When death is ruled to be from "Complications of Obesity"

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Content note: Today we are going to be talking in depth about two tragic deaths and about death and its aftermath for higher-weight people in general. I’ve been writing about these issues since 2009 so I have a lot of experience and a myriad of coping skills but this is, by far, the most difficult piece I’ve researched and written. I’ve tried to write the piece in a way that, first and foremost, respects Ms. Mallory and Ms. Hundley and, second, discusses the specific circumstances following their deaths in the least triggering ways possible. Still, this piece involves death, discussions of autopsies, and the intersections of weight stigma and racism and may be triggering in many ways. Please take care of yourself and of course feel free to skip this.

Many of you have reached out asking me to write about Brandi Mallory and Mandisa Hundley’s deaths. Today is the day I’m going to do that. I want to start by saying that their deaths, regardless of cause, are a tragedy and my heart goes out to them and their families, friends, and loved ones.

Both Ms. Mallory and Ms. Hundley were reality television stars. Ms. Mallory died at 40 years old and Ms. Hundley died at 47.

Both women’s deaths were ruled by Medical Examiners as being due to “complications of ob*sity.”

I want to talk about this in general first. One type of medical weight stigma happens when higher-weight people’s body size is blamed for any and every health issue that they have, up to and including death. To do this ignores several things:

First, the fact that there are thin people with the exact same health issues throughout their lives and at death.

Second, the impact of (possibly a lifetime filled with) weight stigma, weight cycling, and healthcare inequalities, all of which are correlated with the same health issues that get blamed on higher-weight bodies. Even worse is that if those health issues are actually the result of a lifetime of experiences including weight cycling, weight stigma, and healthcare inequalities, they get blamed, instead on higher-weight people’s bodies, then the health issues and deaths of those people are used to justify even more weight stigma, weight cycling, and healthcare inequalities, continuing a vicious cycle.  

This brings me back to Ms. Mallory and Ms. Hundley, because they had something else in common as well – extreme weight loss. I want to be clear that they had every right to attempt weight loss and I am not shaming or blaming them. We live in a culture where this kind of extreme weight loss is encouraged by all facets, including much of the healthcare industry.

Ms. Mallory rose to fame on the show Extreme Weight Loss. The logline for the show is “The show documents the amazing makeover of eight courageous, ob*se individuals who set out to safely lose half of their body weight over the course of a year.” They offer no evidence that there actually is a “safe” way to lose half of your body weight in a year, nor any evidence that unlike the data for the last century shows, these people won’t end up regaining all the weight they lost and more.

In 2014, Ms. Mallory lost 45.9% of her body weight in a single year. At the time of her death she had regained more weight than she had lost (which is exactly what about a century of research tells us will happen. Weight loss interventions have a long and sordid track record of exactly this type of failure since they change the body physiologically inducing it to regain weight.)

Ms. Hundley rose to fame as a gospel singer on American Idol where she recalls being fat-shamed by Simon Cowell, telling Essence magazine “’When I auditioned for ‘American Idol’ Simon Cowell told me I had a pretty face and I was so happy that he didn’t talk about my weight,’ says Mandisa. “But when I was home watching the auditions with my friends he made a comment like, ’We’re going to have to build a bigger stage,’ and my heart broke. Right then me and my friends prayed that God would have mercy on him and give me the strength to forgive him and I did.”

She reportedly lost over 100 pounds and reportedly regained twice that, again, a common outcome of intentional weight loss, particularly extreme weight loss and not an indication that she did anything “wrong".

Part of the way that the weight loss industry has stayed in business so long is ignoring the fact that weight loss and subsequent regain are two parts of the same biological response. Instead, the industry has been brilliant at taking credit for the weight loss that is the first part of the biological response, and blaming customers (and getting their customers and everyone else including their doctors) to blame them for the subsequent regain that is the second part of the same biological response.

Studies that try (or claim to try) to determine life expectancy of higher-weight people are deeply problematic in no small part because they typically don’t explore the impact of things like weight stigma, weight cycling, and healthcare inequalities on life expectancy, instead choosing to blame any shortened life expectancy on higher-weight bodies themselves. Still, even the most methodologically terrible studies claim that those at the highest weights may have a life shortened by around14 years (again, having looked at the research this is a number that I would characterize as far more rooted in weight stigma then reality, at some point I’ll do a full piece about this). I am only discussing this to give context to the situation.

Both Ms. Mallory and Ms. Hundley are Black women and due to systemic racism the life expectancy of Black women in the US is already lowered from 79.2 (for non-Hispanic white women) to 74.8 years (for Black women) in 2021 per the US Census Bureau.

So, again, even by the most egregiously terrible research on the life expectancy of higher-weight people, their life expectancy would have been about 60.8 years. Which means that their deaths happened 20.8 and 13.8 years earlier than would be expected even by, again, the most weight-stigma driven research.

I acquired copies of both of the medical examiners’ reports and I’m left with a number of questions:

What is the official list of “complications of ob*sity” and how are these “complications” exclusive to higher weight people?

Given that thin people can and do pass away with the exact same health issues, how would these cause of death declarations be different if the only difference in circumstance was that the deceased were thin?

Are higher-weight people receiving unequal treatment because weight stigma leads MEs and coroners to simply claim death due to body size and call it a day?

In a system where a medical examiner can completely ignore - in fact not even be aware of - the potential impact of extreme weight loss (including the loss of heart muscle) and extreme weight cycling (which is absolutely not the same thing as simply existing in a higher-weight body) and just claim that someone’s death is due to being higher-weight simply because they are higher-weight, what can be done so that higher-weight people’s bodies are not automatically blamed without considering the things that they are put through at the hands of diet culture?

I wanted to speak to the Medical Examiners in these cases to ask these questions and made several attempts to do so but have not yet heard back. I also made some general inquiries in Facebook groups and to people in the field that I was connected to and the general consensus is that if they can’t find an external cause of death, and the deceased happens to be higher-weight, the Medical Examiner or Coroner is likely to simply rule it as a “natural” death due to “complications of ob*sity.” This is obviously not a scientific way to go about this. Weight stigma impacts higher-weight people in every aspect of our lives, including our deaths.

The cycle of weight stigma must be broken and we must start asking in what ways the harms higher-weight people experience (like weight stigma, weight cycling, and healthcare inequalities,) impact our lives and deaths.

May Ms. Mallory and Ms. Hundley both rest in peace.

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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.