I got a call at 8.30am today (Sept 11th 2014) to ask if I’d go on Radio 5 live between 10-11am to talk about ‘the fat shaming’ story. What fat shaming story?!
The Daily Mail headline was “Telling someone they’re fat makes them eat MORE: People made to feel guilty about their size are six times as likely to become obese.” The Telegraph went with “Fat shaming ‘makes people eat more rather than less‘”. The Guardian got a teeny bit more accurate, but not much, with “‘Fat shaming’ does not help people lose weight, study finds.”
Here’s the link to the original study (Dr Jackson very kindly whizzed me over a copy this am).
The article & press release
Please note from the outset the title of the study and the objective set out by the researchers.
Title: “Perceived weight discrimination and changes in weight, waist circumference and weight status” (my emphasis).
Objective: “To examine associations between perceived weight discrimination and changes in weight, waist circumference and weight status” (my emphasis again).
The press release was undeserving of an academic study – the usual headline grabbing, sensationalist, misleading at best and disingenuous at worst, which we have sadly come to expect. “‘Fat shaming’ doesn’t encourage weight loss.”
The study was not an intervention. It was an observational study using the English Longitudinal Study of Ageing (ELSA) for data. As the ELSA is a study of people aged 50 years or older and as the initial sample of participants was drawn from responses to the Health Survey for England (HSE) in 1998, 1999, and 2001, this is not a study of the general adult population. This was a study of people with an average age of 66 at baseline.
2,944 people were studied over 4 years.They had BMI and waist circumference recorded in 2008-09 and 2012-13 and they were asked for their perceived weight discrimination in 2010-2011 in response to five (subjective) questions.
‘In your day-to-day life, how often have any of the following things happened to you:
1) you are treated with less respect or courtesy;
2) you receive poorer service than other people in restaurants and stores;
3) people act as if they think you are not clever;
4) you are threatened or harassed;
5) you receive poorer service or treatment than other people from doctors or hospitals.
On the basis of these questions, 5% of participants perceived that they had experienced weight discrimination. The study has just become a study of 150 people perceiving discrimination against a control group of 2,794. This is not a study of weight discrimination among 2,944 people.
The perception of weight discrimination ranged from 0.7% in the normal weight category to 35.9% of those classed morbidly obese. Men and women reported similar levels.
This is interesting. I see two shop assistants chatting rather than helping me and I just think that they’re rude. If I were morbidly obese, would I perceive that they were treating me differently because of my size?
Weight: Those who perceived weight discrimination started the study almost 22kg heavier than those who didn’t.
Those who reported weight discrimination gained, on average, wait for it, 0.95kg – not even 1 kilogram! During a four year study.
Those who didn’t report weight discrimination lost, on average, wait for it 0.71kg – that’s about how much dark chocolate I eat in a week. During a four year study.
Another interesting thing – which was completely swept under the carpet – check figure 1 in the paper. There were 6 categories that were studied: normal weight at baseline; overweight at baseline; obese (BMI 30 or higher); obese class I (BMI 30-34.9); obese class II (BMI 35-39.9); and obese class III (BMI 40 or higher). The only groups that gained during the study were the normal weight and overweight people who perceived weight discrimination. All the obese categories – whether they perceived discrimination or not – lost weight on average during the study and the normal/overweight people who did not perceive discrimination lost weight or experienced no change.
Table 1 tells us that there were 7 normal weight people who perceived weight discrimination and 15 overweight people who perceived weight discrimination. Today’s world-wide nonsense is thus based on the perceptions and negligible weight change for 22 people.
From the numbers in the paper, I calculate that the Daily Mail headline about “six times more likely to become obese” derives from the following… The paper reports that “Among participants who were not obese at baseline, perceived weight discrimination was associated with higher odds of becoming obese (25.2 vs. 4.4% OR=6.67).” There were only 22 participants who were not obese at baseline who perceived weight discrimination. To achieve 25.2%, 5.5/22 of these became obese (not sure how). There were 2,102 participants who were not obese at baseline who didn’t perceive weight discrimination. To achieve 4.4%, 92.5/2,102 became obese. So, 5.5 people became obese in one group and 92.5 in the other group. The significant thing that differs is the group size. A couple of people makes a big difference in the group with 22 people. Plus – two thirds of the small group were already overweight, compared with half the large group. It is far more likely that overweight people became obese than normal weight people – in a four year period – and thus the group of 22 had another factor stacked against them. Do you think 5 people justify the Daily Mail headline?
Waist circumference: Those who perceived weight discrimination started the study with an almost 20cm greater waist circumference than those who didn’t.
Those who reported weight discrimination gained, on average, wait for it, 0.72cm – not even a centimeter! During a four year study.
Those who didn’t report weight discrimination lost, on average, wait for it 0.4cm – I doubt you could measure my waist to a 0.4cm degree of accuracy from one day to the next. Again, during a four year study.
I mean – seriously journos – do you ever look beyond the press release?!
Association, not causation.
AND this is – as always – association not causation.
Dear Daily Mail, we have no evidence that anyone was told that they were fat, just that they perceived being treated differently.
Dear Daily Mail & Telegraph, we have no evidence that people ate more. We do have evidence that obese people lost weight whatever their perception of weight discrimination. Maybe they ate less? Maybe they ate more, but better? Who knows.
Dear The Guardian, obese people did lose weight, whether ‘fat shamed’ or not.
Nothing MADE 150 people do anything. There was an association between gaining less than a kilo and losing less than a kilo and the subjective answers to 5 questions in 22 normal weight/overweight people and not even this association in 128 others.
I have been told by many people of all ages, male and female, about the abuse experienced by obese people – particularly morbidly obese people. During the Radio 5 live discussion, “Zanita” made me gasp out loud when she shared comments that had been directed towards her. “Jenny” had been insulted by someone close to her. I’ve just been on BBC Radio Tees and Mike Parr shared comments made to him. Such behaviour is completely unacceptable, rude and ignorant.
Insulting people for any personal attribute – gender, age, diversity, size, attire, anything – is gross human behaviour and it says way more about the abuser by a margin that the abused. I think that people know if they need to lose weight. I know that they want to lose weight. I believe that our current eat less/do more advice sets them up to fail. I think that food is addictive and that obesity is a complex problem, which no insult or abuse is going to help.
BUT – a bag of sugar either way affecting 22 people in a study who perceived that they had been treated differently between two weigh-ins four years apart. Really?!
p.s. (This was the Monday newsletter for 15 September 2014)