She's big mad

On fatness, flimflammery, and the future

CN: Contains discussion of weight stigma and related pharmaceuticals.

A lot of people reading this probably think it’s bad to be fat. Or, if not bad, then at least less-good than being thin. Not ideal. I’m pretty sure a lot of you think that, because a lot of people think it. And sure, I collect a better (and weirder) gaggle of readers than most, and I love you madly for it. But no amount of cyber bullying the founding fathers on my podcast is going to keep everyone with an anti-fat bias out of my internet circle. With the pendulum of unattainable body standards now swinging back from “no one gets that hip-to-waist ratio without at least five layers of spandex” to “no one who eats solid food looks like that,” there’s plenty of fuel around to feed the fire that Weight Watchers sparked in you as a child.

It feels like lately, with Big Pharma pushing weight-loss drugs and celebrities removing their cheeks (facial and butt), one can hardly look up without seeing a think piece about the dawn of the“post-appetite” era (gag).

This is, to be blunt, a real bummer. I could give you a lot of evidence to support my thesis that this fricking sucks. We could talk about the racist, overtly anti-black, colonialist origins of the modern celebration of thin bodies. We could talk about why the BMI is nonsense or how the narrative of an “epidemic” of fatness sprang up from demonstrably biased sources. I could go on a rant about the drugs that pharmaceutical lobbyists are angling to make ubiquitous as a first line of defense for any health problem a person happens to have while being fat, and how people really expect me to believe that temporarily losing 10% of my bodyweight is worth the risk of a deadly taint infection.

An infection!!!

In the taint!!!!

But I actually, totally accidentally, came across an article that shows how ridiculous this all is better than I ever could alone.

So if you’re generally only here for the fun weird stuff, I’m going to ask a favor. Could you sit with me and read about this for another five minutes? I think I can make you start to understand.

Today CNN reported on a very real, pressing, terrifying problem: An unprecedented spike in colorectal cancer rates among young people over the last couple of decades. The way they covered it encapsulates everything you should know about weight stigma in healthcare. (Go ahead and click the link—it’s a wayback machine capture, so you won’t even give CNN traffic.) I’ll take you through it step by step.

1. The article is pegged to a new study on colorectal cancer in young people. The study does not conclude that high weight is the obvious culprit, or that weight intervention is the obvious course of action. The study outlines, in fact, how little we know about these cancers in young people. It calls “for more specialized research centers to focus on younger patients with the disease and for diverse populations to be included in studies on early-onset colorectal cancer.”

2. The first doctor quoted in the piece notes that “there’s probably more than just one cause” behind the rise in disease. (Florals? For spring? Groundbreaking.)

3. An epidemiologist is brought in to list high weight and commonly associated dietary and lifestyle factors as potential culprits. But wait! That’s not all she says! “But the data don’t support these specific factors as solely driving the trend,” she said. “So if you have excess body weight, you are at a higher risk of colorectal cancer in your 40s than someone who is average weight. That is true. But the excess risk is pretty small. So again, that is probably not what’s driving this increase, and it’s another reason to think that there’s something else going on.”

4. The article lists some specific people who have died who weren’t fat when they died, which definitely feels scientific and necessary.

5. We get this quote—“We know that excess weight increases your risk, and we know that we’ve had a big increase in body weight in this country,” she said. “And that is contributing to more cancer for a lot of cancers and also for colorectal cancer. But does it explain this trend that we’re seeing, this steep increase? No, it doesn’t.”—but unfortunately, and predictably, the reporter seems to have gotten stuck on that first sentence, despite it being pretty much the opposite of the point the epidemiologist was making.

6. “Yet scientists remain divided.” Buckle up, babes.

7. Now we bring in a gastroenterologist who is willing to say things like “we know.” We know it’s bad to be fat. We know this is a huge factor. Never mind the measured, data-driven statement that came before. This guy who says he knows things is definitely an equally weighted counter point.

8. A gastro is literally quoted as saying there’s a correlation between body weight increasing and cancer rates increasing, which means… nothing. This is left dangling, as if it means… something.

9. Another gastro comes in to say that it’s probably not just the fat, but that foods are fattening.

10. Yet another expert emphasizes that the data does not actually support this.

11. “That leaves many oncologists scratching their heads.” No fucking shit.

Usually the logical hoops people jump through to pretend it's "common sense" and "proven" that being bigger means being less healthy are a little less obvious than this. But here we are. It’s actually kind of… amazing.

Here’s what really frosts my flakes, folks. There are experts in here sounding the alarm that there is something else going on. People who are demonstrably not fighting for fat liberation are still saying, “hey, listen, fatness can’t explain this.”

Meanwhile, their colleagues—and CNN—are rolling their eyes and saying “but, like, come on, we know it’s cause people are fat, at least mostly.” Imagine swearing to do no harm and then ignoring the evidence that something we’ve yet to identify is killing off young people. Yeah, sure, the problem is definitely my absolute dump truck of an ass. Thanks for cracking the case.

This is a perfect example of how weight stigma makes healthcare worse for everyone, no matter what their size. You might not care that one time I told a doctor I couldn’t knead bread without my hands swelling up and hurting for 12 hours and he told me to go on a juice cleanse to break my “food addiction.” But don’t you want your doctors and epidemiologists and public health officials to actually give a shit about what’s causing a huge surge in deadly cancers?

There’s actually a cherry on top of this article (at the literal top) that further underlines how dangerous anti-fat bias is, even for smaller patients. In the anecdotal lede, the patient they follow explains that, when she started having stools bloody enough to send her to the ER, she figured she needed to try a healthier diet. When she started rapidly losing weight, she figured the diet was working. When a doctor flagged her as being severely anemic, she was finally diagnosed with Stage III rectal cancer. The article wastes zero time reflecting upon the horror and irony of her delayed diagnosis.

She thought her diet was working.

A medical establishment that can confuse withering malnutrition with an increase in health? It fails everyone.

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