Monday, February 6, 2012

*I* Did Not Say *That*

So, in the on-going debate that unfortunately pits people of good will against each other, the greatest enemy, the deux ex-machina that gleefully causes us to raise our hackles against each other, is the righteous indignation that Internet-mediated discussions seem to constantly spawn. In other words:

I (most certainly and emphatically) did not say that. I have been misquoted and my words twisted in ways that defy all intelligence into ideas that I never expressed.

In my last post, I seem to have both provoked this reaction and felt it myself.

I won't go into the provocation side of the equation. To do so would mean picking apart the post that led me to riff on a concept near and dear to my heart, Health at Every Size. And that would no doubt lead to more recriminations, followed by more righteous indignation over my seemingly intentional misinterpretation of someone's thoughtfully expressed words. I don't want to go there.

Sadly, in great part due to the way discussion is obliged to take place on the Internet, honest disagreement is easily viewed as trashing, insulting, or ugly "dissing" behaviour. Most of the time, I therefore find myself refraining from responding to posts I disagree with. An exchange of ideas can quickly turn into, or be perceived to be, an attack, even if that was the farthest thing from the writer's mind when expressing the initial disagreement.

There seems to be little room for disagreement and the comments section of most blogs looks either like a mutual admiration society or degenerates into mud-slinging, hurt feelings or any number of ugly reactions.

Now, on to my potentially feeling the sting of being misinterpreted myself.

I have written a number of posts on Health at Every Size. I insist on spelling out expression rather than using the acronym, HAES, because it seems that whatever I say, somehow the word "health" disappears and I am left with questions like this one, asked by reader Norma in response to my most recent post on HAES:
I am asking this question out of honest curiosity about the HAES belief system and not with snark or sarcasm, so I would appreciate an honest and polite answer. Does the concept of "health at any size" apply to ANY size or only oversized? i.e., do its followers feel that, for example, an 85 lb. anorexic adult woman can be healthy? Again, I am asking this question sincerely only because the only take on the subject of HAES is without except about and by larger people. Thank you.
I didn't have the opportunity to answer the question yesterday for a variety of reasons, so I'll try to respond now, despite the fact that an anonymous reader has already stepped into the fray and given an excellent response too.

First, thank you Norma for framing your question as one not posed out of snark or sarcasm, but rather because you'd really appreciate an honest answer.

Here's my response:

How could I consider an 85-pound anorexic healthy? She is doing everything in her power to kill herself. Anorexia is a lethal disease, and a quick acting one at that. Why, please, please tell me, would I ever consider anorexic behaviour to be healthy? I just don't get it. It's called intentional starvation. Last time I looked, starvation was not considered a healthy way of living.

By the same token, just because I have observed that dieting is often a collection of disordered behaviours (and interestingly enough, the kind of behaviour that gets an anorexic put in hospital is often praised and encouraged by health care professionals when it's an overweight person acting in a similar way); that dieting often leads to further weight gain; and that the diet culture negates the fact that nature is full of size diversity...

[BIG, BIG note to readers: I DID NOT JUST SAY that ALL dieters engage in dangerous, disordered eating behaviours NOR DID I SAY that ALL dieters will eventually eat their way up the scale. I simply said that these phenomena have been observed and I will add that they're not at all that uncommon, in my opinion.]...OK, let's take a deep breath and I'll finish this long sentence...

Despite [the long introduction that you've just read], I have never, ever said that eating yourself silly is any healthier than being an anorexic. Neither the 85-pound anorexic who is starving herself of both vital nutrients and vital calories nor the whatever hundred pound person eating compulsively and constantly are healthy and they are definitely not engaging in healthy behaviours.

The reason I support "health at every size" is because there is a growing body of evidence which shows that simplistically equating body size with good or bad health is downright wrong. People can have health problems when they are slim, medium sized and large. People can also be healthy at a variety of sizes. Yes, certain health problems are correlated with being overweight (and indeed some with being underweight), but that does not mean that the number on the scale can be used as a kind of shorthand to express one's health status.

The work of Dr. Steven Blair (and others) has demonstrated very convincingly that moderate, daily exercise is a much better indicator of health than is one's weight. However, as long as one stays firmly with the weight loss = good health paradigm, and since it is so exquisitely difficult to maintain a significantly weight reduced body, many people have a tendency to give up and not only eat themselves back up the scale, but give up on doable things to help improve their health like moderate, daily exercise, good nutrition and improving one's mental health.

As I've said time and time again, exercise and good nutrition are key. Going from a totally sedentary life to walking 30 minutes a day and making sensible changes to the food one eats (I personally am not in favour of a diet based on junk food, no matter how tightly calorie-controlled it is--but that's just my opinion) can lead to weight loss. But maybe not. Such changes will definitely improve one's health, though.

I know, but what about the knees, the blood sugar, the blood pressure? First, there's correlation vs. causation. If being overweight directly caused these health problems, then they would only be seen amongst the overweight and never amongst the "normal" weight. This, of course, is not the case. One of Dr. Blair's findings shows that overweight people who engage in regular physical activity are not statistically sicker than normal weight people and certainly healthier than people of high, normal or low weight who do not participate in any physical activity.

But you've got a right to ask again "what about the knees, the blood sugar, the blood pressure?" If your weight loss has improved these markers and you can maintain this loss despite the fact that it will become increasingly difficult as you age, "kola kavod" (more power to you, in Hebrew). However, your road to better health (and I mean better health, not simply a lower number on the scale) just does not work in a reliable, sustainable manner for the vast majority of people.

But even more importantly, weight loss is not the only road to health. It's simply the only acceptable road to so-called health that exists in this society, at this time in history.

Long answer.


  1. When I was doing my oncology rotation as RN-in-training, I was struck by the cruel reality that cancer seems to respect no individual, in spite of any so-called healthy life styles. Many patients who had never smoked, had never been overweight, and so forth, felt cheated and angry because they had "done everything right", had sought routine medical testing, practiced "prevention" and healthy exercise, had been in many cases ultra cautious to the point of eating nothing but certified organic foods from the time they were quite young. One woman in her early 20s, newly diagnosed with throat cancer (that week) appeared to be in peak fitness. Now she was being told she had months to live.

    We each do our best to live with the crap and the beauty life throws our way. We have learned, sadly, to judge people based on whether or not they behave and believe in ways that fit our own (biased) beliefs about what constitutes "the good life." We cannot walk in their shoes, but too often we act as if we can--a hurtful socially-learned habit.

    We really don't know, with any scientific certainty, why some people remain healthy and others do not. We don't know what causes mental disorders (such as bipolar, schizophrenia, ADHD, depression, etc, in spite of all the hype we've heard from industry, government agencies, and so forth)-- and we don't know what causes cancers and cardiovascular disease to appear in some, and not in others, or to sometimes go into spontaneous remission.

    I do know that doctors learn what they are taught in medical schools, and they learn a lot of misinformation, bias, myth, and prejudice along with some useful concepts. Many doctors seem to simplify the complexity of obesity, and believe the cultural hype about dieting (and we get much of our misinformation about obesity from health care professionals) just as most psychiatrists have bought into the theory of "chemical imbalance" that can be "effectively treated" with modern psychotropic drugs. I did. Then one reads a book like "Anatomy of an Epidemic" by Robert Whitaker, and one starts to wonder...If the medical field can be so easily led astray by a wide variety of cultural forces when it comes to mental health, then what else are they seriously wrong about?

    Now I'm just rambling here, mostly, probably not arguing a position. I'm going through a major transition in my life, beginning to understand a bit more about the complexities of existence. Seeing the world is not us vs. them, not black or white, not either/or, NOT SIMPLE. I'm an activist, and for that reason I don't like hearing simple answers directed at complex problems, and I don't like hearing analysis repeatedly *done* at the level of individuals--while critical analyses conducted at the social and cultural levels are mostly ignored because the language and results are complex and seem overwhelming.

    I hope this "stings" no one. It isn't an attack. I'm just sharing a piece of my perspective. Peace and love, RNegade :)

  2. No sting here! I know that we can exchange ideas without either one of us feeling hurt or dissed. Would that I could be so with more people.

    As far as why X stays healthy and Y gets sick, I always remember my friend Cathy who had a slim, sylph-like body, ate the finest of organic products only (inasmuch as possible) and would not even take a 10-block taxi ride in a car that smelled of cigarette smoke. She died of breast cancer in her mid-40s.

    Then there was my late MIL who smoked like a chimney, took 5 sugars in her morning coffee (and drank tons of coffee with Splenda the rest of the day), made sure her living room was stocked with a huge supply of junk food (both salty and sweet) at all times and died at age 82 of a massive heart attack. Poof! and she was gone. No suffering.

    Go figure.

  3. Hopeful and Free I too work in healthcare in a variety of roles including in a hospice - and I can relate the unjustness of cancer. The concept of 'health' is so difficult to quantify in an acceptable scientific way - and for me that is why medicine is as much art as science. I took no offence at your comments at all :-)

  4. Hey, NewMe, thanks for sending my blog readers. I was uncomfortable when I read SFG's post too, especially the comments where she lets her hair down. She and Norma oversimplify why people regain. Not everyone gets swept up in the cycles of Nutrisystem, Jenny Craig, et. al. So many dieters do everything right, and the weight comes back. People can be earnest and disciplined, and then disappointed as calorie restriction/energy balancing fails them, no matter how well they excecute it.

    The science of weight management after loss is so immature. We need to know more, and especially outside of mere behavior control. Weight reduced people are different, hormonally and otherwise. Those of us who maintain for long periods may have advantages we don't know about -- endocrine related, genetic -- in addition to all the other social/psychological factors in place that makes joining the 3% club possible. I just cannot fault some HAESers for adopting language that sounds like defeat.

  5. I couldn't agree more with your summary statement mid post: that people can be healthy or unhealthy, whether slim or fat (or anything in the "normal" range). A few fine points to add, from my perspective: anorexia is no more a choice, a suicidal decision, any more than someone who has always been obese has chosen. It's a complicated disease with biological components and coexisting struggles that challenge those suffering to simply "fix it".

    I'm challenged by our grouping the obese into one convenient group. As I see it, there are those who are predisposed to be large, fat even, and have been from their earliest years. They may certainly be large and healthy--as healthy as anyone. There those for whom obesity was not their norm--they have increased their weight over the years as a result of a variety of factors, many of which are in their hands to change. They are perhaps the individuals that may have the greatest health benefit from lifestyle changes.

    And there are those who were overweight from early on due to a poor diet and activity level, for whom weight change is a greater struggle in adulthood. Behaviors are more challenging to alter, as is psychological damage, and biology as well--once those fat cells are formed, they just don't disappear, although they can get smaller, thereby making the struggle a continuing one.

    Focusing on modifiable behaviors would make a lot more sense than than focusing on BMI!

  6. Oooo I wish I had more time to comment! I am grateful for the discussion and the points made above.

  7. HikerRD: fantastic summary of a complicated issue!

    Debra: Yup.

    Sally: Yup to you too!