Ragen Chastain provides tips for navigating comments rooted in weight stigma and diet culture during the holiday season and year-round, including how to uphold boundaries and respond to surprises.

The hostile environment that marginalised people find themselves in serves as a source of constant stress.

A common attempted “justification” for the healthcare inequalities that fat people face is the idea that fat people shouldn’t get the resources they need if they happen to need more resources than the average thin person. When added to a general focus on profit (especially in the US healthcare system) this leads to staff-to-patient ratios that make it impossible to correctly care for fat patients (for example, having adequate staff to safely turn patients to prevent bed sores or help them ambulate to improve post-surgery outcomes.) It can also mean not having the supplies that these patients need in order to have the best outcomes. Some examples are InterDry to prevent/treat skin fold infections or Hoyer lifts so that they can use a commode and avoid bedpans and chuck changes (both of which are made more difficult and dangerous for the patient and more likely to create negative outcomes when staff-to-patient ratios don’t allow for adequate care, even if the practitioners aren’t coming from a place of weight bias.)

All of this, in turn, can create practitioner bias when they blame higher-weight patients rather than the healthcare system that is leaving both patients and practitioners without what they need.   

When healthcare facilities are allowed to decide that they don’t want to spend the money to give higher-weight people the care they need, or they are not adequately funded to do so, then higher-weight patients suffer. Here again the negative impacts of this are often simply blamed on “obsity.” For example, research on post-operative complication rates will often suggest that “obsity” causes higher complication rates without exploring the ways that these size-based healthcare inequalities may actually be at the root of any elevated rate of complications.

Former Harvard Researcher Faked Sleep Apnea Study

Posted: April 13, 2009

A former Harvard researcher has admitted falsifying a medical study. According to Boston.com, Dr. Robert Fogel has been disciplined by the Department of Health and Human Services (HHS) for faking data in a sleep apnea study funded by federal research grants.

This is the second time in recent months that a medical researcher has been caught falsifying a study. As we reported last month, medical journals have been asked to retract <"https://www.yourlawyer.com/practice_areas/defective_drugs">drug studies involving Vioxx, Celebrex, Lyrica and other drugs that were conducted by Dr. Scott S. Reuben of Baystate Medical Center.

Because of Reuben’s “research”, it had become routine for doctors to combine the use of painkillers like Celebrex and Lyrica for patients undergoing common procedures such as knee and hip replacements. Not surprisingly, Reuben has strong ties with the pharmaceutical industry. According to the Journal, he had been a paid speaker on behalf of Pfizer – the maker of Lyrica and Celebrex – and it paid for some of his research. Wyeth provided $10,000 in grant money to. Reuben from 2001 to 2003, the Journal said. Merck also funded some of Reuben’s work.

Fogel also has ties to the pharmaceutical industry. Since leaving Harvard, Fogel has been employed by Merck Research Laboratories, where he is now director of clinical research at its respiratory and allergy division in Rahway, N.J.

According to The Wall Street Journal, in 2006 Fogel apparently confessed to his former supervisor at Harvard’s Brigham and Women’s Hospital that he had falsified data in the 2003 sleep apnea study. According to the Office of Research Integrity at HHS, Fogel:

• Changed/falsified roughly half of the physiologic data
• Fabricated roughly 20% of the anatomic data that were supposedly obtained from Computed Tomography (CT) images
• Changed/falsified 50 to 80 percent of the other anatomic data
• Changed/falsified roughly 40 to 50 percent of the sleep data so that those data would better conform to his hypothesis.
• Published some of the falsified and fabricated data in an abstract in the journal Sleep in 2001.

According to Boston.com, Fogel falsified the data so that it would conform with his hypothesis. The falsified paper concluded that the shape and volume of a person’s airway combines with obesity to make those patients more likely to suffer sleep apnea.

According to the Office of Research Integrity at HHS, Fogel has entered into a voluntary disciplinary settlement, in which he agreed, among other things, to be excluded from research funded by the US Public Health Service for three years unless he is actively supervised.

Fogel told the publication The Scientist that since his admission, Harvard’s office of research integrity reviewed 30 studies in which he was involved. He told The Scientist that the 2003 sleep apnea study was the only one that included fake data.

“What I did was obviously horrendously wrong,” Fogel told the magazine. “I never really thought through the consequences, and once I did this I got myself into a loop that I found I couldn’t get out of.”

Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.

Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.