No Empathy for the Fat in Healthcare

I saw this Scientific American article in my Google Reader this morning, and it struck me right away that this — THIS — is what’s missing from the average fat person’s healthcare, compared to the average thinner person.

Empathy.

Missing But Crucial to Successful Healthcare: Empathy

Sure, empathy is in short supply in many doctor’s offices and bigger institutions, with the growing shortage of healthcare professionals in proportion to those who seek care. But many of the horror stories from First, Do No Harm are about a very particular lack of empathy for fat people from those same professionals, whether they be doctors, nurses, surgeons, nutritionists, and so on down the line.

Underlying the lack of empathy is the appalling prevalence of bias against fat people in the medical community, which often starts in medical school.

Many medical researchers also seem to lack empathy for fat people, as they twist themselves into statistical knots trying to make their conclusions fit the anti-obesity paradigm, making recommendations that are tantamount to the eradication of a whole population of people or children without so much as thinking about fat people as individual humans. They never blink an eye at talking about ‘eradicating obesity.’ But there is no such thing as ‘obesity,’ there are only obese people.

Perhaps if doctors had a little empathy, they wouldn’t start in on the weight discussion when their patient just needs antibiotics for a sinus infection. Perhaps if they had a little empathy, they wouldn’t recommend a course of treatment with such a huge failure rate. Perhaps if they had a little empathy, they would help their patient get that kidney transplant/knee replacement/IVF without demanding they first physically uncover the thin person within as some kind of marker of worthiness; that is, they would help their patient find an anaesthesiologist who can handle a person of their size.  Perhaps if they had a little empathy, they’d think about how to make their patient feel better rather than using Ailment X as yet another ‘teachable moment’ about their patient’s weight.

Empathy is crucial to good health care, as mentioned by the article in Scientific American. And for fat people it is, sadly, in particularly short supply.

More Healthist Doublespeak

The language of Healthism is so intertwined with notions of moral value that we tend to take its dicta as fact. This can lead to unfortunate reporting of scientific results, both by researchers in ‘conclusion’ sections, and by health reporters.

The most recent example of this is a study (h/t Regan at Dances with Fat) that shows people eat more calories after looking at pictures of larger people than say, a picture of a lamp or a person of ‘normal’ weight. This was translated by the study researchers and health reporters to suggest that people exhibit ‘unhealthy’ behaviors after exposure to fat images, with a not-too-subtle additional suggestion that fat images are harmful and fat is contagious through the power of bad example. Typical paranoid fodder for the moral panic.

Let’s just assume that the conclusions were sound, that people indeed do, in a vacuum, eat more calories after viewing pictures of larger people than they do after viewing pictures of ‘normal’ sized people or lamps. How can we deconstruct what’s going on? And how might we suggest that this kind of behavior isn’t, shockingly, necessarily a bad thing?

Let’s try a thought experiment. Let’s suppose we take a group of chronic dieters who self-report to hate their bodies and fear fatness.* Subject them to a slideshow of people who are even thinner, and who aren’t shown eating. As a bonus, the imagery is presented in a way as to suggest that thinness is what makes these models attractive and worthy of love and the good things in life. Directly afterwards, ask the study participants about their feelings towards their own bodies, and see how many candies they take from a bowl.

My guess, based on the literature of similar studies and good old-fashioned logic? They’ll feel even worse about their bodies, and will tend to restrict their eating more than usual.

Then, show the same group of people a slideshow of images from, say, Adipositivity and some fatshion blogs. Show them fat people in attractive poses and lighting, in pictures meant to suggest that they are attractive, and worthy of the good things in life. Would it be any surprise if the study participants, post-slideshow, felt better about their bodies, and tended to relax their chronic restriction a tad?

What I want to know: why is the second scenario supposed to be the ‘unhealthy’ one?

The power of Healthist language and concepts is much more pervasive than we think. Its stranglehold on common sense and higher reason — its doublespeak — ties even those who make a living researching these things into knots of contradiction.

*I chose this group to make the comparison clearer. It applies to a more general group of participants since the majority of women in Western culture have dieted, and are inundated with messages about how thinness is the same as healthiness, godliness, and worth. Men are increasingly being marketed to in a similar way, and more men diet now than ever before.

Weight- and Looks-Bullied Minnesota Girls Fulfill Suicide Pact

This is so sad. Thanks to my husband for emailing the link as soon as he saw it — we’re the parents of teenage girls and are extraordinarily alarmed by the prevalence and virulence of appearance- and weight-based bullying.

These poor girls were only 14. They hadn’t even begun their mature lives, and they already decided — apparently for a long time — that they wanted nothing of this abusive world.

Settle said that her niece, Haylee, had been the victim of bullying after moving to Minnesota from Indiana with her mother and 8-year-old brother.

“She was made fun of for being overweight, her red hair,” Settle said. “She posted on my [Facebook] wall that she really wanted to come back…that the people were mean and cruel and she didn’t fit in.”

Even though Haylee wasn’t severely overweight, she was so uncomfortable about her size that she rarely ate in public at school, Settle said.

Paige was Haylee’s closest friend.

Haylee’s letter was to her mother and detailed plans for her funeral, Settle said.

“She requested everything pink and princess and butterflies,” Settle said.

“She was actually one of the most giving loving girls you would ever meet… She just loved everyone unconditionally…She couldn’t stand people to be made fun of, tortured, teased. She stood up for the underdogs and she was one herself,” Settle said.

If the Fat Acceptance movement needs to be about anything, it needs to be against a world where 14 year-olds (and 9 year-olds, and 4 year-olds) are made to feel absolutely worthless and broken for their ‘wrong’ weight.

My good wishes go out to the family and friends of these poor girls.

Biscuits and Gravy

“Biscuits and gravy! Heh, I can’t believe she ordered it.”

“Heh, I can. Heh, biscuits and gravy.”

The worst part? Those biscuits were the consistency of spongy hockey pucks, and the gravy something between glue and edible. I picked at them, had maybe one bite, and any part of my appetite not killed by the sad copy of food on my plate was killed by humiliation.

We were on a road trip, to some hot state in the middle of the summer. Hotel prices in the sweltering states were cheaper in summer, and my parents more likely to take vacations. So in the van we packed pillows, Walkmans (Walkmen?), luggage, sandwiches, and our sorry selves. Twenty hours later we reached some kind of human destination, unbearably humid.

The best part of the trip, I remember, was when my dad drove and I kept him company, up front in the passenger seat. It was midnight or thereafter; my stepmother and brother slept in the back. We drove through the orange groves in Georgia. The air was spiced with the scent of the groves and honeysuckle. We played the game from the Albert Finney version of A Christmas Carol, “The Minister’s Cat”.

I’ll include it here, since I still feel warm and fuzzy thinking about it:

The next morning we stopped at a southern version of Denny’s. Shoney’s, maybe. As a kid I hated breakfast foods, except hot and cold cereals, and toast. Eggs, bacon, pancakes, English muffins, bagels? Blargh! Breakfast foods were either too sweet or too salty, and sometimes they combined the two in freakish horrors like bacon covered in maple syrup, or the abomination that is chocolate chip pancakes.

At any rate.

So, of everything on the menu, “biscuits and gravy” looked the least breakfast-y. I was hungry, having stayed up all night to keep my dad company while he drove (I was probably 10 at the time). We didn’t have biscuits and gravy for breakfast up North; to me, it was the perfect solution to my breakfast-nausea-dilemma.

I was duly mocked, as noted above. But it didn’t stop there. It turned into the joke of the trip. Then, the joke of the year. The last time I heard it was maybe five years ago, so that’s a good 14 years of torment.

And why was I tormented and mocked for my breakfast choice?

Because that 10-year-old girl was also chubby. And chubby people love gravy, donchaknow!

Maybe they didn’t realize how much their jabs hurt. Maybe they didn’t realize how deeply I internalized the shame I felt, how an intelligent little girl heard, “Biscuits and gravy, heh!” and translated it to mean that she was bad, out of control, a terrible person, a terrible daughter. So when my dad told me later that I should eat veggie burgers, plain popcorn, plain cucumbers, and drink water as my whole diet? I tried, for him. Because I didn’t want him to think I was some gross, out-of-control chubster, some human eating machine that goes bonkers at the idea of gravy. He was the first person to give me diet pills. I lost rapidly, and when I refused to eat even vegetables out of fear of remaining fat or gaining back lost weight, I thought about how I’d vindicated myself. No way he’d accuse me of the sin of “biscuits and gravy” again!

Sometimes, when I’m sitting, my heart flutters in my chest for no reason. I wonder if it has to do with all the diet pills I took when I was a teen. That, maybe, biscuits and gravy would have been a better option than diet pills.

But I guess I’ll never know.

This post is dedicated to my husband, who has never made me feel bad about what I eat.

The Fat Balancing Act

This is a post initiated by Raznay’s “Some Studies Show Fat Is Bad… Mmmkay?” on the never-ending oodles of studies trying in every which way to investigate just why “fat people are so disgusting.” It discusses the implications of the mindset which is generated by assumptions made in these studies — that is, how fat people are commanded to strike an impossible, delicate balancing act in order to be granted the respect and dignity accorded axiomatically to their non-fat peers.

Like Raznay points out, this is often to the detriment of more deserving topics, like cancer research. Then again, many obesity researchers (not all — hi, Dr. Samantha! 🙂 ) I’ve run across in real life, in comments on blogs, and on their own blogs/articles, are convinced that fat cells and hormones are absolutely causing or triggering fat-related diseases in the predisposed.

But I think two major factors are never accounted for in most of these “fat is bad go mutilate yourself/starve your body/feel like a drain on society” studies: dieting history, and current dieting status of participants.

See, lots of fat people diet. In fact, we make up the larger proportion of dieters. (My ‘normal’ -sized stepdaughter would say, “Ew, diet! Why would I ever want to go on one of those? They sound awful.” — but that’s nurture as well as nature, there.)

And those of us who’ve dieted for any length of time know:

  1. Dieting makes brain fuzzy. Huh? What about the food I can’t eat now? Oh you were actually asking a math question? Mmm, math. (Homer drool)
  2. Dieting is very stressful. So is living in a fat-hating world. Researchers are finding out more and more about the deleterious effects of stress on physical health. What they find might account for some the more specious claims correlating cognitive decline and fatness — that is, it might be about anxiety, at bottom.

There are a great many novelists, scientists, and all-around smart people who are big. Some of my most beloved writers are big people. One of my favorite politicians puts Taft to shame. They’re all extremely smart. And they’re not outliers — in fact, I’m willing to wager that intelligent, capable people, correcting for the stress and side effects of a life time of dieting and social stigma, are present in fat populations to the same degree they are present in non-fat populations. If I could commission a study, I would.

Here’s one tweet from the #thingsfatpeoplearetold hashtag which rings particularly true with my own experience of being fat and mingling with ‘intelligentisia.’ —

“Fat people are stupid. If they weren’t, they wouldn’t be so fat.”

I’ve especially gotten this impression from intelligentsia who are/were themselves fat and take it upon themselves to expound on their diet/reduction techniques:

“Oh, it’s easy, I just bag up smaller portions and do all my meetings on the treadmill. I rigged a laptop stand and I can just exercise all day if I want to!”

Of course, they’re smart, but they nevertheless don’t seem to make the connection between their twig-like human garbage disposal of a colleague who hasn’t seen a treadmill in forever, and metabolism and predisposition. If all it takes is living on an exercise machine and having bags of carrots and grain around, whose kind of lifestyle are you living? Your thin colleague’s — who is “better” because he is thin — or a horse’s?

And why the hell should fat people have to live like livestock in order to get the most basic kind of respect freely granted to the naturally-thin? (no insult intended to horses or livestock, of course)

Many fat people who’ve played this game long enough know that we’re expected to conduct a very delicate balancing act every day, seven days a week, until we die. We are supposed to “have it all” — aspire to the high-powered position, parenthood, hobbies, and community involvement — while still paying 15+ hours/week of penance on a treadmill, powered by a handful of carrots, oats, and apples. And advertising, of course, since fat isn’t okay unless you’re ‘doing’ something about it. Then you’re a go-getter! But not if you stay fat for too long!

Sound familiar? It’s chasing the dollar on a string. The dollar is basic human respect and dignity; the string is a tool of oppression, that with which we’re controlled and kept in our place. The man working on his treadmill, surrounded by plastic baggies of veg — is he free? And what is he chasing after? Is it thinness, or is it basic human dignity and respect, despite the fact that he is otherwise an example of success? Perhaps he runs to deserve his success in some intangible way unavailable to a person of his size unless human sacrifice is made? And is this the Puritan work ethic rearing its ugly head yet again, or is it something else?

Being seen as a successful, respectable fat person is a delicate balance, one which I’m not sure most people can strike. But should we have to? When do we get to step off of our treadmills, abandon our baggies of ‘good’ treats, and enjoy the world? When do we get to start being more than second class citizens? Isn’t this world — love, drama, beauty, art, travel, science, family, pleasure — isn’t it our world, too?

Food Addiction the Next Focus of Obesity Epipanic

In a study posted online that will appear in the August print issue of Archives of General Psychiatry, researchers used functional magnetic resonance imaging (fMRI) to study the response of 48 healthy young women in response to cues signaling impending delivery of a highly palatable food (chocolate milkshake) vs. a tasteless control solution; and consumption of a chocolate milkshake vs. a tasteless solution.

The women ranged from lean to obese and had been recruited for a healthy weight maintenance trial. Their eating behavior was assessed using a food addiction scale developed by lead author Ashley Gearhardt, a doctoral student at Yale University.

“Similar patterns of neural activation are implicated in addictive-like eating behavior and substance abuse and dependence,” Gearhardt noted in the study.”Food and drug use both result in dopamine release in mesolimbic regions [of the brain] and the degree of release correlates with subjective reward from both food and drug use.”

Gearhardt and colleagues found that participants with higher food addiction scores showed more activity in brain areas linked with craving. “These findings support the theory that compulsive food consumption may be driven in part by an enhanced anticipation of the rewarding properties of food,” the authors write. “Similarly, addicted individuals are more likely to be physiologically, psychologically, and behaviorally reactive to substance-related cues.

The researchers said that if certain foods are addictive for some people, that could explain in part why they find it so hard to lose weight and keep it off.

While researchers have speculated that an addictive process may be involved in obesity, the authors said that this is the first study to identify distinctive neural or brain activity in people with addictive eating behavior.

In addition, Gearhardt said, ”If food cues take on enhanced motivational properties in a manner analogous to drug cues, efforts to change the current food environment may be critical to successful weight loss and prevention efforts. Ubiquitous food advertising and the availability of inexpensive palatable foods may make it extremely difficult to adhere to healthier food choices because the omnipresent food cues trigger the reward system. (PsychCentral) (emphasis mine)

First, this is clearly a press release — the article doesn’t even come out in print until August. If I know anything about scientific publishing (and I know a little from my day job), it’s obvious that the ink was barely dry on their paper before they released it online, making sure to alert the major channels as soon as they hit “Upoad Article.”

Here’s the link to the online article. Naturally, the full text is behind a paywall. Any of my Fatosphere buds out there got an Athens login?

So this is what we have to go on without even knowing anything about the methodology beyond the statements released by a co-author.

First of all — 48 women. Not a giant sample size. Second — they weren’t all overweight or obese, and they were recruited from a “healthy weight maintenance trial” (if some were obese, and obesity is considered an ‘unhealthy weight,’ then does that imply the obese and possibly overweight women were dieting?) A natural question to ask is if this is going to be another round of ammunition against obese people in the grand moral crusade, how did these addictive responses correlate with BMI? This wasn’t mentioned in the vast majority of statement press-releases (nor in the article quoted above). I dug around and found one person at Consumer Reports who actually read the damn study (shocking, I know, most science ‘journalists’ can’t be bothered to actually read studies), and she said:

The researchers also found that a high score for food addiction didn’t correlate with having a high BMI. You can be lean, but still have an addictive relationship with food. They speculated that this might put lean individuals at an increased risk of future weight gain, unless they can develop behaviors to compensate and keep control of their food addiction. (emphasis mine)

Naturally, BMI isn’t mentioned in 95% of the articles except to implicate this as some factor in the Obesity! Epidemic!

Third — well, where to start. I’ll sketch my ideas, below, my first and later impressions.

First Impressions

As long as they use this study for what it actually shows — that some women out of a tiny sample with higher “food addiction” scores have higher activity in some brain areas linked to reward — and don’t try to generalize to all fat people or fat women, we’re good.

However, it’s unlikely that will happen, given the sensational nature of the science-illiterate press. Also, the co-author herself makes concluding remarks about how this might shape efforts to make people (excuse me, encourage!) lose weight. I.e., change the “current food environment” and restrict “availability of inexpensive palatable foods.”

Well, that’s a funny thing! How would we restrict availability of inexpensive palatable foods? Oh, by levying unpopular food taxes, you say? And you say that if we create a scare, make people afraid of fatty foods by suggesting the foods themselves are dangerous addictive toxins and — horror of horrors! — these are foods readily sought after by especially children and poor people, they might be more in favor of food taxes?

Yeah. Because it’s not like we can just stand by while poor people are actually able to afford energy-dense food, and might even — gasp! — feed it to their children.

Now onto the issue of ‘food addiction’ as an actual phenomenon parallel to addiction to substances like heroin.

When it comes down to it, an “addiction” to food is a silly idea, since it’s not a foreign substance that we can just quit. If someone exhibits higher pleasure or expectations eating food, then it would seem the real root of the issue is why? That ‘why’ is what needs to be discovered and addressed.

Also, food isn’t inherently addictive because there are people who eat loads of fatty, sugary, salty, etc food without experiencing an attachment beyond that being their regular diet. The issue is much more complex than the drug-addiction model, and simplifying it to that point loses precious information about what’s really going on.

I wonder how many of the women who scored high on the “food addiction” scale were former dieters or were currently dieting? I recall items like milkshakes, pizza, etc holding MUCH more fantastic interest when I was dieting (and I’ve heard many, many other dieters talk about this food-fantasy effect, and Keyes did a study years ago that shows it’s a side effect of one’s body experiencing famine). Could it be their wiring is a bit shot, or sensitive, because they’re restricting or have restricted in the past and a bit of their ‘famine’ mindset is still at work?

Final Impressions

This is why a lot of these studies are little more than junk reinforcing cultural biases against fat people or people who overeat. There are so many obvious questions that go unanswered, because all they want to do is generate a quick correlation for a press release. The medical research looking into body size is rife with these kinds of examples.

I took screenshots of a Google News search to prove this thing was an unabashed press release, intended to be — in a very calculated way, mind you — a seminal work in the war against obese people (excuse me, obesity). Some of the article headlines:

  • Heroin vs. Haagan-Dazs: What food addiction looks like in the brain (healthland.time.com)
  • Freakonomics: Another Obesity Explanation: Food Addiction (freakonomics.com)
  • Craving a milkshake? You might be a junk-food addict (Globe and Mail)
  • Can people be addicted to food? (CBS News, 20 hrs ago)
  • Compulsive Eaters May Have ‘Food Addiction,’ Study Finds (BusinessWeek, 14 hrs ago)
  • For Some, Food ‘Addiction’ Similar to Substance Abuse (PsychCentral, 1 hr ago, complete with pic of Sad Addicted Fatty)
  • For Food Junkies, Brains React to Milkshakes Like Drugs (LiveScience.com, April 4, complete with pic of Bad Woman Inhaling Chocolate)
  • ‘Tempting foods as addictive as cocaine’ (Times of India, 11 hrs ago)

What do you think about this study?