Wednesday, November 24, 2010

Third Annual Turkey Awards: Jumping To Conclusions

Well, it's that time of year again.....time for my Annual Turkey Award!

This is an award I created to annually "honor" fat-phobic healthcare providers everywhere.  And believe me, there are plenty of them...a veritable cornucopia of turkeys to choose from for this delightful award.

This year, I want to highlight the caregivers who have made the leap of logic that if a fat woman is at increased risk for a complication, that means there's a GUARANTEE that she will experience that complication. 

Like the recent commenter to my blog who was told that at her size, she WOULD have a deformed baby.  Not a reasoned discussion about possible increases in risk for birth defects or ways to possibly lower that risk, but the doctor telling her that she WILL experience a "deformed" baby, simply because of her size.  Never mind that the chance is actually quite low in terms of actual numbers, the doctor just concluded that it WOULD happen because of her weight.

Or another reader who recently sent me an email about her first pregnancy appointment, where she was lectured about her fat and basically informed she "should neither expect or deserve to have a healthy baby." 

Or there are the the doctors who tell fat pregnant women that they WILL get pre-eclampsia or they WILL get gestational diabetes during their pregnancies.  No discussion of actual numerical risks (which show that the risk, while increased, is still relatively low), no discussion of things they might do to help mitigate that risk ─ just the assumption that these complications WILL occur in all women of size.

[Yes, there are increased rates of PE and GD in women of size, but there is NO study that shows a 100% rate of pre-eclampsia or gestational diabetes in "obese" women, "morbidly obese" women, or even "super-obese" women.....not even close.]

Or there's the recent spate of doctors telling "obese" women that if they try to have a VBAC (Vaginal Birth After Cesarean), they, their baby, or both WILL die (or have a very low chance of survival).  Never mind that there's NO actual evidence to support an increased risk for maternal or fetal death among fat women trying for a VBAC; who needs evidence?  They just know that it's far too dangerous for fat women to even try and therefore fat women shouldn't even be allowed the choice.

This is one of the major problems with over-emphasis on the risks of "obesity" in public health campaigns. People begin getting a distorted picture of the actual numerical risk.

In time, a numerically-low-but-somewhat-increased-risk for a complication somehow gets transformed into a widespread perception that ALL fat people will experience that complication and eventually the perception develops that DEATH will be the inevitable result.

This exaggerated ramping of risk perception occurs even among healthcare providers, who really ought to know better, and in the end, results in people's choices and autonomy being taken away from them.

It's not that we cannot discuss possible risks.  Of course we can; that's an important part of the healthcare conversation.  However, public health discussions about "obesity" have gone from discussing possible risks realistically and without judgment, to making sweeping generalizations and exaggerations of risk in the public's mind, to scapegoating, barbaric scaremongering, and suspension of basic rights by healthcare professionals.

You know things have gone too far when even healthcare professionals are believing the scaremongering sensationalism that goes against every bit of science and reason that they should have been trained to employ, and when they suspend every sense of medical ethics they have been taught.

*Turkey image from Wikimedia.


Ashbet said...

You know it's (not really) funny -- I had pre-eclampsia and hyperemesis gravida (for the full 9 months of pregnancy, to the point that my kidneys almost shut down and I needed IV feedings for a while.)

At the time, I weighed all of 125 pounds (at 5'8".)

This business of trying to frighten women with inflated statistics is patronizing bullshit. And I agree with a comment that I saw recently comparing the doctors' attitudes with eugenics. Ugh.

Ivriniel said...

I've read a couple of times on the blog now Doctors saying that women with high BMI's would be at a higher risk of having a child with a deformity. What is this based on? Admittedly, I am not a medical professional, but I do have a degree in the biological sciences, and I'm having a hard time seeing what the possible link could be here.

Well-Rounded Mama said...

This is actually a blog post (really, a series) I'm working on now.

There are studies that show a higher rate of Neural Tube Defects in women of size. Not all studies have found this, but enough have that there is probably an association.

The question is why. No one knows, and no one is trying to find out. Their solution is always lose weight, and nothing else. Yet many women of size do not have babies with NTDs. Why do some and not others, if obesity is the cause? It has to be more complex than that.

Some of the speculated causes include blood sugar imbalances, insulin resistance, low folic acid/folate stores, dieting, metabolic syndrome, and many others.

Stay tuned for more on this from the blog. I've been working for a while on this series but it's a big one, so it takes a while to prepare adequately. Keep your eyes peeled for more.