Big Fat Science

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bigfatscience
bigfatscience

Is there a link between gestational weight gain and pregnancy outcomes?

If you are fat and you have ever been pregnant, then you know that healthcare providers often demand that fat pregnant people carefully monitor their diet and exercise regularly to avoid gaining “too much weight.” 

This pressure is applied based on the assumption that “excess” weight gain leads to worse outcomes for both the pregnant person and the child. But is this true?

To test this hypothesis, researchers assigned more than 250 fat pregnant people to one of two groups. The intervention group followed a rather intensive eating and exercise plan, including weekly coaching sessions and frequent monitoring of eating and exercise habits. The control group received the usual care offered to pregnant people.

The intervention group did gain about 5lbs less than the control group in the final 24 weeks of their pregnancies. 

But there were no observed benefits of the intervention for rates of gestational diabetes, preeclampsia or gestational hypertension, or high birth weight. In addition, the intervention group experienced a 50% increase in their rates of cesarean section.

When considered in light of the overall mixed results of correlational research attempting to link gestational weight gain with pregnancy outcomes, these experimental results suggest that doctors are not practicing evidence based medicine when they pressure fat pregnant people to limit their weight gains during pregnancy. And in fact, such recommendations may even harm fat pregnant people by dramatically increasing their risk of cesarean section.    

bigfatscience

The results of a meta-analysis nearly 50 studies with over 6000 participants confirms the results I described above. For fat pregnant people without diabetes (subgroup analysis found in the results), “lifestyle” interventions caused an approximately 5lb reduction in gestational weight gain. But once again, there were no observed benefits for maternal or fetal outcomes. 

The meta-analysis did observe some low quality evidence (read: unreliable evidence) indicating that dietary interventions alone may reduce the risk of gestational hypertension among fat pregnant people.

Yet as the authors admit, more extreme restrictive dieting during pregnancy is associated with an increased risk of negative infant outcomes, including birth defects, and coronary artery disease, metabolic syndrome, breast cancer, and diabetes later in life. Thus, doctors who pressure fat pregnant people to control their weight during pregnancy risk these and other known negative infant outcomes in exchange for no clear benefits in return. 

pregnancy weight gain
heavyweightheart
heavyweightheart

Friends, foes, and innocent bystanders, I’m a disabled cancer patient in grad school and I recently lost my departmental scholarship, despite the fact that I have a 4.0 and my financial need hasn’t changed. This is a big loss, especially because a fun quirk of my university is that I pay twice as much for my degree if I go less than full time, which is an accommodation I absolutely need as a sick person.

Please know that my basic needs are met, and I know this has been a hell of a time for everyone, so only give as you’re comfortable. But if you have extra, and you’ve gotten something from my 7 years of “blogging” (lol) here, or you want to support the community-based peer work I’m always engaged in, please consider giving via my Patreon!

Thank you and kol tuv 💗

sciencedirect.com

The obesity wars and the education of a researcher: A personal account

A naïve researcher published a scientific article in a respectable journal. She thought her article was straightforward and defensible...

In 2005, the moral panic about “obesity” was ramping up, and there was big money at stake, all resting on the idea that fat kills. 

Well, Flegal’s research pulled the rug out from under those views, not only showing that fatness was associated with only 1/3 the associated deaths that previous research estimated (and even that smaller estimate can be critiqued), but also showing that being “overweight” conferred no increased risk at all, and may even be a protective factor against all-causes mortality relative to lower weight categories. 

The reaction to these results – which have been verified over and over again in the years since and in decades of prior research – was swift and vicious. Powerful people launched a smear campaign against Flegal and her work:

Her research became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and maneuvers, and complaints to her employer. The goal appeared to be to undermine and discredit her work.

Flegal’s first-hand account of her experience illustrates how power and stigma pervade and bias weight science. This can have a chilling effect:

One of the effects of the public insults may also have been to deter or intimidate other investigators. An anonymous researcher was quoted elsewhere as saying if character assassination is the price for publishing data that contradicts established beliefs, fewer academics will be willing to stick out their necks and offer up fresh thinking.

And all of this is terrible for science and horrific for Flegal. But when the dust settles, who is really hurt? Fat people. Always.

weight science science criticism medical bias medical discrimination
bigfatscience

Anonymous asked:

If I have a set point, why did I gain 30 lbs in the past 5 years without changing my lifestyle at all?

bigfatscience answered:

Are you under age 25? People don’t typically reach their final-for-real adult weight until then.

Did you lose weight right before the weight gain began? Basically everyone who loses weight regains the weight they lost within 3-5 years, and 75% will regain more weight than they initially lost.

Are you under-eating? If you have been eating less than your body requires (between 2500 and 3500+ depending on your size/activity level), then your body may be prioritizing fat gain as part of the natural adaptation to sub-clinical or intermittent starvation.

Do you have a health condition that affects metabolism? PCOS, type II diabetes, and other health conditions can cause your metabolic system to prioritize weight gain.

Do you have a sleep disorder? Sleep apnea causes stress, and the body often adapts to stress by increasing the size of the fat organ (did you know that the fat organ is also a metabolic organ that is particularly active in times of stress?)

Are you under a lot of stress? Stress from social marginalization, poverty, and other adverse conditions can cause the fat organ to grow as your body attempts to protect itself by altering your biochemistry.

Are you experiencing food insecurity? Inconsistent access to food predicts weight gain.

I could go on, but the point is that weight homeostasis depends on an environment that provides adequate and consistent access to food and a low level of stress (among other things). Mess with any of these factors, and your weight may change as your body tries to adapt – even if you don’t change your eating or exercise habits at all.

(And pssst: this isn’t necessarily a bad thing).

bigfatscience

Someone demanded a source for the energy requirements I cited above.  

Objective assessment using the doubly-labeled water method demonstrates that adult women with a BMI in the “normal” range require about 2400 kcal per day on average, whereas women with a BMI in the “overweight” range require about 2750 kcal per day on average. However, individual needs also vary by about 400 kcal in either direction depending on height, age, and activity level. So if you are a young, tall,  fat, active women, this study suggests that you may require well over 3000 kcals per day to meet your energy needs.

[open access source; results in Table 4 in the row labeled “TEE”; 1 KJ = 0.24 kcal] 

Not open access but the same results: [source] [source]

bigfatscience

This seems relevant again as people experience with body changes during the pandemic.

metabolism weight gain

Anonymous asked:

Hi, I wanted to ask if you have any resources/advice for dealing with relapses due to grief specifically. I'm used to fighting my restriction daily through the kind of depression that has followed me for a decade, but I recently suffered a personal loss, and I find myself unable to make myself eat. Unfortunately, when I try to google resources, everything is about "how to stop overeating" or "how to eat healthy" while depressed. I would just like to be eating, full-stop.

I’m sorry for your loss. Falling back to the basics of early re-feeding may be the best approach in situations where it is difficult to eat. That means focusing on highly palatable, easy to digest, energy dense foods. Milkshakes, french fries, pizza, chips, candy, juice and smoothies, cream soups etc. Liquids can be especially useful because it is so easy to consume them even when you are tired and depressed. Some people like those god-awful “energy” drinks, but they trigger dieting shit to me, so I don’t use them. Drinking lots of fruit juices or even pop can help instead.

Remember: eating something is better than nothing. Try to set aside any eating perfectionism if that’s an issue for you (e.g., “if I don’t cook a while meal it doesn’t count!”) and go for eating pragmatism. Yes, making a sandwich or a meal is overwhelming. But can you eat a handful of chips and nuts, and a cup of fruit? Chug a class of juice? That is a win. 

And if you can get any family or friends involved it also helps. When I am struggling, my partner will just put food in front of me periodically and it really makes all the difference.

In recovery, we call this kind of thing “mechanical eating”, meaning it is about the mechanics of putting food in your yob every few hours, it is not about pleasure or desire. It is about keeping your meat sack alive.

Self talk also helps. “Your body needs this food. I deserve to eat. Food is medicine. My body deserves care and nourishment.”

Finally, remember that undernourishment is a huge trigger for depression. For me, eating regularly is the most important anti-depressant I have ever found. So if you can’t find any other reason to eat, eat, eat, maybe that can help, too.

Anonymous asked:

Hi! I'm a thin person and I just saw a tiktok about seat belt extenders that suggested thin people get them too for any fat passengers. I work in mental health and sometimes transport fat clients in my car who have struggled with the seat belt, so I want to get one, but I'm worried about the awkwardness of offering it to people. Do you have any advice for this, especially for people that I know are dealing with body image struggles?

I would just buy one and default to having it installed in the car at all times. It just snaps into one end of the seatbelt, and if thin people don’t want to use it for some reason they can remove it and put it back in when they get out. If anyone asks why it’s there, you can just say, “The seatbelts in my car are ridiculously short!”

elemental.medium.com

How Fatphobia Is Leading to Poor Care in the Pandemic

Weight stigma in health care can impact the care people get for Covid-19
Virginia Sole-Smith

On October 24, Amanda Martinez Beck of Longview, Texas, told her husband: “You need to take me to the ER.” Their whole family had tested positive for Covid-19 a week earlier — Beck’s husband, Zachary, is an English professor and their best guess is that he brought the virus home from campus, or that Beck picked it up at the community pool where she sometimes swims. Within a few days, Zachary and their four children were all on the mend. But despite prescription albuterol, steroids, and antibiotics, Beck was still coughing and sleeping in a recliner at night because staying upright made it easier to breathe. Around 10 a.m. that Saturday morning, her blood oxygen level was just 92%. (A healthy adult should measure close to 100.) Beck packed a bag and Zachary drove her to their nearest emergency room. He couldn’t stay; the Becks’ children are ages four, five, seven, and eight, and they couldn’t call a babysitter since the family was still in quarantine. So Beck kissed them all goodbye, trying not to panic. “My husband thought he was never going to see me again,” she says now.

Beck had another fear underlying her anxiety about her Covid-19 prognosis: Would she, a fat activist and author of Lovely: How I Learned to Embrace the Body God Gave Me, get the medical care she needed? “Fatphobia is an ever-present concern when you’re dealing with medical issues,” she says.

COVID-19 medical discrimination medical abuse healthism ableism