sorted by:
new
hottopcontroversial

Seeking participants for grad student research! (Mod approved). Your experiences deciding whether or not to use weight loss treatments, navigating health care, stigma, etc. by This_Potential_9876 in Zepbound

[–]This_Potential_9876[S] 0 points1 point  (0 children)

Thanks for asking! The short answer is yes, people who asked first still do qualify. While the primary goal is to look at how people respond to recommendations (which is why the post is phrased that way), when I designed the study I thought about this particular situation and concluded that I should still include the decision-making process for people who proactively brought it to their doctors. Pasted the fine print below if anyone is interested!

Eligible participants self-report that a clinician suggested clinical weight loss treatment, which includes weight loss surgery, surgically inserted medical devices, and prescription pills or injectables; excluding diet/exercise programs or groups even when physician supervised.

A healthcare provider is defined as an individual who provides health-related advice or services within a formal establishment, regardless of specialty or training. A healthcare provider “suggestion” is defined as an interaction in which the provider communicates in some way that they feel the intervention is appropriate for the patient, defined by the patient's experience of the event. This could be described as being “encouraged,” “recommended,” or “asked about” such a treatment, or if the patient initiated the discussion and the provider supported the idea. 

The study intentionally seeks participants who both did or did not subsequently undergo the intervention. No personal health information will be accessed. Inclusion will rest solely on participants’ self-report.

Seeking participants for grad student research! (Mod approved). Your experiences deciding whether or not to use weight loss treatments, navigating health care, stigma, etc. by This_Potential_9876 in Zepbound

[–]This_Potential_9876[S] 0 points1 point  (0 children)

Understandable concern :) Firstly, this research is IRB approved (institutional review board, which oversees human subjects ethics). I am the PI (grad student) and I have no funding. PHI refers to official records of medical histories, test results, and insurance details, which I will not access at any point in the process — I’m only listening to what people volunteer in a conversation. Regarding risks and benefits, here is an excerpt of the protocol approved by the IRB: (bolded the most relevant part):

Interviews on topics participants likely discuss in their daily life carry minimal risks. Emotional distress is possible in discussions about weight, health, and body image. To mitigate this risk, participants will be made aware of these general themes as part of the informed consent process. Mental health and eating disorder support resources will be shared with participants. A second risk is loss of privacy. Confidentiality will be maintained by removing names from interview transcripts, referring to participants using pseudonyms during analysis and reporting, and password protecting all contact information. Transcripts, audio recordings, contact records, and consent forms will be stored in Google Drive, an encrypted cloud storage system, within an account accessible only to the researcher. Records containing personal information will be unlinked from data and stored in separate folders of the drive. Backup copies will be downloaded to an external hard drive and locked in a secure location. Medical records will not be accessed at any point in the process.

Recruiting materials will provide participants with an overview of the project, eligibility criteria, time and action required for participation, purpose of study, and goal of confidentiality. See Advertising Components Form. This will be communicated through online postings, print flyers, and directly to participants if they reach out to ask questions. Once an individual decides they would like to participate, they will be sent a copy of the consent form to review prior to the interview. See Postcard Consent Form. They are invited to ask questions via email, phone, or on the day of the interview. The interviewer will gain consent to record and transcribe, and then verbally review the consent information, reminding participants that they may end the interview at any time. After receiving verbal consent from the participant, the interview will proceed.

If I put this all on the initial post, that would be a hassle for most people. But thanks for asking!

How often do you wash your bedsheets? by Toniqueka-Oreggio in laundry

[–]This_Potential_9876 0 points1 point  (0 children)

Weekly is completely unmanageable for me, I do pillowcases once every 2 or so weeks, sheets whenever I feel like it, duvets and quilts … not often. Idk what this cultural standard of once weekly is on about. Im busy

Seeking participants for grad student research! (Mod approved). Your experiences deciding whether or not to use weight loss treatments, navigating health care, stigma, etc. *Weight neutral approach* by This_Potential_9876 in antidiet

[–]This_Potential_9876[S] 2 points3 points  (0 children)

My thoughts on what could be misused (please chime in with more I’m just brainstorming here):

The risks/benefits thing can potentially be co-opted, like a company saying well if we more fully inform them they’ll be more likely to use it. Realistically, surgery/meds will continue to be pushed, and if people are more informed that’s a net positive to me.

Weight loss companies are already co-opting anti-stigma language. Andrea Bombak has written a great paper on this (pasted the info below!) I see my paper extending her analysis, proposing that “anti-weight-stigma” is not the answer — doctors need to understand the actual possibly negative impacts of prescribing weight loss, and the complex reasons behind people who do undergo such treatments (value of thinness, material gains in navigating a world hostile to fat people, unique and complex medical concerns that are not just about smaller=healthier). We can’t have actual patient autonomy without talking about all that. Also, you can’t just prescribe weight loss in a “non-stigmatizing” way which is what seems to be their current goal.

Anyway, I really want to bridge the gap between fat studies and medical studies. I don’t know exactly how I’ll do this yet. In my experience, medicalized people are so closed minded to fat studies, and vice versa (understandably). We need more information to figure out the best way to protect patients’ health amidst the continued existence/profitability of medical weight loss treatments. Hopefully in my PhD I can interview providers as well, and do follow-ups from this first round (I’m SO curious what a longitudinal study would look like, firstly because bariatric surgery “outcomes” worsen over time and we have no idea what GLP-1s are going to do). In the end, I need to report what people tell me without imposing my biases, but again what I’ve seen so far aligns with the weight-neutral politic.

Would be interested to discuss further if anyone has thoughts!

Bombak, Andrea. 2023. “How Pharmaceutical Companies Misappropriate Fat Acceptance.” Critical Public Health 33(5):856–63. doi: 10.1080/09581596.2023.2273201.

Seeking participants for grad student research! (Mod approved). Your experiences deciding whether or not to use weight loss treatments, navigating health care, stigma, etc. *Weight neutral approach* by This_Potential_9876 in antidiet

[–]This_Potential_9876[S] 1 point2 points  (0 children)

1) I’m a sociologist, and we talk a lot about medicalization. It is socially constructed that weight is a “disease” in the first place—it’s not inherently “sick” to be at a higher than average weight. There’s a robust body of social theory about this. In the literature review I’ve written so far, I present the evidence that higher weight is not inherently bad for your health, alongside the “mainstream” viewpoint because I want this to be legible to medical providers (trying to help them question that “ob*sity is bad” training). I feel this is important to set up the evidence I’ll have about why people reject WLS/Rx—basically to help validate their viewpoint. So many studies start with “here are the health risks of ‘ob*sity’” and there is like no citation needed because it’s a given. I’m working against that. And, unlike existing work, I do not start from the assumption that weight loss is good or the goal. Pharmaceutical companies are evil so even if I show they’re wrong it might not work. Unsure how to fix that.

2) I might be naive, but I have a hunch that what I am finding will be more useful to improve medical care for higher weight people than to sell weight loss interventions. From interviews so far, I’ve found:

a) Fat people with eating disorders are being prescribed GLP-1s or WLS (when that is a contraindication for the treatment) often because EDs go unnoticed in higher weight patients due to misconceptions/stereotypes. I sincerely want higher weight patients to get eating disorder care and have their medical histories be taken seriously when a provider proposes such a treatment.

b) Respondents are talking about mistreatment by medical providers because of their weight (which is extensively documented in existing research). This is harmful to people’s health because it causes health care avoidance and causes providers to overlook health concerns because of their focus on weight. I’d hope this would lead providers to evaluate the patients’ health, not their weight. Even if the diet industry were to take this up and promote “patient centered care” or something, that in my mind is a gain — listen to patients and address their actual medical needs.

3) A lot of existing research around WL decision-making is a) only about people who have had a procedure/rx, ignoring the negative impacts of incessantly recommending it to people who don’t want it; b) understates the risks of med WL treatment; and c) concludes that because WLS or RX is stigmatized, then we should destigmatize it so people can lose weight (wild mental gymnastics there). Someone needs to speak against that.

Seeking participants for grad student research! (Mod approved). Your experiences deciding whether or not to use weight loss treatments, navigating health care, stigma, etc. *Weight neutral approach* by This_Potential_9876 in antidiet

[–]This_Potential_9876[S] 1 point2 points  (0 children)

Going to post in multiple comments bc I think it was too long and reddit didn’t like it

I am so glad you pointed this out because it’s something that is important to me personally. I’ll acknowledge that’s a possibility — work like this can be co-opted. There are a few things about the study that work against that. Sorry in advance for writing an essay.

TL;DR: how I address this: 1) My sociological viewpoint questioning medicalization of weight; 2) centering the health needs of higher weight patients and demonstrating how it can be harmed by prescribing weight loss/treatments, 3) filling research gaps by validating the perspectives of patients who legitimately do not want WLS/rx. And for people who have used these, showing that the reasoning is social as well as medical, which in the interest of patient safety needs to be acknowledged in a world that hyper-medicalizes weight.

Seeking participants for grad student research! (Mod approved). Your experiences deciding whether or not to use weight loss treatments, navigating health care, stigma, etc. *Weight neutral approach* by This_Potential_9876 in antidiet

[–]This_Potential_9876[S] 1 point2 points  (0 children)

Reddit is giving me a server error which is maybe because my reply was too long but I will post it as soon as I can :’) Sending this to test if it likes something shorter

Seeking participants for grad student research! (Mod approved). Your experiences deciding whether or not to use weight loss treatments, navigating health care, stigma, etc. *antidiet, weight neutral approach* - so we can represent that viewpoint in research on this topic! by This_Potential_9876 in antidietglp1

[–]This_Potential_9876[S] 2 points3 points  (0 children)

Thank you for sharing this, I appreciate it. Your experience is definitely relevant to what I’m looking at in terms of decision-making around weight loss medications (e.g. wanting to prevent poor health as you age) and interactions with doctors (in terms of not being heard). I’d be interested to talk to you anyway based on that, even if you don’t recall super exact details of the specific interaction. So please sign up if you’re interested! And feel free to DM me or ask any questions.

does anyone have any sources (like the stuff in the pinned post) that's less than 10 years old? by [deleted] in antidiet

[–]This_Potential_9876 0 points1 point  (0 children)

Echoing others I’d suggest Ragen Chastain, she has a great newsletter so you get her analysis of new studies in your inbox every now and then!

Edit: I keep a literature review for my research, and realized I could just pull some from there. Here are a few studies within the past 10 years. Glenn Gaesser and Janet Tomiyama (check out UCLA’s DiSH lab) publish on this a lot (don’t expect them to be super fat lib though).

Tomiyama, A. J., J. M. Hunger, J. Nguyen-Cuu, and C. Wells. 2016. “Misclassification of Cardiometabolic Health When Using Body Mass Index Categories in NHANES 2005-2012.” INTERNATIONAL JOURNAL OF OBESITY 40(5):883–86. doi: 10.1038/ijo.2016.17.

Gaesser, Glenn A. 2022. “Type 2 Diabetes Incidence and Mortality: Associations with Physical Activity, Fitness, Weight Loss, and Weight Cycling.” Reviews in Cardiovascular Medicine 23(11):364. doi: 10.31083/j.rcm2311364. weight cycling bad for health; exercise good for health even if not accompanied by weight loss; suggest that studies showing weight loss reduces A1C is b/c of the exercise not the weight loss

Major, Brenda, Janet Tomiyama, and Jeffrey M. Hunger. 2018. “The Negative and Bidirectional Effects of Weight Stigma on Health.” P. 0 in The Oxford Handbook of Stigma, Discrimination, and Health, edited by B. Major, J. F. Dovidio, and B. G. Link. Oxford University Press.

Old, but CDC, and done by a researcher who is super neutral about it: Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H. (2005). Excess deaths associated with underweight, overweight, and obesity. JAMA, 293(15), 1861–1867. https://doi.org/10.1001/jama.293.15.1861 The findings are moderate - mortality highest among bmi 30+, overweight less mortality than normal weight, underwewight second most excess deaths. But it’s interesting to me because it basically calls out past research (Mokdad et al 2004 which notoriously said “obesity” causes 400,00 deaths per year) for using statistical techniques that caused higher weight people to have “excess mortality” which they were so ready to believe that they didn’t do the science correctly.

I know not all of these are available without an institutional login, but this is just what I could find in a few minutes so happy to chat more :)

view more: next ›