New and Sort of Encouraging Article on the Massachusetts Anti-Discrimination Bill

The Boston Globe Magazine has a new article on the Massachusetts anti-discrimination bill. It’s a mixed bag, but the author seems to see the overwhelmingly compelling argument for passage of the bill. And that’s pretty heartening considering how last week went – where fat people were defending our rights to have friends and be seen on television .

One of the things I’m not thrilled with? It starts off with one of the more public fat-hating loons — the owner of the gym/swinger’s club, the “antigym.” This guy spews hatred to get media attention and free advertisement for his business, and like terrorists and Anne Coulter, he shouldn’t be rewarded with a micropone. But I suppose he also serves a purpose here in demonstrating the kind of harrassment we have to contend with.  

The article gets better as it goes on, and to its credit, debunks the tired canard that fat is a “choice.” The media seems lately to be marginally more courageous in speaking truth to the public about the biology of weight regulation and the general futility of weight loss, and this seems to be part of what I hope is becoming a trend. (Well, wouldn’t it be pretty to think so, anyway). I also liked the coverage of Jeanne Toombs who’s organizing on behalf of NAAFA for passage of the bill, and Rep. Byron Rushing, who’s sponsoring the bill.  (Infinite gratitude to both of them for their work on this.)

Lee Kaplan, an obesity researcher from Massachusetts, is depressingly true to form for his profession. He pays lipservice to opposing stigma: “To turn around and discriminate against people simply because of the hand they were dealt — that’s not just abhorrent…It’s cruel.” Then let’s us know he’s not going to actually help fight that abhorrent cruelty.  Making the fantastic speculation that it may be “the most expensive bill ever written.”

To her credit, the reporter notices that that suggestion is without much basis in the real world, because, for example, nothing of the kind has happened in Michigan, which already protects fat workers against discrimination, nor have similar apocalyptic predictions come true for the Americans with Disabilities Act. 

As a bariatric surgeon, it may not be in Kaplan’s interest to make the lives of fat people viable. But it’s a travesty that in the medical literature you can read study after study by researchers who obviously believe that weight is either largely genetic or otherwise not a matter of “choice.”  And many who flatly denounce stigma and discrimination. But I can count on a single lonely finger the number who have bothered to try and get that message to the public or the general medical community. Or who have taken any responsibility for mitigating the catastrophic damage done to the welfare of fat adults and children by their recklessly-waged “war on obesity.”

Anyway, yes, it has its aggravating moments, but the article’s an interesting and overall encouraging read. It’s free, but you’ll need to register.

Even more worth your time? If you live in Massachusetts, please write your representative in support of the bill. If you’re willing to testify at hearings this fall, contact NAAFA and let them know. If you know anyone who lives in Massachusetts, encourage them to do the same.

A Few More Observations on the Fat Friends Study

It wasn’t a bad dream. Last week the global press was actually debating whether it’s ok to associate with fat people based on a study, which was published (and heavily promoted) by the New England Journal of Medicine. For those of you with the good sense not to follow this kind of news, the report purported to show that obesity spread from friend to friend by fat friends changing each other’s norms of what weights are “acceptable.”

Sandy Scwarcz and Kate Harding, among others, did a beautiful job of debunking this study’s conclusions from different perspectives (the former from a sciency perspective, the latter from a position of pure common sense).

So it’s been said, and said better. But I want to add just a few more things I’ve noticed about what’s wrong with this study. There are so damn many things wrong, that it’s easy to miss a few.

Friends and Relatives

First, you couldn’t have picked a group of “friends” that were more likely to be genetically related if you made a concerted effort. Both the subjects and their “friends” were all children of the original Framingham Heart Study cohort, so their parents were all living in Framingham, Massachusetts sixty years ago. The “friendships” analyzed were narrowed to people who a) this group listed as contacts, b) were also in the Framingham heart study, and c) were not first degree relatives.

In other words, these “friends” were very likely to be second and third degree relatives – cousins, aunts and uncles – and my guess would be that the more likely they are to list each other as mutual contacts, the more likely they were to be related.

Genetics Doesn’t Work that Way. Really.

The researchers wave away the general possibility that genetic similarities could have influenced their results by making a fundamentally wrong assumption: that genetics is a single, static effect. Which is why they believe that adjusting for initial weight excludes the possibility of genetic similarity as a factor in weight change as the decades go by.

I can’t emphasize enough how critical that assumption is to their entire analysis. And how wrong it is. Different genetic effects influencing weight kick in at different points over the lifespan from infancy to old age. So, for example, two relatives with totally different BMIs in young adulthood could share genes that make them both prone to gain weight or distribute it in a certain way in middle age or prone towards frailty in old age.

So that’s a simply wrong understanding of the genetics of weight regulation that underlies their entire analysis (and has a lot to do with their not being obesity researchers).

An elaborate hypothesis covers a multitude of evils

The other obvious problem, which Kate Harding and Sandy zero in on, is that their complicated data analysis spat out downright bizarro results:

1. At the start of the study, having a fat friend actually reduced your chances of being obese (They call it the “Laurel and Hardy effect”).  In fact only weight change, and not fatness or thinness per se, had any positive association between “friends.” (To discover this interesting detail you had to look in a supplementary appendix which needed to be downloaded separately). 
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2. People who listed each other as contacts (defined by the authors as “mutual friends”) were more likely than any other relationship to have a correlated weight change. But only among men.  Female friends didn’t have a significant impact on each other’s weight change.
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3. Opposite sex friends and opposite sex siblings didn’t have a significant impact on each other’s weight change.
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4. Same-sex siblings, spouses and nonmutal friends all seemed to have some impact on each other’s weight change but the difference in impact between these groups doesn’t appear to be significant.
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5. Neighbors don’t impact each others’ weight change.
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6. Geographic distance has no importance. So the impact is the same if your “friend” lives with you, next door, or 3000 miles away. So apparently eating meals together or sharing recreation have no influence on weight change.

It’s a mess. My first impression – and I think the impression of common sense — is that all this is an artifact of the methodology (which is researchese for “you did it wrong.”)

Instead, what the authors did was come up with a flexibly vague, elaborate and speculative hypothesis to try and explain each of the details of the mess.

Here’s how it goes: apparently friends in 1971 had different-sized friends because fat friends like to be with thin friends, and vice versa. This changed in the intervening years because: “Whereas obesity has been stigmatized in the past, attitudes may be changing.” One of their two citations for that unlikely assertion? An article on the size acceptance movement. No, I’m not kidding.

So apparently over the next thirty years as one man falls prey to the nefarious influence of NAAFA (in Framingham Massachusetts, where I happen to know nobody’s ever heard of NAAFA – it ain’t no Northampton)….other male friends say to themselves “hey, I guess it’s OK to be fat.”

Opposite sex friends and siblings are immune to each others’ influence because they don’t see each other as role models. Apparently female friends don’t either. Spouses and siblings take fewer cues from each other than friends do. Shared behavior or shared environment have no role whatsoever because…well they just don’t.

It’s a lot to swallow. Or, Occam’s razor: They did it wrong.

Because It’s Just Not Directionality if it’s Not Significant

The authors make a LOT of the “directionality” of the effect, claiming friends who list you as their friend are less likely to impact your weight than friends whom you list. In other words, you’re more likely to take cues from people you think of as friends than people who think of you as a friend.

That direcionality, they argue, rules out the possibility of confounding variables, and is pretty much the sum total of their justification for arguing that this is about influencing attitudes, and has nothing to do with genetics or anything else.

And that would be interesting. If the “directionality” were statistically significant. But it’s not. The researchers don’t actually admit this, but you can basically eyeball it just by looking at the overlapping confidence intervals for the two types of friendships.

It’s hard to imagine that the entire thesis of an article in a peer-reviewed medical journal is based upon a result that is statistically meaningless. But that appears to be the case.