Saturday, 30 September 2017

PCOS and Hair Loss, Part 1: Prevalence and Diagnosis


September is PCOS Awareness Month. For several years this blog has had an ongoing series about different aspects of PCOS (Polycystic Ovarian Syndrome) and its treatments. Today let's talk about a tough subject: PCOS and hair loss (alopecia).

In our past PCOS series, we have discussed the definition and symptoms of PCOS, how it presents, its testing and diagnosis, and its possible causes. We've also discussed the increased risk for endometrial cancer among those with PCOS.

Now we are discussing common treatment protocols for PCOS, and the pros and cons of each. We've already discussed insulin-sensitizing medications like metformin, the TZDs, and inositol. Then we discussed glucose-lowering medications for those who have developed overt diabetes.

We have also discussed anti-androgenic medications and progesterone supplements for menstrual irregularity. In addition, we did a 3-part series on birth control pills for PCOS.

Now it's time to talk about one of the least-discussed symptoms of PCOS, alopecia (commonly known as hair loss). Today we'll discuss what alopecia is, how it's diagnosed, and what might cause it. In the next post, we'll discuss some of the medical treatments available for it. Finally, we'll discuss some of the cosmetic treatments that women with hair loss may utilize, based on suggestions found on hair loss forums and PCOS boards.

If you have personal experience or expertise in any of these areas, please share in the comments section. Don't let other women walk this path alone; speak up and share your ideas. You are welcome to do so anonymously if you prefer. All comments should be respectful.
Disclaimer: I am not a medical health-care professional. This information is not medical advice about a health condition or treatment. Consult your healthcare provider before making any decisions about your care.
The Undiscussed PCOS Symptom

Irregular periods, sub-fertility, and excess body and facial hair (hirsutism) are the classic symptoms of PCOS, and the ones that get discussed the most on PCOS publications and boards. Acne, weight gain, insulin resistance, and blood sugar issues are other symptoms that get discussed regularly.

However, one of the least-discussed symptoms of PCOS is hair loss (androgenetic alopecia). Even acanthosis nigricans and skin tags get more discussion time on PCOS boards than hair loss.

Sadly, alopecia (and how to deal with it) is not discussed very openly, even among women with PCOS. Sometimes it's simply because the majority of women with PCOS do not experience hair loss, but often it's because of the very strong stigma of hair loss in women. Women simply do not want to admit publicly that they are experiencing hair loss, or they may be in denial about it.

For those who do experience hair loss, it's heartbreaking. Facial hair can be shaved off, but significant hair loss on the scalp is extremely difficult to deal with in a society that judges a woman on her appearance (especially her hair, her so-called "crowning glory"). Shame and embarrassment are common feelings among women with hair loss. "Fixing it" becomes the focus.

Some types of hair loss are fixable, but not all. It's important to acknowledge that up front. Unfortunately, right now there is not a lot that can be done for the type of thinning hair that comes with PCOS except to slow it down. PCOS hair loss is typically caused by the skin being ultra sensitive to androgens. Androgen-blockers can sometimes help, but in most cases, treatment for women with PCOS hair loss only results in slowing down or covering up the hair loss, not reversing it.

However, this does not mean that women with PCOS are without choices. There are many different ways of approaching alopecia, and many ways you can still have a great life despite the PCOS and alopecia. Don't let it stop you or silence your voice.

Types of Alopecia

First, it's important to understand what alopecia is, so let's start with a primer on women's hair loss.

There are many types of alopecia. Some are treatable and some are not, so it's important to know which type you have. Here are a few of the possibilities.

Alopecia Areata


Alopecia Areata (AA) is a patchy type of hair loss, rather than the overall thinning on top of the head seen with the Androgenetic Alopecia of PCOS. It often comes on quickly and results in small circular bald patches. Both men and women can experience it. According to some sources, a person has about a 2% chance of developing AA at some point during their lifetime.

Actor Matt Lucas, wikimedia commons
Some people develop Alopecia Areata Totalis, where all of the scalp hair disappears, leaving the person totally bald on the head. Another subtype is Alopecia Areata Universalis, where all body hair disappears as well as the scalp hair, including eyebrows, eyelashes, leg hair, arm hair, pubic hair ─ everything.

Alopecia Areata is due to an autoimmune condition, and as a result can come and go in severity:
In alopecia areata, immune system cells called white blood cells attack the rapidly growing cells in the hair follicles that make the hair. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continually supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair. 
Scientists do not know exactly why the hair follicles undergo these changes, but they suspect that a combination of genes may predispose some people to the disease. In those who are genetically predisposed, some type of trigger–perhaps a virus or something in the person’s environment–brings on the attack against the hair follicles.
The good news for people with AA is that the condition is usually temporary. They have the hope of their hair growing back at some point. For most, the hair returns, but for some, the hair never does come back. Or their hair may come and go unpredictably through their lives, and they never quite know what to expect.

Mild AA can be fairly easy to deal with, from simply styling the hair a different way or applying a little scalp concealer. However, it can be very difficult to deal with severe AA, especially Alopecia Totalis or Universalis. Dealing with the loss of eyebrows and eyelashes as well as complete baldness on top is not easy, especially for women.

On the other hand, some deal with the loss quite effectively with wigs, false eyelashes, eye liner, or tatooed-on eyebrows. There are many resources for products like these here. Some celebrities have had AA and successfully hidden it, like Christopher Reeve and Neve Campbell.

Others choose not to hide their condition, like actor Matt Lucas or athlete Charlie Villanueva. They find trying to hide it a waste of time and energy and live proudly bald.

Here are some links for further information about AA:
Telogen Effluvium

Telogen Effluvium (TE) is a temporary form of hair loss and will usually resolve. It usually occurs as the result of a shock, crisis, or drastic hormonal change in the body.

Normally, hair does not continually grow on the scalp. It goes through a growing phase ("anagen") and a resting phase ("telogen"). Normally, about 10-20% of the hair follicles on your head are in a resting phase at any one time. Telogen Effluvium occurs when something causes a higher percentage of follicles to go into telogen phase, making the hair look thinner. Usually this resolves within a few months, but sometimes it takes longer or becomes chronic.

One common cause of TE is from medication which changes hormone levels, such as starting or stopping hormonal birth control like oral contraceptives. TE can also result from hormone replacement therapy, Clomid, or steroid use. Some medications for blood pressure, diabetes, hypothyroidism, anti-depressants, or high cholesterol can also cause temporary hair loss.

Probably the most common cause of TE is post-pregnancy hormone changes. The high estrogen levels of pregnancy can cause thicker and more plentiful hair, but once the estrogen levels drop after childbirth, the extra thickness and hair is lost as most of the hair goes into a "resting" phase, making the hair appear thin. It may take a while for hair to normalize, but most women with post-partum thinning go back to their normal appearance with time.

Some chronic illnesses like Crohn's Disease, IBD (Inflammatory Bowel Disease), hypothyroidism, or liver disease can cause Telogen Effluvium too. A severe shock to the system from things like car accidents, crash diets, severe stress, or serious illnesses can cause it. TE is also common after major surgery in women but may take a while to appear.

Dietary deficiencies are classic causes of TE as well. Common ones include deficiencies in iron, ferritin, biotin, protein, zinc, and certain B vitamins (especially B12), as well as too much vitamin A. Sometimes vegans are prone to hair thinning because over time they may develop a B12 deficiency. Many people who have had gastric bypass or other malabsorptive bariatric surgeries have hair fall out eventually as nutritional deficiencies accumulate over time. Eating disorders can also bring on TE.

Anagen Effluvium

Anagen Effluvium (AE) is a rapid and sudden hair loss from exposure to toxins or treatments for cancer. Chemotherapy is a common source of temporary hair loss for those with cancer because it usually targets all rapidly dividing cells. This means it targets cancer, but hair and mouth cells are also rapidly dividing cells and so are often collateral damage. Radiation treatments to the brain also often cause hair loss.

Although hair usually grows back after chemotherapy and/or radiation, it may grow back differently (changed color, straight instead of curly, change in texture). In some cases, it grows back only partially and never gets back to the fullness it used to have. Sometimes this patchiness can be quite pronounced.

Other Types of Alopecia

There are other, more rare types of alopecia as well, including Scarring Alopecia and Traction Alopecia. These result from trauma to the scalp, usually from tight hairstyles like braids, cornrows, tight ponytails, or hair extensions.

Bald spots can also result from trichotillomania, a compulsive pulling of a person's own hair. Infections can cause similiar hair loss, including fungal infections (like ringworm) and folliculitis. Diseases like lupus, congenital adrenal hyperplasia, or syphilis can also result in hair loss. And of course, age causes a gradual thinning of the hair in many people as hormones shift. About half of women experience some degree of hair loss after menopause.

Androgenetic Alopecia 

FPHL involves more diffuse thinning
Androgenetic Alopecia (also called Androgenic Alopecia, or AGA) is the term for typical female-pattern hair loss (FPHL). It is hair loss caused by genetic predisposition and excess "male" hormones or an extra sensitivity to these hormones (androgens). For this reason, sometimes it is called male-pattern hair loss in women but it does not affect women in quite the same way as it does men.

Typical male vs. female hair pattern loss differences
Women's hair loss is usually characterized by more diffuse thinning all over the top of the head behind the hairline, rather than one particular balding area as in men. Because women's hair loss usually involves gradual thinning, it is less obvious at first than hair loss in  men. However, the thinning gradually spreads so that eventually most of the top of the head experiences thinning, the scalp shows through, and the hair loss becomes more obvious. Although less common, some women also experience diffuse thinning on the sides of the head, along the front or temple-area hairline, and further down the back of the head as well.

Dihydrotestosterone (DHT), a derivative of the male hormone testosterone, is the main culprit behind hair loss in both men and women, as one website explains:
Testosterone converts to DHT with the aid of the enzyme Type II 5-alpha reductase, which is held in a hair follicle's oil glands. Scientists now believe that it's not the amount of circulating testosterone that's the problem but the level of DHT binding to receptors in scalp follicles. DHT shrinks hair follicles, making it impossible for healthy hair to survive. 
The hormonal process of testosterone converting to DHT, which then harms hair follicles, happens in both men and women. Under normal conditions, women have a minute fraction of the level of testosterone that men have, but even a lower level can cause DHT- triggered hair loss in women. And certainly when those levels rise, DHT is even more of a problem. Those levels can rise and still be within what doctors consider "normal" on a blood test, even though they are high enough to cause a problem. The levels may not rise at all and still be a problem if you have the kind of body chemistry that is overly sensitive to even its regular levels of chemicals, including hormones. 
Since hormones operate in the healthiest manner when they are in a delicate balance, the androgens, as male hormones are called, do not need to be raised to trigger a problem. Their counterpart female hormones, when lowered, give an edge to these androgens, such as DHT. Such an imbalance can also cause problems, including hair loss.
Many women with PCOS experience Androgenic Alopecia, although it is a far less common symptom than hirsutism or acne. Put another way, though hair loss rates are higher in women with PCOS than in the general population, most women with PCOS do not experience hair loss.

Why some women with PCOS experience alopecia and others do not is not clear. It probably has to do with each person's unique genetic make-up, hormone levels, and sensitivity to androgen receptors.

Summary

The bottom line is that there can be many causes of hair loss. Just because you have PCOS does not mean you could not possibly develop Alopecia Areata or have hair loss due to an underactive thyroid or a nutrient deficiency. You need to have your case reviewed by a dermatologist so you can get to the bottom of the cause of your hair loss.

Many types of hair loss are treatable and reversible, but some are not. Unfortunately, Androgenetic Alopecia, the type most common with PCOS, does not usually seem to be reversible, but there may be things you can do to slow it down. And of course, there are many practical things you can do to disguise it, if you wish to do so. Or you can simply learn to deal with the hair loss and not let it affect your happiness.

How Common is Hair Loss in PCOS?

One difficult question to answer is the incidence of alopecia in women with PCOS.

There is plenty of research documenting how much of the overall population experiences hair loss at some point in their lives, but most of this research does not differentiate between causes of the hair loss, just that it occurs at some point.

It is very difficult to separate out figures of alopecia in the general female population vs. those that are attributable to PCOS alone. First, let's start by discussing alopecia in the female population by age.

Hair Loss by Age

Most research focuses on the prevalence of hair loss differentiated by age. For example, it is estimated that about one-fourth of men begin balding by age 30, but that this increases to about two-thirds by age 60.

In women, the numbers are more uncertain. One study found that about one-third of all Caucasian women experience female-pattern hair loss (FPHL) at some point; however, a lot of this hair loss occurs after menopause. How much occurs before menopause is less clear.

One study found that about 10% of pre-menopausal women experience significant hair loss, and this number increases to about 50-75% of women over age 65. Another study found hair loss rates of about 12% of women in their 20s, which increased to 57% in women over age 80:
Twelve percent of women first develop clinically detectable FPHL by age 29 years, 25% by age 49 years, 41% by 69 years, and over 50% have some element of FPHL by 79 years. Only 43% of women aged 80 years and above show no evidence of FPHL.
How many of these women might have PCOS? It's not clear. One study of Finnish women found that about one-third experienced noticeable hair loss by age 63, and that this hair loss was often tied to strong insulin resistance. The more severe the degree of hair loss, the more severe the insulin resistance the woman likely had. Thus, it's likely that many of these women had PCOS, but the study did not look into that connection directly.

Alopecia Incidence in Women with PCOS

We do know that alopecia and PCOS are tightly tied together. One study showed that two-thirds of women experiencing hair loss had PCOS.

But this doesn't tell us the opposite; how many women with PCOS experience hair loss as one of their symptoms?

Not a lot of research exists on this question. Most studies do not quantify how many women with PCOS also have alopecia, just that it's a relatively uncommon symptom. However, recently some data has emerged, although the sample sizes in the studies are fairly small so the results vary considerably.

One British study (Sivayoganathan, 2011) found that 16% of women presenting with PCOS-like symptoms had hair loss, whereas 56% had hirsutism.

Another slightly larger study (Quinn 2014) found that 22% of women who met strict criteria for PCOS were experiencing alopecia.

Another study (Ozdemir 2010) found that 34.8% of women with PCOS had alopecia, whereas 73.9% of them had hirsutism. Similarly, Christodoulopoulou 2016 found that 36% of women with PCOS experienced alopecia.

So while most women with PCOS do not experience alopecia, between 16-36% do. In other words, between 1 in 6 and 1 in 3 women with PCOS experience hair loss. Yet even among this group, hair loss is largely ignored or talked about only minimally because of the shame and embarassment.

Interestingly, while hirsutism seems to be fairly closely correlated with androgen levels, alopecia does not. It may be less about how much androgens you produce and more about how sensitive your hair follicles are to androgens. This raises the question of whether anti-androgen medications are really an effective treatment for alopecia. (More on that in another post.)

Diagnosing Alopecia

The Ludwig Scale of Female Pattern Hair Loss (1977)
Again, if you have hair loss, it's important for you to see a dermatologist because there are so many possible causes of alopecia in women and some types are temporary or treatable. A dermatologist can help you determine which type you may have and what can be done about it.

The progression of female-pattern hair loss is usually judged on either the 3-point Ludwig Scale (above), the gradated 3-point Savin Scale (see the bottom of this section), or the 5-point Sinclair Scale (see just below). While there are other scales available, the Ludwig or Sinclair scale seems to be the most commonly used.

Sinclair Scale for hair loss
To diagnose alopecia, a dermatologist will usually do a pull test, a density test, and sometimes a scalp biopsy. Patients should provide a summary of any medications they are currently taking or have taken in the recent past. Doctors should take a detailed medical history of other conditions, including family history of hair loss and autoimmune conditions. A manual examination of the thyroid may also be indicated.

Research strongly suggests that tests for nutritional and endocrine issues also be run, including:
  • DHEAs
  • Testosterone
  • Androstenedione
  • Prolactin
  • Follicular stimulating hormone
  • Leutinizing hormone
  • Serum iron
  • Serum ferritin
  • Total iron binding capacity (TIBC)
  • Thyroid stimulating hormone (T3, T4, TSH)
  • VDRL (a screening test for syphilis)
  • Complete blood count 
  • Zinc, Vitamin D
In men, male pattern hair loss usually begins at the crown, then spreads to the temples, and progresses from gradual thinning to total bald spots. The hairline in front often recedes. In the more severe cases, men may be left only with a narrow horseshoe of hair along the back and sides of the head.

Savin Scale of hair loss
In women, the pattern is different. The hair loss begins on the top of the head, and also just behind the front hair line. The first sign is often a widening of the part in the hair, and then the hair on top of the head gradually begins to thin. It can reach down into the temple areas or on the back of the head, just below or around the crown. It is more gradual than men's hair loss, and is usually more diffuse (spread out).

Rarely do women with androgenetic alopecia lose all their hair, have a completely receding front hair line, or have complete bald spots. Instead, the hair becomes progressively thinner and more diffuse, and the scalp shows through more and more, especially in direct light. Eventually, this hair loss can become severe and become near-baldness, especially as women pass menopause.

Women's AGA alopecia tends to become noticeable later than in men, but because they are more conscious of their hair and because the social ramifications of hair loss are more severe, they tend to come in for diagnosis and treatment earlier in the process.

While hair loss is emotionally difficult for both genders, it is especially traumatic for women. Hair loss in men is common and baldness is relatively accepted; in women, it is highly stigmatized, so it is nearly always hidden away and is rarely discussed.

Summary

There are many forms of alopecia and many possible causes for it.

This is why it's important to see a dermatologist in the early stages of alopecia, so you can hopefully find some answers sooner than later. Unfortunately, many doctors are dismissive of these concerns or just put you on strong medications right away instead of trying to determine the root cause of the issue. Women on the PCOS forums stress the importance of seeing more than one doctor if necessary to get answers.

Once a cause is determined, then a course of treatment can be prescribed. Sometimes this is helpful, often it is not, but it may be worth trying just to see. More on these treatment options in the next posts.

Information is power. Make your decisions from an informed place and be aware that there is a lot of quackery and fraud in the hair loss field. People make all kinds of recommendations and claims about treatments, but very little data exists proving whether these treatments actually help.

Be very wary about claims of what can help, even from PCOS resources. Research as much as you can to learn about the benefits and risks of everything you consider trying. Be sure to visit the hair loss forums online so you can gain wisdom and support from those who have already traveled this path before you.

Above all, remember that your looks don't define you. Women with PCOS have many challenges to their self-esteem via hirsutism, acne, weight, and/or alopecia. Dealing with these challenges is frustrating and demoralizing at times, but ultimately these challenges do not define you. Only you can do that.

Remember that who you are inside is the most important thing, and that your confidence and a strong sense of self can overcome society's prejudices. 

Next post: Medications and Treatments for Alopecia


References

J Family Reprod Health. 2016 Dec;10(4):184-190.Clinical and Biochemical Characteristics in PCOS Women With Menstrual Abnormalities. Christodoulopoulou V, Trakakis E, Pergialiotis V, Peppa M, Chrelias C, Kassanos D, Papantoniou N. PMID: 28546817
...MATERIALS AND METHODS: We conducted a prospective observational study of patients 17-35 years of age with PCOS that attended the department of Gynecological Endocrinology of our hospital. RESULTS: A total of 309 women with PCOS participated in the study. In total, 72.2% suffered from menstrual cycle disorders...36% of the sample had androgenetic alopecia and 56.4% had acne....
Fertil Steril. 2014 Apr;101(4):1129-34. doi: 10.1016/j.fertnstert.2014.01.003. Epub 2014 Feb 15. Prevalence of androgenic alopecia in patients with polycystic ovary syndrome and characterization of associated clinical and biochemical features. Quinn M, Shinkai K, Pasch L, Kuzmich L, Cedars M, Huddleston H. PMID: 24534277
OBJECTIVE: To describe the prevalence of androgenic alopecia (AGA) in patients with polycystic ovary syndrome (PCOS) and to characterize associated clinical and biochemical features... SETTING: Multidisciplinary PCOS clinic at a tertiary academic center. PATIENT(S): A total of 254 women with PCOS according to the Rotterdam criteria were systematically examined from 2007 to 2012 by a reproductive endocrinologist, a dermatologist, and a psychologist... RESULT(S): Fifty-six of 254 patients with PCOS (22.0%) had AGA. Subjects with PCOS and AGA were more likely to have acne or hirsutism than those without AGA (96.3% vs. 70.6%)... There were no differences between subjects with and without AGA in biochemical hyperandrogenism or metabolic parameters. CONCLUSION(S): AGA is prevalent in 22% of subjects meeting diagnostic criteria for PCOS. AGA is associated with other manifestations of clinical hyperandrogenism, but not with greater risk of biochemical hyperandrogenemia or metabolic dysfunction than with PCOS alone.
Hum Fertil (Camb). 2011 Dec;14(4):261-5. doi: 10.3109/14647273.2011.632058. Full investigation of patients with polycystic ovary syndrome (PCOS) presenting to four different clinical specialties reveals significant differences and undiagnosed morbidity. Sivayoganathan D, Maruthini D, Glanville JM, Balen AH. PMID: 22088131
OBJECTIVE: This study aimed to compare the spectrum of polycystic ovary syndrome (PCOS) symptoms in patients from four different specialist clinics. DESIGN: A prospective cross-sectional observational study. SETTING: The study was conducted at the infertility, gynaecology, endocrine and dermatology clinics at Leeds General Infirmary, U.K. PATIENTS: Seventy women presenting with features of PCOS: 20 from infertility, 17 from gynaecology, 17 from dermatology and 16 from endocrine clinics.  INTERVENTIONS: Participants were assessed for symptoms and signs of PCOS and underwent a full endocrine and metabolic profile and a pelvic ultrasound scan. RESULTS: All subjects had experienced menstrual problems, 81% were overweight, 86% had polycystic ovaries on ultrasound, 56% had hirsutism, 53% had acne, 23% had acanthosis nigricans, 16% had alopecia and 38% had previously undiagnosed impaired glucose tolerance (IGT) or diabetes....
Acta Obstet Gynecol Scand. 2010;89(2):199-204. doi: 10.3109/00016340903353284. Specific dermatologic features of the polycystic ovary syndrome and its association with biochemical markers of the metabolic syndrome and hyperandrogenism. Ozdemir S, Ozdemir M, Görkemli H, Kiyici A, Bodur S. PMID: 19900078
...DESIGN: Prospective descriptive analysis. SETTING: University-based tertiary care. SAMPLE: One-hundred and fifteen untreated consecutive women diagnosed as having PCOS... RESULTS: The prevalence of acne, hirsutism, seborrhea, androgenetic alopecia and acanthosis nigricans was 53%, 73.9%, 34.8%, 34.8% and 5.2%, respectively. Acne was not associated with the hormonal, metabolic and anthropometric variables. Hirsutism had positive associations with total testosterone, fasting glucose and total cholesterol, and a negative association with age. Seborrhea was found to be related with free testosterone, fasting glucose and insulin. A negative association was determined among androgenic alopecia and free testosterone, low-density lipoprotein and insulin.  CONCLUSIONS: Acne and androgenic alopecia are not good markers for the hyperandrogenism in PCOS. Hirsutism appears to be strongly related with hyperandrogenism and metabolic abnormalities in PCOS women.


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Fatshion: Spooky Fall Look with ModCloth

Disclosure: I received products in exchange for my opinions. All opinions are 100% mine. Hi friends! I have mentioned before how much I love ModCloth. They are committed to body positivity and...

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Monday, 25 September 2017

Why Can’t Plus Size Stars Find Dresses for the Red Carpet?

Actual SizeAward shows represent the big time for designers as they vie to dress the nominees and have their creations seen and talked about all over the media. A quick Google search finds thousands of articles that discuss, in exact details, precisely how the stars get ready for their big day — starting weeks or even months ahead. But there’s one story that doesn’t get told, the story of the plus-size nominees who can’t get designers to make dresses for them at all.

Melissa McCarthy talked about the issue in the July 2014 issues of Redbook:

“When I go shopping, most of the time I’m disappointed. Two Oscars ago, I couldn’t find anybody to do a dress for me. I asked five or six designers — very high-level ones who make lots of dresses for people — and they all said no.”

That’s right, even if they are incredibly talented, fabulously funny, able to break through Hollywood’s staggering size bias, and nominated for one of the most prestigious awards in their field, plus-size nominees still can’t get any respect from the fashion industry. You would think that designers would want their clothes to be seen on a woman who represents billions in buying dollars, but it turns out they would rather cling to their fat bias.

Two years later, as she was preparing for the premiere of the Ghostbusters reboot, Leslie Jones took to Twitter with a similar lament.

Read the rest of the piece here!

Hear fat actress Jennifer Ponton’s talk “So Long Wacky Neighbor – Buh-bye, Best Friend: Changing the Game as a Fat Actress” and more at 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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Sunday, 24 September 2017

The Never-Ending Healthcare Debacle

If you’ve paid attention to political news, you know that Republicans have six days to pass something, *anything* that repeals the ACA under budget reconciliation. The current bill is Graham-Cassidy, which sort of pretends to be a healthcare bill for the next 10 years. It initially cuts funding by a 16%, giving the remainder to states in block grants.  So there’s no pre-existing coverage, no essential requirements that insurance must cover, no *anything* unless states feel like doing so. Even if they want to do everything the ACA did, with less money, they can’t.

Oh, and it “defunds Planned Parenthood.” Because there is no line-item funding for Planned Parenthood, that really means, “prevents people on Medicaid from accessing care (that isn’t abortion, because Federal funds don’t go to abortion) at providers Republicans don’t like, regardless of whether they’re the only provider the patient can afford, or the only provider in the county.”

Unfortunately, none of this actually matters to most Republicans, or to President Trump, for whom pissing on our only Black President’s legacy is all the motivation or justification they need.  Oh, and tax cuts for the rich.

There are, however, a few Republicans opposed. McCain (Arizona) said he would vote against it, and Susan Collins (Maine) said she’s very unlikely to support it, but is waiting for the CBO.  If these are your Senators, call or email them. For John McCain, thank him for opposing it and encourage him not to vote for it.  For Susan Collins, thank her for waiting for the CBO score (because really, why would you vote for a bill before you know what it does?), and encourage her to vote against it.  Especially after Monday when you have specifics in the CBO score to point to.  (Yes, I’m assuming it will be bad because I’ve read up on the bill.  You can’t slash the available budget and the rules that make sure sick people can get insurance and expect puppies and unicorns.)

Lisa Murkowski (Alaska) hasn’t actually said how she’ll vote, so it’s important for Alaskans to call her and ask her to vote against it.  Alaska is one of the states that gets seriously screwed over by this bill, so she’s likely to be against it, but nothing is certain.

If you want to go beyond just calling and emailing (though you should do those too!), Indivisible has a guide for direct action, including sit-ins or die-ins at your Member of Congress’s office. Indivisible has a search for #KillTheBill events near you, so you can coordinate with others.  Tomorrow is the big day of protest for this bill.

So, what can you do if your senators already oppose this cluster? That’s the boat I’m in. My Senators are firmly against Graham-Cassidy, so instead of calling them, I’ve mostly been retweeting them.

You can also support people protesting in other states. It may or may not be helpful to actually show up at those protests. On the plus side, you’re another body, but on the negative, showing up with out-of-state plates gives ammo to the “fake, paid protester” lie. And, really, if you’re not one of a Senator’s constituents, they should be listening to the people they represent rather than you.  That’s not to say don’t go, but take a supporting role for those who live in that state, and be mindful of how you’re perceived. And probably don’t park in front of the Senator’s office with out-of-state plates.

You can also support those protests without going in person.  Kick in money for gas/tolls/public transit.  Provide food and bottled water.  For flashier protests, like die-ins, you can contribute props. Again, there’s the Indivisible  search to find rallies or protests near you.

Another neat tool Indivisible has is Calls to Kill Trumpcare. You call people in targeted red states and ask *them* to call their senators. The tool even lets you put them through to their Senators right then & there.

If this post inspires you to take any action—big or small—against the latest incarnation of Trumpcare, I’d love to hear how it went in the comments.




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Advocating at the Doctor’s Office – Say Something Sunday

Bad DoctorToday for Say Something Sunday, I want to tell you the story of how Rebecca absolutely killed it advocating for herself at the doctor’s office.  Before I tell you that story, I also want to be clear that nobody should have to deal with this kind of fatphobia at the doctor’s office or anywhere else, and that not everyone can/wants to handle it the way that Rebecca did, and that’s ok. This is just one example of how you might advocate for your own medical care.

I had to go get some breathing/respiratory tests yesterday. I had never been to this clinic but had met the doctor at another clinic before and had liked him.

I go in, chairs have arms but they are wide arms and I fit in them so I say nothing. I wait for the tech to take me back.

The tech, who I’ve never met takes me to a scale and says he wants to weight me and get my height. I ask if he will be prescribing any medication or having me be on a machine that has a weight limit. He says no.

I say I don’t want to be weighted then, he doesn’t need it and it’s detrimental to me.

He just stares at me and then asks if I know what my weight is and he can just write it down. I tell him that he can make a visual assessment and that is all he needs. He complies.

We go into the room and he carries out a series of breathing tests and then wants me to get into a chamber that I will not be able to fit in. He says “Oh, you’re too big”.

I say “No, I’m a patient. You do not have the proper tools to service your patients it seems.” He blinks and then nods and says I’m right.

Then they want to take blood. The chair they want me to sit in is a no go. I ask for a proper chair. It is brought.

They can not find my pulse. I am told that it is because my wrist is too round. I say “No, I am a patient, I would expect you to sort out how to do this without pain”. I stop the efforts and tell them not to jab me, that I take back consent. What I would have liked to have said that I thought of later: If you can’t get a proper vein/pulse, then get a machine or something that can- not my job.

I DID suggest that I go to a lab to get blood work if it was necessary. Apparently it was not.

I felt EXHAUSTED but really victorious. It never occurred to me that I could tell them to stop and that it was the fact that they did not have the appropriate tools to serve me properly. But it’s TRUE.

I did not get any hostility, just shock and then compliance. And I got a diagnosis and full treatment plan. So none of it impeded my care ultimately.

I had your cards for dr visit advocacy with me! I read them over for strength before going in!

I particularly love the way that she kept making it clear that her existence wasn’t the problem, and medical fatphobia is – far too often healthcare practitioners who lack the skill and equipment to properly treat fat people try to blame that on their fat patients, and the less we allow them to get away with that, the better.

The cards I created to help fat folks advocate for themselves can be found here!

If you have a story of self-advocacy in the doctor’s office, it would be awesome if you would share it in the comments.

If you want more support to fight fatphobia, 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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Friday, 22 September 2017

A Comment Section Worth Reading

fat shaming naturalOne of the great joys of writing this blog has been the people who leave comments here.  It makes me happy beyond words that the comment section of this blog is full of great insights, advice, support, and conversation.  It means that people who come here can break the cardinal rule of being fat on the internet which is, of course, never read the comments. Recently a massively fatphobic Facebook post generated another comment section that helped restore my faith in humanity. But to tell the whole story, we have to back up a bit…

A “journalist” (who, admittedly, may have been looking more for attention than a great teacher for her kid) recently wrote a piece called “Why I refuse to let my daughter be taught by a fat teacher.” In her own words, the nursery assistant who would be working at the well-rated school with her toddler was “a lovely woman, kind and great with children.”

Unfortunately, this journalist’s stereotypes about fat people got in the way, and she decided to move her child to a different facility. Let’s be clear about what happened — this woman chose a school based solely on how the teachers looked.

She feels that this is acceptable because the teachers look fat and she thinks it should be ok to discriminate against fat people. As if any bigot doesn’t think that their bigotry is justified. Like so many bigots, she tries hard to paint herself as the victim:

“This is the first time I have publicly admitted to feeling this way. Aware that the reaction would be anger and vilification, I censored myself. I told everyone I preferred the other nursery because it was smaller and friendlier. I knew I would be accused of discrimination, or ‘fat-shaming’, if I admitted the truth.”

She’s wrong though, nobody is accusing her of discrimination or fat-shaming — since it’s not an accusation at all, but rather a statement of fact.

This is the textbook definition of discrimination and fat shaming. It’s awful for the teachers involved (apparently there was *gasp* more than one fat teacher at the nursery), though they also probably dodged a bullet avoiding having to deal with this woman. Mostly I feel badly for her child who is growing up with a proud bigot for a mother, and for any fat friends her child will make (if she’s allowed to be friends with fat kids at all.)

If you think this situation can’t get any more screwed up, Garry Robinson of Kaizen Outdoor Fitness would like you to please hold his beer while he uses his Facebook presence to double down on encouraging fat shaming/

But this is where the good news starts. The comment section on this Facebook post is EPIC!

Click here to read the rest of the piece!

Want to create a world where this kind of fat shaming is considered wrong by everyone? 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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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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