Saturday, July 21, 2007

What we know about fat and thin

In response to an anonymous comment made on my last post--don't you love people who attack behind an "anonymous" handle?--I want to clarify a few things about fat and thin.

The biggest cause of fatness is genetics. Heritability for obesity is .7, according to this article in the Proceedings of the Nutrition Society published by Cambridge University Press.

Upward of 90% of people who diet to lose weight gain the weight back and then some. So . . .
Diets don't work.
And . . . when diets don't work, they make people fatter.
Calories in do not equal calories out. (Contrary to anonymous' assertion, this concept does not defy the laws of physics; it's a function of metabolism, which is not uniform from person to person, and which is affected by a wide variety of factors. This not something that I "somehow think"; it's been observed over and over by scientists far more knowledgeable than I.)
Fat people tend to stay fat. (See Kolata.)
Thin people tend to stay thin. (See Kolata, Sims, Minnesota Starvation Study.)
Obesity appears to put people at risk for diabetes.
The relationship between fat/obesity and mortality is much more complicated than fat = bad, thin = good.
The current "moral panic" over fat hangs on a "health and wellness" peg but actually derives more from aesthetics than true health.
Even if we all agreed that fat was bad, we don't know how to make people thinner. See point #1.

And finally:
Fat haters have a lot in common with racists. They may cloak their arguments in other terms, but the bottom line is that they see fat people as ugly second-class citizens who don't deserve to be happy, healthy, or whole.

Now, that's ugly.

Thursday, July 19, 2007

The fat wars and eating disorders

I was going to post this as a comment to the last post, but I feel it needs its own thread here.

I'm so sick of hearing that "eating disorders affect a tiny percentage of the population, but obesity kills thousands."

There is ample evidence that obesity does not kill anywhere near the numbers originally released by the CDC. But that's not where I want to go with this today. Even if it were true, this attitude makes me sick. It's like saying, "Losing a few people to e.d.s is worth it, if the rest of the fatties shape up and lose weight."

As some of you know, my daughter almost died of anorexia, an eating disorder that has the highest mortality rate of any psychiatric illness--up to 20%. It's true that diagnosed eating disorders affect only a small percentage of the population—but they are a very real and very significant problem. Especially if it's your child, your niece, your best friend's daughter.

The argument over whether fat is unhealthy or not is not merely an exercise in fat-bashing and prejudice. If it were, well, as someone said earlier, we could indulge in it until the amusement factor wore off and then be done with it. But there are real, heart-breaking consequences to this. And one is that we are now seeing an unbelievably rabid set of anti-fat messages directed at a vulnerable population: kids ages 8-15. Middle school is a time when just about every kid is horribly self-conscious about bodies to begin with. It's also the average age of onset for eating disorders--in the 13 to 15 range. I think we're going to see a rise in anorexia and bulimia as a direct consequence of this messaging. Anecdotally, I know of many families (including my own) whose eager-to-please children started trying to "eat healthy" in middle school and for a variety of reasons (including genetics) went too far and wound up with AN or BN. For those who are susceptible, this kind of pressure will certainly trigger eating disorders.

So this isn't an academic exercise. There is and will continue to be a very real fallout from the "just eat healthy" messaging. Children, families, and adults will suffer. If you've never really known someone with an eating disorder, let me say that you have NO IDEA how much that person suffers. And not just that person, but their family, and friends. Having anorexia is like living with a demon inside you that torments you 24 hours a day, 7 days a week. There is no vacation from e.d.s. They take over your life. You have no life outside them.

And too many of these sufferers will die. Yes, die from eating disorders. And these young women and men are not negligible. They're not collateral damage in (yet another) stupid, ill-advised, mismanaged war. They are our daughters and sons. And I say, enough.

Wednesday, July 18, 2007

The fat wars

Deja Pseu's thoughtful, informative comment on my last post inspired me to start a new thread, which I've been thinking about all day, between reading and responding to comments here.

Deja asks why it's so much easier for people to accept the realities of a fast metabolism than a slow one. Good question. I think it's like the "career women" (in quotes because that was how they were known at the time) of the 1950s and 60s, at a time when most women didn't have careers outside the home. They were the women who made it by playing hardball with the boys, by becoming one of the boys. They paid dearly for their corporate successes, and they were considered freakish by the cultural norms of the time.

Those women were harder on the next generation of striving career women than any men. Their attitude was, "I had to suffer, sister, and by God, so do you."

And that's what Deja's question, and the whole notion of fat wars, reminds me of. In a culture where thinness confers status, and fatness confers untouchability, of course those who have it, who are thin, will hang on to their notions about it forever. To acknowledge that fat and thin are largely functions of genetics would be to give up that special status. And if you're not a naturally thin person, and you've practically killed yourself getting and staying thin, well, it's human nature to want others to suffer right along with you, isn't it?

Depressing thought.

Tuesday, July 17, 2007

The war on fat, in someone else's words

I won't say where I found this, but this post was written in response to someone raising the question of whether, perhaps, obesity might not be a completely evil phenomenon:

"Obesity is unhealthy. There is no doubt about it. It increases the risk of high blood pressure, heart disease, diabetes (and subsequent problems with high blood pressure, kidney disease, and major foot problems, including multiple surgeries and amputations), stroke (partly secondary to the high blood pressure), arthritis (from the sheer weight on the joints), plus other medical and psychological problems. When it is also combined with smoking, which it often is, there is even more disaster.

It is a huge expense to society to have so many obese people with their medical problems. It is a preventable disease. People just need to eat less and exercise. They need more self-control.

To flaunt it as a nonpreventable problem is just not true. What has changed during the past 50 years is that people eat more and move less. Obese people want respect for their eating problems and acceptance. I think that as long as other people are able to control themselves and discipline themselves to exercise, then there will be contempt for those that cannot.

Also, I think that a lot of people resent the high cost of obesity. Health care would be a lot less if people just didn't eat double bacon cheeseburgers, fries and a Coke, then go out for ice cream or beer, and then sit and watch TV (or drink more beer, which has a lot of calories.)

Personally, I resent so much money being spent for accomodations and gastric stapling/bypass surgery because people want to gorge themselves constantly with fatty food!"

It's rare to see so many misconceptions and such hatred right out there in the open. Next you'll be telling us that fat people are responsible for global warming.

Personally, I resent the millions of dollars being wasted on ill-directed and ineffective "wellness" campaigns in schools and offices. And I resent the hell out of the ignorant assumptions behind your words.

So I'm going to exercise tremendous self-restraint (and you know how hard self-restraint is for a fat person!) and recommend that you educate yourself rather than simply parrot the anti-obesity rhetoric of our time. Start by reading Gina Kolata's new book, Rethinking Thin. Kolata is a well-respected New York Times science writer. She is also, if it matters to you--and I think it does--a thin person.

Then I'd suggest reading a little Paul Campos--he's also a thin person, though formerly fat. Then read this post at Kate Harding's fantastic blog.

Then come back and tell me how you feel about fat.

News flash: obesity is not a public health crisis

This somewhat circuitous essay by Jay Bhattacharya caught my eye. Bhattacharya is an M.D. and all-around policy wonk at Stanford University's Hoover Institution on War, Revolution, and Peace. (Great name!)

Don't be put off by the offhand judgments Bhattacharya seems to be making early on; the essay becomes more thoughtful as it goes along. His basic premise: obesity is not a public health crisis because it's not contagious, harms only the person him or herself and not others, and, maybe, is not under an individual's control. He makes an interesting point about why fat workers earn less money than thin ones (not because of prejudice, he argues, but because employers "pass through" higher health costs to fat employees); according to Bhattacharya, only fat workers with health insurance earn less. Among those without health insurance, there is no wage gap.

Interesting, but I wonder if the real reason is that the kinds of jobs that don't come with health insurance are so poorly paid that there's no room for a wage differential. Twenty percent less than $20 an hour is significant; 20 percent less than $5 is less so.

The best paragraph in the essay is the last, where he makes a compelling case against setting public policy after jumping to conclusions. Worth a read.

Sunday, July 15, 2007

Just for fun--put on your dancing shoes!

Today's New York Times had a story on contradancing and country dancing in the Big Apple.

When I lived in New York City--from 1979 to 1992--this was my subculture. I loved dancing at the church at 13th and Seventh on Tuesday and Saturday nights. It makes me happy to know the dances are still going on. The Times story quoted someone I used to know in the dance scene in New York, Olivia Janovitz. (Hi, Olivia!)

In those days I belonged to a women's sword dance troupe, too. We did things like this.

I miss it! And them.