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Anti-Obesity Is Not the New Homophobia

The views expressed are those of the author and are not necessarily those of Scientific American.


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Obese man, early 20th century

Obese man, early 20th century

Twenty years ago I joined my high school’s football team and over the next four years became intimately acquainted with pasta – the delicious flavor and al dente texture, the margherita and alfredo sauces that could drown it, and the marvelous butter and garlic soaked breads that could accompany it. I owed the joys of these team-bonding dinners to one of the coaches of my team. What I was too meatball-addled to realize then was that like a pig for Christmas dinner, we were being fattened up – not for the December dinner table, but for the football field.

All this because my high school football team had a size problem. Our affluent little town – full of band geeks, video game nerds and lean soccer stars, couldn’t find but a few mountains to hold the line of scrimmage (and those few were bused in from the city). Most of our players were smaller than our opponents – some who produced players who’d later play for Notre Dame. Though it took years of parental indoctrination, I was finally convinced – my coaches had decided to solve the team’s size problem by fattening us up with all-you-can-eat pasta dinners.

Ever since then, it’s been my size problem. I’ve done battle with the self-esteem and social issues obesity presents. I’ve had surgery on a disc that ruptured simply because I bent to pick up my jacket from the floor, and every backache since has me worried that I’ll end up under the knife again. Last year, I was diagnosed with sleep apnea. Then there are the risks I have yet to experience: diabetes, stroke, and coronary artery disease, to name a few. I don’t blame my coaches for this – I doubt they knew any better.

But when Salon publishes an article asserting that anti-obesity is the new homophobia, and that we fat people are really just victims of “moral and aesthetic disapproval”, it isn’t just misguided, it’s dangerous. The article attempts to create equivalence between the treatment of the overweight and the homosexual by the big bad medical establishment:

“Homosexuality” and “obesity” are both diseases invented around the turn of the previous century. Prior to that time, being sexually attracted to someone of the same gender or having a larger than average body were, to the extent they were thought of as social problems, considered moral rather than medical issues: That is, they were seen as manifestations of morally problematic appetites, rather than disease states.

The same medical establishment that pathologized same-sex sexual attraction and larger bodies also offered up cures for these newly discovered diseases. Those who deviated from social norms were assured that, with the help of medical science, homosexuals and the obese could become “normal,” that is, heterosexual and thin.

While it may be the case that obesity should not be seen as a disease, it is and should be seen as a disease-causing factor. A long-term study of men ages 40 to 65 with a BMI between 25 and 29 found they have 75% increase in risk of coronary heart disease, and overweight women a 50% increase. Furthermore, hypertension (which can lead to congestive heart failure), is three times more common in obese individuals. In 2006, another study found that in 2002-2003, nearly 60% of newly diagnosed diabetics were obese, and that in 1997, 18.3 of every 1000 obese people were diagnosed with type 2 diabetes, as compared to only 2 of every 1000 individuals of normal weight.

Despite these diabetes statistics, the article claims that attempts to “lessen the prevalence of diabetes by eliminating ‘obesity’ makes no more sense than trying to lessen the prevalence of HIV infection by eliminating ‘homosexuality’.” The fallacy in this argument is that while there is nothing intrinsic in the biology of gay people that predisposes them to HIV infection, insulin resistance is a well documented result of obesity that can lead to diabetes.

The article insists on one last comparison between obese and gay people:

Telling fat people they ought to be thin is about as helpful as telling gay people they should be straight. It took many decades for the medical establishment to recognize that its “cures” for “homosexuality” did far more damage than the imaginary disease to which they were addressed, and that the biggest favor it could do for gay people was to stop harassing them. Fat people are still waiting for the same favor.

Myself and the other obese people I know are aware of the gravity of our problem, and not because the medical establishment told us. We suffer the physical and societal consequences every day. What we need is a society that partners with us in our weight loss, not a society that supports our obesity. We know we are responsible for taking better care of our health, but the nation as a whole needs to accept that some of our societal values – when taken to extremes – have led to unchecked capitalism in the food industry that has contributed to the epidemic. Only then will we see constructive solutions on the national level, such as health insurance that creates serious incentives for losing weight the way we want to (how about reimbursement plans for martial arts, dance, and yoga classes and not just gym memberships?).

So my message to anyone who thinks they should bear a cross on my behalf – don’t do me any favors. The last thing I need is someone telling me it’s okay to be fat.

 

References:

1.       Campos, P. (August 28, 2012). Anti-obesity: the new homophobia? In Salon. Retrieved August 30, 2012, from http://www.salon.com/2012/08/28/anti_obesity_the_new_homophobia

2.       Center For Disease Control. (May 26, 2011). Obesity: Halting the Epidemic by Making Health Easier. In CDC. Retrieved August 30, 2012, from http://www.cdc.gov/chronicdisease/resources/publications/aag/obesity.htm.

3.       Circulation. 2003; 107: 1448-1453 doi: 10.1161/​01.CIR.0000060923.07573.F2

4.       Circulation. 1997; 96: 3248-3250 doi: 10.1161/​01.CIR.96.9.3248

5.       Geiss, L, et al. Changes in Incidence of Diabetes in U.S. Adults, 1997–2003 American Journal of Preventive Medicine. 1 May 2006 (volume 30 issue 5 Pages 371-377 DOI: 10.1016/j.amepre.2005.12.009)

Image: Ineuw at Wikimedia Commons.

Amr Abouelleil About the Author: Amr Abouelleil is a bioinformatics analyst with The Broad Institute of MIT and Harvard. He holds a BA in Psychology and an MS in Neuroscience. He describes himself as a scientist with the soul of an artist, and he expresses his art through writing. When he isn’t surfing digital genomes, he spends time with his wife and son, blogs, and writes speculative and contemporary fiction. You can follow him on Twitter (@AA_Leil_Tweets), Facebook, or at his homepage and blog, aaleil.com. Follow on Twitter @AA_Leil_Tweets.

The views expressed are those of the author and are not necessarily those of Scientific American.






Comments 26 Comments

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  1. 1. amook2 5:10 pm 09/10/2012

    Your story (and mine) conflict rather heavily with the article you linked. I think the guy is way out in left field.

    Generally, I am the weight I am because of the life I lead – that is largely within the bounds of my free will. Sure, I’m built like a dump truck; that puts some limits on my physical options, but there’s no reason to think that I am doomed to a short life of pain, CPAP therapy, and increasing levels of couch surfing.

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  2. 2. kristinGre 9:41 pm 09/10/2012

    Salon has terrible articles; why are they letting a law professor write about medicine and public health? They want to be “edgy” but really they are doing everyone a terrible disservice. We have a hard enough time getting the public health message out about obesity without junk like that.

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  3. 3. takshakus 9:21 am 09/11/2012

    Hear hear! For the vast majority of fat people, changes in diet and lifestyle would reduce the likelihood of some medical malady. As a society we should support those efforts instead of telling them to accept their bodies in a state that will lead to an early death.

    This is a separate issue from accepting a wide variety of healthy body shapes as beautiful. I think the anti-magazine trend is conflated with the obesity discussion and should be kept separate. Granted, there is some grey area, but this article is obviously talking about clear obesity, not carrying around an extra 10-30 lbs.

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  4. 4. tucanofulano 10:16 pm 09/11/2012

    Obesity and GM “frankenfoods” – what’s the connection?

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  5. 5. debburgard 3:41 pm 09/12/2012

    “What we need is a society that partners with us in our weight loss, not a society that supports our obesity . . . Only then will we see constructive solutions on the national level, such as health insurance that creates serious incentives for losing weight the way we want to (how about reimbursement plans for martial arts, dance, and yoga classes and not just gym memberships?).”

    Mr. Abouelleil, your story is moving and important, and I think one of many stories of exploitation and the devaluing of bodies.

    The problem with your solution is that there is no data that show long-term weight change is possible for the majority of people, “incentives” (read “discrimination”) or not. I would love to see environmental changes that make physical activity more accessible for everyone, athletic or not, able-bodied or not, thin, fat, urban, rural, and so – but just penalizing people who are already vulnerable due to social stigma, fewer economic resources, and higher risk of isolation is emphatically not the answer to making people healthier.

    The data you cite for BMI and health risks are correlational, and it is well-known that insulin resistance actually causes weight gain, while the opposite has not been shown. But whatever we find out, people live in their bodies, and clearly there is no lack of “motivation” supplied by a society that hates fatness so much. To me, the century of failed weight-loss interventions is ample evidence that the answer is not to change people’s weight but rather to use our resources to help people in all of our diverse bodies be as happy and loved and cared for as possible – not have to wait for that until we have an approved-of body. How many of us are white, thin, young, able-bodied, rich, cisgendered, heterosexual, average-height, free of all health risk factors/mental health diagnoses/a history of trauma? If the majority of people have a “non-conforming” body, what are we waiting for? The moral approval from the privileged few is not forthcoming. It will not arrive when you temporarily suppress your weight. The people who have an interest in keeping you blaming your body for their meanness and greed will not want to see you claim your non-conforming body. But when you do in spite of their agenda, you take your power back to love yourself, and many great things become possible.

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  6. 6. AVistry 5:31 pm 09/12/2012

    I registered an account with SA so I could respond to this, but I see Deb Burgard has beaten me to it. Most research confirms that only about 10% of dieters succeed in maintaining substantial weight loss long term, and the dangers of weight cycling are significant. I urge the earlier writers (and readers) to consult the information available from the Association for Size Diversity and Health (ASDAH) and to learn about the movement for Health at Every Size (HAES).

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  7. 7. Amr Abouelleil 6:51 pm 09/12/2012

    @debburgard and AVistry – I appreciate your point of view regarding obesity, society and issues of self-image, and thank you for providing them here.

    While I agree that society does not treat obese people with the respect they deserve, this is not the primary motivator for weight loss among the obese people I know. Just last week, a friend told me she wanted to lose weight because she wanted to be around for her children. My personal desire to lose weight is driven by the signals my body gives me and the science that has established risks of obesity. I’m afraid I can not accept any argument that denies these risks, and I see such arguments as akin to climate change denialism.

    I also can not accept an argument that essentially says ‘since most people fail to lose and keep off weight, we should just give up and accept our obesity’. Man spent much more than a century learning to fly before the Wright Brothers took to the air. The solution to the discouraging weight loss statistics is to determine how we can do better, but we can’t do that if we deny the medical problem.

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  8. 8. debburgard 10:11 pm 09/12/2012

    “My personal desire to lose weight is driven by the signals my body gives me and the science that has established risks of obesity. I’m afraid I can not accept any argument that denies these risks, and I see such arguments as akin to climate change denialism.”

    One does not have to deny science at all. With all due respect, I would ask that you look at the empirical data for and against the value of the pursuit of weight loss in improving long-term health. Many people think you have to deny science to think that the pursuit of weight loss is a greater risk to health than to focus on the practices and environments that actually have shown to empirically improve health for people across the weight spectrum. That’s because weight loss is a culturally-driven solution to nearly any malady and is the dominant way of thinking even among scientists – but let us remember that dominant paradigms in science included many racist, homophobic, earth-centric, and (to address your criticism) climate-change resistant ideologies. Look at the data and decide for yourself. Look at 2-5 year outcomes, the physical and emotional effects of weight cycling, the effectiveness (or lack thereof) of stigmatizing health campaigns, the risk of triggering disordered eating and frank eating disorders, and the great attenuation of risk of higher BMI in both morbidity and mortality, when factors like SES, stigma, physical activity, and weight cycling are accounted for. One does not have to deny risk to see that other pathways are far more productive in producing better health for the majority of people.

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  9. 9. way2ec 12:48 am 09/13/2012

    A friend recently sent me the following quote attributed to Morgan Freeman, “I hate the word homophobia. It’s not a phobia. You are not scared. You are an a**hole.” The same goes for “anti-obesity” and those that make life miserable for the obese. As far as other comparisons to homosexuality, most don’t work for me. Gay Pride vs. Fat Pride? Born gay vs. born obese? Whatever the obesity epidemic is all about, a whole lot of people are affected (including gays). I have to agree with the author, the last thing he needs is a society to send him the message that it is “OK” to be fat, obese, overweight, anymore than it would be “OK” to have cancer, (although I do believe it is “OK” to be gay). I like the commentators here that are making the point that the goal should be to encourage health whatever the size shape or condition of your body.

    I continue to struggle with the word acceptance, perhaps here is where the author was connecting “homophobia” with “fat-phobia”, or at least I am. From my Apple thesaurus…”6 their acceptance of the ruling: compliance with, acquiescence in, agreement with, consent to, concurrence with, assent to, acknowledgment of, adherence to, deference to, surrender to, submission to, respect for, adoption of, buy-in to”. For both obese people and the rest of society, surely we all must not surrender to, submit to, or buy-in to obesity as “OK”. To have respect for, and acknowledgement of the condition, all its risks and challenges, yes. We all need to accept responsibility for the health and well-being of our bodies, and this includes our mental attitudes. Dealing with one’s body image affects all sizes and shapes although here acceptance does come into play. One would have to accept being tall or short just as one has to accept being young or old. But are we to accept obesity as something that we can’t do anything about? Can we restate that obesity is something we all have to deal with, both the obese and the rest of society?

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  10. 10. way2ec 1:46 am 09/13/2012

    This article and the one in Salon.com have a starting point in the disease model. Homosexuality is not a disease. A strong case can be made for obesity being a disease and causing disease. Both articles link the discrimination against homosexuals with discrimination against the obese. Given that homosexuality is not a disease, nor a choice, I think that linking the two distracts us from finding solutions to obesity. As to how much choice the obese have over their condition or disease will be debated but surely choice is involved when viewing both the numbers of people affected in the last decade and the severity of obesity, especially in the U.S., but also worldwide.

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  11. 11. Amr Abouelleil 7:37 am 09/13/2012

    @way2ec, I agree completely that obesity and homosexuality should not be compared, hence the title of the article, and the the reason why I pushed back against the comparisons made in the Salon article.

    Neither my article nor the Salon one suggest that homosexuality is a disease. The Salon article suggests that anti-obesity sentiments and homophobia are similar in that they are both founded on societal notions of normal, and not on medical science. The disagreement comes over the idea that anti-obesity has a weak medical foundation. I find the notion dangerous because it could lead people who are at risk of any number of health concerns to believe they are not.

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  12. 12. ironjustice 10:16 am 09/13/2012

    “Neither my article nor the Salon one suggest that homosexuality is a disease”

    How about intersexual people. How does you ‘science’ based mind feel about them ? They are NOT medically compromised ? This article pretty much spells out the hell in a handbasket when ‘scientists’ cannot even figure out whether a person is medically compromised. One might think the author would also think a Down’s syndrome patient is ALSO a naturally occuring manifestation of evolution which makes them useful in the whole ‘scheme of things’ ? Maybe they have evolved to be humor in the world ?

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  13. 13. ironjustice 10:21 am 09/13/2012

    One can use the recent article which shows older children eating less food actually gain more weight than younger children eating more food ?
    There is a problem with age , it is called age-related iron accumulation and it has been closely linked to obesity.
    This study shows iron stores to be a marker for metabolic syndrome.
    “Iron reduction as a possible treatment for diabetes.”

    This study finds iron to PREcede diabetes and obesity.
    “Iron and iron metabolism may contribute to adipocyte IR early in the pathogenesis of T2DM.”

    This study compared iron levels of off the street vegetarians against meat eaters showing vegetarians had twice as much iron in their stores.
    “Lacto-ovo vegetarians had lower body Fe stores, as indicated by a serum ferritin concentration (microg/l) of 35 (95 % CI 21, 49) compared with 72 (95 % CI 45, 100) for meat-eaters”

    The study found by lowering iron the glucose was effected.
    “Fe depletion consistently enhanced glucose disposal”

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  14. 14. Ralf123 6:31 pm 09/13/2012

    >Most research confirms that only about 10% of dieters succeed in maintaining substantial weight loss long term, and the dangers of weight cycling are significant.

    Correct. The problem is with “diet”. Dieting doesn’t work. What works, though, are sustained (life-long) behavioral changes in nutrition and exercise.
    If it’s not designed to work for the rest of your life it’s not going to change much. That also means that you’ll have to like it.
    Your body changes so slowly that you’ll need years for significant change.

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  15. 15. Amr Abouelleil 8:56 pm 09/13/2012

    Ralf123, that is absolutely true. I have tried diets before, including Atkins (which I do not advise to anyone). However, I did lose 40-50 lbs on that diet, but gained it back. The problem is that it not a sustainable way to eat.

    What I’ve learned is the focus should not be what you eat as much as how much you eat. Travel outside of the United States and you will quickly see how over-sized our portions are compared to those in other countries.

    The behavioral change I’d like to share with others who might find it helpful is to ditch the dinner plate for the dessert plate (No, I don’t mean eat more sweets). Restrict the portion size for all meals by restricting the size of the plate.

    Second, don’t serve food at the dinner table – leave it on the kitchen counter, serve from there, and go sit and eat. This helps fight the urge for seconds or to nibble from the serving dishes after the meal is finished.

    Lastly, I’d like to share my brother’s experience, who has successfully shed ~60lbs and kept it off for several years now. It is as Ralf said – he changed his behavior in two important ways. He tracked caloric intake by using a food diary app, and second, he meticulously measured all his food out on a food scale. I’ve tried this method and lost weight with it. It works as long as you stick to it, and that is the real challenge.

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  16. 16. theronin23 11:54 pm 09/13/2012

    While I 100% agree with article, I feel it important to add that just because I don’t want society telling me it’s okay to be fat, I CERTAINLY don’t want the opposite extreme as it is now.

    This article is NOT a pass to shame people into losing weight. Fat shaming helps NO ONE, and truly only makes it worse.

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  17. 17. way2ec 1:03 am 09/14/2012

    @Amr Abouelleil, thank you for interacting with us, makes for a great follow through. Thank you for making extra clear that you are NOT in any way suggesting that homosexuality is a disease and obesity is NOT the “new homophobia”… which brings us all back to obesity as disease. In my reading I have come across references to the “new normal”. I think this is part of the message that obesity is somehow “OK”. And here begins a debate starting with “overweight”, “fat”, and finally obese, the best defined of the three. If we can agree that obesity is a disease, at what point do we declare it a disability? If there are those who don’t consider obesity a disease, what then? what is it? A life style choice? Or something akin to an addiction, spiraling out of one’s control.

    In your comments I find that you make your case very well that dieting is short term and seldom sustainable, and your recommendations for long term sustainable life style changes are good ones. Do we have a good model in the education of the general public as to the health risks related to smoking? Do we ask the obese to pay for the costs to society for their “disease/disability/life style choice” for example extra large chairs and desks in schools, purchase of two seats on airplanes, higher health care costs to society, or do we give discounts to those who do manage their weight and thereby their health and the health of the society as a whole, as we do with discounts on policies for non smokers? Can we pass along these costs through “sin taxes” by way of soft drinks, super sized fast foods, “fat foods”, alcohol, all you can eat eateries, etc.? Should the obese be charged for motorized devices provided to them when they can no longer walk in stores, airports, and other public places? Disease, disability, life style choice, all of the above? I want to again applaud those who focus on health for all regardless of size, body type, or condition. Discrimination based on any condition is wrong and counterproductive. But as you Amr are trying to point out, you neither need nor want to be sent a message that it is OK to be obese. What message or messages SHOULD both the obese community and the non obese community be sending? And finally, who takes responsibility for this “condition”, personally and/or collectively?

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  18. 18. Amr Abouelleil 9:34 am 09/14/2012

    @theronin23, I agree. Society sends all sorts of negative messages to obese people that in my opinion compound the problem. Promoting ridicule of obese people impacts self-esteem negatively, creating stress for the obese, which (if you are like me), can often lead to self-medication by – guess what – eating! So yes, I agree completely, this is a point I left to be read in between the lines for the sake of brevity.

    @way2ec – Thank you for reading my article and participating in the conversation. I’m enjoying it very much, particular as it has gone from a discussion about the article to a brainstorming session.

    Indeed, obesity is a complex problem, in fact so complex even defining what obesity is causes one’s head to spin. Unline smoking, I don’t think it is easily described as a lifestyle choice. We don’t need to smoke to survive, but we do need to eat. Over-eating then is possibly a disordered version of a necessary behavior. I’m not sure the disease label fits either, at least not when you compare it to cancer or triple E. That’d be like calling cigarettes or mosquitos a disease. No, if we want to describe it in disease terminology, I think it is more appropriate to think of obesity as a disease VECTOR, or disease-causing agent, as I mentioned in my article. Cigarettes cause cancer, mosquitos transmit triple E, ticks transmit Lyme Disease, and obesity promotes diabetes and many other issues that can be described as diseases.

    I have often considered the addiction label, and I think it has some merit, particularly when you consider that like drug addiction, people often eat to feel better and not because they are hungry. Like alcohol addiction, over-eating is an extreme form of a normal behavior. So my current thinking is that the best label is to see it as a disease-vector-forming addictive disorder (yikes!).

    Your list of questions are exactly the sort of things I was thinking of when I said ‘we need a society that partners with us’ and that only then will we see ‘constructive solutions on the national level’. Yes, like insurance discounts for those who manage their weight. I also believe the ‘sin tax’ is a good idea, though I’d call it a ‘health tax’ because these are the foods that make us unhealthy, and therefore should contribute to the problems they create by taking those health tax dollars and say, subsidizing insurance company plans that give discounts to those that manage their weight.

    I don’t believe in ideas that punish the individual for being obese (like charging for motorized devices in malls). This is, as you said, discrimination, and would be wrong. We must understand that obese individuals are not solely responsible for their obesity. Our society has promoted this through unchecked industrialization of food which has created a system in which unhealthy food is cheaper and easier to access. Our government has promoted the wrong kind of eating habits (http://www.thedailybeast.com/newsweek/2012/05/06/why-the-campaign-to-stop-america-s-obesity-crisis-keeps-failing.html). So the answer to your final question is that we must take responsibility personally (because our ability to change behavior comes from within) and collectively (because our societal values have encouraged the economic choices that have led to obesity). My concern is that in a society as individualistic as our own, most people are more inclined to acknowledge the former and not the latter.

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  19. 19. tania_v 1:28 pm 09/14/2012

    Very interesting article, very interesting conversation, too much I want to say, but, unfortunately, a) Debburgard said most of what I wanted to say and b) English is not my native language… Let me give it a shot, though.

    I, too, dislike the comparison between homosexuality and obesity. They do have one thing in common, they are both being discriminated against, but did we ever ask ourselves “Is homophobia the new sexism?” Would there be any point in this? No, the questions I would ask are these:

    Is this, the “Western”, “civilized” society, an anti-obesity one? Yes and no.
    Yes, because
    a) The “fat” kid is most definitely laughed at
    b) Being called “fat” is a very bad insult (no matter your BMI, I might add)
    c) A lot of people (esp. women? Not sure) who aren’t even overweight are on diets
    d) Many people (esp. young women? Not sure) prefer to be unhappy/sick than fat or risking (key word) getting fat (see the alarmingly increasing rate of bulimia, anorexia etc)
    e) Etc etc

    But, also, no, because
    a) For all the campaigns, you’d think they’d do something about the junk food that’s being marketed so much.
    b) You’d think they’d build more playgrounds for children. You’d think, they’d put more physical activities in schools.
    c) You’d think they wouldn’t try to convince people that it is normal to work 10 hours a day on a desk. Do you know what the risk factors are when it comes to that?
    d) You’d think they wouldn’t allow all these “Bodyline” filth steal people’s money with the promise of a Hollywood body, which -needless to say- they never deliver.
    I could go on with the alphabet, but I’m guessing you don’t need me to.

    So, is this a hypocritical society? Yes, very much indeed. Do you realize how much money some people make because the marketing business has us going after fast food and then a liposuction?
    There is an entire industry designed to make people feel awful about themselves in the most cost-effective way.
    Are people idiots for being dragged around by the marketing departments? Yes and no, but that’s not what we’re talking about right now.

    Is obesity a medical condition? The medical community has not actually agreed on it, yet, as far as I know. Is it always “curable”? No, not really. Is it a risk factor for other diseases? Yes. Is it very impractical for the person who is obese? Yes. Is it very stressful because of the social hostility. Yes, very much indeed.

    So, what do we do? What do I, a soon-to-be-doctor, actually, do?
    We need to put an end to the hypocrisy described above and we need to “preach” “Health” above all else. Not the all-vegan, all-biological, homeopathic, magic herbs and I-ll-burn-in-hell-if-I-ever-eat-carbs-again kind of “health” that’s soooo in fashion these days, but, well, the real thing. Balanced eating, exercise (something you LIKE!), playing, laughing, using your mind and body to their fullest capabilities. You know, being whole and happy and all the hippie, zen kind of stuff.

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  20. 20. debburgard 10:55 pm 09/14/2012

    @tania_v So glad you will be caring for people soon, with a clear head about what we know and don’t know, and with your compassionate and playful spirit.

    @Amr What you are describing – eating from a smaller plate, measuring and recording food, etc. for the rest of one’s life – yes, there are a few people who do this and find all the time , effort, and some would say, obsession, worth it. However, we know that the person who is suppressing their weight – i.e., who started at a higher weight and is now x pounds lighter, when compared to someone who has always been at that lighter weight, is using 4-500 calories less each day. So that person has to eat much less than the person who was never heavier, which most people experience as just as hard as that lighter person would if THEY had to eat 4-500 calories less a day for the rest of their life, measure everything, exercise more than an hour a day, etc.

    Moreover, because there are so few people who can sustain this, we don’t even know if a suppressed-weight person has the health risk profile of an always-thinner person. The natural experiments with unintentional weight loss – even those that don’t involve illness – suggest that it does not make people healthier in the long run.

    So this idea that you are proposing as if it is a new one – just keep restricting what you eat and exercising each day to do whatever it takes to suppress your weight – this is not a new idea. It is not sustainable for the majority of people, and as an eating disorders specialist I can testify that many of the people who do sustain it have a whole parallel universe in hell to struggle back out of that way of life.

    So we do need to ask, why would we ask people to do something they have shown over decades is not really possible, for a goal that is not even empirically demonstrable? When instead, we could organize ourselves around making the practices that support people’s health (no matter what their weight) more available and fun and sustainable – whether they lost weight or not?

    When people only do those practices because they are trying to lose weight, when they stop losing weight, they stop the practices. And the people who are thinner don’t think about doing those practices because they aren’t trying to lose weight. So why not just focus on making environments that are more irresistably accessible to everybody who wants to play, not to change into some other body, but because we are all welcome on the playground and the equipment fits all our diverse bodies and abilities, and our different strengths are valued in different ways?

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  21. 21. In-Tokyo 12:25 am 09/15/2012

    In Japan they start in School where kids eat a balanced meal prepared by a nutritionist who balances their desire for a wonderful meal against the realities of their budget calculating nutrition and calories all the way. They mix in meals from around the world and listen to the teachers’ stories about how the kids felt about what they ate and how they got them to eat it. They even take a request here and there.

    In my son’s case, no exception was made to his dislike of vegetables and I had to fight the school to allow him the chance to put some food back from the designated portion so he could comply with the requirement to eat everything.

    American portions are HUGE, the fat content is often INSANE, and gallons and gallons of SUGAR-WATER does not help. At 42 I am thinner than I was at 18. Americans, and the West, have a certain lifestyle that leads to obesity and Japan is becoming more like the West. Still, at least Japanese kids will grow up knowing what a balanced meal really is.

    American sweets … wow talk about excess.

    Alls I can say is that I don’t feel ok when I get heavy. Others may not mind at all. My relatives lose weight when they stay extended time here. Too bad they can’t stay longer.

    Link to this
  22. 22. Amr Abouelleil 12:29 pm 09/15/2012

    @Deb, thank you for the continued discussion. Let me respond to your points in turn:

    “…eating from a smaller plate, measuring and recording food, etc. for the rest of one’s life – yes, there are a few people who do this and find all the time , effort, and some would say, obsession, worth it.”

    Characterizing these behaviors as obsessive is not constructive or accurate. Changing one’s behaviors does take effort initially, but just like any habit forming behavior, it becomes easier over time. Choosing a smaller plate from the cabinet takes exactly as much time as it takes to choose a larger one. Once the habit is formed, it is not burdensome in the least. I agree that measuring and recording food would be burdensome if one did it for the rest of his/her life, but that is not the point of these activities. The point is to use data and awareness to untrain all the unhealthy eating behaviors the food industry and society at large has imposed on us – the acceptance of huge portions as normal, the emphasis on refined foods, and the anywhere/anytime mentality towards mealtime. Measuring and recording ones food retrains the individual, as it has with my brother, until they develop an eye and sense for appropriate eating, at which point the food scales and diaries can be put away.

    “So this idea that you are proposing as if it is a new one – just keep restricting what you eat and exercising each day to do whatever it takes to suppress your weight – this is not a new idea. “

    At no point in my article or this discussion did I say that these ideas were new ones. I think that the continued use of the term ‘suppression’ of weight here implies that all obese people are just naturally overweight, presumably because of their genetics. My personal experience, as outlined above, conflicts with that, as I was not obese until high school. Obviously one man’s experience does not speak for everyone, but neither can we claim that everyone is obese just because of their genes. That is too simplistic as we all have the genes that play a part in obesity, and it is their expression that must be studied. What turns them on and off? Evidence shows that environmental factors (such as BPA) can cause changes in an epigenome (http://www.nature.com/scitable/topicpage/obesity-epigenetics-and-gene-regulation-927), so it is no stretch to suggest that our environment and even our behaviors may influence our genetics.

    Furthermore, if obese people are all just naturally ‘born that way’, then why does obesity vary so sharply across societies? Why do any of my relatives who come from Egypt gain weight when they come to the USA for a few months, then lose it again when they go home , and why do I lose weight whenever I stay there for an extended period of time(I’d love to see a study that investigates this)? Why do Aboriginal people of Australia only suffer from diabetes when they transfer from their traditional hunter/gatherer diet to a Western one? And though there is little quantitative data on pre-Western contact Aboriginals, why does what data is available suggest obesity is so rare in their population (http://apjcn.nhri.org.tw/server/MarkWpapers/mark_books/Downloads/CURRENT%20PROBLEMS%20IN%20PHARMACOLOGY%20%26%20TOXICOLOGY/The%20hunter-gatherer%20lifestyle%20of%20Australian%20Aborigines.pdf)? Perhaps a modernized paleo-centric lifestyle is part of the solution.

    The whole issue of weight-loss being too difficult is something else I’d like to discuss more deeply. I find the 10% success statistic deceiving because it does not parse out success by weight loss methods. The vast majority of people probably try to lose weight through self-directed methods, without a holistic support network that includes physicians, nutritionists, and psychologists. When people are given this support, such as in a medical weight loss program, they fare better than those who self-direct (control group = self-directed). From the New England Journal of Medicine:

    “The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. “

    “In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months. “
    -http://www.nejm.org/doi/full/10.1056/NEJMoa1108660

    The solution to the poor success rate isn’t to give up, but to learn from the failure and do it the right way. I believe these medical weight loss programs are a step in the right direction and have myself enrolled in two weeks ago.

    The idea that the weight loss process itself is a health risk is one which I have taken some time to research at your behest, as I’d never heard that argument before. A 2007 review paper (http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2007.00393.x/abstract) on the long-term effects of weight loss found mixed results for men, which is hardly a reason to discount decades of medical data that suggest otherwise. Furthermore, the study found significantly reduced mortality rates in women (19%-25%). Furthermore, the study confirmed that weight-loss benefits diabetics.

    As you said, there is some data that suggests weight-loss can increase mortality, but the important question is to ask why that is the case before we dismiss weight-loss as providing a net benefit to health. Weight cycling is a factor, as you mentioned, but there are other possibilities, all of which stem from choices (using unsafe drugs, starvation diets, etc) and not biology. This brings us back to the more promising avenue of medically managed weight loss where choices are guided by physicians, psychologists can provide stress outlets for individuals who turn to food when the going gets tough, and nutritionists can help retrain people to reach for fruits and veggies instead of chips and chocolates.

    There is one thing I can agree on, and that yes, we should make environments that welcome everyone regardless of body size. This is a human rights issue and for me there is no debating that all people should be treated equally. People can to choose to be large-and-happy, but they shouldn’t make the choice without knowing all the risks and rewards that go with that choice. And for people who want to lose weight ‘not just to lose weight’ as you put it – but because we believe we will have healthier lives for it – we should create environments that maximize our chance of success.

    Link to this
  23. 23. ironjustice 11:38 pm 09/15/2012

    Quote: Why do Aboriginal people of Australia only suffer from diabetes when they transfer from their traditional hunter/gatherer diet to a Western one?

    Quote: “Cross-Talk Between Iron Metabolism and Diabetes”

    THAT study shows that the iron and sugar TOGETHER is what causes the problems. Previous research has shown Pacific Islanders have the highest iron levels of anyone. When the people move to the city or begin to eat REFINED foods which have lots of sugar .. they manifest their diabetes.
    “Asians,Pacific Islanders have highest blood iron levels ”

    Pretty simple.

    Link to this
  24. 24. debburgard 1:09 am 09/16/2012

    @Amr, thank you for this extended discussion. I very much appreciate the refs and your openness to investigating the data.

    No argument from me about environment interacting with genes, epigenic influences, etc. But one interesting thing to look at cross-culturally is also health outcomes associated with different BMI categories and how there are fewer health consequences in societies that value a wider range of weights.

    The NEJM study you cite (Appel et al., 2011) is one of the new breed of weight loss studies that use a benchmark of 5% – presumably because losses that would actually move a person from a presumably high-risk BMI category to a presumably lower-risk one are nearly non-existent. This study actually shows that it did not matter how “intensive” the intervention was – we already have lots of data that show there really isn’t a difference in ultimate weight outcomes between “good” or “bad” weight loss interventions, medically-supervised or not, etc. For a good review of all (then) extant longitudinal studies, see Mann et al., 2007: http://mann.bol.ucla.edu/files/Diets_don't_work.pdf

    If we are going to argue that being at a high BMI is the problem, we can’t really prove it by showing that someone who is still at that high BMI – OK, 10 pounds less – is in a magically different health situation. The people in the Appel study started and ended in the Class II obese category.

    Still, we have data that people can absolutely be healthy in that weight category – see Wildman et al. (2008) Arch Int Med – and even if they are not, there are practices that will improve health whether there is weight loss or not.

    If we are going to argue that there are health benefits associated with a little bit of weight loss, and that is what some studies do show, we have to distinguish between benefits from weight loss vs. HOW that weight was lost, which is usually better nutrition and more movement. If you look at an equivalent amount of weight loss from liposuction, there are no health benefits. And if you look at just the practices without weight loss, there are still equivalent health benefits. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041737/

    So we are left with the question, what allows people to change their health practices sustainably? That seems to me to be the key question, one I am avidly interested in as a psychologist. It seems to me that different practices are sustainable in different lives, and it also seems to me that when people link the practices to an additional goal of weight loss that will rarely last, it is a burden to them emotionally and physically that is also a threat to the motivation to keep up the practices. You note that your brother has found a peaceful set of habits with eating choices – and that is good news. For him, those practices led to weight loss – in others it might not. I am agnostic about what different people find sustainable – but I am not going to view the ongoing, lifelong stresses that people in the Weight Management Registry describe as something desirable. If it is a habit one needs to change, that’s one thing. That is my point, actually, that habits and practices are easier to change than weight. But I work with people who have eating disorders and I am not about to prescribe for fat people what we diagnose in thin people: a constant battle with one’s body, daily obsessional thinking about food, exercising out of fear of weight gain, daily weights, etc. Those symptoms are partly from trying to suppress one’s weight, and they occur all along the weight spectrum, not just in thin people.

    Moreover, somewhere between one-third and two-thirds of the people who try to lose weight will actually regain more than their baseline (Mann 2007). Some percentage of people who try to lose weight trigger an eating disorder – see Neumark-Sztainer D, Wall M, Larson N, Eisenberg M, Loth K. Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study. Journal of the American Dietetic Association. 2011:111;1004-1111. The same author has found that dieting leaves teens heavier in the long run, no matter their baseline weight: Neumark-Sztainer D, Wall M, Story M, Standish AR. Dieting and unhealthy weight control behaviors during adolescence: Do they predict changes in weight ten years later? Journal of Adolescent Health. 2012;50:80-86.

    To address your cogent observations about your relatives’ weight changes in different envirnments: It is clear that we come to this one “village” from every possible environment – where each of our ancestors survived every possible variation in environmental challenge. Some of us come from people who survived because they were so fast – or had so much stamina – or stayed warm – or were able to slow their metabolic rate down when there wasn’t food – and oh, the variety of food. And here we are in this environment, which isn’t even the same for each of us – we face different levels of racism, poverty, stigma, security, social connectedness. Even when we are eating the same thing or the same amount, we will be all different sizes. And we know next to nothing about how the things we eat support different communities of bacteria in our guts, and how those little guys determine what we do with our fuel. I agree with you that we have so much to look at with our current environments, so much to change to make them safe, beautiful, clean, just.

    I hope this isn’t too weird, but here is my wish to make your medical environment safer: My request, should you want to, is that you ask your medical/psychological providers to give you evidence of what happens doing their specific intervention, for the majority of people who try it, over at least 5 years. If they do not have this information, why don’t they? What other intervention would they offer without data? In the vast majority of situations, even medically-supervised diets won’t have the data – it isn’t enough to report “averages” and “up to x years of follow-up” when we need most of the people, for at least 5 years, and what their trajectories and health markers are over that time. Basic data to answer the question.

    If/when they don’t have this information, then ask them how they justify proceeding without it, especially when longitudinal review data like Mann’s show dieting interventions are likely to make people sicker, heavier, and feeling worse about themselves. Many fat people have been told some version of, “you are doomed if you live in a fat body so we can justify almost any intervention.” Most healthcare providers are not aware of the pervasiveness of weight bias amongst themselves (see http://www.yaleruddcenter.org/what_we_do.aspx?id=10) . Fat people need to watch for that weight bias, even among well-intentioned people, because it can have consequences to your healthcare. Just keep asking for data, not promises, not academic versions of “before and after” pictures, not predictions of doom. You deserve data.

    I wish you all the best from the bottom of my heart. I honor your body and its wisdom. From what I can see, you are a dear soul and an incredibly smart and loving person. Whatever you decide and whatever you learn on your journey, I hope you will be free from harm and that you find the path that allows you all good things.

    Link to this
  25. 25. debburgard 12:05 pm 09/16/2012

    @Amr – PS Here is the Roseto study – one interpretation is that strong social supports and less stigma around body diversity are associated with better health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1695733/

    Link to this
  26. 26. degreecouncil.org 3:00 am 12/22/2012

    Comparing homosexuality to obesity is preposterous.

    Obesity is a CHOICE … but so is speaking English.

    Obesity is NORMAL in America. The idea of “healthy habits” and positive psychology are nothing new. “7 habits of this” and “7 habits of that” books have been best sellers for the last 30 years. Even when given a national stage and expensive trainers, like on the television show, “The Biggest Loser,” Americans continue to battle with food. It’s a sign of the times. It’s quite possibly the first time in modern human history that a civilization has too much food. We PAY people to help us not eat so much. Think about that statement for a second. If you tried to explain that to someone living in third-world squalor, they wouldn’t even understand. “Wait a minute … you pay someone to help you NOT eat?! Huh?”

    Given that fact, we can’t beat ourselves up over this. It’s not our fault that we have so much food. But it has caught up with us. Parents are now obese and passing that down to their children. For most Americans, the refrigerator is a place where food exists … and has ALWAYS existed. Most children in America today have never wondered if they were going to be able to eat. The irony, perhaps, is that most people in America don’t have much money … but that’s just it: you don’t need much money to buy tasty, fast food.

    There’s an old saying: “You can never get enough of what you don’t really want.” Some people will never be able to reconcile themselves with fitness and a constantly full refrigerator. But having a food surplus is not a “habit.” It’s a life, a society, an entire nation. If and when health becomes a priority for parents in America, it’s conceivable that we’ll be able to lessen the obesity wave. Until then, it is an individual choice … and sadly, immediate pleasure usually wins out against long-term pleasure in human animals.

    Link to this

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