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Respectful Observance —

December 28, 2011

Along with the tradition of resolving to make changes for the better in the coming year (which Deah will reflect upon tomorrow), New Year’s Eve has become a time to reflect upon the time that has passed, both for ourselves and for those loved ones who are no longer with us.

The media seems to enjoy promoting a kind of celebrity death roundup, with Washington Post, Chicago Tribune and E! Online publishing slideshows of brief eulogies for celebrities who have passed.

This year, a number of tragic deaths occurred among fat celebrities, which, sadly, have been used to rail against the dangers of obesity. Recently, I discussed the death of Heavy D (44) and how Jenny Craig shill, Mariah Carey, exploited his death to promote weight loss in spite Heavy D’s well-documented history of 100+ pound weight loss and extreme weight cycling.

On Tuesday, the coroner confirmed that Heavy D suffered a pulmonary embolism caused by deep vein thrombosis (DVT) following a flight back from Europe. Among the triggers for DVT, long periods of sitting (as in an intercontinental flight) or bed rest are among the most common.We also lost the talented actress and plus-sized model Mia Amber Davis (36), who also suffered a DVT the day after knee surgery. Lower extremity surgery is another common risk factor for DVT, due to the increased likelihood of immobility caused by the pain being treated or the recovery time afterward.

Although some studies suggest that obesity is a major risk factor for DVT, a closer inspection of the research reveals a definite inflation of the risk posed. For example, this September 2005 study in The Journal of American Medicine says that obese patients have 2.5 times the risk of developing DVT than non-obese patients, while the risk for pulmonary embolism was 2.2 times great among the obese.

This would suggest that the weight of Heavy D and Mia Amber played a causal role in their deaths. Except when you dig into the actual data, you’ll find that although these risk ratios are technically true, the overall risk is rather small for both obese and non-obese people.

DVT and pulmonary embolism were relatively rare but more common in patients diagnosed with obesity. The numbers:

  • Obese patients with pulmonary embolism: 0.76% (91,000 of 12 million people)
  • Nonobese patients with pulmonary embolism: 0.34% (2.4 million of 691 million people)
  • Obese patients with DVT: 2% (243,000 of 12 million people)
  • Nonobese patients with DVT: 0.8% (5.5 million of 691 million people)

Although the risk factor remains low for all people, there will continue to be speculation that when a fat celebrity suffers a pulmonary embolism his or her weight was the cause. Yet weight cycling contributes significantly to the kind of cardiovascular damage that makes a pulmonary embolism more likely.

And this is in spite of the fact that although pulmonary embolisms are more common among the obese, the survival rate of obese people who suffer a pulmonary embolism is higher than that for the non-obese. This is yet another example of what researchers call the “obesity paradox,” as documented in this December 2011 study in Thrombosis Research.

Just 1% of the 18 million obese patients in that study suffered a pulmonary embolism, while  just 3.8% died as a result; but among the 0.6% of the nearly 350 million non-obese patients who suffered a pulmonary embolism, 8.4% died. Ignoring these facts in order to score points for anti-obesity advocates is shameless and disgusting, but will happen nonetheless.

Another fat celebrity we lost this year was the incomparable Patrice O’Neal, the sharp-tongued, take-no-prisoners comedian who reigned over the modern celebrity comedy roast. O’Neal passed away at the age of 41 from complications caused by a stroke he suffered the month before.

Speculation slugs like Matt Drudge put his weight front and center, even though O’Neal struggled with diabetes, a major risk factor for stroke, as two-thirds of people with diabetes will die of stroke or heart attack, according to the American Diabetes Association. So why no headline that reads, “Diabetic Comedian Patrice O’Neal dead”?

Likewise, the death of four-time Pro Bowl defensive lineman, Chester McGlockton (42), who suffered a massive heart attack, was blamed on his weight. This is in spite of the fact that he underweight lapband surgery last winter and had reportedly lost a total of 60 pounds. It seems that even if you take the kinds of drastic surgical steps that many anti-obesity advocates promote, your weight will still be treated as the “true” cause of death.

And, finally, former NFL star Bubba Smith, who I’ll always remember from my own childhood fascination with the Police Academy series, died at at the age of 66 this year. Initially, reports suggested the 6’7″ defensive end died of natural causes, but his autopsy revealed an overdose of phentermine, an appetite suppressant used as a weight loss drug.

In response, the American Society of Bariatric Physicians released this touching tribute:

The American Society of Bariatric Physicians (ASBP) is sad to learn of the death of Bubba Smith. Our condolences go out to his family, friends and fans. The recent news reports regarding the fact that the medication phentermine was a contributing factor to his death are concerning and bring to the forefront the importance of using such medications as prescribed… Phentermine is a safe and effective medication that can assist in the treatment of the chronic disease of obesity when prescribed in conjunction with a comprehensive weight loss program that includes proper diet, exercise, and behavior modification.

In most cases, the risk of not treating obesity far outweighs the risk of adverse events from taking phentermine. It is the job of the bariatric physician to identify and evaluate those rare circumstances in which the risk of taking phentermine is higher than leaving the obesity untreated. In Bubba Smith’s case, it appears from media reports that he suffered from heart disease, atherosclerosis and uncontrolled hypertension, and the ASBP expects these diseases to be taken into consideration when phentermine is prescribed.

Possible adverse effects from phentermine include high blood pressure, rapid heart rate, palpitations, dry mouth and insomnia. Most often these effects are minor and the medication is well tolerated as long as it is taken as prescribed.

In other words, “We’re so sorry Bubba died, but please keep popping our pills (responsibly)!”

The death of fat celebrities will continue to fuel speculation as to the role that weight played in the person’s death. I find this practice disgusting, distasteful and disrespectful toward the deceased. Because of our toxic, anti-fat culture, the full spectrum of risk factors which may have played a role in their deaths goes completely ignored.  Were any of them smokers? Heavy D was, but we don’t know about the others.

Instead of a nuanced picture of the complex inter-relationship that lifestyle, ethnicity, gender and genetics play in the development of disease, none of this will come into consideration. Consider the fact that all five of these fat celebrities were also black, and that racial differences are known to exist in the development of stroke (although the disparity between black and white seems to be narrowing), heart disease (black people between the ages of 45 and 65 are twice as likely to die of coronary heart disease than their white counterparts), and pulmonary embolism (black patients have a 30% higher chance of dying within 30 days of suffering an embolism).

The racial factor may be due in part to socioeconomic status or it may be a genetic susceptibility to cardiovascular problems, but there is a common thread, apart from obesity, that ties them together.

But in the minds of many, fatness and its “obvious” consequences is the only thing that matters. So the deaths of these five celebrities are reduced to morality tales for the rest of us bad fatties.

Meanwhile, non-fat celebrities who died from some form of cardiovascular disease this year are given the respect they deserve without undue speculation as to the underlying causes. In 2011, these deaths included actor Francesco Quinn (48), professional wrestler Randy “Macho Man” Savage (58), screenwriter Kevin Jarre (56), rapper Nate Dogg (41), former NBA star Armon Gilliam (47), former 7’2″ WNBA star Margo Dydek (37), former NFL running back Ron Sprints (54), comic book writer Dwayne Duffie (49), actor John Dye (47), and Kara Kennedy (41), daughter of Ted Kennedy.

I would just like to take this opportunity of remembrance to remind people that what matters when a celebrity dies is not the cause of death. Whatever circumstances lead to the untimely demise of a young and talented individual is not some parlor game for anti-obesity activists. It is a real and very painful moment in the lives of those who know, admire and respect that person, and they should be given every opportunity to define themselves, both in life and in death.

4 Comments leave one →
  1. Fab@54 permalink
    December 28, 2011 10:55 am

    Very Well Said. Thank You. I’m hoping 2012 brings to us a never-before-seen level of enlightenment regarding the acceptance of our fellow humans; regardless of their “visual attractiveness ratings factor” (VARF) — Yes, I believe I just coined that.

  2. December 28, 2011 10:26 pm

    Very nicely written. I think sometimes people want to figure out why someone died so they can feel protected from a particular cause of death, like lung cancer and smoking.

    I’m am crazy annoyed that the ASBP statement saying that treating the disease of obesity is better than not, even when the risk of death is pleasant. I took phentermine once, not as a combination of phen/fen either, but just on it’s own. I don’t think I slept more than 2 hours consectively the whole time I was on it, that just messed with my head like crazy.

    And finally, you have a typo, the football player who died was Ron Springs, not Ron Sprints. Not that it matters, but he’d been in a coma several years before dying. It’s a really sad story.

  3. December 29, 2011 1:00 am

    Thanks for a wonderful post. I thought about your post at least five times tonight as I was bombarded at least a half a dozen times by Weight Watchers Ads starring Charles Barkley shouting from the TV to LOSE like A MAN and join W.W. and Jennifer Hudson warbling about how only after being a loser did she become a winner. Sigh, athletes and celebrities are prime targets for dangerous weight cycling behaviors as are their fans who feel compelled to emulate them.

  4. December 30, 2011 7:29 pm

    A pulmonary embolism isn’t weight related in any way. It can happen to people of any size. I liked Heavy D, he was a sweet person. It’s too bad that he struggled with his weight, because he was fine just the way he was.

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