Good News, For Once!

First, apologies to anybody who is still reading this blog for my several-month-hiatus! Over that period, I gave two talks about HAES topics: one to my medical student peers, and one to some philosophy grad students. Both went over very well! It was nice to find a receptive audience for these ideas.

Third Day Back

We managed to get through two whole days of school this semester without mention of the Scary Obesity Epidemic. On the third day, our final lecture about health care spending and cost analysis was nearly over when the professor decided to use an example of how fat people are going to bankrupt us. After all, the obesity epidemic is no doubt going to cost a fortune because of diabetes and other necessary interventions. And just to make sure that our evidence-based-medicine week had some not-remotely-evidence-based comments, he added that exercise programs for kids that reduce obesity later are likely to have a great return on investment these days.

He really ought to read Junk Food Science occasionally, where he could learn things like childhood obesity prevention programs don't work, or that there's really no evidence that fat people are going to cost more, and being fat may actually save the health care system money.

Research about dieting never changes...

Every few weeks, I get together with some friends who are also interested in fat acceptance and HAES and we discuss a relevant journal paper. The first paper we discussed was a meta-analysis of dieting studies. It's a good paper, published in 2007, in the Journal of the American Dietetic Association. It reviews what we all know: all diets work pretty well at first, then you gain the weight back. In the end, after a year or two, dieters in studies end up about 5 kg lower than they started. Given that this doesn't include the 1/3 to 1/2 of the people that drop out, and also given that initial weights tend to be inflated as people binge before their initial weigh-in, and given that this isn't nearly enough to make any fat person thin ... those 5 kg are pretty meaningless.

Still, this month's Journal of the American Medical Association published a paper called Comparison of Strategies for Sustaining Weight Loss. This study has -- I counted them -- 27 authors! It's published in a top medical journal! It involves over 1500 participants! And can you guess what it showed? Yup, they all lost weight at first, and then regained to end up about 5 kg below where they started.

I really don't get it. Why do they bother? Why does this stuff keep getting published? (And in major journals!) It's all the same.

Fat, Female, Forty, Fertile

We had a lecture about gallbladder surgery this morning. The phrase "Fat, Female, Forty, Fertile" describes the patient most commonly affected by gallstones. The prof simply explained this without moralizing, and even mentioned that rapid weight loss is a substantial risk factor for gallstones. You can discuss fat as a risk factor for specific diseases in an inoffensive way.

Plastic Surgery

This morning we had an hour lecture on plastic surgery. The cases shown were pretty amazing -- individuals recovering from burns, cancer and accidents whose lives have been dramatically improved by plastic surgery.

It was all well and good until the lecturer tells us we have five minutes left, and do we want to see a "really gross case" before the end of class. Of course, the class says yes. So he pulls up a slide that says "Morbid Obesity". He then described and showed images of a panniculectomy. That's an operation to remove a large pannus (basically extra tummy fat that can hang down over the pelvis in fat people). This was an unusually large pannus in an unusally large woman.

I jotted down a few comments, verbatim, from the lecturer:

• "next time you go to the chip truck" (that is, remember this case, because if you eat too many chips you'll get like this)


• "she works at the post office" (just to reinforce other random fat-person stereotypes, I guess)


• "I'm not making fun of her, this is a horrible disease" ... but ... "this disease is from eating"


• "she's still huge! look at the size of her!" (that is, she's still a giant fatty after we've removed the pannus)

This was a whole lecture of cases that could be considered 'gross'. It's gross to see someone's abdomen ripped open, it's gross to see someone with half their face missing, and it's gross to see a hand with no skin on it. Nevertheless, the panniculectomy was the only item in the lecture that was explicitly described as gross. The part that really gets me is that the prof wasn't describing the surgery as gross, rather, he was describing this woman's body as gross. That's the part that really is not okay.

Afterwards, I was pretty upset about this. Over the next couple of days I asked a few classmates for their impressions. The response was pretty uniform. Mostly, they didn't recall the panniculectomy slides at first. Then they agreed that there would have been a less offensive way to say it -- but on the other hand, there's a lot of black humour in medicine, and I'm being a overly sensitive.

I don't think I'm being overly sensitive. This matters. Fat people don't seek medical care because they worry that doctors will think their bodies are "gross".

References

Some basic first resources to point people to when learning about HAES:

"Diets Don't Work" list of blog posts
Penn & Teller Video Clip
Gina Kolata on dieting
A good summary of dieting myths

The right way to talk about fat

Recently we had a lecture about various gynecologic cancers. There were several mentions of weight as a risk factor and it was as simple as that. Not in a condescending way, not in a "they deserved it" kind of way, not in a "and by the way they need to diet NOW" kind of way. Just simply explaining. The lecturer also pointed out that women with ovarian cancer are often told that they're just getting fat when, in fact, they have tumors growing. Not surprising to me, but good to mention to our class, I think.