fitness · health · weight loss · weight stigma

6 things Sam hates about seeing doctors, as a larger person (#reblog, #bloglove)

I’ve been putting off making a doctor’s appointment. Don’t worry. I will, eventually. But here is part of the story about why.

FIT IS A FEMINIST ISSUE

None of this is true about my current set of health practitioners. But they took awhile to find. Right now I’m halfway between jobs and cities and I’m looking for a new family doctor to start. It’s tough. And here’s why!

1. They believe ridiculous things about me. See this article about doctors and bias against larger patient. “Much research has shown that clinicians have biases related to overweight and obesity, conditions that affect more than two-thirds of U.S. adults, Dr. Gudzune said. “[With] the magnitude of the effect of obesity in our country, a substantial number of people are experiencing health care disparities as a result,” she said. Studies have consistently shown that physicians associate obesity with such negative attributes as poor hygiene, nonadherence, hostility, and dishonesty, Dr. Gudzune said. “These types of attitudes are pervasive. It’s not just in the U.S. … [but] physicians across the world…

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fitness · weight stigma

Fervent hope for 2021: that “The Biggest Loser” won’t be renewed for a 19th season

CONTENT WARNING: this post is about critiques of the reality show “The Biggest Loser”, thanks to the podcast Maintenance Phase, a fat-positive and evidence-based show debunking junk science and myths about health and wellness fads. Their critiques include information about weight loss, extreme exercise, extreme eating restriction, eating disorders, body dysmorphia and mental health that may trigger or traumatize some people. For those who want to read this post, it is in service of reminding us that fat phobia and all its harmful sequelae are still out there, but so are we. Maybe 2021 will be the year to go full-force against such toxic media. Hence the hope.

Now to the post.

One of the horrors of 2020 that you may have missed (which is kind of a blessing) was the reboot of the horror reality show, The Biggest Loser (henceforth called TBL). For those of us who prudently turned away from this abomination, there are articles to provide background and critique of the show.

The Biggest Loser is coming back– but should it?

Is the Biggest Loser even a little bit better?

‘It’s a miracle no one has died yet’: The Biggest Loser returns, despite critics’ warnings

However, if you don’t have the time or interest to wade through all that, podcasters Michael Hobbes and Aubrey Gordon of Maintenance Phase offer up five things wrong with TBL. Of course there are one million and five things wrong with the show, but: their incisive and humorous analysis gives me hope that more people will turn their backs on TBL and on the social evils that support it.

Here’s their first one: TBL is wildly unrealistic. How so? Here are some reasons Mike and Audrey shared:

  1. the kinds of participants chosen for the show were fat people with emotional eating issues, who don’t exercise, and are extremely unhappy with their weight. But, fat people are like all people– some are happier, some less happy; some exercise more, some less; some are happy with their bodies, some less so. Like all the people.

2. The purported method of weight loss: go live in a big ranch house with strangers for months on end, and don’t do anything else. They point out that this method is not found in the medical literature. Good to know.

3. According to the show, the contestants lose an average of 16 pounds/7.25kg in the first week. This rate of supposed weight loss is also not documented in medical studies. Furthermore, Mike and Aubrey tell us that the “first week” is really more like 2–3 weeks, according the contestants. Even so, this is still an unhealthy and unrealistic body change for anyone.

Here’s reason number two: it’s fake and unethical. (that seems like two reasons, but I’m considering it a two-for-one reason).

Case in point: former contestant Kai Hibbard gave interviews about the many ways the producers of TBL would distort results, promote fast weight loss, and otherwise create an environment conducive to disordered eating behavior. Here’s more from this article:

… a runner-up said the show gave her an eating disorder, and seven years later, in a series of 2016 reports, The New York Post quoted contestants who said the show’s doctor and trainer told them to lie about how much they were eating; rigged the weight-ins; and even gave them illegal drugs.

Also, the show features super-processed foods in product placements; TBL has more product placements than any other TV show (533 in 2011).

Reason number three: it’s abusive (and horrible). The contestants are deliberatively portrayed in the most unfavorable way in before pictures, and dolled up to the max in the after pictures. That’s to be expected. But, some contestants have been damned and judged in both their before- and after-weights, some of which are dangerously low according the standard medical science. Further, contestants have reported being encouraged to smoke (to reduce appetite), or pressured to exercise while injured or ill. In the new “wellness” season of TBL, a woman injured her knee doing box jumps, and then is shown using a rowing machine with an ice pack on her knee. No. Just no.

Reason number four: the contestants gain all of the weight back, and suffer permanent harm to their resting metabolic rate. There was a study published here, which you can read about in Scientific American here. Or in the New York Times here. The upshot is that after drastic weight loss, contestants gained a lot of weight back and had a much reduced resting metabolic rate, which the researchers attribute to the drastic weight loss. And this harm isn’t reversible according to our current scientific knowledge.

Last reason, number five: TBL is toxic for everyone of all weights and sizes, blasting false and harmful and distorted messaging telling us: a) what sorts of bodies are the preferred ones; b) that we– the public– can get ourselves one of these preferred bodies; and c) how we can get ourselves one of those preferred bodies. It’s a load of lying lies from a pack of lying liars.

Two other things are worth noting here. First, TBL doesn’t focus on any nutritional information, or talk about cooking, or how to enjoy a greater variety of say, plant-based foods. Oh, no. In fact, the show spends most of its time pushing the contestants to do punishing and painful physical activities, and yelling at them when they are (rightly) tired or or not up to doing them.

For me (and I think for us at Fit is a Feminist Issue), this is (one of) the worst things about TBL: it depicts exercise as a punishment for being fat. And exercise is wholly constituted of activities like box jumps, running on a treadmill, or using a rowing machine indoors. Okay, those things are fine, but what about:

  • hiking
  • dancing
  • yoga
  • biking
  • swimming
  • badminton
  • throwing a damn frisbee around with the dog?

Mike and Aubrey make the point that there’s a whole world of fun physical activity, and TBL loser ignores it. Instead, it recreates “the fat kid’s experience of PE”. Great.

Now that I’ve put you all through the wringer of these five reasons why TBL is awful, what’s the positive takeaway?

I do have one. Here it is. The show debuted in fall 2004. It lasted until 2016. In 2020, they tried to resuscitate it and recast it as a wellness show. But it didn’t work– everyone from fitness experts to health columnists to reality show bloggers hated it. We now see it for what it is– a horrible example of our legacy of fat phobia and body insecurity. And those social maladies are not over.

But: no one is talking about how they’re hoping or even considering that TBL is coming back for another season. It’s 2021 y’all. We got no time for that crap.

fitness · weight stigma

Once more, for the cheap seats: body weight is NOT a lifestyle

CW: discussion and critique of an article claiming complex associations between body weight (and other factors) and chronic illness. I use the phrase “body weight” or BMI instead of this term. I’ve written here about why I don’t use that term.

When you’re a teacher, you know that some lessons are harder to learn than others. When I was a student, the subjunctive tense in Italian never quite sunk in (mi dispiace!) I teach a lot of logic, and I know through long experience where the pitfalls lie (e.g. necessary vs. sufficient conditions; a not-very-clear explanation is here, and a really super-long explanation is here). We teachers do what we can, and usually the confusion clears by exam time.

I really wish the same were true with medical researchers and body weight.

Even smiley faces are sighing over this.
Even smiley faces are sighing over this.

In case you missed it, I’m referring to an article published this spring in JAMA Internal Medicine called “Association of Healthy Lifestyle with Years Lived Without Major Chronic Diseases”. The researchers were looking for a correlation between some combo of what they considered to be lifestyle factors and onset of major chronic illness in a database of 116K people, followed for 15+ years. Here are the factors they used:

Four baseline lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) were each allocated a score based on risk status: optimal (2 points), intermediate (1 point), or poor (0 points) resulting in an aggregated lifestyle score ranging from 0 (worst) to 8 (best). Sixteen lifestyle profiles were constructed from combinations of these risk factors.

Okay, so smoking and alcohol intake are standardly considered to be health-related behaviors– things we do that affect our health outcomes (e.g. what diseases we get and when). Physical activity also has been well-documented to affect health outcomes; however, calling it a lifestyle oversimplifies it, for instance ignoring the many physical and economic and other barriers to activity that are beyond people’s control.

But then we get to body mass index (BMI). BMI is listed as a lifestyle factor? Huh?

One of these things is not like the others…

Why don’t I think that BMI is a lifestyle factor? Let me turn this over to one of the several responses to the article, published just this week. Authors Kyle, Nadglowski and Stanford write the following:

Treating BMI as a lifestyle behavior obscures the complex etiologies that contribute to BMI… Perhaps more importantly, it promotes a mistaken notion that is the foundation for weight bias and stigma—that [one’s BMI] is [something] that patients choose for themselves through behaviors they elect. The resulting weight bias is well-documented to harm both health and quality of life of patients [with BMI >30].

Body mass index itself is neither a behavior nor a lifestyle, even though health behaviors and lifestyle factors can influence BMI. Many other factors are contributors. 

Yeah, what they said. There are, oh, about three zillion studies showing that body weight is largely genetic and/or heritable (55–70% in many research papers). That means it’s not a health behavior in the way that smoking, alcohol consumption, or physical activity are. Health behaviors affect body weight (just like they affect our cholesterol levels), but that doesn’t make them lifestyle factors, rather they are biological measures used for many purposes.

The original authors (Nyberg, Singh-Manoux and Kivimaki) respond, saying (I’m excerpting but it’s not out of context, I promise):

Maintenance of healthy weight [BMI <25] is indeed part of a healthy lifestyle…

No. Clearly we need to back up and start again.

Spock is in shock. He doesn’t see how they don’t get this, either.

In this commentary on the article, we get another good try at explaining the situation (this is edited to insert BMI as a term):

Such is the nature of implicit bias about [BMIs >30]. … in their hearts, even some very smart people remain certain that body size must be a matter of choice.

Yes, yes, yes. Very many very smart people (including both the study authors and the editors at JAMA Internal Medicine) still believe that body size is a matter of choice. But it’s not. The replies to this article all cite loads of articles in showing that body size is largely heritable, and if you want some refs, ask me in the comments, and I’ll reply with some standard ones.

So, one last time: body weight is not a lifestyle. But I found this website with 50 lifestyle choices to browse among, if you’re feeling like a change. I claim no responsibility for anything having to do with decisions made on the basis of looking, by the way.

I hope this clears things up.

commute · cycling · weight loss · weight stigma

“On yer bike” for oh so many reasons, but weight loss isn’t one of them

In April, which feels like years ago in terms of the pandemic, Catherine asked, Does COVID-19 care what you weigh?

The answer, not surprisingly, then and now, is that it’s complicated.

Catherine concluded, “I don’t work in medicine, but I do know that there is a humongous evidence gap between what’s happening clinically in a particular hospital and its patients (each with their own complex medical and other histories), and what is true about everyone with higher BMIs in the US (not to mention other countries) with respect to risks related to COVID-19. Right now we can’t say much of anything. So maybe we shouldn’t. Which means the answer to my blog title question is, “we don’t have evidence right now to answer this question”. It doesn’t make for exciting news copy, but it’s the closest thing to the truth right now.”

But nevermind the fact that it’s complicated get in the way of a feel-good media campaign. Britain’s Prime Minister Boris Johnson plans an anti-obesity/anti-COVID-19 campaign, with bicycles front and center.

I have lots of complicated thoughts about all of this. And it’s not helped by all of the cycling advocacy groups which make up a good chunk of my social media newsfeed sharing news of the plan enthusiastically. Treehugger proclaims, Miracle Pill Found for Fighting COVID-19: The Bicycle.

Sigh.

First, it’s not at all clear that if you had to pick one thing to work on to improve COVID-19 control in the United Kingdom it’s weight loss. How about mask wearing? Contract tracing? Or speedy testing? There are many areas in which the UK’s COVID-19 response is lacking. I wouldn’t start by blaming individual citizens for their excess pounds.

Second, it’s not clear that there is a shred of evidence that ‘eat less, move more’ public health campaigns do anything other than shame fat people.

Here’s an obesity doctor’s assessment, “I find it impossible to fathom that anyone with even an ounce of knowledge of the complex, multifactorial, chronic, and often progressive nature of obesity should in this day and age still fail to understand that the proposed plan, which includes the usual talk of changing the food environment (largely by appealing to personal responsibility) and a 12-week weight loss plan app [sic], focussed on healthy living (read, “eat-less-move-more”), is about as likely to noticeably reduce obesity in the UK population, as taking out a full page ad in The Sunday Times stating that “Obesity is bad!”.”

And here’s Susie Orbach’s response in the Guardian: Britain’s obesity strategy ignores the science: dieting doesn’t work.

Third, there are so many, many reasons to encourage people to ride bikes–less pollution, better mental health, happiness, etc–we don’t need to add one that isn’t true to the list.

Note that Boris, like me, is a regular cyclist, who is thought to be by many people someone who could do to lose a few pounds, or even stones, as they say over there. Normally I’m out there defending fat cyclists like me and Boris. See Fat cyclists in the news and Big women on bikes and Pretty fast for a big girl and Not all cyclists are thin and Fat lass at the front?. It’s a thing I write about a lot.

But here he is, a committed, regular, everyday cyclist out there pushing bike riding for weight loss.

Note we’re different kinds of cyclists but neither of us is thin.

I love bikes but I hate to hear them promoted as weight loss tools.

Because, they’re not.

I love to ride my bike. I’m on track to ride 5000 km this year, or about a 100 km a week. You can follow me on Strava, here. On ZwiftPower I’m here. I’ve been doing this for years and I can assure you it’s not making me any smaller.

And I worry that if people start riding to lose weight, and they don’t lose weight, they’ll quit and miss out on all the other benefits of moving through life on two wheels. For example, cyclists are the happiest of commuters.

What bicycling feels like every single time!

In my post on reasons to ride I give some of my reasons for riding a bike, “There are lots and lots of reasons to ride bikes. Some are health related. It’s also a terrific stress relief, and it’s good for the environment. It’s an easy way to incorporate exercise into your day. It’s good to spend more time outside. As well, it’s a sensible financial move. Driving, once you add up the costs of car payments, parking, insurance, and gas is an expensive way to get around. And I agree with all of these reasons but on their own they might not be enough to get me out the door and on my bike. What does it then? The sheer joy of cycling. On my bike I feel like I’m 12 again. Whee, zoom!”

Here are some more reasons people ride:


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athletes · body image · fitness · strength training · weight lifting · weight stigma

Where are the muscular, larger women’s bodies?

There are four blog topics I’ve been thinking about that are all tangled together. Common threads weave through them and they are all part of the same story. Really, it’s a story about strength, gender normativity, and women’s muscular bodies.

First, Catherine wrote about the names we use to describe our bodies. Catherine’s focus is on how complicated that task is when it comes to self-description. I agree but I think it’s partly because the words I want don’t really exist. I lament that there are so many positive words for muscular and heavily built men and no such words for women. Words for larger athletic male bodies? Burly, husky, substantial, strapping, brawny, to name just a few. Note that they are not necessarily gendered but they don’t work so well for women’s bodies.

Sidebar: There have been attempts to reclaim this language.

See CampaignBrawny women wear iconic plaid in #StrengthHasNoGender campaign

Brawny women wear iconic plaid in #StrengthHasNoGender campaign
#StrengthHasNoGender

Second, I wrote about dad bods, asking yet again, where are the muscular-but-gotten-slightly-softer-with-age women’s bodies, the mom bods? Women can be svelte and muscular and desirable but most really strong women are actually large. It’s why there are weight classes in lifting. But no one sings the praises of larger, athletic women’s bodies.

Okay, Nat did in this post.

I think it is important to show that athletes come in all shapes and sizes.

Third, I’ve been wondering if we’ll ever have any idea about women’s true strength potential in sports as long as women athletes are worried about how they look and about gaining weight. I’ve written about this a lot. See, for example, Big women and strength and Bigger, better, stronger? On women and weightlifting. When even women Olympic lifters want to lose weight–see  From the Olympics to the Biggest Loser? Say it ain’t so Holley— you know the forces at work are pretty powerful.

Fourth, and finally, it hit home again with my Zwift avatar. I’m large and she’s medium sized because in Zwift the men’s avatars come in small, medium, and large and the women’s only in small and medium. So even when I am racing with men who weigh the same as me their avatars are much larger! It’s extra odd because your weight is no secret in Zwift. If you’re racing your weight is a matter of public record and it’s easily determined by looking at your watts per kilo and your speed. It’s simple math.

I’ve written about this before saying, “I have one complaint about my Zwift avatar. She’s medium sized person and I’m a large sized person. That’s odd because avatar size is based on your actual kg. It turns out that in Zwift women only come in two sizes regardless of how much we weigh. We’re either small or medium. Men come in three sizes, small medium or large. Here’s an explanation of avatar sizes. So when Sarah and I ride together in Zwift we’re the same medium size. That’s weird because IRL she’s medium and I’m big.”

So like there are no words to describe my body type, there are no avatars either. The message is clear. No woman would want to look like that.

*************************

Here are some images of large, strong women, stronger and more muscular than me.

Vintage Muscle
Image Description: This is a black-and-white photograph of a woman from the 1920’s, posing with her arm flexed. She has visible muscle in her biceps, triceps, forearms and shoulders. This juxtaposed with her vintage pincurl hairstyle makes for a striking image.

This photo is from a guest blog post called What are Women’s Bodies for, Anyway? Thanks Tracy de Boer.

And here’s a modern day image of a strong woman. Jennifer Ferguson is A BC nurse in her 40s who is one of the strongest women in the world. She deadlifts cars for fun.

fitness · weight stigma

It’s dessert week in nutrition science!

CW: discussion of research related to body weight, BMI, and weight gain.

While the rest of us have been busy baking bread at home, nutrition researchers have been hard at work keeping dessert science going strong. They’ve been thinking and plotting and measuring and parceling out various amounts of dessert items to various sizes of people, then watching them closely to see what happens.

A group of busy-bee food science professionals released their results this week in an article investigating associations between body weight and milkshake liking. No, that’s not me rephrasing it– it’s the actual title of the article (using the word “ob*sity”, which I strongly dislike for scientific and ethical reasons).

First, they the formed their hypothesis:

Milkshake hypothesis: Make milkshakes, they said. Boys will come to your yard, they said.
Milkshake hypothesis: Make milkshakes, they said. Boys will come to your yard, they said.

(side note: if you’re not familiar with the references in this meme, you’re in for a sweet treat! Start here, then go here. Important: this is not to be confused with the “mikshake duck” meme, which I just learned about one minute ago.)

Back to the meme at hand: that’s not their research question (better to leave it to the “directions for future studies” section). Here’s what they wanted to know:

Prevailing models of obesity posit that hedonic signals override homeostatic mechanisms to promote overeating in today’s food environment.,,Here we define hedonic as orosensory pleasure experienced during eating and set out to test whether there is a relationship between adiposity and the perceived pleasure of a palatable and energy-dense milkshake.

non-science-journal version: they want to know if people’s body weights have an effect on how yummy milkshake consumption seems to them. What they are actually looking for is whether larger people report yummier milkshake drinking experiences (which they think might partly explain their larger sizes). That’s what these scientists are really up to.

What’s next? The researchers set up their test group: 110 people with BMI 19.3–51.2. They asked them to arrive neither hungry nor full, and to have not eaten for at least one hour. The participants came, and waited.

Please note that this study took place before pandemic social distancing protocols were instituted. Otherwise, group size would be strictly limited.

Safety first: milkshakes are allowed to bring at most 9 boys to the yard. A meme with Kelis.
Safety first: milkshakes are allowed to bring at most 9 boys to the yard.

Back to the study: I can’t tell you about the exact methods because even with my awesome library access I can’t get the full article yet. But: the researchers measured hunger before milkshake consumption and also recorded how much the participants said they liked and wanted the milkshake (during consumption).

Finally, we get the results! Here’s what the article says:

We identified a significant association between ratings of hunger and milkshake liking and wanting. By contrast, we found no evidence for a relationship between any measure of adiposity and ratings of milkshake liking, wanting, or intensity.

We conclude that adiposity is not associated with the pleasure experienced during consumption of our energy-dense and palatable milkshakes. Our results provide further evidence against the hypothesis that heightened hedonic signals drive weight gain.

Uh oh! The nutrition scientists got a negative result! They found that body weight had no effect at all on how pleasurable people said their milkshakes were. Keanu pretty much sums it up:

What if the boys were already on their way to the yard, and my milkshake had nothing to do with it-- meme with Keanu.
Keanu reports test’s failure to find association between two variables. It happens.

Yes, the study did find a correlation between hunger levels pre-consumption and reported pleasure during consumption. But no one doubted that. And yes, it’s a good thing when scientists get and publish a report on failure to find correlations.

This study gives us a glimpse of something very interesting and a bit worrisome to me, as a fat woman and a health ethics researcher: medical research spends a lot of time and effort searching for causal factors involved in body weight and weight gain that are located in individual persons’ actions, psychological makeups and personal habits. Are fatter people fatter because of something they are doing or feeling or attracted to?

These scientific questions make me uneasy about what may be underlying speculations (or assumptions) by researchers, clinicians and even the general public about what fatter people are doing differently or feeling and acting differently that accounts for their increased fatness. These views are likely yet another source for deep-seated fat-biased beliefs and weight-stigmatizing judgments.

Should we stop doing this kind of research? Even as a public health ethics professional, this is not in my lane, so I can’t say. I think we should remain careful about uptake and reliance on nutrition research, lest it leave a bad taste in our mouths.

fitness · weight stigma

Does COVID-19 care what you weigh?

CW: discussion of body weight and fat shaming in news and medical writing.

Even in the midst of a global pandemic, some folks manage to carve time out of their busy schedules for fat-shaming, patient-blaming and promoting all-purpose weight hysteria. On April 16, the NY Times wrote this story:

NYT headline: Obesity linked to severe Coronavirus disease, especially for younger patients.

Okay, but what are those “studies”, and what do they “show”?

Here’s the lede, which is rather unpromising:

The research is preliminary, and not peer reviewed, but it buttresses anecdotal reports from doctors who say they have been struck by how many seriously ill younger patients of theirs with obesity are otherwise healthy.

No one knows why obesity makes Covid-19 worse, but hypotheses abound.

It’s worth noting a few key points here: There are no studies. There are preliminary reports, based on gathering some information about some patients in some places. These reports sound similar to anecdotes from medical workers about particular patients who were 1) young; 2) severely ill with COVID-10; and 3) had BMIs>30.

I looked at the report the NYT was going on about. It’s here, and is accompanied by a serious disclaimer:

This article is a pre-print and has not been peer-reviewed [what does this mean?] It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.
This article is a pre-print and has not been peer-reviewed [what does this mean?] It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

Good to know. But, just out of curiosity, what’s in there?

The upshot is this: the biggest relative risk (by a factor of 10) for being hospitalized for COVID-19 is age (75 and over for huge relative risk, 65-74 for smaller risk). Smaller relative risk factors were BMI>40 and heart failure. BUT: they didn’t control for race, socioeconomic status or quality of care (according to this article in Wired, and also according to me from looking at the original article).

We do know that it’s not always true that people with higher body weights automatically have higher risks of complications or death when they’re hospitalized for respiratory diseases. Here’s what one study on pneumonia found:

The cohort [of veterans who were pneumonia patients] comprised of 18,746 subjects. Three percent [had BMI <18.5], 30% [had BMI 18.5–25], 35% [had BMI 25–30], 26% [had BMI 30–40], and 4% [had BMI>40]. In the regression models, after adjusting for potential confounders, [BMI>40] was not associated with mortality (odds ratio 0.96, 95% confidence interval 0.72-1.28), but BMI 30-40 was associated with decreased mortality (0.86, 95% 0.74-0.99). Neither [BMI 30-40] nor [BMI>40] were associated with ICU admission, use of mechanical ventilation or vasopressor utilization. BMI <18.5 patients had increased 90-day mortality (1.40, 1.14-1.73).

The only group with increased mortality risk was the BMI<18.5 group. The other BMI groups either had a lowered risk or a non-increased risk.

Of course, this is only one study, but there are a lot of studies that fail to show a connection between higher body weights and risks of complications and death during hospitalization for some respiratory illness.

Other investigations are at ongoing and at various stages of revision and peer-review. This is important, as one thing we know for sure is that trying to tease out the influence of one feature of patients on particular health outcomes is very very hard. Small sample size, lack of representativeness, potential confounders and methodological flaws all get in the way of reliable results. Wired gives a good and detailed analysis of ways that some claims about the relationship between BMI and COVID-19-related health outcomes are unwarranted. And they offer a possible explanation:

The fact that researchers have been pointing to body size as a risk factor for weeks now, even in the absence of much evidence, is a clear example of how weight stigma gets enacted in science.

I don’t work in medicine, but I do know that there is a humongous evidence gap between what’s happening clinically in a particular hospital and its patients (each with their own complex medical and other histories), and what is true about everyone with higher BMIs in the US (not to mention other countries) with respect to risks related to COVID-19. Right now we can’t say much of anything. So maybe we shouldn’t. Which means the answer to my blog title question is, “we don’t have evidence right now to answer this question”. It doesn’t make for exciting news copy, but it’s the closest thing to the truth right now.

body image · covid19 · diets · fat · normative bodies · weight loss · weight stigma

The “covid 19” isn’t funny, it’s fat shaming and fat phobic

I wasn’t going to blog about this because when I mentioned it on my FB timeline, more than one person commented something along the lines of “people have different senses of humour and we all need outlets in these difficult times.” But if there is one thing that I can’t stand, it’s “jokes” about self-isolation weight gain. Isolation / shelter-in-place weight gain (“the covid 19,” riffing off of the “freshman 15”) has become a hot topic, as people are confined to their homes, possibly moving less and eating more, routines thrown off. There are articles about how to prevent it (with the usual advice, like all the usual advice). There are even quarantine diets.

That’s all fat phobic, fat-shaming, perpetuating harmful diet culture, and triggering for people recovering or recovered from or in the throes of eating disorders. They buy into harmful social ideologies that vilify fat and weight gain.

Jokes and memes take it to another level. They take it seriously as a thing, even a thing to fear. And they make light at the same time. The “humourous” edge makes it more difficult to take issue.

If you don’t find them funny, you are dismissed yet again as a feminist killjoy. Sometimes reprimanded for wanting to deprive others of their sense of humour (the old “just scroll past” rejoinder).

This Allure article, “Can I Socially Distance Myself from These Terrible Jokes about Gaining Weight While in Quarantine?” does a great job of explaining the harm. The most obvious issue is that “gaining weight is framed as an inherently bad thing–an idea that steeped in fat phobia.” When we frame weight gain as a bad consequence of being in quarantine, self-isolation, or shelter-in-place, we add a further layer onto an already difficult situation that calls for kindness to ourselves, not judgment and self-flagellation.

That kind of thinking can drive people into diet mode, or trigger feelings of self-loathing that come up in chronic dieters or people with eating disorders. As if living in isolation during a global pandemic isn’t challenging enough, bringing with it all sorts of fears grounded in the rapid pace at which our lives have changed, coupled with uncertainty about what awaits us in the future, how long we are going to need to live this way, in this shrunken version of our previous lives.

We do not need another demon. We do not need to shame ourselves for wanting treats. And we do not need to shame ourselves for gaining weight. We are trying to survive an unprecedented global situation. Surely that is task enough right now?

I am well aware that people have different senses of humour. And that people need occasions to laugh in the midst of this pandemic. I am also well aware that some jokes perpetuate social harm. Racist and sexist jokes do that. And jokes about the covid 19 do too. They are fat phobic and shaming. I’m sure we can find other things to joke about and lift our spirits.

Image description: Pie chart of “Things I’ve Learned i the last few weeks,” with the 3/4 of the chart taken up with “I fucking love touching my face.”
Image description: White mug with black printing on it in bold, made to look like a broken mirror, and says “I don’t like this episode of Black Mirror.”
fitness · weight stigma

US report predicts 50% obesity rate by 2030: some takeaways

CW: talk about body weight, obesity, weight stigmatization.

While I was busy grading last December, a report came out in the New England Journal of Medicine that predicted an almost 50% obesity rate in the US by 2030. The report also predicted that almost 25% of Americans would, by that time, be “severely obese” (a term I’m not going to use again, but which means a BMI of at least 35).

This is certainly not good news. However, some people are more worried than others. Jane Brody of the New York Times calls it “dire” and compares it to global warming:

Climate change is not the only source of dire projections for the coming decade. Perhaps just as terrifying from both a health and an economic perspective is a predicted continued rise in obesity, including severe obesity, among American adults.

Brody interviews experts who point to increased snacking, consumption of sugar-sweetened beverages, eating out more, and increased portion sizes as contributing culprits of the trend.

They make the usual policy recommendations, including taxes on sweetened sodas and other sugary beverages (which, in this recent study, found a reduction in sales after being implemented, but may mean that people purchased them in other places); working to create policies to promote reduced meat consumption, reduced portion sizes, and lower-calorie foods. These are the standard responses, and I think old news.

Reading through the original article, though, a number of things struck me that Jane Brody didn’t mention at all. I’ll share them with you, and I’d love to hear what you think as well.

First takeaway: the projected distribution of increased average BMI is not uniform throughout the US. We see it graphically displayed below, with darker colors indicating higher percentages of BMI30+, and BM 35+, respectively.

Projections of BMI>30 (left), and BMI>35 (right) in states of the US, with darker colors indicating greater percentages in those states.
Projections of BMI 30+ (left), and BMI 35+ (right) in states of the US, with darker colors indicating greater percentages in those states.

And what do we see? As an American, I see poorer states, states whose citizens get less good healthcare, states whose legislatures refused to expand Medicaid under the Affordable Care Act. The US is a country with severe health care inequality, and that shows in these graphs and in the tables in the article.

Second takeaway: the NEJM article talks about increase in “severe obesity” (I promised I wouldn’t use it again, but this is really the last time) but that term just means BMI 35+. We know that not all BMIs 35+ carry the same medical risk profiles. The authors of the article mention the need for more information across the BMI spectrum, but their analysis represents a shift only from BMI 30+ to adding BMI 35+. It’s also important to know the distribution BMIs 35–40, 40–45, 45–50, and so on. Why? Because they represent different health needs, and mandate different approaches to health promotion. I’m talking not only with respect to medical conditions that often go along with say, BMIs 50–55, but also with respect to responses that help citizens of those sizes navigate life, work, medical, educational and other public spaces. Which gets me to my next point.

Third takeaway: if we expect many of our citizens to be much larger in the next 10 years and we want them to be healthier, we need for them to be able to be active and present in the community, not barred from participating in ordinary activities of life. Yes, I’m talking about literally making space for larger and heavier populations (from restaurant chairs to hospital gowns), but not just that. We need a variety of ways to make physical activity accessible, easier, and safer for larger people. This means exercise machines that obviously handle larger weights, wider yoga mats, bikes with higher max weights. This also means more outdoor spaces tailored to physically accessible and satisfying activities (e.g. shorter nature trails with benches, railings, surfaces with less steep grades, etc.).

Last takeaway: the NEJM article acknowledges that medical research hasn’t been successful in developing weight-loss methods that will be able to reverse this trend on a nationwide level. The authors suggest turning to prevention as the most important strategy for health. I disagree. I think the most pressing agenda item is reducing weight stigmatization, especially in health care. Health care workers are the second-most common source of weight stigmatization, and the effects on people are a real hazard to their health. We know that stigmatizing weight doesn’t motivate people to lose weight, but instead reduces self-esteem, increases depression and anxiety and social isolation, and often results in increased body weights among those stigmatized. The Lancet published a series in 2015 (I wrote about it here in the Conversation) in which they made a number of recommendations for reframing obesity. One of them was to treat obese patients better. Yes, that sounds right. Let’s do that.

What do you think about these takeaways? Do you have other thoughts about this news? I’d love to hear from you.

body image · competition · diets · fitness · weight loss · weight stigma

Can you watch the Biggest Loser ironically?

No. That’s my answer anyway.

I have some thin friends who say that they just watch it for a joke. They’re looking forward to new episodes. It’s so bad, it’s good they say. I’m not a “it’s so bad it’s good” kind of person.

I said, just stop. It’s not funny. It’s abusive. It doesn’t work. It hurts people. But also, it affects your attitudes towards fat people. Did you know that?

“A 2012 study published in the journal Obesity found that people who watched just one episode of the show exhibited higher levels of explicit bias against fat people. “Participants who had lower BMIs and were not trying to lose weight had significantly higher levels of dislike of overweight individuals following exposure to The Biggest Loser compared to similar participants in the control condition,”the researchers found. Just one hour of watching the show left thinner people with an even greater personal dislike of fat people.” From Jillian Michaels and the Alarming Legacy of the Biggest Loser.

What do you think? We know that my sense of humour about the treatment of large bodied people by the media is running low. You might have read my very very cranky review of Brittany Runs a Marathon.

You can’t miss the announcements: “The all-new Biggest Loser | Premieres January 28th‎.” But you don’t have to watch the show.

We’ve written about the show before. Lots. As you can guess we don’t much like it.

From the Olympics to the Biggest Loser? Say it ain’t so Holly

TV shows, fitness, and weight loss: Love and hate

I know the mistake they made: The biggest losers just stopped exercising

More on the mistakes the biggest losers make: But what about muscle?

The biggest losers just did it the wrong way! They lost the weight too quickly!

Extreme Dieting and Metabolic Adaptation: The “Biggest Loser” Dataset (Guest Post)

Imagine if size didn’t matter. Can you?

So has Caitlin at Fit and Feminist:

THE ‘SHOCKING’ OUTCOME OF THE BIGGEST LOSER IS NOT ALL THAT SHOCKING

Don’t watch the Biggest Loser. Watch this great ad instead!