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White Rabbit —

November 16, 2012

Guys, I think I rushed to judgement.

Last night, we were at the store and while the girls were playing in the toy aisle, I checked the comments and, lo and behold, Dr. Dickhole Katz responded:

Folks- the veil of cyberspace invites rudeness that most decent people would never perpetrate face to face. You might consider that people at whom you choose to hurl insults are real people, whether or not you can see them when you press ‘post.’ I’ll let that go, but simply note that if you make enemies of your friends, you wind up with fewer friends:

All best,

I didn’t have time to read the post, but the idea that Dr. Katz would lecture us on insulting “real people,” struck me as incredibly hilarious. I mean, this is the guy who tried to talk us out of our “knee-jerk opposition” to a proposal that states should take custody of fat kids.

If you haven’t read my post on Dr. Katz’s iron-fisted response to fat ladies on a plane, you really should. Once you do, you’ll better appreciate my response to Dr. Katz (mind the typos):

Dr. Katz,
You lost any claims to civility when you began using (and reusing) your airplane anecdote to compare two complete strangers who are [ate] cheesepuffs in front of a child to a parent who would give their kids drugs or alcohol. You have repeatedly wrote articles that stereotype and degrade fat people as if the underlying health problem is the size of our asses and not the behaviors that day [fat] and thin people alike engage in. In short, you have enthusiastically and unapologetically waged a war on fat people in an over-simplified attempt to discourage bad behavior. You don’t reduce smoking rates by insulting people with yellow teeth, and you don’t reduce the rates of insulin resistance by insulting fatties. So I’m not too concerned about which friends of yours I might lose because you have never been a friend to people like me.


And ya know? It felt really good to let it out because it’s not every day that an anti-obesity crusader offers himself up as some kind of peace offering with such obtuse irony.

I mean, Dr. Katz comes here crying foul after having the audacity to turn a brief encounter with two fat women into the Anecdote of Doom, portending generations of exponentially fatter Americans who running proverbial family meth labs out of their kitchens. And I just happened to see the Anecdote of Doom in one, two separate articles written a year apart for Huffington Post.  How many times do you think Dr. Katz has used the Anecdote of Doom in conversation? In lectures? In awkward moments like when you’re getting a haircut and you don’t know what to say to the lady?

The whole thing galled me and I had a knee-jerk reaction to his comment, but was I wrong to lash out? I hadn’t even clicked the link he sent, which clearly had some special meaning in his moment of sorrow.

I mean, how can we be friends when we’re too busy hurling on real people behind the cyberspace veil? I don’t know. Being a curmudgeonly misanthrope, I’ve never been all that concerned as to whether I might be making enemies of my friends or friends of my enemies or love out of nothing at all.

So, I clicked the link and I was genuinely surprised by what I found. It seems that Dr. Katz has done some serious self-reflection and revision.

You see, something happened to Dr. Katz, which affected the way he sees fat people. He got to know one.

I saw a patient in my clinic last week who came to me for … never mind. I am now her doctor; she is now my patient. What happens between us is private and privileged, and none of your business.

Notice how he almost told us his patient’s health problems, but demurred at the last minute? What a stand-up guy. For a minute he was all like, “Fuck HIPAA!” then he took a step back, reflected and decided that maybe it wasn’t such a good idea to share personal, medical information on The Huffington Post. He could have just omitted the ellipsis, but he walks us through his thought process in real time, sharing that he very nearly told us about her spastic colon, but reconsidered. Now that’s integrity.

But in one regard, this patient was a prototype of countless others, and that can, and perhaps should, be everybody’s business. She was heavy. She was very, very heavy.

Very, very, very, very, very heavy.

Like “she got on a talking scale and it said ‘one at a time please'” heavy.

But her health is nobody’s business, except for everybody. Because she’s really, very, quite heavy.

She, of course, knew she was heavy. She also knew that I knew she was heavy. And she knew that I knew that she knew that she was heavy.

And she knew that I knew that she knew that I’m kind of an ass.

She had, in fact, been heavy her whole life. Dealing with it was the struggle that defined her life, and the merits or demerits of any given day. But this patient’s weight is not the point of our story.

Hear that, guys? Even though he spends the first four paragraphs talking about how very fat she is, her fatness is irrelevant to the story.

This woman came to see me seeking attention for some new medical concerns that had cropped up in her life. I quickly ascertained that seeing a doctor was quite a novelty for her. She avoided us … like the plague.

That’s pretty ironic since fat people are the ones who are treated like plague victims. But that’s not the only irony, Dr. Katz assures us.

How ironic, that expression, for professionals bequeathed the proud legacy of predecessors who risked their own lives to treat such antique scourges as plague!

Ah yes, who can forget those noble plague doctors who roamed the countryside in Spy vs. Spy masks attempting to “cure” those who suffered from Black Death. Of course, the plague wiped out a vast majority of university-trained physicians and the gap was filled by medieval Barbers who often prescribed bloodletting. This was also the age ruled by theories of miasmatic air and vile humours. Of course, the plague physicians did stumble upon an actual solution to the plague, entirely by accident. Miasma theory said that “bad air” was to blame for the plague and that by cleaning up the sanitary conditions of the towns, the bad air would disappear and the plague would be cured. While the theory was ridiculous, the actions taken helped improve the health of the town by removing the filth that attracted the rats who carried the fleas that spread the Plague. This was almost a lucky happenstance, though, as other barbers practiced absurd cures, like shaving a chicken’s butt and strapping it to the afflicted area to soak up the “badness.” Others made potions from arsenic, mercury or “unicorn horns.”

So, it’s an interesting comparison, to say the least. One group of physicians practice ridiculous, unproven, and out-dated medical theories and the others wear bird masks.

She avoided our kind like the plague because we had been that virulent in her life. Across an expanse of medical encounters for an array of reasons across a span of years, a whole battalion of us had abused her. We had treated her not as a patient, but as a fat patient.

This part is seriously true. We know that weight bias is rampant among medical professionals in general, and even obesity specialists. And a recent study found that over half of patients report receiving inappropriate comments on their weight from physicians. This is why many fat people stop going to the doctor all together. And when people don’t have a healthy relationship with a physician who respects their patient and treats them like *GASP* grownups, then they miss vital screenings that can prevent future, costly health problems. So this is one area where Dr. Katz and I agree.

She couldn’t quite bring herself to tell me the specific words of insult and injury she had encountered, again and again. She came close — she told me I wouldn’t believe the harsh words (although, alas, I’m sure I would) — then squared her shoulders and wiped incipient tears not quite escaping the brim of her lower lids. She managed in a combination of few words and silence to convey very eloquently the vile, venal, vituperative reception we had given her, again and again.

Of the entire post, this is the part that I found to be the most overwrought, Thesauraus-bound nonsense of the entire thing. At this point, I began to realize that Dr. Katz might not be as sincere as he is desperately trying to sound. This moment that so moved him, this attempt at verbalizing the abuse she had gone through, has become the emotional spine of his story. And it’s a fairly convincing story.

Whatever her reason for seeking our care, whatever her acute need — we apparently never missed an opportunity to remind her that she was fat. And we made it plain: she was to blame.

That was what was sown in my patient’s medical history. What did we reap?

Notice the “we.” He seems to include himself in his patient’s history, perhaps because he too has judged his patients? He seems to be admitting that he has made mistakes, that he has sown mistrust and now he was seeing the consequences in a patient that had been mistreated by other physicians like him.

I met a woman who should have received medical attention for a variety of remediable issues, but who had not. I met a woman who should have had cancer screening tests, but had not. I met a woman who should have had screening tests for cardiac risk, and received select immunizations — who had not.

I met a woman who had been driven from any and all benefits that modern medicine might offer her by the cold and denigrating judgment offered her by almost every modern medical practitioner she had met.

It’s an honest and real problem that has been proposed as one of the contributors to the fact that fat people have more medical issues than thin people (another is poverty, a correlate of obesity, which limits access to quality healthcare). Had I found these words anywhere else, I would be nodding my head vigorously as I read, but then comes that charming Dr. Katz touch:

In this public forum, I say to my new patient and all others like her: I am sorry. I am sorry for the sins of ignorant brutality originating in a profession that espouses to “first, do no harm.” I am saddened. I am ashamed. And I am profoundly sorry.

Wow. Dr. Katz is apologizing. I was not expecting that. He’s apologizing for mistreating patients and blaming them for their fatness and not treating them like human beings who deserve quality care, regardless of their personal choices.

To my professional counterparts who have perpetrated this abuse, I say in no uncertain terms: shame on you! Have you looked around? Have you noticed that two-thirds of American adults and a rapidly rising proportion of the global population are overweight or obese? Has it not occurred to you that something larger than the will power or motivation of an individual might be in play?

Whoa, wait a minute. Who was he apologizing for? Because it seemed like he had apologized for his own behavior, but now he’s turning the spotlight on his “professional counterparts who have perpetrated abuse.” Shame on them? What about shame on you, Dr. Katz?

Just a few months before this post, you were lecturing America on the behaviors of two fat women, who were not your patients, because they ate cheesepuffs in front of a child. You don’t say that they actually fed the cheesepuffs to the child, they simply ate them in the presence of that child. Your response was “The principle that governs our societal standards in these cases is that responsible adults defend innocent children from harm.”

So, if you have a fat, fat, very fat patient, you shouldn’t judge their behavior because there are larger issues influencing the choices people make. HOWEVER, if you have a fat, fat, very fat airline passenger, then judge away because THINK OF THE CHILDREN!

To any of you who espouses the view that this is all about personal responsibility, I invite you to consider the implications. Given the relatively recent advent of pandemic obesity, this worldview suggests that the current generation of Homo sapiens, across an array of cultural bounds is, ipso facto, fundamentally less endowed with personal responsibility than every prior generation.

If you espouse this view, I have just two words for you: prove it.

This sounds vaguely familiar. Could it be similar to something I said in my Dr. Dickhole post?

Maybe you think you can spot those families who are “poisoning” their kids with “junk” food, but I guarantee you, Katz, you’d be wrong. And even for those parents you nailed for “neglect” and could prove it in a court of law, you still have to contend with the fact that our choices in this world with regards to healthful living are significantly affected by the  social determinants of health, not to mention their own upbringing.

While I agree with his assertion that it’s ridiculous to blame the rise in obesity rates on a sudden, nationwide shift in morality, I also think it’s pretty ballsy for the Mile-High Physician to suggest that it’s those other doctors who are wagging their finger at fatties.

Dr. Katz goes on to spread the blame between fatties and the culture:

The modern environment is profoundly, rampantly, unprecedentedly obesigenic. To one degree or another, it disempowers legions of us endeavoring to lose weight, and find health. It can be overcome, but most lack the skill set to do it.

They will never get it if the health care professionals positioned to help impart it are more interested in misguided recriminations.

Now, here’s where Dr. Katz just goes off the rails. I’m curious if his patient (the one whose history he hid behind the ellipses) shared her history of weight loss attempts. Because I guaran-damn-tee that if she has been fat her entire life, then she has attempted to lose weight her entire life. Dr. Katz blames this on the “obesigenic” environment, but by doing so, he is completely ignoring the real culprit in making weight loss damn near impossible to sustain: adaptive thermogenesis.

Adaptive thermogenesis (which I explain at length in this post) is the way the body responds to caloric restriction. When you reduce your energy intake, your body has mechanisms for reduce energy expenditure to save your ass from starving to death. It’s a well-documented phenomenon that occurs both inside and outside the so-called obesigenic environments. And with each cycle of weight loss and regain, people do a little more damage to their metabolic health and often return to their baseline weight, if not regaining more.

This rather simple concept undermines Dr. Katz’s assertion that if we just fixed the environment, we could all lose weight and live in blissful health for eternity. Except, even if you fixed the environment (which would necessarily have to begin with the free market system, since the products that contribute to its obesigenic nature are wildly popular and profitable), you still haven’t fixed the underlying metabolic system that makes permanent weight loss a modern myth.

The prime directive of the medical profession is “first, do no harm.” In deriding patients for their struggle with weight, we are doing harm. In denying patients the compassion that was the hallmark of our profession long before the cutting edge of biomedical advance was quite so finely honed, we are doing harm. In driving patients away from the very services we are charged to provide them, we are doing harm — and violating our professional oath.

Just as the well-intentioned barbers attempted to save people from the plague by promoting ridiculous cures, modern physicians who pay lip service to compassion and understanding are still prescribing a ridiculous, unproven cure that ultimately harms their patients. The problem isn’t just that biased doctors are driving fat patients from their practice. It’s that biased doctors are ignoring the evidence that recommending weight loss is still a gross violation of the Hippocratic Oath.

To react to the largely unmet challenge of weight control in the modern world with judgment and blame helps no one; harms many; and redounds to our profession’s shame.

While I agree with this conclusion, it is incomplete without recognizing the insufficiency of the “cure” promoted by Dr. Katz and his colleagues. It doesn’t matter how kind you are to fatties if you’re promoting a treatment that has a dismal failure rate and long-term consequences for repeat treatments.

That alone gives me pause in identifying Dr. David Katz as “friendly” to fat people, as a trusted source for medical information on fat people. I am more willing to give that trust to a Dr. Arya Sharma or a Dr. Yoni Friedhoff, who, for all their faults and flaws, seem to get that the current paradigm isn’t working.

But Dr. Katz is even more troubling because after this attempt at a “heart-felt” mea culpa (san mea) he hasn’t even taken his own advice.

You see, the first time Dr. Katz shared the Anecdote of Doom was in this post from April 22, 2010. Just about a year later, he seems to have a change of heart when he posts his defense of fatties on March 16 2011. But you may recall that I mentioned Dr. Katz using the Anecdote of Doom in two posts a year apart… that’s because his defense of swiping fat kids from their families was published on July 14, 2011, four months after saying that we need to be more understanding and compassionate toward fat people.

Four months after saying that doctors shouldn’t judge their patients because the obesigenic environment limits the freedom of choice, Dr. Katz wrote this:

Adults are criminally liable if they give cigarettes or alcohol or illicit drugs to a child. And they are criminally liable for starving a child as well — this constitutes abuse. But our society does not view giving a child a donut or fries or soda as abusive — even if it occurs day after day. How do we sanction state intervention for a bad outcome attached to behaviors we condone every day?

He does some CYA by reiterating his stance on fault:

Don’t get me wrong; I am not maligning these women. Nor am I am suggesting their harmful behavior was even their fault. Our society has yet to provide any clear guidelines on what is, and is not, acceptable when it comes to second-hand obesity.

I mean, Dr. Katz has fat friends, how can he hate fat people? But in spite of his attempt at deflecting blame from the parents, he still advocates state intervention:

But unless we start recognizing obesity for the serious threat that it is, the fate of our children will be cause for tears. And unless we take such matters into our own hands, there is the prospect in severe cases — of the state taking our children into theirs.

In the end, I’m left wondering what Dr. Katz really believes. Does he really believe that fatties are the victims of an obesigenic environment that limits personal responsibility? Or is it a dire threat that demands drastic intervention? You can’t have it both ways. You can’t publicly shame fat people for eating cheesepuffs, then say it’s not their fault. You can’t admonish your colleagues for talking trash about fat patients when you have a column that does just that.

Dr. Katz, as a self-described “leading voice in medical media,” you are setting the tone for how physicians see their patients and, ultimately, how they treat their patients. And you are currently sending mixed messages on how to treat them. You routinely say “It’s not their fault” followed by “But they should just lose weight.” You know it’s far more complicated than that, yet you continue to promote weight loss as a viable solution.

You cannot reconcile these two beliefs. And until you find a way to square the circle, you are going to forever be known by me as Dr. Dickhole, the physician who speaks out of both sides of his big, fat mouth.

17 Comments leave one →
  1. November 16, 2012 12:50 pm

    Medical sociology at its finest, Shannon. Well done, as always.

  2. November 16, 2012 1:27 pm

    It’s a sublime example of doublethink in action. Any apology from Dr. Katz is water from a poison well.

  3. November 16, 2012 1:30 pm

    The difference between the ladies on a plane and the one in his office is simple. One “respects his authouritah” The others don’t. It’s so typical with concern trolls Do whatever I say, or you’re a bad fatty.

    • November 19, 2012 1:21 pm

      Yup, if you submit yourself to Dr. Katz, then you’re one of the good ones.


  4. vesta44 permalink
    November 16, 2012 2:01 pm

    It’s the same as the apology given when one isn’t really sorry: “I’m sorry, but ___________ (fill in the blank with whatever reason the apologizer isn’t really sorry).” I’ve given those apologies a time or three in my life, mainly to get asshats to leave me alone. Dr Dickhole is no different, and that’s exactly what his latest apology is all about. He’s probably thinking that if he issues a back-handed, half-assed apology, all the fat fat fatty mcfattersons will be so grateful that he actually even thought to apologize that we won’t notice he didn’t really mean it. Sorry, Dr Dickhole. contrary to popular opinion, fat doesn’t stupid. We know you didn’t mean it, and we know you still find us to blame for our fatness, and you think if we just visited that Nightmare on ELMM Street, we’d all be thin. Fuck you very much, it ain’t happening.

    • November 19, 2012 1:21 pm

      Exactly. It wasn’t even an apology for his own behavior. It was on behalf of the medical community, which he then distances himself from by shaming them. It’s ridiculous.


  5. Duckie Graham permalink
    November 16, 2012 2:30 pm

    I’m totally with you, Shannon, but I am troubled by your negative use of the word “fat” in your last sentence.

    • November 19, 2012 1:20 pm

      It was a play on words, comparing the traditional definition “fat mouth” (can’t shut up) to his anti-fat ramblings.


  6. November 16, 2012 5:11 pm

    Beautifully done, Shannon. As far as this man’s self serving apology is concerned, I have only this to say: you know the statement, There’s no alcoholic like a reformed alcoholic? Well I would say this applies just as well to his sudden awakening to the humanity of fat people and the disgraceful way they are treated. he is more interested in touting his so called awakening then actually genuinely living it.

    • November 19, 2012 1:19 pm

      Thanks Gaby. And it is totally self-serving, to be sure.


  7. November 16, 2012 10:00 pm

    Perhaps he is the Mitt Romney of the Medical profession? Great post Shannon!!!

  8. November 17, 2012 3:34 pm


  9. Ann Mouse permalink
    November 19, 2012 11:44 pm

    Perhaps Katz is writing through the cognitive dissonance?

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