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Notes from a conference

May 23, 2013

Trigger warning: Discussion of a conference that deals with weight loss and weight loss surgery.

I study weight stigma. For some reason, this is considered to fall under the umbrella of obesity research — a problem in itself. Well, they’re both about fat people, of course. But one is about affording fat people their basic human rights, whereas the other is about wiping them off the face of the planet. A couple of weeks ago, the European Association for the Study of Obesity (EASO) held its annual European Congress on Obesity (ECO) conference in Liverpool, UK, fairly close to where I live and study. My supervisor wanted me to go. After looking at an early version of the programme, I wasn’t keen. She insisted; it was a major international conference right on my doorstep and she wanted me to go. Oh well, methought — know your enemy.

So off I toddled to Liverpool for three days of fat bashing, having paid £200 of my own money for the privilege. The conference was actually four days long, but I was running my own conference on weight stigma the day after it ended (one that EASO, and its British counterpart, ASO, had refused point blank to notify their members about), and I was just too busy to attend the last day. This was a bit of a disappointment because it meant that I missed the session on successful dieting after breast cancer — something that I have long felt should be high on the list of medical priorities. Also missed, for a different reason, was the session on preventive bariatric surgery in adolescents. Sadly, the speaker had to pull out at the last minute for personal reasons, so I never got to see whether he had horns and reeked of sulphur. Almost the entire event was an exercise in weight stigma, although not a single session over the four-day event was dedicated to that subject.

There were moments of hope. The sessions on exercise were consistently sensible, and the experimental studies were of a significantly more rigorous standard than those I witnessed in other areas of study. These people clearly showed that even with supervised, intense exercise, weight loss was minimal, highly variable, and often didn’t happen at all, with some people even gaining weight. But they noted the health improvements that occurred in all participants. People who had worked in the field for longer were even more forthright — we need to stop focusing on weight and start promoting physical activity in its own right. Steven Blair was so righteously pissed off, it was almost comical. Except it wasn’t. Nearly 20 years of high-quality, high-volume data showing that fitness matters as much, if not more, than weight for health outcomes, and yet papers are still being published showing oh-my-god-obesity-will-kill-us-all without taking factors like fitness into account. He said pretty much the same thing in an interview with our very own Atchka – click here to hear him in action (although he does mention the godawful calories in/calories out idea in this interview; oh well, in the words of Osgood Fielding III in Some Like It Hot, “Nobody’s perfect”).

There were, literally, dozens and dozens of posters (summaries of people’s scientific research) showing that programme X, Y, or Z resulted in “effective” weight loss of a few kilogrammes in 12 weeks. Wahoo. Obesity crisis solved. Talk about junk science. How people still get funding to conduct such meaningless research is beyond me.

I also spent a happy 15 minutes haranguing the lady on the Slimming World stand for the strapline in their advertising: “Because you’re amazing.” Why, I asked them, if we were so amazing, did we need to come to Slimming World to change? Oh, they said, because you’re amazing on the inside. So, your outsides aren’t amazing? No, no, no — this isn’t what they mean at all. It’s an accepting, non-judgmental environment where all people are welcomed and supported, apparently, because all people are amazing. Clearly not amazing enough. In the end, I felt a bit sorry for the poor woman. Her company’s advertising is hardly her fault, but maybe I at least made her think a little.

Bariatric surgery, or metabolic surgery as some are now trying to brand it (seeing as how bariatric surgery is developing a bit of a bad name), was well represented. Everyone was careful not to mention the words “weight loss surgery.” Perhaps because, again, the weight loss from weight loss surgery often does not even bring people into a “healthy” weight range; correlates with significant post-surgical health problems, increased rates of depression, substance abuse and suicide; and often isn’t permanent anyway. Barbaric surgery clearly needs a new image. Watch this space for the rise of “metabolic surgery.”

Despite this, a large proportion of the presentations at the conference were about surgery. I chatted to one scientist who was looking at people’s expectations of BS and was planning on following them afterward to see how that affected long-term outcomes. A small study, but interesting enough if people are going to have the procedure anyway. I think the more we know about the psychological and long-term issues, the better. It’s not just about cutting out the unacceptable bits of your body and Bob’s your uncle, something that most of the medics seem to be almost willfully unaware of.

Not that they’d care if they were. Fat people need fixing, after all. It’s a public service. Much like lobotomies in the 1940s and 50s for the treatment of psychosis (over 20,000 performed in the US alone), or removing children’s healthy thymus glands because in autopsies they seemed enlarged. It was a leap of non-logic: enlarged thymus causes illness and death; let’s rip ‘em out prophylactically. Pity the kids needed them to be large to help develop their burgeoning immune systems. If the history of medicine teaches us anything, it’s that we really need to be more careful before destroying bits of people and then saying “whoops.”

Me. BMI 40.

Me at the Fattylympics. BMI 40. This is “morbid obesity.”

But getting back to the lady with the small study. She mentioned the varying levels of family support for the surgery. She said that one older woman was facing a lot of resistance from her husband about the surgery. I suggested that maybe this was a good thing — that he was okay with her as she was and didn’t want her to risk going under the knife. “But but but,” said my well-meaning new friend, “Her weight is seriously impacting her health and quality of life,” absolutely incredulous that anyone could object to her being helped in this way.

“Oh, what’s wrong with her?”

“Well,” she replied. “It’s really affecting her mobility. She struggles to get into her car because the gearshift is in an unusual place; she can’t paint her own toenails, that kind of thing — she’s really distressed by it.”

Her toenails? Given that there were only 18 people being studied, the poster actually listed all of the participants: gender, age, BMI etc.

“Which one is she.” I asked.

“That’s her.” She was 67, female, with BMI of 46.

“Forty-six? For Pete’s sake, my BMI is 40,” said I, doing a little twirl. “Forty-six is hardly cut-off-the-side-of-the-house mobility issues. And she’s 67. Perhaps she might benefit from some kind of physical strengthening and flexibility training,” I suggested. “Has she done that?”

“Oh,” said my friend. “I don’t know.”

This is the world of obesity research. We have completely lost the plot. If it were me, I’d suggest that this woman could increase her movement capacity through some fairly basic training, and possibly suggest she get the occasional pedicure. But clearly that’s just me.

The last day of the event was also the deadline for applying for a student development travel grant from my university for attending an international conference. You had to specify the conference, and why you wanted to attend. My supervisor had suggested the appropriately named TOS (The Obesity Society), presumably a conference of tossers. It’s in Atlanta in November. Having just that morning received yet another email regarding their latest campaign to have obesity treated as a serious health condition, I decided I would never give them a penny, even if it wasn’t mine. (My tweet to TOS to the effect that obesity was not a condition at all but simply a body size, has now been deleted by the recipients — all for dialogue, those TOSSERS.)

Next thought, IASO (the International Association for the Study of Obesity) 2014 conference. Yes, it was in Kuala Lumpur, but looking at the “streams” to be included, it was clearly going to be just a hotter and stickier version of ECO. I was too late to apply for funding for ASDAH — the Association for Size Diversity & Health, in Chicago in June (but it’s not too late to register to attend!), so I put in my application for BEDA — the Binge Eating Disorder Association conference, to be held in Denver, Colorado in April 2014. BEDA are one of the only organisations to have a focus on weight stigma, hosting the annual Weight Stigma Awareness Week each September. They also actually give a damn about both their members, and the people they are supposed to represent. What a revolutionary concept.

I hope to see you there.

Never Diet Again Sigs

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21 Comments leave one →
  1. May 23, 2013 2:18 pm

    Reblogged this on The Cheese Whines and commented:
    “we need to stop focusing on weight and start promoting physical activity in its own right.”
    Simple truth. Yet it will be ignored in favor of the insanity of pursuing impossible thinness, following the same paradigm that does not work and never has.

  2. May 23, 2013 2:41 pm

    Hi, I am doing a PhD which fits within critical obesity geographies. Well meaning people are forever misinterpreting this and sending me links to conferences such as this (and articles, news stories etc). I think it is because ‘obesity’ = bad is presented with such certainty that many people can’t comprehend that my research isn’t like that.
    The idea of preventative bariatiric surgery in adolescents is really scary, and a lot of it sounds very one dimensional, but I’m glad to read there were moments of hope too, it is something to build on, and I hope your presence and questions made some of them think more critically about what they are advocating/promoting etc.

  3. Leila Haddad permalink
    May 23, 2013 3:28 pm

    AlI can say is thank G for your awesome sense of humour. I would have slit my wrists..great piece

    • May 24, 2013 7:19 am

      I actually tweeted to the effect that after half an hour on day one, I had lost the will to live.

  4. Duckie permalink
    May 23, 2013 5:20 pm

    Thanks for taking one for the team and for taking a stand! It always amazes me how flimsy the enemy’s arguments turn out to be.

  5. Dizzyd permalink
    May 23, 2013 7:43 pm

    Barbaric surgery – yeah, perfect name for it. I always wonder too where these idiots get their medical licenses (out of a Crackerjack box, as we stay here in the states). I’m guessing “tosser” is Britspeak for “dickweeds, trolls and creeps”! : ) On the serious side, that BEDA sounds good, what with the “Weight Stigma” part and all!

    • May 24, 2013 7:22 am

      Yep, that is roughly the correct translation for ‘tosser’. The term originates from the wrist motion generally association with, erm, self-soothing in males!
      BEDA is amazing. I’ve been the last couple of years and it honestly was a transformative experience. If you haven’t been at an event surrounded by size-acceptance folks in real life, you really can’t imagine the effect it has. ASDAH in Chicago in June, and BEDA in Colorado next year – if you can, I’d definitely recommend getting to one of them!

  6. Dizzyd permalink
    May 23, 2013 7:44 pm

    Whoops! I meant “say”, not “stay”.

  7. Happy Spider permalink
    May 23, 2013 11:15 pm

    This was really interesting. That sounds good, that bariatric surgery is getting a bad name. I’m sort of shocked by the phrase “preventive bariatric surgery in adolescents”.

    • May 24, 2013 7:23 am

      I think bariatric surgery is getting a bit of a bad name in some fields, but not at all in medical fields, hence the re-branding.

      Yes, ‘sort of shocking’ doesn’t even begin to do it justice. What is WRONG with these people? Who in their right mind could possibly think that might be a good idea. Horrific.

  8. May 24, 2013 7:28 am

    By the way, Atchka, is 7 ratings (WLS, DW, DT, etc) a record?

    • May 24, 2013 10:09 am

      Sorry, I had eight in my letter to Dan Savage.

      By the way, I had no idea that British people still said “Bob’s your uncle.” You Anglos and your weird ways. 🙂

      Great post. It’s kind of sad how bariatric surgery has gone from being a last-ditch alternative to preventative medicine. I’m pretty disgusted with the industry, especially after learning of Dr. Klein’s Amazing Stomach Pump!!! Gee, what could go wrong?

      Peace,
      Shannon

      • May 25, 2013 3:38 am

        Ah, now you’ve thrown down the gauntlet! What an absolutely superb post that was. I will also be bookmarking it. Love the Scottish data about IQ. As an English person, I could suggest that’s just an artefact due to all Scottish people being more stupid in general, but that would be rude. And I’m only joking really. When I have some time I’ll watch your debates with the haters.

        Re the stats – I wouldn’t worry about it too much. The majority of people reading these articles, and a significant proportion of those writing them, don’t understand the statistics. Papers of studies conducted by medics, rather than scientists, in particular have an absolutely appalling rate of inappropriate and incorrect statistics. When we meet up, I can give you a primer, but common sense will get you a long way. If it’s unintelligible to a native English speaker, that should tell you something.

        Ang 🙂

  9. Rubyfruit permalink
    May 24, 2013 1:49 pm

    First, thanks for enduring this. I don’t think I’d be able to go to this conference without screaming and/or throwing things.

    Second, that T-shirt is awesome and I totally want one.

    • May 25, 2013 3:51 am

      Isn’t it! Ragen has an image with the phrase she uses on some of her blog posts. That’s how I first saw it. I tried to track down the owner of the copyright for the phrase, but without any luck. So I had it made – it has my company branding on the back. But you could always make your own.

  10. Lisa in Boston permalink
    May 24, 2013 5:20 pm

    Hi Angela! I so admire how gutsy you are attending these crazy conferences and asking some uh, “uncomfortable” questions. Veeeeerry interesting about the whole bariatric name change… kinda reminds me of “diets” becoming “lifestyle changes”. I hope I live to see these surgeries fully discredited. I SO WISH you were coming to ASDAH!! But at least we will hopefully meet again at BEDA 2014. Lisa 🙂

    • May 25, 2013 3:48 am

      I am coming to ASDAH! I’m presenting 🙂
      I just wouldn’t have got the funding in time for ASDAH so it wasn’t worth putting ASDAH on my application.
      See you there!!!

  11. May 26, 2013 11:51 am

    Where can I get that T-shirt?? ❤

  12. May 26, 2013 11:51 am

    Sounds pretty obvious you and yours are far more needed at conferences like this. If we’re ever going to change the paradigm people like you must infiltrated their ranks, or at least their echo chambers like this conference, & get individuals to start thinking.

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