Fat’s Real Barriers To Health
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Fat Justice In Healthcare
This is Aubrey Gordon, an author, podcaster, and fat justice activist. What does that mean?
When it comes to healthcare, we previously covered some ideas very similar to her work, such as how…
There’s a lot of discrimination in healthcare settings
In this case, it often happens that a thin person goes in with a medical problem and gets treated for that, while a fat person can go in with the same medical problem and be told “you should try losing some weight”.
Top tip if this happens to you… Ask: “what would you advise/prescribe to a thin person with my same symptoms?”
Other things may be more systemic, for example:
When a thin person goes to get their blood pressure taken, and that goes smoothly, while a fat person goes to get their blood pressure taken, and there’s not a blood pressure cuff to fit them, is the problem the size of the person or the size of the cuff? It all depends on perspective, in a world built around thin people.
That’s a trivial-seeming example, but the same principle has far-reaching (and harmful) implications in healthcare in general, e.g:
- Surgeons being untrained (and/or unwilling) to operate on fat people
- Getting a one-size-fits-all dose that was calculated using average weight, and now doesn’t work
- MRI machines are famously claustrophobia-inducing for thin people; now try not fitting in it in the first place
…and so forth. So oftentimes, obesity will be correlated with a poor healthcare outcome, where the problem is not actually the obesity itself, but rather the system having been set up with thin people in mind.
It would be like saying “Having O- blood type results in higher risks when receiving blood transfusions”, while omitting to add “…because we didn’t stock O- blood”.
Read more on this topic: Shedding Some Obesity Myths
Does she have practical advice about this?
If she could have you understand one thing, it would be:
You deserve better.
Or if you are not fat: your fat friends deserve better.
How this becomes useful is: do not accept being treated as the problem!
Demand better!
If you meekly accept that you “just need to lose weight” and that thus you are the problem, you take away any responsibility from your healthcare provider(s) to actually do their jobs and provide healthcare.
See also Gordon’s book, which we’ve not reviewed yet but probably will one of these days:
“You Just Need to Lose Weight”: And 19 Other Myths About Fat People – by Aubrey Gordon
Are you saying fat people don’t need to lose weight?
That’s a little like asking “would you say office workers don’t need to exercise more?”; there are implicit assumptions built into the question that are going unaddressed.
Rather: some people might benefit healthwise from losing weight, some might not.
In fact, over the age of 65, being what is nominally considered “overweight” reduces all-cause mortality risk.
For details of that and more, see: When BMI Doesn’t Measure Up
But what if I do want/need to lose weight?
Gordon’s not interested in helping with that, but we at 10almonds are, so…
Check out: Lose Weight, But Healthily
Where can I find more from Aubrey Gordon?
You might enjoy her blog:
Aubrey Gordon | Your Fat Friend
Or her other book, which we reviewed previously:
What We Don’t Talk About When We Talk About Fat – by Aubrey Gordon
Enjoy!
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Severe Complications for Pregnant Veterans Nearly Doubled in the Last Decade, a GAO Report Finds
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ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Series: Post-Roe America:Abortion Access Divides the Nation
After the Supreme Court overturned Roe v. Wade, ending nearly 50 years of federal protection for abortion, some states began enforcing strict abortion bans while others became new havens for the procedure. ProPublica is investigating how sweeping changes to reproductive health care access in America are affecting people, institutions and governments.
Over the past decade, the rate of veterans suffering severe pregnancy complications has risen dramatically, a new federal report found.
Veterans have raced to the hospital with dangerous infections, kidney failure, aneurysms or blood loss. They’ve required hysterectomies, breathing machines and blood transfusions to save their lives. Between 2011 and 2020, 13 veterans died after such complications.
The report found that among people getting health care benefits through the Department of Veterans Affairs, the rate of severe complications nearly doubled during that time, from about 93 per 10,000 hospitalizations in 2011 to just over 184 per 10,000 hospitalizations in 2020. Black veterans had the highest rates.
The report, which was put together by the Government Accountability Office, also made recommendations for reducing the problem, which focus on conducting more routine screenings throughout pregnancy and in the postpartum period.
“It is imperative that the VA help ensure veterans have the healthiest pregnancy outcomes possible,” the report said, highlighting the increasing number of veterans using the agency’s maternity benefits as well as the troublesome complication rates faced by Black women.
The report’s findings are an unfortunate trend, said Alyssa Hundrup, director of health care at the GAO. The office analyzed data on 40,000 hospitalizations related to deliveries paid for by the VA. It captures a time period before 21 states banned or greatly restricted abortion and the military was thrust into a political battle over whether it would pay for active service members to travel for abortion care if a pregnancy was a risk to their health.
Hundrup, who led the review, said the analysis included hospital records from days after delivery to a year postpartum. The report was mandated after Congress passed a law in 2021 that aimed to address the maternal health crisis among veterans. The law led to a $15 million investment in maternity care coordination programs for veterans.
The report recommended that the VA analyze and collect more data on severe complications as well as data on the mental health, race and ethnicity of veterans who experience complications to understand the causes behind the increase and the reasons for the disparity. The report also states that oversight is needed to ensure screenings are being completed.
Studies show there’s a connection between mental health conditions and pregnancy-related complications, VA officials said.
The report recommended expanding the screening questions that providers ask patients at appointments to glean more information about their mental health, including anxiety and PTSD symptoms. It urged the VA to review the data more regularly.
“You don’t know what you don’t measure,” Hundrup said in an interview with ProPublica.
The VA health system, which historically served a male population, does not provide maternity care at its facilities. Instead, the agency has outsourced maternity care. But when patients were treated by those providers, the VA failed to track whether they were getting screened for other health issues and mental health problems.
Officials hope the improved data collection will help the VA study underlying issues that may lead to complications. For example, do higher rates of anxiety have a connection to rates of high blood pressure in pregnant people?
VA officials are working with a maternal health review committee to monitor the data as it is gathered. The agency recently conducted its first review of data going back five years about pregnancy-related complications, said Dr. Amanda Johnson, acting head of the VA’s Office of Women’s Health, who is overseeing the implementation of the report’s recommendations.
The VA has created a dashboard to monitor pregnant veterans’ health outcomes. The VA’s data analysis team will also examine the impact of veterans’ ages on complications and whether they differ for people who live in urban and rural areas.
VA officials will begin to review mental health screenings conducted by maternal care coordinators in March. The coordinators advocate for veterans, helping them between health care visits, whether their providers are inside or outside the VA.
Johnson said that reducing racial and ethnic disparities is a priority for the agency. In 2018, ProPublica published “Lost Mothers,” a series that shed light on the country’s maternal health crisis. Studies have shown that in the general population, Black women are three times more likely than white women to die from pregnancy-related complications. While deaths made up only a small portion of the bad outcomes for Black veterans cited in the report, VA care could not spare them from elevated rates of severe complications. Johnson said the maternal health crisis also persists within the VA.
“There is a disparity,” Johnson said. “We are not immune to that.”
Research shows pregnant people who have used the VA’s coverage have higher rates of trauma and mental conditions that can increase their risks of complications and bad outcomes.
This may be because many people who join the military enter it having already faced trauma, said Dr. Laura Miller, a psychiatrist and the medical director of reproductive mental health at the VA.
She said veterans with PTSD have higher rates of complications such as preeclampsia, a potentially fatal condition related to high blood pressure, gestational diabetes and postpartum depression. If untreated during pregnancy, depression also increases the likelihood of preterm birth and lingering problems for babies.
Hundrup said she hopes this proactive work will improve maternal health.
“We want these numbers trending in the other direction,” Hundrup said.
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The Brain-Skin Doctor
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Of Brains And Breakouts
This is Dr. Claudia Aguirre. She’s a molecular neuroscientist, and today she’s going to be educating us about skin.
What? Why?
When we say “neuroscience”, we generally think of the brain. And indeed, that’s a very important part of it.
We might think about eyes, which are basically an extension of the brain.
We don’t usually think about skin, which (just like our eyes) is constantly feeding us a lot of information about our surroundings, via a little under three million nerve endings. Guess where the other ends of those nerves lead!
There’s a constant two-way communication going on between our brain and our skin.
What does she want us to know?
Psychodermatology
The brain and the skin talk to each other, and maladies of one can impact the other:
- Directly, e.g. stress prompting skin breakouts (actually this is a several-step process physiologically, but for the sake of brevity we’ll call this direct)
- Indirectly, e.g. nervous disorders that result in people scratching or picking at their skin, which prompts a whole vicious cycle of one thing making the other worse
Read more: Psychodermatology: The Brain-Skin Connection
To address both kinds of problems, clearly something beyond moisturizer is needed!
Mindfulness (meditation and beyond)
Mindfulness is a well-evidenced healthful practice for many reasons, and Dr. Aguirra argues the case for it being good for our skin too.
As she points out,
❝Cultural stress and anxiety can trigger or aggravate many skin conditions—from acne to eczema to herpes, psoriasis, and rosacea.
Conversely, a disfiguring skin condition can trigger stress, anxiety, depression, and even suicide.
Chronic, generalized anxiety can create chronic inflammation and exacerbate inflammatory skin conditions, such as those I mentioned previously.
Chronic stress can result in chronic anxiety, hypervigilance, poor sleep, and a whole cascade of effects resulting in a constant breakdown of tissues and organs, including the skin.❞
So, she recommends mindfulness-based stress reduction (MBSR), for the above reasons, along with others!
Read more: Mind Matters
How to do it: No-Frills, Evidence-Based Mindfulness
And as for “and beyond?”
Do you remember in the beginning of the pandemic, when people were briefly much more consciously trying to avoid touching their faces so much? That, too, is mindfulness. It may have been a stressed and anxious mindfulness for many*, but mindfulness nonetheless.
*which is why “mindfulness-based stress reduction” is not a redundant tautology repeated more than once unnecessarily, one time after another 😉
So: do try to keep aware of what you are doing to your skin, and so far as is reasonably practicable, only do the things that are good for it!
The skin as an endocrine organ
Nerves are not the only messengers in the body; hormones do a lot of our body’s internal communication too. And not just the ones everyone remembers are hormones (e.g. estrogen, testosterone, although yes, they do both have a big impact on skin too), but also many more, including some made in the skin itself!
Dr. Aguirra gives us a rundown of common conditions, the hormones behind them, and what we can do if we don’t want them:
Read more: Rethinking The Skin As An Endocrine Organ
Take-away advice:
For healthy skin, we need to do more than just hydrate, get good sleep, have good nutrition, and get a little sun (but not too much).
- We should also practice mindfulness-based stress reduction, and seek help for more serious mental health issues.
- We should also remember the part our hormones play in our skin, and not just the obvious ones.
Did you know that vitamin D is also a hormone, by the way? It’s not the only hormone at play in your skin by a long way, but it is an important one:
Society for Endocrinology | Vitamin D
Want to know more?
You might like this interview with Dr. Aguirre:
The Brain in Our Skin: An Interview with Dr. Claudia Aguirre
Take care!
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Could Just Two Hours Sleep Per Day Be Enough?
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Polyphasic Sleep… Super-Schedule Or An Idea Best Put To Rest?
What is it?
Let’s start by defining some terms:
- Monophasic sleep—sleeping in one “chunk” per day. For example, a good night’s “normal” sleep.
- Biphasic sleep—sleeping in two “chunks” per day. Typically, a shorter night’s sleep, with a nap usually around the middle of the day / early afternoon.
- Polyphasic sleep—sleeping in two or more “chunks per day”. Some people do this in order to have more hours awake per day, to do things. The idea is that sleeping this way is more efficient, and one can get enough rest in less time. The most popular schedules used are:
- The Überman schedule—six evenly-spaced 20-minute naps, one every four hours, throughout the 24-hour day. The name is a semi-anglicized version of the German word Übermensch, “Superman”.
- The Everyman schedule—a less extreme schedule, that has a three-hours “long sleep” during the night, and three evenly-spaced 20-minute naps during the day, for a total of 4 hours sleep.
There are other schedules, but we’ll focus on the most popular ones here.
Want to learn about the others? Visit: Polyphasic.Net (a website by and for polyphasic sleep enthusiasts)
Some people have pointed to evidence that suggests humans are naturally polyphasic sleepers, and that it is only modern lifestyles that have forced us to be (mostly) monophasic.
There is at least some evidence to suggest that when environmental light/dark conditions are changed (because of extreme seasonal variation at the poles, or, as in this case, because of artificial changes as part of a sleep science experiment), we adjust our sleeping patterns accordingly.
The counterpoint, of course, is that perhaps when at the mercy of long days/nights at the poles, or no air-conditioning to deal with the heat of the day in the tropics, that perhaps we were forced to be polyphasic, and now, with modern technology and greater control, we are free to be monophasic.
Either way, there are plenty of people who take up the practice of polyphasic sleep.
Ok, But… Why?
The main motivation for trying polyphasic sleep is simply to have more hours in the day! It’s exciting, the prospect of having 22 hours per day to be so productive and still have time over for leisure.
A secondary motivation for trying polyphasic sleep is that when the brain is sleep-deprived, it will prioritize REM sleep. Here’s where the Überman schedule becomes perhaps most interesting:
The six evenly-spaced naps of the Überman schedule are each 20 minutes long. This corresponds to the approximate length of a normal REM cycle.
Consequently, when your head hits the pillow, you’ll immediately begin dreaming, and at the end of your dream, the alarm will go off.
Waking up at the end of a dream, when one hasn’t yet entered a non-REM phase of sleep, will make you more likely to remember it. Similarly, going straight into REM sleep will make you more likely to be aware of it, thus, lucid dreaming.
Read: Sleep fragmentation and lucid dreaming (actually a very interesting and informative lucid dreaming study even if you don’t want to take up polyphasic sleep)
Six 20-minute lucid-dreaming sessions per day?! While awake for the other 22 hours?! That’s… 24 hours per day of wakefulness to use as you please! What sorcery is this?
Hence, it has quite an understandable appeal.
Next Question: Does it work?
Can we get by without the other (non-REM) kinds of sleep?
According to Überman cycle enthusiasts: Yes! The body and brain will adapt.
According to sleep scientists: No! The non-REM slow-wave phases of sleep are essential
Read: Adverse impact of polyphasic sleep patterns in humans—Report of the National Sleep Foundation sleep timing and variability consensus panel
(if you want to know just how bad it is… the top-listed “similar article” is entitled “Suicidal Ideation”)
But what about, for example, the Everman schedule? Three hours at night is enough for some non-REM sleep, right?
It is, and so it’s not as quickly deleterious to the health as the Überman schedule. But, unless you are blessed with rare genes that allow you to operate comfortably on 4 hours per day (you’ll know already if that describes you, without having to run any experiment), it’s still bad.
Adults typically need 7–9 hours of sleep per night, and if you don’t get it, you’ll accumulate a sleep debt. And, importantly:
When you accumulate sleep debt, you are borrowing time at a very high rate of interest!
And, at risk of laboring the metaphor, but this is important too:
Not only will you have to pay it back soon (with interest), you will be hounded by the debt collection agents—decreased cognitive ability and decreased physical ability—until you pay up.
In summary:
- Polyphasic sleep is really very tempting
- It will give you more hours per day (for a while)
- It will give the promised lucid dreaming benefits (which is great until you start micronapping between naps, this is effectively a mini psychotic break from reality lasting split seconds each—can be deadly if behind the wheel of a car, for instance!)
- It is unequivocally bad for the health and we do not recommend it
Bottom line:
Some of the claimed benefits are real, but are incredibly short-term, unsustainable, and come at a cost that’s far too high. We get why it’s tempting, but ultimately, it’s self-sabotage.
(Sadly! We really wanted it to work, too…)
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Managing Sibling Relationships In Adult Life
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Managing Sibling Relationships In Adult Life
After our previous main feature on estrangement, a subscriber wrote to say:
❝Parent and adult child relationships are so important to maintain as you age, but what about sibling relationships? Adult choices to accept and move on with healthier boundaries is also key for maintaining familial ties.❞
And, this is indeed critical for many of us, if we have siblings!
Writer’s note: I don’t have siblings, but I do happen to have one of Canada’s top psychologists on speed-dial, and she has more knowledge about sibling relationships than I do, not to mention a lifetime of experience both personally and professionally. So, I sought her advice, and she gave me a lot to work with.
Today I bring her ideas, distilled into my writing, for 10almonds’ signature super-digestible bitesize style.
A foundation of support
Starting at the beginning of a sibling story… Sibling relationships are generally beneficial from the get-go.
This is for reasons of mutual support, and an “always there” social presence.
Of course, how positive this experience is may depend on there being a lack of parental favoritism. And certainly, sibling rivalries and conflict can occur at any age, but the stakes are usually lower, early in life.
Growing warmer or colder
Generally speaking, as people age, sibling relationships likely get warmer and less conflictual.
Why? Simply put, we mature and (hopefully!) get more emotionally stable as we go.
However, two things can throw a wrench into the works:
- Long-term rivalries or jealousies (e.g., “who has done better in life”)
- Perceptions of unequal contribution to the family
These can take various forms, but for example if one sibling earns (or otherwise has) much more or much less than another, that can cause resentment on either or both sides:
- Resentment from the side of the sibling with less money: “I’d look after them if our situations were reversed; they can solve my problems easily; why do they resent that and/or ignore my plight?”
- Resentment from the side of the sibling with more money: “I shouldn’t be having to look after my sibling at this age”
It’s ugly and unpleasant. Same goes if the general job of caring for an elderly parent (or parents) falls mostly or entirely on one sibling. This can happen because of being geographically closer or having more time (well… having had more time. Now they don’t, it’s being used for care!).
It can also happen because of being female—daughters are more commonly expected to provide familial support than sons.
And of course, that only gets exacerbated as end-of-life decisions become relevant with regard to parents, and tough decisions may need to be made. And, that’s before looking at conflicts around inheritance.
So, all that seems quite bleak, but it doesn’t have to be like that.
Practical advice
As siblings age, working on communication about feelings is key to keeping siblings close and not devolving into conflict.
Those problems we talked about are far from unique to any set of siblings—they’re just more visible when it’s our own family, that’s all.
So: nothing to be ashamed of, or feel bad about. Just, something to manage—together.
Figure out what everyone involved wants/needs, put them all on the table, and figure out how to:
- Make sure outright needs are met first
- Try to address wants next, where possible
Remember, that if you feel more is being asked of you than you can give (in terms of time, energy, money, whatever), then this discussion is a time to bring that up, and ask for support, e.g.:
“In order to be able to do that, I would need… [description of support]; can you help with that?”
(it might even sometimes be necessary to simply say “No, I can’t do that. Let’s look to see how else we can deal with this” and look for other solutions, brainstorming together)
Some back-and-forth open discussion and even negotiation might be necessary, but it’s so much better than seething quietly from a distance.
The goal here is an outcome where everyone’s needs are met—thus leveraging the biggest strength of having siblings in the first place:
Mutual support, while still being one’s own person. Or, as this writer’s psychology professor friend put it:
❝Circling back to your original intention, this whole discussion adds up to: siblings can be very good or very bad for your life, depending on tons of things that we talked about, especially communication skills, emotional wellness of each person, and the complexity of challenges they face interdependently.❞
Our previous main feature about good communication can help a lot:
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What Matters Most For Your Heart?
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Eat More (Of This) For Lower Blood Pressure
Heart disease remains the world’s #1 killer. We’d say “and in the US, it’s no different”, but in fact, the US is #1 country for heart disease. So, it’s worse and perhaps some extra care is in order.
But how?
What matters the most
Is it salt? Salt plays a part, but it’s not even close to the top problem:
Hypertension: Factors Far More Relevant Than Salt
Is it saturated fat? Saturated fat from certain sources plays more of a role than salt, but other sources may not be so much of an issue:
Can Saturated Fats Be Heart-Healthy?
Is it red meat? Red meat is not great for the heart (or for almost anything else, except perhaps anemia):
The Whys and Hows of Cutting Meats Out Of Your Diet
…but it’s still not the top dietary factor.
The thing many don’t eat
All the above are foodstuffs that a person wanting a healthier heart and cardiovascular system in general might (reasonably and usually correctly) want to cut down, but there’s one thing that most people need more of:
Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
And this is especially true for heart health:
❝Dietary fiber has emerged as a crucial yet underappreciated part of hypertension management.
Our comprehensive analysis emphasizes the evidence supporting the effectiveness of dietary fiber in lowering blood pressure and reducing the risk of cardiovascular events.❞
Specifically, she and her team found:
- Each additional 5g of fiber per day reduces blood pressure by 2.8/2.1 (systolic/diastolic, in mmHG)
- Dietary fiber works in several ways to improve cardiovascular health, including via gut bacteria, improved lipids profiles, and anti-inflammatory effects
- Most people are still only getting a small fraction (¼ to ⅓) of the recommended daily amount of fiber. To realize how bad that is, imagine if you consumed only ¼ of the recommended daily amount of calories every day!
You can read more about it here:
Dietary fiber critical in managing hypertension, international study finds
That’s a pop-science article, but it’s still very informative. If you prefer to read the scientific paper itself (or perhaps as well), you can find it below
Recommendations for the Use of Dietary Fiber to Improve Blood Pressure Control
Want more from your fiber?
Here’s yet another way fiber improves cardiometabolic health, hot off the academic press (the study was published just a couple of weeks ago):
How might fiber lower diabetes risk? Your gut could hold the clues
this pop-science article was based on this scientific paper
Gut Microbiota and Blood Metabolites Related to Fiber Intake and Type 2 Diabetes
Take care!
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The Epigenetics Revolution – by Dr. Nessa Carey
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If you enjoyed the book “Inheritance” that we reviewed a couple of days ago, you might love this as a “next read” book. But you can also just dive straight in here, if you like!
This one, as the title suggests, focuses entirely on epigenetics—how our life events can shape our genetic expression, and that of our descendants. Or to look at it in the other direction, how our genetic expression can be shaped by the life experiences of, for example, our grandparents.
The style of this book is very much pop-science, but contains a lot of information from hard science throughout. We learn not just about longitudinal population studies as one might expect, but also about the intricacies of DNA methylation and histone modifications, for example.
Depending on your outlook, you may find some of this very bleak (“great, I am shackled by what my grandparents did”) or very optimism-inducing (“oh wow, I’m not nearly so constrained by genetics as I thought; this stuff is so malleable!”). This is also the same author who wrote “Hacking The Code of Life“, by the way, but we’ll review that another day.
Bottom line: this book is the best one-shot primer on epigenetics that this reviewer has read (you may be wondering how many that is, and the answer is… about seven or so? I’m not good at counting).
Click here to check out The Epigenetics Revolution, and learn how dynamic you really are!
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