Fat Bias Isn’t Just About Rapport

As noted on Twitter, the article Tara Parker-Pope wrote for the New York Times about a study in Obesity looking at how fat patients aren’t always welcomed by doctors. Not news, though I suppose it’s good to have quantitative research supporting it.

Really, though, this is just the tip of the iceberg.  Here’s some more.

For patient stories on health professionals, check out the crowdsourced http://fathealth.wordpress.com

ASDAH is collecting videos on weight bias in healthcare.

The Yale Rudd Center is not a fat-accepting organization, but they do research on weight bias and their publications page can be very useful.

• Yale Rudd Center Policy Brief on weight bias (PDF)
• Stigma of Obesity (PDF) by Rebecca M. Puhl and Chelsea A. Heuer, published in Obesity, in 2009.
• New Developments in the Law for Obesity Discrimination Protection (PDF) by Jennifer L. Pomeranz and Rebecca M. Puhl, published in Obesity, in 2013.

Naafa on weight discrimination.

Typing “Fat People Are” into Google

I understand if anyone doesn’t want to read this.  But it says something about our society.

When typing “fit people are” into Google,* it helpfully tries to finish the thought for me, providing “more successful”, “happier”, “harder to kill”, and “smarter”.  The search results are similar.

Google for “fit people are”

Typing in “thin people are” shows options like “better”, “beautiful”, and “more successful”.  The top piece discusses the latest “moderately fat people live longer” study.**

Results for “thin people are”

Finally is the “fat people are” results: “gross”,” lazy”, and “stupid”.

Typing “fat people are” into Google

Google doesn’t just index the web.  It also aggregates what other sites are linking to and what people are searching for — and what they navigate to.   The effort Google puts into making their search results find what people are looking for makes it also a somewhat accurate reflection of our society.

*Google does, over time, reflect what an individual has searched for in the past.  As I frequently search for fat-positive items, these screenshots were generated using a browser I rarely use, where I wasn’t logged into Google. I’d also cleared the browser cache.

**If Google is using IP addresses to adjust results this may be due to my usual fat-positive bias. Might be helpful to know if anyone else sees this.

UPDATE: Several other folks get the same or similar results.

Things to Read

A clear explanation of why  New York’s fat hatred is much more harmful than the soda ban from Melissa McEwan:

People do not die of “obesity.” Some fat people die from complications of what are commonly known as “obesity-related diseases,” like heart disease and diabetes, but those diseases have only been shown to be correlated with fat, not caused by fat. (Which is why thin people have them, too.) So it’s not even accurate to assert that obesity kills indirectly.

This, however, is a thing that is accurate to say: Fat hatred kills people all the time.

And speaking of correlation, an explanation of causation vs correlation at The New York Times makes use of a correlation between ads for junk food and fatness:

The problem is that their policy recommendations rest on a crucial but unjustified assumption: that any link between obesity and advertising occurs because more advertising causes higher rates of obesity. But the study at hand showed only an association: people living in areas with more food ads were more likely to be obese than people living in areas with fewer food ads. [...] In fact, it is easy to imagine how the causation could run the opposite way (something the article did not mention): If food vendors believe obese people are more likely than non-obese people to buy their products, they will place more ads in areas where obese people already live. [...]

This is not an arcane statistical point or a mere technical criticism of one academic article. Too often, relationships that are far from being understood are assumed to reflect a particular, strong causal connection, leading to no end of regulatory mistakes. 

(Emphasis added)

And from a woman’s story of getting fat after marriage:

I missed the husband who loved me no matter what, not the new anti-fat crusader he had changed into. But he felt the same way: he’d fallen in love with a plump-but-not-fat woman who wanted to be thin, and now he had a fat wife who’d “given up on herself.” And Ihad given up: given up on dieting, given up on the idea that my body needed to be fixed.

 I already wished I hadn’t spent so many years beating myself up for being fat; I wasn’t going to stay in a marriage where my husband did it for me.

The article is good, and bonus points for a photo of the author in scuba gear with the caption “Cage diving with great white sharks: more fun than dieting”.

Does It Matter?

Tonight I overheard some thin 20somethings discussing fat people as a group (nothing said about the 40ish couple at a nearby table). The terms and statements made were rather derogatory. There was laughter. Then their discussion moved to other topics.

Image courtesy of Stocky Bodies

This wasn’t pleasant. I tweeted about it. I then focused on dinner with the man of the house.

Why?

In the microcosm of this hour and this room, their comments did not necessarily have to affect me.  Their opinions did not cause me to lose my job or my home. And their finding fat people unsexy doesn’t undo what we did this morning. ;)

At the same time, however, the anti-fat views expressed by a group at a bar  encourages and reinforces anti-fat views at the societal level. Society’s view that anyone can lose weight, and that fat people are stupid or in denial or lazy to not be thin,  makes it less likely that I will be hired than a thin person with my qualifications. Or that I’ll be paid as well as a thin person. It’s also part of why medical professionals view fat people as non-compliant and deficient, since we are “willfully” avoiding thinness. Etcetera.

Does it matter to me what a random stranger thinks of fat people?  Individually, maybe not. But society’s view of fat people matters a great deal.

Five Things Make A Post

1) I am sooo looking forward to tomorrow morning, when Mark Reads will post the second-to-last chapter of Deadline.   Mark Reads reviews books a chapter at a time, progressing through books every other weekday, and it’s been building to this OMG HUGE second-to-last chapter for weeks.  (Need I say “spoilers”?) Some of the books he’s done this with in the past are the Harry Potter books, The Hobbit, The Lord of the Rings,  and The Hunger Games.  Deadline is the middle book of the Newsflesh trilogy & Mark’s reading the whole thing, starting with the first chapter of Feed here.

2) I got myself a Fitbit Zip to help me be more consistently active — I use it as a pedometer that does built-in recordkeeping, so I can get a sense of how active I am in general, not just a single day. Since I got it I’ve found myself at work focusing deeply for one to two hours and then getting up to walk and get water or coffee or tea or something.  I’d quit feeling guilty about it because I found that a brief break to walk and stretch lets me focus better afterward.  This article helps me rationalize it more ;)

3) A year ago today I signed my father’s hospice paperwork as his medical power of attorney.  The anniversary was a bit freaky this week.  At the moment I’m at peace with it all, but I know my reactions will likely continue to change.

4) I’ve been posting on fat discrimination at http://fatdiscrimination.tumblr.com. It’s not a subject I want to dive into a lot, so posts are somewhat sporadic.

5) Like Paul Campos, I probably wouldn’t vote for Chris Christie.  But it’s not about his weight.

Quotes: Pretty

“You have such a pretty face. You should lose weight.”
— Relatives

“A pretty face and fine clothes do not make character”
— Anon

“Who cares about pretty? I’m going for noticeable.”
— Veronica Roth

“It has been said that a pretty face is a passport. But it’s not, it’s a visa, and it runs out fast.”"
— Julie Burchill

“After all those years as a woman hearing ‘not thin enough, not pretty enough, not smart enough, not this enough, not that enough,’ almost overnight I woke up one morning and thought, ‘I’m enough.’”
— Anna Quindlen

“It suddenly struck me that that tiny pea, pretty and blue, was the Earth. I put up my thumb and shut one eye, and my thumb blotted out the planet Earth. I didn’t feel like a giant. I felt very, very small. ”
— Neil Armstrong

Harriet Brown on Weight Bullying by Parents

Image courtesy of Stocky Bodies

[Discussion of bullying and weight punishments; feel free to skip.]

Harriet Brown has a piece in the New York Times Well blog on “Feeling Bullied by Parents About Weight“:

Parents and other adults who are “only trying to help” may do harm rather than good, as a recent study from the journal Pediatrics makes clear.

It is a good discussion and I’m glad to see it.  At the same time, it can be upsetting to see things you’ve lived with discussed dispassionately. Dr Rebecca Puhl, from the fat-phobic Rudd Center, appears, as does Ellyn Satter.

“There still remains the widespread perception that a little stigma can be a good thing, that it might motivate weight loss,” said Dr. Puhl, a clinical psychologist. (Medical doctors, too, fall prey to this misconception.) But research done at the Rudd Center and elsewhere has shown that even well-intentioned commentary from parents and other adults can trigger disordered eating, use of laxatives and other dangerous weight-control practices, and depression.

Hells yes, y’all, parents can bully their fat children.  Or maybe you don’t want to call it “bullying.”  Maybe you want to call it teasing, belittling, or harassing.  Oh, here’s one: providing incentive.  Maybe buying your kids clothes that “will fit when you lose weight” instead of now, or pointing out that the fat kid gets different (less) food than the rest of the family, is just something that “has to be done” too.  No, it’s not.  It is abusive. And you should not be surprised if the kids you reject for being fat reject you in turn.

Kudos to Harriet for broaching a topic that many parents like to pretend doesn’t exist.  Also for common sense suggestions, including

¶ Don’t blame your child for his weight. [...]

¶ Don’t engage in “fat talk,” complaining about weight and appearance, whether it’s your own, your child’s or a celebrity’s. [....]

¶ Don’t promise your child that if only he lost weight, he wouldn’t be bullied or teased. [...]

¶ Don’t treat your child as if he has — or is — a problem that needs remedying. “This will make him feel flawed and inferior,” says Ellyn Satter, a dietitian and therapist in Madison, Wis., and author of “Your Child’s Weight: Helping Without Harming.” Instead, she suggests, focus on a child’s other good qualities, and encourage traits like common sense, character and problem-solving skills.

I would strongly recommend NOT reading the comments in the Times. 

Today in Don’t Read The Comments

Marilyn Wann takes on weight bias in healthcare in “Big deal: You can be fat and fit” on CNN.COM:

…People are telling their stories of weight bias in medical care on websites like First, Do No Harm, This Is Thin Privilege and Obesity Surgery Gone Wrong. The National Association to Advance Fat Acceptance has been speaking out on behalf of fat people’s civil rights since its founding in 1969.

Health professionals of good conscience are joining this effort in increasing numbers. They’ve developed an approach called Health At Every Size that is proving to be better for people’s health than weight-loss attempts. The Health At Every Size professional organization,Association of Size Diversity and Health, this week launched the project Resolved, a response to New Year’s weight-loss resolutions. It invites people to share stories about weight discrimination in health care and opinions about what needs to change.

Weight bias has been documented among doctors, nurses, fitness instructors and other professionals on whom a fat person might need to rely for help. Last year, researchers who themselves are part of an anti-”obesity” institution (Yale’s Rudd Institute) surveyed medical professionals who specialize in caring for fat people and found that they had high levels of weight bias, viewing us as “lazy, stupid, and worthless.”

Image courtesy of the Rudd Center Image Gallery

Paul Campos uses the latest “obesity paradox” study with “Our Absurd Fear of Fat” in The New York Times to argue that policing fat is worthless:

The study, by Katherine M. Flegal and her associates at the C.D.C. and the National Institutes of Health, found that all adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals. If the government were to redefine normal weight as one that doesn’t increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.

[...]

Now, if we were to employ the logic of our public health authorities, who treat any correlation between weight and increased mortality risk as a good reason to encourage people to try to modify their weight, we ought to be telling the 75 million American adults currently occupying the government’s “healthy weight” category to put on some pounds, so they can move into the lower risk, higher-weight categories.

In reality, of course, it would be nonsensical to tell so-called normal-weight people to try to become heavier to lower their mortality risk.  [...T]iny variations in relative risk in observational studies provide no scientific basis for concluding either that those variations are causally related to the variable in question or that this risk would change if the variable were altered.

Both articles are well worth reading, but I would skip the comments on those sites. If you must discuss with someone, chat about it here ;)

Happy New Year!

Image courtesy of the Rudd Center Image Gallery

Hello and welcome!  I’m back at work with my new cartoon-a-day calendar (New Yorker cartoons) and new wall calendar (Pacific Northwest landscapes).  I even cut off some of the photos from last year’s wall calendar to decorate my cube.  Ready to work!  (Yes, I know it’s Wednesday, but today feels like Monday to me.  Yay four-day weekends! )

I adjusted the layout, let me know if you can’t find things.  Also, let me know if you have additional topics or questions you’d like me to write about.

As for resolutions, well, there’s resolve and then there’s Resolve the carpet cleaner, (Two Lumps).  There’s also ASDAH’s Resolved: Addressing Weight Bias in Health Care Project, collecting health care stories in video or written form.  Please see their site to see what they are asking for and the submission methods.

 

In the meantime, some things to read / discuss if you wish – warning for fat hate:

People are living longer! I thought this would be a good thing. Oops! As Fatties United discusses, some people aren’t happy with this.

Since so many fat people have had the audacity to keep on living instead of dropping dead on schedule, Dr. Mokdad is predicting that all these fat folks will be old sick fat folks and require lots and lots of medical treatment.

Study results show that “normal weight” folks don’t live longer than overweight folks? (Again?) Oh noes, must include lots of fat panic in the news coverage!

Charlotte Cooper writes about The UK Royal College of Physicians and their concerned about obesity!  Oh dear.

Reading the report is like a journey into Opposite Land. The work is well-meaning, but it exists with a framework that is profoundly problematic. For example, it is hard to disagree that current service delivery for fat people is really poor, particularly for those who undergo weight loss surgery, and that there needs to be proper auditing, quality control and monitoring of all obesity treatments.

But the report, as is typical in a medicalised discourse of fat, is entrenched in a view that regards weight loss as the universal solution to the problem of fat people and health. The authors throw about “severe complex obesity,” a term they’re obviously pretty proud of, coming soon to a healthcare provider near you, and bound to further medicalise and stigmatise fat people. They make the crucial mistake of failing to question the effectiveness of weight loss at all, so it’s not weight loss surgery that ruins fat people’s health, it’s the fact that the care pathways surrounding the surgery need tweaking. This ties them up in all kinds of knots, looking for answers in the wrong places, for example suggesting that the UK needs a Michelle Obama figure to galvanise the population against obesity, even though her crusade in the US has been disastrous in re-stigmatising fat kids, and even though we’ve already seen Jamie Oliver screw things up over here.

Anyway, let’s be careful out there. Now, I’m going for a walk.

What is a job for a morbidly obese woman?

Courtesy of the Rudd Center image gallery

This showed up as one of the search terms used to get to my blog:

what is a job for a morbidly obese woman?

Let’s see…”morbid obesity” is usually defined these days as having a BMI value of 40 or higher.    The BMI Project includes photos of multiple folks who are, officially, morbidly obese.

So, what sort of job is good for a morbidly obese woman? How about one that she has the skills for? One that she enjoys doing?

Dr Regina Benjamin is fat and the US Surgeon General, though I don’t know her BMI. Melissa McCarthy, Rebel Wilson and Dawn French are actors.   Beth Ditto is a singer-songwriter.

Courtesy of the Rudd Center image gallery.

But what about in everyday life?

Fat women are doctors. Clerks. Nurses. Programmers. Saleswomen. Lawyers. Engineers.  Housewives. Writers.  Bosses.  Janitors.  Baristas. Fat women are everywhere.  And we may not look as fat as you think we do.

So are fat men.

Even so, fat people, especially fat women, are less likely to be hired (there are fewer fat actors for a reason). Fat people are also often paid less and harassed more than similar-qualified people who are thin. As noted in an article in the California Law Review,

“highly obese” women earn 24% less than thin women while the so-called moderately obese earn 6% less. A Harvard Public Health Study found that fat women have household incomes $6,710 lower than thin women. Fat women also have a 10% higher rate of poverty.

I didn’t know all this when I was in college.  I knew that I didn’t fit the late-80s “Dress for Success” look, and that being fat didn’t help, but I didn’t realize that weight discrimination was being studied.  I knew I wouldn’t look like the stereotypical Seattle programmer , but I majored in computer science anyway.  I’m  likely to be paid less than others in my field, but at least it’s a field with above-median pay to start with.

Are there jobs that fat people can’t do?  Probably not jobs where being small is part of the job, such as being a jockey.  Weight Watchers refuses to hire people for certain jobs that don’t maintain their WW-determined “Goal Weight”. There are also jobs that fat people may not WANT to do — I’m afraid that individuals do tend to be individual about their wants, needs, and skills.

What do you think?  Stupid question?

Women standing up against a society [that bastardizes] thin and athletic women

[Discussion of fat hate & discrimination]

OK, I wanted to give people the benefit of the doubt.

When Lesley Kinzel wrote about the Kickstarter campaign to raise money for a to stand up for “thin and athletic women” who are oppressed by society’s expectations, I wondered if:

1. The author of the Kickstarter campaign thought that using hyperbole about “a society that protects fat culture” would be eye-catching, and,
2. If the author of the Kickstarter campaign had conflated society’s dislike of visible muscles on women as “pro-fat”.

The photo of the author on Kickstarter definitely shows visible abs definition, and yes, “feminine” usually correlates to “few or no visible muscles”.  Some women do fear gaining visible muscle and avoid weightlifting as a result.  Women bodybuilders are sometimes viewed as “masculine” or “freaky”.

From the Kickstarter description of the project:

Collection of images of women standing up against a society that protects fat culture while bastardizing thin and athletic women.

[...]

There are millions of women out there and im sure you know at least one looking for a voice , not from tvs and magazines, not from victorias secret.. but from the ground level , to speak up and tell them that its okay to want to be in better shape.

[...]

But.. if it just makes it into the hands of ONE little girl who feels like she has to be overweight to fit in with the current 70% of the overweight population of America, and it gives her the strength to know that being healthy isnt a bad thing.

Then this whole project is worth all the time and effort i can possibly afford to put into it.

…. ah no.

Obese individuals are highly stigmatized and face multiple forms of prejudice and discrimination because of their weight (1,2). The prevalence of weight discrimination in the United States has increased by 66% over the past decade (3), and is comparable to rates of racial discrimination, especially among women (4). Weight bias translates into inequities in employment settings, health-care facilities, and educational institutions, often due to widespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in self-discipline, less competent, noncompliant, and sloppy (2,5,6,7). These stereotypes are prevalent and are rarely challenged in Western society, leaving overweight and obese persons vulnerable to social injustice, unfair treatment, and impaired quality of life as a result of substantial disadvantages and stigma.

— Rebecca M. Puhl and Chelsea A. Heuer writing in “The Stigma of Obesity: A Review and Update” published in Obesity.

Look, I get that nobody’s life is perfect.  There’s a reason the Romneys believed  their college years were a “struggle”.  There’s a problem with how our society regards bodies, especially women’s bodies, as open to public discussion.  But I have trouble believing that a thin, fit woman is going to be less likely to be hired than a fat woman with the same qualifications.  I have trouble believing that a fit, thin woman is going to be told to gain weight to when she goes to the doctor’s. And I certainly don’t buy this belief that women need to be told it’s okay to want to get into better shape when every women’s magazine assumes getting into better shape is every woman’s dream.

Things to Read

From Paul Campos discusses the failure of a “sophisticated and expensive attempt” to validate the hypothesis that “significant long-term weight loss improves health outcomes”:

It will probably come as a surprise to most readers to learn that this hypothesis remains almost completely unconfirmed by the medical literature – in part because we simply don’t know how to produce significant long-term weight loss in a statistically significant group of people, so the hypothesis has been impossible to test.

The study, called Look AHEAD, has been covered elsewhere.  Participants lost 5% of their body weight and maintained that loss for over 11 years.  Yes, the researchers considered a “significant” weight loss to be a 5% loss from baseline.  Not “reducing BMI to “normal”".   Losing 5%.   If losing 5% of your weight would put you in the “normal” BMI bracket, it’s likely you’re there already.

And the study found that maintaining that “long-term, significant” weight loss didn’t improve health outcomes.

Lesley Kinzel discusses “glorifying obesity” with sarcasm and smarts.

If reminding folks that fat people are people first — that they are individuals and not some monolithic amoeba of disease rolling itself over the planet, and that their bodies are not shameful, not ugly, not embarrassing, not immoral, but as worthy of acceptance as every other body is — if THIS is the same as glorifying obesity, then bring on the glory. I will carry the banner. I won’t be sorry, not for my part in changing our culture around bodies in general and not for my own body that I live in, right now — I won’t be sorry, and I won’t apologize. Neither should you.

And if you want a smile, you should read Jess Zimmerman on Moses, the baby elephant, and his adoptive family.  Moses also has a blog maintained by his human family.

Things to Read

Free speech means that yes, you get to say anything you want (with some legal limits regarding libel and slander laws, advocating harm of another person or threatening someone with death or bodily harm, blackmail, all that), but free speech also means that other people get to say what they want, too, whether you like it or not.

Free speech does not mean the freedom to not be called an asshole.

Free speech also does not mean  you get off scott-free for saying legally actionable things about or to other people.

Threatening people is not protected under free speech.  Just in case you were getting any ideas.

— Polimicks

I felt that people would look at me and assume I was diseased, and shudder and move away. And even though I was doing something ostensibly good for my health, this understanding and awareness that people find me gross did not make it easier or more rewarding to care for my health.

— The Fat Nutritionist

Medical Things

Those following along on twitter know that I went to the Urgent Care near work to deal with a UTI. This, of course, brought up the “Seeing the doctor issues”.

Fortunately the actual appointment went well, with no weight fight.

Then it was off to the pharmacy.  The nice part was that the UTI pain relief pills are over the counter now, so I could get them right away and not have to wait for the backed-up pharmacy.

Realizing that I was freaked, but still needed to go, got me thinking.  The Urgent Care didn’t give me a bad time for being fat.  They had furniture that fit me.  There were multiple sizes of blood pressure cuffs in the exam room. There was not only a scale that could weigh me, but again, it was in the exam room, so privacy.  It wasn’t a bad experience at all – but it still stressed me out, because it was a medical situation, and my history is that medical situations are where I am judged, rejected, and hated.

And I started thinking about other medical things I’ve been putting off.   I have a referral to an allergist.  I’ve had it since spring.   I’ve been putting off scheduling a physical longer.

Yes, I also have a work schedule that puts a large lake between my work and my doc.  I’m finishing my father’s estate. And so on.  But I’m wondering, again, just how much that one extra thing tends to result in people not getting standard, basic care.

Fat Doesn’t Require Apology

You may have seen the video where WKBT anchor Jennifer Livingston responds to a viewer complaint about her weight.  In her response, Livingston thanks those who have come to her support.  She encourages people to speak against bullying and to think about what they say in front of  kids.

What she does not say?  Jennifer Livingston does not apologize for her size.  Livingston acknowledges her size and does not try to justify or explain it.  No “I’m working on it.”  No “I’ve tried to change it.”  She doesn’t even point out that being fat is not a “habit”.*   Her size is her size.  No apology.

I loved that she did not get teary. I loved that she spoke strongly and positively about herself and against bullying.  But the fact that she did not apologize or justify her weight struck me the most.

*As the Academy for Eating Disorders put it, “Weight is not a behavior and therefore not an appropriate target for behavior modification.”  Weight is also not a “habit”.

Day in the Life: the search term

One of the more popular search terms leading people to my blog lately has been “day in the life of an obese person,” leading to the series I did when I first started the blog. Being curious, I googled it. Some of the highest results? “News” stories about people in fat suits. Because seeing how a thin teen’s acquaintances react to their seeming to gain 80lbs overnight is so typical of the fat experience!  Not to mention wearing an unfamiliar, bulky suit is just like walking in your own body!  That’s why a 3rd grader on stilts moves and feels just like a 6′ tall adult! It’s much more “objective” than actually studying a broad sample of fat people – or even showing actual fat people (with heads) who choose to speak out.

I don’t think that every superfat person has the exact same experiences I do.  Far from it!  I also know there is a lot of myths about fat people out there.    I can’t speak for everyone, but I can speak for myself, and those myths do not apply.

If you’re curious, my day in the life posts are linked to http://living400lbs.wordpress.com/day-in-the-life/

O-Word For The “Win”

Ever notice how a news story will use “obesity” even when that’s not really the point?

Example: A study looking for correlations between cognitive decline and metabolic syndrome, explicitly calling out fat.  Headline? ”Obesity ‘Bad for Brain’ by Hastening Cognitive Decline“.

At least one earlier study tied metabolic syndrome with cognitive decline, but didn’t explicitly called out “obesity”.  Marketing fail?