You Don’t Know What You Think You Know

I’ve gotten some emails from people  – not trolls – but totally brand spanking new to the subject who are just dead sure they understand everything they need to know about fat: we’re in an obesity crisis, and fat is just calories in/calories out.

So for all of you folks, I am going to kick you off with two articles – which aren’t from fat positive sources at all – just to problematize everything you think you know about fat.

Scientific American –  Obesity: An Overblown Epidemic?

War on Obesity Not the Obese

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How Hard Must I “Try” Before You Stop Hating Me?

It’s very weird.  In online environments where I indentify as a fat chick with a BMI of 37, I get so much more hostility directed at me than I do in the “real world.”  To be honest, IRL I get very little weight-related harassment, despite my ginormous marked-for-instant-death BMI.  If people guess my weight, they guess waaaay lower than the 212 pounds I actually am.  I’ve actually had people say to me, “But you’re not obese.”  Rather than revel in this pseudo-thin privilege, however, I take the time to correct them.  Typically I then get some kind of shrugging response along the lines of, “Well, I guess you’re different, then.” Read the rest of this entry »

More Evidence…

…that there’s no evidence behind the War on Fat Kids.  According to a review of weight monitoring in children published in Health Technology Assessment:  

No sound evidence supports weight monitoring to identify and treat obese children, according to a review of worldwide research published this month in the United Kingdom.The relative benefits and harms of monitoring have not been determined, and the effectiveness of current treatments is doubtful,” say review authors led by Marie Westwood, Ph.D., of the University of York.

Also the press release points out another admission – this time by the American Academy of Pediatricians – that there was no evidence behind the AMA’s recently released weight loss protocol for kids. (Which, to review, instructs doctors to use increasingly aggressive weight-loss “interventions” for 15% of children, including dieting, “behavioral modification” and “consideration of” very low calorie diets, medications and surgery):

The American Academy of Pediatricians, members of which served on the expert committee, acknowledges the lack of evidence on prevention and early identification of obesity in children. Their policy statement adds, “The enormity of the epidemic, however, necessitates this call to action for pediatricians using the best information available.”

Let’s set aside that it’s completely disingenuous to imply that “the best information available” suggests that either “prevention” or enforcing weight loss on children works (just the opposite, actually). What’s phenomenal is that in one fell swoop both the rules of evidence and the principle of “do no harm” have been tossed aside.

And how do they justify this suspension of the normal checks and balances? “The enormity of the epidemic necessitates” it. What they’re really saying is: “the sheer size of the population who will be affected by our recommendations means we don’t need any evidence.”

Come again? With any other “condition” the size of the affected population is precisely what restrains public health officials from making recommendations without solid evidence. If millions of patients (especially children) will be affected – that’s when they are ordinarily compulsive about evidence – because the potential for harm if you’re wrong is staggering.

I have never heard of – nor can I really imagine – another situation where the size of the target population alone was the only reason given for not using caution and not waiting for evidence.

It is a mind-blowing abandonment of both restraint and logic.

Big Girl (You Are Beautiful)

…then this came along and cheered me right up: 

(via Every Woman Has an Eating Disorder)

The Trouble With Normal Weight, part 2

Stef very helpfully pointed out in her comment on The Trouble With Normal Weight:

Eric Oliver in Fat Politics has a couple of pages about the historical developmental of the concept that “average” is the same as “ideal”. He discusses a Belgian astronomer named Adolphe Quetelet who, in the 1830s, invented the notion of BMI by studying the height and weight of members of the French and Scottish armies…

This is what I get for buying, but not reading Fat Politics. When I read that comment I glanced up at my bookshelf, where the book stared back at me reproachfully.

It turns out Quetelet is the very same statistician that Michael Warner credits with instigating the conflation of the “statistical average” with “health” in medicine starting in the 19th Century. Warner’s concerned with the pernicious effect this had on the construction of homosexuality, and I didn’t put together that he was the same statistician who created the BMI until I read Stef’s comment.

quetelet2.jpgI looked up the Quetelet section in Fat Politics, and it puts the pieces together. If you haven’t bought it (or – ahem – read it), you should. Anyway, I know what I’m going to be reading for the next few days.

Oliver explains:

Among his many accomplishments, Quetelet first derived the concept of the ‘average man.’ Because most people congregated around average points in their physical characteristics, Quetelet believed that deviants, criminals or troublemakers could be identified by their physical abnormalities….The farther someone was from the average weight, the more they violated other social norms, and the more they could be monitored, institutionalized, or controlled.

Which is what the moral panic of the obesity epidemic, is all about, isn’t it? It’s why so much of the focus is on controlling behavior of fat people. And too little is on whether that  “control” actually makes anyone healthier. Read the rest of this entry »

The Trouble With Normal Weight

I’m reading Michael Warner’s  “The Trouble With Normal,”  about homosexuality and…well…the trouble with the idea of “normal.” I had to share this passage…which was so relevant to the relationship of fat to the “normal”:

As [19th Century] doctors began using…statistical methods [to determine the statistical norm], they usually thought they were discovering natural laws…normal came to mean right, proper, healthy. What most people are, the new wisdom went, is what people should be….

He points out how these “norms” are invariably dependent on just who is chosen as “normative” (e.g. White Europeans? People in which environment? Which age group? Which era?), and something that should be fairly obvious, health itself is impossible without variety and variability in the population in order to allow for change and adaptability. “Health requires variation. Not a pregiven norm.”

He continues:

…From the late nineteenth century onward, people had to work very hard to resist this medical fallacy, which was rooted in the confusion between statistical regularities and natural laws. The lesson in this struggle should have been one of skepticism toward all norms of health that express social norms, preferences for certain ways of living, or tastes of the majority.

This so resonates with “the trouble with normal weight.” Fat-phobia is not just about a taste for certain body-shapes. It’s also about a taste for a certain way of living. And the fear that people who don’t have the right body shape, aren’t living the right way. It’s almost impossible to listen to discussions about the “obesity epidemic” without hearing it morph into a detailed dissection of what it means to live “right”, and the need to “educate” or otherwise coerce the fat (especially the poor and minorities) to change their imagined “poor lifestyle” into something more presentable.

And of course, the most aggressive and ill-considered fallacy on which most people premise their pronouncements about weight, is, of course, that everyone is “meant” to be a single weight – that variations from the “normal” aren’t about natural human variability – they’re “abnormal,” and therefore “unhealthy” and therefore “disease.”

bell_curve.jpg

And since those same people also tend to believe that fat isn’t heritable and is purely a reflection of “lifestyle,” then the distance from which you travel from the “normal” is a reflection of your distance, not only from “health” but from “good behavior.”

By the way, I’m not discounting any correlations of fat with health effects. Every human variation has its own “risks” – as a woman I know I’m at risk for breast cancer, ovarian cancer, and osteoporosis.  Men have other risks. Short people have certain risks, and tall people others. Straight men have different risks from gay men who have different risks from lesbians. Every ethnicity has its own risks too. And as I enter middle age I find myself confronting an array of risks I didn’t have when I was young. Am I now officially “unhealthy?”

And just as importantly, whatever health correlations there are for weight vary immensely depending on who you’re talking about, their age, their gender, their ethnicity, their illnesses, and any number of other variables. 

So that in general the  label of “unhealth” to fat is so vastly overgeneralized, oversimplified and hyperbolically stated that it serves little value in improving health. It only serves to rationalize hate and discrimination, to foster panic-driven (and not evidence-driven) public policy, and to undergird the (il)logic of a universal prescription for weight loss without consideration for benefits, dangers, (in)efficacy….or simple humility in the face of how much is not yet known.

How does the idea of fat as simple “unhealth”  jibe with two studies this week that showed that the fat have a lower risk of suicide, and that fat people with heart disease fare better than others? They make it jibe by calling it “The Obesity Paradox.” Yes, it must be a paradox because we’ve already labelled fat as unhealthy.

But why are we so quick to impose the label of “unhealth” on any and all variations from “normal weight?” For the most part it’s simply because we’re always quick to assume that anything straying from the statistical average -“the normal” – is by definition deviance and disease.

Open Fat Thread

If anybody feels the urge, use this space for shameless self-promotion, interesting links you’ve found, fat rants, fat raves, questions, complaints, Deep Thoughts, grocery lists, or just to say “hi Mom!” (Not that your Mom is reading this, but you never know.)  

In the meantime, if you haven’t run across them already:

  • The brilliant Kate Harding (of Shapely Prose), is now a contributor at Shakesville. I was grinning all day when I heard this. Check out her rapidly growing body of work
  • Bored with scrolling through pages of tedious and repetitive fat hatred in your threads?  Wish you had a nickel for every time you’ve been lectured on thermodynamics by someone who can’t spell the word? Red No. 3 has your answer: Fat Hate Bingo.
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  • So you think you should boycott So You Think You Can Dance? You’re right, and Rachel of the The f-word tells us why.
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  • BABble found an oh-so-timely article on the dangers of food-restriction in kids. In the mainstream press even.