Majikthise on that “maybe fat isn’t so awful” JAMA study
| April 27th, 2005I hope that no one will take my critique of Majikthise’s post as me saying that Majikthise herself is anti-fat-people, or a bad person, etc etc; nothing could be further from my intent. I criticizing this one post, not Majikthise’s views as a whole, or Majikthise as a person.
Majikthise is worried that this recent JAMA study (.pdf link), which found that deaths-per-year attributed to “overweight” and obesity were much lower than previously reported - and which even found that the “overweight” tend to live a bit longer than people of “normal” weight - is being misunderstood. She points to this New York Times column by John Tierney, and also to this press release from The Center for Consumer Freedom (which I think is supported by the fast-food industry in some way).
Much of Tierney’s article is tongue in cheek (like the suggestion of picketing gyms, as if the JAMA study had found working out to be unhealthy). He also repeats some anti-fat stereotypes, like the assumption that fat people never exercise. But Tierney’s right on target when he says “the crusade against fat was never just about science.”
Majikthise dismisses the Center for Consumer Freedom’s critique of the CDC:
In the press release, the Center for Consumer Freedom basically accuses the CDC and the authors of the earlier study of propagandizing the public, if not of outright scientific malpractice. The data were there in the Center’s computers all along, they press release claims. Well, yes. Of course data sets used by Flegal and her colleagues [authors of the JAMA study] have been around for awhile. They’re the three National Health and Nutrition Examination Surveys (NHANES) compiled by the Department of Health and Human Services and used for countless studies over the years. But that doesn’t mean that it should have occurred to the scientists who made the earlier estimates of obesity-related mortality to use the same statistical methods as the Flegal team.
I don’t think Majikthise has fairly dealt with most of the CCF’s critique. The CCF is critiquing, I think, not just the flawed “400,000 fat deaths per year” study, but also the anti-fat ideology that made it seem appropriate to the CDC to take an obviously questionable study and trumpet it all over the media. From the CCF’s press release’s “timeline”:
March 2004 The CDC releases its report during a highly publicized news conference saying obesity kills 400,000 Americans a year and is poised to become America’s number one preventable death, resulting in alarming front page headlines across the nation.
May 2004 Science magazine reports on the 400,000 deaths figure: “Some researchers, including a few at the CDC, dismiss this prediction, saying the underlying data are weak. They argue that the paper’s compatibility with a new anti-obesity theme in government public health pronouncements — rather than sound analysis — propelled it into print.”
November 2004 The Wall Street Journal publishes a front-page story on errors in the 400,000-deaths study. The paper notes the study “inflated the impact of obesity on the annual death toll by tens of thousands due to statistical errors … Dr. Pechacek wrote to colleagues that he had warned two of the paper’s authors, as well as another senior scientist, ‘I would never clear this paper if I had been given the opportunity to provide a formal review.
The point is, the “400,000″ study did not get an enormous P.R. push because of scientific merit. There was an idealogical need to trumpet a study proving that fat is “the new tobacco”; and by serving the needs of ideology rather than science, the CDC put itself in a position where it deserved criticism. (Nor can the criticism be dismissed as solely coming from fast-food industry flacks; independent fat activists have been making the same criticisms since the study came out.)
The huge publicity given the “400,000″ did have a scaremongering effect; it encouraged a level of anti-fat hysteria unjustified by sound science. (”Hysteria” is the correct word; the director of the CDC called fat worse than the black plague.) The CDC made itself a leader of the “fat=bad” mentality that emphases bathroom scales and self-loathing for the fat, rather than emphasizing healthy eating and exercise for everybody. Isn’t that something that merits criticism?
Majikthise then goes on to discuss the JAMA article itself. The article made two findings: First, that being overweight is actually associated with a longer lifespan than being “normal” weight. And second, that being obese (rather than just overweight) contributes to about 112,000 deaths a year.
It’s telling how different Majikthise’s approach is, when considering each finding. When it comes to the idea that “overweight” people might be healthier than “normal” weight people, Majikthise is skeptical, suggesting several alternative explanations.
Being overweight is good for you, the flacks insist. Well, not exactly… (Being overweight is probably healthier than yo-yo dieting, eating disorders, or extreme bariatric surgery, but this study doesn’t bear on those important issues.) […] The effects of being overweight are uncertain […] But does being slightly overweight actually improve people’s health? Or is this finding some kind of artifact? […] It certainly doesn’t follow that it’s better to be overweight throughout one’s life, rather than just during the critical years. […] Brooks, Tierney, and the restaurateurs also overlook the fact that being overweight is itself a risk factor for future obesity. […]
(Gee, being overweight is “probably” healthier than having an eating disorder? Thanks.)
There’s nothing wrong with skepticism, of course. But I can’t help but notice that, when it comes to the harms of obesity, suddenly Majikthise’s skepticism vanishes, and alternative ideas aren’t even mentioned:
…There is no doubt that obesity increases the risk of death and ill-health. […] this study suggests that if obesity rates increase, excess deaths will increase as well.
In fact, Majikthise sounds more certain about the obesity/death association than the JAMA authors themselves do. From the JAMA article:
Other factors associated with body weight, such as physical activity, body composition, visceral adiposity, physical fitness, or dietary intake, might be responsible for some or all of the apparent associations of weight with mortality…. Obesity is associated with a modestly increased relative risk of mortality, often in the range of 1 to 2. In this range, estimates of attributable fractions, and thus numbers of deaths, are very sensitive to minor changes in relative risk estimates.
Many of the factors that Majikthise suggests might confuse the findings regarding “normal” weight people - yo-yo dieting, weight-loss surgery, etc - seem if anything more likely to be an issue with obese people. So why aren’t those factors also reason to question the findings about obesity? Majikthise, like all of us, lives in a culture with an anti-fat ideology. It’s anti-fat ideology, not sound logic, which says that findings that “overweight is healthier” should be treated skeptically but “obesity = death” findings from the exact same study, arrived at with the exact same methodology uncritically accepted.
That same ideology also dictates that, even if being overweight might not kill you early, it’s important to bring up the possibility that it’ll ruin your life in other ways. As Majikthise writes:
The study didn’t even attempt to measure the detrimental effects of excess weight on general health or quality of life.
Well, no, it didn’t; that’s outside the scope of a mortality study. To be fair to Majikthise, the study authors themselves brought up this concern. Curious, isn’t it, that the study authors didn’t feel obligated to suggest that there might be detrimental effects of underweight on general health or quality of life?
Imagine for a moment that a new study found the “male early death” factor isn’t as large as once believed. Would people feel the same need to temper this good news by reminding us that maybe men will be living longer, but their quality of life might still suck? Would people still be objecting if newspaper columnists treated such a finding as the good news it is? I doubt it.
Even if obesity “only” kills 100,000-odd people per year, that’s still a lot of preventable death.
There’s probably no word I’m less fond of, in the fat-mortality debates, than the word “preventable.”
What does that mean? “Preventable” how?
Majikthise seems to be thinking of weight-loss diets (i.e., “Maybe relatively modest weight loss will also turn out to be a huge benefit for people who are already obese.”) I’d point out that there are virtually no studies that show that obese people can either 1) reliably become non-obese over the long term through weight-loss dieting, or 2) improve longevity by losing weight. As the JAMA article writers say, “Even if body weights were reduced to the reference level, risks might not return to the level of the reference category.”
Given the incredibly high failure rate of weight-loss diets over the long run - and the damage done by failed weight-loss diets not only to physical well-being, but also to self-esteem and mental health - I don’t believe that pushing weight-loss as a remedy is justified. Weight-loss fanatics have dominated the conversation about fat for over half a century; what can they show for their efforts? Are Americans now less fat? Are we happier about our weights and our bodies?
Pressuring Americans to be thinner has a record of utter failure for longer than most of us have been alive. If people were capable of thinking reasonably about weight, that would be enough to convince most of us that it’s time to try a different approach. But anti-fat ideology is too powerful, much more powerful than logic. It doesn’t matter how much the new data differs from the old: the remedy is always the same. Diet, diet, diet, weight, weight, weight.
Tierney and others imply that if mere overweight is good for people, then our public health programs must be misguided. But if being overweight really extends people’s lives, then we should redouble our public health efforts to stop millions of overweight Americans from drifting into obesity. For these people, even a small weight gain could have dire consequences.
The study actually found no consistent connection between weight and mortality until BMIs of 35 and over. (”The majority of deaths associated with obesity were associated with BMI 35 and above”). Since “overweight” was defined as BMI 25-30, it would actually take a very substantial weight gain to put an “overweight” person into the high-risk category; this study does not support the idea that “a small weight gain could have dire consequences.”
Maybe relatively modest weight loss will also turn out to be a huge benefit for people who are already obese. Even preventing further weight gain in obese people might save many lives. If so, perhaps obesity interventions are even more cost-effective than we thought.
There’s a lot of “maybes” and “perhapses” going on there, and no actual evidence. But in our society, no one is expected to question the ideology that says fat people must be pressured to worry about weight (since we’re so unpressured already!). In our society - in anti-fat ideology - all unfounded speculation seems reasonable so long as it endorses losing weight as the solution.
Again - and I know I repeat this a lot, but it needs repeating - there has never been a diet that’s been shown in a peer-reviewed study to lead to healthy, sustainable weight loss in most fat people over the long run. Much more often than not, weight loss dieting leads to depression, damaged self-esteem, moodiness, long-term weight gain, and in some cases the ill effects of weight cycling - but not to long-term weight loss.
So Majikthise is arguing for an “intervention” that fails to work around 95% of time; that has nasty side effects; that makes the condition it addresses worse at least as often as it makes it “better”; and all of this is to address “modestly” higher risks that may be attributable, in significant degree, to other factors. If the “condition” being treated was anything but fat, we’d think that was crazy. But in our society, it’s difficult to even see irrationality, because anti-fat ideology has clouded everybody’s vision.
* * *
There are probably a lot of preventable deaths in that 111,909 figure. Fat people, due to the enormous pressure to not be fat, are more likely to have tried diet after diet, leading to yo-yo dieting - and, quite possibly, to a higher weight in the end. A lot of obese people would be healthier and live longer if they remained steadily obese, rather than weight cycling. Similarly, extreme weight-loss surgeries - liposuction, stapling, etc - could easily be shortening fat lives. (For one thing, those interventions are sometimes fatal.)
Second of all, the belief that fat is the most important barometer of health discourages fat people from steady, lifelong exercise and healthful eating. A lot of fat people try exercise and better eating for a while, but then quit because it “failed” to make them non-fat.
More appropriate definitions of “success” - such as being able to walk a treadmill longer without losing breath - would prevent many deaths. Unlike weight loss, the empirical data on the benefits for fat people of regular exercise is very strong, and the negative side effects almost non-existent. (I think Majikthise agrees with me that it’s better to emphasize health than weight.)
Majikthise begins her post by criticizing John Tierney’s Times article. This may be the only time I’ll ever agree with John Tierney rather than Majikthise, but I think Tierney has a better grasp on the real problem. The main message Tierney suggests isn’t “eat all the big macs you want!” but “anti-fat hysteria needs to be mocked.” The main message Majikthise conveys, despite her good intentions, is “possibly overweight people are healthy, although maybe that’s just a statistical artifact, but we must not lay off the obesity-equals-death message.”
Fat lives would be both better and longer if we could spread the former message widely, while burying the latter message as deeply as possible.
April 27th, 2005 at 5:54 am
Amen, and say it again!
I fall into the category of overweight (or beyond, BMI 31). I eat healthy, and exercise often and hard - though not for weight-loss purposes. Interestingly enough, my health is robust - maybe one cold in a year, no chronic problems whatsoever (ever in my life). Why then does doctor after doctor tell me I need to lose weight for health reasons?
With any other “condition” it would be downright insane to tell a patient “Let’s treat this problem that isn’t bothering you at all by subjecting you to radical lifestyle changes that have a significant chance of lowering your metabolism, rebounding your condition (weight) even higher, and compromising your health - and that probably won’t work.” With weight, almost every doctor I’ve ever had has mentioned it.
In my opinion, most of the unhealthy aspect of overweight can be laid at the doorstep of a culture that says overweight is unacceptable and thereby leads to mass malnutrition as people strive to get rid of something that is doing no harm.
This comment was written by Tapetum.Report this comment to the moderators
April 27th, 2005 at 7:00 am
I want to agree with you, and I mostly do. There’s no point in fruitless dieting, you would be 10 times better off to swear off all dieting and just start going for a 20 minute walk every day — whether you lose weight or not. But what stops me from endorsing your view wholeheartedly is that I can see where it will lead: fast food commercials about how weight isn’t bad and you can eat at McDonald’s three times a day, no problem! And vending machines for schools really are OKAY!!! Hey, and why should we appropriate money for parks and bike trails anyway?
Just another form of denial, and of course, YOU aren’t saying that, but the message will snowball into a form that people want to hear and it isn’t eat healthy foods and exercise regardless of how much you weigh. No one wants to hear that, even though it’s obviously the real problem, because “losing weight” has been the “carrot” that supposedly makes poeple go for the “stick” of eating vegetables and exercising (except that it doesn’t really work either). Basically, I am just very depressed about the role of food in American life — abundant but trashy. I spend all kinds of time cooking and planning meals and I’ve gotten my kids to the point that there is nothing they reject out of hand, not even Brussel sprouts and spinach. I won’t even eat at most restaurants anymore because the food is so tasteless — hey, but you can take the leftovers home and reheat them for days! ( I do like spicy “ethnic” cuisines and high end fusion restaurants).
Obesity does have some risk factors independent of diet — diabetes, hypertension, arthritis (doesn’t cause but clearly exacerbates) and yes, even infertility. It’s also harder to diagnose certain types of diseases or conditions in an obese person. Yes, I agree that the CDC has been caught with its pants down around its ankles — the inherent bias they brought to the exercise probably caused them to be a lot less scrupulous with their analysis than they should have been. And now we are going to see the gleeful backlash, spearheaded by the fast food industry.
This comment was written by Barbara.Report this comment to the moderators
April 27th, 2005 at 7:06 am
I am in agreement with Lindsay that we should be distrustful of Brooks’, Tierney’s, and the CCF’s motives. I have a hard time believing that these people/groups are truly interested in quelling the ‘fat is bad’ message and stressing a message of health over weight. Rather, it seems they are cherry-picking and highlighting this finding because it is amenable to their larger agenda.
This comment was written by scf.Report this comment to the moderators
April 27th, 2005 at 7:07 am
Doctors can be really obnoxious about telling you to lose weight. I’m a size 16 now, so not obese, but you can bet that every time I go to the doctor I get this serious, horrified talk about losing weight. Like I don’t know that I’m overweight or something. Or no one’s ever mentioned that it might be bad for me. If I have a health problem, most of the time they are unwilling to treat it, preferring to attribute it to my weight. Knee hurts? Too fat. Digestive problems? Lose weight. Feeling sick in the mornings (no, I’m not pregnant)? Must be weight. That’s great, maybe it would help, but for now: can we not ignore the problem? I’m willing to try weight loss more seriously if you would just, you know…determine that that’s actually the cause instead of automatically blaming weight. And this happened a couple years ago when I was a size 12, as well, when I was maybe 10 pounds above the ‘normal’ weight for my height (and I’m a ‘generously’ preportioned girl, so cut me some slack). Its really upsetting how people are willing to just treat being thinner as a cure-all, like slender people never have health problems. Its not that being heavy has never caused a health problem, but living healthy is more effective than appearing healthy. (By the way…I freely admit that my move back to a 16 is squarely my own fault. Too much sitting on the couch, too much cheap fattening food. My boyfriend and I gained weight together due to our video game addiction! However, I was healthy and happy 2 sizes down, yet still apparently in danger because of my weight. It is absolutely insane to develop a one size fits all definition of what size you need to be and lifestyle you need to follow to be healthy.)
This comment was written by Rabbit.Report this comment to the moderators
April 27th, 2005 at 7:52 am
Barbara, the problem with holding onto “fat is bad” in the hopes that it will lead to healthy eating and exercise is that it doesn’t. Instead of saying “Gosh, I can’t be fat, guess I better eat carrots,” people look for the shortcuts. Atkins, purging, sweat-wraps, whatever, especially because the measure of fat most people use is weight. (Lost 10 pounds of water in a week? Woohoo, you’re healthy!)
Emphasizing that junk food and sloth, not fat, will kill you still goes to that healthy message. You can’t really make people be healthy by telling them to be skinny.
This comment was written by mythago.Report this comment to the moderators
April 27th, 2005 at 8:49 am
scf: You’re correct, we should remain suspicious of Brooks and Tierney. There is a strong implication in their recent columns that anti-fat hysteria is a product of the left in some way, blue-staters imposing their ascetism on real Americans who know better. This is a misunderstanding of the role anti-fat hysteria plays in American culture, I think (although not entirely so). But they’re still right on the central point, even if they labor a bit too much to bring that point in line with their axes that need daily grinding.
This comment was written by djw.Report this comment to the moderators
April 27th, 2005 at 9:04 am
I don’t see anybody with a vested interest and available resources who is willing to promote the “eat healthy and exercise” message. I don’t know how fast food restaurants will react, in truth, because they are probably somewhat cautious given the caveats in the revised study — obesity is an independent risk factor, and other risk factors of more moderate weight gain may be masked by better treatment. Telling people to get skinny obviously doesn’t work, but most people want to see in rather concrete terms the “payback” for their “asceticism.”
This comment was written by Barbara.Report this comment to the moderators
April 27th, 2005 at 9:08 am
I see where scf (and Lindsay) are coming from, in the sense that there’s no question that the fast-food industry may misuse the findings, and the CCF has ulterior motives for publicizing the study (and the gross problems with the earlier one.) But, still, I think this ends up being like dismissals of arguments as “partisan.” Just because they arguments serve dubious purposes doesn’t mean they’re not right. And given that the previous JAMA study was such a disgraceful shambles, I don’t think they’re entitled to the presumption of good faith one would normally have for professional scientific studies, and the fact remains that their evidence that being overweight, as an independent variable, creates serious health problems remains negligible. And, at the very least, I do think that the study’s claims, as Ampersand says, have to be analyzed with equal skepiticism.
This comment was written by Scott Lemieux.Report this comment to the moderators
April 27th, 2005 at 9:11 am
Bravo. Exceptionally well put. One thing I’ve seen quite often from anti-fat critics is this manner of inconsistant reasoning. 86,000 fewer deaths is a minor figure which is likely due to statistical anamolies. 112,000 more deaths is such an enormous figure that it cannot even be questioned. It just doesn’t make sense. Were talking about a difference of 26,000 seperating unsupportable and indisputable? It defies all logic.
This comment was written by Brian.Report this comment to the moderators
April 27th, 2005 at 10:02 am
No, Brian, it’s just that the 86,000 doesn’t cancel out supposedly avoidable 112,000 deaths. At least that’s how I would describe it. Let’s put it this way, if you showed that 86,000 people didn’t die this year because they had stopped smoking, those deaths wouldn’t “cancel out” the 112,000 people who might have died because they continued to smoke. Smoking would still be worthy of public health intervention.
Here, the picture is much cloudier — people don’t die from obesity, but from allegedly secondary health effects, the most notable being diabetes. One of the interventions for diabetes is to lose weight, it does sometimes work (it doesn’t always, by any means, as there are thin Type II diabetics). On the other hand, by the time you’ve been diagnosed as a type II diabetic, you have probably passed through whatever period of life in which it might have been easier or at least optimal for you to lose weight (say, in your 20s). This is the problem that the CDC sees coming down the road: the increasing percentage of people who are overweight and obese at a younger age leading to a higher percentage of older people who are obese or morbidly obese, with attendant risks.
I got arthritis at a young age (
This comment was written by Barbara.Report this comment to the moderators
April 27th, 2005 at 10:07 am
Since everyone here is interested in these issues, I am posting this issue of Nature Neuroscience which is a review of current understanding of the neurobiology of obesity and other eating disorders. Its available for free for the next 30 days due to sponsorship by NIH. The articles discuss findings from animal studies and are mostly related to specific disorders in humans. They’re for a scientific audience, but non expert so everyone should be able to find them accessible. Hopefully someone out there finds them interesting
Nice post AMP, a very well put argument (as usual). I would just add that the more pressing problem with the fast-food industry may well turn out to be the use of trans-fats. These are very bad for you, and new effects are being discovered all the time. Unfortunately, the world supply of alternative resources is not large enough to allow the industry to move completely away from them.
This comment was written by Ted.Report this comment to the moderators
April 27th, 2005 at 10:07 am
Don’t know what happened to the rest of my post, apologies if this or something like it shows up twice — I got arthritis at a young age so I am probably more sensitive than I need to be about the impact of weight, because extra pounds (especially if not muscle) are hard on the joints. If I were overweight and got arthritis much later, I would not be in as good a position to lose weight. No one can undo a lifetime of accumulated effects of bad habits, whether thin or not, and this probably should be the message: Whatever personal risks you are taking now (food, alcohol, weight, smoking, lifestyle related) will likely catch up with you. Losing weight has been sold like a raffle ticket at a fund raiser — a short cut to make you do something supposedly good without any explanation as to why you should be doing good even in the absence of a short-term concrete benefit. It also trades on social bias and is obnoxious on that account.
This comment was written by Barbara.Report this comment to the moderators
April 27th, 2005 at 10:31 am
I’m mostly irritated at this point that the corporate apologists are using this to make it seem like they are so rock and roll–we’re defending your right to some fun burger eating! Yeah right.
This comment was written by Amanda.Report this comment to the moderators
April 27th, 2005 at 10:53 am
Thanks for the link, Amp.
The CCF asserts that the earlier study was a flawed piece of propaganda, but they don’t offer any evidence to support that allegation. Everyone agrees that the new study is better than its predecessor. But that’s how science works. You publish your findings, people criticize them, someone does a new experiment that gets around the limitations of the older work. It doesn’t mean that anyone was incompetent or venal.
Amp, you say that:
No one doubts that there are some excess deaths attributable to obesity, least of all the authors of this study. If obesity becomes more common, then there will be more excess deaths attributable to it. That’s just arithmetic.
The issue of obesity-related health problems is critical. The authors argue that overweight and obesity are less dangerous today because of better treatments for high blood pressure, high cholesterol, diabetes and other ailments associated with excess body fat. The CCF spin is that overweight is harmless or beneficial. The reality is that we’re getting better at compensating for some of the serious health risks. It’s still a major health problem if large segments of the population are dependent on drugs for the rest of their lives. I’m sure everyone would rather avoid high blood pressure in the first place, even if there are meds that can bring their life expectancy back to normal.
Finally, I’m not arguing that we should encourage anyone to go on a diet. I think the best public health efforts are things like PE in schools, community bike trails and tax cuts for employers who want to provide exercise facilities for their workers, support for breast feeding (reduces baby’s future risk), better prenatal care (help women gain the optimal amount of weight for a healthy baby and minimize their risk of gestational diabetes), tax incentives for fresh food stores in urban areas, cutting corn syrup subsidies, etc., etc.
This comment was written by Lindsay Beyerstein.Report this comment to the moderators
April 27th, 2005 at 11:22 am
I think it’s important to draw a distinction between anti-fat hysteria (which is bad) and the CCF’s agenda (which is not necessarily anti-anti-fat hysteria). If the CCF were really anti-anti-fat hysteria, they’d take on the fashion industry, not the CDC. What the CCF’s really about, however, is deflecting criticism of crappy food, not deflecting criticism of fat folks.
This comment was written by nolo.Report this comment to the moderators
April 27th, 2005 at 11:37 am
Has there been a change in the rates of anorexia and bulimia in the last few years? Is there less of it?
One of the most common anti-fat rants I read is the complaint that young women who are a little chubby wear clothes that reveal their midriffs. Maybe I’m just being optimistic, but I’m hoping that more women are taking pride in their bodies as they are, rather than hurting themselves in an effort to maintain an unnatural body composition.
By the way, has anyone pointed out that Terri Schiavo’s heart failure was the result of her bulimia — an indication of the health risks of self-imposed malnutrition?
This comment was written by Brian Vaughan.Report this comment to the moderators
April 27th, 2005 at 11:40 am
Lindsay - you said “The issue of obesity-related health problems is critical.” I would disagree with that. The issue of health problems which occur more frequently in obese patients is critical. There is a huge difference between association and causation.
Many, if not most, of the obese people in this county are malnourished, have diets heavy in unhealthy foods, under-exercise, undergo periodic dieting with resultant weight loss/regain, and tend to (with society’s heavy encouragement) loathe their own bodies, which frequently results in general poor self-care. Given these conditions I would be downright startled if obesity weren’t associated with increased risks for all sorts of things. Association is not causation. I have yet to see a study which adequately demonstrates any kind of causation for the obesity itself.
That said, there are some health issues for which a lower weight is more comfortable - any kind of arthritis would be a prime example. But that doesn’t even mean that the obesity is actually making the condition worse, just that it’s making it more painful (a moot point for the individual, I know). I am in mind of a lady in Tae-kwon-do who needed to be able to do a jump-kick board break in order to pass a belt test. Her weight was seriously impeding her ability to do the break. She went on a diet, jumped higher, and passed the test - but within six months had developed an immune disorder that put her out of commission for nearly a year. Losing weight demonstrably helped her functioning (she could jump higher more easily), but it did not help her health.
Until I see something that a) shows some reasonable signs of causation between weight and health risks for mild obesity, and b) some reasonable plan that would enable one to losing weight without increasing your risk for all the byproducts of dieting, I’ll just keep on keeping on as I am.
And since when is “Someone will misuse it” a good excuse for not telling people the truth about their own bodies? McDonald’s is going to try to make their profit regardless of anything. People can’t make informed decisions about what McDonald’s is telling them without information.
BTW - there is clear association between underweight and myriad health concerns also. I don’t see anyone chasing the skinny people waving food at them (except perhaps the stereotypical Jewish mother).
This comment was written by Tapetum.Report this comment to the moderators
April 27th, 2005 at 11:48 am
You have probably said this already somewhere on your blog, Amp, so let me be the second to say: why is this our #1 public health agenda? Why aren’t our federal public health officials working on the issue of infant mortality, for example? We have one of the highest rates of infant mortality of any industrialized country. Why does fat come first? How about the lower life expectancy rates for African Americans, something that Bush has publically acknowledged? You know, it’s not like we don’t know why that is, we know very well that African Americans do not get fair medical treatment. Take a look at this article, Equality in the 1990s would have saved 900 000 black Americans.
This comment was written by balabusta.I think this all fits in with the Republican idoelogy of making all social problems the responsibility of individuals. That way, if you are sick, we can blame you for it. Gross.
Report this comment to the moderators
April 27th, 2005 at 11:58 am
Barbara, no one is suggesting they cancel out anything. The closes thing to that point is not letting the CDC off the hook for attacking those people in the first place. And continuing to do so, for that matter.
The issue is that people want to act like 86,000 fewer deaths is a meaninglessly small number but an increas of 25% makes for a statistic that cannot be argued with and completely justifies the extremist anti-fat campaign that had previously depending on a number 400% bigger. Its not a logical, nor consistant, treatment of the statistics. You cannot say one number is insignificant while another nearly identical number is so significant that no one can question it or the conclusions you draw from it.
The response to a massive overstatement of the problem should not be, “yes, but its just as big a problem.” That’s precisely what it isn’t. What we are seeing are the tortured lengths some people will go to justify a pre-concieved notion. This buffet style use of statistics has always been the problem with the anti-fat critics. Especially with mortality studies. Now the justifications are just on display and I guess we can’t blame the scientists who’ve been pulling this for years. Clearly it is a problem that is fundamental to our culturally ingrained assault on fatness. Its been self-justifying for so long that no information is always rationalized into place so it doesn’t challenge existing beliefs.
Concerning the CCF, personally I’d like them to shut up, already. They’ve revealed numerous times that they don’t care about fat people so I always find their celebration dubious. They are right by accident, not by design. By the same token, I see no reason to look at the CDC as being any more saintly. They’ve engaged in a very expensive and dangerously unfounded propaganda campaign against fat people. This is not the CDC’s mission, but I’m sure it makes for flashy headlines and make the multi-billion dollar diet industry very happy. They strike me as just as much of corporate shills on this issue as the CCF.
This comment was written by Brian.Report this comment to the moderators
April 27th, 2005 at 12:10 pm
The major health risks of obesity include diabetes — not all Type II diabetes, but much of it, hypoxia, certain types of cancer are more prevalent in obese people, particularly those who have fat concentrated around the middle, which supposedly increases cellular activity of a negative kind (as opposed to fat being in the hips and thighs). (Belly fat naturally increases with age in all people.)
Hypertension and asthma worsen with excess weight, as does arthritis (and it’s not just the pain — the health of the joint can be affected by excess non-muscle tissue).
Obesity is a risk factor for infertility and maternal/fetal complications — particularly those associated with gestational diabetes. In some women, the obesity is caused by hormonal imbalance which is also itself the cause of the infertility, so it’s a complicated picture.
For some of these risks, the issue is that your organs are working to serve a larger body than they were designed to — like using a room air conditioner to cool a whole house. Which is why, generally, you have to be very overweight for these things to become really serious health risks.
The NYT article and the study suggested that about 8% of the adult population fit within the class of people who have serious obesity related health risks. It’s not everyone who is overweight, even significantly (assuming the current standard). You can ameliorate these risks for yourself without engaging in unhealthy dieting. It’s not a good idea to overstate or understate them.
This comment was written by Barbara.Report this comment to the moderators
April 27th, 2005 at 12:12 pm
Poor medical treatment might be a significant factor in the health of fat people as well. The anecdotal evidence I’ve seen is frightening. Many fat people have their health concerns ignored or dismissed by doctors who are only concerned with lecturing them about their weight. This attitude can be a powerful discouragement from visiting a doctor, and often causes doctors to non-diagnosis serious conditions. Furthermore, surgical treatment of fat people is still years behind that of thin people. The only reason its remotely close is because Weight Loss Surgery proved worthy enough to justify learning appropriate techniques for opperating on fat people. That’s an absolute embarassment.
The focus on weight has not simply been unproductive, but rather has been counter-productive in persuing improved health for fat people. Dieting has been shown to not only have a negative impact on health, but a negative impact on weight as well. And with diet companies agressively targeting thinner and thinner people, is it really such a mystery why people are getting fatter? The need to stop berating people about their weight on the basis of flimsy and rapidly evaporating evidence of weight as an independant risk is critical. Weight loss is a failed treatment. The answer isn’t to keep saying the same thing over and over and hope it becomes true. We don’t only need to reexamine the answers, but the questions as well. We need a new approach. One which acknowledges that healthy eating and moderative activity help all people and ought to be the method for improving the health of all people. Not the method for making everyone thin.
This comment was written by Brian.Report this comment to the moderators
April 27th, 2005 at 12:31 pm
Are we talking about the same
study here? Just to keep the facts straight,
The bolding is mine. OK, OK, I’m just bitter for being too poor to buy food ;__;
This sounds good. It’s short, gets to the point, and is not ambiguous. Translated into a slogan (while retaining all its qualities), it could do more good to the fat acceptance movement than endless ranting. Just IMHO ^_~
The medical people are rather customed to their “excess fat correlates with unhealthiness” and “so we just got to get rid of the excess fat” (which is a simplification). Of course, this kind of “rule-of-the-thumb” thinking is “easier” for them than considering each patient individually.
It would be nice to see a study considering three variables: fat, lifestyle, and health. Such study might prove that while fat may correlate with health, this might be due to fat correlating with lifestyle.
This comment was written by Mikko.Report this comment to the moderators
April 27th, 2005 at 1:06 pm
Re eating disorders - I was speaking with a woman who is a guidance counselor in a private school and I guess that she was dealing with a lot of eating disorder issues when she told me that a lot of kids had problems with perfectionism, pressure, high parental expectations. She said not so much any more, now she sees a lot of self-cutting.
This comment was written by Tara.Report this comment to the moderators
April 27th, 2005 at 1:10 pm
bean, it’s both the symptom and the cause of the problem — which is to say, there are different causes. Some women suffer from PCOS (which causes both weight gain and infertility), and some women suffer solely from gestational diabetes, but many women are infertile who do not suffer from PCOS, and there is evidence that being (very) overweight can have some impact on fertility independent of both PCOS and diabetes. The diabetes/obesity link is also complicated, but there are many people whose need for greater diabetes intervention decreases markedly when they lose weight. What benefit is there is in simplifying this unduly? I may not be a scientist but I am not engaging in ignorant thinking.
This comment was written by Barbara.Report this comment to the moderators
April 27th, 2005 at 1:19 pm
Brian, You keep writing about the poor medical treatment for obese people by doctors based on anecdotal evidence. My experience has not been the same, but I have been in an ER where the majority of patients were obese and were presenting from complications of type II diabetes. This is a fact of life in South Texas (unfortunately). It was always my belief that they recieved outstanding treatment (especially considering that most of them couldn’t pay, but it was a county hospital). A good deal of the teaching to the patient was on weight loss (via diet alterations), but not because we wanted to berate them about their weight, we wanted them to change their diets as to help their diabetes (which does work). Moreover, these were almost always really sick people, not the kind you’d see in your average doctors office. Having said that, it is still an interesting notion, perhaps you should write the grad student at Rice (someone posted her website on that list) who did the study on treatment of fat people in malls to suggest a study. I’m sure she’d be up to it, or could point you to some relevant studies to support your argument.
Someone mentioned type II diabetes not increasing in adults and they cited a USA today article. That article neglected to mention the large increases that have been observed in adolescents. I think that is why the CDC is so alarmed about diabetes. Type II diabetes has traditionally been a disease of the old (50+) but the demographic has changed substantially. Since type II diabetes becomes harder to manage over time and the risks of neuropathy, blindness, etc., increase with the length of time the disease is present it is a major concern. Whether or not it is actually linked to obesity is another question, but the dietary links are there for both conditions.
This comment was written by Ted.Report this comment to the moderators
April 27th, 2005 at 1:40 pm
I don’t think is true at all. Remember, most science that the public knows about is only what gets reported by the press. The press loves weight loss. Just doing a quick search of the national library of medicine for obesity came up with 80,000 articles in the scientific literature. Searching for HIV came up with 180,000 articles and breast cancer 130,000 articles. Don’t let the press convince you that scientists hae an agenda, some might, but the vast majority have none. Such an attitude quickly gets you labelled by your peers and is the easiest way to end a career.
There was an interesting article in Nature this week on a couple of scientists doing work on minimally conscious states and some of the press wrote a story on them saying that they had come up with a way to treat persistent vegitative state. Of course, they had done no such thing, and protested strongly about the title of the article, but to no avail. This sort of thing happens all the time, much to our consternation. If you really want to know what is going on in the scientific world about obesity I strongly suggest you follow the link I put up in post 12, the articles are not by the press, they are from scientists and show what the current thinking is and what the future of treatment is likely to be.
Scientists accepted a long time ago that diets do not work for long term weight loss and are in fact often bad for the health of the dieter. Pills on the open market (OTC) are usually worse. I don’t think anyone really works on that sort of thing anymore. Current research is focused on genetic causes and understanding the neural systems that regulate energy balance, which we still understand only minimally.
This comment was written by Ted.Report this comment to the moderators
April 27th, 2005 at 1:42 pm
By diets I mean “fad diets”
This comment was written by Ted.Report this comment to the moderators
April 27th, 2005 at 1:54 pm
Well done, Ampersand.
It’s about time people stopped conflating our aesthetic desire for extreme skinniness and the more legitimate reasons to eat healthier and exercies more.
This comment was written by Battlepanda.Report this comment to the moderators
April 27th, 2005 at 2:04 pm
Mikko, studies have looked at fat/health/lifestyle. They consistantly show that lifestyle impacts health far more strongly than fat does. That fact that such studies get no attention and make no impact is why fat acceptance types have to resort to “ranting”. We have slogans. Its called “Health at Every Size,” a movement championed by many health-care professionals. And yet, still we see people arrogantly insist that we not question “fat=bad” and that this is an unstoppable truth which must not be subjected to critical analysis. Still we have people who think fair debate means saying something like “no one can argue that fat isn’t a health disaster” to people saying precisely that. They insist on a terms of discussion which presuppose there is no discussion. See how quickly you’d come across as “ranting” if you kept having to make the case that you can even have a case in the first place.
I’d rather be seen as ranting the as one of those constantly chanting “fat is bad” no matter evidence is put before them. If a study shows fat is bad, something must be wrong with the study. If diets don’t work, it must just be that they are “fad diets”. All 95-99% of them, I guess. In the medical establishment, if you question the anti-fat crusade, that automatically makes you unfit to discuss the issue. Doesn’t matter how much of an expert you are. If you don’t concede that fat people must be eliminated, you don’t get a seat at the table. The same myths get repeated over and over, as if repeatition will make them true. People need to stand up and demand a new approach. Its not pretty to challenge an oppressive opinion like this, but it needs to be done. Even if the anti-fat crowd find it terribly upsetting that people want to critically assess their position, it needs to be done. Enough is enough.
This comment was written by Brian.Report this comment to the moderators
April 27th, 2005 at 3:42 pm
And Gee, It’s Been Working So Well, Too!
Even assuming that we accept the paradigm that “fat is bad,” which I don’t, but let’s pretend for a moment that we do, this point seems obvious. Hello, folks, wake up and smell the frigging coffee!
This comment was written by Dogged Blog.Report this comment to the moderators
April 27th, 2005 at 7:59 pm
I said this on the battlepanda blog, as well, but I think it bears repeating.
There are several different issues that get mixed up in talking about whether Americans are too fat, and whether that’s cause for worry.
We can argue about whether 20 or 30 or even 50 pounds makes much difference to a person’s health. However, the number of people who are 100 or more pounds overweight is rising. 3.8 million people in America weigh more than 300 pounds, and 400,000 people weigh more than 400 pounds. It’s one of those bell-curve type arguments. The fact that the mean weight of an American increases by 20 pounds over a generation (or whatever the number is) doesn’t seem too alarming. 20 pounds more isn’t going to hurt y0u, and who knows? It might even be beneficial. However, in a normal distribution, if the mean shifts by 20 pounds, that means that the number of people weighing 300 pounds or more increases a lot. Between 1962 and the year 2000, the number of obese Americans (those who are 100 pounds or more overweight) grew from 13% to 31% of the population. That’s pretty significant.
This comment was written by Daryl McCullough.Report this comment to the moderators
April 28th, 2005 at 8:08 am
Amp, you wrote (in response to Majikthiese):
(Gee, being overweight is “probably”? healthier than having an eating disorder? Thanks.)
Obviously, those are not mutually exclusive. The notion that all folks with eating disorders are thin is an unfortunate one. Plenty of bulimics, not to mention compulsive over-eaters, have serious eating disorders. When we assume that all eating disorders head in one direction, we make a serious mistake.
This comment was written by Hugo Schwyzer.Report this comment to the moderators
April 28th, 2005 at 9:45 am
I know this is just anecdotal, but when I was at 5′9″/185 (i.e., right in the middle of the overweight-but-not-obese category), my cholesterol was dangerously high and my blood pressure was borderline high. When I lost 35 pounds, the cholesterol went down to barely borderline high, and my blood pressure dropped significantly. Granted, the initial drop may have been due to improved diet and exercise, but they haven’t gone up in subsequent tests, even during periods where my diet has been less-than-ideal (I run 40-45 miles a week now at a vigorous pace, so I have kept off the weight). Talking to my dad, he has experienced the same thing: it doesn’t matter what he eats or how much he exercises–his health depends almost solely on his weight. From this I conclude that there is a class of at least two people for whom being even modestly overweight is, in fact, dangerous.
One question for the “I’m offended that people think that fat people don’t exercise” commentators–do you know any moderately overweight or heavier people that get regular, VIGOROUS (i.e., walking or Curves doesn’t count–I’m talking about running or cross country skiing or biking at a pace that causes you to gasp for air after 5 minutes and causes you to be sore for the rest of the morning) exercise at least five days a week that hasn’t lost a ton of weight? I don’t. On the other hand, I know several people that exercised at a light-to-moderate intensity, didn’t lose weight, then started training for a marathon/75 mile bike ride/etc. and lost a ton of weight quickly. It’s purely anecdotal, but based on my experience, I find it hard to believe that someone that followed a very restrictive diet (low fat, low processed sugar, high fiber) and exercised VIGOROUSLY (see above) for five days a week or more wouldn’t lose weight. It isn’t fun, especially if you aren’t one of those lucky people for whom high intensity exercise releases a relatively large amount of endorphins to block physical discomfort–but it can (and has, at least by me) be done, so by choosing not to lead that sort of lifestyle, you are choosing to be fat.
I know this is an unpopular view, by the way. I feel bad about it. But in my heart of hearts, I honestly believe that for most (90%+) overweight people, it is a conscious choice not to do what needs to be done to achieve a “normal” weight, based on the discomfort that would be required to do so.
This comment was written by Joe.Report this comment to the moderators
April 28th, 2005 at 10:54 am
Joe, I don’t think that you can conclude that those people who theoretically could lose weight have made a conscious choice not to do so. I think you underestimate the time, monetary, and logistical barriers that many people face in getting exercise and nutritious foods. A disproportionate number of obese people are poor and minority — until society makes an investment in, say, recreational facilities and programs, and various other public health initiatives, no one is going to be able to address this issue. One of my concerns is that by telling ourselves that obesity or its effects truly isn’t a health consideration, that’s one more excuse not to make the effort.
This comment was written by Barbara.Report this comment to the moderators
April 28th, 2005 at 11:32 am
Ted, I think you are right that a lot of the hype around the national attention to obesity as a key public health issue comes from the press. Nevertheless, I do believe that the current administration’s healthcare initiatives come from a mindset of assigning all responsibility for public health to individuals. I googled and found this fabulous (!) website: http://www.healthgap.omhrc.gov/ What is the key initiative to reducing the healthcare gap between African Americans and Latinos and everyone else? Take Your Loved One to the Doctor Day.
Does this not seem ludicrous to you? We have a huge population of uninsured people, the feds are cutting the funds to the CHIPs programs that cover uninsured children, we have documented bias in providing healthcare. So naturally, we should focus our public health attention on making it the job of African Americans and Latinos to take their presumably unwilling relatives to the doctor.
Right after they go online to create their personal nutritional pyramid. You don’t think this reads like satire? Of course not–at least, not compared to “freedom on the march”, the Help America Vote Act, No Child Left Behind and the USA Patriot Act. Gosh, it’s starting to seem a bit, I don’t know, silly or something!
This comment was written by balabusta.Report this comment to the moderators
April 28th, 2005 at 11:53 am
“Joe, I don’t think that you can conclude that those people who theoretically could lose weight have made a conscious choice not to do so.”
I don’t want to get into a semantical discussion, but if you know that you could take various actions to change something about your life that you do not like, yet you do not take those actions because you consider them to be unpleasant, in your mind the costs of remaining in the status quo exceed the costs of reversing it. You have made a logical, rational choice.
“I think you underestimate the time, monetary, and logistical barriers that many people face in getting exercise and nutritious foods. ”
Really? I disagree. As for time, one hour a day should do it–go for a hard 35 minute run, drink a bottle of water, shower, and you’re done. An hour max, and probably closer to 50 minutes. I’m usually at work from 8:30-8:30, and I find time–I just get up at 5:30 to get the run in. Now, getting up that early to exercise isn’t pleasant, but again, one really must decide what is more important to him or her: losing an hour of sleep or remaining fat. I can see arguments either way, but it is a choice that each individual gets to make on their own. With respect to food, I had a nice spicy red sauce and tuna pasta last night that took 15 minutes to make. Salads take even less time. On days where I am really exhausted, sliced cucumbers, tomatoes and smoked fish on crackers can be a great dinner that takes 2 minutes to prepare.
As for money, please. A pair of decent running shoes will run you $80 and last six months, at least. For those that live in cold weather climates, there are always cheap gym alternatives (e.g., the Y) where you will have access to a stairstepper or treadmill. Heck, use a jumprope. And as for food, a diet high in fruits, vegetables and whole grains is typically cheaper than the average diet (ex: the lunch I just had of cheerios, a big apple and a slice of flaxseed bread was probably $1.50 or so). This is especially true given the advances in frozen food technology. The above-mentioned pasta dinner, which fed two, cost approximately $4, including the cost of the olive oil and spices used to prepare it.
As for logistics, I guess I don’t understand how this is different that time.
In general, I guess my point is that for the overwhelming majority of people, it really is a choice that they have to make. There certainly are drawbacks to this choice–either (1) stay fat, or (2) lose sleep, subject yourself to a tedious and uncomfortable hard workout, eat things that don’t taste as nice as the other things you could eat, etc. But it is a choice nonetheless.
This comment was written by Joe.Report this comment to the moderators
April 28th, 2005 at 12:46 pm
Joe, I don’t know you, I don’t know what you do for a living, whether you have children, where you live, etc. But where I live many people get up at 4:00 in the morning to get themselves and their children ready for work and school, and to take 1 or 2 or 3 buses to reach their office by 8 or 9 am, and they are not wasting time. They do the same in reverse on the way back, make dinner, make sure their kids get their homework done, get to bed, have clean clothes for the next day, etc. They have no close by grocery stores, and no car, making a true “shopping trip” pretty difficult on a regular basis. This is the reality for many people in urban America, in particular, and this is where obesity is particularly evident (especially for women). It’s not my reality and for that reason I do find time to exercise and shop for good food. For those who could squeeze in the time to exercise and do better with their diet but don’t — yes, okay, they ought to if it matters to them. But ignoring poverty and its collateral effects is unjustified.
This comment was written by Barbara.Report this comment to the moderators
April 28th, 2005 at 12:50 pm
Balabusta,
I certainly agree that the Bush administration’s policies are ridiculous. Health Care for minorities is an outrage as well and has been irregardless of what party was in office for far too long. I’m from South Texas and now live in Montreal Canada and the access to healthcare here is great, for everyone. Unfortunately, the overall quality of care is only decent, but at least everyone gets that decent care. I don’t know much about the African American community and health care access, although I’ve seen enough to be fairly sure its bad. I do know quite a bit about the disadvanteges/disrimination that occurs against the hispanic community and it is really terrible. It is almost completely on a monetary basis though, at least in South Texas. Once someone finally finds the resources they need the care is excellent. Anything to help, though, is a step in the right direction. At least someone is trying to promote education, we used to have the hardest time trying to get people with diabetes to cut down on sodas (which for most of them is all they really need) mostly because they didn’t understand just how much sugar they had.
Having said that, it is an outrage that in the world’s only superpower (not for long I’m sure) there is no universal health care. As for how the administration sets their healthcare agenda, I think it likely involves very little sceince. Afterall, they’ve succeeded in kicking most scientists off their committees and replacing them with MDs with right-leaning views and political cronies (but that’s a whole other can of worms)
This comment was written by Ted.Report this comment to the moderators
April 28th, 2005 at 1:10 pm
Joe,
You make an argument that seems logical on the surface but I think cannot be supported by our current understanding of energy balance in humans. It is quite likely that in more than 10% of the overweight population they would continue to be overweight no matter what they did based on their genetic makeup. Moreover, in obese individuals (obese in medical terms) taking on such a program might be very dangerous and even if there was an attempt to do so by gradually working up to it, the presence of other conditions might make it permanently prohibitable.
ON the other hand, the time excuse might be very real, but it shouldn’t be. There is nothing more important than health and in our increasingly technological society we must (as a society I think) promote eating healthy and exercise for everybody, no matter what their size or shape. Some of the people on this post have really opened my eyes to how “fat discrimination” works against a healthy lifestyle for all people. I’d never considered that aspect before, and I think its important when we consider judgements we make about the situation of others and how they would be best served (especially for those of us in the health field).
This comment was written by Ted.Report this comment to the moderators
April 28th, 2005 at 1:46 pm
“But where I live many people get up at 4:00 in the morning to get themselves and their children ready for work and school, and to take 1 or 2 or 3 buses to reach their office by 8 or 9 am, and they are not wasting time. They do the same in reverse on the way back, make dinner, make sure their kids get their homework done, get to bed, have clean clothes for the next day, etc. They have no close by grocery stores, and no car, making a true “shopping trip”? pretty difficult on a regular basis.”
This sort of person would fall outside of the “most of the obese” that I used in the prior comment. I really question, however, how many of the obese are single mothers with a work-time-plus-commute of 14+ hours a day, no domestic assistance from a relative, and virtually no access to a store that has fresh and/or frozen produce. I live within a few blocks (OK, more like 4 blocks) of one of the economically depressed urban areas of the country, and two of those factors would not apply on their face (public transportation makes commutes of over an hour virtually unthinkable, and there are tons of nearby stores close to public transportation with cheap fresh and/or frozen produce).
“It is quite likely that in more than 10% of the overweight population they would continue to be overweight no matter what they did based on their genetic makeup.”
Maybe. I’ve never seen the numbers. I do know a couple of active, healthy individuals that probably couldn’t be skinny no matter what they ate and how much they exercise, so I know they exist. What percentage of the obese that they are? Got me, but I’d be surprised if it was higher than 10%. Just thinking about it, I know a lot of fat people. With the exception of the foregoing two people, most of them are fat because they have very poor diets and refuse to exercise because “I don’t like it.”
“Moreover, in obese individuals (obese in medical terms) taking on such a program might be very dangerous and even if there was an attempt to do so by gradually working up to it, the presence of other conditions might make it permanently prohibitable.”
Clearly, (1) I didn’t mean to imply that clinically obese people should be thrown on the street with a pair of running shoes and told to run 5 miles as hard as they can, but instead, should begin a gradually intensifying fitness program to work up to being able to do that, and (2) I don’t mean to suggest that there aren’t obese people that are permanently medically unable to exercise at a high intensity–and they, of course, shouldn’t be told or encouraged to. However, aside from the elderly (who shouldn’t worry as much about obesity in any event), I’m not quite sure that there would be many of these individuals. I could be wrong, though.
This comment was written by Joe.Report this comment to the moderators
April 28th, 2005 at 1:47 pm
Joe, yes many of us can make a choice to eat healthier and exercise more. Some are doing the best they can with their situation, and spending an hour a day exercising doesn’t fit into that. Not everyone has the same options, but I know that’s hard for some people to understand. Thing is, even a choice to eat healtheir and exercise will not result in a thin body for everyone who does so. If it did, we wouldn’t have a 95-98% failure rate for weight loss programs. There’s nothing wrong with making healthier choices; I’m all for it. But you can’t extrapolate your own case to mean that a) everyone who is fat is unhealthy, b) that it’s a simple matter of choice, and c) that healthier diet and exercise habits will invariably lead to weight loss.
This comment was written by pseu.Report this comment to the moderators
April 28th, 2005 at 1:48 pm
Oh, and recent medical research has shown that lack of sleep may be a contributing factor to obesity.
This comment was written by pseu.Report this comment to the moderators
April 28th, 2005 at 2:10 pm
Stress also contributes to weight gain, especially weight gain of “belly fat” the kind that is apparently more dangerous.
This comment was written by Barbara.Report this comment to the moderators
April 28th, 2005 at 2:40 pm
Joe,
I don’t think anyone knows the numbers on genetics and obesity, but we seem to have differing opinions on which side of the 10% it would fall. My opinion is based largely on failure of weight loss programs and what I have read in the literature (I am a scientist and pay fairly close attention to it because my direct field, cannabinoid pharmacology and neuroscience, is the hot topic in obesity right now). My guess is it will be a large proportion (30% range), in the obese population. But who knows? You could well turn out to be right.
As for the sleep thing, there appears to be a connection, but there are just as many that think the obesity is the cause of sleep deprivation. My understanding now is that there isn’t much more evidence than a strong correlation right now, but that’s another hot topic so I’m sure more will be on the way soon. The whole metabolic neuroscience field is really growing by leaps and bounds right now. There should be alot of advances coming soon. In fact, the first cannabinoid weight loss pill, called rimobrant, is set to hit the market in Europe sometime soon. Its very effective in animals and worked well in trials so it’ll be interesting to see if that translates into help for the morbidly obese (the population it is being aproved for). Its a pretty powerful appetite suppressant, think the opposite of the munchies (pharmacologically that’s exactly what it is).
This comment was written by Ted.Report this comment to the moderators
April 28th, 2005 at 4:43 pm
And now the inevitable “I did it, so everyone can” arguement. I don’t know how we can be expected to respond to someone who “on faith” just believes all fat people are lazy gluttons who could be thin if they wanted. Why on Earth would people choose to be scorned, discriminated against, and abused by society? Its no different than those who say all gays and lesbians choose their lifestyle. A rational which always carries an implicit endorsement of the abuse of these people. Because we’re “asking for it”. Its prejudice, pure and simple. And even if you insist you wouldn’t call for the abuse, you are standing up for the same hateful ignorance which justifies it. You can’t have one without the other.
This comment was written by Brian.Report this comment to the moderators
April 28th, 2005 at 5:13 pm
Telling people to get skinny obviously doesn’t work, but most people want to see in rather concrete terms the “payback”? for their “asceticism.”?
The problem being “see”. Most people who eat better and exercise regularly will feel better and healthier, but not many people will stop them and say “Wow, you ran right up those stairs and didn’t get out of breath–that’s marvelous!” It’s about how thin you look, not about your health, diet or level of exercise.
This comment was written by mythago.Report this comment to the moderators
April 28th, 2005 at 6:16 pm
Joe,
I just wanted to throw in my two cents as someone who has to lose more weight than you did in order to appear ‘thin.’
I lost 120 lbs through vigorous exercise and lifestyle changes. That was about a third of my body weight. For the past 4 months, I have not lost an ounce, in spite of the fact that I’ve kept up the same rigorous routine, exercising 7 days a week from 2 to 4 hours a day. It’s not gentle walks I’m doing - I mountain bike (on actual mountains, of which we are lucky to have a couple nearby), lift weights and run. After two months with no drop in my weight, I increased the level of difficulty in my rides and runs. The result was that my body started desperately demanding more food. It’s only 200-500 cal more a day, but it is enough to keep me from losing more weight.
I wouldn’t be surprised if losing a third of its weight causes a body to react with alarm and try to put on the brakes. After all, as far as the body is concerned, if I maintain my healthy habits at their current, frenetic level, it can only end in death.
I’m not the only person of my acquaintance who has had this experience - in fact all the 100+ lb losers I know (I know five) reached a plateau after losing a third of their body weight, and three of us are still, by American standards, fat (I wear size 14). Of this group, three regained substantial amounts of weight - in one case, all 143 pounds. I’ve noticed this pattern also in 100+ lb weight loss bloggers I’ve read over the long term.
Anyway, I agree with you that the vast majority of people WILL lose a lot of weight if they change up their exercise regimens and eat better - - but that DOESN’T mean they will appear thin. Almost two years into this very time-consuming weight loss campaign (I agree with Barbara on that - it takes a lot of time and a lot of focus. Money doesn’t hurt either), I still look fat. I’m also willing to bet I am a lot more fit than the drunk guy who mooed at me out his car window as he was speeding by the other night.
Thanks for an interesting discussion!
MG
This comment was written by Mary Garden.Report this comment to the moderators
April 28th, 2005 at 6:34 pm
I suppose this is the point at which I should interject that weight is not the all-important number. Muscle weighs more than fat. If you do a lot of weight training in addition to your cardio, you’ll “plateau” and “stop losing weight”–because your body is replacing lightweight fat with heavy muscle.
And of course that’s the point at which a lot of people cut back or stop exercise. If the magic scale numbers aren’t dropping they don’t see the point.
This comment was written by mythago.Report this comment to the moderators
April 28th, 2005 at 6:51 pm
If you’re literally gasping for air, you’re overdoing it and likely putting yourself at risk for a heart attack.
It’s important for everyone to exercise and eat reasonably well. It’s important for fat people and for thin people. And while I think you’re vastly overestimating how accessible exercise is (I’ve looked into the cost of my local Y, and I wouldn’t be able to afford it), I think we’re better off talking about exercising and getting your veggies, rather than focusing on losing weight.
This comment was written by Sally.Report this comment to the moderators
April 28th, 2005 at 8:59 pm
I am not sure of whether to cry or laugh at this whole prescription of how we just have to do all this exercise and reduce food intake in order to have a healthy weight.
I’ve been fatter than my society thought I should be since adolescence. Looking back at photos of myself as a young girl and teen, I was not actually fat by any reasonable standard, but I had curves and tits and that was SO not cool in the 60s and 70s. Then in my 30s and early 40s I became morbidly obese.
As I got fatter I found it harder and harder to do things, to be active, to even muster up the energy to do anything other than my job. It wasn’t about the desire or commitment, it was about a physical inability, a drained and fatigued feeling that was totally debilitating.
Was this because of my weight? That would make sense, but two years ago I discovered it was because of how I was eating, not my weight. I learned that because when I changed the way I ate, before I lost a pound, my energy shot through the roof. Wow. Who knew?
Indeed… who knew that the prescription of low fat, high carb was pure poison for me? (And I didn’t eat sugar! Imagine being able to become morbidly obese without even eating sugar.) For whatever reason, the standard weight loss/health prescription diet had the opposite effect on me. It made me sleepy, tired, and hungry.
So, I invite you to my life before I changed the way I ate. I invite you to face the idea of being more active when getting out of bed seems daunting. I invite you to eat less when you have a wild beast prowling around your blood stream, a beast called “plummeting blood sugar.” I invite you to restrain your appetite not just a few isolated times a day, but EVERY WAKING MOMENT.
No one has enough will power to live that way. No one.
Now, I have lost over 123 pounds in the last 23 months eating a very healthy, high fat, low carb plan that works very well for me. I have been thinking a lot lately about will power and this plan, and why it works for me when other ways of eating did not.
There is a thing our bodies seem to have, called an “appestat.” (Whether we “have” one or not I don’t know - perhaps this is just a metaphor.) It’s like a thermostat on a heating or cooling system, but it regulates our perception of being full or hungry. In many of us who are obese, it’s broken. Thin people, when put into clinical studies where they are required to eat more food than they want to, find it hard to do. They might gain some weight, but as soon as the study ends, they rapidly lose it and return to previous intake of food. They have normally functioning appestats.
But if your appestat is malfunctioning, the reality is, it’s very hard BIOLOGICALLY to realize you’ve eaten enough, or that you aren’t hungry, or that you need to eat. The connection between a physical need to eat and other prompts to consume food, such as boredom, loneliness, or just the desire to taste something, has been disrupted. ALL your decisions are being made under the constant influence of blood sugar flucuations (which are biochemical but have effects that feel emotional) or cravings (ditto!) or a sincere inability to recognize if something is or isn’t “hunger.” What IS that odd feeling in your tummy? Who the hell knows, when the whole system is busted! Are you thirsty? Tired? Stressed? Do you have ANY idea?
People with functioning appestats most likely DO know the answers to these questions when they consider them. Those of us whose appestats are not working - honestly don’t. It’s like that pathway in our brain is just not going where it’s supposed to be going.
What Joe seems to be saying is that we have to decide intellectually what we are going to eat and not deviate from that, regardless of how our bodies respond. That is the key of the “willpower,” or “decision-based” response to eating problems. But let’s be real. Who among us can, literally every moment of every hour of every day, rely on strength of will and our intellect and our previous decisions, and NEVER deviate from them? Who doesn’t get tired or stressed, or forget to plan a meal, or run out of money to pay for whatever it is you’re SUPPOSED to be eating? None of us.
And when in situations of stress, or fatigue, or when rushed or sick, we don’t tend to make our best decisions no matter who we are. And for people with eating disorders and serious weight problems, all issues around food become even more emotionally-charged and stressful, which just perpetuates a negative emotional state. So inevitably, we falter, we fail, we backslide, we mess up. Which also feeds the downward spiral.
This is why my particular plan works so well for me: It restored the functioning of my appestat and removed the 95 percent of my problem with food that was biochemical rather than genuinely emotional. My “decision making ability” and “will power” (which are formidable) were able to handle that 5 percent, probably could have handled even more. But they simply weren’t enough, and couldn’t possibly have been enough, to overcome the 95 percent that was biochemical. No one is that strong, and no one should have to be that strong when other strategies will work better than the exercise of willpower.
I can fight a craving for a few hours. I can fight a couple bad days a month around my period. I can get through a normal amount of stress, and a few crises in a year. What I can’t do is resist cravings and hunger and a complete lack of feedback from my body as to whether or not I’m hungry, full, whatever, every waking moment of my life. NO ONE can do that. It’s impossible.
Having gone from having no functioning appestat to almost overnight having one, I am excruciatingly aware of the difference. This is not about will power or decisions, at least, not about being able to use them as a weight control strategy. It’s doomed to failure in all but the most extraordinary of individuals.
As long as I eat this way, which I find very easy and satisfying, my willpower is sufficient to handle the minor emotional impulses to eat and the PMS factor. I can use tools like certain supplements that make cravings less, like chromium, and I can check the amount of fat in my diet and increase it, knowing that makes me feel less hungry. I can stay in a range where the demands on my will power are modest and don’t overwhelm me.
But I couldn’t live with each meal being a battle. I couldn’t go back to my life before this change. I couldn’t bear it if every day was like the day before my period, when there is a beast in my gut demanding to be fed.
And that is the reality for most people who either do not benefit from the plan that helped me, or who don’t discover a plan that works for them for whatever reason. And no amount of santimoniousness on the part of someone else (including me), can change that.
This comment was written by Christie.Report this comment to the moderators
April 29th, 2005 at 12:21 am
Fighting Obesity
Kleiman basically suggests that we should change land-use patterns (building more walkable neighborhoods) and regulate convenience foods in some way. Although these measures seem commonsensical, and maybe they’re worthwhile things to do, I think they…
This comment was written by Ragout.Report this comment to the moderators
April 29th, 2005 at 7:03 am
Christie:
Where did you get the word appestat??? I’ve never heard that one before. While I think I understand what you mean by what you wrote, is there a definition from the source?
This comment was written by Ted.Report this comment to the moderators <