bigfatscience

[bigfatscience]

A four-year prospective, longitudinal study of more than 1000 adult Spanish twins who did not have lower back pain at baseline confirmed that fatness does not increase the risk of experiencing chronic low back pain in the future.

(cite: https://doi.org/10.1016/j.spinee.2016.10.006) 

Does fatness cause low back pain?

Low back pain is one of the most common health complaints around the world, affecting some 65% of adults at some point in their lives. 

Common wisdom suggests that fatter people are more likely to experience low back pain than thinner people, and weight loss is often prescribed to treat or manage low back pain. But does the science actually support these beliefs?

In a word: No.

There is no reliable and consistent evidence that fatter people suffer from lower back pain more than thinner people. For example, in one highly-cited systematic review of 65 epidemiological studies, each with more than 3000 participants, only 30% of the studies observed a weak association between weight and low back pain. Thus, as another review concluded, “the available data at this time is controversial with no clear-cut evidence connecting low back pain with obesity.”

And what about weight loss? I was unable to locate any published randomized and controlled experiments demonstrating that weight loss improves low back pain. Prescribing weight loss to treat low back pain is not evidence-based medicine.

#low back pain

[bigfatscience]

Is there a link between gestational weight gain and pregnancy outcomes?

If you are fat and you have ever been pregnant, then you know that healthcare providers often demand that fat pregnant people carefully monitor their diet and exercise regularly to avoid gaining “too much weight.” 

This pressure is applied based on the assumption that “excess” weight gain leads to worse outcomes for both the pregnant person and the child. But is this true?

To test this hypothesis, researchers assigned more than 250 fat pregnant people to one of two groups. The intervention group followed a rather intensive eating and exercise plan, including weekly coaching sessions and frequent monitoring of eating and exercise habits. The control group received the usual care offered to pregnant people.

The intervention group did gain about 5lbs less than the control group in the final 24 weeks of their pregnancies. 

But there were no observed benefits of the intervention for rates of gestational diabetes, preeclampsia or gestational hypertension, or high birth weight. In addition, the intervention group experienced a 50% increase in their rates of cesarean section.

When considered in light of the overall mixed results of correlational research attempting to link gestational weight gain with pregnancy outcomes, these experimental results suggest that doctors are not practicing evidence based medicine when they pressure fat pregnant people to limit their weight gains during pregnancy. And in fact, such recommendations may even harm fat pregnant people by dramatically increasing their risk of cesarean section.    

#pregnancy #weight gain

[bigfatscience]

Fat people are the ones who know best about their lives, their behaviours, and their experiences. Fat people are knowers, and fat people know. Fat people produce knowledge. And if what they have to share, say, or show, contradicts the norm, or common sense, or the accepted truth – that’s too fucking bad. But that doesn’t make it any less true.

Cat Pause, On the Epistemology of Fatness

#fat liberation #trolling

[bigfatscience]

In 2005, the moral panic about “obesity” was ramping up, and there was big money at stake, all resting on the idea that fat kills. 

Well, Flegal’s research pulled the rug out from under those views, not only showing that fatness was associated with only 1/3 the associated deaths that previous research estimated (and even that smaller estimate can be critiqued), but also showing that being “overweight” conferred no increased risk at all, and may even be a protective factor against all-causes mortality relative to lower weight categories. 

The reaction to these results -- which have been verified over and over again in the years since and in decades of prior research -- was swift and vicious. Powerful people launched a smear campaign against Flegal and her work:

Her research became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and maneuvers, and complaints to her employer. The goal appeared to be to undermine and discredit her work.

Flegal’s first-hand account of her experience illustrates how power and stigma pervade and bias weight science. This can have a chilling effect:

One of the effects of the public insults may also have been to deter or intimidate other investigators. An anonymous researcher was quoted elsewhere as saying if character assassination is the price for publishing data that contradicts established beliefs, fewer academics will be willing to stick out their necks and offer up fresh thinking.

And all of this is terrible for science and horrific for Flegal. But when the dust settles, who is really hurt? Fat people. Always.

#weight science #science criticism #medical bias #medical discrimination

[bigfatscience]

they may have “nothing tastes as good as skinny feels” but we have “metabolic adaptations to energy deprivation lead to chronic depression & anxiety, food & body preoccupations, and inevitable weight gain” and i think that’s pretty catchy!

#metabolism #weight loss #dieting #eating disorders

[bigfatscience]

This seems relevant again as people experience with body changes during the pandemic.

If I have a set point, why did I gain 30 lbs in the past 5 years without changing my lifestyle at all?

Are you under age 25? People don’t typically reach their final-for-real adult weight until then.

Did you lose weight right before the weight gain began? Basically everyone who loses weight regains the weight they lost within 3-5 years, and 75% will regain more weight than they initially lost.

Are you under-eating? If you have been eating less than your body requires (between 2500 and 3500+ depending on your size/activity level), then your body may be prioritizing fat gain as part of the natural adaptation to sub-clinical or intermittent starvation.

Do you have a health condition that affects metabolism? PCOS, type II diabetes, and other health conditions can cause your metabolic system to prioritize weight gain.

Do you have a sleep disorder? Sleep apnea causes stress, and the body often adapts to stress by increasing the size of the fat organ (did you know that the fat organ is also a metabolic organ that is particularly active in times of stress?)

Are you under a lot of stress? Stress from social marginalization, poverty, and other adverse conditions can cause the fat organ to grow as your body attempts to protect itself by altering your biochemistry.

Are you experiencing food insecurity? Inconsistent access to food predicts weight gain.

I could go on, but the point is that weight homeostasis depends on an environment that provides adequate and consistent access to food and a low level of stress (among other things). Mess with any of these factors, and your weight may change as your body tries to adapt – even if you don’t change your eating or exercise habits at all.

(And pssst: this isn’t necessarily a bad thing).

#metabolism #weight gain

[bigfatscience]

#fat liberation #lived experiences #asian fat phobia #family

[bigfatscience]

Hi! I'm a thin person and I just saw a tiktok about seat belt extenders that suggested thin people get them too for any fat passengers. I work in mental health and sometimes transport fat clients in my car who have struggled with the seat belt, so I want to get one, but I'm worried about the awkwardness of offering it to people. Do you have any advice for this, especially for people that I know are dealing with body image struggles?

I would just buy one and default to having it installed in the car at all times. It just snaps into one end of the seatbelt, and if thin people don’t want to use it for some reason they can remove it and put it back in when they get out. If anyone asks why it’s there, you can just say, “The seatbelts in my car are ridiculously short!”

[bigfatscience]

On October 24, Amanda Martinez Beck of Longview, Texas, told her husband: “You need to take me to the ER.” Their whole family had tested positive for Covid-19 a week earlier — Beck’s husband, Zachary, is an English professor and their best guess is that he brought the virus home from campus, or that Beck picked it up at the community pool where she sometimes swims. Within a few days, Zachary and their four children were all on the mend. But despite prescription albuterol, steroids, and antibiotics, Beck was still coughing and sleeping in a recliner at night because staying upright made it easier to breathe. Around 10 a.m. that Saturday morning, her blood oxygen level was just 92%. (A healthy adult should measure close to 100.) Beck packed a bag and Zachary drove her to their nearest emergency room. He couldn’t stay; the Becks’ children are ages four, five, seven, and eight, and they couldn’t call a babysitter since the family was still in quarantine. So Beck kissed them all goodbye, trying not to panic. “My husband thought he was never going to see me again,” she says now.

Beck had another fear underlying her anxiety about her Covid-19 prognosis: Would she, a fat activist and author of Lovely: How I Learned to Embrace the Body God Gave Me, get the medical care she needed? “Fatphobia is an ever-present concern when you’re dealing with medical issues,” she says.

#COVID-19 #medical discrimination #medical abuse #healthism #ableism

[bigfatscience]

If someone has GI issues, the odds that they have disordered eating/ED are quite high, roughly 1 in 2 by some estimates (I’m inclined to think the odds might be even higher, but that’s plenty high). Of course this doesn’t tell us whether the GI distress came about as a result of the disorder or whether it’s the reverse, but automatically assuming that food or specific foods are to blame for GI issues and failing to explore the possibility that the issues originate in the disordered fear and avoidance of food keep a lot of people suffering. This is especially true with functional gut disorders, but even in the presence of a confirmed disease like celiac, the health of a person’s relationship with food should still be a central focus (while avoiding gluten, obviously). Decades of diet cultural indoctrination have warped most of our relationships with food, and allergies/intolerances are less common than disordered eating, and even where they do exist they can easily lead to disorder. Disorder around food is the most normal thing there could be in a disordered society; it’s not a “fake” condition and it’s nothing to be ashamed of.

#Gastrointestinal Disorders #eating #recovery #food #digestion #eating disorders

[bigfatscience]

I was doing pretty well on unlearning diet culture but now I’m trying to figure out my chronic heartburn (think all day, every day) and what foods could be making it worse and I’m so stressed out about it! And I am starting to blame myself for my pain because I’m overweight... I feel like I’m backsliding. Any advice on how to approach both addressing my acid reflux issues without internalizing the diet talk?

Did you know that chronic dieting and disordered eating can damage your digestive tract? Leading to delayed stomach emptying and slow digestion, resulting in chronic acid reflux and indigestion because food stays in the stomach too long? Often, these and other similar kinds of digestive problems are called functional gastrointestinal (GI) disorders. That means that there is a problem with digestion that is not caused by injury or obvious disease of the digestive tract. 

Fully 97% of people who are diagnosed with restrictive eating disorders have functional GI disorders, and about 40-50% of people who are diagnosed with a functional GI disorder have a history of disordered eating or chronic dieting. 

Often these disorders emerge during recovery when eating adequately and regularly stresses a digestive system that is damaged and slow from years of abuse and misuse. As I have said before, consuming less energy than you need to survive causes catabolism -- basically, your body starts breaking down muscle for energy, and that includes the muscles of the digestive tract. Starvation can also damage the nerves that co-ordinate digestion, including the vagus nerve (woop woop, trauama also fucks up the vagus nerve!).

So when I hear that someone is in recovery from restrictive eating and dealing with chronic reflux or other digestive complaints, my first thought is that those two things are related. 

What can people do about it? 

See your doctor and get evaluated and tested, and get a prescription for acid control medications to relieve your symptoms. It’s NOT your fault. You deserve to have relief. 

Work with a non-diet dietitian to help normalize your eating, which in turn can heal and regulate digestion. Eating regularly and adequately can help to heal the digestive tract. 

Develop and internal mantra of “Fuck you Fatphobia” that you repeat whenever you start blaming your weight for this problem that was most likely caused by trauma or restrictive eating, neither of which are your fault.

#eating #food #recovery #eating disorders #Gastrointestinal Disorders

[bigfatscience]

Friendly reminder that I tag every post on this blog and I have curated a ‘clickable’ list of common tags and common health problems in my FAQ! 

#faq

[bigfatscience]

Do you have any thoughts on trying to lose weight just to be able to do something? Like I used to ride horses and I'd love to get back into it, but at 320+ lbs I'd probably hurt any horse I tried to get on. So I'd like to lose some weight but every article I read seems to tell me that it's nearly impossible to lose weight for good, and that just makes me really sad. Is it futile to even try since it probably won't work? Will I do more damage to my body than if I didn't try at all?

The short answers to your questions are “yes,” and “yes.”

The long answer is to read through my “dieting” and “weight loss” tags to learn more about the many harms of intentional weight loss. And try reading my “resources” and “fat liberation” and “haes” tags to learn more about how you can come to terms with this reality – including coming to terms with both the limitations posed by accepting your body size and the amazing freedoms that come with practicing radical self-acceptance.

#for Anon #fat liberation #exercise

[bigfatscience]

This is a strange question and I apologize in advance, but when you say "move in a way that feels good".. What exactly is the point of it? I've always been raised that the only purpose of exercise is to lose/maintain a goal weight, but if we're prescribing to the idea of a set weight that your body deems ideal, what is the point of exercise? What purpose does it serve? Sorry if this is a terribly simple question, but I'm floundering a little.

Moving your body in ways that feel good can:

Stimulate digestion and appetite.

Strengthen muscles that will make all of life’s activities easier and more manageable.

Improve and support circulation, especially to extremities.

Support metabolism of blood glucose into energy (in other words, help you get lots of energy out of what you eat).

Help you fall asleep easier at night and stay asleep through the night

Help people to regulate their moods by reducing depression and anxiety

Increase positive emotions through the release of endorphins

Improve cardiovascular health -- lung, heart, and blood vessel health

Decrease stress by activating the parasympathetic nervous system and by helping to “scrub” cortisol and other stress hormones from the blood stream (especially true for stretching, yoga, tai chi and similar breath-based practices)

Increase feelings of connection to your body

Produce feelings of efficacy and competence (”I did it!!”)

Reduce pain by moving lactic acid out of muscles and reducing inflammation

You don’t need to punish yourself to achieve these and other desirable outcomes. You can go for a walk -- ideally outside! You can do some stretches or accessible yoga videos at home. Do some gardening. Dance around in your underpants. Wrestle or play tag with your kids or your pets. Have orgasms. Clean your house. Just find ways to use your body to have a good time.

#exercise #recovery #fat liberation

[bigfatscience]

My mom did something right when she let us eat as much as we wanted whenever we wanted from our massive bag of Halloween candy. When we would eat too much to the point of getting sick she would just go "See? Now you know better." And never tried taking it away. We learned for ourselves how to pace our eating and how much candy makes us feel good. All children are capable of learning this for themselves if you just let them. Believe it or not people, children don't need to be micromanaged.

Wise words.

We do this with our kids, too. One year, my then five year old ate too much and got sick. Never happened again! And now I can remind him: “Go easy, listen to your body, you don’t want to get sick” and he knows what it means. My other son didn’t need that experience to learn. But every kid is different!** And now my kids love Halloween and they love trick-or-treating, but they are not obsessive and fetishistic about their candy haul. Most years, they don’t even eat it all. 

This is a huge contrast to my childhood, where I would try to eat all the candy as quickly as possible because I knew if there was any left the day or two after Halloween, my mom would take it away. The fear of losing the candy definitely spoiled the enjoyment.

(**Note: some kids might always need help and external guidance to regulate their eating, especially some kids on the autistic and/or ADHD spectrum who can have trouble with self-regulation and interoception [i.e. awareness of internal states, including hunger and fullness]. Many kids never need to experience sickness to learn about the consequences of eating too many sweets, and for many others, one sickness episode will be enough. But if this happens repeatedly, then it may be time to consider an adapted form of intuitive eating that includes some gentle, child-centered rules or extra check-ins for your kids). 

#kids #intuitive eating #halloween discourse

[bigfatscience]

I just read the phrase "unconditional permission to eat" and oh my god that precisely describes my (relatively new and much healthier) attitude towards food! I have a lot of mental and sensory issues, and often i'll just not eat unless I can eat one of a few foods (i.e. canned chicken soup) and my life has gotten drastically better since i decided to just start having those foods on hand and not trying to force myself to eat "healthier" or "properly". Thank you so much for putting it into words!

Unconditional permission to eat.

All foods are good foods.

Eating something is better than nothing.

Scarfing down a handful of nuts, a slice of cheese, and a fruit cup is a meal.

All good words to live by.

#intuitive eating #recovery

[bigfatscience]

When I was a kid my parents would only allow my sister and I to keep one handful of candy from Halloween and we would turn around and give away the rest at the door to make sure it wasn't in the house (and this was DEFINITELY not a case of not being able to afford giving out candy). It escalated to pat downs after trickortreating of course because I tried to hide candy etc. I'm going to pick up halloween candy on discount at the grocery store tomorrow, being an adult is SO much better.

It’s amazing to me how parents will treat kids in such abominable ways around food and just... think it’s normal. The depths of the cultural disorder about food are so profound.

#kids #disordered eating #eating disorders #halloween discourse