Thursday, February 24, 2011

Who Are the Fat People?

You know the story about the blind men and the elephant? One touched the tail and thought the elephant was long and skinny. One touched the trunk and made up his mind about the shape of the animal. Another touched one of his flanks and got a completely different image.

I had the same thing happen to me a few years ago when I accompanied a commission of enquiry around the country to examine the question of violence against women. After ten days of horror stories, I started feeling like I was suffering from PTSD and almost forgot that there are lots and lots of good men out there who wouldn't lay a finger on anyone.

I'm starting to feel the same way about how fat people are portrayed and portray themselves on the Internet. After reading many blogs in the weight loss community, here's the impression I get:

  • fat people are all current or recovering binge eaters
  • fat people are all addicted to sugar, fat, carbs, name your poison
  • fat people have been or still are junk food addicts
  • fat people know that they must shoulder all the blame and responsibility for the fine, fat mess they've got themselves into.
This leaves me a bit perplexed. I don't know anyone like that, though the people I know come in a variety of shapes and sizes:

  • S. who eats with gusto, exercises obsessively and looks like she just came out of a concentration camp.
  • C. who eats with gusto, cooks with gusto, isn't particularly fond of junk food, goes to the gym fairly regularly and carries around a nice chunk of extra weight.
  • J., who has slowly gained weight over the years, though he walks at least an hour a day and does not eat gargantuan quantities of food. He recently cut out drinking a glass of unsweetened juice before bed, has cut down his portions slightly and has been losing weight slowly. He is not on a diet.
  • I., a woman in her sixties who was quite slim in her younger years and now is rather round. She is the epitome of an intelligent eater: always the last to finish her food, does not stuff herself, exercises regularly.
  • L., who has not eaten red meat in over twenty years, is interested in healthy eating and yoga; managed to successfully keep her weight at around a "normal" BMI until she had a child; is now somewhat overweight.
  • Cl., whose weight has never fluctuated more than a few pounds during his 70 -odd years on this planet. Has been known to lose weight and look gaunt when having health problems. And his 30-something son looks exactly the same.
  • B., a fitness professional and certainly one of the fittest people I know, totally vegan and yes, overweight.
  • S., who was anorexic as a teenager. Now eats normally though never quickly, dislikes sweets, is neither fat nor slim, with just a bit of middle-aged spread.
I could tell you about many other people I know, some fat, some thin. None of them have much in common with most of the weight loss blogging community. Maybe blogging attracts those who are suffering the most? Certainly, this community, for the most part, looks nothing like the world where I live. Maybe I'm lucky.

Please don't get your knickers in a twist. I don't look down on the weight loss community. It's full of brave people fighting high odds against them. It's just that I see a very different world around me.

Wednesday, February 23, 2011

The Body that I Was Born With

My parents were both short. My father was always quite slim, probably due to a combination of genetics and being a Holocaust survivor who was parcimonious about everything he used or ate. He was a truly ascetic man--as was his brother, whom I came to know very well in his later years.

My mother, who came to Canada long before the Holocaust, was always on the "round" side, though she was pretty cute in her younger years. In her teenage and early adult years, she ice skated and rode her bike some seriously long distances. Unfortunately, by her forties, she was suffering from severe osteo-arthritis, which made any kind of exercise impossible. She could barely walk down the steps from the front door to the driveway, never mind go for a nice stroll. Throughout her life, she was interested in good nutrition and practised what she preached, eschewing processed foods and sugary treats. Although she "sat on her duff" (because it was so hard to move), she was not the stereotypical fat person who spent all day watching TV and eating Twinkies.

I was their only child.

As the years have gone by, it has become apparent that in all the ways that really count that I take after my mother: excellent fertility (she was 43 when I--her first and only child--was born and I had my children in my late 30s without "trying" for more than a month in both cases), a strong tendency to gain weight easily, early onset osteo-arthritis, thyroid problems. All I seem to have inherited from my father is my delicate skin that never tans and always burns (my mom apparently tanned really easily). I know I carry my dad's genes, of course, because I see them in my children, both physically and intellectually.

I have never, ever, been slim. And despite the fact that I have always stayed away eating a poor or excessively calorie-laden diet, I have always had trouble keeping my "over-weight" from going even further over. I have also never, ever been athletic. My only claim to fame, athletically speaking, is a vague recollection of having been able to do a handstand on my friend's feet when I was about five years old (she would lie on her back with her feet in the air and I held onto to her feet and did a handstand--pretty amazing if I do say so myself!). My athletic abilities were all downhill after that.

I was a chubby child and ever since I was a teenager, I have fought the battle of the bulge. I have had some periods of relative success, though again, even at my "slimmest", I was by no means slim. This weekend at my cousin's house, I saw a picture of myself from when I was about 30. I did look really quite yummy, though my face was still rather chubby, but what was most interesting was what my cousin told me about that picture. She remembered that at the time I was on an extremely strict diet, with many limitations on what and how much I ate. Those were the days. Not!

Some twenty-odd years later, age, gender, heredity, childbirth and no doubt other factors have left me with the body I have today. Yes, I am overweight by dreaded the BMI standards, but that's the body I was given. I cannot just lose weight and go back to a body that I never had in the first place. I am quite sure of one thing though: all my late mother's "nattering" about healthy foods did pay off. I'm quite sure that if I'd been raised in a fast-food loving family, my weight would be significantly higher today than it actually is, as high as it may seem to some.

Monday, February 21, 2011

Dr. Sharma's Article

I consider myself a thoughtful person and one who doesn't take everything at face value. However, one of my serious shortcomings is a lack of patience. It's probably in part due to the ferociously fast-paced nature of my work, where time to mull over an issue is measured in milliseconds.

I am therefore in awe of bloggers like Debra (and a number of her readers) who have both the intelligence and patience to take apart complicated concepts and analyze them for both their strengths and weaknesses. In the field of weight loss/gain/management/maintenance, nothing is as it seems.

As time goes by, I realize that there is no one single way to manage one's weight. Most people never succeed because there is no single method that works successfully for everyone on a long-term basis. The weight-loss success stories I have read belong to people who have made weight-loss at very least a part-time, if not full-time job, filled with strict rules, limits and requirements. That's OK, if that's your choice, but let's not kid ourselves. If all the "normal" weight people we know had to manage their weight the way these success stories do, our society would fall apart: between counting calories, weighing food and exercising obsessively, we simply wouldn't have the time to keep the wheels of the economy moving. People who have never had a weight problem do NOT measure every morsel they put in their mouthes; nor do they count every calorie in and every calorie spent on exercise.

Which leads me to this article, by Dr. Arya Sharma of the Obesity Network. Entitled "Eating More Calories Increases Weight (In Some People - Sometimes - Maybe)", the gist of the article is that while the physics of "calories in - calories out" is unassailable, the biology governing how specific bodies react to the principle varies greatly from one person to another.

According to the laws of physics when [calories in] exceed [calories out] people gain weight.

Unfortunately, when you actually deal with people (read: biological systems), this simple law is anything but simple. This is because, thanks to complex biological feedback mechanisms, designed by nature to keep us alive and thriving, changing caloric intake in turn affects caloric expenditure and vice-versa.

In keeping with my impatient nature, I will simply ask you to read the article (as well as the very interesting comments, ranging from stupid--"duh! fatso: eat less, move more" to thought-provoking--"what about gut flora? what about whether different bodies metabolize fats, proteins and carbohydrates differently and more or less successfully?").

Why do I like articles like this one by Dr. Sharma (and the writings of Dr.Linda Bacon, and Debra's blog, and...the list goes on)? Because they recognize the fantastically extreme complexity of the weight conundrum, rather than reducing it (pardon the pun) to a question of "willpower" and calories in-calories out.

Monday, February 14, 2011

An Unusual Valentine's Day Gift

My husband gave me two official Valentine's Day gifts last night: a pair of red mittens (amazingly, I had almost bought myself a pair of red mittens at the airport on Saturday, while waiting for my flight home--just goes to show how well he knows me!) and a book by an author I just discovered whom I really like.

Bu there was another gift that he gave me and I'm sure he doesn't realize how important it was to me: Now, when he's down in the basement watching wrestling on TV (he got addicted to late-night wrestling while he was doing his Master's degree--go figure) or football or whatever, he hops on the elliptical trainer and does a little workout. I've made a few gentle suggestions to this effect over the years, but now he's finally doing it. He couldn't make me happier!

What did I give him? Two books, one on how to cook various kinds of meat and the other on spirits. He's a real foodie.

Thursday, February 10, 2011

Health at Every Size: The Article You MUST Read

In a recent post, I talked about the "what everyone knows": that good health is synonymous with a "normal" weight, usually as defined by the BMI.

But is this a fact or an assumption?

The history of science is littered with "scientific facts" that were subsequently proven to be utter bunk. Until relatively recently, for instance, bloodletting was considered a valid medical intervention. Well into the 19th century, bloodletting was one of the principal ways of curing many diseases. It was "medicine" and sacrosanct. No one questioned its validity.

I think that our scientific understanding of weight, weight management and health will also undergo a sea change in the coming years. The whole area is awash with assumptions that are considered to be facts. Furthermore, there is an enormous amount of controversy: high or low fat; no carbs; calories in-calories out; exercise is essential; exercise makes little difference, etc. etc. But something's got to give, because even the most die-hard diet supporter cannot shut her eyes to the fact that most people who go on a diet end up...fatter, often unhealthier and certainly unhappier.

Via the Fat Nutritionist, I recently read a long, scholarly article in Nutrition Journal entitled "Weight Science: Evaluating the Evidence for a Paradigm Shift", by Dr. Linda Bacon and Dr. Lucy Aphramor. If you have the time, I highly suggest you read the entire article here. It's much too long and detailed an article to properly summarize, but I'd like to give you a flavour what it says so that you will go and see for yourself. This article is certainly one of the most important articles on weight and health that I've seen in a very long time.

The article begins with the observation that despite major concern from the medical and public health authorities over the issue of overweight and obesity, and despite the fact that huge numbers of people are desperately trying to lose weight (and fueling a weight loss industry worth close to $59 billion per year), the majority of people cannot lose weight and keep it off, nor do they achieve the expected health benefits resulting from a lower weight. At the same time,

Concern has arisen that this weight focused paradigm is not only ineffective at producing thinner, healthier bodies, but also damaging, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight stigmatization and discrimination [6-8]. As evidence-based competencies are more firmly embedded in health practitioner standards, attention has been given to the ethical implications of recommending treatment that may be ineffective or damaging [5, 9].
In response to this sad state of affairs, a growing number of individuals and organizations are proposing a new paradigm, (or, if you will, a completely new way of seeing things) to replace the weight loss=success=health paradigm that has proved itself to be mostly unattainable and questionably correct. This new paradigm is "health at every size" (HAES).

The authors then deal with a list of assumptions about the conventional, weight-focused paradigm. Each assumption is accompanied by an evidence-based refutation.

Here are the assumptions, which I'm sure many, if not most of us, believe are "facts". (These assumptions are directly quoted from the article.):

  • Adiposity poses significant mortality risk.
  • Adiposity poses significant morbidity risk.
  • Weight loss will prolong life.
  • Anyone who is determined can lose weight and keep it off through appropriate diet and exercise.
  • The pursuit of weight loss is a practical and positive goal.
  • The only way for overweight and obese people to improve health is to lose weight.
  • Obesity-related costs place a large burden on the economy, and this can be corrected by focused attention to obesity treatment and prevention.

These assumptions are the basic "truths" of the weight-loss paradigm. Yet, Bacon and Aphramor have deftly refuted each one using almost 180 references from other serious studies to back up their statements.

Please take the time out of your busy day to read this article in full. Then tell me what you think. It's a real eye-opener and it's going to make a lot of people squirm. But that's often what happens when someone speaks truth to power.

It's time to stop wailing about the fattening of our society and looking at what we can do about our health. The two are not necessarily linked and constantly trying to establish a causal relationship between overweight and illness is robbing us of the time and energy we need to all be healthier in the body that we were born with. P.S. "The body that we were born with" is worth a post all on its own. Stay tuned.

Note: Dr. Arya Sharma has also published a post recently on this article. It's worth reading here.

Monday, February 7, 2011

Is this you?

It sure is me, more often than I'd like to admit! Feel free to laugh or cry. Both are appropriate.

I will be embarking upon a three-city, five-day round of conferences. I've been working on a couple of blog posts and will hopefully be able to finish them as I wait around at two different airports. But in the meantime, enjoy this video.

Thursday, February 3, 2011

Let's Put It This Way...

What's more important?

Seeing the number on the scale go down--which you can achieve by going on a "diet", even if it's a diet of junk food? Or seeing your BMI number go down--which you can easily achieve by going on a starvation diet, except that you'll probably lose a great deal of muscle instead of fat?

Or totally reconsidering the quality (rather than the quantity) of the food you eat? (Warning: you might end up eating less food overall if the quality of your eating improves.)

Or reading the nutrition labels on food you buy in order to find out about nutritional content and preservative content rather than simply the number of calories?

Or shopping more in the fresh produce aisle?

Or finally understanding why you feel you have to eat a loaf of bread at one sitting or a bowl of cookie batter? (Warning: you may have to leave a bad relationship if you do.)

Or choosing to go for a walk every day?

Or choosing to take public transit rather than the car?

Or going to your local community centre and going for a swim (cost: a few dollars--a lot less than a gym membership)?

What's better? A healthier lifestyle that doesn't focus on weight? Or getting those numbers down, come hell or high water, no matter what the actual cost to your health?

Wednesday, February 2, 2011

Weight and Health

Back in the 60s, dieting was just as big an obsession as it is today. Everyone wanted to be slim, though perhaps not quite as slim as today (no thanks to Photoshop), but slim nevertheless.

However, the discourse around being slim and dieting to get there was radically different from today's discourse, at least amongst adults (teens are a whole different species).

Forty years ago, we were urged to diet in order to look good: to fit into a bikini in the summer, or a sleek, black cocktail dress for the Christmas office party. Women wanted to have the waif-like look of Audrey Hepburn.

Today, dieting is no less an obsession than it was in those days. However, the motivation for dieting has changed dramatically. Looking good did not provide enough motivation to make people thin. We needed more and that "more" was our health.

In recent years, the media has been awash with the threats that overweight and obesity pose to our health as individuals and to our economic health as a society. A BMI of over 25 and up to 30 is the antechamber of death. A BMI of 30-40 means a serious threat hangs over your head and one of over 40 is a death sentence that will be carried out in short order.

Virtually every diet blog that I have read in the past two years insists on the immediate and lethal dangers of being overweight. Virtually all diet bloggers have accepted, no questions asked, that being even the slightest bit overweight is a ticket to an early death.

And the way to avoid this early death? Why to diet, of course. And to lose the weight as quickly as possible. Underlying the admonition to diet is the assumption (taken as FACT), that being over a certain BMI means that you are automatically unhealthy and that conversely, maintaining a BMI of 25 or under is an automatic "get out of jail/you are healthy" card.

Being of "normal" weight or indeed being slim is automatically equated with health. People of normal weight do not suffer from diabetes, cardiovascular disease, arthritis or any number of conditions that people know for a fact are CAUSED by overweight. This assumption is so widespread (pardon the pun) that no one questions it.

Virtually all weight-loss bloggers truly believe that they are in a battle for their lives.

The strange thing is, this battle for our lives leaves 95% of us fatter than we were when we started trying to lose weight.

Unfortunately, fighting the proverbial battle of the bulge creates huge stress in the average weight loss warrior: additional weight gain due to yo-yo dieting, severe self-hatred brought about by the inability to fight the body type that nature gave us, not to mention societal stigma (lower pay for work of equal value, gratuitous insults, etc.) in a world where the overweight are automatically assumed to be gluttonous, lazy pigs and undeserving of decent treatment.

Actually, there are numerous studies that question the healthiness of yo-yo dieting, which perhaps has a more negative effect on our physical health than simply accepting our bodies as they are. Many further studies negate the automatic belief that low weight is a proxy for good health.

I can hear the screams over the Internet: you are advocating people accepting and embracing their bad health! Not at all!

What I am advocating is taking all this misguided energy (dieting) and putting it into learning to eat healthful foods in moderate quantities, moving our bodies on a regular basis and to the best of our abilities and seeking to understand through therapy (of whatever kind) the psychological roots of one's overeating (if that is indeed a problem). Under such conditions, weight loss may occur, but it is not the principal objective.

But first, we must understand that not everyone is physically made to be thin and that health can come in all sizes.

I recently came across an article that explains in great detail and with numerous citations, the basis for Health at Every Size (HAES). An overview of this extremely important article will be the topic of my next post.

P.S. The admittedly lovely Audrey Hepburn, who was also an extraordinary philanthropist, died at the relatively young age of 63 from cancer. Her slimness clearly did not grant her long life.