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November 30, 2012 When Fat People Get Sick One of the consequences of rampant size bigotry, discrimination and bullying in society in general is that it bleeds over to healthcare providers and healthcare concepts. A new study concludes that “There are unacceptable levels of weight bias among UK students training to become nurses, doctors, nutritionists and dietitians.” [trigger warning: this study is not necessarily Health at Every Size] This leads to any number of issues but a major issue is that the misinterpretation of correlational relationships as causational relationships means that people believe that being fat causes diseases. The fact that the media has jumped on this band wagon means that even though the Congressional Budget Office is clear that obesity is NOT the reason for the increase in healthcare costs, people keep insisting that it is. That means that when a fat person gets sick, they not only have to deal with whatever illness they have, but also with the shame of being a “bad fatty” who brought this on themselves, and is increasing everyone’s health insurance etc. And that’s bullshit. And here’s why: First is the issue of correlation vs. causation. My first semester of my first research methods class we had to say “correlation never ever, never ever, never ever implies causation” every day during class. It’s the cornerstone of good research. Correlation means that two things sometimes – but not necessarily always – happen at the same time. Causation means that we can prove that one thing causes the other. Let’s say that every August there are more murders and more ice cream is eaten. We cannot conclude that eating ice cream causes murders. If there are a rash of murders we cannot say that there is an ice cream epidemic. And we cannot conclude that taking ice cream off the shelves will cut the murder rate. They could both be caused by a third factor (maybe heat makes people cranky and they either eat ice cream or commit murder) or they could be completely unrelated and the correlation could be a coincidence. (More thorough explanation is here.) The same diseases that are correlated to obesity are also correlated with being under a lot of stress for a long period of time. Like, perhaps the stress of living under constant stigma with the government waging war on you for how you look. Since no study can control for the effects of stigma on fat people, no study can claim to know that diseases are caused by being fat. Not to mention the fact that there are health issues that cause both weight gain and other diseases, and that both weight and many diseases have strong genetic components. This issue is not nearly so cut and dried as media hacks and people making money from it’s perpetuation would have you believe. There’s no point in speculating how someone got a health problem, or blaming someone for a health problem. They are a person with a health problem, it’s time for them to make decisions about their treatment and have those decisions respected, including the decision of who to tell by the way. I remember people’s outrage that Paula Deen hadn’t been public about her Diabetes – that’s ridiculous. It’s not anybody’s business. Paula Deen has a cooking show and yet she still she doesn’t owe anybody cooking instruction let alone a medical history. There are no such things as “fat people” diseases. Thin people get all the diseases that fat people do. People get to make their own decisions about priority of health, path that they want to take to reach their goals etc. In order to avoid being massive hypocrites, people either support the idea that other people get to make their own decisions about their bodies, health, and habits, and have those decisions respected; or those people must be willing to let anyone who thinks they know better dictate what they eat and how they exercise. Health is multi-dimensional and includes behaviors (past and present), environment, genetics, stress, and more. Some of these components are within our control and some aren’t. We cannot control the end result and if we get a disease we will probably never know for sure exactly why it happened. More to the point, it doesn’t matter. People of all sizes get sick for all kinds of reasons. Once someone is sick it’s time to skip shame, blame, and bullshit and move to getting them the care they choose. If you can’t help get them the care they want or find another way to support them – if you are interested in shame or blame – then, in the words of Henry Rollins, the captain has turned on the sit the f*ck down and shut the f*ck up light. If you are fat and sick there is absolutely nothing to be ashamed of. Nothing. You deserve compassionate care of your choosing. You do not deserve any of the things that our culture’s stigmatization and oppression of fat people might create – that’s the result of bigotry, and that’s not your fault either.