Everyone Secretly Hates Fat People?

This blog was inspired by my paper discussing the content and accuracy/quality of that content on weight loss and weight acceptance blogs, so I figured I should look at one of the issues commonly addressed (indirectly, usually, but sometimes directly) in the fatosphere.

The fatosphere, first off, is like a pocket of the blogosphere dedicated to fat acceptance. It's pretty fun and I learned a lot about perspectives and experiences very different from mind. From an anthropological view, I had a great time writing that paper.

This week's post is dedicated to thin privilege, and I will be looking at it through the lens of physician bias. 

Now, I'm not here to degrade the work of any doctor. I applaud anyone who works in the healthcare system to improve the lives of other human beings and, in many cases, to save some of those lives. So far, this blog has been just me but I have dreams of a grander future and I do not want to give the impression that doctors of any kind are bigots by nature. 

But...

Several studies^{(1, 2, 3, 4)} have found a significant weight bias among physicians, even those who research or work with obese patients. Some results have suggested this negative bias extends to other institutionalized forms of discrimination, including adoption proceedings⁽⁴⁾. There is compelling research to show we can use social pressure to change such biases among physicians⁽⁵⁾, but the unsettling truth is that it is there in the first place. 

Similarly, while there is evidence to suggest that moderate weight loss can alleviate chronic illnesses like hypertension (a precursor to heart disease) and hyperlipidemia⁽⁶⁾ and diabetes^{(7, 8)}, one study showed some doctors will treat the chronic illness instead of the obesity⁽²⁾.

Schwartz and colleagues used the Implicit-Associations Test to examine the subconscious biases of clinicians and researchers attending an international obesity conference and found a statistically significant amount (p<.0001) maintained an anti-fat bias⁽⁹⁾. These are people who understand obesity better than any other doctor, they know it has multiple causes, and a significant number still have an anti-fat bias. 

Is it clear why I put the disclaimer about doctors at the top? It's important to remember that the IAT is an *implicit* associations test. No one started it thinking fat people were lazy and worthless, at least not consciously. The point of this is that this stigma extends so deeply in many Western societies that even the obesity experts may still have a bias. This may interact with the fact that their job is often figuring out how to reduce obesity, but it does not justify or explain any bias.

Where does biology or biomedicine come in to this? Well, it doesn't. By itself. But in the healthcare system where such strong bias exists, where health professionals (doctors, nurses, researchers, etc.) who are entrusted with the care of the sick may implicitly avoid the necessary treatment out of a subconscious bias, these problems will be nearly unsolvable. When less than 50% of physicians feel confident in their ability to prescribe weight loss programs and only 14% believe they are successful in treating obesity(2), how can we expect to fight the "obesity epidemic" and help those who are unhealthy and obese? 

We can't. And this is why healthcare needs more anthropology. 

More on that next week.

Cheers,

J.G.

1) Schwartz, M. B., Chambliss, H. O. N., Brownell, K. D., Blair, S. N., & Billington, C. (2003). Weight bias among health professionals specializing in obesity. Obesity research, 11(9), 1033-1039.

2) Foster, G. D., Wadden, T. A., Makris, A. P., Davidson, D., Sanderson, R. S., Allison, D. B., & Kessler, A. (2003). Primary care physicians’ attitudes about obesity and its treatment. Obesity Research, 11(10), 1168-1177.

3) Jay, M., Kalet, A., Ark, T., McMacken, M., Messito, M. J., Richter, R., & Gillespie, C. (2009). Physicians' attitudes about obesity and their associations with competency and specialty: A cross-sectional study. BMC Health Services Research, 9(1), 106.

4) Puhl, R., & Brownell, K. D. (2001). Bias, discrimination, and obesity. Obesity research, 9(12), 788-805.

5) Puhl, R. M., Schwartz, M. B., & Brownell, K. D. (2005). Impact of perceived consensus on stereotypes about obese people: a new approach for reducing bias. Health Psychology, 24(5), 517.

6) Goldstein, D. J. (1992). Beneficial health effects of modest weight loss.International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity, 16(6), 397-415.

7) Lifshitz, F., & Hall, J. G. (2002). Reduction in the incidence of type II diabetes with lifestyle intervention or metformin. J Med, 346, 393-403.

8) Knowler, W. C., Fowler, S. E., Hamman, R. F., Christophi, C. A., Hoffman, H. J., Brenneman, A. T., ... & Steinke, S. C. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374(9702), 1677-1686.

9) Schwartz, M. B., Chambliss, H. O. N., Brownell, K. D., Blair, S. N., & Billington, C. (2003). Weight bias among health professionals specializing in obesity. Obesity research, 11(9), 1033-1039.

Space, the Final Frontier (for Airplane Seat Designers)?

I know this blog has gotten off to a rocky start, but now that I'm mentally weaning myself off winter break, I'm no longer sick, and I have a computer that works, we should be much better moving forward.

Is "airplane seat designer" a real job by itself? It is for this post.

Last time, I wondered about the effects of obesity and tiny airline seats. The typical airplane seat is 17-inches wide, which I have found is barely big enough for me and I'm of average size. And I'm a woman. The average man has broader shoulders than I do so we will always be rubbing arms and hating each other no matter what.

I wondered specifically about long-haul flights (four hours or more according to the article I will be using, but also used to reference trans-oceanic or overnight flights) in mind and how temporary sedentism can exacerbate the effects of chronic sedentism when the person is squeezed into the airplane seat. I recently had to sit through a couple of these, and my own joints get stiff and sore despite being young and healthy.

Unfortunately, no one has wondered quite the same thing I have and I could not find any research regarding staying seated in cramped spaces for four hours or more. I did find one article that touched on this so I will be speculating off of this.

It should be noted that I am focusing specifically on the size of the seats. Research has been done on leg room and passenger comfort and I acknowledge that the loss of leg room over the years in aircraft carriers hoping to maximize seating contributes to the general problem. I would like to say that this may worsen conditions that result from having one's legs bent for long periods of time, especially cardiovascular problems.

So, as airplanes have been getting larger and making longer flights, airlines have been working to maximize seating while providing guest comfort, especially on long haul flights⁽¹⁾. Dampening the noise from the engines, changing engine location, creating ergonomically designed seats, and adjusting for crossing time zones and changes in cabin pressure have all been strategies used to promote passenger comfort (and thus health). It should be noted that the airlines recognize the threat of edema, thromboses, and cramps but arrangements to actually relieve these problems (more leg room or incentives to get up and move around for a few minutes every couple of hours, if not more frequently) have been slow to be incorporated.

The point of this is the conflicting pressures. Airlines want to make the most money as possible, which means making passengers comfortable while maximizing seating. Larger passengers, especially overweight or obese passengers, are pressured to keep to their own space and take responsibility for the burden they impose on others when they do not fit into their own seat. Airlines are pressured to create policies to meet the needs of obese and non-obese customers but often fall very short of this or outright fail in the process. In addition, the negative health effects of sitting for four or more hours may not be immediately realized on the plane, but considering many Americans lead fairly sedentary lives, such seating certainly makes things worse.

Here, the interaction of health (affording adequate seating for all passengers to minimize risk of health detriment) and society (pressures on airlines, passengers of size, and average passengers) offer no win-win solution. Ideally, there may be a middle ground in which airplanes are designed with enough comfort and space to reduce health risk and passenger overlap while maximizing profit for the airline itself. However, even if such a middle ground existed, the ever-changing fluctuation in population body size averages and extremes would quickly make it irrelevant.

I don't have an answer, here, and the point of this blog isn't to find answers but rather to ask more questions that take into account multiple factors and how social and biological needs intersect. So, I would ask here, is it possible for everyone to be happy given the current cultural paradigm toward passengers of size? Or do we need to change the way we think about each other, especially during an activity as stressful as air travel? How responsible is a larger person for the space they occupy when they aren't fat through any particular action or will of their own? Finally, what other parallels are there in travel or anytime many people of different shapes and sizes get to together for hours on end that could benefit from finding an answer to the air travel problems?

Next post on Thursday with a new topic!

Cheers,
J. G.

1) DeHart, Roy. 2003. Health Issues of Air Travel. Annu. Rev. Public Health. 24:133-151

Computer Death

Computer issues, no post this week. Also, new posts will now be made on Thursdays to fit better with my work schedule.

Cheers,
J. G.