This came up in our monthly subscriber Ask Me Anything. When I break down research I often talk about using absolute risk reduction and statistical significance to determine the efficacy of an intervention. Another number that helps determine efficacy is the Number Needed to Treat (NNT). This number helps us understand how many patients need to be treated with an intervention in order to avoid a single negative outcome. 

You can’t win if you don’t play.

That’s what the PowerBall ad said. I could pay $2 for a ticket and possibly win a $20 million jackpot. Of course, I have a 99.9999997 percent chance of losing which may be why my stats teacher used to say that the lottery was a tax on people who didn’t pay attention in her class.

So why am I going on about the lottery in a newsletter about the intersections of weight science, weight stigma, and healthcare?

Because I hear a similar type of “logic” all the time from the weight loss industry, lay people, even doctors.

I got the following question from reader Naomi

“Thanks for the information on the CDC growth charts. I wonder if you could talk about how to understand them. My pediatrician said that my child is more than 120 percent of the 95th percentile. What the h e double hockey sticks does that even mean? Help!” 

I’m happy to try to explain.

Today we’re going to talk about a new study called whose goal was to assess the “relationship of cardiorespiratory fitness (CRF) and Body Mass Index (BMI) on both cardiovascular disease (CVD) and all- cause mortality risk” by Nathan R Weeldreyer, Jeison C De Guzman, Craig Paterson, Jason D Allen, Glenn A Gaesser, and Siddhartha S Angadi.

There are many ways that weight stigma occurs in healthcare. One that is harmful on multiple levels happens when higher-weight people are blamed for the ways in which healthcare fails them. This occurs when a patient is blamed for being “too big” for something they need. 

I’ve now had eleven different doctors ask me about this article, so let’s talk about it! Here is one of the emails:

“I’m an MD and I just read this article in Medscape about “clinical ob*sity.” Should I be worried? I feel like I should be worried. I understand it hasn’t happened yet, but it seems like one of those things that will happen all at once without any chance to pushback. Any ideas on how to handle this?” 

Regular readers may know that while speaking and writing are my primary work, I’m also a Board Certified Patient Advocate and I sometimes work directly with patients, typically in emergency or complex medical situations. Recently I was advocating for a patient at a cardiology appointment (who has given me permission to share this.) I was waiting outside the treatment room while my patient got settled, near the area where the scale that is used for weigh-ins was located. In this practice each cardiologist has a nurse and the nurse is responsible for getting weight as well as actual vital signs. As I was standing there a nurse brought a patient over and asked them to step on the scale. The patient made an “Ugh” noise and the nurse laughed and said “I know, weighing in is the worst. I postponed my last appointment by two weeks so that I could lose five pounds first.”

At that exact moment I was called into my patient’s treatment room and so I switched my focus 100% to the patient but I am reaching out to start a dialog about this at the practice. 

So, what went wrong, and what go be done better?

I received the following question from reader Jin,

I’m a pharmacist and one of the things I’ve learned from following you over the years is the importance of language. I wanted to ask you about language like “anti-ob*sity” medication and “ob*sity treatment.” I notice that you still use terms like weight loss drugs and I imagine that is on purpose. I’d love to understand more about this. Feel free to make it a Substack post if you’d like.

Thanks for noticing and thanks for asking Jin!  

I received the following question from reader Alina:

I’m a family med doctor and I’ve started seeing lots of publications, even research, using the terms “person with ob*sity” and “person with overw*ight.” I took some CME [Continuing Medical Education] where they said that it was for weight stigma reduction. I’m not sure why, but it just doesn’t feel right at all (Does person with overw*ight even make sense?) I would love to see a newsletter about this.

Thanks for asking Alina, your feeling that something’s not right here is spot on.

There are many aspects of weight stigma within the healthcare system that harm higher-weight people. There is an issue that isn't often discussed that underpins many of the harms that the healthcare system does to higher-weight people.

Research. Or a lack thereof.