It’s sadly fitting that these two stories are together on The New York Times homepage.
People do not die of “obesity.” Some fat people die from complications of what are commonly known as “obesity-related diseases,” like heart disease and diabetes, but those diseases have only been shown to be correlated with fat, not caused by fat. (Which is why thin people have them, too.) So it’s not even accurate to assert that obesity kills indirectly.
And speaking of correlation, an explanation of causation vs correlation at The New York Times makes use of a correlation between ads for junk food and fatness:
The problem is that their policy recommendations rest on a crucial but unjustified assumption: that any link between obesity and advertising occurs because more advertising causes higher rates of obesity. But the study at hand showed only an association: people living in areas with more food ads were more likely to be obese than people living in areas with fewer food ads. […] In fact, it is easy to imagine how the causation could run the opposite way (something the article did not mention): If food vendors believe obese people are more likely than non-obese people to buy their products, they will place more ads in areas where obese people already live. […]
This is not an arcane statistical point or a mere technical criticism of one academic article. Too often, relationships that are far from being understood are assumed to reflect a particular, strong causal connection, leading to no end of regulatory mistakes.
I missed the husband who loved me no matter what, not the new anti-fat crusader he had changed into. But he felt the same way: he’d fallen in love with a plump-but-not-fat woman who wanted to be thin, and now he had a fat wife who’d “given up on herself.” And Ihad given up: given up on dieting, given up on the idea that my body needed to be fixed.I already wished I hadn’t spent so many years beating myself up for being fat; I wasn’t going to stay in a marriage where my husband did it for me.
Reading yet another piece on an exercise study, this one with older (60-74 years) sedentary women, I giggled at this observation:
“They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.
Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.
As noted in the study abstract, the groups working out twice or four times a week (half strength training and half aerobics) had about the same physical improvement as the group working out six times a week, and became a bit less active overall than the other 2 groups. And, of course, this is about averages and older women, and individuals vary. But it’s nice to see recognition that you don’t have to work out every day to have useful strength or endurance results. Or that people might have things to do besides exercise.
1) I am sooo looking forward to tomorrow morning, when Mark Reads will post the second-to-last chapter of Deadline. Mark Reads reviews books a chapter at a time, progressing through books every other weekday, and it’s been building to this OMG HUGE second-to-last chapter for weeks. (Need I say “spoilers”?) Some of the books he’s done this with in the past are the Harry Potter books, The Hobbit, The Lord of the Rings, and The Hunger Games. Deadline is the middle book of the Newsflesh trilogy & Mark’s reading the whole thing, starting with the first chapter of Feed here.
2) I got myself a Fitbit Zip to help me be more consistently active — I use it as a pedometer that does built-in recordkeeping, so I can get a sense of how active I am in general, not just a single day. Since I got it I’ve found myself at work focusing deeply for one to two hours and then getting up to walk and get water or coffee or tea or something. I’d quit feeling guilty about it because I found that a brief break to walk and stretch lets me focus better afterward. This article helps me rationalize it more ;)
3) A year ago today I signed my father’s hospice paperwork as his medical power of attorney. The anniversary was a bit freaky this week. At the moment I’m at peace with it all, but I know my reactions will likely continue to change.
4) I’ve been posting on fat discrimination at http://fatdiscrimination.tumblr.com. It’s not a subject I want to dive into a lot, so posts are somewhat sporadic.
David B. Allison, who directs the Nutrition Obesity Research Center at the University of Alabama at Birmingham […] sought to establish what is known to be unequivocally true about obesity and weight loss.
His first thought was that, of course, weighing oneself daily helped control weight. He checked for the conclusive studies he knew must exist. They did not.
“My goodness, after 50-plus years of studying obesity in earnest and all the public wringing of hands, why don’t we know this answer?” Dr. Allison asked. “What’s striking is how easy it would be to check. Take a couple of thousand people and randomly assign them to weigh themselves every day or not.”
Yet it has not been done.
And, in the meantime, you have parents, doctors, families, and friends advising people to follow these myths. You have weight-loss companies making money from these myths. And they don’t work. Or, they work for some people. Or, they work temporarily before all the weight comes back (plus more). Feel like hitting one of the lying liars who lie and mislead people into putting all that time and energy and work and money into eventually gaining even more weight yet?
Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.
What sort of myths? Back to Gina Kolata, here’s some weight loss ideas that have been proven to not work, yet are commonly preached to people everywhere:
- Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.
- Set a realistic goal to lose a modest amount.
- People who are too ambitious will get frustrated and give up.
- You have to be mentally ready to diet or you will never succeed.
- Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.
Kolata also highlights some ideas that have not yet been proven true OR false:
- Habits in childhood set the stage for the rest of life.
- Add lots of fruits and vegetables to your diet to lose weight or not gain as much.
- Yo-yo diets lead to increased death rates.
- People who snack gain weight and get fat.
- If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.
…and yet, again, these are in diet books, diet programs, and in the last, calls to change how cities are laid out. (Not to say that bike paths, jogging trails, sidewalks or parks are bad. Just that they won’t automagically make people thin.)
Why is this? Doctors believe that being fat is terribly, horribly bad. They want to give people something concrete to do. And, often, doctors aren’t educated about nutrition or obesity research. We end up with these myths being repeated over and over, endlessly, and people blame themselves when they don’t work or don’t work long-term. Or they figure it probably works for most people, just not me. Even the list of “Facts – Good Evidence to Support”, which starts with “Heredity is important but is not destiny”, makes me wonder how much of it suffers from the “must hold out hope of weight loss!” bias. Especially when the article notes that losing 10% of their weight is typical, and very few lose more.
Overall, the NEJM paper is a call to improve the research. Even so, they’re not tackling the big “weight loss improves health” idea, or how much of its support comes from short-term studies that include exercise as a component (and never mind that exercise can improve health on its own, independent of weight loss). Even the reference to most weight loss being in the 10% range will likely not burst the FOBT.
“It is now our generation’s task to carry on what those pioneers began. For our journey is not complete until our wives, our mothers and daughters can earn a living equal to their efforts. Our journey is not complete until our gay brothers and sisters are treated like anyone else under the law for if we are truly created equal, then surely the love we commit to one another must be equal as well. Our journey is not complete until no citizen is forced to wait for hours to exercise the right to vote. Our journey is not complete until we find a better way to welcome the striving, hopeful immigrants who still see America as a land of opportunity until bright young students and engineers are enlisted in our workforce rather than expelled from our country. Our journey is not complete until all our children, from the streets of Detroit to the hills of Appalachia, to the quiet lanes of Newtown, know that they are cared for and cherished and always safe from harm.”
— President Obama, in his second inaugural address
The US is so behind in so many ways. But this feels hopeful.
Marilyn Wann takes on weight bias in healthcare in “Big deal: You can be fat and fit” on CNN.COM:
…People are telling their stories of weight bias in medical care on websites like First, Do No Harm, This Is Thin Privilege and Obesity Surgery Gone Wrong. The National Association to Advance Fat Acceptance has been speaking out on behalf of fat people’s civil rights since its founding in 1969.
Health professionals of good conscience are joining this effort in increasing numbers. They’ve developed an approach called Health At Every Size that is proving to be better for people’s health than weight-loss attempts. The Health At Every Size professional organization,Association of Size Diversity and Health, this week launched the project Resolved, a response to New Year’s weight-loss resolutions. It invites people to share stories about weight discrimination in health care and opinions about what needs to change.
Weight bias has been documented among doctors, nurses, fitness instructors and other professionals on whom a fat person might need to rely for help. Last year, researchers who themselves are part of an anti-“obesity” institution (Yale’s Rudd Institute) surveyed medical professionals who specialize in caring for fat people and found that they had high levels of weight bias, viewing us as “lazy, stupid, and worthless.”
Paul Campos uses the latest “obesity paradox” study with “Our Absurd Fear of Fat” in The New York Times to argue that policing fat is worthless:
The study, by Katherine M. Flegal and her associates at the C.D.C. and the National Institutes of Health, found that all adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals. If the government were to redefine normal weight as one that doesn’t increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.
Now, if we were to employ the logic of our public health authorities, who treat any correlation between weight and increased mortality risk as a good reason to encourage people to try to modify their weight, we ought to be telling the 75 million American adults currently occupying the government’s “healthy weight” category to put on some pounds, so they can move into the lower risk, higher-weight categories.
In reality, of course, it would be nonsensical to tell so-called normal-weight people to try to become heavier to lower their mortality risk. […T]iny variations in relative risk in observational studies provide no scientific basis for concluding either that those variations are causally related to the variable in question or that this risk would change if the variable were altered.
Both articles are well worth reading, but I would skip the comments on those sites. If you must discuss with someone, chat about it here ;)
Hello and welcome! I’m back at work with my new cartoon-a-day calendar (New Yorker cartoons) and new wall calendar (Pacific Northwest landscapes). I even cut off some of the photos from last year’s wall calendar to decorate my cube. Ready to work! (Yes, I know it’s Wednesday, but today feels like Monday to me. Yay four-day weekends! )
I adjusted the layout, let me know if you can’t find things. Also, let me know if you have additional topics or questions you’d like me to write about.
As for resolutions, well, there’s resolve and then there’s Resolve the carpet cleaner, (Two Lumps). There’s also ASDAH’s Resolved: Addressing Weight Bias in Health Care Project, collecting health care stories in video or written form. Please see their site to see what they are asking for and the submission methods.
In the meantime, some things to read / discuss if you wish – warning for fat hate:
People are living longer! I thought this would be a good thing. Oops! As Fatties United discusses, some people aren’t happy with this.
Since so many fat people have had the audacity to keep on living instead of dropping dead on schedule, Dr. Mokdad is predicting that all these fat folks will be old sick fat folks and require lots and lots of medical treatment.
Charlotte Cooper writes about The UK Royal College of Physicians and their concerned about obesity! Oh dear.
Reading the report is like a journey into Opposite Land. The work is well-meaning, but it exists with a framework that is profoundly problematic. For example, it is hard to disagree that current service delivery for fat people is really poor, particularly for those who undergo weight loss surgery, and that there needs to be proper auditing, quality control and monitoring of all obesity treatments.
But the report, as is typical in a medicalised discourse of fat, is entrenched in a view that regards weight loss as the universal solution to the problem of fat people and health. The authors throw about “severe complex obesity,” a term they’re obviously pretty proud of, coming soon to a healthcare provider near you, and bound to further medicalise and stigmatise fat people. They make the crucial mistake of failing to question the effectiveness of weight loss at all, so it’s not weight loss surgery that ruins fat people’s health, it’s the fact that the care pathways surrounding the surgery need tweaking. This ties them up in all kinds of knots, looking for answers in the wrong places, for example suggesting that the UK needs a Michelle Obama figure to galvanise the population against obesity, even though her crusade in the US has been disastrous in re-stigmatising fat kids, and even though we’ve already seen Jamie Oliver screw things up over here.
Anyway, let’s be careful out there. Now, I’m going for a walk.
The Kindle edition of A Year of Biblical Womanhood: How a Liberated Woman Found Herself Sitting on Her Roof, Covering Her Head, and Calling Her Husband “Master” by Rachel Held Evans is $1.99 right now. I enjoyed it, and not just for the debunking of the “Wives are required by God to appear pretty/sexy” meme. (Rachel is also the author of “How to win a culture war and lose a generation“, “15 Reasons I Left Church“, and “15 Reasons I Returned to The Church“.)
The Fat Nutritionist post on “Stuff people assume I believe vs. stuff I actually believe” is cool, but it’s sad that it’s needed. (See also comments on how if I keep exercising I’ll lose weight. No, not necessarily, and that’s not the point anyway.)
You may have seen the video where WKBT anchor Jennifer Livingston responds to a viewer complaint about her weight. In her response, Livingston thanks those who have come to her support. She encourages people to speak against bullying and to think about what they say in front of kids.
What she does not say? Jennifer Livingston does not apologize for her size. Livingston acknowledges her size and does not try to justify or explain it. No “I’m working on it.” No “I’ve tried to change it.” She doesn’t even point out that being fat is not a “habit”.* Her size is her size. No apology.
I loved that she did not get teary. I loved that she spoke strongly and positively about herself and against bullying. But the fact that she did not apologize or justify her weight struck me the most.
*As the Academy for Eating Disorders put it, “Weight is not a behavior and therefore not an appropriate target for behavior modification.” Weight is also not a “habit”.
One of the more popular search terms leading people to my blog lately has been “day in the life of an obese person,” leading to the series I did when I first started the blog. Being curious, I googled it. Some of the highest results? “News” stories about people in fat suits. Because seeing how a thin teen’s acquaintances react to their seeming to gain 80lbs overnight is so typical of the fat experience! Not to mention wearing an unfamiliar, bulky suit is just like walking in your own body! That’s why a 3rd grader on stilts moves and feels just like a 6′ tall adult! It’s much more “objective” than actually studying a broad sample of fat people – or even showing actual fat people (with heads) who choose to speak out.
I don’t think that every superfat person has the exact same experiences I do. Far from it! I also know there is a lot of myths about fat people out there. I can’t speak for everyone, but I can speak for myself, and those myths do not apply.
If you’re curious, my day in the life posts are linked to https://living400lbs.wordpress.com/day-in-the-life/
No, it’s not news that lack of sleep is tied to fat.
What sleep researcher Dr. Orfeu Buxton found is more information on how this occurs.
The resting metabolic rate of the volunteers by the end of the five weeks was 8% lower than where they had started. […] That could explain why night shift workers tend to gain more weight and have a higher likelihood of obesity than day workers; such weight gain is linked to an increased risk of diabetes and heart disease.
Wow, it’s like the number of calories burned isn’t standard across all bodies at all times! Or not just affected by exercise!
The scientists learned something else interesting about another mechanism that put the disrupted sleepers at higher risk of diabetes: the combination of having their circadian clocks reversed (sleeping during the day and waking at night) and the poorer sleep they got as a result had an effect on their insulin levels. After three weeks in the lab, the participants produced about a third less insulin from the pancreas in response to meals; with less insulin available to break down glucose, blood glucose levels started to rise and three of the 21 volunteers showed high enough levels to qualify them as pre-diabetic.
Two things struck me about this. First is that it occurred after 3 weeks. Second is that only 3 of the 21 volunteers reached the pre-diabetic range, even though they were all living in the same lab undergoing the same regimen. Again, it’s like they’re individuals or something.
The website Fark makes fun of news stories that are not, actually, news.
Why isn’t it news? Well, it’s a common story that pops up once a year or two, and relies on people not thinking about which is more likely to get janitorial attention.
Today my Google Health section looked a bit like Fark.
First: Paula Deen has diabetes. Because she’s fat and publishes “unhealthy” recipes, she’s being blamed for “bringing it on herself” with unhealthy food. Fat people being blamed for their health problems, gee, where have I heard that before.
( Never mind that Ms Deen is 64 and the American Diabetes Association states that the risk of type 2 diabetes goes up with age — 26.9% of people over 65 have it. Or that the American Diabetes Association states that “Most overweight people never develop type 2 diabetes” and that eating sugar doesn’t cause diabetes.)
I’ve written about my vitamin B12 absorption problem before. The NY Times recently posted a good primer on B12 deficiencies, including those at risk:
Natural plant sources are meager at best in B12, and the vitamin is poorly absorbed from them. […C]hronic users of acid-suppressing drugs like Prilosec, Prevacid and Nexium, as well as ulcer medications like Pepcid and Tagamet, are at risk of developing a B12 deficiency and often require a daily B12 supplement.
Stomach acid levels decline with age. As many as 30 percent of older people may lack sufficient stomach acid to absorb adequate amounts of B12 from natural sources. […]
Synthetic B12, found in supplements and fortified foods, does not depend on stomach acid to be absorbed. But whether natural or synthetic, only some of the B12 consumed gets into the body. Treatment to correct a B12 deficiency typically involves much larger doses than the body actually requires.
Free B12 from both natural and synthetic sources must be combined with a substance in the stomach called intrinsic factor to be absorbed through the gut. This factor is lacking in people with an autoimmune disorder called pernicious anemia; the resulting vitamin deficiency is commonly treated with injections of B12.
Although most doctors are quick to recommend injections to correct a B12 deficiency, considerable evidence indicates that, in large enough doses, sublingual (under-the-tongue) tablets or skin patches of B12 may work as well as injections for people with absorption problems, even for those with pernicious anemia.
The latter is something I make use of — I appear not to absorb much B12 from food, but the little I absorb of “a lot” is enough. I also like that supplements are over-the-counter and I can take them daily. Shots would be prescription and often weekly or monthly. :)
Apparently Poise is thinking “light bladder leakage” sounds nicer than “incontinence”, and that framing its products as “feminine” will do better than as “geriatric”. They are probably correct.
I do know I ran into one problem discussed in the industry. The New York Times quotes market researcher Rob Walker:
“[T]he biggest challenge for the industry is that vast numbers of sufferers are too embarrassed to raise the problem of incontinence with their health practitioner, or worse, even buy available products at a retail outlet.”
Or, in my case, to realize they existed. I initially assumed that if you leaked at all, you needed full-on diapers, which of course would not be available in my size. It did not occur to me to even look for pads designed for stress incontinence. I ran across Poise pads by accident one day when the local Rite Aid was reorganizing stock.
To address that, Mr. Walker added, “the commercial opportunity here is for the big international hygiene players to humanize (or even Viagra-ize) incontinence, making products as accessible, consumer-friendly and embarrassment-free as, for example, women’s sanitary protection.”
I first wrote about stress incontinence a few years ago in quite a bit of detail. I haven’t been finding the “wings”, so I’ve been wearing “moderate” pads. I will probably try the new “hourglass” shape. FYI, Poise also has samples and coupons available at their site.
On the one hand, it’s good to have actual research backing this up. On the other hand, it’s insane that this didn’t exist before. From the NY Times:
When poor people are given medical insurance, they not only find regular doctors and see doctors more often but they also feel better, are less depressed and are better able to maintain financial stability, according to a new, large-scale study that provides the first rigorously controlled assessment of the impact of Medicaid.
In other news, water is wet? Not quite.
The study became possible because of an unusual situation in Oregon. In 2008, the state wanted to expand its Medicaid program to include more uninsured people but could afford to add only 10,000 to its rolls. Yet nearly 90,000 applied. Oregon decided to select the 10,000 by lottery.
Economists were electrified. Here was their chance to compare those who got insurance with those who were randomly assigned to go without it. No one had ever done anything like that before, in part because it would be considered unethical to devise a study that would explicitly deny some people coverage while giving it to others.
But this situation was perfect for assessing the impact of Medicaid, said Katherine Baicker, professor of health economics at the Harvard School of Public Health. Dr. Baicker and Amy Finkelstein, professor of economics at M.I.T., are the principal investigators for the study.
In good news, Oregon did end up finding the money to insure the other 80,000 people within 2 years.
From Reuters, on a study in patients with coronary artery disease that looked at fitness levels and BMI:
[Heart specialist and study leader Dr. Francisco] Lopes-Jimenez said, the lesson for patients is clear: try to improve your physical fitness. “It is much easier to become fit than it is to become slim,” he said. “Anybody who has gone into an exercise program would agree with that.”
While Lopes-Jimenez seems to presume his patients want to exercise (or otherwise take action to improve their health) it is radical to see a heart specialist stating that a person can improve their fitness without being slim. Or that exercise doesn’t automagically cause slimness. Or that it can be easier to become fitter than to become thinner — which has certainly been true in my case.