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Dr. Oz Investigates Waist Training: My Response

On February 12, celebrity doctor Mehmet Oz took on the topic of waist training for a second time in his show titled “Dr. Oz Investigates Waist Training – Is It Safe?”. I suspected this would happen, as in October you may remember that Dr. Hirschhausen (another celebrity doctor in Germany) performed the first known MRI scan on a tightlaced subject.

A month later in November, Oz’s producers contacted me about doing a second segment about waist training on the show (in which I declined to participate since I had seen his angle on it the first time).

Ann Grogan (Romantasy Exquisite Corsetry) has already responded to Dr. Oz in an open letter on her own blog, but I have also been asked by a dozen or so people to write my own response – make no mistake that I am not a medical expert, but I do believe that the results are worth talking about and sharing. I’d like this to become a conversation between the corsetry and medical industries, and for us to come to a mutual understanding that not all shapewear is the same and not all of them are suitable for all applications (including and especially waist training).

Oz’s segment can be viewed here, and I will address each concern in order.

 

First video: theoretical discussion and MRI results  

Corsets can theoretically squeeze your lungs, compress the ribs and reduce oxygen intake

This is true if the corset is not made to fit your body and deliberately tightened to reduce the size of the ribcage. It’s also more likely to be true with an overbust corset rather than an underbust, as it encases more of the ribcage. In my article about corsets, lungs and breathing, I address some common concerns and myths regarding corsets and respiratory infections. My response article to the “Hidden Killers of the Victorian Home” episode on corsets also showed that the maximum loss to the reporter’s vital capacity was about 10%, even after strapping on an overbust corset for the first time, lacing down several inches immediately (and over a bulky sweater) and then proceeding to sprint up and down a staircase repeatedly for several minutes – altogether a scenario that would have never happened in the Victorian era.

There are corsetieres who are dedicated to patterning their corsets to deliberately curve around the ribcage and accommodate the ribs instead of affecting their position, for those who find it more comfortable and prefer this silhouette. Now, it is possible to reduce the lung capacity slightly simply by the nature of pushing up the stomach and diaphragm slightly, but again this depends on the reduction held – and in many cases the temporary reduction in capacity is small enough that it would only be noticeable in situations of hard exertion, not tidal breathing (a normal breath while at rest only uses about 15% of the vital lung capacity, and many sedentary people very rarely use their full capacity).

Myself (Lucy) wearing a cupped-rib hourglass corset made by Sugarkitty, designed to compress only the waistline and not the rib cage.
Myself (Lucy) wearing a cupped-rib hourglass corset made by Sugarkitty, designed to compress only the waistline and not the rib cage.

 

Corsets can cause acid reflux

If the stomach is pushed up, heartburn is possible – especially if you eat a semi-large meal prior to lacing up (but who does that?). Corsets can exacerbate reflux in those people who already suffer from GERD (a condition caused by a loosened lower esophageal sphincter, production of too much stomach acid, hiatal hernia, abdominal obesity, etc).

Pregnancy can often cause heartburn, not only because the baby is competing for space and pushing up on the stomach, but also because the elevated hormones can cause the sphincter of the stomach to relax. Common tips given to pregnant women include eating small meals (and eating slowly), avoiding foods that are commonly known to bring on heartburn (like spicy food and caffeine), and keeping hydrated and drinking fluids throughout the day – all healthy tips that can be done anyway, and all tips that have helped corset wearers to avoid reflux as well. I eat small, regular meals by choice and I cannot remember one incident of heartburn I’ve experienced while wearing a corset.

Some may be interested to read Sarah Chrisman’s experience in how wearing a corset had helped to stop her GERD (which she previously believed was a chronic, hereditary condition that she’d have to deal with for life).

That said, if you know that you experience GERD, if you have a hernia or any other health condition, it’s always a good idea to speak with your trusted medical professional before trying a corset.

 

MRI results of a waist trainer

For contrast, I want to compare Dr. Oz’s methodology and subsequent results with the MRI results of a tightlacer on Dr. Hirschhausen’s show. On Hirschhausen’s show, Eden Berlin (the tightlacer and willing subject) wore a custom fit corset made by Tonia of Korsett Manufaktur Tomto, specially constructed with plastic synthetic whalebone instead of steel, and also nonferrous grommets so as not to react in the MRI machine. The results demonstrated how a well-fit corset does not seem to drastically affect the morphology or position of kidneys or lungs. Even her liver looked similar in shape and simply shifted upwards slightly. The only organ that got ‘trapped’ was her transverse colon, and Eden mentioned that she had been rushed in putting on the corset and lacing down 5 inches within mere minutes – she said that if she had more time to lace down slowly and properly, she may have been able to shift that colon down appropriately, as Fran Blanche describes in her tightlacing articles “The Cycle Method” and Divide and Conquer”.

 

Why corsets are not the same as stretch shapewear

I have several criticisms with the way Dr. Oz performed his version of the experiment, namely the fact that he used a rubber cincher instead of a corset. It’s understandable that they would opt for this, as 1) the rubber faja is gaining popularity as exercise gear these days, and 2) since it tends to contain no metal, it is a quick and easy ‘substitute’ for steel boned corsets.

I have been over the superficial differences between rubber cinchers and corsets before, as well as given my response regarding other types of shapewear, but this MRI experiment revealed something else to me: rubber cinchers create an even pressure over the whole torso instead of focusing the majority of the restriction at the waistline, meaning that the wearer has little control over what’s “squished” and what’s not.

Elastic latex/rubber waist cincher or faja
Lucy wearing a rubber waist cincher or faja. Although there is not as much compression as my usual corsets, what pressure IS there cannot be controlled or concentrated.

The way a stretchy rubber or neoprene faja is constructed, it is not custom-fit to the individual’s anatomy, and it’s designed to compress everywhere that it touches – from the ribcage to the hips. It will compress whatever gives the least resistance, whether that is the sides of the waistline or the front and back; whether that includes the floating ribs or not (Marianne has an article on The Lingerie Addict about different the compression feels between corsets and shapewear). Because each individual has a different amount of muscle tone or body fat percentage, because each person has very slight differences in position and size of their internal organs, because the exact amount of compression on the body is difficult to control because it fastens with hooks and not laces, it’s very difficult to predict how the outcome would look in each person. Only two days ago someone commented on my site asking if it’s normal to experience uncomfortable pressure on the back from rubber cinchers (to answer this quickly: pain is never normal; if you ever experience discomfort, the responsible thing to do is to loosen or remove the garment).

By contrast, a corset can be drafted to accommodate each person’s individual anatomy and we can control exactly where the compression is occurring and how much (0 inches, 2 inches, 4 inches) due to the adjustability of the laces.

In a custom-fit corset, there is a gradient of pressure that is maximized at the skeletal waistline (the squishy area below the ribs and above the pelvis), dissipating to zero compression up over the ribcage and down over the hips. The compression is also focused primarily laterally (on either side of the body, and not from front and back). In most cases, a strong front busk will prevent dishing or collapsing of the waistline in the front of the body, and a proper corset is also specially drafted to ensure no compression of the back, as it should support a healthy posture and maintain a proper lumbar curve. A well-fitting corset should be drafted in such a way that if the organs come into play, then the hollow membranous organs like the intestines flatten in response to the compression, and the corset should not affect the retroperitoneal organs such as the kidneys, as shown in Hirschhausen’s results.

 

Stand-up MRI imaging vs traditional reclining patient

Dr. Oz used a stand-up MRI facility to do the test, which may show a slightly different view of the organs compared to the conventional MRI scans where the patient is lying down. I believe that stand-up and positional diagnostic imaging is a fantastic tool, especially considering that most corset-wearers are standing or sitting for most of their day and not reclining – but this also means that Oz’s results cannot truly be accurately compared with Hirschhausen’s, since the position of the organs may shift slightly depending on the body’s position, with or without a corset.

My friend and fellow tightlacer Michael informed me that when internal diagnostic imaging was first discovered (e.g. X-rays where you could see the positions of solid organs like the heart and liver against less dense organs like the lungs), there were several unnecessary surgeries performed to “correct” the position of the organs. Before stand-up imaging, physicians’ only knowledge of organ positions in the human body came from examining corpses (who were obviously reclining) and from performing surgeries (where patients were also reclining), and they didn’t realize that the organs can and do slightly shift from standing to lying down.

I’m currently investigating this history further to verify the details – but it’s easy to imagine how, for instance, breasts can look incredibly different from standing to reclining even with the presence of Cooper’s ligaments keeping them relatively in place, so it’s not hard to believe that the position of the organs can also slightly shift from standing to reclining as well, despite ligaments and the visceral membrane keeping them relatively in place.

It’s not known whether Oz’s subject was scanned while standing up or lying down, as the brief video clip merely showed her “spinning” somewhat in the machine. Perhaps she wasn’t standing nor completely reclining but was at a slight incline. It is also unknown whether the angle of imaging with and without her rubber cincher had been performed at the same angle. If they had by chance been performed at different angles, this change in position may have skewed the results from the cincher.

 

Should we be scared by a grooved liver?

Dr. Oz expressed some shock upon discovering indentations in the woman’s liver caused by the ribcage – I was hoping that he would explain how such indentations would prove deleterious but unfortunately it was not mentioned (or the clip was cut short). However, indentations of the liver are not all that uncommon. Although the liver is one of the more solid organs, it is still described as pliable, and the shape and size naturally varies.

In a 1986 publication in the JPMA, the liver shapes of 500 live humans were studied via radio-colloid imaging. Over 15% of the subjects showed indentations of some kind on the liver, and these are from healthy individuals who were not wearing corsets. This is consistent with the indented livers I’ve seen in rat dissections in school. These slight variances in liver morphology are not necessarily tied with the health of the individual.

Another issue to bring to light is that organ crowding and indentations may also occur in those who are pregnant, those who have a high percentage of visceral (intra-abdominal) fat, and those who have skeletal issues like scoliosis, which shortens the torso and the amount of space for the organs within it – yet particularly in the last case, bracing a scoliosis patient often involves torso compression of a couple of inches, in the interest of stabilizing and correcting the spine – would this not further compress the organs of a person who is already experiencing compromised organ space? The history of the modern brace lies in corsetry, and research in the physiological effects of corsetry is not a vain apologist activity. More research into the functional effects of organ crowding may lead to new innovations in the medical field as well.

 

The Sforzesco brace for scoliosis
The Sforzesco brace for a scoliosis patient creates an hourglass silhouette similar to that of a corset. Click through to read more about this brace.

 

Video 2: Interview with Dr. Nicole Florence, bariatrician

Can Waist Training lead to Weight Loss?

Dr. Florence states that there is no clinical evidence that waist training can result in weight loss. That’s not for want of trying though, as a 2010 study by Wikstrand et al attempted a trial of wearing “soft corsets” for a period of 9 months to maintain weight loss – however, the results could not be properly evaluated due to low compliance (the subjects didn’t wear their corsets). I was as disappointed as the next person.

I tend to agree that weight loss is not necessarily guaranteed with the use of a corset, and the corset should not be treated as a substitute for diet or exercise (I’ve spoken at length about this before) – however, it can be seen as a non-surgical aid in many individuals. As mentioned above, I would personally be delighted to perform long-term studies on corset wearers, and rely on real data instead of anecdotes, given the funds and the opportunity. Universities and research centers may feel free to contact me if you’d like me to lead a proper trial in your facility. (I’m not kidding.)

Since Dr. Florence is a bariatrician, I would also like to study real quantifiable health risks associated with moderate corset wear as compared with gastric band surgery, where 10-20% of patients require a second procedure to correct complications, up to 30% of patients develop nutritional deficiencies / absorption disorders, and up to 33% of patients develop gallstones according to the Cleveland Clinic’s Bariatric and Metabolic Institute, with a 53% chance of gaining the weight back within 15 years according to this 2013 study. If I were in the position to opt for either bariatric surgery or corsets, I’d personally try the corsets first, but that’s just my subjective stance.

 

Do corsets lead to eating disorders?

I have always tried to tread lightly on this subject as it is a sensitive topic for many. Dr. Florence believes that wearing corsets can create body dysmorphic disorder or distorted body image, and there was implication that the corset may become a gateway to eating disorders or more drastic body modification.

It’s my personal belief that body dysmorphia starts in the mind and then the body follows, not the other way around. Extreme weight loss associated with conditions like anorexia are the later symptoms – the physical manifestations of the psychological/ emotional struggle that has already existed in the person for months or years prior. Is it possible that some people who already have body dysmorphic disorder or eating disorders use corsets as a tool? Yes, I would say that it’s probable that some individuals use corsets for this reason, but it’s insulting to imply that all people who wear corsets are at risk of developing an eating disorder or are already there, especially as I have personally seen corsets used to help some of my friends overcome their personal body image issues and fall in love with their own body. I don’t believe that corsets cause body image issues any more than bra cutlets would contribute to delusions about one’s own natural breast size, or high heel shoes would create insecurity in one’s natural height.

 

Other health concerns mentioned

Dr. Florence says that corsets can cause pneumonia (again, I’ve written about pneumonia in this article), and that they can cause constipation (I’ve addressed this in my Corsets and Toilet Issues article, although more and more I’m hearing from viewers how abdominal compression has helped keep them regular, interestingly). She also wrote that corsets can cause chronic pain and bruising, to which I respond that if it hurts, you’re doing it wrong. Pain or bruising when wearing a corset is never ever ever ever normal – and if this is happening, then you are using a corset that is not the right shape for you, or you’re cinching too tight, too fast, or for too long a duration than your body is ready for.

She also mentioned that corsets can cause fainting – she erroneously stated that the origin of “fainting couches” had their origin in the Victorian era to catch women fainting from their corsets, which is known to be untrue. The Chaise Longue has existed for well over 2000 years. Corsets may have caused fainting in Victorian women if overtightened (which was not unheard of during balls and other special events), and yes corsets can affect blood pressure, but women also fainted from exhaustion, dehydration, low blood sugar, overheating and overexertion, just as many people faint today without a corset. Victorian ladies also faked fainting because it was the cool thing to do.

 

In summary, I don’t believe that Dr. Oz gave the last word or drove the nail in the coffin for waist training, but I do think it’s important to take all information into account. Recall that after Hirschhausen’s episode on corsets, I said, “I would love to repeat this MRI study with different tightlacers to see how the positions of organs change slightly depending on the individual, the silhouette of corset worn, the reduction of the corset, and how long they’ve been training.” My position hasn’t changed; on the contrary, Dr. Oz’s contribution has only strengthened my resolve.

If we’re to truly understand the physiological effects of corsetry, we need a sample size of more than 1, we need some consistency in the type of corset used (not simply *any* compression garment) and we need a consistent method of imaging.