Friday, January 09, 2009

Obesity problems--true and faux


An anonymous reader posed a question to me on another thread, which I thought deserved its own thread. He or she wrote:

I've been reading your blog on and off for about 8 months now. Do you ever recognize that there is an obesity problem in the States? Though I am on board with the message that 'fat' does not equal 'unhealthy,' and I am certainly opposed to pathologizing a group of people who have nothing wrong with them, I still believe there is an obesity-related health problem in this country.

In public, I feel I need to be an advocate for fat acceptance (or maybe, Health at Every Size), but I also want to find a way to acknowledge and distinguish the obesity-related health problem that does exist. I'd love to hear your thoughts about how to address this with an even hand.


I'm not an epidemiologist; I haven't done any studies on this question. I've read extensively, I've thought about it, I've talked to people. I'll tell you what I think, personally, and then I'd like to hear from other readers who may know more than me.

What I've read suggests that there is no obesity explosion in this country. That in general Americans are a little heavier than they were, say, 50 years ago. They are also a little taller. Some of what I've read suggests that these two go hand in hand. I know that there was a surge in obesity statistics about 10 years ago, when BMI cutoffs were changed overnight. People who went to sleep merely overweight woke up obese, and an alarming new statistic was born.

I've read research suggesting that weights went up in the late 1980s, after several years of the low-fat craze. Which brings me to the point here: While I don't think we can say with any certainty that people are fatter now and/or why that might be, what we do know is that we can't make them thinner. So let's set assume for a moment that yes, people are fatter now. Let's take it a step further and proclaim that this rise in weight is a Serious Health Problem (and I'm not saying it is; as others have pointed out very well, fat is not equivalent to poor health, and thin does not correlate good health).

Here's the thing: We can't change what people weigh. Some people lose weight for a short time by dieting. But 98 percent of them gain it back, and then some.

So diets don't work for adults. They don't work for children, either. School interventions are notoriously ineffective when it comes to making kids thinner.

Now let's go back to that assumption, that weight is a serious health problem. There is little to no evidence of this. There is a correlation between obesity and diabetes, but it's a correlation, not cause and effect. We don't know that obesity causes diabetes; maybe whatever malfunctioning metabolic shift causes diabetes actually causes obesity. In which case, trying to "cure" obesity would be like trying to "cure" OCD by, I don't know, strapping someone's hands to their sides so they can't obsessively wash them. It would be treating the symptom rather than the cause.

When it comes to other measures of health, the statistics don't bear out the notion that obesity is a serious health issue. In fact, Katherine Flegal's now-famous mortality study points to modest advantages to being "overweight," especially as people age.

So in answer to your question, Anonymous, no, I don't know that obesity is a serious health problem in the U.S., and neither do you, or anyone else, for that matter. We don't have enough information; we don't even really understand the information we've got. Losing weight sometimes raises people's risk of dying from cardiac disease, in fact. We just don't know.

While we don't really understand all the implications of weight, we do know that fitness is good. Eating a varied diet that includes (but isn't necessarily limited to) fresh fruits and veggies is good. Exercising (but not to the point of obsession) is good. Feeling good about yourself is good (and feeling bad about yourself is bad for you).

So until I know more, really know more, I'm going to stick to my guns on this one. Eat well. Live well. Move your body. And, most important, love yourself as you are right now. Not 20 pounds from now but today, this minute. Self-loathing--the kind that is a natural consequence of the current anti-obesity hysteria--is far worse for people than extra pounds. As far as we know.

22 comments:

Meowser said...

Nice job, Harriet. Like you said, the important things to remember are:

1) The corollary of "fat is bad for you" is not "weight loss is good for you"; there's absolutely no evidence to suggest that people who have to struggle with all their mights to be thin are conferred the same, or anywhere near the same, health benefits as people who get and stay thin with relatively little effort. It's not even well established that former fat people are better off healthwise than current fat people; the evidence seems to suggest that the struggle to get and stay thin, if successful, might confer some health benefits, but raise risks for other health conditions. Which brings me to...

2) It really doesn't make much of a difference if people are better off thin than fat, if there's no safe reliable way to make most fat people permanently thin. Part of the reason we don't have a lot of studies comparing the health and longevity of former fat people to that of current fat people is that former fat people -- people who were "obese" once and have been "nonobese" for 10 continuous years or more -- are shockingly difficult to find.

If those studies existed and it turned out that the health and longevity differential was similar to that of former and current smokers, you think the diet industry wouldn't be trumpeting about that every possible second? They would KILL for a set of data like that if they could get it. But they can't. It doesn't exist. And anyone who thinks it's because most fat people haven't tried and tried and tried to be thin is not paying attention.

So then you're left with prevention -- if we can't make the fat people thin, we can at least keep thinner people from getting fat, right? Good luck with that. For one thing, you'd pretty much have to ban all antidepressants except Wellbutrin, all birth control pills, all antipsychotics, all neuroleptics, some chemotherapy and antiretrovirals, and probably a fistful of others. Sure you want to go there? Also, don't let anyone go on a diet, and especially not anyone younger than 18. The more diets you've been on, the slower your metabolism. Funny how that works, huh?

Jen said...

Damn, I think I'm in love. Great post!

ZaftigWendy said...

What a calm and reasonable post! kudos!

I'm going to forward this to my (fat and beautiful) daughter to use as ammunition in her continuing "discussion" with her cousin over dieting and fat acceptance.

Bill Fabrey said...

I feel that your response to "anonymous" was excellent. Actually, in asking why all the hysteria about an alleged "obesity epidemic", one should ask, who stands to benefit financially from such hysteria? I am not going to answer this--I suspect that most readers of your blog can figure it out for themselves.

Bill Fabrey
Council on Size & Weight Discrimination (cswd.org)
Mt. Marion, NY

Harriet said...

I'd like to thank Anonymous for prompting me to think about this and write this post. His/her comment was reasonable and well put, and it's what many people are thinking, even those who are open to HAES and all the rest. So thanks, Anon.

SharonC said...

Superb, Harriet, just superb.

April D said...

Wonderfully articulated post Harriet! Thanks for this; now I have to mail a few people I know who have been asking/arguing this same spin with me for a while. I have a feeling the clear way you've laid this out will at least show where I'm coming from! :)

JJ said...

I really like this post!

"While we don't really understand all the implications of weight, we do know that fitness is good. Eating a varied diet that includes (but isn't necessarily limited to) fresh fruits and veggies is good. Exercising (but not to the point of obsession) is good. Feeling good about yourself is good"

^I couldn't agree more with that. I have a hard time believing that a size 2 women who stays thin by chain smoking, eating one meal a day, and not exercising is healthier than a size 20 woman who exercises and eats really well! I wish the focus would switch to living a healthy lifestyle rather than "OMG OBESITY WILL GET YOU, GET LIPO NOW!".

Noelle said...

Thank you, what a great article. I put a link to this article on my blog, so I can get back to it when I need ammo to talk to the well-meaning but clueless friends who insist that you have to lose weight or...else.

peggy Northrop said...

Great post Harriet. After all the stories I've read and edited on this topic, I've become convinced that the focus on fat is completely misplaced. The real epidemic is being sedentary and sleep-deprived (sleep is so bound up with stress and metabolism that one doc we interviewed called it the "cheapest and easiest obesity treatment ever"). Plus we're all seemingly addicted to food that's bad for the planet... If we all paid more attention to those three things we'd be healthier, happier, and live more sustainable lives. Most of us would save money if we ate more local in-season foods--and a few people would probably lose weight. But that shouldn't be the point. Mark Bittman's new book "Food Matters" is out this month, very interesting take on the subject.

cynth said...

Awesome post Harriet. Thank you so much for writing this.

Harriet said...

I'll have to take a look at the Bittman, Peggy. Thanks, everyone, for the kind words. I should have forced myself to articulate these things before. Better late than never!

Anonymous said...

I don't know about statistics. But I know there are children who are very overweight. I would not put them on diets. But I have seen kids that are very unhealthy, and this was linked to being over weight. For example, a 1.5 year old who was 40 pounds, drinking loads of sugar drinks and juice daily, eating junk but no nutrients, truly malnourished though grossly overweight. A HAES approach would help her, monitoring weight would do nothing. But as a health professional, I have seen this increasing. It IS a problem. We need HAES badly.

Of course, the main thing is with the parents--they eat junk and then expect restricting the child will work. Versus the whole whole family eating healthy foods and having it available at all times, period, no judgement. (I guess junk in moderation for those families, though I don't like it and don't have it).

Maybe call it a health crisis instead of a weight crisis? Even though there *is* a link (junk food will push not all but most people above their natural weight), it doesn't help and probably hurts to focus on that.

--Barb

Anonymous said...

Hey, thanks for putting so much thought into answering! I was thinking about this as I was falling asleep last night.

I guess maybe the argument that makes most sense to me is: if you go home to your lonely abode, watch Special Victims Unit while drinking beers and eating chips, you run a risk of being unhealthy. If you go home and watch Special Victims Unit while drinking beers and eating chips, you also run a risk of gaining weight. That doesn't mean that the fat has any causal effect on the poor health. Similarly, if you fall off your bike and brake your right wrist and your left ankle, it would be misguided to say that your fractured right wrist caused your broken ankle.

For the record, I really hate the fat-antagonism and kind of think the whole "fat is unhealthy" craze is just another callous and maybe even unintentional way to put people down. I also think there are actual public health problems that we should be worried about: too much stress at work, not enough sleep, not enough time to take care of ourselves, not enough time to be with our loved ones, and all the mental troubles that come from this lifestyle. And yes, if I had more time and a roof deck and my own personal garden and plenty of time to play badminton with my friends and family, I might be thinner too... but I'd probably be too happy to care.

So anyway, thanks for reminding me that fat is not even necessarily a causative factor of poor health. (Plaques in arteries, yes, but that can be caused by lots of things.) And anyway, fat is not the point. We care about healthy, happy people, darn it. Let's keep our eyes on the prize!

Thanks again,
anon

Harriet said...

Anon,

If we really cared about people's health there are so many things we could do differently, starting with true mental health parity and moving on to public transportation, access to fresh food . . . this whole thing really makes me feel cynical sometimes.

Lisa said...

This is one of the most well-thought-out, levelheaded discussions of this issue I've ever seen. I sincerely hope this gets as wide a readership as possible, because it's an excellent example for others to follow.

Anonymous said...

While this post is well thought out and I respect your opinions, I have to say that I have my own proof that being overweight is very unhealthy and decreases your quality of life. My dad has been overweight or obese for most of his life and today he can barely walk because of the stress it put on his joints. He is on 15 medications for blood thinners, heart rate stabilizers, and mood stabilizers because being overweight has made him depressed. Even if he was totally healthy at this weight his quality of life would be less than stellar. He can't shop at a normal clothing store, people give him evil glares in public places as if hes not allowed to be there, he can't sit at booths at restaurants, the list goes on. And because he is very unhealthy due to his weight he is limited even further. And it effects more than just him. I have to spend extra time taking care of him and so does my mom. I'm not even going to discuss the childhood memories of people teasing me or him due to his weight because Ive worked for a looong time to repress them. Its unfortunate that you don't believe obesity or being overweight causes physical health problems, thats your choice though. But I can't understand why you don't see the social, mental, and family problems being overweight creates. Maybe if my dad lost a few lbs when everyone asked him to he would be a lot healthier/happier today, and I wouldn't be so bitter that I'd write a huge post on some random blog...

Harriet said...

Dear Anon,

I respect your experiences and feelings, and am glad you posted a comment on this random blog. I like being able to talk over these issues with people who've had all kinds of experiences.

Your comment made me feel sad, both for your dad and for your family. I'd like to address some of what you said specifically.

You say your father's physical health is poor and that he can hardly walk because of the stress excess weight has put on his joints. I'll take your word for it, even though I know that sometimes poor health is ascribed to overweight willy-nilly. (Any fat person who's gone to the dr for, say, an ear infection and has been told to lose weight knows this too.) I'll bet your father has been on and off diets all his life, trying to lose that weight. Research shows that this cycling itself causes all kinds of health problems. We really don't know whether your father's health problems come from being overweight or from a lifetime of weight cycling, binging and depriving, etc. So that's one thing. There's also the fact that doctors often *treat* overweight as if it were an illness.

You blame your father for not losing "a few pounds when everyone asked him to." I can understand your bitterness. Oprah Winfrey, one of the richest women in the world, cannot lose weight and keep it off; your dad is not unusual in being unable to do the same. My point was that our expectations around losing weight are grounded in fantasy, since 98 percent--nearly everyone--who diets gains the weight back and then some.

As for the rest of your comment, I want to suggest something radical to you: Are the "evil glares" and the lack of shopping options your father's fault, or the fault of those who cast those evil glares, who don't make clothes in his size, who design booths and airline seats only for thin people, etc.? In other words, you seem to be blaming your father for some widespread social issues. Research shows that you're right--the stigmatization that comes with being overweight can negatively affect a person's physical and mental health. But that's not their fault. The fault lies with those doing the stigmatizing--in this case, all of society.

If your father was teased for some other characteristic--a different skin color, an accent--would you blame him, or would you be angry at those who teased him? Maybe your father could use some support and love for who he is. When the whole world is telling you you're worthless garbage because you weigh more than other people, it's awfully hard to hang on to your self-esteem.

I'm just saying.

Anonymous said...

I just wanted to add my 2 cents here! Sorry for posting anonymously, I'm happy to provide my email if you wish to speak with me :)

As a 23 year old girl, having always been larger my whole life and not thinking much of it, life started to get a little uncomfortable.

When I walked my thighs rubbed together and chafed, leaving them swollen, red, and often bleeding. Both of my knees had become weak and often left me unable to walk for days at a time if they were playing up, I had pain in one of my heels, and if I ever sat down on the ground getting up was an uncomfortable process!

Although I'd never thought much about my weight, I decided that I'd give my body a break and see if losing weight would help. By paying attention to what I was eating, moderating my treats, and exercising every day (enjoying time out alone, listening to music and getting out in the outdoors) I lost over 20 kilograms.

After this weight loss, I am by no means 'skinny'and love the curves I have (dimply thighs and all!) but I no longer have any of the health problems I did before. Losing weight wasn't a miracle cure for all of life's issues - it didn't get me a new job, make me a rock star, or clean my house - but it did relieve the health problems that were directly related to the extra weight my 23 year old frame was carrying.

I've kept this weight off for nearly three years now... and just wanted to say that it's great to accept yourself at whatever size you are, but sometimes losing weight DOES have its place.

Kendall

Harriet said...

Kendall,

I would never judge anyone's personal decision. I'm glad you are feeling well. Health is indeed an individual issue, and what makes you feel good won't necessarily make me feel good, or be healthy.

Good luck to you.

PJ said...

To the person who said that obesity was obviously unhealthy because his obese father could hardly walk for the stress it put on his joints:

I used to weigh 520 lbs. Eventually I weighed 467 lbs. And eventually I weighed 400, and then 375 (where I am currently). I am not dieting. I am learning to eat in a way that makes me feel good physically. For awhile, weight came off me; and then for awhile (2 years now) weight hasn't come off. Whatever, I don't care that much, I'm not about being a barbie since my man loves me however I am, I just like feeling good enough to be active.

I know people my height who weigh less than I do and need crutches to walk. They say it's because they are so heavy their joints can't take it. The doctor confirms this.

I disagree. This is not because they are fat. I am here to tell you that when I eat SUFFICIENT PROTEIN for my weight, and when I get up and move even a little bit, consistently, I am far more mobile and limber and fit than a ton of people I see who are half my size and riding carts around walmart. I can shop for hours, spend hours in the kitchen, go walk a mile with the kid in the walking park, lift weights until I'm drenched with sweat.

If he is supersized, he needs to EAT MEAT. Nothing has made me feel better in my life than getting this simple fact through my head, that for someone large, meat is FOOD, it is what feeds the bones, muscles and tendons that have to support that weight. Every day (in fact every hour over 3 from the last mealtime) that you don't have enough protein, your body is catabolic--it is eating your muscle for energy (that's why intense bodybuilders eat protein every 3 hours if they can). Now imagine someone who is really large (AND male, they need more) and getting probably a fraction of the protein he needs. Mostly because of a world terrified that eating dietary fat will kill you (as if man has not been eating animals as primary food since the dawn of time for goddsakes. And for the still fat-phobic, turkey is incredibly lowfat).

'The Protein Power Lifeplan' is considered a diet book. I can't in good conscience recommend a diet book on a fat-acceptance website because well you know, that really contradicts the whole idea of fat acceptance! But I can tell you that no matter WHAT size a person is, learning to treat yourself good, to take care of yourself, is important.

Fat people end up not doing any of that. I didn't used to dress up, or wear makeup, or even bother matching my clothes half the time, and if you knew what a total fashion zombie performer I was until mid-20's when I gained 200# in less than 2 years, you'd know how profound a psychological statement that is. I'd say, "Why bother?" I didn't paint my nails, or put lotion on my skin, or bother getting dressed if I didn't have to go out. AND, this is the main point: I also didn't look at things like, "What kind of food, exercise, fashion, etc. would make me feel good?"

Thin people spend all kinds of time obsessing about what kind of food is best for them, and I'm not talking about weight loss here at all, I'm just talking about what makes them feel good, whether it's the 100% Kona coffee with a ghirardelli 60% cocoa square, Caramel DaVinci (SF) and cream that I just had ten minutes ago... or the protein foods I eat because at 375 lbs, if I don't, I am weak, have no energy, have no strength.

To give you an example of how literal this is: if I do not eat at least 80g protein, for say 2 days, I have to walk up my porch stairs (5 with the top higher than the others) very slowly. If I don't eat that for 5 days, or eat less than that, I have to walk up them with both feet per-stair, slowly, clutching a handrail like a little girl. But if I'm eating ~120g protein a day, I can RUN up them two at a time, back down, back up, several times. I've spent the last two years learning something about my body and what I've learned is that my functionality as a fat person is greatly dependent on treating myself WELL. Just as well as a thin person would who takes vitamins or eats broccoli because it's good for them.

Fat people have their own body needs resulting from their weight. That's not a bad thing. It's just a thing. Just like some people are gluten or lactose intolerant and other people get the jitters from caffeine, people with a lot of lean body mass--and fat people have it simply from carrying the overall weight around--need sufficient protein.

If you can encourage your father to eat a lot of it (not so much so fast it's injurious, just probably a lot more than he's eating), I really believe this will go a long way toward helping him--it certainly has me and many people I know.

It has taken me half my life being fat to finally get around to giving a damn about what works for my body and how to be happy in it and feel good in it. It's a shame that sometimes the knee-jerk reaction in the FA field means that things like this aren't ever talked about because they are dangerously close to 'diet talk' since most the specialists/ authors who mention it are referring to diets (well, or bodybuilding). I think it's pretty important.

PJ

Harriet said...

PJ,

Thanks for sharing your point of view. I haven't heard this before and it's very interesting. Makes sense, too.