18 posts tagged health care
Logically, greater weight does put greater downward pressure on the joints. It’s just an effect of gravity, a mechanical wear-and-tear issue. However, that still doesn’t justify 1) denying treatment to fat people who experience pain 2) suggesting weight loss, which doesn’t work for a significant amount of weight in the long run, as a preventative measure.
Bodies wear out, some faster than other due to various reasons. Medical science is so backwards that instead of concentrating on cheaper, more effective, more reliable therapies/treatments for this wearing-out process, which are accessible to all bodies, the narrative is instead, “Just try to become one of those bodies that wears out the least quickly.” For most people it’s not possible to change your body that drastically, and for people with chronic diseases/injuries/etc that make them wear out faster, it’s patently silly.
We are not in an age of medical enlightenment. The science of the body is still incredibly backwards. We are barely beginning to understand the genome. We know even less about preventative measures for largely hereditary traits.
Here’s an article that talks about the relationship between osteoarthritis and weight: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096275/
It finds a correlation. The suggestion of weight loss before surgery at the end is, as noted for the reasons above, not one that I support. I also suggest that you check out the article’s references.
The problem here isn’t that some conditions are correlated with higher weight. The problem is the 1) abysmal treatment of fat people by medical professionals, 2) the #1 go-to treatment of “weight loss first,” which can be incredibly harmful to patients who are in pain, especially, since it denies them the near-immediate relief that would be offered to them if they were thin, and is a measure with a stunning 5% success rate in the long term, 3) the slow-moving research on joint replacements that are stronger and lighter, and other treatments for fat people that don’t include “weight loss,” because giving fat people access to the same kind of treatments thin people get is considered to be “glorifying obesity” by the popular culture.
There could be an economic reason that medical devices standardized for higher weights aren’t being made, but given that there’s a demand for these devices and they’re not even being made available at a higher price, there has to be more to the story. Perhaps the regulatory burden is too large, or the approval process is too cumbersome, or the market is not competitive enough. But those are structural issues that have nothing to do with the inherent economic viability or technological feasibility of making devices that are standardized for higher weights.
The system is broken, not just a little, but fractured in many places. And fat people are bearing the brunt of the failures of a broken system, at least in this case. It’s not an uncommon story — underprivileged groups tend to bear the brunt of the social and structural problems of their time. The people in power don’t want to change the status quo, so they scapegoat a popular target so people don’t notice where the true problems lay.
In response to your “Why do you care if someone is 400lbs?” post let me say this — Obesity health care costs are at $191 billion per year - which actually accounts for 22% of the United States medical spending each YEAR. Out of that $191 billion there is $14 billion spent on childhood obesity — which has risen almost 35% since the 1980’s. There are so many cancers and diseases that do not even see 5% of that annual 191 billion each year. Obesity is preventable with diet, exercise, willpower, and — if needed — medical intervention. There is no reason on this EARTH for someone to be obese to the point that they are 400 pounds or more. There is no excuse for it.
Most of those numbers are bunk aggregates where the costs of all possible associations between fatness and diseases were attributed as caused by fatness — and there isn’t any definitive proof of that.
You’re also assuming it’s a societal imperative for citizens to subsidize each other’s healthcare. It’s not. It’s a philosophical choice. And guess what? If you decide that you want a society where people subsidize each other’s healthcare, you don’t get to pick and choose which people’s healthcare you subsidize. And if you don’t want a society where people subsidize each other’s healthcare, then your whole argument is meaningless: don’t be anti-fat, be anti-socialized healthcare.
And please please please if someone here wants to cite statistics please understand where they come from first. Otherwise you just sound ignorant.
"Dr. W. Scott Butsch, an obesity medicine specialist at Massachusetts General Hospital, keeps hearing deeply disturbing stories from patients who have lost lots of weight.
They tell him that within a few months of slimming down, they find themselves suddenly enjoying new recognition and promotions at work. Which is wonderful — until it hits them that their newfound success suggests that they were being discriminated against when they were heavier.”
But please. Do go on about how thin privilege doesn’t exist… -FA
First of all, I apologize for taking so long to answer your post. When I received it I was still out of town. Second, I wanted to write something thoughtful and I needed time to not write something out of anger. Anger that you would accuse me of doing harm by not mindlessly insisting on weight loss as the ultimate solution to a fat person’s health problems.
To start with I would like to state that I do not refuse to advocate weight loss, where it is appropriate to do so. I assume that you are operating on the false assumption that being fat automatically makes a person unhealthy. I can assure you that it does not.
"But, what about the obesity epidemic? What about the diabetes epidemic? But what about…?" I hear you ask.
There are lots of illnesses that have been statistically correlated with being fat. But the thing to understand is that correlation does not equal causation.
Lets use Type 2 diabetes and fatness as an example. Diabetes type 2 is an illness of insulin resistance. That means the body requires more insulin to produce the same sugar lowering effect than a nondiabetic body would need. Insulin is produced by cells in the pancreas called beta cells.
Contrary to popular belief, people don’t just go from being nondiabetic to diabetic overnight. Rather there is a process that occurs. We have found that there are differences in a person’s beta cells that happen long before a person even begins to show signs of insulin resistance. Many people who go on to become type 2 diabetics will have higher levels of insulin circulating in their bodies for years before they even become prediabetic. One of the other functions of insulin in the body is to promote the storage of excess energy as fat. So, insulin makes people fat, and keeps people fat (makes it harder to lose weight).
Can you see where I’m going with this? The question now becomes, are people diabetic because they are fat? Or are they fat because they are diabetic? This is an extremely important distinction to make.
When I see a diabetic person, fat or not, I tell them to make sure they get plenty of exercise and to watch what they eat to control their carbohydrate intake. What does this sound like? “Diet and exercise.” The difference is that I don’t tell people to lose weight. Many of my patients who follow this advice do in fact lose weight, and that is fine. Many of my patients do not. That is also fine. They all have better control of their sugars, and in most cases, to similar degrees. I fail to see how not insisting on losing weight is “doing harm.”
There are times when a person’s weight turns out to be a factor in their illness and where weight loss may help in treating it. In those cases, I do suggest some weight loss. But in NO case is it ever necessary for someone to get to their “ideal body weight” to help their condition.
Finally, let’s look at the idea of “doing harm.” Did you know that studies (link and link) have shown that the medical profession as a whole is biased against fat people? That there are countless stories about people having serious illnesses going undiagnosed because they are fat and doctors refuse to look beyond that? That fat patients stop going to their doctors after being repeatedly made to feel ashamed for being fat by their doctors? For trying so hard to lose weight but not being “successful?” That, to me is the real harm that is done. The psychological harm. The physical harm that results from not going to the doctor for a serious problem because the doctor will either ignore it or just embarrass them again.
Are you aware that the vast majority of people who lose weight are not able to maintain that weight loss over the long term? And that people can end up far fatter than they would have become otherwise due to the lose-gain cycle. That that cycle can also cause serious harm to a person?
I care about each and every one of my patients whether they are fat or not. Whether they are healthy or not. Fat patients get the same consideration given to their concerns as thin people. I don’t simply dismiss things because a person is fat or tell them that losing weight is the ultimate answer. If my medical work up indicates that losing a small amount of weight may help, then I suggest it. Otherwise, it is not necessary.
Finally, before you try to tell me about all the research that shows being fat is unhealthy, I have a few of links to lots of evidence-based medical research that shows that being fat does not necessarily make one unhealthy.
Serious question? Serious answer.
The doctor is fucking IN
I just had a nursing student stand in front of my desk and say to his female also nursing student friend “I’ve got something gross to show you” while pulling out his phone. I thought it was some nursing thing, I used to work in a hospital, I understand.
He then started to go on and on about how “sick” and “disgusting” whatever was in the pics was. Then they both start laughing about the picture and talking about how nasty fat people are. Another buddy walked by and he was showing the pictures to her, too. It was of a fat woman. He described her wearing *gasp* tight pants! And went on in detail about how you could see her *oh noes* fat rolls!
And there I was. Getting his papers together. Sitting there, being fat, listening to these future nurses talk about how sick and gross fat people are.
Fatphobic fucks like you are why people like me avoid going to the doctor.
Thin privilege isn’t being harassed by doctors when you try to get contraceptives (for whatever reason you need them) because you dare to be fat at the same time.
Woah. That is amazing. Thanks so much for sharing!
Thanks for sharing. To your doctor: You are awesome.
Honestly, why do you believe fat people with joint problems should be prescribed a ‘treatment’ that has a 95% chance of failure in the long term instead of being treated well and given options like therapy, pain medication, reconstructive surgery, etc — the options given to thinner people who yes, ALSO experience pain because they have bodies with more than zero mass that exert pressure on their joints?
This whole, “Fat is objectively unhealthy because JOINTS” is the last resort of healthists desperate to maintain their hatred and fear of fat people. Everyone with joint issues would technically ‘benefit’ if they had decreased mass. That’s physics. It’s only fat people, however, who are MADE TO ENDEAVOR (with the aforesaid abysmal chance of success) to lose mass in order to get treatment. And that’s discriminatory, and wrong.
Fucking healthists, man. I’m getting so sick of your repetitive narrow-minded pseudoscientific hate-laced bullshit. You aren’t superior because you imagine, based on how someone looks, that they don’t work out as much as you do, or eat the ‘right’ foods. It’s fucking absurd, and I’m just astonished at how snowed you have to be (indoctrinated, truly) not to see that hamsterwheeling ‘enough’ and nibbling out of the ‘right’ food bowl doesn’t make you a better person. It means fuck-all to anyone but yourself.
(made rebloggable by request)
Survival of the fittest is bogus in so many ways. Next time someone evol-psych fat shames you, or uses it to justify any other prejudice, I recommend calling up this thought experiment of David Deutsch’s
“ Imagine an island on which the total number of birds of a particular species would be maximized is they nasted at, say, the beginning of April. The explanation for why a particular date is optimal will refer to various trade-offs involving factors such as temperature, the prevalence of predators the availability of food and nesting materials, and so on, suppose that initially the whole population has genes that cause them to nest at that optimum time. That would mean that those genes were well adapted to maximizing the number of birds in the population - which one might call ‘maximizing the good of the species’.
“Now suppose that this equilibrium is disturbed by the advent of a mutant gene in a single bird which causes it to nest slightly earlier - say, at the end of March. Assume that when a bird has built a nest, the species’ other behavioural genes are such that it automatically gets whatever cooperation it needs from a mate. That pair of birds would then be guaranteed the best nesting site on the island - an advantage which, in terms of the survival of their offspring, might well outweigh all the slight disadvantages of nesting earlier. In that case, in the following generation there will be more March-nesting birds, and, again, all of them will find excellent nesting sites. That means that a smaller proportion than usual of the April-nesting variety will find good sites: the best sites will have been taken by the time they start looking. In subsequent generations, the balance of the population will keep shifting towards the March-nesting variants. If the relative advantage of having the best nesting sites is large enough, the April-nesting variant could even become extinct.
“This change has harmed the species, in the sense of reducing its total population (because birds are no longer nesting at the optimum time). It may thereby also have harmed it by increasing the risk of extinction, making it less likely to spread to other habitats, and so on. so an optimally adapted species may in this way evolve into one that is less ‘well off’ by any measure.
“Evolution can even favour genes that are not just suboptimal, but wholly harmful to the species and all its individuals. A famous example is the peacock’s large, colourful tail, which is believed to diminish the bird’s viability by making it harder to evade predators, and have no useful function at all. Genes for prominent tails dominate simply because peahens tend to choose prominent-tailed males as mates.
“If the best-spreading genes impose sufficiently large disadvantages on the species, the species becomes extinct. Nothing in biological evolution prevents that. It has presumably happened many times in the history of life on Earth”
The Beginning of Infinity, “Creation”, 89-92
I’d argue fat genes are some of the best-spreading among humans. And it clearly isn’t enough of a disadvantage to make our species extinct.
This argument is riddled with assumption fallacies. You get your basic premises wrong, and I would be arguing against a straw man if I attempted to refute them.
So instead, I’ll refute your premises.
Fat pregnancies aren’t necessarily less healthy than thin pregnancies, all things being equal. The thing is, they’re often NOT equal.
- Fat people are bullied and put under stress and told to diet (or not gain weight) their whole pregnancies. They’re told their babies will die or develop complications if they dare to be fat while pregnant. Fat people are told THEY will die if they dare to be fat while pregnant. They’re induced early because of ‘fat baby’ scares, then pressured to tie their tubes so they don’t get pregnant again. They’re pressured to terminate their pregnancies because, ‘No fat woman can have a healthy pregnancy.’
- Fat people are told their pregnancies are high-risk by virtue of them being fat. Bariatric obstetrics threatens to take low-risk care options away from fat women completely. Risks associated with ‘obese’ pregnancies are distorted and magnified.
- Fat people are often bullied into C-sections and/or denied access to alternative non-hospital birthing options like waterbirth.
- Fatness can be a symptom of an underlying disorder that might have an effect on whether or not someone can carry a healthy pregnancy. In many studies these disorders are assumed to be caused by fat, and the chain of causation is writ: FAT -> DISORDER -> RISKY PREGNANCY with FAT as the base case, when really it’s the DISORDER that makes the pregnancy risky.
Please peruse The Well-Rounded Mama for a more critical eye on the trope of fat high-risk pregnancies. The author’s posts are replete with references, so you can read the studies she discusses and references for yourself.
Fat people are having our reproductive rights threatened. We’re told we 1. can’t get pregnant and we won’t be allowed the same access to fertility services as thin people, and when we do get pregnant that 2. we shouldn’t stay pregnant, and when we stay pregnant that 3. we can’t possibly have a healthy pregnancy, and if we have a healthy pregnancy that 4a. we’re ‘lucky’ and should get our tubes tied so we never ‘run the risk again,’ and if we have an unhealthy pregnancy that 4b. our fatness caused it, no matter our other underlying disorders, family history, stressors, and the fact that not all thin people have healthy pregnancies either.
You’re young. You’ve got a lot to learn. I encourage you to start waking up to the lies you’ve been fed about fatness and health NOW, before they infect you any further.
Thin privilege is going to see a physiotherapist for a knee injury and not being being told ‘it wouldn’t have happened if you lost weight.’ despite never having this problem when you were 60kgs heavier and the injury actually being a result of overuse from 2+ years of hard work to lose said weight.
Thin privilege means your cancer will be properly diagnosed in time and the pain you’re experiencing won’t be dismissed by an asshole doctor who jokes about you holding weight in your stomach area being the reason you’re in pain, so the cancer won’t have time to spread. Thin privilege means that you won’t have to go months in pain because the doctors aren’t taking you seriously, so when your cancer IS finally caught, by someone who isn’t even a doctor, it hasn’t spread.
Ties into white privilege, which means every doctor will care about you and actually give a damn about you having cancer, and you won’t be talked over, or turned away from the Cancer Treatment Center of America, and you won’t have your treatments stopped by lazy doctors who simply don’t want to waste anymore time on you but instead come up with the BS excuse that the treatments weren’t working, even when they were. You won’t go ignored as you lay dying in the hospital, and doctors and nurses won’t decide to stop feeding you or even giving you water, because you’re thin and white so they won’t regard you as less than an animal and they’d rather starve you and let you become more dehydrated than properly care for you.
Oh, and should you die from cancer due to the negligence of the medical community, lawyers will actually take your family seriously when your family wants to file lawsuits for malpractice, and your family won’t be lied to and told there’s nothing that can be done.
Happened to my mom. Anyone who thinks thin privilege and white privilege aren’t real is an asshole. I will NEVER AGAIN trust ANY doctor. I hate them all, every last one of them. Mom would still be alive today if they didn’t all have a God complex and think anyone who isn’t a white twig doesn’t deserve basic respect and care. I hate all doctors and will NEVER forgive them.
"They’re not all like that."
BS. Yes they are. They ALL are. I HATE THEM!!
Thin privilege is not being body shamed at a health clinic for being overweight and having gained 40 pounds after 7 months of pregnancy.
My sister, who was moderately “overweight” before becoming pregnant, was incessantly shamed about her perceived eating habits at her recent WIC appointment.
She is experiencing mild preeclampsia, which was brought on as soon as she entered her third trimester. This is a condition that does not discriminate against weight and can effect ANYONE, but because “obesity” is sometimes attributed to its cause (which is a theory and nothing more) the clinic nurse saw an opportunity to body shame and seized it.
This woman insisted that she must be eating poorly to have gained so much weight (apparently the recommended “healthy” weight gain during pregnancy is 25-25 pounds so is a mere 5 pounds above the norm really something to shame a pregnant woman over?) And also had the gall to suggest that my sister’s high blood pressure due to her preeclampsia must be attributed to her diet.
Before leaving, this nurse actually told her: “This isn’t the time to diet, but you need to watch your weight.”
None of her 5 other doctors had ever brought up her weight as an issue - BECAUSE IT ISN’T. But this woman decided to prey on an overweight pregnant woman and shame her, during a time when “watching your weight” should be at the bottom of the list of things one needs to worry about when expecting a baby.
My sister already blames herself enough for her condition, thinking she brought it all on herself (when she absolutely didn’t, she has maintained a relatively healthy and normal diet throughout her entire pregnancy). Shit like this just gives her more reason to be afraid for herself and her baby, when what she needs now is SUPPORT - not SHAME and more reason to stress.
Thankfully, my sister was able to see through this bullshit. In her words:
"I know I don’t eat badly - I obviously know that too much weight gain too fast isn’t good for me or the baby, but if I want to eat a fuckin Little Debbie snack IMMA EAT IT! This is what my body has decided to gain, to whatever."
So proud. <3
When someone brings up fat =/= healthy or some other fat shaming “health” bullshit, I think about my mom. She’s 63. She’s also a beautiful, strong and healthy woman. She has some of the healthiest eating habits I have ever seen, she runs all of her errands on foot and has done so for most of her life (and her flat is on the second floor), if not for the pain in her joints, she could run a marathon, her heart and lungs are strong and her skin is glowing with healthiness. And she’s fat.