An AP article reports on a new study, published in this month’s Pediatrics. The study found that teen girls who “frequently read magazine articles about dieting” five years ago, are two to three times more likely to use means such as fasting, laxatives, induced vomiting and cigarette smoking to lose weight, compared to girls who don’t read such articles as often.

It didn’t seem to matter whether the girls were overweight when they started reading about weight loss, nor whether they considered their weight important. After taking those factors into account, researchers still found reading articles about dieting predicted later unhealthy weight loss behavior.

44% of girls reported reading such articles, compared to 14% of boys. The study didn’t find any effects of the articles on boys.

There’s a sort of “duh!” response to articles like this - I mean, of course girls who read lots of articles about weight loss are more likely to be sticking fingers down their throats or fasting or whatever. What’s surprising to me is that no such effect was found among boys, since I’ve read several articles suggesting that boys are becoming more body-conscious and fat-phobic.

So here’s a thought: If we can ban trans fats in restaurants to protect health, can we also ban diet articles from teen girl magazines to protect health?

I have a bad cold today; I feel like my head’s stuffed with cotton, and I have next-to-no ability to concentrate for more than a few minutes at a time. So rather than attempt to write an original post, I’m going to quote from an excellent article from The New Republic about fat, health, and weight-loss. It’s an excellent article, and I’d highly recommend reading the whole thing.

What accounts for the conflict between studies that claim being “overweight” is a significant health risk and those that suggest such weight levels might actually be optimal? The biggest factor is that researchers fail to point out that, in practical terms, the differences in risk they are measuring are usually so small as to be trivial. For example, suppose that Group A consists of 2,500 subjects and that over the course of a decade five of these people die from heart attacks. Now suppose that Group B consists of 4,000 subjects and that five members of this group also die from heart attacks over the same ten-year span. One way of characterizing these figures is to say that people in Group A are subject to a (implicitly terrifying) 60 percent greater risk of a fatal heart attack than those in Group B. But the practical reality is that the relevant risk for members of both groups is minuscule. Indeed, upon closer examination, almost all studies that claim “overweight” people run significantly increased health risks involve this sort of interpretation (or, less generously, distortion) of their data. […]

In a decided majority of studies, groups of people labeled “overweight” by current standards are found to have equal or lower mortality rates than groups of supposedly ideal-weight individuals. University of Virginia professor Glenn Gaesser has estimated that three-quarters of all medical studies on the effects of weight on health between 1945 and 1995 concluded either that “excess” weight had no effect on health or that it was actually beneficial. And again, this remains the case even before one begins to take into account complicating factors such as sedentary lifestyle, poor nutrition, dieting and diet drugs, etc. “As of 2002,” Gaesser points out in his book Big Fat Lies, “there has not been a single study that has truly evaluated the effects of weight alone on health, which means that ‘thinner is healthier’ is not a fact but an unsubstantiated hypothesis for which there is a wealth of evidence that suggests the reverse.”

And from later in the article….

If fat is ultimately irrelevant to health, our fear of fat, unfortunately, is not. Americans’ obsession with thinness feeds an institution that actually is a danger to Americans’ health: the diet industry.

Tens of millions of Americans are trying more or less constantly to lose 20 or 30 pounds. (Recent estimates are that, on any particular day, close to half the adult population is on some sort of diet.) Most say they are doing so for their health, often on the advice of their doctors. Yet numerous studies–two dozen in the last 20 years alone–have shown that weight loss of this magnitude (and indeed even of as little as ten pounds) leads to an increased risk of premature death, sometimes by an order of several hundred percent. By contrast, over this same time frame, only a handful of studies have indicated that weight loss leads to lower mortality rates–and one of these found an eleven-hour increase in life expectancy per pound lost (i.e., less than an extra month of life in return for a 50-pound weight loss). This pattern holds true even when studies take into account “occult wasting,” the weight loss that sometimes accompanies a serious but unrelated illness.

And here’s a point I wish Campos had developed further:

Americans… long to believe that medical experts can solve the problem of their expanding waistlines. The reason for this can be summed up in six words: Americans think being fat is disgusting. That psychological truth creates an enormous incentive to give our disgust a respectable motivation. In other words, being fat must be terrible for one’s health, because if it isn’t that means our increasing hatred of fat represents a social, psychological, and moral problem rather than a medical one.

Again, I recommend reading the whole article.

(This is a guest post, written by a med school student, who prefers to remain anonymous. –Amp)

At least at my school, I have often felt that fat-hating is explicitly built into the pre-clinical medical curriculum. I have, thus far, only taken pre-clinical classes, so I have no idea whether the attitudes taught in 1st- and 2nd-year persist beyond this point (or even if anything taught in the first two years matters at all!)

Nevertheless, I was rather infuriated about the way fat was approached in our curriculum. At the time, I had not yet heard of fat acceptance or HAES¹, and was still firmly in a dieting mindset. Still, I found the difference between how fat was treated compared to how just about anything else was treated quite remarkable. For every other potentially loaded topic, from smoking to mental illness, there was a concerted and explicit emphasis on (1) following an evidence-based approach, and (2) to treating individuals with kindness and empathy. When it comes to teaching about fat, suddenly all that is thrown out the window.

Some representative examples would be cases where a fat man is described, for comic effect, as having difficulty fitting into a waiting room chair. Or where a woman with a BMI of 23 is described as appearing overweight. Or clinical tutors who repeatedly tell us that “calories in = calories out”, and that fat people simply lack willpower. Or lecturers who tell us that 1200 kCal per day is a reasonable weight-loss diet to recommend to patients. Or descriptions of how weight-loss dieting is the most appropriate response to bullying of fat kids. Or students who make comments in class such as “fat people don’t lose weight because they are stupid”. Or numerous alarmist lectures about the “obesity epidemic”. Etc, etc, etc.

My personal favorite, though, had to be the diabetes lecture where we were given a graph showing rates of obesity and rates of type II diabetes in various countries. The rates did not match up; some countries were identified as having soaring obesity and relatively stable diabetes rates, while others had soaring diabetes and relatively stable obesity rates. The conclusion drawn in the lecture was that the data must be wrong, because, after all, we all know that obesity causes diabetes! If it wasn’t so disturbing it would be quite funny - after all, I’m pretty sure I was taught at some point that the scientific method and evidence-based medicine are not _supposed_ to be about discarding data that do not match your pet hypothesis… ;-)

Those are just my personal impressions, and I don’t know how medical students’ attitudes objectively compare to the general population. I would guess that the teaching doesn’t so much make attitudes worse but rather reinforces the anti-fat attitudes that you’d typically find in a group of affluent young people. Of course, that’s not good enough! They should be actively teaching us to treat fat people well as much as they actively teach us to treat members of any other marginalized group well.

1. HAES = “Health At Every Size.” (back)

(Okay, only one of them is a model.)

First, Big Fat Blog has a “three quick questions” interview with Lindsay Hollister, a very cool American actress who has a size-acceptance mentality. From the interview:

[First,] I’m constantly torn between wanting to work and not wanting to perpetuate the myth of fat people. That we are lazy, sad, pathetic, etc. kind of people. Second, it affects me as a fat woman who has to watch these programs that portray fat people in a negative light. I am fat but also happen to be a successful, well dressed, outgoing woman who has been in a loving relationship for three years. Somehow, Hollywood fails to put that on screen and instead continues to write stereotypical roles for fat women. It’s an injustice to say the least, mostly due to the fact that the majority of Americans are overweight and deserve to see some real representation of their lives on the big (or small) screen.

Second, the Sydney Morning Herald’s “Entertainment Blog” has an interview with Paris-based model/actress Velvet d’Amour, who recently made a splash walking the runway wearing lingerie designed by Jean Paul Gaultier. What makes this interview interesting is that the blogger/interviewer keeps on asking mainstream anti-fat questions like “What do you think about TV programs such as ‘The Biggest Loser’? Do you think that they’re a good idea in encouraging people to lose weight?” Velvet does a great job answering these questions while (amazingly) keeping her cool. She also refuses to get drawn into dissing thin woman.

There’s a fallacy that abuse is about individual acts, and that you can measure the abusiveness of a relationship by tallying what people did to each other.

This ignores a basic truth about abuse, which is that you can’t abuse someone unless you have power over them.

The academic version of this fallacy has been doing the rounds in New Zealand. It’s being promoted by men who are terribly upset that there’s even one day a year where men are expected to take a stand against Violence Against Women. This coverage from the New Zealand Herald is fairly typical:

Professor David Fergusson and Associate Professor Richie Poulton said their respective long-term studies of people born in Christchurch and Dunedin in the 1970s showed that most domestic violence was mutual.

“In a high proportion of these couples, we are seeing mutual fighting. It’s brawling,” said Professor Fergusson.

In contrast, the commission is backing White Ribbon Day on November 25, which asks men to wear a white ribbon to show that they do not condone “men’s violence towards women”.

These men’s views of domestic violence and abuse are limited by the tool they used to measure it. Both studies used the Conflict Tactic Scale (CTS), a scale that measures individual ‘hits’, and the people who designed the scale have specifically rejected its use to compare men’s and women’s violence. I’m not going to argue the academics of the CTS; Ampersand did a very good job of this and Trish Wilson has a page of links. I want to make my point in a more basic way and I’m going to start with a really obvious example.

One of the questions the interviewees are asked is if a partner had ever: “Called you fat, ugly, or unattractive.” They seem to believe that statement is ungendered - it is equally abusive if a man says it to a woman as it would be if a woman said it to a man. To me, that is so unrealistic to be almost surreal.

I have known several couples where a woman does make comments about her male partner’s size (usually in the context of them both getting more exercise or eating differently). I have a problem with those conversations, and would rather not be around them, but the women are not being abusive, psychologically aggressive, or exercising any form of power (in fact it’s usually tied to the idea that women are responsible for their partner’s health). Whereas, I was at a pub six years ago with a couple I didn’t really know, and I can still work up rage at the man for telling his partner not to eat particular fries, because they were ‘fat sticks’.

Women are not set up to be the judges of men’s appearance and self-worth, so most women who comment about their male partner’s appearance are usually not exercising power. Whereas, men are given that power, and so such comments are far more likely to be abusive.

Obviously, there are many factors that could change this dynamic. Non-heterosexual relationships would obviously have a completely different dynamic, and the power related to appearance would likely to be much more varied. But that doesn’t stop that question being a really useless way of measuring psychological aggression.

I’d go further, I’d say other acts on the CTS list take different meaning depending on the power within the relationship. Let’s imagine a couple in a heterosexual relationship who are having an argument and in the course of this argument the man hits the woman. He doesn’t hurt her, but he’s stronger than her. This could be an assertion of power: “I could have hurt you, but I didn’t. No-one would believe that I hit you, no one would care if they did. Everyone knows that it’s wrong to hit your girlfriend, but I can hit you.”

Now let us reverse the situation: this time the woman hits the man. In this context hitting him could be a statement of powerlessness: “I can’t stop you, I can’t hurt you, I can’t do anything to make this stop.”

I’m not saying that everytime a man hits a woman it means something similar to my first example, and every time a woman hits a man it means something similar to my second example. What I am saying is that the meaning (and abusiveness) of individual actions is found within the power dynamic of that relationship, and in our society power dynamics within heterosexual relationships are going to be gendered.

Unfortunately it’s not just researchers who believe that you measure abuse by examining individual actions. I’ve found the idea all too common in people who are confronted with abusive relationships among their friends. Rather than looking at the power dynamic involved in an abusive relationship, I’ve seen people too easily slip into the classification of ‘mutually abusive relationship’ or ‘fucked-up situation.’

Power within a relationship isn’t a zero sum game - both parties can have, and misuse, lots of power against each other. I’m not arguing that mutually abusive relationships don’t exist, but that no-one should come to the conclusion that an individual relationship is mutually abusive without thinking about the power involved first.

‘Mutually abusive relationship’ as the default setting creates the idea of a perfect victim. If anyone who fights back is in a ‘mutually abusive relationship,’ then the only way you are entitled to support is if you don’t fight back. But if you react to the abuse, physically defend yourself, act jealous or fucked up by what’s happened to you, then you don’t deserve support, and people around can wash their hands and walks away from what they term a mutually abusive relationship.

As a feminist, as a human being, it is my duty and my desire, to support the powerless against the powerful, and to not wash my hands of women who fight back.

Amp put up a list of privilege lists on Alas. For those not familiar with the format, most are based on Peggy McIntosh’s White privilege: Unpacking the invisible knapsack.

When they stick to the specifics these lists can be illuminating - I’m probably not the only white person who had never had to think about the colour of ‘flesh-coloured’ bandages. But seeing all those lists together raised some real questions for me.

This is partly because I think there’s a real problem with the way privilege is framed in these lists - anything which one group of people have and another doesn’t is considered a privilege. I’m fine with describing a man who doesn’t do his share of housework and has women around him picking up the slack as privileged. I’m much less OK with describing a man who doesn’t have to worry about being raped, if he walks home after dark, as privileged. Not being afraid of rape is a right, not a privilege.

I disagree with the content of some of the lists. I think an extremely large proportion of the average sized person are not true for many women - whatever their size (particularly this one: I do not have to be afraid that when I talk to my friends or family they will mention the size of my body in a critical manner, or suggest unsolicited diet products and exercise programs - I find the idea that ‘average-sized’ women can be free from this fear almost ridiculous). The white-privilege list seems to assume that the white-people in question are middle-class. Some of the non-trans-privilege list also apply to many non-trans women (particularly the stuff about gender and medical care). This is from a social class privilege check-list: “There are places where I can be among those exclusively from my social class” - which suggests he’s never been to a factory, poor neighbourhood, or a prison. I get that it’s a blunt instrument, but a lot of these lists are obscuring more than they’re illuminating.

I also think there’s a real problem in treating different sorts of oppression as if they operate the same way. I’ve written about this before. But these lists, which are all based on each other in some respect really seem to suggest that privilege all works in the same way. For example, representation in media plays a part in most lists, but I would say the role media plays in upholding different oppressions is really different.

But most fundamentally I just don’t have much time for analysing the world through privilege. It so often leads to individualistic non-action - to someone interupting a conversation to say “but even having this conversation is a privilege.” On an individual level I think it’s important to know where you come from, to know what you’ve been given, and to analyse how you benefit from this system. I absolutely think that everyone has a responsibility to not use the privilege, and power, society gives us - over people we know. But you can’t give up privilege as an individual - you can just fight to end it by working collectively.

*********

Note: I’ve had a disturbing amount of support from right-wing assholes for this post. I think they glided over this sentance:

On an individual level I think it’s important to know where you come from, to know what you’ve been given, and to analyse how you benefit from this system. I absolutely think that everyone has a responsibility to not use the privilege, and power, society gives us - over people we know.

I think I should make the point more explicit. I believe that when you interact with someone who has less power and resources tha you do you have a duty not to wield your advantages over them, or to act like you’re superior because you have that power and those resources. Snapping at workers in the service industry? Absolutely unacceptable for anyone who believes in any kind of equal society. Asking why those in poverty get hire purchaces (when you can always get credit from your parents)? Equally obnoxious. Obviously in order to do this, you need to understand what power and resources our society has given you.

However, I believe this step is only a necessary pre-requisite for meaningful political action, it is not meaningful political action in and of itself. I’m not saying that you shouldn’t realise what society gives you, it’s just that realising it doesn’t doing anyone any good at all unless you organise.

Also posted at Capitalism Bad; Tree Pretty

It has taken me a while to write about the stupidest thing I read this week. But it hasn’t got any less stupid:

South Africa’s AIDS crisis is fuelling a second epidemic as obesity rates rise steadily, particularly among women eager to prove they don’t have the disease by packing on extra pounds.

Many in South Africa associate being thin with terminal illness due to AIDS, while valuing plumpness as a sign of wealth and good health.

The trend is most widespread amongst black women.

“(Patients) will say to you, ‘But I don’t want to lose this weight because (they) will think that I’m dying of AIDS,’”

Some background this was said at a South African obesity conference (sponsored by Roche), by Tessa Van Der Mer - the head of the countries first obesity clinic. So no disinterested parties were involved in the making of this news story. More than that - no actual research went into that statement either - it’s just one woman’s observation of what people said to her. Yet it is reported around the world the Independent in Britain and the Canadian National Post (and then reproduced in a Feminist Carnival - of all places).

I really don’t have time for the many levels of stupidity in Tessa Van Mer’s argument. But the breathless way it’s been reported that some people don’t want to be thin, is really disturbing. The world has always been the way it is right now among media circles in New York and London. The only reason people would see things any differently would be because of fear of a terrible disease, and we have to show them they’re wrong immediately.

Also posted at Capitalism Bad; Tree Pretty

Over at I Hate People. Go! Look! Link!

Amp has asked me to guest post again this month. Expect some posts on recent New Zealand union developments (we fought! and won! - it was very exciting), praise for the irony free, and the usual rants about feminism, bodies, capitalism, Joss Whedon and collective action.

But I thought I’d reintroduce myself by cross-posting two memories I have, that I wrote about yesteday.

I generally refer to my primary school (for non New Zealanders primary school generally goes from ages 5-12) as ‘my hippy school’. It was run as a parent co-operative; we all worked at our own pace; the entire school was thirty children; and every family had to do one half-day parent help each week. It was a gillion times better for me than my other primary school in New Zealand where I’d been bored and miserable. Although I don’t know how it would compare with the primary school I went to in London, where my Mum says I was really happy (my main memory from that school is not liking gravy, but being too shy to ask the school dinner people not to put any gravy on mine).

I was going to write a post about what my ideal primary school would be like (I’ve written it now, and it’s here). But as I was thinking about writing that post, I remembered something I hadn’t thought about in years. So I thought I’d write about that memory first. Otherwise I feel I’d have to go into it in great detail in a footnote in the other post, and that’d be a little bit distracting.

I don’t know how old I was at the time, I think I was ten or eleven, I certainly wasn’t older than that. I know because the main teacher of the school (and the one who taught us ‘big kids’) left before I turned 12. Anyway she decided that four of the girls around my age were getting fat, and therefore we had to go for walks (everyday? Once a week? I don’t remember). We were to go out of the school down to the park up a hill and come back again.

We didn’t always do it, of course (no adult came with us). Sometimes we’d go down to a creek bed instead. Sometimes we’d stop behind some bushes that was a fairy place (I was still young enough to like ‘fairy places’).

There were four girls my age who didn’t have to go on these walks, two of whom were reasonably serious gymnasts. I wonder, looking back, how much of it was that the teacher had forgotten how girls’ bodies change. We were the first older girls in the school for a number of years (the school always had more boys than girls), and we were all eldest daughters. Maybe puberty took them by surprise.

You see, it was only the girls they did this to. There had been fat boys about our age in earlier years, and no-one thought there was any need for intervention.

It makes me so angry, looking back. Not at the activity itself - it’d be sad if the great injustice of my life was having to go for a walk. If they’d decided that kids who weren’t particularly physically active needed to do more walking, I think that would have been cool (and I would certainly have been one of them, but so would some of the thin girls). I am really angry that an alternative school, where there was at least some feminist analysis among the people who ran it, dedicated time and energy into making sure pre-teen girls knew they should try and control their weight.

So tomorrow you’ll hear all about my plans for an alternative model for schools. But remember that individualised attention isn’t always a good thing, it can allow all sorts of individualised way for teachers to passed on fucked-up ideas.

Of course there is plenty of scope for this at normal secondary schools. In fourth form (fourteen) I was taught nutrition by a woman with anorexia. The thing I remember most about that was an exercise where we had to write down everything we ate over a certain period of time. We were told the number of calories we should eat each day, and everyone I knew in that class (it was an all girls school) worked really hard to make sure we ate less than that number of calories. To the extent that I thought that was the point of the exercise, to make sure we weren’t eating too much. Because the important thing to teach fourteen year old girls is to make sure that they eat less than the calories they need to live.

Also posted at Capitalism Bad; Tree Pretty

The end of the day on Sunday is the deadline for the Fifth Big Fat Carnival, to be hosted by I Hate People. Please use this form to submit favorite fat-positive and anti-sizism posts, either that you have written yourself, or that you’ve come across in your browsings. Soopermouse’s suggested theme is “Daily living with fat, in dignity,” but as usual off-theme submissions are also welcome.

Also, we need a host for the sixth big fat carnival (to appear the first week of December), so please leave a comment or drop me an email if you’d like to do that. (Or any future BFC, for that matter).

The third fifth Big Fat Carnival, to be hosted by I Hate People, is approaching, but we’re weirdly low on submissions this time! Oh, no! The humiliation! How will we ever be able to face the other Carnivals at the Carnival Sock-Hop?

But we can save the Big Fat Carnival! Please use this form to submit excellent fat-positive and anti-sizism posts, either that you have written yourself, or that you’ve come across in your browsings. Soopermouse’s suggested theme is “Daily living with fat, in dignity,” but as usual off-theme submissions are happily accepted! (Submission deadline is the end of the day on Sunday, October 1st). And if other fat-positive and allied bloggers could link to or reprint this call for submissions, I’d really appreciate it. :-)

Thanks!

Maia at Capitalism Bad, Tree Pretty writes:

In particular, several fast-food chains were in the news a couple of weeks ago. This is how it was reported in the The Dominion Post:

Representatives of the multinationals fronted up to Parliament’s health select committee yesterday and insisted their products did not cause obesity.

Because the only way to evaluate our food is whether or not it causes obesity. […] As soon as the discourse becomes about obesity, the makers of food don’t have to justify what’s in their food, and can instead claim that things aren’t there.

Go read the whole thing.

Over at Creek Running North, Timothy Burke (in comments) writes:

It’s the language of “public health panic” that worries me. Language like “epidemic”, which slips away from precision and proportionality just as the language of “addiction” does. Suddenly there’s a whole army of experts who have staked their claim and hung out their shingle on trying to advise people about their “addiction” to this and that. It becomes ok to spend millions, even billions, on pointless PSAs, on interventions of various kinds, on consultation contracts, and so on.

There are a great many “public health panics” of this kind in the past that have been more or less baseless or more commonly disproportionate.

In this case, I think the main problem, if you’ll excuse the unintended pun, is a proportionality problem. There’s no question that obesity is a public health issue and that it is occurring in more people and in more ways. But how big an issue is it, and how much should we worry about it? If life expectancies in the developed world are up to a very significant extent over the last century, and obesity curtails that slightly, so what? Why does that matter, how much does it matter, and how much effort should that occasion from us? How much does obesity negatively affect quality of life vs. efforts to curtail obesity negatively affect quality of life?

I particularly get frustrated with the language of efficiency in these kinds of “public health panic” discussions, about how much money is allegedly wasted on treatment, because they’re impoverished both as hard-nosed economics and as a kind of humanistic discourse. On the hard-nosed side, it’s the kind of thing that some economists are good at being playful at but do-gooder experts and suchlike make many bad assumptions about. For example, is it a net loss or gain if people die at earlier ages from smoking tobacco? You want to make a big deal out of this as a purely economic question, you have to run the numbers. How much does that affect productivity? How many people make their living out of selling the tobacco? How many people make their living out of treating the people who get sick from it? How much money in various costs do those people save by dying earlier? If you reject on principle those kinds of questions, don’t talk about how much money public health problems cost, just talk about the humanistic issue of quality and length of life. Which takes you back to having to make philosophical arguments that may limit or constrain the kinds of interventions or projects you entertain under this heading. If if turns out that obesity costs you three years on average, and has a relatively minimal effect on life satisfaction rates for the average person, then maybe you say it’s not a good thing, but you don’t lead a huge and expensive crusade with targeted interventions about it, you save your efforts for something else. The problem here is that people reason from themselves in really flawed ways and get to major projects that consume public resources and energy. I’ve personally been liberated by literacy and scholarly thought, but it’s not clear to me that literacy beyond basic competencies is equally liberating to all people. I would want to think about evidence for that, step back from my own satisfactions, and then think about cost/benefit ratios to making literacy a chief or driving objective of social policy.

That’s my issue: that there are a zillion people out there desperate to make a given issue a huge, prepossessing public priority, using the language of epidemic or crisis or disaster, without offering either hard cost/benefit analysis or thoughtfully situational humanism to explain why the issue at hand ought to be at the top of a list of concerns we all ought to share. I’d like to be thinner and in better shape myself, but I’m not at all certain why you or anyone else should really care that much if I’m not–or if you do, why you shouldn’t care equally about whether I drink, about whether I wear seatbelts, about whether I’m male, about whether I like to climb mountains, about whether I use my computer too much, and much else besides. If my employer should care about my weight because they don’t want me to croak or cost them too much in health insurance, every single one of those other issues is also potentially relevant. And frankly, maybe they want me to croak: a 27-year old version of me is a lot cheaper for them. My family and friends should care; should my society? If society should care because all people are valuable and full of potential, aren’t there issues which impede the value and potential of people far more pressing than whether a middle-class white professional is 50 lbs. overweight? Or even whether a working-class black man living in inner-city Philadelphia is 50 lbs. overweight?

My thanks to Timothy for the permission to quote him so extensively.

On Monday, I wrote about a recent study, published in the New England Journal of Medicine¹ , which is intended to refute last year’s CDC study (published in JAMA² ) showing that “overweight” people live longer than “normal” weight people.

According to media reports, this new study proved that even a slight weight gain can be deadly. The AP wrote “Being a little overweight can kill you, according to new research that leaves little room for denial that a few extra pounds is harmful.” NPR wrote “being even a bit overweight can potentially kill you.” The Star-Ledger ominously asked “Those few extra pounds won’t kill you … or will they?”

The NEJM study, by Adams et al., is — frankly — a badly conducted study. It uses a non-representative sample (members of The American Association of Retired People, or AARP) with an incredibly low response rate of 18%. Even worse, height and weight were self-reported.

But for the study’s authors, who were determined to come up with a study proving that fat equals death, the data presented a much more serious problem: the people in the “overweight” category were longer-lived than the people in the “normal weight” category. How to spin data showing that overweight people live longer, into their desired message that fat is always deadly?

In Monday’s post, I quoted Linda Bacon extensively. Today I want to expand on one of her points:

…Let’s take a look at the data itself. The authors worked hard for their conclusion. They examined records from over a half million AARP members that had been surveyed over a ten year period. What they found was entirely consistent with the earlier JAMA report: “overweight” people had the lowest mortality risk. But that wouldn’t serve their purposes. NEJM’s press release wouldn’t look nearly as attractive with that headline.

So they subjected their data to numerous manipulations before finally arriving at a suitable conclusion. First they threw out data on people who were smokers or former smokers. Nope, still shows overweight as benign. They hid this with a sleazy method: using only the top (BMIs of 23 to 24.9) of the “normal weight” group compared to the whole of the “overweight” group.

Here’s a table of some of the relative risks reported in the Adams et al. study (if you have trouble reading it, click on the image for a larger version):

The yellow column indicates the relative risk of death for “normal weight” people (the heaviest set of “normal” weight people are used as the baseline; all other risk ratios on this table are in comparison to those folks). The red outlines indicate the areas where the relative risk of death is as low or lower for “overweight” people as it is for “normal weight” people.

• Note that for “all men” and “all women,” the risk of death is less for people who are slightly “overweight” than it is for people in the “normal weight” categories.
• Looking at where the red outlines are located, can anyone seriously argue that the take-away finding of this data is that being a little overweight is generally a killer?
• In nearly every category, being in the “normal weight” BMI ranges of 18.5-20.9 or 21-23.4 carries a higher risk of premature death than being in the “overweight” BMI ranges.
• In most categories, being slightly “obese” (BMI 30-35) is slightly less risky than being in the middle of the “normal weight” category (BMI 21-23.5). In many categories, being solidly “obese” (BMI 35-40) is slightly less risky than being at the thin end of the “normal weight” category (BMI 18.5-21).
• In order to produce the finding that “overweight” is less healthy than “normal weight,” Dr. Adams did a very dishonest statistical manipulation - he compared just one “normal” BMI range, representing the heaviest people in the “normal” range, to the entire “overweight” range. This is because the majority of people in the “normal weight” categories had a greater risk of death than the majority of people in the “overweight” category.
• Race and sex have a strong impact on these findings. The “fat equals death” findings that were reported in the media shouldn’t be taken seriously by anyone, but black women especially would be well advised to ignore the reporting. This study actually found that black women, more than anyone else, have an elevated risk of death if they’re in the “normal weight” category, and live longer if they’re in the “overweight” category.
• The strongest association between “overweight” and increased mortality were for Latina women, and for the combined category of Asians, Pacific Islanders and American Indians (both male and female). However, the the sample size for these groups were significantly lower than the sample sizes for the other groups. For example, the finding that white men in the BMI range of 35-39.9 have a relative risk of 1.32 was based on the deaths of 1,862 white men in that BMI range; in contrast, the finding that Hispanic women in the BMI range of 35-39.9 was based on the deaths of only 10 Hispanic women in that BMI range. This makes these findings much less reliable.
• None of these risk ratios should be taken seriously. Why? Because they’re all very low³ — almost none of the risk ratios rise above two (for smokers the risk ratio of death by lung cancer, compared to non-smokers, is 23.3 for men and 12.7 for women⁴). Many of the risk ratios are so small (e.g., 1.07 - remember, 1.00 is a null result) that it’s impossible to imagine that they could have any realistic real-world significance to someone evaluating her own health.

  With very small risk ratios - especially in a study with poor data-gathering and many possible factors not controlled for, such as this study - determining causation isn’t really science; it’s guesswork. Maybe these differences are being caused by fat (even though at many BMI ratios fat people live longer); but the cause may also be one of the many factors this study did not account for, such as yo-yo dieting, use of weight loss drugs, body shape, discrimination, and socioeconomic class, to name a few.

So that’s one of the ways Adams and his co-writers twisted the data to produce their desired result. But they weren’t done yet, and so neither am I: watch for a future post on how they used retrospective data (i.e., asking people “do you remember what you weighed when you were 50?”) to twist their data further, and for what they actually found out (but didn’t report): Losing weight is deadlier than gaining weight.

1. Adams, K., et al., Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old. New England Journal of Medicine, 2006. 355(8): p. 763-8. (back)
2. Flegal, K.M., et al., Excess deaths associated with underweight, overweight, and obesity. Journal of the American Medical Association, 2005. 293(15): p. 1861-7. There are “Alas” posts discussing this study here and here. (back)
3. The sole exception is the 4.12 risk ratio for Hispanic women with BMIs of 40+. This finding — based on the deaths of just 16 women — is such an extreme outlier that it’s almost certainly statistical noise. (back)
4. The Surgeon General’s “Health Consequences of Smoking 2004,” chapter 7, page 881 (back)

Mayo Clinic researchers have designed a chairless classroom that they say may cut down on childhood obesity even as it helps children focus on learning and being happier in school.

“We know that a major culprit behind obesity is a lack of physical activity,” says Dr. James Levine, a Mayo Clinic obesity researcher who has studied the connection between everyday movement and weight.

Levine wondered if a different type of classroom could encourage movement, and ultimately, reduce the risk of obesity. Earlier this year, Levine and Mayo Clinic colleagues put the notion to the test. They designed what they believe is the first classroom without chairs using a range of creative and mobile tools. Each student had a “standing desk” on wheels that could easily move around the classroom. Apple loaned wireless notebook computers and iPods, which students used in regular learning activities.

My high school chemistry class had high tables and stools for students to sit at. The experiments were done at these tables or at the high counters along the walls. Each student had a table and lab partner — except for me. I sat alone at the front of the class at a low table about a yard from the chalk board.

When we had experiments, I joined some duo, peering at what they worked on with the project at my eye level. There was no way I could participate hands-on, particularly when volatile chemicals were used. A few experiments I could do at my low table. Alone. Where I didn’t have the camaraderie of teamwork that the other students all enjoyed.

Similar to my chemistry classroom furniture, many restaurants now feature tall tables and stools for guests. Some busy lunchtime cafes even have wall-hugging counters with no chairs at all so workers can stand and eat — part of the hurried lunch break of American work culture. By law, these establishments have to provide accessible wheelchair seating. I don’t know what the exact occupancy ratio is, but frequently this means one or two normal-height tables in a corner somewhere for the likes of me — if the place is ADA-compliant. A similar problem exists in bars, and restaurants that have lots of booths.

When an environment is apportioned out so that, by furniture design, wheelchair users are excluded from most of the space and all that space creates a social environment as high or higher than the wheelchair user’s eye-level, the exclusion can be keenly felt. It’s spatial discrimination, really. There’s a place for you, but you can only stay in your place since the rest of the environment is designed in a way that is not usable.

It’s fundamentally different from seating at, say, a stadium or theater where wheelchair access seating must be integrated into the whole floor plan. It may not be optimum seating — in fact, it rarely is, since building owners can make more money keeping the premium seats wheelchair inaccessible — but there’s the potential for everyone present to be seated, more or less equally. (Nondisabled people standing at concerts and giving wheelchair users only butts to look at from their equally-expensive seats is another topic for another day.)

I like the idea of classrooms where the furniture is all mobile and teaching allows for movement and more dynamic and varied gatherings of students, but if classroom furniture begins to be designed for the standing student, the sitting ones will be even more excluded spatially. The mobile part would be excellent — more room for wheelchairs to get around. But furniture for standing students raises the plane of classroom conversation over the wheelchair user’s head.

The ADA doesn’t account for perceptual/conceptual discrimination of this kind so there would be no legal recourse, as far as I know. I’m all for making classroom learning a more comfortably physical experience. Perhaps there’s some way to copy what I’m told is a West Point custom: students who feel in danger of falling asleep during lectures are encouraged to get up and stand in the back of the classroom, promoting activity to focus attention. At least that’s voluntary.

Article via Amy Tenderich at Diabetes Mine

Crossposted at The Gimp Parade

(The ADA, for those who don’t know, is the “Americans With Disabilities Act.”)

From the Disability Law Blog (thanks to Blue for emailing me the link!):

This morning, the Sixth Circuit issued its decision in EEOC v. Watkins Motor Lines, Inc. The EEOC had brought suit on behalf of a worker who claimed he had been fired because of his morbid obesity (he weighed up to 450 pounds). The Sixth Circuit held that the worker did not have a “disability” for purposes of the ADA, because he did not show that his obesity had a “physiological cause” and therefore qualified as a “physiological disorder.” Although the EEOC had shown that the worker’s weight was more than 100% greater than the norm (sufficient for a diagnosis of morbid obesity under the traditional definition), they failed to show that the weight was “the result of a physiological condition.”

This decision seems to me quite confused, though it’s a confusing area so I cut the court some slack. What does it mean to say that morbid obesity has a “physiological cause”? All of our behavior has some physiological cause, if only from hormones and brain activity. And there’s lots of reason to believe that brain proteins that alter appetite and activity levels, not to mention genetics, are substantial contributors to morbid obesity. More broadly, every fact about our body is by definition physiological. And morbid obesity, being a condition of one’s physiology, is by definition a “physiological condition.”

So the problem can’t be that the worker’s morbid obesity had no “physiological cause” or was not a “physiological condition.” The problem has to be that he had no physiological “disorder.” But what does that mean? The theory of “disorder” can’t be a condition that has some identifiable organic etiology, or most “syndrome”-type conditions would be ruled out. We often just don’t know what the etiology of a particular condition is, even when doctors diagnose it, recognize that it calls for treatment, and treat it. For it to make any sense, I think “impairment” has to be defined medically — according to what are the conditions that are the basis for recognized medical (and psychological, since the statute includes both physical and mental impairments) diagnoses. On that score, morbid obesity that meets clinical criteria should always be an “impairment” — which doesn’t mean it will always be a “disability,” as the plaintiff will still have to show actual or perceived substantial limitation of a major life activity.

The Court’s decision can be read here (pdf link). I think they made the wrong decision, but maybe making the wrong decision is the right thing to do at this time. Basically, they argued that for an obese person to qualify for ADA protection, the obesity must have a “physiological cause.” But it’s a little tricky to support that interpretation based on the text of the ADA itself. The relevant section of the ADA reads:

Any physiological disorder, or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genito-urinary, hemic and lymphatic, skin, and endocrine.

So the court is in the position of arguing that obesity has to be shown to be a physiological “disorder” and not a “condition” to qualify for ADA protection - even though the ADA’s own definition clearly includes physiological conditions. To see how finely they had to chop their arguments, consider this: Judge Gibbons, in her concurrence, concedes that a “literal” reading does not support the Court’s position, but argues that a missing comma which existed in an earlier piece of legislation the ADA took its language from should be the controlling authority.

I think that fat acceptance and disabled rights, while not identical, have significant areas of overlap - both literally, in the bodies of people who are both disabled and fat, and philosophically. In the end, both movements are about the idea that there is no one correct form that all human beings are obliged to fit into, or to work to become; and that all human beings, regardless of how their bodies differ from the average, are deserving of equal dignity and equal rights.

Perhaps the biggest difference between anti-disabled bigotry and anti-fat bigotry is that disabled people are not seen as responsible for their “condition,” whereas fat people are by and large blamed for being fat. I think this underlying prejudice is the unstated logic driving the Sixth Circuit’s decision. While obese people who can prove that their obesity is not their fault may be covered by the ADA, obese people in general are to blame, and thus must not be covered by the ADA.

So why did I say “but maybe making the wrong decision is the right thing to do at this time”? Because I think that when Congress passed the ADA, they probably didn’t intend for it to apply to most “morbidly obese” people, because the Representatives and Senators probably share the idea that most obese people have only themselves to blame and can reasonably be discriminated against by employers. I worry that if the Courts found that the ADA covered all “morbidly obese” people, the result would be a backlash against the ADA and the Courts, at a time when the ADA itself is still very controversial and not totally secure. Probably more work needs to be done to change the “hearts and minds” of the American population about obesity; court victories based on the ADA might not be sustainable until the fat acceptance movement has achieved at least a small degree of mainstream acceptance.

[Crossposted at Creative Destruction. If your comments aren’t being approved here, try there.]

Late last month, a National Cancer Institute study published in the New England Journal of Medicine was given a lot of unskeptical press coverage.

This report, from the AP’s Alicia Chang, is typical in its gloom-and-doom prognosis:

Being a little overweight can kill you, according to new research that leaves little room for denial that a few extra pounds is harmful. Baby boomers who were even just a tad pudgy were more likely to die prematurely than those who were at a healthy weight, U.S. researchers reported Tuesday.

Fortunately for overweight people, the NEJM study is pretty awful, combining bad methodology with dishonest interpretation. The results of this NEJM study, if honestly reported, show that overweight people on average live as long or longer as “normal” weight people; and that the one group of overweight people who did seem to have a significantly elevated risk of mortality, were overweight 50-year-olds who lost weight.

Expect multiple “Alas” posts criticizing this NEJM study. Starting us off is a commentary by Linda Bacon, quoted here with her kind permission.

New Weight Scare Based on Faulty Analysis

by Linda Bacon, PhD, Nutrition Researcher and Professor, NAAFA member

At least 400,000 Americans die of overweight and obesity every year, making it soon to surpass smoking as the leading cause of preventable death [1]. At least that’s what the Centers for Disease Control (CDC) told us.

But an updated federal report, published last year in the Journal of the American Medical Association (and reported in the Late Spring 2005 NAAFA Newsletter), acknowledged that the previous analysis suffered from computational errors [2]. In fact, obesity and overweight only result in an excess of 26,000 annual deaths, far fewer than guns, alcohol or car crashes. And separating overweight from obesity reveals further interesting information: “overweight” people live longer than “normal” weight people.

The data weren’t surprising to those of us who study these issues. This is not an anomaly, but consistent with many other investigations. That it came from the CDC and got published in JAMA were the real astonishing facts.

We waited for the backlash. Fear-mongering about weight is worth billions to industry and is consistent with government policy. Few stand to gain from the news that overweight is benign, if not beneficial. The backlash has been slowly building, and recently came out full force in a highly publicized study published in the August issue of the New England Journal of Medicine [3].

The front page leader in my local paper loudly proclaimed: “Just a few extra pounds is bad for you” and the article title reinforced the message: “Study finds risks for the barely overweight.” Turn to the original report, and you find a consistent conclusion in the abstract: “excess body weight during midlife, including overweight, is associated with an increased risk of death.”

But before you dust off those diet books, let’s take a look at the data itself. The authors worked hard for their conclusion. They examined records from over a half million AARP members that had been surveyed over a ten year period. What they found was entirely consistent with the earlier JAMA report: “overweight” people had the lowest mortality risk. But that wouldn’t serve their purposes. NEJM’s press release wouldn’t look nearly as attractive with that headline.

So they subjected their data to numerous manipulations before finally arriving at a suitable conclusion. First they threw out data on people who were smokers or former smokers. Nope, still shows overweight as benign. They hid this with a sleazy method: using only the top (BMIs of 23 to 24.9) of the “normal weight” group compared to the whole of the “overweight” group.

Then they found an even more creative trick. When they asked participants - some of whom were in their 70s - what they had weighed at the age of 50, they hit paydirt: at last, overweight - at midlife - was associated with increased risk, albeit modest. This will grab the headlines. No need to highlight that we had to whittle our data down to about 5% of the original sample to get this result! (That 40% of the participants chose to leave the question on recalled weight blank should give some indication of the ability of people to accurately report this information.)

Their paper is weak for many other reasons: they had a very low response rate (18%) from a sample that is not nationally representative; their data is based on self-report, which is known to be inaccurate; adjustments for potential confounders were weakly conducted; the list goes on. And they neglected to note another important conclusion: weight loss is associated with a significant increased risk of death for middle-aged “overweight” people.

Come on, New England Journal of Medicine. We expect scholarship, not propaganda.

References

1. Mokdad, A.H., et al., Actual causes of death in the United States, 2000. Journal of the American Medical Association, 2004. 291: p. 1238-45.
2. Flegal, K.M., et al., Excess deaths associated with underweight, overweight, and obesity. Journal of the American Medical Association, 2005. 293(15): p. 1861-7.
3. Adams, K., et al., Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old. New England Journal of Medicine, 2006. 355(8): p. 763-8.

[Crossposted at Creative Destruction, where even the anteaters are covered in chocolate. If your comments aren’t being approved here, try there.]

I found myself watching an episode of “Hell’s Kitchen,” which was reasonably entertaining. But I hated that a fat kitchen staffer was berated for being fat by the host, Gordon Ramsay: i.e., “get your lazy fat ass in gear,” “you fat jerk,” etc. (I’m paraphrasing, but I think I’ve got the gist right). I tried to imagine the popular revulsion if the host had berated a Jewish worker in the same way - “get your lazy Jewish ass in gear” and so forth. Is there any question that the host would have been fired?

Looking online a bit, I find that Ramsey also constantly referred to contestant Sara Horowitz (pictured) as “a fat cow,” “a bloody cow,” “a stupid mouthy cow,” etc. (Ramsay did this so often that another contestant bought Sara a toy cow as a gag gift). Unlike the fat man Ramsay berated, Sara isn’t fat. But she’s not skinny, and on TV all non-skinny women are considered fat.

(The final two contestants were both model-thin. If Ramsay had called Sara “a Jewish cow,” and if all Jewish contestants were cut before the final round, wouldn’t people be questioning whether or not Ramsay’s judgements were unbiased?)

Anyway, what the hell, at least fat people appeared. On TV, that’s a pretty rare thing.

In other news, I took this “Rate Your Life” quiz (via Melancholy Revolutionary). I understand that quizzes like this are just fluffy entertainment, not to be taken seriously. Nonetheless, I was struck by the fact that three of the opening questions asked me to put myself into categories that I just don’t fit clearly into.

Am I overweight, or healthy weight? The question implies a contradiction between being “overweight” and being “healthy.” And the answer to this one question made a very large difference in the results (see below).

Am I straight, or undecided? Nowadays I self-identify as a straight-leaning asexual, but that option isn’t included. There’s not even an “other” option - I’m either straight, gay, bi or undecided.

Am I married? Not legally, and not in the sense that the author intends. But I have two people I share lives with; we’ve lived together since the late 80s, and it’s a lifetime commitment. In terms of rating the quality of my life, my relationship with my life partners is as relevant as another person’s relationship with their legal spouse.

(There are other implicit assumptions in the quiz as well - for instance, the only choices for “sex” are male and female. But the above three were the ones that applied - or, rather, failed to apply - to me).

(Click below to see how my results changed depending on the above assumptions.)
Read the rest of this entry »

Here, at Body Impolitic. A lot of great links there; please go check out & please link!

Hey, fatso - and friends of fatso, too - time to put fingers to keyboard! Body Impolitic has put out a call for submissions for the Fourth Big Fat Carnival. Please submit your own work, or any other blog posts from the past couple of months that you think were wonderful examples of fat advocacy in the blogosphere.

We still don’t have a host for the fifth Big Fat Carnival, so if you’d like to host, please let me know.