Podcasts about beast the politics

We're going to talk about food and nutrition next week. But first, we need to talk about beauty.Spoiler warning: You're beautiful.Links: Amelia is doing Youtube Lives again starting this Friday @4pm eastern!(From now until the end of Murderbot.)Bob the Drag Queen⭐️ Drink Water and Mind Your Business by Dr. Donna Oriowo ⭐️(Emily loves this book and blurbed it!)Get it from:SourcebooksAmazonBook Moon BooksDr. Yaba BlayThe Whites of Our Eyes is a short documentary film that follows Dr. Yaba Blay as she returns to her familial homeland of Ghana to explore the relationships between beauty, bodies, and b/BlacknessRad Bod or Dad Bod (Youtube)The NorthmanLindsay Ellis explains The Little Mermaid (Youtube)FD Signifier explains edgelords (Youtube)Jessica Kellgren-Fozard explains ugly laws (Youtube)Wreck-it Ralph villain support group (Youtube)Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun HarrisonHealth at Every SizeGood Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and HealthWhy Diets Make Us Fat by Sandra AamodtFSP 2020 Episode 18: The New HotnessThe Body Project Turia Pitt(it looks like Amelia's episode with Turia isn't up yet.)Ubuntu Reclaiming Ugly by Vanessa Rochelle Lewis

In many ways, the health and wellness industry is killing Black people. For our audacity to exist with melanated skin, we've historically endured subjugation, political and economic disenfranchisement, and centuries-long death. And it hasn't stopped yet. In June 2023, Jay talked about it with Da'Shaun L. Harrison for season 7 of BHY. Da'Shaun is a self-described Black, fat, trans, disabled, queer abolitionist, community organizer, writer, and editor at Scalawag magazine. Their award-winning book, Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness, explores desirability politics, gender, policing, and the fallacies of healthiness. __________________________ Black History Year (BHY) is produced by PushBlack, the nation's largest non-profit Black media company. PushBlack exists to amplify the stories of Black history you didn't learn in school and explore pathways to liberation with people leading the way. You make PushBlack happen with your contributions at BlackHistoryYear.com — most people donate $10 a month, but every dollar makes a difference. If this episode moved you, share it with your people! Thanks for supporting the work. Hosting BHY is Jay (2020-2023) and Darren Wallace (2024). The BHY production team includes Jareyah Bradley and Brooke Brown. Our producers are Cydney Smith and Len Webb for PushBlack, and Lance John with Gifted Sounds edits and engineers the show. BHY's executive producers are Julian Walker and Lilly Workneh. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Reader Shauna asked “I just saw an article about the Body Roundness Index, is that as silly as I think it is?”The Body Roundness Index seems to be the weight loss industry's response to finally having to (at least begin to) admit that the Body Mass Index (BMI) is nonsense. The BMI is a ratio of weight and height that has been used to pathologize bodies based on their size alone and has its basis in racism. I talked about that in depth in this piece.Earlier this year the AMA, which takes hundreds of thousands of dollars in donations from the weight loss industry,  tried a little sleight of hand with this, admitting that there are serious issues with the BMI (which has been used as a justification for the much of the weight loss paradigm) but instead of acknowledging that simply pathologizing bodies based on shared size is an idea lacking scientific basis and merit that has done incredible harm, they instead said that we just needed more and different ways to pathologize bodies based on shared size.That brings us to the study Shauna sent me: “Body Roundness Index and All-Cause Mortality Among US Adults” published in JAMA (the Journal of the American Medical Association.)The authors reported no conflicts of interest, even though one of the authors, Qiushi Lin, MD, PhD, literally works for Sanofi Aventis which just had its weight loss drug preliminarily rejected by an FDA panel.Where the BMI is used to pathologize bodies based on weight and height, the The Body Roundness Index (BRI) uses weight and waist circumference.The specific calculation they used is “364.2 − 365.5 × √(1 − [waist circumference in centimeters / 2π]2 / [0.5 × height in meters]2)”The use of mathematical formulas tends to lend these concepts an heir of scientific validity that they do not deserve. They explain that “Due to the lack of a reference range, BRI was categorized into 5 groups according to the 20th, 40th, 60th, and 80th quantiles to explore the association with all-cause mortality.”They find a “U-shaped association between BRI and all-cause mortality. Our findings provide compelling evidence for the application of BRI as a noninvasive and easy to obtain screening tool for estimation of mortality risk and identification of high-risk individuals, a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies.”By this they mean that those at the lower and higher ends of this scale have higher all-cause mortality. As I've talked about before, one of the cornerstones of research methods is that correlation does not imply causation. The U-shaped association they found might be a valid correlation. The mistake happens if the assumption is that the BRI is the REASON for the increased risk and, when it comes to weight and health (particularly those of higher-weight people) that's what typically happens. That's what I think the problem is going to be. In our culture, there is a tendency to jump at any perceived “proof,” no matter how shoddy, that being higher weight causes health issues/is a health issue. What these researchers have found is an unexplained correlation between being at lower and higher weights and higher rates of all-cause mortality. What they absolutely have not found is that being at lower and higher weight CAUSES higher rates of all cause mortality. They don't ever claim that they've found causation but then they conclude “a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies” and not, for example, that causal mechanism(s) should be identified prior to foisting this formula on the public, it gives me the sense that they are jumping the gun here. I'm not going to do a deep dive into the methodology here because the concept is so deeply flawed at its base.I'll start with those at lower BRI range. Their BRI could be due to extreme illness (including everything from cancer, to substance use disorders, to eating disorders and more )that are the actual reason for increased all cause mortality. What they may have found is that those in the lower BRI categories are more likely to be very ill which means their findings would not extrapolate to those at the lower end of the weight spectrum who are not experiencing illness. When it comes to higher-weight people, we know that experiences of weight stigma, weight cycling, and healthcare inequalities are all associated with increased all-cause mortality. People with a higher BRI are more likely to have these experiences. Not only did these study authors fail to control for these, they failed to even mention them. Without controlling for these possible confounding variables, what their findings may indicate is just that they've found even more evidence that experiences of weight stigma, weight cycling, and healthcare inequalities increase all-cause mortality.So, if the lower someone's BRI category is, the more likely it is that they are very ill and the higher someone's BRI category is, the more likely that they've experienced/experience greater weight stigma, weight cycling, and healthcare inequalities, then we would see the exact “U-shaped association between BRI and all-cause mortality” that the study authors found.I'm not saying those are definitely the reasons, I'm saying that's the research we should be doing, not more research to reinforce a questionable correlation until the weight loss industry starts claiming that if there are *that many* studies that show correlation then it *must be* causation. Besides the weight loss industry (mis-)using this concept, I am worried about what this will lead to in terms of healthcare. The weigh-ins that patients are expected/pushed to endure in order to calculate BMI already cause some patients to delay or avoid healthcare appointments. How much worse is that going to become when healthcare providers are running after patients with tape measures to get a waist circumference measurement so they can calculate BRI. If BRI is “incorporated into public health practice” as these authors suggest using simply the correlation they've found, then the mostly likely outcome is that the suggestion is to manipulate BRI to improve all-cause mortality risk. This will be another way for the weight loss industry (including Sanofi Aventis if they can get their new drug into the endzone) to continue making money hand over fist, but for patients it will be the same old thing, which makes its use instead of BMI basically a distinction without a difference. Whether it's due to profit incentive, paradigm entrenchment, or a combination of both, the people doing this research seem to be willing to do absolutely anything other than control for confounding variables or consider the evidence that focusing on supporting health directly (rather than maintaining our obsession with weight loss,) may provide more benefits with fewer risks.Driven by the weight loss industry, weight science has gone a long way down the wrong road and they would rather step on the gas then slow down, let alone turn around. A healthcare system that is committed to viewing the existence of higher-weight people as a problem to be solved will never create polices or interventions that truly support the physical or mental health of higher-weight people. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Joeita speaks with Kate Mann, Associate Professor Cornell University's Sage School of Philosophy & author of "Unshrinking: How to Face Fatphobia," which draws on personal experience & rigorous research to expose how size discrimination harms everyone, and how to combat it. HighlightsThe Insidiousness of Fatphobia - Opening Remarks (00:00)Society's Fixation on Weight & the “Ideal Body” (01:07)Introducing Kate Manne, Author of “Unshrinking: How to Face Fatphobia” (01:59)Philosophical Interest in Misogyny & Fatphobia (02:22)Defining Fatphobia (04:17)Complicated Relationship Between Fatness & Health (06:03)Fatphobia in the Healthcare System (10:15)Weigh-In Process & Weight-Inclusive Physicians (12:27)Diabetes, BMI & Stigma (13:19)Intersections of Fatphobia, Race, Class, Ability & Gender (16:22)The Politics of Anti-Fatness as Anti-Blackness (18:28)Thin-Privilege (19:36)Beyond Body-Positivity (22:24)Thinsplaining - Book Excerpt (24:22)Find the Book “Unshrinking: Facing Fatphobia” (27:51)Show Close (28:33)Guest Bio - Kate Manne is an associate professor of philosophy at Cornell University, where she's been teaching since 2013. Before that, she was a junior fellow at the Harvard Society of Fellows. Manne did her graduate work in philosophy at MIT and is the author of two previous books, Down Girl and Entitled.“Unshrinking: How to Face Fatphobia” By Kate Manne from Penguin Random House“An elegant, fierce, and profound argument for fighting fat oppression in ourselves, our communities, and our culture.”—Roxane Gay, author of HungerFor as long as she can remember, Kate Manne has wanted to be smaller. She can tell you what she weighed on any significant occasion: her wedding day, the day she became a professor, the day her daughter was born. She's been bullied and belittled for her size, leading to extreme dieting. As a feminist philosopher, she wanted to believe that she was exempt from the cultural gaslighting that compels so many of us to ignore our hunger. But she was not.Blending intimate stories with the trenchant analysis that has become her signature, Manne shows why fatphobia has become a vital social justice issue. Over the last several decades, implicit bias has waned in every category, from race to sexual orientation, except one: body size. Manne examines how anti-fatness operates—how it leads us to make devastating assumptions about a person's attractiveness, fortitude, and intellect, and how it intersects with other systems of oppression. Fatphobia is responsible for wage gaps, medical neglect, and poor educational outcomes; it is a straitjacket, restricting our freedom, our movement, our potential.In this urgent call to action, Manne proposes a new politics of “body reflexivity”—a radical reevaluation of who our bodies exist in the world for: ourselves and no one else. When it comes to fatphobia, the solution is not to love our bodies more. Instead, we must dismantle the forces that control and constrain us, and remake the world to accommodate people of every size.Articles:In 'Unshrinking,' a writer discusses coming out as fat and pushing back against bias - NPR InterviewFighting Fatphobia and Embracing ‘Unshrinking': The Ms. Q&A With Kate Manne - MS Magazine Reference:Belly of the Beast The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. HarrisonTo live in a body both fat and Black is to exist at the margins of a society that creates the conditions for anti-fatness as anti-Blackness. Hyper-policed by state and society, passed over for housing and jobs, and derided and misdiagnosed by medical professionals, fat Black people in the United States are subject to sociopolitically sanctioned discrimination, abuse, condescension, and trauma.Da'Shaun Harrison—a fat, Black, disabled, and nonbinary trans writer—offers an incisive, fresh, and precise exploration of anti-fatness as anti-Blackness, foregrounding the state-sanctioned murders of fat Black men and trans and nonbinary masculine people in historical analysis. Policing, disenfranchisement, and invisibilizing of fat Black men and trans and nonbinary masculine people are pervasive, insidious ways that anti-fat anti-Blackness shows up in everyday life. Fat people can be legally fired in forty-nine states for being fat; they're more likely to be houseless. Fat people die at higher rates from misdiagnosis or nontreatment; fat women are more likely to be sexually assaulted. And at the intersections of fatness, Blackness, disability, and gender, these abuses are exacerbated.Taking on desirability politics, the limitations of gender, the connection between anti-fatness and carcerality, and the incongruity of “health” and “healthiness” for the Black fat, Harrison viscerally and vividly illustrates the myriad harms of anti-fat anti-Blackness. They offer strategies for dismantling denial, unlearning the cultural programming that tells us “fat is bad,” and destroying the world as we know it, so the Black fat can inhabit a place not built on their subjugation. About The PulseOn The Pulse, host Joeita Gupta brings us closer to issues impacting the disability community across Canada.Joeita Gupta has nurtured a life-long dream to work in radio! She's blind, moved to Toronto in 2004 and got her start in radio at CKLN, 88.1 FM in Toronto. A former co-host of AMI-audio's Live from Studio 5, Joeita also works full-time at a nonprofit in Toronto, specializing in housing/tenant rights. Find Joeita on X / Twitter: https://twitter.com/JoeitaGupta The Pulse airs weekly on AMI-audio. For more information, visit https://www.ami.ca/ThePulse/ About AMIAMI is a not-for-profit media company that entertains, informs and empowers Canadians who are blind or partially sighted. Operating three broadcast services, AMI-tv and AMI-audio in English and AMI-télé in French, AMI's vision is to establish and support a voice for Canadians with disabilities, representing their interests, concerns and values through inclusion, representation, accessible media, reflection, representation and portrayal. Learn more at AMI.caConnect on Twitter @AccessibleMediaOn Instagram @accessiblemediaincOn Facebook at @AccessibleMediaIncOn TikTok @accessiblemediaincEmail feedback@ami.ca

Kate Manne joins Let's Talk Memoir for a conversation about coming of age in fatphobic culture, disentangling the threads of weight, health, and diet culture, the racism at the root of anti-fatness, writing ourselves out and then back into our work, the psycho-social consequences of fatphobia on our bodies, the shame around shame, organizing our time, writing while mothering a young child, gathering and incorporating research in our work, and her new book Unshrinking: How to Face Fatphobia.   Also in this episode: -the rhetoric around dieting -becoming self-compassionate through writing -why we might not trust pleasure    Books mentioned in this episode: Fearing the Black Body by Sabrina Strings Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison Hunger by Roxanne Gay You Just Need to Lose Weight by Aubrey Gordon What We Don't Talk About When We Talk About Fat by Aubrey Gordon Fat Talk by Virginia Sole Smith   Kate Manne is an associate professor of philosophy at Cornell University, where she's been teaching since 2013. Before that, she was a junior fellow at the Harvard Society of Fellows. Manne did her graduate work in philosophy at MIT, and works in moral, social, and feminist philosophy. She is the author of three books, Down Girl: The Logic of Misogyny, Entitled: How Male Privilege Hurts Women, and Unshrinking: How to Face Fatphobia, which came out in January. You can subscribe to her substack newsletter, More to Hate, for musings on misogyny, fatphobia, their intersection, and more.  Connect with Kate: Website: http://www.katemanne.net/ Substack: https://katemanne.substack.com/ X: https://twitter.com/kate_manne, Instagram: https://www.instagram.com/kate_manne Get “Unshrinking” here: https://www.penguinrandomhouse.com/books/722318/unshrinking-by-kate-manne/   — Ronit's writing has appeared in The Atlantic, The Rumpus, The New York Times, The Iowa Review, Hippocampus, The Washington Post, Writer's Digest, American Literary Review, and elsewhere. Her memoir WHEN SHE COMES BACK about the loss of her mother to the guru Bhagwan Shree Rajneesh and their eventual reconciliation was named Finalist in the 2021 Housatonic Awards Awards, the 2021 Indie Excellence Awards, and was a 2021 Book Riot Best True Crime Book. Her short story collection HOME IS A MADE-UP PLACE won Hidden River Arts' 2020 Eludia Award and the 2023 Page Turner Awards for Short Stories. She earned an MFA in Nonfiction Writing at Pacific University, is Creative Nonfiction Editor at The Citron Review, and lives in Seattle with her family where she teaches memoir workshops and is working on her next book. More about Ronit: https://ronitplank.com Sign up for monthly podcast and writing updates: https://bit.ly/33nyTKd   Follow Ronit: https://www.instagram.com/ronitplank/ https://twitter.com/RonitPlank https://www.facebook.com/RonitPlank   Background photo credit: Photo by Patrick Tomasso on Unsplash Headshot photo credit: Sarah Anne Photography Theme music: Isaac Jo

Send us a Text Message.Simone Samuels, B.A. (Hons.), J.D., B.C.L. is a consultant in equity, diversity and inclusion and a weight-neutral personal trainer/group fitness instructor.  A lawyer by training and a fitness professional, she has consulted for fitness organizations in Canada, US and the UK and has delivered courses on weight stigma, fatphobia, anti-racism, allyship and anti-oppression.Simone is a tireless advocate for making the fitness and wider world a more inclusive place.I was SO excited to chat with Simone and knew it would be a confronting and very important conversation. She was incredibly generous with her time and I know you will very much enjoy this meaty conversation.We chatted about:How white female Fitpros can actually be inclusive in the fitness space?The racist roots of the BMI and diet culture.  Simone recommends some must-read books for those serious about doing the work.According to the BMI the ROCK (Dwayne Johnson) is morbidly ob*se. It was never meant to be used at a population level.Overcoming fatphobia in fitness spaces.  How we can get informed.Finding real joy in movement in this hustle culture and untangling weight loss and exercise.We chat about Aqua Zumba and ask why aqua is always associated with an older demographic.What a chat!  I was truly buzzing afterwards and cannot wait to get Simone back for part 2.  Recommended Reading for Fitpros or anyone engaged in the fitness industry:Sabrina Strings - Fearing the Black Body. The Racist Origins of FatphobiaDa'Shaun L. Harrison - The Belly of the Beast: The Politics of Anti-Fatness as Anti-BlacknessIbram X Kendi: Stamped From The Beginning: A Graphic History of Racist Ideas in AmericaIf you'd like to know more about  Simone, find her on Instagram or have a look at her website, where she has lots of different options to work Are you feeling stuck in the 'earn and burn' cycle with your exercise routine, or as summer approaches, are you feeling self-conscious about wearing a swimsuit on the beach? Maybe you just want to stop worrying so much about food or how your body looks.You are not alone and your body is NOT the problem Please reach out if you would like some support. We both have limited slots for Intuitive Eating Coaching, so get in touch with Christine or with Ela.AND if you enjoyed this episode, please share and follow the 'Find Your Strong podcast' and if you have time, write us a short review. It would honestly mean the world. Love to you all, Ela & Christine x

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!This is the final in a three-part series about Tirzepatide (Brand name Mounjaro for Type 2 diabetes and Zepbound for Weight Loss.) In part one we discussed the basics of the drug, in part 2 we discussed the authors of this study and finally, in part three we'll finish discussing the most recent study on Zepbound - SURMOUNT -4.(the text in italics is from the study itself.)SURMOUNT-4 was designed to find out what happens when higher-weight people (without type 2 diabetes) go on the drug for a while and then go off of it. The study was divided into two periods In the first 36 weeks all of the participants took Tirzepatide. Then there was a 52-week period during which subjects were randomly assigned to receive either tirzepatide, or a placebo.The basic findings, per the study:After 36 weeks of open-label maximum tolerated dose of tirzepatide (10 or 15 mg), adults (n = 670) with obesity or overweight (without diabetes) experienced a mean weight reduction of 20.9%. From randomization (at week 36), those switched to placebo experienced a 14% weight regain and those continuing tirzepatide experienced an additional 5.5% weight reduction during the 52-week double-blind period.Here's a graph that shows the average results:Some things to note:First, the graph clearly shows that people who go off the drug rapidly start regaining the weight they lost, and their weight was trending up when follow-up ended, suggesting that the weight regain will continue (as we've seen in about a century of research and in the history of weight loss drugs.) In addition to being exposed to the side effects of these drugs (some of which can be fatal) these people will also be subjected to the risks that come from weight cycling which include everything from increased risk of type 2 diabetes and hypertension to increased cardiovascular disease and overall mortality. This is important since there are any number of reasons why someone would have to go off the drug, from side effects, to expense, to availability.For those who remained on the drug, weight loss slowed considerably and by the end, had started to rise slightly, which means that the claim that weight loss will be permanent as long as people stay on the drug is not supported by the evidence.Let's go beyond average results and get into some specifics - 783 participants were enrolled in the initial 36-week study in which all participants took Tirzepatide, but 113 discontinued the study drug before the 36-week stage even ended, most commonly due to an adverse event or participant withdrawal. So a little over 14% didn't even make it 9 months on the drug, and that's including the fact that the drug was started at a minimal 2.5mg dose and then increased by 2.5 mg every 4 weeks until a maximum tolerated dose of 10 or 15 mg was achieved.300 participants (89.5%) receiving tirzepatide at 88 weeks maintained at least 80% of the weight loss during the lead-in periodDid you catch that? First, 10.5% of the group who were still taking the drug during the one-year follow-up had already gained back more than 20% of the weight they lost in the first 36 weeks- again even though they were Still. Taking. The. Drug. As for the rest, they could well have been regaining the weight because of the way the study defined “maintaining.” For the purposes of this study, “maintaining” weight loss doesn't mean that people lost weight and kept it off (as the word would be used in any reasonable context.) For this study, “maintained” just meant that they were regaining the lost weight slowly enough that by 52 weeks these participants hadn't regained 20% of the weight that they lost in the first 32 weeks…yet. (This is one of those examples of words having different meanings in weight loss research.)Let's take a look at side effects:A total of 81.0% of participants reported at least 1 treatment-emergent adverse event during the tirzepatide lead-in treatment period, with the most frequent events being gastrointestinal (nausea [35.5%], diarrhea, [21.1%], constipation [20.7%], and vomiting [16.3%]… [During the follow up period] Gastrointestinal events were more common in the tirzepatide group than in the placebo group (diarrhea, 10.7% vs 4.8%; nausea, 8.1% vs 2.7%; and vomiting, 5.7% vs 1.2%)Of course, the trial wasn't long enough to determine long-term impacts. They also say :A significantly greater percentage of participants continuing tirzepatide vs placebo met the weight reduction thresholds of at least 5% (97.3% vs 70.3%), at least 10% (92.1% vs 46.2%), at least 15% (84.1% vs 25.9%), and at least 20% (69.5% vs 12.6%) from week 0 to week 88Let's say the above another way: 2.7% of people who took Tirzepatide for 88 weeks, opening themselves up to side effects and unknown long-term consequences failed to lose even 5% of their body weight, 7.9% failed to lose even 10%, 15.9% failed to lose 15% and 30.5% failed to lose 20%. This is important since they are touting the mean weight loss as 25.3% in their results section. That's the kind of thing that healthcare providers should include in an informed consent conversation.The study group is also problematic in terms of extrapolation. Study findings can only be reliably applied to people in the demographics that were studied. In this case, the randomized participants were 70.6% cis women and there was no trans or non-binary representation. The mean age was 48 and the participants were 80.1% white despite having study sites at “70 sites in Argentina, Brazil, Taiwan, and the US.” In fact, the study states “The study was not designed to represent the racial diversity of each of the participating countries.” This, to me, is unconscionable – if you can't get a more representative sample than this, then just don't proceed with the study until you can.The lack of a weight-neutral comparator group is also an issue. Research suggests that weight-neutral, health-supporting behaviors can have more health benefits with far less risk than intentional weight loss, including with diet drugs. By comparing their drug to a “placebo group” that is still attempting intentional weight loss, just without pharmaceutical support, they are stacking the deck, taking advantage of the fact that they KNOW that behavioral weight loss interventions don't work long-term (they literally admit that in their introduction.)  It also allows them to avoid a comparison of the actual health impacts of their drugs against the health impacts of a weight-neutral health intervention – including the difference in risk.So, does the conclusion say that about 10% of people who take the drug can expect to lose weight over the first 36 weeks and then regain more than 20% in the next 52 weeks? Does it say how many others were slowly regaining weight, though they hadn't (yet) regained 20% after a year?No.They conclude:“In participants with ob*sity or over*eight, withdrawing tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction.”That, I would suggest, is what happens when Eli Lilly and Company are involved in the study design and conduct; data collection, management, analyses, and interpretation of the data; preparation, review, approval of the manuscript; and decision to submit the manuscript for publication, and almost every listed author is either taking money from them, or is directly employed by them.Let me offer an alternative suggestion as to what may have happened here: Participants joined this study, ostensibly, because they wanted to lose weight. They took a drug for 36 weeks that disrupted their natural sense of hunger and satiety and their natural digestive processes while (if we take their claims at face value) eating 500 calories a day less than their bodies need to properly function while exercising 150 minutes or more per week.At 36 weeks, the drug is withdrawn from some participants whose bodies then return to their normal function and try desperately to return to stasis (which is a process that we see in non-drug induced weight loss from behavioral interventions when, after about a year of weight loss people begin to regain weight, with the vast majority regaining all of the weight they lost.)Remember, too, that they know they are part of a trial and that they may continue getting the trial drug, or they may be getting a placebo. As almost anyone who has attempted behavior-based intentional weight loss (aka dieting) can tell you: trying to exercise while restricting food is very unpleasant, more so for this group now that their natural sense of hunger is not experiencing drug-induced interference. The fact that they no longer feel sick after their injection and/or that they can once again experience natural hunger means that they are likely aware that they are in the placebo group. They regain the weight they lost rapidly because of their body's natural reaction to being under-nourished (changing physiologically to become a weight regaining/weight maintaining machine) and the fact that their digestion is no longer impaired and their hunger is no longer suppressed.Meanwhile, another group is kept on the hunger and digestion-disrupting drug. Their weight loss slows dramatically at 52 weeks and, for many, begins to reverse by the end of 72 weeks. This is perhaps their body finally being able to overcome the drug-induced food deprivation they've been experiencing. There is no reason not to expect continued weight gain if these patients are tracked beyond 72 weeks (which, since the company funding the research is the company that wants people to take the drug, seems unlikely to me.)Again, everything about this study is designed to overstate the drug's effectiveness, and that's not surprising given the drug manufacturer's deep participation in every aspect of the study which is why, with weight loss interventions, it's always buyer beware.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Happy 2024! I am ready for another year of writing about the intersections of weight science, weight stigma, and healthcare and I'm glad you are here reading! This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I received the following question from reader Lisa:I notice that when you write about things that can hurt larger people's health you usually mention weight cycling, weight stigma, and healthcare inequalities. I've read your posts for the first two – is there a post that describes the third one?Thanks for asking Lisa, I've been meaning to write this and you've given me the perfect gentle push! For the record the piece for the harm of weight cycling is here and the one on the harm of weight stigma is here.The idea of healthcare inequalities is difficult to quantify because it's such a vast category. In terms of a definition, the one I'm going to use here is any way in which higher-weight people's healthcare experiences differ from those of thin people to the detriment of higher-weight people.It's always important to remember that when we discuss these inequalities we are clear that they don't impact everyone equally, as people's weight becomes higher their experience of inequality typically increases as well and, utilizing Kimberlé Crenshaw's framework of intersectionality, those who have multiple marginalized identities will also face greater inequality in their individual marginalizations and at the intersections of them.Finally, I want to point out that thin people can face healthcare disparities as well based on things like marginalized identities and socioeconomic status. The comparisons I'm drawing here are about the typical experience of thin people and are not meant to indicate that thin people never face issues in accessing healthcare, just that as a group thin people are not systematically marginalized within the healthcare system because of their size.I also want to be clear that this is not an exhaustive list and I welcome you to add other examples in the comment section. I'm going to divide these up into groups to help give this conversation some structure.Practitioner BiasThis includes a lot of different things. Before I get into it, I want to point out that providers aren't necessarily bad actors who just hate fat people (though, sadly, some absolutely are.) Many are simply a product of a healthcare system (including healthcare education) that is deeply rooted in weight stigma. Regardless of how they got to this place, these practitioners are responsible for the harm that they do.Some practitioners are operating out of implicit bias, which is to say that the bias is subconscious. Others are operating from explicit bias, they are fully aware of their negative beliefs and stereotypes about higher-weight people and they are working with higher-weight patients based on those beliefs and feelings. This can lead to a lot of negative impacts. Some examples:There is the classic (and far too prevalent) example of a practitioner who offers ethical, evidence-based treatments to thin patients for health issues, but sends higher-weight patients with the same symptoms/diagnoses/complaints away with a diet.There's the “Occam's razor” mistake. Occam's Razor states “plurality should not be posited without necessity.”  Said another way, when choosing between theories, the simplest one is usually correct. This gets applied to the care of higher-weight patients when providers don't address individual health issues/symptoms/diagnoses/complaints for fat patients because they assume weight loss will solve them all (and/or they want to see what weight loss solves before attempting the ethical, evidence-based treatments that thin people would typically get for the same issues/symptoms/diagnoses/complaints.)Some practitioners assume that fat patients are lying if what they are telling the provider doesn't match up with the provider's stereotypes of people their size. These practitioners base decisions and recommendations on their stereotypes rather than what the patient is telling them.There are practitioners who, consciously or subconsciously, are reluctant to touch fat patients or manipulate their bodies which can impact everything from examinations to post-operative care.There are practitioners who think it's worth risking fat people's lives and quality of life in attempts to make them thin. Some of these practitioners take this further by deciding that they know better than fat people and so try to manipulate/trick/bully fat people into weight loss interventions (including dangerous drugs and surgeries) by almost any means necessary including intentionally failing to give a thorough informed consent conversation – blowing patients off with phrases like “all drugs have side effects” or “it's nothing to worry about” rather than being honest about the risks and/or making threats about the patient's health and life expectancy that are not supported by evidence. These inequalities can lead to many harms. First of all, we know from a century of data that weight loss almost never works and typically results in weight cycling which is independently linked to a number of harms. It can also delay care – when a thin person gets an intervention at their first appointment but a fat person with the same symptoms/diagnosis gets sent away with a recommendation to lose weight the higher-weight patient's actual care is delayed.The “Occam's Razor” mistake creates similar problems. It must be remembered that Occam (actually, it seems, Ockham but that's a whole other thing) was a philosopher, not a physician. Deciding to treat something as complex as the human body by going for the simplest strategy is problematic on its face, even before we add the ways that weight stigma impacts providers' beliefs around and treatment of higher-weight patients.And there is another layer of harm here. As we'll see over and over, the harm from healthcare inequalities is intensified when the results of the harm are blamed on fat bodies. For example, higher-weight patients follow practitioners' advice to attempt weight loss. They lose weight short term and gain it back long term (which is exactly what all the research we have says will happen.) Their doctors tell them to try again, they weight cycle again. This happens repeatedly across their entire lives. Eventually these patient are diagnosed with cardiovascular disease (CVD). The fact that CVD is strongly linked to weight cycling is completely ignored and research (often created by/for the weight loss industry) blames “ob*sity” for the CVD and uses these higher rates of CVD to lobby for greater insurance coverage of weight loss treatments and the cycle of harm continues unabated.Structural InequalitiesThis occurs when the things that higher-weight patients need in order to access healthcare don't accommodate them. This can be because the things don't exist or because the healthcare facility that the patient is visiting doesn't have them.Again, there are too many examples here to name. One very common example is chairs. Having sturdy armless chairs in the waiting room, treatment rooms, and anywhere a patient may need to sit is the absolute least a facility can do and it's deeply disturbing how many facilities don't even get this right.Then there are the absolute basics of care – when the practice doesn't have (or can't find) properly sized/accommodating blood pressure cuffs, proper length vaccine needles, gowns, scales (for medically necessary weigh-ins like those to dose medications or check for edema from a heart condition). These are all things that thin patients can typically expect to be available.Durable medical equipment is another area where structural inequalities can compromise care – crutches, braces, walkers, wheelchairs, prosthetics.  Even when these things are available, they are often exponentially more expensive even when they don't have to be custom made.Then there are more specialized tools like operating tables and surgical instruments. Often the only place these instruments can be reliably found is in centers that focus on weight loss surgeries, meaning that higher-weight patients are excluded from the kind of surgical care that is routine for thinner patients.Next is imaging -   MRI and CT scanners that have high-weight rated tables and large enough bore sizes, ultrasounds that can appropriately view through adipose tissue, x-ray tables and spaces that are accommodating and more. Harm is added here when energy from those in the healthcare system is wasted on complaining that higher-weight people exist or justifying the lack of care, rather than focusing on solutions and working from the basis that healthcare should fit bodies, bodies shouldn't have to be changed to fit healthcare.As an example of this, let's look at the ways that a single MRI appointment can create healthcare inequalities. A patient is referred for an MRI of their knee with contrast. First, the patient goes to the facility to which their doctor referred them but is turned away because the MRI is too small. They call the referring doctor, who isn't aware of any other option and tells them to call around. After hours of research they find an MRI with a 550 pound weight limit and a bore size that will accommodate them, but unlike the first facility this one has a backlog so they'll have to wait three more weeks. When they arrive for their appointment the MRI tech is using a Gadolinium-based contrast agent (GBCA). The dosage table the tech has stops at 300 pounds and the patient says that they weigh more than that. So the tech decides to use a GBCA calculator, using the formula of the recommended dose (mmol/kg) multiplied by weight (kg) and divided by concentration (mmol/mL). Except the scale in the MRI facility has a limit of 400 pounds which is less than this patient weighs. The tech explains the risk of incorrect dosage and tells the patient that they can either cancel the MRI or give the tech their best guess of their weight. The patient offers their best guess. The patient is given a gown to change into, but it's way too small. The patient is told that they don't have gowns that are any bigger. The patient offers to wear their own clothes, explaining that they have worn 100% cotton clothes for exactly this reason. They are told that it's against policy and that the tech will have to ask their boss. The boss is off today so the patient can be rescheduled in 3 weeks and the tech says he will “try to remember” to ask his boss about the patient wearing their own clothes but suggests that the patient keep calling to try to verify and also that the patient find a scale that works for them so that they can give the tech an accurate weight. The patient comes back in three weeks with an accurate weight and having confirmed that they can wear their own clothes. They lay down on the MRI table and the tech tries to put the knee in the dedicated knee coil that allows the MRI to view the knee structure. It is too small for the patient's leg. The patient is told that there is no way to get an MRI of their knee.This is just one scan for one patient, and this is based on a true story. The failure of the healthcare system to accommodate higher-weight patients has the potential for a massive amount of harm, most of which goes uncaptured or, worse, is blamed on “ob*sity.”Research BiasThis also happens in multiple ways. It can include higher-weight people being left out of research. For example, it is well known that clearance rates of some anesthesia drugs can vary based on the amount of adipose-tissue a patient has, but higher-weight patients have traditionally been excluded from the trials for anesthesia medications so there isn't good data on this.Here harm is also increased when naming the inequality is seen as sufficient remedy. I recently spoke at the combined conference for the Washington State Society of Anesthesiologists and British Columbia Anesthesiologists' Society (which was an absolute delight! I gave a keynote and then had the honor of being on a panel with Dr. Lisa Erlanger and Dr. Sandi Pitfield.) In preparation for this, I read hundreds of pages of anesthesia research. What I repeatedly found were decades of studies that started by saying that higher-weight patients' exclusion from drug trials created serious knowledge gaps, but then just moved on. Admitting that there is a problem is the first step, it must be followed by taking steps to solve the problem. The solution is not to cobble together what exists and keep creating guidelines based on shoddy research.Part of this issue is researcher bias, limitations of time and money, and perceptions that it's not worth studying fat people or that it's reasonable for fat people to be excluded from research (often under the guise that it's acceptable to make fat patients become thin before they can access ethical, evidence-based medicine.)Another issue is the massive amount of money that is earmarked only to study the prevention and/or eradication of fatness instead of researching how to actually support the health of fat people.It Seems Like A Lot…This happens when we actually do know what fat patients need, for example, in terms of dosage. But they are still under-medicated because the amount that higher-weight people need “seems like a lot” to those who are dosing the drugs and who are used to the dosage for thinner patients.When someone's education is focused on thin patients (including viewing thin patients as “normal” and higher-weight patients as “different/abnormal/extra” and the treatment protocols for thin patients are the focus, then those practitioners can balk at what higher-weight patients actually need.Risk predicated on sizeThis happens when patients who are higher-weight are given treatments that are more dangerous based on their size alone. In an example I wrote about more in depth here, thin patients with type 2 diabetes are not referred to weight loss surgeries that create a permanent disease state in their digestive systems, carry extensive risk, and have very little long-term term data. Patients with so-called “class 1 ob*sity” have the surgery offered if they can't reach their glycemic management goals. Those with so-called “class 2 ob*sity” have the surgery “recommended” if they can't reach their glycemic management goals. Patients with so-called “class 3 ob*sity” have the surgery “recommended” regardless of their glycemic management. Even if someone believes that these surgeries meet the requirements of ethical, evidence-based medicine, the reality is that they are risky and suggesting that someone with well-controlled type 2 diabetes have a dangerous surgery simply because of their size is another dangerous healthcare inequality.BMI-Based Denials of CareI've written about these, and options to fight them, quite a bit (this is a good place to start). This occurs when a fat patient is denied healthcare (often a surgical procedure) unless or until they change their height-weight ratio. These denials are often “justified” using rationale that comes from blaming fat bodies for the negative outcomes of weight stigma, weight cycling, and other healthcare inequalities (for example, as I wrote about above, higher rates of post-op complications) and they amount to holding healthcare hostage for a weight loss ransom (and a ransom that most people will not be able to pay.) While all of the denied procedures are important, in some cases (like some organ transplants,) the procedures that are denied are truly life or death.Saving Money Through Healthcare InequalitiesA common attempted “justification” for the healthcare inequalities that fat people face is the idea that fat people shouldn't get the resources they need if they happen to need more resources than the average thin person. When added to a general focus on profit (especially in the US healthcare system) this leads to staff-to-patient ratios that make it impossible to correctly care for fat patients (for example, having adequate staff to safely turn patients to prevent bed sores or help them ambulate to improve post-surgery outcomes.) It can also mean not having the supplies that these patients need in order to have the best outcomes. Some examples are InterDry to prevent/treat skin fold infections or Hoyer lifts so that they can use a commode and avoid bedpans and chuck changes (both of which are made more difficult and dangerous for the patient and more likely to create negative outcomes when staff-to-patient ratios don't allow for adequate care, even if the practitioners aren't coming from a place of weight bias.)All of this, in turn, can create practitioner bias when they blame higher-weight patients rather than the healthcare system that is leaving both patients and practitioners without what they need.   When healthcare facilities are allowed to decide that they don't want to spend the money to give higher-weight people the care they need, or they are not adequately funded to do so, then higher-weight patients suffer. Here again the negative impacts of this are often simply blamed on “ob*sity.” For example, research on post-operative complication rates will often suggest that “ob*sity” causes higher complication rates without exploring the ways that these size-based healthcare inequalities may actually be at the root of any elevated rate of complications.This is not an exhaustive list of healthcare inequalities that higher-weight people face (please feel free to add other examples in the comments.) I'll also say that this is made much worse because these harms are not adequately measured or remedied and the harms from them get attributed to “ob*sity” rather than the inequalities that higher-weight people face.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Part one of this was published on December 13, but this piece was pre-empted when the USPSTF put forth dangerous dieting recommendations for children (remember that the public comment period ends January 16.) In the past I've written pieces specifically about issues and mistakes that are made with terminology that is used…let's call it differently in weight science as well as common statistics mistakes and mishaps. In part 1 I offered some additional terminology troubles today in part two we're discussing statistics shenanigans. Using a percentage that seems high without proper context:In one example of this, early in the COVID-19 pandemic I saw a news report claiming that so-called “ob*sity”* was a risk factor for severe COVID because, in a particular city, 25% of severe negative outcomes were in people who are classified as “ob*se.”  At first, that might seem like a large number, but that doesn't justify calling being higher-weight a risk factor. In order to even begin to be able to draw conclusions from this, we have to at least know the total number of so-called ob*se people who live in the city - otherwise we have no way to know if 25% is higher or lower than the total percentage of this population. I looked it up and that number was 38%. Several things are issues here.First, if I were trying to draw conclusions from this (and I wouldn't, more on that in a moment) I would conclude that being higher-weight is protective, since 38% of the community is higher-weight, but only 25% of the people with severe outcomes were. (Said another way, people who weren't “ob*se” were 62% of the overall population but 75% of the severe outcomes.) That's the main statistical issue here. You can't use a percentage like this without contextualizing it.Moreover, I wouldn't draw conclusions from this at all. First, because “ob*sity” is simply a ratio of weight and height. Making assumptions that since a group of people have some physical characteristic in common (like, in this case, height-weight ratio) then that physical characteristic is the reason for the difference in outcomes is on extremely shaky ground, scientifically speaking. In this example, since there are many other factors that can impact this result (including the fact that higher-weight people are at the mercy of a healthcare system in which practitioner weight bias is rampant and, even if that's not an issue, the tools, best practices, pharmacotherapies and more, that are used are typically developed for thin bodies/excluding fat bodies) we don't know what number of those severe outcomes were due to healthcare inequalities or other factors.Relative vs Absolute RiskNovo Nordisk recently used this one in their manipulative press release about the possible cardiovascular benefits of Wegovy. Relative Risk Reduction is the percentage decrease of risk in the group who received an intervention vs the group that didn't receive the intervention. This number can be helpful to determine differences in outcomes between groups, but it's not that helpful in determining individual risk. For that you need Absolute Risk Reduction.Absolute Risk Reduction is the actual difference in risk between the group that got the intervention and the group that didn't. This helps us understand the likelihood that a given individual will benefit from an intervention.Relative risk reduction can often be a much larger number than absolute risk reduction and those who are trying to manipulate statistics (and those who don't know about this - like reporters quoting a Novo Nordisk press release) can use relative risk reduction to make people believe a treatment has a greater effect than it actually does.Let's use a super simplified example. Let's say that 200 people who have Condition X are enrolled in a study to see if Medication Y reduces death from Condition X. 100 of them are given the medication (the intervention group) and 100 are not (the control group). At the end of the observation period, 1 person in the intervention group dies and 2 people in the control group die. The relative risk reduction (percent risk of death in the intervention group divided by percent risk of death in the control group, in this case .01 divided by .02) is 0.5 or 50%. That seems like a lot – a company with incredibly poor ethics might issue a press release saying that their drug reduced death by 50% without mentioning absolute risk.Absolute risk is calculated by subtracting the percentage of risk reduction in the intervention group from the percentage of risk reduction in the control group, or 2%-1% which is a 1% reduction. A much smaller number that more accurately predicts individual experience.So when a weight loss company gives a percentage of risk reduction, it's important to ask if it is relative or absolute risk reduction they are talking about.For example, in the Novo Nordisk press release they wrote that their drug “reduces the risk of major adverse cardiovascular events by 20%”. That is the relative risk. The absolute risk reduction was less than 2%.These are the basics, if you want to really dig into relative vs absolute risk, there's plenty more to it. There's an interesting piece about it here for starters.LOCF vs BOCFLast Observation Carried Forward (LOCF) and Baseline Observation Carried Forward (BOCF) are two ways of dealing with dropouts in a trial to determine an endpoint value for those who dropped out.Let's look at another example with easy numbers. Let's say there is a weight loss intervention trial where weight is taken at the beginning, at 1 year, and at 2 years. They start with 100 participants and all 100 participate in the initial weigh-in and the 1-year weigh-in, but only 50 participate in the 2-year weigh-in (just fyi, this is not an uncommon dropout rate in weight loss studies.)When the study authors are trying to calculate the success of the intervention, how do they handle the 50% of people who dropped out?If they use LOCF, they take the person's weight from the 1-year weigh-in and use that as if it were the 2-year weigh-in number.If they use BOCF, they take the person's weight from the beginning of the study and use that as if it were the 2-year weigh-in number.Pop quiz – which do you think the weight loss industry typically uses?If you guessed LOCF, you are exactly right. And that's an issue.Absent actual follow-up to find out the reason that the participants didn't turn up for the final weigh-in (and that follow-up almost never happens) we don't know if they didn't show up because they regained weight that they had lost (and, given 100 years of research showing that this is the outcome for the vast majority of those attempting intentional weight loss that's not, like, out of the question). So using the 1-year weigh-in number for the 2-year weigh-in may very well artificially exaggerate the success of the intervention.Just to make the math easy, let's say that all 100 participants lost 10 pounds at the one year weigh-in. Then let's say that the 50 people who returned for their year two weight-in had regained 5 pounds (again, a super common occurrence.) Meaning that they were 5 pounds less than their baseline weight at the two-year weigh-in.Now the authors have three basic choices:They could just ignore the dropouts as if they never existed, and claim that the average weight loss was 5 pounds (ignoring both the dropouts and the fact that the participants' weight was climbing at the time that observation ended). Despite this being the kind of thing that would get you a solid “F” in your Freshman Research Methods class, it's a pretty common occurrence in weight loss research.But, if they use LOCF, they can use the 10-pound loss for the 50 people who didn't turn up at year 2. This will boost their total to an average of 7.5lbs per participant. This, again, is quite common in weight loss research.Now, if they used BOCF (which I would argue is far more appropriate given our base knowledge around weight regain and the fact that they should make every effort not to artificially inflate the success of their intervention) they would have an average of 2.5 pounds lost per participant. This is incredibly uncommon in weight loss research. And again, they should be honest that, in those who were weighed at year two, weight was being regained. In an ideal world, weight science research would be transparent and would not use terminology and statistics to mislead or obfuscate. Unfortunately, we don't live in an ideal world so it's up to us to know what questions to ask, and to ask those questions.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Episode 6 invites Ragen Chastain, activist and author, and Joel Lexchin MD of York University, to discuss myths about weight and health, the hype around Ozempic and Wegovy, and the unclear connection between weight loss and health.  Pharmanipulation is produced by PharmedOut, a project at Georgetown University Medical Center that advances evidence-based prescribing. To learn more about Ragen Chastain and her work, please visit her website: https://weightandhealthcare.substack.com/ Additional Resources Dances With Fat Monthly Workshop – September: Navigating Weight Stigma at the Doctor's Office date changed from September 27 to October 11 to avoid overlap with ASDAH's annual meeting. Link: https://danceswithfat.org/monthly-online-workshops/  Books “Fearing the Black Body: The Racial Origins of Fat Phobia” by Sabrina Strings. Link: https://nyupress.org/9781479886753/fearing-the-black-body/ “Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness” by Da'Shaun L. Harrison. Link: https://www.penguinrandomhouse.com/books/670607/belly-of-the-beast-by-dashaun-harrison/ Articles "Semaglutide: a new drug for the treatment of obesity" by Joel Lexchin and Barbara Mintzes. Drug Ther Bull. 2023 Oct 25:dtb-2023-000007. doi: 10.1136/dtb.2023.000007. Link: https://pubmed.ncbi.nlm.nih.gov/37879878/ “How the ‘It's Bigger Than Me' Campaign Is Harming Fat People for Profit" by Ragen Chastain. Link: https://themighty.com/topic/eating-disorders/its-bigger-than-me-campaign-harms-fat-people-for-profit/  “Weighing the Consequences of Weight-Loss Drugs” by Judy Butler and Dr. Adriane Fugh-Berman. Link: https://www.medpagetoday.com/opinion/second-opinions/104482 Igho J. Onakpoya, Carl J. Heneghan and Jeffrey K. Aronson. Post-marketing withdrawal of anti-obesity medicinal products because of adverse drug reactions: a systematic review. BMC Medicine 2016;14:191. Link: https://pubmed.ncbi.nlm.nih.gov/27894343/ Prescrire's "Semaglutide (Wegovy°) for excess body weight" Prescrire International 2023; 32 (245): 36-38. Link: https://english.prescrire.org/en/81/168/66102/0/NewsDetails.aspx Please note: the full article is available for subscribers only. PharmedOut is supported primarily by individual donations. To donate, please visit: https://sites.google/com/georgetown.edu/pharmedout/donate

Hello again, fupas!! In this episode, the fatties share their dream ice creams and explore the pronunciation possibilities of different nuts. Then we pivot to a column from Dear Prudence about kink and the complexities of grappling with ~parental worries~ or external involvement in our romantic relationships. We get into fetishism, gaining, “pleasure politics”, edtwitter, autonomy, and, as always, desire. Grab a sundae and get into the first part of our conversation about fat kink.  P.S. We recorded this months ago before we got our audio sorted out. Sorry for any hiccups!  P.P.S Say hello to the many pets in the background of this episode!   This episode's advice column: Help! My Parents Seem Intent on Forcing Me to Reveal My Kink.   Media mentioned:  The Color of Kink: Black Women, BDSM, and Pornography by Ariane Cruz  Samuel Delaney's keynote talk “Aversion/Perversion/Diversion”  Revenge Body by Caleb Luna  Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun Harrison  No Health, No Care The Big Fat Loophole in the Hippocratic Oath by Marquisele Mercedes  Find us on social media! Unsolicited on Twitter Unsolicited on Instagram Find Da'Shaun: Twitter/Insta: @DaShaunLH Find Mikey: Twitter: @marquisele Insta: @fatmarquisele Find Jordan: Twitter/Insta: @jordallenhall Find Caleb: Twitter/Insta: @dr_chairbreaker Find Bryan:  Twitter/Insta: @blackqueeriroh

This is the Weight and Healthcare newsletter! If you appreciate the content here, please consider supporting the newsletter by subscribing and/or sharing!I've previously written a series about fat people and joint health, including joint pain, osteoarthritis, and resources to fight BMI-based joint surgery denials. I've added a new resource to the list thanks to Dr. Greg Dodell who let me know about this new study.Before I get into this particular study, I want to offer a reminder that even if higher-weight people didn't have the same outcomes as thin people:1.       That wouldn't mean that the patient's weight is the problem. There are any number of confounding variables (including the impact of weight cycling on the patient, practitioner weight bias impacting the procedure, structural weight stigma impacting the procedure - including tools, best practices, and other medical equipment being developed for thin bodies and often to the exclusion of fat bodies - and the impact of patients trying to lose weight prior to surgery and going into the surgery undernourished.) 2.       That wouldn't make weight loss the correct next step. First of all, because it's highly unlikely to work and second of all because it's possible that the weight loss attempt, even if it is successful in the short term, could negatively impact surgical outcomes as this study shows. 3.       That shouldn't automatically be a reason for denying the surgery. The idea that fat people only deserve healthcare if they have the same outcomes as thinner people is based in weight-stigma. It also means that the ways that the healthcare system fails to support and accommodate fat people then gets taken out on fat people, then subsequently used to justify more exclusion of fat people from care. Fat people getting a surgery to reduce pain or improve quality of life is a worthy goal, even if there might be more complications or different outcomes. If there is actually a higher risk for higher-weight people (and that would require good, unbiased research to detect) then, first and foremost, we should get better at performing surgeries and after care on fat patients and, in the meantime, the risk should be communicated accurately to the patient and then the patient should be allowed to make the choice. I want to note that that would require systemic change to the way that surgeons' performance/statistics are judged so that they aren't encouraged to cherry pick the easiest cases and deny care to those who might be (or whom they perceive might be) at greater risk for complications.With all of that said, let's look at this study - Differential Impact of Body Mass Index in Hip Arthroscopy: Ob*sity Does Not Impact Outcomes., by Suri et al published in The Ochsner Journal.This study reviewed the medical records of 459 patients who had undergone hip arthroscopy at a single facility from 2008 to 2016. They divided the patients into BMI-based weight categories of “underweight,” “normal weight,” “overweight.” and “ob*se.” (Note that the entire idea of categorizing people by BMI is unscientific and harmful.) Then they looked at their rates of improvement at 1 and 2 years after surgery.They utilized three metrics:The Harris Hip Score (HHS) which considers pain, function, absence of deformity, and and range of motion, the physical component score from the 12-Item Short Form Survey (PCS-12) and the mental component score from the 12-Item Short Form Survey (MCS-12).They found thatAt 1 and 2 years postoperatively, all cohorts experienced statistically significant improvements in the HHS and PCS-12. At 3 years postoperatively, statistically significant improvements were seen in the HHS for all cohorts; in the PCS-12 for the normal weight, overweight, and ob*se cohorts; and in the MCS-12 for the normal weight cohort. Intercohort differences were not statistically significant at 1, 2, or 3 years postoperatively.They concluded:In our population, BMI did not have statistically significant effects on patient outcome scores following hip arthroscopy. All patient cohorts showed postoperative improvements, and differences between BMI cohorts were not statistically significant at any postoperative time point.Statistical significance is a measure of how likely it is that the effect was due to the intervention or rather than by chance, there is a more detailed explanation here.Interestingly, in follow up three years after surgery (which was the longest follow-up) the “ob*se” group had the highest overall score on all three instruments, followed by the “overweight” group, then the “normal weight” group, with the the “underweight” group showing the lowest overall improvement:There are limitations to this study including the small sample size, the single facility, the relatively short follow-up, and the lack of information about re-surgery rates.Still, this finding is important because, as the study authors point out, “the goals of hip arthroscopy are to alleviate symptoms, improve hip function, and delay the progression of hip osteoarthritis.”So if this surgery is denied based on BMI, then it would be expected that the patient's symptoms would continue to worsen, possibly leading to the need for a total hip replacement which is even more likely to be denied based on BMI. This leaves fat patients with completely unnecessary pain, suffering, and mobility issues.Again, even if higher-weight people had worse outcomes, reducing their symptoms, improving their hip function, and delaying the progression of hip osteoarthritis would still be worthy goals, and fat people would still deserve surgery, just like “underweight” people deserve surgeries.And again, this study has significant limitations, and, regardless of the results, people of all sizes deserve healthcare. Still, it is often suggested that all the research supports a narrative of higher-weight people having worse surgical outcomes and it's important that misinformation and commonly held misbeliefs in healthcare be challenged. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Like this piece? Share this piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.Note I don't link to everything I discuss in this post because I don't want to give traffic and clicks to dangerous media. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today's History Story: Our Hatred Of Fat Is Actually Anti-Black In many ways, the health and wellness industry is killing Black people. For our audacity to exist with melanated skin, we've historically endured subjugation, political and economic disenfranchisement, and centuries-long death. And it hasn't stopped yet. We'll talk about it with today's guest, Da'Shaun L. Harrison. Da'Shaun is a self-described Black, fat, trans, disabled, queer abolitionist, community organizer, writer, and editor at Scalawag magazine. Their award-winning book, Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness, explores desirability politics, gender, policing, and the fallacies of healthiness. To learn more about their work and to purchase their book Belly of the Beast: The Politic of Anti-Fatness, visit www.dashaunharrison.com. Black History Year (BHY) is produced by PushBlack, the nation's largest non-profit Black media company. PushBlack exists to amplify the stories of Black history you didn't learn in school and explore pathways to liberation with people who are leading the way. You make PushBlack happen with your contributions at BlackHistoryYear.com — most people donate $10 a month, but every dollar makes a difference. If this episode moved you, share it with your people! Thanks for supporting the work. The BHY production team includes Tareq Alani, Brooke Brown, Tasha Taylor, and Lilly Workneh. Our producers are Cydney Smith, Len Webb for PushBlack, and Ronald Younger, who also edits the show. Black History Year's executive producer and host is Julian Walker. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Recently I was made aware of something that was happening with the National Eating Disorders Association (NEDA) helpline. For the past twenty years, NEDA has run a helpline providing support to tens of thousands of people a year via text, chat, and phone. That helpline was recently replaced with an AI-driven chatbot. Investigating this I learned that it happened around a labor action. As Vice reported, sourcing Abbie Harper's piece on LaborNotes, a group of four paid helpline staff, including Harper, decided to unionize because “they felt overwhelmed and understaffed.”Harper explains:“We asked for adequate staffing and ongoing training to keep up with our changing and growing Helpline, and opportunities for promotion to grow within NEDA. We didn't even ask for more money. When NEDA refused, we filed for an election with the National Labor Relations Board and won on March 17. Then, four days after our election results were certified, all four of us were told we were being let go and replaced by a chatbot.”For their part, NEDA claims that this was a “long-anticipated change” which, if true, means that for a long time NEDA thought it was a good idea to replace six paid staffers, supervisors, and up to 200 volunteers supporting people whose lives and health can be in serious peril, with an AI chatbot. I think that would have been an astonishingly bad idea even if this wasn't about union-busting.But it gets worse. Before I get into it, a bit of background. The National Eating Disorders Association (NEDA) has a long history of either ignoring higher-weight people (as well as others with marginalized identities) or treating us poorly. (NEDA tends to focus their attention on thin, white, cis girls and young women to the exclusion of others.) For a brief time, they brought on Chevese Turner, founder of the Binge Eating Disorder Association, and it looked like they might be turning things around in terms of intersectional work. During this time I was asked to become an official ambassador. Then Chevese was summarily fired without explanation, and I publicly left the organization. Since then, NEDA has faced a significant amount of controversy for their actions around higher-weight people. Recently they were one of the only eating disorders organizations that failed to clearly denounce the disastrous American Academy of Pediatrics Guidelines for higher-weight youth.I'm writing about this here because NEDA has significant funding (we'll get to that in a moment) spending, per their 2021 filing, over $800,000 a year on digital and social media support, and they have a tendency to delete or bury criticism, so it's easy to be unaware of this.Activist Sharon Maxwell decided to test the bot. Her experiences were chilling to anyone who is knowledgeable about the intersections of weight, health, and eating disorders. I have viewed the screenshots of the chat transcripts. Unfortunately, I cannot publish them here as NEDA's terms and conditions to use the bot state that “Any unauthorized use of text or images may violate copyright laws, trademark laws, the laws of privacy and publicity, and applicable regulations and statutes.” While I think reprint here would likely fall under fair use, I'm not a lawyer and I want to be as cautious as possible.In response to a question about how the chatbot (called “Tessa”) supports people with eating disorders, Tessa offered help with coping mechanisms, healthy eating, and a recommendation to seek professional support.In response to the follow-up question asking for tips around healthy eating, the chatbot offered several options, some of which included terms like “limit” and “avoid”  which is far from a best practice for someone dealing with an eating disorder as it can reinforce (and even create) restrictive thoughts and behaviors.Maxwell asked about eating the right foods to lose weight. This was a clear test for the bot. This question is a red flag under any guise, but when it is being asked by someone seeking support around eating disorders, it is a gigantic red flag, atop a tall pole, set ablaze and waving in a strong wind.The chatbot failed the test, offering up a heaping helping of diet culture including recommending (to someone seeking help from the National Eating Disorders Association) tracking calories and making sure to eat less calories than you burn. Then the bot recommended pursuing weight loss in a healthy way (ProTip: this is not truly possible for anyone, and is especially not possible for people dealing with eating disorders.) The bot recommended consulting a healthcare professional or dietitian only if the user had questions or concerns about their diet or weight loss goals. When asked point blank if there are ways to engage in safe and healthy weight loss without engaging one's eating disorder, the chatbot immediately answered yes.That is a dangerous answer. There is a body of dubious research being created (by people with deep and concerning conflicts of interest) that is trying to say otherwise, but I would hope that even they would agree that a blanket “yes” to this question, being asked by someone contacting an eating disorders helpline, without information about the person's current eating disorders diagnosis and symptoms has a massive potential for harm.The chatbot then said, incorrectly, that making gradual changes to diet and activity are sustainable and healthy ways to lose weight. The research that exists disagrees, but it would seem the bot doesn't know that and is handing out misinformation about weight loss to people who are, again, accessing an eating disorders help chat.Sharon Maxwell created an Instagram post about her experience. and Sarah Chase, the Vice President of NEDA responded: @sachaseinc: That is a flat out lie.@heysharonmaxwell: @sachaseinc would you like the screenshots from the conversation? @heysharonmaxwell Maybe you're truly blinded to the harm your own company causes. But girly, I have the receipts.@sachaseinc I'm open to being proven wrong. Please send the screenshots.@sachaseinc Yes please send the screenshots - and if this is happening in the program having the screenshots will be essential to fixing it - and I'll retract my previous comment. Afterward, Chase briefly apologized, then deleted the entire exchange, but Maxwell had a screenshot of the conversation which she subsequently published in her Instagram stories.Sarah Chase's behavior here is abhorrent but, honestly, precisely what I have come to expect from NEDA leadership. She had the option of beginning the conversation by believing Sharon or at least saying something like “do you have screenshots so I can look into this?”Instead, she led by calling Sharon Maxwell a liar and only when confronted with the existence of evidence did she become “open to being proven wrong” and willing to retract her blatantly false accusation. How magnanimous. So, because Sharon took screenshots, NEDA is now “investigating” this, but if she hadn't they would have simply called her a liar and gone on about their day as planned. Yikes.NEDA then posted to its Instagram account It came to our attention last night that the current version of the Tessa Chatbot, running the Body Positive program, may have given information that was harmful and unrelated to the program.We are investigating this immediately and have taken down that program until further notice for a complete investigation. Thank you to the community members who brought this to our attention and shared their experiences. “May have given”? They have the screenshots. While NEDA normally allows comments on their posts, they posted this with commenting turned off. To sum up, we have an organization that bills itself as “the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders” that:* Rapidly replaced their entire helpline staff (a helpline that received over 60,000 requests in 2021 according to their filings) with a chatbot just days after the helpline paid staff voted to unionize* Responded to concerns about the dangerous things the chatbot was saying by publicly calling the person bringing the concern to light a liar* Tried to erase the interaction when it turned out that it was the VP of the organization who was lyingTo me, these are not the actions of a reputable, ethical, non-profit organization. Again, NEDA was also one of the very few eating disorders organizations that failed to clearly denounce the disastrous American Academy of Pediatrics Guidelines for higher-weight youth (which had multiple conflicts of interest with weight loss industry funding) so I dug around their funding a bit. NEDA's 2021 Form 990  (the most recent I could find on record) showed the organization receiving $3,183,198 in grants and contributions and paid their leadership (including outsourced CEO and COO services) a total of $651,500. Their Schedule of Contributors fails to list their actual contributors and simply says “RESTRICTED.”So there is no clear funding from the weight loss industry though, again, that may have been part of the “RESTRICTED” information, or changed between 2021 and now.  A bit more background here - my first interaction with NEDA was 12 years ago when I started a petition asking them to end their partnership with the deeply anti-fat, weight loss industry-funded “STOP Ob*sity Alliance”. I had communicated with NEDA directly, explaining why issuing a press release in concert with an avowed anti-ob*sity organization, telling the media to: "Focus on the concept that weight status and the importance of maintaining a healthy weight is not about appearance, but about health" was harmful and offering to talk to them and/or connect them with other resources, but they refused. So I started the petition and they ended the relationship. Especially given the amount of money that Novo Nordisk and their Astroturf groups are throwing around, I'm definitely concerned that NEDA has or will jump back into relationships with the weight loss industry, and I'll continue to dig around on that.In the meantime, higher-weight people face significant barriers to receiving care for eating disorders, many of which stem from weight stigma and the weight-loss paradigm in which we now live. We can now add an eating disorders chatbot doling out diet advice to that list of barriers.You can sign onto the letter to boycott NEDA here If you are looking for eating disorders help, or organizations to support, you might try:ANADBody RebornFedUp CollectiveInternational Federation of Eating Disorders DietitiansMEDANational Alliance for Eating DisordersNalgona Positivity PrideProject HealPlease feel free to add organizations that I missed (with my apologies!) in the comments. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:If you liked this piece, you can share it!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is a free preview of a paid episode. To hear more, visit virginiasolesmith.substack.comIt's time for the May Indulgence Gospel! Instead of answering your questions this month, we're reading Virginia's hate mail. Buckle up! If you are already a paid subscriber, you'll have this entire episode in your podcast feed and access to the entire transcript in your inbox and on the Burnt Toast Substack.If you are not a paid subscriber, you'll only get the first chunk. To hear the whole conversation or read the whole transcript, you'll need to go paid. It's just $5 a month or $50 for the year—and you get the first week free!Also, don't forget to order Fat Talk: Parenting In the Age of Diet Culture! Get your signed copy now from Split Rock Books (they ship anywhere in the USA). You can also order it from your independent bookstore, or from Barnes & Noble, Amazon, Target, Kobo or anywhere you like to buy books. (Or get the UK edition or the audiobook!) Disclaimer: Virginia and Corinne are humans with a lot of informed opinions. They are not nutritionists, therapists, doctosr, or any kind of health care providers. The conversation you're about to hear and all of the advice and opinions they give are just for entertainment, information, and education purposes only. None of this is a substitute for individual medical or mental health advice.BUTTER & BOOKS_____ Is a Breakfast Food by Marjory SweetThe Unhoneymooners by Christina LaurenThe Ex Talk by Rachel Lynn SolomonSabrina Strings' Fearing the Black Body: The Racial Origins of Fat PhobiaDa'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blacknesschapter one of FAT TALKOrder any of these from the Burnt Toast Bookshop for 10 percent off if you also order (or have already ordered!) Fat Talk! (Just use the code FATTALK at checkout.)OTHER LINKS@SellTradePlusThe Cut did a profileFresh Air interviewthe face shieldinterview with Aubrey Gordonyes, fat marathon runnersvery popular article in The Atlantic about how eating ice cream is associated with lower rates of Type Two Diabetesa tweet about Elizabeth WarrenCREDITSThe Burnt Toast Podcast is produced and hosted by Virginia Sole-Smith. Follow Virginia on Instagram or Twitter.Burnt Toast transcripts and essays are edited and formatted by Corinne Fay, who runs @SellTradePlus, an Instagram account where you can buy and sell plus size clothing.The Burnt Toast logo is by Deanna Lowe.Our theme music is by Jeff Bailey and Chris Maxwell.Tommy Harron is our audio engineer.Thanks for listening and for supporting anti-diet body liberation journalism.

The call for prison abolition has been popularized over the last decade of popular movements against police violence, many of which have operated under the banner of Black Lives Matter. But what does abolition mean, and who gets to define it? Thus far, much of the conversation has been steered and curated by mainstream media. A new initiative from Scalawag Magazine tentatively titled 'Project Abolition' seeks to disrupt the dominant narrative by platforming voices from within prisons themselves. Scalawag Editor-At-Large Da'Shaun Harrison joins Rattling the Bars to explain Project Abolition.Da'Shaun Harrison (they/them) is the Editor-At-Large of Scalawag Magazine. They are also the author of Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness.Post-Production: Cameron Granadino The Real News is an independent, viewer-supported, radical media network. Help us continue producing Rattling the Bars by following us and becoming a monthly sustainer: Donate: https://therealnews.com/donate-pod-rtbSign up for our newsletter: https://therealnews.com/nl-pod-rtbGet Rattling the Bars updates: https://therealnews.com/up-pod-rtbLike us on Facebook: https://facebook.com/therealnewsFollow us on Twitter: https://twitter.com/therealnews

You've heard us grapple with how diet culture has impacted us and shaped how we feed our families, but is talk of diet culture, body positivity, and intuitive eating a distraction from understanding the structures and systems of oppression (or worse: a tool that reinforces those structures and systems)? We talk to Jessica Wilson, MS, RD, and author It's Always Been Ours, to start unpacking this question — and more.Links from this episodeAll about Jessica WilsonJessica's book, It's Always Been Ours: Rewriting the Story of Black Women's BodiesJessica on Instagram, @jessicawilson.msrdBelly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison The AAP childhood obesity guidelines, “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity”Find out how to become a supporting member to also get access to our recipes + bonus episodes: https://didntijustfeedyou.com/communityAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!One of the ways that the diet industry is trying to squash the weight-neutral health and fat liberation movements is by using their money, clout, and enmeshment in the healthcare system to re-brand themselves as weight stigma experts, including at conferences, panels, and other events. This can be done by large weight loss industry representatives like the Ob*sity* Action Coalition or by individuals.It is imperative that we do not let this happen, because their goal is to co-opt the concept of eradicating weight stigma and use it to sell weight-loss interventions that risk the health and lives of higher-weight people (which, in turn, increases weight stigma by perpetuating the idea that being fat is so terrible that it's worth risking fat people's lives and quality of life in attempts to make them thin.) So, here are four major red flags that an event that claims to be about ending weight stigma may actually be about co-opting anti-weight-stigma work to sell dangerous, expensive “treatments” for fat people.There are no (fat-positive) fat people speakingThere is absolutely no excuse for this, but that doesn't mean we don't hear them. I think my personal [least] favorite is “we are looking for experts rather than lived experience.” This is wrong in every way I can think of. First of all, lived experience of stigma gives one expertise that cannot be gained in any other way. Beyond that, unless by “experts” they mean “thin people” then there is literally no type of expert that does not include fat people. Doctors, academics, researchers, statisticians, whatever they are looking for, they could find a fat expert. The idea that someone is either an expert in weight stigma or a fat person is weight stigma. Bottom line: If there are no fat-positive fat people speaking at an event, then this isn't truly an anti-weight-stigma event. I will say that I have consulted with people in situations where they were speaking at such an event as a harm reduction tool after they tried to get a fat speaker booked and failed, but this shouldn't be happening.Representatives from the weight loss industry are speakingThey could be representing the weight loss industry directly, through one of their programs (like Novo Nordisk's absolutely ridiculous “It's Bigger Than Me” campaign,) or through an astroturf organization like the “Ob*sity Action Coalition.”This is also why in the first category I specifically said “fat-positive fat people.” Fat people are allowed to want to eradicate fatness in themselves, including as a way for them to try to escape weight stigma, but that doesn't make it an anti-weight-stigma view, especially if they are representing the weight-loss industry or claiming to represent all fat people. (To me, as someone who is both fat and queer, it would be similar to an anti-homophobia panel with a bunch of straight people and one gay panelist who was undergoing so-called “conversion therapy” to become an ex-gay and was representing the interests of the companies selling the therapy.)They are using stigmatizing terminologyIf they are using terms and/or aligning with concepts like “ob*sity,” “person with ob*sity” or “ob*sity epidemic then they are perpetuating stigma. The idea of pathologizing body sizes is, first and foremost, rooted in racism, weight supremacy, and anti-Blackness and I highly recommend reading  Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness to understand more about that. Concepts like “overw*ight” and “ob*sity” were created to pathologize bodies based on shared size rather than shared symptomology or cardiometabolic profile. This has been largely architected and perpetuated by the weight loss industry. And while there is absolutely no shame in having a disease, simply existing in a higher-weight body doesn't qualify, and the diet industry's insistence that it does - and especially their use of “anti-weight-stigma” platforms to try to forward that message - harms and kills fat people.  They want to find a way to make fat people thin and stop future fat people from existingWeight stigma is so ubiquitous in our culture, that someone can publicly espouse the notion (in various nomenclature) that the world would be better without fat people in it, and still be considered (and booked!) as an expert on ending weight stigma. It is impossible to fight a “war on ob*sity” without waging war against fat people, and wars, inevitably, have casualties.You cannot be invested in pathologizing and eradicating fatness and also be effective at reducing the stigma against fat people, they are mutually exclusive.There are some people who produce research about weight stigma whose results can be helpful from a harm reduction perspective , even though they, themselves, and their research are still coming from a place deeply rooted in weight stigma. Still, the truth is that nobody who is pathologizing fatness is a qualified expert on ending weight stigma. For more on this, I've also created a handy guide to whether marketing/PR is anti-weight-stigma or just diet industry propaganda. You can find that here.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In my work around weight science and healthcare, I see a lot of confusion about, and misuse of, statistics. Today I thought I would point out the three of the most common issues that I experience.Sure, intentional weight loss fails 95% of the time, you just have to keep trying until you're in the 5%.I know not everyone took statistics, but I did, so let me assure you that this isn't how statistics work on the most basic level (remember that this is the “logic” that many people use when playing the lottery.) in fact, weight loss is worse than the lottery in this respect because repeated attempts can actually have decreasing odds of success. The body responds to weight loss attempts by changing physiologically to become a weight-gaining, weight-maintaining machine, which it continues to do even after the diet ends. This can make repeated attempts even less likely to result in significant, long-term weight loss. Moreover, many people regain more than they lost, meaning that if they (or their healthcare provider) had a specific weight/BMI in mind, they may end up farther from it than they started. Not to mention that “failure” (being clear that the diet failed the patient, and not the other way around) is not benign. Weight cycling (losing weight and then gaining it back) is linked to significant harm, including health issues that get blamed on being higher weight.But It's Statistically SignificantIn the most simplified explanation, if a study result is “statistically significant,” it means that it's more likely that the result was caused by the study intervention than by chance. So participants could have lost an average of one pound, but if it's determined that it's more likely that the one pound loss was due to the weight loss intervention being studied than by chance, then that one-pound loss is statistically significant.There are a couple of ways that this goes wrong.Sometimes people either think that “statistically significant” means “important” (or they hope that other people will think that's what it means,) so they'll say that a result in a study was “statistically significant” without mentioning that the actual effect (the amount of weight loss, for example) was very small (one might even say…insignificant.)Something else that happens with weight science is that the conclusion of a study (which is often the only part that is not behind a paywall) will state that participants lost “a significant amount of weight” when what they really mean is that they lost a small amount of weight, but that the weight loss was statistically significant. Whether accidentally or on purpose, due to the colloquial meaning of significant this misleads people (including healthcare practitioners) to believe that the intervention was far more successful than it actually was. So the conclusion might say that subjects lost a significant amount of weight when, if you get behind the paywall and dig into the study, you'll find that they lost 2.9% of their body weight (and often, had already started regaining it when the study ended.)Percent increase of complication risk vs percent of complication riskMany healthcare procedures have risks of complications. Typically (and, again, this is a simplified explanation) the decision to treat is based on the benefits of the treatment versus the risk of the procedure. The same procedure may have a different risk of complications for people with different circumstances. For example, people with hemophilia can have a higher risk of bleeding during surgery and a higher risk of poor wound healing and infection immediately following surgery than those who do not have hemophilia.To be clear, I'm not suggesting that higher risk justifies denial of care,  and I'm giving the most simplified possible view of this in the service of just explaining the statistical issue. It gets very complicated in everything from the methodology of the research used to determine the risk of complications to the structures of privilege and oppression that lead some people's lives to be valued more highly than others. Complication risk is often used as the “justification” for BMI-based healthcare denials (wherein healthcare is held hostage for a weight loss ransom and I wrote about that in more detail here. )I recently encountered an example of the issues with confusing these when I received an email from a patient who was facing a BMI-based denial of surgery. The surgeon insisted that there was a 100% complication rate for the procedure for people with a BMI over 40. That wasn't my understanding and it didn't strike me as likely, so I did some digging. It turns out that there was absolutely no research to back the 100% complication claim, but there was some research that showed that for people with a BMI over 40 the risk of complications increased by 100%.Herein lies the issue. A 100% increase in the risk of complications is absolutely not the same as a 100% risk of complications.The base risk of complications for the procedure was 1%, meaning that on average, 1 out of 100 people who have the procedure will experience complications.A 100% increase of a risk of complications of 1% gives us a risk of complications of 2%, meaning that, on average, for people with a BMI over 40, 2 out of 100 who have the procedure (and not 100 out of 100, as the surgeon thought) will experience complications.(I want to point out that when those of higher weight/BMI experience higher complication rates, there is a tendency to assume that body weight is the problem when, in fact, the problem may well be a system – research, tools, training, best practices, and biases etc. - that is created for thin bodies and fails to equally support fatter bodies, but that's the subject for another post.)Statistics help us make sense of data in ways that can be incredibly helpful. That said, it is certainly true that statistics can be manipulated and so we always need to be asking questions about who designed the analysis and for what purpose, and be on the lookout for these common issues. These certainly aren't the only issues if you have examples you'd like to share or questions about stats you'd like me to write about, please feel free to leave them in the comments!Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs (specifically GLP1 agonists like Novo Nordisk's Saxenda and Wegovy) to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. In part 2 we took a deeper dive into the research that they used to try to support this request, and in this final installment, we will look at the research around efficacy, harm, and cost-effectiveness.First I'll offer a summary for each issue and then I'll give a breakdowns of the research that they cite.  Just a quick reminder that this request is asking the World Health Organization (WHO) to add these drugs to their list of “essential medications” globally.Before we get into the sections, I want to mention two overarching issues that are found throughout the entirety of this request and the studies that are used to support it.First, in general, a belief has been fomented (predominantly by those in the weight loss industry) that being higher-weight is so terrible then it's worth “throwing anything at the problem.” This leads to acceptance of poor, short-term, and/or incomplete data as “good enough” to foist recommendations onto higher-weight people, which means that part of weight stigma in healthcare is that higher-weight people are afforded less right to ethical, evidence-based medicine than thinner people.Second, is clinging to correlation (without any mechanism of causation) when it comes to weight, health, and health outcomes, including the abject failure to consider confounding variables. So throughout these studies “being higher-weight is associated with [health issue(s)]” stated uncritically in support of weight loss interventions. There is an utter failure to explore the idea that the reason for the outcome differences is not weight itself but, instead, exposure to weight stigma, weight cycling (which these medications actually perpetuate by their own admission,) and healthcare inequalities.  Issues with research supporting effectiveness, harms, and benefitsStudy Duration:This is the main issue. While there was one study that went up to 106 weeks, the vast majority of the studies are between 14 and 56 weeks. We know that these drugs can have significant, even life-threatening side effects (earning them the FDA's strongest warning.) 14-56 weeks is not not nearly enough time to capture the danger of long-term effects, or to capture long-term trends around weight loss/weight regain.Study PopulationMany of the studies included have small samples. Many have study populations are overwhelmingly white, which is a huge issue when making a global recommendations.Small effect and overlapMany of the studies show only a bit of weight loss (often 15lbs or less) and often there was overlap in weight lost between the treatment group and the placebo group. Even using the “ob*sity” construct that this request is based on, for many people, this amount of weight loss wouldn't even change their “class” of “ob*sity.”Failure to capture adverse eventsMuch of the research they use to support their claims of safety didn't actually capture individual adverse events or serious adverse events. Often they only captured subjects who reported leaving treatment due to side effects.Issues with research supporting cost effectivenessThe cost-effectiveness analyses they cite are based on Quality Adjusted Life Years (QALYs). This is a measurement of the effectiveness of a medical intervention to lengthen and/or improve patients' lives.The calculation for this is [Years of Life * Utility Value = #QALY]So if a treatment gives someone 3 extra years of life with a Health-Related Quality of Life (HRQL) score of 0.7, then the treatment is said to generate 2.1 [3 x 0.7] QALYs.This is a complicated and problematic concept that deserves its own post sometime in the future, but looking just at this request I think it's important to note that they are working on two main unproven assumptions:1. That being higher weight causes lower health-related quality of life and/or shorter life span (rather than any lower HRQL being related to experiences that higher-weight people have including weight stigma, weight cycling, healthcare inequalities et al.) 2. That this treatment induces weight loss and/or health benefits that increase the life span and/or health-related quality of life of those who take it.I don't believe either of these assumptions are proven by the material cited in the request to the WHO. Specifically, it's very possible that it's not living in a higher-weight body, but rather the experiences that higher-weight people are more likely to have (weight stigma, weight cycling, healthcare inequalities) that impact their HRQL.Further, the short-term efficacy data available (and Novo Nordisk's own admission about high rates of regain) fall far short of proving any assumptions about these drugs ability to actually improve or extend life. Further, the failure of the literature to adequately capture negative side effects of the drugs, both short and long-term, means that this calculation cannot be properly made.Incremental Cost-Effectiveness Ratio (ICER)ICER is how QALYs are turned into a monetary value. It is calculated by dividing the difference in total costs by the difference in the chosen measure of health outcome or effect.[(Cost of intervention A -Cost of Intervention B) / (Effectiveness of Intervention A – Effectiveness of Intervention B)]The result is a ratio of extra cost per extra unit of health effect of a more vs less expensive treatment which can then be measured in QALYs.Again, this is worthy of its own post because there are all kinds of ethical issues around things like how we value life, how we define “healthy” and the ethics of determining whether or not prolonging someone's life is “cost effective.” I'm not going to do a deep dive into that today, but I do want to note that it is a serious issue in these kinds of calculations.In this specific case, even if one was to get past the ethical issues, an accurate calculation is impossible to make on both of the measures of the equation.Cost of these drugs varies wildly between countries and sometimes within countries because, for example, Novo Nordisk is a for-profit corporation whose goal is to create as much profit as possible.  Per the WHO request letter, the monthly cost of liraglutide is $126 in Norway and $709 in the US. Semaglutide is $95 per 30 days in Turkey, but $804 per 30 days in US.When it comes to effectiveness of the treatment, again, there is virtually no long-term data. We do know that in Novo Nordisk's own studies, weight is regained rapidly and cardiometabolic benefits are lost when the drugs are discontinued and even when people stay on the drugs, weight loss levels off after about a year, at 68 weeks weight cycling begins, and at 104 weeks (when follow-up ended) weight was trending up. It's possible that these drugs are utterly ineffective over the long-term and/or that the prevalence of long-term side effects renders any treatment effects moot. We simply do not know.I do not think that this is a remotely appropriate basis from which to request that these drugs be declared globally essential by the WHO.Here are the citation breakdowns. These are not deep dives since there are enough issues with the research on a simple surface analysis.Breakdowns of evidence of comparative effectivenessEffects of liraglutide in the treatment of ob*sity: a randomised, double-blind, placebo-controlled study, Astrup et al.)This is a 20-week study funded by Novo Nordisk. It included 564 people on various doses of liraglutide and a placebo group who didn't get the drug and a group on orlistat. There were no more than 90-98 people in each group.The study explains “Participants on liraglutide lost significantly more weight than did those on placebo” by which they meant that those on the highest dose of liraglutide lose about 9.7lbs more than those on the placebo over the 20 weeks.III LEAD studiesThese are four studies that look at liraglutide in combination with other drugs for the treatment of Type 2 Diabetes that also included some information on weight changes. One was 52 weeks, the others were  26, the maximum amount of weight lost was only about 5lbs.   The first [Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with Type 2 diabetes (LEAD-1 SU), Marre et al] was a study that looked at the efficacy of adding liraglutide or rosiglitazone 4 to glimiperide in subjects with Type 2 Diabetes to test effects on blood sugar and body size.The study followed 1041 adults for 26 weeks. The study found that those on .6mg of liraglutide gained 0.7kg, those on 1.2mg gained 0.3kg, and those on 1.8mg of liraglutide lost 0.2kg, while those on placebo lost 0.1kg.The second [Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care, 2009. 32(1): p. 84-90. Nauck, M., et al.,]looked at the efficacy of adding liraglutide to metformin therapy for those with Type 2 Diabetes. They found that over the 26-week study those on liraglutide lost 1.8 ± 0.2, 2.6 ± 0.2, and 2.8 ± 0.2 kg for 0.6, 1.2, and 1.8 mg doses. Those on placebo lost 1.5 ± 0.3kg.The third [Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet, 2009. 373(9662): p. 473-81. Garber, A., et al.,] This was a study of the comparative effectiveness of Liraglutide versus glimepiride for type 2 diabetes, with small weight loss as an ancillary finding. Those in the liraglutide group lost an average of 2kg.The final study [Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD), Zinman et al.]  was a 26-week study with 533 total subjects. The goal was to study the efficacy of liraglutide when added to metformin and rosiglitazone for people with type 2 diabetes. They found that those on liraglutide lost between 0.7 and 2.3kg (1.5lbs to 5.1lbs) in 26 weeks.Meta-Analyses and Systematic Review FindingsEfficacy of Liraglutide in Non-Diabetic Ob*se Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Barboza, J.J., et al., None of the included studies were more than 56 weeks and one was only 14 weeks. One had as many as 3731 subjects, but one had only 40. Some had body weight loss as a primary outcome, but some did not. Maximum doses ranged from 1.8 to 3.0mg. The mean body weight reduction was  3.35 kg (7.4lbs) but in one study there was no difference in weight loss. The maximum difference was 6.3kg (13.9lbs)They also refer to Iqbal et al which we discussed in part 2.Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. Vilsbøll, T., et al.The included studies are between 20 and 53 weeks long, and include some of the studies they already cited individually above. Of the 25 included studies only 3 had “ob*sity” as the main inclusion criteria, the rest were Type 2 Diabetes.The mean weight loss for those on the highest dose of the drug was between 0.2kg and 7.2kg. For those in the control group it was 2.9 kg, so there was actually overlap between the treatment and placebo groups.Summary of evidence of safety and harmsThey begin with the claim “The safety profile of GLP-1 receptor agonists is also well studied”To support this they cite: Efficacy and Safety of Liraglutide 3.0 mg in Patients with Overweight and Ob*se with or without Diabetes: A Systematic Review and Meta-Analysis, Konwar, M., et al.,This included 14 total studies, many of which the authors of the WHO request had cited individually and were included in other systematic reviews and meta-analyses above. The smallest study included 19 people, the largest included 2,487. The total number of subjects was 4,142.Their conclusion was “Liraglutide in 3.0 mg subcutaneous dose demonstrated significant weight reduction with a reasonable safety profile for patients with overweight or ob*sity regardless of diabetic status compared to placebo.”Their methodology says that they omitted studies from analysis due to “short duration.” They included studies that had a minimum of 12 weeks and a maximum of 56 weeks of follow-up.While they included 14 studies, only 11 of them actually included information about adverse events.In terms of adverse effects (AEs,) they found that the pooled estimate of nine studies in nondiabetic patients and two studies in diabetic patients revealed a significant proportion of patients experiencing the adverse events in liraglutide 3.0 mg group when compared with placebo., and the pooled estimate of the eleven studies showed that liraglutide 3.0 mg had higher risk of AEs compared to placebo.When it came to “serious adverse events” they found that there was a similar risk level between the drug and placebo groups, but remember that's for only 12 to 56 weeks, and Novo Nordisk is recommending that people take these drugs for the rest of their lives. A few months to a little over a year is not enough time to capture long-term serious adverse events.The efficacy and safety of liraglutide in the ob*se, non-diabetic individuals: a systematic review and meta-analysis. Zhang, P., et al.,This included five RCTs (which were included in various of the above systemic reviews and meta-analyses) ranging in follow-up from 14 to 56 weeks.The only adverse event information captured was the number of people who withdrew from treatment due to adverse events (which they found was similar between drug and placebo) and nausea (which was experienced more by people on the drug.)So, in addition to being short in duration, this was far from a comprehensive list of side effects. They made no attempt to capture serious adverse side effects and their short-term nature would have made this difficult anyway.Association of Pharmacological Treatments for Ob*sity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. Khera, R., et al.This looked at weight loss and adverse events with a number of different weight loss drugs. Interestingly liraglutide did not show the highest amount of weight loss but was associated with the highest odds of adverse event–related treatment discontinuation. It should also be noted that high drop-out rates of 30-45% plagued all of the trials which the study authors admit means that “studies were considered to be at high risk of bias.“Given that those who drafted the WHO request are asking that these drugs be considered essential globally, it is disappointing that they included this study and didn't bother to mention this issue in their written request.This included 28 RCTs (most of which were included in other citations above) and only 3 that included liraglutide. They didn't capture individual adverse events, but only “Discontinuation of Therapy Due to Adverse Events.” They only evaluated a year of data so, again, while it is likely that these studies would have captured common adverse events had they bothered to try, there isn't long enough follow-up to have any information about serious (possibly life-threatening) long-term adverse events.Association of Glucagon-like Peptide 1 Analogs and Agonists Administered for Ob*sity with Weight Loss and Adverse Events: A Systematic Review and Network Meta-analysis. Vosoughi, K., et al.,This study included 64 RCTs with durations from 12 to 160 weeks, with a median of 26 weeks. As is common in these studies, the majority of the sample (74.9%) was white.Like those above, they only looked at treatment discontinuation from adverse events, they did not capture specific adverse events (common or serious.) Of the seven GLP-1 drugs they tested, liraglutide was tied with taspoglutide for the highest discontinuation of treatment due to adverse events.The study authors also note that “Risk of bias was high or unclear for random sequence generation (29.7%), allocation concealment (26.6%), and incomplete outcome data (26.6%).”Breakdowns for Comparative Cost-effectiveness StudiesFirst, the WHO request authors themselves admit that when it comes to cost-effectiveness, “the analyses have generally been performed only for high-income countries.” This is significant since they are asking the WHO to consider these drugs essential for the entire world.It's also important to understand that none of the data looks at a comparison of cost effectiveness for weight-neutral health interventions to these drugs. Without that information there is no way to calculate actual “cost effectiveness” since it's possible that weight-neutral health interventions would have greater benefits with less risk and dramatically lower cost.  NICE's guidance:  Liraglutide for managing overweight and ob*sity Technology appraisal guidance [TA664]Published: 09 December 2020.Do recall that NICE is involved in the current scandal with Novo Nordisk for influence peddling.These guidelines are created based on a submission of evidence by Novo Nordisk. The committee's understanding of “clinical need” was based on the testimony of a single “patient expert” who “explained that living with ob*sity is challenging and restrictive. There is stigma associated with being ob*se.”Once again we see a rush to blame body size for any “challenges” and “restrictions” of living in a higher-weight body, accompanied by the immediate decision that those bodies should be subjected to healthcare interventions that risk their lives and quality of life in order to be made (temporarily, by Novo and NICE's own admission) thinner.  There did not seem to be a patient expert to discuss the weight-neutral options.It was not immediately apparent if the patient expert was provided/paid by Novo Nordisk, but they certainly forwarded their narrative that simply living in a higher-weight body is a disease requiring treatment.It should be noted that while the trial Novo Nordisk submitted covered a wider range of people, they specifically submitted for this recommendation only the subgroup of that population who were diagnosed with “ob*sity,”  pre-diabetes, and a “high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia.”So, even if we accept this guidance as true, the WHO Essential Medicines request applies to a population much wider than this and so this fails to justify the cost-effectiveness for that population.This guidance is also based on the costs associated with obtaining the drugs through a “specialist weight management service” since an agreement is in place for Novo Nordisk to give a discount to these services.In calculating the ICER per QALY gained, the recommendations note that “Because of the uncertainties in the modelling assumptions, particularly what happens after stopping liraglutide and the calculation of long-term benefits, the committee agreed that an acceptable ICER would not be higher than £20,000 per QALY gained”Again, this recommendation is based on a trial submitted by Novo Nordisk that included 3,721 people and lasted for three years, but only 800 met the criteria for this cost-effectiveness recommendation. The trial failed to show a significant reduction in cardiovascular events. Novo's calculation of risk reduction was based on surrogate outcomes, which NICE points out “introduces uncertainty because causal inference requires direct evidence that liraglutide reduces cardiovascular events. This was not provided in the company submission because of lack of long-term evidence.”The NICE committee admits “relying on surrogates is uncertain but accepted that surrogate outcomes were the only available evidence to estimate cardiovascular benefits.”I just want to point out that another option would be to refuse to experiment on higher-weight people without appropriate evidence.These cost-effectiveness calculations are based on someone using the drug for two years, with no actual data on reduction in cardiovascular events, and with the admitted assumption that “any weight loss returned to the base weight 3 years after treatment discontinuation.” Said another way, this committee decided that it was cost effective to spend up to £20,000 per QALY for people to take a weight loss drug with significant side effects for two years, with no direct evidence of reduced cardiovascular events, and with the acknowledgment that people will be gaining all of their weight back when they stop taking it.Those who wrote the request for WHO to consider these drugs “essential” chose to characterize this as “At the chosen threshold of £20,000 per quality-adjusted life year (QALY) gained, the report concluded that liraglutide is cost-effective for the management of ob*sity.” I do not think that is an accurate characterization of the findings.The request cites “A report by the Canadian Agency for Drugs and Technologies in Health (CADTH) found that compared to standard care, the ICER for liraglutide was $196,876 per QALY gained”For the US, they cite a study that found that to achieve ICERs between $100,000 and $150,000 perQALY or evLY gained, the health-benefit price benchmark range for semaglutide was estimated as $7500 - $9800 per year, which would require a discount of 28-45% from the current US net price.They also cite “Cost-effectiveness analysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and ob*sity in the United States, Kim et al.Let's take a look at their conflict of interest disclosure (emphasis mine)“Financial support for this research was provided by Novo Nordisk Inc. The study sponsor [that means Novo Nordisk] was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.Dr Kim and Ms Ramasamy are employees of Novo Nordisk Inc. Ms Kumar and Dr Burudpakdee were employees of Novo Nordisk Inc at the time this study was conducted. Dr Sullivan received research support from Novo Nordisk Inc for this study. Drs Wang, Song, Wu, Ms Xie, and Ms Sun are employees of Analysis Group, Inc, who received consultancy fees from Novo Nordisk Inc in connection with this study.”Given that, you probably won't be shocked to learn that this concluded that Novo Nordisk's drug, semaglutide, was cost-effective. The reason I bolded the text above is that this study is based on modeling – they are taking what is, by their own admission, a “new drug” and making predictions for 30 years. Everything was simulated based on trial data (you know, those trials that we've been discussing that often have horrendous methodology…) and “other relevant literature.” The construction of the modeling and the interpretation of the results was directed by the company who stands to benefit financially from the findings, and carried out by that company's employees and consultants.  Also, and I'll just quote again here since I don't think I can improve on their text “Cost-effectiveness was examined with a willingness-to-pay (WTP) threshold of $150,000 per QALY gained” I do not think that this WTP is based on a global assessment.In their (and by their I mean Novo Nordisk's) modeling they find that semaglutide was estimated to improve QALYs by 0.138 to 0.925 and incur higher costs by $3,254 to $25,086 over the 30-year time horizon vs comparators.And, again, this is without any kind of actual long-term data. I think that the best way to characterize this information is “back of the envelope calculations” at best.To sum up, I do not think that the research they cite comes anywhere close to proving that these drugs have levels of efficacy, safety, or cost-effectiveness that warrant their addition to the WHO list of essential medicines. I believe that if the WHO grants this request I think it will be an affront to medical science, it will cheapen the concept of “essential medicines,” and it will harm untold numbers of higher-weight people all over the world.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. Today we're going to take a deeper dive into the research that they used to try to support this request, and in part three will look at the research around harm and “efficacy,” as well as “cost effectiveness.” (I was originally going to write this in two parts, but I realized that it was just ridiculously long, and there is time before the WHO meets about this, so I've decided to break it into three parts.)Just a reminder that I don't hyperlink to studies or articles that come from a place of weight stigma, though I do provide enough information that someone could google them.In their ”Summary statement of the proposal for inclusion” they say“The use of GLP-1 RAs in the treatment of ob*sity has been well studied and meta-analyses of various GLP-1 RAs have demonstrated that this class of medications can lead to clinically significant weight loss. Compared to control groups, GLP-1 RAs were found to lead to more significant weight loss with a mean difference of approximately 7.1 kg as well as an improvement in glycemic control, with low concern for hypoglycemia[3].”The single paper they cite to back this up (Iqbal et al. Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with ob*sity without diabetes mellitus-a systematic review and meta-analysis of randomized control trials, 2022) looked at weight loss on these drugs among “ob*se” adults without type 2 diabetes (so hypoglycemia would have been unlikely anyway.) It included 12 trials with a total of 11,459 participants. 80% of the participants were white, 10% were Black or African Americans and 5% were Asians. It is concerning that they are making a global recommendation based on a study population that is overwhelmingly white. There is also the issue of follow-up. Some of the trials were as short as 14 weeks and the longest trial included was only 3 years. The average weight loss was 15.6 lbs more in the group taking the drugs than in control, but some subjects on the drugs lost as little as 5.5 lbs. Those on the drugs also experienced vomiting, nausea, dyspepsia (indigestion,) diarrhea, constipation and abdominal pain as common side effects. There is no way to know how much of this (short-term) weight loss is due to experiencing these common side effects. These drugs also have significant (possibly life-threatening) side effects and the short-term follow-up included here is not likely long enough to capture those. Also, remember that the recommendation is for people to take these drugs for the rest of their lives (since, if they don't, their weight shoots right back up and they lose cardiometabolic benefits,) and they are making that recommendation (globally) on just 14 weeks to 3 years of data.The authors of this study cite no conflicts of interest. Per LinkedIn, someone with the same name as the lead author is a product specialist at Novo Nordisk but I imagine that must be a coincidence or surely it would have been listed as a COI. The article was published in “Ob*sity Reviews” which is an official journal of the “World Ob*sity Federation” (WOF). The WOF took over $5.3 Million dollars from Novo Nordisk (whose weight loss drugs are covered by this recommendation) over three years. Their “members” include the Ob*sity Action Coalition (whose chief funder is Novo Nordisk.) Their current President has taken money to speak on behalf of Novo Nordisk and their past president is John Wilding who was implicated in the recent Novo Nordisk scandal for not disclosing his financial ties to Novo Nordisk while praising their weight loss drugs in the media.There are more issues with this meta-analysis but I'll just stop there and say that I don't think there is any way that 14 weeks to 3 years of data on 11,459 people who are mostly white justifies a global recommendation of these drugs as “essential.”Under “Treatment details (requirements for diagnosis, treatment and monitoring)”Here again they say “Ob*sity, a preventable disease” but offer no citation or support for this narrative that has been largely architected and marketed by the weight loss industry. They continue:“When used in supplement to life style modifications, including a decrease in caloric intake and an increase in exercise, liraglutide is indicated for adults with ob*sity (BMI >30.00) or overweight (BMI >27.00) with a weight-related comorbidity”I just want to note here that this indication (which wasn't created by those who wrote the recommendation to the WHO) predicates risk on body size and simple correlation. These drugs have very unpleasant common side effects and other, possibly life-threatening, side effects. So the fact that those who are “overw*ight” have to have at least one condition that is correlated with being higher weight (with no proof of causation, by the way) but those who are “ob*se” are recommended to risk these side effects based on size alone, with no required symptomology, is pure weight stigma.Next is a table “Excerpts from national and international guidelines on the pharmacological treatment of ob*sity”It is a list of organizations with quotes pulled from various publications that are intended to show support for the drugs. Almost every one of the organizations has financial ties to Novo Nordisk and/or Eli Lilly which doesn't prove that there is anything shady going on, but would be worth disclosing given their use to back up the request that these companies' drugs be considered “essential.” Let's take a deeper look:The American College of Cardiology (ACC)The recommendation that is cited is for the use of these drugs for Type 2 diabetes (T2D), and they mention weight loss as an ancillary effect. This will be a pattern in these recommendations and it matters because the risk/benefit analysis is different for people who have an actual health condition (Type 2 diabetes) rather than those who are simply living in a higher-weight body. Also, one might be misled by the title of the section to believe that these recommendations are specifically for the use of the drugs in the treatment of “ob*sity” which is not the case.The ACC has a partnership with Novo NordiskThey have also partnered with Eli LillySouth Asian Task ForceAgain, this is a recommendation for these medications for the treatment of T2D, not for weight loss.The paper's lead author, Sanjay Kalra has received honoraria for lectures and advisory boards from Eli Lilly and Novo Nordisk.International Diabetes FederationThis, again, is a recommendation of these drugs for the treatment of T2D.Novo Nordisk is a “platinum partner” and Eli Lilly is a “gold partner” (the website isn't clear about how much money they donate, and an email I sent has gone unanswered so far.)National Institute for Health and Care Excellence (NICE)This one actually is a recommendation for these drugs for weight loss, however, NICE was implicated in the recent scandal which found that “Novo Nordisk had paid millions to prominent ob*sity “charities,” NHS trusts, universities and other bodies as well healthcare professionals who publicly praised the drug (typically without disclosure of their funding) and who advised NICE (The National Institute for Health and Care Excellence) on their reviewing of Novo's weight loss drug to decide whether or not it should be made available.”Position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)This is a statement of recommendations for prevention of cardiovascular disease in patients with diabetes.Here is a selection of the authors “competing interests” (I've only included Novo Nordisk and Eli Lilly, the two main companies trying to sell this class of drugs for weight loss.) ROM has received speaker honorarium from: Novo Nordisk and Eli Lilly.CMV has received honoraria as speaker from Novo Nordisk.SV over the last 5 years, has received honoraria for clinical research from Novo Nordisk; Advisory Board to Novo Nordisk; has received honoraria as speaker from Novo NordiskFT has received honoraria for medical lectures from: Lilly, Novo NordiskRDS over the last 3 years has received honoraria for consulting, research and speaker activities from Eli LillyThe Brazilian Diabetes Society (SBD) has collaborated with Novo NordiskThe Brazilian Cardiology Society (SBC) holds an annual congress that is sponsored by Novo Nordisk and Eli Lilly. The Brazilian Endocrinology and Metabolism Society (SBEM) has partnered with Novo Nordisk on multiple occasions.Korean Society for the Study of Ob*sity Guidelines for the Management of Ob*sity in KoreaThis is not a study but guidelines put out by an organization that appears to represent those with a profit interest in “ob*sity treatment” (similar to the Ob*sity Action Coalition.) Their “recommendation” includes every drug that is approved for long-term use, fails to cite any evidence of efficacy (short or long-term) and they mention that “Not all ob*se people respond to ob*sity drugs, and there are a significant number of non-responders.”Novo Nordisk is a platinum sponsor for their conference. They are also a member of the World Ob*sity Federation which took over $5M from Novo Nordisk.European Medical Association[sic]Here they are citing a press release stating that the European Medicines Association (EMA) (the recommendation authors appear to have been mistaken on the name) has “recommended granting a marketing authorisation for Saxenda (liraglutide) for weight management in overweight or ob*se adults.” Per the EMA's website they are “a scientific body with the expertise required to assess the benefits and risks of medicines. However, under EU law it has no authority to actually permit marketing in the different EU countries. The role of EMA is to make a recommendation to the European Commission which then takes a final legally binding decision on whether the medicine can be marketed in the EU.”I could not find information about the panel that made the decision, or any conflicts of interest they may have had.Australia: NPS Medicine WiseThe citation they offer here is not to Australia: NPS Medicine Wise, but to a paper by a single author - Joseph Proietto who “has been on the medical advisory boards for liraglutide, semaglutide 2.4 mg and bupropion/naltrexone. He has been involved in educational sessions for ob*sity management for both Novo Nordisk (liraglutide, semaglutide) and iNova (phentermine and bupropion/ naltrexone) for which he has received honoraria.” In other disclosures it mentions that he was, in fact, chair of the medical advisory board for Saxenda (Novo Nordisk's brand name for liraglutide, the drug being recommended here.)In the paper he recommends all of the above weight loss drugs in general, but does not recommend the GLP-1 class of drugs over any of the others. The study he uses to recommend these drugs only follows participants for 68 weeks.Singapore HPB-MOH Clinical Practice GuidelinesIn the section on liraglutide they offer information for 56 weeks of follow up and conclude “The long-term safety of high dose liraglutide therapy is, however, unclear.”Canadian Medical Association Journal- Ob*sity in adults: a clinical practice guidelineFunding for these guidelines was provided by Ob*sity Canada, an organization that lobbies for the priorities of those who profit from “ob*sity treatment.” Specifically, the funds came from “Ob*sity Canada's Fund for Ob*sity Collaboration and Unified Strategies (FOCUS) initiative” Novo Nordisk is a supporter of this fund, as well as a sponsor for their annual summit.Here are excerpts from the 1,293 word competing interests statement for the authors (I've only included Novo Nordisk and Eli Lilly, the two main companies trying to sell this class of drugs for weight loss.) Sean Wharton reports receiving honoraria and travel expenses and has participated in academic advisory boards for Novo Nordisk, Eli Lilly. Sean Wharton is also the medical director of a medical clinic specializing in weight management and diabetes. David Lau reports receiving grants and research support from Novo Nordisk, speaker bureau fees from Eli Lilly and Novo Nordisk; and consulting fees from Eli Lilly and Novo Nordisk. Michael Vallis is a member of advisory boards for Novo Nordisk. Michael Vallis has also received consulting fees from Novo Nordisk and speaking fees from Novo Nordisk. Arya Sharma reports receiving speaker's bureau and consulting fees from Novo Nordisk. Laurent Biertho is a member of advisory boards for Novo Nordisk. Denise Campbell-Scherer reports receiving research funding from Novo Nordisk. She also reports receiving an unrestricted education grant from Ob*sity Canada, funded by Novo Nordisk Global. Jennifer Brown reports receiving nonfinancial support from Novo Nordisk, and personal fees Yoni Freedhoff is the co-owner of the Bariatric Medical Institute and Constant Health, which provide weight management services; Constant Health has received a grant from Novo Nordisk. Yoni Freedhoff also regularly speaks on topics related to ob*sity and receives honoraria and travel costs and expenses for same. Michel Gagner reports receiving consulting fees from Novo Nordisk. Marie-France Langlois reports receiving personal fees from Novo Nordisk, Eli Lilly. David Macklin reports receiving personal fees from Novo Nordisk. Priya Manjoo reports receiving personal fees from Novo Nordisk. Marie-Philippe Morin reports receiving speaker honoraria from Novo Nordisk, Eli Lilly and research subvention from Novo Nordisk, and consultation honoraria from Novo Nordisk, Eli Lilly. Sue Pedersen reports receiving personal fees from Novo Nordisk, Eli Lilly and grants from Eli Lilly, and nonfinancial support from Novo Nordisk and Eli Lilly.Megha Poddar reports receiving honoraria for continuing medical education (CME) from Novo Nordisk, Eli Lilly, education grants from Novo Nordisk, fees for mentorship from Novo Nordisk; fees for membership of advisory boards from Novo Nordisk. Paul Poirier reports receiving fees for consulting and continuing medical education from Eli Lilly, Novo Nordisk. Judy Shiau reports receiving personal fees from Novo Nordisk. Diana Sherifali reports receiving a grant from Ob*sity Canada to support the literature review process, during the conduct of the study. Shahebina Walji reports receiving consulting or advisory board fees from Novo Nordisk and speaker's bureau fees from Novo Nordisk.All of their recommendations around liraglutide are level 2a (Evidence from at least 1 controlled study without randomization) and Grade B ( Directly based on level 2 evidence or extrapolated recommendation from category 1 evidence) they suggest that these recommendations should use the terms “may” or “can” (as opposed to “should.”) The studies that they cite offer, at most, only 56 weeks of follow-up.Information supporting the public health relevanceIn this section they claim that “not only is the prevalence of ob*sity increasing, but the number of global deaths attributed to BMI has substantially increased from 1990 to 2017 (Figure 1) [23]. The global burden of disease of ob*sity study also found that though the age-standardized rate of high BMI related disability adjusted life years (DALY) increased by 12.7% for females and 26.8% for males, the actual global number of high BMI DALYs has doubled, despite sex”The study that they cite to support this (The global burden of disease attributable to high body mass index in 195 countries and territories, 1990-2017: An analysis of the Global Burden of Disease Study, Dai et al., 2020) calculates these numbers based on the assumption that the health problems higher-weight people have are due to their weight (even though people of all sizes experience them). They also fail to control for the health impacts of weight stigma, weight cycling, or healthcare inequalities, despite the research that shows that they are confounding variables. The assumption that higher-weight people's health issues are caused by their weight coupled with the failure to account for (or even discuss) confounding variables suggests to me either near-complete incompetence of the study authors around basic research methods, or a desire for specific conclusions.The study is at least honest that they don't know if weight loss would change this, stating “Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases” [emphasis mine].Thus, this doesn't actually support the recommendation to the WHO. Without proof that these medications would reduce disease or increase life years long-term, there is no reason to consider them “essential,” and no such evidence exists.Next they claim that “Ob*sity also plays a role in health care related costs; for patients and families, total healthcare costs for patients with ob*sity were higher than that of patients who are overweight.”First of all, this begins to wade into the idea that higher-weight people should be eradicated because they are “too expensive,” which is heading down a bad road when it comes to ethics. Further, the study they use to support this is based on 97 Dutch people who filled out a survey. The study included costs such as “expenditures related to the respondent's weight, such as adapted clothing, gym subscription, diet books, parking permit, food, etc.” First of all, thin people also have gym subscriptions and parking permits, but, moreover, telling fat people that they should buy diet books and pay for various weight loss foods and methods (despite the near-total failure rate,) then blaming them for the cost of following those dubious recommendations (as well as the additional costs of living in a world where structural weight stigma creates a lack of accommodation in clothing etc.) as a justification for more expensive, more dangerous “interventions” is a long way from being ethical science and is a particularly craven marketing tactic. I'm just going to stop there, but to say that I've seen elementary school science fair projects with more rigorous methodology and I would be beyond embarrassed to cite this for any reason ever, other than as an example of the piss-poor state of weight science.They finish up the section with “Given the global burden of ob*sity and the goal of reducing preventable disease related deaths, it is evident that affordable and available pharmacotherapy for ob*sity is needed on a global level.”Let's rephrase this to reflect the evidence they provided: “Based on a survey taken by 97 people, a study that failed to control for any confounding variables and made wild assumptions about causality based on simple correlation, and their own research's acknowledgment that changing body size may not change health outcomes, it is evident that affordable and available pharmacotherapy for ob*sity is needed on a global level.”Which is to say, what they provided here does not come close to justifying their request.In part three we'll wrap this up with a look at the evidence they use to discuss harm, effectiveness, and cost-effectiveness.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!There are a number of different ways that bias can impact the healthcare that higher-weight patients receive. This includes provider bias and structural bias (when the healthcare system is created for thin bodies and/or to the specific exclusion of fat bodies.) Today I want to talk about what happens when these two types of bias intersect. It's a perfect storm that both supports and increases this bias. It doesn't have to be this way, and there is a simple first step (though it's certainly not the only step,) that healthcare providers can take to interrupt it. Let's look at some real-world examples (shared anonymously with permission):A fat patient arrives for a mammogram. They receive a gown but it doesn't fit, they ask for a larger gown and the tech says “If you're too big for that one I can give you a second one and you can wear both.”A fat patient needs an MRI. They get on the table, and it begins to move. But the patient's hips catch on the sides. The tech stops the table, and says “Your hips are too wide for the MRI, we wont' be able to do the scan.”A patient goes to the pharmacist to get Plan B for pregnancy prevention. The pharmacist asks the patient's weight and then says “Your weight is too high for this pill to be effective.”A fat patient calls 911 because they have symptoms of a stroke. The paramedics arrive and say “you are too wide to fit on our gurney, we're calling a special ambulance to transport you.”A fat patient gets a report back on a CT scan and it says that conclusions could not be drawn because of the “patient's body habitus.”A fat, pregnant patient arrives at an Ob/Gyn practice for their first pre-natal visit. The receptionist says “You are too heavy for our tables so we can't accept you as a patient.”A fat patient points out to the receptionist that all of the chairs in the waiting room are too small for them, the receptionist says “I'm so sorry but if you don't fit in the chairs you'll need to stand.”A fat patient is at the doctor for their annual pap smear. The gynecologist says “I'm sorry but you are too heavy for our largest speculum, if you want to make another appointment and bring your own, we can proceed.”A fat patient has injured their knee and sought care in the ER. The doctor says that “there is nothing he can do to help, you'll need to get an MRI and see an orthopedist and you should keep the knee immobilized and not put any weight on it or you could cause catastrophic injury. Unfortunately, your knee is too big for the immobilization braces we have, and your weight is too high for the crutches. We can let you use a wheelchair to get to your car but then you're on your own.”A fat patient has come to the ER for chest pains. An EKG has shown arrhythmias and blood tests show elevated troponin. The nurse explains that the patient is being admitted but says “I apologize but you are too heavy for our ER beds, we are waiting on a bariatric bed to be brought down.”Again, these are all true stories that have happened to higher-weight patients and there are a LOT of things wrong here that negatively impact patient care. But did you notice the one thing that all of these scenarios had in common? The one thing that, had providers done it differently, could have immediately reduced the weight stigma being experienced by the patient (even though many other steps are necessary to actually solve the problem)?Feel free to take a minute to think about it, or read on for the answer.The one thing that each of these scenarios have in common is that healthcare providers blamed the patient's body for the lack of accommodation. This is a common way that we see both implicit and explicit bias surface and intersect with structural weight stigma. The patient is already experiencing structural weight stigma that is impacting their care, the added stigma of being blamed for the healthcare systems' failure to accommodate them adds insult to injury and adds harm.Solving weight stigma can be difficult and involve a lot of action from a lot of different people, but this one can be solved by each individual provider at the point of care. The patient isn't “too big,” “too wide,” “too heavy,” etc. The equipment is too small. The patient is never the problem. Healthcare should be accessible to everyone and, if it's not, then that's a failure of healthcare, not a failure of the patient for existing in a body with needs that were completely predictable.One way to think about this is “Did the decisionmaker here not know that fat patients existed, or did they just not care if fat patients got the same care as thinner ones?” Either way it's an absolute failure of the healthcare system, not the patient.It's entirely possible that the lack of accommodation is not the fault of the provider who is currently working with the patient, but they can still be the one to apologize and make it clear to the patient that this is not their fault and shouldn't be happening.Again, this is only a first step, but it's not just a first step for the patient, it's also important for providers to consistently remind themselves that they are part of a system that too often fails their fat patients and that fat patients aren't to blame for that.Here is a guide to what to do if you aren't able to accommodate a higher-weight patient.For a deeper dive into how weight stigma shows up in healthcare, check out this piece.I also have a guide to creating a size-inclusive healthcare practice here.I wrote more about the patient who was asked to bring their own speculum here.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In Part 1 we talked about how Novo Nordisk got suspended from The Association of the British Pharmaceutical Industry for their shady marketing practices. Today, we're going to talk about an investigation by The Observer that found what so many of us have been saying for a looooong time - that Novo Nordisk had paid millions to prominent ob*sity “charities,” NHS trusts, universities and other bodies as well healthcare professionals who publicly praised the drug (typically without disclosure of their funding) and who advised NICE (The National Institute for Health and Care Excellence) on their reviewing of Novo's weight loss drug to decide whether or not it should be made available.The Observer article by Shanti Das and Jon Ungoes-Thomas “‘Orchestrated PR campaign': how skinny jab drug firm sought to shape ob*sity debate” (Note: per my policy I'm not linking to it because it still comes from a place of weight stigma) found that in three years, Novo Nordisk had shelled out £21,700,000 (about $26,415,301.50 USD) over 3,500 transactions which were separate from their research and development spending.The Observer found:“The payments include donations, event sponsorship, grants and other fees to prominent ob*sity charities, NHS trusts, royal colleges, GP surgeries, healthcare education providers and universities - on top of £28m spent by the company on research and development. A further £4m in payments such as consulting and lecture fees went to health professionals, including experts on ob*sity. The business has also provided financial support for the running of the all-party parliamentary group on ob*sity - a cross party group of MPs and members of the Lords that lobbies the government on health policy.”I've written before about how major papers like the New York Times are writing articles that are, essentially, lobbying for Novo Nordisk's priorities where every expert quoted is on Novo's payroll with no disclosure. One question I get asked a lot is “how is that legal?” First I'll point out that legal and ethical are two different things. Beyond that, there is a tendency to believe that doctors and academics are somehow immune to industry influence (or to the ways that their promotion of the weight loss paradigm will support their careers) such that reporters and others (including those on the pharma industry's payroll) claim that disclosing these conflicts of interest isn't important.An excellent example of the ways in which those who are seen as “impartial” experts in academia are, in fact, on the payroll of these companies and actively shilling for them is Professor John Wilding. Professor Wilding is at Liverpool University, where he leads clinical research on “ob*sity.” He also serves as president of the “World Ob*sity Federation” (an astroturf organization similar to the Ob*sity Action Coalition) which took more than £4.3M over three years, per The Observer. Somehow, this did not make its way onto his conflicts of interest statement. Meanwhile, he was quoted extensively in the media recommending Novo's drug Wegovy. Jason Halford, who is the Head of the School of Psychology at the University of Leeds, told an audience of millions on BBC that Wegovy is “one of the most powerful pharmaceutical tools” for treating “ob*sity.” He did not disclose that he is also the president of the European Association for the Study of Ob*sity (EASO), another astroturf organization (which is to say, an organization that claims to advocate for marginalized people but, in reality, is predominantly funded by and acting as a lobbying arm of, the pharmaceutical/weight loss surgery industry.) The Observer found that the EASO received more than three-quarters of its income (more than £3.65m) from Novo Nordisk. He was also a previous member of Novo Nordisk's UK advisory board.I'm glad Novo Nordisk's lack of ethics are getting wider coverage (though, as I pointed out in part 1, people in fat liberation and weight-neutral health advocates like Mikey Mercedes, Louise Adams, Asher Larmie, myself and others have been talking about this for some time,) but I don't expect it to stop them until we can put enough pressure on them to force them to stop. This is a company that orchestrated aggressive price gouging on insulin, proving beyond a doubt that they will kill people for money. And as pressure in the US is forcing Novo to lower the price of insulin, they seem to have a lot of eggs in the Wegovy basket. Prior to launch, they promised their shareholders the “fastest ever” post FDA-approval launch and that they would double their “ob*sity” sales by 2025. In fact, The Observer found that Novo Nordisk's sales on their new “ob*sity treatments” rose 84% in 2022 to $2.4B – a figure Novo projects will “grow significantly” in 2023.And what will they do to grow this figure significantly this year? I think their behavior makes it clear – absolutely anything they can get away with.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!If you have read this newsletter for any period of time, you've read my accounts of how pharmaceutical company Novo Nordisk has been using extremely shady marketing practices (many taken from the playbook that Purdue Pharma used to push oxycontin) to promote their drugs for weight loss. Things likePutting doctors on their payroll to promote their drugs to the media without disclosing their ties to the NovoCreating astroturf organizations that claim to be advocacy groups for higher-weight people but are, in fact, funded by Novo and other pharma and weight loss surgery groups.Marketing their drug through Grand Rounds presentationsCreating PSAs and Sponsored Content using people who (you can't make this stuff up) play doctors on TVCo-opting the concept and language of anti-weight-stigma activists in order to sell their weight loss drugsAnd I'm far from the only person talking about this.Mikey Mercedes has publicly called this out. Louise Adams from Untrapped has been all over it  (I had the chance to join Louise Adams and Fiona Willer on Louise's Podcast All Fired Up to talk about this)Asher Larmie, The Fat Doctor, has also been talking about thisAnd there are plenty of others.Part of the issue is that in the United States pharma companies are allowed to market direct-to-consumers , and the rules and regulations that exist are often loosely enforced. That's why I was thrilled to learn that The Association of the British Pharmaceutical Industry (ABPI,) a trade association that works in England, Scotland, Wales, and Northern Ireland in partnership with the government and the NHS on behalf of their members, had suspended Novo Nordisk for being in breach of the ABPI code of practice.Interestingly, just a month ago, the president of ABPI was Novo Nordisk UK General Manager and Corporate Vice-President Pinder Sahota. Sahota stepped down from the board in February “to avoid an ongoing process around a Novo Nordisk ABPI Code of Practice breach becoming a distraction from the vital work of the ABPI.”The complaint was made to The Prescription Medicines Code of Practice Authority (PMCPA) which is “the self-regulatory body which administers the Association of the British Pharmaceutical Industry (ABPI) Code of Practice for the Pharmaceutical Industry, independently of the ABPI. It was established by the ABPI on 1 January 1993.”The complaint centers around a LinkedIn post offering practitioners a free “weight management” course. The only “weight management” treatment covered in the course was GLP1-RA drugs. Novo Nordisk was, at the time, the only company selling these drugs. The course was “sponsored” (paid for) by Novo Nordisk, but that was not clear in the LinkedIn Ad.Not only did this “course” offer information, but they also offered a free Patient Group Direction (PGD). Per the NHS a PGD is  “a written instruction for the sale, supply and/or administration of medicines to groups of patients who may or may not be individually identified before presentation for treatment. May or may not be identified means an individual can either be known to the service/have an appointment (e.g. a baby immunisation clinic) or not be known in advance of presenting at a service (e.g. a walk in centre).PGDs are not a form of prescribing. PGDs allow health care professionals specified within the legislation to supply and/or administer a medicine directly to a patient with an identified clinical condition without the need for a prescription or an instruction from a prescriber. The health care professional working within the PGD is responsible for assessing that the patient fits the criteria set out in the PGD.”The complainant pointed out that the PGD was part of what was being offered to individual health professionals by Novo Nordisk, that it had a value, and that it was being given to individuals for their own personal benefit to run private clinics. The complainant suggested that this amounted to bribing health professionals with “an inducement to prescribe.”The complainant noted that on the website the course had been run several times, so it was likely that a large number of health professionals had received this offer.The ABPI review panel found that the training was provided by a third party, but attendees and PGDs were sponsored by Novo Nordisk. The training mentioned three drugs, the first two (orlistat and naltrexone/bupropion) were presented as having significant side effects and contraindications, while the third drug, Novo's Saxenda, did not include side effect information (though they are significant) and the training noted that Saxenda could be provided by an appropriate health professional with a valid PGD (which was provided by the course.)The training included 21 slides about Saxenda, but no such detail on the other two drugs.Sponsorship of third party trainings by drug companies are permissible by APBI “only if there had been a strictly arm's length arrangement with no input by the company and no use by the company.” In this case, the agreement between the training provider and Novo stated that “Novo Nordisk will be in attendance at training meetings and will be given delegates to follow up” and the panel found that “Novo Nordisk had reviewed the training materials used on the course for medical and factual accuracy.”The panel concluded that “the course (webinar and e-learning) was, in effect, promotional material for Saxenda for which Novo Nordisk was responsible”The Panel found that “the webinar, in effect, promoted Saxenda which Novo Nordisk was responsible for, and considered that Novo Nordisk's involvement in relation to such promotion, including that its medicine would be discussed in detail, was not made sufficiently clear at the outset. Therefore, a breach of the Code was ruled. Novo Nordisk's appeal on this point was unsuccessful.”The contract between Novo and the third party was signed in February 2020, with the intention that 13,000 professionals be trained over 2 years, each of whom were to be provided a PGD making Novo Nordisk's maximum contract £357,500 (about $455,578 USD). As of July 1, 2021, 4,399 health professionals had completed the training and 599 PGDs had been activated.The Panel found that “the provision of funding by Novo Nordisk for the PGD was clearly linked to the promotion of Saxenda; the Panel did not consider there could be any intention other than to directly increase the use of Saxenda. Furthermore, the Panel noted that the cost of the provision of the PGD to prescribe Saxenda was given to individual health professionals. Such funding to individual health professionals did not meet the requirements of the Code and was an inducement to prescribe, supply, administer and/or recommend Saxenda and the Panel therefore ruled a breach of the Code. Novo Nordisk's appeal on this point was unsuccessful.”“The Panel considered that the arrangements between Novo Nordisk and the training provider, particularly in relation to the PGD, brought discredit upon, and reduced confidence in, the pharmaceutical industry. A breach of Clause 2 was ruled. Novo Nordisk's appeal on this point was unsuccessful.”Novo Nordisk's decided to appeal on the basis that they didn't know it was a breach. This backfired spectacularly.The Appeal Board was “very concerned that Novo Nordisk did not recognise that this was a large-scale Saxenda promotional campaign which Novo Nordisk knowingly paid for and which was disguised. In the Appeal Board's view the gravity of the breaches was compounded by Novo Nordisk's failures to recognise that its own behaviour was not compliant with the Code…The Appeal Board was concerned about the potential impact on patient safety of providing unbalanced information to a wide audience, particularly given that the arena of weight loss was a highly emotional arena, and particularly given the lack of balance of Saxenda's safety profile and side effects when comparing it with its competitors.”The Appeal Board decided to publicly reprimand Novo Nordisk for “its failings and the potential impact on patient safety.” They also ordered an audit and decided that “the circumstances were so egregious that a report to the ABPI Board was the only appropriate course of action.”The ABPI Board unanimously decided that further action must be taken, and while they chose not to expel Novo outright, they noted that this option could be exercised at a later date. While a majority wanted to immediately suspend Novo Nordisk's membership, they didn't reach a 75% threshold and so decided to conduct an audit.Subsequent to that audit they determined that Novo Nordisk's actions were ““likely to bring discredit on, or reduce confidence in, the pharmaceutical industry” and suspended them for two years, with reinstatement pending a future audit.In Part 2 we'll talk about some investigative journalism that caught Novo Nordisk in more shady marketing practices. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Transcript This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Reader Marcel sent me the following question:I just got diagnosed with sleep apnea. My doctor told me that if I could just lose 5-10% of my body weight, it would go away. I've yo-yo dieted all my life and sometimes got to 5% lost before it came back, but never even got to 10% and most times I ended up heavier than when I started. I'm nervous to try again, but sleep apnea is really scary.There are a lot of things that can contribute to obstructive sleep apnea (OSA,) including everything from enlarged tonsils to hereditary structural issues, to heart issues and more. It's possible that someone's size and/or the way that their adipose tissue is distributed could contribute to OSA. But it's complicated, in part because sleep apnea is known to induce weight gain so when they say x percent of people who have sleep apnea are fat, we don't know to what extent it may be a chicken and egg situation.It can also simply be a function of the number of fat people who exist. For example (and I'm using made-up numbers for this,) the statistic might say “being fat is a risk factor because 60% of people with sleep apnea in the US are fat.” However, if 70% of people in the US are fat and only 60% of people with sleep apnea are fat, then fat people are actually underrepresented. (Incidentally, I've seen a lot of this mistake happening with COVID numbers.)  It may also be a function of testing bias – if fat people are tested much more often for sleep apnea than thinner people, then it would not be surprising if fat people had a higher incidence.It's also important to understand that even if someone's sleep apnea is caused by weight/adipose tissue distribution or body size in general (for example, body builders have also been shown to be at higher risk with associations to their BMI and also to their neck circumference,) that still doesn't mean that weight loss is an appropriate treatment. For that to be true, weight loss would have to meet the requirements of an ethical, evidence-based intervention. Given that it fails the vast majority of the time, and has the opposite of the intended effect up to 66% of the time, it doesn't qualify.While there is some short-term research that shows a decrease in OSA symptoms/severity with weight loss, those studies don't capture the likely weight regain, nor do they separate the impact of the behavior changes that people make from the impact of weight loss (in research around other health issues, it's been found that it's likely the behavior changes, not the weight loss that create the health impacts.) There are other studies that find that, for example, “physical activity has been found to have a 32% reduction in the AHI (a reduction of 6.27 events/h) and a 28% reduction in daytime sleepiness, as well as a 5.8% increase in sleep efficiency and a 17.65% increase in VO2peak, having found no significant reduction in the BMI. (The role of physical exercise in obstructive sleep apnea, de Andrade 2016.) This is consistent with other research about movement and health. Of course, this isn't a deep dive into the research, I just want to make the point that when people claim that the research shows that weight causes OSA and weight loss solves it they are not stating anything resembling a proven fact.Moving on to Marcel's doctor's claim that losing 5-10% of body weight will make the sleep apnea go away. There are people of all weights with (and without,) sleep apnea, so suggesting that losing a specific amount of weight will help is based on some questionable logic and math. For example,A 300-pound person has sleep apnea and is told that losing just 5%-10% (thus weighing 270-285 pounds) will make it go away.But if someone who weighs 270-285 pounds has sleep apnea, they are told that…losing 5-10% of their weight will make it go away.Then, a 200-pound person who has sleep apnea, even though they are 100 pounds lighter than the first person, will be told that…losing just 5-10% of their weight will make it go away.Also, remember that up to 66% of the time, weight loss ultimately ends up in regain. So if a 300-pound person has sleep apnea and tries to lose 5-10% of their body weight, but then regains to 315-320, they would be told that they should lose 5-10% of their body weight to make their sleep apnea go away…which would put them right back at 300 pounds.This is not scientific. Essentially, whatever weight/BMI a healthcare practitioner says someone should achieve in order to help their apnea, there are already plenty of people at that weight/BMI who have sleep apnea (and that's before we point out that significant, long-term weight loss fails for the vast majority of people and that weight loss isn't an ethical, evidence-based treatment for anything.)If you are dealing with OSA, there is a HAES Health Sheet here with weight-neutral options.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In the early days of the pandemic studies were rushed out and highlighted in the media claiming that higher-weight people were at higher risk of COVID death. I wrote about the issues with this in my previous blog, as did Christy Harrison, Paul Campos and others.Now an umbrella review has been published. This is a review of existing systematic reviews and metanalyses.Quick background. A systematic review (SR) starts with a research question, creates inclusion criteria for evidence, and then attempts to gather and summarize all of the available empirical evidence that fits the inclusion criteria. A meta-analysis (MA)  is the application of statistical methods to the results of the studies collected by the systematic review. An umbrella review (UR) synthesizes all of the available systematic reviews and meta-analyses about a broad research question, typically taking into account not just the findings of the SRs and MAs, but also the quality of evidence within them. This is important because if the SR/MAs include poor quality studies, then they risk poor quality summary/analysis/conclusions.So, this study “Risk of bias and certainty of evidence on the association between ob*sity and mortality in patients with SARS-COV-2: An umbrella review of meta-analyses” by Silva et al, 2023 looked at systemic reviews with meta-analyses (SR-MAs) “to evaluate the risk of bias and the certainty of the evidence of SR-MAs on the association between ob*sity and mortality in patients with SARS-CoV-2.”They begin that:“Poorly conducted SR-MAs can lead to inaccurate illustrations of evidence and misleading conclusions, leading to limited applicability.”Then point out that:“There are concerns that in the panic to provide answers to help administer the COVID-19 pandemic, SR-MAs are being conducted without many of the keystones of robust methods”They sought to answer two questions with their UR: 1. What is the quality and certainty of evidence on the association between ob*sity and mortality in patients with SARS-CoV-2?2. What is the magnitude of the association between ob*sity and mortality in patients with SARS-CoV-2 demonstrated by SR-MAsThey reviewed 24 SR-MAs from multiple countries. Ultimately they found that, while most SR-MAs did show an association between being higher weight and COVID mortality, there were serious questions as to the quality of the research that led to those conclusions.They found that “most SR-MAs had critically low quality, and…the certainty of the evidence was very low.” In fact, in terms of certainty of evidence, 21 of the 24 SR-MAs were classified as “very low.” In terms of quality, 66.7% of the SR-MAs were “critically low quality,” and 29.2% were “low” quality. Only one of the included SR-MAs reached the “moderate” quality level and it DID NOT find a significant link between being higher-weight and COVID mortality.The UR author's explanation for this is that the pandemic created the need for fast information (which is, of course accurate) but that in the rush to get data “many of the keystones of robust methods are being forgotten.” I would add that, as we often talk about in research reviews here, when it comes to weight science, the keystones of robust methods are often thrown out the window regardless of how much time the authors have to conduct their research (Lucy Aphramor has an excellent piece about this.) For example, this has happened before. During the 2009 H1N1 outbreak, fat people had poorer health outcomes (and researchers and media were quick to jump on the bandwagon of assuming that fat bodies were the cause the and trying to figure out what about fat bodies caused this.) It turns out the actual issue was that fat people were systematically treated later with antiviral medication than thin people. Per a study on the subject (Sun et. al. 2016) “After adjustment for early antiviral treatment, relationship between ob*sity and poor outcomes disappeared.”The findings of this UR are, of course, a far cry from all the headlines claiming that being higher-weight created higher risk and from the subsequent programs and suggestions that fat people have an obligation to become thin (despite no evidence that that is even possible) as part of COVID mortality prevention. Unfortunately, when it comes to research, the media, and public health policy anti-fatness is often published, often enacted, and rarely questioned.Frustratingly, even the UR authors in their introduction section uncritically buy in to the pathologization of body size, and the blaming of health issues/deaths on higher-weight bodies rather than, at the very least, acknowledging the confounding variables of weight stigma, weight cycling, and healthcare inequalities. Still, perhaps there is some clarity in the fact that these findings come from researchers who seem to be fully invested in the anti-fat paradigm.Finally, I want to point out that healthcare inequalities, including everything from practitioner bias to lack of accommodating equipment (blood pressure cuffs, hospital beds, etc.) as well as medications, dosing, and clinical best practices that are created for thin bodies that may not work as well/at all for fat bodies (for example, around respirator use) can create worse outcomes for higher-weight people (which typically are subsequently blamed on their body size.) This does the most harm to those at the highest weights and those with multiple marginalized identities. Further, I was part of a broad-based coalition that re-wrote California's Care Rationing Protocols (the guidelines for what to do when there aren't enough resources to treat all patients) to remove weight stigma, ableism, and racism. Still the guidelines are not law, even in California, and it is permissible in many cases for those making rationing decisions to use BMI as a reason to deny care in rationing situations. For these reasons and more, I think that the continued treatment of higher-weight people as higher-risk/higher-priority for vaccines and other treatment remains appropriate.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Finding out that you need an x-ray, MRI, CT or other scan can be scary for people of all sizes, but fat* people can face a lot of additional and, unfortunately, well-founded fears about the experience. Here are some tips and tricks for people who offer these scans to make the experience better for higher-weight patients.I know that many people won't be able to do all of these things, what I'm asking is that you use any power/privilege/leverage you have to do what you can (and know that anything you can do WILL make a difference) and then consider finding allies who you can work with to push for larger changes.1.      Know what you are working withKnow everything you can about the equipment and facility. What is the weight-rating of the table/bed/chair? What is the bore size of the scanner? Are there any other size/weight limitations? If you don't have the most accommodating equipment that exists, proactively create a list of who does so that you can refer patients. Make sure all of that information is easy to access for everyone who might be patient-facing.2.      Know the people you are working withBe aware of all the patients you may work with. Sometimes when it comes to inclusion, identities can become siloed. So even if there are protocols for higher-weight patients and protocols for wheelchair users who need to transfer, there may not be protocols for higher-weight patients who are wheelchair users who need to transfer. Sometimes a lot of focus is put toward accommodating patients physically, but less focus is put on making sure patients, including neurodivergent patients, are psychologically comfortable. Consider bringing in educators and/or consultants to help you think through all the patients you might work with and proactively create protocols so that every patient will have a positive, seamless experience.3.      Communicate what you are working with to the people you are working withGive as much information as you can – including the weight ratings and bore sizes of your equipment, any accommodations you offer (for size, disability, neurodivergence etc.) be honest about who you can't accommodate (and offer referrals to places that can). Don't wait for patients to ask and don't make assumptions about who needs to know. Provide this information to every potential patient early, often, and through as many delivery methods as possible – on your website, when patients call, on their MyChart or other online patient record, in appointment reminder texts, literally in every possible way.Communicating about accessibility and accommodations helps people who need the access and accommodations AND it educates people who may currently have privilege that puts them in a situation where they don't know what they don't know. It can help them stop taking their access for granted, help them to be more educated for the people in their lives who may not typically be accommodated, and help them in the event that their needs change.4.      Create an accessible experience start-to-finishIt's not just about the equipment. Do you have armless chairs in your waiting room and in any treatment rooms? Do you have the largest possible gowns? If you take blood pressure do you have cuffs that work for all arm sizes? Don't take the patient's weight for no reason (ie: “routine weigh-in.”) If you truly need to get the patient's weight (for example, if you're using weight-based contrast medium dosing) instead of just asking their weight (which might be jarring/upsetting to them) explain it to the patient in a non-judgmental way. For example “The contrast is dosed by weight. We don't care about your weight except to get the dose right!” There is a size-inclusive healthcare office audit here.5.      Center the patient's experienceStory time! (Shared with permission, of course.) I was recently acting as an advocate at an orthopedic appointment that included an x-ray. Ortho appointments can be some of the most fraught for fat patients so the patient was nervous and I was on high alert. We had talked through scenarios and worked out a signal they would use if they wanted me to jump in (in a nod to The West Wing, they would tug their ear lobe.)Things had gone very well so far - great chair options in the waiting area, no fat-shaming, a positive response to declining weigh-in, and the tech knew exactly what the weight-rating of the x-ray table was (650lbs). The patient had limited mobility and was moving slowly (because they had a knee injury, which is why they were at the orthopedist!) They explained that they could walk from the exam room to the x-ray room at which point the tech said “great, you can stand for the x-ray.” They explained that, in fact, they couldn't do that so they would need to use the table. The tech sighed audibly. As the patient worked to get onto the table without using their injured dominant leg the tech continued to sigh. The patient said “I can tell I'm frustrating you” and the tech said, “this is just taking a LOT longer than normal.” Earlobe tug. I stepped in and cheerily said “Isn't it interesting how there isn't really a ‘normal' and different patients need different amounts of time!” Then I put my body between the the tech and the patient, turned to the patient and said calmly “take all the time you need.” (The rest of the appointment was outstanding. It may be in part that the patient's issue is genetic, but the ortho said that he didn't think surgery was warranted but never mentioned weight loss or suggested that surgery would not be an option for this super fat patient.)This is an example of a tech centering their own experience. I know that often techs are under time pressure and that sucks, but it's certainly not the patient's fault, and making the patient feel guilty and embarrassed for taking the time they need won't make things go any faster, but it may make the patient less likely to try to access care in the future. So even if you are feeling pressured or stressed try to center the patient's experience. Also try to put yourself and the patient on the same team – the two of you against unfair time constraints, rather than you against them.6.      Do The Right Thing When Things Go WrongSometimes things go wrong – it can happen despite the best intentions, and it can often be outside of your control. Maybe the patient was accidentally scheduled on the standard MRI instead of the wide-bore, or even though you tried to get information about the CT weight limit to them they didn't realize that it would fail to accommodate them. I suggest that you always start by apologizing and making it clear that it's not the patient's fault. Even if it's not your fault, apologizing and taking the blame (or at least shifting the blame from the patient) can help them avoid a shame spiral that will lead to them disengaging from care. Ask the patient what they want – do they want help solving this, do they just want to leave, do they want a list of referrals. Respect the patient's requests and support them to the best of your ability.As always, it's unlikely that you can change everything, but you can change something and what you change will make a real difference in the experiences and lives of your patients, any effort you put into this will be more than worth it. I thank you in advance on behalf of all the patients you help. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I've been getting a lot of requests to write about Weight Watchers' acquisition of Sequence, so here we go. One note that, in order to keep this from becoming Tolstoy-esque in length, there are a lot of links so that you can dig in more where you want!I've been writing about Weight Watchers (aka WW) for more than a decade and I've noticed that one thing you can always count on Weight Watchers to do is…anything it takes to keep their stock prices up.Using celebrities to create body shameAdvertising to people with eating disordersCreating an entire campaign to gaslight us into believing that they are solving weight stigma rather than creating itMarketing a dangerous weight loss app to childrenChanging their name to try to co-opt the work of anti-weight stigma activists to claim they are about “health,” not weight (while selling the same old fatphobia-driven weight loss) Keeping that going publicly while moving back to their old weight-focused messaging (and name!) in individual communicationsFunding research that grossly and purposefully misrepresents the data that shows their abject failure to create significant, long-term weight lossAnd now…taking advantage of proposed legislation to increase access to telehealth, and piggybacking on Novo Nordisk's massive marketing campaign for their dangerous new weight loss drug, by purchasing a telehealth company whose focus is prescribing dangerous weight loss drugs.What is this company they are acquiring? Sequence is one of the scavenger companies that have popped up to capitalize on the massive marketing campaign around the new GLP-1 agonist class of weight loss drugs. Essentially the company employs a group of doctors and practitioners who prescribe weight loss drugs (including the new drugs as well as older drugs) with dangerous side effects and no long-term efficacy data, as well as a diet and exercise plan to people who pay a monthly subscription of $99 (which may or may not include their drugs.)Their marketing gives us the same old thing – big print that claims that people lose 15% of their body weight on average, small print that points out that this is for a people who have been on the program for at least 26 weeks, conveniently capturing the period when weight loss is expected (about the first year,) and not capturing the 2-5 years after when research shows that about 95% regain all of the weight that they lost, without any link to the actual study to see if they are ignoring drop out rates or using other sketchy research practices. And even that claim is contradicted on their “FAQ's page” which says “Sequence members lose 5% of their body weight within 3 months, and 10% of their body weight within 6 months.” They, of course, leave out the fact that the research does not support the idea that 5-10% of body weight loss creates health changes. (In fact, they don't discuss actual health at all, only body size changes, taking advantage of the common myth that weight loss automatically improves health.) And, again, all of this ignores the fact that almost everyone will regain all of this weight based on all the research that exists.They claim that medications “jumpstart” sustainable weight loss when there is absolutely no research to back that claim (and, in fact, the research says the opposite.) And if you dig into the website they are more honest that “The effects [of the “GLP Medications”] stop immediately if you stop taking the medication, and it is likely in most cases that some weight regain will occur.” (In fact, it is likely that people will regain all of the weight they lost and very likely more. Novo stopped the research after a year when people had gained back 2/3 of the weight that they lost in 68 weeks, but the trajectory was still going straight up.) What they don't show is that there isn't any data to suggest that the weight loss is sustainable at all. They have a “research” page, but there is literally no research there about their actual program available there, though there are a bunch of diet articles that look like they were copy/pasted from 1987 and one obligatory article on developing a “positive body image” among a sea of articles that pathologize fat bodies and encourage people to risk their health, lives, and quality of life trying to change those bodies.On almost every page they have their 15% weight loss claim with an asterisk that directs the reader to the claim “*Based on 5,377 members who have been on the Sequence program for at least 26 weeks. Average reported body weight lost was 15.17% and the top quartile lost an average of 19.90% of body weight.” I cannot find a published study with these numbers so for all I know they were produced via…rectal pull. What I do know is that, per Forbes and the Washington Post, they were founded in 2021, had 24,000 members at the end of February 2023 and annual revenue of about $25 million, but only 5,377 people managed to stay on for six and a half months? I have A LOT of questions about this data, but no answers due to their total lack of transparency.Their terms of service page is also illuminating, including (all caps theirs)TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, IN NO EVENT WILL WE OR OUR AFFILIATES, OR ANY OF OUR RESPECTIVE LICENSORS OR SERVICE PROVIDERS, HAVE ANY LIABILITY ARISING FROM OR RELATED TO YOUR USE OF OR INABILITY TO USE THE SERVICES FOR ANY ACTION YOU TAKE BASED ON THE INFORMATION YOU RECEIVE IN, THROUGH, OR FROM THE SERVICES.THESE LIMITATIONS WILL APPLY WHETHER SUCH DAMAGES ARISE OUT OF BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE) OR ANY OTHER THEORY OR CAUSE OF ACTION AND REGARDLESS OF WHETHER SUCH DAMAGES WERE FORESEEABLE OR WE WERE ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.WE DO NOT GUARANTEE CONTINUOUS, UNINTERRUPTED OR SECURE ACCESS TO THE SERVICES OR ANY OTHER RELATED SERVICES. THE OPERATION OF THE SERVICES MAY BE INTERFERED WITH BY NUMEROUS FACTORS OUTSIDE OUR CONTROL. UNDER NO CIRCUMSTANCES SHALL WE BE LIABLE FOR ANY DAMAGES THAT RESULT FROM THE USE OF OR INABILITY TO USE THE SERVICES, INCLUDING BUT NOT LIMITED TO RELIANCE BY YOU ON ANY INFORMATION OBTAINED FROM THE SERVICES OR THAT RESULT FROM MISTAKES, OMISSIONS, INTERRUPTIONS, DELETION OF FILES OR E-MAIL, ERRORS, DEFECTS, VIRUSES, DELAYS IN OPERATION OR TRANSMISSION, OR ANY FAILURE OF PERFORMANCE, WHETHER OR NOT RESULTING FROM ACTS OF GOD, COMMUNICATIONS FAILURE, THEFT, DESTRUCTION, OR UNAUTHORIZED ACCESS TO OUR RECORDS, OR PROGRAMS. YOU HEREBY ACKNOWLEDGE THAT THIS PARAGRAPH SHALL APPLY TO ALL CONTENT, DATA, AND INFORMATION SUBMITTED TO THE SERVICES.We may terminate your use of the Services for any or no reason at any time. YOU AGREE THAT WE WILL NOT BE LIABLE TO YOU OR ANY OTHER PARTY FOR ANY TERMINATION OF YOUR ACCESS TO THE SERVICES.And it goes on. That, to me, does not have the ring of a company that is prioritizing people's health.The leader of their medical team is Dr. Spencer Nadolsky. He specializes in “ob*sity* medicine (which, of course, raises a lot of red flags.) A quick browse of openpayments.cms.gov finds that Dr. Nadolsky has accepted small payments from Novo Nordisk, Eli Lilly, AstraZeneca, Boehringer Ingelheim, Janssen Pharmaceuticals, EISAI, GlaxoSmithKline, (if these names look familiar, it may be because they are funders of astroturf orgs that lobby for insurance coverage and expanded use for these drugs,) and Purdue Pharma (makers of Oxycontin, and architects of the marketing program that Novo and others are copying, including the use of astroturf orgs to lobby for insurance coverage and expanded use of drugs.)Now all this belongs to Weight Watchers.Weight Watchers is no stranger to the monthly-fee-for-harmful-service model, but this really ups the ante. Again, Novo Nordisk's own research has already shown that when people go off the drugs, they rapidly regain the weight (even faster than people regain weight after a year on Weight Watchers, which is saying something.) So Novo's marketing strategy is to suggest that living in a higher weight body is a “chronic lifelong health condition” that requires people to take their drug for life. It should be noted that they only have data on the drug for 68 weeks and their own data shows that weight loss had already leveled off and actually ticked up slightly even while people were still on the drug during those 68 weeks, so there's no proof that staying on the drug long-term will create sustained weight loss, though we do know that it will create greater exposure to the dangerous side effects, and a ton of profits for Novo Nordisk (and now Weight Watchers.)Again, this fits in with Weight Watchers original model. They have known from the beginning (and put in their company charter) that they are a repeat business model. As with all intentional weight loss interventions, almost everyone will lose weight short-term and gain it back long-term. They've been a large part of rebranding this weight cycling (which is independently linked to harm) by taking credit for the first part of the biological response (when people lose weight) and then blaming their victims for the second part of the same biological response (when the weight is regained.)From its inception, Weight Watchers has realized that if they were willing to harm fat people they could make a ton of money. Their current leadership is continuing their long tradition of putting profits before people. Their C-Suite and shareholders will celebrate while the people generating all that money will suffer.Oh, by the way, Weight Watchers stock went up about 50% after the announcement of their acquisition of Sequence.So here's a final reminder that Weight Watchers fiduciary responsibility is to their shareholders, not their customers.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I write and talk a lot about weight stigma and its negative impacts on health. Today I want to talk about a study that looks at how we can protect ourselves. In September of 2022, Angela Meadows and Suzanne Higgs published “Challenging oppression: A social identity model of stigma resistance in higher-weight individuals.” Big thanks to Dr. Meadows who read a draft of this piece and offered commentary which is quoted below.This study was the first to attempt to identify what factors predict whether a fat* person does or does not internalize weight stigma. They begin by explaining that, while higher-weight people make up about two-thirds of the population in western countries, weight stigma is still ubiquitous in every area of life including education, healthcare, employment, interpersonal interactions, and in the media. They also point out that being immersed in a culture of weight stigma leads many fat people to internalize that stigma, leading them to devalue themselves.They explain that “the most fundamental component of weight-related stigma directed at oneself remains the endorsement of negative stereotypes attributed to higher-weight individuals, applying those stereotypes to oneself, and exhibiting reduced self-worth as a result of one's higher weight status.”The next piece of this is the fact that internalized weight stigma had been linked to “a wide range of negative health and behavioural outcomes in both treatment-seeking and community sample.”Given this, the ability to avoid internalizing weight stigma is “generally associated with superior psychological and physiological outcomes compared with stigma internalisation or inaction.”In order to identify predictors of weight stigma resistance, they examined factors including the alignment with the group “Fat.” They start from social identity theory, which is, as Meadows explains“A theory of intergroup behaviour that was developed in the 60s and 70s. Evidence from many types of marginalised groups suggest that where people can leave a devalued group, that is usually the strategy they pursue. This is what we knew from experience, but it hadn't previously been applied to the idea that weight controllability beliefs constitute that permeable/impermeable group boundary, so should predict activism or alternative behaviours.”In the context of that framework, the assumption was that those who think weight is changeable are likely to be working to leave the “Fat” group to enter the “Not Fat” group, whereas those who have come to the conclusion that long-term significant weight loss is improbable (including through their own experience of weight-cycling) may come to view themselves as permanent members of the “Fat” group. For those members of the “Fat” group, the next determinant of stigma resistance becomes if they believe that they deserve lower status, or if they think that lower status is being unfairly foisted on them.The study authors created an online survey to measure perceived stigma, level of identification as an “overw*ight*/fat” person, perceived legitimacy of anti-fat discrimination, group permeability, stigma resistance, internalized weight stigma, and global self-esteem. Based on their answers, subjects were sorted into three groups: about a third were “Internalisers” who “tended to agree with statements relating to internalised weight stigma beliefs.” About 17% of the subjects were classified as “Indifferent” - they “tended to disagree or had no strong opinion about statements relating to either weight stigma internalisation or weight stigma resistance.” Finally, 50% were “Resisters,” those who “tended to disagree with or have no strong opinions about internalisation statements and tended to agree with statements about weight stigma resistance.”In the subsequent analysis, “perceived legitimacy of weight stigma” was the most important predictor of internalized stigma. Meadows explains“I think it's easier to understand conceptually if you think of it as a kind of continuum (even though it's not fully linear with internalisers at one end and resisters at the other). The point here is that legitimacy beliefs were the best predictor of whether people tended to be internalisers or resisters – internalisers had higher perceived legitimacy beliefs (although still not ‘high') whereas resisters were waaaay down at the bottom of the measurement scale.”Investment in the “fat” group also predicted resistance, but people were able to reach “Resistor” status even if they didn't invest in the “fat” group. Meadows says:To me, this is the most exciting and important piece. Group identity is usually considered the major determinant of activism/resistance. That resisters existed who weren't identified with the group was super interesting – you could use an allyship angle. Everyone needs to fight stigma, whatever their own body looks like or their relationship with it. It's a place we can start even if we haven't quite got to full acceptance yet – as is the case with many of us who have discovered fat acceptance/liberation movement. We get it in principle but it's hard to overcome all that brainwashing. But we can still fight stigma because stigma is bad.Group investment brings benefits on its own – ingroup identity is associated with improved wellbeing across marginalised groups.This study is groundbreaking and the authors themselves point out that there is much more work to be done. Still, what actions might we take based on these findings?First, we can recognize that weight stigma is all around us, and that internalizing it can do real physical and mental harm.We can become conscious of our own current thoughts about higher-weight people (including ourselves and others) and start to question the legitimacy of the weight-stigma-based beliefs that we have internalized. (I have a video workshop to help with that if you'd like more support and there is a pay-what-you-can option so that money isn't a barrier.)Understanding that we get many weight-stigma messages from so many places, we can acknowledge (and keep reminding ourselves) that the work of learning that weight stigma is not legitimate is ongoing. We can seek out messages (books, articles, social media accounts and more) that help us to constantly and consistently remember that weight stigma is real, that it is wrong, and that while it may become our problem, it is not our fault and it should not happen.We can also choose that, instead of thinking of ourselves as potential future thin people, we can identify as fat people, and insist that as fat people we have the right to exist without shame, stigma, bullying, or oppression no matter why we are fat, if there are any “health impacts” of being fat, or if we could become thin.Until we live in a world that affirms our right to thrive in fat bodies, we can push  back against any message that tries to convince us otherwise.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Recent guidance has come out recommending children have surgery or go on drugs to lose weight. Why is this a problem and what's the history behind anti-fat politics in America? Katelyn and Oliver sit down with writer, journalist and theorist Da'Shaun Harrison to explore these questions and learn about how anti-fatness is rooted in and inextricable from anti-blackness. Da'Shaun is the author of Belly of the Beast: The Politics of Anti-fatness as Anti-Blackness and Editor-at-Large of Scalawag Magazine. A very special thanks to our Cancellation List and above Patreons Megg, Catherine, Dahlia, I Beauregard, Leslie, Adrienne, Diego, Mae and Siobhan for making this episode possible. You can submit your requests for out of context cancellations, support our work and join our community by visiting www.patreon.com/CancelMeDaddy.

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I've written before about weight stigma in healthcare practice, and I'm currently co-authoring a study with Dr. Lesleigh Owen about the harm weight stigma does to the highest-weight patients. Today I'm going to dig into the research that already exists that explores the harm done to fat* patients by weight stigma.As we get into the research, a few reminders:First, weight stigma is rooted in and inextricable from racism and anti-Blackness, and continues to do disproportionate harm to those communities today. I urge you to read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness to understand more about this.Second, typically research over-represents privileged people and under-represents (or fails to represent at all) marginalized people, and thus the harm done to them is also under- or un-represented.Third, I wrote here about how weight stigma research is often still rooted in anti-fatness. I recommend reading this to contextualize a lot of the research and researchers I will talk about here.Many of the studies that will be discussed in this article look at perceived weight bias/weight status. In this way, weight stigma can harm people of many different sizes, so just a reminder that weight stigma, in particular structural weight stigma, always does the most harm to those at the highest weights and/or those with multiple marginalized identities.I also want to point out how often the things that are correlated with both weight stigma and body size are blamed on body size itself without any discussion of weight stigma as a strongly researched possible confounding variable (this is also common with weight cycling and healthcare inequalities.)In this piece I'll be looking at studies that show harm to physical and/or mental health, including iatrogenic harm, which means harm that is done by the healthcare system/healthcare practitioners. Weight stigma does much, much more harm in all aspects of the lives of higher-weight people that won't be examined here. Also, this provides brief overviews of the studies included and is far from an exhaustive list. Please feel free to add other examples in the comments.Finally, just a reminder that my policy is that when I refer to studies that perpetuate anti-fatness and harm, I will provide enough information to Google them, but I won't link to them directly. Last last thing before we dig in: studies refer to this variously as weight stigma, weight bias, sizeism, and other less common (sometimes more stigmatizing!) terms, I'm combining those for the purpose of this article.Content note: This section will discuss physical and psychological harm that can result from weight stigma, including bias and self-harm, and may be harmful/triggering to higher-weight people, so please take care of yourselfI think therefore I am: Perceived ideal weight as a determinant of health, Muennig et al., 2008This study looked at whether stress related to negative body image perception and the desire to lose weight could impact health, and found that the difference between actual and desired body weight was a stronger predictor of physical and mental health than actual body mass index (BMI) in cis women. “[cis] Women who say they feel they are too heavy suffer more mental and physical illness than women who say they feel fine about their size - no matter what they weigh.”The body politic: the relationship between stigma and ob*sity-associated disease, Muenniug, 2008This work examines the relationship between weight stigma and health issues, and finds that weight stigma may drive health issues that are typically blamed on body size.“Stigma and prejudice are intensely stressful. Over time, such chronic stress can lead to high blood pressure and diabetes.”The Weight of Stigma: Cortisol reactivity to manipulated weight stigma, Himmelstein et. al:Young women who were told in an experiment that their weights “weren't ideal” experienced higher levels of the stress hormone cortisol, regardless of their actual size.“Experiencing weight stigma was stressful for participants who perceived themselves as heavy, regardless of their BMI. These results are important because stress and cortisol are linked to deleterious health outcomes...”Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population, Hatzenbuehler, 2009* Perceived weight discrimination is associated with substantial psychiatric morbidity and comorbidity.* The results remained significant after adjusting for perceived stress (a possible confounding variable)* Social support did not buffer against the adverse effects of perceived weight discrimination on mental health.* Controlling for BMI did not diminish the associations, indicating that perceived weight discrimination is potentially harmful to mental health regardless of weight.They concluded that “These results highlight the urgent need for a multifaceted approach to address this important public health issue, including interventions to assist [higher-weight] individuals in coping with the mental health sequelae of perceived weight discrimination.”Weight stigma as a risk factor for suicidality, Brochu, 2020This study examined the connection between subjective perceptions of “overw*ight” and risks of suicidality and found that they were “associated with increased risk of suicidal ideation, plans, and attempt in a large sample of US adolescents, even when controlling for participant age, gender, race/ethnicity, body mass index (BMI), and depression.”I think that this is part of the serious danger of the new AAP guidelines which call for an intense focus on the weight of children, starting to label them as “overw*ght” and “ob*se” as young as two years old.Weight Discrimination and Risk of Mortality, Sutin et al, 2015The study found that* Perceived weight discrimination was associated with an increase in mortality risk of nearly 60%* This increased risk was not accounted for by common physical and psychological risk factors* In addition to its association with poor health outcomes, weight discrimination may shorten life expectancyWeight stigma and health behaviors: evidence from the Eating in America Study, Lee et al., 2021This study points out that “weight stigma is pervasive across the U.S. and is associated with poor health outcomes including all-cause mortality” and seeks to find if weight stigma drives poorer health behavior. (As a reminder, health is an amorphous concept and is not an obligation, barometer of worthiness, or entirely within our control.)The study found that weight stigma was significantly associated with greater disordered eating, sleep disturbance, and alcohol use.Overcoming Weight Bias in the Management of Patients With Diabetes and Ob*sity, Puhl, et al., 2016The health impacts of weight stigma can include:* increased blood pressure, blood sugar, and levels of the stress hormone cortisol* reduced engagement with health care services, reduced trust of health care providers* depression, anxiety, substance abuse, and suicidal tendency* unhealthy eating behaviors, binge eating disorder, and lower motivation for exercise* long-term health impacts including more advanced and poorly controlled chronic disease, and low health-related quality of lifeI want to point out here, again, how much overlap there is with health issues that get blamed on body size, and that studies that link being higher-weight to health issues typically don't even mention weight stigma, let alone control for it.Weight Stigma Among Healthcare Practitioners that Can Impact CareStigma in Practice: Barriers to Health for Fat Women, Lee and Pausé, 2016https://www.frontiersin.org/articles/10.3389/fpsyg.2016.02063/fullI recommend reading this in its entirety. Some of the highlights:* Fat individuals are less likely to access healthcare, and are less likely to receive evidence-based and bias-free healthcare when they do engage* Anti-fat attitudes are found in both practitioners and students, from physicians/doctors, researchers, clinicians, physiotherapists, dieticians, and nurses and  students in the medical and dietetic fields* Negative attitudes about fat patients result in doctors choosing to spend less time with fat patients and often resulting in fewer preventive and diagnostic tests for fat patients* Whether due to improper equipment, lack of education, bias, or an interaction between the three, it is clear that providers also present a barrier to the health and well-being of fat individuals.Nurses' Weight Bias in Caring for Ob*se Patients, Tanneberger & Ciupitu-Plath, 2018* Nurses found higher-weight patients lazy, stupid, noncompliant, less healthy, gluttonous* Biases stemmed from belief that weight is under the individual's control and/or that they would require more resourcesImpact on Nurses* Care was given out of disapproval or condemnationImpact on Patients* Canceling or delaying appointments after experiencing negative attitudes, discourteous treatment, and too small equipment being used during careThe Stigma of Ob*sity: A Review and Update, Puhl and Heuer, 2009* Over 50% of doctors found their higher-weight patients awkward, ugly, weak-willed and unlikely to comply with treatment.* 28% of nurses were “repulsed” by higher-weight patients* 12% of nurses said that they did not want to touch higher-weight patientsWeight bias among health care professionals: A systematic review and meta- analysis, Lawrence et al., 2021This is a systematic review and random- effects meta-analysis of 41 studies. It's important to note the overall quality of these studies was very low and the authors point out the need for better-quality research.“Findings show that medical doctors, nurses, dietitians, psychologists, physiotherapists, occupational therapists, speech pathologists, podiatrists, and exercise physiologists hold implicit and/or explicit weight-biased attitudes toward [higher-weight] patients.”I agree with Lawrence et al that we need more and better-quality research. And I think a major aspect of better quality is research that comes from a perspective that affirms the existence of higher-weight people and not from a perspective that is fully invested in the pathologization and eradication of existing fat people and the prevention of any more from existing. Weight stigma research that is invested in the weight-centric paradigm, as so much of the research above is, both displays and perpetuates additional weight stigma. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!The Ob*sity* Action Coalition (OAC) claims to be a non-profit advocacy group for higher-weight people. The truth from my perspective is that they are anything but.I wrote about the OAC in 2014 when their priority had been lobbying the AMA to declare that “ob*sity” is a disease. Today their priority is the “Treat and Reduce Ob*sity Act” the goal of which is to expand  Medicare coverage for weight loss interventions, including specifically expanding coverage for weight loss drugs.These priorities make a lot more sense when you realize that the OAC is not an advocacy group for higher-weight people, but rather an organization that is predominantly funded by, and lobbies for the priorities of, the weight loss industry.When I first wrote about the OAC the “Platinum” level of their Chairman's Council (a distinction for those providing funding of $100,000 or more annually) included:·         Allergan – Manufacturers of the lap band·         American Society for Metabolic and Bariatric [weight loss] Surgery·         Covidien – “committed to better patient outcomes through bariatric surgery“·         Eisai – manufactures of the weight loss drug Belviq (now pulled from the market)·         Vivus – manufacturers of the weight loss drug QysmiaAll of these organizations stood to profit from the AMA's declaration of being higher-weight as a disease (and the lobbying was successful, not only did the AMA declare living in a larger body to be a disease, but they blatantly ignored the findings of their own Committee on Science and Public Health which had studied the matter for a year and recommended against it in order to do the weight loss industry's bidding.)Having simply existing in a larger body re-branded into a disease was a major step forward, but not the only step. The next big step for Big Pharma is insurance coverage for dangerous, expensive (and almost certain to fail) weight loss “treatments.”And now the OACs “Platinum” level is down to one company – Novo Nordisk. A company that, having made a literal fortune price gouging on insulin, has promised their shareholders that their new weight loss drug, Wegovy, will make them billions. The rest of the sponsorship levels are still chock full of weight loss companies. They've also separated their Chairman's Council from what they are calling “Corporate Partners”. Here Novo is again the top funder at “more than $500,000 annually” with Eli Lilly kicking in “more than $100,000” and the list goes on. I've included the lists below.There is something else in common between the OAC of 2014 and today. At both times, they were involved in parallel campaigns that claimed to be about ending weight stigma, but were in fact about selling more weight loss interventions.We've seen this before. It was a tactic used by Purdue Pharma and other pharma and medical device companies to sell opioids – they created non-profits like the American Pain Foundation that were billed as advocacy groups for pain patients (a legitimate group of patients who deserve advocacy and treatment,) but were, in fact, funded by and acting in the interest of the pharmaceutical industry. The work of these non-profits influenced legitimate government and healthcare organizations to do the pharma companies' bidding, including influencing the behavior of doctors and other healthcare providers with their patients, creating an explosion in pain diagnoses and opioid prescriptions.This is exactly what Novo Nordisk and other weight loss companies want to do, so it's not surprising that they are taking a page or two from the Purdue Pharma Oxycontin playbook.Fool us once, a lot of people are harmed and killed in the service of pharma industry profits. Fool us twice, even more lives are irreparably harmed and lost. That is why it is critical that we not allow the OAC to get away with this - that we not allow them and their spokespeople to claim to be fighting weight stigma when they are really shilling for the weight loss industry.When you see “Ob*sity Action Coalition” you should think “Novo Nordisk and their weight loss industry buddies” and treat them accordingly, with extreme suspicion.Current “Corporate Partners”Note: the date represents how long they've been an “OAC Partner”Platinum (contributing more than $500,000 annually)Novo Nordisk (2013)Gold (more than $100,000 annually)Eli Lilly (2020)Silver (more than $50,000 annually)Boehringer Ingelheim (2010)Ethicon (2012)Medtronic (2010)Bronze (more than $25,000 annually)American Society for Metabolic and Bariatric Surgery (2005)Currax pharmaceuticals (2020)Fujifilm (2018)Patron(more than $10,000 annually)Bariatric Advantage Nutritional Products (2008)Intuitive (2021)Rhythm (2018)The Ob*sity Society (2012)Wondr Health (2017)Weight Watchers aka WW (2015)Source: https://www.obesityaction.org/corporate-partnersCurrent chairman's council funders:Platinum (donates more than 100k annually to OAC's general operating efforts)Novo NordiskGold: between 50k and $99,999 annuallyAmerican Society for Metabolic & Bariatric Surgery Bariatric Advantage Boehringer Ingelheim Eli Lilly and Company Pfizer Potomac CurrentsSilver $10k-$49,999 annually Amgen Currax Pharmaceuticals Ethicon INTUITIVE Medtronic RoBronze $5k-$9,999 annually Allurion Calibrate Health Found Geisinger Healthcare System ReShape Lifesciences Rocky Mountain Associated Physicians Wondr HealthPatron $1k-$4,999 annually Bariatric Medicine Institute Billings Clinic BonusLife ConscienHealth Gainesville Medical Ob*sity Specialty Clinic HorizonView Health New Life Center for Bariatric Surgery Rhythm The Better Weight Center The Ob*sity Society Weight & Life MD Woman's Hospital Source: https://www.obesityaction.org/donate/corporate-support/chairmans-council/Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Reader Eliah sent me the following email:I've seen you write about how the idea of “ob*sity”* as a disease is problematic which is I think why I started noticing that in all the articles about these new diet drugs it seems like it says at least once that “ob*sity is a disease like asthma or type 2 diabetes” I thought you might have some insight into the concept in general and why this specific phrasing is being used.This is a great question. This specific phrase “ob*sity is a chronic disease like asthma or type 2 diabetes” is indeed making the rounds. I'll start by talking about the veracity of the claim, and then answer the question as to why people are saying it.Before I dig in, I want to be clear that there is absolutely no shame in having a disease or diagnosis of any kind, this is about the intentional misapplication of the concept and the damage it does.First let's answer the basic question: Is “ob*sity” a chronic disease like asthma or type 2 diabetes? In order to get to the bottom of this, let's examine each diagnosis in turn.In order to be diagnosed with asthma, there has to be documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (that the signs or symptoms decrease with asthma therapy,) and no clinical suspicion of an alternative diagnosis.In order to be diagnosed with type 2 diabetes one of the following thresholds must be met (typically with at least one repetition): an A1C of greater than or equal to 6.5%, fasting blood glucose of greater than or equal to 126 mg/dl, a two-hour blood glucose of greater than or equal to 200 mg/dl on an Oral Glucose Tolerance Test, or blood glucose of greater than or equal to 200 mg/dl on a Random Plasma Glucose Test.In order to be “diagnosed” as “ob*se” one's weight in pounds times 703 divided by their height in inches squared has to be 30.0 or higher.  There is no shared symptomology among this group of people, it includes people with various health diagnoses, people without any health diagnoses, and with widely varying cardiometabolic health, body composition, etc. Literally, the only thing this group has in common is a similar ratio of weight and height (and being “diagnosed” using a deeply problematic math equation.)When you take into account the “class” system (ie: class 1, class 2, and class 3 ob*sity) the folly of this becomes even more apparent. Consider that, for class 1 ob*sity, 1 pound, or 1 inch in height canbe the only difference between someone who is “diagnosed” with “ob*sity” and someone who is not, again with no shared symptomology or cardiometabolic profile. Even more ridiculous, while class 1 and 2 each encompass a 4.9 point BMI spread, class 3 is defined as a BMI of 40 to…infinity. That does not have the ring of sound science.Then there is the issue of treatment. For both asthma and type 2 diabetes, treatments focus on managing the common symptomology. With “ob*sity” the “treatment” is focused on making the patient look different by changing their size. Setting aside that the “treatment” almost never works and has considerable risks, no matter what size someone ends up at, there will be people of that size who have the same (and different) actual health issues.So the answer to the question of whether ob*sity is a disease like asthma and type 2 diabetes is: No, it absolutely is not.This is pretty clear cut, so why are people (including doctors) still spouting this nonsense? In a word (or four): the weight loss industry. The classification of simply existing in a higher-weight body as a “disease” is the holy grail for them. It increases their market to every fat person for the entire time that they are alive. They've been pushing this (both blatantly and surreptitiously,) pouring money into the effort for many years. I've been writing and speaking about this since 2009, and there are many people who have been doing it far longer (including since before I was born.) It's actually one of the first things I wrote about when I launched this newsletter. So we've heard them try to claim that being fat is a “chronic lifelong health condition.” The addition of this comparison to type 2 diabetes and asthma seems to be specifically in the service of selling diet drugs like Wegovy.Novo Nordisk's research has shown repeatedly that, while people lose weight short-term on their drug (though even in their 68-week trial weight loss had leveled off by the end) as soon as people go off the drug the rapid weight regain begins. Participants regained 2/3 of the weight they had lost, and lost 2/3 of the cardiometabolic health benefits in just the first year off the drug. So Novo Nordisk's (wildly profitable, completely untested) “solution” is just to suggest that people stay on the drug for the rest of their lives.So the use of this phrase is them trying to take advantage of people's understanding that actual chronic health conditions require lifelong treatment, to suggest that their $1,300+ a month drug should be taken by people for life despite the fact that they only have 68 weeks of data about the weight loss (and even in that short term they had significant, dangerous side effects and the weight loss had already leveled off.) There is also a horrid irony here in that Novo Nordisk's aggressive price gouging of insulin killed people with diabetes because they could not access the needed treatment, so that Novo Nordisk could maximize their profits.The use of this phrase also allows for the dangerous re-branding of weight cycling (also known as yo-yo dieting) into a so-called successful intervention that people are told to simply repeat for the rest of their lives, thus exposing higher-weight people to very real, and wholly unnecessary, health risks.Obviously, it makes sense for the weight loss industry, but what is going on with doctors? The enmeshment of the weight loss industry in the healthcare system is almost impossible to overstate, from medical education, to major health organization committee assignments, and more the weight loss industry is constantly working to transform their marketing messages into healthcare education and practice and so it's not surprising if even well-meaning healthcare practitioners get caught up in it.Beyond this, companies like Novo Nordisk simply pay a stable of doctors to serve on their “speaker's bureau” or provide “consulting”  or “education. Those doctors are then foisted on unsuspecting audiences of medical students and practitioners, and interviewed as “experts” by the media where they toe the party line (typically without any disclosure of their financial relationship with the companies whose marketing copy and drugs they are promoting.)I want to repeat that there is no shame at all in having a disease. The issue is that simply existing in a higher-weight body doesn't qualify, and claiming that it does causes massive harm to higher-weight people, with the most harm done to those at the highest weights and those with multiple marginalized identities.The weight loss industry is really putting their all into the effort to make higher-weight people into an endless profit center, and we have to put our all into pushing back. Size is not symptomology, size diversity is not a diagnosis, and anyone who says otherwise is probably trying to sell weight loss.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:More research:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing at WeightAndHealthcare.com!Sam Sessamen is someone I've had the opportunity to work with multiple times over the last three years and her work is something that I've truly appreciated. Recently she told me about a new screening tool that she had created, and I wanted to share it here in case it's helpful. Here is some background from Sam followed by a link to the screening tool.Tell us a bit about you and your backgroundI'm a therapist in NY that specializes in trauma and Eating Disorders. I am passionate about providing trauma informed and weight neutral care as a result of my own experiences with weight stigma and disordered eating.   What made you decide to create this screening?Many people struggle with disordered eating, body image issues, disordered exercise and the impacts of weight stigma. If you rely solely on standardized diagnostic screening tools and the DSM criteria, you risk missing huge populations that could benefit from working on the above-mentioned issues.Can you share the screening tool development process with us?I wanted this screening to be as comprehensive as possible so anyone struggling in the following areas could be flagged as needing support: Attitude & Thoughts Towards Food, Unhealthy Food Behaviors, Unhealthy Exercise Patterns, Body Image Struggles & Common Medical Complications because of Disordered Eating. The screening questions in each category include DSM criteria, criteria for Orthorexia and reoccurring issues that I see in my own practice that aren't typically included in a diagnostic tool (e.g. Do you feel like you are waiting to be happy until you can “lose the weight?”).Once I was happy with the questions and format, I put a call out on IG for the assessment to be reviewed. I had 5 HAES-aligned providers, including folks in larger bodies, review the assessment and give me feedback.Were there difficulties and barriers that you faced in putting the tool together?The most difficult part was trying to keep this assessment concise, specifically in the body image and attitudes toward food sections. Since weight stigma and diet culture have catastrophic effects, it would have been easy to continue adding examples of how diet culture and weight stigma show up in folks' thoughts and behaviors.How do you hope that the tool will be used?First, it's a screening tool to help mental health professionals identify folks that need help with anything that falls under the disordered eating umbrella. I specifically hope this will circulate to professionals that don't specialize in Eating Disorders. Many disordered thoughts and behaviors go unflagged by those not trained in Eating Disorders because they are deemed ‘healthy' by diet culture.Second, I hope it can be a trailhead for professionals and their clients to explore how diet culture and weight stigma impact many areas of clients' lives.You can find the screening tool here! Please note that it was created for individual patient care only and is not a standardized diagnostic tool. Please seek written permission from Samantha Sessamen, LMHC (samanthasessamenlmhc@gmail.com) if you wish to use this in any other context (educational purposes, trainings, etc).Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part one of this series we looked at the phenomenon of BMI-based treatment denials. In part two, we looked at resources to fight these denials. Today we have a first-person patient experience. Beckie Hill is someone who had to battle to have the surgeries she needed, and it's a battle she won, twice. So I asked her to share her story for the newsletter and she graciously agreed! The rest of this piece is in her words: I injured both my knees on 08/17/2019 while working. I had x-rays done, followed by a round of physical therapy, massage, medication, activity limitation, taping, and injections. It did not improve my range of motion, activity tolerance, and/or pain. At that time, my physiatrist and primary care physician referred me to an orthopedic surgeon. I saw him on February 3, 2020. He recommended surgery right away, for both knees, and requested authorization for the surgeries through my worker's compensation insurance.On 02/19/2020, the utilization review (UR) company for the worker's compensation insurance provided the following decision: “Recommend denial. Failed to meet the criteria for TKA since her BMI is ##, and the Medical Treatment Guidelines (MTGs) require the BMI to be less than ##”.The UR makes a recommendation to the worker's compensation insurance and they can then agree or disagree with the UR's recommendations. Worker's compensation chose to deny surgery.I began the search of scholarly articles supporting knee surgery in larger-bodied patients. [Editor's note – you can find a collection of those here.] I reached out to professionals within the weight-neutral community for articles, ideas and suggestions. My surgeon also provided documentation to worker's compensation. He also had phone calls with the medical director. On 04/20/20, my surgeon informed the medical director that I would be in a wheelchair within 6 months.Worker's compensation still denied the surgery.Worker's compensation directed me to lose weight or undergo intentional weight loss surgery. The suggestions and denial of medically necessary surgery re-activated a pre-existing eating disorder of atypical anorexia and bulimia. I lost weight, but I was also very sick. I met with an intentional weight loss surgeon during this time, told them about the need for knee surgery, direction to lose weight, and my eating disorder. This surgeon emphatically indicated that weight loss was contraindicated for me from a nutritional, medicinal, and surgical basis. ***Please note, I would NOT have undergone surgery and have been offered weight loss medications many times and refuse to take them.Worker's compensation was provided with documentation from the intentional weight loss surgeon and still denied the surgery.I ultimately retained an attorney to help me navigate this system given the stress and toll the process had taken on me.I was ultimately provided with a cane, walker, an electric scooter, and a disabled parking permit. I lost the job that I was injured at because they were not able/willing to accommodate my work restrictions. Commuting to my place of employment after that became very difficult, and that employer was not able to continue to accommodate my work-from-home status as they had during much of the pandemic. My third job wanted me to work more hours than I was released to do, even though I did try.My lawyer, worker's compensation, and the attorney general had months of discussion and both knee surgeries were ultimately authorized. I had my right knee surgery on 12/29/2021, 680 days after the orthopedic surgeon's recommendation. In June of 2022, my surgeon provided surgery information for the left knee surgery and worker's compensation denied that surgery, again due to BMI. It was ultimately authorized and occurred on 08/10/2022, 904 days after the initial surgery recommendation.Did I ever get close to the BMI that the MTGs “required”? No, in fact, based upon the UR reports I have seen, it went up. It was far more important for me to nourish my body so that I could try to navigate life and recover from surgery if it was/were ever authorized.Not only has the denial of the surgery for each knee been physically traumatic, but it has also been professionally, mentally, emotionally, and financially devasting. I am an “N” of 1. I am not a BMI number. I am a human with a body that is different than every other body on this planet.I am doing okay with the knee recovery. Both surgeries went well and I have almost full ROM in my right knee, and I am about 5 weeks out from the left and doing more movement than the first surgery. There were no complications during or post-op, no issues with wound healing, and while I still have some pain, my surgeon did not anticipate being at maximum medical improvement for one year post-op.I had a surgeon willing and able to do the surgery. And yet, an archaic system and humans within that system made decisions about my body and my life using a system created in the 19th century. The BMI is an abhorrent way for insurance companies and medical providers to render decisions about people. It was not developed to make these decisions, and yet “we” are still making medical decisions and judgements based upon BMI alone.—I am so grateful to Beckie for sharing her story, even though it's a story that should not have to be told, because it never should have happened. If you are dealing with a BMI or weight-based denial of care, know that you deserve far better. You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Transcript:In part one we talked about the issues with BMI-based denials. Today we'll talk about your options if you are facing a BMI-based healthcare denial. Part three will be the story of someone who successfully fought these denials.First of all, if your healthcare is being held hostage unless/until you reach a certain BMI (or lose a specific amount of weight etc.), please know that this is not your fault, even though it's becoming your problem. Your options include finding different circumstances, fighting the denial, or trying to reach the BMI requirement. We'll talk about each of these in turn. Note that, while the advice here may be helpful in other places, it is predominantly focused on the US experience and that it is generalized options and, as everything in this newsletter, is not medical advice.And remember, unfortunately you are not in control of the situation, so if you are not successful, that's not because you did anything wrong, it's because the system is rooted in weight stigma and really messed up.The basicsThe first place to start is by finding out as much as you can about the denial. If possible, you want to get this information in writing (for example, by sending emails or utilizing a patient portal like MyChart,) or recorded (you can try saying something like “I'm afraid I won't be able to remember everything from the appointment, do you mind if I record it?”) You can also bring someone along to take accurate notes.Collecting as much information as you can upfront can make future steps easier. Just as a reminder, this situation should not happen. It is absolutely unfair that fat people should have to fight for the treatment that thin people get. Even if this is becoming your problem, it is not your fault. Here are some questions to start with:Where is the denial coming from?* It is typically the surgeon, anesthesiologist, facility, or insuranceWhat are they claiming is the reason for the denial?* Is it anesthesia risk? Risk of complications with the surgery? Concerns about recovery time/complications? Concerns about outcomes not being as good as a thinner person's outcomes?* Rather than offering up these explanations, you can ask more circumspectly - “what concern is at the root of the denial?” Again, try to get this answer down verbatim.What are they hoping that weight loss will do?* This is typically tied to the answer to the question above. Getting the answer to this can be very helpful if you decide to fight the denial.Ok, let's look at the three main options to handle these denials. Before I start I do want to be clear that aspects of privilege, socioeconomic status, and intersectional oppression pervade all of these options and have the greatest impact on those of the highest weights and/or who are multiply marginalized.Option 1: Finding different circumstancesStart with the information you gathered about the source of the denial. Here the fact that these limits are often applied utterly inconsistently can be helpful.If it's the surgeon, you can try to find another practitioner. A place to start is Mary Lambert's Weight Neutral Provider list.If it's the anesthesiologist, you can see what the options are to get another anesthesiologist. One option is to ask if they offer weight loss surgery in the facility and, if so, if one of those anesthesiologists can do the anesthesia for your surgery. (This can be particularly helpful in situations where someone has been denied a surgery that they actually need/want because of anesthesia risk, and has then been referred to weight loss surgery.)If it's the facility, you can see if the surgeon you want to work with has privileges at other facilities that might have different BMI limits, or you can try to find a surgeon who operates at a different facility.If it's your insurance, then you could look at options to switch insurance coverage. Of course this can be difficult or impossible, especially if it's your employer's workers compensation plan. In this case you can also look at options for cash paying if that's accessible to you.Option 2: Fight the denialStart with where the denial is coming from and look into the official process to challenge the decision. This may be found on the website of the facility or insurance company, or through a facility customer service representative, or ombudsman.Some denials are easier to fight than others. For example, if the denial is coming from a specific surgeon or facility, you may have more options since these are often arbitrary. On the other hand, if you are being denied a transplant, there is more of a standardized denial not that standardization makes this any less wrong, but it can make it more difficult to fight.If your surgeon is on board but the facility and/or insurance is not, then you may be able to enlist the surgeon to help you fight.Before we get into the counterarguments, I want to note that these are not necessarily based in social justice, but rather in a harm reduction model of finding ways to get care in a fatphobic system.In general, if you live in a place (like Washington, Michigan, or the Bay Area) where weight and size are part of nondiscrimination laws, then you can try using that to your favor.You might also retain a professional patient advocate and/or attorney to help you fight if that's an option for you financially.I would also recommend surrounding yourself with as much support as you can, because this process can be incredibly challenging mentally since it is, at its root, a denial of your humanity.Here are some options that have worked for folks in various situations, of course, none of them are guaranteed.If the denial reason is about risksUnderstand that what also may be at play is that surgeons are judged on their “stats” and those stats are based on thin patients (which is why it's important that we also work to create a system that doesn't institutionalize the idea that if fat people might not have the same outcomes as thin people, then fat people don't deserve care, or that incentivizes surgeons to cherry-pick their patients.) For now, in this case possible counterarguments include:* They recommend weight loss surgeries to people my weight, and those use anesthesia. Perhaps we could get an anesthesiologist from the bariatric department* Ask them to provide the research that they are basing their decision on, so that you can take a look at it and/or look into research that shows that the surgery is safe at your size (Note, I currently have collected resources for joint surgery denials here, in the coming months I'll work to create resource collections for other commonly denied procedures.)* Offer to sign a document giving your informed consent to undertake a more risky procedureIf the argument is that you/your weight created this health issue and/or that you're “going back to a lifestyle” that will exacerbate it:You don't have to accept the premise here (the tendency to blame higher-weight people's size for, well, everything is far more rooted in weight stigma than evidence,) but you can point out that even if that's true, athletes routinely get surgeries to correct issues that they definitely created, even though they are returning to a lifestyle that can make the treatment less effective/ long-lasting.For example, I know someone who plays soccer recreationally – not a pro player or anything, literally plays with their friends. They are on their third knee surgery. Their surgeon said “You should probably stop playing, but if you want to keep playing, I'll keep fixing your knee.”The extent to which weight stigma has been codified into our healthcare system is truly horrifying and it can help us to name it when it happens.If the reason given is that your outcomes won't be as good as a thin personYou can point out that it's not surprising that a system built from the ground up for thin bodies doesn't work as well for fat bodies, so you understand that your outcomes might not be the same, but that shouldn't mean that your desire to be, for example, in significantly less pain, or to have a gender affirmation procedure that is critical to your mental health, isn't valid and shouldn't be granted.If they deny your surgery, but then refer you to weight loss surgeryYou can make the case that if they are willing to do bariatric surgery, for which there are significant risks, few prognostics and almost no outcome data past ten years, then they should be able to give you the surgery that you need which likely has better data, and is also likely to have a much lower risk of re-surgery than weight loss surgery.Option 3: Trying to Reach the BMI RequirementEither at the outset, or after exhausting other options, some people might make the very personal decision to try to “make weight” for their surgery.If that's the case I think it's important that they be aware that* Unless it's just a few pounds, the chances of success are not very good.* Even if they are successful, the most likely long-term outcome will be weight regain, which means that they'll have to time the procedure before they regain to a point where they no longer meet the BMI requirement* Weight cycling which is, by far, the most common outcome of weight loss attempts is independently linked to harm to health including higher mortality* The process of weight loss, especially if someone is trying to achieve rapid weight loss, could negatively impact surgical outcomes (if prolonged undernourishment improved surgical outcomes, they would recommend it to thin patients as well.)* There is always the possibility that the weight loss attempt can create/exacerbate an unhealthy relationship with food, body, and/or movement up to and including an eating disorder* If someone turns to weight loss drugs or weight loss surgery then the risks/side effects, including risks to life itself, rise significantlyThis is a matter of choice for the person who wants/needs the surgery, but I also think it's important to mention that if they lose weight (at least short-term) they are likely to get positive, weight-stigma-based feedback. This can be really difficult for someone who is forced to go against their beliefs around weight-neutral health and/or fat affirmation in order to access healthcare.If someone is choosing this option, I would suggest thinking ahead about how to respond to this (for example: “I have no interest in weight loss and I know I'll likely gain it all back, I'm having to lose weight in order to get a medical procedure” or “I'm really uncomfortable that you are monitoring my body – please stop, or at least stop talking to me about it” etc.). Conversely, they should take care not to engage in behaviors that perpetuate weight stigma like posting “before and after” pictures and/or celebrating the ways in which they are (at least temporarily) less exposed to weight stigma.Having your healthcare held hostage for a weight loss ransom can be terrifying and dehumanizing. It should not happen, and if it does it becomes your problem, but it is not (and never was) your fault. You deserve the care you need and want in the body that you have now. In part 3 I'll share the story of someone who successfully fought BMI-based denials, twice.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Da'Shaun L. Harrison is an organizer, trans theorist, Editor-at-Large at Scalawag Magazine and winner of the 2022 Lambda Literary Award in transgender nonfiction for their book Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness. For our series Black.Queer.Rising, they share their understanding of the connection between anti-fatness and anti-Blackness, why and how they're able to show up as their full unapologetic self, and what they view as the limitations of liberation while existing within an oppressive system.  To read the full transcript, see above.

Da'Shaun L. Harrison is an organizer, trans theorist, Editor-at-Large at Scalawag Magazine and winner of the 2022 Lambda Literary Award in transgender nonfiction for their book Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness. For our series Black.Queer.Rising, they share their understanding of the connection between anti-fatness and anti-Blackness, why and how they're able to show up as their full unapologetic self, and what they view as the limitations of liberation while existing within an oppressive system.  To read the full transcript, see above.

One of the ways that weight stigma harms fat people is through Body Mass Index BMI (and other weight-based) limits. BMI is a ratio of weight and height, and its use is deeply problematic in multiple ways. BMI and weight-based healthcare denials occur when people above a certain BMI or weight are refused medical procedures unless or until they meet the BMI or weight requirement. In part 1 of this three-part series, I'll offer a general discussion of these limits, in part two I'll provide some options and resources to help fight them, in part three I'll share the story of someone who successfully fought BMI-based denial of surgery. I previously published specific resources to fight joint surgery denials and moving forward I will be compiling resources for other common types of denials as well. If you have a specific request, please feel free to share in the comments or email me directly. I do want to note that, while this information can be helpful to people outside of the US, these posts will focus on the US healthcare system.BMI limits are typically “justified” based on the idea that there are higher risks of complications during or after procedures for people above a certain BMI vs people below that BMI, or that higher-weight people's outcomes won't be as good as thinner people's outcomes.The first thing I want to point out is that this is blanket discrimination based on a simple height/weight ratio. The people whose care is being denied can and do vary wildly in everything from body composition to metabolic health and more. The use of BMI also codifies racism and anti-Blackness into the process and I urge you to read Sabrina Strings': Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's: Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness to learn more.BMI limits are based on, and further perpetuate, weight stigma. In our current healthcare system, research, tools, best practices, education, and training are very often developed based on thin bodies (and to the exclusion of fat bodies,) so even if someone believes that higher-weight people have more complications and/or worse outcomes, that wouldn't be surprising due to the ways that weight stigma impacts every level of their care. What BMI-based denials do is take this weight stigma further by deciding that instead of getting better at providing care to fat people, or at least allowing them to consent to take possibly greater risks in order to get care that can improve their health, quality of life, or potentially save their lives, higher-weight people will simply be denied care unless or until they become thinner.There are other issues with BMI limits as well:The research that is used to justify these denials can be questionable (at best,) and/or contradicted by other evidence which is not taken into account.Often patients are denied needed surgeries, but are then referred to weight loss surgery. This is particularly ridiculous when the risk cited in the former surgery is anesthesia (as if weight loss surgeries don't also use anesthesia,) and/or the risks of the weight loss surgery far exceed those of the surgery the patient actually needs. When a doctor denies a needed surgery and refers the patient to weight loss surgery it's important to understand that the doctor is mitigating their risk (of having a patient with complications/poorer outcomes) by recommending that the patient take much greater risk with their life and quality of life.On the flip side, patients who have had their healthcare team push weight loss surgery on them for years can find themselves denied a surgery that they actually need/want when the time comes.Sometimes a needed surgery is denied until either the person becomes thin, or until the situation becomes dire enough to be considered an emergency surgery, causing far greater risk since the person can't plan for their procedure, and the surgery is performed by whatever surgeon and anesthesiologist are available. Sometimes those in power decide that what would be an emergency for a thin person does not warrant the needed treatment for a fat patient. This can and does lead to the death of fat patients.On the other hand, fat people in the emergency room have been offered surgeries (for example, gallbladder removal,) but after weathering the acute attack have said that they would prefer to have the surgery in a way that was more planned, only to then to have the procedure denied due to BMI limits.These limits can vary between surgeons, anesthesiologists, facilities, and insurance companies (including, and sometimes especially, workers compensation companies) who can have a financial incentive to deny them. That means that whether or not someone can get the procedures can be essentially arbitrary – if they happen to find the right practitioners, or facilities, or insurance company they will get the care they need. If not, they will be denied care and left to suffer.Sometimes these denials are made because of a healthcare system that rewards/makes demands of surgeons and other practitioners for their “stats” which leads them to cherry-pick the cases that they assume will have the best outcomes. The change needed isn't just in practitioners, but also in the system in which they work. (I'm working on a piece specifically about this.)Sometimes these surgeries are denied because fat people may require more resources to recover, which could cut into the profits of the institution in which they would be recovering. Here again, systemic change is needed. People's lives and quality of life must be valued over healthcare profits.Sometimes the requirement isn't for a specific BMI but for a percentage of weight loss. This proves the nonsensical nature of the entire enterprise. Let's look at an example: If the weight loss requirement is 10%, then someone who comes in at 330 pounds would be required to lose 33 pounds to get surgery, putting them at a weight of 297. But a person who came in at 297 would be told that they needed to lose 29.7 pounds in order to get surgery.Finally, asking people to get below a certain BMI is typically asking the impossible. Intentional weight loss attempts almost never lead to significant, long-term weight loss. This means that patients who need or want care that is being held hostage by a BMI limit have very few options.Even those who (despite the evidence,) still claim that significant, long-term weight loss through behavior change is possible, agree on a rate of weight loss of about two pounds per week as a “safe” amount. So, if someone needed to lose just twenty pounds to meet the BMI requirement, they would delay their procedure by about two and a half months. If they had to be one hundred pounds lighter, that's almost a year and, again, there is only a miniscule chance that they would be successful, with the most common outcome being that they regain the weight, very possibly regaining more and ending up heavier than when they started which makes them a “worse” candidate for surgery even by the “logic” of those who endorse BMI-based denials.  Meanwhile, as people are spending weeks, months, or years trying to “make weight” for their procedures, their health issue is progressing, they are suffering, and they are being denied care that could help. This also leaves many people in a situation of having to choose between participating in dangerous interventions – from starvation diets to dangerous drugs and weight loss surgeries – or being denied necessary healthcare.In addition to physical harm, there is the psychological harm of knowing that you aren't seen as worthy of care. This can exacerbate intersectional oppression, for example for those who are seeking gender-affirming care, which is often held hostage for a weight-loss ransom.In addition to causing physical and psychological suffering, in some cases such as organ transplants and other potentially life-saving procedures, this denial of care is fatal.There have even been cases (as I wrote about way back in 2014 in my original blog) where BMI-based denials were simply used as a way to reduce medical costs and cut wait times for thinner patients. That is, simply put, unconscionable.Regardless of the reason, demanding weight loss as the ransom to be paid for healthcare is simply wrong.In part two we'll discuss some options for fighting these denials.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Stunkard et al.'s 1959 study “The Results of Treatment for Ob*sity: A Review of the Literature and Report of a Series” is one of the earliest studies that really sought to determine the success of weight loss interventions. As someone who works full-time pointing out that weight loss interventions almost never succeed at creating significant, long-term weight loss and often do harm, every time I read this study it is a combination of validating and incredibly frustrating.Content note: this post will include discussion of calories and weight loss so please make sure to take care of yourself. Let's dig in:They begin by saying: “The current widespread concern with weight reduction rests on at least two assumptions: first, that weight-reduction programs are effective, second, that they are harmless.”They continue “Recent studies indicate that such programs may be far from harmless. This report documents their ineffectiveness.”Again, it's validating to see that they were explaining this in 1952, but incredibly frustrating that the only thing that has changed since then is that the weight loss industry profits have grown exponentially, and the interventions have become more dangerous and more expensive.The study looks at weight loss success/failure in two ways. First, a review of the weight loss literature for the previous 30 years, and second, an examination of the outcomes of the treatment of 100 consecutive higher-weight patients at New York Hospital's Nutrition Clinic.Literature ReviewHere they use a phrase that I say or write some version of pretty much daily. “Hundreds of papers on treatment for ob*sity* have been published in the past 30 years. Most, however, do not give figures on the outcome of treatment, and of those that do, most report them in such a way as to obscure the outcome of treatment in individual patients.” They point out the following issues:* Reporting the number of patients and total pounds lost without specifying how much/the average that each patient lost* Short-duration studies* Reporting as a percentage rather than a number of pounds* The exclusion of those who dropped out or were “uncooperative” who the authors explain likely represent intervention failure and comprise an “impressive part” of the study samplesThey point out that “if papers with these shortcomings are omitted, the vast literature on treatment for ob*sity shrinks to just eight reports.”I'll point out that these are still incredibly common occurrences in weight loss research. That, to me, indicates that those doing the research aren't interested in creating good research, but are interested in creating research to prop up the failed weight-loss paradigm. Anyway, back to Stunkard et al.The eight studies had subject groups ranging from 48-314.  Of the eight studies, interventions ranged from “self-selected diet,” to starvation diets (from 600 to 1,000 calories per day), to amphetamines.Four of the studies had more people lose less than 10 pounds than those who lost 10 or more pounds. Only one had a majority lose more than 20 pounds.  Overall, only 25% of people were able to lose 20lbs and only 5% where able to lose 40lb short-term (and remember that research since 1959 has repeatedly shown that about 95% of this small group will regain all of the weight within five years.)Study of 100 patientsMoving on to their study of 100 patients. Here they point out that the health of “most subjects” was good, suggesting that they were referred for “treatment” solely to manipulate their body size. They were prescribed diets of 800 to 1,500 calories (all below, and some far below, the caloric intake for the Minnesota Starvation Experiment.)They characterize the results of these 100 people as “even poorer than those reported in the literature.” Of the 100 patients, 39 dropped out after the first visit, 28 never returned to any clinic in the hospital (suggesting that the intervention lowered their overall healthcare engagement, which the authors refer to as “a rupture of at least two therapeutic relationships” since patients only come to the Nutrition Clinic by referral from another clinic in the hospital.) Only 12 managed to lose more than 20lbs and only one of those was able to lose more than 40lbs.In terms of maintenance of weight loss, they found that, of the 12 who lost at least 20 pounds only 6 had maintained at least a 20 pound loss a year later, a number that dwindled to 2 people after two years. Moreover, 4 had already regained all of the weight they lost at two years, the others had already regained significant amounts of weight. Of the two “successes,” at two years the man who had the greatest weight change (-51lbs) reported that the diet had been “associated with mounting tension which culminated in what was diagnosed as an acute schizophrenic reaction” requiring a four-month hospitalization and treatment with tranquilizers. He regained 35 pounds before follow-up stopped.While they were still coming from a “body-size-as-disease” model, a lot of the discussion section of this study is, to speak colloquially, fire!  They point out that the idea of higher weight as unhealthy and weight loss as health supporting had grown “in recent years” resulting in doctors and patients considering weight loss as a therapeutic intervention. They also explain that “lay institutions, notably the magazines for women, has seized upon this growing interest in weight reduction and has helped to magnify it to the proportions of a national neurosis.” They further insist that “The medical profession…must accept some responsibility.” They characterize the pervasive blaming of patients by their physicians for not losing weight by saying “Rarely have physicians so readily surrendered a part of their domain to moralizing, indifference, and despair.”They go on to say that “the naïve optimism of the medical profession about treatment for ob*sity has been widely accepted by the lay public.”And even though they cling to the body-size-as-disease and weight loss as “treatment” model, they admit that “perhaps” some higher-weight people should not undertake weight loss interventions.One thing that I've had happen to me (and seen happen to others) is that when we talk about the failure rate of weight loss interventions, someone will claim that it's “just that one study from the 1950's” so this is first a reminder that this study actually looked at 30 years of research, and that these findings have been consistently replicated through today.  So, as I said, it is validating to see that others reached the same conclusions that those of us doing work around weight science still are, but it's also incredibly frustrating that it is 64 years later (94 considering that they looked at data since 1929) and researchers are still pulling the same fail-your-freshman-research-methods-class nonsense, and the medical profession is still operating from the same combination of naïve optimism and patient blaming about interventions that have been utter failures since the 1920's.Fat people deserve better. We deserve a weight-neutral paradigm that focuses on supporting us in the bodies we have rather than risking our lives and quality of life in failed attempts to shrink us. And we deserve more than that - we deserve medical science and healthcare systems that do the work to then move from a weight-neutral to a truly weight-inclusive paradigm.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Why are women judged for their size? What if you decided that you had the right to remain fat? This episode explores: Our born desire to like ourselves as we are. How we get shamed out of that at such a young age, and so very quickly. How hard it is to re-learn how to like yourself. Why our cultural commitment to fat-phobia harms us all. A Discussion of the book You Have the Right To Remain Fat. Our guest is: Virgie Tovar, who is an author, activist, and a lecturer on weight-based discrimination and body image. She holds a Master's degree in Sexuality Studies with a focus on the intersections of body size, race and gender. She edited the anthology Hot & Heavy: Fierce Fat Girls on Life, Love and Fashion (Seal Press, November 2012), is the author of You Have the Right to Remain Fat (Feminist Press August 2018), The Self-Love Revolution: Radical Body Positivity for Girls of Color (New Harbinger Publications 2020), and The Body Positive Journal (Chronicle Books 2022). She has received three San Francisco Arts Commission Individual Artist Commissions as well as Yale's Poynter Fellowship in Journalism. Our host is: Dr. Christina Gessler, a historian of women and gender. Listeners to this episode may also be interested in: Fatty Fatty Boom Boom, by Rabia Chaudry What We Don't Talk About When We Talk About Fat, by Aubrey Gordon Belly of the Beast: The Politics of Anti-Fatness, by Da'Shaun L. Harrison Fearing the Black Body: The Racial Origins of Fat Phobia, by Sabrina Strings The Body is Not An Apology, Second Edition, by Sonya Renee Taylor Welcome to The Academic Life! On the Academic Life channel we embrace a broad definition of what it means to lead an academic life. We view education as a transformative human endeavor and are inspired by today's knowledge-producers working inside and outside the academy. Find us on Twitter: @AcademicLifeNBN. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Da'Shaun L. Harrison has penned one of my favorite texts in the past five years. I have read it three times in nine months and I have become more and more delighted with the person that I become absorbing these words. In Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness, Harrison presents theoretical frameworks that compel us to meaningful action. I will tell you now and I will tell you for free: belief that compels me to meaningful action is exactly my shit. I am grateful, to my bones, for theory. Blessed are the workers who make the way clearer with their weighty, weighty words. I relish texts like this.read the full essay (and join bookclub!) at ismatu.substack.comJazz songs of the episode:Skylark x Wynton MarsalisAbide With Me x Thelonious Monk SeptetFools Rush In x Teddy Wilson (this is what was playing when my mom interrupted me)My Romance x Gene Ammons (remastered by Rudy Van Gelder)Confirmation - Take 3 / Master x Charlie Parker QuartetCup Bearers x Tommy Flanagan, George Mraz, and Elvin JonesA Sleepin' Bee x Wynton Marsalis Stomping At The Savory x Red Gardland, Paul Champers, Art Taylor This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit ismatu.substack.com/subscribe

In this episode, I am joined by Kalpana Mohanty, writer, Ph.D. Candidate and Trudeau Scholar at Harvard University. She works on disability, colonialism, and gender in South Asia. Kalpana grew up in Portugal, Canada and India. Her proposed PhD topic focuses on the history of disability in India, particularly during high colonialism. Inspired by her own lived experience as someone with chronic illness who lives with a disability, Kalpana is passionate about accessibility in all forms, whether that be making academic spaces accessible for all students or making scholarly work engaging and interesting for a non-academic audience. She is committed to using the rigorous framework and theory of academia to address wider cultural issues ranging from the serious to the trivial as a cultural commentator. Kalpana reads and we discuss her incredible article, Beautiful Lies, where she asks why public discourse on beauty remains so shallow. Kalpana's Links:Twitter:  @kalpanamohantyWebsite: https://kalpanamohanty.squarespace.com/ Audio clips included: Now This News: Sabrina Strings Explains How 'Fatphobia' is Rooted in RacismIntersections of Disability Justice and Transformative Justice Ft. Elliott Fukui and Leah Lakshmi Piepzna-Samarasinha by Barnard Center for Research on WomenVenmo: Elliot Fukui @elliottseiji Buy Leah Lakshmi Piepzna-Samarasinha's books hereLinks Mentioned:Beautiful Lies | Kalpana Mohanty Mobeen Hussain is the Cambridge scholar who studies skin lightening in India. Jaclyn WongAfghan Girl Portrait by Steve McCurryConstant Cravings by Alice WongBook and other recommendations included:Fearing the Black Body: The Racial Origins of Fat Phobia  by Sabrina Strings | Thick: and other Essays by Tressie McMillan Cottom | Alok V Menon | The Age of Instagram Face by Jia Tolentino| Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison | Maybe Baby | Haley Nahman| The Right to Sex by Amia Srinivasan | What We Don't Talk About When We Talk About Fat by Aubrey Gordon| Maintenance Phase Podcast  | Perfect Me by Heather Widdows --- Support this podcast: https://podcasters.spotify.com/pod/show/ayandastood/support

The response to eurocentric Beauty standards has been to diversify and include more people of marginalized identities. But this vital response alone is not enough. Our society regards Beauty as something inherently aspirational, noble, and good.  Is it?  Full transcripts to all episodes are available here.Even as more people are included, the terms and conditions of inclusion are exclusive and rooted in the same toxic beauty standards. At the same time, Beauty still functions in harmful ways to exclude and ostracize the most marginalized. What, exactly, are we fighting to be included within? What are the ugly ways that Beauty functions in our society? What is the Ugliness of Beauty?In this series, I invite you to reconsider Beauty as a social heirarchy, and move towards reimagining what Beauty (or something much better!) could be. I hope you enjoy this episode and if you do,  leave a review and share it with a bestie!Highlights:  (03:28) Reframing capital B Beauty(04:10) What could beauty be? More on this in later episodes…(05:25) What is the paradox of Beauty?(12:54) Why is Beauty ugly + what does Beauty do?(17:51) Roles within the supply chain(26:25) How our obsession with beauty reinforces our obsession with whiteness(34:50) The allure of Beauty & how it justifies racism, oppression  and exploitation(45:27) The ugliness of beauty as a political conceptSources:Audre Lorde Essay: The Transformation of Language into Silence and Action“Moving Toward the Ugly: A Politic Beyond Desirability” by Mia MingusBelly of the Beast: The Politics of Ant-fatness as Anti-Blackness by Da'Shaun L. Harrison is a fantastic book and resource! Follow them on Twitter here @DaShaunLHOn the Politics of Ugliness book edited by Sara Rodrigues and Ela PrzybyloMy links: Substack: ayandastood.substack.com Tiktok: @ayandastoodPodcast Instagram: @reimaginingwithayandastoodMy Instagram: @ayandastood --- Support this podcast: https://podcasters.spotify.com/pod/show/ayandastood/support

Hello Sunshine! Welcome to another episode of Reimagining with Ayandastood. Today, we are joined by the one and only Mia Mingus.  In this episode, we explore Beauty, Desirability, Ugliness and Magnificence. Full transcripts to all episodes are available here.Mia Mingus is a writer, educator and trainer for transformative justice and disability justice. She is a queer, physically disabled, Korean-American transnational adoptee raised in the Caribbean. She works for community, interdependence and home for all of us, not just some of us, and longs for a world where disabled children can live free of violence, with dignity and love. As her work for liberation evolves and deepens, her roots remain firmly planted in ending sexual violence. Find Mia at @MiaMingus on Twitter and suppert her on Venmo @Mia-Mingus if you can! I hope you enjoy today's episode. Don't forget to subscribe and share it with a friend! Highlights:(03:22) Intro to Mia Mingus(07:42) What brings Mia joy(11:28) What does it mean to Move Towards Ugliness?(16:07) Experiences that led Mia into this work(27:15) What does it mean to embrace each other's Magnificence?(33:19) How desirability has been used to commit violence(46:36) How the need to feel beautiful is rooted in harm(1:06:25) How can we find ways to Move Toward Ugliness?(1:13:13) What is the antidote to shame?(1:18:49) Why is the burden of Beauty so high?Links:Mia Mingus:Venmo: @Mia-MingusWriting: About | Leaving EvidenceTwitter: @miamingusIG: @mia.mingusReading: “Moving Toward the Ugly: A Politic Beyond Desirability” by Mia MingusMentions:Sip & Politic is an incredible podcast by my mutuals Joy Malonza & Carla Marie Davis. Find it on Apple here and Spotify hereSupport my amazing mutual Ismatu on Substack here and on TikTok @ismatu.gwendolynAudre Lorde Essay: The Transformation of Language into Silence and ActionBelly of the Beast: The Politics of Ant-fatness as Anti-Blackness by Da'Shaun L. Harrison is a fantastic book and resource! Follow them on Twitter here @DaShaunLHAyanda:Substack: ayandastood.substack.comTiktok: @ayandastoodPodcast Instagram: @reimaginingwithayandastoodMy Instagram: @ayandastood  --- Support this podcast: https://podcasters.spotify.com/pod/show/ayandastood/support

A Conversation about Feminism and Reality TV It's no secret that there is a lack of diversity of bodies in reality tv… especially in the Bachelor. In 20 years The Bachelor has not changed their casting practices and we're over it. On today's episode, Rah chats with Jenna and Rach from the newly launched group Roses for Everybody. They're here to change the game with their Fat Bachelor Inclusion campaign and challenge you to get rid of your anti-fat biases.    SIGN THE PETITION HERE   Books Recommended by Roses for Every Body: Fearing the Black Body: The Racial Origins of Fatphobia by Dr. Sabrina Strings Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison Tipping the Scales of Justice: Fighting Weight-Based Discrimination by Sondra Solovay, J.D.  Shameful Bodies: Religion and the Culture of Physical Improvement by Michelle Mary Lelwica  One to Watch by Kate Stayman-London Support our guest and host: Follow Roses For Every Body: Instagram // Twitter // TikTok Follow Rah: Instagram // Twitter // TikTok   Beyond the Box: Our weekly round-up of blog and podcast content delivered directly to your inbox every Friday Check out our online community here!    This episode was edited by Claudia Neu and produced by Renee Powers on the ancestral land of the Dakota people.   Original music by @iam.onyxrose Learn more about Feminist Book Club on our website, sign up for our emails, shop our Bookshop.org recommendations, and follow us on Instagram, Twitter, TikTok, Facebook, Pinterest.

Vox's Anna North talks with Da'Shaun Harrison, the activist, author, and 2022 Lambda Literary Award recipient for their book Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness. Da'Shaun explains the ways in which society's anti-fatness is structural, and connected —historically and politically — to the structures of anti-Blackness that took root alongside slavery in America. Anna and Da'Shaun discuss common misunderstandings and myths about fatness, how these pathologies insidiously infiltrate the criminal justice system, and why Da'Shaun envisions a liberatory future in the idea of destruction. Host: Anna North (@annanorthtweets), Senior Reporter, Vox Guest: Da'Shaun Harrison (@DaShaunLH), author; editor-at-large, Scalawag References:  Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun Harrison (North Atlantic; 2021) "The past, present, and future of body image in America" by Anna North (Vox; Oct. 18, 2021) "The paradox of online 'body positivity'" by Rebecca Jennings (Vox; Jan. 13, 2021) Fearing the Black Body by Sabrina Strings (NYU; 2019) "CDC Study Overstated Obesity as a Cause of Death" by Betsy McKay (Wall Street Journal; Nov. 23, 2004) "Correction: Actual Causes of Death in the United States, 2000" (JAMA; Jan. 19, 2005) Killer Fat: Media, Medicine, and Morals in the American "Obesity Epidemic" by Natalie Boero (Rutgers; 2012) "The Bizarre and Racist History of the BMI" by Aubrey Gordon (Oct. 15, 2019) "Mama's Baby, Papa's Maybe: An American Grammar Book" by Hortense J. Spillers (Diacritics, 17 (2); 1987) Joy James: Captive Maternals Enjoyed this episode? Rate Vox Conversations ⭐⭐⭐⭐⭐ and leave a review on Apple Podcasts. Subscribe for free. Be the first to hear the next episode of Vox Conversations by subscribing in your favorite podcast app. Support Vox Conversations by making a financial contribution to Vox! bit.ly/givepodcasts This episode was made by:  Producer: Erikk Geannikis Editor: Amy Drozdowska Engineer: Patrick Boyd Deputy Editorial Director, Vox Talk: Amber Hall Learn more about your ad choices. Visit podcastchoices.com/adchoices

There's a commonly held belief that Black folks are thicker, bigger, and carry more fat than others…but where did this idea that our bodies only look a certain way come from? Join us as we disentangle fact from oftentimes fat-phobic fiction when it comes to assumptions about how our bodies are shaped. . In our Season 2 finale, "Baby Got Black", we dissect whether here is a genetic difference between the body shape of Black folks compared to other populations. Black women and men have consistently been exoticisized for their unique body features. We explore the genetics behind this starting with a publication by Dr. Jeff on the genetics of body shape and tell the historical stories behind Venus Hottentot (Sarah Baartman). . In Those Genes is an educational podcast that contains explicit language that might be difficult for some to hear. No worries, we got you! You can still get all the facts dropped in our cleaned transcript we affectionately call The Nucleus that will be posted soon. . This is our last episode for Season 2, thanks for being part of the fam! Be sure to follow us on social media to stay up-to-date on Season 3. . Want to learn more about the guests on this episode? Check out their work below. Da'Shaun L. Harrison,@DaShaunLH (Twitter), https://dashaunharrison.com/. Da'Shaun recently published a book on the overlap between anti-fatness and anti-blackness — Belly of the Beast: The Politics of Anti-fatness as Anti-blackness. Here's where you can get a copy: https://www.penguinrandomhouse.com/books/670607/belly-of-the-beast-by-dashaun-harrison/ We also recommend you check out Da'Shaun's reading list on fat studies, body and desirability politics: https://dashaunharrison.com/fat-studies-body-and-desirability-politics-a-reading-list/ + this video from PBS on why diets fail: https://www.youtube.com/watch?v=eLtUrvnmOfc&t=1s . Dr. Sabrina Strings, @SaStrings (Twitter) https://www.sabrinastrings.com/. Dr. Strings is the author of Fearing the Black Body: The Racial Origins of Fat Phobia (NYU Press) – a book that was instrumental to this episode. Here's where you can get a copy: https://nyupress.org/9781479886753/fearing-the-black-body/ . Want to unpack this episode with other In Those Genes Family and like minded folks? If so, be sure to come to our after show, In Our DNA ( https://kinkofa.com/inourdna/ ), hosted by our good friends over at Kinkofa (https://kinkofa.com/ ) every other Wednesday (the week following an episode drop) at 7:30PM EST. Register here, https://lu.ma/INOURDNA ! . Kinkofa is the future of genealogy. Connect to culturally-relevant tools, resources, and support needed to uncover your unique #familyhistory. Join their community here, https://kinkofa.com/community/! . Making a podcast ain't cheap. And as an independently funded podcast, we depend on our community to sustain us. Please consider donating $5, $10, or $20 to In Those Genes through our PayPal or commit to a monthly donation through our Patreon, if you're able. . PayPal: https://paypal.me/inthosegenes Patreon: https://www.patreon.com/inthosegenes . If a monetary donation isn't in the cards you can support us by rating and writing a review of the podcast, following us on social media, and sharing this podcast with everyone you know! . No matter how you show your support, thank you fam

This week, jh and Tre'vell invite filmmaker Amber J. Phillips, and author Da'Shaun L. Harrison (Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness) to the show for a conversation about fatphobia (read: jh's fatphobia). Regular listeners may recall jh's response to an email calling him out for expressing satisfaction that his beard hid his “double chin”. The critique was that “double chin” was code for fat, and that jh's fatphobia was showing. Amber and Da'Shaun were both given permission to drag jh, so that he, and FANTI listeners, can confront their own fatphobia, which is Anti-Black as well. Strap in! Mentioned in the show:Author Sabrina Strings - Fearing the Black Body: The Racial Origins of FatphobiaUnsolicited: Fatties Talk Back podcastDIS/Honorable Mentions jhHM: Candice Marie Benbow's Red Lip TheologyHM: Lizzo's Watch Out for the Big GrrrlsTAM: Ralph Lauren unveils HBCU collection exclusively for Morehouse, Spelman College https://twitter.com/phil_lewis_/status/1503739113933000705?s=21HM: American Song Contest - Jewel, Sisquo, Michael BoltonBHIHEKetanji Brown JacksonFANTI: Amber J. Phillips and Da'Shaun L. HarrisonOur Sponsors This WeekMicrodose GummiesTo get free shipping and 30% your first order, go to MicrodoseGummies.com and use code FANTI.BrookLinenFANTI listeners can get $20 off a purchase of $100 or more by using the promo code FANTI.Go ahead and @ usEmail: FANTI@maximumfun.orgIG@FANTIpodcast@Jarrett Hill@rayzon (Tre'Vell)Twitter@FANTIpodcast@TreVellAnderson@JarrettHill@Swish (Senior Producer Laura Swisher)FANTI is produced and distributed by MaximumFun.orgLaura Swisher is senior producer Episode Contributors: Jarrett Hill, Laura Swisher, Tre'Vell Anderson,Editor: Will HagleMusic: Cor.eceGraphics: Ashley Nguyen

We're excited to introduce you to Gender Reveal, an award-winning podcast made by and about trans people. Host Tuck Woodstock interviews LGBTQ+ artists, activists, and educators; answers listener questions; breaks down this week's gender news; and gets a little bit closer to understanding what the heck gender is.In this episode, Tuck speaks with theorist, author, and abolitionist Da'Shaun Harrison (they/them). Topics include:The way fatness functions as its own genderWorking towards a better world without hope that we'll achieve itWhy the concept of health is unsalvageableWhy we're tired of talking about pronouns with cis peoplePlus: destroying gender!Find Da'Shaun and Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness at linktr.ee/DaShaunLH.References: “Mama's Baby, Papa's Maybe” by Hortense J. Spillers.Find episode transcripts and starter packs for new listeners at genderpodcast.com. We're also on Twitter and Instagram @gendereveal. Join our Patreon (patreon.com/gender) to receive our weekly newsletter, plus stickers and other rewards.