Tuesday, 18 February 2020

Does Being Fat Cause Arthritis? Does That Even Matter?

fat people deserve ethical, evidence-based healthcareI wrote a piece about the issues with fatphobia, fat people and our knees (and the problems that we have in receiving any kind of competent healthcare when we have knee issues.) It was shared by a reader on Facebook who received this response:

 I agree that often the problems are tightness in the muscles and that should always be addressed if it’s an issue. But there is also a lot of research about the pure physics of having more force exerted on joints and feet that cause more wear and tear and lead to more arthritis. Is that research wrong? Is there counter-research being done? If you know of it, can you direct me to it? Thanks.

That’s not actually the most important question, but I’ll answer it anyway because it’s so very misunderstood.

To clarify, for this discussion when I talk about arthritis, I’ll be talking about osteoarthritis. And it’s way more complicated than just larger body = greater risk, first because so many factors are involved (everything from access to supportive footwear to participation in athletics at various ages, to the knowledge of coaches and trainers if one does participate etc.)

Research shows a correlation between larger bodies and greater risk, but that’s far from showing causation. Before the cause could be attributed to body size alone, there would have to be studies that control for the many variables that impact fat people.

To name just a few:

Fat people’s inability to get competent healthcare for joint pain (especially early joint pain,) Instead, we are typically being prescribed weight loss  – which causes additional issues:

The effects of weight-cycling (ie: yo-yo dieting) on long-term joint health since most diets end in weight regain, and most fat people are put on multiple diets, thus experiencing weight cycling.

The effects of exercising while purposefully giving your body less fuel than it needs (which is typically suggested to fat people as a “weight loss intervention”) on joint health.

The effects of stigma including the impact of stigma on fat people seeking out care at the same rate and level of injury/pain that thin people do, on fat people participating in physical activities that might mitigate their risk for arthritis etc.

These are just a few of the issues with research around weight and health. The truth is that, because of weight stigma, fat people experience the world differently than thin people do, and these differences impact our health – including our joint health – and all of that must be accounted for before we attribute health issues to fat bodies.

But like I said, that’s not the most important question. In fact, it doesn’t really matter because even if fat bodies were proven to cause arthritis, the advice/treatment given to fat people should not change.

There’s not a single study in which more than a tiny fraction of the participants succeed at significant long-term weight loss. In the vast majority of weight loss attempts, people lose weight short term, then gain it all back in a few years.

Even knowing these odds many doctors still prescribe weight loss under the “logic” that, while it almost never works it would, in theory, be great if it did. This is roughly the same as prescribing flying to patients with joint issues. I mean, if you jump off your garage and flap your arms really hard you probably won’t fly, but think of the joint pain relief you would feel if it worked and your feet never had to touch the ground!

Beyond that, the majority of dieters actually gain back more weight than they lost, so if someone believes that larger bodies are at greater risk for arthritis, a recommendation of intentional weight loss is the worst thing they could suggest, since the most common long-term outcome is of weight loss attempts is weight gain. (And of course more dangerous solutions – like dangerous diet drugs and  stomach amputation surgeries – risk fat people’s lives and quality of life for outcomes that could be achieved through far less dangerous means.)

If the medical establishment wants to improve fat people’s health, a good first step would be to actually care about our health, rather than refusing to give us good healthcare unless and until we become thin people.

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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!

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