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Hey queer ladies — just like your nosey mother, the federal government wants to know what’s going on with your weight. So much so, in fact, that the National Institutes of Health have given researchers at Brigham and Women’s Hospital nearly $3 million over the last four years to figure out why lesbians are more often classified as obese than straight women. Their biggest conclusion so far? It’s because lesbians don’t play sports. I guess all those softball stereotypes just aren’t true. In an era of significant funding problems in the NIH and disturbing data about LGBT health disparities, why continue to fund a study like this? It might be because mainstream straight culture and medical science is hopelessly fixated on the alleged “obesity epidemic.”
As a culture, we are absolutely obsessed with weight and dieting. In 2012, the diet-and-weight-loss industry was roughly a $61 billion empire, hawking pills, books, exercise equipment, videos, and meal replacements. A 2012 report showed there were over 100 million dieters in the US, and — big shock here — a whopping 85% of weight-loss product consumers were women. Despite the preoccupation (and profits) associated with this weight-loss and diet craze, the US still has a lot of fat people; the CDC classifies more than one-third of Americans “obese.” We’re not just obsessed with our weight, either. We’re intensely focused on other people’s size, so much so that a 2009 Yale study found that sizeism infects just about every aspect of our lives. Weight-related discrimination affects people’s employment, their ability to get quality health care, their access to education, and more. Oh, and that same study also found that anti-fat bias disproportionately affects women. Another study demonstrated that concern over being judged about their size is stressful enough to cause measurable changes in women’s physiology. Many say this fixation on body size is a health concern, but the research supporting it is sketchy at best.
You almost can’t read the news anymore without seeing the phrase “obesity epidemic.” According to many health researchers, the US is looking at a huge obesity health care crisis over the coming years. Even First Lady Michelle Obama is on this train with her “Let’s Move” program for combating childhood obesity. Unfortunately, there are two big problems with much of this research— almost all of it is based on the completely bunk Body-Mass Index scale, and a growing body of research is demonstrating that many of the diseases associated with obesity are actually more likely due to physical inactivity. Let’s start with BMI. Like I said, it’s basically completely meaningless hogwash. So why do researchers and doctors continue to use it? Because it allows the them to categorize huge groups of people into relatively arbitrary research categories based on two simple measurements, weight and height. This, in turn, allows them to do large population obesity study far more cheaply and with less effort than the more complicated (and accurate) skin-fold testing. Unfortunately, what BMI-based studies ignore is a basic truth of all research: garbage in, garbage out. If you start with junk data (like BMI), your studies aren’t worth the paper they’re printed on. It can come as no surprise then, that there’s some pretty seriously mixed results when all that BMI stuff is forcibly shoved into models that include actual biological and medical data, like heart disease, diabetes, and mortality rates. Kate Harding at Shapely Prose sums it up well:
“Weight itself is not a health problem, except in the most extreme cases (i.e., being underweight or so fat you’re immobilized). …Obesity research is turning up surprising information all the time — much of which goes ignored by the media — and people who give a damn about critical thinking would be foolish to accept the party line on fat. Just because you’ve heard over and over and over that fat! kills! doesn’t mean it’s true. It just means that people in this culture really love saying it.”
The bottom line is that being active and maintaining good physiological measures of health, like fasting blood glucose, blood pressure, and blood lipid profiles, are considerably more important to one’s health than making sure your weight remains proportional the square of your height.
via Shutterstock
You’re probably saying to yourself, “Okay Mari, I get that BMI is zebra-droppings and the weight-loss trendiness is a truck load of festering garbage, but what does this have to do with the lesbians in that first study?” Well, inquisitive hypothetical reader, there’s a second interesting tidbit in all that “lesbians are more likely to be fat” business. As it turns out, queer girls (lesbians AND bisexuals) are ALSO more likely to NOT THINK they’re fat, even when their BMI puts them in one of the “overweight” categories. On the flip side, straight girls are more likely to think of themselves as fat even when they’re not. That’s right, “overweight” queer ladies tend to be less critical of their bodies than straight women.
Researchers want to call this a problem of self-perception, but I have a different theory. It could be, perhaps, that queer girl culture doesn’t suffer the incessant, unreasonable pressure of the male gaze in the same way that straight girl culture does. After all, if you don’t have to concern yourself with attracting men as romantic partners, it’s considerable more reasonable to not give a fuck about their photoshopped-magazine-and-mainstream-pornography-fueled beauty standards, and you might be less likely to internalize that garbage. A dig through some psychology journals show that I’m not making this up. One study showed that lesbians tended to rate the attractiveness of bigger women higher than straight women did. A later study showed that women who felt a strong connection to the lesbian community scored better in personal body image and had fewer indications of depression.
So, we’ve got an NIH study about fat lesbians, a problematic cultural fixation on weight and weight-loss, and a rejection of heterosexual beauty standard by queer ladies. What’s the takeaway here? It’s that we should be concerned when science and medicine make such considerable efforts to pathologize aspects of queer culture that conflict with mainstream straight culture, especially when those aspects of straight culture are hideously broken, like the fat-hate and weight obsession. The fact of the matter is, the study from Brigham and Women’s operates on a unpleasant, and perhaps unfounded, base assumption — that there must be something wrong with queer women because they tend to be larger than straight women. Given the lengthy history of the medical establishments need to assign diagnoses to members of the LGBT community for violating cisgender and heterosexual cultural norms, I think we ought to take a critical eye to research like this, especially when it’s founded on as something as inaccurate and useless as BMI. Loving each other at all shapes and sizes is perhaps one of the best things about queer lady culture. Let’s not let some shaky science wreck that up.
I love this so much. I love you so much, Mari. Just. Perfect. YES.
Thank you for writing this! I’m a fat queer lady and the second-to-last line basically made my day. And I had Chipotle for lunch, so that’s quite an accomplishment.
A thousand times yes!
Every single thing about this is delightful.
Yay! We’re doing something right! This makes me really really happy. I’ve only this year found my local lesbiqueer community and it has helped me a lot in terms of mental health/self-acceptance. I LOVE US AND ALL OF YOU, is what I’m saying, so keep being your fabulous selves (or not-fabulous if that’s more your style)!
Can we please stop discrediting science and the scientists doing the work? I’m more than happy to agree with you on the social aspects of fat shaming and society’s bullshit attitude towards an obsession on body weight and body image.
I’m a scientist who spends most of my day buried in obesity research literature. I’m more than capable of using critical thinking to recognise when studies are taking crap measures, such as BMI, into account. It’s pretty freaking insulting to hear the science of obesity called “shaky”. Some of it is, sure. Not any more so than any other woke in any other field. There are always some bad studies published everywhere, and this isn’t restricted to science.
Obesity is a disease we should be taking seriously. It leads to a number of other serious health problems, not all that can be fixed by just dealing with weight. This isn’t just correlative either, there is a ton of work out there on how this actually happens.
The research I do is not focused on these population studies such as the one you’ve mentioned on queer women, the work I do is more along the lines of the pathology of the disease and how it affects your overall health.
If you want more information on the science if obesity I’d be happy to steer you in the right direction. I can even filter out the crap for you.
Thank you! Obesity is an epidemic and discrediting science just because you dislike or are uncomfortable with a particular outcome makes you no different than conservatives who constantly discredit environmental and social sciences when it suits them.
Thank you, I really appreciate someone with an actual science background chiming in here. A lot of bloggers talking about fat issues have some really great insights on social issues, but they are not scientists and I’ve seen a lot of appallingly inaccurate claims about science.
I agree with a lot of this article, actually, but I think the high obesity rate among lesbians is worth looking into. Obesity is correlated with low socioeconomic status and poor mental health, and due to discrimination, lesbians are more likely than straight women to fall into both of those categories. I believe lesbians are also less likely to access health services anyway, so I am glad researchers are looking into this as I think it really could be a serious issue in our community.
I also thank you for your reasoned assessment very personal issue. I took a principle of nutrition class in college and one important thing I got of it was there is a difference between being merely overweight and obesity. It’s true they are some people who over average body weight and are physically active enough that most health problems associated with body fat don’t seriously effect them. Heck a great video they should us cultural dimensions of both obesity and anorexia featured one overweight man who was a triathlete, but that’s being overweight. Obesity applies to being in a “sick” realm of overall body fat.
At least, I’m pretty sure that’s the difference. So Hannah feel free to correct me.
“This isn’t just correlative either, there is a ton of work out there on how this actually happens.”
Have there actually been studies demonstrating causation? Whenever I read about studies in popular media, they don’t do anything to get me past association (regardless of what the headline might say).
Seems like you could do it — like pay people to lose weight & then see if mortality rates dropped. Just never seem to hear about studies set up that way.
Yes absolutely. Unfortunately there is a lack of translation from science to the general public, which is another problem entirely (and something I am passionate about).
To answer your question, obesity is, in part, characterised by chronic low grade inflammation. What does this mean?
In short, when the fat cells take up more fats from the bloodstream, they get larger. The cells get stressed, as they are packed in close together and will release stress signals. Certain immune cells respond to this by moving into the fat tissue and releasing inflammatory molecules.
This is essentially the same as what happens when you have an infection, or damage something in your body. Except in this case, there is no infection or damage caused. In normal circumstances, when there are inflammatory molecules in the bloodstream, all kinds of cell types respond to them and can make changes to what they do in order to let the body deal with the situation. This is part of the reason why you feel crap when you have the flu, but once you get rid of the flu virus, everything goes back to normal.
In obesity, when there are these inflammatory molecules present constantly, the rest of the body doesn’t know to stop reacting to them, so the body remains in this stressed out inflammatory state. This results in all kinds of health problems, such as type II diabetes, hypertension, abnormal metabolism and reproductive function. When you’re dealing with obesity, dealing with the weight only solves part of the problem.
Yes. This.
I emphatically agree with you Hannah.
I am a health professional working in the field of non-communicable diseases (you might call it lifestyle diseases). I too have some pretty serious objections to this article and would have preferred it be published as an opinion piece.
Overweight and obesity is an epidemic. It is as undeniable as climate change. True for the US, for Australia where I am, and it is an emerging and very serious truth for developing countries around the world, which is the focus of my work.
Overweight and obesity is a significant public health problem which bears exponential costs to our health systems. Body image is also a significant health problem which bears a significant (though not as well quantified) cost to the individual. These problems co-exist. But their determinants are quite different. The answer to one is not denying or minimising the other.
I am an overweight queer person. I have great body image and I am grateful for it, it is important for my wellbeing. But it doesn’t change the fact that I am in an unhealthy weight range and am at increased risk of developing a scary array of diseases. I live in fear of the day I develop type 2 diabetes, it is more a ‘when’ than an ‘if’. So I, for one, welcome any health research on my particular sub-population. Even if it does use the the imperfect, relative, never-to-be-used-without-context measure of BMI.
I have skim-read the sources cited in this article and they lack scientific rigour.
I appreciate what you’re trying to do and I agree that the science aspect needs to be more carefully scrutinized, but at the same time when you have science (or sometimes “science”) constantly thrown in your face as a justification for treating you as less than human, sometimes it’s a relief to have a break from that. That doesn’t mean I believe it’s ok to discredit scientists or toss out baseless scientific claims. Fat may be unhealthy. Lots of things are unhealthy but the myopic obsession with obesity seems to be rooted in cultural bias. I don’t discredit scientists as much as I believe that scientists, like any human being, carry these cultural biases into their work as well. I think it’s ok to be critical of science since it has also historically been used to justify discrimination. So yes, I agree that is important to be aware of the science but it’s also important that science is not immune to society.
Seconded.
Just to add to what Hannah said, even if Obesity and health were only correlative rather than causative (which it most likely isn’t) exercise and healthy eating are beneficial to everyone in a number of ways, and exercise has even been shown to improve mood. Even if you don’t lose weight, exercise is still good for you. It’s definitely important to exercise, even a twenty minute walk can help you to have better health. That being said, I strongly disagree with body shaming. You can’t treat a person poorly because of their health.
Look: Body-shaming is not okay. Bullying is not okay. Making people feel bad about their weight is not okay. Telling women that they don’t deserve autonomy over their own bodies is not okay. An unreasonably thin beauty standard is not okay.
But that doesn’t change the fact that obese people are at a very high risk of a host of serious health problems, not limited to type-2 diabetes and heart disease. These are among the leading causes of death and a positive self-image won’t prevent them from happening. Denial of the grim effects of obesity is every bit as unscientific as the anti-vaccine movement, AIDS denialism, and global warming denialism.
And before anyone responds citing the ONE study that showed that overweight people live longer, please understand that this isn’t how science works. One small study does not overthrow the findings of literally thousands of others. There’s a reason that people who have gone to medical school are supposed to analyze these findings, not armchair scientists on the internet. There are also a handful of studies showing smokers live longer– so does this mean that we need to ignore the fact that lesbians have much higher rates of smoking (another serious problem in our community)?
Please, ladies, love your bodies. Know that you’re beautiful. Know that it’s not anyone’s place besides yours to dictate what you do with your own body. But the fact is that obesity is dangerous and will almost inevitably take a toll on your health. If that’s your choice, rock on, sister, and love yourself anyway. But please know what you’re choosing.
Saying people are “choosing” to be fat is rather hurtful and whether it’s intentional or not, mirrors a lot of the hateful statements that get thrown our way. As a fat woman who also has bulimia, that statement is so triggering on so many levels. I think it’s great you’re against body shaming, but at the end of the day, somebody else’s body isn’t really anyone else’s business. To say it’s a choice is a gross oversimplification of a very complex issue that even medical doctors aren’t entirely unified over. And yes, there are many doctors out there that don’t follow the whole “obesity is the worst thing ever” mantra.
Chloe, bulimia and eating disorders are a serious problem. We can and do have multiple problems in society. Acknowledging that obesity is a problem does not take away from eating disorders. Just because there are doctors out there that don’t follow the obesity is the worse thing ever mantra doesn’t mean the medical and scientific community haven’t come to a consensus about the danger.
Thank you! The idea that it’s offensive for the NHS to study why many queer women are in a higher risk category for some diseases – and obesity puts you in a higher risk category for some diseases! It doesn’t mean that you’ll get those diseases! It’s a predictor for some people! – is just. Really offensive to me? Among other things, there are a lot of external predictors of obesity itself, including poverty and social isolation.
Another -very queer- obesity researcher here!
Thanks so much for this response! I could feel my blood going to my head while I was reading this and was so relieved to see another researcher in the area had already responded!
I can’t talk about the specifics of the actual study but discrediting BMI just like that by quoting some randomer, when tons and tons of research have been done on this complicated topic and evidently there is a fair correlation between BMI and body fat percentage in the general population. And YES elevated fat storages are a risk factor for cardiovascular disease, diabetes and certain types of cancer! Just have a look at the World Health Organization website if anything else, unless you believe there’s a whole conspiracy theory or something!
Autostaddle I love you but I am SO disappointed at this article!
Riese, I think you have done a good job bringing people of colour and trans people speaking for themselvesa and obviously fat people should be the ones talking about their own experiences. Just like scientists should be the ones talking about the actual science! If you ever need an obesity scientist to talk about topics like that, who will not jump to oversimplified and biased conclusions and will mention credible references to support their arguments feel free to contact me.
Viewpoints like that from people that don’t know what the hell they’re talking about can be catastrophic.
#notallobesityresearchers
I would like to consider myself has sporty fat :)! I really do like working out cause i got tired of being fat
I’m also sportyfat in a non threading yet normative bodymind way, and i feel.
If you ever wanna exchange underpants or share a (large) hot tub with me, hmu.
I love this article. ♥ The bit about ‘Queer-Culture’ being outside of the heterosexual-porn-gaze and how that affects the psychology of gay/bi women is fantastic. There’s much to be said about how important it is to fill your world up with images, words and other fabulousness that is healthy to your perception of yourself and others. We should definitely celebrate these things a lot more. :)
Yes to everything in this article! As a fat queer lady I relate to this a lot.
I have to agree with Hannah the scientist. I work as a nurse in a critical care unit and we deal with the “obesity epidemic” every day. I am all about body positivity if it is focusing on healthy people. Not everyone is a size zero but telling people to disregard science and just be happy with themselves is dangerously ignoring the facts. If you are genuinely obese loving yourself and feeling happy when you look in the mirror isn’t going to magically block the myriad of health issues that come along with this disease. How can you keep up your cardiovascular health if you are too heavy to step on the treadmill? Or the weight of your body is too much for your joints to bear? How can you keep up the integrity of your skin if you have gotten so obese that you can’t properly wash or dry your skin folds and yeast is growing and smelling all over the place?
It’s great that we are trying to shift the standard of beauty or that we don’t give a hoot about what men think but let us not put our blinders on or bury our heads in the sand because we truly owe ourselves more than that.
Indeed Daisy.
Before I worked in public health on NCDs I was a crit care nurse in ICU and ED. You and I have been up close and personal with this problem and it’s pretty hard to ignore when you have seen what we have seen. Bariatrics didn’t even exist as a specialty when I trained as a nurseI We need MORE research, MORE funding, MORE attention.
Thank you, Daisy. The voice of medicine and science gets lost in the desire to fight unhealthy ideals.
Well put, Daisy! I absolutely love the part of the article that’s all about “screw male gaze”; I completely agree that fat shaming is awful and disgusting; I am appalled at the mainstream culture in which paper-thin women manage to see OMIGODFAT every time they look in the mirror and hence start themselves to near death. All that nonsense needs to just die. But I also think it’s dangerous to ignore the fact that yes, obesity does have an effect on health (although it’s important to note that what’s now considered mild overweightness might actually be health-neutral and even in some cases health-beneficial). Yes, BMI is more appropriately abbreviated BS, but just because BMI is not always an accurate measurement of whether a person is obese, it doesn’t mean that no one is obese anymore and everything is dandy. A lot of people, sadly, are obese, and even though many other factors go into determining an individual’s health, obesity is not generally something that’s good for it, even if other factors might mitigate it to a greater or lesser extent.
So all ya queer ladies, love yourself, love your beautiful bodies, have fun with your bodies, and nurture your bodies so they continue to be fun to inhabit for many years to come! And yeah, screw male gaze :)))
But what if increased obesity is one of the drivers of LGBT health inequality? Shouldn’t we find out?
BMI may not always be useful for individuals, but it has its place as a measure of populations.
I’m actually reassured that public funding is being devoted to this topic. I would guess that in the past, minorities haven’t been found so worthy of study.
Objectively establishing the health risks of obesity is not necessarily fat shaming. People need reliable information to make their own health choices — that is true empowerment. In the same way that smokers now know that they are choosing cancer, overweight people need to know that their weight will increase their cancer risk substantially (if you don’t believe that, pubmed it and see if that changes your mind, but don’t rely on the media to present scientific findings correctly). If they chose it, that’s fine, and nobody should criticise that choice or ever comment on another’s body, or assume they know their health from their weight. It is unfair to let people make that choice without knowing it, as we have more than enough data.
And let’s not assume, without study, that increased obesity results from positive factors such as self-acceptance. It could equally arise from socioeconomic factors (i.e. eating healthily costs more), emotional eating, increased use of alcohol. It may also not be positive that lesbians are less likely to do sport — could that be lack of acceptance on teams? If we don’t know, let’s find out.
As a population scientist who has dabbled in epidemiology I’m happy other commenters have also brought up the anti-science bias of this article.
I’m struggling with how to put this, but as a non-US resident American discussions about obesity seem really peculiar to me. This article, and many others, seem to frame body size as a personal issue (this applies to both fat-positive and fat-negative discussions) but the high prevalence of obesity in America seems to stem from a variety of societal and cultural factors. There are smallish things that strike an European visitor or immigrant as odd, such as huge servings sizes; the difficulty to find healthy, affordable and unprocessed foods in basic grocery stores; having to drive even short distances because in many cities the infrastructure just doesn’t allow walking or bicycling etc.
Then there are large-scale issues like huge government subsidies to the production of meat, dairy and corn syrup, the existence food deserts, the unsafety of many neighbourhoods which makes exercise unattainable for many people in lowe socio-economic groups… As mentioned in earlier comments, obesity in the United States is linked to poverty and other measures of low socio-economic status. Queer women’s higher body weight is probably linked to all the other ways we are marginalised in.
Hm, I guess what I’m trying to say is that the situation in your home country and the high rates of obesity might look normal to you, but the American case is indeed very particular. You could do something about the “obesity epidemic” – and shaming individual people and their bodies is clearly not the way to go. Anyway, I find the research you dismissed very relevant.
Like this study (http://www.ncbi.nlm.nih.gov/pubmed/24347406) that Autostraddle reduced to “lesbians are fat because we don’t play sports, well what about softball har har” seems actually super interesting.
“RESULTS: Sexual minorities (i.e., lesbian, gay, bisexual, mostly heterosexual) reported 1.21-2.62 h/week less MVPA (p < 0.01) and were 46-76 % less likely to participate in team sports than same-gender heterosexuals. Gender nonconformity and athletic self-esteem accounted for 46-100 % of sexual orientation MVPA differences.
CONCLUSIONS: Physical activity contexts should be modified to welcome sexual minority males and females. Targeting intolerance of gender nonconformity and fostering athletic self-esteem may mitigate sexual orientation MVPA disparities."
The homophobia in sports is usually discussed in the context of pro athletes and difficulties in their careers, but the conclusion of this study is that it actually impacts all queers and our physical well-being. This is HUGE and very disturbing.
I appreciate your point of view Monae. I’m not sure that US realises it is the case study for the rest of the world on this issue.
And as a recent returnee-tourist, OhMyGoodness portion sizes! There needs to be some serious legislation around that. I can’t see a solution to this problem without first addressing the ubiquity of processed food and portion sizes.
I understand where where your coming from and understand the fact that portion sizes. But I worry that attempts to regulate portion will in effect raise the price food. The first lady’s campaign for changing food lunches has made it very difficult for food insecure children to get enough calories. Paradoxically, this contributes to obesity because families buy more unnutritious food to fill in the gap. Undernourished people that get more than enough calories but not enough vitamins are often overweight.
(From the social perspective) I think it’s great to hear that Science says bigger bodies are more accepted within the queer women’s community – rock on! So…as a member of the community, why do I still value thinness above all and hate my own body so much? :/
Any advice on anaesthesia? My wife has an extremely severe needle phobia and has been waiting 2 years to have a tooth out (less than 1/2 remains). She needs to be gassed before general anaesthesia can be injected.
She’s been given 16 weeks until the appointment but the lady who met her to tell her about it apparently looked at her like she was a whale and told her it would be decided on the day by the person doing it but she doubted they would gas someone her size.
She suggested she lose weight before then… But she didn’t weigh her before saying this nor say how much she ought to lose.
It’s pretty unlikely much change will happen and she’s not otherwise unhealthy/unwell.
Is it really that dangerous? Is there anything we can do to convince them to do the procedure?
that is some bullshit and they are giving her the runaround and need to help her fix her goddamn tooth. I’m sorry that’s happening for her. sizeism in medicine is such a huge problem and prevents people from seeking or accessing care, on all levels, and in conclusion, yes, larger people go under anesthesia and don’t die. There may be other considerations, and I’m not a doctor, but they are, and it is on them to figure it the fuck out. But fuck that though, like literally one time I went in because I had a big splinter in my hand and they were like “have you thought about losing some weight” and I was like “Here for splinter, not for fat.”
There are societal issues over obesity and there are medical ones and there may be some overlap completely, but to insinuate that the medical issues are fictions and just doctors being biased is unfair and off base.
There is a societal tendency to assume that people who are overweight or obese are that way by choice or because of laziness when often there are structural inequalities at work. People who cannot afford healthy food are often given lots of carbs, and they get obese and become diabetic. And we can both recognize that these people are not inherently bad or lazy but also try to change the structures that led to this mass increase in health problems like diabetes and heart disease.
There are health risks corresponding with obesity. Anesthesiologist don’t ‘hate fat people’ or something. They aren’t being sizeist. When people are morbidly obese, it greatly increases their risk of aspirating when they go under anesthesia. Sometimes in major surgeries, morbidly obese people will actually have to be intubated while they are still awake to minimize the risk of them aspirating. I had a patient who had heart disease who couldn’t be put under general anesthesia during a major surgery because the drugs affected his cardiovascular system and there was a risk of death. So he was given a nerve block. We didn’t discriminate against him for having heart disease, we did what was necessary to get him the surgery he needed without killing him.
There may also be healthcare professionals who bring up your weight more often than you would like or feel is necessary, and it is possible that some of them have societal biases. Its also possible that r at least some of them are trying to treat you well and address all of your issues. If you come to the emergency room for chest pain and they find out you have diabetes or are an alcoholic, or need to start getting cancer screenings, should they not mention the rest of your health as well because you came for your chest pain?
If you eat well and exercise, then your weight is likely your natural healthy body weight. If you cannot eat well or exercise, we should try to do as much as we can as a society to make it easier for you and everyone else to be healthier. This means recognizing that its not all individual choices but still trying to make progress, whether by encouraging people to walk for the first couple of bus stops before getting on the bus to work or campaigning to change the health standards for school lunches. It is never right to be rude to someone because of their weight, but it is also not right to pretend that the science about obesity and the American diet and its associated health risks doesn’t exist because its not politically correct.
I am not an anaesthetist, I am a nurse who has worked in operating theatre.
There is criteria that an anaesthetist (Anaesthetic doctor) follows to safely provide anaesthetic to their patient.
A patient who is considered overweight or obese by an anaesthetist is considered an anaesthetic risk over certain physiological parameters. For an anaesthetist to ignore the reality of a patient meeting certain physiological criteria is just unsafe for the patient and professionally stupid for the anaesthetists career.
It may be easier for your wife to overcome and face her needle phobia. I cannulate patients as part of my job. I put cannula in patients veins in order to provide and administer certain intravenous medications. It might be a lot safer and less risky for your wife to receive conscious sedation (using Midazolam and small amounts of Diprivan) intravenously than it would be for an anaesthetist to risk your wife’s respiratory/cardiovascular status by instead receiving anaesthetic gas.
Most people have veins that an expert cannulator can find. Most anaesthetists are expert cannulators, so they won’t cause your wife much grief while cannulating. Most patients dislike ‘needles’, but in truth, once the metal needle of the cannula has entered the vein, that wound is the start and end of the pain, then the flexible plastic cannula is advanced into the vein, and is secured, and when the medication is administered, if the cannula is located securely within the vein (which is evidenced by flashback of venous blood in the chamber), then there is no pain beyond that, as conscious sedation can be administered.
There are solid scientific reasons that medical and nursing staff minimise risk to their patients. Risk minimisation is done to protect a patient, not for any other reason.
I totally commend you on this article Mari. It’s brilliant and something that needs to be said. I take the life scientists’ points (would like to note I think us social scientists are scientists too!). Fair point on the use of the word ‘shaky’ but I don’t think the article was meant to claim studies on obesity are pseudo-scientific.
I think this issue relates to something I have been interested in for a long time- studies of lesbian motherhood. A lot of current research in demographics, development, and other areas (some studies being medical, many being more social) completely skew the data because they themselves are based on heteronormative assumptions about family, women, and lesbians. It drives me crazy!
So thank you so much for this. I would love to see more work done on the issue!
Ugh, as a lesbian demographer I find this thing super annoying as well. I think this problem comes down to two issues: 1. It is hard to do a quantitative study on any small sub-population. There is just not enough data! People who study, for example, immigrants run into this same issue – there just isn’t enough cases to do a proper analysis. This issue might be smaller in a big country such as the US or Germany, but I come from a small country and it is really hard to get enough data on minorities. But even the big countries have the same problem. 2. When you do a large quantitative analysis, you have to estimate and extrapolate a bunch of stuff. For this you have to choose a method that results in least error, which might result in excluding minorities or doing heteronormative assumptions.
But ALSO there is a lot of heteronormativity and conservatism behind this, of course. Most researchers are straight and while many mean well, I don’t think they even come to think of sexual minorities and non-normative family configurations when they design a study.
Big ups to Mari and this article.
All y’all dissenters, consider that this might be an opportunity for you to engage in allyship rather than trying to prove fat people’s inferiority with science. If fat people have things to tell you about their experiences of being marginalized and belittled, you should probably believe them. Having access to science makes you educated but it doesn’t make you an expert of anybody else’s experience.
Not a big fan of being told to be an ally to myself in a way I disagree with.
There seems to be an assumption among some commenters that only people who are both otherwise unhealthy AND fat are the target of scientific, medical, social, and other “obesity epidemic” interventions. But it isn’t clear that this study is distinguishing between lesbian women who are obese (by BMI) and healthy and those who are obese (by BMI) and unhealthy. There’s the assumption that obese = unhealthy in this study, and from what I understood, Mari was criticizing that assumption rather than criticizing research or science in general.
Also, it’s really important to question the researchers concern about the “problem” of queer women not thinking they’re overweight when they fall into the overweight (NOT obese) BMI category.
*content note for weight comments, body policing*
I’ve been lectured by doctors about needing to lose weight even though I fall within the so-called “normal” range, because I gained a few pounds within that range. One doctor told me explicitly that in an obesity epidemic, “you can’t be too careful.” I see Mari celebrating that within queer women’s culture, at least, we don’t have to be constantly vigilant about gaining a pound or two, because the culture is so (comparatively) body positive. But the researchers frame this is as a “problem” of self-perception, clearly thinking that women who fall within the “overweight” category of BMI should be concerned, because, like my doctor said, “you can’t be too careful.” Ugh.
Thank you Nika. That’s pretty much exactly what I’m getting at!
I’m one of those healthy overweight people, and I struggle with interactions with the healthcare system, even as a medical professional. I get badgered about my weight at every single medical appointment, even though I have absolutely perfect fasting blood glucose, blood lipids, hemoglobin A1c, resting pulse, and blood pressure. I’ve had serious health issues totally unrelated to my weight that physicians have ignored because they were convinced had to be related to my size. One of the HUGE problems with much of this research is that it’s poorly understood by physicians who use it to dismiss the health concerns of overweight people, or to label all their overweight patients has “unhealthy”.
Look: Body-shaming is not okay. Bullying is not okay. Making people feel bad about their weight is not okay. Telling women that they don’t deserve autonomy over their own bodies is not okay. An unreasonably thin beauty standard is not okay.
But that doesn’t change the fact that obese people are at a very high risk of a host of serious health problems, not limited to type-2 diabetes and heart disease. These are among the leading causes of death and a positive self-image won’t prevent them from happening. Denial of the grim effects of obesity is every bit as unscientific as the anti-vaccine movement, AIDS denialism, and global warming denialism.
And before anyone responds citing the ONE study that showed that overweight people live longer, please understand that this isn’t how science works. One small study does not overthrow the findings of literally thousands of others. There’s a reason that people who have gone to medical school are supposed to analyze these findings, not armchair scientists on the internet. There are also a handful of studies showing smokers live longer– so does this mean that we need to ignore the fact that lesbians have much higher rates of smoking (another serious problem in our community)?
Please, ladies, love your bodies. Know that you’re beautiful. Know that it’s not anyone’s place besides yours to dictate what you do with your own body. But the fact is that obesity is dangerous and will almost inevitably take a toll on your health. If that’s your choice, rock on, sister, and love yourself anyway. But please know what you’re choosing.
It’s interesting to me to see so many people calling me anti-science, considering the first line of my bio mentions that I am, in fact, a scientist. I’m even a medical scientist, specializing in medical genomics. I hold a BS in Biochemistry and another in Medical Laboratory Science, and I’m a PhD candidate in Genetics and Molecular Biology. I’m also a board-certified Medical Laboratory Scientist by the American Society for Clinical Pathology, and licensed as such in several states. I’ve published several papers, and presented worked at meetings of the American Society of Human Genetics, the Association for Molecular Pathology, and the International Society for Prenatal Diagnostics.
If that’s not enough to convince you that I’m not an “armchair scientist,” consider the follow two articles I’ve published on TransAdvocate covering the science of transgender issues:
Clinging to a dangerous past: Dr Paul McHugh’s selective reading of transgender medical literature
Crossfit’s “scientific” refusal to allow Chloie Jönnson to compete in women’s division not actually supported by science.
Oh yeah, and the first of those two articles was quoted in a press release by the World Professional Association for Transgender Health.
My biggest gripe with this study, in particular, is that it fails to have cultural understanding about queer women. That’s a HUGE flaw in a study design. When you’re studying unique minority populations, it’s ESSENTIAL to have some grasp of the cultural underpinnings and how they may confound your analysis. That’s missing from this study.
On the industry of obesity research in general, I’ve ALSO done a lot of reading on this, considering that my dissertation research is as part of the CHARGE Consortium. The VAST majority of work done on obesity and disease that points to any kind of effect directionality between obesity and disease has been done in mouse models. Unfortunately, we learn more and more every year that mice make terrible models for human diseases, particularly complex human diseases. Our genomes, transcriptomes, and epigenomes are simply structured and regulated in too different of ways for the research to translate into knowledge about how human beings work.
In any case, my larger objection to the entire situation is the constant equating “size” with “health”. Many people who are classified as “overweight” or even “obese” are QUITE healthy from all metabolic and cardiovascular measures (I’m one of those people). Many people who are a “healthy” weight are in terrible cardiovascular health. Instead of telling people (especially women) that that need to lose weight (which I can tell you from years as both a patient AND medical professional is EXACTLY what doctors do), is time we focused efforts on education about the importance of a healthy, diverse diet and consistent moderate exercise. Research show pretty consistently that most of the US fails on both those accounts, whether they’re thin or fat.
Oh, and if you think that you need to go to medical school to interpret science, then you don’t know much about science or medical school. I TEACH medical students and residents.
I admit that I did not realize you had scientific qualifications. Perception is funny. I admit that I’m changing the way I’m viewing the article. I respect that your a PhD candidate and know something about what your talking about. That said from my understanding the vast majority of people categorized as obese don’t have those those healthy metabolic and cardiovascular scores you mention.
Mouse studies aren’t good for studying complex health problems. But you can’t run a simple experiment on obesity with humans. It would be unethical to induce obesity. Also, It reads like obesity isn’t your main research focus. There is a big difference between a research review and having a career studying something. I believe two different people directly stated that they study obesity. The fact that they find your article dismissive of their work is pertinent.
“But you can’t run a simple experiment on obesity with humans. It would be unethical to induce obesity.”
No, but people are generally OK with inducing weight loss as part of a study (which is actually probably even more relevant to the question of whether we should be pressuring people to lose weight).
Google was able to point me to just one randomized controlled trial on the effects of weight loss intervention: http://www.ncbi.nlm.nih.gov/m/pubmed/21775558/
I definitely have no expertise in this field, but those are the kind of studies are the most compelling for me. “Trust what your doctor says” just doesn’t work for me.
As another obesity researcher I find this article very very problematic at its discussion of BMI, the effects of weight loss and the overall “blame it all on the physical inactivity” very unsupported argument.
The whole language of the article, framing the obesity epidemic as a kind of conspiracy and phrases like “garbage in, garbage out” and “completely meaningless hogwash” is more like the language of the daily mail and not of someone discussing science seriously.
I was expecting much more from a fellow scientist and I find this article very insulting for the kind of work me and my colleagues are conducting.
This is really an attitude I don’t get in the lesbian feminist community.
I am a woman, I am a lesbian and a feminist and I honestly don’t think there could be something more distructive than this whole “body positive” concept.
To put this in simple words, obesity is bad for anyone. It’s one of the steps on the path to insulin resistance, type II diabetes, cancer, just to name a few.
There is no thing such as benign obesity.
I personally come from being obese.
Please stop telling people it’s ok to be obese.
Look at how type II diabetes has turned into an epidemic in the les decades.
There are, however, very distinct differences in how individuals react to certain levels of weight. When dealing with an individual patient, it is essential to understand their personal weight history. Maybe that 20 pounds overweight is exactly where they have been for 25 years and disturbing that balance would do more harm than good. Maybe they are “normal weight” but have suddenly lost 20 pounds over the last three months without changing lifestyle habits (bad, bad, bad). Ethnicity affects how individuals react to certain weights; for example, a BMI of 28 would probably have minimal affect on T2D risk in an African-American woman with regular physical activity while it might shift a Thai-American woman’s risk of T2D up by quite a bit. Cut-offs are by definition somewhat arbitrary, and CONTEXT really tells you the story of that individual.
Personally, I find team sports participation rates to be relatively un-important. One of the most common forms of exercise in the US is walking, and I’m pretty sure that they don’t have walking teams.
Amen re context and the importance of context for an individual.
There are so many interconnecting intersections than “enable” obesity and less than optimum health in the world.
The links between motivations for human behaviour + the emotional responses to stress + the ensuing debt of emotional stress on the physical body will frequently drive the overall equation of someone’s health.
To rely on merely one of these factors in the overall equation of health is failing to see the whole picture of someone’s life balance/imbalance. Health for an individual requires science and attempting to optimise someone’s lifestyle choices, within the resources and support available, and this is where the solution can falter. The solution can falter because of intersecting social injustices which can compound poverty, inequality, injustice, disenfranchisement, etc.
Context of a human, is all important and effects everyone’s degree of quality of life and health access.
I, for one, care a great deal. I care a lot that members of marginalized groups in our society, specifically people of color, poor people, and lesbians, are the people who deal most the issue of obesity and obesity related illnesses. I care that these groups are disproportionately poor, disproportionately lack access to health care, and have the added burden of dealing with obesity related illnesses, which means them spending money, time, and energy they likely don’t have. I care that they need to spend money and time at doctors when they have lower rates of insurance and lower access to health care because of obesity and obesity related illness. I care that these marginalized groups are dying younger, dealing with more illness, and having lower quality of health than groups that aren’t marginalized.
This article, one recent one on xojane on the same subject, and much of the information I’ve seen from many fat activists are so frustrating, for the fact that these educated, mostly middle class activists have decided that medical research is being done into groups that are largely ignored by most medical research is somehow bad because THEY feel that THEY specifically are healthy obese, to hell with the disproportionately large numbers of those groups that aren’t. It’s so frustrating to hear what a waste of money it is to spend on this research, because either doesn’t apply or make some fat activists feel bad, oh well if it means that large numbers of systematically oppressed people end up dying earlier, having poorer health, and have additional health care burdens placed on them.
I, for one, am very happy that the medical community is paying attention to the health of minorities. No, this study and the use of BMI isn’t perfect, but it’s step in the right direction to improve the health of marginalized people in our society. It’s a step in the right direction that they are trying to find out what are the root causes of obesity in these groups, rather than just chalking it up to “eat less, fatty.” It’s important that they are trying to find out the nuances of causes and solutions for different groups when it comes to obesity related disease, rather than just doing a one size fits all approach that is dominated, like much medical research, by the needs of white men. Please don’t discourage this research because you think “we don’t care.” Many of us to do care a great deal.
Part of me likes this, and part of me has the same feelings I have every time I read articles that imply or state outright that queer women are somehow above the pressure to conform to beauty norms. I had an ED for years, and when I read this stuff I feel like I did something phenomenally wrong, like I invalidated my own identity and was somehow disloyal to and betrayed the community as a whole.
I know a lot of that is my own bullshit and my own struggle with identity and whatever it means, but it still always makes me feel like I fucked it up and that my consistent struggle not to fall back into those old habits and ways of thinking means I’m failing at queerness.
^^making it all about me, obviously.
I am have also had an ED for many years, and I too feel like my identity is invalidated in some ways when I read things like this, because I am unable to celebrate or embrace my body– and it has nothing to do with the male gaze and very little to do with media messages, etc. It feels difficult to own a queer identity and a longtime problem with food and body image at the same time.
First of all, I like this piece in it’s critique of our hegemonic cultural fixation on weight loss.
However, after reading it, I’m left feeling a bit like it’s coming from a white person’s perspective. I guess what I’m getting at is that, from my understanding, there is a racial disparity with respect to obesity and Black Americans and Latin@s. People of color have higher obesity rates, as well as higher rates of diabetes, high blood pressure, etc.
Now, I’m not necessarily interested in creating a causation between obesity and other health conditions. But, in all honesty, what troubles me is this article’s total silence on the social conditions (poverty, lack of access to quality foods, higher amounts of fast-food chains in low-income areas, lack of access to health care, etc.) that create health disparities–obesity included–among these populations of people. And we simply can’t reduce higher rates of obesity among POC to the (perhaps racialized?) idea that Black Americans and Latin@s like bigger bodies in ways white people don’t. I’m not discounting cultural variation in regards to how different populations value differently shaped bodies. However, I don’t think we should ignore the social conditions I mentioned.
Maybe it’s just me, but I rarely come across white fat activists bringing up these issues.
This is what I am saying too. Intersecting injustice compounding health issues. Obesity is just one issue.
But, in all honesty, what troubles me is this article’s total silence on the social conditions (poverty, lack of access to quality foods, higher amounts of fast-food chains in low-income areas, lack of access to health care, etc.) that create health disparities–obesity included–among these populations of people. And we simply can’t reduce higher rates of obesity among POC to the (perhaps racialized?) idea that Black Americans and Latin@s like bigger bodies in ways white people don’t. I’m not discounting cultural variation in regards to how different populations value differently shaped bodies. However, I don’t think we should ignore the social conditions I mentioned.
Maybe it’s just me, but I rarely come across white fat activists bringing up these issues.
Woah. No. This is not just weird about science, this is weird about how science interacts with justice. Obesity can be a strong predictor for some diseases in some people. IN SOME PEOPLE, it’s the result of exposures to certain factors – physical inactivity, social isolation, POVERTY POVERTY POVERTY, lack of access to medical treatment for lifestyle-hampering illnesses and injuries. The BMI is not an acceptable personal measure of health, but it was designed for exactly this kind of population-wide survey of overall health.
Queer people, ESPECIALLY queer women, are an understudied group, and our marginalization in health research shows up in our health outcomes. There are huge health disparities between straight cis people and LGBTQ people. The personal politics of body acceptance are valuable, because at the end of the day, there doesn’t seem to be much research that shows that body size is strictly an individual choice. But it can be influenced by external, systemic factors, and researching that is pro-justice.
That’s very true, but there has to be a way we can have that conversation while also being inclusive and mindful, and not spreading more fear-mongering lies and half-truths with shoddy science behind it about THE OBESITY EPIDEMIC. We can talk about the institutional and social justice-related implications and care about health without going into that whole nasty policing aspect of body shaming. We can also do all of this while pointing out, like Mari did, how grossly overstated the “obesity epidemic” is, and how this culture’s solution to it-“diet” fads, extreme exercising and starvation, shaming, etc-is actually super unhealthy and abusive and bad for you in the long run. Nuance is key.
Absolutely. I think to me, the key point is that personal choices just aren’t that strong a predictor of body size, on an epidemiological level. Geography, class, other socioeconomic factors are much stronger predictors. This is a design problem in the way we live, not a question of individual willpower. (Individual choices can definitely influence factors like “activity level” and “quality of diet”, within the limits of the individual’s means and abilities, but whether those choices will lead to a change in body size is thoroughly up in the air). I guess guess that that’s why I object to the denigration of population-wide measures in this article – population-wide measures are useful for one thing, and that’s for designing population-wide solutions. I don’t know if we’ll get there, but trust me, epidemiologists don’t think the answer is to give a quick talk on willpower and then blame the individual.
Purps you have said what I clumsily tried to say.
“Obesity can be a strong predictor for some diseases in some people. IN SOME PEOPLE, it’s the result of exposures to certain factors – physical inactivity, social isolation, POVERTY POVERTY POVERTY, lack of access to medical treatment for lifestyle-hampering illnesses and injuries. The BMI is not an acceptable personal measure of health, but it was designed for exactly this kind of population-wide survey of overall health”.
I was getting ready to go to work and forgot to put quotes around what GG said which I also agree with.
I totally agree that socioeconomic factors, compounding intersectionality, (race, ethnicity, religion, culture, gender, age, class, wealth) drive one’s health.
I also believe that intersectionality is THE reason for unequal health access and failure to access health services by some groups, and is the reason why some people with greater privilege are healthier than others.
Also, a person’s reaction to stress and the toll of stress on the body (anger/stress blood pressure, grief) have a strong connection with our bodies overall health if the emotional responses are strong enough to impact physical health.
This is what I meant to do with GG’s comment
“But, in all honesty, what troubles me is this article’s total silence on the social conditions (poverty, lack of access to quality foods, higher amounts of fast-food chains in low-income areas, lack of access to health care, etc.) that create health disparities–obesity included–among these populations of people. And we simply can’t reduce higher rates of obesity among POC to the (perhaps racialized?) idea that Black Americans and Latin@s like bigger bodies in ways white people don’t. I’m not discounting cultural variation in regards to how different populations value differently shaped bodies. However, I don’t think we should ignore the social conditions I mentioned.
Maybe it’s just me, but I rarely come across white fat activists bringing up these issues”.
Health is a combination of one’s physiology, socioeconomic and intersectionality status and one’s response to stress, so placing the burden of “health and wellbeing” on only one part of the equation, such as “science” without including socioeconomic drivers and the impact of stressful emotions on the body, is simplistic.
One may have an inflammatory response ie the research Hannah is doing
“To answer your question, obesity is, in part, characterised by chronic low grade inflammation. What does this mean?
In short, when the fat cells take up more fats from the bloodstream, they get larger. The cells get stressed, as they are packed in close together and will release stress signals. Certain immune cells respond to this by moving into the fat tissue and releasing inflammatory molecules.
This is essentially the same as what happens when you have an infection, or damage something in your body. Except in this case, there is no infection or damage caused. In normal circumstances, when there are inflammatory molecules in the bloodstream, all kinds of cell types respond to them and can make changes to what they do in order to let the body deal with the situation. This is part of the reason why you feel crap when you have the flu, but once you get rid of the flu virus, everything goes back to normal.
In obesity, when there are these inflammatory molecules present constantly, the rest of the body doesn’t know to stop reacting to them, so the body remains in this stressed out inflammatory state. This results in all kinds of health problems, such as type II diabetes, hypertension, abnormal metabolism and reproductive function. When you’re dealing with obesity, dealing with the weight only solves part of the problem”.
but what is driving the cells to be stressed?
I suspect the answer lies in what stresses most people: Life and its challenges. Human beings are a part of a system and our bodies are parts of our system, everything interacts and responds and life is frequently challenging and stressful. It is no wonder health and wellbeing is challenged more for some of us than others.
Brighe, before I begin my massive comment I want to clarify a few things: I respect you and your credentials as a scientist. Hell, before I start, I should probably mention that I don’t yet have my B.S. I absolutely believe that ‘obesity’ is a shaky classification and not a measure of health, is not a disease, and while it may certainly have strong links to (or be caused by) disease, on its own is not sufficiently proven to be a source of disease.
I say this to clarify that when I say that I find your article troubling, it is not because I believe that “obesity = bad” or that you are “promoting obesity”, or that I want to discredit you in any way. It is because I take issue with a bunch of connections you made:
1. This thesis: “Lesbian-identified folks are free from the pressures of the male gaze, yeeeahhh rock on!” is, well… 1A) Not necessarily true on a personal/psychological level. Being told you’re ugly/broken/worthless/etc. is a psychologically harmful statement regardless of whether or not you’re sexually interested in the person saying it. Possibly less harmful, but not harmless. 1B) Flat-out not true in the overarching social context (a fat queer woman is just as likely, if not more so, to be passed over for a job or promotion by a male manager as a fat straight woman is, and similarly, is probably just as likely to experience the vitriol of male strangers in public). 1C) Dangerously dismissive of the fact that the queer women most likely to be fat- that is to say, queer women of color and/or poor women and/or women with disabilities- are also the ones whose lives are most likely to be vulnerable to/harmed by systematic male power.
2. The tangle that you’ve sidestepped- the ties between class, race, disability, health and weight- specifically, the ways in which lack-of-privilege tends to beget itself- is such a complicating factor that without it or its constituents I’m not sure an article on the subject of women’s weight and self-perception can be complete.
3. Many of the studies you are using to support this thesis use either 3A) fairly poor data sets (162 Australian lesbians who identify as “part of the lesbian community” is not a great representation of queer women in the Western world overall) or 3B) are made of populations that cannot be considered representative for the purpose of the extrapolations you’re making. While the Growing Up Today study is solid, the majority of queer adults would not have self-identified as queer in their youth, and the percentage that did decreases the farther back in time you go, meaning of the queers adults who would have been of the appropriate age/location etc. to participate in that survey in 2009, chances are only a minority would have identified as queer at that time- and even fewer of the ones who would have qualified for the 2003 survey. This gets even messier when you take into account the religious, cultural, and economic influences that bear on a youth’s ability and/or willingness to determine their queer identity. In short, you can’t make predictions/generalizations of the queer population based on self-identified queer youth, as they are a very specific subset that is arguably highly determined by outside forces. This in the addition to the awkward part that 3C) these studies fly in the face of years upon years of research showing strong predisposition towards depression, mental health issues, and self-esteem issues among the queer population.
4. Finally, this idea hearkens uncomfortably closely to a messed-up old trope of the 70’s: that women could just fix the sexism in their lives by forcing themselves to be lesbians. This is both 4A) a preposterous way to not work on dismantling systematic issues, and 4B) a flagrant dismissal of the identity, desires, struggles, and consent of women who happen to be straight
Although I appreciate the merit of some of your arguments (i.e. It’s good that lesbians/bi women are less considered with crushing heteronormative beauty standards than their straight counterparts), I can’t help but feel that you’ve missed the point of the study at large…Obesity IS a health crisis plaguing modern life, and one that disproportionately affects people from disadvantaged backgrounds.These types of studies are necessary so outreach efforts can be tailored to the specific needs of a historically undermined community…And I want to clarify: no one denies that BMI is an imprecise way of measuring body fat. However, just because this particular method is “imprecise” doesn’t mean it’s “inaccurate” in reflecting broader trends of excessive weight gain. And yes, weight gain alone is not unhealthy, and the physiological measures you’ve mentioned (fasting blood glucose, blood pressure, etc) are more determinative of good health, but again, you’re missing the mark. There is undoubtedly a causative connection between excessive weight and abnormal changes in such physiological functions! Is it possible that someone with an “obese” BMI would pass such tests with flying colors? Of course! But it’s not PROBABLE. The latter factors are dependent upon maintaing a healthy weight. To say that diabetes, high blood pressure, high cholesterol, etc are health concerns and then vehemently deny that the largest risk factor (i.e. excessive weight gain) as a legitimate contributing factor is crazy talk…
I’m also writing to express serious concerns about the characterization of the science and the scientists described in this article. NIH is currently funding a large scale study on the intersection between gender, sexual orientation, and obesity. This includes understanding why lesbian identified adults are more likely to be overweight but it is not the sole focus of the study. The study is described here- http://projectreporter.nih.gov/project_info_description.cfm?aid=8703150&icde=21539564
From clicking through the links provided on this post, it appears that the majority of the citations used to support the writer’s perception of the Brigham & Women’s Hospital researchers are from The Washington Free Beacon. As the author is no doubt aware, unfortunately it is very easy for the popular press to misinterpret scientific papers. This is the case here. The link above to NIH provides the accurate summary of the goals of the researchers.
As for the papers that were cited- The first study summarized by the author, linked under the words “lesbians don’t play sports” discusses differences in physical activites amongst children ages 12-22 years of age. It reports that kids of that age that identified as one of many non-heterosexual options were less likely to participate in sports than heterosexual identified kids. There is no mention anywhere in the article about this lack of physical activity being why lesbian identified adults are more likely to be obese. Instead the authors of this study discuss the intersection of sexual identity, athletic self-confidence, gender expression, acceptance, and homophobia.
The second article linked by the writer, under “queer girls (lesbians AND bisexuals) are ALSO more likely to NOT THINK they’re fat” summarizes the results of a survey disseminated to almost 13,000 high school students living in MA between 2003 and 2009. As the writer here accurately notes lesbian identified teens who had a BMI that put them in the overweight or obese category were more likely to identify their weight as healthy/underweight than heterosexual peers. Not summarized in this post are a host of other findings. Female bisexual identified teens were less likely to accurately perceive their weight than female heterosexual identified peers. In this case the findings occurred in both directions- bisexual teens were both more likely to misperceive their weight as overweight when their BMI suggested otherwise, or more likely to misperceive their weight as underweight/healthy when their BMI suggested otherwise. Both female and male gay/lesbian and female and male bisexual identified teens were more likely to engage in behaviors consistent with eating disorders than heterosexual peers. The take home message of the study is not that lesbian identified teens misperceive their weight at greater frequency than straight peers, but that sexual minority teens are engaging in multitude of unhealthy eating behaviors at greater rates their their straight identified peers.
Ultimately what is troubling is the accusation that the researchers here are attempting to pathologize lesbian women. The authors appear to be doing just the opposite- understand why there are discrepancies in health outcomes between gay and straight identified women. Epidemiology has a crucial place in medical research in characterizing associations. It enables modeling complex behaviors, bringing both biological and social constructs into the mix. So called “hard science”- bench science, clinical studies that can spend hours measuring an individual’s health with precision, psychological studies that can more accurately characterize mental health behaviors and attitudes- all of these projects compliment the type of work these researchers are doing. Each aspect of science has its strengths and weaknesses, its own assumptions. But each aspect is crucial in understanding the big picture. Only with a multitide of perspectives will we be able to understand how best to promote healthy living for minority groups.
It seems to me that there is a psychological undercurrent to all of these (intelligent and relevant) arguments being made. People are people, no two are alike, and each and every one of us has a lifetime of unique experiences (health issues, lack of health issues, queerness) that will almost inevitably affect how we feel about these things.
My particular background leads me to believe that we would be doing ourselves a disservice to not acknowledge the problem of obesity/overweight in favor of body-positivity. I think what we need to work on is helping those who are suffering (and please note I do not assume every overweight/obese person feels this way) with excess weight while simultaneously avoiding shaming them or making them feel bad for being who/where they are in regards to their health and fitness.
I have struggled with my weight my entire life. That being said, I’m like Mari in that, on paper, I appear very healthy. All my numbers are normal, and my resting pulse is even low at 48 bpm. Even so, I’m not happy with where I am physically. Something inside of me knows that, despite my numbers (aside from BMI, which labels me obese), I would feel better without the 20 excess pounds I currently carry around on my body. Exercise would be easier and I would also feel better about the way I look. That’s just where I am.
So anyway, I think we need to come to a place where body-positivity and healthful beneficial weight loss can co-exist. As someone who wants to be smaller than she is, I have often felt shamed for not being “okay with your body just as it is” or “being too critical” of myself. No, I’m not overly critical. I’m overweight. AND I do love and care about my body. It’s BECAUSE I love and care about my body that I want to take care of it and avoid weight-related diseases that are totally preventable.
Anyway, perhaps I’ve gone a little off topic. Just my two cents.
A better study would be about healthcare disparities in the queer community, which are very real. Obesity may be a contributing factor in disease but the study here is missing the point by only talking about obesity in lesbian communities. Do we need better access to proper medical care and assessment? Yes? Do we need to make sure we shame our bodies more/as much as straight women to get that? No.
Mari, I really appreciate this piece. I’m very much in favor of science in general (as I know you are too — yay women in STEM!). But I agree with your assessment — there’s an important cultural dimension that hasn’t been taken into account here. “Different” isn’t always “worse,” and the body-positivity many queer women express is definitely something worth studying. Hopefully that study will be soon to follow.
I can’t decide whether to laugh or cry at all these comments about how the medical community/science KNOWS THAT OBESITY IS A DISEASE!!! There have been studies and everything!!! (Studies, that despite what the some of the commenters–none of whom linked actual studies–seem to think, only prove correlation not causation.)
Y’know what else was a DISEASE with studies, entries in medical textbooks, articles in journals, and was something everyone knew (and if they didn’t they were just in denial) was bad, unnatural, and sick?
Well, I think this crowd can answer that question for themselves.
and there’s the mic drop.
BOOM.
Thank you for this. I was so upset reading through the “BUT OBJECTIVE SCIENCE REALITY KNOWS OBESITY=EPIDEMIC & DISEASE” comments that I had to close out before getting through them all. So disappointed at the overwhelming number of likes they got, too. I was still thinking about it and still upset almost a week later, and felt like I needed to comment. But I was glad to come back and see this.
I wonder if the folks who commented about being offended at the ~dismissal of science~ or their work think about how damaging it is to hear, over and over again, that your body is a disease. I wonder if the folks who commented about ~sure love yourself but just know that the self you love & choose to keep is gonna kill you~ think about how patronizing that is.
We don’t get a lot of space to challenge the way that we are talked about a lot, and it was disheartening to see that the response to Mari’s challenges, rather than to listen, learn & reflect, was to tell fat people that they are wrong, and that they are objectively doomed.
Fuck.
I’m actually an obese person that was bothered by this article and support the comments pointing out some of the problems I find with it, namely that obesity is also often associated with other things such as poverty and mental health issues. I think it is flippant and dismissive to dismiss BMI as it relates to a population, not individuals, and not talk about all the factors that might influence obesity. Yes, I find it disheartening to know that I might not get jobs because of my weight, to have things and comments thrown at me when I’m walking down the street, and to have doctor’s dismiss every ailment I might have as related to my weight. However, I also find it disheartening that some people seem to think that the factors which influence obesity, and disproportionately affect black women, aren’t worth looking at. They are worth looking at and of course they are worth looking at right, but this article seems entirely dismissive.
And I have to say that the way obesity is talked about in supposedly social-justice oriented communities is oftentimes exhausting. Disproportionate obesity levels can be a real indication of disproportionate access to healthy environments, food, and healthcare but those conversations are often lost in a sea of voices pushing back against “obesity epidemic” talk to the point that I feel any discussion about obesity levels and health among communities is lost. I think there is a real chance that communities with access to regular and cheap healthy food, electricity, cooking equipment, walkable and relatively safe neighborhoods, non-reliance on free and reduced school lunches, time to cook regularly, etc. are less likely to have high rates of obesity than those without access to those things. Of course obesity shouldn’t be the end-all and be-all factor but studying the rates within specific populations can be a place to start and hopefully influence policy in terms of subsidies, school lunch programs, park funding, youth sports leagues and anti-bullying funding, mental health funding, etc. There is a real problem with the discussion on health not including those things and any hand-wringing over obesity that doesn’t look at those things is missing the point imo. However, I just feel like a lot of the ways my body gets talked about is fueled with condescension and paternalism from both supposed hand-wringers and self-identified HAES/FA supporters. Those feelings are defiantly brought to the surface when some people who support the article choose to use “we/us” and tell the people criticizing it to “reflect and listen” as though some of us who are fat and obese don’t share the sentiments that it is dismissive of the health disparities obesity can be an indicator of and something we should care about as a community.
Last I checked, being queer/non-straight-identified (since I assume that’s what you’re getting at) isn’t directly correlated with a plethora of serious health problems like Type 2 diabetes/insulin resistance, heart disease, etc.
It is possible that Mari’s piece was a little flip, in a joking way, about the work of the scientists doing this study. That said, as a fellow fattie, I know that us fat folks face microaggressions every day and right-out-there aggression on the regular from folks who think we should care what they think about our bodies. Medical folks and regular folks and family and friends and strangers. There is triggering stuff out there every. damn. day. The bigger your body, the more hostility you face from the world. If we are a little sassy about more of this same crap, there is a reason for it and I feel like it is justified.
That said, I’m sure the scientists had the best intentions. I think the point Mari was trying to make here was that the study itself is flawed. We know that fat does not equal unhealthy. Unhealthy equals unhealthy. You can be thin and unhealthy. You can be average sized and unhealthy. You can be fat and unhealthy.
Mari also postures her own theory, backed by some research, that perhaps self-identified queer women engage in a culture that is less preoccupied with thinness as the only ideal of beauty. This makes sense and is a theory that I, personally, love. We work hard in queer spaces to be more inclusive and less classist, racist, ableist, etc. It makes sense that we would create space for more bodies to be considered beautiful.
On the obesity stuff, I just don’t buy that obesity = death. Even if it does, we have obviously lost that battle. Fighting our bodies hasn’t made them healthier. Regardless of size – thin, fat, somewhere in-between – we are perpetuating self-hatred, disordered eating, discrimination, poor health. No one is “winning” the war on obesity. I subscribe to the theory of health at every size (HAES), which promotes
Wringing your hands about the number on the scale is not helpful. Focusing on your health and wellness and happiness is better. The fact that obese people are disproportionately low-income is no surprise. Perhaps the focus should be on what kind of food people have access to: the affordability and availability of fresh produce in poor neighborhoods, whether people working multiple minimum wage jobs have time to cook fresh food, school lunch programs, and other intersections of race, class, culture, etc.
I’m 5’3″ and 215 pounds. I went to a new doctor recently for a check-up and was told I was one of the healthiest patients she’d seen in a while. I’m vegan. I have low cholesterol and low blood pressure. I am fat. Obese, by BMI chart standards. I just ate 2 delicious vegan cupcakes as I was typing this. I know that I would like to move my body more–get more exercise, but I’m not worried about a number on a scale. I eat carbs. I also eat a lot of naturally low-fat foods and veggies and “good fats.” I feel OK about all of that.
my doctoral research was on obesity but in the field of medical anthropology and specifically how it relates to stress in immigrant populations. i cant even begin to talk about my feelings on how body image, health, and queerness relate because that is another dissertation entirely and no one wants that. but i did want to say that as an anthropologist who is pretty informed on this topic, i believe these comments are illustrative of the emotionally fraught nature of the obesity research field at large.
the views people hold about body size, health, diet etc are particularly and uniquely susceptible to cultural values and personal narrative and yes i absolutely believe that extends to the scientific community as well (the culture of science and scientific research was, in the end, one of the most fascinating and valuable things i learned about as a grad student and also why i chose to leave the academy but i digress…). there are well-respected obesity researchers and medical doctors who do believe weight is a poor proxy measure of overall health. that debate has not been settled, and the truth is an explicative model of obesity simply doesnt exist and “calories in, calories out” is not fucking it i want to stab that phrase with a fork IT IS THE WORST lets never talk about it again. so i support obesity researchers whose intentions are to improve the health of people especially vulnerable minority groups (and i am glad to see some AS people are obesity researchers, this gives me some hope for the future) but i think it is equally important for the scientific community to understand how cultural variables fit into their research and not dismissing or invalidating the fat acceptance movement or queerness in the process of producing science. it is absolutely necessary that researchers are reminded of their own cultural biases and stereotypes before developing and executing successful studies on this topic and it is even more important when implementing public health initiatives. so thank you,mari,for writing this and starting this discussion. it is so important and the only way we are going to get anywhere.
Thanks for this well-stated response, Lomy. I appreciate the nuance you bring to the convo.
Did you mean, “garbage in, garbage out”? I don’t think Mari wrote “calories in, calories out,” unless I missed it.
I feel like BMI studies have been debunked over and over. The CDC, which touts BMI as a way to measure body size, even has to admit that “BMI is not a diagnostic tool.” It was created my a mathematician via statistical analysis, not a scientist and has no scientific grounding. It was never meant to be used in the way it is used today. I don’t think it is extreme to say that BMI is junk science, personally.
oh no, i dont believe mari is supporting the “calories in, calories out” nor was i directly referencing anything she said in her piece (although i am sure garbage in, garbage out is a reference to this principle). i was more just making a general statement (which i think mari is agreeing with based on her piece) that when people try to simplify something as complex as the human body’s response to food (any food! doesnt matter! apple slices? a mcgriddle? cardboard? who cares! your body is stupid and doesnt know the difference! its allllllll calories right?) to “calories in, calories out” a little piece of me dies and probably a puppy somewhere too. it is just so patently untrue and patronizing. like fat people who struggle to lose weight and remain fat just dont understand addition and subtraction like thinner people. i cant talk about it without getting irritated.
and the bmi has been debunked many times and i think you are absolutely right to call the bmi junk science. and while everyone agrees at this point it is flawed, people still use it because you know formulas? they seem legit? i really could not tell you. i will say it is marginally better than weight. i am glad we have at least moved away from weight being the default, but i would have hoped to see a new, refined measure by now. i hope this reflects a desire in the research community to move away from numbers all together. i am not sure there is a formula out there that will ever be able to quantify health status in a way that would be accurate, easy to calculate, and universally applicable. i hope obesity researchers start to work towards a more holistic and nutrition-based approach as opposed to a numbers-based approach that focuses on more isolated variables. but im an anthropologist and all the “hard” scientists would tell me why that is not viable and they are probably right but I CAN DREAM.
Ahh, I get your “calories in, calories out” reference now. And I totes agree. Also, I don’t want puppies to be die and now I’m reminiscing about when I used to be a manager at McDonald’s and we would scarf all the leftover McGriddle cakes in the office after breakfast service. Oh god/dess(e/s), I really want a McGriddle now. Can I veganize that?
Also, I heart you and everything you said. :) I think I may have misunderstood what you were saying in your first comment and for that I apologize. I think we’re 100% on the same page here. Also, you are very smart and I like your face.
The author wrote this like an angry fat lady. Really and for a self proclaimed scientist it is horribly written.
Bottom line is that in Western culture we eat bad food, we are lazy, and we would rather spend time lounging, browsing and eatig than working out. Diets fail because most are fads. Most people dieting are women because it is harder for women to lose weight. Estrogen is a bitch, I know, I lift and a woman who can supplement with testosterone can drop trunk fat fast.
A misconception among big women is that society wabts them to change. No, we do not. Most adults couldnt care less if you are big or small. Big women see what our culture defines as the perfect body and feel upset and angry. Well, we skinny women do too…. because no matter who you are you want bigger this or smaller that. Naturally men do not hate on fat chicks. Straight men and women are driven deep down by hormones. It is a fact straight women find muscular men with large penises to be attractive. Straight men like women with a small waist and nice hips or nice breasts more attractive. Why? Because we still think like paleo humans and those are signs of the best genes and reproductive abilities. Maybe LGBT is driven not by reproduction but some other factor. Do not blame men.
BMI is useful but not as useful as body fat analysis. Problem is that people in the USA who have a high BMI are not typically lifting weight. It is likely they do not even work out. Meaning they are over their BMI boundary because they are too fat. And if a person is too fat in the USA and theres a good chance they gotthat way by eating the wrong foods and neglecting exercise. It doesnt take long on the diets we eat to get big. So, stating BMI doesnt matter in this case is just a way the author is trying to justify unhealthy behavior.
This article is so misguided and the government is not wanting to get into our business. You credit them if the FDA recalls products that contain e.coli or salmonella or warn of viruses that are life threatening but get all defensive when it comes down to the health threat that many of you choose to ignore, not taking care of your body or your health. Nobody is asking you to live on celery sticks and enter a beauty pageant but becoming morbidly obese to make a political statement about misogyny is stupid, period. I am an lean and very athletic lesbian who is proud of my abilities and strength which match that of a man, but am very happy to wear my makeup and mascara. I take care of my body and nourish it and take care of my skin. I don’t want to be a fat lesbian on a one way ticket to diabesity or disability and be sporting the blue and white logo on my rear view mirror. I will be happy to have a 26.2 bumperstick, thanks for asking. I have some advice for you lesbians who don’t care about health, you better start caring because no one else will, especially if you become disabled like many of the Baby Boomer generation lesbian retirees.
Such a positive list of Comments to an artical basically preaching sickness.
If ya want to be overweight which is a health issue go for it!
This way at least there is some population control in the future!
I subscribed to comments on this article months ago because I hate myself, I guess. The comments on this article were so toxic. But I’m so grateful to Mari for writing this article. And Reise’s article on Rosie today prompted me to finally reply to something here.
Do you know how much damage comments like this cause? That the world would be better off if fat people didn’t exist? That we’d be doing the world a favour if we died? These kind of comments are far less ~healthy~ than any body, and if people like you actually cared about peoples’ health, you wouldn’t make them.
https://www.autostraddle.com/comment-policy/: “There is nothing wrong with being fat, nor is there anything inherently unhealthy about being fat.”
This is a deliberately abusive/hateful comment, and I’d be really grateful if it was removed as per the policy (thank you for having such a good one, AS).