Tag Archives: medical fatphobia

Weight Loss for Its Own Sake: At What Cost

We support a ceasefire in Palestine

Several Ozempic pressure applicators, arranged loosely on a background of Rx labeled wallpaper

Laurie and Debbie say:

Ozempic: it’s a diabetes drug which also works for weight loss; it’s a wonder drug that will solve the obesity epidemic; it’s a rich people’s drug that will ensure that only poor people are fat; it’s a scam; it’s all things to all people.

We’ve been very skeptically watching Ozempic’s trajectory through the news since it started being regularly available (to some people) about two years ago. Weight loss wonder drugs tend to appear, fail, and vanish. Ozempic (also called Wegovy when it’s prescribed for weight loss) is lasting longer than most. So, the problems it causes are getting very obvious.

As we know so well, the vast majority of doctors believe that fat is, in itself, a disease and health risk which must be eliminated at all costs–and now the doctors have a drug that will actually “work” to meet the doctors’ goals–whether or not those are the patients’ goals. Angelina Chapin, writing for The Cut, has a heartbreaking set of stories of patients (generally women) pushed by their doctors into taking the drug. Chapin cites five examples–different stories, same underlying medical myth:

Marcy was diagnosed with lymphedema, a condition that causes fluid to build up in her legs, in 2021. The 53-year-old from Queens wanted to work with a nutritionist to follow an anti-inflammatory diet that she hoped would lessen the pain and swelling. Her primary-care doctor made a referral last year, but the callback came from an office administrator at a hospital weight-management center. The person told her that she’d need to be evaluated and then choose between having weight-loss surgery or going on Ozempic. Marcy, who describes herself as “visibly plus size,” told them there must be a misunderstanding. Her goal was to develop better eating habits, not to lose weight. But the administrator said that in order to work with a nutritionist, Marcy had to join the weight-loss program, which a nurse reiterated in a follow-up call.

It felt to Marcy like these health professionals had seen her BMI and made the assumption that “All fat people are unhealthy.” Though her medical chart says she’s obese, Marcy doesn’t have diabetes, high cholesterol, or high blood pressure. The swelling from lymphedema has made her gain weight, but she doesn’t eat regularly because the pain “kind of curbs my appetite.” And yet, medical workers are “focusing on the number on the scale,” she says. “You’re ignoring my diagnosis. How am I supposed to get better?”

Another example in Chapin’s article has high cortisol levels which the doctor told her “don’t matter.” More than one have eating disorder histories and are afraid of the psychological consequences of limiting their food intake.

This is bad enough. If Chapin found five examples, there are probably 5,000 people out there dealing with this right now. Or, there were about that many until last month, when Medicare approved the drug. Dylan Scott, writing for Future Perfect at Vox, has a powerful analysis of what Medicare approval means. Please note that Scott has a wide-eyed naive acceptance of the “obesity epidemic,” and thus of the medical value of Ozempic. Despite this shameful assumption, he comes away with major reservations about widespread prescription of Ozempic:

there is growing data that these drugs also reduce heart disease risk — one clinical trial involving more than 17,000 patients found Wegovy significantly reduced the chances of an adverse cardiovascular event such as heart attack or stroke. Just 6.5 percent of participants who received Wegovy experienced an acute cardiac emergency, compared to 8 percent of patients who took a placebo. …

The medications are extraordinarily powerful at controlling patients’ appetite and therefore aiding weight loss; in clinical trials, patients lost an average of 15 percent of their body weight in little over a year.

But that’s only as long as patients continue to take them — once a patient stops the drug, the benefits go away. And medication adherence is a struggle across the US health system.

And even if people do adhere to regular doses, taking Wegovy or Ozempic long-term may prove prohibitively expensive. Even Medicare enrollees can pay up to $2,000 out of pocket annually for their prescription drugs, depending on their specific plan.

The available evidence suggests patients will gain back some or all of the weight they had lost if they stop taking semaglutide. The whiplash of losing and then regaining weight may even be worse for a person’s health than if they had never lost the weight in the first place, Stacie Dusetzina, a health policy professor at Vanderbilt University, told me. Doctors call it “weight cycling.”

No reader of Body Impolitic is likely to be unfamiliar with the medical dangers of “weight cycling,” or “yo-yo dieting,” or whatever you want to call it. Scott apparently never heard of it. But look!

Given the evidence that people struggle to maintain weight loss over time, some experts have called for putting less emphasis on losing weight for people who are obese or overweight and more on improving their access to medical care.

Holding Chapin’s article next to Scott’s, we immediately see that Medicare’s coverage of this drug will result in tens of thousands of people being pushed by their doctors into taking it. Some of them will be aware enough to understand that their weight is not their problem, and at least try to push back. Others–the vast majority–will buy into the combination of the social conviction that fat is always and forever bad for you, and the pressure from their medical care team, and will not even have the tools to examine the recommendation.

At the end of her article, Chapin returns to Marcy:

Marcy, the woman with lymphedema, tells me she recently found a nutritionist who has agreed to discuss an anti-inflammation diet without pushing weight loss. She’s excited to finally work with a health professional who won’t jump to conclusions based on her size. “I’m not on a couch, eating a half-gallon of ice cream,” Marcy says. She now hopes to become more active with the help of a pump to massage the fluid in her leg and compression leggings. “I want to do Alaska next year,” she says, “and I want to be on a dog sled.” It’s something most doctors she’s been treated by didn’t see in her future.

The United States (and much of the world) is culturally incapable of separating fat from health, acknowledging that in some situations fat contributes to health issues and in other situations it does not. This country is medically incapable of expecting doctors to listen to patients’ concerns (such as wanting to be on a dog sled) and address them rather than jump to a sometimes completely inaccurate conclusion. It is also politically incapable of reining in Big Pharma and requiring affordable drugs and drug plans (although the Biden administration is addressing that issue with moderate success). Until all of these things change, Ozempic should be administered cautiously, to people who both need it and are not threatened by its side effects, and in ways that break no one’s pocketbook.

Fat chance.

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Debbie has deleted her Twitter account. Follow her on Mastodon.

Follow Laurie’s Pandemic Shadows photos on Instagram.

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Returning with Links

Debbie says:

As you may have noticed, we were down for most of a week due to a malware attack. Endless thanks to our webmaster for tireless efforts to bring the blog (and the website) back up safely.

When the attack happened, I was just about to put up a links post, so that’s where we’re starting now.

Our own Lynne Murray found a fascinating article on webburgr about a newly discovered photographer, Vivian Maier:

woman walking in cityscape

Perhaps the most important street photographer of the twentieth century was a nanny who kept everything to herself. Nobody had ever seen her work and she was a complete unknown until the time of her death. For decades Vivian [Maier]’s work hid in the shadows until decades later (in 2007), historical hobbyist John Maloof bought a box full of never developed negatives at a local auction for $380.

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I’m not sure when I’ve read a better manifesto about diversity within a marginalized community than this one by smartassjen at Jen Richards.

This is a sample of the kinds of trans people I’ve personally met, talked to, learned from, heard about through mutual friends, or seen in the last two years. It is not intended to be comprehensive or definitive, but rather a glimpse from one specific person’s experience, over a relatively brief period of time, and in utterly random order. …

Trans women who are over six feet tall and still rock high heels. Tiny ones next to whom I feel like a beast. Some who wish they were taller, some incredibly anxious about their stature and who instinctively shrink their bodies. Tall trans men. Short trans men. Trans men so masculine that I don’t even notice their height. Trans man/woman couples so comfortable with their inversion of ‘normal’ height differences that the idea of normal becomes laughably absurd.

People who don’t identify as men or women, or who identify as both, or third sex, or as nonbinary or genderqueer or genderfluid or some combination of these. Some who see various stages of gender expression and identity as stops towards a final destination, others who comfortably live outside of any binary structure.

Trans women who love their cocks and have no desire for surgery, some who have always hated them, and every shade of horror, acceptance and enjoyment between. Some who have mutilated their own, through creative and dangerous ways, some successfully, some with painful consequences. Women who have their testicles removed, but do not want further surgery, and some who do that first and save up vaginoplasty later. One who medically transitioned, with hormones and surgeries, but remained their assigned gender in public. Trans men who pack and those that don’t. Trans men that bind and those that don’t. Trans men who sometimes pack or bind and other times don’t, or do or don’t at different times in their transition. Men who want phalloplasty, men who don’t. Trans men who love being penetrated and trans men who don’t ever want to be touched there. Many men and women whose feelings towards their genitals evolve over time.

And so much more.

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At The Weekling, Dr. Santayani Dasgupta has a very thoughtful and complex post about doctors and fat patients

The patient is large. Very large. At more than 600 pounds, he is a mountain of flesh.

“My stomach hurts,” he says, his voice surprisingly high and childlike.

THE OTHER DAY, a colleague brought to my attention an essay from The Washington Post called “A morbidly obese patient tests the limits of a doctor’s compassion” written by a Dr. Edward Thompson. Just the first two lines of it above had me furious. Not only were they a study in the power of negative metaphors, but as a fellow physician, they felt all-too familiar. T…

Indeed, although studies show that physicians are nicer to thinner patients, many of my medical colleagues don’t seem to realize that personal and institutional violence against fat people (and I use that term in solidarity with the fat activism and fat studies movements) is a thing. A real, grotesque and infantile thing. A real, grotesque and infantile thing that negatively impacts the health care that fat individuals receive….

As a faculty member in the Master’s Program in Narrative Medicine at Columbia University, I know about the power of stories: stories told by physicians, stories told by patients. I know that having health care students read, write and analyze narratives can deepen their training in bioethics, medical professionalism, reflective practice, self-care and patient-centered care. Narrative study can help our students effectively diagnose, treat, and otherwise attend to the lives of their patients.

Yes, stories are powerful. But let’s not get too precious about them. Simply reading any story with a medical student or engaging them in a narrative writing prompt is not the same as actually educating them in structural issues of oppression and inequity. Those of us in the medical humanities professions must teach our students not only to listen to stories, but to listen to them critically; asking themselves questions like “who is speaking?”, “who is being spoken for?”, “what larger narratives is this story supporting?”, and “what additional stories are being silenced by this one?”

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Maybe I just can’t see clearly from my vantage point of being 60+, but I smell trouble coming for Silicon Valley:

Nitasha Tiku at Valleywag, working off an article by Noam Scheiber at the New Republic, says:

If I had $1 million for every time a founder told me “It’s impossible to raise funding if you’re not a twenty-something dude,” I could lead their Series A round. The same bias applies to hiring. The ideal resume shouldn’t be much longer than “Dropped out of Prestigious University.”

The body image connection? Plastic surgery to make men look younger. Scheiber talked to Dr. Seth Matarasso, a San Francisco plastic surgeon:

… the age at which people seek him out is dropping—Matarasso routinely turns away tech workers in their twenties. A few months ago, a 26-year-old came in seeking hair transplants to ward off his looming baldness. “I told him I wouldn’t let him. His hair pattern isn’t even established,” Matarasso said. …

… In ascending order of popularity, the male techies favor laser treatments to clear up broken blood vessels and skin splotches. Next is a treatment called ultherapy—essentially an ultrasound that tightens the skin. “I’ve had it done of course. I was back at work the next day. There’s zero downtime.” But, as yet, there is no technology that trumps good old-fashioned toxins, the most common treatment for the men of tech. They will go in for a little Botox between the eyes and around the mouth. Like most overachievers, they are preoccupied with the jugular.

For the record, I’m 100% in favor of young people having positions of responsibility, decision-making, and institutional power. At the same time, I believe diversity in all categories is the spice of strong choices.

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Eric Stetson at Daily Kos reports that JPMorgan Chase won’t process payments for Lovability, a mother-and-daughter condom company, because they are a “reputational risk”: Anyone want to bet they make the same decision about Trojan? Stetson got his facts from the Huffington Post.

I wanted to let you know that we actually will not be able to move forward regarding processing with Chase Paymentech, as processing sales for adult-oriented products is a prohibited vertical. I apologize for the confusion and wish you and your growing brand the best of luck in the future.

Remember, JPMorgan is an investment bank for the rich, but Chase is around every corner in big cities. You don’t have to bank with them, if you consider them (as I do), a “reputational risk.”

Most usual sources: Feministe, Feministing, io9, and Shakesville. And also, this time, Lynne Murray.