The enduring myths of fat and weight loss

A great summary of our society’s myths about fatness, weight loss and health from Big Fat Science, just as we hit the peak “starting a diet for the New Year” season.

“Obesity is one of the biggest killers in the Western World” 

False. Not even close. That would be poverty and lack of access to adequate nutrition and health care. Weight is actually a very weak and inconsistent predictor of mortality.

“there is no better way to curtail its effects on health than a healthy diet and exercise”

False. There is actually no known permanent and safe method for making fat people thin, and even if there was, losing weight does not improve health. Good nutrition (e.g., eating lots of fruits and vegetables) and exercise actually benefit everyone’s health, fat and thin, but do not change body size.

“ If you’re overweight or obese the best solution is to make incremental, lifelong changes to how you eat and exercise.

False.  There is actually no known permanent and safe method for making fat people thin. Moreover, dieting is unhealthy, and this is especially true for young people.

“Even this will have limited use in reversing the damage caused by years of unhealthy eating and a sedentary lifestyle (certainly in those who have been obese from a young age)”

False. Body size is largely determined by genetics, not controllable behaviors like eating habits and activity level. Also, fat kids (and adults) actually eat less than thin kids and fat kids are just as active as thin kids.

The initial comment BFS was responding to spouts all the usual religious dogma of fat hatred. Don’t we all know that obesity is the Biggest Killer Of People and Healthy Diet And Exercise fixes everything and it’s Just That Easy?

But none of these things are true, and while we continue to accept them as gospel, all we do is continue to harm fat people and fail to address real causes of poor health and nutrition.

A final point of interest for me is the assertion “no doctor would ever promote yo-yo dieting”. It goes back to the post I wrote about Dr Robyn Toomath’s “giving up” on her holy quest to make fat people thin. A number of people asserted at me that I was misrepresenting her, that she would never stigmatize fat people or push dangerous messages about crash diets.

The problem is, any diet, meaning a specific change to the way someone eats or exercises with the goal of inducing weight loss, is a crash diet. Any plan designed to make people lose weight is 95% likely to be step one (or three, or five) of a yo-yo diet. Because diets do not work. They cannot work, because they all rely on the assumption that being thinner is healthier than being fatter, and thus that doing whatever it takes to become thinner must be a healthy activity.

And the horrible irony of it all is that through dieting, stigma, prejudice and outright medical malpractice, we as a society are actively damaging the health of fat people, and thin people too.

Advertisements

The despair of “obesity battlers”

A few tweets I made this morning after seeing this lamentation on Radio NZ’s website:

This is an idea I’ve had rattling around in my head for a while – the constant messages and stigma focused on fat people (right from the get-go, depersonalizing us by talking about “obesity” as an amorphous, scary phenomenon) aren’t science any more. They’re religion.

Perhaps I’m too cynical, but making a headline by quitting and parrotting the usual demonizing lines – the Obesity Monster will destroy us all, the Obesity Monster is ruining our health system – and then mentioning “oh, by the way I have a book out soon” rings far too hollow to me.

For more information about Health at Every Size, I cannot recommend enough checking out Dr Linda Bacon’s website. Also:

I know this runs counter to so many ideas which are so deeply embedded in our society and media. We’re constantly reminded to associate physical size with health, and health with moral virtue. We’re meant to believe that weightloss is just this easy and that the only reason 95% of diets don’t work is because of personal failure and weakness.

But when we step away from the framing of “obesity” as a modern-day Nothing and remember we’re talking about people who happen to be fat, the whole facade starts to crumble. We can see that there’s a difference between having a certain body shape and having an actual defined health issue (like diabetes – which doesn’t only affect fat people – or high blood pressure – which doesn’t affect all fat people – or PCOS – which can cause weight gain but isn’t caused by being fat).

That’s crucial to being able to do something about those conditions instead of ignoring all the evidence that diets don’t work and fat stigma harms people far more than being fat does. That’s evidently something Dr Robyn Toomath wasn’t able to do. So, frankly, good riddance to her.

QOTD: Beware that latest “diet breakthrough”

A must-read article at io9:

I Fooled Millions Into Thinking Chocolate Helps Weight Loss. Here’s How.

Other than those fibs, the study was 100 percent authentic. My colleagues and I recruited actual human subjects in Germany. We ran an actual clinical trial, with subjects randomly assigned to different diet regimes. And the statistically significant benefits of chocolate that we reported are based on the actual data. It was, in fact, a fairly typical study for the field of diet research. Which is to say: It was terrible science. The results are meaningless, and the health claims that the media blasted out to millions of people around the world are utterly unfounded.

Here’s how we did it.

The story of how they got their study published and turned into blaring, inaccurate, weight-loss-promoting headlines across the world make for fascinating and worrying reading.

But it’s not just about the reporting. There’s a hugely important message about weight-loss “science”:

I know what you’re thinking. The study did show accelerated weight loss in the chocolate group—shouldn’t we trust it? Isn’t that how science works?

Here’s a dirty little science secret: If you measure a large number of things about a small number of people, you are almost guaranteed to get a “statistically significant” result. Our study included 18 different measurements—weight, cholesterol, sodium, blood protein levels, sleep quality, well-being, etc.—from 15 people. (One subject was dropped.) That study design is a recipe for false positives.

So why should you care? People who are desperate for reliable information face a bewildering array of diet guidance—salt is bad, salt is good, protein is good, protein is bad, fat is bad, fat is good—that changes like the weather. But science will figure it out, right? Now that we’re calling obesity an epidemic, funding will flow to the best scientists and all of this noise will die down, leaving us with clear answers to the causes and treatments.

Or maybe not. Even the well-funded, serious research into weight-loss science is confusing and inconclusive, laments Peter Attia, a surgeon who cofounded a nonprofit called the Nutrition Science Initiative. For example, the Women’s Health Initiative—one of the largest of its kind—yielded few clear insights about diet and health. “The results were just confusing,” says Attia. “They spent $1 billion and couldn’t even prove that a low-fat diet is better or worse.”

The ironic thing about Attia’s “lament” is that the lack of clear evidence about diet and health didn’t stop him cofounding an organisation whose website cries out for proper research and funding – but still assumes that the “dramatic rise in obesity” in the US is a “crisis” and not a blip caused by changing the definition of “obesity” in the 90s.

The authors of this terrible study did it deliberately to make a point about bad science and bad science reporting. There are plenty of others out there doing it for a far worse reason: the ridiculous amount of money there is to be made from promoting health anxiety and fat panic.

The personal impact of fat-hatred

I woke up yesterday looking forward to a relaxing fourth-day-of-a-long-weekend.

And one of the first things I saw on Twitter was an article which panickedly declared that

 

And I could go through all the same arguments which rapidly lose me Twitter followers: about the fact that classifications about what constitutes “overweight or obese” are almost entirely unscientific, about the fact this research was done by a “global management consulting firm”, about the incredibly influence and resources of the weightloss industry, about the fact that being overweight, obese, or even deathfat does not put you at higher risk of dying, about the fact that fat is incurable.

But that information’s already out there and if people are refusing to look at it, they’re not going to change their minds. So, I present a personal Twitter whinge-fest about how this kind of unscientific scaremongering affects me, personally.

And in the context of all that, some facts: it has been proven that doctors and nurses are biased against fat people. It’s proven that fat people fear medical discrimination so much they’ll avoid getting important checkups. And inflating healthcare costs actually aren’t the fault of fat people.

Maybe, if we’re really worried about the ~costs of obesity~, instead of promoting more diets (and medications, and surgical procedures) that don’t work and more bullying disguised as “get active” programmes, we could get the medical profession to treat fat people with basic dignity, respect, and proper practice. Might cut those costs a little, you think?

The problem with paleo

Jason Wilson has a fascinating post up at The Guardian discussing some of the problems with the paleo “lifestyle” which is currently very en vogue:

The assumptions underpinning paleo have a superficial plausibility. While technology and culture have changed, it’s argued, our bodies have pretty well stayed the same. We evolved to be hunter-gatherers, and contemporary life, with its carbs and computers, is a mismatch with our biological make-up.

It’s shame, then, that the entire enterprise is to my way of thinking intellectually bankrupt.

I don’t judge people on the food they choose to eat, whether it fits today’s definition of “healthy” or not – it’s an individual choice laden with so much social pressure and judgement that it’s safer to leave people to decide what’s best for them.

(Statement of the obvious: when people are endangering their children’s lives with toxic broth or lack of food, I’m judgey as anyone; and secondly this doesn’t mean ignoring issues around access, resources and inequality which mean a lot of people have far less “free choice” than I do.)

So I don’t have a problem with people choosing to eat paleo. What does concern me is when anyone starts making grandiose statements about what’s “natural” or “proper” behaviour for human beings, as though humans are as monolithic and unvaried as your average one-episode Star Trek species. As Jason Wilson notes, this kind of thinking raises some big red flags around reinforcing a very socially-conservative view on gender:

[Paleo author John] Durant constructs an image of the “natural” that is entirely ideological. The real appeal of hunter-gatherer life is what he imagines to be its strict partition of gender roles, where “Men were hunters, women were gatherers” and where “women rewarded great hunters” with sex. Paleo eating is here connected with an image of society which reproduces itself largely through masculine competition.

It’s also – like many of the food “movements” of the past few decades – a lifestyle which really requires you to already be pretty well off in terms of money, knowledge, time, and access to the “proper” kinds of food. There’s an innate paradox in preaching a return to our “natural” ways of living while enjoying many of the fruits of modern “civilisation” – and of course, no one promoting the paleo lifestyle is talking too loudly about the 33-54 year life expectancy our ancestors enjoyed.

All this is really just a set-up for my favourite paleo punchline, the anecdote which undercuts everything about paleo philosophy. At paleo site RobbWolf.com, Amy Kubal addresses a terrible dilemma of the meat-loving life: the increased risk of cancer from eating delicious char-grilled BBQ. Kubal’s second suggestion for mitigating your risk?

Nuke it!  Pre-cook your meat in the microwave for 1-2 minutes before putting it on the grill.  Microwaving releases some of the compounds that contribute to HCA formation.  Additionally, starting the cooking process reduces the grilling time.

That’s right. Microwave your meats … exactly the same way our ancestors did.