This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing! Reader Marcella wrote: “I keep seeing the term weight-related health conditions. Can you explain what this means?” Thanks for asking Marcella!
An article landed in my inbox today entitled: "Weight loss rarely leads to type 2 diabetes remission in real-world settings," reporting on this study: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004327. In a nutshell, while weight loss was associated with improved glucose control in folks with T2D, only 6.1% of the 37,326 people enrolled in the study remained in remission from type 2 diabetes at the 8-year mark. The authors write: "...both the incidence of diabetes remission and the probability of its long-term sustainability were low with conventional management in real-world settings,..." However, rather than blaming the long-term unsustainable nature of intentional weight loss, they call on "...policymakers to design and implement early weight management interventions and diabetes remission initiatives" that are somehow more compatible with the real world. I call that a woefully missed opportunity.
Thanks as always, Ragen. This article is helping put in new light something that happened to me last year. I was denied a breast reduction because my BMI is over 30. The reason given by the surgeon is that I'd "have a higher chance of complications after the procedure." I had explained that I have binge eating disorder and his response was something along the lines of "well, if you get that undercontrol and lose 15 pounds, then call me back." So even thought I told him that I have disordered eating and that dieting triggers it, he told me to just ignore that and lose that weight.
The more I consider it, the relief I would experience from the procedure is being held hostage (your words) and weight loss is the price I must pay to get it. This makes me so angry. Do you have any next steps you'd recommend to restart this conversation to get the outcome that I'm after?
I'm so sorry that you are dealing with this. This is what I would consider double weight stigma because it's highly likely that any increase in post-surgical complications is due not to patients being higher-weight but due to the healthcare inequalities that higher-weight patients experience in post-surgical care, that instead get blamed on their weight. I have a series here on the basics and specific steps for fighting these denials (https://weightandhealthcare.substack.com/p/bmi-limits-healthcare-held-hostage). Some of the studies listed here may also be helpful: https://weightandhealthcare.substack.com/p/resources-to-fight-bmi-based-denials
This is such a great guide to how medicine stigmatises fat people. I want to throw something in frustration after reading your pieces, because of how dubious the research methodology in the studies is.
Thank you so much for this, and all your other articles, Ragen. Do you happen to know of any "research methodology 101" type classes for the lay person? Reading your newsletter has made it clear how little I know about correct methodology. As a higher weight person with multiple health issues and a history of disordered eating, it seems in my best interest to learn how to better tell the difference between a well-designed study and a shoddy one.
Hi Morgan, the book Stephanie remembered is a good one. Bad Pharma is another book that really breaks down the issues with medical research (it was written a decade ago I think and, sadly, is completely relevant today.)
I remember reading a book called How to Lie with Statistics during college. It's from a long time ago, I think, but if I remember correctly, it showed how easy it is for researchers to manipulate data in a way that makes people fall for it.
I don’t know much about statistics so in general, for example with COVID, I looked to authorities in the subject for what I should do health-wise. I can’t read a study and determine if it was well-done so I leave that to the experts. It really freaking sucks to not be able to trust “experts” when it comes to the size of my body.
Thank you for this breakdown! At this point, using the flawed BMI as the yardstick, aren’t the majority (>50%) of people (at least in the US) considered “overweight or ob*se”?
I ask because at this point, can’t we pretty much assume that ALL medical conditions are “weight-related” simply because the majority of people are higher weight? (I don’t mean this is correct, I just mean that’s the way these Research Methods 101 flunkees are interpreting reality.)
It seems like such a garbage metric from every possible angle. And a very sloppy way to get out of providing proper healthcare to all patients, while continuing to help the weight loss industry break profit records year after year.
Thanks! It's actually closer to 70% (insert eyeroll here). You absolutely make a good point. I've seen research that tries to suggest that something is linked to "ob*sity" because 25% of people in the impacted group were labeled "ob*se" when more than 30 % of the population studied were labeled as such. It absolutely messes with the way that research is conducted!
An article landed in my inbox today entitled: "Weight loss rarely leads to type 2 diabetes remission in real-world settings," reporting on this study: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004327. In a nutshell, while weight loss was associated with improved glucose control in folks with T2D, only 6.1% of the 37,326 people enrolled in the study remained in remission from type 2 diabetes at the 8-year mark. The authors write: "...both the incidence of diabetes remission and the probability of its long-term sustainability were low with conventional management in real-world settings,..." However, rather than blaming the long-term unsustainable nature of intentional weight loss, they call on "...policymakers to design and implement early weight management interventions and diabetes remission initiatives" that are somehow more compatible with the real world. I call that a woefully missed opportunity.
Thanks as always, Ragen. This article is helping put in new light something that happened to me last year. I was denied a breast reduction because my BMI is over 30. The reason given by the surgeon is that I'd "have a higher chance of complications after the procedure." I had explained that I have binge eating disorder and his response was something along the lines of "well, if you get that undercontrol and lose 15 pounds, then call me back." So even thought I told him that I have disordered eating and that dieting triggers it, he told me to just ignore that and lose that weight.
The more I consider it, the relief I would experience from the procedure is being held hostage (your words) and weight loss is the price I must pay to get it. This makes me so angry. Do you have any next steps you'd recommend to restart this conversation to get the outcome that I'm after?
I'm so sorry that you are dealing with this. This is what I would consider double weight stigma because it's highly likely that any increase in post-surgical complications is due not to patients being higher-weight but due to the healthcare inequalities that higher-weight patients experience in post-surgical care, that instead get blamed on their weight. I have a series here on the basics and specific steps for fighting these denials (https://weightandhealthcare.substack.com/p/bmi-limits-healthcare-held-hostage). Some of the studies listed here may also be helpful: https://weightandhealthcare.substack.com/p/resources-to-fight-bmi-based-denials
You're also welcome to email me (weightandhealthcare@substack.com) and I'll help in any way I can!
Thanks so much, Ragen, so appreciate it. I will take a look and get back to you if I have any questions.
This is such a great guide to how medicine stigmatises fat people. I want to throw something in frustration after reading your pieces, because of how dubious the research methodology in the studies is.
We have something in common then - because I want to throw something while I'm writing them!
Thank you so much for this, and all your other articles, Ragen. Do you happen to know of any "research methodology 101" type classes for the lay person? Reading your newsletter has made it clear how little I know about correct methodology. As a higher weight person with multiple health issues and a history of disordered eating, it seems in my best interest to learn how to better tell the difference between a well-designed study and a shoddy one.
Hi Morgan, the book Stephanie remembered is a good one. Bad Pharma is another book that really breaks down the issues with medical research (it was written a decade ago I think and, sadly, is completely relevant today.)
I wrote a piece about this that you can find here: https://weightandhealthcare.substack.com/p/quick-guide-to-evaluating-weight
I also have a workshop called "Understanding the Research on Weight and Health" that might be helpful (there is a pay-what-you-can option so that money isn't a barrier) https://danceswithfat.org/monthly-online-workshops/#Understanding-the-research-about-weight-and-health
Wonderful! Thank you so much, Ragen!
I remember reading a book called How to Lie with Statistics during college. It's from a long time ago, I think, but if I remember correctly, it showed how easy it is for researchers to manipulate data in a way that makes people fall for it.
Thank you! I'll look for it. :)
I don’t know much about statistics so in general, for example with COVID, I looked to authorities in the subject for what I should do health-wise. I can’t read a study and determine if it was well-done so I leave that to the experts. It really freaking sucks to not be able to trust “experts” when it comes to the size of my body.
Thank you for this breakdown! At this point, using the flawed BMI as the yardstick, aren’t the majority (>50%) of people (at least in the US) considered “overweight or ob*se”?
I ask because at this point, can’t we pretty much assume that ALL medical conditions are “weight-related” simply because the majority of people are higher weight? (I don’t mean this is correct, I just mean that’s the way these Research Methods 101 flunkees are interpreting reality.)
It seems like such a garbage metric from every possible angle. And a very sloppy way to get out of providing proper healthcare to all patients, while continuing to help the weight loss industry break profit records year after year.
Thanks! It's actually closer to 70% (insert eyeroll here). You absolutely make a good point. I've seen research that tries to suggest that something is linked to "ob*sity" because 25% of people in the impacted group were labeled "ob*se" when more than 30 % of the population studied were labeled as such. It absolutely messes with the way that research is conducted!
Bravo!! Perfection in clarity.