Category Archives: Fat Acceptance

Something I have become conscious about in the last few years is the importance of reviewing the background of information that is presented to you. It’s important to become critical of data and want to know where it has come from, how it was produced and what influences may have been placed on the creation of the data.

I learned very early with computers the GIGO principle – Garbage In, Garbage Out. It doesn’t matter how good a computer is, or how good the software is. If what you put into it is tainted, or skewed, or wrong, what comes out of it will be tainted, skewed or wrong. This principle applies to scientific research, news and other information just as much as computers.

I think it is important to analyse information that is presented to me. I think the Australian media should do a better job of getting facts right and making sure that what is reported isn’t biased or at least mentioning any conflicts of interest that people interviewed may have.

I’ve been in the media a couple of times to talk about being fat and the discrimination against fat people. It might be fair to suggest that I am biased, and perhaps even some people who see me on these programs would think that. The thought could run across someone’s mind that I am against fat discrimination and believe in fat acceptance, health at every size and other principles only because I am fat. “Perhaps he should just stop complaining and put down the fork” might be a response from some people in the community.

When a doctor or academic talks about these sorts of things, it might be fair to think that there would not be any bias. They are there to take information and make informed decisions that are based on the facts in front of them. Why would there be any need for them to promote fat acceptance or weight loss? If an academic says that a fat person can be healthy, or that childhood obesity is on the rise, there doesn’t seem to be a need to question it.

Yet I think that everything should be questioned.

For example it was reported back in 2008 that childhood obesity rates are not rapidly increasing as per the media scare campaigns. Yet we are still bombarded in the media with the message that kids are getting fatter and fatter.

Which was the main point put across in a story on Today Tonight called Obese Kids. Such an original title. But I’m getting petty.

The obesity expert presented this evening was Dr George Hopkins. He talked about how obesity was on the rise in children and the types of medical issues that obese children could look forward to later in life, like Type II Diabetes, Heart Disease, and even increased risk of Cancer! Yup, the big C. I’ve never seen that one used before but there is probably some research out there that supports this view.

He also went on to talk about how he was having great success rates with bariatric surgery on kids up to 13 or 14 years old. 13 or 14 years old. I couldn’t help but scream at the television. I’m not a doctor, but I am a human. I can’t imagine how someone that young could be in the right state of mind to make a decision about bariatric surgery which has so many repercussions in later life.

So who is this Dr Hopkins, obesity expert? Well Dr Hopkins is a bariatric surgeon (surprise!) who runs the Brisbane Gastric Banding Centre. He has a link to the LAP-BAND® website as the second and third links on his links page. His first link is to the Obesity Surgery Society of Australia and New Zealand (OSSANZ), of which he is a member..

I suppose that it would make sense to link to your professional body on your website when you are a member. If you wish to know who sponsors OSSANZ, you need to email them. I didn’t bother, but in a submission to the 2008 Australian House of Representatives’ Inquiry into Obesity in Australia, Coviden made a submission which included the following paragraph:

In Australia, Covidien has been closely involved in supporting the work of bariatric surgeons treating obesity and its co-morbidities since 1996. Our early commitment to this important field of surgery began by working with a small group of surgeons to help grow the Obesity Surgery Society of Australia and New Zealand (OSSANZ) to the point where it now has membership of approximately 150 bariatric surgeons. Throughout the last 12 years, Covidien has also been responsible for supporting the training of many General and Gastro Intestinal surgeons in the latest techniques used in the rapidly advancing field of metabolic surgery.

Who are Coviden? Well Coviden and Allergan joined forces in 2007 to co-promote Allergan’s LAP-BAND® Adjustable Gastric Banding System. So presumably they would be quite for lap banding procedures. And I’m sure that Coviden would not provide OSSANZ with any support for research into lap banding. (Well I’m not sure either way).

Oh, I forgot to also mention that you can find Dr Hopkins through the website “Gastric Banding Procedure” which just happens to be run by Allergan. Take a look at the site. Unless you knew that Allergan wast the company that made the LAP-BAND®, you would think it was a general information site. Surely there is no agenda there.

This story is a beat up and just a promotion by people who stand to make a large amount of money by having kids sent to them to have bariatric surgery. This makes me mad.

A little sidenote is that the Today Tonight website links to Baker IDI. You would hope that they are a completely unbiased organisation. Well let’s look into that.

The International Diabetes Federation (IDF) Taskforce on Epidemiology and Prevention of Diabetes released a paper called Bariatric surgery: an IDF statement for obese Type 2 diabetes.

Professor Paul Zimmet was one of the authors on this paper. The paper notes: “PZ has received a consulting fee from Covidien Australia.” He is also Director Emeritus and Director of International Research, Baker IDI Heart and Diabetes Institute and Professor (Hon) Monash University.

Associate Professor John Dixon was another author on this paper. He is Associate Professor, Department of General Practice, School of Primary Health Care, Monash University and Senior clinical scientist, Human Neurotransmitters Laboratory, Vascular & Hypertension Unit, Baker IDI Heart & Diabetes Institute. In the paper it notes that “JD is a consultant for: Allergan Inc, manufacturer of the LapBand System®; Metagenics, manufacturer of Bariatric Advantage® nutritional supplements; and Scientific Intake, manufacturer of the SMART® device. […] His institutions, Monash University and Baker IDI Heart & Diabetes Institute, have received support for his research from Allergan Inc, […].”

No, surely they aren’t getting money from the companies who sell the very same products that their research promotes and recommends? This should be an outrage! But it isn’t. The media don’t ever look at it. They don’t care.

So I say that it is important to make my voice heard. Even one small voice can make a difference. Hugh props to Dr Samantha Thomas and Frances Lockie for standing up for the rights of fat people and telling it how it is, without corporate backing.

A good friend of mine and fellow fat activist Sonya wrote an article over at Lip. I left a comment on it due to some of the other comments completely missing the point of her article. Since the comment was a little TL;DR I thought I would post it here as well, since it is probably more of a blog post/rant than a comment. You should probably check out the original post first for context.

Are you all serious? (ok most, not all)

Think back about all of the weight loss products you or your friends have tried over the years. Have any of them helped you lose weight and then keep it off for ever? A small percentage of you will say yes, and good luck to you. For the large percentage of people the answer is no, No, NO!

Scientific studies that have been done in recent years show that short term weight loss is achievable through all sorts of diets but that long term weight loss is very much a pipe dream. Those who achieve short term weight loss and then gain end up gaining more weight than when they started.

I’m a prime example. I used to weigh around 120kg in my 20s. I went on weight watches and got below the ‘magic’ 100kg mark. I then ballooned up to 135kg. I did that TWICE. That left me around the 150-160kg mark. Perhaps if I had not dieted, I’d still be around the 120kg mark.

That isn’t the point though. The point is that what you feel about your body is about what is in your head. I read an excellent article this morning which talked about a lady who was a size 10, who wouldn’t be happy until she was a size 8. When she was a size 8, size 6 was where she had to be.

You have to make a conscious decision to realise that most people stuffer from some form of body dysmorphia. You will always feel fatter or uglier or than you are until you realise that.

It isn’t easy. You have to work at it. I have some awful days. I have some brilliant days. But life goes on regardless. I eat well and exercise. I’m healthy, give or take. That’s what life is about. Not unattainable goals.

Thanks to Sonya for trying to point this out. It is a shame that the point was missed on most of you.

When reviewing the recent BMI research that was printed in the Lancet for my post on the “Tsunami of Obesity” something occurred to me. The paper was at pains to say that they had split the data they were reviewing by sex, because “BMI trends can differ in men and women”. Even when looking at the trends on a global basis, the results were still talked about with regards to men and women. I even mentioned how some of the lowest mean BMI were found in different countries for men and women, whereas the highest mean BMI for both men and women was found in Nauru.

What about those people who don’t identify as male or female? Where would they fit into this research? Are they being excluded because of the use of this false gender dichotomy?

I don’t blame the researchers here for this. They were using preexisting data collected between 1980 and 2008. Importantly they noted that much more data was available for women, whereas 59% of the national data for men was from the 2000s and 34% was from the 1990s. I think that shows just how much emphasis was placed on women when looking into weight issues during the 1980s and possibly even earlier.

I think it provides an insight into how weight management has been viewed historically – as a female issue, not a human issue. I would suggest that the pressure on women to conform to the idea of a “healthy weight” has been around a lot longer than it has been for men. When I was growing up, men had “beer guts” while women “had a bit of a pudge they needed to get rid of”.

Yet here is still a group of people who identify as neither men or women who aren’t included in this research. What does this mean for them? It certainly doesn’t reduce the pressure placed on them to confirm to the socially acceptable idea of weight and size.

I think it would be fair to suggest that gender identity is important when it comes to research into weight and health issues. Social pressures would be different depending on the gender identity which could lead to different trends in these groups than what we see if we try to make them fit into the false dichotomy. Why not just look at this as a human issue, rather than focusing on gender?

What do we do about this? I don’t think I have the answer.

It is not surprising to see the media reach for the sensationalist headlines when a new study about “obesity” comes out. Today’s headlines were all on the same theme – the “Tsunami of Obesity” that is sweeping the planet. It’s an interesting use of a word which I don’t normally associate with “obesity”. So I wondered why researchers were suggesting that there was such a “Tsunami” and what evidence there was to back up this claim. Thanks to a couple of wonderful sources I managed to get a hold of the research papers related to the media frenzy, and this is my take.

The “Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group” released three reports today that describe global population-level changes in body-mass index (BMI), systolic blood pressure, and cholesterol over three decades. I’ll be frank: I have not read through the articles relating to blood pressure and cholesterol. Each article covers its own subject area and was then summarised in a further commentary. My review considers the research undertaken in regards to the BMI and the summary of all three reports.

The report notes that in 2008, 1.46 billion adults had a BMI of over 25, with 502 million of those with a BMI of over 30. The summary indicates that this means that “obesity” affects one in nine adults. I’m not sure that one in nine constitues a tsunami. The report also shows that the prevalence of “obesity” is nearly twice that which existed in 1980.

All of these figures sound really scary when you leave them on their own like that. There is no context. So let’s add some context.

Over the study period (1980 to 2008) the mean global BMI increased by 0.4-0.5 per decade, which is roughly 1.12-1.4. The mean BMI for women was higher at 24.1 whilst mean BMI for men was 23.8. It should be noted that men had a higher BMI than women in high-income regions, while this trend reversed in medium- and low-income regions. It’s important to note that the largest mean BMI values for both men (33.9) and women (35.0) came from Nauru. The lowest values were found in east Asia and high-income Asia-Pacific sub-regions (21.4-2.9) for women and in sub-Saharan Africa and in east. south and southeast Asia (20.6-28.1).

In the discussion, the paper looks deeper into these figures. There are two important parts that I think need to be considered by the media and the world at large:

Research is undoubtedly needed into the proximal and distal causes of the recorded trends. For example, to what extent have changes in physical activity versus increases in caloric intake or changes in dietary composition brought about BMI rise? What explains the heterogeneous BMI levels and trends, including by sex, in high income countries (Asia-Pacific vs western Europe vs Australasia and North America) or in Africa’s sub-regions?

Or in other words, why are BMI trends and levels not similar within countries with similar socio-economic levels or even in similar regions of the world? Some high-income countries to have low increases in BMI, for example France and Switzerland yet other countries with a similar socio-economic level such as Australia had larger increases.

They further point out how more research is required into the efficacy of long term weight loss benefits:

Randomised studies of diet change, some of which increase the amount of exercise, have shown moderate weight loss benefits for up to 2 years, but long-term and community effectiveness of such interventions is not clear. Simple advise and exercise alone have not been efficacious, even in trials.  Structural, regulatory and economic interventions have potential to change physical activity of dietary patterns for whole communities and populations, but few have shown effects on weight.

There goes a few of the weight loss industry myths right there. But they go further:

That interventions on metabolic mediators might partially mitigate the health effects of rising BMI is supported by results from randomised trials, and more importantly from the fact that many countries have successfully reduced blood pressure and lipids despite rising BMI, and by a larger amount in people with high BMI.

So dispite the “Tsunami of obesity” research supports the fact that increasing metabolic rates through exercise can mitigate the health effects of being fat. I take that to read that you can be fit and fat. I’m not a scientist, but that’s what I read. How about you?

As a final note, it should be noted that the research into BMI did not mention the term “Tsunami”. This was part of an overall commentary of the three pieces of research. In fact, the title of the commentary was “Stemming the global tsunami of cardiovascular disease” (my emphasis). They did mention a “Tsunami of Obesity” in passing but the main comment they are passing is that urgent attention needs to be paid to cardiovascular health. So I wonder why the media decided to focus on the “Tsunami of Obesity” instead of the “Tsunami of Cardiovascular Disease”?

Citations

National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants
Mariel M Finucane AB,Gretchen A Stevens DSc,Melanie J Cowan MPH,Goodarz Danaei MD,John K Lin AB,Christopher J Paciorek PhD,Gitanjali M Singh PhD,Hialy R Gutierrez BS,Yuan Lu MSc,Adil N Bahalim MEng,Farshad Farzadfar MD,Leanne M Riley MSc,Prof Majid Ezzati PhD,on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index)
The Lancet – 4 February 2011
DOI: 10.1016/S0140-6736(10)62037-5

Stemming the global tsunami of cardiovascular disease
Sonia S Anand,Salim Yusuf
The Lancet – 4 February 2011
DOI: 10.1016/S0140-6736(10)62346-X