Reader Abby let me know that Karen Hitchcock is a doctor, and I mean that only in the strictest definition that she completed medical school, not the she is someone to whom anyone should turn for actual professional medical care. She has penned a piece for The Monthly, called Fat City – What Can Stop Obesity. It is a tribute to bigotry, poor science, and perhaps the old adage that the person who graduates last in their med school class is still called “doctor.” Trigger Warning: the article is truly awful and I will not link to it. Her quotes are indented, you can skip them if you haven’t banked enough sanity points this week. Also, if you have trouble picking up on sarcasm this post is going to give you a bit of trouble.
I think the phrase that best encapsulates the multitude of issues with the article is this one:
I have moments of clarity – I think of the way Emily ate – and obesity seems simple: more in than out. Then I am engulfed once again by the high science of genetics, by the concept that obesity is a disease.
Nothing says “medical professional” quite like ignoring science and just assuming that if you know one person you can extrapolate a treatment plan for a population of millions. Not to mention that Emily was a fat person who, in “doctor” Hitchcock’s estimation, ate a lot- at no point are we told that she ate less and lost weight. So Hitchcock isn’t creating a treatment protocol based on one successful case, she’s basing it on someone who never tried the protocol. But who needs pesky science? Let’s just cut off all this ridiculous money for medical research and get one of each person who shares a single physical characteristic. Treating a brunette? There’s an app for that. Not to mention that we’ve been giving fat people the same advice for 2500 years and it’s never worked but don’t worry about it because we have Karen Hitchcock and Emily.
So is fatness a doctor’s problem? Studies show that verbal interventions during an episode of serious acute illness can result in a change in behaviour – people quit smoking, cut down on their drinking and sometimes lose weight. But usually counselling people to lose weight is hopeless.
You know what else doesn’t work – counseling people with joint problems to fly. Don’t they know how much better their joints would feel if they would just fly? Sure there’s no study that shows that it’s possible, but I think we should blame the people with joint pain both for their joint pain and for their lack of flying. These people just refuse to respond to treatment.
Is fat inherently ugly? Ask Aristotle, Susie Orbach, Naomi Wolf.
Why would I do that? Why do these three people get to decide what beauty is? Why don’t we ask Maya Angelou, Peter Paul Reubens, and me (hey, if we’re just picking random people I thought I’d throw my hat in the ring.)
Today when we look at those who are thin, part of what we see is a triumph of will over gluttony, so the beauty is a moral beauty; it has little to do with health.that also doesn’t make it true.
It also has little to do with reality. The fact that we’ve made body size about morality doesn’t make it true.
Obesity is bad because it causes disease
Obesity is correlated with diseases which, if “doctor”Hitchcock had managed to stay awake during class, she would know is not the same as causation. (Many studies have shown that habits, and not body size, are a much better determinant of future health, but we’ll get to that in a minute.) Obesity is, in fact, correlated with with almost all the sames diseases with which being under stress over a long period of time is correlated. Unlike Dr. Hitchcock in her article, I’m going to go ahead and cite some of that high science of which she is so dismissive. Research by Peter Muennig at Columbia University found that “Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms.” Driven, for example, by doctors who write articles like this.
Fat men and women make less money, marry less often and are less educated than the lean. They are more often depressed.
And if you think that the solution to that is changing fat people, and not changing the society that stigmatizes them, then you are working the wrong end of the problem.
If you quit smoking and get fat, you may as well have kept on smoking.
Please stop being a doctor now, you have no business practicing medicine. Her suggestion here is that the life expectancy is similar but she doesn’t define “fat” nor does she mention that studies show that overweight people live longer than their thin peers
Prescribe exercise? Walk for an hour at an average pace and you’ll only burn off the equivalent of one slice of bread.
Seriously, please find another profession because you are unbelievably incompetent. There is literally a MOUNTAIN of evidence showing how about 30 minutes of movement a day 5 days a week has tremendous health benefits. This is what happens when we substitute body size for health, and caloric intake for healthy habits and ignore research in favor of “The Emily Diet”
Matheson, et al: Healthy, Lifestyle Habits and Mortality in Overweight and Obese Individuals
“Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.”
Steven Blair – Cooper Institute
“We’ve studied this from many perspectives in women and in men, and we get the same answer: It’s not the obesity, it’s the fitness.”
Glenn Gaesser – Obesity, Health, and Metabolic Fitness
“no measure of body weight or body fat was related to the degree of coronary vessel disease. The obesity-heart disease link is just not well supported by the scientific and medical literature…Body weight, and even body fat for that matter, do not tell us nearly as much about our health as lifestyle factors, such as exercise and the foods we eat…total cholesterol levels returned to their original levels–despite absolutely no change in body weight–requiring the researchers to conclude that the fat content of the diet, not weight change, was responsible for the changes in cholesterol levels.”
Paffenbarger et. al. Physical Mortality: All Cause Mortality, and Longevity of College Alumni
“With or without consideration of …extremes or gains in body weight…alumni mortality rates were significantly lower among the physically active.”
Wei et. al. Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men
I wish you could get really fat and stay healthy. I wish you could get morbidly obese and be considered beautiful. Maybe it will change with time, as we all become enormous, and we’ll look back on the skinny-is-beautiful era with distaste, regarding high cheekbones, defined jaws and long sculptured thighs as skeletal and ugly.
You don’t have to wish angel, there are plenty of healthy fat people, and everyone is beautiful if you just learn to see it. But as long as we’re making wishes, I wish we didn’t act like seeing the beauty in fat people means diminishing the beauty that we see in those who are not fat. I wish doctors would treat actual health instead of body size and quit adding to the stigma and shame that fat people face by also giving us lazy, incompetent medical care. I wish they would understand that Health is multi-dimensional and includes things within and outside of our control including genetics, environment, access, and behaviors. Health is not an obligation, nor is it a barometer of worthiness. Nobody owes anybody else “health” or “healthy behavior,” and those who aren’t interested in health are not better or worse people than those who are interested in health. Prioritization of health and the path that someone chooses to get there are intensely personal and not anybody else’s business. The rights to life, liberty and the pursuit of happiness are not health or healthy habit dependent. Public health should be about providing access and information, not making the individual’s health the public’s business. People who have health issues should be given shame-free, future oriented options for care and accommodation as they wish, not judged or asked to prove that their health issues are not their fault.”
This year I started work as the physician in an obesity clinic with a group of bariatric surgeons.
Well, that’s absolutely terrifying.
The attempt to help people lose weight is generally seen as one of the most futile acts we as doctors of internal medicine can perform: pretty much all we can do is make you feel crappier about yourself than you already do.
This is half true. There isn’t a single study where more than a tiny fraction of participants have successfully lost weight long term and doing the same things that those studies did is likely to lead to the same failure. I don’t feel crappy about myself at all and you won’t be able to make me, but there are certainly plenty of fat people who have been beaten down by the type of stigma and stereotype with which this article is laced. You have a choice – if you would practice from a Health at Every Size perspective research shows that you would help people become healthier and increase their self-esteem. Why not give that the old college try?
I once attended a hospital lecture on the genetic determinants of obesity delivered by a specialist physician. The doctor giving the talk was very fat. As he went on, his face got red and stains of sweat spread from his armpits. Obesity is genetic, he argued, wiping his brow
Wow, way to keep your eye on the ball there, that explains why you did not seem to learn anything from the presentation. If, god forbid, you are ever asked to give a talk like this you will find that it’s hot under those lights and giving a talk, at least a good one, is a physical endeavor. I have been part of conversations with very thin speakers, some of whom are physical fitness professionals, who were discussing how to deal with sweat on stage. Also, there’s a word for using the way someone looks to discredit what they say, and that word is bigotry.
Throughout the piece she goes from saying horrible things about fat people…
Emily was white and loud and the fattest person I had ever seen outside a caravan park.
To acting like she’s the victim for having to say them…
Globally, we are carrying 18.5 million tonnes of excess fat under the skin of the overweight and obese, which – if it were still food rather than adipose tissue – would feed 300 million people for life. Fat people have been compared to petrol-guzzling cars. I feel terrible typing these sentences. I apologise; they are ugly.
You know what’s better than apologizing? Not saying ridiculous, inflammatory, stigmatizing things with no evidence basis to begin with. Not repeating ridiculous inflammatory statements. Adding something to the discourse on global hunger slightly more sophisticated than my mother’s admonition that I should eat all my broccoli because kids are starving elsewhere in the world. Not taking a group of people who are identifiable by sight and then trying to calculate their cost on society in support of their eradication.
The pro-fat bloggers are smart, sassy and pissed off. I’d hang out with them. Yet, if they could click their fingers and be thin, would they?
No, you wouldn’t, at least not with this blogger. And no, I wouldn’t. When I say that I love and cherish my body, I don’t mean “I guess if I can’t have a thin body I’ll just like this one.” I love my body and I entrust my health to that high science of research that you are so willing to eschew for a treatment program that didn’t worked for one person one time. Since you doctors have no good options that are likely to make fat people thinner, I’m also very glad that I can model the option of falling in love with the bodies that we have, and give people like you an opportunity to question their stereotypes.
This isn’t a complete discussion of the piece because, as science is to Dr. Hitchock’s medical practice, so brevity is to her writing. The piece is interminable and packed with prejudice, assumption, stereotype, bigotry, and a devil may care attitude toward science that I find seriously disturbing in someone claiming to be a medical professional. Let me end with this bit of research from Rebecca M. Puhl and Chelsea A. Heuer “In a study of over 620 primary care physicians, >50% viewed obese patients as awkward, unattractive, ugly, and noncompliant. One-third of the sample further characterized obese patients as weak-willed, sloppy, and lazy.”
Welcome to the club Dr. Hitchcock, I wish you weren’t such a proud member. Especially since people are going to come to your clinic in the hope of getting compassionate, competent, evidence-based medical care and instead they’ll get you.
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You may have already heard about Kelly Gneiting. He is a 400 pound trained sumo wrestler who just finished his second LA marathon in 9 hours, 48 minutes. This was an improvement of more than 2 hours over his previous time. And it was no ordinary marathon – according to reports it was extremely cold and the rain has been described by some of the participants as “torrential”. He is also a hero of mine and so, with all the talk about fat athletes going around, I thought I would re-post a piece.
One of the things that I was excited about when I moved to California was Trader Joe’s. Austin is predominantly Whole Foods and I won’t shop there because of their 
