In this issue:
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Featured MSSI Community Artwork
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Association for Weight and Size Inclusive Medicine’s first CME webinar!
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THREE NEW MSSI Resources!
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Evidence-Based Archives
MSSI Community Artwork
Call for Art Submissions
We are excited to announce a new initiative aimed at celebrating the beauty and diversity of all bodies through art. MSSI invites you to submit your creative works—whether visual art, poems, reflective stories, or any other form of expression—that capture the essence of living in and caring for diverse bodies.
Our goal is to highlight the experiences and triumphs of individuals within the body liberation movement, and the unique perspectives of medical providers dedicated to inclusive and compassionate care. This is an opportunity to showcase the beauty, strength, and resilience found in all body types, and to inspire others within our community and beyond.
Submission guidelines:
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Who can submit their art: MSSI members and advisors
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Accepted formats: Visual art (paintings, drawings, photography), poetry, short stories, personal reflections and any other creative expressions!
Selected pieces will be featured in our upcoming newsletters, shared on our social media platforms, and potentially included in a special online gallery. We believe that your art can spark important conversations and bring a deeper understanding of the importance of size inclusivity in healthcare 🙂
Please submit your work to the Google Form below. We look forward to seeing your beautiful and powerful contributions!
AWSIM (Association for Weight and Size-Inclusive Medicine)’s FIRST CME Event!
Join AWSIM (Association for Weight and Size-Inclusive Medicine) on Wednesday, Dec 4 at 5-6:30 PM PT / 8-9:30 PM EST for their inaugural CME seminar! The webinar will feature an introduction to weight inclusive medicine, as well as a Q&A panel with practicing physicians from the AWSIM Board, including Dr. Lisa Erlanger, Dr. Naomi Busch, Dr. Katarina Wind, Dr. Mónica Peralta, Dr. Anna Whelan, and Dr. Mara Gordon.
Registration is FREE for AWSIM members and students!
Three NEW MSSI Resources!
Our members have been hard at work over the last few months finalizing some resources for advocacy for size-inclusive healthcare. Take a look at the three new tools our teams have created:
**NEW** Mini-Guide: What If a Patient Expresses a Desire to Discuss Weight/Weight Loss?
MSSI Mini-Guides are brief informational sheets centered around specific topics within the realm of size inclusive medicine! We hope you find them useful to your learning and/or advocacy work. Please let us know if there are additional topics you would like to see us cover.
**NEW** Bariatric Surgery Informed Consent Resource
For years we have seen referrals being made out to bariatric surgery programs specifically aimed at promoting weight loss. We are concerned that patients may receive misleading or insufficient information from their healthcare providers before undergoing these major operations.
While MSSI does not believe weight & BMI are accurate measures of health, or that weight loss improves health outcomes, we also champion patient autonomy. Weight discrimination permeates so many aspects of society, and the physical and mental harm it directly causes fat people is immeasurable and far-reaching.
Our goal is to give patients desiring to pursue bariatric surgery a more comprehensive understanding of the risks and benefits associated. Knowing what alternatives are available is part of full informed consent, so we also include evidence-based options for improving health that do not require weight loss.
Link to the bariatric surgery resource
MSSI Student Contributors: Rachel Stefaniuk, Sophie Lalonde-Bester, Jackie Liu, AsiaLuna Patlis, Marisa Langton
**NEW** Weight-Centric vs. Weight-Inclusive Comparative Chart
Utilize the table below to learn more about the Weight-Centric and Weight-Inclusive models of healthcare. This table is meant to be used as a guide to start conversations. We recognize that this is a nuanced topic that encompasses a spectrum, rather than two clear-cut categories. You may find you fall somewhere in between these two models of care.
Additionally, the Weight-Inclusive column may feel aspirational due to larger systemic issues. It is okay if what you’ve practiced in the past or present does not always reflect this approach. Our intention is not to call out, but to shed light on how personal beliefs about body weight and health impact patient care and outcomes, and how these beliefs can be shaped by medical training and healthcare systems.
Main Authors: Abigail Faust, Samantha Temucin, Hannah Wisniewski, Sarah Leonard Main Reviewers: Ragen Chastain, Dr. Katarina Wind, Dr. Lisa Erlanger
Evidence-Based Archives
MSSI is excited to present our fourth installment of “Evidence-Based Archives,” our monthly column highlighting and summarizing seminal research in the field of size-inclusive healthcare. In this section, we hope to celebrate our scholars, empower each other with knowledge, and stock up on citations for the next time we’re called upon to justify size-inclusive healthcare in the classroom, clinic or wards!
Content warning: Medicalized fatphobia, ob*sity, anti-fat language
Disclaimer: We use the terms “ob*sity” and “overweight” in our summaries when it is otherwise impossible to accurately describe findings from certain studies, due to the language and descriptors chosen by researchers. We acknowledge the inaccuracies and harms that these labels have perpetuated in medicine and society. Please keep your mental health in mind when reading, and feel free to reach out to us with any feedback or suggestions at any time!
This month’s highlight:
In 2016, the Global BMI Mortality Collaboration (GBMC) published a meta-analysis that supposedly demonstrated a consistent association between higher BMI and greater all-cause mortality. As the study encompassed “239 prospective studies in four continents,” it was accepted as justification for subsequent public health and primary care campaigns against “overweight” or “obesity” as defined by the notoriously flawed body mass index. Yet…this meta-analysis was flawed for a number of reasons. This month, we summarize Flegal et al.’s critical dissection of the methods used in the GBMC study to explain why we ought to take their conclusions with a HEAVY grain of salt.
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Data Selection: The GBMC article was a META-ANALYSIS, not a systemic review. While “239 prospective studies” sounds large, the pool of included studies was sourced largely from articles known to the authors (and had conclusions supporting the author’s claims). Large studies meeting GBMC’s inclusion criteria were notably absent, including a prospective 2015 study of 12 million Korean adults (far greater than GBMC’s total sample size of 3.9 million) by Yi et al. which demonstrates that the “overweight” classification is not associated with an increased risk of death (hazard ratio of 0.85) and “grade 1 obesity (BMI 30–35)” was associated with only a very small increased risk of death (hazard ratio of 1.06).
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Data Restriction: To arrive at their conclusions, the GBMC article removed over 60% of the data from the “239 studies” that they initially considered and about 75% of the deaths. This exclusion was performed by removing any current/former smokers and anyone with a known chronic disease from the dataset. They also omitted any deaths occurring within the first 5 years of follow-up.
GBMC claims that this was done to limit the effect of “confounding variables and reverse causality” on their analysis. However, they had (1) No prior evidence that doing so would increase the validity of their findings, and (2) No way of reliably identifying smokers or people with baseline chronic diseases from the studies they examined if these parameters were not specified by the studies’ original authors.
At best, GBMC’s ultimate conclusions are inapplicable to anyone who smokes or has cardiovascular disease, cancer, respiratory disease, or any metabolic disease. In fact, Flegal et. al notes that “there is substantial and constantly growing evidence from multiple studies in wide ranges of disease states and in numerous disease settings and using many ways of analyses, that shows that once a chronic disease is established, “overweight” (BMI 25–30) or “mild obesity” (BMI 30–35) is associated with incremental longevity as compared with those patients with a normal BMI (18.5 to <25).”
Had GBMC not seriously cherry-picked data to arrive at what they considered to be reasonable conclusions, the studies they included would have definitively identified the lowest mortality category to be those individuals classified as “overweight.”
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Self-Report Bias: GBMC’s final analyses included far more participants who self-reported their weight and height than those with measured weight and height. BMI category misclassification based on self-report is well-documented, and considering the proportion of self-report in GBMC’s analysis, the effects could have been strong enough to change the direction of mortality hazard ratios.
In summary, “given the major flaws in the selection process, in the adequacy of the data, in the data analysis, and in the interpretation, the GBMC conclusions cannot be trusted as a guide to action, either for clinical decisions or for public health in general.”
Have thoughts?
We are open to feedback and interested in the lived experiences of our MSSI members. Have you referenced this article in your clinical work, used it to guide patient counseling, or used it to communicate with your colleagues? How did it go?
Feel free to share your stories, reflections, expertise, and advice using the link below. With your permission, we may publish reflections in future installments of this column.
If you have a favorite article you’d like us to highlight in our next installment, feel free to submit it for consideration, also by using the link below! We look forward to hearing from you.
This newsletter was authored by Jay Liu and Sophie Lalonde-Bester, MSSI members and medical students (Stanford University and University of Alberta, respectively).