#askbfs

[bigfatscience]

[this is gonna take up about 3 asks, I'll send them chronologically and labeled, but I wanted to warn you since I'm on anon]: Aside from the obvs medical biases when it comes to weight, I'm inclined to think that one of the reasons that being obese/overweight is associated with illness is because thin people are more inclined to believe that they're healthy no matter what, it must be something they ate or allergies etc, than fat people are, seeing we've all been told since childhood that

fat=unhealthy. As inthin people will experience something like heart palpitations or chest painsand assume it’s anxiety/stress and just an acute symptom and not go to theirdoctor (or find a doctor since a lot of adults don’t have primaries) whereasfat people will immediately assume the worst and go to the doctor like they’resupposed to, which leads to a higher percentage of fat people being diagnosedwith various conditions than thin people by default. Like its obvs not a badthing that fat people have a higher tendency to see a doctor -seeing a doctorfor maybe-ailments is highly recommended lol, it’s better that we do imo- butit seems like (ironically I might add) that this tendency of being sure thatyou are healthy adds to the stereotype that fat people (aka the you in thisscenario) are not. (I don’t think this benefits the stereotype too much, likeas in overall it’s probably only contributing like 5% of the total work to saidstereotype if that makes sense, kinda like the way the wind influences thesize/speed of a wave on the ocean, but I do think that it still makes a bit ofa difference). What are your/your followers thoughts? 

Ahhh. ‘Tis an interesting theory. But one fly in the ointment is the fact that fat people actually avoid going to the doctor! Mostly because we fear being stigmatized, blamed for our own health conditions, and treated with disgust by fat-phobic health providers.

We are more likely to be tested  and monitored for various “fat” diseases, though, and that increased testing could account at least in part for our higher rates of diagnosis compared to thin people. After all, you can’t be diagnosed for a disease you have never been tested for!

[bigfatscience]

the estrogen & excess adipose tissue thing leading to increased risk for cancers - is that true? are there any other documented factors like that? is there any way to counteract that? i just want to have the best knowledge of this topic. i love your blog and am grateful for it as a resource. i don't necessarily think llbadams11 was derailing with the adipose tissue comment - that is the medical term for fat and in this context i thought it was appropriate. either way - thank you.

I did a quick search yesterday and didn’t find anything saying exactly what that poster said. If you want to search you can go to Google Scholar and search “cancer obesity estrogen meta-analysis” (that last term will return papers examining effects across many studies, which are the most definitive studies on a given topic). Leave out the last term of you want single-study papers, or add the term “adipose” in place of “obesity.” Or maybe you can message the person who brought it up and they can provide a citation?

In my own search, I did find some very interesting articles about fatness, estrogen,and breast cancer, some describing quite surprising results I had not heard before, so I’ll summarize that research soon.

(PS: if you are also fat, then of course you are free to react to that post however you like! Just remember that your reaction has no bearing on the validity of my own reaction. And if you are thin, then I am sorry friend, but you do not get a say in what is or is not fat phobic.)

[bigfatscience]

does being fat can cause skin issues due to body folds which non-fat people don't have to the degree we do? like, that's legit the only thing I can think of that we have that thin people don't.

Yes, that is an example of a health condition that is probably unique to fat people. <-- Oops! I maybe spoke too soon!

Another such disease may be lipedema , which is thought to affect between 11% and 39% of women:

Lipedema (painful fat syndrome) is a chronic disease that occurs mostly in females. It is characterized by bilateral, symmetrical fatty tissue excess, mainly in the hip region, upper and lower leg areas and combined with a tendency for leg swelling that worsens with standing. In male patients lipedema is extremely rare (1).  Lipedema is often misdiagnosed as bilateral lower extremity lymphedema or as simple obesity.

So lots and lots of fat people have lipedema, including some people in the tumblr community. @afatfox has spoken openly about her own diagnosis with lipedema, and @khaleesidelrey has also shared her own experience. 

Apparently it is a very common condition, yet most doctors don’t know about it. This is especially problematic because people with lipedema cannot lose weight from the affected areas of the body, and so they probably suffer a lot in our diet and weight loss obsessed culture.

[bigfatscience]

Can you link/cite studies that show thin people getting so called "fat" diseases at similar rates? I can't find any. :(

Well, you won’t find any such studies because those diseases – like cardiovascular disease, diabetes, gastroesophogeal reflux disease, sleep apnea, etc – are so named precisely because fat people are more likely to get those diseases than thin people! But remember, that does not mean that fatness causes any of those diseases.

And of course, thin people DO get all of those diseases as well. For example, in one recent study, it was observed that about 30% of so-called “normal weight” people are metabolically “unhealthy” whereas about 50% of so-called “overweight” people are metabolically “healthy”. Thus, using body weight (or more specifically, the BMI) as an indicator of health results in the misclassification of some 75 million people in the United States alone. 

Moreover, there is a large body of literature showing the fatness has beneficial health effects too. Fatter people are more likely than thin people to survive infection, heart attack, and cancer treatment. We also fare better than thin people on dialysis and when we suffer from kidney disease and diabetes. We also have about half the risk of dementia as thin people and can even live longer. 

The association between weight and health is far more complex than the media, and many health professionals, would lead you to believe. 

[bigfatscience]

Your blog dispels lots of myths about fatness and disease and risk factors. Is there any disease or illness that IS correlated with fatness, or caused by fatness?

Nearly all of my science posts include links to studies demonstrating a correlation between weight and health. The first link in this post about cancer, for example, leads you to a meta-analysis of many studies demonstrating a correlation between weight and a number of different cancers.

It is well publicized that fat people are more somewhat more likely that thin people to experience diabetes, heart disease, polycystic ovarian syndrome (PCOS), some cancers, sleep apnea, gastroesophageal reflux disease, and others. I have never tried to dispute those correlations. They exist and they are real.

But determining that fat actually causes the diseases with which it is correlated requires scientific evidence that does not yet exist, in part, I believe, because fat phobia stops researchers from rigourously testing alternative models and ruling out confounds. Moreover, there is a lot of contradictory evidence that does not get publicized. For example, thin people also experience all of the same diseases that fat people experience, weight loss does not cure any of the diseases with which fat is associated, and behavioral interventions can decrease symptoms for many “fat diseases” without weight loss.

We need more research, especially research that is not biased by fat phobia, before we can really know whether fat causes disease. Given the current state of the literature, it is premature – and irresponsible – to claim otherwise.

[bigfatscience]

For the person concerned about insulin resistance: diet and exercise may not be enough, but quite a few doctors are prescribing metformin/glucophage for insulin resistance these days because it increases insulin sensitivity, which can delay or even prevent the onset of diabetes. Keep eating healthy and being as active as possible, but there's also no shame in using medication.

^^^

[bigfatscience]

why do people make weight and health into moral issues? losing weight (or overcoming an illness) doesn't make a person better or more worthy of love and respect. sure, i've lost quite a bit of weight myself, but i'm certainly not -proud- of having succumbed to societal pressures...quite the opposite, in fact.

Ahhh… these are big questions my friend with big answers. Well worth thinking about more, because if you really start to pick at those threads the whole nasty fabric of classism, colonialism, and cultural oppression starts to fray.

[bigfatscience]

In response to the "So there's no way to lose weight and keep it off?" anon and answer: It will never be possible to keep a healthy weight if a person does not change their lifestyle, but just goes on a diet &exercises for a while. The scientific community has shown that people who diet and exercise for a short time gain it back, but the people who make it a part of their every day life (without sacrificing their mental health) can maintain a healthy weight. It is a journey, not a destination.

No. This is not true. I know it is hard to accept, especially if you personally have invested a lot of energy into dieting and weight loss and suffered for both. I know the 60 billion dollar diet and medical industry *tells us* what you are saying. But the actual empirical science says otherwise.

Fifty years of scientific research shows that there is no permanent and safe way for the vast majority of people (i.e. upwards of 95%) to intentionally to lose weight. No “lifestyle change,” nothing. Peoples weights do naturally fluctuate within a relatively narrow window of about 15lbs (their set-point window) in response to all sorts of factors, but intentional attempts to lose weight, especially below one’s set point, nearly always result in weight regain, and usually more than people initially lost. This is what the science really says.

If you know of a meta-analysis published in a reputable empirical journal that supports your assertions, I would be happy to read it. Until then, I will continue to believe the empirical literature over diet-industry propaganda.

PS: People can support their health without losing weight. The notion that thinner is always healthier is untrue, and the notion of a “healthy weight” being the same weight for everyone is also untrue.

(In future , I will not answer asks like this, I will simply reblog this response).