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Think fat people are a burden to society? A blight on the landscape? Lazy gluttons with a death wish? 4 out of 5 doctors agree! But what if that's all wrong?

As a fat person, the most dangerous place I go in my everyday life is the doctor's office. My weight isn't what's scary. Weight bias is.

Yesterday, the American Medical Association passed a vote — against the advice of their own scientific advisory board — that will make doctor's offices even more threatening. They decided that being fat is a disease.

One reason the AMA gave (according to the New York Times): "[I]t would reduce the stigma of obesity that stems from the widespread perception that it is simply the result of eating too much or exercising too little."

In fact, the medicalization of weight diversity has long served to drive anti-fat attitudes and outright discrimination. The AMA has just greenlighted even more egregious weight discrimination: "Don't hire fatties, they're lazy gluttons and they're sick." (There are very few laws against height/weight discrimination. Massachusetts considers one next week.)

Doctors, who already harbor high levels of weight bias, will be even more likely to view fat patients as "lazy, stupid, and worthless."

When fat people seek medical care, we're likely to be denied tests and treatments that we need, based on our weight alone. At the same time, we're also likely to be pressured to undergo dangerous (and often ineffective) "cures" for our weight. A classic line fat people hear: "You're too fat for us to operate on. You should get stomach amputation!" More such horror stories are compiled at the First, Do No Harm blog.

If anti-"obesity" [sic] fearmongers actually cared about fat people's health, you'd think their first concern would be to make sure we can see a doctor. Instead, the label of "morbid obesity" [sic] has long been used to justify the outright denial of health insurance to individual applicants. (Such a denial is why I became a fat activist, way back in the mid-90s. "You're fat? No health insurance for you!")

When the Affordable Care Act takes effect in 2014, fat people will be allowed to buy insurance like everyone else, but we may have to pay a third more for it, thanks to weight-based reward/penalty systems — so-called "wellness" programs. Such discriminatory programs are encouraged under the ACA's Safeway Amendment. (Safeway's CEO told Congress that his company saved tons of money by charging fat people more for healthcare. Never mind that Safeway's program took effect three years after the period when costs stayed down. Also: research shows no lasting benefit from these types of discriminatory wellness programs.

In response to the AMA decision, fat activists started the #IAmNotADisease hashtag on Twitter and I started a petition, which is already getting strong support. Please sign and share!

Liberals, who show admirable skepticism about corporate power and for-profit interests in other areas, have not only failed to question the motives behind the prevailing and popular vilification of fat people, they've been proud defenders of The Man, rushing to blame fat people for everything from rising healthcare costs to global warming. As I've long said, "The only thing anyone can diagnose by looking at a fat person is one's own level of prejudice toward fat people."

This is not about fat people's health, it's about making big, fat profits.

Doctors are assuring their reimbursements under the ACA's even more intensely weight-scrutinizing system. Weight-loss surgeons and hospitals are making millions, cutting off or choking off healthy internal organs. There are two new diet drugs to prescribe (one of which can cause birth defects, the New York Times reports). Public health officials know they'll get funding when they promise to fight "obesity" [sic]. Meanwhile, the war on so-called "obesity" [sic] is a war on fat people. And it comes at a heavy price.

This year, Americans will waste $66 billion on weight-loss products. The "weight-loss" industry is a misnomer: nearly everyone regains lost weight and up to two-thirds gain back more than they lost. Repeat customers are the business model of the weight-regain industry — an industry that expands every year, even during recession. (Which wouldn't happen if their products worked, right?) With the money that people waste this year on weight-loss products, based on my calculations, we could feed the hungry or house the homeless or send 90% of high school grads to state college.

Why does Michelle Obama agree with Mike Huckabee when it comes to fat people (and especially fat children)? Why is this attack on an entire demographic group non-controversial?

Liberals and conservatives alike think they know about fat people. We're lazy gluttons who perversely choose to be the targets of widespread social derision. Weight loss is supposedly a simple matter of calorie-in/calories-out.

However, the scientific data doesn't support those assumptions. A powerful new, evidence-based approach called Health At Every Size® offers a way to avoid the harms of a weight-centered, weight-loss approach to health and also promises to right the social justice wrongs that the weight-centric approach has inspired.

Better yet, Health At Every Size is enjoyable and sustainable. Instead of forcing yourself to forego pleasures, it harnesses the pleasure principle in service to health and happiness. The basic idea: Love your body. Enjoy eating well. Find physical activity you truly like to do. And make the world a welcoming place for people of all sizes. Whatever you weigh in the process, that's your healthy weight. Nutrition professor Linda Bacon, PhD, published  research comparing a HAES approach to a traditional weight-loss approach. Two years later, the non-dieters were still healthier and happier and eating better and exercising more. In contrast, the only lasting effect for dieters was increased depression and lower self-esteem. Think about it: How many New Year's Resolutions to lose weight last until the next January? You only need motivation to do something if it's unpleasant. If your approach is enjoyable, no one can stop you from pursuing it. We'd all be a lot healthier and happier if our doctors told us to take good care of ourselves because we're worth it right now, not to make less of ourselves.

2:06 PM PT: For a good intro to Health At Every Size®, check out the Association for Size Diversity and Health, a professional organization. Also, these books for a start:

Health At Every Size, by Linda Bacon, PhD

Talking Fat, by Lonie McMichael, PhD

Big Fat Lies, by Glenn A. Gaesser, PhD

The Fat Studies Reader, co-edited by Esther Rothblum, PhD, and Sondra Solovay, JD

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Comment Preferences

  •  Once you've won the war on fat people (10+ / 0-)

    you can start on the war on smokers, then there's alcoholics and people with diabetes. I have fallen under all three of those. There are lifestyle issues that have a very real impact on health. People have to take personal responsibility for them. Trying to conflate them with issues about which people have no choice such as race, gender and sexual orientation is not a productive approach.

  •  If Every Other Factor is Equal (9+ / 0-)

    An obese person is at higher risk of health issues than a non-obese person.  Generally speaking, a person who is obese or overweight would be more healthy if they lost weight.

    Your criticisms of the diet and weight loss "industries" are spot on, but it's unfair to simply equate those industries with all efforts related to reducing obesity.

    There is no war on fat people.

    Too Folk For You. - Schmidting in the Punch Bowl - verb - Committing an unexpected and underhanded political act intended to "spoil the party."

    by TooFolkGR on Wed Jun 19, 2013 at 11:45:00 AM PDT

    •  Actually (10+ / 0-)

      There was a recent study that looked at one of the big human cohort groups. They focused on obesity and four health-promoting behaviors -- exercising, eating vegetables, not smoking, and moderate drinking. If all of those factors were equal (i.e. if you compared fat individuals and thin individuals who followed all the healthy behaviors) the difference in mortality risk between fat and thin groups was insignificant.

      Promoting widespread adoption of these healthy behaviors will have more impact than promoting weight loss.

      Do you not see that it is the grossest idolatry to speak of the market as though it were the rival of God?

      by kismet on Wed Jun 19, 2013 at 12:13:51 PM PDT

      [ Parent ]

    •  thanks, kismet! (5+ / 0-)

      That's a great piece of research, kismet! I'll get the link for it. It's worth reading! Definitely supports the Health At Every Size® focus on sustainable behaviors and not a focus on weight or weight loss.

      TooFolkGR, correlation doesn't prove causation, as I mentioned in another comment. Fatter people are more likely to live in poverty, to have a history of weight-loss attempts and yoyo dieting (which increase health risks), and to face discrimination in society (bad for health) and in medical care (which could be very bad for health, huh?). So if fatter people are more likely to experience some health challenge, it could well be caused by any or all of these confounding variables, which have powerful effect on health, and weight could be unrelated. (Except for the fact that being fat puts people at risk for being poorer, thanks to workplace weight discrimination, to dieting, and to encountering fat-hating doctors.)

      Your claim that fat people would be healthier if we weighed less is not super helpful — and really seems to be a lot about wishful thinking and social conformism — because none of the existing weight-loss methods, even medically imposed ones, produce lasting weight loss for the majority of people. Even survivors of stomach amputation or stomach squeezing regain the weight. They also tend to suffer complications related to longterm nutritional deficiencies. Not healthy, that!

      Please ask yourself why you want people to weigh less. Really. Because saying you're concerned about fat people's health is known, in the fatosphere, as concern trolling. It's not cool and it's counterfactual.

      •  Yes, but you can adjust for (2+ / 0-)
        Recommended by:
        TooFolkGR, yellowdog

        the higher rates of other issues such as those you mention with multivariate analyses, and many published articles have done that. It seems like you are saying that no researchers have attempted to adjust for confounding.

      •  The Convenient Shorthand of the Fatosphere (1+ / 0-)
        Recommended by:
        Richard Lyon of no interest to me.

        I want people to be healthy.  That's a hundred times more important than weight.  And papers about how an obese population could theoretically be a healthy population are more or less good for lining birdcages on a planet where our obese population isn't healthy.

        You are correct that correlation does not equal correlation.  But correlation equals correlation.  And if you randomly selected 100 obese individuals and 100 non-overweight individauls we both know which group would have better habits in the areas of diet and excercise.

        Too Folk For You. - Schmidting in the Punch Bowl - verb - Committing an unexpected and underhanded political act intended to "spoil the party."

        by TooFolkGR on Wed Jun 19, 2013 at 12:37:42 PM PDT

        [ Parent ]

  •  I think the research is overwhelming that (16+ / 0-)

    obesity significantly increases a person's chances of things like coronary heart disease, type 2 diabetes, hypertension, and several other conditions.  While there always are exceptions, generally speaking, an obese person's risk for those things goes down if he/she loses enough weight so that he/she no longer is obese.  There's no denying the link between obesity and health risks.

    Rather than this move being some "war" on the obese, it seems to me that this is a step toward treating the obese more humanely, and toward treating obesity as a medical condition instead of simply a failure of "willpower" (eating too much) or "laziness" (not exercising enough).  The move by the AMA to call it a disease is intended, I think, to open up the opportunity for obesity to be treated medically as the health risk that it generally is, for obese people to get medical treatment for their obesity through their doctors (rather than waiting for some other condition to develop that is statistically linked to the obesity), and for insurance to cover medical treatment for obesity.  

    I'm kind of surprised that an advocate for the obese would see this move as an attack, frankly.  I saw it as the opposite.  

    •  Obesity is NOT OK (3+ / 0-)
      Recommended by:
      Richard Lyon, viral, TooFolkGR

      The health problems relating to obesity make all our health insurance costs go up.

      I know that some people have solid bodies that aren't fashionable.  That's not what we're talking about.  And the very well muscled will have a high BMI.  Not relevant.  Some people are genetically inclined to build fat on their bodies...they would have survived a famine in years past.

      U. S. obesity rates have tripled in the last forty years, and there is a reason that needs to be found.  In 1962 13% of adults were obese.  Lately 36% of adults and 17% of children are obese.  That is not OK.

      •  The reason has already been found. (0+ / 0-)

        It's because the definition of "obesity" has been altered downward.

        So clarify this for me: is it being genetically inclined to build fat on your body that is NOT OK, or is it refusing to spend your entire life at constant war with your genotype?

    •  I'm coming from a different paradigm... (1+ / 0-)
      Recommended by:
      True North

      I share your concern that people with heart disease and diabetes and other health challenges get useful treatment for those conditions. All of the health concerns that are attributed to being fat also occur in thin people. I'm concerned about the inaccuracy of drawing a line across the weight bell curve and labeling all of the people at weights above the line as having a disease.

      When I say that correlation doesn't prove causation, I mean that other factors than weight, factors that are more common among fat people, might be involved in the development of health problems. Fitness level alone is a powerful influence on health, independent of weight. Weight cycling (or yoyo dieting) is highly correlated with increased risk of illness and shorter life; fat people are more likely to have dieted repeatedly. Being in a group that experiences stigma and discrimination, also bad for health. So why do we assume that being fat is the cause of illness and disregard other factors that could explain those trends?

      Defining a third (or more) of the population as diseased does increase the potential customer base, er, patient population.

      Another point where I think we diverge... I don't see medical attempts to cure fatness as having reliably health-enhancing results. The typical outcome is weight regain with no lasting health improvement. People who undergo so-called weight-loss surgeries rarely get down to the weights they anticipate, and after the first year or so start to regain. After a while, many people face problems absorbing nutrients. Anemia is common. People lose hair, teeth, develop vision and neurological problems. Their stories are rarely told because of the shame ("failing" at their last hope to be "normal") and because public attention goes mainly to the fantasy of extreme weight loss via surgery. I know of one email list where survivors tell such stories: (People who haven't had weight-loss surgery may read, but not post.)

      Then there are diet drugs, which interrupt the body's weight-regulating system, a survival mechanism. Such drugs produce little weight loss compared to placebo. They can have dangerous side effects. I remember the recall of Redux and fen/phen. When Peter Jennings came on the evening news to report the story, he started by saying, "In what could be a bigger public health disaster than thalidomide..." Yet I saw little or no public outrage.

      When fat people die from weight-loss treatments, I get the impression some people think, "At least they died trying..."

      I've commented about the near-total failure rate of eating/exercise weight-loss approaches already.

      I don't share your trust that medical treatments related to weight will yield generally positive results for people who undertake them. The doctors who are promoting this new definition may well have good intentions, but I think they're continuing to pursue an approach that has yielded decades of disappointing data. Try harder is not the only possible answer.

      •  Eating/exercise and Glenn Gaessner's book (1+ / 0-)
        Recommended by:
        Batya the Toon

        I'm glad you mentioned Dr. Glenn Gaessner's Big Fat Lies.

        Dr. Gaessner is a professor at the University of Virginia whose area of expertise is exercise.

        He's run a number of research studies, recruiting a diverse range of subjects of various sizes, shapes, ages, fitness, gender, etc. He has experimented with different kinds of exercise, duration, conditions, etc.

        One thing he found is that people who are fat and fit are healthier than people who are thin and unfit.

        He also found in his studies that exercise leads to people getting healthier--blood pressure, cholesterol, fitness, and so on--whether they are losing weight or not.

        The improvement in health kicks in long before dieters would see much change. Sometimes, his subjects were showing improvement within days.

        That message is a very positive. People (of any size) who are concerned about their health should take a look at what they're doing by way of exercise. And read Big Fat Lies.

  •  As an "obese" person... (16+ / 0-)

    My doctor explained to me that she hated recording my BMI in the computer because the insurance company would list me as "obese".  

    Even though I run marathons twice a year, pass the Army Physical Fitness Test with an average of 250 (out of 300 points), i'm considered 70 to 100 pounds over weight.  Well over my "ideal" weight.  At 6'3" and 275 pounds my BMI is 34.4. (Obese is >30, morbid obese is >35)

    I'm in better health than many "normal" weight people, but i'm considered obese by the insurance company and now the AMA.  I need to become "healthy" by getting to a weight I only weighed when I was 16 (and four inches shorter).  I hate this BS about the obesity epidemic.

    I'm a paramedic in Cleveland, there are obese people out there (often on the third floor with no elevator).  But what the BMI says is obese is not that.

    Stupid question hour starts now and ends in five minutes.

    by DrillSgtK on Wed Jun 19, 2013 at 12:24:11 PM PDT

  •  Sorry to point this out... (9+ / 0-)

    At some point being overweight is not healthy.  OK 275 is not the end of the world.  But what about 350 or 450 or more?  The strain on knees and hips and feet is indicated.  
    Yeah, there are 90 year old smokers.  But not many.

    •  Paul Campos's analogy... (2+ / 0-)
      Recommended by:
      OldDragon, Batya the Toon

      You're aware, I hope, that being a cisgendered man increases your risk of illness and death. Castration has historically proven to reduce those risks. Men are respected and welcomed members of society. If men were the targets of widespread societal prejudice, as fat people are, perhaps we'd be hearing several hundred times a day in mainstream media about the "masculinity epidemic." And the AMA would be rushing in to offer what they'd call help.

    •  Weight-loss treatments... (1+ / 0-)
      Recommended by:
      True North

      don't become more effective, or safer, the more someone weighs. I don't think that focusing on weight or deciding that some number of pounds must produce some negative result, helps people live well. I know lots of people at the weights you mention. Many people say they yoyo dieted their way up to higher weights. (Lose 10 pounds, gain back 15. Lose 25, gain back 50, etc.) I hear stories from people who say their weight only stabilized and they were only able to find a sustainable way to enjoy health-enhancing habits, by rejecting weight goals.

  •  I see some problems with what you've written (9+ / 0-)


    1. You don't link at all to this "health at every size" company (?) you say is doing better at this. Nor do you disclose if you work for them, and thus have a vested interest in mocking other approaches, as I suspect from the way this is written.

    2. Michelle Obama's "let's move" campaign is not an attack on fat people. It is an attempt to help kids get healthy by promoting exercise. This fearmongering tactic only strengthens my suspicion that you're not really interested in helping fat people, but promoting the company you work for (?), health at every size.

    3. Obesity does cause real medical problems for people. Now, granted, we know that obesity has numerous factors, including extended poverty and subsidies to unhealthy foods. We also know it's not fair to demonize people for being poor, uneducated, or without resources, but come on ... type 2 diabetes doesn't lie.

    I'd love for you to comment further. Thanks.

    •  Association for Size Diversity and Health (5+ / 0-)

      A professional organization for people in all sorts of health disciplines who use a Health At Every Size® approach. It's a registered mark to protect it from misuse and co-opting by weight-loss profiteers.

      The stated mission of the Let's Move campaign is:
      "solving the problem of childhood obesity [sic] within a generation."

      Sounds creepily eugenics-y to me.

      You're confusing correlation with causation. Fat people are more likely to be poor thanks to weight discrimination in the workplace. Poverty itself poses health risks. Type 2 diabetes is largely about genetic predisposition. While fat people are more likely to be diabetic, that doesn't prove being fat causes the condition. Fat people who are diabetic live longer than thin people with Type 2 diabetes. (In the research literature, every time fat people fare better, it's called a paradox. The people who claim to be concerned with fat people's health can't believe it when they get good results about us.) 7 out of 8 fat people are not diabetic and never will be. The incidence of Type 2 diabetes is so low in children under 18 that it's difficult to measure. Government data estimate 11 cases for every 100,000 children under 18. In comparison, there are hundreds and perhaps thousands of children under 18 in every 100,000 who suffer from disordered eating and clinically diagnosed eating disorders. When we put out a message nationally to children of all sizes, "Don't be fat," we not only encourage negative attitudes and eating disorders, we also encourage bullying related to weight. Fat children are routinely bullied and weight bullying is only increasing. There are no major campaigns to protect children from weight bullying. Telling children not to be fat is, in my view, yet more bullying.

      •  Thank you for your response. (5+ / 0-)

        Specific responses to what you said, below.

        "Sounds creepily eugenics-y to me."
        --Doesn't to me. Sounds like they care about children's health and well-being.

        "Poverty itself poses health risks."
        --I'm well aware of that.

        "Type 2 diabetes is largely about genetic predisposition."
        --From what I've heard, it's largely about lifestyle, including failures to exercise and eat right. But yes, I do acknowledge that doesn't mean we should blame people for being poor/uneducated/disadvantaged when it comes to their health.

        "When we put out a message nationally to children of all sizes, "Don't be fat," we not only encourage negative attitudes and eating disorders, we also encourage bullying related to weight."
        --How about when we put out a message nationally to children of all sizes, "Exercise! Get out there and move your body any way you choose, from dancing in your room to playing basketball"? That's what I hear in the Let's Move campaign ads. I honestly see no harm in that, and think while you're clearly coming from a compassionate perspective, you're both wrong and overly paranoid on this particular issue.

        " There are no major campaigns to protect children from weight bullying."
        --Again, I hear ads all the time talking about the many ways children are bullied, especially on-line. I agree we need to do more, including actually funding our schools so they can educate kids on all these issues, but I think you aren't taking note of the ways in which this is already happening.

        Thank you for engaging me on this issue. I hope we can talk more about this, rather than just yelling past each other. :)

        •  Thanks! (2+ / 0-)
          Recommended by:
          True North, allergywoman

          I appreciate your interest in engaging on the issue. I think children are aware of the overall weight-loss goal of the Let's Move program, no matter how much the messaging focuses on fitness, etc.

          I would totally love it if children of all sizes could enjoy a program that was about the feel-good, good-for-you delights of fitness and nutrition, with no negative weight goals involved. I think these health-enhancing behaviors can be super fun and enjoyable and should be promoted for their own sake. Adding weight-loss goals seems unnecessary and potentially harmful to me.

          I've heard of very few anti-bullying campaigns that specifically address weight bullying. The common belief is that weight is mutable and fat children should change themselves to escape bullying.

          •  I don't know. (0+ / 0-)

            I think most of us adults who have experience bullying are aware that there is no way to change to avoid it. Bullies will bully, no matter what. Lose weight? They'll attack your hair, or your voice, or something else you can't change.

            •  prejudice & bullying... (0+ / 0-)

              That sucks, of course. And schools and other institutions, adults, etc., need to address it effectively when bullying's about characteristics that are not linked to prejudice.

              But when bullying is about characteristics that are linked to wider societal prejudices, then I think it has a different impact. And it's especially intense if the adults and institutions don't address it as bullying related to that particular kind of prejudice. I think it's important to address bullying that involves homophobia, for example. In the same way, I hope for people and institutions to address bullying inspired by weight prejudice. Here's a great organization that uses a fat-positive and Health At Every Size® approach to peer-to-peer education designed to prevent eating Their videos for all different age groups are especially great.

  •  There are real health issues, like knees and backs (8+ / 0-)

    joints can only carry so much weight, so there is no "healthy at ANY weight"

    We should talk about how to stop this epidemic, all the things that need to change, but denial will not help

    •  denial? (1+ / 0-)
      Recommended by:

      Perhaps you're in denial about the near-total failure rate of weight-loss methods. I'm interested in people of all sizes being able to live well and happily in the best possible health. From the totality of the medical data I've seen, weight-loss efforts do not reliably or lastingly help and can often do harm. A weight-neutral approach seems vastly more effective, from initial research. The resistance to such a suggestion seems motivated not by science, but by stereotype.

      •  People lose weight and maintain it all the time. (1+ / 0-)
        Recommended by:

        The problem is that the people who gain the weight back go back to eating the way they did before they started their diet. In reality, if you want to lose weight and maintain it, you need to shift your lifestyle.

        I've seen a lot of those studies, and they tend to say "weight loss program A doesn't work", which is true, because you can't stay on Weight Watchers or Jenny Craig forever. But just eating less calories and exercising more will result in weight loss if you do it right.

  •  I plead guilty. (9+ / 0-)

    I'm interested in eradicating social prejudice, generally, but I do catch myself throwing "fat" around as an epithet.

    It does nothing but spread misery. I'm working at putting the brakes on it.

    Thanks for the diary.

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Wed Jun 19, 2013 at 12:37:49 PM PDT

    •  the F-word (2+ / 0-)
      Recommended by:
      chimene, True North

      Thanks for the consciousness, karmsy! The word "fat" isn't inherently negative unless you put that spin on it. In fat activist community, we reclaim the F-word for two reasons: First, it's the simple word (fat/thin, young/old, short/tall). Second, it's a political act, a way to refuse shame and stigma, akin to queer pride and other communities.

      The other words available seem highly and inherently objectionable to me.

      The O-words...blecch!
      - overweight: Over what weight. The word carries a negative judgment, no matter that it's deemed more polite in current usage than fat. It carries a hope of a world free of fat people, and that's super creepy.
      - obese: This word sounds like a diagnosis. It inaccurately medicalizes weight diversity. Also, the term is used to justify discrimination in all sorts of settings.

      the euphemisms:
      - hefty, chunky, fluffy, zaftig (Yiddish for juicy!), plus-size, full-figured, husky, etc.
      The only reason to use a euphemism is to cover something considered negative. I don't consider weight diversity a negative fact, so no need for fake niceties.

      I don't go around telling people they're fat. It's precisely this top-down naming power that I find unnecessary and harmful. The government, or a doctor, or the fashion industry, draw cutoff lines and people beyond that weight are immediately second-class citizens. Instead, I hope to expand the liveable space for all of us and part of that is being able to claim and name our own bodies. I identify proudly as a fat person. You get to own your body.

  •  OMG. Marilyn Wann?! (7+ / 0-)

    I am delighted to see you here at Dkos! I have tried to share information here about HAES (which is not a company but rather a health and wellness paradigm, for people unfamiliar) but it can be a bit of a slog. It's interesting and frustrating at times to see the progressives here who are SO savvy and rightly skeptical of the military industrial complex and the growing corporate state accept what the medical and pharma industries try to sell us about weight. The pursuit of weight loss is a 60 BILLION dollar a year business, folks! It's much harder to make money off of people not desperate to lose weight.

    For anyone who wants to learn more about Health At Every Size, you can google it, or check out ASDAH, the Association for Size Diversity and Health. There are MDs, PhDs, RNs, RDs, and mental health clinicians of all different types who use the HAES approach with their patients. My primary care doctor fully supports my HAES orientation to my health care and seeing how healthy I am in my fat body, he's recommended it to other people as well. And as a mental health and eating disorders clinician I take a HAES approach with my patients.

    Lisa :)

    All Kossacks are my allies, but if you can't express your thoughts in a civil and kind manner, I won't be engaging in a conversation with you.

    by Boston to Salem on Wed Jun 19, 2013 at 01:01:31 PM PDT

  •  I understand that this is what (4+ / 0-)
    Recommended by:
    Richard Lyon, SteelerGrrl, FG, TooFolkGR

    you do for a living. I also have -some- sympathy for the general line of thought you're delivering here.

    I'm curious to know whether there's anything else at all that you're interested in, or whether all your writing here will be confined to pushing this single issue.

    Because if it is, then I have to say, slightly reluctantly, that this post is spam.

    It is a valid viewpoint, and it is evidently fairly well accepted as a valid viewpoint (I just spent about an hour on the Google, and you do have a pretty fair following). But you have books to sell, and speaking engagements to book, and name recognition to push. However valid the viewpoint, this seems a bit more aimed at publicity than genuine interaction with this community.

    At least half the future I've been expecting hasn't gotten here yet. Sigh.... (Yes, there's gender bias in my name; no, I wasn't thinking about it when I signed up. My apologies.)

    by serendipityisabitch on Wed Jun 19, 2013 at 01:18:11 PM PDT

  •  You lost me here. (5+ / 0-)
    When fat people seek medical care, we're likely to be denied tests and treatments that we need, based on our weight alone.
    I'm an RN with 20 years of experience in cardiology. The only time I have seen patients "denied" tests based on weight is if they were physically too large for the imaging machine. At one facility my camera's limit was 350, and we could refer to another location with a limit of 500lbs.

    The mere fact that a new patient comes in to see us tells me their symptoms are compelling enough to get checked out by a specialist. If anybody denies care from there, it'll probably be your insurance company, not our docs. Big Insurance likes "peer to peer" preapprovals that can take days to orchestrate and take clinicians away from face time with actual patients.

    Obesity is a risk factor for cardiovascular disease. That doesn't mean every obese person can, or should, go to extreme measures to lose weight. But if there's a test or treatment that may help and you're a candidate, I've seen no evidence of categorical denial based on weight alone.

     I can think of no more stirring symbol of man's humanity to man than a fire engine.     -- Kurt Vonnegut

    by SteelerGrrl on Wed Jun 19, 2013 at 03:09:51 PM PDT

    •  Respectfully, I have. (3+ / 0-)

      I hear stories from patients all the time about this kind of stuff. Many MANY fat people have presented to their primary care or a specialist with concerning symptoms and been told "just lose some weight, it will go away".

      You can go to the blog "First Do No Harm" to read some pretty harrowing stories. You can look at the research done through the Yale Rudd Center about this happening to folks.

      Sad, but true.

      Lisa :)

      All Kossacks are my allies, but if you can't express your thoughts in a civil and kind manner, I won't be engaging in a conversation with you.

      by Boston to Salem on Wed Jun 19, 2013 at 03:52:51 PM PDT

      [ Parent ]

      •  With equal respect (0+ / 0-)

        Obesity is a risk factor for cardiovascular disease. That's a fact. If someone presents with chest pain and any lifestyle risk factor -- smoking, substance abuse, lack of exercise, poor nutrition (I know skinny vegetarians who eat like crap) -- it's medical professionals' responsibility to include better lifestyle choices in a treatment plan with medication and/or therapy.

        I've checked out the blog and understand that many have had bad experiences, but I don't think a collection of unfortunate anecdotes constitutes a "war on fat people." If anything, I think classifying obesity as a disease opens the door to awareness of how complicated it is and a less judgmental approach toward treating it. That is how I try to approach it as a caregiver.

        I appreciate your insight!

         I can think of no more stirring symbol of man's humanity to man than a fire engine.     -- Kurt Vonnegut

        by SteelerGrrl on Wed Jun 19, 2013 at 06:11:05 PM PDT

        [ Parent ]

        •  C. Everett Koop (3+ / 0-)

          declared war on "obesity" from the White House lawn when he was surgeon general. If someone declared war on left arms, I'd take it personally, too; my left arm is part of me. Some percentage of people will always be fat. Fat people are part of society.

        •  Just to offer a terrible analogy ... (1+ / 0-)
          Recommended by:
          Boston to Salem

          ... classifying homosexuality as a disease didn't open any doors to a less judgmental approach toward it, as far as I ever heard.

        •  asdf (1+ / 0-)
          Recommended by:
          Batya the Toon

          Yes, being fat can be a risk factor. It's also a protective factor for other illnesses and diseases, hence the "obesity paradox" literature.

          And there's nothing wrong with a medical provider to try to encourage patients to BEHAVE differently to improve symptoms. I, personally, do this all. day. long. It's my job. It's actually my speciality, as I am trained in Motivational Interviewing techniques.  

          What I don't do (and and increasing number of mental health and medical professionals are learning not to do) is to recommend trying (once again, for many fat people) to lose weight because there is no evidence that any significant number of people can sustain a weight loss for any significant amount of time. And there's plenty of data showing that *even when people do not lose any weight doing it* increased physical activity and improved nutrition improve symptoms.

          It's really not about the weight, it's about behaviors.

          And lastly - my very fair skin is a risk factor, my history of bad childhood sunburns is ALSO a risk factor, my family history of colon cancer is yet again ANOTHER risk factor. But I have no one telling me that my fair skin is a disease, or is my fault, or that I'm "unhealthy" JUST BECAUSE I have fair skin. I have no one shaming me because I got bad sunburns in the past. I have no one shaking their head at me and threatening me with some vague future health threat because colon cancer runs in my family.

          This is not true about my fat body. And it's not OK. And it needs to stop.

          The data showing the amount of weight bias present amongst medical professionals is appalling. If you are interested, I will post again with a half-dozen links to some of the research. To think it doesn't effect the kind of health care fat people get is really concerning.


          All Kossacks are my allies, but if you can't express your thoughts in a civil and kind manner, I won't be engaging in a conversation with you.

          by Boston to Salem on Thu Jun 20, 2013 at 03:09:02 AM PDT

          [ Parent ]

    •  Weight-based barriers to care... (1+ / 0-)
      Recommended by:
      True North

      do exist and come up in all sorts of setting. It's wonderful that your setting doesn't have that problem! I hear from people who need to find imaging equipment with higher weight limits and their care providers have no info for them. Common problems are blood pressure cuffs that aren't large enough and give falsely high readings. I was, luckily, at the doctor visit when my mother had this happen. She was afraid for her life when she heard her bp was 250-something over 120. I had to ask three times before the office personnel found a cuff that worked for her. (And she's in the low-200-pound range.)

      I've heard from people whose surgeons refuse to do all manner of needed procedures (too risky, too difficult, etc.) but who in the same visit encourage the person to undergo weight-loss surgery.

      People are denied placement on organ transplant lists based on weight. Bone marrow donors are excluded based on weight. (I think the extraction needle might not be long enough?)

      The classic story is about any and all complaints being attributed to weight. In fat community, people rehearse saying, "If a thin person came to you with my symptoms what would you recommend?"

      One young woman who testified in San Francisco, in support of height/weight anti-discrimination legislation here (passed in 2000), told the story of being 16 years old and having a common gyno complaint that wouldn't resolve without an antibiotic. The NP told her she just needed to lose weight and sent her away with no treatment. Luckily, she was in touch with fat community, and had the gumption to ask her mother to make another appointment with a different provider, where she got what she needed.

      Another person in fat community told about a doctor misrepresenting the results of a blood sugar test and telling her she was diabetic (when she was not) in an attempt to pressure her into a weight-loss treatment.

      I don't have the link at hand right now, but years ago, a study found that the fatter a woman is, the less likely her ob/gyn is to do a Pap smear. Here's a piece of research about weight-based barriers to gynecologic cancer screenings that Health At Every Size® pioneer Pat Lyons, RN, did with people at Berkeley...

      As I mentioned in this diary, people are telling stories of weight bias in medical care at a blog called First, Do No Harm. (

      I hope this isn't overload!

    •  I've been denied specific medical treatment (1+ / 0-)
      Recommended by:
      True North

      on the grounds that it would require anaesthetic, and there is a law in my state against anaesthetizing patients over a certain BMI outside of a hospital setting.

      There is no provision made by the clinic for arranging to provide the treatment within a hospital setting, or to refer the patient to a hospital that can provide it.  A patient whose BMI is too high is told "come back when you've lost some weight."

      It happens.  It happens a lot.

      •  It's terrible (1+ / 0-)
        Recommended by:
        True North

        that you faced that. Someone told me she'd been denied abortion at her nearest clinic for this same reason. She was able to travel, but others might not be. Oh, and there was the story from someone who was benefitting from physical therapy in the pool until the pool stopped the treatment because their rescue equipment wasn't rated for her weight.

        •  And concepts like "upgrade the rescue equipment" (0+ / 0-)

          don't seem to occur to anyone.

          The overweight person is seen as the problem, not the insufficient equipment.

          •  equipment rights! (1+ / 0-)
            Recommended by:
            Batya the Toon

            Yeah, that's the choice. There are a lot of connections between fat activism and disability activism, which I think is fabulous. When I get contacted by a family member who's scared for their mother or brother because the person needs diagnostic imaging and isn't allowed to use the machine, I sypmathize with their fears. I also think about how the company that made the machines and the facility that bought the machines makes a choice. I'm not fully informed about the technicalities, but I imagine that part of what's being protected are the bearings on the slide tray that moves people in and out of the device. Also, there could be image resolution differences in making the device larger and more accommodating. But these are engineering challenges that I hope would be addressed because human lives matter. I'm not arguing for devastating costs. Just the classic: reasonable accommodation. Medical offices can have wider (or armless) chairs in waiting areas, readily accessible larger bp cuffs, longer speculums, all possible sizes of gown (if they're not using those gigantic paper tarps). They can have information about resources (like larger imaging equipment capacity) in case people needed it. There's a training aspect, too. I've heard from a wonderful ob/gyn who had a fat partner that she figured out how to have a fat person lie back in a certain way and shift her belly at a certain angle so she could palpate the ovaries effectively. That's not standard training, yet ob/gyns are all likely to see fat women for gynecologic cancer screenings and they often just forego trying to do that part of the exam out of frustration misplaced onto the fat person's fatness. Then the fat patient gets pressured to lose weight instead of getting screened properly for cancer. And if there happen to be higher rates of gynecologic cancer among fat people, that's blamed on the person's weight.

  •  You can stop smoking in one day. (3+ / 0-)

    I am eighty pounds over my goal weight, 120 pounds over the "proper" weight for my height.

    I lost four sizes and thirty pounds last year. My friends and family notice. To the average person on the street, I'm still fat. I'll still be fat when I hit my goal weight.

    I am not losing weight because I don't want to be fat anymore, or I am ashamed of my body. I want ankle surgery, and have a bad foot, and physics are inescapable; I hurt less when I weigh less.

    But the reason I lost four sizes and only thirty pounds is because I am doing yoga and taking all opportunities to move (within the standing budget imposed by the bad foot) and avoiding emotional eating, as opposed to a rigid calories in and out sort of diet. My back doesn't hurt any more (in the sore muscle way, at least) because I've been building core muscle. I've also been doing a lot of mental work to work out what makes me binge eat or comfort eat.

    My goal for this year is the size sixteen pants in my closet. I'll still be fat in the eyes of the world.

    When you come to find how essential the comfort of a well-kept home is to the bodily strength and good conditions, to a sound mind and spirit, and useful days, you will reverence the good housekeeper as I do above artist or poet, beauty or genius.

    by Alexandra Lynch on Wed Jun 19, 2013 at 07:02:08 PM PDT

  •  I'm very glad to see marilyn here even though I (1+ / 0-)
    Recommended by:
    Batya the Toon

    disagree with her on some things.  I'm hoping that labeling "obesity" as a disease doesn't mean they'll call us sick and lazy or [any other character defect here.]  It'm hoping they'll decide to remove the character deficit subtext from the description...and then, all we have to debate is a. is it a disease?  I say yes, Marilyn says no, and that's fine) and b.  What factors, all of them...make this disease up.  Emotional.  Hormonal Physical. Mental. Financial [yes it can be cheaper to buy lousy food than healthy food.]  My low thyroid and my lymphedema contribute to body size. My disabilities put limits on exercise.  Those are the parts I cannot eliminate ever.   I speak for myself alone when I admit that a large percentage  [but not all]  of the rest of the cause my problem is a truly addictive relationship with food.  
    The irony is of course, that if you're a drunk or a drug addict you can go to rehab and "get off" the stuff.  No one would ask an alcoholic to go to a bar once a week and only order a diet soda...but in a way  that's what I'm supposed to do, and my perception is that that is impossible for me.
    So that's where I disagree with the diarist...but:

    What I really enjoy about Marilyn's pov is that she makes clear that there are outside forces that make this worse. And what are the factors from outside, from beyond our bodies that make it worse, not better.    I have a thirty two year old back injury that has never been addressed because docs believe it is only due to weight. [It isn't I fell down a flight of stairs.]

    Fat shaming, jeering, name calling, jokes...making one individual overweight person the demon of the healthcare system (as happens in the grocery store often.)  "You!  You're the problem! and I won't use my tax dollars to pay for you.!   They don't see my cerebral palsy or lymphedema or depression.  Once it's about the fat, then you are just a cancer on the system that needs to be removed.  That kind of public judgement never leads me to make better choices.  Ever.  Just makes me cry...and like as not head for more carbs.

    So at the very least if you want to see more healthy folks, encourage excercize, as in Haes, healthy food choices...but do it positively and quit obsessing over numbers on a scale.  Don't make us the last acceptable joke...It. Doesn't. Help.

    Dear budget cutting GOP'ers: Public transit is my “car.” And frankly, I’d like it back.

    by imfunnytoo on Thu Jun 20, 2013 at 10:56:15 AM PDT

    •  Hi! (0+ / 0-)

      There are a lot of acceptable jokes, not just fat jokes, so I avoid saying "last acceptable" in relation to weight prejudice because it's way more fun to be in solidarity with the fight against other oppressions, rather than do Oppression Olympics.

      I imagine that there are thin people who have all of the health concerns that you have. They likely don't get the same sort of shame and blame that a fat person faces, as well as the quite dangerous varieties of weight bias that you describe.

      People of all sizes experience disordered eating, too. HAES experts who specialize in treating eating disorders try to steer their profession away from basing assumptions and treatment on the weight of the person involved. Focusing on weight can play a large role in perpetuating eating-disordered thinking, for people of all sizes, from what I hear from colleagues.

      I am suspicious about the urge to ask why someone is fat. It seems motivated by a kind of prurient othering. A weight-neutral approach would address people's health and disability concerns respectfully and encourage people to reclaim enjoyable eating and exercise habits out of a sense of self-worth. Whether or not a person's weight changed, the approach would be the same.

      The definition of what is a disease seems more about cultural attitudes than science. Given the pervasive negative attitudes about fat people, this definition seems to me even more about that dynamic.

      •  "the urge to ask why someone is fat" (0+ / 0-)

        YES.  Exactly.

        Asking why someone is fat presupposes that Not Fat is the default normal setting on humans, and that if a human is fat then something must be responsible.  Calling it a disease is another aspect of the same thing: normal healthy humans aren't fat.

        This is utterly and provably false.

        •  Well said! (0+ / 0-)

          I just came across a David Allison article from 2010 last night. (He's a researcher in the typical fat=doom vein.)

          It collects data on numerous animal species, all of which have had population-wide weight gain similar to what has happened among people in the last several decades.

          Yes, the food industry sells nutritionally disappointing products for profit. Yes, people who live in poor neighborhoods may have less access to vegetables and safe physical activity (although I've heard that some of the research on so-called food deserts overlooks perfectly lovely veg that are available in bodegas, etc.) Soda and sugary beverages trigger a lot of pitchfork reactions. But none of these trends affects marmosets. And evidently, the average weight of marmosets (and other creatures) has been going up.

          Another point that we hear little about. The rate of weight increase in the U.S. has leveled off. Katherine Flegal, the CDC's statistician on weight, released that info a while ago and it got little or no play in the media. It doesn't further the money interests of various anti-"obesity" [sic] players.

          •  Population-wide weight gain in animals? (0+ / 0-)

            How odd.  I can't figure how that could be connectable to a similar weight gain in humans, as so few of the same factors apply to both/all populations; as you say, marmosets are unlikely to be affected by sugary drinks.

            (By the bye -- it isn't correct usage to put "[sic]" after any mention of obesity; the quotation marks are sufficient.  Using [sic] doesn't mean "so-called" -- it means you're directly quoting a specific written or spoken statement and reproducing it faithfully, which you aren't here.)

  •  Fat-hatred killed Cynthia McQuillin. (0+ / 0-)

    She was beautiful, smart, talented, a gorgeous singer, and very fat.

    Only when she collapsed in a coma did doctors FINALLY examine her in detail (as opposed to "Come back when you've lost 100 pounds") - find the thyroid problem she'd had her whole life, and correct it - and she lost 100 pounds in one WEEK. Tragically, it was that drastic weight LOSS that was too much for her heart, and she died.

    If I had to count the number of her music fans who made asshole comments ("Maybe if she had some self-respect," "If she only ate enough for one") that I had to refrain from slapping cross-eyed...  One such is a perfectly healthy woman who constantly diets and loathes her own body.

    I'm 220 - and I can swim a mile at a go. One of my pleasures in life is being a role model for the other girls at the pool - especially the fat girls, who see that there's no contradiction in being fat and strong and healthy and fit! (We do the Fat Girl Belly-Bump.)

    Thank God, the Bob Fosse Kid is here! - Colin Mochrie

    by gardnerhill on Sat Jun 22, 2013 at 12:08:22 PM PDT

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