When Fat People Get Sick

ShamelessOne of the consequences of rampant size bigotry, discrimination and bullying in society in general is that it bleeds over to healthcare providers and healthcare concepts.  A new study concludes that “There are unacceptable levels of weight bias among UK students training to become nurses, doctors, nutritionists and dietitians.” [trigger warning:  this study is not necessarily Health at Every Size]

This leads to any number of issues but a major issue is that the misinterpretation of correlational relationships as causational relationships means that people believe that being fat causes diseases.  The fact that the media has jumped on this band wagon means that even though the Congressional Budget Office is clear that obesity is NOT the reason for the increase in healthcare costs, people keep insisting that it is.

That means that when a fat person gets sick, they not only have to deal with whatever illness they have, but also with the shame of being a “bad fatty” who brought this on themselves, and is increasing everyone’s health insurance etc.  And that’s bullshit.  And here’s why:

First is the issue of correlation vs. causation.  My first semester of my first research methods class we had to say “correlation never ever, never ever, never ever implies causation” every day during class.  It’s the cornerstone of good research.  Correlation means that two things sometimes – but not necessarily always – happen at the same time.  Causation means that we can prove that one thing causes the other.

Let’s say that every August there are more murders and more ice cream is eaten. We cannot conclude that eating ice cream causes murders. If there are a rash of murders we cannot say that there is an ice cream epidemic. And we cannot conclude that taking ice cream off the shelves will cut the murder rate.  They could both be caused by a third factor (maybe heat makes people cranky and they either eat ice cream or commit murder) or they could be completely unrelated and the correlation could be a coincidence.  (More thorough explanation is here.)

The same diseases that are correlated to obesity are also correlated with being under a lot of stress for a long period of time.  Like, perhaps the stress of living under constant stigma with the government waging war on you for how you look.  Since no study can control for the effects of stigma on fat people, no study can claim to know that diseases are caused by being fat. Not to mention the fact that there are health issues that cause both weight gain and other diseases, and that both weight and many diseases have strong genetic components.  This issue is not nearly so cut and dried as media hacks and people making money from it’s perpetuation would have you believe.

There’s no point in speculating how someone got a health problem, or blaming someone for a health problem.  They are a person with a health problem, it’s time for them to make decisions about their treatment and have those decisions respected, including the decision of who to tell by the way.  I remember people’s outrage that Paula Deen hadn’t been public about her Diabetes – that’s ridiculous.  It’s not anybody’s business.  Paula Deen has a cooking show and yet she still she doesn’t owe anybody cooking instruction let alone a medical history.

There are no such things as “fat people” diseases. Thin people get all the diseases that fat people do. People get to make their own decisions about priority of health, path that they want to take to reach their goals etc.  In order to avoid being massive hypocrites, people either support the idea that other people get to make their own decisions about their bodies, health, and habits, and have those decisions respected; or those people must be willing to let anyone who thinks they know better dictate what they eat and how they exercise.

Health is multi-dimensional and includes behaviors (past and present), environment, genetics, stress, and more.  Some of these components are within our control and some aren’t.  We cannot control the end result and if we get a disease we will probably never know for sure exactly why it happened.  More to the point, it doesn’t matter.  People of all sizes get sick for all kinds of reasons.  Once someone is sick it’s time to skip shame, blame, and bullshit and move to getting them the care they choose.  If you can’t help get them the care they want or find another way to support them – if you are interested in shame or blame – then, in the words of Henry Rollins, the captain has turned on the sit the f*ck down and shut the f*ck up light.

If you are fat and sick there is absolutely nothing to be ashamed of.   Nothing.  You deserve compassionate care of your choosing. You do not deserve any of the things that our culture’s stigmatization and oppression of fat people might create – that’s the result of bigotry, and that’s not your fault either.

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Published in: on November 30, 2012 at 11:50 am  Comments (23)  

23 CommentsLeave a comment

  1. I would love to share this on FB for my “family” to read. I still don’t think they would get it. But thank you, at least someone is saying it and saying it well. Hugs

  2. Yesterday, when I saw my doctor about hip and back pain related to developmental hip dysplasia, he gave me the obligatory order to lose weight. I nodded politely, grateful for affordable health care, but with no intention whatsoever of going on any kind of diet. I would like to have cited Health At Every Size to him, but this is Korea, and one does not argue with doctors here. Thanks to blogs like yours, I did not burst into shame after the appointment but instead realized that the doctor had some biases that affected his ability to provide me with the best possible health care.

    • Hello from the U.S.A.!

  3. I really like your post, and agree with all of it, except for one thing – sometimes correlation DOES imply causation. It doesn’t prove it, but it can certainly imply it in a meaningful way. Prolonged drought has a strong correlation with crop failure, or higher water usage, for example. Rising migration into a city can correlate very strongly with rising rents. Not saying that correlation = causation, or that it’s not a widely misunderstood concept, or that correlations between fat and health = causations. Just that if all correlations were meaningless, a lot of statistical knowledge would be as well.

    • To add to that, don’t say “correlation does not equal causation” when what you mean is “positive predictive value does not equal 1”. Most smokers will not get lung cancer, and some people with lung cancer are not smokers. This doesn’t mean that smoking doesn’t cause lung cancer, just that it’s not 100% in either direction.
      So the fact that thin people get diabetes does not necessarily imply that overweight could not be a cause of it (I’m not saying it is, just that the logic there is faulty.)

      • Hi Agnes,

        I did not mean “positive prediction value does not equal 1.” I meant that correlation does not imply causation. That’s why I specifically said causation means that we can prove that one thing causes another,” rather than saying “causation means that every person with the trait has the same outcome.”

        I also never said that the fact that thin people get the same diseases that fat people do implies that being overweight could not be the cause – (though it does demonstrate that being thin is neither a sure preventative nor a sure cure.) The discussion of correlation and causation and the mention that there are no fat people diseases are separated by an unrelated paragraph. The reason I pointed it out was because from the media you would get the idea that ONLY fat people get these diseases and that’s just not true.

        The widespread misunderstanding of these things is what leads doctors to recommend weight loss to fat people who get diseases, but recommend interventions shown to help the diseases for thin people who get them.


    • Imply, yes. If there is a strong correlation it makes sense to take another look at the issue–as well as other factors that may have affected both things that are correlated. But correlation does not PROVE causation. If the conversation was that “these things seem to happen together, we should look into why that might be” that would be wonderful, but jumping to “cause” causes all sorts of problems.

    • Hi bodycrimes,

      My guess would be that you are using a lay person’s definition of “implies.” I am using the statistics definition of “imply” which is “to be sufficient circumstance.” That doesn’t mean that correlations are meaningless, just that it’s never sufficient circumstance to assume causation.


      • Double thumbs up! This is not just in statistics, but in logic and math. The “imply arrow” (=>) has a very strong meaning. In science/statistics/math, a lot of words have a very technical definition that differs from their lay meaning. For example, “significant difference.”

        Wikipedia has a good article, bodycrimes: http://en.wikipedia.org/wiki/Correlation_does_not_imply_causation Scroll down to the “Usage” part.

      • Sure, I agree. I just wanted to be clear that you weren’t suggesting that correlations are always meaningless.

  4. If you are fat and sick there is absolutely nothing to be ashamed of. Nothing. You deserve compassionate care of your choosing. You do not deserve any of the things that our culture’s stigmatization and oppression of fat people might create – that’s the result of bigotry, and that’s not your fault either.

    Thank you. I am 27, fat, and disabled. People always have judgmental eyes when they look at me; “oh, you’re fat, so you’re lazy, so you can’t have a fake disease like fibromyalgia.”

    I have no words for how awful that makes me feel. I’m going to bookmark this link and start handing it out to people, irl and online. Thank you.

    • There’s a huge lack of understanding and sympathy for people with any kind of physical illness that is not well understood (or even, any illness where there aren’t major external signs), and the lack of understanding plummets even more when the ill person has a supposed “character flaw” (fatness, mental illness).

      I hope you can find the support you need. If you can at least find an understanding doctor, that can help immensely. As for friends and family, sometimes educating them helps (but sometimes it doesn’t). If they say or do things that are demeaning, you might need to distance yourself from them, because maintaining your health/energy can be hard enough without any “black holes” around.

      I just want to add one more thing…I’m not trying to minimize your experience at all, but for me, I think that some of the “judgmental eyes” that I saw was a misinterpretation on my part. I thought all of my family and friends were judging me and looking down on me because I had to register with the disabilities office at my school, take a lighter class load, sleep 12-18 hours per day during flare ups, take lots of medicine, etc. When I started interacting with people with a determination to give them the benefit of the doubt, I stopped seeing so many judgmental eyes. I’m not saying that people never do nonverbal judging–it might even happen a lot more than I think it does. But I’m so much happier when I assume people aren’t judging me.

      Again, I don’t want to minimize your experience. I have had issues with social interaction my entire life, making me more prone to misinterpreting people’s nonverbal cues (and jumping to poor conclusions). Your interpretations could very well be spot on.

      • I teared up from your reply, really. You’re probably right. I’m just so SCARED, you know, that I’m being judged, and… it colors a lot.

        Thank you. I have a lot to think about now.

        • Awww, we’re even then because I teared up when I read your initial post. :) Feelings of shame, frustration, worthlessness, and helplessness sometimes accompany chronic illness. One tip I got from a therapist is that if you have a negative thought that is eating at you, sometimes saying it out loud to someone who is close to you can help relieve you of that burden. For example, you can say to someone close, “I have this feeling that everyone thinks I’m lazy and my illness is fake.” Saying something like this out loud can be scary because it makes you vulnerable. But it might also take the power away from the burdensome thought.

          Another thing that can help is countering an accusation that you have against yourself (or that you think other people have against you) with positive affirmations. For example, you can say to yourself, “I’m patient, resilient, and compassionate,” whenever negative thoughts start to creep in. Sometimes the frustration and shame that comes along with a chronic illness (and living in a society that sometimes values efficiency and competitiveness over other traits that are equally valuable, but not contingent on being “healthy,” such as empathy and generosity) can make it hard to see those things in oneself.

          • I don’t know what to say, beyond thank you. You’re so helpful and I really appreciate it. I hope I can return the favor, or pay it forward, some day.

            • You’re welcome. :) Those tips are actually from a cognitive behavioral therapist. They sound simple, but they seem to help. The final tip would be not to compare yourself to other people with disabilities–even if they have the same illness. People with the same illness can face different obstacles, and have different abilities. It’s OK to look to someone for inspiration, but it’s not fair to yourself to say, for example, “Magic Johnson has a chronic illness, and yet he’s able to run a multi-million dollar corporation, so I should be able to do that.” His circumstances are different from yours or mine; he has access to a lot of resources. That’s an extreme example, but the point is that it’s better to value your own achievements and abilities, and not expect them to be the same as someone else’s.

              • Thanks for reminding me that we’re <>. It helps me remember to stop taking on others’ values that aren’t meaningful to me and instead listen to my own values.

              • I hear that CBT is really useful for those of us who are chronically ill. This just seems to prove that fact. Hmm. Thank you.

  5. I’ve become so frustrated by people’s acceptance of correlation equaling causation when it comes to weight and health (I work in a public school… so, school nurses…state requirements for school lunches…health classes… even my own classes’ materials for teaching and nearly ALL of my content peers seem to have bought into the whole childhood obesity/obesity=ill health/fat=bad) that I am counting the days to retirement so I can get away from all of this. I’ve already managed to change the way I present material about nutrition and health to take away focus on weight management and more on long term health benefits of good nutritional habits (like reducing chance of cholesterol and diabetic issues). But I can’t even have a discussion with our SRO (school resource officer) about bullying in regard to fat without him jumping on the bandwagon that fat IS unhealthy.

    When I retire, I hope to find a way to promote a healthy at every size lifestyle/support group in my home town. Right now, I don’t have enough time open in my day and need to heal my body from current issues.

  6. Currently, being fat puts me at higher risk for developing certain diseases, whether that is due to weight-related issues or social stigma or some other unidentified factor. The thing is, so what?

    Being African American puts one at higher risk for certain diseases. But we don’t go around telling African Americans to try to be less black in order to reduce their risk of disease, because that would be ridiculous and offensive.

    The issue comes down to the fact that people view fatness as a thing that can and should be changed. Personally, I know that all the scientific evidence tells us this is not true. I’ve looked up the studies for myself.

    But obviously the vast majority of society has not gotten the memo. Worse, most people who are confronted with the evidence insist on disbelieving it. Why do (non weight loss industry) people have so much invested in perpetuating the idea that fat people can get and stay thin?

    I really want that to change. Man, do I want that badly.

  7. Another great post. I particularly appreciate the way that you put emotionally loaded concepts into calm declarative sentences. You help me think calmly about these things, and that is making all the difference.

  8. I haven’t been to the doctor’s in half a year.

    I need to go to the doctor’s for prescription refills and birth control. Yet I don’t–the reason being, half a year ago I was about 5 pounds over the allotted BMI chart, and my doctor was already going on rants about how I needed to get active, eat better, etc, because of my family history.

    I’m convinced this is why my doctor did not take my sleep or digestive issues seriously.

    After that, I figured I just did not need the humiliation.

  9. I really appreciated this post. I have been working on improving my body image for a long time, and have come a long way, but fighting feelings of shame (particularly in instances where my health isn’t “perfect” and I immediately feel like its because of my weight) is still a commonly occuring challenge for me.
    I have a question that’s a bit tangental to his post… I would like to know if you know of any resources for obtaining health insurance if one’s height/weight requirements are above the medically underwritten standard. Right now I have insurance through my job, but I would love to know if there are other (affordable?) options available. I hate feeling that I have to stay in a certain type of job just to make sure I have access to healthcare.

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