In part 1 Dr. Zed Zha discussed a patient experience that elucidated the issues that happen when assumptions are made about the relationships between weight and health. In part 2 she began a discussion of four conditions that must be met to rigorously prove the theorem that weight loss lowers inflammation - “weight ↓ → inflammation ↓”. In part 3 of this 4-part series, she’ll discuss the third and fourth conditions.

In November I responded to readers’ questions about a paper that was being teased to the media suggesting a new definition for “ob*sity.” The paper is now out, and it’s even worse than I thought. I’ve had a lot of requests to write about it and there is a ton of media on it right now (though, sadly, not a ton of any kind of critical/investigative journalism.)

As regular readers know, I am in the middle of a four-part series with Dr. Zed Zha about weight and inflammation. I’m pausing that today to give an overview of the issues with this article from the initial analysis that I’ve completed. After the final two pieces of the inflammation series are published, I’ll have a deep dive into the massive conflicts of interest and methodological issues with this paper.

In Part 1, Dr. Zed Zha (M.D. and Fellow of the American Academy of Family Physicians) discussed a patient experience that illuminated the need to look beyond simple assumptions about weight and inflammation. In part 2 she will begin a deep dive into the research around weight, weight loss, and inflammation.

In discussions around weight and health, the concept of “inflammation” almost always arises. This is a complex discussion and so I am thrilled and honored to share a four-part series in which Zed Zha, MD, FAAFP (Fellow of the American Academy of Family Physicians) and I explore assumptions around weight, weight loss, and inflammation.

Here now, Part 1 - Patient Story - as told by Dr. Zha

On Saturday I posted a piece helping patients navigate weight stigma in healthcare, today I want to offer some support to healthcare providers to avoid creating weight stigma.

Higher-weight people too often find themselves in healthcare situations where they are being treated poorly/unequally because of weight stigma. These situations are, sadly, too numerous to count and in some cases need to be addressed in very specific ways. In many cases though, there are some standard responses that higher-weight patients and/or those advocating for them can use to try to get appropriate care.

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.