Thanks for this. There's also the point that EVEN IF the correlation between higher weight and health issues is robust, that still does not demonstrate that causation exists, or the direction of the causation if it does exist. You touch on this with your example of baldness and cardiac events, but I think it's worth repeating!
For instance: according to my endocrinologist, there is growing evidence that insulin resistance causes weight gain, NOT vice versa. In other words, higher weight may well be a SYMPTOM of Type 2 diabetes, not a CAUSE of diabetes. If that is the case, then blaming fat people for "causing" their diabetes is as nonsensical as it would be to blame my swollen knuckles for "causing" my osteoarthritis.
"Growing evidence" -- they've known that IR causes weight gain for decades! When I was diagnosed with diabetes in the '90s, "unwanted weight gain" was listed as a known symptom of Type 2 diabetes. It wasn't until diabetes medications started being looked at for weight loss that being fat became blamed for the cause of T2DM. [The glitazone class of drugs (Rezulin, Actos, Avandia, etc.) were marketed to cause weight loss, because their intended result was reduced insulin resistance. After they became popular to use it became clear that a) they didn't cause weight loss; instead most patients gained weight, and b) they were damaging people's hearts and livers.]
That is very interesting indeed. Thank you. I was only diagnosed with T2DM in 2016, and my endocrinologist presented "IR causes weight gain" as a new discovery.
The context was that I asked him why I had gained 30 pounds in less than a year, when I'd made no changes in my diet and was exercising more than before. He said "You've gained weight because you've become insulin resistant" and then explained that many "recent studies" indicated that the causation works in that direction. He was only in his 30s, I think -- maybe he didn't know that this was already recognized in the 90s!
One thing I think about a lot is the stress-health relationship and how damn hypocritical it is for a doctor to be shaming us for our size while simultaneously saying we need to lower our stress levels. They’re the cause of much of my stress! I’m just flabbergasted that these supposedly educated professionals can’t put two and two together here.
I think you touch on this in the post, but even before I understood much about bias and was just living as a fat person in the world, a physical issue itself as a potential fourth causal relationship always seemed like common sense to me.
There's so much in science and medicine that continues to be discovered, it seems like a really lazy approach to say 'well, people who are fat also have a high rate of X therefore fat causes it' instead of looking for common factors that might be contributing to both. Thanks for continuing to connect the dots where actual evidence leads.
Could you please offer cites for the baldness - cardiac events correlation? Thank you!
It doesn't surprise me; there's so many correlations with cardiac events. My favorite is when they found that C-reactive protein levels, a marker of inflammation, are higher in people who have had cardiac events. They concluded that means people with high C-reactive protein levels are going to have heart attacks! Then someone dug through the research and found that nobody looked to see what their levels were BEFORE. There were no comparisons. And for a bonus, they then realized that your C-reactive protein levels can go up from just about anything, from chronic allergies, a bad and stressful event, autoimmune diseases, etc.
I don't know of a source directly about male pattern baldness and heart attacks, but elevated testosterone causes both early baldness and an increased risk of heart attack.
I'm reading a book now about medical reversals (when doctors stop using a treatment because oops, it doesn't work after all) and there are a bunch of stories like that. They discuss, for example, a class of blood pressure medication that very successfully lowered people's blood pressure but did not do anything to lower incidence of heart disease and only barely lowered stroke risk. Surrogate endpoints are *very* tricky and often lead to false confidence in treatment.
Thanks for this. There's also the point that EVEN IF the correlation between higher weight and health issues is robust, that still does not demonstrate that causation exists, or the direction of the causation if it does exist. You touch on this with your example of baldness and cardiac events, but I think it's worth repeating!
For instance: according to my endocrinologist, there is growing evidence that insulin resistance causes weight gain, NOT vice versa. In other words, higher weight may well be a SYMPTOM of Type 2 diabetes, not a CAUSE of diabetes. If that is the case, then blaming fat people for "causing" their diabetes is as nonsensical as it would be to blame my swollen knuckles for "causing" my osteoarthritis.
"Growing evidence" -- they've known that IR causes weight gain for decades! When I was diagnosed with diabetes in the '90s, "unwanted weight gain" was listed as a known symptom of Type 2 diabetes. It wasn't until diabetes medications started being looked at for weight loss that being fat became blamed for the cause of T2DM. [The glitazone class of drugs (Rezulin, Actos, Avandia, etc.) were marketed to cause weight loss, because their intended result was reduced insulin resistance. After they became popular to use it became clear that a) they didn't cause weight loss; instead most patients gained weight, and b) they were damaging people's hearts and livers.]
That is very interesting indeed. Thank you. I was only diagnosed with T2DM in 2016, and my endocrinologist presented "IR causes weight gain" as a new discovery.
The context was that I asked him why I had gained 30 pounds in less than a year, when I'd made no changes in my diet and was exercising more than before. He said "You've gained weight because you've become insulin resistant" and then explained that many "recent studies" indicated that the causation works in that direction. He was only in his 30s, I think -- maybe he didn't know that this was already recognized in the 90s!
Thank you so much for this post!
One thing I think about a lot is the stress-health relationship and how damn hypocritical it is for a doctor to be shaming us for our size while simultaneously saying we need to lower our stress levels. They’re the cause of much of my stress! I’m just flabbergasted that these supposedly educated professionals can’t put two and two together here.
I think you touch on this in the post, but even before I understood much about bias and was just living as a fat person in the world, a physical issue itself as a potential fourth causal relationship always seemed like common sense to me.
There's so much in science and medicine that continues to be discovered, it seems like a really lazy approach to say 'well, people who are fat also have a high rate of X therefore fat causes it' instead of looking for common factors that might be contributing to both. Thanks for continuing to connect the dots where actual evidence leads.
I wish there was a button to SUPER-LOVE this post!!!
Could you please offer cites for the baldness - cardiac events correlation? Thank you!
It doesn't surprise me; there's so many correlations with cardiac events. My favorite is when they found that C-reactive protein levels, a marker of inflammation, are higher in people who have had cardiac events. They concluded that means people with high C-reactive protein levels are going to have heart attacks! Then someone dug through the research and found that nobody looked to see what their levels were BEFORE. There were no comparisons. And for a bonus, they then realized that your C-reactive protein levels can go up from just about anything, from chronic allergies, a bad and stressful event, autoimmune diseases, etc.
I don't know of a source directly about male pattern baldness and heart attacks, but elevated testosterone causes both early baldness and an increased risk of heart attack.
I'm reading a book now about medical reversals (when doctors stop using a treatment because oops, it doesn't work after all) and there are a bunch of stories like that. They discuss, for example, a class of blood pressure medication that very successfully lowered people's blood pressure but did not do anything to lower incidence of heart disease and only barely lowered stroke risk. Surrogate endpoints are *very* tricky and often lead to false confidence in treatment.