Fourth Thought

Blog 4 Research Annotated

With the amount of information now available to a researcher, organization becomes increasingly vital. An important tool available for reference is the annotated bibliography, which ideally toes the line effectively between brevity and clarity. Much is made as to the different software options which allow the researcher to be strategic in how they organize their information. As I progress in my academic career I am swiftly realizing that this type of software is swiftly transforming from convenient to necessary. Regardless of how comfortable you may find it to dive into new bibliographic software, it seems that annotating references is a valuable practice, and something I have neglected as of yet to engage in with in regards to my paper on obesity–

Sabin Janice A., Marini ,Maddalena,  Nosek, Brian A.

2012 Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender. PLoS ONE 7(11): e48448.

This article is a survey to measure the implicit and explicit reactions that medical doctors have towards obesity and fatness in general. It would likely interest the psychologist, sociologist, anthropologist and clinician. This paper is typically structured as introduction, methods, results and discussion. The methods separate the implicit and explicit opinions of doctors. Explicit is measured as self-reported by MD’s as their opinion and comfort level with treating obese patients. Implicit reactions are measured by ease of association of thin and fat with positive and negative words. The question to be answered is whether MD’s have differing anti-fat bias from that of the general public. The general public have anti-fat bias both implicitly and explicitly.

This paper supports the contention that anti-fat stigma is pervasive in the general public. It also answers the question as to the reactions and feelings that MD’s have toward fatness and obesity. Most revealing in this paper is finding that the majority of doctors explicitly have anti-fat sentiments. This finding is important in two ways-

1. It supports my claims about culture and its influence in medicine. This is direct evidence that the dissemination of health care may not be blind to cultural influence. This anti-fat bias surprisingly and most interestingly is not necessarily a risk to obese patients. In fact, there is evidence to support that obese patients with heart disease risk factors have better outcomes than those with matching factors and whom are of normal weight. The hypothesis here is that doctors with their anti-fat bias treat their obese patients symptoms more aggressively and urgently, and thus their patients have better outcomes.

2. Also evident in this paper is that anti-fat bias is acceptable. Explicit responses from MD’s measure the amount of bias they freely admit to. This suggests that a large portion of primary care doctors believe it is acceptable to have such bias. This result really amplifies the contention that even among those of our population who are supposed to be the most neutral in terms of patient bias, they still find it ok to admit to biased thinking. I contend in my paper that obesity of one of the remaining acceptable forms of discrimination; this paper will be pivotal to that assertion. This article tackles questions about fatness clinically, psychologically and socially and is a very important piece of the obesity picture in that it makes connections with those three fields.

Kantartzis, Machann, Schick, Rittig, Machicao, Fritsche, Häring, Stefan

2011 Effects of a lifestyle intervention in metabolically benign and malign obesity. Diabetologia 54:864–868

This article describes a study that aims to bolster the mounting evidence supporting the separation of the metabolically healthy and unhealthy obese for the purposes of treatment. The experiment is lifestyle intervention (9 months), diet and exercise, and a comparison of the effectiveness of this change between the obese insulin resistant and the obese insulin sensitive. This intervention is designed to increase insulin sensitivity. This paper is especially relevant for primary care physicians and anthropologist who are interested in first-line treatment in over-weight patients. Methods, results and discussion aim to support the growing contention that special and separate consideration needs to be taken towards obese patients that have healthy insulin sensitivity. Moreover, this study also aims to show that patients who are obese and insulin resistance should be treated more aggressively since their insulin sensitivity can be quickly increased.

This article fits nicely into the popular topic of healthy obesity. The primary literature on this topic has been mostly speculation and experimentation on why this sub-phenotype exists and in what way we can therefore learn about the etiologies of obesity. This study firmly supports the assessment of an obese patient’s insulin resistance as the first step in developing a treatment strategy.

This paper has importance to the practical aspects of a resource limited field like health care. It struck me almost as a type of triage where the obese patient that can benefit most from the intervention should be given priority. In fact this paper could have effectively been reframed with a type of Malthusian tilt towards resource management.

This paper is especially relevant to my work since I am arguing that obesity is erroneously painted with the same brush. Since it is as much about appearance and cultural interpretation of health with modern issues of obesity, I argue that the assumption that all obesity should be treated wholesale is not biologically defensible. This paper is also complemented by several other papers that have tested obesity with respect to heart disease- they too have found that a significant sub-group of obese are not at any elevated risk, and that lifestyle interventions do not always improve outcomes.

Sims, Ethan A.H.

2001 Are there persons who are obese, but metabolically healthy? Metabolism 50: 12: pp 1499-1504

This is an early paper on those who are obese yet have a healthy metabolism. This article is much more like an anthropological discussion than it is like a medical one; it even begins with a lengthy anecdote about a woman who is doing everything to lose weight yet remains unsuccessful. This paper is important for anthropology and medical theory as it addresses why some obese are more metabolically ‘normal’ than others and how this is relevant to the practice of medicine. The organization of this article is reminiscent of a logical discussion as to the evidence of this sub-group, the number of studies that suggest this, explanations as to why this might be the case, and why this is important news clinically and academically. This paper effectively answers the question of so what; why should be care about healthy obesity. It also thoroughly addresses ideas about what to do in the future, and what this might mean as far as the obesity epidemic.

This is one of the seminal papers about healthy obesity. In fact the term MHO (metabolically healthy obese) had not been coined yet. This type of investigation into healthy obesity stems from some of the anomalous findings in the data when comparing BMI to health. This study is one of the first to suggest that these anomalies are because of this healthy sub-population, whose physiology operates as if they were of normal weight. This paper is quite bold in offering explanations as to why this might be -which is of great interest to my work. It suggests that healthy obesity may involve adaptive mechanism in the body. The authors claim that people who have been obese since early childhood preferentially display healthy obesity as adults. This claim has not subsequently been supported by evidence, but it has stirred myself into forming ideas as to anthropological perspectives in obesity.

This paper now is quite outdated; the MHO phenomenon has made a serious dent on the landscape of obesity study as of late. It does offer a more anthropological framework than the typical and more recent papers on MHO. It does focus much of its attention on the practical aspects of MHO; diagnosis in particular, but also more generally commentary on clinical thinking and physiological theory, aspects that I intend to be focused heavily on in my work on obesity.

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7 thoughts on “Fourth Thought

  1. Hello again,

    Thank you for sharing; I am very interested in the topic that you are researching and always look forward to learning more about the available literature. You stated that this is your first time creating annotations. I am curious, now that you have done it for three of the articles, do you think it may be something you continue to do? Or, rather, do you think that this was something that you had already done but on a less elaborate scale? I find them very helpful and don’t always do them when I am researching, but approach each article in a frame of mind as if I were to write an annotation.

    In terms of your post you have done a great job of explaining how the research will help to influence your own work. Do you feel that each paper was intended for a particular audience and can therefore contribute to your research in different ways?

  2. Hi there,
    I appreciate your question about how I might find continuing to annotate further. I think I was a very useful exercise to read and be very concise in describing a paper. I like your thoughts about your approach to the articles you read, im sure it helps to recall the details of the papers.

    Yah, I feel that appealing to a diverse audience will be one of the strengths of my paper. It should have components of medicine, anthropology, sociology and psychology. It is useful also to think about the organization of my argument in those terms.

  3. This was a good read, Jonathan. It is interesting to know that MDs themselves admit their own biases when being surveyed. Does this mean that their biases then have biases, leading to an infinite regress of biases? To be conscious of these cultural implications must be tight-rope when confronting a patient concerning these issues. It is also interesting that the authors use the term ‘anti-fat’, suggesting that the rest of the non-obese population are against the overweight and obese. I don’t know why, but I’ve always found medical literature interesting to read precisely because of the culturally-laced terminology they use. Thanks for this blog post!

    • Hey matt,
      I’m not quite sure what you are getting at with your comment regarding an infinite regress, but funny enough, I just ran across an article today which includes an experiment about the anti-fat biases of MD’s who specifically work in the field of obesity treatment and prevention. They do exhibit biases like that of the general public! Perhaps you could clarify your comments about anti-fat bias. To me, it is simply a neutral term describing bias against obesity and fatness in general.

  4. Hi there,
    I found your post particularly interesting and look forward to hearing more about your study topic/paper in the future. I was curious whether you felt these articles adequately addressed their proposed topics or if you feel their are gaps in the literature. By that I mean, do you feel their are seminal components absent in these articles that would not only make them more accessible to a broader audience or more applicable to your area of research? Thank you for your blog post!

    • Hi there,
      Well I tend to believe there are many gaps in the literature, and I am going to attempt to highlight some in my paper. I’m not quite sure how to interpret ‘seminal’ components, but a strongly feel, because of so much of the conflicting opinions and findings, that the issue of obesity and its causes are not yet very well understood. I think these articles are particularly accessible- I think that was part of the reason I chose them, but indeed many papers in the literature are pretty esoteric. Its a problem!

  5. Hi Jonathan,
    This is a nice mix of articles, and they are giving me a pretty good sense of where your article is going. You can see how the annotations can become pretty useful rough drafts of ideas you want to get on paper. In fact, if you ever have writer’s block, it is good to go to one of the more useful papers in your research and focus on that second part of the annotation — why do I want to engage with this kind of research? What is my entry point into this discussion? Why do I love/hate this article, but also (more importantly) how can i productively engage with it? Anyways, for now, I’ll echo others — an interesting read.

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