symptoms include dodgy studies (this one was published in an online journal, in an insurance company sponsored issue), and government reports full of errors and questionable assumptions, cited hysterically and uncritically in the press along with pictures of headless fatties.

Older, poorer, and sicker people tend to be heavier, and that is controlled for in most studies. However, there's a built-in assumption that the relationship between health problems and obesity is always cause/effect, with obesity coming first. In reality, people with mobility problems often gain weight. Type II diabetes and obesity may be caused by the same genetic syndrome. Some medications cause significant weight gain. Prejudice and low social status can contribute to poor health, and fat people are treated very badly in our society. Telling fat people that they're inherently unhealthy may tend to become a self fulfilling prophesy.

The cost of pathologizing obesity is also considerable: weight loss surgery and its medical consequences, medically supervised diet and exercise programs, weight loss drugs, and "Obesity prevention" programs (which never seem to have an effect on prevalence); all "costs of obesity" that would disappear if we didn't believe that fat bodies need to become thin.

In the U.S., it's also common to blame the exorbitant cost of the health care system - which leaves over 16% of the population out in the cold, a disproportionate percentage of whom are fat - at least partly on the high obesity rate.

Of course, obesity is referred to as a disease and yet also somehow assumed to be entirely a personal choice or a result of ignorance. Just thinking about this is probably giving me high blood pressure, which would of course be considered... ready? A cost of obesity.

The Organization for Economic Co-operation and Development has a cornucopia of international data on all kinds of things, including health and health care expenditures. I love this shit! Few things are more fun to me than playing with statistical databases. I'm just going to take a quick look at these numbers...

I'm including a subset of the data here. Most of it is from 2007. I've brought in some obesity numbers from 2006 or 2008, since they weren't provided every year for every country. The first thing that I notice is that there's no measured data for obesity in most countries. And, where there's both measured and self reported data, the relationship between the two is unpredictable. Self reporting always causes the obesity rate to be underreported. However, people in some countries (the US and Australia) are better about knowing when they fall within the obese category, while others (in Ireland and Canada) seem pretty clueless about how obesity is defined. Mainland Europe is a big question mark here. The self reporting might be just a little off, or the actual obesity rates might be twice the self reported rates.



All of the white-majority countries that have measured obesity rates are actually pretty similar, except the US's (notably, around 30% Black and Hispanic), which is higher. If you eliminate the US as a special case, health care expenditures don't correlate well to average BMI. The UK, for example, has a relatively high obesity rate and low health care expenditures. Spain and Greece have lower health care costs and higher percentages of self-reported obesity than other European countries. Incidentally, all of these countries have average life expectancies between 78 and 83, rounded off, and average BMI doesn't correlate dependably to life expectancy either.

So, what does this tell us? That obesity has no bearing on health care costs? No. There are so many factors that we'd have to control for that it's impossible to say: quality of care and access to care, among many other things. What this does indicate to me is that obesity is not a primary driver of health care costs, internationally. This tells us that while the US has both the world's most expensive health care system and possibly the highest obesity rate in the world, this is almost certainly an example of correlation not equalling causation.

A few non-fat acceptance types agree that all this talk of obesity driving health care costs is garbage. For example here, on The Incidental Economist, where Bob Harnsberger (who doesn't even question the usual assumptions) takes a look at what percentage of US health care costs can be blamed on disease prevalence (it's very low) and on Health beat, where Maggie Mahar points a finger at medical technology and the structure of the US system.

Myself, I've always tended to blame the insurance companies and drug makers. In most ways, I'm a good capitalist, but turning healthcare into a growing business - when ideally, you'd like to minimize the need for it - seems questionable to me. More people defined as sick = more drugs sold. The insurance companies' profits come from maximizing premiums while minimizing care. And, of course, it's in the interests of the insurance companies to blame individuals for increasing costs.

The Truth About Weight Loss Maintenance

Trigger warning: diet talk

Dieting. Food restriction; following someone's plan, counting calories, or cutting out certain foods with weight loss as the goal. Almost all of us have done it in the past; its long-term failure rate has led many of us to fat acceptance. Sometimes it seems like nobody wants to believe the truth: that it almost never results in significant, long-term weight loss. Not dieting, and not dieting combined with exercise.

Doctors don't want to believe that dieting doesn't work long-term for most people. The media certainly doesn't believe it. Most fat people don't want to believe it, even after they've dealt with it repeatedly.

Why? Because intuitively, we know that the energy in = energy out equation has to work at some level. Our bodies need food to fuel physical activity. If they're not fed enough, they will dip into their energy reserves; they'll lose fat (and muscle, and other types of tissue). Fact. We must be able to exercise some control over our weight by using this knowledge, right? Hollywood actors and pop stars obviously manage to keep themselves very thin - they can't all naturally be so gaunt.

Here's the lowdown. Studies have failed to support the idea that fat people and thin people have different eating habits, or that fat people burn fewer calories than thin people.

So, while it is theoretically possible to exercise control over our weight and even to become and stay thin, the habits that are necessary to do so are profoundly unjust and very difficult to maintain over a period of years, let alone decades. To maintain even a little bit of weight loss, it's necessary to eat less and exercise more than a person who starts out at the lower weight. To maintain the type of weight loss that actually takes someone from fat to thin takes a huge amount of effort and absolute control. It is NOT just a matter of "cutting down on the junk food" or "taking a brisk walk every day."

After an initial high energy panic stage, a body that's below it's set point - its natural weight - will fight with every tool at its disposal to regain. It will never fail to absorb the maximum number of calories from food. It will slow down all of its systems, causing us to feel cold all the time, to feel tired and irritable, and to have trouble concentrating. It will do everything it can to encourage us to eat more: chronic hunger, preoccupation with food, and a difficult to resist binge reflex. (In this context, bingeing isn't a mental issue. It's a physical compulsion.) Ancel Keyes saw all of this in his WWII-era starvation study.

The effort, control and endurance that it takes to maintain weight loss isn't compatible with most people's lives. It's just too uncomfortable. When someone who's maintaining weight loss decides that they want to feel better; wants to feel normal; to not be cold, hungry and moody anymore? That they'd like to feel full occasionally? That they need to give their body a break from all of the exercise? Or maybe they suffer an injury or give in to the binge reflex? The weight comes back on. Quickly or gradually, it's regained. Often, just to guard against future famines (because our bodies interpret diets as famines), we over-gain, past our old setpoint to a new, higher one.

And then - because there IS actually eating, even bingeing, involved; because we may have cut down on our physical activity - we blame ourselves. We blame ourselves, and everyone silently concurs. This is a bitter, painful experience and many of us have dealt with it over and over again.

But what about the few people who do manage to successfully maintain a significant weight loss?

DebraSY has been a BFB commentator for many years. She sometimes says that she's "failed at HAES." What she really means is that she's chosen the much more difficult and demanding path of weight loss maintenance. She respects the "no diet talk" policy in the fatosphere and she generally doesn't discuss it here, but she has started a blog where she does reflect on weight loss and maintenance, honestly and critically. I think that Debra's experience and point of view are a piece of the puzzle that's usually missing from our discussion. We've talked about people's experiences with weight loss surgery in the fatosphere in the past, at BFB and at Shapely Prose. Now, let's take a look at what unaided weight loss maintenance really involves, for those who can manage it.

Debra is not a proselytizer and fundamentally agrees with fat acceptance, although many people may still find her posts triggering.

On her blog, Debra talks about the potential harm that can result from the diet mentality. She's also posted a critical discussion of "diet experts." These posts are pretty much straight-up fat acceptance.



If you feel okay reading about weight control, it helps to have the background she's laid out in her "about" and her first few posts: "The Unfairness of Weight Loss Maintenance", "Weight Loss Maintenance: the Job Description", and "The Slide Into Hell: Regaining Lost Weight." The truths that Debra discusses here are both familiar and revolutionary. THIS is what fat people keep running up against, and this is the truth that doctors, the media and the government want to deny. Unfortunately, their heads are in the sand; their hands are over their ears.



This is what reading Debra's blog confirmed for me: I'm not interested in emulating her. The price is too high. I've proven over and over again to myself that I have the persistence and insight to accomplish the things that I really care about. Weight loss maintenance is just not one of them. Frankly, if Michelle Obama, Jillian Michaels, the media, and the medical establishment think that's wrong, then they can go to hell. I'll take brisk walks and avoid junk food most of the time. I'll do the same things that a naturally thin person would to feel healthy and stay reasonably fit - that's HAES. But, I will not exist at the razor's edge of starvation and exhaustion in order to have a fashionable body and a doctor-approved BMI.



I'm here to say that it's entirely reasonable to say "no" to this, even if you think you might be able to manage it.

This just in: Actual data not as necessary as you might think

I have a coworker who loves to come to me with fat-related articles. This afternoon I received a gleeful IM: "I bet this one's gonna enrage you!" Then he sent me a link to this article about a study funded by Allergan, peddler of lap bands and other weight loss surgery products (as well as various pharmaceuticals). According to the study, not only do fat people take too much extra time off work, but apparently the time we spend at the office is somehow less productive, costing the poor companies who employ us millions billions of dollars a year.

My coworker was right. I read this article and now all I want to do is hiss and spit and jump up and down and maybe jam a pen in my eye. Because what the hell? There are no details whatsoever in the article that explain what is meant by loss of productivity or how it is measured, there are only dollar signs and percentages. For instance, if you're a woman with a BMI of 30-34.9, you will experience 6.3 days of 'presenteeism' or lost productivity throughout the year. At BMIs of 40 and above the number of days of lost productivity jumps to 22.7. For men the numbers are 2.3 days and 21.9 days, respectively.

But what does that actually mean? And where are those figures coming from? Where is the data? Your guess is as good as mine. What incenses me so much about this is that people are going to read this article and it will just reinforce every stereotype they've ever thought about fat people and laziness and it will give them justification to not hire or promote a fat person, to not pay them the same as everyone else. And you and I both know that the concept that fat people are not dedicated hard workers is complete and utter BS!

Feel free to vent with me in the comments.

PCA/ACA Fat Studies 2011 Call for Papers

CFP: 2011 Fat Studies Area Popular Culture/American Culture Associations National Conference (San Antonio,TX)


Fat Studies is becoming an interdisciplinary, cross-disciplinary field of study that confronts and critiques cultural constraints against notions of “fatness” and “the fat body”; explores fat bodies as they live in, are shaped by, and remake the world; and creates paradigms for the development of fat acceptance or celebration within mass culture. Fat Studies uses body size as the starting part for a wide-ranging theorization and explication of how societies and cultures, past and present, have conceptualized all bodies and the political/cultural meanings ascribed to every body. Fat Studies reminds us that all bodies are inscribed with the fears and hopes of the particular culture they reside in, and these emotions often are mislabeled as objective “facts” of health and biology. More importantly, perhaps, Fat Studies insists on the recognition that fat identity can be as fundamental and world-shaping as other identity constructs analyzed within the academy and represented in media.


Proposals in the area of Fat Studies are being accepted for the 2011 PCA /ACA (Popular Culture Association/American Culture Association) National Conference in San Antonio, TX (April 20-23, 2011, meeting with the Southwest/Texas regional at both the Marriott Rivercenter and Riverwalk Hotels). We welcome papers and performances from academics, researchers, intellectuals, activists, and artists, in any field of study, and at any stage in their career.



Topics may include but are not limited to:



■ representations of fat people in literature, film, music, nonfiction, and the visual arts

■ cross-cultural or global constructions of fatness and fat bodies

■ cultural, historical, inter/intrapersonal, or philosophical meanings of fat and fat bodies

■ the geography and lived experience of fatness and fat bodies

■ portrayals of fat individuals and groups in news, media, magazines

■ fatness as a social or political identity

■ fat acceptance, activism, and/or pride movements and tactics

■ approaches to fat and body image in philosophy, psychology, religion, sociology

■ fat children in literature, media, and/or pedagogy

■ fat as it intersects with race, ethnicity, class, religion, ability, gender, and/or sexuality

■ history and/or critique of diet books and scams

■ functions of fatphobia or fat oppression in economic and political systems


By December 15, 2010, please send an abstract of 100 - 250 words or a completed paper to Fat Studies Area Co-Chairs Julia McCrossin (jmccross@gwmail.gwu.edu) and Lesleigh Owen (goddess_les@yahoo.com).



Please include your complete contact information and a CV and/or 50 word bio, along with anticipated A/V needs. All submissions are welcome, but please use the information above to ensure your paper fits within the academic and political scopes of Fat Studies. Please also be mindful that Fat Studies is a political project and not merely an umbrella term for all discussions of larger bodies. Also, we encourage submitters to rethink using words like “obesity” and “overweight” in their presentations unless they are used ironically, within quotes, or accompanied by a political analysis.



Presenters must become members of the Popular Culture Association. Find more information on the conference and organization at PCA/ACA Conference.

Do parents discriminate against their fat kids?

This seems like such an obvious concept to me. After all, parents are people who grew up in our fat-hating society, so of course that will have some effect on how they treat their fat children. This video from the Today show touches on these issues but despite my gut feeling that discrimination is obviously happening with parents and fat kids, the study they're discussing seems a little problematic. I'm not entirely convinced that you can determine special treatment based on one factor, like how much money the parents gave their kids to buy a car. It makes me wonder if the study took into account money the parents had spent (as my parents did) on therapists, nutritionists, diet plans and fat camp to correct their child's fatness. Maybe they already spent the car fund on the very important cause of shrinking little Susie's fat ass. Or maybe they don't want her skinny siblings to think that they care about Susie more because they keep spending wads of cash on her. So Susie gets to go to ridiculously expensive fat camp and her sister gets to buy a nicer car.

Anyway, it would have been nice if they allowed more time at the end of the segment for the experts to talk (Dear Today show, here's a tip: don't book two experts if you don't have time for an actual discussion), because some solid points were being made about parenting fat kids. Take a look...what do you think?



Visit msnbc.com for breaking news, world news, and news about the economy

Good News - Upcoming Fat Studies Conference

via Obesity Timebomb-

There will be a free seminar on "Experiencing and Celebrating Fatness" in London, England on November 18th and 19th.

It's part of an Economic Social Research Council seminar series: Fat Studies and HAES: Bigness Beyond Obesity.

There's a flyer here and you can register here.

Speakers will include:
• Keynote: Sondra Solovay: attorney, adjunct professor of law and fat activist, Berkeley, California
• Stacy Bias, fat activist, Portland
• Kay Hyatt, Big Bum Jumble, London
• Dr Samantha Murray, Macquarie University
• Kim Singleton, University of Liverpool
• Caroline Walters, University of Exeter
• Dr Rachel White, University of Westminster
(more may be added)

There's more information on Obesity Timebomb.

Fat studies is a relatively new area of academic inquiry, and it's encouraging to see that it's growing and thriving. I was fortunate to be able to attend a fat studies conference a few years ago, and it was a wonderful experience. Having the opportunity to hang out with university activists and to meet people whose work I'd read and admired was truly energizing. Fat acceptance and HAES are slowly gaining visibility and mainstream legitimacy through the efforts of academics and activists. If you live near London or can travel there, it's a great opportunity to meet some of them and hear about their work.

Bad News - "Huge" Cancelled



"Crap! It was a surprisingly good show."

I'll take this opportunity to direct people over to the Fatshionista blog to commiserate on the cancellation of ABC Family's surprisingly subversive teenaged fat camp show. This link will take you to the cancellation post, along with all of Lesley's excellent episode-by-episode recaps.

To take action, join Shannon of Fierce Fatties "Save Huge" group on Facebook, sign Jezebel's petition, or write to ABC family and let them know how you feel, either through their web-based form or snail mail:

ABC Family

500 South Buena Vista St.

Burbank, CA 91521-6078

YES! Fistbump, Secret HAES Handshake

In today's news, the U.S. surgeon general is brilliant and wonderful and may actually have a positive effect on the nation's health. Yay, Dr. Benjamin!






I would urge BFB readers and commentators - especially US citizens - to send the surgeon general letters in support of this position. It could make a lot of difference; this will be controversial, and we need to let the Surgeon General's Office know that Americans support this approach. A letter - especially one you wrote yourself - will make a bigger impression than an e-mail or a phone call. The address given on the website is:



Office of the Surgeon General

5600 Fishers Lane

Room 18-66

Rockville, MD 20857

Telephone: 301-443-4000

Fax: 301-443-3574

Nothing Has Changed

Sociological images has posted a British PSA from 1967, in three parts.

In the PSA, it's assumed that fat people just need to be educated. However, even in the 1960s, the idea that any fat woman didn't know the common wisdom about nutrition - chapter and verse - must have been laughable.

Heritability is mentioned and confirmed, yet the PSA continues to imply that being fat is entirely due to poor eating habits and inactivity. In fact, it actually shows a fat woman eating sweets while talking about heritability. Am I sick for finding that hilarious? So transparent!

Of course, the most pathetic figure of all is the fat girl from the single parent home. Clearly, she's doomed to a life of shame and isolation.






The worst thing about this PSA is that, in 2010 - more than 40 years later! - most people, including doctors, don't have a more sophisticated understanding of weight regulation in the human body. It's still "eat a healthy diet and exercise, and you'll be thin!"

Since watching these can be depressing, try playing a game of "spot the stereotype." I know there's a lot to talk about here that I haven't touched on.

Fat Kids Targeted

Let's start with a basic fact. Build is as heritable as height; obesity is predominantly hereditary. Many fat parents have fat children. Why? Is it because fat parents are teaching their innocent children their lazy, gluttonous habits? Not so much. It's mostly because fat parents are passing on their genes. Here's a short article from the American Journal of Clinical Nutrition that discusses the evidence: "Obesity: still highly heritable after all these years"

The First Lady thinks that encouraging Americans to eat healthy diets and be physically active will eliminate obesity. This is because, as everyone knows, fat people (and especially fat kids) sit on their asses eating all the time, while thin people follow the food pyramid and recommended caloric intake while exercising for at least an hour a day. Also, back when people ate less and were more active (do we have proof of that? No?), there were no fat children. Remember "Our Gang" and "Little Rascals" from the 1920s - 1940s? No fat kids there! Oh wait...
/sarcasm

Michelle Obama's "Let's Move" initiative... the front page of the web site looks so positive and harmless. Encouraging kids to be active is a fine idea. However, click on any of the tabs and you'll find some questionable stuff. Weight is equated to health. Nowhere is it acknowledged that people can be active, eat a healthy diet and still have a BMI in the obese range. Nowhere does it mention the fact that some fat kids grow up into thin adults, or that some fat kids grow up into healthy, fat adults with long, productive, joyful lives.

Finally, the stated goal of the program is "solving the challenge of childhood obesity within a generation so that children born today will reach adulthood at a healthy weight." Trying to eliminate obesity from the population by encouraging children to exercise and eat less? Given the heritability of body size, that's just not going to work. People naturally come in a variety of sizes. Why would anyone want to eliminate an aspect of human diversity? And of course, trying to wipe out the defining characteristic of an culturally denigrated group of people... it's not pretty.

All of this tsk tsking and oh-so-magnaminous concern about the size of children will rightly be interpreted by fat children and their families as more unjustified shaming, bullies will take it as encouragement, and thin kids will be even more likely to shun fat kids. Speaking as a former fat kid, if there's a reason to hide inside in front of a screen while eating comfort food, then being bullied and shunned by your peers is it. And, while being active and eating a healthy diet may not make most fat people thin, it is true that comfort eating and hiding indoors tend to make us a bigger. Nice.

And if parents refuse to take part in the shaming and fail to treat their higher-than-average BMI children as if their bodies are unacceptable? If they dare to believe that their healthy, active child is all right in spite of population-level statistical tools saying that they're at the large end of the bell curve? They're considered incompetent. It's assumed that BMI means more than the knowledge that parents have about the health and habits of their specific, individual children.

If the government were really interested in helping fat kids, they'd have a program encouraging all children to do well in school, live balanced lives, develop self respect and respect for others, and take care of their bodies. They wouldn't call attention to kids' size, but they would be aware of things that are more physically challenging for heavier kids and offer help in accomplishing them, if it's wanted. Fat kids should learn to listen to their bodies - to trust them and to push their limits - just like other kids. They shouldn't be taught that their bodies are inherently wrong and unhealthy. Being a fat kid who grows into a fat adult shouldn't be viewed as a horrible fate. A lot of fat kids do grow into fat adults, and that's fine. It is not a guarantee of poor health, underachievement, and loneliness, but targeting fat kids with the kind of attention that's bound to worsen bullying and social isolation certainly makes those outcomes more likely.

Lesley Kinzel has written probably the best material I've read on this topic on Newsweek's site and on Fatshionista. If you only read two of the links in this post, read these.

There's also an excellent article at Huffington Post that's full of good points and good links.

Even We Are the Real Deal agrees that there are problems with this approach.

BFB members: What do you think? What were your experiences as a kid? What kind of experiences are your kids having? What's really best for kids, fat and thin?

Oh, and if you've posted about this topic on your blog or know of a good post on another blog, feel free to share the link in the comments.

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