Paul Campos is interviewed over at Megan McArdle’s blog. There’s a lot there worth reading, but I’ll highlight this bit in particular, since the study he’s discussing has been much in the news:
Consider the methodology of this study. It tried to calculate changes in health costs if everybody with a BMI over 30 had a BMI under 25. But leaving aside the preposterous assumption that all increased health risks associated with a level of body mass are caused by that level of body mass, the idea that somehow we could make fat people into thin people is bizarre.
A study like this isn’t talking about turning 180 pound women into 165 pound women, which at least in theory might actually be possible. It’s talking about turning 200 pound women into 130 pound women, on statistical average. The success rate for such attempts is about .1% Even stomach amputation does not turn fat people into thin people.
So even if it were true that we knew it would be beneficial to turn fat people into thin people (which we don’t) it’s not something we have any idea how to do. The statements in the study indicating that there are known methods for doing this are simply lies of the most egregious sort.
Now lets talk about excess health care costs. if you look at the study, nearly half of the excess health care costs associated with being fat are from higher rates of drug prescription. But why are fat people being prescribed more drugs than thin ones? Largely, because they have the “disease” of being fat, which is then treated directly and indirectly by prescription drugs!
For instance, statins. Statins are a multi-billion dollar business, but there’s very little statistical evidence that they benefit the vast majority of people to whom they’re prescribed. Basically the only people who have lower CVD [cardiovascular disease] mortality after taking statins are middle-aged men with a history of CVD.
But the heavier than average are prescribed statins at higher rates simply because they’re heavier than average, even though there’s no evidence this is beneficial for them. And of course this doesn’t touch on the costs of all the treatments for “obesity” itself, which are uniformly ineffective. […]
I mean, there’s no better established empirical proposition in medical science that we don’t know how to make people thinner. But apparently this proposition is too disturbing to consider, even though it’s about as well established as that cigarettes cause lung cancer. So all these proposals about improving public health by making people thinner are completely crazy. They are as non-sensical as anything being proposed by public officials in our culture right now, which is saying something.
It’s conceivable that through some massive policy interventions you might be able to reduce the population’s average BMI from 27 to 25 or something like that. But what would be the point? There aren’t any health differences to speak of for people between BMIs of about 20 and 35, so undertaking the public health equivalent of the Apollo program to reduce the populace’s average BMI by a unit or two (and again I will emphasize that we don’t actually know if we could do even that) is an incredible waste of public health resources.
Also well worth your reading time is Megan’s followup post, in which she refutes the usual objections people posted in her comments. (Thanks, Sebastian!)
Ok, so diet by iteself doesn’t long term reduce weight, unless you are essentially anorexic. What about diet and exercise? Or weight lifting by itself? Can you be the same weight, but have less adipose tissue and maintain that? My spouse is obsessed with her weight (I blame society) and I’d like to be able to know what I’m talking about.
Furthermore, BMI doesn’t take into account other factors that may increase a person weight in a healthy way. Ask any bodybuilder what their BMI is and you’ll soon find that under that scale, they’re all way “overweight.” BMI may be a good measurement tools that gives you some indication of a person’s health, but there are much better ones out there. If anything, people should be judged on a case by case basis.
“judged on a case by case basis”?
I think part of the point here is they should not be judged at all.
Health is not easily measured, but one thing is for certain BMI is not a individual indicator of health. I don’t mean it is a poor one. I mean it isn’t one. It is merely a quantification of the ratio between your height and your weight. It doesn’t measure fat. It doesn’t measure blood pressure. It doesn’t measure of cholesterol or heart rate or blood sugar or thyroid levels or T-cells or red blood cells or any of a dozen other health indicators that individuals can review to know their health and their risk of disease. Any relationship BMI has with other health indicators is usually spurious (look it up).
BMI is about size and judging on the basis of size is discrimination and discrimination, by the way, is a risk factor for poor health, one with way more data supporting it than BMI.
Megan’s second post gives short shrift to environmental factors, mentioning only, “You [“normal” BMI people] just have a different environmental and genetic legacy than they [obese BMI people] do.” It’s bizarre, because she acknowledges an environmental factor — the cheapness of calories — as the primary driver in increased obesity: “Calories are getting cheaper. Self explanatory. In my view, the dominant reason. People eat more calories because they like it, and can afford to.”
So how about making certain calories less affordable and accessible? Her only reference to the ability to influence children’s lifelong habits is through schools’ lunches and PE, completely ignoring the availability of candy, soda and other high calorie-low nutrition foodstuffs on school campuses (often brought on campus as a way to supplement diminished state budgets for education). What about taxing all food and beverages where sugar/high-fructose corn syrup are among the first few listed ingredients? What about moving agricultural subsidies from corn to fruit?
The first post has some holes too: “the morbidly obese are very sick, but die young.” Yes, but how much money is spent on their health care before they die? It’s not like the health care savings allegedly reaped on smokers, who conveniently get fast-moving, almost untreatable cancers and die at the ends of their useful working lives.
There is a lot of money you can spend on treating conditions related to excess visceral fat, and you can spend it for decades before the patient passes away. Just in what a cardiologist might be called upon for: high cholesterol medication, high blood pressure medication, type 2 diabetes medication (i.e. insulin), stents, cardiac caths, bypasses, motorized wheelchairs for people whose joints and/or heart have trouble supporting them when they walk or use a manual wheelchair. Statins (a class of drugs that lower cholesterol) are a small portion of the total cost: even if you pay retail and don’t get the benefit of insurers’ bargaining with the drug companies, a still-under-patent statin costs about $150 a month, or $1800 a year; a generic will cost less than $400 a year at retail (i.e. before insurance’s bulk discounts).
I agree that there should be no treatments for obesity itself (and I’m curious as to what those are, exactly; if there were a medication to reduce fat, I’m sure doctors’ offices would be filled with middle and upper class women demanding a prescription). But a high level of visceral adipose tissue affects health for many, many people.
EdgeWise,
Can you be the same weight, but have less adipose tissue and maintain that?
I think this is possible for many (perhaps most?) people, but some people’s bodies due to a combination of hormones — thyroid especially — and genetics may not be able to do so. Weight in itself is meaningless to health until it’s at the point that it affects your joints’ ability to support you when you walk, and that’s unlikely to occur if most of that weight is itself bone and muscle.
Pointless, stupid, blame-fat-people propaganda.
The vast majority of health care expenses, per capita, deal with caring for people who are going to be dead soon, no matter what doctors do. A lifetime of annual checkups, even with the $300 blood panels I used to get every year, is a whopping $38,000 if I lived to 76 years of age. But let me wind up with congestive heart fail and 76 years and a day, and that $38,000 — whether or not I’m fat — is going to be gobbled up by my relatives being in denial that I’ll be dead soon.
When so much is wasted on denial of death as a natural process, who cares if 10% is caused by “obesity”. Even if it is “Denial of Death” easily causes far more.
I think the logic in this is fundamentally flawed–for instance, women have higher BMIs in general, across the world, than men do. Do women die earlier than men, in general? Their fat doesn’t necessarily lead to health problems (“apple” fat = bad, “pear” fat = good) because of the efficiency of the breakdown of the adipose tissue. Then, fit individuals who are “morbidly obese” may be in better physical shape than someone who is of normal or low weight who does not exercise. The moral: even if weight were the answer, it isn’t, because weight is NOT the best determiner of a person’s health problems. It’s fat distribution, something which doctors consistently dislike to measure, confusing “weight” with “shape” and “health.”
Considering McArdle was saying less than 2 years ago that we shouldn’t give food stamps to poor people because they’re too fat already (no, seriously), she’s come a long way in a short period of time, at least on this subject. Good for her.
And Campos is seismic, as usual. Yeah, folks, so you lost 20 pounds watching what you eat and exercising, that means I can lose 100 pounds doing the same thing? That’s almost exactly the same thing as saying, “I can hold my breath for 60 seconds, so it should be no problem for you to hold yours for five minutes.” That only makes sense if I’m eating five times as much as the 20-pound loser, and believe me, I’m not. Binge eaters that extreme are a stone rarity. (And they are much more likely to be among the few successful “losers,” too.)
Also, I can’t believe almost nobody has connected “fat people have more prescriptions” to the fact that the most popular prescription meds — namely antidepressants — have weight gain as a side effect (with the exception of Wellbutrin), especially over long-term use. Neuroleptics and antipsychotics cause lots of weight gain too. If you want me to quit Remeron to be thinner, it’s not going to lengthen my life span, believe me.
Meowser,
I share Brad DeLong’s skepticism that McArdle has sincerely embraced advocacy for the acceptance and equality of fat people, rather than embracing the hope that if opponents of health care reform can undermine Obama’s claim that we will save enough over the long run to make this budget-neutral, reform will fail.
DeLong and some other critics of McArdle and Campos on this subject were rounded up by the NYT here.
I am not very familiar with the latest medical advice on antidepressants. Do most people on antidepressants take multiple medications to treat their condition, or just one? Because if most aren’t taking a cocktail, it seems unlikely that they would be showing up as taking a statistically significant greater number of medications. In contrast, people who have high cholesterol very often *also* have high blood pressure, and are given two medications (plus maybe yet another medication to counteract the side effects of one or both). So inasmuch as a high level of adipose tissue increases the propensity to high cholesterol, high blood pressure and Type 2 diabetes, I would think that such a constellation of conditions would in itself require more medications than depression generally would.
Incidentally, as of 2006, the single largest selling drug in the world as tabulated by revenue was Lipitor, a statin, because not only was it under patent, but so was its nearest rival in the statin market (Zocor).
I share Brad DeLong’s skepticism that McArdle has sincerely embraced advocacy for the acceptance and equality of fat people, rather than embracing the hope that if opponents of health care reform can undermine Obama’s claim that we will save enough over the long run to make this budget-neutral, reform will fail.
You know, it hasn’t escaped my attention that the political persuasion most likely to be fat-accepting is libertarians. However, now that you mention it, “the automatic gainsaying of anything Obama says” thing employed by the right wing could have potentially interesting fallout for fat people, especially those of us who are politically progressive. We already know that if Obama says the sky is blue they are required to riposte, “No, you secretly-French doofus [or something like that], it only looks blue.” But if Obama declares open season on fatasses, I could certainly see right-wingers who were previously heavily invested in “it’s all your fault for being such a pig” doing a total 180 just to be a pill to him. I’m not sure I want these people arguing my cause; I’m already a little queasy about libertarians doing it.
Do most people on antidepressants take multiple medications to treat their condition, or just one?
I am on three different daily brain meds, two of which I am taking to counter the appetite and weight increasing and sleep-12-hours-a-night side effects of Remeron. (Which, when you are first on it, will make you so hungry you can’t see straight; this drug is commonly given at the more appetite-stimulating lower dosages to people with wasting illnesses with the intent of getting some food into them, and it’s shockingly effective.)
Any antidepressant that works on serotonin, which is almost all of them, is bound to make you a giant snoozypants and require a multi-drug cocktail to counterbalance. The only exceptions seem to be Prozac and Wellbutrin, which anymore are only prescribed to people as monotherapy if their depression is very mild. (And people for whom prescription drugs don’t work tend to discontinue them pretty fast. Are they differentiating between people who are given a scrip just because that’s what the doctor does reflexively for someone their size, and people who continue to get refills on those scrips?)
Remeron is one of the few antidepressants known to be an appetite stimulant for almost everyone who takes it; you might ask, then, why my shrink gave it to me if I was already fat. Well, let’s put it this way. My most major weight gain (about 65 pounds) happened with 7 years on Zoloft, which didn’t increase my appetite, it just slowed my metabolism down to shit. And SSRI drugs (e.g. Zoloft) and SNRI drugs (e.g. Effexor), in addition to being equally soporific, make me twitch. And I mean twitch, as in “we’re putting you through the MRI scanner right now because you’re scaring us” kind of twitching. Plus, Remeron is the heavy horseshit; you don’t take it for mild depression, you take it when you are about to die from your depression and nothing else has worked. Oh, and I have a p.r.n. benzo also, which I very rarely use (it’s taken me a year to go through 3/4 of one scrip bottle) because it just knocks me out cold at any more than 1/16 of a pill.
And I “just” have unipolar depression. It’s not uncommon for people with schizophrenia, schizoaffective disorder, bipolar disorder, psychosis NOS, etc., to be on multi-drug cocktails, too, for much the same reasons. And yeah, they keep checking my BP to make sure it hasn’t spiked. It started out very low, and now it’s “normal.” (Hypertension being another one of those things that’s largely hereditary, and incidentally, much more likely to be deadly in a thin person who has it than in a fat person, since in a thin person it’s more likely to be the result of increased vascular resistance, rather than increased cardiac output as it tends to be in fat hypertensives. There are, of course, individual exceptions to both.)
For instance, statins. Statins are a multi-billion dollar business, but there’s very little statistical evidence that they benefit the vast majority of people to whom they’re prescribed. Basically the only people who have lower CVD [cardiovascular disease] mortality after taking statins are middle-aged men with a history of CVD.
This, I’m afraid, is flat out untrue. One of a number of references.
I tend to wonder if statins aren’t part of the reason that mortality for “fat” people is lower than for “normal weight” people on the population level. Consider two 55 year old women who go to the doctor for a checkup. Both are 5′ 4″, one weighs 130 pounds, the other 180 pounds. Both have cholesterols of 205 with LDLs of 135 and no other risk factors. Which one will be prescribed a statin? The fatter one. But statins reduce cardiac and overall mortality, regardless of weight. So which one is now more likely to die of cardiac disease? The thin one. Just a wild guess, not something I can present data to prove. At this time.
I was going to say something along the lines of what Diane said. I’m totally guessing, but I’m wondering if the higher health-care costs associated with obese people come from doctors assuming “obesity” is the problem and “losing weight” is the solution for any fat person who walks in their door. Foot pain? Lose 10 pounds! Back trouble? Lose 10 pounds! Depressed? Well, exercise is a great mood-lifter…and how’s your self-esteem? Maybe if you lost some weight…Heart flutter? Lose some weight! And so on. So the person has to keep going back and going back, raising costs, because sometimes foot pain is foot pain on its own, sometimes people are depressed because their brain sneezed the wrong chemicals all over the place, not because they’re fat.
You know, it hasn’t escaped my attention that the political persuasion most likely to be fat-accepting is libertarians.
I’m surprised you’d say that Meowser I’m curious to know why.
I don’t know if there’s a political persuasion that gets it, more a personality type, the people who understand are so varied, it’s hard to sense more of a poltical bias, but they do tend to have similar personality characteristics. Even fat people who’ve always resisted diets could fit into this group. Maybe because the arguements against are mainly emotive.
The political aspect is interesting though, I don’t know whether it harms or hurts FA from a progressive perspective to have rightists argue in favour.
I’ve never got the feeling that FA is seen as apolitical, waiting for an affliation anyhow. I think that there is an instinctive suspiscion amongst a lot of progressives that FA is somehow non-U.
That might seem unfair, but I do think the ‘progressive’ fatosphere if you like, seems to have a distinct difference in character and tone to the rest of the progressive blogosphere.
B. Adu @ 12:
Libertarians tend to be pathologically “hands off” on most personal matters. Progressives and social liberals of other sorts, are likewise “hands off”, so there are entire spectrums of political ideologies that should predictably include some amount of Fat Acceptance in them.
FCH,
Libertarians tend to be pathologically “hands off” on most personal matters.
Indeed, so I can get that they’d be against government action. They also seem to be v. big on the individual too. And yet Megan McArdle seems even to be questioning the will to power argument. It’s the progressives and liberals that seem most vociferous in their defense of this point. That feels ironic to me.
As Paul Campos said;
“I mean, there’s no better established empirical proposition in medical science that we don’t know how to make people thinner. But apparently this proposition is too disturbing to consider”
Dianne #10 — Your link didn’t work. Could you please try again? Thanks.
B. Adu,
Libertarians generally believe that government isn’t going to make anything better, so they naturally are going to oppose the government’s taking an interest in health. This sudden attack on epidemiologists who are concerned about obesity is pretty generally understood simply to be part and parcel of McArdle’s opposition to health care reform.
Liberals and progressives are not talking about willpower. They’re talking about how government action can affect the various factors that impact fat levels and overall health. They’re looking at how government can use its power over schools, transportation, agricultural subsidies, taxation and a host of other elements that affect how many and what kind of calories go in, and how many go out. Pure Willpower is a conservative argument, because it keeps government out of the matter. Even McArdle acknowledges that the willpower canard is an argument coming from her own commenters, who mostly are conservatives and libertarians, not liberals and progressives.
However, it is pretty fundamental to modern liberalism and especially to progressive ideology that collective action, particularly in the form of government action, is capable of making our lives better. Conservatism and libertarianism treated racial discrimination as a matter of private morality (Barry Goldwater voted against the Civil Rights Act of 1964 saying “You can’t legislate morality); liberalism treated it as a matter of public concern.
So it is with the effect of high visceral adiposity on health: liberals and progressives look at the problem, and instead of denying it is a problem, or denying that anything can be done about it except through individual willpower (conservatism), or denying that it’s anyone’s concern except that of the poor sod who has Type 2 diabetes (libertarianism), liberals and progressives are trying to figure out what can be done to ameliorate the problem. They are looking for solutions that don’t throw all the responsibility on individuals’ shoulders, when we know our lives are shaped by forces beyond individuals’ control.
David Kessler, btw, whose book The End of Overeating I linked in another thread, is a good example of the liberal/progressive view. Although appointed to the FDA by Bush Sr., Republicans didn’t like him because he actually wanted to use his power to protect consumers: during his tenure (which was continued when Clinton reappointed him) the FDA instituted the standardized Nutrition Facts labels and attempted to regulate tobacco as a drug. He thinks that government can play a role by forcing manufacturers to be honest about their products, but he also sees our ability to change unhealthy behaviors as requiring societal shifts. He does not think it’s as simple as willpower; his book describes how early exposure to what might be called McDonald’s food — carefully engineered for maximum appeal, full of salt, sugar and fat — actually affects children neurologically and trains their bodies to expect to keep getting that food. He gets how we develop addictive behavior to the compounds in food just as we developed it with regard to tobacco. And as with tobacco, he doesn’t pretend that it’s as simple as willpower.
They are looking for solutions that don’t throw all the responsibility on individuals’ shoulders, when we know our lives are shaped by forces beyond individuals’ control.
But they still believe that if individuals manage to exercise and eat their veggies, because the social order has made it easier for them to do so, that everyone (or nearly so) will be thin — the idea being that if we’re all “allowed” to exercise and eat veggies and we aren’t thin, we’re doing it wrong. (Don’t get me started about how they ignore the millions of fat people with habits every bit as “healthy” as theirs are right now.) And they also believe that those of us who are fat are dopey cows hopelessly under the spell of Big Food. They have different ways from right wingers of labeling us stupid and self-destructive and completely ignoring individual neurobiology and entrenched issues of societal class (and able) prejudice, but they’re still doing it.
PG,
Liberals and progressives are not talking about willpower.
I think those fat people who’ve had the arguments shouted at them constantly by liberals and progressives are in a better position to make that call than you.
liberals and progressives look at the problem, and instead of denying it is a problem, or denying that anything can be done about it except through individual willpower (conservatism),
I told you before on the other thread, if you wish to challenge an arugment that comes from an FA perspective, then grasp exactly what that perspective, or at least what the arguent is, before you try arguing with it. Or you end up merely wrestling with your own ignorance.
It is not FA that is ‘denying anything can be done’, that is the prerogative of those who wish to keep repeating ad infinitum that which has repeatedly and demonstrably failed, ad nauseum. Repetition, in this case, is a strategy to avoid progress.
The solution is likely to be an exercise of will, how could it not be if it is something within our control?
It is an exercise of will to take pills, it’s an exercise of will to pretend diets are going to start working anytime soon etc. How could any potential conscious involvement in the regulation of weight, not involve an exercise of will?
It’s just that exercise of will is hardly likely to be dieting. I am exercising my will my curiousity my mind to think about this. I think weight loss surgery is an abomination, I’m in favour of finding a solution for those who feel they need it or seek it.
Nor do I require any lessons on providing the kind of social provisions you speak of, I remember when my friends and I used to hang out at the local swimming baths. They shut them down to save a few pence to give tax cuts to the rich.
Where were the liberals and progressives then shouting about it, like they’re shouting at us now? If they had made a noise, maybe those things wouldn’t have been lost, or less of them.
So I don’t need any lectures on any asinine ‘campaigns’ to bring back that which was only taken because virtually no one thought it mattered worth a damn whether we had those things or not.
This is why poorer people get fed up, no matter how hard they try to get some things going for their kids and the society around, it can be taken away at the stroke of a pen, and there isn’t a whole lot they can do about it.
As Meowser said@ no.18, the motives of liberals and progressives are not clear on this one. I’m well aware of their philosophical underpinnings and how they normally behave, that’s why their behaviour on this one doesn’t make any sense, it doesn’t follow form.
It may well be for a lot of very middle class libs and progs, class solidarity comes before political solidarity on this one, rather like those prog feminists who felt it was OK to use sexism against Sarah Palin.
B. Abu @ 19:
There are two different sense of “willpower”, and it looks like you’re using a very loose definition.
Yes, everything we do that involves thinking about it is an exercise in “willpower”. Putting on your socks — willpower. Shoes — willpower. Fairly soon, I will put on some street clothes and head out for coffee, then over to a business I’m hoping to partner with — willpower. Sometime between now and then, I’ll have another cigarette — willpower.
But whether or not I put on those shoes and socks, and whether or not I smoke that cigarette are two entirely different kinds of “willpower”. I’m not compelled, somehow, to put on a specific pair of shoes or socks. The death sticks — entirely different matter. And that’s how I read PG’s comments about “food” and the entirely different kind of willpower that’s involved.
I think those fat people who’ve had the arguments shouted at them constantly by liberals and progressives are in a better position to make that call than you.
Perhaps I should rephrase, then — a liberal and progressive argument does not entail solely discussing individual willpower. Someone who self-labels as liberal or progressive may make such an argument, just as a person who self-labels as liberal or progressive may deny the existence of institutional/structural racism, but that doesn’t make the argument itself liberal or progressive, because it does not follow from the ideological premises of those political philosophies.
It is not FA that is ‘denying anything can be done’,
Who said it was FA? But since you feel comfortable telling me that I am ignorant about FA, please inform me as to what, if anything, FA says should be done. You are making a lot of claims that do not fit with what occurs in American politics, such as liberals and progressives would rather give tax cuts to the rich than provide public services for the middle and working classes. If you’re talking about something that happened outside the U.S., you might want to explain why that is relevant to a post titled, ‘Paul Campos on “10% of US Health Costs Are Due To Obesity”’ that is about a blog interview between two Americans, discussing the future of American health policy, particularly a study published in an American health journal, and the relevance of obesity to American health care reform…
It is great to get perspectives from other countries, but such perspectives are not very useful if they’re just free-form accusations about liberals and progressives in those countries (I have no idea what is considered liberal or progressive in Canada, UK, NZ, etc.) without any effort to provide context that makes it relevant to a discussion of U.S. health policy.
FCH,
There are two different sense of “willpower”, and it looks like you’re using a very loose definition.
No, I’m using the definition of willpower as I think it can only be used, conscious intent directing one’s actions.
The fact that willpower can’t make dieting work, doesn’t erase the fact that willpower has been exterted, or even negate willpower itself, it just shows how intrinsically defunct dieting is, precisely because it won’t yield to willpower, not the other way around.
PG,
it does not follow from the ideological premises of those political philosophies.
I couldn’t agree with you more, which is why I said at no.19;
that’s why their behaviour on this one doesn’t make any sense, it doesn’t follow form.
please inform me as to what, if anything, FA says should be done.
I told you already, those who believe that calorie counting= thin, aren’t doing anything, they are parodying doing something by repeating what has already failed. Not every opinion can fit into the way you see things, if people see things differently.
You are making a lot of claims that do not fit with what occurs in American politics, such as liberals and progressives would rather give tax cuts to tthe rich than provide public services for the middle and working classes.
Meet me half way and read what I actually write please.
What I said, in brief, was when a lot of the collective social provision was being decimated from the 1980’s and beyond, where were the liberals and progressives to raise hell about it?
The social changes that you complain have lead to obesity and ill health have happened over the last thirty years, where’s the fuss been? The reason I made that comment is because of this;
liberals and progressives are trying to figure out what can be done to ameliorate the problem. They are looking for solutions
I mean if you are going to replace a system of at least attempting to fed children balanced meals in what you call public schools, and transfer that to catering companies who’s imperative is maximum profit, where was the big campaigns against that? IOW, object to those changes in the first place, not after the fact.
‘Paul Campos on “10% of US Health Costs Are Due To Obesity”’ that is about a blog interview between two Americans, discussing the future of American health policy, particularly a study published in an American health journal, and the relevance of obesity to American health care reform…
Er, because, shockingly enough, these same arguments are being made in other countries too numerous to name. Frankly, I think this is a desperate point on your part, one which nobody has ever stooped low enough to make to me no matter how much we’ve disagreed, ever, congratulations on that.
B. Adu,
will power, –noun: control of one’s impulses and actions; self-control.
Also, willpower.
Origin: 1870–75
Random House Dictionary, © Random House
Evidently you don’t want to offer anything in response to my query as to what FA thinks should be done in response to the health problems linked to high levels of visceral adiposity, even though I’ve already explained what constitute liberal and progressive potential solutions (government’s use of its power over taxes, subsidies, transport, schools, etc. to increase the availability and accessibility of healthful food and exercise), which doesn’t sound much like individual “counting calories” to me, nor have anything to do with “thin.”
I find it unlikely that an organized and vocal movement *doesn’t* offer any ideas on this — indeed, it’s certainly contrary to what I know of FA, but since you’ve decided my knowledge is worthless, I thought I had better be safe by getting info directly from you — so either you don’t want to tell me or you don’t know yourself.
What I said, in brief, was when a lot of the collective social provision was being decimated from the 1980’s and beyond, where were the liberals and progressives to raise hell about it?
Again, in this country, PLENTY OF THEM DID. There’s a reason Reagan’s name is mud even among liberals and progressives who aren’t much bothered by his foreign policy; his domestic policy was essentially a War on the Poor to replace the old War on Poverty. Try searching “Reagan ketchup vegetable” in Google news, for example, and you’ll find plenty of liberals and progressives in the 1980s time period who were raising hell about what Reagan was doing to school lunch programs.
If matters were different where you were (though you haven’t said where that is, exactly, so I have to take your word for it that your memory is correct that no liberals or progressives were raising hell, rather than being able to conduct my own research), that’s unfortunate and a mark against those political groups wherever you were, but it means your complaints don’t apply to the American political situation, and thus your accusations against liberals and progressives of indifference to the welfare of the middle and working classes don’t apply to American liberals and progressives.
It’s not some sort of low blow to say, “But that’s not true in the U.S.” about a set of claims. If someone says, “There’s very little conflict between the auto unions and companies for which they work,” and I say, “That’s not true in America, and we’re in a discussion of politics in America, so your statement isn’t relevant,” the appropriate response is to explain why a statement of a situation that is different from what occurs in the country under discussion is nonetheless relevant.
B. Adu @ 22:
Uh, “willpower” CAN make dieting work, it’s more a question of what you mean by “willpower” and “work”. At the extreme, going on a complete starvation diet — willpower — will definitely cause one to lose weight. It may also produce death, heart disease, kidney and liver failure, and a few other problems. “Willpower” covers an awful lot of ground, including making healthful choices beyond “I’m fat, there’s nothing I can do about it, might as well accept it.”
I’ve never seen anyone with even a shred of knowledge about diet / fat acceptance who also falls into the “Liberal” or “Progressive” political spectrum suggest that. There are right-wingers of all stripes who say “People have to accept responsibility for their choices”, and then ignore that there are no choices (public schools which have soda machines, but not natural fruit juice machines …), but the left is usually much more on the ball, particularly in recognizing that the Food Industry doesn’t give a flip about “choice”, it only cares about “profit”.
Nor is the political arena here in the States devoid of people screaming bloody hell on the subject. Texas gets quite the supply of Coke products from Mexico, where they are still made with cane sugar. It’s not lost on my friends (most of whom are Progressive types) and I (stark raving loon Conservative) that “High Fructose Corn Sweetener” is more about selling product than producing hunger satisfaction after consumption. There is a difference between raising hell and not achieving results (for some reason — political opposition to ones goals, for example) and being quiet and complicit.
Dianne #10 — Your link didn’t work. Could you please try again? Thanks
Oops. Sorry about that. Pubmed link.
There is a difference between raising hell and not achieving results (for some reason — political opposition to ones goals, for example) and being quiet and complicit
Amen. As is particularly clear to liberals/progressives in places like TX.
PG writes:
I live in Austin. Farmers markets abound. Bike pathways lead all over the place, but only in the core of the city (blame Hippies for that one — they blocked new road construction for decades, and the newer roads have no bike lanes …), we’ll get light rail some day whenever they fix the crossing gates, mass transit is somewhat usable, plenty of parks, large public pools (Deep Eddie, Barton Springs being the hugest), movie and play nights in the park (Zilker), the city electric utility subsidizes solar power installations, Habitat for Humanity is very active, a least one nude beach, plenty of places for hiking (Lady Bird Lake being a favorite). The city motto is “Keep Austin Weird”.
And it isn’t like that anywhere else in Texas. Sadly, Austin is full. So … anyone who wants to move here, please pick California or Colorado.
Here’s the part of the argument I don’t understand:
People change weight, and they grow old, and they die, and get born. If you prevented people from becoming obese in the first place, then you can, over time, significantly change the population.
So: Why not adopt a prevention issue? Why not simply use a “stop here” system, where the goal of fat people is to avoid getting fatter, while the avoid of not-fat people is to avoid getting fat at all? Losing weight is quite different from not gaining weight, after all; nobody gets to a BMI of 30 without passing through a lower BMI en route.
It may be easy to skewer the study as unrealistic if you set up the convenient straw man of “oh, lets ask people to lose 35% of their body weight.” but it’s a bit more difficult to avoid the obvious prevention aspect: we have plenty of other programs which continue for decades; why not this one?
It’s always difficult to fix the established stuff: it is hard to educate 40 year old people who got bad schooling; it is hard to get addicts off their fix; it is hard to get people to lose significant amounts of weight; it is hard to repair the effects of some childhood diseases. But it is comparatively cheap and easy to prevent these things: to give better nursery and elementary schools; to reduce additive tendencies and access to addictive substances; to teach better eating habits and weight goals; to vaccinate early and often.
Why not here?
So Sailorman believes that I got fat due to lack of education?!?!
OMIGAWD!
Do you know how many hours of reading, writing, tracking my weight (and body measurements) and exercising that I, and many others like me, did to fight my body’s natural tendency towards being fat? Do you really believe that all fat people are lazy people who do nothing but hurt themselves all day long? You think fatness exists because of ignorance and sloth?
PREVENTION is just as stupid as trying to get people to lose weight. Several other countries are trying prevention programs right now — education, exercise, etc. — and it doesn’t work. It doesn’t work because fat is NOT an illness. Fat is a natural variation of human beings.
I learned all about calories and exercise by the time I was 11 years old (my first time in Weight Watchers). I was an athlete in high school, running long distances. I was fat and a runner. Oh, and I am a successful dieter. Three different times in my life, I lost over 85 pounds, with the biggest lost being 130 pounds. I gained the weight back and more within months after reaching my goal. This screwed up my immune system to the point of disability.
Weight is a complex phenomenon and NO ONE knows much about it because EVERYONE is JUST SURE that it is bad. NO ONE has studied weight with a neutral stance. They decided that being fat was bad and then proceeded to try to figure out how to lose it. They never really asked any true scientific questions about weight, just started correlating it with disease. Well, being male is correlated with a lot of diseases, so, should we castrate little boys to prevent disease? BTW, being male is a risk factor for a shorter life span as well. Of course, we should not do anything such thing. Why? Because, a correlation does NOT EQUAL a cause. A risk factor removed does not necessarily remove risk.
Here’s the thing I don’t get. Why do we have to worry about weight at all? If the weight police are sure that exercise and eating well will promote healthy weight, then why do they reject the idea of simply promoting exercise and eating well and forgetting about weight. If it is about health, why not promote health?
The concept of Health at Every Size does just that. It says that instead of weighing people we should promote the joys of exercise and eating well. It says that if people are strong, flexible, and have good stamina they will carry their weight well. It says that weight is NOT a health indicator and that we should be measuring good health with good health indicators — blood pressure, blood glucose, cholesterol, etc.
See, I know that the weight police don’t care a bit about fat people or their health because if they truly believed that good eating and regular exercise lead to weight loss, they wouldn’t care how we got to that point. But they are more interested in policing (weighing) than promoting good health.
To bring it back to the issue at hand, if we spend our money collectively trying to prevent fatness, we will spend it foolishly and costs will not be reduced. All we will accomplish is the continued stigmatization of a population that will still not utilize a system for fear of being shamed until it is late in the process, thus adding costs (early detection = less expensive interventions). If we get over this fat prejudice and teach all persons regardless of their size to take good care of their bodies, then we will cut costs.
Of course, more importantly it would help to cut costs, if we also did away with the fee for services system of payment, and reduced pollution, violence, poverty and stigmatization, and promoted drug safety, health care professional competence, and effective vaccines. But, hey, silly me, mucking up the discourse with some factors of real concern.
Pattie,
Oh, and I am a successful dieter. Three different times in my life, I lost over 85 pounds, with the biggest lost being 130 pounds. I gained the weight back and more within months after reaching my goal. This screwed up my immune system to the point of disability.
Did the weight come back even while you were sticking to the same behaviors that led to weight loss? I agree that “diet,” in the sense of briefly eating in a ridiculous fashion (600 cal./day starvation; living on grapefruit), cannot sustain weight loss. However, people who change their eating and exercise pattern in a sustainable, permanent way seem to keep fat off. They don’t go from fat to skinny, because their body genetically isn’t meant to be skinny, but they can go from an obese level of body fat to an overweight level.
Women in my family are genetically prone toward fat accumulation in the “hourglass” figure — even my sister whose coarse BMI is almost at the underweight level can’t avoid carrying more fat in her chest and hips than her friend who doesn’t have similar genes — but it is possible for us to reduce somewhat our level of abdominal fat (visceral adiposity), which does have relevance for health.
Weight is a complex phenomenon and NO ONE knows much about it because EVERYONE is JUST SURE that it is bad. NO ONE has studied weight with a neutral stance. They decided that being fat was bad and then proceeded to try to figure out how to lose it. They never really asked any true scientific questions about weight, just started correlating it with disease. Well, being male is correlated with a lot of diseases, so, should we castrate little boys to prevent disease? BTW, being male is a risk factor for a shorter life span as well. Of course, we should not do anything such thing. Why? Because, a correlation does NOT EQUAL a cause. A risk factor removed does not necessarily remove risk.
I agree with this for weight, but I don’t think it’s true for body fat. Scientists have studied the mechanisms of insulin resistance, and come to the conclusion that a high level of body fat can dull insulin receptors, thus leading to diabetes.
Incidentally, I have noticed that when someone who doesn’t think that diet and exercise can sustainably change people’s bodies cites to personal experience, this is accepted as a valid data point, but if someone says, “diet and exercise has changed my body,” this is seen as an instance of trying to generalize invalidly from oneself to every single other person.
When I refer to what’s happening with my body or that of my family members, I’m not trying to make a claim that this is true for every other human being on the planet. All bodies are different. However, government policies are set for the most common denominator; some 18 year olds have been ready for adult responsibilities for years, some won’t be ready for many more years, but they’re all legally treated as adults. Unless there are more Americans whose bodies can’t be sustainably changed by diet and exercise than there are those whose bodies can, it’s perfectly reasonable for the government to prescribe policies that will encourage people to change their diet and exercise to improve their health.
In contrast, physicians who work with individuals rather than the entire population of a state or nation should make individual-based assessments; a doctor who keeps insisting that one should diet and exercise more when diet and exercise have had no appreciable effect on health is being useless.
The answer to the question as to whether I maintained the same behaviors that helped me lose the weight is that the methods I used were not sustainable. In all three cases I had a health crisis that caused me to stop the extreme dieting that I had to do to get results. I did not however binge to gain the weight back & I’ve been an active person (walking & biking) most of my life. An injury causing nerve damage slowed that down a couple of years ago.
As far as fat being related to inusin resistance. That may or may not be valid (I would need to see data & understand how fat was mesured) but again it misses the point.Establishing correlation does not equal cause.
Pattie @ 29:
I think you make one good point, and one really BAD point.
The first point is that the human body evolved during a period of food scarcity and definitely has a natural tendency towards storing food energy. Any discussion of fatness that doesn’t understand that is destined to failure. Our ancestors were … hunters and gatherers. We were not “sit in the trees eating nuts and berries.” Stone tools were not designed to make pretty stuff to look at, and even the pretty stuff our ancestors made is often about The Hunt.
But, yes, you DEFINITELY got “Fat” because of a lack of education, and I’m not saying it’s your fault, that you’re stupid, lazy, ignorant, want to hurt yourself or anything else of the sort.
We live in a Capitalist society in which the only way a company makes more money is to increase profit margin OR increase sales volumes. That’s it — increase the percentage of sales that are profit, or increase the number of sales. And for FOOD, as another poster noted up thread, that’s meant engineering food so that you eat more than you need, and probably more even than you want. Why? Because “food” works just like every other stimulus that produces a sense of reward. Just =thinking= about a chocolate chip cookie makes me want one (and now that my stomach is gearing up to eat some, I probably will), and that’s what the food companies have to do in order to sell more food. Go to the store, buy a soda, drink the soda, your body has no clue it just consumed 250 Kcal because HFCS doesn’t register in the body like sucrose.
The cookies were good. Yum.
The point is that in the increasing competition for our food dollars, Big Food is making foods that trigger those centers of the brain that say “I want more!”, and it doesn’t matter if you NEED more, because your blood sugar is low and your stomach empty, all that matters is you WANT more because you’ve now been engineered to think sugar / salt / fat belongs in everything, and you just want MORE. And it’s not an accident that all this HFCS is all over the place, right next to people who have a high level of adipose tissue —
And that’s what we have to stop. We have to stop the next generation of kids from being bio-engineered into thinking sugar and fat are two of the three main food groups and having their metabolism altered — not “left alone” or “accepted”, but actually altered by Big Food — so that they want more than what their body needs.
Pattie @ 32:
Yeah, but it does a pretty good job. Multivariant analysis and other statistical tools can pretty much rule out “chance”, which is what would have to be the case if people “just got fat”. Weight loss as a means of controlling Type II diabetes has, so far as I know, pretty much been proven effective. That high fructose diets affect insulin levels and can lead to insulin resistance and an increase in adipose tissue is fairly well established (though imperfectly understood) as well.
Pattie,
The answer to the question as to whether I maintained the same behaviors that helped me lose the weight is that the methods I used were not sustainable. In all three cases I had a health crisis that caused me to stop the extreme dieting that I had to do to get results. I did not however binge to gain the weight back & I’ve been an active person (walking & biking) most of my life. An injury causing nerve damage slowed that down a couple of years ago.
Then that’s exactly what I was talking about with the unethical 600cal/day diet or absurd “live on grapefruit” diet — no human being lives that way. In contrast, I have a friend who does an hour of cardio nearly every day; weight trains a few times a week; and doesn’t eat after 8pm at night, drink alcohol or caffeine, or eat desserts unless it’s a very special occasion. She’s lived that way for 10 years. It is a sustainable way of life. If I turned the hour(s) a day I spend browsing and commenting online into exercise time, and wanted to eat and drink in such a limited way, I could do exactly what she does. I just don’t want to: I enjoy reading and writing much more than exercise; I like to eat with my husband instead of at the office and we both come home late; I like to drink alcohol and caffeine; I LOVE sweets.
My way of life is a lot more common than my friend’s, but that doesn’t mean hers is less sustainable if someone’s priority is health rather than daily life enjoyment. I am bad at delayed gratification and I’d rather have pina coladas with my husband today than live an extra few years at the end of my life (he’s older than I and men die earlier, so it’s not like I’m probably going to get those years with him anyway). But I don’t tell myself that I’m doing what I do because the alternative is utterly useless to health.
I don’t even know you, and I wouldn’t ordinarily presume to comment on you personally because it rarely goes well for either party. That said, I’m not willing to let you trump generalities with personal anecdotes. f you continue to speak from a personal-anecdote perspective I will eventually need to respond to those anecdotes, so I think it may make more sense to keep this general.
Er, can you quote where i said that?
Fatness (by which I am referring to the presence of excess adipose and NOT to weight) exists, generally, because you eat more calories than you need (the general ‘you’, not you specifically.) It can happen if you exercise or if you don’t; if you’re slothful or if you’re not.
But it can’t happen without knowing about it, obviously. And unless you’re incapable of controlling how many calories you eat, then generally speaking you can control your CHANGE in weight.
Well, there are a variety of reasons why prevention is quite different from trying to get people to lose weight. In fact, I referenced a variety of analogous conditions for which it is far simpler to prevent than to cure/change the condition once established. If you think those analgies are incorrect I would be curious as to why.
You personally may be someone who is physically incapable of not being fat. Again, I prefer not to comment on you personally. That says very little about the general population.
Er… if this is true, how are you so gosh-darn certain that fat is A-OK, natural variation, can’t be prevented, etc.? I can understand the “nobody knows” position. But I don’t get the “nobody knows, so my side is right” claim.
This doesn’t really make a lot of sense. What are you trying to say?
We don’t worry about weight per se. Weight is only a concern insofar as it is a (usually poor) proxy or indicator for other conditions, such as % adipose tissue or diabetes or what have you.
Promoting “health” on a large social scale involves using cheap and speedy prescreens and/or indicators, such as BMI/weight.
Surely you’re not claiming that HAAS is, as you put it, a neutral organization who actually has solved the problems of weight. (You did just say that no such group exists.)
I care about health on a wide view, not an individual one. But in either case, you’ve managed to move the conversation from no weight gain (prevention) to weight loss (post-problem cure, if you treat obesity as a problem.) I believe that i specifically discounted weight loss.
I might also note that descriptors like “good” eating are not conducive to this conversation. You may define “good” eating differently than I do, including in that category the consumption of otherwise-healthy quantities of food which lead to obesity. Judging from your post, I think that is a safe bet.
Why? Is it just that your attempts to diet (weight loss, not prevention) have led you to believe that all weight-related issues are beyond our reach? Is it that you disagree that there are any ill effects of adipose tissue? Is it some other reason?
Sure, but generally speaking “taking good care of your body” involves maintenance.
You appear to be arguing a contradiction: you want people to take good care of their body (whatever that means to you) but you want adipose to be cut out of the “good care” equation, or so I grok from your post.
You choose what concerns you, by all means. But the “you should focus where I want you to focus” line doesn’t go over very well here.
This sounds like you’re saying anti-fat bigotry doesn’t actually exist, and the only thing motivating weight “concern” is that it’s a proxy for other conditions. Is that your view?
Sailorman @ 36:
And you would be absolutely, completely and totally wrong if you believed that. It’s not just “calories” that affects weight, it’s also the underlying physiology of ones metabolism, a person’s genetic background, the diet (“food mixture”, not “calories”) best suited for ones body. I’m pre-disposed to Type II diabetes — paternal grandmother, father, other paternal relatives. I can either eat like I did decades ago and gain weight, or I can adjust to these new facts and keep my weight where I want it. Fortunately, I’m a political whacko, so I read and study and learn about these issues — and food is one hell of a complex issue.
Other factors affect weight — our metabolism slows as we age. So, in addition to our bodies being engineered by Big Food to eat the Wrong Food and Unhealthy Food, we also have to deal with declining food needs. When I was younger, especially when I was in Dallas and cycling all over town (for anyone with a map, I lived in Plano and worked inside the 635 loop — and I bicycled that), I ate 9,000Kcal a day. That’s a boat load of food to be processing and it can, and probably did, permanently affect my metabolism.
“Fat” is far more complex than the simple platitudes you want to express.
This sounds like you’re saying anti-fat bigotry doesn’t actually exist, and the only thing motivating weight “concern” is that it’s a proxy for other conditions.
Well, the jumping off point for this discussion was your post quoting Campos’s response to the study published in Health Affairs. Do you think that the study’s authors* considered the question of how obesity affects medical spending because of their anti-fat bigotry or their concerns about public health?
* Eric Finkelstein is director of the Public Health Economics Program at RTI International in Research Triangle Park, North Carolina. Justin Trogdon is a research economist in that program. Joel Cohen is director of the Division of Social and Economic Research, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland. William Dietz is director of the Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, at the Centers for Disease Control and Prevention in Atlanta, Georgia.
1.) No one is denying that “diet and exercise can sustainably change people’s bodies.” Weight loss is not the only kind of change to people’s bodies that exist. Much of Health At Every Size is premised on the beleif that diet and exercise can sustainably change most people’s bodies for the better.
2) The difference is, when people say something like “weight loss plans don’t lead to significant long-term weight loss for the large majority of people,” and goes on to illustrate that with an anecdote, their case doesn’t rely solely on anecdotes. There are truckloads of empirical studies of weight-loss plans not leading to significant long-term weight loss for the large majority of test subjects.
In contrast, when people say something like this:
They are saying so with absolutely no evidence other than the anecdotes they mention.
I don’t care about your friend who does an hour of cardio nearly every day, or your sister, or whatever other examples you bring up. I mean, don’t get me wrong — I “care” in the broad sense that I wish your sister and your friend to have good dental health, don’t want them to lose their jobs and be forced to sell their kidneys, hope their rose gardens bloom, etc..
But in the narrow sense, as evidence for the proposition “However, people who change their eating and exercise pattern in a sustainable, permanent way seem to keep fat off…. they can go from an obese level of body fat to an overweight level,” I don’t care about your friend or sister. I want to know if you can back up your claim with multiple, well-designed, peer-reviewed studies.
PG @ 39:
They aren’t mutually exclusive. And based on all the studies I’ve read (except the HFCS and other nutritional component studies that look at metabolic changes), there is a high degree of anti-fat bigotry because they focus primarily on caloric intake and not on metabolic differences between groups.
For example, cholesterol levels, after you’ve noted, is dominated by internally produced cholesterol. That, in turn, is affected by insulin resistance, and insulin resistance is associated with dietary consumption. Treating everything like it’s “calorie related” has the effect of putting all the responsibility on the person, and none of the responsibility on the person’s physiology. For example, I take chrome supplements. As long as I remember to take them, my symptoms from insulin resistance are much lower. But if I forget, things can change rapidly. Same caloric intake, entirely different body response.
That’s oversimplistic, to say the least. Obviously, I don’t know these four people, and I can’t speak to what motivates them, any more than I can say for certain what motivates a particularly employer who promotes a male rather than female employee, or what motivates a particular cop who pulls over a black driver.
The “can you say for sure what motivated this particular individual in their particular individual action” question isn’t a way to facilitate discussing bigotry; it’s a way to avoid discussing bigotry. I’m not falling for that trick.
Regarding Sailorman’s claim that fatness or weight is simply a matter of how many calories one eats, I’ll quote The New England Journal of Medicine:
(Kassierer, Jerome and Angell, Marcia (1998), “Losing Weight – An Ill-Fated New Year’s Resolution,” New England Journal of Medicine, vol 338(1), p 52-54.)
Looking at more the global than individual level, I’d recommend this review essay (pdf link), looking some of the many factors which have possibly contributed to increasing weight in our society. Things aren’t nearly as simplistic as you imagine, SM.
Actually, I’m right.
If calories absorbed > calories burned, then you gain weight. (I’m ignoring nonabsorbed, excreted, calories) Your physiology and metabolism have an effect on calorie absorption, and on calorie usage. But they do not change the fact that absorbing more calories than you burn leads to weight gain. (That weight isn’t necessarily bad, it’s not necessarily directly proportional to the extra calories, and it isn’t necessarily fat; I’d have to absorb a lot of extra calories if I were trying to become a bodybuilder.)
I have a fairly advanced science background and I am by no means unaware that there are a variety of things which affect metabolism. In fact, it can be a moving target, in which a reduction in caloric intake leads to a reduction in metabolic burn, or vice versa. Be that as it may, it remains true on a general level that you can’t absorb more calories than you burn and fail to change something, be it muscle or fat. If you think you have a way around that, i’d love to hear it.
[ETA: I haven’t read that article. Have you read the entire thing and do you have a full-text link? I have read enough abstracts in my time to know that what the abstract says is not necessarily supported by the article, so I tend not to put an enormous amount of weight on abstracts.
Also, as y’all know, fat = 9 cal/gram and muscle = 4 cal/gram. If you metabolize 9 extra calories and turn it into fat, you gain 1 gram; if you turn it all into muscle you gain 2.125 grams (very general summary.)
If you convert 1 gram of fat to the equivalent energy of muscle without changing the caloric value of your body at all, you actually gain weight.
The high storage energy value of fat is one of the many reasons why our bodies accumulate it.
But in any case, it doesn’t sound like the article disagrees with what I am saying. The body adjusts its metabolism in various ways, which can alter both the absorption and burning of calories, and also alter both the relative use and creation of fat and muscle. So the calories you eat on Day 2076 of your life may be quite different than the calories you eat on Day 3192 of your life if the goal is to balance intake and burn.]
No.
Anti-fat bigotry certainly exists. Though as with many other issues, I believe the FA movement does a fair bit to confuse “process with anti-fat conclusion” with “biased process with unwarranted antifat conclusion.” Since most anti-fat conclusions tend (as far as my limited knowledge extends) to get branded as antifat bigoted conclusions, then I often distrust the “that’s bigoted!” claims of FA folks, more than I do many other equivalent claims of bigotry.
I am least skeptical of claims of bigotry related to social issues (hiring, etc) and am much more skeptical of claims of bigotry which apply to an entire group of people unrelated other than by profession, like “the medical field” or ‘doctors.”
but in any case: if you want to have a discussion about weight or health which purports to be scientific, but you want to pre-exclude any conclusion which results in advocating lower weights, then that makes no sense.
Your understanding of statistics is incomplete. Just because chance can be ruled out does not establish causation. Correlation is only correlation, full stop. In statistics, saying “fat accumulation is correlated with insulin resistance” is the exact same as saying “insulin resistance is correlated with fat accumulation.” There are many equally-weighted possibilities as to why this correlation is true: Perhaps fat accumulation causes insulin resistance, perhaps insulin resistance causes fat accumulation, perhaps sun flares cause them both. The statement says nothing about cause. NOTHING. (An old example from Stats101 comes to mind: a study found that sunburn was highly correlated with eating ice cream cones. Does this mean ice cream causes sunburn? Or that sunburn causes cravings for ice cream cones? No, they both tend to occur on hot, sunny days, and are hence correlated).
In the case of correlative studies with a clear timeline, then causality can be inferred (but not proven). For example, studies where exposure to a certain drug or substance was ceased years before disease or condition development. These implicate causality of the disease by the drug, however even these are not enough to establish scientific or statistical causality. The only thing that can establish causality is a randomized clinical or laboratory study with a testable hypothesis (and in the scientific community, usually several studies are required to establish causality). Many of the studies required to establish clear causality are not ethical on human beings. For instance, it’s pretty well accepted that “smoking causes lung cancer.” There has been a preponderance of statistical correlation, with and without clearly established order of use vs disease incidence, and a preponderance of randomized animal laboratory studies. However forcing randomized subjects to either smoke cigarettes or a placebo for X amount of years then following up on them 30-70 years later and assaying for lung cancer cannot be done, yet it’s precisely this that would be required to establish scientific and statistical causality. (Which is why/how the cig companies can argue that a causal link has not been proven, btw).
The “can you say for sure what motivated this particular individual in their particular individual action” question isn’t a way to facilitate discussing bigotry; it’s a way to avoid discussing bigotry. I’m not falling for that trick.
But I’m not asking “can you say for sure.” I’m asking what you think the action seems indicative of. Do the authors’ actions in undertaking such a study strike you as indicative of anti-fat bigotry? Are you skeptical that anyone would undertake such a study in the absence of anti-fat bigotry in our society?
leah @ 46:
No, my expressed understanding of statistics in a short blog post is limited by how fast my fingers work, and how limited the size of this box is. I’ve had graduate level statistics, and I use a lot of statistics. I just don’t type a doctoral thesis when I put fingers to keyboards.
Causes can be ruled by out (they all can’t be ruled out — rule out “Controlled by the Flying Spaghetti Monster”? No, not so much) because causation DOES imply correlation. That is, if A causes B, the correlation between A and B =must= be high. It’s that fact that A -> B != B -> A that screws people over (B may have other causes, unrelated to A). However, A -> B == ! B -> ! A is true for all A and B and if B is “Correlation greater than X”, A can be ruled out as a cause if ! B (okay, still not a PhD dissertation).
But that’s not true.
A double blind prospective randomized controlled study is the gold standard, to be sure. But you can get extremely close to eliminating confounding factors with a large enough population and good enough retrospective data. Obviously, it also depends on what you are trying to study.
I don’t want to derail further in talks of statistics from two people who have had a lot of it (it sounds like our education and job use are similar – I’m a bioscientist so I do this crap for a living). But yes, multivariate regression can rule out alternate causes, and causation does imply correlation. However one is highly limited by study design, which is what I was trying to get at. Precious few studies are designed to even address causality, and if you don’t gather the correct data you could miss something really important (and often in medical studies one doesn’t even know which questions to start with – which is, perchance, the biggest flaw of most obesity and pregnancy-related studies). Crap in, crap out. It also seemed as if you were saying a statistical study of high enough power and low enough type alpha and beta errors could prove causality, which is always patently false. But as I said, discussions of scientific study design and what stats does and does not say is a different thread.
Ah but getting extremely close to proving does not equal proving. It’s very useful, helpful, and can be applied externally to the study, but that’s not the same as proving (but now we’re getting deeply enmeshed in what scientists & statisticians call proving and what the medical establishment can use to base treatment on – my opinion is that they use waaaay too much and play fast and loose with stats; did you know most med schools do not require any stats in undergrad or medical education? It’s a crime!).
Outside mathematics, “proving” something is a matter of professional agreement as to likelihood of correctness. Even for gold standard studies, P < 0.05 or sometimes <0.01 is fine; the required level of P /=0, or even p<0.00001.
So yes: getting extremely close DOES equal “proof,” as that word is generally used in the scientific medical community. You don’t have to even get that close; 0.01 isn’t that small a number. It’s actually frighteningly large if you think about it.
Anyway, enough of the statistical derail; I don’t think we really disagree here at all ;)
Sailorman,
You realize now that “Calories In” now has no causal relationship with “Fatness” because varying “Calories In” does not predict “Fatness”. Causation really does imply correlation and the lack of correlation between “Reduced Calories” and “Reduced Adipose Tissue” puts the nail in that coffin for good.
One of the things many people don’t fully comprehend is that fat requires certain things to be present in order to be metabolized. They include both carbohydrates and water. But when “bad carbohydrates” are being consumed and preferably converted to lipids, it takes still more “bad carbohydrates” to meet the carbohydrate requirements for fat metabolism.
That’s the secret sauce to dietary (as in, composition, not calories) weight management — optimizing the metabolic needs without screwing up the body even more. It’s also why “Calories In” will never work reliably — you gotta get the feedstock right or the correct metabolism never happens. And if the metabolism is completely out of whack, it can take extra work to get it right enough for fat metabolism to take place.
Okay, I admit that I knew Sailorman wasn’t singling me out. I also admit that I do use my own experience in my responses. I do this because I am angered by long-standing policies that have made my life, and the lives of others who look like me, difficult. We fat people cannot be sure how much damage that has been done over the years following “medical” advice that has been tainted by the stigmatization and cultural attitudes that are pervasive about fat & fat people. I do take this personally even if I recognize that those who propose such measures do not intend to hurt. Their actions hurt just the same and, at times, I use personal experience in an effort to show the pain, unintended or otherwise, that these measures have and will cause.
I have a better than average understanding of medical studies. I have done a fair amount of research over the years, including research for a book on the topic published in 2005. So I’m not just talking from my own experience even when I use personal experience as illustration.
But if you want to challenge me on the basis of relying too much upon the personal case (which I did for illustrative purposes, as others have pointed out, it is difficult to put several dissertations worth of research into single posts), then lets stick to what I do know as a Ph.D. in Sociology of Health and Aging, with several years experience working as a researcher on health in Canada, in which my contribution was an understanding of the health consequences of stigma. In Canada, I looked most often at the effects of stigma of aging on medical outcomes among the elderly. The current rhetoric in the US health care debate of cost savings by population intervention has a direct parallel to the questions we were addressing in Canada.
The prevention ideas that have been proposed here and in other places, rely upon BMI as a measurement of health, sometimes at the population level and sometimes at the personal level. BMI is simply a ratio of one’s height to one’s weight. It is a measurement of size. Thus, it is a demographic, not a health indicator. Basing medical decisions and health care system outcomes effectiveness on a demographic smacks of physiognomy, the effort to deduce information about people simply on the basis of how they look. While changes in physical appearance can indicate underlying conditions (skin turning yellow, sudden weight loss or gain, dark circles under the eyes, etc), simply assigning medical conditions to persons on the basis of their physical appearance has been rejected as pseudoscience for several hundred years now. BMI is about size, not health and as such it is always going to evoke stigmatization when it is used as a measure of health.
It is imperative in a managed health care system (and reducing costs at a population level is an aspect of managing a system) that the data collected and the interventions invested in are based upon meaningful evidence. Since BMI is not a health indicator and not a good predictor of health, it makes for a lousy basis for intervention in order to cut costs. Let’s be clear about cause and effect.
Few things in science PROVE cause and effect. One does not make a proof, one MAKES A CASE for cause and effect, and the case is always under scrutiny by others. So no intervention is going to be fullproof. In order to support a case for cause and effect, three elements need to be present: (1) the cause must take place in time before the effect; (2) a change in the cause must result in a significant change in the effect (correlation); and (3) NO OTHER EXPLANATION is demonstrated to explain #2. Thus, a lack of a correlation can demonstrate no cause and effect, but the presence of a correlation alone cannot be used to show cause and effect. A correlation is a necessary but not sufficient aspect of the case.
The problem with fat and disease is that it is extremely difficult to demonstrate #1. Even in so-called gold-standard studies, the dynamics of disease (when did you get the disease? a diagnosis is always after the event) and the physiology of fatness (where you born with a predisposition to fatness? if you gain and lose weight while contracting a disease, when does it count?) creates more questions than can be answered. So all this rhetoric about how fat causes this or that is always questionable, though stronger cases can be made for some things than others, knowing which came first can only be answered in a longitudinal study with a technology that allows us to understand genetic predispositions. Can’t be done. Hasn’t been done. Too expensive to do.
In addition, few studies, including gold standard ones, have done little to examine or account for alternative explanations. Yes, reducing statistical models helps, but only to the extent that the original model included the alternative factor. If the factor isn’t known or isn’t studied, then a strong correlation can exist without it originating from a causal relationship. So BMI, size, weight, fat, adipose tissue, or whatever you want to call it, is a difficult and unsupported factor for intervention.
Perhaps, if what we know about fat and disease were all that we could rely upon, we might could justify using it, but we have other measurements both on population and personal levels that are much easier to study and much more reliable. Physical activity is one that stands out as a great intervention and looking at its effects on metabolic health has been, can be and is easily done. Increase in physical activity is easy to measure in controlled settings, as are before and after metabolic numbers. These studies provide strong evidence in the case for cause and effect and show beneficial effects in persons of all sizes and abilities. There is also evidence that given the right circumstances of safety and friendliness, most people, especially most children, will increase their physical activities. Thus, relatively inexpensive interventions such as safe public parks, school & community sports and centers for exercising, and pedestrian/runner/bike friendly cityscapes could provide sizable and measurable savings to the health care system.
So why do the fat police want to weigh us? Why do so many people propose BMI as a serious intervention tool? I believe it is rooted in a fat-hating culture and not in any sound epidemiological, medical or scientific practice. There are billions of dollars invested in our continuing to diet or reduce our girth, and lots of people (including Big Ag, btw) who want to sell us products and procedures to fight our fat. These investments include researchers who have staked their careers on conducting ineffective or questionable studies, usually funded, in part, by this industry. There are serious fortunes at stake. This is why I’m so tired of the “people are fat because of big business interests” rhetoric I hear on the left all the time. The big money is in weight-loss and it is a capitalist’s wet dream because when the product fails, the consumer blames themselves and buys again.
If it is about health and not fat, then why not take a direct approach and look at metabolic measurements. They are not expensive to examine and certainly a population with good metabolic numbers will be healthy and happy and cost less. If we make it about size, instead of health, even if there is a relationship between size and health, we are still going around our elbows to get to our proverbials.
One final thought. If we go the route of making fat people feel bad about their bodies, we will pay two prices, both of which will increase health care costs. First, we will ignore the health and well-being of so-called “normal” children. A Health-at-Every-Size approach promotes the well-being of everyone and thus will promote healthy habits such as exercise for all kids. The second price is that even if fat people have better access to health care, they will delay that access. Delays result in higher costs, higher morbidity and higher mortality.
So no intervention is going to be fullproof.
Clever. I agree that coarse BMI is useless, which is why I’ve been trying to stick to talking about the effect of literal fat, specifically visceral adiposity, on health. That requires more than a scale to measure.
This is why I’m so tired of the “people are fat because of big business interests” rhetoric I hear on the left all the time. The big money is in weight-loss and it is a capitalist’s wet dream because when the product fails, the consumer blames themselves and buys again.
Annual spending in U.S. just on fast food and sodas is $120 + 65 = $185 billion.
Annual spending in North America for weight loss industry is $50 billion.
There is more money in food and drink that has been engineered for maximum appeal with minimal nutrition, and that is high in cholesterol, saturated fat and calories, than there is money in the weight loss industry.
Moreover, I don’t necessarily have to buy more stuff than I would otherwise even if I’m on an unsustainable diet like the 600cal/day or grapefruit-only or what-have-you. I had a roommate who was on a ridiculous diet where she was supposed to live on some kind of celery-based soup. She spent a lot less on the ingredients required to make the soup, even for the total of 6 meals that she managed to stay on that diet and throwing most of the soup away, than she would have spent going to McD’s for those 6 meals. In contrast, business interests have engineered food to create a feedback loop of hunger and thirst: e.g., my fries are salty, so I want a soda; I’m full of soda but don’t feel satisfied by those calories so I need more food.
I recommend former FDA Commissioner David Kessler’s boook The End of Overeating for those who don’t believe that big business interests have invested a ton of money, and are now reaping the profits, by making food chemically appealing and nutritionally-useless. He talked to them and they admitted it. He makes an interesting parallel to tobacco (which he tried to bring under the FDA’s control) and how the tobacco companies made their products increasingly addictive and toxic.
Because this:
is not entirely correct.
Any group of minimally competent people can measure and report BMI using widely available, non medical, fairly accurate, nonthreatening, non powered tools.
I do not know the details of measuring metabolic rate, but I am fairly certain that it requires at a minimum some higher level of training to perform. I would be unsurprised if it also required some more specialized equipment which was both more expensive and dependent on power, cleanliness, etc.
People use what they have, and strongly weight “ease of use.” It’s why colleges use GPA instead of interviewing everyone. It’s why we use BMI instead of giving everyone a full metabolic screen. A single health aide can get gross BMIs of 100 people in under an hour.
Certainly there are things we could do which would improve the situation. Skinpinch measurements for example are not especially accurate but are surely more accurate than gross BMI, and are probably much simpler to deal with than a metabolic screen. they may be a better target on the cost/benefit scale.
There are several ways to measure metabolism, of varying accuracy. Some of these are:
The just-as-useless-as-BMI method, the Harris-Benedict formula:
* For women, 655 + (9.6 x weight in kilograms) + (1.8 x height in centimeters) – (4.7 x age in years)
* For men, 66 + (13.7 x weight in kilograms) + (5 x height in centimeters) – (6.8 x age in years)
The $50 (per device; available at many gyms) method, the BodyGem: breathe into a mouthpiece or face mask that determines your body’s exchange of oxygen and carbon dioxide while at rest, then spits out your individualized resting metabolic rate. Any number of factors can skew the results. If you ate or worked out within a few hours of taking the test, the measurement will be off. Being on pain medication or lying down instead of sitting could also alter the outcome.
The $200 (per device; available at many gyms) method, the NewLeaf: similar to BodyGem but can be used also to determine active metabolic rate, e.g. while on a treadmill. Can be similarly skewed by various factors.
The gold standard method, a metabolic chamber: a sealed room in which a person stays for a day while every bit of energy consumed is tracked and the oxygen and carbon dioxide content of the room is continuously monitored.
PG — Fast food & drink includes diet food & drink. People eat salads & diet sodas at fast food restaurants. This is more complex than how you have presented. AND many of the same companies are perfectly happy to sell both.
Sailorman — Okay, BMI is easier. But it is useless AND it has the contraindication of creating more stigma, which does have a cost for the system.
BTW, metabolic measurements are not the same thing as “metabolic rate.” Metabolic measurements include heart rate, blood pressure, blood sugar, thyroid function and cholesterol levels (I’m probably leaving something out). While a couple of these are somewhat invasive & expensive tests, checking heart rates, blood pressure & blood sugar is generally inexpensive, requires little training, and can actually be monitored by individuals on an ongoing basis. These are the things a regular check-up would monitor and in a system where access is easy, most people ought to be going to a nurse or doctor and having these measurements collected. In Canada, such measurements are aggregated (without identifying personal information) and available for researchers to review. Of course, these would not be the only things that one would look for in creating interventions. I am suggesting, however, that these things would serve as better indicators of the health outcomes that BMI purports to track.
Pattie,
PG — Fast food & drink includes diet food & drink. People eat salads & diet sodas at fast food restaurants. This is more complex than how you have presented. AND many of the same companies are perfectly happy to sell both.
What do you consider “diet food”? I assume you were speaking of things like Weight Watchers meals and Snackwells, i.e. foods designed and marketed for people who are On A Diet. You consider all salad-eating to constitute dieting? What about the folks commenting on this blog who have talked about their love for raw veggies?
For the most part, I would agree that it has to do with packaging, thus snackwell, lite foods, diet drinks, etc. But there are many fast food places that present so-called “healthy choices” in food and offer artificially sweetened or non-sweetened drinks that are marketed for people who are “on a diet.” Taco Bell, for example, has a set of choices that low in fat. Subway’s Jared campaign, etc. I’m saying (which others have said) that food is complex and the selling of diet food for dieters is big business that overlaps with the fast foods, packaged foods, big foods, etc. If one is concerned about things like corn syrup, one can’t discount diet foods — lots of “low-fat,” “non-fat,” and “lite” options have corn syrup and other fructose additives.
My point is that most of the talk I hear about the connection between food and the panic over our collective gaining of weight seems to leave out the place of diet foods in the equation. In the same space and time that we have supposedly succumbed to the evils of Big Food we have been constantly bombarded with dieting messages and diet products as well. Thus, the message that it can all be blamed on conditioning is a little mucky. I think a strong case could be made that we are being conditioned to diet just as vigorously as we are being conditioned to overeat. There are some, in fact, who have suggested that are yo-yo dieting has resulted in the collective weight gain. I’d have to look up reference, but I do remember one researcher who compared the United States to France found that the US had a greater range of weights than France — we have fatter people but also have thinner people. The researcher suggested that the culture view of food might account for this as Americans starve themselves more often and eat large meals more often than the French.
One side note, which is only slightly on topic…
Any discussion about food and food choices cannot be done without understanding that some of the demonization of “processing” and “preservatives” leaves out some real contributions that such processes and preservatives have made to feeding the world.
Vilifying in broad strokes seems short-sighted. Would I rather fresh, locally grown produce be available to all people? Yes, not because I think they will necessarily gain that much in health or because I think it has anything to do with weight or fat, but because good veggies and fruits are yummy and provide something that does seem to promote well-being.
But let’s be real, starvation is more detrimental to health than eating something that has been preserved or processed. Mass production of foods has been a good thing even if it has gone awry. I’d rather not throw the baby out with the bathwater, to use a disturbing metaphor. There is room for improvement but without processing and preservatives most of us would pretty much be dead from either lack of food or diseased food.
I think a strong case could be made that we are being conditioned to diet just as vigorously as we are being conditioned to overeat.
It’s not so much being conditioned to diet as being conditioned toward a single beauty norm. People who are “naturally” thin have already fulfilled that part of the beauty norm and are not socially pressured to diet. There’s really not enough money in the message “eat less!” The money is in persuading people to eat more: to Supersize for 50 cents more; to head to Taco Bell late at night for a “fourth meal”; to associate our major national holidays with large quantities of meats and sweets and alcohol. On a daily basis, I don’t feel directly pressured to eat celery or drink diet Coke; rather, I feel pressure to Be Thin, and then figure out for myself whatever means will accomplish that end. (That’s how we end up with bulimia.)
I don’t think anyone here has been demonizing preservatives, which certainly have done a tremendous amount in making the amount of food produced translate efficiently into the amount of food consumed. But they’ve been around for decades — people used to can and preserve their food at home. Processing of food is more questionable, especially as we end up with what have been called “food-like substances.”
I don’t disagree with the “Be Thin at any cost” being a dominant message, but I’m wondering how this is different from dieting or eating less messages?
I think there is a huge amount of money being spent on diet drinks — Crystal Lite, Diet Coke, Diet Pepsi, Diet Dr. Pepper, Lo-Carb Beer — and diet foods — Special K, Yoplait Lite, 100 calorie soups, Lite frozen dinners (I either change the channel or mute when any commercial comes on, so I’m having trouble making a list right now). Hell, bottled water is a diet food now. And then, what about all the examples of medical and fitness “experts” showing up on all forms of media almost daily — even NPR and PBS have some weight loss message a few times a week.
I’m just saying that if our collective weight gain could be explained by these influences (which I don’t believe they can and I’m not particularly alarmed by in the first place), then the case would be weakened by the other influences that push for diet drinks and diet foods and dieting.
What I would love to see if something that celebrates food and encourages intuitive eating (following one’s own body’s appetites and cues). All this debate on food seems to just lead to an obsessed national culture that doesn’t really understand a nice sensuous (sensual?) eating experience. Nobody except the food channel & PBS’s Create ever spends time talking about flavors for example. What about smell? What about color? What about presentation? What about the joy of sharing a meal with others?
But I think I am getting far afield from the original topic so I’ll shut up now.
Pattie writes:
If you read the two journal abstracts I posted above, you’d know that “conditioned” is the wrong word. More like “bio-engineered”.
It’s very likely that by the time a “fat person” is “fat”, most of the damage from bio-engineering by Big Food has been done.
I don’t disagree with the “Be Thin at any cost” being a dominant message, but I’m wondering how this is different from dieting or eating less messages?
Eating less doesn’t make anyone any money. If I reduce my calorie intake from 2000 to 1500 by simply eliminating a meal (or all snacks and desserts), no one makes any money on my “diet.” It’s only when I engage in substition (“I’ll have Diet Coke instead of regular Coke; I’ll have Snackwell’s instead of a real cookie; I’ll buy SmartOnes microwave meals instead of HungryMan”) that my behavior change can make anyone any money (and even there, it’s at most just moving the money from one corporation to another; as you say, these conglomerates often own both diet and regular brands). So to the extent that “be thin at any cost” allows for reduction rather than substitution (and I think it does: what else is anorexia?), it’s also reducing GDP.
Exercise is distinct from dieting, and I don’t think it’s a bad thing for people to get the message that they ought to be more active, so long as they do it in a way that is appropriate for their body. (Every one of those messages I’ve seen, including in the media, on the gym contract and labeled on the gym machines, says to consult one’s own doctor before beginning an exercise program. Yay tort law!) The only exercise messages that I find somewhat destructive are people who are selling a product, like those machines that promise to provide sufficient exercise in just 5 min. a day, or those weird bands that will somehow vibrate your fat off, etc.
But that fits my general theory: people who are trying to make money on you will say whatever you find most appealing, and with exercise, that’s going to be “You don’t really have to alternate every day with 30 min. of cardio and 30 min. of strength training that can be completely free. (Running is free, strength training that uses your own weight is free.) You just need to spend thousands of dollars on these torture-looking devices, and you’ll get what you want without sacrificing time and effort. Just sacrifice some money instead.”
That’s part of the substitution, too. “You don’t have to give up soda, just switch to diet. You don’t have to give up cookies, just switch to diet. You don’t have to give up easy microwave meals, just switch to diet.” They’re not selling the Only Method Of Weight Loss; they’re selling the allegedly Easy Method Of Weight Loss.
FurryCatHerder writes:
I looked back to see the abstracts. I am interested in the effects of high fructose consumption on the body and would like to know where these studies are published. I looked for references and did not find any in your comments. (Sorry if I’m blind.)
I don’t think studies that link food consumption (amount or kind) with fatness are going to be that convincing because no one really knows (or has studied neutrally, that is, without assuming it is a disorder) why people are fat. I think there are plenty of fat vegetarians and fat healthy eaters who do not and have never consumed large amounts of fructose or fat and who got fat anyway. I come from a long line of fat ancestors who worked on farms, led very active lifestyles and got fat long before high fructose, processed products were introduced to the market. My great-grandfather died at age 99, weighing over 300 pounds. (Yes this is anecdotal, but in this case, it is important, because you are suggesting that fatness is bioengineered and negative single cases do diminish this assertion.)
I do suspect, however, that higher incidences of certain immune system and metabolic conditions may be due to a more sedentary lifestyle and dietary changes. (This is tempered, however, with the knowledge that certain metabolic conditions have undergone changes in thresholds for diagnosis in the past 20 years and thus, increases in incidences can be, in part, attributed to this change in how something is diagnosed and not in the number of people who have the condition.)
But even if one accepts that we have a lot more metabolic disorders in our population, I don’t see how measuring BMI or promoting weight loss or preventing weight gain is the best policy.
I just think these metabolic disorders and their causes could be studied directly instead of always having to worry about body size in the mix. Again, I’m wondering why worry about weight at all? If it isn’t good to eat certain things in large amounts, shouldn’t we get that message to everyone without villifying fat people. Even the concept of prevention would work better if we studied the reduction of the number of cases of a certain condition rather the amount of pounds lost.
Size is a demographic. Sure, weight is an individually fluctuating demographic (actually height is too, but the fluctuations are a smaller range and we don’t obsess over measuring it after a certain age), but generally it is not very informative about health. Fat people and their bodies vary tremendously in levels of fitness and health.
I’m guessing that some people who change their eating habits and increase their levels of activities might even lose significant amounts of weight. If we addressed questions of food and activity with children, some of them may not gain weight they might otherwise have gained over time (though how we would show this is beyond me).
But these would be side-effects of the direct approach. There would be plenty of other people of any size who would also benefit from good metabolic health that would not change in size at all.
So why weight? why BMI? The only reason I can think of for including this in the discussion is based upon stereotyped, stigmatizing understandings of size and fatness. It is prejudice and misinformation, not science. Bad science will equal increased costs in health care.
Pattie,
Here are the links for the articles FCH was quoting:
http://www.ncbi.nlm.nih.gov/pubmed/18703413
http://www.ncbi.nlm.nih.gov/pubmed/12399260
Thanks PG.
I’m changing my name. Yanno, “FCH” looks took much like something else at time ;)
Pattie,
I’m not much into caring about weight. I’m a lot more focused on health because I come to the table from a position of having been profoundly underweight and having health issues because of it — and still having many of them today. For example, my sense of “Hunger” is fairly well destroyed because I was self-starving for 14 years of my life.
That said, I agree with what you said about BMI and weight. I think I’ve written here in the past that my BMI and health are poorly correlated. Some of that was having a BMI of 17 for a good many years. Some of that was going from a very, very active life in Dallas to a somewhat less active one here in Austin. But definitely — complete agreement that BMI and weight are pointless and that health should always be the goal.
And now that PG has been kind enough to provide the PubMed links, I think you’ll find those articles convincing. My own personal understanding of diet-related metabolic changes tells me that they are likely on to something. What I also hope is that as Science begins to understand how obesity is being engineered into people that the stigma of being overweight will decrease, and genuine help will be available so that people can be healthy, at whatever weight they are at.