Change Your Name (Just for a Day)!

Gentle readers. In the spirit of Kate and Wills wedding madness, I humbly entreat you to change your name for a day. Perhaps, with your new name, you too will be invited to the festivities.

My new (though sadly, temporary) name is:

Lady Anna Tiger-Douglas of North York

Isn't that incredibly posh?

Here's how to create your own, wonderfully aristocratic name:

1. Take a title: either Lord or Lady.
2. Take the first name of one of your grandparents.
3. Create a double barrelled surname by taking the name of your first pet and hyphenating it with the name of the street where you grew up.
4. For added cachet, add the name of the city, town or even district where you lived as a child.

What's your name?

Crossover?

Should I be posting about the very real dangers of anorexia and bulimia? Should I devote most of my blog to exploring the physical and psychological dangers of these two frightening eating disorders? Neither anorexia nor bulimia have ever been part of my personal experience, despite the fact that my first "diet" (when I was around 16) involved a liquid fast once a week and utter food vigilance on the other six days of the week--a behaviour that went on for several months and which could conceivably have led to anorexia, though it didn't.

Here's why I'm asking the question:

Once in awhile, I'm drawn to reading blogs and articles on anorexia and have watched a number of documentaries on youtube dealing with this disorder.

A few months ago, I came across the blog of an anorexic woman who is passionately concerned about the dangers of obesity. She intends to start a new blog with the word "obesity" in the title. The "theoretical" posts in her current blog all deal with fighting obesity though she does also talk about her own struggles with anorexia (although she refuses to term herself an anorexic, preferring to describe the problem using the more amorphous term, "eating disorder"). She writes for a weight loss audience.

She's clearly a bright woman, and definitely has her heart in the right place, but I have to say that her anti-obesity crusade disturbs me, especially given the havoc anorexia has wreaked on her own health.

I have refrained from even gently questioning her motivations, but it is my right to express an opinion here, which I'm doing as diplomatically as possible. I guess it's time for me to stop reading her blog. It's way too sad and strikes me as fundamentally wrong on so many levels.

And in answer to my own question: why not? It's a free world. However, I think if I were to do so, it would be more of an exercise in "there but for the grace of God go I" than anything else. I prefer to talk about what I know from the inside and leave anorexia to the professionals who treat it and those who suffer from it.

Urban Poling

I spend a lot of mental energy raging against all kinds of things: unfairness in the world, sexism, small mindedness, "first past the post", religious fundamentalism, the nightmare on ELMM street, arthritis...you name it. Actually, I spend way too much time on such things.

But in this post, I shall break with my usual habit and talk about something fun and healthy and more importantly something that I, despite my fragile body, seem to be able to do--hopefully without making anything worse...so far, so good.

And what is this marvel of healthy movement that has not made my knee puff up, my sciatica start sending out signals down my leg, my hip freeze and/or my mid-back whimper with pain (yes, these are all things I deal with almost every day)?

Urban poling. Also known as "nordic walking".

The best way to describe urban poling is cross-country skiing without the skis or the snow, in other words, walking down the street with poles.

Here's a video to give you an idea of what urban poling is all about:



A much longer version of this video actually came with my poles. I don't want to be a salesperson for this particular brand of pole. I'm sure they're all just fine, but I'm posting the video because it shows urban poling in action.

So what would a "normal" person feel after 45 minutes or so of poling?

• your heartrate would be right up there
• you'd be sweaty
• you might be a bit out of breath
• you'd probably feel like you'd been out jogging (not that I can do that, so it's just a suspicion on my part)

And all this without sore joints. A blessing indeed.

My poles cost me about $100. You could probably find a used pair on Craig's List or e-bay for less. All in all, they're a pretty cheap way to get moving without getting your body totally out of joint.

I'd love to hear if anyone has tried them and what they think!

Reductionism...But Not Weight Loss

Does a person who weighs X with a BMI in the so-called "normal range" have to eat a set number of calories (Z) to maintain his or her weight? Will you always gain (or conversely lose) exactly a pound of fat if you over/undereat to the tune of exactly 3,500 calories? Reductionism: it's not about losing or gaining weight. It's about oversimplification to the point of meaninglessness.

A few days ago, I read this article, entitled "Skinny genes: how DNA shapes weight loss success". It's a bit of a hodge-podge, mixing some interesting science with the usual "eat less move more and all will be fine" pap. There's also some discussion of how hormones can have an effect on hunger, satiety and even one's desire to exercise. As I said, it's quite the dog's breakfast. But an interesting one, nevertheless.

Essentially, here's the deal: some people get fat looking at doughnuts and some people stay skinny no matter how much they eat. OK, I won't fall into the trap of oversimplification, but here's what the article says, quoting Arya Sharma, one of the only doctors on the face of the planet who doesn't believe losing weight is all ELMM (he's the one who coined the term, "the nightmare on ELMM street"):

“Just go out on to the street and pick out 100 people at random – give them the same food to eat, the same amount of exercise, and some will gain weight and some will lose it. Even whether or not you like exercising is very strongly genetically determined.”

Of course, the author of the article has to keep up her "fat = automatically unhealthy" creds, so she immediately goes on to say:

But before anyone concludes that diet and exercise are futile weapons in the war on weight, researchers have also found that the simple eat-less, move-more strategy can overcome the known genetic susceptibilities for excess weight. Some people just have to move much, much more and eat far, far less to see results.

...move much, much more and eat far, far less. Sounds like a great plan! Or maybe not--we all know just how effectively that works for the majority of people.

I'm one of those people who must be perpetually in a state of low-level hunger to lose weight. I must never, ever eat until I'm feeling satisfied if I want to keep whatever I've lost off. And yet, I never enjoy overeating. It is very rare indeed that I eat to the point where I feel even vaguely uncomfortable, but if I eat slightly more than what I "should" eat over one or two meals, I will automatically gain a significant amount of weight. And getting it off is nigh impossible...without feeling constantly hungry for a long period of time, something which I am no longer willing to do.

I don't know what role exercise would play in my weight since I cannot engage in anything even vaguely strenuous. I do know that in the days before my knee didn't scream for several days after spending a minute on the bike, I once spent about a month biking 6 days a week on my exercise bike at a speed that caused sweat to fly off my body. The result: no weight lost or gained. Now, that may have been because I was also taking a medication that is known to cause weight gain (in retrospect, I shouldn't actually have been on this medication and will never allow any doctor to prescribe it to me again). So the jury's out on how my body responds to serious exercise.

But enough of me.

Let's stop being reductionists and believing that everyone's body will react exactly the same way to ingesting and burning the same number of calories. If that were the case, everyone would be a calorie counter and we'd all be able to predict with pinpoint accuracy what our weight would be from one week to the next.

People like Dr. Scherer (read the article!) would just not exist. He's a man who

can put away a cream soup and a platter of penne with Italian sausage and wash it all down with a large Coke. And even though he’s 47, and driving his son to hockey is the closest he comes to rigorous daily exercise, he’s still as trim as a teenager.

And there would be no dieters, starving to lose a pound a week and gaining it back and more within the space of one meal--a meal no doubt much more reasonable than what Dr. Scherer can eat regularly with no ill effects--at least to his waistline.

The Ecological Fallacy

Wow! I just learned a new expression and boy, it is great: "ecological fallacy".

Here's the Wikipedia definition:

An ecological fallacy (or ecological inference fallacy) is an error in the interpretation of statistical data in an ecological study, whereby inferences about the nature of specific individuals are based solely upon aggregate statistics collected for the group to which those individuals belong. This fallacy assumes that individual members of a group have the average characteristics of the group at large. This can also be referred to as the fallacy of division.

Isn't that just wonderful?

It certainly goes an awfully long way towards explaining fat prejudice...because we all know that ALL overweight people are lazy, junk food addicts who got themselves into this fine mess all on their own and are wholly responsible for their terrible health and their shortened lifespan. That's what the media tell us and the media always tell the truth, based on infallible scientific data.

Not.

Just Not Right

Rob Ford was elected mayor of Toronto, Canada's largest city, in November 2010. I did not vote for him and honestly, to use an expression coined my by SIL, I would rather eat a shoe than vote for a person like him.

In his skivvies, Ford probably does look a lot like the picture above. On TV, he often seems out of breath and sweaty--he's probably not in particularly good shape. Of course, I would NOT suggest Ford go on a diet. In keeping with the principles of health at every size (HAES), I suspect this ex-football player could do with a more nutritious diet and more physical activity. Of course, any changes would be Ford's decision, and his alone, to make.

But whatever Ford's health status is, this clearly photoshopped picture is totally unacceptable and smacks of fat prejudice, pure and simple.

The decision to vote for (and support) a candidate should be based on whether one does or does not agree with the candidate's platform, not on his or her weight. Rob Ford will certainly not get my sympathy vote in the next election. However, despite the fact that Now Magazine has written some excellent analyses of Ford's terrible policies and shortcomings, it has crossed the line with this picture and dealt the Ford opposition a terrible blow. For shame!

More Dueling Studies and Contradictory Results

Debra recently wrote a post regarding duelling research. The following post, which I began quite awhile ago, continues on the topic:

In 2006, Dr. Carlos Grilo, a professor of psychiatry and psychology and Director of the Eating Disorders and Obesity Research Program at Yale University published a book entitled "Eating and Weight Disorders".

I found this book through the blog of someone who is passionately concerned with the dangers of obesity. She is interested in scientific texts and puts great weight in what the scientists have to say. So off I went to amazon.com to see what Dr. Grilo had to say.

Here is a quote from the second paragraph from the book's first chapter. The passage reads as follows:

[...] At the other end of the weight continuum is obesity, a common problem that is continuing to increase in prevalence despite pervasive societal pressures and individual desires to achieve thinness. Obesity has one of the highest associated mortality rates of any medical condition. In the United States alone, over 300,000 premature deaths are attributable to obesity annually (Allison, Fontaine, Manson, Stevens and VanItallie, 1999.) Obesity substanstially decreases life expectancy and increases early mortality (Peeters, Bonneux, Barrendregt & Nusselder, 2003). The steady increase in life expectancy observed in the nineteenth century has slowed during the past three decades (Oeppen and Vaugel, 2002) and a recent sophisticated analysis suggests that the United States may face a decline in average life expectancy due to the effects of obesity on longevity (Olshansky et al., 2005).

This is indeed frightening reading and the information, backed up by scholarly studies, is enough to give anyone pause for thought.

The problem is, there is an equally serious (and more recent) study showing that the 300,000 number (some now even say 400,000) is a gross exaggeration. The truth is far more nuanced, as shown in the results of this study from the Journal of the American Medical Association (Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity Katherine M. Flegal, PhD; Barry I. Graubard, PhD; David F. Williamson, PhD; Mitchell H. Gail, MD, PhD):

Results Based on total follow-up, underweight was associated with significantly increased mortality from noncancer, non-CVD causes (23 455 excess deaths; 95% confidence interval [CI], 11 848 to 35 061) but not associated with cancer or CVD mortality. Overweight was associated with significantly decreased mortality from noncancer, non-CVD causes (−69 299 excess deaths; 95% CI, −100 702 to −37 897) but not associated with cancer or CVD mortality. Obesity was associated with significantly increased CVD mortality (112 159 excess deaths; 95% CI, 87 842 to 136 476) but not associated with cancer mortality or with noncancer, non-CVD mortality. In further analyses, overweight and obesity combined were associated with increased mortality from diabetes and kidney disease (61 248 excess deaths; 95% CI, 49 685 to 72 811) and decreased mortality from other noncancer, non-CVD causes (−105 572 excess deaths; 95% CI, −161 816 to −49 328). Obesity was associated with increased mortality from cancers considered obesity-related (13 839 excess deaths; 95% CI, 1920 to 25 758) but not associated with mortality from other cancers. Comparisons across surveys suggested a decrease in the association of obesity with CVD mortality over time.

This quote from the Flegal et al. study is long and complicated. I have seen various interpretations of the results that lead to estimates of from 26,000 to 100,000 additional deaths due to obesity. The study also shows that there are actually fewer premature deaths amongst the overweight (BMI of 30 or less) than amongst underweight or even "normal" weight people (BMI of less than 25). Clearly, there's a big difference between these numbers and 300,000 (or 400,000).

Now, no one is happy about one premature death too many. However, announcing that the sky is falling and well over A QUARTER OF A MILLION people are dying from overweight and obesity, when that is not the case, is very disturbing, especially when one takes into account a) that 95% of people do not succeed in losing and keeping the weight off and b) the level of fat shaming and anti-fat prejudice is growing by leaps and bounds, aided, abetted and inspired by the 300,000 death study.

The Grilo quote makes another sweeping and dangerous generalization: that the increase in life expectancy is endangered by the obesity "epidemic". I am not a scientist, but I can think of other, just as compelling reasons that explain, at least in part, the slowing of the upward longevity curve: the discovery of antibiotics and a growing resistance to antibiotic efficacy. The development of antibiotics created a huge leap forward in life expectancy. However, we are now seeing an increasing number of antibiotic resistant bugs and have yet to find new pharmacological ways to fight them. Medically speaking, such watershed moments are few and far between.

Fat shaming is yet another reason that also accounts for lowered longevity amongst people of higher weight. Overweight--and particularly obese--people tend to shy away from the doctor's office since their concerns and symptoms are often brushed aside by health professionals who attribute all medical problems to overweight. "Just lose some weight and you'll be fine," is the not uncommon message they receive. Dr. Sharma recently wrote an article about fat bias amongst medical students. Attitudes are shocking and completely at odds with the mission of medical professionals: to care and cure. If you want to read actual testimonials of people whose medical problems were ignored due to their weight, take a Valium and then read a blog entitled First Do No Harm, where people tell their own personal stories of fat bias in the medical system.

But let's get back to the statistics--and lack thereof. Here's my question: How much work has been done on understanding why some people are both fat (and yes, even obese) and healthy? What do we know about them? Without having the statistics to back me up, I suspect that there are more people who are both fat AND healthy around than we think. But I don't want to rely on anecdotal evidence, one way or the other. I have read (and received comments) from bloggers who have seen great improvements to their health through massive weight loss. But there are also blogs written by obese and incredibly fit people like Ragen Chastain at Dances With Fat. I dare any one of my readers to keep up with Ragen, who is a professional dancer.

Another study (or in fact, series of studies) that I would like to see would look at the non weight-related effects that improved nutrition and regular physical activity (not of the Biggest Loser variety, just walking, biking or swimming for example) have on people. What would happen to all those "fat, lazy slobs" (not my opinion, I'm just using words that are all too common) the media loves to show us if they didn't, I repeat didn't go on a diet but rather changed their eating habits, started taking a walk every day and got to the roots of their eating disorder (i.e. bingeing), if that were an aspect of their personality. I suspect that some would lose some weight, others would lose a significant amount of weight and yet others would just improve their numbers and their overall health (BP, cholestrol, tra-la, tra-la) without seeing any significant change in weight.

Weight can, but does not necessarily, have an impact on one's health. In the meantime, there are many other factors that are much easier to modify and that can effect significant improvements in health. Why does our society continue to stress weight loss as the only valid marker of good health and the only real action we must take to be healthier? Weight is the most incredibly difficult factor to manipulate--much more difficult than modifying one's diet (as in what we eat, not how much of it) or one's activity level. Why aren't the researchers spending more time looking at these behaviours rather than the elusive holy grail, weight loss?*

*If someone can help me find a study that was done in Quebec about weight maintenance, health status and intuitive eating using a cohort of women, I would be eternally grateful.