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530 pounds, 240 kilograms, 38 stone.
July 14, 2008 1:13 PM   Subscribe

A graphic yet poignantly written first-person account of what it is like to weigh 530 pounds. The author of this account is unflinchingly brutal in her candor, which, although it makes some graphic moments in her narrative difficult to read, also brings you deeply into her world and her perspective. (A July 2008 update.)
posted by WCityMike (332 comments total) 32 users marked this as a favorite

 
The story of her surgery is engrossing, if a little nerve-wracking.
posted by Astro Zombie at 1:27 PM on July 14, 2008


My lower belly is so large and heavy that having it hang from my body is actually painful. I have a lot of problems with infections between my skin folds and summer really isn’t helping matters.

Oh wow, that's really disturbing. Though I don't understand the long rant in the beginning in regards to weight loss surgery. What exactly is wrong with weight loss surgery? Isn't that just perpetuating that overweight people are lazy? At least that's what I gathered from the article, even though it goes onto say, " ... but in this case it is different," which is sort of a laugh. Why is it different? You have to be that overweight to seek surgery?
posted by geoff. at 1:28 PM on July 14, 2008


She explains her points in her followup. She seems to be wresting with a sense that it is possible to be overweight and healthy, and that there is too much socially generated hatred for people who are heavy, so therefore some people might opt for the surgery who really don't need it.

In her case, her weight was obviously affecting her health. But it sounds as though the surgery was not an easy decision to make at all.
posted by Astro Zombie at 1:31 PM on July 14, 2008


She's resorted to surgery after deciding she doesn't believe in dieting.

What about exercise to help lose the weight? She can't because she's too big. So diet, lose some weight, and start exercising. But she won't; she doesn't believe in dieting. Instead she believes people should just accept her the way she is.

It just staggers the mind. She's a ball of contradiction and confusion.

I think the focus should be on WHY and HOW she got to 530 pounds and WHY she never did anything to help prevent it up until now. Try and understand what's going on so that other people headed down a similar path might have some lessons to learn from.
posted by ruthsarian at 1:32 PM on July 14, 2008 [8 favorites]


It is quite interesting and a good post. But then you read down to the comments at the bottom. It seems she make about three quarters of them cry!

Sample: Wow. I’m glad I was alone when I read that, because I’m now crying like a big baby.

Heidi — that was an amazing story. Thank you so much for sharing it. Like others have said, it was a very courageous thing to do.


It's nice that she wrote it and everything and I wish her luck. Really I do hope it works out for her. But I'm not crying, not even a sniffle. In fact I don't think I've ever cried after reading a total stranger's blog. Am I missing something? Do I have a heart of stone?
posted by rhymer at 1:33 PM on July 14, 2008 [3 favorites]


Wow, that was really something to read. As of April she was down to about 380 pounds and still losing, and sounded like she was enjoying the benefits to her health.

At the end of the first link she writes:

I absolutely believe there are people who weigh 530 pounds and are happy and healthy. I’d never be so myopic as to claim my experience as the norm.

(At the end of the second link she qualifies that statement by saying that she is simply not going to judge others.)

I understand the nuanced political point she is making -- what I am wondering is about the practical physiology question: is it actually common to be over 500 pounds and not suffer the mobility and health issues that she did? Or, is there some boundary of weight above which the human body simply does not function well?

Thanks for posting this -- I found it a really interesting read.
posted by Forktine at 1:36 PM on July 14, 2008


What exactly is wrong with weight loss surgery?

Some critics have argued that it is often sold as a cure-all and that patients are not properly appraised of the risks, which are significant. The risk of mortality from gastric bypass surgery has been reported to be as high as 2%, so it really should be reserved for only the most extreme cases.
posted by mr_roboto at 1:37 PM on July 14, 2008 [1 favorite]


I absolutely believe there are people who weigh 530 pounds and are happy and healthy.

Happy perhaps. Healthy. No. No. No.
posted by rhymer at 1:38 PM on July 14, 2008 [6 favorites]


she doesn't believe in dieting

She explains that as well. She says she doesn't believe in diet plans, but does believe in eating well. Honestly, I think treating morbid obesity as some sort of personal failing is pretty useless. It doesn't help the person who is dealing with their weight, although it might help the person who is judging them feel a little better about their own lives. People I've known who are morbidly obese are often already dealing with a lot of shame and self-worth issues, and I'm not in favor of compounding those. I don't know if medicalizing obesity is the best solution, but it takes some of the stigma away, and, honestly, there often are a lot of medical issues that go into this sort of obesity, and result from it.
posted by Astro Zombie at 1:42 PM on July 14, 2008 [29 favorites]


By "eating well," I mean "eating in a healthy manner."

I believe in eating well, meaning "eating foods rich in fat and cholesterol," and it hasn't helped my weight.
posted by Astro Zombie at 1:44 PM on July 14, 2008


I absolutely believe there are people who weigh 530 pounds and are happy and healthy.

It feels insensitive to say this, but maybe that combination of denial and skewed perspective is one of the reasons she got into that state to begin with.

I'm no expert, so burn me alive if I'm wrong.
posted by crunch buttsteak at 1:44 PM on July 14, 2008 [5 favorites]


I take it she's not a fan of WALL-E.
posted by billysumday at 1:45 PM on July 14, 2008 [3 favorites]


I absolutely believe there are people who weigh 530 pounds and are happy and healthy. I’d never be so myopic as to claim my experience as the norm.

I came here to dropjaw at this too. Human organs and bones are not that flexible. It's nice to be generous and allow that there are different body types and ways to define "healthy," but this is just delusional, and I call it disinformation.

Why is she so defensive about her own unhappiness with her health condition?
posted by Ambrosia Voyeur at 1:47 PM on July 14, 2008 [1 favorite]


Being that overweight seems incredibly uncomfortable, but what confuses me about the fatosphere is well...even being a little over weight can be uncomfortable. I was in the overweight BMI range, not the obese, and my thighs would chafe, my breasts sagged achingly if I dared go without a bra, my belly folds would get rashes on them, and I also had gastroesophageal reflux disease (that's realllly bad heartburn). The fatosphere is either in denial or they don't realize that chafed aching thighs are not normal.

I guess the people posting on the thread about how terrible and "anorexic" it is for her to have WLS are the misery-loves-company crowd.
posted by melissam at 1:47 PM on July 14, 2008 [6 favorites]


I admire this woman's strength and her writing ability. But even though I'm a large man, I usually find myself without words when looking at the viewpoint of "fat acceptance," which this woman espouses and believes; it never made much sense to me. Making fun of overweight people is very societally acceptable and is very widespread in our popular culture, and it shouldn't be; were "fat acceptance" confined merely to a sort of "pride" movement to respond to such attacks, I'd perhaps understand.

It goes far beyond that, though. To imply that one can have so much weight and still have a healthy body is something I just don't understand. I hesitate to draw the analogy, since it's so loaded, but it also seems an apt one: Holocaust deniers insist on their reality despite virtual mountains of facts, locations, and personal experiences to the contrary. It seems as if there are similarly virtual mountains of facts, locations, and personal experiences to the contrary that would operate against the "fat acceptance" viewpoint that one can be extremely fat and yet entirely healthy, yet they seem equally as wedded to their viewpoint.

If we have someone who believes as such and was drawn to this entry, I'd honestly be interested in hearing your viewpoint as to how this can be explained, whatever reasoning and evidence you feel supports that line of argument.
posted by WCityMike at 1:49 PM on July 14, 2008 [10 favorites]


There's a good show on Discovery about people who are morbidly obese. It follows hospital visits and everything.
posted by wannaknow at 1:49 PM on July 14, 2008


All other things being equal, fat people use more soap.
posted by Faint of Butt at 1:49 PM on July 14, 2008 [3 favorites]


I really struggle with the whole fat acceptance thing. It's a bit like pretending that smoking 40 a day is a fantastic lifestyle choice.
posted by rhymer at 1:50 PM on July 14, 2008 [3 favorites]


What exactly is wrong with weight loss surgery?

There is a series on bariatric surgery at Junkfood Science - start here and follow the links on the sidebar.
posted by ferociouskitty at 1:50 PM on July 14, 2008 [1 favorite]


That was excruciating.

She seems to be wresting with a sense that it is possible to be overweight and healthy.

I don't understand this. I've read a bit about fat acceptance and the more radical adherents seem to deny what is pretty well accepted medical science...

They contend that accepting fatness will make people less likely to aspire to achieve a healthy weight. Fat activists, on the other hand, will argue that the idea of a "healthy weight" is one without meaning, as health can be found in people at all weights and sizes.

I just... I don't get it. Being chronically overweight seems like being alcoholic... something out of many people's control but nonetheless detrimental to their health. While you shouldn't blame them for the problem, acceptance does not seem like the compassionate thing to do.
posted by phrontist at 1:51 PM on July 14, 2008 [2 favorites]


On (what should have been) Preview: What WCityMike said.
posted by phrontist at 1:52 PM on July 14, 2008


.
posted by Brandon Blatcher at 1:56 PM on July 14, 2008 [2 favorites]


I think the focus should be on WHY and HOW she got to 530 pounds

anybody who's gained just 10-15 unwanted pounds can understand how a person can get that fat.

It's simple denial strengthened by several vicious circles (the emotional, of course, and the physical fact that the heavier you are the harder it is to get proper exercise).
posted by yort at 1:57 PM on July 14, 2008 [1 favorite]


It takes balls of steel to muster that kind of candor. Totally brutal read.
posted by The Straightener at 1:57 PM on July 14, 2008 [9 favorites]


acceptance does not seem like the compassionate thing to do.

I accept all sorts of things I disagree with and find personally odious, because to not do so isn't really my business. I mean, what are the other options? Write long missives about how being fat IS unhealthy, god damn it, so stop being so crazy and drop the sandwich?

I suppose if it were a family member or a close friend, I would be inspired to say something, as I would with alcoholism or smoking or any other unhealthy behavior. But fat people really do seem to be the brunt of a lot of eggregious misbehavior at the hands of strangers, and a lot of it comes from the sense that they wouldn't have this problem if they'd just steer clear of the twinkies. I think they deal with enough without having me laugh down my sleeve at them.

And, while I can't think of any 500 pound people who are especially healthy, there are some atheletes who tip the scales at 350-400 pounds who my doctor might argue I would be healthier patterning myself after than continuing with my current behavior.
posted by Astro Zombie at 1:58 PM on July 14, 2008 [8 favorites]


I accept all sorts of things I disagree with and find personally odious, because to not do so isn't really my business. I mean, what are the other options? Write long missives about how being fat IS unhealthy, god damn it, so stop being so crazy and drop the sandwich?

No, I don't think it makes sense to comment on the health decisions of individuals unless you know them really bloody well.
posted by phrontist at 2:00 PM on July 14, 2008


Honestly, I think treating morbid obesity as some sort of personal failing is pretty useless.
If you mean useless as in not likely to convince the person to start taking better care of themselves, I'd agree. But it is a self-inflicted phenomenon, even if inflicted passively rather than actively, and taking personal responsibility where due is never a bad thing.
I could stop bathing, shaving, brushing, and flossing and before long I'd look like shit. How much support would I get if I took the political stand that I should be accepted as I am and that the very idea of active maintenance of one's body is an evil perpetrated by society?
posted by rocket88 at 2:00 PM on July 14, 2008 [6 favorites]


In fact I don't think I've ever cried after reading a total stranger's blog. Am I missing something?

I'm guessing most of her readers don't think of themselves as strangers.
posted by Nelson at 2:02 PM on July 14, 2008 [1 favorite]


This is, unfortunately, the extreme end of the Fat Acceptance movement - the refusal to diet, refusal to acknowledge that there is a point where you are too fat, the delusion that anyone can be happy and healthy at 530lb, and that no one should ever be congratulated for losing weight. I read through her blog a couple of days ago, and in one entry she discusses how some FA sites have removed her links because she had the surgery, declaring her a traitor to fat activists everywhere - her mother had to wipe her arse, people! Her legs are black from lack of circulation! She can't stand, let alone walk! She put on 20lb in the three weeks between scheduling and going in for the surgery (550 - how many calories do you have to eat even to maintain 500lb+, let alone gain?), and with that level of disordered eating I don't see that she had an option, frankly.

If she is telling the truth in her blog, she has an absolutely messed up life. I wish her all the best in her endeavours for happiness.
posted by goo at 2:02 PM on July 14, 2008 [4 favorites]


I could stop bathing, shaving, brushing, and flossing and before long I'd look like shit.

And I would assume you had schizophrenia, of which these are classic symptoms.
posted by Astro Zombie at 2:04 PM on July 14, 2008


anybody who's gained just 10-15 unwanted pounds can understand how a person can get that fat.

I totally disagree with that. There is a world of difference between "no time to exercise, and spending 5 months a year away and having to eat in US chain restaurants" and so gaining a few pounds that are hard to shift, versus more than doubling your body weight. Glandular/medical means of gain in weight aside, someone needs to eat a LOT of food well after they already know they are overweight to get to 500lbs... Just not eating as much will keep it in check, never mind actively doing things to prevent the gain.

I think "I don't understand how anyone can get to 500lbs" is a reasonable point of view, actually.
posted by Brockles at 2:05 PM on July 14, 2008


"Being chronically overweight seems like being alcoholic... something out of many people's control but nonetheless detrimental to their health."

I don't really believe any behavior is beyond a person's control. They have elected not to exercise control and possibly convince themselves they lack the ability to control themselves. There are alcoholics, smokers, and crackheads who have just quit cold turkey and never gone back. They neatly invalidate the premise that things are beyond a person's control.
posted by Sukiari at 2:07 PM on July 14, 2008


Well, I don't really understand how someone can get to 500 pounds either. But it doesn't seem too hard to do, based on what I see when I leave my apartment. And, when I was 21, I'm not sure I would have understood how someone can get to 190 pounds, my current weight.
posted by Astro Zombie at 2:07 PM on July 14, 2008


Astro Zombie: The NFL has had to fight charges that it encourages medical obesity in its players for a couple of years now.
posted by Weebot at 2:08 PM on July 14, 2008 [1 favorite]


Honestly, I think treating morbid obesity as some sort of personal failing is pretty useless.

Right or wrong, shame is a powerful motivator for individuals in societies. Probably more powerful than the threat of economic penalties, incarceration or other means of compelling behavior.
posted by Blazecock Pileon at 2:09 PM on July 14, 2008 [3 favorites]


There are alcoholics, smokers, and crackheads who have just quit cold turkey and never gone back. They neatly invalidate the premise that things are beyond a person's control.

And there are people of enormous willpower who can't quit smoking. Sometimes will isn't the only issue, and reducing it to that seems guaranteed to replace compassion with contempt, which doesn't seem to me like it would help anybody at all.
posted by Astro Zombie at 2:09 PM on July 14, 2008 [15 favorites]


Blazecock Pileon: "Right or wrong, shame is a powerful motivator for individuals in societies. Probably more powerful than the threat of economic penalties, incarceration or other means of compelling behavior."

Shame's a pretty crappy motivator when judged on its poor success rate, and the problems caused when it doesn't motivate (insular behavior, perpetuation of the problem, etc.).
posted by WCityMike at 2:11 PM on July 14, 2008 [4 favorites]


Fat acceptance is a spectrum--but the more moderate end is intent on drawing attention to the inaccuracy of definitions of "fat" that do not take into account, for example, studies that seem to show slight "overweight" helping some people live longer, and that assume that all fat people have heart disease. There are people who are statistically overweight and yet have low blood pressure and cholesterol, and are active. The measurements we as a culture use to determine fat/not fat are often based far more on assumptions than actual science. If you're a woman, insult is added to injury by the fact that until recently, fat studies were all using men as the norm, and labeling women who were outside that norm too fat. There are different body types, muscle mass, family histories, all determining what your danger level is, but all we ever go by are outdated insurance charts that demand virtual starvation to achieve.

It was not very long ago that doctors prescribed speed to make you thin, and advised pregnant women against gaining very much weight, which is very dangerous for the fetus. You don't have to look around much to see all the quack science and dangerous "approved" drugs thrust at fat people (fen-phen, etc.) because Being Fat is the worst possible fate there is. Even if you're not actually very fat at all.

This tends to radicalize people who feel like victims of the system--and it's very easy to over-compensate for the idiocy of size 00-idolizing culture by declaring all fat is wonderful and natural.

For the writer, obviously, none of that applied; she had crossed into true bodily harm. The defensive tone of her post, though, probably stems from having most of her support system being in the fat acceptance movement, which sees WLS as just one more way society attacks them. Not saying that's right, but it's completely understandable.
posted by emjaybee at 2:11 PM on July 14, 2008 [18 favorites]


It's great that she's getting weight loss surgery to improve her quality of life, because obesity is generally unhealthy.

And I think fat acceptance proponents are insane.
posted by kldickson at 2:12 PM on July 14, 2008 [1 favorite]


I've heard the shame argument before, and it always seemed like someone trying to justify being an asshole. I bet most overweight people already have enough shame for a lifetime, and piling more on isn't really going to help.
posted by Astro Zombie at 2:12 PM on July 14, 2008 [8 favorites]


Heartrending. I can only hope things turn around for her. I am sad to say I am not optimistic.

Morbid obesity seems to me a lot like alcoholism, and maybe other addictions. I don't mean addicted to food, but the resignation, the denial of the insidious bit-by-bit nature of the thing. One more day of drinking won't hurt. This is my last time. One more won't hurt.

It's so easy to see what we need to do to turn our lives around, but so hard to do it.
posted by Xoebe at 2:13 PM on July 14, 2008 [4 favorites]


She's a ball of contradiction and confusion.

Yeah, she really does read like someone who isn't sure which way is up. I suspect that this paragraph is an answer to some of that:

I have pre-diabetes, hypertension, high cholesterol, gastroesophageal reflux disease, depression and social anxiety and am on medication for all of it. I take a lot of pills! I’ve had to sleep sitting up for the last several months. I do sleep but not long and not deeply…I miss dreaming.

Between worries of health, loss of sleep, mixed medication, and depression I can imagine that all sorts of scary things were going on in her head.
posted by quin at 2:14 PM on July 14, 2008


For those interested in looking into it: Wikipedia links on "health at every size" and fat acceptance, and NAAFA.
posted by WCityMike at 2:15 PM on July 14, 2008


I miss dreaming.

OK, that sucks. My empathy module just kicked in.
posted by Cool Papa Bell at 2:15 PM on July 14, 2008 [1 favorite]


It's really sad for me that she's struggling with fat acceptance versus emergency treatment, because I know how it feels to go around and around in your head with worries and insecurities and reassurances to yourself about your weight. Having this massive problem guarantees that you think about it daily, hourly, always, and overthink it, and try to figure out why you're like that, and whether your feelings are real, or the world's opinion of you is valid, and thus, you spin your wheels until you've really lost direction.

In the end, it's a personal battle of will, a choice between a thousand easy comforts and living with the neuroses, or a lifetime of failures, persistence, and hard work.

Therefore, I'd love to hang about in this thread and explain in further depth the multi-faceted complexity of my point of view, but I have to go to the gym.
posted by Ambrosia Voyeur at 2:16 PM on July 14, 2008


I place my hands on my belly and I whisper to my body how sorry I am. Sorry that she’s going to have to be cut up; sorry that I couldn’t fix things on my own; sorry that I let things go so far before I asked for help; sorry that she’s hurting so much

I found this part really interesting: the idea of seeing your own body as an "Other," of a conceptual divide between you-you and body-you.

That's really hard to get my mind around. I do it sometimes, kind of, with parts of my body ("my flat feet/bow legs/aching ankles really don't like jogging..."), but to think of the whole bag of bones and fluid beneath my brain as something somehow distinct from Me, that I'm just kind...attached to (and in her case, imprisoned by and answerable to)? Wow.
posted by gottabefunky at 2:16 PM on July 14, 2008 [7 favorites]


My BMI puts me in the morbidly obese camp and while my self esteem certainly takes a hit, it doesn't slow me down much physically -- I walk about a mile a day, regularly take four or five mile hikes on weekends, take the stairs at work, etc. No chafing, no joint pain. Just don't ask me to sprint.

I had an interesting experience last year after I counted calories a while and dropped forty pounds (over six months) -- basically I just felt wrong. My mental image of my body was badly out of sync with the reality, and I found myself deeply unhappy about that. Since then I've put the weight back on and my mind and body are once again happy together.

Ah well, it's not the only way my brain is trying to kill me. At least it's not nicotine and alcohol.
posted by tkolar at 2:17 PM on July 14, 2008 [2 favorites]


mortality from gastric bypass surgery has been reported to be as high as 2%

USPSTF guidelines
suggest that postoperative mortality rate is 0.2%, but that "re-operation may be necessary in up to 25% of patients.

That said, I feel that tertiary care for such strongly behaviorally-linked obesity-related diseases as diabetes, cardiovascular disease, colorectal cancer and the like sucks up a lot of resources which could have been better spent on primary care for exponentially more people-- especially in developing countries.
posted by The White Hat at 2:17 PM on July 14, 2008


There's a few comments here and there making bleak predictions about her future. I'd point you to the July 2008 update — she's down to 375.
posted by WCityMike at 2:18 PM on July 14, 2008


She put on 20lb in the three weeks between scheduling and going in for the surgery (550 - how many calories do you have to eat even to maintain 500lb+, let alone gain?)

over 3500kcal/day.
posted by demon666 at 2:20 PM on July 14, 2008


She's a person who was fractured in some very basic part of herself in dealing with food. Just as others find the same to be true when it comes to alcohol, tobacco, caffeine, spending, maintaining living space, responsibilities, emotions, sex, violence, pot, work, and anything else we giant hairless apes can get fixated upon.

Unfortunately, her fracture caused a very obvious and, eventually, disastrous effect to her physique, which compounded several emotional issues she appeared to already be labouring under. So, while she was working to be "strong" and "capable", she had this one area of her life where she didn't require that of herself and it bit her in the ass in a way that everyone else could see.

Any negativity you can imagine to throw her way, any judgment, she's already heard and likely tells herself the same thing. I mean, there's this:

"And sometimes I cry out of sorrow. I place my hands on my belly and I whisper to my body how sorry I am. Sorry that she’s going to have to be cut up; sorry that I couldn’t fix things on my own; sorry that I let things go so far before I asked for help; sorry that she’s hurting so much; sorry that I feel imprisoned by her; sorry that I don’t always love her or treat her the way I should. I cry and I apologize for everything that’s been done to her and for all the things to come. I cry and I thank her for being so strong and putting up with so much; asking her to hold on for just a little while longer and promising her that things will get better. I cry and I ask her to forgive me for what I have to do to her because it’s the only option I have left. Because I know it’s the best decision for me, no matter how hard it was to make."

The Fat Acceptance Movement is the same as the Binge Drinking Acceptance Movement is the same as the Smoking Acceptance Movement is the same as the...you get the idea. The broken ideas and pleading for understanding is the same for them all.

And what's wrong with that, really? It's their choice, it's their life, it's their misery. They just want you to quit judging them for their particular fracture, just like you'd like others to not judge you for yours.

Oh, sure, there's the insurance thing. But if you sit down with an actuary and break down the risky and "risky" decisions people make every day - or even just once in a lifetime - fat people no more deserve your narrowed gaze and puckered-lip "tsk tsk" than the lady with eight kids or the 40 year old smoker or that one guy who went skydiving and didn't land right. And as to resource consumption...they're pikers compared to the corporations and wealthy individuals in our world.

Their affliction is obvious and has been imbued with shame, judgment, and abuse. It has been proven time and again that none of those will ever help any person with a fracture in handling food and movement.

Encourage them to make the right choices, cheer them on when they're succeeding, avoid being part of their temptation loop, and be supportive when they are having to resist their drug when it advertised in every form of media and on every roadway and surface advertisers can get their hands on and, the hardest part of all, when food is something you have to have in order to live, so it's not like you can just go cold turkey.

Support the prevalence of workout space for all who would like to use it. Encourage your employers (if you have one) to let people make time for fitness. If you know fat people (and, if you aren't fat yourself, you're bound to have at least one fat friend or relative), offer to be a walking buddy/swim friend/DJ/dance partner so that they can have a social incentive to be uncomfortable and miserable for however long they can bear to be active.

You're dealing with people with an illness, regardless what the medical community wants to think of it. Many - MOST - fat people want a different way to cope but have no idea what or how. Sometimes, the isolation of being imperfect and incapable of battling your compulsions (or the results thereof) is so powerful that you begin to believe that you really are safer in that shell of fat and that if all of those groovy people out there are only going to be nice to you when you're not fat, you don't need to know anyone, anyway.

And if you can't do all that or any of that or you still find yourself completely bereft of even an iota of sympathy for these people for whom the basic necessity of nutrition and the beguiling temptation of good food have become warped by physique, physiology, or psychology, at least put into your own mind that if your own vices made such an obvious mark on you, you'd be going through the same thing they are.

Maybe then I can go on my walks or get my swimming in or otherwise exercise outside of my cramped apartment without someone yelling, "GO HOME FATTIE!"

Heck - there's an idea: next time you see a fat person trying to get some exercise, cheer them on and let them know it's okay to be in progress, just like 99.9% of the rest of humanity.
posted by batmonkey at 2:22 PM on July 14, 2008 [79 favorites]


As an additional note, that link to the US Preventive Services Task Force page on obesity offers some good information on best-practices for intensive counseling. It doesn't have to (and one might argue it ought not) be a cold turkey situation. Lifestyle changes are difficult and require lots of counseling and support, but they can happen (and one might argue they ought to happen) among obese adults.

Then there's the whole cultural issue...
posted by The White Hat at 2:27 PM on July 14, 2008


Shame's a pretty crappy motivator when judged on its poor success rate, and the problems caused when it doesn't motivate (insular behavior, perpetuation of the problem, etc.).

I would argue that banning smoking has a lower success rate than a society expressing distaste at the cosmetic effects of smoking: bad breath, yellow teeth, body odor. Sex appeal -- and associated shame for not having sex appeal -- has done more to proscribe smoking than any law or tax policy seen to date.

Similarly, we don't ban drinking in the United States for adults, but in addition to local laws, we do assign public shame to people who behave inappropriately with alcohol, with respect to quantity and location. Right or wrong, David Hasselhoff's cheeseburger incident, for example, does not make him a hero, but an object of public ridicule.

It's clear there's an obesity epidemic in the country. The symptoms are tragic: heart disease, type II diabetes -- increased morbidity and vastly reduced quality of life. The question is not whether to encourage overweight people to lose weight, but how. Public shame is one tactic that could work well, in counter to growing fat-positive or fat-acceptance movements that attempt to recast the problem as a non-issue.

As far as shame perpetuating hurtful behavior, I'm afraid I can't see what motivates that, other than a failure of willpower that can happen regardless of whether shame is involved. Can you explain more clearly what you mean?
posted by Blazecock Pileon at 2:27 PM on July 14, 2008


This is, unfortunately, the extreme end of the Fat Acceptance movement - the refusal to diet, refusal to acknowledge that there is a point where you are too fat, the delusion that anyone can be happy and healthy at 530lb, and that no one should ever be congratulated for losing weight.

Fat acceptance is no different than addicts trying to convince you that their affliction is a disease. Addiction isn't a disease. AIDS is a disease. Ebola is a disease. Getting shitfaced everynight because your dad kicked your ass isn't a disease, it's practicing psychiatry without a license. Put the bottle down, rummy. Put the needle down, junkie. Put the cupcake down, fatty. Etc.

The problem that people aren't understanding is that for many fat people, "fat" is not a physical description. It's an identity, just like "black" or "gay". It means more than additional mass. The reason they are fat is that they have a psychological problem which they are trying to self-medicate with food, just like other people have psychological pain they try to soften with liquor or dope.

What makes a food addiction worse than a drug addiction is that there is no going cold turkey--you have to eat to live. And not eating is itself an entirely different psychological disorder. Furthermore, one might not even realize they suffer from a food addiction until its progressed for years, when the cumulative weight gain becomes it's own problem. At that point, the person has to rebuild their entire behavior and habits with respect to food while continuing to eat a non-trivial amount of it.

What doctor-run fat support groups try to do is find a way to address the isolation that is responsible for the overeating in the first place. "Accept me as me," and once that happens, it is easier to sever the identity and the body image from the extra pounds of flesh that in no way define who you are as a person.

What fat acceptance groups on the internet do, however, is reinforce the "fat" as social identity, which implicitly mandates the person remain fat. Notice the woman here laments that links to her site were removed from other FA sites. Well, she's on her way to not being fat anymore, right? So why does she care?

Because in her mind, she's still fat. She could be 200 lbs, or 120 lbs, and she will still think of herself as fat as long as she's embroiled in those websites and chatrooms. I am telling you, unless she addresses the psychological problems deep down, she could weight 80lbs and she will have ghost pains 6 inches out from the edge of her body where the fat used to be, the way an amputee will sometimes feel a missing limb.

Worse, the FA sites will tell her she doesn't belong because she's not fat, and she will be isolated again from her peers, but this time all her peers are ostracizing her because she isn't fat anymore. Guess what she'll do to address that loneliness. She won't overeat as much because the surgery makes that very difficult, but she will overeat, and her weight loss will end when she is still at an unhealthy weight.

The fact that she found the practical difficulties of 530lbs and is proud of having lost some weight in no way addresses the underlying problems. And we know those problems are their because she gained another 20 pounds in the weeks before her surgery. Anxiety = eating. She needs to do some very hard work in therapy if she wants to keep this weight off.
posted by Pastabagel at 2:28 PM on July 14, 2008 [6 favorites]


I found it pretty disturbing that she felt such shame over letting down 'the movement' by having weight loss surgery, and the fact that she's having to come to terms with being 'that asshole who claimed to be fat-positive but had weight loss surgery anyway'.

So the fat-positive movement is like a mirror image of the pro-ana scene, and saving one's life is letting the side down? I'd always assumed it was more about railing against the societal pressure to be absurdly thin (maybe that's 'fat acceptance', and 'fat-positive' is a sort of militant wing?)
posted by jack_mo at 2:29 PM on July 14, 2008 [4 favorites]


I mostly wanted to say that I appreciate that this thread is more or less civil and respectful.

I fall in the fat acceptance/health at any size camp so I suppose many of you would consider me biased, but the main thing I think is worth trying to get across to folks who don’t share my views is this:

Fat is one area where it is completely acceptable for a bunch of strangers to sit around making moral judgments about someone they don’t know - often with a lack of basic respect or empathy, with little knowledge about the science around this issue, and with no knowledge of an individual fat person’s particular circumstances.

Even if you aren’t interested in hearing about the genetic component of body size, or about health at any size, or whatever, perhaps you’ll consider that most of the time, you really don’t know why someone is fat and you really don’t need to. Every human being is a complicated blend of experiences, choices, feelings and physical traits, and there’s no sane reason why this one particular trait – fat – should be singled out for the whole world to judge.
posted by serazin at 2:29 PM on July 14, 2008 [6 favorites]


Getting shitfaced everynight because your dad kicked your ass isn't a disease, it's practicing psychiatry without a license. Put the bottle down, rummy. Put the needle down, junkie. Put the cupcake down, fatty. Etc.

Gosh. It really is just that easy.
posted by Astro Zombie at 2:30 PM on July 14, 2008 [12 favorites]


But fat people really do seem to be the brunt of a lot of eggregious misbehavior at the hands of strangers, and a lot of it comes from the sense that they wouldn't have this problem if they'd just steer clear of the twinkies.

Except that if by "steer clear of the twinkies" you mean "eat healthy" then most most fat people wouldn't have the problem if they'd steer clear of the twinkies.

Look, I am about 15 pounds overweight. Down from 20 pounds overweight. You know why? Because I really fucking love chocholate chip ice cream and double-double cheeseburgers from In-n-Out and I really fucking hate exercising. I'm not going to make excuses; I ate lots of junk and I stopped exercising much. That's it. And that's true for most people who are 20 pounds overweight. It's also true of most people who are 200 pounds overweight.

What is wrong with saying that I gained 20 pounds because I like eating junk and not exercising? Now I'm eating less and exercising. Yes, it's hard not to eat the twinkies. Yes, it's hard not to eat that In-n-Out burger double double with grilled onions with a side of fries and a vanilla shake. That doesn't mean the solution is to pretend that the problem is somehow not that people like to eat double-doubles with fries and a vanilla shake.
posted by Justinian at 2:33 PM on July 14, 2008 [2 favorites]


Gary Taubes, a science researcher, believes that overweight is a hormonal disorder, not a matter of "eating too much." The disorder of obesity, in his opinion, is caused by carbs (really the insulin response to those carbs) but the big idea is that it's not a question of willpower. Just as children grow vertically and have appetites to match, fat people grow fat and have appetites to match. It's not that kids grow because they eat so much, it's the other way around. Same thing with obese people.

Taubes's lecture at Berkeley.
posted by callmejay at 2:34 PM on July 14, 2008 [6 favorites]


Ah, I see all my questions were answered while I went off to, er, make a sandwich before hitting 'Post Comment'.
posted by jack_mo at 2:35 PM on July 14, 2008


Gosh. It really is just that easy.
posted by Astro Zombie at 5:30 PM on July 14


Says the guy whose website is currently featuring a picture of him holding a 2/3's empty bottle of Bombay Sapphire gin.

Cheap shot, I know, but I couldn't resist.
posted by Pastabagel at 2:36 PM on July 14, 2008


And that's true for most people who are 20 pounds overweight. It's also true of most people who are 200 pounds overweight.

Do you have references for that statement? You seem very sure of it.
posted by tkolar at 2:36 PM on July 14, 2008 [2 favorites]


I got as far as "overly performed".
posted by joe defroster at 2:37 PM on July 14, 2008


Oh, sure, there's the insurance thing. But if you sit down with an actuary and break down the risky and "risky" decisions people make every day - or even just once in a lifetime - fat people no more deserve your narrowed gaze and puckered-lip "tsk tsk" than the lady with eight kids or the 40 year old smoker or that one guy who went skydiving and didn't land right. And as to resource consumption...they're pikers compared to the corporations and wealthy individuals in our world.

Not so fast there, batmonkey. 1.7 trillion spent on healthcare in 2003. $1 in $10 went to the treatment of diabetes alone in 2002 (to say nothing of CHD, which accounted for 19% of days spent in hospital. A little mental math suggests that the cost of DMII alone is $170,000,000,000. Bill Gates is worth $20 billion. I can handle a couple pikers, but when they all get together they start sucking resources.
posted by The White Hat at 2:38 PM on July 14, 2008 [2 favorites]


serazin: "I mostly wanted to say that I appreciate that this thread is more or less civil and respectful."

Serazin, without challenging your individual right to handle things in your life as you see fit, would you be willing to expound in the more theoretical sense (as opposed to making it personal and being nosy about your life) on the main point most people are bringing up?

Basically, I've never understood what evidence, rationale, supporting argument, etc. the fat acceptance movement has used to counter the position that to be obese and overweight is to be unhealthy. I'd like to hear what it is, not necessarily for the purposes of a challenge-debate situation but just for learning purposes, i.e., knowing the structure of a viewpoint in this subject other than my own.
posted by WCityMike at 2:40 PM on July 14, 2008


The disorder of obesity, in his opinion, is caused by carbs (really the insulin response to those carbs) but the big idea is that it's not a question of willpower

Hush now. The first rule of Metafilter is that behavior is determined solely by willpower. We determine our own futures from an abstract place not tied to biology in any way. We are not machines, damnit!
posted by tkolar at 2:41 PM on July 14, 2008 [1 favorite]


Getting shitfaced everynight because your dad kicked your ass isn't a disease, it's practicing psychiatry without a license. Put the bottle down, rummy. Put the needle down, junkie. Put the cupcake down, fatty. Etc.

....so it should also be quite easy to stop being ignorant, then?
posted by Debaser626 at 2:41 PM on July 14, 2008 [7 favorites]


Gary Taubes, a science researcher, believes that overweight is a hormonal disorder, not a matter of "eating too much."

If you input more calories than your body metabolizes, then your body will store the remaining calories as fat. If you believe Taubes on the basis of his being a science researcher, you should believe what I say, as well, as neither of us have a proper background in medicine.
posted by Blazecock Pileon at 2:42 PM on July 14, 2008 [1 favorite]


RTFA, people:
1. When I say I don’t believe in “dieting” I mean I don’t believe in Weight Watchers, Jenny Craig, Nutrisystem, etc. Because most people gain the weight back once they stop “dieting.” God knows I did! Just because I don’t believe in the diet industry doesn’t mean I don’t believe in eating healthy and exercising. Just because I don’t believe in the diet industry now doesn’t mean I haven’t tried every single diet in existence before making the decision to have surgery.

2. When I said that it’s possible for someone to weigh 530 pounds and be happy and healthy? I said that because it’s not my place to judge the health or happiness of others. I’m not going to make a blanket statement saying “X>certain weight, therefore X = unhealthy and miserable.” If someone weighs 530 pounds and says they’re happy and healthy, who the fuck am I to disagree? I’m not them and I’m not their doctor so it’s not my place to scream about how impossible that must be.

3. Perhaps the Fat Acceptance movement wouldn’t have to exist if people weren’t so quick to tell folks that they should die/kill themselves/are worthless/useless/etc. simply because they’re fat. You’re pretty much proving its necessity by harassing and threatening the people who belong to it.
posted by designbot at 2:45 PM on July 14, 2008 [5 favorites]


wow. a double pity party with fatty culture kowtow sprinkles and a side of gross-me-the-fuck-out. yum.

You're a very clever asshole.

And I'm going to go way out on a limb here and guess that you guys in the "just put the needle down, dude" camp don't know what it feels like to wake up first thing in the morning when you have a $400 a day drug habit. The decision tree doesn't have many branches at that point. Choice is a pretty meaningless concept when there's an air raid siren accompanying flashing neon signs saying "DOPE DOPE DOPE" going off in the lizard brain.
posted by The Straightener at 2:45 PM on July 14, 2008 [12 favorites]


I can't speak for anyone else, but I have first-hand experience which suggests some kind of corollary between decisions I make and my weight.

I am willing to extrapolate from my sample size of 1 and propose that for some people, there is some kind of corollary between decisions they make and their weight.
posted by everichon at 2:46 PM on July 14, 2008


And that's true for most people who are 20 pounds overweight. It's also true of most people who are 200 pounds overweight.

I'm curious about this. I've struggled with my weight quite a bit and firmly believe in taking full responsibility for my weight, but I'm not sure I could ever become 200 lbs overweight even if I tried. I would be shocked if there aren't other things in play once you reach that level of overweightness.
posted by specialfriend at 2:46 PM on July 14, 2008


But callmejay, Taubes does not say that obesity is inevitable/OK, he just says the mainstream diet/exercise story is wrong. According to Taubes it's not calories in/calories out that matters, it's the kind of food that matters. Advice I'm sure Heidi and others could benefit from because it frees you from starving yourself. On her blog some of the foods she mentions make me cringe for her pancreas. Tres Leches cake? My blood sugar would diiiiiiiiiiiiie.
posted by melissam at 2:50 PM on July 14, 2008 [1 favorite]


And I'm going to go way out on a limb here and guess that you guys in the "just put the needle down, dude" camp don't know what it feels like to wake up first thing in the morning when you have a $400 a day drug habit.

I don't know what a $400 a day drug habit is like, but I do know what compulsive, joyless eating is like. As far as trying to understand the difference between the two situations, I'd ask you if there is a Dope Acceptance movement, while we know there are Fat Acceptance and Fat Positive movements. I think there's a social component there that helps perpetuate the problem.
posted by Blazecock Pileon at 2:50 PM on July 14, 2008


The lack of empathy demonstrated by many in this thread is appalling but not unexpected.

Still, if you haven't struggled with addiction, it's quite difficult to understand the power it has.

And unlike practically every other form of addiction, you cannot go cold turkey from food. So, you see, no matter how far you back up the road to health and normality, you're still always standing on that fucking slope: ever so eager to welcome you back down with a greasy hug from its fat draped, maggoty arms.

Yeah, I've been there. And I'm mostly better now.
posted by seanmpuckett at 2:51 PM on July 14, 2008 [1 favorite]


I'd ask you if there is a Dope Acceptance movement,

We don't need one. Dope is cool. Drugs are cool.
posted by tkolar at 2:51 PM on July 14, 2008



....so it should also be quite easy to stop being ignorant, then?
posted by Debaser626 at 5:41 PM on July 14


About as easy as detecting sarcasm. I wasn't saying addiction wasn't serious, I was saying that if drug addiction is a serious problem, so is food addiction. But in my opinion neither addictions are diseases themselves, they are both very damaging mechanisms for coping with some other psychological problem.

I didn't mean to trivialize any addictions, only to place food addiction on par with other well-recognized addictions.

And the fact that two people misunderstood the same comment in the same way means the problem is my shitty writing, so I owe Astro Zombie an apology for my comment above as well.

ducks
posted by Pastabagel at 2:51 PM on July 14, 2008 [2 favorites]


Me: "anybody who's gained just 10-15 unwanted pounds can understand how a person can get that fat."

I totally disagree with that.

my point was unwanted weight gain. Having gained 10 unwanted pounds (twice), I know what the denial process is.

I'll deal with it later.
Shit, what's another pound anyway.
I don't care any more.
Fuck it. If I'm going to be fat I might as well be happy.
posted by yort at 2:55 PM on July 14, 2008


The White Hat:

That's not a rebuttal. That's an incomplete data point.

Fat people are not the only portion of the population with diabetes. All types of diabetes are rising, even the ones that those acceptably slender folks and cute widdle kids get. Not even all people who are diabetic for making poor food choices are fat.

I've personally got two dead friends and one dead relative who were normal weight diabetics. Only one was killed by diabetes directly. He wore size 32 jeans and used cigarettes, alcohol and bad food to bury his feelings of worthlessness. No one would ever have shamed him for his afflictions, because being a slender person who smokes, drinks, and loves Jack in the Box is A-OK, even if you do spend your insulin money on gaming books and tacos.

You're wrongly confusing a symptom - obesity - with (multiple) causes and coping disorders.

"Damn it, Otto, you have Lupus." - Mitch Hedberg
posted by batmonkey at 2:55 PM on July 14, 2008 [1 favorite]


We don't need one. Dope is cool. Drugs are cool.

I guess. Maybe people form that idea in their head, because they don't get to meet junkies, except on street corners, or they shuffle off their family members to rehab and wipe their hands of the situation. Or its a mindless response to authority, or perhaps its boredom, and people get sucked into the drug scene. Not sure that's quite the same, in any case.
posted by Blazecock Pileon at 2:56 PM on July 14, 2008


New York Times: “It is entirely possible that weight reduction, instead of resulting in a normal state for obese patients, results in an abnormal state resembling that of starved nonobese individuals.”
The results did not mean that people are completely helpless to control their weight, Dr. Stunkard said. But, he said, it did mean that those who tend to be fat will have to constantly battle their genetic inheritance if they want to reach and maintain a significantly lower weight.

The findings also provided evidence for a phenomenon that scientists like Dr. Hirsch and Dr. Leibel were certain was true — each person has a comfortable weight range to which the body gravitates. The range might span 10 or 20 pounds: someone might be able to weigh 120 to 140 pounds without too much effort. Going much above or much below the natural weight range is difficult, however; the body resists by increasing or decreasing the appetite and changing the metabolism to push the weight back to the range it seeks.

The message is so at odds with the popular conception of weight loss — the mantra that all a person has to do is eat less and exercise more — that Dr. Jeffrey Friedman, an obesity researcher at the Rockefeller University, tried to come up with an analogy that would convey what science has found about the powerful biological controls over body weight.

He published it in the journal Science in 2003 and still cites it:

“Those who doubt the power of basic drives, however, might note that although one can hold one’s breath, this conscious act is soon overcome by the compulsion to breathe,” Dr. Friedman wrote. “The feeling of hunger is intense and, if not as potent as the drive to breathe, is probably no less powerful than the drive to drink when one is thirsty. This is the feeling the obese must resist after they have lost a significant amount of weight.”
posted by designbot at 2:56 PM on July 14, 2008 [8 favorites]


I've never understood what evidence, rationale, supporting argument, etc. the fat acceptance movement has used to counter the position that to be obese and overweight is to be unhealthy

From a medical perspective the most common argument I've seen is that many of the links between obesity and diseases like heart disease are not causal, but that many people assume causation when only correlation has been proven.

I think in general the less wacky people in the movement are just trying to stand up and denounce people that treat fat people (especially women) as lesser life forms. Some of the comments in this thread show some of the condecending attitudes towards fat people that exist but really this is pretty tame considering the usual level of discourse.

I know it's not the best analogy, but from my perspective the worthwhile part of the FA movement is similar to the support given to gay people with AIDS when it was seen as only being a problem in the gay community. It's less about saying that everything is great and nobody needs to worry about anything, and more about trying to stop human beings from being treated like subhuman scum.
posted by burnmp3s at 2:59 PM on July 14, 2008 [4 favorites]


or about health at any size,

As seen in this post, there are some sizes that are just not healthy.
posted by Brandon Blatcher at 3:00 PM on July 14, 2008


Fat is one area where it is completely acceptable for a bunch of strangers to sit around making moral judgments about someone they don’t know - often with a lack of basic respect or empathy, with little knowledge about the science around this issue, and with no knowledge of an individual fat person’s particular circumstances.

This is not true. Individuals--and the state--make moral judgments all the time on the basis of identity. The demonization of homeless persons and "welfare queens", gay marriage referendums, the scaling back of affirmative action, etc, etc.....most civil rights issues come from a place of moral judgment with, as you put it, "no knowledge of an individual['s] particular circumstance."
posted by youarenothere at 3:02 PM on July 14, 2008 [1 favorite]


Mostly, I think anyone’s body size (or height, or skin color, etc) is none of anyone else’s business. But here’s where I’m coming from in my personal ideology about body size:

1) Certain health conditions are associated with certain physical traits. For example, tall people die younger. And we now know that environment influences height. Yet we never judge tall people for their irresponsible, tall lifestyle choices. Moralism about fat is not based on “fact” or “science”, its based on social expectations that are unevenly applied.

2) Many of the health problems associated with fat may actually be caused by other factors – activity level and quality of diet – rather than the presence of fat. Studies have not been clear on this and there is evidence both ways. I find this convincing.

3) There is NO PROVEN, EFFECTIVE METHOD FOR SIGNIFICANT LONG-TERM WEIGHT LOSS. Show me a study that shows a large group of participants loosing a significant amount of weight and keeping it off for a significant length of time. As far as I know, there is no study of this nature. To borrow from Marlyn Wan, take the challenge of 3’s: Find 3 people who have lost 30 pounds (or more) and kept it off for 3 years (or more). Personally, I can’t think of a single person I know who meets these criteria – and I hang out with a lot of fat folks.

4) Related, there is good evidence that body size has a strong genetic component. People may have little control over their size.

So my thinking comes down to this: let’s work on helping people get high quality, nutritious food, making exercise accessible for more people, and treating everyone we meet with kindness and respect.


See also the books Big, Fat, Lies and Rethinking Thin.
posted by serazin at 3:04 PM on July 14, 2008 [7 favorites]


let's stop discriminating against the poor and/or ugly while we're at it. all aboard the space ship equality. next stop alpha centauri.
posted by breakfast_yeti at 3:06 PM on July 14, 2008


This was a powerful link for me, especially today. I am making the decision right now about the same surgery. I am filled with words, feelings and thoughts about this place in life I find myself. Many of you simply will never understand (and some of the comments prove this).

For those that do, and for those like the blogger who are facing life as a fat person, God speed.
posted by UseyurBrain at 3:07 PM on July 14, 2008 [3 favorites]


the space ship equality does have some seating restrictions, however.
posted by breakfast_yeti at 3:07 PM on July 14, 2008 [2 favorites]


On her blog some of the foods she mentions make me cringe for her pancreas. Tres Leches cake? My blood sugar would diiiiiiiiiiiiie.

Her description of having to shred her meat and mix it with mayonnaise in order to eat it leads me to the conclusion that she doesn't really Get It with regard to healthy eating, never mind her protests to the contrary.

I'm afraid I don't really get Fat Acceptance, though I've tried, as there are many obese people in my family, some of whom have decided that FA is up their alley. I just can't see how it's much different, pathologically and psychologically speaking, than the pro-Ana movement.
posted by padraigin at 3:07 PM on July 14, 2008 [2 favorites]


All other things being equal, fat people use more soap.

or not...
posted by quonsar at 3:07 PM on July 14, 2008 [1 favorite]


Blazecock Pileon:
"I'd ask you if there is a Dope Acceptance movement, while we know there are Fat Acceptance and Fat Positive movements. I think there's a social component there that helps perpetuate the problem."

Sure, there's a Dope Acceptance Movement. Amy Winehouse and her mates are members of that movement. My dad and his buddies were a member of that movement. Anyone who gets themselves into a social group that validates and enables poor decision-making and coping when one is struggling with a destructive compulsion fits that bill.

Got at least one pal who you can share that secret pleasure with? Know of at least one song or t-shirt or bumpersticker or movie that makes it seem like you're part of some sick/brave club for whatever your vice is? You're part of a movement of enabling yourself to think there's nothing wrong with what you're doing.

There's *always* a social component that helps perpetuate the problem.

Worse, though, is that once the social component is gone (and, at some point, it generally will be), these same people will continue doing damage to themselves all alone, because now they've fulfilled every negative prophecy they or anyone else has ever made about them.

Like yort was saying, it goes something like:
"Fuck it. They were right anyway. I'm worthless. May as well keep doing this wholly destructive thing and just let it end where it will."

When you're being judgmental, snarky, mocking, negative, hateful, abusive, shaming, or whatever to a person trying to unlearn their bad coping habits/decision-making patterns, you're just reinforcing them back into that frame of mind, no matter how much they'd like it to be different.

And, really, who in the world could possibly imagine that positivity could result from negativity? Unless you're trying to make a person into the human equivalent of sodium chloride, being negative to someone with this kind of issue is only going to make it harder for them to simply make the right decisions.

No one likes to be judged, blamed, or abused. We are hard-wired to react to these emotions unproductively. Why make it harder on a person who already has issues so deep that they would feel helpless or so in need of comfort that they would accept harming their body and limiting their lives so drastically?

I'll never understand it.
posted by batmonkey at 3:11 PM on July 14, 2008 [11 favorites]


Public shame is one tactic that could work well, in counter to growing fat-positive or fat-acceptance movements that attempt to recast the problem as a non-issue.

Is the fat-acceptance movement really that prominent or such a force that it even registers with the vast majority of overweight people? I just don't see it as being something so powerful that it needs combating.

Extreme morbid obesity must often stem from psychological problems (or cause psychological problems that perpetuate the problem). If it is the case that extreme morbid obesity is connected to psychological issues (I don't know that it is, it just seems like a reasonable assumption), I don't see how shame would work.

Severely overweight people already deal with constant shame anyway, so shame is clearly not having a great effect on curbing the obesity epidemic in the United States (and increasingly in other developed countries). It also just seems really really mean and heartless to "shame" overweight people who already probably struggle constantly with how they look.
posted by Falconetti at 3:14 PM on July 14, 2008 [2 favorites]


Her description of having to shred her meat and mix it with mayonnaise in order to eat it leads me to the conclusion that she doesn't really Get It with regard to healthy eating, never mind her protests to the contrary.

Or perhaps you don't get it, with respect to post-surgery diet for the operation she had?

My sister-in-law went down this route, and the dietary changes are significant and often counter-intuitive.
posted by tkolar at 3:15 PM on July 14, 2008 [3 favorites]


Do you have references for that statement? You seem very sure of it.

You want a reference for the idea that you gain weight when you consume more calories than you burn, and you consume calories by eating them? I guess I can repost the first law of thermodynamics.
posted by Justinian at 3:18 PM on July 14, 2008 [8 favorites]


Relatively rare for me, but I'm skipping reading this thread and tacking my comment on here at the end.

I was really surprised by how not-surprising all this was. Apparently my assumptions about hugely fat people were pretty much right on the money in her case. That's a little creepy.
posted by Shutter at 3:21 PM on July 14, 2008


The number of posts in this thread demonstrates just how much anti-fat energy there is in society.

Can you imagine if all that energy, that contempt, that disgust, could be directed at the actual reasons for the recent increase in fatness? At McDonalds, and Cargill, and the farm bill structure? If it was as socially unacceptable to walk into a Jack in the Box, skinny or fat or neither, as it currently is to weigh 500 lbs?
posted by gurple at 3:22 PM on July 14, 2008 [4 favorites]


take the challenge of 3’s: Find 3 people who have lost 30 pounds (or more) and kept it off for 3 years (or more).

Well, I'll be the first of 3. Lost about 70 lbs around 2001ish, kept it off since then.

It's a bit of a nuisance watching your weight, but not that difficult.

The thing, most people who want to lose a few pounds don't join up for studies, they just put down the twinkies. Hence the studies tend to be of people who already have difficulty losing weight.
posted by TheophileEscargot at 3:22 PM on July 14, 2008 [1 favorite]


You want a reference for the idea that you gain weight when you consume more calories than you burn, and you consume calories by eating them? I guess I can repost the first law of thermodynamics.

Hah hah! That's clever!

No, I was looking for a reference for this statement:

I ate lots of junk and I stopped exercising much. That's it. And that's true for most people who are 20 pounds overweight. It's also true of most people who are 200 pounds overweight.

I generally buy your statement for people who are 20 pounds overweight, because it matches my experience. My experience with people who are 200 pounds overweight does *not* match that -- I find that they often eat reasonably and exercise, but remain overweight.

However, had I realized that your expertise was in thermodynamics and not diet and nutrition, I wouldn't have bothered to ask for a references. So sorry.
posted by tkolar at 3:24 PM on July 14, 2008 [1 favorite]


I don't see how shame would work.

I don't see how pride would work. Americans love indifference and solutions that don't require any effort, even better if they are made to feel proud for getting fatter, which is where our society's weight regression line goes. I would see how pride would make the obesity epidemic worse.
posted by Blazecock Pileon at 3:24 PM on July 14, 2008


Can you imagine if all that energy, that contempt, that disgust, could be directed at the actual reasons for the recent increase in fatness? At McDonalds, and Cargill, and the farm bill structure? If it was as socially unacceptable to walk into a Jack in the Box, skinny or fat or neither, as it currently is to weigh 500 lbs?

Even better: All that corn syrup could help feed our independence from foreign oil, instead, and we could go back to a locally-sourced, organic diet, with even fewer petrochemicals involved. Imagine the numerous and wonderous possibilities of a healthy change in diet.
posted by Blazecock Pileon at 3:27 PM on July 14, 2008


You want a reference for the idea that you gain weight when you consume more calories than you burn, and you consume calories by eating them? I guess I can repost the first law of thermodynamics.
posted by Justinian at 3:18 PM on July 14 [+] [!]


The relationship between calorie and fat intake and body weight is not clear.
posted by serazin at 3:28 PM on July 14, 2008 [1 favorite]


That's not a rebuttal. That's an incomplete data point.

You're right, but your offering of anecdotes doesn't even come close to addressing the fact that even if we treat my numbers as a fermi calculation, I'm still probably in the correct order of magnitude, which is to say billions of dollars. I'll do one more back-of-the-envelope demonstration, but any more wild guesses will cost my standard research rate of one cold Yuengling per hour.

25% of adult Americans are obese (BMI=>30 [USPSTF]). This site suggests that 80% of obese patients have one or more of the following comorbidities:
* Diabetes.
* Dyslipidemia.
* Coronary-artery disease, hypertension.
* Gallbladder disease.
* Osteoarthritis.

This website provides even more detailed information: "46 percent [of DMII patients] have a BMI greater than 30." To go back and revise my numbers, then (and this is assuming that all DMII cases cost about the same), $170,000,000,000 x .46 = $78,200,000,000, or nearly four Bill Gateses, and I can guarantee you that very few of those patients have such wonderful foundations. This is to say nothing about the other comorbidities, but I don't see any Yuengling around here so you'll have to work those totals out for yourselves.

To reiterate, then: 1) obesity sucks up a lot of healthcare resources. 2) It's extremely difficult but also very possible for an obese person to get down to a healthier weight, and even more possible for effective educational programs to prevent a great deal of obesity (11% in children now, if I recall correctly). 3) I think they all ought to.
posted by The White Hat at 3:30 PM on July 14, 2008 [1 favorite]


Why is over consuming food "acceptable" and over consuming oil, or electricity, or money (or even alcohol and tobacco) not acceptable?

Could it be people who drive Humvees, own 20,000 square foot mini-mansions in the suburbs, and own boats, and four wheelers are simply filled with shame? Just like morbidly obese people?

We judge obscene conspicuous consumption fairly harshly. In light of living a world with so much poverty it seems rather perverse. But eating 12,000 calories a day when there are BILLIONS of people who can barely get 500 calories a day... that's okay?

Or could it be that it's all part of the same over consumption continuum. And it's not only killing us as individuals, but it's killing the planet. This sentimental notion of blind "acceptance" is really not much of an option once you see it all like that.

I saw nothing in that blog that even attempted to address this equation. Or even the most important part of it... WHY? HOW?

No. it just happens. And when it does it's all supposed to be okay. Even though plainly we can see in this poor woman's horrific story and in the scientific evidence of what obesity is doing to our society that it is not okay.
posted by tkchrist at 3:32 PM on July 14, 2008 [2 favorites]


*huggles* you made the right choice for you!
posted by speedo at 3:33 PM on July 14, 2008


Could it be people who drive Humvees, own 20,000 square foot mini-mansions in the suburbs, and own boats, and four wheelers are simply filled with shame? Just like morbidly obese people?

Whenever I see someone drinking a Coke I think of them as sitting rather comically in the driver's seat of a little tiny Hummer.

Then again, I'm an asshole that way.
posted by gurple at 3:34 PM on July 14, 2008


Can you imagine if all that energy, that contempt, that disgust, could be directed at the actual reasons for the recent increase in fatness? At McDonalds, and Cargill, and the farm bill structure? If it was as socially unacceptable to walk into a Jack in the Box, skinny or fat or neither, as it currently is to weigh 500 lbs?

You can't be serious. Now availability of cheap food is the problem? What about convenience stores? They sell unhealthy food. What about making supermarkets put everything that isn't strictly healthy up on REALLY high shelves?

There is nothning wrong with eating a burger. There is nothing wrong with Jack in the box (except that fucking stupid man thing they have), but there is something wrong with only eating Jack in The Box. This is a perfect example of people needing to take responsibility. Providing the food that people want to eat is not a bloody crime, and so your energy diversion is totally misguided.

Jack in the box and McDonalds are NOT the reason people are fat. What rubbish and responsibility avoidance that is.
posted by Brockles at 3:35 PM on July 14, 2008 [3 favorites]


I find that they often eat reasonably and exercise, but remain overweight.

Are you a doctor? A nutritionist? Or a researcher? That is not what study after study has demonstrated.
posted by tkchrist at 3:35 PM on July 14, 2008


I don't see how shame would work.
I don't see how pride would work.

While I have to agree that pride in being fat would be partially counterproductive, the absence of shame would offset that in a big way.

As this thread shows, there's nothing like ashamed human beings to bring out the bullies. There are posters in this thread advocating the idea of kicking people while they're down -- and really, the world could use a lot less of that.

Basically, I'd rather have the problem of talking people out of misplaced pride than having to try to assure them that they won't be verbally attacked if they dare to go out in public.
posted by tkolar at 3:37 PM on July 14, 2008


So my thinking comes down to this: let’s work on helping people get high quality, nutritious food, making exercise accessible for more people, and treating everyone we meet with kindness and respect.

<>
posted by Flipping_Hades_Terwilliger at 3:38 PM on July 14, 2008


I don't see how shame would work.

I don't see how pride would work.


It is not zero sum, nor did I mean to imply that. Those are not the only two options and I think the fat pride movement in its extreme manifestations is delusional and unproductive. I also said that shame wouldn't work in the context of extreme morbid obesity being connected with psychological problems like depression..

All the evidence you've given towards shame being an effective tool in combating rising obesity has been generalized as ways in which societies attempt to control the behavior of its members. While this is absolutely true it does not follow that shame is an effective response in all such situations. As this thread demonstrates, people generally don't have any compunctions in shaming the extremely morbidly obese and while I don't have any studies at my fingertips, I think most would agree that society already shames and shuns the obese. Based on this and its lack of stemming the tide of rising obesity, my layperson's guess would be that shaming would not be effective in the particular circumstance of convincing individual obese people to stop being obese or in functioning as a general deterrence towards reducing the overall number of obese people.
posted by Falconetti at 3:38 PM on July 14, 2008


That <> was meant to encapsulate the word "applause". That'll teach me to use pseudo-HTML.
posted by Flipping_Hades_Terwilliger at 3:38 PM on July 14, 2008


Now availability of cheap food is the problem?

Yes. And yes, of course I'm serious. When the cheapest calories are also the least healthy, there is a problem.

There is nothning wrong with eating a burger. There is nothing wrong with Jack in the box

There are a great many reasons to disagree vehemently with you on both of those points, and I do, but the one that's most relevant to the discussion is this: if fast food places didn't/couldn't market their filth so aggressively, not as many people would eat so much of it. You can talk about personal responsibility until the cows come home, but that's only part of the equation.

Really, though, fast food is just the outlet. It's the whole food supply that's messed up.
posted by gurple at 3:38 PM on July 14, 2008 [2 favorites]


The opposite of shame is not acceptance.
posted by tkchrist at 3:39 PM on July 14, 2008 [2 favorites]


Skimmed the comments. Just a few points to add:

1). Isn't the idea that obesity is mainly some kind of genetic, hormonal abnormality given the lie by the fact that morbid obesity was extremely rare only several decades ago? I have no doubt that there are genetic factors that predispose some people toward obesity. But those factors were also present in the population 100 years ago, yet people managed to stay thin, at least relatively so. The thing that's changed is the availability of satisfying, high-calorie food -- not the rate of hormonal imbalances or genetic predispositions.

2). Sure, there might not be a direct causal link between being fat and having heart disease, or diabetes, or stroke, or any of the other assorted ailments that are commonly associated with morbid obesity. But in reality, the correlative link between being grossly obese and having at least some condition that disposes you toward terrible health problems and early death is so high that it would be ridiculous for anyone to assume that because being obese doesn't necessarily imply poor health, he or she might be one of the fractionally minuscule percent of the population that can carry a ton of extra weight and yet somehow remain completely healthy. Correlation may not equal causation, but in practice, they're often one and the same.
posted by decoherence at 3:39 PM on July 14, 2008 [9 favorites]


I find that they often eat reasonably and exercise, but remain overweight.
Are you a doctor? A nutritionist? Or a researcher?


Nope, just a personally interested observer and reader of medical literature.

That is not what study after study has demonstrated.

Studies like the ones that serazin pointed out above?
posted by tkolar at 3:40 PM on July 14, 2008


Jack in the box and McDonalds are NOT the reason people are fat. What rubbish and responsibility avoidance that is

Actually Jack and Ronald are pretty much to blame for everything
posted by freshundies at 3:43 PM on July 14, 2008


if fast food places didn't/couldn't market their filth so aggressively, not as many people would eat so much of it.

Now advertising is to blame as well? What rubbish. There can be no people in this (1st) world that doesn't know that fast food is bad for them. But now you are suggesting that seeing enough adverts makes it irresistible to eat bad food?

That's even further down the 'blaming everyone else' path that it is laughable. Advertising doesn't make people eat. It may make them choose something else to eat, but it doesn't make them hungry - the problem is it may make them THINK they are hungry, but being easily led by advertising is a human failing of the consumer, not of the advertiser.
posted by Brockles at 3:44 PM on July 14, 2008 [2 favorites]


Blazecock Pileon: Public shame is one tactic that could work well, in counter to growing fat-positive or fat-acceptance movements that attempt to recast the problem as a non-issue.

If public shame worked in regards to healthy body weight, the obesity epidemic would have been nipped in the bud in the 70s and 80s.

Blazecock Pileon: If you input more calories than your body metabolizes, then your body will store the remaining calories as fat. If you believe Taubes on the basis of his being a science researcher, you should believe what I say, as well, as neither of us have a proper background in medicine.

Except that the math just doesn't add up. Even 200 lbs of fat over 10 years is only 2% more energy per day than someone who maintains a stable weight over the same period. And, you have to deal with the messy problem that medical trials have found a less than 50% long-term success rate for loosing weight for compliant people under medically supervised diets. Even the best case, of a person with medical support and significant nutritional counseling, diets and exercise programs are only marginally effective for long-term weight loss. The findings in the peer reviewed research has been consistently dismal on this point. Exercise and diet does have other substantial health benefits beyond weight loss, but at this point in time, using body weight as a metric for success in terms of diet and weight loss is clearly junk science.

Blazecock Pileon: As far as trying to understand the difference between the two situations, I'd ask you if there is a Dope Acceptance movement, while we know there are Fat Acceptance and Fat Positive movements.

Well, I'll gladly throw my hat in the ring as a person who argues that the current approach to substance abuse makes the problem much, much, worse. And a medical approach to dealing with substance abuse that doesn't treat addicts as criminals or deviant, with possibly even the option of continued maintenance dosage under medical supervision as an alternative to cold-turkey counseling would ease a number of medical and social ills.

And likewise, I've seen what big heapings of shame have done to family members who were medically obese, all it did was give someone I love a pretty severe long-term mental illness which has done as much to destroy her health as her weight.

So I came to a very ugly realization. The "shame" position is little more that a license for people to be abusive fucks.
posted by KirkJobSluder at 3:45 PM on July 14, 2008 [17 favorites]


I am always curious about the trajectory from big to massive, from obese to "super-obese" as it is known now. That is, does one truly not notice the change, even without a scale, from 225 to 275 or something similar? Because when we weigh people in this range they express genuine, profound shock and amazement at the change, as if they truly had no idea or worse yet had no reason for alarm at 250 but now, at 310, well, maybe it's time for a change.

That said, weight loss surgery is, on a population based level, the only workable solution. Good studies will show time and again that lifestyle will not work. And surgery is incredibly cheap in the medium and certainly long term. If you're worried about the cost of health care you should be handing out business cards for bariatric surgeons wherever you go and find someone tipping the scales at a 40+ BMI, which is pretty much everywhere nowadays.
posted by docpops at 3:47 PM on July 14, 2008


I'm not part of the Fat Acceptance Movement, but many here are confused about something:
Acceptance = accepting that other people's fucked up coping mechanisms are just as valid as yours and don't warrant abusing, shaming, or judging the person as unfit for existence. That's all it means.

It doesn't mean you have to suddenly have fat people in your home or anything. God knows they'd probably just break the furniture and eat your dog, amirite? Just quit picking on them and give them room to heal emotionally so that they can be strong enough to do the hard work of healing physically and psychologically.

Over-consumption IS bad. All over-consumption of ANYTHING. Picking on fat people just because it's been okay for a few hundred years in this society doesn't make them the only over-consumers and certainly doesn't make it right.

There are probably a couple of slender freegans living in power-free yurts in here. You guys are off the hook. Everyone else: you're probably part of the problem, too. Those of you up on the anti-fattie high horses are just giving yourselves permission to have a segment of humanity you get to be an asshole toward. Maybe you'll never accept that about yourself, but it's okay - we've accepted it for you.

Is stubbornly driving a Hummer after having a $300 dinner at the steakhouse as worthy of shame and disgust as a wage slave soothing the inequities of existence with a double cheesburger? I don't know. I can't answer that question. But I do know that I don't make it a practice to increase the misery of those who are already miserable.

Anti-obese-person bias is so extreme that the logical conclusion available in this study - psychiatric disorders and obesity are often found together - is warped to make it so that the obesity *causes* the disorders. I hope I don't need to explain that the opposite is more true, but with articles like that, maybe I do.

Shame does not work. The linked article focuses on teens, but I can tell you directly that it's true for adults and small children, too.

Being a good role model, encouraging movement and healthier choices, not being a hypocrite - these are all way better (and far more effective) approaches to helping obese people come to a better state of mind and body.
posted by batmonkey at 3:47 PM on July 14, 2008 [15 favorites]


I don't see how pride would work. Americans love indifference and solutions that don't require any effort, even better if they are made to feel proud for getting fatter, which is where our society's weight regression line goes. I would see how pride would make the obesity epidemic worse.

"Acceptance" isn't the same as "pride." I just think most fat people know that they're fat, and that their doctors are probably better people to talk to them about their health than you or me.

I think a lot of stuff the Fat Acceptance people say makes sense from a political standpoint, but it's really not a belief system that makes total sense. Like, giving people shit for trying to drop some weight for health reasons doesn't make a lot of sense to me.

I really, really, don't think putting on 20 lbs. through inattentive eating and slacking off at the gym isn't the same as weighing 530 lbs.. There's a huge difference between shopping at Lane Bryant and not being able to walk because your body literally can't support your weight, and there were obviously mental health factors that caused a lot of that. (I'm not assuming, she talks about seeing a therapist, etc., in some of her older posts.)

It was a really interesting read, and I'm glad she's getting better.
posted by SoftRain at 3:47 PM on July 14, 2008


[Advertising] may make them THINK they are hungry, but being easily led by advertising is a human failing of the consumer, not of the advertiser.

On the individual level, you have a point, and if you want to walk around pointing your finger at individual people and saying "BAD fat man" in a stern voice, far be it from me to stop you.

At the level of large groups of people, whether advertising makes people hungry or makes people THINK they are hungry, or if there's even a discernable physiological difference between the two, is largely irrelevant.

Well-marketed, cheap, unhealthy food will lead to more people being fat; does anyone seriously disagree with that statement?
posted by gurple at 3:48 PM on July 14, 2008 [1 favorite]


Studies like the ones that serazin pointed out above?

Or, you know, the ones that the US Government uses, stating that:

"In 29 trials with at least 1-year followup, the NIH review found average weight change in diet and/or physical activity groups (some including behavioral therapy) of 1.9 to -8.8 kg (mean, -3.3 kg) corrected for change in controls (Table 1).11 Counseling for low-calorie diets (1,000-1,200 kilocalories [kcal] per day) reduced body weight by an average 8 percent over 3 to 12 months and decreased abdominal fat. Although very-low-calorie diets produced greater initial weight loss than low-calorie diets, results were similar beyond 1 year. Counseling for physical activity (24 RCTs) led to 2 percent to 3 percent loss of weight and reduced abdominal fat. Combined diet and physical activity counseling produced greater reduction of weight and abdominal fat than either approach alone. Behavior therapy was a useful adjunct to diet and/or physical activity counseling. Longer-term efficacy depended on continued intervention."

So perhaps the 500lb person ought to get surgery, but there is hope for all.
posted by The White Hat at 3:49 PM on July 14, 2008 [2 favorites]


Studies like the ones that serazin pointed out above?

That's not what that study (Studies) says. Not at all. You didn't read them. They in no way relate to your point. We've discussed those studies here before. (BTW the sample was 87 soldiers. 87?)

BTW. The second study was on limiting dietary FAT intake.

People DO lose weight with increased physical activity and reduced calories. The problem is they gain it back. Because they do not meaningfully alter their lifestyles long enough.
posted by tkchrist at 3:50 PM on July 14, 2008


But those factors were also present in the population 100 years ago, yet people managed to stay thin, at least relatively so.

So all those plump statues of the Buddha, Babylonian fertility goddesses, Greek and Roman women, and paintings of generously sized Renaissance babes were all done without models?
posted by tkolar at 3:50 PM on July 14, 2008 [2 favorites]


While this is absolutely true it does not follow that shame is an effective response in all such situations.

That's fair, which is why I said "right or wrong," shame is a motivator.

My judgment on shame as a technique is not entirely value-neutral. I know I don't like to be shamed. It hurts.

But I know that it compels some behaviors I would prefer not to engage in — and really should not engage in, because it's not healthy. Rather, what does shame accomplish?

Shame can accomplish a lot to dissuade irrational behaviors. And, to me, shame is not applied to obese people to the degree that acceptance/positive movements actually suggest the entire opposite.

Shame can be misapplied — it has been misapplied, and often, for singling out people for no good reason.

But is overeating rational or irrational? What is the damage done to an individual by overeating? To the degree that shame can help compel rational behavior and improve the quality of people's lives, it should be used, carefully, and I'd argue probably no more than that.
posted by Blazecock Pileon at 3:51 PM on July 14, 2008


Heck - there's an idea: next time you see a fat person trying to get some exercise, cheer them on and let them know it's okay to be in progress, just like 99.9% of the rest of humanity.

As somebody who is now reasonably fit but used to be overweight, I always smile proudly when I see somebody gasping for air while jogging. Those are the people who need to exercise, not the triathletes! More power to them. I always try to encourage and guide anybody new at the gym who is obviously struggling so they will stick it out through the first few weeks. It takes time and reasonable expectations to establish more healthy habits.
posted by benzenedream at 3:53 PM on July 14, 2008 [1 favorite]


All other things being equal, fat people use more soap.

Their surface area to volume ratio is lower, so they actually need less soap per pound. Which means more soap. Plus the anarchic, Fincher-directed ones can alchemy their bodyfat into soap. Throw in a pillowcase and we're screwed.
posted by kid ichorous at 3:53 PM on July 14, 2008


On the individual level, you have a point, and if you want to walk around pointing your finger at individual people and saying "BAD fat man" in a stern voice, far be it from me to stop you.

You are making a massive leap that is nowhere near justified or warranted by any of my comments.

Well-marketed, cheap, unhealthy food will lead to more people being fat; does anyone seriously disagree with that statement?

Not necessarily. But I would definitely disagree with the extrapolation that people being fat is the fault of Well-marketed, cheap, unhealthy food and its availability, as they are completely different things.
posted by Brockles at 3:55 PM on July 14, 2008 [1 favorite]


I hope things go OK for her. A friend of mine had some kind of weight-loss surgery. She lost the weight but got messed up emotionally and mentally afterwards.
posted by marxchivist at 3:57 PM on July 14, 2008


tkchrist: That's not what that study (Studies) says. Not at all. You didn't read them. They in no way relate to your point. We've discussed those studies here before. (BTW the sample was 87 soldiers. 87?)

My goodness, clearly you are statistically incompetent and therefore, anything you say about a research study can be safely ignored.

The White Hat: Counseling for low-calorie diets (1,000-1,200 kilocalories [kcal] per day) reduced body weight by an average 8 percent over 3 to 12 months and decreased abdominal fat. Although very-low-calorie diets produced greater initial weight loss than low-calorie diets, results were similar beyond 1 year. Counseling for physical activity (24 RCTs) led to 2 percent to 3 percent loss of weight and reduced abdominal fat.

Yes, because we know that a drop from 500lbs to 460lbs is going to fix the problem.

tkchrist: People DO lose weight with increased physical activity and reduced calories. The problem is they gain it back. Because they do not meaningfully alter their lifestyles long enough.

And this happens even in the best case with ongoing supervision and counseling. If the best medical science can offer is short-term losses for motivated people receiving ideal care, then the peddling of weight loss as a metric for diet and exercise is junk science.

Of course, moderate fat acceptance is not about "fat is good" or "fat is healthy" it's about treating fat people as human beings, and not subjecting them to the kinds of verbal abuse and discrimination that we would quite rightly condemn if targeted against any other group.
posted by KirkJobSluder at 4:03 PM on July 14, 2008 [4 favorites]


She'd be slim if she ate Ayn Rand.
posted by srboisvert at 4:03 PM on July 14, 2008 [9 favorites]


Or perhaps you don't get it, with respect to post-surgery diet for the operation she had?

My sister-in-law went down this route, and the dietary changes are significant and often counter-intuitive.


Really? I thought that small, low-fat, nutrient rich meals were the norm. A prescribed diet of mayonnaise goes a little beyond counter-intuitive and straight down the road to WTFville.
posted by padraigin at 4:03 PM on July 14, 2008


But I would definitely disagree with the extrapolation that people being fat is the fault of Well-marketed, cheap, unhealthy food and its availability, as they are completely different things.

There are parallels between consumption of processed foods and average weight gains: "Fast food consumption is associated with a higher calorie intake, primarily from carbohydrates and fat. Patients consuming fast food also have higher sodium intake and higher interdialytic weight gains."
posted by Blazecock Pileon at 4:03 PM on July 14, 2008


serazin: The relationship between calorie and fat intake and body weight is not clear."

I don't think you understand the argument that is being made here. If you consume more calories than you burn, your body stores the extra energy as fat, while if you burn more calories than you consume, your body burns fat to supply the energy needed. The studies you linked to do not attempt to disprove this fact.
posted by ssg at 4:03 PM on July 14, 2008


Not necessarily. But I would definitely disagree with the extrapolation that people being fat is the fault of Well-marketed, cheap, unhealthy food and its availability, as they are completely different things.

Then I think we're just talking past each other without any real disagreement. We both agree that the availability and acceptability of cheap, lousy food can lead to fatness on a societal scale. When you're thinking of "fault", you're thinking of the individual consumer's choices, and I can definitely agree that individuals can make bad choices. When I'm thinking of "fault" I'm thinking of the corporate players and the unnatural relationship of American society to food.

It's not that I think you're wrong, it's just that I don't know what solutions can possibly come out of blaming the individual.
posted by gurple at 4:05 PM on July 14, 2008


I find myself wondering how many people in this thread hit post and then went out for a smoke...followed by a few Altoids, so no one's the wiser.
posted by gnomeloaf at 4:06 PM on July 14, 2008 [1 favorite]


tkchrist wrote...
People DO lose weight with increased physical activity and reduced calories.

The statements I was responding to posited that being overweight was a result of lack of exercise and unhealthy eating. That is not necessarily true -- people get to and maintain very unhealthy weights on perfectly reasonably diets and decent exercise plans.

I am personally lucky enough that I can reduce my calorie intake to a place still within the healthy range and lose weight. Not everyone is that lucky. I know a person who maintained 300 pounds on 1200 calories per day for over a month. He stopped because his body was telling him in no uncertain terms that what he was doing was unhealthy.

It always startles me how quick people are to assign a standard body to all humans. Do people really think that the wide range of physical traits that humans display stops at skin, eyes, and height?
posted by tkolar at 4:06 PM on July 14, 2008


Except that if by "steer clear of the twinkies" you mean "eat healthy"...

To many gay men "steer clear of the twinkies" has a very different meaning.
posted by ericb at 4:09 PM on July 14, 2008


let's stop discriminating against the poor and/or ugly while we're at it

The nice thing about being ugly is that nobody blames ugly people for being ugly. People do sometimes blame poor people for being poor though, it usually goes something like this:

Rich Guy: Poor people are lazy, that's why they are so poor.
Other Guy: How could that be? I've met poor people who were not lazy at all...
Rich Guy: That doesn't matter. I'm rich, and I got this way by working really hard. If I was lazy, I would be poor. Therefore, all poor people are lazy.
Other Guy: ...

Obviously being poor and being fat are two completely different issues, but a lot of the arguments made by thin people explaining why fat people are fat come across similar to the arguments made by rich people explaining why poor people are poor.
posted by burnmp3s at 4:13 PM on July 14, 2008 [2 favorites]


When I'm thinking of "fault" I'm thinking of the corporate players and the unnatural relationship of American society to food.

Yes. If McDonalds was actively involved in putting supermarkets and their healthy sections out of business, then they are part of the problem. There is always an alternative to eating crap.

Admittedly, in the typical american supermarket, you have to try a bloody sight harder to find it. Good god, but your country likes to stock shelves and shelves of shit in brightly coloured packaging. More than any other country I have been to, in fact. Your point about "the whole food distribution" is well made. It is a tiny proportion of shelving space in your average food mart/supermarket that is actually left for real food, rather than processed shit. Such is, I am guessing, the result of a "the consumer is king" mentality for so long.
posted by Brockles at 4:15 PM on July 14, 2008


That is, does one truly not notice the change...

As someone is a close to normal range, that has fluctuated 25 lbs, I can truly say I did not notice. I rely on comments from friends and family for my cues, and make changes in direct proportion to explicit feedback, especially from the significant other.
posted by StickyCarpet at 4:19 PM on July 14, 2008


I don't think you understand the argument that is being made here. If you consume more calories than you burn, your body stores the extra energy as fat, while if you burn more calories than you consume, your body burns fat to supply the energy needed. The studies you linked to do not attempt to disprove this fact.
posted by ssg at 4:03 PM on July 14 [+] [!]


I understand the argument perfectly. I also understand that there are a lot of claims made in this thread based on what seems inuitively true, rather than on science. You are telling me that if I consume more calories than I burn, my body stores the extra energy as fat. I'm asking you to show me replicated, reliable medical studies that support your assertion.
posted by serazin at 4:19 PM on July 14, 2008


I thought that small, low-fat, nutrient rich meals were the norm. A prescribed diet of mayonnaise goes a little beyond counter-intuitive and straight down the road to WTFville.

Again, RTFA. Four paragraphs down from the mention of mayonnaise:

I’m supposed to eat fuller fat products because my body no longer absorbs the fat due to my surgery and they contain less weird chemicals. So my eating butter or mayo or sour cream isn’t the end of the world.
posted by designbot at 4:20 PM on July 14, 2008


It is a tiny proportion of shelving space in your average food mart/supermarket that is actually left for real food, rather than processed shit.

My understanding is that this has a lot to do with the need for big growers to dump massive amounts of subsidized commodity crops (mainly corn & soy) into the economy. You can get people to eat a lot more calories (and therefore more actual tonnage of crops) if you reduce the bulk down to something that seems manageable and develop entire industries (flavoring and marketing) around making it appealing.

The perception is that the consumer is king, but in reality the consumer is being led around like an animal by his eyes, nose, and taste buds.
posted by gurple at 4:23 PM on July 14, 2008 [2 favorites]


Of possible interest.

We now return you to our Moral Panic, already in progress.
posted by Kinbote at 4:27 PM on July 14, 2008 [3 favorites]


All this discussion about shame ignores an issue: whether or not a stigma against fatness motivates or harms the fat people, to what degree does this stigma motivate the non-fat to watch themselves and remain non-fat?

The thing, most people who want to lose a few pounds don't join up for studies, they just put down the twinkies. Hence the studies tend to be of people who already have difficulty losing weight.

This fact annoys me very much when I hear about and look into these studies. They've generally seemed to only include those self-selected for failure to lose weight. If you decide to lose some weight, start eating better, start exercising, and lose the weight, you never get to the point where you're at the doctor's asking him for help and the doctor has a chance to put you in the study.

And of course "diet and exercise" won't succeed long term if "diet and exercise" means the temporary adaptation of healthier habits until fat is lost and then a resumption of the less healthy habits that led to the fat in the first place.
posted by TheOnlyCoolTim at 4:28 PM on July 14, 2008 [3 favorites]


serazin wrote...
You are telling me that if I consume more calories than I burn, my body stores the extra energy as fat. I'm asking you to show me replicated, reliable medical studies that support your assertion.

Actually, I'd settle for just a plausible explanation of why a person who weighs 300 pounds maintains that weight at both 1200 and 2400 calories per day.
posted by tkolar at 4:32 PM on July 14, 2008


ssg: Well, it's clear that you didn't read the linked articles either:
"The correlation between body weight and calorie intake, although statistically significant, was low."

If you hypothesis was correct, then body weight should be strongly correlated with caloric intake. The low correlation is incompatible with the simplistic model weight gain ~ needed calories + excess calories.

"During two one-week periods the relation between per cent body fat and per cent of calories derived from fat was examined. In one instance a significant positive correlation was found. In the other instance the correlation was not significant."

Which finds inconsistent support for another hypothesis expressed in this discussion: fat people eat fattier food than thin people.

This study is pretty typical in finding that only 55% percent of people on a supervised low-calorie diet achieved 5% weight loss, and only 42% maintained weight loss after a year. this meta-study also finds the success of diets to be modest. 40% maintain a loss of 5% or more, 30% maintain a loss of 10% or more, 25% maintain a loss of 10% at the 7 year mark.

Given that the best medicine can offer (absent current drug trials) is a 50% chance of loosing 5% of one's body weight, most of this discussion here is junk science.

gurple: My understanding is that this has a lot to do with the need for big growers to dump massive amounts of subsidized commodity crops (mainly corn & soy) into the economy. You can get people to eat a lot more calories (and therefore more actual tonnage of crops) if you reduce the bulk down to something that seems manageable and develop entire industries (flavoring and marketing) around making it appealing.

Scientific American ran an interesting issue on the world-wide obesity epidemic. The people studying this epidemic strongly suggest that we should change our subsidy structure towards fresh vegetables and fruits rather than soya, corn, and animal products. There is also a disturbing correlation in the United States between poverty, lack of access to grocery stores, and obesity.

But, I actually think that the current oil crisis, if it lasts for an extended period of time, is going to help. People who take public transportation or walk are significantly more healthy than people who drive.
posted by KirkJobSluder at 4:35 PM on July 14, 2008


This may be somewhat off topic but Heidi's account of her surgery reminded me of the 'hidden' health effects of obesity. I know we always talk about diabetes, atherosclerotic disease etc etc when we talk about obesity but it wasn't until medical school that I realized that there was another dimension as well.

Patients who are obese are often very difficult to examine. I have a hard time doing and abdominal, pelvic and rectal exams and even listening to heart and breath sounds when a patient is obese. The simple mechanics of turning patients to listen to their back can be awkward and often embarrassing for patients. Even imaging can sometime be difficult to interpret. I know I'm just a trainee and I hope that my skills will improve but sometimes I worry that my patients who are obese are not getting an accurate/thorough enough exam.

Some therapeutic procedures are difficult as well. IVs can be hell to start. Heidi mentions some of the issues her nurses had in starting IVs before her surgery. And I hate to have to poke patients more than necessary. Intubating more obese patients can be more difficult as well.

Heidi also mentions her trouble with skin infections as she is unable to keep her skin clean and dry. I too have seen terrible skin infections in patients who are obese. One case that comes to mind was a gentleman who had an infection of his groin/scrotal area that had clearly been developing over days but that he did not notice as he could not see that part of his own body. He had come to the hospital for an unrelated reason but had mentioned some discomfort of his scrotum. I am so glad I did a thorough exam as he was in the OR within the hour for a massive debridement.

I could go on as there are many other challenges with evaluating/treating patients who are obese but as this was already off topic I'll stop here. It was just something that I have been noticing recently that I didn't think much about before. I think most of us try our best to give patients the highest quality healthcare possible regardless of their size. I hope we are succeeding - with some flexibility, ingenuity and a whole lot of respect.
posted by madokachan at 4:36 PM on July 14, 2008 [9 favorites]


While I generally agree that 90+% of people 530lbs and over are unhealthy, I cannot deny that there are counterexamples such as the 15 year veteran of sumo wrestling Konishiki Yasokichi. I'm sure he has an increased likelihood of mortality, but it's hard to say whether the 15 years of wrestling or being overweight are more responsible for that.
posted by BrotherCaine at 4:37 PM on July 14, 2008


You are telling me that if I consume more calories than I burn, my body stores the extra energy as fat. I'm asking you to show me replicated, reliable medical studies that support your assertion.

Pretty much sums up the internet, right there.
posted by kid ichorous at 4:39 PM on July 14, 2008 [11 favorites]


batmonkey: No one likes to be judged, blamed, or abused. We are hard-wired to react to these emotions unproductively. Why make it harder on a person who already has issues so deep that they would feel helpless or so in need of comfort that they would accept harming their body and limiting their lives so drastically?

Unfortunately, it's human nature to enjoy feeling morally superior to others.

tkolar: So all those plump statues of the Buddha, Babylonian fertility goddesses, Greek and Roman women, and paintings of generously sized Renaissance babes were all done without models?

Of course there were some overweight people back when most people didn't have enough food; the difference is that being overweight was high-status.

The genetic explanation of obesity doesn't explain the relatively recent increase in obesity. See this CDC graph (from here), which shows the increase in obesity in the United States over the last 30 years.

Nor does it explain the differences in obesity rates between countries.

While our genes haven't changed, (a) what we eat and (b) how much physical activity we get have both changed significantly over the last 30 years.
posted by russilwvong at 4:41 PM on July 14, 2008 [3 favorites]


The genetic explanation of obesity doesn't explain the relatively recent increase in obesity. See this CDC graph (from here), which shows the increase in obesity in the United States over the last 30 years.

It's the decades of nuclear testing after WW II. America mutates fast, if it never fasts.
posted by Blazecock Pileon at 4:48 PM on July 14, 2008


So how does a person get to be super morbidly obese? Well, you can start with a little kid of about 6 years old who seems to be a little too pudgy, and take her to a nutritionist, where she’ll see little plastic models of food that tell her what serving sizes look like, and give her stickers when she sits quietly with an empty plate while the rest of the family enjoys dessert. Of course, that’ll just teach her to climb on top of the counter to reach the leftover cake on top of the fridge, but you don’t realize that right away, so you take away her afternoon snack too. Which leaves her hungry enough to wait up in bed until everyone’s gone asleep to find something – anything to eat.

Maybe you’ll try again when she’s 8 years old. You’ll take her to Weight Watchers with you, but you’ll have to get a doctor’s note, because she’s so young. No problem, though, because she already weighs over 160 lbs. Of course she needs to lose weight. She learns about exchanges and checks off little boxes but doesn’t mention the treats she traded a week of math homework for. You make her get out and exercise more too, now, but eventually she uses her allowance to go to the drugstore and buy candy.

By the time she’s 12, her friends are the usual band of misfits – the asthmatic, myopic, and awkward. Her peers remind her daily that she’s different, and she’s taken to shoplifting Dexatrim to ward off the hunger pangs. She gets so much attention and praise for any reduction in weight, and all of her favorite outfits are bought four sizes too small, for motivation. Of course, her truly favorite outfits are out of reach, because she’s already wearing women’s plus size clothing when most of the girls her age are just moving from girl’s to juniors.

Throughout her high school years, take her back to Weight Watchers. Buy her Slim-Fast. Take her to a nutritionist, an endocrinologist, a psychiatrist. Put her on Phen-Fen and Redux. Watch her lose 20 pounds, and then gain 30. Do this over and over again, until she graduates from high school at over 400 pounds. Watch her try to walk in her own neighborhood, where she’s supposed to feel safe, and have people yell at her that she’s a fat piece of shit, and watch her go home and comfort herself with sugar. Watch her try low-fat, low-carb, very low calorie, joining a gym, and watch her lose those 20 pounds over and over and over again – gaining 30 in between each time. Watch her metabolism get so extremely fucked up that she can reduce her caloric intake to 1200 calories a day and exercise 7 days a week and gain weight. Watch her brain get so extremely fucked up about this fact that she cuts her large, round belly with an exact-o blade exactly five times every day.

Heck, watch her post her painful personal experience online and then watch the ridicule she faces afterwards, and then tell me if you can’t possibly understand how someone gets to be that big.
posted by ferociouskitty at 4:49 PM on July 14, 2008 [62 favorites]


russilwvong: While our genes haven't changed, (a) what we eat and (b) how much physical activity we get have both changed significantly over the last 30 years.

And I'll argue that both of these need to be changed at levels considerably higher than mere consumer choice.
posted by KirkJobSluder at 4:50 PM on July 14, 2008


I hear circumcision cures obesity.
posted by Nelson at 4:52 PM on July 14, 2008 [1 favorite]


I was once obese, I'm now overweight. I lost 50 pounds and have since gained ten back and plateaued.

As far as I can tell, and from my personal experience, being overweight is what happens when you internalize the paradox of the heap: if you have a heap of sand, and you remove one grain, you still have a heap... which works over and over until you only have one grain of sand remaining and yet somehow it's still a "heap."

Addictions are that in reverse. If you're a healthy weight and gain a pound, you're still a healthy weight -- so why worry? Similarly, if you're morbidly obese and lose a pound, you're still morbidly obese -- so why bother?

We, as a species, are really bad at understanding how small increments become big changes. We can recognize that being 530 pounds is Very Bad For You, and eating a cookie is A Little Bad For You, but for many people (including myself) there's a gaping chasm between those two logical pathways.

It's easy to say "figure it out, dummy" but it's not just about the conscious realization or conscious willpower. If you don't make it part of the very fabric of your subconscious behavior, you'll just end up (as described by others here) "battling" yourself constantly. Sometimes you'll make short term gains but at the cost of being conflicted and unhappy most of the time.
posted by Riki tiki at 4:53 PM on July 14, 2008 [3 favorites]


russilvwong writes...

The genetic explanation of obesity doesn't explain the relatively recent increase in obesity.


Point taken.
posted by tkolar at 4:54 PM on July 14, 2008


So all those plump statues of the Buddha, Babylonian fertility goddesses, Greek and Roman women, and paintings of generously sized Renaissance babes were all done without models? - tkolar

The Fat Buddha is, in fact, Siddartha Guatama during pre-buddhahood when he was experimenting with extreme indulgence (and in turn, asceticism) - he was a born a prince. After attaining Buddha-hood he is not thought to have been portly. Babylonian fertility goddesses were extreme caricatures. Very little greek or roman art depicts overweight people, and when they do, they are typically the very wealthy. During the renaissance painters like Reubens (who had a thing for full formed women) were exclusively depicting the wealthy. Who else could afford to have paintings like that done of them?

Until the rise of industrialization, particularly factory farming and food processing, no one could afford to be overweight - it was just too hard to find the fats and carbohydrates. Is our modern western ideal weight realistic for everyone? No - there has always been variation in natural body sizes. But weight extremely disproportionate to height and muscle mass is a modern affliction with all but a few exceptions.
posted by phrontist at 4:55 PM on July 14, 2008 [2 favorites]


were exclusively depicting the wealthy - when depicting more voluminous figures.
posted by phrontist at 4:57 PM on July 14, 2008


TheOnlyCoolTime asked:
"All this discussion about shame ignores an issue: whether or not a stigma against fatness motivates or harms the fat people, to what degree does this stigma motivate the non-fat to watch themselves and remain non-fat?"

My thought is that if it does motivate those who are currently at a normal weight, it doesn't do so in a healthy manner. Maybe we should divide our conversation between males and females to figure out where the usefulness-of-shame delta develops to better leverage whatever hidden healing powers shame may have.

People are afraid of being shamed or humiliated or judged. Modern society is comfortable with bigotry and cruelty based on weight. Weight is a HUGE problem in the US & UK.

Parents are so defensive about their children being perceived as "normal" (and thus their parenting as adequate) that they'll ignore obvious physical signs of unhealthy weight gain. That can't be helping.

Healthy (and accurate) body image is vital to being healthy (imagine that!), and it seems that undue pressure to maintain an ideal size is actually harmful to mental and physical health. In other words, body shame produces the opposite, unintended effect. Body shame used as a public health tool, then, is one of the more bitter ironies we've concocted.

If you are completely certain that your negative, shame-based approach to the obese is valid, you'll certainly benefit from some insight into why you feel that way. [salon, so prepare for an interstitial]
posted by batmonkey at 5:00 PM on July 14, 2008 [2 favorites]


damn. Tim. Not time. And I borked my usual comment formatting. ah, well. hopefully if it's of some use, anyway.
posted by batmonkey at 5:01 PM on July 14, 2008


The genetic explanation of obesity doesn't explain the relatively recent increase in obesity.

No, but the effective end of natural selection for the human race, combined with the spread of infectobesity might.

posted by BrotherCaine at 5:02 PM on July 14, 2008


While I generally agree that 90+% of people 530lbs and over are unhealthy, I cannot deny that there are counterexamples such as the 15 year veteran of sumo wrestling Konishiki Yasokichi. I'm sure he has an increased likelihood of mortality, but it's hard to say whether the 15 years of wrestling or being overweight are more responsible for that.

The sumo wrestlers' training regimen apparently results in them putting on fat in a very different way (evenly subcutaneous) than other fat people. It seems this is much more healthy than the fat generally put on by others, though the sumo wrestler still has a shorter life expectancy than the general Japanese populace.
posted by TheOnlyCoolTim at 5:05 PM on July 14, 2008


docpops: I am always curious about the trajectory from big to massive, from obese to "super-obese" as it is known now. That is, does one truly not notice the change, even without a scale, from 225 to 275 or something similar? Because when we weigh people in this range they express genuine, profound shock and amazement at the change, as if they truly had no idea or worse yet had no reason for alarm at 250 but now, at 310, well, maybe it's time for a change.

In my adult life I've fluctuated from 180-260. I have a really hard time noticing the difference. I know that sounds incredible, but even at 180 I've got a belly, a roll of extra skin and fat that makes me look fat. It's hard to look at that objectively, hard to really look in the mirror and see my body, and consequently, I often don't notice when I lose or gain weight. About 10 years ago I was ~80 pounds heavier than I am now, and restricting my diet and (re)taking up vigorous exercise allowed me to slim down. I've kept the weight off for years (which makes me another one of those 3), even though I fluctuate a bit within the (much) thinner range than I occupy now. I recently lost a bunch of weight because I was training for something, and friends told me I looked like I was wasting away, and even then I could see little difference when I looked in the mirror.

(I can see myself better in pictures, and I have a hard time looking at pictures of myself when I weighed 240, say, not just because I look fat in a way I find unattractive, but because I did not, at the time, see myself the way the pictures reveal me to be. It's a very complex psychological phenomenon. Basically I think our object permanence (a good thing) works to our disadvantage in situations like this.)
posted by OmieWise at 5:06 PM on July 14, 2008 [2 favorites]


You are telling me that if I consume more calories than I burn, my body stores the extra energy as fat. I'm asking you to show me replicated, reliable medical studies that support your assertion.
Pretty much sums up the internet, right there.


You might like this too.
posted by tkolar at 5:07 PM on July 14, 2008


KirkJobSluder: And I'll argue that both of these need to be changed at levels considerably higher than mere consumer choice.

Agreed. A 2002 Lancet article (PDF) on childhood obesity describes a "toxic environment":
In the late 1970s, children in the USA ate 17% of their meals away from home, and fast foods accounted for 2% of total energy intake. By the mid-1990s to late-1990s, the proportion of meals eaten away from home nearly doubled to 30%, and fast food consumption increased five-fold, to 10% of total energy intake. From 1965 to 1996, per capita daily soft drink consumption among 11–18-year old children rose from 179 g to 520 g for boys and from 148 g to 337 g for girls. There are 170 000 fast food restaurants in the USA alone. These trends have been driven, in part, by enormous advertising and marketing expenditures by the food industry, including an estimated US$12.7 billion directed at children and their parents. ... By contrast, the advertising budget for the US National Cancer Institute’s “5-A-Day” programme to promote consumption of fruits and vegetables was $1.1 million in 1999. Large meals, often containing a child’s total daily energy requirements, can be purchased for little additional cost over smaller portions, whereas fresh fruits and vegetables tend to be less readily available and comparatively more expensive. Furthermore, fast-food and soft-drink vending machines pervade schools. That US children overconsume added sugar and saturated fat, and underconsume fruits, non-starchy vegetables, fibre, and some micronutrients, is therefore not surprising.

Availability of sedentary pursuits, including television, video games, computers, and the internet, has risen greatly. Children in the USA spend 75% of their waking hours being inactive, compared with remarkably little time in vigorous physical activity; estimated at only 12 min per day. Opportunities for physical activity have decreased for various reasons. Physical education, typically considered less important than academic disciplines, has been eliminated in some school districts. In schools that do offer physical education, large class size and lack of equipment present barriers to successful programme implementation. After-school participation in unstructured activities can be limited, because of absence of pavements (sidewalks), bike paths, safe playgrounds, and parks in many neighbourhoods. Moreover, our culture places a premium on convenience: the car is preferred to walking, the lift to stairs, and the remote control to manual adjustment.
posted by russilwvong at 5:09 PM on July 14, 2008


I know quite a few people who are obese. Some of them are not doing anything about it.

While others have fought quite hard for modest, or even extreme reductions in weight, long-term maintenance at a stable weight, or the achievement of medical goals that are invisible to casual examination. They still look fat to the casual observer who increasingly isn't afraid to make a value judgement that these people just don't care and are pigging out on empty calories.

And that's what I strongly object to. There is this pervasive myth that if you cared and just had the willpower that one can drop, 30%, 40%, 50% of your body mass and come within spitting distance of an ideal BMI, and conversely, if you are not within spitting distance of an ideal BMI it means you just don't care.

Dealing with these problems means accepting some realistic expectations on the effectiveness of diet and exercise. And that means accepting the fact that 5% may be more realistic than the big transformation myth they sell in commercials. And accepting that perhaps you just can't judge what a person is doing about their weight just from the fact that they are fat.
posted by KirkJobSluder at 5:27 PM on July 14, 2008 [4 favorites]


Actually, I'd settle for just a plausible explanation of why a person who weighs 300 pounds maintains that weight at both 1200 and 2400 calories per day.

In a lot of cases, it's because when the energy income is reduced people cut down the amount of energy they're burning -- ie, they subconsciously arrange to do less, so the net outcome is more or less the same -- less energy in, less energy out, no fat burned.

Which is a depressing task for the very obese, I think. It's hard enough for me, who doesn't have a food problem and is light enough to be able to run and thin enough to not mind going to the pool, to get motivated to exercise my lazy ass. It's a battle of wills between me and my inbuilt indolence.

If I was simultaneously fighting an even more difficult battle with my inbuilt chomper, man there isn't enough willpower in the world for both those fights. I suppose it's not dissimilar to coming off heroin and booze at the same time.
posted by bonaldi at 5:28 PM on July 14, 2008


The genetic explanation of obesity doesn't explain the relatively recent increase in obesity.

How about the genetic explanation of obesity IN THE PRESENCE OF REFINED CARBS. And I'm not talking about HFCS. It's that and the sugar and the flour and the potatoes. Our bodies did not evolve with foods that spike our insulin so much. We ate meat and veggies and maybe some berries. Bread was invented a few thousand years ago. And in the 60s and 70s, food stopped being cooked from scratch and started being processed with all sorts of carby garbage because it's cheaper. The carbs play with your hormones and hormones are a big freaking deal in fat storage and appetite regulation.

The answer's right there in front of your faces! You're asking, "How can someone let themselves get that way?" and "How can so many people be so fat when it's so SIMPLE to lose weight?" The answer is that calorie restriction (in the absence of carb restriction) treats the symptoms rather than the cause, and it can only work for so long. Eventually, your body will give in to the urges just as our bodies will eventually give in if we try to hold our breath.

The problem is exacerbated by the advice to limit dietary fat, which effectively raises carbohydrate intake even more for the very people who need to be reducing it.
posted by callmejay at 5:31 PM on July 14, 2008 [3 favorites]


(The hormonal explanation also explains the genetic component of obesity. Not all people get fat in the presence of carbs.)
posted by callmejay at 5:34 PM on July 14, 2008


>>Unfortunately, it's human nature to enjoy feeling morally superior to others.

Yet another of our asinine behaviors. Not a one of us is perfect, but instead of handling our own issues, the majority just want to rag someone else, because it's oh-so-easy. "Human nature" is a cop out for remaining flawed while highhorsing or saying "nothing will ever change".

It was pointed out above, but in times when calories were scarce, thickness was seen as impressive, wealthy and sexy. Since in our infinite wisdom as a species we covet what is rare and eschew what is common, all that was required for the fat to go from "yowza" to "anyone can make fun of 'em!" was for calories to become commonplace. So the world changed its mind. That easy.

Here in 10 years or so when food's a little harder to come by because we can't control our reproduction, our warlike bullshit, and our baseless xenophobia, fat will be back in vogue. That's how easily manipulated we are.
posted by SaintCynr at 5:43 PM on July 14, 2008


Calories in, calories out is essentially true. It is also mostly useless in this discussion, because there are large uncertainties in both values. The human body is not a tuned generator designed to . Not all calories you consume are utilized. And the percentage that are is not a constant. We do not know all the things that affect that percentage. In addition, the metabolic rate is not constant. And we don't know all the things that affect it. And on top of that, there are feedback mechanisms between all of the processes involved.

This is just my pet theory, but I think that a big part of the reason that weight loss is so difficult for people is because the maintainable shift in caloric balance is generally less than the human body is capable of compensating for through changes in utilization and metabolism. And even where this is not the case, it becomes the case as weight is lost and total caloric needs drop.
posted by Nothing at 5:49 PM on July 14, 2008



Might there be actual toxins involved as well? I Am Not A Scientist, but maybe someone who is knows whether there might be (studies of?) a connection between obesity and environmental pollution like endocrine disrupting chemicals?
posted by girandole at 5:50 PM on July 14, 2008


Not a one of us is perfect, but instead of handling our own issues, the majority just want to rag someone else, because it's oh-so-easy.

No, we want to rag someone else, because it makes our own issues seem not as big.
posted by Brandon Blatcher at 6:02 PM on July 14, 2008


bonaldi: In a lot of cases, it's because when the energy income is reduced people cut down the amount of energy they're burning -- ie, they subconsciously arrange to do less, so the net outcome is more or less the same -- less energy in, less energy out, no fat burned.

Well it's not just that. The actually energy content of fat is trivial compared to what we eat on a daily basis. There is considerable evidence out there that the human metabolism actively resists changes in body weight. This would back up evidence that it's much easier to maintain a constant weight for five years than it is to loose more than 5% of your body weight over the same period.

Behavioral-dietary treatments are not a panacea to the problem. So if we are going to actually treat obesity, we have to accept very modest gains from behavioral-dietary treatments, and take a look at the hormonal regulatory mechanisms involved in this equation.
posted by KirkJobSluder at 6:02 PM on July 14, 2008 [1 favorite]


I love how the first thing she eats when she gets home from the hospital is a chicken taco!
posted by ChickenringNYC at 6:08 PM on July 14, 2008


Because seriously, most excess energy is pissed away. It's not the case that excess energy = fat, regardless of how much Weight Watchers has made calorie counting into an obsession.
posted by KirkJobSluder at 6:11 PM on July 14, 2008


russilwvong said:
"Unfortunately, it's human nature to enjoy feeling morally superior to others."

What a baffling response.

It actually isn't human nature to enjoy feeling morally superior to others. That's a social construct built around the reward center for productive decisions which make one successful in one's environment.

Enjoying feeling morally superior to others is basically someone choosing judgment of those with more problems as inferior to sate one's own internal judgment monster and provide external proof that one has correctly perceived the narrow boundaries of social approval by shunning the preferred marginalised population.

Hypocrisy is a huge justifier for those with compulsion/over-consumption afflictions. Behaving as if one is morally superior for being able to see that someone else's coping mechanism hurts them is pretty disgusting.

Frankly, I'd be a bit more worried about the person obsessing over what someone else is doing to their own body than the over-eater. One is sociopathic, the other is socially isolated. The former is more likely to further social break downs than the latter, just be dint of needless division. We've plenty of that in the world already, thank you.
posted by batmonkey at 6:20 PM on July 14, 2008


It was pointed out above, but in times when calories were scarce, thickness was seen as impressive, wealthy and sexy.

You guys we are talking about a person who was over 500lbs! This kind of obesity was never seen as commonly "sexy" unless you're talking about some fairly obscure Polynesian or tribal societies.

There is nothing "natural" about being 400 to 500 lbs. This is what is troubling. There is something terribly wrong with the way we are living and how we are making our food if it's becoming increasingly possible for people to get to 400 to 500 pounds. Increasingly see people 200lbs over weight is not some aesthetic choice for gods sake nor is some return to a past ideal. It's unprecedented.

But nor is it natural for everybody to have a body like Kate Moss either. And this is our problem. Being troubled by one is not an endorsement of the other. This is not an issue of body image. This is life and death.

Expressing reluctant to embrace "Fat Acceptance" as a movement is also not bigotry towards or against one body type over another. We are not talking about how people look. We are talking about these extremes becoming more and more common. And obesity itself is an indicator AND cause of serious health problems. It's not merely an aesthetic. It's a canary in a coal mine. And it impacts everybody in our culture very seriously.
posted by tkchrist at 6:36 PM on July 14, 2008


Whenever I think of our obesity issue over the past few years, I think of this article. Not the article content itself, which has nothing to do with the price of tea in China. What I think of is the picture. One frightened but capable young mother, and four hardworking nurses, and all five of them -- well.

Obesity has lodged itself into the race and class vortex. As a writer I can't remember said: no one in polite society would dare say, "I hate seeing all those black [and/or] poor people slobbing through the aisle with their stupid black [and/or] poor kids at the Wal-Mart. It just makes you so depressed about humanity." Replace "black [and/or] poor" with "fat," though, and you have a pretty standard joke. It's fine to mock fat people and their failings and their children and their giant purchases.

In our society, a fat person is perceived as someone who is controlled by their life, who at best doesn't have the resources and at worst doesn't have the character to eat well and exercise. And what's worse, in America, than not being in control of your own life?
posted by Countess Elena at 6:43 PM on July 14, 2008 [3 favorites]


[Erratum: looks like there's just four people in the picture]
posted by Countess Elena at 6:45 PM on July 14, 2008


tkchrist said:
"We are talking about these extremes becoming more and more common. And obesity itself is an indicator AND cause of serious health problems. It's not merely an aesthetic. It's a canary in a coal mine. And it impacts everybody in our culture very seriously."

I absolutely agree.

This is why shame has to come out of the picture. We need those who are suffering/choosing to suffer in this way to feel free to speak up to their physicians and for medical professionals to quit marginalising, ignoring, over-simplifying, under-treating, and mis-diagnosing fat people.

In order for an accurate picture of the how/why/what of obesity to be developed - including possible culprits beyond over-consumption like leaching plastics, hormone disruption, and increasingly harmful rates of social isolation - there needs to be open and honest dialogue about what is happening to people and why.

We need fat people to feel okay about being out in public so that they can do social things instead of trapping themselves in the house with their tormentor. We need to not pick on how people look at the beach, because, for the love of puppies, we should just be happy these people are getting some freaking exercise already.

Most importantly, we need people to quit throwing rocks at other people's glass houses instead of working on their own imperfections and challenges. When the judgmental get all their problems figured out, maybe they can then offer classes to those who want to learn how to succeed, too. I'm willing to bet those who use honey instead of vinegar will get more students.
posted by batmonkey at 6:54 PM on July 14, 2008 [1 favorite]


batmonkey: It actually isn't human nature to enjoy feeling morally superior to others.

You go on to use some quite emotionally charged words to describe people you disagree with--"disgusting," "sociopathic"--suggesting that you regard them as morally inferior.

Let me put it this way: even if it's not human nature, judging others and regarding them as inferior appears to be universal human behavior. It's not just weight. There's completely trivial examples, like PC vs. Mac flamewars. People participating in them really do seem to believe that the other side is morally inferior because they use a different kind of computer.

Of course cruelty and bigotry should be opposed, and US society has made great progress in certain respects (racism, for example). But I would suggest that even if fat acceptance becomes the norm (more likely as the incidence of overweight and obesity increases), people will just find something else to use to judge others, because it's satisfying. Intelligence, for example.
posted by russilwvong at 6:58 PM on July 14, 2008 [1 favorite]


tkchrist: Expressing reluctant to embrace "Fat Acceptance" as a movement is also not bigotry towards or against one body type over another.

Ok, what exactly do you object to:
1) That people should not experience arbitrary discrimination because of their body size?
2) That we should accept that the weight loss benefits of diet and exercise are likely to be modest compared to the invisible benefits?
3) That people should not be subjected to harassment on the basis of their weight?
4) That concerns about health issues and diet are a private matter shared between a person and his/her doctor?
posted by KirkJobSluder at 7:03 PM on July 14, 2008 [3 favorites]


I owe Astro Zombie an apology for my comment above as well.

Well, you gotta drink something before you start waving your guns around.
posted by Astro Zombie at 7:04 PM on July 14, 2008


Actually, I'd settle for just a plausible explanation of why a person who weighs 300 pounds maintains that weight at both 1200 and 2400 calories per day.

Off the top of my head...how about Hypothyroidism or a high level of insulin resistance?

KirkJobSluder, I find it distubingly odd that I can agree and disagree with almost all your posts. I have to ask, are you really asserting that diet and exercise are not a viable option for weight loss? That is...extremely...ridiculous.
posted by P.o.B. at 7:12 PM on July 14, 2008


I know I'm just a trainee and I hope that my skills will improve but sometimes I worry that my patients who are obese are not getting an accurate/thorough enough exam.

You are 100% correct.

And thanks for sharing, Omiewise. Seriously.
posted by docpops at 7:12 PM on July 14, 2008


Wait, who owes me an apology for what? I'm drunk.
posted by Astro Zombie at 7:13 PM on July 14, 2008


That was a heart wrenching, brutally honest bit of writing. I hope everything works out for her.
posted by dejah420 at 7:21 PM on July 14, 2008


batmonkey you sure are worked up over stuff. Stuff I never said or even implied.

I never said fat people should be shamed. What I said was it's ALL part of the same over consumptive complex our society has.

And I mean that in both the psychological sense of the individuals, be they over eaters or over consumers of materials, and in the economic sense be they companies that produce shit food or shit pollution. And until we get that simple concept nothing will change. People have to make better individual choices - deprive the companies of the profit from selling this shit that is killing us AND we have to change our food production and food politics to safee more sustainable healthy practices.

I was pointing out we seem to have have no problem judging one over-consumptive group but suddenly cry bigotry over judging the other. And this is hypocritical. I don't think calling people names in either circumstance is useful. But we HAVE to make some sort of moral judgment or how do we make things better? And that judgment is that it is damaging us to go on like we are.

My problem is with that much of "Fat Acceptance" movement has an agenda to downplay the health and societal impact of obesity. With this it's similar to the corporate lobbies calling for our right to consume ANYTHING as much as we want when ever we want and damn the consequences. In fact much of what we think of as "Fat Acceptance" is a spun mantra of personal greed essentially sponsored by fast food chains just hiding behind anti-bigotry language. These people are being used. Just because what people consume ends up in their bodies, rather than their drive ways, (actually no, it ends up in the environments one way or another) doesn't give them a free pass on the environmental and social impacts of producing and distributing the product they consume.

You go on to use some quite emotionally charged words to describe people you disagree with--"disgusting," "sociopathic"--suggesting that you regard them as morally inferior.

No kidding.
posted by tkchrist at 7:22 PM on July 14, 2008


Ok, what exactly do you object to:

Why would I object to ANY of those things? I never expressed any specific objections. I expressed "reluctance."

I do object to the loudest voices of a movement that seems to be implying that being 200+ pounds over weight is merely an aesthetic choice with no greater repercussions to society at large.
posted by tkchrist at 7:27 PM on July 14, 2008


Also, this seems like it's a good time to mention Joy Nash's Fat Rant. It's fabulous.
posted by dejah420 at 7:30 PM on July 14, 2008 [2 favorites]


PoB: KirkJobSluder, I find it distubingly odd that I can agree and disagree with almost all your posts. I have to ask, are you really asserting that diet and exercise are not a viable option for weight loss? That is...extremely...ridiculous.

Only about half of people who undergo medically prescribed diets maintain a loss of >5% after 5 years. Only about a quarter of people who undergo medically prescribed diets maintain a loss of >10% after 5 years. This is consistent across multiple individual studies and meta-analysis studies.

I suspect that the weight loss success of people who try to loose weight without counseling and medical support is likely to be even worse.

These are the facts that we have to wrestle with until there is a radical new treatment. Now diet and exercise also have a ton of positive benefits that are not visible on casual examination, and if you are a member of the minority who manages to permanently loose >10%, more power to you. But the fundamental facts are that the weight loss gains from medically prescribed diets are likely to be quite modest, and are not going to be a magic bullet.
posted by KirkJobSluder at 7:34 PM on July 14, 2008 [1 favorite]


tkchrist: I do object to the loudest voices of a movement that seems to be implying that being 200+ pounds over weight is merely an aesthetic choice with no greater repercussions to society at large.

I think there's two different issues here. One is societal. The other is at the individual level.

At the societal level, increasing obesity is a major health issue. And yes, the constant advertising of soft drinks and fast food to children is probably a big part of it, fitting right in with over-consumption in general.

At the individual level, though, I think it becomes much more difficult to judge whether a particular individual is eating too much and not exercising enough, or has some kind of medical issue (e.g. is hungry all the time), or something else. They may already be working as hard as they can to improve their fitness.

As I understand it, fat acceptance groups are primarily providing social support to individuals, they're not going around advocating non-action at the societal level.
posted by russilwvong at 7:36 PM on July 14, 2008


KirkJobSluder the point is preventing people from getting that obese in the first place. THAT is the missing discussion here. And that is what we need to spend our time working on.
posted by tkchrist at 7:37 PM on July 14, 2008


tkolar posted: The statements I was responding to posited that being overweight was a result of lack of exercise and unhealthy eating. That is not necessarily true -- people get to and maintain very unhealthy weights on perfectly reasonably diets and decent exercise plans.

Maintain, ok. bonaldi tackles that situation, above. But getting to? I'd like to see the perfectly reasonable diet and decent exercise plan that leads a person from healthy weight to morbidly obese. Calories aren't magic. If you're burning what you're taking in, where are the extra calories coming from?

The Only Cool Tim: every bit of your comment was on the money. Especially this:

of course "diet and exercise" won't succeed long term if "diet and exercise" means the temporary adaptation of healthier habits until fat is lost and then a resumption of the less healthy habits that led to the fat in the first place.

On gaining 20 versus 200 pounds: it probably is a different kind of beast, but I think only because the body starts processing things differently and hormone levels change at certain tipping points, not because the underlying psychology is so different.

On "shame", I go back to TOCT's comment -- there may very well be a difference in how it affects those who are not yet overweight/obese versus those who are. At a certain point, it seems reasonable that a kind of learned helplessness kicks in and shame just feeds denial. That doesn't mean that societal reaction to fat isn't keeping a whole lot of people from blindly going down that road in the first place. People keep bringing up the smoking analogy. I remember those yellow teeth/face cancer posters, and the backlash against them, with the quite reasonable argument that this is not going to get through to smokers. Probably true. But I bet it got through to a lot of non-smokers who might have started. Societal disapproval was the lynchpin for a mostly non-smoking west. Not health effects. (or am I in some strangely non-smoking enclave?)

Oh, and tkolar, you said: I had an interesting experience last year after I counted calories a while and dropped forty pounds (over six months) -- basically I just felt wrong. My mental image of my body was badly out of sync with the reality, and I found myself deeply unhappy about that. Since then I've put the weight back on and my mind and body are once again happy together.

I went from unhealthy-thin (extreme) to, well, I think the healthiest I've ever been, and so long as I don't look at myself in full view it looks practically men's-health-mag good. But full-length, that head just does not look right on that body, and I want the famine-thin body back. Because I'm used to it. *shrug* I figure it will go away eventually. Yeah, I'd feel more comfortable if I looked the way I did, but that's what my brain is for -- to identify my irrational impulses as such and do what's actually good for me; not necessarily what feels good right now.

Sorry for the monster comment. It's been a monster thread.
posted by Durn Bronzefist at 7:38 PM on July 14, 2008


As I understand it, fat acceptance groups are primarily providing social support to individuals, they're not going around advocating non-action at the societal level.

What I have seen is a sort of libertarian 'Fuck you you can't tell me what I put in my body" attitude by the loudest proponents of fat acceptance. The flaw being, like so much of the libertarian angle, is assuming that it all happens in some sort of vacuum. Which it doesn't. It doesn't occur in a vacuum and the effects to society don't occur in a vacuum. I can't say these people typify the FA movement or not but they certainly seem to get the most play.
posted by tkchrist at 7:45 PM on July 14, 2008


tkchrist: KirkJobSluder the point is preventing people from getting that obese in the first place. THAT is the missing discussion here. And that is what we need to spend our time working on.

Well, with all due respect. That is what YOU need to spend YOUR time working on. For some of the people I love and I care about, that opportunity done gone. And so my priority is trying to raise awareness and calling out people on their prejudices.

And you know what, we've been trying to shame people into staying thin, being thin, becoming thin going on 40 years now. It hasn't worked. Why does anyone think that we need more of the same.
posted by KirkJobSluder at 7:47 PM on July 14, 2008


At the individual level, though, I think it becomes much more difficult to judge whether a particular individual is eating too much and not exercising enough, or has some kind of medical issue (e.g. is hungry all the time), or something else. They may already be working as hard as they can to improve their fitness.

And I could not be MORE sympathetic to those people. As I have written about here before with my experiences training some severely obese people.
posted by tkchrist at 7:47 PM on July 14, 2008


Well, with all due respect. That is what YOU need to spend YOUR time working on. For some of the people I love and I care about, that opportunity done gone. And so my priority is trying to raise awareness and calling out people on their prejudices.

And you know what, we've been trying to shame people into staying thin, being thin, becoming thin going on 40 years now. It hasn't worked. Why does anyone think that we need more of the same.


KirkJobSluder what is wrong with you. Nobody is saying we need to shame anybody.

With all due respect to you I can't believe you seriously think it's fine to allow another generation of kids to become morbidly obese and die way to young - likely collapsing our already fragile health care system. I know you don't mean that.

I personally think we can achieve a healthy happy society with out "shaming" anybody. But prevent obesity we must.
posted by tkchrist at 7:56 PM on July 14, 2008


What we have to remember here as well is that weight loss, when done properly, is an achingly slow process -- a pound a week is a good average. If you're 200 pounds overweight, that almost four years of work, not counting the plateaus, and there are many, and the slips in willpower, which are natural, and the fact that the body resists weight loss because it is designed to store fat easily and release it under duress. Add to that the fact that you have to retrain habits that overweight people have sometimes developed over a lifetime, and we're not talking about just one bad habit, we're talking about hundreds. And add to that the very great likelihood that the overweight person is struggling with a lot of emotional issues, and, in some cases, actual mental illness --

Well, it's a tough fucking row to hoe.

Perhaps there are fat people out there who just don't care, and just eat, and eat, and eat. But almost every overweight person I have ever met has fought the fight, with some success, and many are fighting the fight at the moment you see them. Unless they are someone close to you, you can't know how much they weighed a month ago, or a year ago. Put down the twinkie, fattie, just isn't very helpful for someone who has put down the twinkie more times than you can count.

Maybe I have sympathy because losing 20 pounds was like waging war with my own body, and, eight months later, despite the fact that I eat healthily and have, at worst, a very mild sweet tooth, 10 of those pounds are back.
posted by Astro Zombie at 8:01 PM on July 14, 2008 [8 favorites]


Well, with all due respect.

Am I the only one who usually figures that someone who says this means "none"?
posted by Justinian at 8:02 PM on July 14, 2008


tkchrist: KirkJobSluder what is wrong with you. Nobody is saying we need to shame anybody.

Well, actually that really has been brought up multiple times as a possible solution (most recently by Durn Bronzefist.)

With all due respect to you I can't believe you seriously think it's fine to allow another generation of kids to become morbidly obese and die way to young - likely collapsing our already fragile health care system. I know you don't mean that.

No, of course I don't mean that.
posted by KirkJobSluder at 8:06 PM on July 14, 2008


Am I the only one who usually figures that someone who says this means "none"?

It's like how "ma'am" really means "beeee-yatch."
posted by tkchrist at 8:07 PM on July 14, 2008


Oh, dang, tkchrist, I'm totally not saying you're saying that. I'm saying that's the feeling in general.

I should have done what everyone else does and write that whole "'you' is general 'you' in interest of discussion, not you specifically".

My apologies!

Same goes to TheOnlyCoolTim and most others. My responses are riffing off of your responses.

I have no idea who's playing Devil's Advocate and who isn't, so I'm just responding to that which forces me to reflect on the accuracy of what I've learned and believe I know so far.

Since I've toasted this kind of discussion before with over-emotional investment and all that, I've been working on finding a different way. Looks like I have more adjustment to make to prevent folks from thinking I'm going off on them....I promise I'm definitely not - my tone is absolutely one of factual and friendly discussion. Danged limitations of text :/
posted by batmonkey at 8:07 PM on July 14, 2008


The relationship between calorie and fat intake and body weight is not clear.

serazin: These studies do not say what you are implying they say. Or rather, I made no claims about fat intake, only calorie intake. The relationship between calorie intake and weight gain is very clear. It's just that when you add a third factor "fat intake" the correlations became a little murky.

The second study is completely off point and even the first admits there was a statistically significant correlation between calorie intake and weight gain. Are you really going with the idea that it doesn't matter how many calories you eat? That's a stunningly bold assertion.

I'd be willing to wager my entire net worth against yours that if you eat 1500 calories a day and I eat 4000 calories a day I'm going to gain more weight than you if we do the same amount of exercise.
posted by Justinian at 8:11 PM on July 14, 2008


Nobody is saying we need to shame anybody.

Well, actually that really has been brought up multiple times as a possible solution (most recently by Durn Bronzefist.)


I would say that there's a big difference between shame as a societal force and shaming someone - as an act of one person to another. That someone making a choice -- not for life, not for this month, but for this meal -- considers the impact on their body and maybe societal cues about this, is a long way from laughing at random obese person down at the 7-Eleven. But I take batmonkey's earlier point that this doesn't necessarily result in healthy reactions, either. (neurotic fixation with "thin-ness", etc.)
posted by Durn Bronzefist at 8:20 PM on July 14, 2008


Well, actually that really has been brought up multiple times as a possible solution

But not by me.

I think the problem is some hear obese and think "25lbs over weight." Thus thinking to them selves it's a judgment on the typical person. Or on themselves.

While, when I hear obese I think "200+ Lbs over weight." Which is purely a judgment on the increasingly common extreme. And I find it terrifying that we could ever entertain that state as natural or healthy. A few fringe cases may demonstrate an individual can live healthily with 200 extra pounds - but that is an extreme minority.

I have trained people 150-200lbs over weight. People who never exercised a whit before in their entire lives. We got them down 80-120lbs over the course of a year to 18 months. Almost all them kept most that off as far as I know. None of them turned into BradJolina. But that is not the point of the exercise and we make that abundantly clear as far as expectations. I never concentrated on the nutritional side of things, though now the trainers do. In fact I was only concerned with technical performance in the kick boxing curriculum. It become obvious that better eating habits produce better results in terms of performance. So people usually self corrected and ate better on their own.
posted by tkchrist at 8:22 PM on July 14, 2008


Justinian - there is not a good study that shows that fat people eat more than thin people. If you know of one, please point it out to me. For your point to be significant of course, I'd need to see multiple studies pointing to the same conclusion.

Wager away, I'll stick with the science.
posted by serazin at 8:22 PM on July 14, 2008 [1 favorite]


I would just like add a couple of links to the radical idea of reducing the caloric intake in our diets.

Otherwise I'm going to bow out of this discussion of beans on a plate.
posted by P.o.B. at 8:23 PM on July 14, 2008


Hugs and organic chocolate chip cookies all around.
posted by tkchrist at 8:25 PM on July 14, 2008


Beans on a plate are good for you. High in fiber and protein.
posted by tkchrist at 8:26 PM on July 14, 2008


Actually, in my case it meant that I respect your position in that matter, but I feel that for me, personally, I have other priorities. I was completely non-sarcastic when I said it, and I agree that preventing obesity should be a major social priority.

On the other hand, I'm routinely disgusted every time this issue comes to metafilter by the level of contempt and prejudice expressed in a purely abstract way towards people I love deeply, grounded on some fundamentally misguided beliefs. So yes, I do believe that some level of "fat acceptance" is needed.
posted by KirkJobSluder at 8:26 PM on July 14, 2008 [1 favorite]


As someone who's fat: Telling a couch potato "Eat healthy and exercise so that you lose all your weight and become Normal" means that if they don't see results, they'll stop doing those things. Wouldn't it be so much better to tell everyone what behaviors are healthy, enable and encourage those behaviors as much as possible, and then treat people with dignity and respect?

I probably weigh twice as much as my grandfather, who apparently subsists entirely on Fritos and yet is as skinny as a rail. He recently was diagnosed with Type II diabetes. With any luck, I hope to avoid the same fate by eating reasonably, exercising, and working with my doctor/getting the necessary bloodwork/taking the correct insulin-related and thyroid medications... but if I do those things and achieve a good level of health and fitness (freedom from disease/discomfort and the ability to perform physically) and am still fat, whatever. That's what Health At Every Size means to me. Not that I want to be fat, but that becoming Perfect And Skinny is not the way I want to approach my health.

A few mostly-disorganized thoughts and links, feel free to skip if you're already rolling your eyes:

-The pop culture obsession with Fashion! and Beauty! and Being The Perfect Fuckable Female! means that being fat is a pretty different experience for women than for men.

-In a fat woman's mind, the aforementioned obsession with superficial looks and fad diets and tabloid pages ragging on Britney for gaining 10 pounds OMG fat whale can make it hard to discern rational medical advice in all the noise. And not all obesity research that's reported by the media is rigorous in its science or led by unbiased researchers, further confusing things.

-On top of that, many fat people have horrible experiences with doctors. In case you hadn't guessed, I'm still working on my trust issues with doctors. I'm sure I'm not the only one who's afraid to discuss basic health concerns for fear of having them all waved away under the "these will all go away if you'd just lay off the twinkies, lardo" umbrella. So I'd say the shame thing is pretty much not helping.

-Disordered eating is not fun and not a good thing, and many people yoyo between unscientific self-starvation and emotional overeating in a way that is neither effective at reducing weight nor healthy in any sense. If the Fat Acceptance movement, whatever that really means, can help people find a less disordered way of eating, and encouragement to go out there and live their lives and move their bodies and be happy, I think that's a good thing.
posted by rivenwanderer at 8:27 PM on July 14, 2008 [7 favorites]


Durn Bronzefist (like the name) says...
If you're burning what you're taking in, where are the extra calories coming from?

That's the problem right there. The definition of a healthy diet is not "burns exactly what you're taking in", particularly with regards to short term and long term energy availability. The human body wants and needs some oversupply to store as fat -- which is to say that a regular appetite will very naturally put some weight on you. One would hope that would stop when you reached a point of diminishing returns, but that does not appear to always be the case.

Yeah, I'd feel more comfortable if I looked the way I did, but that's what my brain is for -- to identify my irrational impulses as such and do what's actually good for me; not necessarily what feels good right now.

What's good my long term mental well-being is not always the same as what is good for my physical well-being. At the moment I'm quite sanguine to remain 70 pounds overweight and not be at war with myself. When that changes I know exactly how I'll approach the issue and I'm pretty sure I'll be successful -- but I count myself very lucky that I have the time, mental resources, and metabolism that will let me do that.
posted by tkolar at 8:27 PM on July 14, 2008


The filters at work aren't letting me read this, but does she say anything about her wide collection of party hats?
posted by turgid dahlia at 8:29 PM on July 14, 2008 [1 favorite]



I think the problem is some hear obese and think "25lbs over weight."

According to this if I was exactly 25 lbs over my fit, high school self I would be obese.
posted by tkolar at 8:33 PM on July 14, 2008


I've wondered why people who've tried every other method of losing weight don't simply cut a check to a neutral party for some extremely large sum, then ask them to cash it only in the event that they fail to lose some specified amount of weight after a short time period. For most of us, I'd imagine, $20k riding on losing, say, 10 pounds over a month would be more than enough incentive to follow through. You can use similar means for making sure you keep the weight off. The trick for overcoming obstacles that require huge amounts of willpower is to change the incentive structures so that it's really no longer even a question of exercising willpower, because to not do so would be utterly disastrous and absurd.
posted by decoherence at 8:34 PM on July 14, 2008


Wager away, I'll stick with the science.

You're not sticking with science, you're sticking with some weird ideology. I mean, weight gain not correlated with calorie intake? Come on, be serious.
posted by Justinian at 8:38 PM on July 14, 2008


I've wondered why people who've tried every other method of losing weight don't simply cut a check to a neutral party for some extremely large sum,

Might work for some folks, but for people who fit the addiction profile it would be a waste of money. Very few crackheads give up their habit because of money.
posted by tkolar at 8:38 PM on July 14, 2008 [1 favorite]


I mean, weight gain not correlated with calorie intake?

CDNIC
posted by tkolar at 8:40 PM on July 14, 2008


Wouldn't it be so much better to tell everyone what behaviors are healthy, enable and encourage those behaviors as much as possible, and then treat people with dignity and respect?

Good heavens, sir! This is Metafilter we are speaking of!
posted by Cool Papa Bell at 8:42 PM on July 14, 2008


tkolar, there are some relatively well-known studies of heroin addicts returning from Vietnam (where they acquired the addiction) who, upon returning to an environment where their addiction was no longer "acceptable" outlet for coping with the stresses of war and where heroin was no longer easily available, were able to give it up quite easily. In general, I think environment -- and the incentives and disincentives intrinsic to it -- matters a lot more for these sorts of things than most people realize. Society, culture, the market, whatever provides huge incentives to continue eating and gain weight, so the key is to counter with equally forceful disincentives, however they're imposed.
posted by decoherence at 8:46 PM on July 14, 2008 [1 favorite]


You're not sticking with science, you're sticking with some weird ideology. I mean, weight gain not correlated with calorie intake? Come on, be serious.
posted by Justinian at 8:38 PM on July 14 [+] [!]


I'm serious. Show. Me. One. Study. Just because your intuition tells you something, doesn't mean it's true. Repetition doesn't make it true either.
posted by serazin at 8:48 PM on July 14, 2008 [2 favorites]


The definition of a healthy diet is not "burns exactly what you're taking in", particularly with regards to short term and long term energy availability. The human body wants and needs some oversupply to store as fat -- which is to say that a regular appetite will very naturally put some weight on you. One would hope that would stop when you reached a point of diminishing returns, but that does not appear to always be the case.

Again, there's no magic here. Hope does not enter into it. Yes, the human body does well with some reserves of fat, but if at that point your consumption and burn do not level off then your weight will not do so either. Using a phrase like "diminishing returns" suggests to me that you are not taking a mechanistic approach to this. And that's what this is. Body mechanics. If you'd like to tell me how, on a regular basis, unspent calories do not turn into additional body weight over time, I'm all ears.
posted by Durn Bronzefist at 8:54 PM on July 14, 2008


I'm serious. Show. Me. One. Study.

#@$%!!!

Common sense, it's what's for dinner!
posted by P.o.B. at 8:56 PM on July 14, 2008 [1 favorite]


Durn Bronzefist:
"there may very well be a difference in how it affects those who are not yet overweight/obese versus those who are. At a certain point, it seems reasonable that a kind of learned helplessness kicks in and shame just feeds denial. That doesn't mean that societal reaction to fat isn't keeping a whole lot of people from blindly going down that road in the first place."

It isn't reasonable. No matter how much it seems it is, it isn't. I linked to a LOT of info on the fact that shame *doesn't* work, that it creates the opposite effect.

General social environment of shame doesn't help. Does not help. Period. Doesn't. It creates bad reaction loops - some go the too restricted route, some metabolise it into body hate, some spread their fear of being shamed onto other people, some go from being normal weight to corpulent in retaliatory defiance or sad resignation.

Those of you who have been blessed by not having to worry about these things probably think "wtf? why can't they just control themselves?" 1) It's not just a lack of control or discipline or effort - other medical issues are often at play & 2) the over-eating cycle is generally not rational. Even when it seems rational, it is generally based on an insidious and destructive self-hate that only looks rational on the surface.

The irrational thing is the hardest part. If you had a homogeneous society with all the same upbringing, resources, issues, and metabolisms, you'd still have the warp of personal perception to contend with.

Why in the world would anyone try to find a way to justify shame when there are so many other helpful, productive, respectful, humane approaches?

No, shame is not justifiable for keeping people on the straight and narrow regarding food and body image. Too much potential for damage (as has been proven) for far too little benefit (which is completely unproven).

Like I've said above a few times: trade shame for encouragement. Barbs for cheers. If you can manage it, maybe even swap out that sneer of disgust for a simple smile.

As a society, be part of promoting ease of access to physical fitness facilities and equipment. Insist upon open green spaces that allow people to be on the grass. Don't pick on those who are smaller or weaker or fatter or whatever else causes you to want to pick on someone. Insist that your community provides healthy food choices to everyone, even the poor. Donate your time at community centers to teach people how to move, eat, or think in a healthy manner.

Join other citizens in lobbying for constraints or at least clearer advertising/labeling on anything that makes food non-nutritive - chemical additives, sweeteners that don't metabolise, hormone disruptors, et cetera. Eat healthy, yourself. Don't worship at the altar of indulgence. Choose activities that encourage movement. Help others get out of their houses. Work to make your city a safer place for people to get out and move around.

Contribute usefully instead of taking the easy (destructive) way out.

All (any) of this will help more than shame ever could, and doesn't produce the collateral damage of a shame-based society.
posted by batmonkey at 8:57 PM on July 14, 2008 [1 favorite]


Sumo wrestlers are healthy 500 pounders? I don't think so.

The negative effects of the sumo lifestyle become dangerously apparent later in life. Sumo wrestlers have a life expectancy of between 60 and 65, more than 10 years shorter than the average Japanese male. They often develop diabetes and high blood pressure, and are prone to heart attacks. The excessive intake of alcohol can lead to liver problems and the stress on their joints can cause arthritis. Recently, the standards of weight gain are becoming less strict, in an effort to improve the overall health of the wrestlers.

WP article.

Fat, OK.
Obese, medical definitions seem over-inclusive.
Morbidly obese, illness probably with both environmental and genetic causes, like a lot of things.
Super-morbidly obese, we're not talking about "fat-acceptance," we're talking about individually-assured self-destruction. Fact, regardless of causes, personality, ethics, shame, etc.
posted by cogneuro at 9:06 PM on July 14, 2008


This poor woman had been told for years that she needed to lose weight because she was fat. Maybe shaming her would have helped her lose her 140 pounds.
posted by leftcoastbob at 9:07 PM on July 14, 2008


decoherence: Society, culture, the market, whatever provides huge incentives to continue eating and gain weight, so the key is to counter with equally forceful disincentives, however they're imposed.

Bwah? You mean like frequent harassment, medical problems, a media that casts you into a limited number of stereotypes (jolly, bitchy, evil), and frequent discrimination are like actually incentives for gaining weight?

Durn Bronzefist: If you'd like to tell me how, on a regular basis, unspent calories do not turn into additional body weight over time, I'm all ears.

Most of the excess energy you eat is flushed down the toilet. Seriously, the hundred pounds extra weight a person might be carrying is only 2-5% of a person's caloric intake when spread out over 10 years. That model is too simple. It doesn't explain why optimistic studies find that restricted diets are only 50% likely to result in >5% weight loss. It doesn't explain why weight is notoriously resistant to change.

Those are the facts you have to deal with, and these are not obscure studies by any means, these have been widely reported in places like the NYT and Scientific American.

PoB: Common sense, it's what's for dinner!

That study doesn't support the hypothesis of a simple correlation between caloric intake and weight gain/loss. From the abstract: "The results suggest that there is some 'threshold' quantity of caloric intake that must be exceeded if changes in body composition, which result from differences in the periodicity of food intake, are to be observed."
posted by KirkJobSluder at 9:12 PM on July 14, 2008 [1 favorite]



Common sense, it's what's for dinner!
posted by P.o.B. at 8:56 PM on July 14 [1 favorite +] [!]


What KirkJobSluder said, only I'd add that I'd prefer to see a study based on human beings in real-world scenarios, not on rats on forced obesity and starvation diets.

Common sense used to tell us that the world was flat and that tomatoes were poison. Common sense can be wrong.
posted by serazin at 9:16 PM on July 14, 2008 [2 favorites]


The actually energy content of fat is trivial compared to what we eat on a daily basis.

Fat is the most efficient energy store that the body can metabolize, by weight.
posted by Blazecock Pileon at 9:19 PM on July 14, 2008


Bwah? You mean like frequent harassment, medical problems, a media that casts you into a limited number of stereotypes (jolly, bitchy, evil), and frequent discrimination are like actually incentives for gaining weight?

Of course not. But they're apparently not strong enough disincentives for gaining weight. Don't read "incentive" in the narrow sense as some kind of lure, but rather in the broader sense of anything that promotes a certain behavior, however subtly. It's almost trivially correct to conclude that for obese people, the incentives for gaining weight have outweighed the disincentives over time.
posted by decoherence at 9:29 PM on July 14, 2008


these have been widely reported in places like the NYT and Scientific American.

Will definitely follow this point up. Thanks, KirkJobSluder.
posted by Durn Bronzefist at 9:29 PM on July 14, 2008


This study discusses the issue of metabolic set-points in rats. When a rat is at a metabolic set-point, increases in weight result in increases in metabolism, and decreases in weight result in decreases in metabolism. this article discusses set points in humans:
An adult human ingests about 214,000 kilojoules per year. The caloric content of adipose tissue is about 1.7 kJ per gram. Thus, a cumulative "error" in the balance of energy intake and output of as little as 5% could result in accumulations (or losses) of 6kg of adipose tissue per year. Body weight or composition in "free-feeding" humans generally does not show yearly fluctuations of this magnitude. In fact, body weight remains remarkably stable over long periods of time, even the the absence of conscious efforts to control it, and experimental perturbations of body weight are met by resistive metabolic forces tending to return body composition to its starting state.
posted by KirkJobSluder at 9:31 PM on July 14, 2008 [1 favorite]


If you'd like to tell me how, on a regular basis, unspent calories do not turn into additional body weight over time, I'm all ears.

I'd like to know myself. See my example upthread about a 300 pound man maintaining his weight at both 1200 and 2400 calories per day. Where do those 1200 calories go?

Using a phrase like "diminishing returns" suggests to me that you are not taking a mechanistic approach to this.

Quite the opposite. I'm treating the human body as an extremely complex and sometimes inefficient machine, one that does not always do what you expect.

The idea that you put 100 calories into your body and use 50, and therefore the other 50 become stored fat is such a broad brush as to be useless.

For starters, there are some known limitations. Overall the human body appears incapable of processing more than 6500 calories per day -- so, note to you bingers out there, once you've passed 6500 it really doesn't matter any more. Nothing else will be processed that day.

On the low end we have the well known "starvation diet" effect, where your intestinal tract slows down to allow you to draw more calories out of the same amount of food and the rest of your body slows down to use less energy in general.

In between there are a whole slew of variables that control how many calories you metabolize and how they are used. I recommend The Second Brain as a guide to just how complicated things get. When I say "diminishing returns" I'm talking about an enormously complex system designed to regulate body weight, appetite, waste disposal -- one that has feedback loops and constantly balances any number of bodily functions. Having it restrict the appetite when one has enough fat reserves would be one of the simplest functions of this system, but as I say, it doesn't always work as we would like.

Furthermore, a slew of other factors play into our metabolisms. How much stress we're under for example -- the same diet will cause you to lose weight during finals week and gain it on vacation. "Fat and happy" isn't a myth. Many people are incapable of processing various types of calories while others are hyperefficient -- and who is who can shift depending on what else is going on in their bodies.

In short, while the traditional "eat less and exercise" works for a large number of people including yours truly, it is not a cure all for every human who walks the planet. And the human body is not a simple generator where you can calculate that X amount of fuel will run it for Y hours. It's a heck of a lot messier than that.
posted by tkolar at 9:31 PM on July 14, 2008 [5 favorites]


decoherence, I don't think that's the case at all--I think that shame-based "disincentives" actually help to increase disordered eating. Of course I don't have a handy survey to back this up, but I'll find one if you find one :)
posted by rivenwanderer at 9:34 PM on July 14, 2008


Nobody's reading down here, but I'm going to post this anyway, because this kind of statement just infuriates me every time it's used as an "argument":

Sukiari: I don't really believe any behavior is beyond a person's control. They have elected not to exercise control and possibly convince themselves they lack the ability to control themselves. There are alcoholics, smokers, and crackheads who have just quit cold turkey and never gone back. They neatly invalidate the premise that things are beyond a person's control.

Wrong, wrong, WRONG. These examples don't "invalidate the premise that things are beyond a person's control" -- they only prove that those specific people were able to do what they did. They prove that some people have the ability to change their habits. The almost infinite differences in the human condition invalidate your ignorant and smug statement.

This is the same puffed-up "bootstrap" argument made by people who assume that if they can do it, everyone can do it, which is an extraordinarily self-centric attitude--everyone is just like me, therefore anyone who hasn't done what I've done is lazy / not trying very hard / doesn't care. Bullshit bullshit bullshit.
posted by tzikeh at 9:35 PM on July 14, 2008 [5 favorites]


decoherence: But they're apparently not strong enough disincentives for gaining weight. Don't read "incentive" in the narrow sense as some kind of lure, but rather in the broader sense of anything that promotes a certain behavior, however subtly. It's almost trivially correct to conclude that for obese people, the incentives for gaining weight have outweighed the disincentives over time.

Well ok, what "disincentives" would I accept:
1) No more coke machines (or even juice machines) in schools.
2) Plan transportation policy around walking and public transportation.
3) Changing agricultural subsidy systems away from sugars, grains, and meats towards fresh vegetables.
4) Creating a healthy culture for physical activities at all levels.
posted by KirkJobSluder at 9:36 PM on July 14, 2008 [1 favorite]


That study doesn't support the hypothesis of a simple correlation between caloric intake and weight gain/loss. From the abstract: "The results suggest that there is some 'threshold' quantity of caloric intake that must be exceeded if changes in body composition, which result from differences in the periodicity of food intake, are to be observed."

Seriously, what? It does give a simple correlation, as you've highlighted, between caloric intake and weight gain/loss.
posted by P.o.B. at 9:40 PM on July 14, 2008


Seriously, what? It does give a simple correlation, as you've highlighted, between caloric intake and weight gain/loss.

That word, it does not mean what you think it means.

If there is a threshold at which the effect kicks in, it's not a simple correlation.

(By the techicolor yawn of bacchus...)
posted by KirkJobSluder at 9:45 PM on July 14, 2008


Well then I shall wave my hand and dismiss everything you say. Wow, I do like the taste of smugness!

You are obfuscating physiology into some kind of shamanistic practice or something. The way the human body works is not that confusing, the way people treat themselves sure can be.

The science is already out there. It has been tried and tested, dare I say, billions of times already and it works.

Changing a persons lifestyle to include better diet and exercise on an ongoing basis works. That is it.
posted by P.o.B. at 9:51 PM on July 14, 2008


This study discusses the issue of metabolic set-points in rats. When a rat is at a metabolic set-point, increases in weight result in increases in metabolism, and decreases in weight result in decreases in metabolism. this article discusses set points in humans:

If there is such a set-point, what in recent decades has grabbed the knob and set it, on average, higher? Your linked article discussed it as heritable, so we go more-or-less back to genetics, implying a massive genetic shift.
posted by TheOnlyCoolTim at 9:53 PM on July 14, 2008


HF-CS
posted by P.o.B. at 9:59 PM on July 14, 2008


The science is already out there. It has been tried and tested, dare I say, billions of times already and it works.

What science is that? Can you point to some studies that show that restrictive diets and exercise lead to significant, long-term weight loss? Because I haven't seen those studies in this thread or anywhere else.
posted by serazin at 10:05 PM on July 14, 2008


I guess it's time I weighed in.:) Today is the first I have heard of the "Fat Acceptance Movement" and well, I've been fat the majority of my life, and I have led a great life. But I'm sure I have not lived my BEST life. At my biggest I was 398, and now weigh 306, that was just this morning. That 92lb difference has had a pretty significant affect on my life, and I'm guessing the next 92lbs I lose will too. I am extremely lucky to say that at the ripe age of 46 I have no health problems which is really good, because at my size, I'm pretty much not insurable. I didn't have any medical problems at my largest either. But I knew then and still do now, that being morbidly obese is a real bitch, and I can't imagine any reasonable person endorsing it as a wise lifestyle choice. Being morbidly obese is no cake walk, although one can certainly make "adjustments" to cope. But the real fact is you just miss out on too much of life when you are out of energy and your stressed mentally and physically. (try strapping two 50lb sacks of flour on your body for just 24hrs, I suggest one on your butt and one on your abdomen to get the full effect) That's my life EVERYDAY. The reality is you plain just don't fit in spaces where most people do and I personally found, not just physically but mentally, that fact wore me out. I remember meeting a lovely girl when I was younger, she had thrown a poker party at her apartment, and man she had the tiniest of furniture! I spent the whole night squatting over this chair, convinced that if I put just half my weight on it, it would smash to a million pieces. I had a lifelong friend confess to me that she didn't invite me over to her house because she thought I would ruin her new couch. Hearing that sucked, but she was right. I've been fortunate enough to be successful monetarily so I could, for lack of a better term, "build my own little world" in which I spent most of my time. But some times you have to venture out and, well, the ONLY place I have found that my size can be an advantage is at the water park, man nobody goes faster than me on the water slide! Also I totally ROCK the cannonball! LOL But I would easily trade my speed on the slide to be able to dance with my wife and not break out in a flop sweat during the first few steps. The reality is that for me, that is not as easy a trade as it would seem. I have to be really vigilant about diet and exercise and when the double stuff Oreos or Ben and Jerry call my name I have to be prepared with something healthier. I considered Gastric bypass but somehow mentally it just didn't sit right with me. The blue has been a great help, as I have found places like stronglifts.com and fitday.com here, and have read great informed comments from folks such as tkchrist. I guess what I am trying to say, is yes, it's possible to be Happy as a Hippo, (which I truly am) thus my handle but I think I might be even happier as a gazelle or maybe a tiger, at least I aim to find out. As for the the blogger in the FPP I wish her all the best and hope she finds her bliss.
posted by HappyHippo at 10:19 PM on July 14, 2008 [5 favorites]


KJS, those are exactly the sort of structural incentives and disincentives that might actually lead to reduced obesity levels throughout the population. Lacking any kind of major public policy shifts, however, the burden's going to fall on the individual to figure out ways to fix his or her own health; the incentivizing method I proposed (self-imposed financial risks), as a means of reducing one's reliance on sheer willpower without adequate short-term rewards, might be one such way. It's a bit of a far-fetched suggestion, but I don't doubt it would work.
posted by decoherence at 10:33 PM on July 14, 2008


Good for you HappyHippo, and the best of luck to you.

Yeah, serazin, it's crazy I just can't find any evidence to support my far flung ideas. I mean has anybody broadcasted this myth on T.V. yet?
posted by P.o.B. at 10:39 PM on July 14, 2008


Uh, P.o.B, serazin keeps asking for proof of long-term weight loss, and you keep providing proof of short term connection between diet and weight.

I have yet to see serazin suggest that there's no short term connection between diet and weight, and I have yet to see you provide any support for the idea that controlling diet will work for long term weight control.
posted by tkolar at 10:43 PM on July 14, 2008 [1 favorite]


> I think the focus should be on WHY and HOW she got to 530 pounds and WHY she never did anything to help prevent it up until now. Try and understand what's going on so that other people headed down a similar path might have some lessons to learn from.

She is probably not aware of that. She has a bunch of other concerns in her head, as shown by what she wrote.

> I found this part really interesting: the idea of seeing your own body as an "Other," of a conceptual divide between you-you and body-you.

>I am always curious about the trajectory from big to massive, from obese to "super-obese" as it is known now. That is, does one truly not notice the change, even without a scale, from 225 to 275 or something similar?

How she got that way may well relate to her alienation from her body. The body is not the self. It's this thing we drag around, that we received punishment for, that people humiliate us for, even if we are minimally fatter than the skinny kids. The shamers are cruel. It is easy to dissociate from the body, its shape and most sensations, avoid the world, and find solace in food. There is no peace and sense of humming along wholististally. No balance. Maybe some thrills in flavour or sexual release. Unfortunately, as you lose muscle tone and activity habits, you are even more out of touch with your body. There can be an addiction like aspect where you eat compulsively, even to the point of feeling sick, but I don't think the main thing is addiction, but dissociation. You learn to protect yourself when looking in the mirror, and your eyes slip around things associated with the shaming. Maybe you notice your beautiful eyes, hair or smile, etc, on a good day, but the bulk is not seen. Is not felt. One day something happens and it is felt. Maybe illness. Maybe discovering the need to do canoeing and the inability to pull oneself back in the boat without sinking it. Could be anything. The trajectory out begins.
posted by Listener at 11:00 PM on July 14, 2008 [3 favorites]


This study discusses the issue of metabolic set-points in rats. When a rat is at a metabolic set-point, increases in weight result in increases in metabolism, and decreases in weight result in decreases in metabolism.

I was aware of set point theory, but I thought that diet and exercise affect metabolism in predictable ways. I will have to read up on this some more.

On happenstance skim upthread:

It isn't reasonable. No matter how much it seems it is, it isn't. I linked to a LOT of info on the fact that shame *doesn't* work, that it creates the opposite effect.

batmonkey: learned helplessness. I was saying it's reasonable to believe that a person may reach a point where negative messages are not in any way constructive. You've concluded that negative messages simply cannot be constructive. I doubt that is so. Normative systems are not created by encouragement alone. You think people have largely stopped smoking because they have discovered that it isn't healthy? This isn't anything that my grandparents didn't know.
posted by Durn Bronzefist at 11:02 PM on July 14, 2008


Uhm... tkolar, you mean aside from the third and fourth links which show results after one year?

How about extending out those timlines? You think if the same guidlines are followed you would bounce back somehow?

Or are you suggesting that *gasp* when people stop exercising and participating in a healthy diet, you will stop recieving benefits from them?

There are no easy outs. You put in the work, you'll get the results. No one said it was going to be easy.

I've spent the last twenty years reading all kinds of literature I could get my hands on. I've spent the last fifteen around pro level athletes. Some of my good friends are top level strength coaches.

So excuse me if I scoff at all this, but some of what has been espoused in here is absolute nonsense.
posted by P.o.B. at 11:04 PM on July 14, 2008


This has nothing to do with metabolic set-points or shame as public policy, so maybe nobody will be interested in it, but something leapt out at me in her description of the surgery:
[leaving for the hospital:] I say, bye as I walk out the door and my dad says it back. Thanks so for your words of kindness and concern! I almost murdered my mom on the drive there.... Because all I needed at that moment was my mom yelling every five minutes.

[emerging from anaesthesia:] My mom squeezes my hand and tells me she has to leave. I still can’t speak or open my eyes and am barely conscious but she has to leave. Because she doesn’t want to hit traffic.

I’m told I’m being discharged! Wooo! I call my mom and tell her. My dad refuses to go to work early so I have to wait four hours to be picked up.
She's in hospital for five days and they never visited her once. I just don't understand.
posted by ook at 11:26 PM on July 14, 2008


Or obesity could be viral (via a previous post).
posted by girandole at 11:30 PM on July 14, 2008


*Smacks forehead* Of course it could be.

It looks like this one is all figured out!
posted by P.o.B. at 11:51 PM on July 14, 2008


What P.o.B. said.

You can always find shitty studies and metastudies of those shitty studies that throw up their hands and say "Whoa, no correlation between calories and weight loss!".

Studies which use food diaries and food frequency questionnaires (FFQs) are riddled with errors, mostly being underreporting. Almost all behaviors which lead to obesity are highly correlated with underreporting of calorie intake. So, a study which relies on food diaries and FFQs is highly likely to show no effect on a fixed diet because of bad data. The metabolic chamber studies referenced by P.o.B. are basically 'prisoner' studies where subjects are only able to obtain a fixed diet. In determining the relationship between single variables (e.g. calcium intake) and weight gain these studies are the only reliable and well controlled ones to draw mechanistic conclusions from. However, the real world is a mess, and any weight loss agent has to be evaluated in a full double blind clinical trial with as many controls as possible before one can say that a given regimen or supplement "works" in the wider world where M&Ms are the cheapest source of calories and soda is easier to get than tap water.

Anyone really interested in the topic should read the Hungry Gene.
posted by benzenedream at 1:17 AM on July 15, 2008 [3 favorites]


P.o.B., Do you think working with elite athletes may be giving you some confirmation bias? Most of the people I know who have broken biofeedback mechanisms (metabolism slows dramatically in response to dieting, always hungry even after eating a meal, etc...) aren't exactly capable of becoming elite athletes, even when they spend hours a day training at the gym.

Myself, I was stuck at 165+/-1 pounds (6'2") for about 8 years before I got diabetes. During that time I ate between 3000 and 6000 calories in a day, and exercised about an hour a day on average. After diabetes, the better my blood sugar control is, the more weight I gain unless I happen to spend about 8 hours a week in the gym. I used to be able with great effort to lose about 10 pounds of weight in a month. Now the best I can hope for is 6-7 if I spend 2 hours a day in the gym 4 days a week (1 hour weightlifting, 1 hour of exercise at ~160bpm heart rate). At that level of exercise though, I occasionally reinjure myself at sites of old injuries (bad ankle, rotator cuff, etc). When that happens, I wind up reducing my level of activity until it heals, and the farther I am from my last peak weight, the more easily I gain weight until I'm back where I started (at least 10-15 pounds a month). If I restrict my caloric intake, I can hold off the weight gain a little bit, but my energy levels go down until I can barely function (oversleeping, can't focus, etc...). The huge difference between those time periods in my life, wasn't exercise or nutrition, but how my metabolism responded to excess calories.

Read up on N.E.A.T (non-exercise activity thermogenesis), because you clearly are only getting a small part of the picture if you think caloric intake and exercise are the only factors in weight gain. NEAT is the primary factor.
posted by BrotherCaine at 1:53 AM on July 15, 2008 [1 favorite]


Also, one of the big disincentives for me to lose weight (as opposed to trying to stay fit at the level of weight I am now) is the expense and space of maintaining clothes in 4 different waist sizes. I know that sounds like it should be trivial, but it is more of a pain than carrying 30-40 extra pounds over my 'ideal' weight.
posted by BrotherCaine at 1:56 AM on July 15, 2008


rocket88: it [morbid obesity] is a self-inflicted phenomenon, even if inflicted passively rather than actively, and taking personal responsibility where due is never a bad thing.

Is it? My theory is that behind every pathological, self-destructive behavior, there lies some kind of illness or physical disfunction. Whether it's mental / psychological, hormonal, digestive, my guess is that reaching 530 pounds is actually a symptom of a root problem that needs to be identified and addressed. I would like to see a type of acceptance that says, "let's help you treat your underlying medical issues and get you healthy". I think that view is more helpful/healthy than either the "you're fat, you're great, no problem" kind of acceptance, as well as the "ha-ha blubber butt" kind of juvenile mockery.

I could stop bathing, shaving, brushing, and flossing and before long I'd look like shit. How much support would I get if I took the political stand that I should be accepted as I am and that the very idea of active maintenance of one's body is an evil perpetrated by society?

If you stopped bathing, shaving, brushing and flossing, I would hope that someone who cares about you would encourage you to visit a doctor and/or psychotherapist to look for deeper/root problems.
posted by syzygy at 4:15 AM on July 15, 2008 [1 favorite]


TheOnlyCoolTim: If there is such a set-point, what in recent decades has grabbed the knob and set it, on average, higher? Your linked article discussed it as heritable, so we go more-or-less back to genetics, implying a massive genetic shift.

Ohh please, read the entire thread for fucking context before you throw up more half-baked straw men.

By all means it is a given that increases in caloric intake and sedentary lifestyles are primary factors behind the obesity epidemic.

However, given substantial evidence that human physiology resists changes in body mass and composition through metabolic changes, the naive view that weight is a linear function such that weight gain/loss ~ excess caloric content is junk science. Furthermore, the long-term weight-loss gains of diet and exercise with medical support are quite modest, and expectations that everyone would be able to loose >5% of their body mass given the proper application of social shame and responsibility are unrealistic.

benezenedream: You can always find shitty studies and metastudies of those shitty studies that throw up their hands and say "Whoa, no correlation between calories and weight loss!".

Straw man. Go directly to jail. Do not pass go. Do not collect $200.

The argument is not "no correlation" the argument is "the correlation is not simple or linear." Weight loss is complicated by the fact that weight loss is only one metabolic response to restricted caloric intake.
posted by KirkJobSluder at 5:23 AM on July 15, 2008


benzenedream: However, the real world is a mess, and any weight loss agent has to be evaluated in a full double blind clinical trial with as many controls as possible before one can say that a given regimen or supplement "works" in the wider world where M&Ms are the cheapest source of calories and soda is easier to get than tap water.

Certainly, and until the real-world clinical trials that are performed deliver better than 50% loose >5% after 5 years, expectations of real-world weight loss should be kept equally modest. That's all that's being advocated here.
posted by KirkJobSluder at 5:39 AM on July 15, 2008 [1 favorite]


The Hungry Gene looks interesting. Review in the Washington Monthly.
Like [Eric] Schlosser, Shell ends with the now-familiar call for a ban on marketing junk food to children. It's absolutely the right prescription, but one that invokes a "Yeah, right" response. This country will never ban Happy Meal ads on TV.
Maybe, but parents can control how much TV their kids watch, especially when they're very young.
posted by russilwvong at 6:41 AM on July 15, 2008


LJ commenter gramcracker writes:
I made the mistake of browsing through some of the comments on the digg link, and much of the metafilter thread. The ignorance and hatred on display astounds me. Even the relatively civil and accepting metafites community can barely hide their raging fat-hate. I could fill a dozen fat-hate-bingo cards.
posted by russilwvong at 6:56 AM on July 15, 2008


Even the relatively civil and accepting metafites community

This community does not exist.
posted by Brandon Blatcher at 7:05 AM on July 15, 2008 [1 favorite]


there is not a good study that shows that fat people eat more than thin people.

serazin--I find your position disturbing and problematic. You seem to be replacing a justified frustration at the difficulty with losing weight and maintaining weight loss with a dismissal of the extensive science that shows that increased calorie consumption leads to increased weight. One need not abandon a belief that this is a complex issue in order to admit that there are some strong correlations that can be drawn between calorie intake and weight gain. It's a kind of distasteful fundamentalism to insist that this is all so complex that we know nothing about it, and it weakens all aspects of your argument.
Overweight children find food more reinforcing and consume more energy than do nonoverweight children.
"RESULTS: In both experiments, overweight children found food more reinforcing and consumed more energy than did their leaner peers."

Sugar intake, soft drink consumption and body weight among British children: further analysis of National Diet and Nutrition Survey data with adjustment for under-reporting and physical activity.
"In logistic regression (adjusted for age and gender, under-reporting, and dieting), overweight was positively associated with energy intake (MJ) (odds ratio [OR]=1.58, confidence interval [CI]=1.42-1.77) and sedentary activity (h) (OR=1.11, CI=1.01-1.23), and inversely associated with moderate/vigorous activity (h) (OR=0.71, CI=0.58-0.86)."

Compensation for energy intake from fast food among overweight and lean adolescents.
"Overweight participants ate more than lean participants whether energy was expressed in absolute terms (1860 [129] vs 1458 [107] kcal, P =.02) or relative to estimated daily energy requirements (66.5% [3.1%] vs 57.0% [2.9%], P =.03)."

Effects of dietary energy on growth performance and carcass quality of white growing peking ducks from two to six weeks of age."As dietary energy increased from 2,600 to 3,100 kcal of AME/kg, the weight gain of ducks increased significantly"
There are many many more studies available at PubMed that confirm this finding, with all types of different species. It's a bit incredible that you think that it's science-based to suggest that it is specious.

There are undoubtedly many other factors that affect weight gain and problems losing weight. And I'm familiar with the studies that show that it's very hard for people to lose weight and keep it off for significant lengths of time. I'm not aware of studies (although they may exist) that show that overweight people who maintain restricted diets and exercise programs gain their weight back. This is a crucial distinction, often not addressed by those who point to the poor outcomes from studies. It's probably true that diet and exercise changes will not do enough epidemiologically to stem the obesity epidemic, but I've never seen them fail (when adhered to) with individuals. I know from my own experience that my weight is directly correlated with my diet and exercise. This is the testimony provided in the national weight loss registry as well. That it's difficult to maintain diet and exercise changes does not mean they do not work. At the risk of indulging an analogy I find mostly unhelpful, the heroin addicts I work with find it very difficult to stay clean when they're using. It's much easier for them stay clean when they don't take heroin. Addicts often want being clean to be easy, to be comfortable, but it isn't that, at least not for a long time. I have the feeling that, like heroin addicts, who have given up the discomfort of being clean for the discomfort of needing to get well, people who give up in their effort to lose weight are in some despair about the difficulty that they have to experience to lose. But just because it isn't easy to maintain doesn't mean that diet and exercise don't work.
posted by OmieWise at 7:51 AM on July 15, 2008 [5 favorites]


Durm Bronzefist:

Clearly you are tied to a particular path. I hope you are not encouraging others to go along with it or using this on anyone out in the world other than yourself.

This world is hard enough as it is without other people adding to it by thinking they have some kind moral obligation to shame others into obedience.

You keep using smokers as an example. Smoking is not a required activity of the human body. Eating/drinking is. Shame applied to something you have to do everyday does not create good decision-making.

As pointed out in the links (and many crappy, ignorant comments) above, "weightism" is already a virulent and pervasive attitude. This is the shame you are talking about. In line with this shame - as it has risen and become more accepted - weight issues in the US & UK have also risen.

SHAME DOESN'T WORK. Go up there and click links. Read. Watch. Learn.

If it did, the two nations with the highest levels of weightism would have healthier people in them. Since they don't and studies are proving time and time again that no matter what fanciful permissions for being an asshole people can think up for justifying shame as a weight control device for the rest of society (or even just one's own kid), it doesn't work.

You also seem to think, by applying your "learned helplessness" link, that overweight people are inherently weak in all ways. This also implies that you believe shame is a condition that other human beings should accept. You're wrong on both counts.
posted by batmonkey at 7:51 AM on July 15, 2008 [1 favorite]


Even the relatively civil and accepting metafites community
This community does not exist.


Yes it does. It's just in a constant battle with the simplistic and judgmental metafites community.
posted by tkolar at 7:55 AM on July 15, 2008


And I'm going to go way out on a limb here and guess that you guys in the "just put the needle down, dude" camp don't know what it feels like to wake up first thing in the morning when you have a $400 a day drug habit. The decision tree doesn't have many branches at that point. Choice is a pretty meaningless concept when there's an air raid siren accompanying flashing neon signs saying "DOPE DOPE DOPE" going off in the lizard brain.

Again, it makes me feel like a dick to say this, common sense or something like that forces me to speak up. While I possess some level of sympathy for addicts and the like (right around "damn, that sucks."), I am lacking this complete 130-piece tool set of compassion that some of you seem to have.

From what I understand, before an addict is rock-bottom, broke, passed-out-by-the-toilet, and their life is completely fucked, at one point they are sober.

And then sometime in between being sober and being completely fucked, they make their first decision to take that first step down the path of self-destruction.

Am I wrong in thinking that people should think for a second before making a decision like that? Before choosing to completely fuck over your poor, innocent, unknowing lizard brain with all this fucking garbage like smack, twinkies, alcohol, etc, if they know what the hell is good for them?

And now, after all the damage is done, I'm supposed to sit here and feel sorry for them, give them my money, pat them on the back, and tell them it's okay? It's not fucking okay. Maybe I'm alone in this, but it really isn't okay with me. I guess that makes me a dick after all.
posted by crunch buttsteak at 7:59 AM on July 15, 2008


Also: I don't believe shame creates more non-smokers than other approaches.

In fact, I believe it accomplishes the opposite.

The smoker who quits based on shame is already looking for society's approval, which means an approval or education model would work better without also have shame on top of it.

The smoker who does not care for society's approval is made more entrenched.

I know. My entire family (other than the kids under 20) smokes, and any amount of shame or disapproval just makes them more determined to "decide for themselves". I know dozens of other people who are the same way. They will reject any piece of good information based on one moment of shame.

Think about the effects of shame on the human body. Think about how it increases cortisol. Think about how it brings up already broken decision-making patterns. It's actual, factual science.

Now consider that most people who smoke (or eat indulgently/obsessively) are doing so out of a desire to mitigate stress they are already under or in reaction to negative situations.

Increasing stress or negativity on people who are already over-burdened in their abilities to cope with these elements of life does not help them. It is destructive and cruel and needless. It is proven to not work, it is proven to accomplish the opposite.

You can use encouragement and education instead of shame, and much more usefully. Just don't do the second unsolicited, since other people's choices regarding their own bodies (when it doesn't harm anyone else) are really not your responsibility.
posted by batmonkey at 8:07 AM on July 15, 2008


Am I wrong in thinking that people should think for a second before making a decision like that? Before choosing to completely fuck over your poor, innocent, unknowing lizard brain with all this fucking garbage like smack, twinkies, alcohol, etc, if they know what the hell is good for them?

Eating one twinkie doesn't make you fat (though the things taste like crap, so there's no reason to eat them.)
Most people who try a beer don't become alcoholics.
Most people who try heroin don't become heroin addicts. (It seems, in our culture, to be more addictive than alcohol or cocaine, less addictive than cigarettes.)
In fact, even most people who try a cigarette don't become addicted to tobacco.
posted by TheOnlyCoolTim at 8:20 AM on July 15, 2008 [1 favorite]


If you cannot control hunger, learn to enjoy it.

Is possible.
posted by Laotic at 8:30 AM on July 15, 2008 [2 favorites]


But just because it isn't easy to maintain doesn't mean that diet and exercise don't work.

When you look at any medical treatment -- CPAPs for sleep apnea for example -- compliance is a huge part of deciding whether they work or not. CPAPs have close to a 100% success rate, if only patients would use them consistently, but only a fraction of patients do.

I feel like we're having the same argument here. CPAPs "work" in the sense that if you get patient compliance they will have a good outcome. CPAPs do not "work" in the sense that patient non-compliance is rife.

The researchers who brought us the CPAP did not just stop after the trials and say "Okay, we found a solution, it's not our problem if people don't use it." A whole slew of variants came out, patient training was instituted, treatment monitoring was built into the machines, all because the treatment was not considered to be working sufficiently due to low compliance rates.

And the compliance rates are still marginal. If someone were to come up with a sleep apnea treatment that 70% of patients would actually use, CPAPs would be abandoned tomorrow.

As I say, it feels like the same argument here: As often someone says "I lost 40 pounds by restricting intake and exercising", someone else can point out that there is a 50% chance that they were unable to maintain that weight loss over an extended period.

50% is a lousy cure rate, and I have yet to see the P.o.Bs in this thread address that. Instead there seems to be the sense that because diet and exercise have worked for the determined atheletes he trains, it is therefore a workable solution to the obesity epidemic. Problem solved, let's move on...
posted by tkolar at 8:34 AM on July 15, 2008 [3 favorites]


From what I understand, before an addict is rock-bottom, broke, passed-out-by-the-toilet, and their life is completely fucked, at one point they are sober.

Actually that's not entirely clear. If by "sober" you mean "not intoxicated" then yes. If you mean "sober" as in "not addicted" then not so much -- the genetic roots of addiction are pretty clear.

Put another way, an experienced social worker/psychologist can look at a 5-7 year old's family and circumstances and make a pretty good guess about the role substance addiction will play in their life.
posted by tkolar at 8:42 AM on July 15, 2008


OmniWise: But just because it isn't easy to maintain doesn't mean that diet and exercise don't work.

And yet, even with the best case clinical studies, when diet and exercise "work" the gains are relatively modest. This is the entirety of my argument. Modest weight-loss goals of 5-10% that are reasonably achieved by many people who stick with diets is a better expectation than the unrealistic goal of a 21-23 BMI. If a person reaches a difficult and modest 10%, they shouldn't be judged according to the prejudices expressed here that they are lazy and snarfing down twinkies. Setting unrealistic goals when you know that those goals are very difficult for many people to achieve is a bad thing.

crunch buttsteak: Am I wrong in thinking that people should think for a second before making a decision like that? Before choosing to completely fuck over your poor, innocent, unknowing lizard brain with all this fucking garbage like smack, twinkies, alcohol, etc, if they know what the hell is good for them?

These analogies to smoking, alcohol, and heroin are a bit false in that obesity likely can't be tied to buying that first pack, binge drinking with some friends, or trying that first hit.

Instead, you have the cumulative effect of a lot of little things that the person may make for entirely different reasons. Kids who watch TV or play inside because the playgrounds are trashy and unsafe. Families that get their meals from nearby fast food or convenience stores because the local grocery is a one-hour bus-ride away and the taxis don't come to your neighborhood. Suburban parents who drive their kids a half-mile to school because the neighborhood was designed entirely around cars. You take a job in a commercial park on a four-lane road off the interstate because it pays good, and if you are lucky, you get time in the evening to drive another half-hour to a gym. Even if you have pedestrian access to your job, you drive in because you don't want to offend co-workers or clients.
posted by KirkJobSluder at 9:06 AM on July 15, 2008


I feel like we're having the same argument here. CPAPs "work" in the sense that if you get patient compliance they will have a good outcome. CPAPs do not "work" in the sense that patient non-compliance is rife.

I agree (I also happen to work with a lot of medication compliance issues in my job), but I'm actually making a slightly different argument. While I think that because of the low compliance rates diet and exercise isn't going to "solve" the obesity epidemic, I'm making a distinction between the individual and the statistics. Choosing to be compliant with diet and exercise are just that, a choice. It may be harder for some and easier for others, but it's still a personal choice. The evidence that statistically it doesn't work is not evidence that it isn't effective, just that people aren't compliant. People can make a choice about that, and the arguments citing the studies seem to suggest that there is no choice involved: since large groups don't lose weight consistently that way, diet and exercise must not work. But there's a difference between saying that they don't work for most people, that they don't work as population responses, and that they don't mechanically.

Look, I'm a social worker working in an inner-city HIV clinic with indigent patients. I work with people who have huge behavior problems, from poly-substance abuse to personal interaction problems to difficulty holding a job for longer than two weeks. I'm by no means a strict behaviorist: I'm not only a social worker, but also a psychotherapist, and I see so many adverse environmental and physical causes for my patients' problems that it's often difficult to know where to start. But I don't think anything is served, least of all hope, by abandoning personal agency in the face of those problems. We can't deify the exceptional successes in the name of ignoring the huge obstacles folks face, but neither can we afford to tell people that they should just give up because they face too much. It would be unethical, and it would serve the opposite function, of making of those who have poured their heart and soul into overcoming so extraordinary as to be invisible. It's a delicate balance to achieve, but, for me, that balance is in the space between statistics and individual agency, between the crushing (and unavoidable) exigencies of environment and the behavioral choices we all make.
posted by OmieWise at 9:20 AM on July 15, 2008 [14 favorites]


The blogger wrote an amazing, brave, incredibly raw and self-baring set of posts around her experiences and conflict with regard to WLS, and some folks here just don't seem to have any respect or compassion for that, for her.

When the vast bulk of your support system has certain expectations and beliefs, it is really fucking hard to go against those, much less do it publicly, and she did that. Obviously her parents, while providing functional support (transportation, hygiene assistance, most likely financial assistance), are not there for her emotionally. They couldn't be bothered to visit her in the hospital over a 5-day period, for crying out loud.

Fat Acceptance as a movement has a place, I think. Shame as a social motivation tactic results in discrimination, estrangement, and low self-esteem, regardless of which trait or behavior it's applied against, and it's not effective. If it were, the West would have no obese adults, the Middle East would have no pre-marital or extra-marital sex, etc. It is possible to have a higher BMI and be healthy, just as it's possible to have a lower BMI and be unhealthy. That shouldn't surprise any of us.

What we need is a better understanding of the causes and effects of obesity -- including metabolism, viruses, set-points, correlations to diabetes and other insulin-related conditions (chicken and egg scenarios including, without preconceptions), the whole ball of wax -- and a significant shift in food subsidizing, marketing, and availability that moves us toward more fruit, vegetables, whole grains, and fish and away from refined sugars, fatty meats, and highly processed foods in general. Not because it's necessarily going to result in wholesale weight loss, but simply because it will result in higher quality input and increased wellness, at whatever size.

@serazin: "To borrow from Marlyn Wan, take the challenge of 3’s: Find 3 people who have lost 30 pounds (or more) and kept it off for 3 years (or more). Personally, I can’t think of a single person I know who meets these criteria – and I hang out with a lot of fat folks."

Anecdotally, I can beat that challenge of 3's. I lost over 60 lbs. 4 years ago and have kept it off. A close friend lost over 150 lbs. at about the same time and has kept it off -- she's still over 200 lbs., but very healthy and in the gym several hours each week, even works in a fitness-related field. My cousin lost 140lbs over 18 months, in order to qualify for a liver transplant, and is doing fabulously. My sister, who was heavy throughout childhood, lost about 80lbs. and has kept it off for over 10 years now.

None of this means that every person with a higher BMI would have success following the methods we did, or that they're unhealthy at their current weight, or even that they should lose weight. But for those of us whose weight is tied to overeating and/or underexercising, it is possible to get it off and keep it off, with time and persistence.
posted by notashroom at 9:52 AM on July 15, 2008


Instead, you have the cumulative effect of a lot of little things that the person may make for entirely different reasons.

I agree - I don't believe in willpower or "choice". We are analog beings with genetically or environmentally determined levels of desire. Weight loss is all about frustrating a desire to eat by putting as many roadblocks in the way as possible. Unfortunately as KirkJobSluder's work park example shows, North America puts hurdles in the way of moderate healthy exercise (walking) but puts vending machines full of high density food everywhere.

Again, a plug for the Hungry Gene book. The conclusion from the author is that overweight is mostly determined by genetic levels of hunger (and intake of HFCS which bypasses normal satiety mechanisms). Shame, judgement, and comparison of different individuals who likely have different endogenous levels of hunger is not terribly useful. The idea that we can magically control our desires without radically rearranging our environments leads to bad policy and science.
posted by benzenedream at 9:52 AM on July 15, 2008


I just want to say that the fat hating in society is really, really evil, and I have known that for a long time. I think that's where my misanthropy started, but anyway I just shake my head at the stupid, cruel, destructive and constant attacks. The important thing in fat acceptance is the acceptance, not the fat. Healthy at any weight can get a bit out of hand, as it does in her blog post, but come on, fat-haters, shape up your attitude.

Good for her that she decided to face the issue and do something about it, something other than giving up the job and staying home where someone else could take care of her.
posted by Listener at 9:55 AM on July 15, 2008 [1 favorite]


OmieWise: I don't know who exactly you are arguing against here. Not one single person is saying that fat people "should just give up." Not. One. Single Person.

The reason why these discussions are so frustrating is that it doesn't seem like there is really a dialog going on. How the heck do you get the idea that fat people should just give up from the previous discussion? Let me know because I can't be any more clear:

People who are obese should do what they can.
They shouldn't be negatively judged if that's only a moderate loss of weight.

I'll make the counter-argument that we do deify the exceptional successes here. It pains me that my relatives who dropped to a lean 21BMI and run three marathons a year in middle age are showered with praise, while my relatives who fight just as hard to maintain a stable 10% weight loss while religiously watching their diet and blood sugar, are still judged as lazy gluttons according to the standards of Metafilter health moralism.

The people in my family who are obese have worked very hard with considerable sacrifice and heartbreak to loose a significant quantity of weight, change their diet, and get more physical activity. No one here is in the position to cast a moral judgment on them.
posted by KirkJobSluder at 10:04 AM on July 15, 2008


KirkJobSluder--I can tell by the periods after each capitalized word that you Really. Want. To. Emphasize. Your. Point, but perhaps if you looked at the comments I've responded to you'd have a better idea of who it is I'm addressing, and which arguments seem to me to encapsulate the notion that because losing weight is difficult, we should not expect people to be able to do it.
posted by OmieWise at 10:20 AM on July 15, 2008


Not one single person is saying that fat people "should just give up." Not. One. Single Person.

Maybe not here, but over on the fat acceptance blogs that's the standard line, that attempts to lose fat are to be avoided.
posted by TheOnlyCoolTim at 10:32 AM on July 15, 2008


notashroom -
you and your friends present an unusual set of examples. Statistically, we know that the vast majority - somewhere in the 90% range depending on the study - regain the weight. Most people interpret that data to mean that 90% of fat people are lazy or refuse to follow through. Given evidence related to set-points, genetics, etc, I think that statistic means that for most people, significant, long-term weight loss is not possible.

I'd also ask you, how hard to you have to work to keep off that weight? While thin people can relax, fat people who loose weight and want to keep it off usually must work diligently for the rest of their lives - to a level that I think most thin people just don't understand - to keep the weight off. Correct me if that doesn't apply to you.

Omiewise -
I really appreciate you going to the science on this. The main thing that angers me about the issue of fat is how moralistic people are about issues which they know almost nothing about beyond what they’re told on TV.

For the record (and if you look at my previous comments they’ll confirm this) I think quality of food does matter. In fact, I also support public health measures like banning fast-food advertising, removing soda machines from schools, etc. I think people of all sizes will benefit from eating more nutritious food.

The study you linked around how much fast-food children choose to eat depending on body size was convincing to me, if limited. (Limited because this studied children during one meal and during a two-day period – not looking at the children’s normal, everyday diets over a longer period). In one of the other studies you linked I don’t understand what “reinforcing” means in that context, but again, it supports your point and I appreciated reading it. I’m willing to look more at the idea that fatter kids eat more than thinner kids.

Based on what I’ve read, other studies have failed to support this conclusion. Here’s one that suggests that the quality of the food may matter more than the quantity. We also now know for sure that many other factors, some surprising ones, impact body size.

But where you really lose me is with your ending paragraph. You veer off into your assumptions – that continued calorie restriction and exercise will lead to long term weight loss or maintenance of a lower weight. You assume that people are falling off their diets – and that assumption makes intuitive sense – but it’s your assumption not science. Even if your assumption is correct, good studies show that calorie restriction in fat people looks, metabolically, like starvation. Most people blame a lack of willpower for the failure to keep weight off, but evidence points to something else.

Like you Omie, I work in the health care field. I write health manuals for community health workers outside of the US and I’m starting nursing school in the fall, so I’m very familiar with the mainstream thinking on this topic. I’ve had to look a little to find alternate viewpoints, but I think its been worth the research. Some places where I’ve read research that questions that popular thinking on this include Rethinking Thin – the Gina Kolata book excerpted in the NYT article I linked above, Big, Fat Lies, Tipping the Scales of Justice, and this blog.
posted by serazin at 10:45 AM on July 15, 2008


OmieWise wrote...
Choosing to be compliant with diet and exercise are just that, a choice. It may be harder for some and easier for others, but it's still a personal choice. The evidence that statistically it doesn't work is not evidence that it isn't effective, just that people aren't compliant

It's taken me a while to respond this as I think we're largely in agreement re the difference between being effective for one person vs. effective for populations.

Perhaps this is going off too far in a philosophical direction, but: If large portions of the human population is making "choices" that are directly and obviously detrimental to themselves, then doesn't that cast suspicion about whether the activity is a choice or not?

I mean the point of free will is that you are able to make decisions that one way or another are good for you. So while it's possible that big chunks of the population are simply Doing It Wrong, doesn't it seem more likely that the behavior is driven by a more basic instinctual force?

Anyway, as I said we're largely in agreement. I understand the balance you're making between environmental pressure vs. free will, I guess we just come down differently on where exactly the tipping point is.
posted by tkolar at 10:47 AM on July 15, 2008 [2 favorites]


As a side issue (since there are plenty of side issues already being discussed), I will say that as a man who needs to lose a lot of weight, one thing that angers me is how medical insurers oft treat issues relating to medical recovery from obesity as cosmetic or otherwise uncovered. Want to see a nutritionist or dietician to alter your eating habits? How about a physiatrist to get an exercise routine that your physical body can handle? Did you lose a lot of weight and now you literally look like a sharpei? Better not expect your insurance company to help you out with any of those things.

And, yes, I realize that a counterquestion that can then be asked is, "Why should a medical insurance company help someone recover from the aftereffects of their own vices?" To that I'd respond that a moment's thought yields thousands of examples every day where medical insurers cover medical treatment that helps people recover from the aftereffects of their own vices and/or choices. Childbirth. Smoking. Heart attacks. Lacerations incurred while drunk. (And accidents caused by drunk driving.) Alcohol and/or drug rehabilitation programs. And so on. We make mistakes with our body every single day, and they incur a medical cost to our body's well-being. Most of those medical costs are alleviated by insurance. But when it comes to alleviating the costs incurred by obesity, not so much — and what puzzles me is that preventative and "repair" treatments has got to be more cost-conscious than heart bypasses, etc., so why the hell don't they?
posted by WCityMike at 10:50 AM on July 15, 2008


Statistically, we know that the vast majority - somewhere in the 90% range depending on the study - regain the weight.

Notashroom, in the examples you give, did they involve these people going to the doctor for a Weight Loss Program With Medical Support or did they just lose the weight?
posted by TheOnlyCoolTim at 10:52 AM on July 15, 2008


TheOnlyCoolTim: Studies vary on this. One problem is that few studies of weight loss do real, long-term follow up. One year is considered "long-term" but in real life, we know that people regain later. From what I understand, studies in medically controlled environments show greater weight regain than people's personal weight-loss programs without help. It's hard to know whether the difference is just in the reporting though. I'd check out this article to start exploring this issue.

Also, gastric bypass is not the magic bullet everyone hopes it is.
posted by serazin at 11:08 AM on July 15, 2008


OmieWise: I can tell by the periods after each capitalized word that you Really. Want. To. Emphasize. Your. Point, but perhaps if you looked at the comments I've responded to you'd have a better idea of who it is I'm addressing, and which arguments seem to me to encapsulate the notion that because losing weight is difficult, we should not expect people to be able to do it.

If weight loss is such a difficult metric to achieve, should it always be the primary goal of a diet or exercise program? I had an experience where I plateaued with a bit of a spare tire around my middle while I was training up to the half-marathon level. Does this mean that all that work extending my endurance and quickening my pace was wasted? Are there not cases where other metrics and considerations should have priority over weight loss?

There is two problems with "we should expect people to be able to do it." First of all, some people are not able to do it. So we need to accept that some will not, and that this is probably not a moral failing on their part. Secondly are those expectations not a private medical concern to be shared among a person's medical specialists and possibly family? Why is it my business to set these expectations for the stranger sitting next to me?

And if a person does achieve only minimal or modest goals. Shouldn't that be celebrated?

WCityMike: And arguably a thousand dollars of prevention would save the company a may thousands of dollars in critical care treatment.
posted by KirkJobSluder at 11:12 AM on July 15, 2008


Not knowing anything about the science of weight loss, I'm happy to accept for the moment the idea that people have a "set" weight, given their genetics and their environment. Where I become mystified, however, is why the "fat acceptance" people are putting their effort into, well, fat acceptance, rather than mass advocacy for changes to the built environment, food systems, and so on.

You can't change the genetics, but our environment is entirely mutable. I have zero problem with the idea that a somewhat higher BMI can be perfectly healthy (if at times inconvenient)... but I have a really tough time accepting the idea that what gets termed "morbid obesity" and beyond is healthy for anyone, barring some very unusual individuals.

So I'm all for "fat acceptance" if that means not harshing on some actress for gaining half a pound, or if it means broadening our ideas of "healthy" to accept the nuances of weight, where perhaps an increased risk of one disease is balanced by something else, in certain ranges of the BMI scale.

But where the fat acceptance people lose me, and lose a lot of people, is in the proposal that someone as obese as the woman who wrote the blog in the FPP is remotely healthy. Outside of the possible exception of sumo wrestlers and NFL frontliners (both of whom actually suffer real consequences from their weight, but with the compensation of being able to tear irritating skinny people into small pieces at will), weighing that much just isn't good for you.

And where the fat acceptance people really lose me is in the assertions that a) fatness is simply a given; b) increased fatness across a society should be met with acceptance rather than public health measures (like banning HFCS or whatever) that address the increase in obesity; and c) that weight loss does not work. The last point is really connected to the second point -- it seems quite obvious to me that long-term weight loss is very difficult in a society where one can drive everywhere and get soda in 44 ounce (and larger!) "single-serving" containers from drive-through windows.

But that doesn't mean that weight loss is impossible -- it means that weight loss is extraordinarily difficult unless we change our environment. And that's why I am so puzzled at the focus on "acceptance" rather than environmental change. You don't need some skinny guy like me to "accept" fatness -- you need mass mobilization to force the sorts of changes to our social and physical environment that make leading a healthy life the default option, rather than something one has to struggle and strain to try and achieve in the face of enormous odds.
posted by Forktine at 11:24 AM on July 15, 2008 [3 favorites]


KirkJobSluder: "WCityMike: And arguably a thousand dollars of prevention would save the company a may thousands of dollars in critical care treatment."

Precisely. Even operating within the (rather justifiable) model of insurance companies as heartless bastards with no interest in well-being and every interest in profit, their actions don't make sense. To stave off repeated skin infections (and associated complications if staph develops and can't be squished) by preventative removal of excess skin ... it makes financial sense. To pay for a cardholder's visits to a nutritionist and physiatrist in order to prevent future high costs with cardiology and/or stomach-stapling ... makes financial sense. Insurance companies can be reliably counted to do what's in their best financial interests. Except in these cases. I just don't get it ...
posted by WCityMike at 11:26 AM on July 15, 2008


OmieWise: The evidence that statistically it doesn't work is not evidence that it isn't effective, just that people aren't compliant.

I'll take issue with this, because even with compliance the actual effects of diets in real-world clinical trials are modest. Typical success is still only averages 5-10%, which for most medically obese people is still obese.

forktine: Where I become mystified, however, is why the "fat acceptance" people are putting their effort into, well, fat acceptance, rather than mass advocacy for changes to the built environment, food systems, and so on.

Because there are multiple forms of institutional and informal discrimination and harassment.

And where the fat acceptance people really lose me is in the assertions that a) fatness is simply a given; b) increased fatness across a society should be met with acceptance rather than public health measures (like banning HFCS or whatever) that address the increase in obesity; and c) that weight loss does not work.

a) for the time being, there are going to be fat people participating in our culture,
b) false dichotomy in that it's quite possible to have humane and respectful (acceptance) public health measures that work to reduce obesity,
c) at this time, there is no magic bullet that enables all people to achieve a non-obese BMI. The typical gains from current treatments are modest, even with full compliance.
posted by KirkJobSluder at 11:33 AM on July 15, 2008


you need mass mobilization to force the sorts of changes to our social and physical environment that make leading a healthy life the default option, rather than something one has to struggle and strain to try and achieve in the face of enormous odds.

Waiting for the government or the corporations to take your best interests at heart is a sucker's game. If someone needs an environmental change to lose weight, they'd best change their personal environment. I mean, I'd support the types of top-down changes you discuss, but the government don't give a shit if you suffer and die.
posted by TheOnlyCoolTim at 11:35 AM on July 15, 2008


My mom fought being fat her whole life. No, she didn't exercise a lot or eat perfectly, but she wasn't as bad as she was big....it didn't make sense. She had this surgery 4 1/2 years ago and it changed her life. She was 5 ft 2 inches and 260, and is now 130. She now walks and is active and doing so well and is a totally different person-active-wise.

Its a horrible cycle-you get a little bigger so it gets harder to exercise and lose that weight and its very self-defeating...and for a lot of people its not as easy as 'jsut stop eating junk food.' it wasn't like that for my mom. She fought and fought her whole life and eventually gave up and then really ballooned. its awful to watch.

I"m thankful she had this surgery...She's healthier and more active then she's ever been (in the 35 years I've known her) and I feel very lucky that she could afford to have it done (she paid for it in cash because she wasn't 'big" enough or sick enough to have her insurance pay for it. )
posted by aacheson at 11:36 AM on July 15, 2008


KirkJobSluder--There is two problems with "we should expect people to be able to do it." First of all, some people are not able to do it. So we need to accept that some will not, and that this is probably not a moral failing on their part.

I didn't say we should expect people to be able to do it, I said we should not not expect people to be able to do it. Those are significantly different statements. And I never made a comment on whether or not weight loss is the best (or only) metric of success. I've still got a spare tire and I run 100 mile races, which I obviously think leads to a certain amount of fitness. And, I never made moral judgments at all, in fact, I argued against it.

serazin--You veer off into your assumptions – that continued calorie restriction and exercise will lead to long term weight loss or maintenance of a lower weight. You assume that people are falling off their diets – and that assumption makes intuitive sense – but it’s your assumption not science.

Those aren't assumptions, they're conclusions. Again, I think you tread dangerously close to an untoward fundamentalism in insisting that losing weight just isn't possible or sustainable. If there are studies that prove that staying on a diet leads to weight gain after subsequent loss, I'd love to see them.

And I still haven't seen any accounting for the 5000+ people listed in the National Weight Loss Registry, people who should not be there if the outlook is dismal.
posted by OmieWise at 11:49 AM on July 15, 2008


Hey Omie,

I think the weight loss registry is flawed because it is based on self-reporting and you can sign up with only 1 year of sustained weight loss.

Also, I didn’t say that dieting causes regain of weight, but I think evidence points to the idea that dieting does not keep weight off over a long period - not for most people.

I don´t think we´re going to convince each other at this point. But thanks for your civility and thoughtfulness on this issue. You stand apart from many others in this thread. I do hope you’ll consider looking at one of the books I mentioned or at least the NYT article.

Take care!
posted by serazin at 12:05 PM on July 15, 2008


serazin links to an excerpt from Gina Kolata's book. According to Kolata, obesity is primarily inherited.
[Albert Stunkard and his colleagues] concluded that 70 percent of the variation in peoples’ weights may be accounted for by inheritance, a figure that means that weight is more strongly inherited than nearly any other condition, including mental illness, breast cancer or heart disease. ...

The findings also provided evidence for a phenomenon that scientists like Dr. [Jules] Hirsch and Dr. [Rudolph] Leibel were certain was true — each person has a comfortable weight range to which the body gravitates. The range might span 10 or 20 pounds: someone might be able to weigh 120 to 140 pounds without too much effort. Going much above or much below the natural weight range is difficult, however; the body resists by increasing or decreasing the appetite and changing the metabolism to push the weight back to the range it seeks.
The NYT has a Q&A page. Someone asked about the recent increase in obesity. Kolata's response:
... even though Americans are heavier now than they were in the past, they have not, on average, gained enormous amounts of weight. At the lower end of the weight distribution, nothing has changed, not even by a few pounds. As you move up the scale, a few additional pounds start to show up, but even at midrange, people today are just six or seven pounds heavier than they were in 1991. Only with the massively obese, the very top of the distribution, is there a substantial increase in weight of about 25 to 30 pounds. As a result, the curve of body weight has been pulled slightly to the right, with more people shifting up a few pounds to cross the line that experts use to divide normal from obese. In 1991, 23 percent of Americans fell into the obese category; now 31 percent do, a more than 30 percent increase. But the average weight of the population has increased by just 7 to 10 pounds since 1991.
I'm wondering why she's using 1991 as the baseline.

Here's a chart (from here) showing the corresponding shift in Canada, between 1978-1979 and 2004. The median BMI has shifted from 24 to 26 (the overweight cutoff is 25).
posted by russilwvong at 12:06 PM on July 15, 2008 [2 favorites]


OmieWise: And I still haven't seen any accounting for the 5000+ people listed in the National Weight Loss Registry, people who should not be there if the outlook is dismal.

It's a self-selecting sample of success stories (say that one three times fast). It doesn't speak to the overall success rate or levels of success for people attempting to lose weight.
posted by KirkJobSluder at 12:07 PM on July 15, 2008


Also, I hope I was clear that I advocate high quality food and regular exercise for everyone. But I think a more realistic, and compassionate goal is to focus on improving real health indicators (diabetes rates, heart disease rates, etc) through quality nutrition and regular physical activity – NOT by simply emphasizing weight loss (which, we barely mention in this thread, is most often achieved through methods that are established as UNhealthy – I’m thinking of diet pills, crash diets, fad diets, high protein diets, yo-yo diets, and surgery here)
posted by serazin at 12:09 PM on July 15, 2008


Wow, this thread started off so well. I feel like as I've been scrolling down I've been digging deeper into a mud pit.
posted by onalark at 12:26 PM on July 15, 2008


HappyHippo wrote: and have read great informed comments from folks such as tkchrist.

Thank you. You're too kind.
posted by tkchrist at 12:27 PM on July 15, 2008


P.o.B., Do you think working with elite athletes may be giving you some confirmation bias?

I actually never stated my abilities or that I’ve worked with elite athletes, although I have worked with average joe up to Olympians that’s not what I’m getting at. What I meant to express by that was I’ve seen what has worked over and over and over again. So if someone is going to be say exercise doesn’t work that leaves me dumbfounded.

if you think caloric intake and exercise are the only factors in weight gain.

Actually I never said that, but this conversation has taken multiple fronts I only try to address the general idea that modification of diet and exercise does work.

Certainly, and until the real-world clinical trials that are performed deliver better than 50% loose >5% after 5 years, expectations of real-world weight loss should be kept equally modest. That's all that's being advocated here.

Talk about Straw Men. The articles you keep mentioning only prove that it’s hard for people to maintain the modifications to their diets and lifestyles. NOT that diet and exercise roughly = 50% loose >5% after 5 years. If you start to talk about how hard it is for people change a lifetime of habits I’m all with you.

c) at this time, there is no magic bullet that enables all people to achieve a non-obese BMI. The typical gains from current treatments are modest, even with full compliance.

And you insert statements such as this. People don't fully comply that is the failing.
posted by P.o.B. at 12:34 PM on July 15, 2008 [2 favorites]


50% is a lousy cure rate, and I have yet to see the P.o.Bs in this thread address that.

tkolar, maybe you should actually read what I wrote and linked to.
posted by P.o.B. at 12:38 PM on July 15, 2008


People don't fully comply that is the failing.

The failing is that traditional weight-loss programs do not make long-term compliance possible without extreme and very rare willpower. This does not reflect weakness on their part but simple human nature. Hormones regulate appetite. Appetite (usually, eventually) regulates behavior. One has to be almost superhuman to maintain a significant weight loss if they are genetically predisposed to obesity in the presence of carbohydrate. Avoiding carbs may short-circuit this whole process, but there aren't really any good longevity studies.
posted by callmejay at 1:55 PM on July 15, 2008 [1 favorite]


I don´t think we´re going to convince each other at this point. But thanks for your civility and thoughtfulness on this issue.

Likewise. Take care.
posted by OmieWise at 2:16 PM on July 15, 2008


weight-loss programs do not make long-term compliance possible without extreme and very rare willpower...One has to be almost superhuman

Let's not go overboard. Your statement falls flat when you read HappyHippo s story. How many people need to pop in here and say I've lost x amount of weight and kept it off for people to realise maybe there is something to diet modificatin and a regime of exercise.

The failing is going at this from a weight loss perspective. One should really be set on making a change to their lifestyle. Let's all forget about diets, drugs and what have you and concentrate on that. This is what the woman wrote about in her blog. Whether she likes it or not she now must deal with a totally different set of rules in which she has to treat her own body. She is constatntly going to have to adjust to it's needs rather than satiating her own.

I threw together a post a couple of weeks ago in hopes people may find some extra resources with which to help themselves and it was largley ignored. It included a link to one of the most reasonable health & fitness articles I've read in awhile though. Whatever, no biggie.

But now I come in here and read time and time again people throwing around "plausible reasons" as to why people can't lose weight. These counter arguments reek of some kind of twisted justification.

Well, whatever, have at it. Throw all the roadblocks you want up. I would much rather talk to people who believe they can and will handle these things themselves in spite of it.
posted by P.o.B. at 3:17 PM on July 15, 2008 [1 favorite]


Great link P.o.B. That dude was right on.
posted by tkchrist at 4:26 PM on July 15, 2008


Exposure to food advertising among children (pdf)*:

- Children ages 2–7 see an average of 12 food ads a day on TV. Over the course of a year, this translates into an average of more than 4,400 food ads—nearly 30 hours (29:31 hr) of food advertising.
- Children ages 8–12 see an average of 21 food ads a day on TV. Over the course of a year, this translates into an average of more than 7,600 food ads—over 50 hours (50:48 hr) of food advertising.
- Teenagers ages 13–17 see an average of 17 food ads a day on TV. Over the course of a year, this translates into an average of more than 6,000 food ads—over 40 hours (40:50 hr) of food advertising.
- Half (50%) of all ad time on children’s shows is for food.
- Among all ads children see, food is the largest product category for all ages (32% for 2–7-year-olds, 25% for 8–12-year-olds, and 22% for 13–17-year-olds), followed by media and travel/entertainment.

Types of food products in ads targeting children and teens:

- 34% are for candy and snacks, 28% are for cereal, and 10% are for fast food.
- 4% are for dairy products, 1% are for fruit juices, and none are for fruits or vegetables.

* I work at the place that produced this report, but I don't work in the policy area and have nothing to do with the research or writing of these reports. Emphasis above is mine.
posted by rtha at 4:29 PM on July 15, 2008 [1 favorite]



The failing is that traditional weight-loss programs do not make long-term compliance possible without extreme and very rare willpower. This does not reflect weakness on their part but simple human nature. Hormones regulate appetite. Appetite (usually, eventually) regulates behavior. One has to be almost superhuman to maintain a significant weight loss if they are genetically predisposed to obesity in the presence of carbohydrate. Avoiding carbs may short-circuit this whole process, but there aren't really any good longevity studies.


Here is where shame should come in. No, not being ashamed of your body, but being ashamed of certain foods. I think my vilification of certain foods (as well as the fact that it's kind of nice not having a pot belly) is the reason I've kept my weight off. I guess I'm lucky in that for me, those bad foods have immediate consequences (stomach ache), as well as the chronic (weight gain). These days I look back on what I used to eat and shudder. I mean, I was eating something like six slices of cheesecake in one sitting! I wouldn't touch that stuff now. I don't just look different, I think differently.

It's not like I don't eat cake or fries, it's that I'm pretty sure they are evil and that I should have limited contact with them and I've cut out a lot of bad foods that also had the distinction of not being that tasty in the first place (white bread and pasta). If I eat cake, it better be the best cake in the world considering what it does to my body.
posted by melissam at 4:32 PM on July 15, 2008 [1 favorite]


If comments were pounds, this thread would be morbidly obese. Moderators, start trimming because I don't believe in dieting.
posted by Frank Grimes at 4:45 PM on July 15, 2008


I'm having a hard time believing anyone can say that weight loss isn't caused by eating less & working/exercising more.

Let's reverse it... many labour/concentration camps, in many countries, have been liberated/disbanded over the last century.

I have yet to read of the huge % of inmates found to be overweight.
posted by selton at 5:38 PM on July 15, 2008


serazin,
It may be true that my examples are statistically insignificant. They were anecdotal, in response to an anecdotal challenge. With regard to how difficult it is for us to keep off the weight, the two with the biggest weight losses definitely have the harder time keeping it off. A little slip-up in what they eat can have a big effect for them, and they have to work hard to get it back off. The numbers, I gave, by the way, are from starting points to top of set-point range for each of us. My sister and I don't struggle as much, but on the other hand, we've made more significant changes in our eating habits. She hasn't had chicken skin in at least 10 years. I eat probably 20 or 30 times as much sushi as hamburgers. My cousin and my friend still eats most of their meals at/from restaurants and I think have a harder time with portion and ingredient control as a result.

TheOnlyCoolTim,
My sister and I lost our weight on our own, although she went with a medical diet to do so (I believe it was from the American Heart Association). My cousin did it under direction and supervision by her liver specialist, with Weight Watchers for the last 50 lbs. or so. My friend lost and maintained to this point on her own, but is using Weight Watchers to try to lose another 40 lbs or so. Three of us did not report loss to our doctors or check in with them except for unrelated issues. The fourth did, on a very regular basis.
posted by notashroom at 5:38 PM on July 15, 2008 [2 favorites]


I have been obese. So obese I couldn't walk for more than a minute or two at a time, because after that the joint pain was so bad I couldn't stand.

That was in 2002. I weighed 95kgs, on a 160cm frame. Nothing compared to some, I know, but it was more than my joints and skeleton could handle (I have some bone density issues).

I lost 30kgs in 6 months. Because I was just so fed up with not being able to do daily stuff.

In the intervening years, I've regained about half of that (mostly due to periods of severe depression). I'm working on losing it again, with a combination of diet and exercise.

I am hungry all the time. All. The. Time. No matter what I eat, or don't eat, or anything - I am hungry all the time. The only time this does not happen is when my carbohydrate intake is absolutely minimal - around the 100g a day mark or less. Then I'm only sort-of hungry around mealtimes - in other words, I have a normal appetite.

I'm still overweight. As of last week, I'm no longer obese, according to the scales.

Importantly, though, I'm not fat. If you saw me on the street, you'd wonder why, exactly, I was at all bothered about my weight. Several friends have questioned my desire to lose weight, and reassured me that I look just fine how I am.

But this is the thing. It's not because I think my ass looks big. It's not because I think my thighs are embarassing in a swimsuit. It's because my back aches constantly, my injured knee occasionally buckles, and because my feet hurt all the time.

Health at any size? Not for me. Not, in fact, for anyone I know, male or female.

And this is why I don't get being fat-positive. I've been like that; it was incredibly painful. I can't imagine how people can function when they get heavier than that. I just can't imagine it. I can't imagine not getting fed up and taking whatever steps are available to mitigate the problem. Because it is so painful being that way.

Maybe I'm just a wuss.
posted by ysabet at 6:16 PM on July 15, 2008 [3 favorites]


But now I come in here and read time and time again people throwing around "plausible reasons" as to why people can't lose weight. These counter arguments reek of some kind of twisted justification.

No, it's much more reasonable to believe that the 95% of people who are unsuccessful at keeping the weight off really *choose* to overeat by 500-2000 calories a day even though they hate being fat and are shamed in one way or other every single day.
posted by callmejay at 6:53 PM on July 15, 2008


It's odd to me that people are pointing to this thread as an example of overwhelming "fat-hate." I'm not seeing that at all; I'm seeing genuine concern for health. If we're not very obese ourselves, we likely have a friend that is. I'm also seeing some touching stories from people who have been there before, attesting to the dangerous health conditions. I've witnessed real fat-hate and it's nowhere near as civil as this thread is.

As an aside, I wonder if there are many (or any) medical doctors who align themselves with this movement. I also wonder if there are any lawyers or law review articles dealing with the subject. It seems worth exploring, at least in employment discrimination and similar areas.
posted by naju at 6:56 PM on July 15, 2008


Well, for what it's worth, I've lost over thirty pounds and kept it off for over five years. As one person put it: "When you got here, you had some girth, but now you look like a normal healthy guy!" Which is a compliment, I guess.

I recognize that some people out there think that's not a lot of weight, and will dismiss it. But there's two things I wanted to say. The first is that isn't and wasn't a question of willpower: I am STILL the kind of person who snacks on anything you put in front of him. I recognized that and substituted fruit for cookies and chips. By that I mean I stopped buying them. It was easier for me not to buy them at the store, because if they were in the house, they were going to be gone very quickly. I also started drinking water instead of soda and juice, which, eh, I don't really miss anymore, to be honest. I found a sport that I really love playing, and I play it a lot. And there are days where I do come upon a box of cookies in the wild and devour them, but generally it is about what you eat every day, and not what happens once in a while. It's not a question of moral superiority or willpower, but more a question of: I have this weakness, and I try to work around it. I mean, I really like apples, but have you ever tried to eat 1200 calories worth of apples? And I don't beat myself up when I fail, because I have two choices at that point: try my best, or give up, and only one of those choices is really helpful.

The other thing is that I really get an off feeling about these threads because people keep linking to Junk food Science and saying how excellent it is, but every time that blog talks about one of the topics I know a bit about (osteoarthritis), I'm a little disappointed at the distortions in the pictures the lady paints, and it makes me doubt the rest of her stuff.

I mean, one of the articles is talking about how people these days are exercising so much that knee replacement surgery rates are really up. She doesn't mention that yes, one of the things which is closely correlated with osteoarthritis is previous knee injury, but another major thing which is closely correlated is obesity, which has also been going up recently. This is in fact mentioned in one of the articles she references, but somehow it does not make it into her story.

Another article was talking about how doctors were denying the obese knee replacement surgery until they lost weight. The way she presents it, the doctors are being ridiculous and knee replacement surgery works just fine for the obese. What she doesn't mention is that that total knee replacements eventually tend to fail. IIRC, the time is around 15-20 years. To do a total knee replacement, they flip your kneecap to the side, take off the top of your tibia and the bottom of your femur, and sink shafts to fix the replacement. The first time they use short shafts. The second time (if and when the first one fails) they use long shafts. There is no third time.

So far, this has been all fine and well because generally it is the elderly who receive total joint replacement, and 30-40 years (to be frank) is about how much more time they're going to need them. Now if there is some worry over increased load resulting in wear on the replacement (and hence not even giving 15-20 years), and if the obese people are younger and possibly planning on living longer than that, it would be irresponsible for a doctor to put in the replacements knowing that after two cycles, this person will have no knees.

These are all things you can verify for yourself if you care to do a literature search and would rather not take my word for it.
posted by Comrade_robot at 7:20 PM on July 15, 2008 [7 favorites]


Comrade_robot, that Junkfood Science blog, which is popular with many Objectivists ( she's on the staff of the Competitive Enterprise Institute) I know, which led me to question it. Some stuff:

Why does Sandy hate science?
Doctors are conspiring to convince you you're sick!
Attacking consensus - a sure sign of a crank
Obesity Crankery - A growing problem

I didn't start disliking her because of the obesity thing, it was her constant denouncement of sustainable food that tipped me off to her bias. Yet she is fascinating, because she is a perfect illustration of why the big ag food industry lurvves the whole fat acceptance thing. Conagra and their ilk are wonderfully happy to hear people cheerleading for the idea that obesity is not caused by overeating(or merely just eating) certain foods. The Conagra and Kraft executives are probably toasting the fatosphere over HFCS cocktails at this very moment.
posted by melissam at 7:50 PM on July 15, 2008 [1 favorite]


I'm also not seeing much fat hate in this thread. I'm seeing a pretty broad skepticism towards the extreme version of fat acceptance, lots of dubiousness about the idea that eating less and exercising more will have little or no effect on one's weight, and a lot of interesting anecdotes about weight gain and loss.

But unlike some LOL-fatty threads in the past, the tone of the discourse in this one is really refreshing, and I'm reading this feeling like I'm learning things -- this is the fresh seasonal cuisine of fat threads, compared to the junk food versions I've seen a few times before.

Let's reverse it... many labour/concentration camps, in many countries, have been liberated/disbanded over the last century. I have yet to read of the huge % of inmates found to be overweight.

I had thought of that, and of country-wide semi-starvation like in North Korea or parts of Ethiopia, etc. But I also am reminded of the oldest photos in my family, of hard-scrabble farmers about 100 years ago -- all the kids and younger adults were whip-thin from poor food and endless hard work. A few of the older people got kind of plump, but no one under the age of about 60. (The area I worked in as a Peace Corps volunteer was exactly the same, in terms of lifestyles and body types, as those old family photos, too.)

Now, that's a lifestyle I don't really recommend to anyone -- marginal semi-subsistence farming is a brutal existence and having your kids not eat every night really hurts. But it does emphasize that whatever one's "set point" for weight is heavily influenced (if not controlled) by one's environment.

You can create a personal environment that is a lot healthier -- just because everyone else drives doesn't mean you can bicycle; just because others eat at McDonalds doesn't mean you can't eat a nice plate of pasta primavera or whatever. But that's really hard, and clearly not something that most people are going to do anytime soon, any more than they are going to do anything else that is inconvenient and socially difficult.

So the answer is clearly societal, but in the meantime all one has is the personal, which is where a lot of the tension here comes in, I think. It's like trying to solve global warming, but beginning by taking any possibility of societal action off the table, leaving you only with difficult and marginal options like throwing out your appliances or harvesting your own pond algae for eating.
posted by Forktine at 8:00 PM on July 15, 2008 [1 favorite]


melissam: Yet she is fascinating, because she is a perfect illustration of why the big ag food industry lurvves the whole fat acceptance thing.

Wow. That's insane. SourceWatch on Sandy Szwarc. Apparently Coca-Cola has made significant contributions to CEI.
posted by russilwvong at 9:51 PM on July 15, 2008 [2 favorites]


You can create a personal environment that is a lot healthier ... But that's really hard

I quote this:

I recognized that and substituted fruit for cookies and chips. By that I mean I stopped buying them. It was easier for me not to buy them at the store, because if they were in the house, they were going to be gone very quickly. I also started drinking water instead of soda and juice, which, eh, I don't really miss anymore, to be honest. I found a sport that I really love playing, and I play it a lot.

I think the key might be to set up your environment/lifestyle so that healthiness is easy, rather than a privation. Definitely no. 1 is cutting out the soda pops and other commercial sugar waters. A 20 oz. Coca-Cola is like sixteen teaspoons of sugar except it's HFCS. I sometimes make a nice pitcher of iced tea and sweeten it to my desire and the same 20 oz. contains maybe 4 or 5 teaspoons of sugar.
posted by TheOnlyCoolTim at 10:06 PM on July 15, 2008


P.o.B. on further reading of the thread I agree with almost all of your points. I think there has been a lot of talking past one another in the comments. I was responding more to emphasis than anything.

TheOnlyCoolTim, as a diabetic, I avoid HFCS like the plague, and I also try to minimize artificial sweeteners, as I feel they affect my palate and make me crave sweeter things. I use a lot of what I've heard referred to as 'psychological' sweeteners. Cinnamon, anise, nutmeg, lemon zest, etc... things that my mind associates with sweetness.
posted by BrotherCaine at 12:33 AM on July 16, 2008


P.o.B. thank you so much for that link to testosterone nation.

In order to preserve muscle you should focus on training methods that stimulate a large portion of your motor unit pool and challenge anaerobic glycolysis (the energy system that makes you feel nauseous). If a workout aimed at fat-burning isn't making you feel nauseous, you're not training hard enough, or you're challenging the wrong energy system.

I've dialed back my training at times in response to nausea, but now I realize I should ride that edge just below the point of throwing up. That is very helpful.
posted by BrotherCaine at 12:36 AM on July 16, 2008


As to making fun of fat people, shaming them, telling them to "put down the twinkie", no. Doesn't help, never will.

Here's what I've learned after 6+ years of heavy alcohol, caffeine, and nicotine consumption and a lifetime of avoiding exercise - I feel tired. I notice. I'm not fat, but god damn I notice. And I'm starting to feel ashamed. Before I was young enough to not care and I always felt like there were bigger problems in my life, but now, well, it's not even that I feel more tired, or more out of shape than before, or that I feel other problems have mitigated, it's just that I'm out of excuses.

Addictive, impulsive behavior is the culprit, and if we're not winning the war on terror, how do you think a society can wage war on impulsive behavior?

I don't have the answer right now, but I know that's what gets "us" as a society into these messes. I blame everything that encourages it.

Good for her for getting the surgery she needs and coming to terms with her problem.
posted by saysthis at 5:15 AM on July 16, 2008


No, it's much more reasonable to believe that the 95% of people who are unsuccessful at keeping the weight off really *choose* to overeat by 500-2000 calories a day even though they hate being fat and are shamed in one way or other every single day.

Well ... personally speaking, I did. Again, maybe it wasn't a lot of weight compared to some people, but when and where I was growing up, it was enough to make me the 'fat kid'. It was a combination of vague, inaccurate calorie counting (once I wrote down everything in Fitday, it was obvious that I was under-counting, and sometimes forgetting to put in things like all the orange juice I was drinking. Orange juice has about the same number of calories as soda!), and a sort of "Oh, well, I guess I could lose a few pounds, but it's not that bad."
posted by Comrade_robot at 5:17 AM on July 16, 2008


I've dialed back my training at times in response to nausea, but now I realize I should ride that edge just below the point of throwing up. That is very helpful.

I can’t tell if you’re serious or not, but if you are trying to achieve the results that author was talking about you would ride that edge. Do I, or anyone else, really need to tell you when you should be working harder or not? I’ve found most people usually judge their stopping point by how much they really want to obtain their goals.

No, it's much more reasonable to believe that the 95% of people who are unsuccessful at keeping the weight off really *choose* to overeat by 500-2000 calories a day even though they hate being fat and are shamed in one way or other every single day.

Well you’ve reframed my statement onto a larger issue, but nonetheless I’ll reply. First I don’t buy into the 95% “fail” rate. Since no one ever linked to these mysterious articles no one really checked this out. I found references to two articles about these “long term” studies. One of them was actually a review after five years. From what I gathered, after the initial counseling and diet modification they basically told the people to have at it. Came back five years later, lo and behold, most of the people had gone off the crash diet and regained the weight. I believe we should look at percentages taken from something more realistic. Such as how many people are able to give up smoking or some other lifestyle change (yes I realize these are not the same things). You would have much more realistic percentages to compare against.

Now I’m not sure whether your statement was sarcastic or not, but the answer is obvious and often painful for people to hear. Personally I don’t care what people to do their own bodies. I believe it is your choice to treat it any way you feel you need to. Eat, drink, smoke, etc. whatever you want.

Go ahead and talk about rough it is and how hard it is to change. Shoot, I’ll even sit back and listen to you tell me how God, the gods, or the Flying Spaghetti Monster deemed it fate that you are the way you are. But the minute you step into an open forum and start building an argument against one of the best things you can do for yourself. Then I think I have every right to open my big mouth and call out bunk on what you’re spewing.

Some of what was discussed here could’ve easily been refuted by a quick look into a Junior High Health Ed. Textbook. The human bodies affinity for homeostasis is well known. You obtain a certain mass, you’re body only responds by wanting to maintain it. It is called hunger. Do we really need to discuss how everyone’s body is different? Yes, some people will retain adipose tissue a little easier. Others will have an affinity for muscle. But aside from genetic anomalies we all work the same way.

By the way there are plenty of people who are overweight, perfectly happy, and feel no shame whatsoever. So I’d appreciate it if you didn’t try to wrangle me into some kind of guilt trip about shame.
posted by P.o.B. at 1:21 PM on July 16, 2008


P.o.B. I'm totally serious. My personal trainer failed to explain the nausea to me, and I assumed that it was an underlying health condition unique to me rather than the intensity of training. I like to push myself as hard as possible without risking injury when training, because the results in terms of quality of life outside of the gym are definitely worth a little discomfort. I thought nausea meant I was pushing too hard, but now that I know it is a part of the process, I'll ride the edge (while avoiding actual vomiting). I'm reading your earlier post as well, and hope to get some good tips.
posted by BrotherCaine at 2:28 PM on July 16, 2008


I'm also glad to learn about the nausea being a good thing. I hope that means dizziness is, as well. Between the two, I'd given up on gym workouts altogether, something I used to really enjoy, and dialled down to walking and whatnot that don't leave me waiting 20-30 minutes after a workout to feel safe to drive home.
posted by notashroom at 7:08 AM on July 17, 2008


GottabeFunky:
I found this part really interesting: the idea of seeing your own body as an "Other," of a conceptual divide between you-you and body-you.

That's really hard to get my mind around. I do it sometimes, kind of, with parts of my body ("my flat feet/bow legs/aching ankles really don't like jogging..."), but to think of the whole bag of bones and fluid beneath my brain as something somehow distinct from Me, that I'm just kind...attached to (and in her case, imprisoned by and answerable to)? Wow.
You are describing a version of what the writer described. You do not feel that you are the parts of your body that suck.
I have a degenerative collagen disorder, among other issues. This creates chronic pain. I have always felt dissociated from my body. It is other. It is limited and sometimes holds me back. I am more than my body and do not want to feel defined by it. After years of therapy, I healed a great deal. But, I don't think that this basic dissociation will ever go away. I think that other people who experience chronic pain and disability probably experience similar mental acrobatics :)
posted by Librarygeek at 1:08 PM on July 17, 2008 [1 favorite]


Well I suppose this lands upon my shoulders.

Nausea = Meh. Common to working out too hard. Don't work out as hard or eat so close to working out if you want to avoid it.

Dizziness = Potentially dangerous. Possibly low blood sugar or maybe something much worse. Should probably be avoided if possible.
posted by P.o.B. at 2:09 PM on July 17, 2008 [1 favorite]


i didn't read all the comments here because i really don't want to get pissed at how many people truly, truly hate fat people.


but, there seems to be some confusion between the "health at any size" movement and the "fat acceptance" movement, which do obviously overlap a lot.

health at any size believes that even fat people can be healthy, that just because you weigh 180 or 280 or 380 doesn't mean you automatically have diabetes, heart failure, etc. it's a movement that focusses more on medical stuff and doctors who don't look at your chart or your patient history or your actual reason for the visit and just tell you to eat less, exercise more and consider weight loss surgery. i'm here for a rash on my arm doc, i don't need to hear about wls. fat people really, truly, seriously are treated badly by many doctors; their needs are not met because their doctors overlook everything and just focus on the weight. HAAS is more about that aspect of things.

fat acceptance is more about being treated as a human being and not a piece of trash just because you're fat. i weigh 300 pounds, but i don't deserve your hatred and your insults and your mistreatment. it's about changing society's perception of us, and helping us to change our perception of ourselves. many fat people hate themselves, loathe themselves, are ashamed of themselves and engage in self destructive behavior because they feel they are worthless. where does that mentality come from? it's from years of our parents our family our peers and teachers and doctors and strangers telling us that we are less than them. that no one will ever love us until we are thin. that we don't deserve to go on dates or even go out in public because we are so fucking hideous. that we are an embarassment to ourselves and that our very appearance offends the delicate sensibilities of those around us.

fat acceptance is a pride movement of sorts. we need to teach ourselves that we're not worthless and that we're just as deserving of love and fancy jobs and feeling pretty as every single other person in the world. it is hard to learn that. it's hard to believe it. gay people don't come out of the closet because it is hard to be gay in this climate. they've internalized the hatred that many people have for them. sometimes it's self-preservation to stay in the closet. they can pass as straight and go about their day in an almost normal way. fat people can't hide who they are. every time we step out the door we run the risk of being harrassed. it wears you down.

so fat acceptance is not a bad thing. i don't know that i will ever accept myself as a fat person, and i know that "society" will never accept me as a fat person and that i will always face prejudicies that my skinny friends don't face (and this isn't about not being able to buy clothes in every store). but other people deserve the chance to love themselves, even if they are 530 pounds.
posted by misanthropicsarah at 10:20 AM on July 18, 2008 [4 favorites]


Thank you for responding, misanthropicsarah, although I think you would find the thread far less full of "fat hate" than you suspect.
posted by WCityMike at 11:05 AM on July 18, 2008


Interesting update to this conversation, from Time magazine: The Myth of Moderate Exercise, addressing whether it's possible for most people who are significantly overweight to lose weight from moderate exercise and dieting.
posted by notashroom at 6:43 AM on August 6, 2008 [1 favorite]


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