{"id":2055,"date":"2006-02-03T12:18:00","date_gmt":"2006-02-03T19:18:00","guid":{"rendered":"http:\/\/www.amptoons.com\/blog\/?p=2055"},"modified":"2006-02-03T12:18:00","modified_gmt":"2006-02-03T19:18:00","slug":"anti-fat-science-uk-edition","status":"publish","type":"post","link":"https:\/\/amptoons.com\/blog\/?p=2055","title":{"rendered":"Anti-Fat "Science" (UK Edition)"},"content":{"rendered":"

Summary<\/strong>\n\n

Two British charity groups, Cancer Research UK and Weight Concern, recently made headlines with a new survey purporting to show that fat people were unaware of health issues and “in denial” about their weight. The poll results, in fact, showed very little difference in knowledge between fat people and what the survey writers called “normal” people; and “in denial” refers to any fat person who is content with their body as it is.<\/p>\n

Caroline Swain, Executive Director of Weight Concern said, “The survey findings highlight a widespread lack of concern about obesity.” In fact, the survey shows that 80% of obese people want to lose weight.<\/p>\n

The survey was used to introduce a weight loss plan, Top Ten Tips. This plan, according to its creators, is scientifically-validated, easy to follow, and requires no major lifestyle change.<\/p>\n

However, the studies cited to support Top Ten Tips indicate that the vast majority of people who try this plan do not lose nearly enough weight to turn an obese person into a so-called “normal” person. A typical study cited by Top Ten Tips found that the average short-term weight loss is only 11 pounds, and long-term weight loss is even less. Furthermore, the exercise study cited by Top Ten Tips recommends up to 90 minutes a day of exercise, which most people would find to be a major lifestyle change.<\/p>\n

The weight loss studies cited by Top Ten Tips are plagued by dubious methodologies. For instance, one study cited had a 77% drop-out rate. Another study cited by Top Ten Tips excluded all people who didn’t<\/em> lose weight from the study (Imagine if drug companies were allowed to claim their drugs “worked” based on studies which excluded everyone who tried the drug but didn’t get better!). Virtually none of the studies examined whether or not weight-loss was maintained over the course of five years; many didn’t even follow subjects for a full year.<\/p>\n

To claim that such studies are scientific proof of the effectiveness of the Top Ten Tips program is simply dishonest. Furthermore, by spreading disinformation, Cancer Research UK and Weight Concern are validating unfair bigotry against fat people, and obscuring more realistic and proven ways that fat people can improve their health.\n<\/pracut>\n

Part One: A Biased Survey Produces Biased Results.<\/strong>\n\nFrom Reuters<\/a>:<\/p>\n

LONDON (Reuters) – Many obese people are in denial about their size and do not want to lose weight even if it would improve their health, according to a poll on Monday.<\/p>\n

More than half of 4,000 people questioned by the charity Cancer Research UK were overweight or obese but a quarter of them were not concerned about losing weight. […]<\/p>\n

“These results show far too many of those at greatest risk are choosing to ignore their weight,” Walker added. “They are unaware of their increased risk of cancer and unaware of many of the benefits of a healthy lifestyle.”<\/p>\n

Cancer Research UK and the charity Weight Concern said people who are overweight or obese should try to eat at the same time every day, choose reduced-fat foods, exercise, select healthy snacks, limit alcohol, and watch their portion sizes.<\/p><\/div>\n

About a quarter of fat people aren’t interesting in losing weight – the horror! The horror!<\/p>\n

Curious about the report, I searched around and eventually found the actual poll numbers<\/a> (scroll all the way down). “In denial” means “any fat person who is satisfied with their weight.” The bigotry inherent in believing that any content fat person must be “in denial” is appalling.<\/p>\n

As for being “unaware of the benefits of a healthy lifestyle,” It turns out that fat people, compared to “normal” weight people, are slightly <\/em>less likely to realize that avoiding excess drink, exercising and eating well reduce the risk of cancer; but fat people are slightly more <\/em>likely to say that “maintaining a healthy weight” will reduce cancer risk.<\/p>\n

But the differences really are pretty slight. For example, 24% of “normal” weight Brits surveyed were aware that avoiding excess drinking would reduce their risk of cancer, versus 21% of fat Brits who were aware of that. Yes, it’s a statistically significant difference, but is that a difference that matters? Or that justifies headlines saying that fat people, in particular, are ignorant of cancer risks?\n<\/pracut>\n

Part Two: Introducing The Top Ten Tips For Weight Loss<\/strong>\n\n

But never mind all that; turns out the survey is just the leading publicity edge for an associated weight-loss program:<\/p>\n

Cancer Research UK has joined forces with the charity Weight Concern to develop Ten Top Tips “\u201c a set of weight management guidelines that can be incorporated into everyday routines without radical lifestyle change. The scientifically-based programme involves adopting ten simple steps and using a weekly checklist over eight weeks to monitor progress and help reinforce the new habits.<\/div>\n

Note the claim that this is a “scientifically-based program” – which means, I assume, that the Top Ten Tips have been shown to lead to significant, long-term weight loss in scientific studies. There’s also a second claim: the Top Ten Tips do not not involve “radical lifestyle change.” As we will see, neither claim is true.<\/p>\n

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: […] “These results show far too many of those at greatest risk are choosing to ignore their weight. They are unaware of their increased risk of cancer and unaware of many of the benefits of a healthy lifestyle.”<\/p>\n

“The Reduce the Risk campaign offers people health messages and practical advice they can use to change unhealthy habits for healthy ones. With support and information, the quarter of obese and overweight people who do not wish to lose weight will hopefully join the majority who would like to.”<\/p><\/div>\n

First of all, notice Dr. Walker’s assumption that not wanting to lose weight and having a “healthy lifestyle” are incompatible.<\/p>\n

Second, despite the “practical advice” available, according to their own survey the 75% of fat people who want to lose weight are nonetheless still fat<\/em>. If the advice is so damned practical, then why are all these people still fat?<\/p>\n

To be fair, Dr. Walker doesn’t literally say that the 25% of fat people content with their weight will actually lose weight<\/em> if they “join the majority”; instead, they’ll just join the other 75% in wishing they were thin but actually remaining fat. What a victory that would be!<\/p>\n

Professor Jane Wardle, director of Cancer Research UK’s Health Behaviour Unit said: […] “The Ten Top Tips programme is specifically designed to help people develop routines that are easy to follow and become ‘automatic’ over time. If followed over the long term they will help people lose weight and keep it off.”<\/p>\n

Caroline Swain, Executive Director of Weight Concern said, “The survey findings highlight a widespread lack of concern about obesity. Education and support are a vital component in tackling the alarming rise in obesity in this country. By working together and sharing our combined expertise, Cancer Research UK and Weight Concern are offering people practical and simple ways to control their weight and reduce their risk of cancer.”<\/p>\n

The set of scientifically-based guidelines is designed to help people adopt healthy habits that can be sustained for long-term weight maintenance. Based on psychological theories of habit formation, the easy-to-follow tips can be incorporated into people’s everyday routines without major lifestyle change.<\/p><\/div>\n

I am puzzled by Ms. Swain’s alarm over the “widespread lack of concern about obesity.” Her own survey shows that 80% of obese people would like to lose weight. How widespread will concern over obesity have to become before Ms. Swain will stop claiming that there’s a widespread “lack of concern,” I wonder? If 90% of obese people hated their bodies, would that be enough to make Ms. Swain happy? If 95% had a almost certainly hopeless desire to be (in the words of Ms. Swain’s survey) “normal,” would Ms. Swain finally be able to sleep well at night, or would the thought that 5% of obese Brits have failed to absorb the requisite amount of self-hatred keep her counting cracks in the ceiling?\n<\/pracut>\n

Part Three: So What Are The Top Ten Tips?<\/strong>\n\nBut moving on. What are these amazing weight-loss tips – these “easy” “practical” “long-term” “without major lifestyle change” “scientifically-based” Top Ten Tips? They must be something really new and innovative<\/em>; after all, if such Tips had been widely known for a long, long time, then hardly any of the 80% of the obese who want to lose weight would still be obese!<\/p>\n

Here they are – the much-heralded Top Ten Tips:<\/p>\n

1) Keep to your meal routine
\nTry to eat at roughly the same times each day, whether this is two or five times a day.<\/p>\n

2) Go reduced fat
\nChoose reduced fat versions of foods such as dairy products, spreads and salad dressings where you can. Use them sparingly as some can still be high in fat.<\/p>\n

3) Walk off the weight
\nWalk 10,000 steps (equivalent to 60-90 minutes moderate activity) each day. You can use a pedometer to help count the steps. You can break-up your walking throughout the day.<\/p>\n

4) Pack a healthy snack
\nIf you snack, choose a healthy option such as fresh fruit or low calorie yogurts instead of chocolate or crisps.<\/p>\n

5) Look at the labels
\nBe careful about food claims. Check the fat and sugar content on food labels when shopping and preparing food.<\/p>\n

6) Caution with your portions
\nDon’t heap food on your plate (except vegetables). Think twice before having second helpings.<\/p>\n

7) Up on your feet
\nBreak up your sitting time. Stand up for ten minutes out of every hour.<\/p>\n

8) Think about your drinks
\nChoose water or sugar-free squashes. Unsweetened fruit juice is high in natural sugar so limit it to 1 glass per day (200ml\/ 1\/3 pint). Alcohol is high in calories. Try to limit the amount you drink.<\/p>\n

9) Focus on your food
\nSlow down. Don’t eat on the go or while watching TV. Eat at a table if possible.<\/p>\n

10) Don’t forget your 5 a day
\nEat at least 5 portions of fruit and vegetables a day (400g in total).<\/p><\/div>\n

I for one feel underwhelmed.<\/p>\n

2, 4, 5, 6, 8, 9 and 10 can be summed up as “eat more fruit and veggies, and cut your calorie intake.” (Number 9 doesn’t appear at first glance to be a calorie-cutting tip, but when you read the details it turns out they think that people who eat in front of the TV eat more). 3 and 7 can be summed up as “exercise more.” So 9 of the Top Ten Tips are the two most commonplace and well-known weight loss strategies known to humankind.<\/p>\n

Do they honestly think that the 75% of fat people (80% of obese people) who want to lose weight have never thought of<\/em> eating less and exercising more? That notion has just never been presented to them before January 2006, and that’s why they’re fat?<\/p>\n

Good lord, how can these people look at themselves in the mirror? (Answer: they’re thin, and to them that’s the only criteria that matters.) What kind of brainless moron of a researcher brightly chirps to newspapers that fat people should try and lose weight by eating less and walking more<\/em>, as if this is news?<\/p>\n

Jesus Christ! (And I say that as an atheist Jew.)\n<\/pracut>\n

Part Four: What Is This Scientific Evidence You Speak Of?<\/strong>\n\nIt gets worse. The “Top Ten Tips” comes from a charity called Weight Concern. Weight Concern’s front page<\/a> repeats the claim of scientific grounding: “New! Top Ten Tips! Weight Loss Tips Based On Scientific Evidence.<\/em>”<\/p>\n

Again, these “new” tips boil down to eating less and exercising more. But let’s check out the much-ballyhooed “scientific evidence” (pdf link<\/a>). I’m not determined enough to go through all ten tips, but I’ll go through the first three, which is (I think) quite enough to demonstrate the level of scientific support behind these tips. Remember, this is being billed as reliable, easy-to-follow advice to enable fat people to have long-term weight loss.<\/p>\n

TIP ONE<\/strong>
\nThe first tip – have a regular meal schedule – is cited to a study called “Behavioural correlates of successful weight reduction over 3y.” from The International Journal of Obesity<\/em>.(2004, 28:334-335.)<\/p>\n

Here we see a common problem of the studies cited by weight-loss gurus: The study combines lousy methodology with an extremely forgiving standard of “success.”<\/p>\n

Lousy Methodology: The study had a 77% drop-out rate<\/strong>. This means that the researchers have no idea how many people followed their instructions, found that they weren’t losing weight, and so quite reasonably dropped out. All the researchers can claim is that of the 23% minority who didn’t<\/em> drop out, those who had a regular meal schedule were 70% more likely to have a “successful” weight loss.<\/p>\n

Forgiving definition of “success”: ” weight loss of 5% or more from baseline to 3 y FU was defined as successful weight reduction.”<\/p>\n

5%? Let’s say a 300-pound man loses 5% of his weight, and so becomes a 285 pound man. Will that mean that he’s now classified as “normal” weight? No. If he says that he’s now satisfied with his weight, will Ms. Swain find that acceptable? Again, no. And what if he gains back the fifteen pounds if we measure it across 5 or 6 years, instead of three (weight loss maintenance declines steeply over time) – will that be acceptable? No.<\/p>\n

And keep in mind, the amount of weight loss drops steeply over time – so when these studies consider a “success” to be weight loss at six months or even three years, they’re greatly increasing the “successes.” If “success” was described as taking the weight off and keeping it off for a lifetime, the success rate of these studies would be near-nonexistent.<\/p>\n

<\/p>\n

This is a double-standard that weight-loss boosters constantly employ. When they spout statistics intending to show how horrible the obesity “epidemic” is, being at all larger than “normal” is categorically unacceptable, and probably a cause for not just concern but panic. But when you look at the scientific studies they cite to show that weight loss is reasonably possible, they define “success” as a fat person who becomes a slightly less fat<\/em> person.<\/p>\n

Which is it? Either people can be fat and healthy, in which case their panic statistics have no basis. Or fat people are not healthy – in which case most of the cited “successful weight reductions” can’t really be called successes at all.<\/p>\n

So – of the 23% of subjects who didn’t drop out altogether – how many actually succeeded in maintaining a 5% weight loss over the course of three years? 48%. Put another way, of the minority who were able to stick with this study’s plan, most weren’t even able to lose 5% of their weight over three years.<\/p>\n

But what about the most successful group of dieters – those who managed to obey seven separate restrictions for all three years? (That’s a grand total of 198 dieters out of the initial group of 6,857). Of this tiny, select group, 40% failed to meet this study’s extremely forgiving standard of “successful weight loss.”<\/p>\n

The second study cited to support Tip One (“Promoting long-term weight control” International Journal of Obesity<\/em> 2004, 28:278-281) neatly avoids the problem of dieters failing to lose weight by using a selective sample; the sample considered includes only people who have already <\/em>lost 30 pounds and kept it off for at least two years. They then look at how these successful dieters behave, and assume that if everyone else behaved the same way, they too would lose weight.<\/p>\n

The problem with that is, for all the researchers know, many people who aren’t successful at losing weight may have used the exact same weight-loss strategies.<\/p>\n

It’s as if they had taken a sample of people who win marathons and studied the training regimens the marathon winners used. It would be illogical to assume either that every person is capable of following the regimen, or that every person who follows the regimen will necessarily win marathons.<\/p>\n

And again – note the forgiving standard of success. I weigh about 330 pounds; if I lost 30 pounds, none of the folks behind the “Top Ten Tips” would call me “normal” or view my weight as a success. Plus, even among this group of specially selected super-dieters, the average participant only maintained the weight loss for five and a half years.<\/p>\n

TIP TWO<\/strong>
\nThe second tip is to eat low-calorie foods. “There is a great deal of evidence to support the effectiveness of low-fat diets (where 30% or less of total daily energy is from fat), which produce weight loss by decreasing calorie intake. Following a low-fat diet is also associated with better weight maintenance.”<\/p>\n

They provide two citations to support this tip.<\/p>\n

The first is to a UK government document entitled “Management of obesity and weight loss”; the UK link appears to be dead, but the google catche<\/a> still works. In the section discussing calories and weight loss, they referred to two peer reviewed meta-analysis studies.<\/p>\n

The first peer reviewed study in the UK government report, “The role of low-fat diets in body weight control” (International Journal of Obesity<\/em> (2000) 24 1545-52), was a meta-analysis of several other studies. The meta-analysis showed that the average dieter using a low-fat diet loses seven pounds for between 2 and 12 months (they didn’t include studies which checked for success past 12 months). However, fat dieters on average lost 13 pounds for 2-12 months. Nothing in this analysis justifies a claim that fat people can reliably use this diet plan to become “normal,” or that the small weight loss that occurs is maintained over the long term.<\/p>\n

The second study mentioned in the UK government report, was another meta-analysis (“Advice on low-fat diets for obesity,” The Cochrane Library<\/em>, Issue 3, 2002). This analysis included studies that went all the way to 18 months (although most only covered 6 months) – again, not long enough to say anything about long-term weight loss. They found that low-fat diets were actually slightly less <\/em>effective than other diets, producing an average weight loss of about 11 pounds in fat and obese subjects – again, nothing to justify a claim that fat people can become what Weight Concern calls “normal.”<\/p>\n

Finally, let’s look at the second citation in support of “Tip Two,” “Successful Weight Loss Maintenance,” in Annual Review of Nutrition<\/em> 2001, 21:323-341.<\/p>\n

As usual, the definition of “success” is quite lenient. “We propose that individuals who have intentionally lost at least 10% of their body weight and have kept it off at least 1 year be considered successful weight loss maintainers.” Even by this very relaxed standard, however, four out of five dieters this study considered failed to maintain the weight loss – and had they used better standards, such as weight loss maintained for at least five years, the failure rate would have been much higher.<\/p>\n

The authors note that there are health improvements associated with a 10% weight loss. That’s true – but people who eat healthier food and exercise without losing weight experience the same health improvements<\/a>.<\/p>\n

And in any case, 10% is certainly not enough of a loss to turn most fat people into what Weight Concern calls “normal” people. This study doesn’t support claims that low-fat diets are reliably associated with long-term weight loss, or that they reliably turn fat people into non-fat people.<\/p>\n

TIP THREE<\/strong>
\nTip three is to walk a lot to lose weight. This tip is supported by a link to a glossy UK government hand out on the benefits of physical activity (pdf link<\/a>), which gives no particulars at all on how much weight loss walking provides, or how long-term the studies are. Tip Three is also supported by one scientific consensus statement<\/a>, which reports that “There is compelling evidence that prevention of weight regain in formerly obese individuals requires 60″\u201c90 minutes of moderate intensity activity or lesser amounts of vigorous intensity activity.”<\/p>\n

I have no idea how long-term this is, or how much weight loss is claimed. (Some research – not cited in the Top Ten Tips, unsurprisingly – has shown that exercise has only minor long-term weight loss effects. However, exercise is good for health regardless of weight). What strikes me about this, however, is that the Top Ten Tips are advertised as “easy to follow” “practical” and “without major lifestyle change.”<\/p>\n

We’re talking between an hour and an hour and a half of exercise every day. I’m willing to bet that the typical citizen wouldn’t find adding 90 minutes of exercise a day “easy,” or “practical” – especially not if they have minor impediments like, you know, jobs<\/em>. Or children<\/em>. And I suspect most people would <\/em>find 90 minutes of exercise a day a “major lifestyle change.”\n<\/pracut>\n

Conclusion<\/strong>\n\nThe survey these folks wrote and publicized puts all people into three classes: “normal,” “overweight” and “obese.” (A fourth class, “underweight,” is mentioned once and then ignored). Only being “normal” (and perhaps “underweight”) is considered acceptable, by their standards. Not to worry – they have a “scientifically-based program” “based on scientific evidence” which does not involve “radical lifestyle change.”<\/p>\n

Now, when I see such claims, I expect – at the very least – a single study showing that fat people have used this program to become so-called “normal” weight and have been able to maintain that weight loss over the long term. But there is no such study<\/em>. Instead, they link to studies showing that a small amount<\/em> of weight can be lost over the short term<\/em> in the minority <\/em>of subjects who are able to follow the plan, but is mostly regained<\/em> several years later.<\/p>\n

Oh, and apparently 90 minutes of exercise every day is easy, practical, and doesn’t represent a change of lifestyle. (Do any of these people have children?)<\/p>\n

These people are selling snake-oil. They are claiming that their “cure” for fat has been proven to work, when their own studies<\/em> show that the cure doesn’t work. Their weight-loss plan will not <\/em>turn a fat person into a so-called “normal” person.<\/p>\n

So what’s the harm of selling snake oil?<\/p>\n

* By claiming that losing weight has been scientifically proven to be both practical and easy, they’re legitimizing bigotry against fat people, by spreading the myth that the only reason anyone remains fat is laziness and lack of caring.<\/p>\n

* They’re likewise encouraging lack of self-esteem – and even fat-hatred – in fat people.<\/p>\n

* By pushing weight-loss methods that have been scientifically shown, according to the studies they themselves cite<\/em>, to not work in the long term, they’re encouraging yo-yo dieting, which has terrible health consequences.<\/p>\n

* By making weight their only measure of health, they’re obscuring the fact that eating well and exercising regularly has enormous, maintainable, long-term benefits for fat people regardless of if any weight is lost<\/em>.<\/p>\n

* By making weight their only measure of health, they’re obscuring the fact that being “normal” weight is no guarantee of good health; health-concerned “normal” people need to eat a healthy diet and exercise, too.<\/p>\n

If Cancer Research UK and Weight Concern really want to improve fat people’s health, the best thing they could possibly do is to shut the hell up.<\/pracut>\n","protected":false},"excerpt":{"rendered":"

Summary Two British charity groups, Cancer Research UK and Weight Concern, recently made headlines with a new survey purporting to show that fat people were unaware of health issues and “in denial” about their weight. The poll results, in fact, … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30],"tags":[],"class_list":["post-2055","post","type-post","status-publish","format-standard","hentry","category-fat-fat-and-more-fat"],"_links":{"self":[{"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/2055","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2055"}],"version-history":[{"count":0,"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/2055\/revisions"}],"wp:attachment":[{"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2055"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2055"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/amptoons.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2055"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}