What do you expect from the research journal Obesity?

This is what you get, at least on the cover of the journal's November issue:



I don't know about you, but I think Santa looks kind of grim. Ill, even. Someone should tell him that physical activity and fitness are a lot more important than weight. He might want to read up on the fact that being heavier later in life isn't such a bad thing, that in fact weight loss later in life isn't a good idea. So long as he stays active, making and delivering all those gifts, he'll likely live to a ripe old age whatever his weight.

Someone should give that guy a cupcake.

Can you say disconnect?

That's the only word that came to mind when I read this story on Time.com about the extra costs women pay for being obese.

According to researchers at George Washington University, women who are obese lose twice as much money—nearly $5,000 a year—as their obese male counterparts. But not because they use more health-care dollars. The difference comes mostly from discrimination.

Fat women are paid less than women who aren't fat; fat men, on average, earn comparable salaries to men who aren't fat. So women are penalized by employers for being fat.

This says something about how women are perceived in our culture, and it's not news. But it is newsworthy, because, damn it, it's 2010 and we're supposed to be better than this as a society. All the young women who don't identify as feminists because they don't have to fly that flag anymore should take note of studies like this one. Gender discrimination is alive and well in 21st-century America.

But that's not where the writer of this story went. No, her conclusion was quite different. She wrote, It's bad news, but maybe it will help fund better prevention strategies and new treatment methods for this growing scourge.

Excuse me? Did I hear you right? The answer to discrimination is getting rid of the quality that's being discriminated against? How about taking on the concept of discrimination instead? How about educating people about the emotional and other costs of fatphobia, and about how discrimination (and its attendant stressors) actually makes people fatter?

I'm not surprised; this is exactly the kind of disconnect I've seen over and over in the media. It's as if we are constitutionally unable to see the logical extension of our behaviors around weight, especially when it comes to women.

Big fail.

Poor Dr. Lundberg

Apparently Dr. George Lundberg is a little upset because back in 2004, he put forth his ingenious stop-obesity plan and it didn't work. And it didn't work, he tells us, because fat people just didn't listen to his plan, which is really simple and practical when you think about it. It consists of two words:

Stop eating.

Dr. Lundberg goes on to clarify what he means:

I did not say fast; I did not say starve. I said Stop Eating too much; stop eating high calorie snacks between meals, stop eating everything on your plate; stop eating such large portions; stop eating desserts; stop routinely eating bread and butter; stop eating three full meals a day when two are enough; stop eating fats and refined carbohydrates when you can eat fresh fruits and vegetables and complex carbohydrates.

And while you are at it, STOP DRINKING alcohol and sugary drinks.

I wonder if Dr. Lundberg understands anything at all about metabolism. If he did, I suspect he would not so angrily and aggressively put forth his diet plan--because that's what it is, a diet plan, one built on restriction. He would know that dieting, restricting, whatever you want to call it, ultimately makes people fatter, not thinner. He would show more sensitivity to the link between dieting (or restricting, etc.) and eating disorders. And I hope he would not so blithely recommend gastric "interventions," as he writes a few paragraphs farther down, which not only are often unsuccessful but which carry relatively high risks of death, infection, malnutrition, blood clots, and other consequences.

He writes rather plaintively, toward the end of his editorial, "A lot of obese people got really angry at me for hurting their feelings. But I don't really care that much, as long as we did get some people to adjust their eating and drinking behavior. STOP EATING and DRINKING EXCESSIVELY and STAY HEALTHY."

Tell me, Dr. Lundberg, what is "excessively"? To me it sounds like you think three meals a day is excessive. You think any amount of dessert is excessive. You think any amount of fats or refined carbohydrates is excessive.

Whereas actually, I think you're the excessive one. Your rules, restrictions, and most of all your rigidity and, yes, rage--what do these remind me of? Oh, yes, I remember. They remind me of the rigidity, rules, and rage of an eating disorder. You know, a lot of people think there's nothing wrong with having a little eating disorder, as long as you're not fat.

Those of us who have seen or experienced an eating disorder up close feel rather differently about that, of course. And I'll tell you what I think, Dr. Lundberg: I think you should confine your judgmentalism to yourself. You are free to eat and drink (or not eat and not drink) to your heart's content. You are free to manipulate your weight as much as you want.

And you're free to say whatever you want, of course, just as I am. But I hope to God, Dr. Lundberg, that you might educate yourself a little more before you spout off next time about obesity. I hope you'll talk to some people who know a little more than you about eating disorders and metabolism and all that complicated science-y stuff. I hope you'll talk to some families with children with eating disorders, and listen to them say their daughters and sons developed those eating disorders after middle school wellness classes that scared the crap out of them around being fat.

Until then, I hope you're not a practicing doctor anymore. I would hate to think of anyone I care about experiencing your judgmentalism, rigidity, and rage.

A troll among many trolls

I don't normally bother with trolls, but this one sent me an email to my work address that is so vile, I have to share it here with all of you.

Barry, I suspect you are what I think of as a self-loather. Maybe you were once fat. Maybe you're fat now. Maybe you're deathly afraid you will be fat in the future.

Personally, I love how you toss aside research in favor of your own baseless and warped opinions. That Barry, he sure knows better than those high-falutin' doctors who actually research this stuff!

Since you think shame is a good health-care strategy, I'll take your idea a step further and see if shame is a good strategy for curing haters like you. Probably not, alas.

I hope my readers will respond to you in the same spirit in which you wrote to me.



I was mystified and angered by your article in the Times today. Are you actually arguing that obesity is a healthy lifestyle? Are you really saying that fat people have no control over their food intake and amount of exercise? Eating too much is nothing to be proud of, just as drinking too much alcohol is nothing to celebrate. You are lying to yourself if you think you are not shoving far too many calories into your mouth. You're fat because you can't control yourself--it's that simple.

The reason we stigmatize obesity is because it really is a choice, unlike skin color, ethnicity and the religion you were raised in. Obesity is a signal to others that this fat person is living an important part of his/her life totally out of control. It signals a lack of self-discipline and a warped sense of self-worth. Your position on this means means you're proud of your lack of control about how much, and what, you eat. It's delusional to be proud and pleased that you are out of breath when you climb stairs, that you are heading for a horrible old age--if you live that long, that making love to your partner is a problem instead of a happy event, and that you can't perform simple tasks from properly wiping your ass on the toilet to picking up an earring you've dropped.

Delusional: For example, you state that the emotional stress of the prejudice against fat people causes the health issues that result from obesity. That is not science, that is nonsense. We know stress can be a contributing factor to poor health, but you're trying to blame others for the conditions you create by eating too much. Reminds me of alcoholics saying they drink too much because of all the pressure on them to stop drinking.

On the one hand you blame doctors for relating to obese people differently than normal weight folks because, as you say, doctors believe fat patients won't follow orders, won't show up for appointments etc. Then later in your article you say fat people don't show up for doctor appointments because they feel bad about themselves and worry about how doctors will relate to them. Doctors know from experience that fat people miss appointments and can't or won't take care of their own health. Of course they relate differently to people like you who disdain main stream medical advice.

When Lincoln University tried to help fat kids get well and avoid incipient heart and other diseases, you condemn them for their efforts. What you fail to understand is that your stance actually kills people by making gluttony and self abuse through food a good choice, a choice to be proud of. What you are doing diminishes the real harm of prejudice which punishes innocent people for the color of their skin or their ethnicity--things they can't and should not want to change.

But obesity is a lifestyle choice, like smoking and alcoholism, a self-destructive lifestyle choice that harms the people who choose to follow that course. Anyone can get thinner and improve their overall health. It is not easy but rarely are the important life choices easy. That doesn't make your choice a virtue. It is difficult to diet and exercise on a regular basis and change your attitude about stuffing as much food as you can into your face. We've all heard the reasons people live your way, and none of them are good, abuse as a child, the comfort derived from eating lots of fatty creamy things, the hit of sugar, the bad habits of a deprived upbringing blah blah blah. We rightfully despise drunks who abuse themselves and others, ruin careers and the lives of those who love them. Similarly obese people are wearing a big sign that says "it's all about me and screw you who object to my overeating, it's costs to society, it's bad example to young people, it's strong signal that I'm out of control. I do it because it feels good and I'm proud of that." This is called selfish and irresponsible--nothing to be proud of.

Think about the damage your article has done. Making a virtue out of a lifestyle that any scientist, medical person or just plain educated folks know is harmful. Shame on you.
Barry XXXX
NY

PLEASE NOTE: THIS THREAD IS NOW CLOSED.

A difficult childhood = health risks?

I know from my own experience that childhood traumas can turn into psychological issues in adulthood. Now new results from a long-term study in California suggest that certain kinds of childhood traumas can translate into other kinds of health risks.

As reported in Time magazine, researchers at Kaiser Permanente have found correlations between certain kinds of traumatic events in childhood--sexual, physical, and emotional abuse--and elevated risks of heart attack, stroke, depression, emphysema, and, yes, my favorite bugaboo, obesity.

Here's a quote from the Time story:

"For the past several decades, the ACE study has recorded reports of negative childhood experiences in more than 17,000 patients. Adverse experiences include ongoing child neglect, living with one or no biological parent, having a mentally ill, incarcerated or drug-addicted parent, witnessing domestic violence, and sexual, physical or emotional abuse. . . . Compared with a person with no adverse childhood experiences, or ACEs, a person with four or more has almost double the risk of obesity. Having four or more ACEs more than doubles the risk of heart attack and stroke, and nearly quadruples the risk of emphysema. The risk for depression is more than quadrupled. Although many of these outcomes could reflect the influences of genes and other environmental influences — beyond those occurring in childhood — the tight relationship between increasing ACE numbers and increasing health risks makes the role of child trauma clear."

Some of these correlations seem straightforward, like the one between ACEs and emphysema, which can be explained at least in part by higher levels of smoking-as-self-medication. But this study takes the correlation a step further:

"Early adverse experience can disrupt the body's metabolic systems," says Dr. Jack Shonkoff, director of Harvard's Center for the Developing Child. "One of the cornerstones of biology is that our body's systems when they are young are reading the environment and establishing patterns to be maximally adaptive." Researchers also posit that high levels of stress hormones caused by ACEs can wear down the body over time. A temporary spike in blood pressure in response to a stressful event may be useful to power an adaptive fight-or-flight response, but over the long term constant high blood pressure could raise a person's risk for heart attack and stroke. Studies have also found that consistently elevated levels of stress hormones, like cortisol, can lead to permanent damage in certain brain regions linked to depression.

Even more interesting, they suggest that such stress-induced physiological changes can be passed down through the generations through epigenetics, changes in the traits expressed by genes that don't come from mutations in DNA.

Fascinating stuff. What it suggests to me is yet another refutation of Cartesian dualism. What we think and feel and experience may shape us in more ways than we know.

What do you think?

Obesity & eating disorders: the link

Researchers at the University of Minnesota (where, 60 years ago, Ancel Keys did his pioneering work on starvation) are beginning to quantify the links between overweight and eating disorders in kids. Their newest study looks at the risk factors that make overweight teens vulnerable to behaviors that are part of eating disorders: self-induced vomiting, using diet pills and laxatives, and binge eating. They also look at socio-cultural factors that contribute--reading a lot of magazines articles about dieting, for instance.

The research is led by Dianne Neumark-Sztainer, who's done some excellent work on weight over the years. It's worth checking out, especially in light of our current hysteria around obesity and the plethora of intervention efforts aimed at kids, which I fear are creating a tidal wave of eating disorders. (They certainly don't make kids thinner.)




Thanks to Jane for pointing out this research!

They don't even know they're doing it

Like most smallish local newspapers these days, the one in my town picks up a lot of copy from various sources. I'm not a fan of such content recycling, though I understand why it's done.

This item is the kind of thing I mean: a list that ran in a section called The Daily Dose, under a headline reading "Indulge, But Not Too Much." The intro copy reads "Almost everyone needs to indulge once in a while, so why not today, Memorial Day? Here are some ways to limit the damage, nutritionists say:"

Then follows a list of seven tips. Here's number 1 (the quotes are from the original):

Keep it occasional. There's nothing wrong with a little "cheating." Whether it's once a day or once a week depends on your weight, health, overall diet and activity level.

Can I tell you how many ways from here to next week this pisses me off? For starters, the assumption that everyone who reads this is on a diet. And not only are they on a diet, they're always on a diet. Hence the word cheating.

Wake up, people. Diets don't work. You know it, I know it, and researchers at UCLA said so several years ago, so it must be true. Yet this inane little piece assumes that everyone is continually on a diet. Or should be.

It's the assumption that gets me: the idea that any "indulgence" constitutes "cheating," that your entire life is supposed to be spent restricting what you eat, counting calories and fat grams. This assumption underlies 95 percent of the ongoing cultural conversation. It's so insidious we don't even name it, much less question it.

And check out the infantilizing language around this: We indulge like naughty children. We cheat like even naughtier children. When we're not being good, we're being bad. And like naughty children, we must be punished for our transgressions--in this case, by threats of the "damage" we're causing ourselves, and with warnings about how being fat will kill us.

I hated this kind of thing when I was 5. I damn well hate it now.

We don't hear much about findings like this one, which show that overweight heart attack survivors outlive thin ones, including those who follow the doctor's orders and lose weight after a heart attack.

My point is that by now, the bias against fat in every form is so widespread, so widely accepted, that to question it is the equivalent of throwing a rock through the neighbor's window: being a naughty child par excellence.

I wish the editors at my local paper had thought about this item before they plugged it into the hole on the features page*, but I really can't blame them. In 21st-century America, it's far worse to be fat than to be unfaithful to your spouse, to bilk your investors, to not give to charity. Several years ago, researcher Abigail Saguy coined the term moral panic to describe the way we talk and think about being fat in this society. I would add "unthinking, unquestioning moral panic." As items like this underscore all too well.


*In many ways, it doesn't even make sense. The list goes on to suggest that you "eat the real stuff" like ice cream (though only a half cup! Never more than that!) and "mix salt with fat" by adding peanut butter to your pretzels, but ends with the admonition, "Pretzels and baked potato chips are examples of tasty snacks without artery-clogging trans fats." Hello, how do you think we got to where we are now? It wasn't until the low-fat craze of the 1980s that Americans' weight began to rise.

Full

Lunch today was a delicious salad nicoise, not unlike the one pictured here. I ate nearly all of it, stopping because I was full.

Why am I telling you this? Because it's been about 7 months since I have eaten and felt full. Not because I'm starving myself but because I've been taking an anti-depressant that messes with my metabolism. I knew it would have this effect. I knew this intellectually, but still, over the last few months, I've struggled with various kinds of fallout from never feeling full.

You eat more when you don't feel full. Especially if you are, like me, a person who likes food and likes to eat. Normally food stops tasting good as you begin to feel full. But if you never feel full, the food keeps right on tasting good, and it's an effort of will and intellect to stop eating.

I say that I knew this medication would have this effect. What I actually mean is that I think it has this effect on me (and on others). But part of me didn't buy it. On some level I've been flagellating myself for the last few months for eating so much and never feeling satisfied.

We do such a good job in this culture of conflating appetite with gluttony, with greed, with being out of control in a scary way; I don't know if it's possible to think of appetite in neutral terms. Certainly it isn't for me. Certainly it's been tough to say to myself, "The little thingy in my brain that signals satiety is not working right now." Much easier to say to myself, "What a greedy, insatiable fill in the blank I am."

So along with that feeling of fullness today came another feeling: relief. It feels good to feel full. It's satisfying.

But it's disturbing to feel this kind of relief. I may very well have to back on this medication, or one like it, in the not too distant future. Part of me says unh-unh, never doing that again, I don't care what the consequences are. But is that really true? Would I rather be thinner and more depressed? Thinner and more anxious?

The questions make me think back to this study, which found that people would rather give up years of their life, be severely depressed, lose a limb, go blind, be unable to have children, if they could only be thin.

I think of myself as smarter than that. And yet--it feels good to be full again.

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.

What do YOU do?

So I'm sitting at brunch with some neighbors--new neighbors, people I don't yet know very well but whom I like a lot--and the subjects of eating disorders and weight come up, as they inevitably seem to do. It is just after New Year's, after all, and we are sitting at brunch--a feast of a brunch, actually, with omelets and homemade waffles, a big bowl of whipped cream, berries, lox, roast potatoes, clementines. Everything is delicious and there's plenty of it.

So of course the conversation turns to dieting and New Year's resolutions, obesity and anorexia. And in the space of about 5 minutes I hear pretty much every myth about eating and weight there is:

"Children are much much fatter today than they've ever been and we have to do something about it."
"There's an explosion of diabetes among children today."
"Anorexia--that's all about control, isn't it?"
"Anorexics are doing that because they want to be thin. It's a cultural pressure kind of thing."

As I've said, these are people I like but don't know very well. But I can't just keep my mouth shut. I can't. I try to maintain a reasonable facade but within minutes I'm arguing, spouting statistics and opinions, trying to keep my voice friendly, hearing the urgency in my own words. I explain that one reason for the so-called explosion of obesity in America (among adults as well as children) is that the cutoffs for overweight and obesity changed overnight, so millions of people woke up one morning and were suddenly considered overweight or obese. That while more children are diagnosed with diabetes now than, say, 30 years ago, some of that number is certainly due to increased awareness and earlier diagnosis, which is a good thing. That the numbers don't differentiate between cases of Type 1 diabetes, which is largely genetic, and Type 2, which is linked to diet and activity.

I tell them about Health At Every Size, and try to conjure as many of Deb Burgard's talking points on size acceptance as I can remember. I tell them that Tom Cruise has been considered obese according to the BMI charts.

I tell them that no, anorexia is not about control, that it's not "about" anything except having the shitty luck to be genetically vulnerable. I tell them that for a person with anorexia, eating is like--oh, I don't know, maybe jumping out of a plane without a parachute. Covered in writing snakes. Giving a lecture on the way down. That for some people, restricting (aka dieting) sends them straight down the rabbit hole, that anorexia distorts thoughts and perceptions and feelings, that it's not a question of just picking up a fork and eating.

One of my new neighbors is in medical school. She's particularly interested in these subjects because she will have to adopt a professional attitude about them sometime soon. She'll have to figure out what she thinks and how to talk to people on all parts of the weight and eating spectrum--her patients. She listens. Everybody listens. We actually have a lively and interesting conversation. I think.

But I lay awake last night replaying it in my mind, wondering if I should have taken a different approach to the discussion. It's not so much that I think I was obnoxious (though maybe I was, a little) as it is the fact that I find these conversations exquisitely painful. Every time I hear the words It's all about control, isn't it? it's like some synapse in my brain starts overheating. How do I offer my knowledge and opinions without being obnoxious or driving myself beserk?

What do YOU do when the conversation turns to subjects like this?

Say What?

This poll from CBS has to be one of the weirdest things I've read in a while. It reminds me of the kind of question you'd ask at an 8th-grade sleepover: Which is worse, burning to death or freezing?

I point it out because one of the questions asks,, "What's worse, being obese or suffering from anorexia nervosa?" Take a guess how "people on the street" responded. The pollsters go on to explain that 20 percent of anorexics die from the disease, whereas a 25-year-old obese woman has only a .01 percent chance of dying.

Other questions included comparisons between smoking pot and cigarettes, between having a swimming pool and a loaded gun, and between being married and miserable or single and happy. Each time there was a "counterintuitive" answer. People were apparently surprised to learn that anorexia is deadlier than obesity, that having a swimming pool is more dangerous to your family than keeping a loaded gun, and so on.

Weird, but maybe useful.

One result of the hype around "the obesity epidemic"

Thanks to fellow blogger Carrie Arnold over at Ed-Bites for picking up on this study out of Australia, which points out an alarming rise in both obesity and disordered eating--together, in the same people.

As Carrie and some of the commenters on her blog point out, many doctors would applaud weight loss in someone considered obese, no matter how s/he achieves it. As the study's authors write:

In recent years, the obesity ‘‘epidemic’’ has received much attention in the media and from politicians, public health promotion, clinical health professionals, and others treating obesity. Perhaps these confronting, and at times alarmist, messages, have been conducive to increased levels of body dissatisfaction among obese individuals, and to a perception that weight loss at any cost is the best outcome. This might also account for the observed increase in the prevalence of binge eating and extreme weight control behaviors, as body image dissatisfaction is a risk factor for disordered eating.

Weight loss at any price—that sums it up nicely. And when diets fail (as they nearly always do), some people turn, out of desperation, to restricting, purging, and other unhealthy behaviors. Teenagers are especially vulnerable, I think, because they get a heavy dose of judgment from both peers and doctors.

So if you're a pediatrician, I hope you'll take a closer look at this study and think about its implications. If you know a pediatrician, I hope you'll forward the study on. I think our best hope for change around this issue is not creating these attitudes in the first place.

Eat well. Exercise because it feels good. And love your body for its power, its strength, its beauty, and its sturdiness.

Naturally fat?

This comment, made in response to an earlier post, seems to epitomize so much of the anti-obesity attitude that I thought it deserved its own post:

Of course there's nothing wrong with being fat. I don't get why fat people get offended when we say that obesity is dangerous. We're not talking about people who are fat. We're talking about people who are dangerously obese. You remind me of the naturally skinny girls who get offended when people speak out against anorexia nervosa and complain, "Why does everyone hate skinny people? Wah!"

There is absolutely nothing wrong with being naturally fat or naturally skinny. But if someone is deathly thin or morbidly obese then it is a real problem.

So first of all, please tell us how to distinguish between "naturally fat" and "morbidly obese." What is "naturally fat"? Is it the-amount-of-fat-I would-have-had-if-I'd-never-gone-on-a-diet? Is it 5 pounds "overweight"? 20? 50? Is it the same for you as it is for me? Is it fat that comes from eating avocados and almonds as opposed to chocolate cake and ice cream? Who decides what constitutes natural fat vs. unnatural fat?

I'm fascinated by the semantics around this issue. Morbidly obese = morbidity = a death sentence if you're fat. When's the last time you heard anyone called "morbidly skinny"? And yet semi-starvation can certainly kill you.

Personally I don't know any "naturally skinny girls who get offended when people speak out against anorexia nervosa." Someone who is thin but not eating disordered typically wouldn't be offended by this. Someone who's eating disordered, either diagnosed or subclinically, might well be offended because the nature of anorexia is to be ego-syntonic. They identify the illness with themselves and will defend it to the death--their own. They can't help it; it's a symptom of the disease.

I hope my readers will weigh in (so to speak) on this one. I'd like to know what you think.

It stands to reason

that if your knees have deteriorated enough to limit your mobility, you are less able to exercise. But that little piece of common sense hasn't stopped the British health care system, which refuses knee replacements to Britons who are considered "clinically obese"--with BMIs of over 30.

Now a study from the University of Southampton demonstrates that yes, Virginia, fat people benefit from knee replacements, too.

Just for a little context: My BMI is 30.9. I am a physically active person who bikes or walks to work (3 miles), runs up stairs, bikes 8 or 10 miles for fun, and loves to go dancing. If I needed a new knee, I would be one pissed-off person if I was told I was too fat to get one.

For once, common sense may prevail. Though let's see if the NHS changes its policies before we celebrate.

If you live in Scotland, you'd better not be fat

Because if you are, according to the Sunday Herald, your doctor can prescribe Accomplia (generic name: rimonabant) if you haven't "responded to other treatments"--i.e., if you're still fat despite his/her best advice.

That's because Scotland has gone completely bonkers on the subject of fat. Especially when it comes to the children. According to a spokesman for the Scottish National Health Service, "Being overweight or obese during childhood can lead to physical and mental health problems in later life, such as heart disease, diabetes, osteoarthritis, back pain, low self-esteem and depression."

Maybe he hasn't seen this study on how feeling bad about your weight is much worse for your health than actually being fat.

Accomplia, on the other hand, has been linked to depression and other mental health issues, heart attacks, and suicide. Sounds like a perfect "fix" to me.

Thankfully, not everyone in Scotland has leapt onto the anti-obesity train. The Sunday Herald quotes Dr. Ken Paterson, chairman of the Scottish Medical Consortium, as having said, ". . . our advice is that [the drug] shouldn't be used. . . . People regain weight very quickly when they come off this drug, so the real question is what is the benefit of having a short-term, non-sustained weight reduction? We don't believe it should be in general use."

I worry, I really do, about what life will be like here and elsewhere in 10 or 15 years if you're fat.

Why I am a fan of Leora Pinhas

She's a psychiatric director for the eating disorders program at the Hospital for Sick Children in Toronto. At the recent Canadian Pediatric Society Conference, Dr. Pinhas said two things that endeared her to me.

First, she compared childhood eating disorders to cancer:

"We have this thing that [they're] not really serious. But one in 10 will die. We need to act like it's a serious illness."

Thank you, Dr. Pinhas.* And thank you even more for going on to put the question of eating disorders into the context of the ever-more-prevalent obsession with childhood obesity:

Pinhas dismissed the attention being given to childhood obesity rates - which she says have not increased since 2003 and have not increased in any clinically significant way since the late 1990s.

The most disturbing thing about the constant news about obesity rates is it's likely fuelling eating disorders, Pinhas said.

"Dieting is the gateway to eating disorders. If you have people encouraged to diet because being fat is so bad, you're only giving them an intervention that will make them fat, or give them an eating disorder or make them feel bad about themselves."

In the current culture, which supports weight-loss interventions for children as young as 2, Dr. Pinhas' perspective is not just refreshing--it could be a life-saver.


*Though she also went on to say that "most people recover from eating disorders." I'd like to know where that statistic comes from, since the numbers I've seen are far bleaker.

A headline I couldn't resist

Obesity Researchers May Need Jaws Wired Shut

Warning: There's an egregious fattie picture accompanying this article--not headless but with eyes rolled back in ecstasy? abandon? seizure? as the fork is lifted. But there are some pretty good lines in here.

Big Brother has arrived . . . in Japan

This article made my jaw drop over my morning tea. I don't know why--this kind of government intrusion into private lives is the logical consequence of all the anti-obesity hype we're hearing. It's coming here too, I fear, under the guise of a national health plan that ties "wellness" to "consequences."

But here's the thing: In Japan, talk about eating disorders is very hard to come by. I sit on a committee at the Academy of Eating Disorders with international representation, and the member from Japan has talked repeatedly about how hard it is to get any of the media there to write about eating disorders. And how difficult it is to discuss e.d.s in Japan.

And yet the Japanese government is imposing sanctions on those whose waists exceed a randomly set number?

Once again, the connection between the war on obesity and eating disorders scares the hell out of me. For good reason.

Fat karma

This study, reported in the New York times, confirms what some of us have known for years: Fat cells, like other matter, cannot be destroyed. Each adult has a certain number of fat cells, and that number remains constant throughout your life. When it comes to anything to do with metabolism, the body seems to be very efficient at seeking out and maintaining a state of homeostasis.

E.A. Sims' famous Vermont Prison Studies found that prisoners who were fed 75 percent more than normal gained relatively little weight, and quickly returned to their normal weights when their normal eating resumed, we've understood this mechanism. Notice that the word their is highlighted, because, as we know, there is no one weight that's "normal" for everyone.

So it's not surprising to find that the number of fat cells in an adult human remains more or less constant. But you can bet your sweet tooth that corporations--I mean obesity researchers--are going to keep scrambling to find ways to change that magic number.

So far, every effort we've made to futz with metabolism has either been unsuccessful or backfired and created more harm than good. Maybe we'd do well to take a more Buddhist approach: Your fat karma is unalterable, at least in this lifetime.

Another book the world doesn't need

Spring is here, and I've been feeling mellow. A new book deal is proceeding apace. Life is good. I was beginning to think I'd used up my quotient of outrage for the year.

And then Maggie sent me this.

"This" is a book written by a plastic surgeon, aimed at kids to explain their mothers' plastic surgery.

As you can see from the sample panel I've included, it's worthy of outrage on many counts, including lousy illustrations and self-serving, poorly written text. Amazingly (or not), it's gotten quite a bit of national press, much of it rather positive.

I'm giving it two thumbs down. I only wish I had more than two hands.