I am in the middle of a five and a half hour layover in an airport that is 2 hours from my house. If I weren’t so tired I would rent a car but as it is I’m just going to hang out. I was planning to catch up on e-mail and the first e-mail that I had was from a blog fan who was writing me because she is fat dancer who is conflicted about her day job. Before I get into this I want to say to the person who wrote me that I’m going to very honest about this situation but I’m not angry with you – you have every right to do whatever you want for a job and I sincerely hope that you don’t feel that this is an attack on you, what you describe happens constantly and so made a perfect example, but for me this is about the situation and not you personally. Cool?
Okay, she writes:
On the other hand, I am highly conflicted. For my day job, I work as a communications professional for a public health campaign. We focus on Preconception Health (getting women healthy before pregnancy, even if they are not planning) and for many years we focused on folic acid alone. Last year, we expanded our campaign to include other health messages that includes “Healthy Weight.” Our leadership decided that there are so many obesity programs out there, but they don’t do enough to to target women who may become pregnant. We had an MPH student research the relationship between weight and adverse outcomes for both mom and baby. When we started this whole “healthy weight” thing we looked for evidence-based programs that are effective in reducing weight. Guess what? There are none! However, we decided to plug away anyway.
The first problem with this is that there is a correlation vs. causation error. Even if it’s true that fat women have worse pregnancy outcomes (and I’m not sure that it is, because often these studies are done by people coming from a place of confirmation bias – already sure that fat causes problems and just looking for proof), still even if it’s true that fat women have worse pregnancy outcomes, that doesn’t prove that making them thin will solve the problems. It’s possible that the fat and the pregnancy problems are both caused by a third factor (for example, the stress of being constantly stigmatized). It’s possible that the fat and the pregnancy problems are unrelated.
But the biggest problem with this situation is that it doesn’t matter if being thin would be better for women who want to become pregnant because there is not a single proven method to make them thin. If women with narrow hips have worse pregnancy outcomes the solution isn’t to try to make them have wider hips. If short women have more negative outcomes the solution is not to try to make them tall. It might also be better for pregnant women to be able to fly but nobody is running a “Flying Preggos Initiatives”. Because there is absolutely no evidence that we can get any of those things done. Just like there is no evidence that we can make fat people thin.
A tremendous amount of time, money (and confirmation bias) goes into researching why people would be better off thin. What if we spent all this time and money trying to research how to make people’s (including fat people’s) lives better. It’s bad enough that programs like this waste time and money suggesting that people do something that isn’t possible. What’s worse is that by far the most frequent outcome of weight loss attempts is weight gain. So if it’s true that being fat is an issue for women who want to become pregnant, then suggesting that they lose weight means that the intervention will actually make the situation worse for 95% of clients. Clients, by the way, who are under the impression that these programs are run by professionals who know what they are doing and wouldn’t set them up for failure. How is that responsible? How does it meet the requirements for evidence-based medicine?
Absent any evidence that we can make people thin, it’s time to stop researching if fat people’s lives/health/whatever would be better if they were thin. Let’s just figure out how fat people can make their lives better and healthier if they choose. If you are interested in information about fat pregnancy, check out The Well Rounded Mama, her work is awesome!
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