Wednesday, March 5, 2008

Maybe it's not the weight!

From Rethinking Thin: The New Science of Weight Loss--and the Myths and Realities of Dieting, by Gina Kolata:
By then he was truly fat, weighting 202 pounds...he was only 5 feet 5 inches tall..."I have been compelled to go down stairs slowly backwards, to save the jar of increased weight upon the ankle and knee joints, and been obliged to puff and blow with every slight exertion, particularly that of going up stairs."

Okay, look:
I am fatter than that. I am shorter than that. I HAVE ARTHRITIS! And I do not have to "go down stairs slowly backwards to save the jar of increased weight" blah blah blah. If the guy quoted was having those issues, it wasn't his weight causing it. It's said that he changed his diet, and "began to feel better immediately". Well, he cut out starches and sugars. He probably had diabetes (this was in the 1860s, so no insulin or blood sugar testing), and once his diet change got that under control, the symptoms of joint pain and shortness of breath went away.

I love how people talk about fat people's joints getting so much damage from omg fat. Your joints are MORE at risk if you're engaging in a lot of athletic activity; doctors started seeing a huge increase in sports-related injuries, and I've seen some say that they are seeing 70-year-old joints in 30-year-old people because of our national obsession with vigorous exercise. (I am sorry that I don't have a link for that; I thought I did, but can't find it now). It's funny, too, because when I look up information about this, they talk about how "All of that running, jumping, and pounding can easily damage tendons, cartilage, or bone", then, invariably, add "but omg don't be fat too, because fat is bad" as almost an afterthought.

(But wait, I thought we were all supposed to exercise ourselves to death so we didn't get fat, because fat is bad? It looks like you're doomed either way, and, honestly, I'd rather take the less painful route to bad knees.)

I have a better idea than all of these dire warnings: How about, in each individual case, we determine the actual cause of the joint pain, and deal with it that way? And, by actual cause, I mean, the doctor doesn't look at a fat person and say, "Your joint pain is because you are disgustingly fat. Eat less and exercise more. Goodbye," without so much as an x-ray or even looking at the joints in question. I wonder if my aunt could have been spared knee replacements if the doctors had caught her rheumatoid arthritis before she entered Stage IV, and had the cartilage in her knees completely destroyed--not by her being too heavy, but by her immune system going haywire and eating up the cartilage. I am just thankful that they caught it when they did, before the RA caused her organs to fail, but still.

As for being out of breath? I had asthma when I was a skinny child and teen. Because it was unmanaged, I had to deal with asshole gym teachers screaming insults at me for not being able to run a mile without wheezing and coughing. Now that I'm fat, of course, people will tell me I'm "out of shape". No, dumbasses, my airways are inflamed, and I need medicine to open them up. Asthma affects people of all sizes. If someone makes a dietary change, and their breathing is improved, don't be so quick to assume it's fat-related. My asthma improved remarkably when I cut certain allergens out of my diet (and I haven't had a major emergency since I eliminated peanuts from my life).

It just annoys the hell out of me when people assume that TEH FAT is causing the problem, when it isn't the only factor involved.


vesta44 said...

I was diagnosed with arthritis in my knees when I was 34 (and told I was too young to have arthritis). Now, most of my aunts and uncles have arthritis, my parents have it, and all of my grandparents had it. I've also had a lot of injuries to one knee (falling a lot on that knee when I was a teen and did a lot of roller skating). But was any of that considered a cause? Nope, it was because I was too fat, and my fat was putting too much stress on my joints, and the arthritis would get better if I just lost 1/2 of my body weight. Now, if my weight was putting too much stress on my joints, why didn't I have arthritis in my ankles and hips too (and both of my ankles have been broken, one roller skating, and one when I slipped and fell on ice)? I knew back then that it wasn't my weight causing the arthritis, so I just agreed and went on my merry way with the prescription for NSAIDs. I still hear how my weight is aggravating my arthritis, but I tell them until they can come up with a fool-proof, permanent, safe way to lose weight, they had better think of something else to alleviate the pain, because weight loss ain't happening.

Mercurior said...

i have 2 broken ankles, i used to play rugby league, like american football but tougher. The i slipped on some mud and my bone broke in my ankle, after 4 trips to 2 different hospitals (they had closed the plastering room in my local), one saying broken one it isnt. and it ended up healing broken. now i have a weakness in it, then a few years later i over compensated on the other. that went.

the rest of my joints are fine.. but i am waiting for them to say constant pain in the tendons is a sign of being fat, or the other crap they say. Sometimes its a case of which came first with me, was i going to be fat with or without my bad ankles, i would never be skinny, i would still have been classed as obese if i followed the bmi of today.

Karen said...

vesta44: I think, in your position, I'd have more fun telling them that if they could find me a 25% chance of safe, permanent weight loss, but that's because, if you haven't been inundated with the 95% ineffective rate, it sounds so easy. I mean, c'mon, most doctors wouldn't recommend any procedure with a 75% fail rate unless your other option was certain, immediate, death, and even then they wouldn't push it just offer. But I'm contrary.

M. said...

I had my first knee surgery at twelve, thanks to soccer as a child. At twelve is also when I was diagnosed with arthritis.

Which is why I just laugh at people who tell me my knee problems are all because of my weight. Both parents have arthritis, my grandparents have arthritis, even the grandmother who starved herself thin on Weight Watchers for 30 years (I cannot think weighing every morsel of food that enters your body is anything but an eating disorder).

But, yup, my arthritis is all because I'm currently a size 22.

Anonymous said...

I never had bad knees my whole fat life until I lost weight and started jogging. I managed to be a runner for about three weeks when the hideous pain set in. I went to an orthopedist who blamed the pain on my "jelly thighs" (bless the PA who said, "What's wrong with you? She just lost 60 pounds and she RUNS!") and diagnosed me with chondromalacia that three doctors have informed me will eventually require surgical intervention. Now I have regained that weight and while I still have bad patches with my knees, they don't hurt anywhere near as badly as they did when I was exercising an hour and a half every day. Also I eat actual fat in my diet, so I probably have more well-lubed joints as a result! (I have no idea if that's true, but it feels right so I'm going with it.)

So, fuck you, mainstream medicine. Diet and exercise ruined my knees, and my lovely fat has made them better. Or at least made it possible to live with it.

Nan said...

A few years ago I was hired as a contract writer to do some informational pieces on medical technology. One dealt with artificial joints (hips, knees, whatever). Before starting the research I assumed the typical patient would be old ladies who'd fallen and destroyed hip joints that way. Nope. Most patients getting joints replaced were men in their 40s who destroyed their joints through rough contact sports (e.g., football) or addictions to running. Osteoarthritis is caused by wear and tear, not just compression, so I figure that "your weight is going to destroy your knees" line is total crap.