Marc Armbinder is enlightened, as “anti-obesity activists” go; he admits that obese adults aren’t going to be losing weight ((I assume he means “most” obese adults)) and he dismisses as useless any policy based on hectoring people to lose weight.
But he also writes:
And with obesity, we’re dealing primarily with children and prevention. Obese adults are not going to lose weight unless they decide to have their stomaches separated from their digestive tracts. Megan is pessimistic about any policy intervention and questions any such intervention from a moral level. But any sensible policy is designed to change the environment for children, not for adults.
I don’t really object to the idea of trying to reduce the frequency of obesity in the next generation; although I think the health effects of obesity per se ((As opposed to the health effects of factors that tend to be correlated with obesity, such as lack of exercise, and the stress from anti-fat discrimination.)) have been greatly exaggerated, I do think there is legitimate reason to believe that obesity has negative effects on health for a sizable number of people. If it’s possible to make children healthier without stigmatizing fat kids or making their lives worse, then I’m all for that. (I don’t really believe that Marc or anyone else has a practical, proven method for reducing obesity in kids, but that’s another post.)
However, I can’t agree with Marc that because “obese adults are not going to lose weight,” it follows that “any sensible policy is designed to change the environment for children, not for adults.” This assumes that “changing the environment” is only worthwhile if it leads to weight loss. Just because obese adults aren’t (by and large) going to lose weight, however, doesn’t mean they should be written off. An obese adult who doesn’t regularly exercise — just like a thin adult who doesn’t regularly exercise — could benefit a lot from policies that encourage regular, moderate exercise, like making cities more walkable and bikable, creating public parks, or subsidizing gym memberships. A policy that increased the frequency of moderate exercise among adults, even if no one loses much weight, could lead to lower health-care costs in the long run.
The preliminary research on Health At Every Size techniques to improve health among fat people looks extremely promising; some NIH funding for further research along these lines would do a lot of good. But thanks in part to the myopic focus of anti-obesity activists, there’s no money for interventions that make fat people healthier but don’t promise to make them thinner.
Mark writes that “The idea that anti-obesity activists think the problem will be solved by putting grocery stories in urban areas is kind of a myth.” Well, there are plenty of anti-obesity folks who think that putting grocery stores in cities is part of the solution, although I’m sure none of them think it’s a magic bullet. But more to the point, even if policies encouraging grocery stores in urban areas doesn’t “solve” obesity, that doesn’t mean it wouldn’t be beneficial to health, by enabling urban people to eat healthier even if they don’t lose weight.
Which brings me to the title of my post. The problem with “anti-obesity activists” is that their goal isn’t a healthier population; it’s a less obese population. But treating “health” and “not obese” as synonymous is harmful, because it places many policies that would increase health for everyone — including the obese adults Marc writes off — out of bounds. “Sensible” health policy should attempt to improve the health of all people — including those “obese adults” who aren’t going to lose weight.
(A note about the top image: I hope the top image, by Flickr user ~Twon, doesn’t come off as a “headless fatty” image. There simply aren’t many non-mocking images of fat people exercising, or at least not many I could find. And even though the head is cut off, this photo doesn’t seem to me to contain the same “ew, gross!” subtext contained in most “headless fatty” media photos.)
Which is very sad. I’m sure many fat people, like myself, would love to exercise more, but are discouraged by the way our culture makes the image of a fat person “trying” to exercise ridiculous.
I’m less concerned about the exercising person’s size than their clothing — cargo pants and leather (?) dress (?) shoes?!
Amp,
I thought the image in this news story was fairly neutral, but I assume you mean it’s difficult to find images that are free to be copied. It does seem particularly difficult to find images of obese women exercising that aren’t mocking — the bikinis that no real woman would exercise in are a quick tipoff.
The particular focus on children is due to the difficulty of changing neurological patterns and life habits once they become set. It took me almost 10 years to adjust to an American diet that centers every meal around meat, after having grown up in a food culture that treats rice as the only expected element and often has no meat on the table. I was puzzled by my classmates in elementary school who said they didn’t like vegetables, until the day my mom didn’t have time to pack me a lunch and I had to eat from the school cafeteria. Those were vegetables? Why were they so soggy, and why was the only flavoring to them of butter and salt? Where were the mixed vegetables in the spaghetti, and why were there huge chunks of meat in it?
When I went to college, I lost weight rather than gaining the Freshman 15 because my body had trouble digesting beef and pork, which my mother never served, and because I didn’t have a car and had to walk or take the bus everywhere. Even now, when I have time to cook rather than eating delivery, and I’m cooking only for myself rather than sharing the meal with someone raised on an American diet, I rarely cook meat-based meals because it’s not a kind of cooking with which I feel at home.
If kids grow up with the idea that vegetables aren’t just an optional side but an integral part of almost every meal, they’re going to be healthier even if they’re not thinner. It’s difficult for people to change their ideas from childhood of what they’re supposed to be eating. In particular, whenever someone suggests that perhaps Americans could do with a bit less protein in animal form, she’s treated like a Communist for threatening Our Way Of Life, the success of our nation embodied in the chicken in every pot. A similar reaction arises when the sacred suburbs and small towns are threatened with the concept of planned communities in which one can bike/walk to schools, stores, maybe even workplaces.
The suggested change in eating habits is associated with those Damn Hippies, and the suggested change in movement habits is associated with those Elitist City Folks (in which the city is always Boston, NYC, Chicago, or SF), but the end result is the same: people who have grown up a certain way feel personally threatened and insulted by the idea that um, maybe, that way of life isn’t terribly healthy. Children are easier to brainwash if you get your hooks in them early enough.
When you point out that no peer-reviewed study has show that obese people were able to sustain weight loss over 5 years, that’s because the study participants left the conditions that created the weight loss and went back to their normal lives. It’s a lot easier to lose pounds (and visceral adiposity, which is of greater relevance to health) if you have someone showing up at your door a few times a week to watch you work out for an hour and discuss your eating with you. Since most Americans don’t have and can’t currently afford personal trainers, that’s not “normal life” for them. Has any study kept participants in the “abnormal” conditions (of having a professional care about what they’re eating and the amount of exercise they’re getting) for 5 years and seen whether weight/fat loss is sustained then?
julian,
Maybe the odd workout clothes are meant to indicate that the person is just starting an exercise regime? I’ve started taking spinning classes (under a physician’s threat that if I don’t get my cholesterol down, I’m going on the statins that Paul Campos, non-MD, informs us are totally useless), and I saw a tall, gangly guy in class one day who was wearing loose khakis, button down shirt and loafers. Let’s just say that outfit works better on an elliptical trainer than a spin bike.
PG, try this. Not only can’t you force a naturally fat body to become permanently thin other than those few rare exceptions who make thinness their full-time job for life, but you also can’t force a naturally thin body to become permanently fat.
I certainly know American adults (of all sizes) who were forced to eat vegetables in childhood, and it didn’t make them develop a taste for them; quite the opposite. I also know plenty of fat people who love vegetables, always did even as kids. Many are even vegetarians or vegans. But school food has always sucked. Schools look for stuff they can buy in bulk that’s easy to prepare. And if you send your kids to school with “healthy” lunches they dislike, they’ll trade with their friends or cadge some money to buy a burrito at the 7-11.
As for Armbinder’s ideas…good luck with that, Marc. You’ll have to make sure none of those kids ever needs psych meds or neuroleptics, and I fail to see how the problem is that kids aren’t dieting enough, when about half of fourth grade girls and almost all seventh grade girls are already dieting, and have been for decades now. You’d think, if Armbinder was correct, that the girls would be a lot skinnier than the boys, but nope. Doesn’t work like that, I’m afraid; in fact, of the fat people I know, the fatter they are the younger they were when they started dieting.
Okay, so the reengineering of the environment to prevent obesity in adults and children is very familiar ground for me as someone who works in public health, on the non-infectous disease side of things.
Some of the things that the “anti-obesity activists” promote are really good things, in my opinion. I’m in favor of grocery stores in “food deserts” because I think everyone needs a choice of a variety of foods. I want more green spaces (we have a ton of parks where I live), and more bike-ability and walkability because it makes for more cohesive communities. Better school lunches? Great! Why not better schools, too? Safe places for kids to play, inside and out, also good whether or not it impacts fatness. Subsidizing fresh produce — also something I favor. Many of the people working implementing “anti-obesity environmental changes” don’t really believe that you can turn fat people into thin people either.
The thing is, we don’t really know how to prevent people from becoming fat, either. Dieting seems to make people fatter, so avoiding dieting seems like a good step in that direction. We don’t know how to keep people from never gaining beyond a BMI of 25 — except for the people who point out that there weren’t any fat people in concentration camps (although it’s probable that those who did survive the camps had higher BMIs, from fat or muscle or both, to begin with than those who didn’t.)
I am one of those public health people arguing for looking at improving health — everyone’s health — instead of trying to make or keep everyone, even children, thin. I fight this fight every day, and it takes it’s toll on my psyche.
If fat people are able to live longer, enjoy better health, exercise, eat well, what, exactly is the problem?
Meowser,
I understand that you’re pointing to the article for its findings regarding genetics, but just as the 75% of cholesterol that is produced by the liver is not a good reason for me to give up trying to bring the other 25% down through changes in what I eat and how much cardio I do, I don’t understand why the fact that “70 percent of the variation in peoples’ weights may be accounted for by inheritance” means that we shouldn’t make an effort on the 30% we can control (though I’m not interested in weight so much as body fat levels, which do affect health). Without statins, I’m never going to have as low of cholesterol as most people my age do, because my liver doesn’t work like theirs. But I know that I can move my cholesterol from “scary high” to “higher than normal” if I change my behavior.
It would take a jerk to tell someone like me, who can get a cholesterol of 195 if I completely cut animal fats out of my life and do a lot of exercise for my heart, that I’d have an even lower cholesterol if I just had the willpower. No, asshole, these are pretty much the limits of my body. But I don’t think there is anything asshole-ish in my doctor saying, or in there being in the public square information saying, that I can do better than a cholesterol of 250 (which is what I tend to go back to if I get to eat cheesecake when everyone else has a slice). I will always be teetering on edge of borderline risk, but I don’t have to be high risk. Maybe some people with livers even worse than mine can’t get below the borderline category, and a few can’t get out of the high risk category. But we can do better than just eating and exercising like the people whose livers do exactly what they’re supposed to do. We got dealt the “limited animal fat for you” card in the genetic lottery.
I didn’t see your linked article mentioning a study in which treatment conditions continued for the full span of the study.
The Rockfeller study of weight loss only seemed to involve starving people (an adult body given 600 calories a day will act like it’s starving? who knew?) for four weeks until they were 100 lbs lighter, then being shocked that people restored to their normal, non-starving lives gained back the weight and “had a psychiatric syndrome, called semi-starvation neurosis.” These researchers must have been seriously dim not to guess that if you put adults on half the number of calories required for a healthy baby, on the kind of calorie allotments that Holocaust prisoners were given, they would starve and that it would screw up their psychology regarding food. (There’s guidelines about discussing nutrition in Israel and other places where you might be dealing with significant populations of Holocaust survivors and their families, because the experience of being starved changes your relationship with food, and talking about awareness of calories, fat grams etc. can bring back that trauma.)
You couldn’t do the 1959 Rockefeller study today, not because there’s a scientific consensus that weight-loss is bad for people, but because there’s an ethical consensus that starving people is immoral and can cause permanent psychological, if not physical, damage. There has got to be better research out there than that.
But I don’t think there is anything asshole-ish in my doctor saying, or in there being in the public square information saying, that I can do better than a cholesterol of 250
That’s true, PG, but you are generalizing your personal experience as if it is universal and applies to all conditions when that isn’t the case. What has happened to you and to your body is unique and it would behoove you to listen to some people who’ve had different experiences before you offer sermons about health issues you don’t seem to understand very well.
Cholesterol is a great example, actually. There was a commercial not long ago that had bubbles with numbers over people’s heads that indicated their cholesterol. The message was “ANYONE can have high cholesterol! Ergo you should buy our product and talk to your doctor.” The hook was you couldn’t tell by looking at a person – which meant both fat and thin people should buy the product, of course.
But when my doctor looks at me and sees “fat chick” and doesn’t see that my cholesterol is 170, and puts me on statins or a no-meat diet because I *must* be sick because I’m fat regardless of any actual, that’s where we get into serious problems. That’s where we get people who are or could be healthy being given drugs and lectures they don’t need, where we get spending on procedures and pills that aren’t actually making anyone healthier, where we get into serious anti-fat prejudice that focuses only on appearances rather than the actual measurable health indicators – most of which are completely unseeable. But a lot of people on a anti-obesity crusades seem not to notice that fact.
It’s a lot easier to lose pounds (and visceral adiposity, which is of greater relevance to health) if you have someone showing up at your door a few times a week to watch you work out for an hour and discuss your eating with you.
Even the longer-term studies that have been done under medical control have failed to show weight loss maintained. The human body will fight with all its resources to get you to maintain the weight it believes you should be at, thanks to genetics and an incredibly complex metabolic system that is far more complex that the bunsen burner “calories in versus calories out” model. Short of situations like concentration camps (involuntary starvation) nobody can sustain that kind of deprivation without going insane or cracking and restoring the sustenance that’s been missing.
“I certainly know American adults (of all sizes) who were forced to eat vegetables in childhood, and it didn’t make them develop a taste for them; quite the opposite. I also know plenty of fat people who love vegetables, always did even as kids.”
Absolutely, Meowser. I grew up in white middle-class suburbia. And I’ve always loved green salads and most varieties of raw vegetables. (Cooked vegetables were a whole different story, see below.) One of Mom’s favorite Electrokid stories involves a trip to McDonald’s with a bunch of young children. One of said children had a birthday and her mom arranged a trip to McD’s with all her friends (plus several parents to help ride herd on the hyper horde) as a special treat. When it was my turn to order, I wanted a salad. “Um… this is a special occasion, dear, you can have whatever you like.” “I know. I want a salad.” According to Mom, the other parents gave her the hairy eyeball for that. As in, you evil health-nut mother, have you brainwashed this poor little girl so completely that she doesn’t know the joys of hamburgers and fries?
“Those were vegetables? Why were they so soggy, and why was the only flavoring to them of butter and salt?”
I agree with you here, PG. I think most American cooks can definitely use some help in this department. My mom always made those horrible soggy frozen mixed vegetables when I was growing up, and all they were ever flavored with was minimal amounts of margarine. No salt; she firmly believed that salt was the embodiment of culinary evil and gave my dad disapproving looks when he dared to salt his food. Oh, how I ever hated those mixed vegetables. I ate them because “You are going to sit here until you eat those vegetables, young lady, and if they get cold then you’ll eat them cold!”. Whenever possible I tried to swap a salad for my evening allotment of soggy tasteless crud.
It took meeting and befriending an Indian family for me to learn that cooked vegetables and even- gasp!- beans could be delicious. The first time B. cajoled me into trying some of her dal and a vegetarian curry was mindblowing. Holy smokes, THOSE were vegetables? And a member of the hated bean family? It was delicious! I wanted more… yet the dish was made of cooked vegetables! Astonishing.
If more American families learned to cook vegetables with flavor, I bet a lot more kids would eat them. This would not make fat kids skinny- I’ve been fat pretty much since day one- but it would contribute to overall good health. To those adults reading this who have been scarred by terrible childhood experiences with veggies… try them Indian-style and ignore any killjoys who bleat, “But they put butter and/or cream in those curries!”. Butter and cream do not magically remove the vitamins and fiber from everything they touch. Eating should not be a penance for the sin of being fat.
My local authority (the borough of Waltham Forest in London) subsidises memberships at the leisure centre for under-16s, over-60s, the unemployed (me) and people on incapacity benefits. I have a free membership which lets me use the pool for £1 (£1.50 at peak times) and the gym for about £2. It’s brilliant, and a really forward-thinking policy.
DRST,
But when my doctor looks at me and sees “fat chick” and doesn’t see that my cholesterol is 170, and puts me on statins or a no-meat diet because I *must* be sick because I’m fat regardless of any actual, that’s where we get into serious problems. That’s where we get people who are or could be healthy being given drugs and lectures they don’t need, where we get spending on procedures and pills that aren’t actually making anyone healthier, where we get into serious anti-fat prejudice that focuses only on appearances rather than the actual measurable health indicators – most of which are completely unseeable. But a lot of people on a anti-obesity crusades seem not to notice that fact.
And that’s a problem, not only because these medications have side effects that could be harmful to the individual without benefiting her, but because that creates an unnecessary cost to the health care system as a whole. However, that sounds like a problem with your doctor being very stupid (putting people on statins when their tested cholesterol is well within the healthy range? are you sure s/he doesn’t have a financial interest in this?), not with a message of “Your diet and exercise can affect your health.”
Even the longer-term studies that have been done under medical control have failed to show weight loss maintained.
OK, I haven’t seen any of those. Would you provide a link or citation? As the repeated references to the Rockefeller study that I’ve seen on this blog show, simply seeing the word “studies” doesn’t tell me much about what the study did. Starving people on a 600 cal./day diet is both grossly unethical in its treatment of human subjects, and no-shit-Sherlock impractical as a method for long term weight loss.
Electrogirl,
I know some kids who like raw veggies, but from what I understand, children’s taste buds are more sensitive to bitter tastes than those of adults, so it’s really easy for them to taste a vegetable that to them is bitter even if it is OK for adults. I first heard about this when I brought fancy dark chocolate to some 2nd graders, who rejected it as not tasting good.
So I think we have to get better with cooked vegetables in those school lunches. The people I know who like Indian food all think it would be brilliant to convert school cafeterias to Indian cuisine — you can cook it in massive quantities without losing quality, and it’s not expensive to cook (the prices Indian restaurants charge always amaze me), but some folks just don’t seem to like it, especially in vegetable form. (Even the people who don’t like most Indian food seem to make exceptions for samosas, naan and tandoori-coooked meats.)
ignore any killjoys who bleat, “But they put butter and/or cream in those curries!”
That tends to be more true with North Indian food or Anglicized bastardizations thereof such as chicken tikka masala. In much of South India, people traditionally didn’t use cows for anything (milk came from buffalo, goats, etc.), and the curries are cooked mostly in vegetable oils. But some people who like North Indian cuisine don’t like South Indian food because they find it too oily.
God, this entire subject makes me insane. As so many people, including Amp & others in this thread, have noted (again and again and again), there is indeed reason to worry about many people’s health. But those health concern are IN NO WAY restricted to those who are fat. How many times do we all have to bang our heads against the wall saying that?
As for the targeting children thing, yeah, I could get on board with that if all the evidence I’ve seen so far didn’t indicate that inaccurate information and scare tactics are the main vehicles for this. As far as I can see, all these campaigns are doing is making sure that the current younger generation is going to end up with even more prevalence of eating disorders and the attendant health problems than the current one.
Which, if you wanted to go 5 times a week, would mean £20 – £40 a month, depending on what activities you wanted to do. For many, many people, that just isn’t realistic. Even 3 times a week would be too expensive for many. Then add on the time it takes, the availability of transport (trust me, outside of London it’s a different world), and, most importantly, the fact that only a tiny minority of people even know what appropriate (in relation the individual’s fitness level), effective exercise consists of, and is it any wonder people feel overwhelmed?
Health is not a personal or “lifestyle” problem, it’s a social one. And it isn’t going to get fixed until all of us change our attitudes about work & wages, social organisation and how food is grown and distributed. Hammering individuals over the head about all this is not helpful.
PG, the government did a huge study a few years ago. It was called the Women’s Health Initiative Dietary Modification program and what they did was divide about 48,000 postmenopausal women into two halves: one of whom was told to eat whatever they wanted, the other of whom was put on a restricted program where they were monitored carefully to make sure they ate lots of vegetables, lots of whole grains, almost no animal fat, very little fat overall, a diet which wound up averaging about 350 kcal less per day than the control (or should I say, no-control) group. This went on for 8 years. (They focused on postmenopausal women because that’s the age group most vulnerable to cancer, heart disease, strokes, diabetes etc.)
The researchers expected that at the end of 8 years, the restricted-diet group would weigh a lot less, and have much lower rates of cancers, heart disease, diabetes, and strokes than the control group. They published the results in JAMA, and guess what? They found nothing. At the end of the 8 years, the restricted-diet group weighed an average of 1.5 pounds less than the control group — null result. No statistically significant difference in any of the diseases they studied, either, including 30 different cancers.
They hated the results so much they tried to bury them; their press release (and subsequent media hype) focused on the fact that the restricted-diet group had a 17% lower incidence of ovarian cancer. That sounds impressive until you realize that 1) there were very few cases of ovarian cancer in either group and 2) ovarian cancer is one of the most strongly genetically linked of all cancers.
I’m sorry to have to rely on Junkfood Science for the links to this, but you’d have to purchase the JAMA issues or articles to read them directly; they don’t provide links to the full data. I’ll post them one at a time so as not to trip the spambot. Here’s the first:
http://junkfoodscience.blogspot.com/2007/10/junkfood-science-exclusive-big-one.html
Second one: http://junkfoodscience.blogspot.com/2007/10/jfs-exclusive-part-two-of-countrys.html
And third:
http://junkfoodscience.blogspot.com/2008/11/null-series-healthy-eating-for.html
Meowser,
Thanks for the links.
where they were monitored carefully to make sure they ate lots of vegetables, lots of whole grains, almost no animal fat, very little fat overall, a diet which wound up averaging about 350 kcal less per day than the control (or should I say, no-control) group. This went on for 8 years.
But the monitoring clearly had its limits, as the women didn’t stick entirely to the prescribed diet, and the decrease in fat associated with animal products doesn’t seem to have been very large: “small decreases in saturated (2.9%), monounsaturated (3.3%), and polyunsaturated (1.5%) fat.” I had concerns similar to those expressed here:
The point about age strikes me as the most important, and reinforces Armbinder’s focus on inculcating good habits in children at an early age, rather than trying to change the life patterns and bodies of middle-aged and elderly adults. Arthrosclerosis (hardening of the arteries due to cholesterol deposits) begins early in life and isn’t going to be easily reversed after 50.
Since you said the control group was not monitored, the only thing I’m suspicious about is that they might have had a diet of their own, probably not the exact same as the one in the studied group, but it’s a trope that most women diet (if 6th graders almost all do it, I bet women in their 50s also do). I don’t know how true it is, you all probably know more than I do. I don’t personally diet.
I’m too much out of the loop for any anecdotal evidence I bring to be of much use. The only one I know enough about eating habits is myself, and I’m a walking anomaly.
I’m not sure how other diets would affect their disease chance and/or their weight gain/loss.
It would be interesting to know if they actually did take some measurements of calorie intake and such from the control group. Was the 350 kcal lower than control group assumed from a statistical average from another study, or actually measured?
Any diet study that focuses purely on Kcals and not on where those Kcals are coming from is just pointless.
My doctor wanted me to change my diet because my cholesterol was creeping up. So, I did everything he told me. My cholesterol shot up and I gained about 20 pounds. I went back to my crappy, high red-meat-content diet and I lost the 20 pounds and my cholesterol went back down.
And I’ve known other people just like me. I can eat meat and a steamed green veggie (none of the yellow or white ones) all day long and not gain weight. Our ancestors did not all live in the same food environment, pretending that a Kcal is a Kcal is dumb.
With the “and such” I meant also the content of what they ate, including weight or some other type of measurement.
For example:
500 g of beef
750 ml of 2% fat milk
6 tbsp of coffee beans
It’s not that hard to measure if you mostly eat home and/or cook yourself. That might not be for everyone I guess, and as far as my own experience tells, its worst if you’re single and/or living alone. I have no desire to cook food for only myself. And the same goes for my boyfriend. But for us two, he’s willing to go the extra mile (and so am I).
I wonder how feasible it would be to measure the ingredients this way for a large scale study, and by extension, their nutritive value in vitamins and iron and all that. Pretty much everything is labeled these days with nutritive value, but do people really pay attention to other things besides kcals on those labels?
Since you said the control group was not monitored, the only thing I’m suspicious about is that they might have had a diet of their own
It’s likely at least some of them did, and some probably had medically-related food restrictions of some kind also (either temporary or permanent). But they weren’t all on the same kind of diet, and they weren’t on those diets for all eight years of the survey, other than the ones who had permanent medically-related restrictions.
It would be interesting to know if they actually did take some measurements of calorie intake and such from the control group. Was the 350 kcal lower than control group assumed from a statistical average from another study, or actually measured?
I’m pretty sure that everyone had to report in what they ate, whether they were being restricted or not.
And PG…if by age 55 or 60 it’s “too late” for dietary restrictions to make any difference in a person’s health, and eight years isn’t enough to make a difference, how come doctors keep prescribing said restrictions to people that age and older, even to people old enough that they might not have another 8 years left in them? It seems to me that from all the medical reports I’ve created (thousands upon thousands), it’s the people over 70 who have the most dietary restrictions, not the fewest. Do you think they’re wasting people’s time by doing that? (I often wonder how well people manage to stick to a low-fat, low-cholesterol, no added salt, 1800 calorie a day diabetic diet of soft foods only, after discharge when they’re no longer in a controlled environment.)
Meowser,
But medically restricted diets for senior citizens can be for reasons other than trying to prevent the diseases that were studied in the Women’s Health Initiative Dietary Modification Trial (colorectal, breast and ovarian cancer; cardiovascular disease; stroke).
For example, a high fiber diet may be recommended to decrease the likelihood of constipation; such a diet encourages consumption of whole grains and fresh fruits and veggies, as well as discouraging consumption of ice cream, cheese, meat and processed foods. Dietary restrictions also can help avoid acid reflux, and that’s a long list of stuff I’d hate to give up: coffee, alcohol, foods high in fat, any kind of large meal, carbonated soft drinks, chocolate, peppermint, tomatoes and tomato-based preparations, citrus fruits and juices, cabbage, cauliflower, broccoli, and Brussels sprouts (yes, the exact veggies you’re supposed to eat to avoid constipation), dairy.
For someone in her 70s or 80s, a lot of lifestyle recommendations will be oriented toward increasing the quality of life (and acid reflux and constipation can make life suck — my sister suffered from both simultaneously when only in her early 20s), not toward maximizing the quantity of years. I think that is sensible.
But there is a difference between not eating a certain food or type of food because it doesn’t agree with you (i.e. you know it will cause severe discomfort or organ malfunction very shortly after eating it) and not eating a certain food because you think it’s going to hurt you someday, even if you feel perfectly fine after eating it now. A pretty big difference, actually.
It never ceases to amaze me how many people are sent home from the hospital with these diets of “low fat, low cholesterol, 2 grams sodium, no sugar or starch, low residue,” etc. Just a huge laundry list of things they’re not “supposed to” eat. How many people do you think comply 100% for the rest of their lives? Probably not many. But if they know that eating peanut butter is going to put them on the toilet all night with a diverticulosis attack, they won’t touch the stuff.
But there is a difference between not eating a certain food or type of food because it doesn’t agree with you (i.e. you know it will cause severe discomfort or organ malfunction very shortly after eating it) and not eating a certain food because you think it’s going to hurt you someday, even if you feel perfectly fine after eating it now. A pretty big difference, actually.
Agreed, I was just responding to your statement that “it’s the people over 70 who have the most dietary restrictions, not the fewest.” Low sodium is to keep blood pressure down, and that is one that has a pretty direct effect in about a third of the population. Reducing alcohol intake also decreases hypertension.
A propos no previous comments, just some thoughts about obesity and health:
1. If we are serious about making weight loss work on a population level, the first big funding needs to go not to public health initiatives but to research. We don’t know how people gain and lose weight, we don’t even really know why the average weight has gone up over the past couple of decades. Knowing those things may help with this problem. If it is even the best problem to attack, which is entirely less than clear to me.
2. Dieting is ridiculous. Telling people that they just need more “willpower” is ridiculous. Anyone here know any Greek mythology? Remember the story of Tantalus? At least he didn’t have to snatch the food from his own mouth. If food is available, hungry people will eat it. Trying to coerce them to do otherwise is cruel as well as foolish.
Dianne,
A lot of the initiatives that have been proposed deal with what kind of food is available to people who are hungry. Will it be what the capitalist market provides (cheap, non-nutritious, fat-filled fast food), or will we make healthier food more accessible and unhealthy food less so?
Will it be what the capitalist market provides (cheap, non-nutritious, fat-filled fast food), or will we make healthier food more accessible and unhealthy food less so?
Certainly making more, healthier food options available is going to help overall health, but I have doubts about whether it will lead to weight loss for all the reasons amp has described repeatedly. Another problem is that people get into habits and want to keep doing what they have been doing. So, how to motivate people to take advantage of healthier options if they do become available? And how available is really available? If you work 110 hours a week at 3 jobs, fast food is going to look a lot better to you than cooking a fresh dinner every night, even if the ingredients are available to you.
Another problem is that people get into habits and want to keep doing what they have been doing.
That would be Marc Ambinder’s suggestion of focusing on children and getting them into healthy habits at an early age.
And how available is really available? If you work 110 hours a week at 3 jobs, fast food is going to look a lot better to you than cooking a fresh dinner every night, even if the ingredients are available to you.
Los Angeles has put a one-year moratorium (due to expire soon, if it is not renewed) on building fast-food restaurants in poor neighborhoods. (This article about the moratorium cites a different Greek myth, that of Sisyphus.) If you can get healthy food more easily than non-healthy food, then you’ll tend to eat the former rather than the latter. For example, if your neighborhood grocery has prepared meals by an express checkout line, then it’s just as easy to grab that rather than have to leave your neighborhood to find a McD’s. I cook dinner maybe once a week, usually on a weekend, but there are plenty of things that you can get from a grocery store and keep in the fridge to eat that are better for you than even a McD’s salad.
I cook dinner maybe once a week, usually on a weekend, but there are plenty of things that you can get from a grocery store and keep in the fridge to eat that are better for you than even a McD’s salad.
Works well if you have time off on the weekend (remember there are only 168 hours in a week so someone working 110 has only 58 hours to eat, sleep, get to and from work, do the laundry, etc) and the utensils and stove for cooking. Being able to grab a prepared meal from the grocery store sounds better than McD’s to me (especially since I worked there in HS…it’s probably not as bad as you fear but maybe worse than you hope). Where I live there is a home delivery service which provides reasonably healthy meals ready for the microwave…though it’s probably not really in the price range of a minimum wage employee. The more alternatives the better.
Pardon me if my posts are a bit incoherent and/or self-contradictory. The problem is that I don’t really have a position or argument and am basically rambling about the problem.
Personally, while I know it’s physically doable, I doubt someone could last long working 110 hours a week every week save maybe 2 weeks a year. I’d get burned out faster than you can say laid off.
For many people, working 35 or 40 hours a week at their job, plus the commute, is more than enough.
Or you can always do like my brother did, do hard drugs that cost just about what money you make working like a devil (I calculated he made 3000$ a month, but he was always broke before paying the bills or rent, or food), fall like a brick on the weekend sleeping 24 hours in a row and a bomb wouldn’t have wakened him. He didn’t sleep at all 6 days in a row though, so he could have done 110 hours of work.
I can’t name a single person I know who works more than 60 hours a week. 80 might be doable for some on a regular basis. I just doubt 110. Do you know some personally?
By the way my brother worked about 60 hours a week maybe 70 tops. But the way he did things (those drugs are hard), he would have lasted 2-3 years tops. Having a cardiac arrest at 22 is not fun.
Schala,
I don’t know anyone who works 110 hours a week most weeks of the year, but I do know lawyers at the associate level who work that for a month or so at a time when a transaction is about to go through or they’re about to go into court for litigation (that’s how people end up billing over 3000 hours in a single year). It’s humanly possible, but it’s also a lifestyle for people in their 20s and early 30s. You don’t see the middle-aged partners pulling those hours; it’s something you can do when you’re young and the gallons of coffee haven’t already destroyed your stomach lining.
The way Dianne presented it this was someone with three jobs, probably three 35 hours job, not a job that sometimes demands big hours like trucking or your example of a lawyer on a big case. So to not do it year round, that person would have to drop at least one job sometime, and hope to get back another later (or arrange a sort of weird schedule with that employer so you can get hired back).
If anything, working 110 hours year round is a cause of early death imo. No better than being drugged 24/7. It will quickly affect health, and the extra cash will be lost in medical expenditures, or mortuary arrangements.
Schala: Actually, I do personally know people who have worked 110+ hours a week for long time periods. Let me start with myself: I was a resident in the days before work restrictions. It’s frankly not pretty. But the case I was thinking about was not myself or any colleague, but a patient who came in asking for weight loss advice. There didn’t seem to be anything wrong with her, no reason to suspect a pituitary tumor or thyroid problem (though I ran the inevitable tests to make sure) so I asked her about her daily schedule and eating habits. She was working more hours than I was! I’ve always wished I’d had the guts to give her the real advice she needed to become healthier if not lose weight: quit two of the jobs and organize a union so you can have a living wage in the third. Once I started asking I found that working 80+ hours a week at multiple part time jobs wasn’t that uncommon in the patient population (midwestern state, generally uninsured) though 110+ hours is an extreme example.
BTW, 80 hours is much easier physically than 100, but once you pass 100 it almost doesn’t make any difference if it’s 110 or 120 or 130. It’s just all nightmarish. And, yeah, it’s a damn good thing that they put a stop to that 110 hour crap.
Anyway, my original point, which I guess I didn’t make so well, is that obsesity, unhealthy eating habits, and poor health maintenance in general are multifactoral, social level issues and simple solutions like train the youngsters to eat better and put supermarkets in poor neighborhoods may help (whatever help means in this case) but they aren’t panaceas. For either obesity or the more reasonable target of bad nutrition.
Great post. You cited a Health at Every Size study I did a few years ago at UC Davis. Just wanted to let you know that I have since written a popular press book that discusses the research in much more depth, called Health at Every Size: The Surprising Truth about Your Weight (www.HAESbook.com). You’ll find it provides a lot of scientific (and practical) support for the ideas you raise here. Lots of free resources on the website too.
Not sure if this is a thread derail, but wasn’t sure where else to put this link of this Doonesbury cartoon from today (Sunday, June 27):
http://www.doonesbury.com/strip/dailydose/index.html
What do you all think about it?
It’s stupid. Basic training will turn him into a better soldier than anything an undernourished, short lightweight could ever aspire to be. The sergeant should be happy with the recruit. He WILL get some time and assistance before the ASVAB (vocational) and even if he fails the IST (Initial strength test for the Marines) he will be speeded up on his way if he really wants to serve.
In the military, being fit is your job, and everyone with the right attitude and without a medical condition will become what the drill sergeants want him to become.
No, really, it’s stupid. The guy looks heavy, but healthy.
I was one of the last people to go through the mandatory service in France (ended one year later), and two of my best friends have served as conscripts as well (Bulgaria and Russia) All three of us agreed that EVERYONE gets in shape by the end, at least in the non-construction units.