Tag Archives: bariatric surgery

HAES, Intersectionality, Inclusion, and Bravery

Debbie says:

Jessica Wilson is the most exciting HAES (health at every size) blogger I have come across in a long time. Blogging at My Kitchen Dietitian from my home town of Oakland, California, she identifies herself as a thin woman of color, not the most common description of a size-acceptance-friendly dietitian.

She doesn’t mince words and she doesn’t cut corners. Browsing through her blog, I find:

There is no limit to the number of people willing to tell us what our bodies need to be “healthier”. They are screaming it from daytime and prime time television, from books, from home shopping networks, from newspapers and magazines. They are offering up these shoulds and shouldn’ts, in a way that seems like they’re doing us a favor. As long as we follow their rules we’ll be so much better off!

Upon examination these people tend to have a few things in common. They are usually 1. White, 2. Cis gendered and heterosexual, 3. Higher SES [socio-economic status], 4. Have often self-appointed themselves the expert of everyone’s needs on the planet (Dr. Oz anyone?). 5. Have never met me.

Let me tell you, as a queer person of color, I am totally over straight white folks in self-appointed power telling me what I need to do in order to live my life, and be “healthy” as defined by the aforementioned stranger.

I think that this paternalism is just one aspect of the bigger issue here; as a nation our health literacy is in the toilet. With the constant barrage of “right” and “wrong” ways to do things—each of which contradict each other—we are completely without the knowledge to know that our body has individual needs and how to clue into them.

She also addresses the question how HAES intersects with racism. Responding to a list from Dr. Linda Bacon of the advantages of thin privileges (you can see the list at the link), she says:

I … wondered if there was another thin person of color, like me, in the room and how they felt about that list. Was there anyone in the room at the NAAFA conference who, like myself, has walked into a clothing store and been asked to leave their bag at the door only to find other white shoppers with their bags? Was there anyone in the room who has been followed around a store to ensure payment for desired items, as I have? I wondered how it would have felt to listen to that speech as a fat person of color, and reflect on the ability to find a loving and supportive partner in a culture of thin privilege and white supremacy. Was there anyone in the room who needed to buy two airplane tickets to travel and experience a public hair pat-down by TSA, as I have, because they wore their hair naturally? Did anyone in the room wonder about the way that thin privilege intersects with other identities? Thin privilege definitely makes life easier for me, for Dr. Bacon, and many others, I am not questioning that. To fully address fat oppression in our society, though, I believe the conversation needs be broadened from the one-dimensional topic I have found it to be.

She says she has been told by others that bringing in race is “muddying the waters.” On the contrary, any conversation about privilege that doesn’t bring in other kinds of privilege (such as a conversation about gender privilege that doesn’t address ability) is an incomplete conversation. Wilson is not muddying the waters, she is opening the floodgates in ways they need to be open. Without a commitment to intersectionality, we can’t even look at the real problems we face.

In November and December, she plans a series of blogs about the intersection between HAES policies and weight-loss surgery patients, and she is being very clear (while also being perfectly polite) that she doesn’t intend to sugarcoat or ignore any misuse or dismissal of these patients by the HAES community.

She’s the best resource I’ve come across in a long time, and a welcome addition to my blog reading. Watch for more links to her blog and posts about her in the months to come.

Thanks to Marcia for the pointer!

Another Black Mark for Weight-Loss Surgery

Debbie says:

Earlier this week, the San Francisco Chronicle ran a story about how people who’ve had weight-loss surgery (or “bariatric” surgery) are much more likely to show up in the hospital with acute liver failure due to acetaminophin poisoning. Acetaminophin, more commonly known as Tylenol in the U.S. and as paracetamol in Europe, is an extremely common drug–it’s also found in “more than 200 prescription and over-the-counter medications, including narcotics Vicodin and Percocet along with NyQuil and Sudafed,” in the U.S. at least.

Although the study was very small, the number of liver-compromised people was 17 times what you would expect–one percent of the U.S. population (not a small number) has had weight-loss surgery, and seventeen percent of the people in this tiny study were in that group.

A different report of the same study, with different numbers but the same conclusions, is here. This write-up suggests twice as many patients (still a tiny sample) and also (in direct contradiction to the Chronicle article) says that several kinds of weight-loss surgery are tentatively implicated, including not only stomach stapling but also Roux-en-Y and duodenal switch. The difference in how the study is reported just tells you how useful mainstream news is when reporting science.

If you have had weight-loss surgery, be careful !

The most common link to “bariatric” and “acetaminophen” is about how wonderful acetaminophen is for post-weight-loss-surgery patients, so if you’re planning WLS, please warn your doctor. Because this is a small study, and because no one can follow all the studies out there, you could be hugely overexposed to danger if you don’t advocate for yourself.

Third, notice the “faith sentence” in the Chronicle article. “Obesity is such an important public health problem, and bariatric surgery is highly effective.” In fact, this may not be so true.

If there are significant hidden cases of WLS-related deaths by acetaminophen-fueled liver failure, the numbers may be worse than we know.