Archive for March, 2010

A copy of an article with that title from Clinician Reviews, August 2006, was posted on the wall of Issa’s doctor’s office. The paper on which the article was based was published in JAMA, a peer-reviewed medical journal. Given the credentials of the people involved, you’d think they’d know that correlation does not imply causation.

Weight gain throughout adulthood appears to increase a woman’s risk for postmenopausal breast cancer. Women who gained at least 25 kg since age 18 were more likely than those who had maintained their weight to develop breast cancer. Weight loss since the age of 18 decreased breast cancer risk.

Weight gain of at least 10 kg since menopause was associated with an increased risk of breast cancer. However, women who lost at least 10 kg after menopause reduced their risk of breast cancer.

First, notice that the weight gain is being portrayed as the cause of the increased cancer risk. Even though some sentences use the correct, “correlation” language (“weight gain … was associated with an increased risk”) there are more sentences that use “causation” language, such as, “weight gain … appears to increase a woman’s risk,” “weight loss … decreased breast cancer risk,” and, “women who lost … reduced their risk.” A scientist should know better. A person with a high-school education in the scientific method could point out the logical flaw here: what if there is a third, unidentified factor, that results in both weight gain and increased cancer risk? That the authors of the study appear to have overlooked this obvious avenue for exploration (or that they simply do not consider it worth pursuing) is an example of fat-bigotry. The idea that fatness is the cause of bad health is seen as tautological, and so scientific results that support that idea are seen as correct and final, and not worthy of further investigation.

The article concludes with this morsel:

“Women should be advised to avoid weight gain and counseled on the potential benefits of weight loss after menopause,” according to Eliassen and colleagues. Given the difficulty experienced by many persons trying to lose weight, the authors add, weight maintenance should also be emphasized.

Right. Because the reason people gain weight as they get older is that they’ve never been counseled to avoid weight gain. Is there, anywhere in America, a single person who has not received the message that getting fat as they get older is bad? Is lack of education really the problem? At least the authors acknowledge that many people have trouble losing weight, but what’s their answer? Exploring the reasons WHY many people have so much trouble losing weight? No. Just add weight maintenance to the list of things you’re going to counsel your patients on. So, now, in addition to saying, “You’re fat and you should lose weight or you’re going to die,” doctors can also say, “You’re not fat yet, but if you get fat, you’re going to die.” What. A. Fucking. Improvement.

If doctors “advising” people to lose weight made people lose weight, there wouldn’t be any fat people left. It seems like “scientists” would have considered this.

There is a more subtle form of fat-bigotry going on here that I’d also like to point out. What if the study had said, “women’s hair turning gray was associated with an increased risk of breast cancer, therefore doctors should advise women not to let their hair turn gray as they age.” It’s understood that a person’s hair turning gray is not something a person can control, and so the suggestion would be correctly perceived as ridiculous, and we would wonder what world the authors were living in. Since it’s perceived that a person’s weight is largely within their control, the suggestion to mitigate breast cancer risk by managing weight is seen as reasonable, but in a world full of fat-hate, where 70% of people are still defined as medically overweight or obese, you’d think that evidence-based scientists would be more receptive to the idea that a person’s weight is not as “in their control” as, say, the length of their fingernails.

Which is not to say that the authors of this paper are bad scientists or bad people—they’re probably not. But, like all of us, they live in a culture that is full of fat-hate. One message that we can take from this is that if people who have devoted their careers to evidence-based conclusions can be swayed by the culture of fat-hate, what does it mean for the rest of us?