Tuesday, 19 September 2017

Healers 4 Harvey – New Indie Music Compilation Supports Hurricane Victims

In the last few weeks we’ve seen incredible devastation from Hurricanes Harvey and Irma, and it seems like there’s more to come.

I know that many people in Houston are still struggling to get their lives back after Hurricane Harvey. So I’m pleased to be included in the Healers 4 Harvey compilation. It features over 30 songs from indie artists, mostly women, and all proceeds go to the Houston Food Bank, which is helping victims of the hurricane.

Please click below to buy the album for just $10. You’ll get a gazillion great songs plus you’ll be helping those in need.

And please use the share buttons below to get the word out on social media!

Side note: I decided to include my song, “The Waves,” because to me it reminds me of both the beauty and the fearsomeness of the ocean. I sing about frolicking, about being in love with the Atlantic, and the sunlight on your partner’s face, but also about the undertow, flimsy rafts, and the simultaneous feelings of peace and danger.

Want to be in the know about Golda’s shows, new releases and more? Click here to sign up for her mailing list and get a free download of her new, unreleased song, “Little Sister.”

Crossposted to www.thatgolda.com.

Healers 4 Harvey – New Indie Music Compilation Supports Hurricane Victims originally appeared on Body Love Wellness (http://ift.tt/GY7f6u) on September 19, 2017.



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Friday, 15 September 2017

PCOS and Endometrial Cancer Risk: The Dilemma of Weight Loss and Weight Cycling


September is Polycystic Ovarian Syndrome (PCOS) Awareness Month. As part of our ongoing series on PCOS, today we are going to talk about endometrial cancer.

PCOS is a hormonal disorder usually characterized by very strong insulin resistance. This insulin resistance causes many problems in the body, including irregular menstrual cycles, strong susceptibility towards weight gain, unwanted hair growth on the face and body (hirsutism), hair loss on the head (alopecia), cystic acne, body tags, a strong tendency towards diabetes, infertility, and many other symptoms.

Among other risks, PCOS is associated with a high risk for endometrial cancer (cancer in the lining of the uterus). Because PCOS tends to cause an irregular menstrual cycle, a woman's uterine lining may not get sloughed off each month. Some women with PCOS have extra long cycles (35 or more days), while others go months or even years without a menstrual cycle. This causes the lining of the uterus (the endometrium) to build up excessively; in time, atypical cells may develop. This is called endometrial hyperplasia, or overgrowth of the uterine lining. This hyperplasia can eventually turn into endometrial cancer.

This is why it is so important that women with PCOS get treatment. They need to have regular periods so that this overgrowth does not occur. There are many options for this, including progesterone treatmentsbirth control pills; insulin sensitizers like metformin, TZDs, or inositols; and androgen blockers.

However, most doctors' first recommendation is weight loss.

The Weight Loss Dilemma

The majority of women with PCOS have an "overweight" or "obese" BMI. Because of the very significant insulin resistance with PCOS, these women have a strong tendency towards weight gain over time.

Women of size with PCOS face a difficult dilemma in how they approach their weight. Care providers push them to lose weight, often telling them weight loss can "cure" PCOS or get rid of most of their symptoms. Weight loss is considered by many to be the first line of therapy for PCOS.

It's true that some short-term research does seem to suggest benefits from weight loss for women with PCOS, especially in shocking the system into ovulation. But this research is almost always based on fairly short follow-ups because most weight comes back within a few years after a significant weight loss. The very loss that leads to short-term benefits may backfire later into weight gain and worsened insulin resistance.

The critical question is whether women are better off in the long term trying to lose weight, or whether the high potential for weight cycling overcomes the possible benefit of weight loss. In particular, we need to know how weight loss and weight cycling affects the chances of getting endometrial cancer.

Here are two studies that demonstrate this weight loss dilemma. One study (Luo 2017) looked at intentional weight loss in "obese" women and how that affected their risk for endometrial cancer. (The study did not look specifically at women with PCOS but weight and PCOS are so tightly tied together that weight is a pretty fair proxy for presumed PCOS when discussing endometrial cancer.)

In the study, those women who intentionally lost weight lowered their chances for endometrial cancer. The effect was particularly strong in obese women who intentionally lost weight. So if  you can lose weight and keep it off, it looks like there might be some benefit.

However, remember that the majority of women who lose weight gain it back, and often end up at a higher weight than they started. In the Luo study, women who gained weight were at increased risk for endometrial cancer. So you take a calculated risk; if you lose weight and keep it off, you might significantly reduce your risk for endometrial cancer. However, if you regain that weight and end up heavier than you started, you probably have increased your risk for endometrial cancer.

Weight fluctuations up and down the scale may also have its own independent effect. The second study (Welti 2017) found that weight cycling 4-6 times was associated with an increase in risk for endometrial cancer. Many women of size cycle far more times than that; how increased is their risk?

Summary

High BMI women with PCOS face a difficult dilemma when deciding what to do to lessen their risk for endometrial cancer.

Intentional weight loss ─ if they can keep it off ─ might lower their risk for endometrial cancer. On the other hand, if the weight loss attempt leads to weight cycling and/or overall weight gain ─ as it does for so many ─ then that weight loss attempt probably actually increases their risk. 

In other words, high BMI women with PCOS are faced with a game of Russian Roulette when it comes to weight loss and endometrial cancer.  

There are no easy answers here. Each individual woman gets to make her own choices about weight loss as a treatment for PCOS, taking into account her own personal weight history and habits.

Although most doctors don't acknowledge it, it is a perfectly reasonable choice not to pursue weight loss as a treatment for PCOS. That doesn't mean that lifestyle is irrelevant. One can choose to emphasize sensible nutrition and exercise as a treatment for PCOS without measuring the worth of those treatments by weight loss. A Health At Every Size® approach can work for PCOS.

Care providers need to recognize that their constant pressure on patients to lose weight may actually backfire and create more risk rather than less. They need to recognize the right of the patient to choose whether or not to pursue weight loss, that it is possible to emphasize healthy lifestyle without tying that to weight loss, and to acknowledge the need for multiple tools beyond weight loss to address the unique needs of their PCOS patients.



References

Cancer Epidemiol Biomarkers Prev. 2017 May;26(5):779-786. doi: 10.1158/1055-9965.EPI-16-0611. Epub 2017 Jan 9. Weight Fluctuation and Cancer Risk in Postmenopausal Women: The Women's Health Initiative. Welti LM, Beavers DP, Caan BJ, Sangi-Haghpeykar H, Vitolins MZ, Beavers KM. PMID: 28069684
BACKGROUND: Weight cycling, defined by an intentional weight loss and subsequent regain, commonly occurs in overweight and obese women and is associated with some negative health outcomes. We examined the role of various weight-change patterns during early to mid-adulthood and associated risk of highly prevalent, obesity-related cancers (breast, endometrial, and colorectal) in postmenopausal women. METHODS: A total of 80,943 postmenopausal women (age, 63.4 ± 7.4 years) in the Women's Health Initiative Observational Study were categorized by self-reported weight change (weight stable; weight gain; lost weight; weight cycled [1-3, 4-6, 7-10, >10 times]) during early to mid-adulthood (18-50 years). Three site-specific associations were investigated using Cox proportional hazard models [age, race/ethnicity, income, education, smoking, alcohol, physical activity, hormone therapy, diet, and body mass index (BMI)]. RESULTS: A total of 7,464 (breast = 5,564; endometrial = 788; and colorectal = 1,290) incident cancer cases were identified between September 1994 and August 2014. Compared with weight stability, weight gain was significantly associated with risk of breast cancer [hazard ratio (HR), 1.11; 1.03-1.20] after adjustment for BMI. Similarly, weight cycling was significantly associated with risk of endometrial cancer (HR = 1.23; 1.01-1.49). Weight cycling "4 to 6 times" was most consistently associated with cancer risk, showing a 38% increased risk for endometrial cancer [95% confidence interval (CI), 1.08-1.76] compared with weight stable women.  CONCLUSIONS: Weight gain and weight cycling were positively associated with risk of breast and endometrial cancer, respectively. IMPACT: These data suggest weight cycling and weight gain increase risk of prevalent cancers in postmenopausal women. Adopting ideal body-weight maintenance practices before and after weight loss should be encouraged to reduce risk of incident breast and endometrial cancers. 
J Clin Oncol. 2017 Apr 10;35(11):1189-1193. doi: 10.1200/JCO.2016.70.5822. Epub 2017 Feb 6. Intentional Weight Loss and Endometrial Cancer Risk. Luo J, Chlebowski RT, Hendryx M, Rohan T, Wactawski-Wende J, Thomson CA, Felix AS, Chen C, Barrington W, Coday M, Stefanick M, LeBlanc E, Margolis KL. PMID: 28165909
PURPOSE: Although obesity is an established endometrial cancer risk factor, information about the influence of weight loss on endometrial cancer risk in postmenopausal women is limited. Therefore, we evaluated associations among weight change by intentionality with endometrial cancer in the Women's Health Initiative (WHI) observational study. PATIENTS AND METHODS: Postmenopausal women (N = 36,794) ages 50 to 79 years at WHI enrollment had their body weights measured and body mass indices calculated at baseline and at year 3. Weight change during that period was categorized as follows: stable (change within ± 5%), loss (change ≥ 5%), and gain (change ≥ 5%). Weight loss intentionality was assessed via self-report at year 3; change was characterized as intentional or unintentional. During the subsequent 11.4 years (mean) of follow-up, 566 incident endometrial cancer occurrences were confirmed by medical record review. Multivariable Cox proportional hazards regression models were used to evaluate relationships (hazard ratios [HRs] and 95% CIs) between weight change and endometrial cancer incidence. RESULTS: In multivariable analyses, compared with women who had stable weight (± 5%), women with weight loss had a significantly lower endometrial cancer risk (HR, 0.71; 95% CI, 0.54 to 0.95). The association was strongest among obese women with intentional weight loss (HR, 0.44; 95% CI, 0.25 to 0.78). Weight gain (≥ 10 pounds) was associated with a higher endometrial cancer risk than was stable weight, especially among women who had never used hormones. CONCLUSION: Intentional weight loss in postmenopausal women is associated with a lower endometrial cancer risk, especially among women with obesity. These findings should motivate programs for weight loss in obese postmenopausal women.



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Saturday, 9 September 2017

Falling into Autumn

Some people revel in the change of the angle in the Sun.

I am not one.

The slanted, golden rays only remind me of hard times.

Whenver the bottom drops out, the shoe drops, it's fall.

Fall is full of falling apart, falling by the way side, falling ill.

Autumn sounds like a funeral drum for a hanging. au-TUM.

A relentless beat of time reminding me another year is gone.

These are my Summer years but I spend a third of them in the dark.

Shut the windows. Bar the doors. The reaper is coming.



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Thursday, 7 September 2017

That Questionable “Fit and Fat” Study

fat people have the right to existA blog reader asked me to take a look at this study.  It’s another one of those studies that headlines claim prove that you can’t be fat and “fit” (we’ve been here before and it was crap then as well.)  Let’s talk about this:

First, they are making an extremely basic correlation vs causation mistake – the fact that two things happen at the same time does indicate that one causes the other.  (Short example – they are suggesting that if people with fatter bodies have higher rates of cardiac incidents than thinner people, then making fat people look like thin people will give them the same health outcomes. That’s not good science. For comparison: men with male pattern baldness have higher rates of cardiac incidents than men without male pattern baldness.  Imagine if, upon finding out that information, researchers did as these researchers have done and suggested that in order to reduce the cardiac incidents, we need those bald men to grow hair – then the government started a “war on baldness,” studies calculated the cost of “baldness” on society etc. In this case while there is a correlation, there is no causation – both the baldness and the cardiac incidents are caused by a third factor, but if researchers had treated baldness like they treat body size we wouldn’t know that.)

One of the measures of “unhealthiness” that they are using is “increased waist circumference,” so they are studying whether it’s unhealthy to live in a larger body and they are using having a larger body as a measure of  “unhealthiness.” You can do that I guess, but you probably shouldn’t call it credible research.

They don’t control for the negative health effects of dieting and/or weight cycling (aka yo-yo dieting) which the larger bodied participants can be much more likely to have engaged in. Let’s not forget that in a diet culture, whenever anyone studies the effects of having a larger body, they are also studying the effects of dieting since that’s what is encouraged for fat people in our culture.

They don’t control for the negative health effects of living in a society where larger people are shamed, stigmatized, bullied, and oppressed in a number of ways including a lack of evidence based healthcare (because of systemic fat bias as well as doctor’s individual bias and the tendency to prescribe diets to fat people when they would have given a thin patient an evidence-based intervention), being hired less and paid less than thin people and, as Peter Muennig from Columbia found in his research, just living in a society where one is stigmatized is correlated with many of the same health issues that this study used to judge “unhealthiness.”

One of the quotes in the article my reader sent says that “information on physical activity, smoking, diet and social status could be adjusted for.” Looking at the study while they claim to have “adjusted the data” it does not appear that they actually had this information from the study participants. This is important because studies that do include behaviors (including Wei et. al; Matheson et. al; and The Cooper Institute Longitudinal Studies) have found that behaviors are a much better predictor of long term health than is body size, so studies that don’t include participant’s actual behaviors aren’t really relevant and are either poorly designed, or specifically designed to get exactly the results that this study did. (For an exhaustive list of evidence around this, check this out.)

The conclusion that if fat people are in more danger of cardiac incidents then it’s “not ok to be fat” or that one should attempt weight loss is problematic on a number of levels. First, they are acting as if body size is something that we can control, but provide absolutely no evidence for that. (Hint: it’s because there is none. The research shows that the most common outcome of weight loss attempts is weight gain, and there isn’t a single study where more than a tiny fraction of people achieve long term weight loss and even among those the weight loss is often just a few pounds.)

Again, saying that if fat people have more cardiac incidents than thin people then we should try to make them thin, is like suggesting that if men have more cardiac incidents than women we should recommend that they go through sex reassignment surgery (note that this is not be the same thing as correctly recommending gender confirmation surgery that a trans person might choose.)

People are at higher risk for health incidents based on everything from genetics, to race, to height and more, so suggesting that we try to make some people look like other people to make them healthier is seriously questionable. (Speaking of race, I think we should stop funding studies that under sample and/or ignore People of Color.  For far too long studies like this have been allowed to act as if white people are the only people worthy of study, and that’s bullshit.)

I also noticed that many of the doctors quoted in this article and others seem absolutely giddy that fat people might diet sooner. I think that this is part of a (fatphobic) process by which scientists, healthcare professionals, and public health professionals are shirking their responsibilities to tackle the difficult things that would actually improve health – access to non-biased physical and mental healthcare for everyone, a good wage for everyone, enough vacation and down time for everyone, a world without oppression and more (these are often referred to as Social Determinants of Health.) Instead, these “professionals” shift the conversation to suggest that the “problem” is that fat people exist, and then they claim that fat people could be thin if we wanted, so they conclude that all the world needs to be healthier is just a little more fat-shaming and weight loss culture, which isn’t just lazy, it’s dangerous and wrong. We have to start calling them on this behavior.

More important than any statistical analysis is that health is a complicated, multifaced concept. Health is not an obligation, a barometer of worthiness, entirely within our control, or guaranteed under any circumstances. Nobody owes anybody else “health” or “healthy behaviors” by any definition. Fat people have the right to exist in fat bodies without shame, stigma, bullying, or oppression and it doesn’t matter why we are fat, what being fat “means” for our health, if we could become thin, or if doing so would make us “healthier” by some definitions. The right to life, liberty, and the pursuit of happiness are not size (or health) dependent.

The conclusions being drawn here (that if fat people have higher rates of cardiac incidents then fat people should be eradicated – yes, eradicated is the right word) are sizeist and healthist and add to the stigma that negatively effects fat people’s health, includingthe suggestion of dangerous so-called “weight loss interventions” that include things like drugs, stomach amputation surgeries, and balloon swallowing, that end up killing fat people. So the most important takeaway needs to be that, regardless of what any study finds, it’s ok to be fat no matter what.

Want to create a world where researchers don’t call for the eradication of fat people? Join us for the Fat Activism Conference!

Click Here to Register for the Fat Activism Conference

The Fat Activism Conference is all online, so you can listen by phone or on your computer wherever you are.  Plus you get recordings and transcripts of each talk so you can listen and read live and/or on your own schedule. The conference is happening October 6-8, 2017!

If you enjoy this blog, consider becoming a member or making a contribution.

Like this blog?  Here’s more cool stuff:

Become a Member! For ten bucks a month you can support fat activism and get deals from size positive businesses as a thank you.  Click here for details

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

If you are uncomfortable with my selling things on this site, you are invited to check out this post.

 



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Saturday, 19 August 2017

Be Principled Without Being a Sucker

I’m still pretty sick over Charlottesville, and right now there’s a lot of argument about the principle of free speech as it applies to white supremacists.

The “Unite the Right” rally was initially moved from downtown Emancipation Park to a larger park outside of downtown for safety reasons, but the ACLU challenged that. On free speech grounds, they made sure that the rally went on as planned. If it had been a peaceful rally, that might have been fine.  But the intent was never a peaceful rally. The heavily armed white supremacist groups surrounded a church, trapping people inside.  They stalked and harassed people. They beat them with pipes, attacked them with torches, and ran over them with a car. Richard Spencer described the rally as “a huge moral victory in terms of the show of force.”

Essentially, a violent white supremacist group conned the ACLU into supporting them with talk of free speech and peaceful assembly. My understanding is that between organizers making violent threats and public discussion of plans to come heavily armed, this should have been apparent to the ACLU. But whether it was or wasn’t, Nazis and the KKK did a bang-up job of using the banner of “free speech” to threaten and assault a lot more people than they would have if their rally had been in the alternate park, which wasn’t in downtown.

The ACLU initially claimed that it was in no way responsible for the violence, but later stated that it would start looking more closely at rallies asking for ACLU support and would not represent protesters who want to carry firearms. This seems pretty reasonable to me. The First Amendment includes a right “to peaceably assemble,” not “to show up better armed than the local police and beat the shit out of counterprotesters.”

It also seems to me to be an indicator of a lot of larger problems. One that’s been discussed a lot is the way Donald Trump is supporting and encouraging racism, but the larger problem I want to talk about is more abstract.  It’s basically this: No principle, no matter how noble, is immune to being abused by manipulative people. Abusers and manipulators of all stripes, from a controlling partner to someone who doesn’t want to pull their weight at work or school to literal Nazis and Klansmen who want to literally murder every Black or Jewish person in the country, are all really good at taking good things and twisting them.

To me, this means two things. First, the fact that something can be abused can’t make it bad, because *everything* can be abused. Secondly, having good principles doesn’t absolve you from being smart and savvy about how you adhere to those principles. If, for example, you work for the ACLU and are asked to defend a rally, do your best to find out whether these are people who want to peacefully express their ideas (good, bad, or genocidal) or a heavily armed mob intent on violence.

Or, to put it in D&D alignment terms, because I’m a geek like that, it’s not enough to just be lawful. Evil people will get your support for their evil by appealing to your lawful principles. If you want to be lawful good or even lawful neutral, you need to think really critically about the motivations of people who are trying to appeal to your principles.




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Wednesday, 16 August 2017

Fatshion: Palm Springs Looks

Hey friends. How are you all holding up? This is a tough time for the US (not that this is new but still). The alt-right fascist push-back we get from any progress we make is disgusting but not...

Read more here!

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Saturday, 12 August 2017

VBAC Prediction Models: Actual Results are Better than Predicted

Original checklist by Melek Speros

Many women with a prior cesarean who want a Vaginal Birth After Cesarean (VBAC) are counseled that they are not "good candidates" for a trial of labor because a VBAC Prediction Model suggests that they have a very low chance of VBAC "success."

In particular, the MFMU VBAC Prediction Model considers weight a strong negative predictive factor for VBAC. As a result, many obese women are told that their chances for VBAC are very low, implying they might as well just sign up for the repeat cesarean now. Many doctors strongly discourage VBAC in women with a high Body Mass Index (BMI). Some hospitals and practices even have BMI restrictions on who is allowed to have a Trial of Labor After Cesarean (TOLAC).

Similarly, many women of color are discouraged from pursuing a VBAC because they are told that they have a lower chance of success. Imagine the negative pressure against VBAC when these two factors intersect in a high BMI woman of color!

However, a recent study from UCLA actually examined how predictive this model was in their institution. They found that it was highly accurate for women predicted to have a very strong chance of VBAC. But to their surprise, they found it was NOT that accurate for women predicted to have a low or moderate chance of VBAC.

The difference was particularly striking for those predicted to have a low chance of a VBAC. 57% of this group actually had a VBAC, when only 29% were predicted to have one, nearly twice the expected rate. 

Of particular note, the authors also documented that, unlike the MFMU prediction model, neither BMI nor ethnicity were associated with lower rates of VBACs in their institution. 

This is especially meaningful to the many women of color and women of size who have been actively discouraged from pursuing a VBAC because of the MFMU prediction model. It also suggests to me that risk perception and the way women are managed in labor (higher induction rates and a lower surgical threshold are common in TOLAC in high BMI women, for example) may influence VBAC "success."

Personally, my VBAC prediction scores were extremely low (22%!) due to multiple risk factors, yet I went on to have not one but two VBACs. If I had let negative predictions discourage me, I would have missed out on my VBACs and their easier recoveries, and I would have been exposed to increased risk for placenta previa and accreta by having additional scars on my uterus.

I know from my work with the International Cesarean Awareness Network (ICAN) that many women are told they have a poor chance at a VBAC and yet go on to have a VBAC anyhow. In fact, few women meet all the "ideal conditions" for VBAC success, yet most will go on to have a VBAC.

If you have been told that you are not a good candidate for VBAC because of your BMI, your race, or various other factors, remember this study and the anecdotal experience of so many women in ICAN. It's okay to consider risk factors, but don't let them overly influence your decision. Group risk factors don't predict what will happen with any one individual. 

No one can guarantee you a VBAC, but neither can anyone reliably predict who will not have a VBAC when given a fair and adequate chance to labor. As the authors conclude in the UCLA study:
As part of efforts to safely decrease cesarean rates in the United States, patients interested in TOLAC (and their providers) should not be discouraged by a low predicted success score.

Reference

AJP Rep. 2017 Jan;7(1):e31-e38. doi: 10.1055/s-0037-1599129. Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population. Maykin MM, Mularz AJ, Lee LK, Valderramos SG. PMID: 28255520  Full free text here.
OBJECTIVE: To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. METHODS: We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal-Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (<35%), moderate (35-65%), and high (>65%). The actual versus predicted success rates were compared. RESULTS: In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p < 0.001) and moderate (61 vs. 52%; p = 0.003) groups. In the high probability group, the observed and predicted VBAC rates were the same (79%). CONCLUSION: When the predicted success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.



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