From doctors to obese people
February 16, 2021 7:32 PM   Subscribe

Everything You Know About Obesity Is Wrong.
Every discovery in public health, no matter how significant, must compete with the traditions, assumptions and financial incentives of the society implementing it.

Most of the article is probably not new information to Metafites but it is well presented in a sharable way.

You may remember this being posted recently. The previous thread was deleted on the poster request for unrelated to the article reasons rather than a problem with the content.
posted by Mitheral (70 comments total) 101 users marked this as a favorite
 
You may know the author of that piece, Michael Hobbes, from the You're Wrong About podcast. He and Aubrey Gorden (formerly known as Your Fat Friend) have a newish podcast, Maintenance Phase, that does a similar debunking thing for nutrition bullshit, fat-related bullshit, and general wellness bullshit. I recommend it!
posted by ArbitraryAndCapricious at 7:39 PM on February 16 [36 favorites]


I think that I need to start listening to Maintenance Phase.
posted by Halloween Jack at 7:57 PM on February 16


This was really good. I wish we could just stop seeing torture as the solution to every problem under the sun. I remember my older relatives pointing to women they didn't approve of at the beach & saying "Don't be like that" and now I'm thinking back like why would you do that? How was that supposed to work?
“It can be stressful when [patients] start asking a lot of specific questions” about diet and weight loss, one doctor told researchers in 2012. “I don’t feel like I have the time to sit there and give them private counseling on basics. I say, ‘Here’s some websites, look at this.’”
These are probably the same doctors who accuse people of "Dr. Google" when they show up informed & prepared.
I was thinking the other day that you can try to force yourself to do anything but if that doesn't work the only advice you get is to force yourself to force yourself, and if you can't do that you're probably just a bad person. No matter what it is this seems to be our whole mental model of how to exist & it doesn't work.
posted by bleep at 8:50 PM on February 16 [43 favorites]


About 40 years ago, Americans started getting much larger. According to the Centers for Disease Control and Prevention, nearly 80 percent of adults and about one-third of children now meet the clinical definition of overweight or obese. More Americans live with “extreme obesity“ than with breast cancer, Parkinson’s, Alzheimer’s and HIV put together.

...

Since 1980, the obesity rate has doubled in 73 countries and increased in 113 others. And in all that time, no nation has reduced its obesity rate. Not one.


Huh. Well, that certainly sounds like an epidemic. I wonder if it's affecting anything other than humans?

The obesity trend isn’t only affecting humans — chimps, pets, and lab rats are getting fatter too

It's Not Just Us: Even American Animals Are Getting Fatter
"Animals in strictly controlled research laboratories that have enforced the same diet and lifestyle for decades are also ballooning."

So we know there's something other than diet and exercise that's making obesity more prevalent across multiple species.

My guess is that the changes we're making to the atmosphere are having deep and unanticipated effects on our biology. But whatever it is, it's getting worse.
posted by MrVisible at 9:08 PM on February 16 [51 favorites]


Thank you for posting this excellent and easily digestible (ha!) work. This week I saw someone post on social media, "You can't hate yourself into a better person." How many years have I spent trying that tactic?

More anti-diet resources: The Food Psych Podcast by Christy Harrison, MPH, RD, is a responsible resource on actual nutrition and breaking free of diet culture, with an emphasis on lifting up BIPOC practitioners and exposing the racism and colonialism baked into the diet industry (Harrison is White).

There's also Harrison's well-researched book Anti-Diet and Carolyn Costin's 8 Keys to Recovery from an Eating Disorder. I have not yet read The F*ck It Diet but it's been recommended to me by trusted sources.

Last year after two decades of yo-yo dieting and binge eating, I worked with a Health At Every Size (HAES) eating disorder coach on dismantling a lot of the binge eating behavior and fatphobia. It's a long journey that I'm still on but a worthwhile one. Virtually everyone I know, no matter their weight, is obsessed with becoming smaller and thinner. I'm finally freeing up some mental space to obsess about other things, like hiking and reading and appreciating the people and beauty around me.
posted by rogerroger at 9:08 PM on February 16 [31 favorites]


thank you for sharing this. it's well written, and i spent the read alternately yelling YEAH!! and crying.
posted by tamarack at 9:10 PM on February 16 [4 favorites]


A 2016 study that followed participants for an average of 19 years found that unfit skinny people were twice as likely to get diabetes as fit fat people
As if getting fat is somehow protecting people from getting diabetes.
posted by jamjam at 10:23 PM on February 16 [7 favorites]


What amazes me that many doctors don't dive into patients individual metabolism rates, their hormone balances etc... they go for the obvious - reduced calories and increased exercise. There is SO much more to it than calorie counting.
posted by greenhornet at 1:09 AM on February 17 [14 favorites]


What amazes me that many doctors don't dive into patients individual metabolism rates, their hormone balances etc... they go for the obvious - reduced calories and increased exercise. There is SO much more to it than calorie counting. Are you suggesting general practitioners do actual work for the money they are given? That's not why most doctors go to medical school.
posted by parmanparman at 2:07 AM on February 17 [3 favorites]


Robert Lustig is a pediatric endocrinologist who has considered the reasons for rising obesity by casting a big net. He blames the rise of the epidemic of metabolic syndrome on our economic and political systems’ mastery of manipulating our brain’s reward mechanism (i.e., dopamine, endogenous opioids, and cortisol). He makes a convincing argument in The Hacking of the American Mind. His solution in a nutshell? Seek happiness, not pleasure. His book has specific recommendations on how to do it.
posted by villard at 2:22 AM on February 17 [24 favorites]


In a 2013 journal article, bioethicist Daniel Callahan argued for more stigma against fat people. “People don’t realize that they are obese or if they do realize it, it’s not enough to stir them to do anything about it,” he tells me. Shame helped him kick his cigarette habit, he argues, so it should work for obesity too.

This belief is cartoonishly out of step with a generation of research into obesity and human behavior. As one of the (many) stigma researchers who responded to Callahan’s article pointed out, shaming smokers and drug users with D.A.R.E.-style “just say no” messages may have actually increased substance abuse by making addicts less likely to bring up their habit with their doctors and family members.

Plus, rather obviously, smoking is a behavior; being fat is not. Jody Dushay, an endocrinologist and obesity specialist at Beth Israel Deaconess Medical Center in Boston, says most of her patients have tried dozens of diets and have lost and regained hundreds of pounds before they come to her. Telling them to try again, but in harsher terms, only sets them up to fail and then blame themselves.


A bioethicist. That is so fucked up.
posted by Bella Donna at 2:24 AM on February 17 [25 favorites]


I 💖 Michael Hobbs, Maintenance Phase and You're Wrong About. And Christy Harrison too -- her book and podcast are gamechangers! Thanks for this post, Mitheral. All great stuff here.
posted by iamkimiam at 2:55 AM on February 17 [7 favorites]




After coming across Dr. Jason Fung's videos on fasting I tried that a couple of years ago and shed 80 pounds and mostly kept it off. Granted it's not for everyone and I realize I'm probably one of those weird people who actually feel better not eating after 2-3 days of a total fast. I felt better, my mind was clearer, I had more energy and best of all, after the first two days you stop thinking about food altogether. After a 5-day fast (my longest) I didn't even want to start eating and the first day after I ate fewer than a 1000 Calories (partly due to the fact that it takes time for your gut to "wake up" after a total fast.)

Like I said, it's not for everyone but it's something I now do periodically just because it gives me a boost.
posted by drstrangelove at 3:54 AM on February 17 [4 favorites]


Let this thread be free from "right sure, science is as certain as it gets that the vast, vast majority of people cannot influence their weight... but here's the fad diet/lifestyle that worked (so far) for me, so maybe give that destructive cycle one mo' go 'round."

Please.
posted by thoroughburro at 4:50 AM on February 17 [112 favorites]


Let this thread be free from "right sure, science is as certain as it gets that the vast, vast majority of people cannot influence their weight... but here's the fad diet/lifestyle that worked (so far) for me, so maybe give that destructive cycle one mo' go 'round."

I agree with you. I've struggled with weight all of my life and it was only when I committed to an undeniably extreme diet that I finally managed to lose weight and keep it off. There is obviously much more to the problem than the usual "stop eating you fat bastard" unhelpful "advice."
posted by drstrangelove at 5:09 AM on February 17 [8 favorites]


You are excited that your current iteration of the struggle seems to be working, and people like to share what they are excited about. I understand.

However, you are either mistaken that this iteration is the magic one which will finally work or you are a far statistical outlier which is necessarily unhelpful to others.

Note: I do not struggle with my weight.

Also note: I am obese. I nonetheless do not struggle with my weight.

Science is mystified by what is going on, but what it does know is that individual struggle to control weight does not work.

I actually did try intermittent fasting before I stopped struggling and got happier and healthier. It seemed to work for a while and then didn't.
posted by thoroughburro at 5:17 AM on February 17 [20 favorites]


We live in a culture that is dominated by black-and-white thinking, and so we apply that to everything. I feel like the dominant opinions on the subject seem to be "LOL FATTIES LOSE WEIGHT" vs "dieting is impossible and never works." To me, neither one seems to reflect the complex reality.

While I have never been obese, I did go through a period a couple years back where I lost about 40 pounds. When I transitioned to normal eating, I gained back maybe 10 pounds, but other than that, I've mostly kept it off.

This is what I feel they don't tell you about dieting:

• Dieting is easy, keeping weight off is hard. If you've got a certain amount of obsessiveness and stubbornness to your character, you absolutely can lose weight. All you have to do is be super mean and absolutist with yourself. But it works. You absolutely can lose weight. But how do you keep it off? You can't diet forever. It's not sustainable. Your body will fight back (in my case, I essentially wound up giving myself IBS). So what do you do when you're finished dieting? Dieting doesn't teach you how to eat a healthy, balanced diet. So I think some people go for "diet forever" and give themselves an eating disorder, or else just go back to their old ways and then they gain it all back. I actually had to go to a nutritionist who gave me the (somewhat unwelcome) news that yes, I did need to eat some carbs, and yes, I did need some protein (in my case, meat. sorry vegetarians, don't judge!)

• When you lose weight, your body basically becomes the mean shitty manager who put you on a PIP at work. He's basically just standing by, waiting for you to fuck up. I learned this during the pandemic. Like many others, I shifted into some unhealthy eating/drinking habits early in the pandemic, and guess what? My body started to put back on weight. I don't know if it's like this for everybody. Perhaps people who never lost a large amount of weight have more of a "buffer" where they can maybe go for a period of unhealthy eating and their body isn't so eager to put the weight back on. But from what I've heard and read, my experience is common. Again, this isn't a foregone conclusion. I was ultimately able to lose the weight I put back on. But it took a lot of work, and the truth is I just don't have the same margin of error as other people. This is fine with me, I guess. I eat really healthy, I like eating healthy, and I really don't want to have unhealthy eating/drinking habits. But I definitely sympathize with people who haven't been as successful at keeping the weight off. Your body is basically just not on your side when it comes to this.

• Exercise won't help you lose weight all that much, but never exercising makes it pretty much impossible to lose weight or keep it off. Like if you have a lifestyle where maybe you walk to work, and then have a pretty normal social life, you're burning a bunch of calories without really thinking about it. And then if you do some sort of physical activity, you'll burn even more. This doesn't really help you lose weight all that much -- it takes like 40 minutes of pretty vigorous exercise just to burn off like a bagel's worth. But if you take away that exercise, like say for example you're in the middle of a pandemic and suddenly you work from home and the gyms are closed, you suddenly have to pay WAY more attention to what you eat. Again, your "buffer" disappears. Maybe before you could have had a couple glasses of wine a day and maybe some extra carbs, but now if you do that, you'll start to put weight back on.

Anyways, all these "lessons" are of course super subjective, and I can't make any claims that they apply to anyone but me. But I think what they do indicate is that weight loss and general body shape is not a simple matter, and way more complex than "LOL FATTIES LOSE WEIGHT" vs "dieting is impossible and never works."
posted by panama joe at 5:26 AM on February 17 [12 favorites]


Another thing I should say about exercise is that, even though it doesn't help with weight loss all that much, it really is important for cardiovascular and mental health. Super important for people like me who are prone to anxiety, and whose father and grandfather both had heart attacks in middle age.
posted by panama joe at 5:43 AM on February 17 [11 favorites]


Thanks for posting this interesting article. It has certainly given me something to think about. I am overweight, and I am trying to loose weight in preparation for an elective but necessary surgery. It's not going well, and though part of that is corona, the article points out some other good reasons.
Before I was overweight, I was underweight. So much that I struggled with breast-feeding my child, my periods disappeared and my hair fell off. I had symptoms of menopause at 36. But when I went to my then doctor (who I suspect had her own eating disorder), she said I was just fine. I was very sick, the childcare nurse and pediatrician were worried, and she told me I was fine because my weight was within the normal BMI. But individuals are not statistics, I was underweight relative to what my normal weight should have been then.
I have no idea what happened that made me gain weight. It coincided with 9-11, my much beloved granddad passing and a failed relationship, so I've been thinking it might have been a depression that started it. But with this article I'm wondering how I am also part of a more universal trend.
My current doctor is not interested in my weight, as long as my other test-results are good, and they are. I realize now that I am lucky to have a doctor like that.
posted by mumimor at 5:44 AM on February 17 [2 favorites]


> dieting is impossible and never works

This is closer to an example of scientifically-based reason than black and white thinking. To be accurate: dieting is unhealthy and almost never works.

> Dieting doesn't teach you how to eat a healthy, balanced diet

And eating a balanced, healthy diet doesn't have anything to do with weight.

I don't have the energy to go through your whole comment, but it's unscientific and unhelpful.
posted by thoroughburro at 5:45 AM on February 17 [23 favorites]


And eating a balanced, healthy diet doesn't have anything to do with weight.

Why don't we just discard the notion that everyone's body is the same and responds the same way to the same conditions? Seems like that would be a lot closer to reality.
posted by panama joe at 5:48 AM on February 17 [5 favorites]


Let this thread be free from "right sure, science is as certain as it gets that the vast, vast majority of people cannot influence their weight... but here's the fad diet/lifestyle that worked (so far) for me, so maybe give that destructive cycle one mo' go 'round."

I lost 100 pounds between 2017 and 2019. That does not mean that anyone else can, nor that anyone else should. At best, it's a difficult thing to do. For some, it may be unnecessary. We should celebrate diversity in body size and shape. Neither group should be stigmatized.

For some people, though, there are health effects. COVID-19 demonstrates that. And some people can lose weight and maintain that weight loss. Does our healthcare system suck? Why yes it does. Sure, metabolic disorders are a medical problem. But the causes of metabolic disorders result from political and economic forces.

The "certainty of science" about the futility of weight loss does not account for the manipulation of our behaviors by corporations and culture, as described by Robert Lustig in my comment above. Our dopamine/opioid metabolism might be more significant than our metabolic rate. Humans cannot evolve fast enough to adjust for the effects of food science and marketing.

We all are fighting an uphill battle, regardless of weight. There are other monkeys on our backs besides food, and the ability of marketing to manipulate our behaviors contributes to, or perhaps causes, all of them. That "favorite" link below will give me a little opioid high every time someone clicks on it. On the other hand, the community aspects of MetaFilter generates serotonin. That's what we need to seek.
posted by villard at 5:50 AM on February 17 [10 favorites]


> Why don't we just discard the notion that everyone's body is the same and responds the same way to the same conditions?

Because that would mean ignoring the science that almost all bodies do not respond to weight loss efforts in the way you imply they should.
posted by thoroughburro at 5:53 AM on February 17 [4 favorites]


Yeah, I didn't mention that, but to support others' comments: I have always eaten a healthy diet of mostly vegetables, some starch and meat as a side, and I have always been very athletic. Before I had children, I was more athletic, but my weight didn't change when I cut down exercise to have more time with my children, it changed almost exactly on the date after 9-11.
I have gained weight earlier in my life, and lost it, and those weight gains have been clearly and directly linked to depression. Maybe the depression was linked to hormonal change (puberty, pregnancy) and maybe it was the other way round.

One factor I think may be relevant to the demographics of obesity is that I was very often undernourished as a child. I think this makes your metabolism overreact? I was not and am still not in a demographic that is normally at risk of malnourishment, it was because of my mother's mental health issues.
posted by mumimor at 5:57 AM on February 17 [3 favorites]


The article: science has proven time and again that obesity is a result of something external to individual habits, diets, lifestyles, and efforts. We're not sure what it is, but it effects nearly everyone. Even animals with fixed diets and lifestyles.

The thread: but why don't people just try not to be fat? Here's one weird trick...

I can't even. It's so predictable.
posted by thoroughburro at 5:58 AM on February 17 [78 favorites]


Without any commentary on weight loss (what do I know), I'm amazed there's no mention of the most obvious culprit for societal (and global!) weight gain since the mid-century: the global diet changed!

This is all old-hat Michael Pollan stuff, but the rise and then near-universal consumption of processed white flours, corn and corn byproducts (especially in the US when you'd be hard pressed to find a label without some ingredient provided thru USG corn subsidies), and added sugars. Not to mention whatever difficult to understand knock-on effects we get from moving from an agriculture predicated on thousands of different domesticated species grown in a living soil to the handful of hybrids we have now grown in fields deadened by herb- and pesticides and massive quantities of mined mineral fertilizer.

If the article's right that gaining weight pretty much locks in the weight gain for most people, then the focus seems like it should be on what's causing that initial gain for everybody. And uhh the answer is capitalism and corn subsidies more or less
posted by TheProfessor at 6:18 AM on February 17 [20 favorites]


One of the things about the article that shocked me (being from a country with public healthcare), was how this can influence your insurance in the US. I have a million things to say and nothing to say at the same time.
(And sorry about my first comments being about me, this is personal, I guess).
posted by mumimor at 6:19 AM on February 17 [4 favorites]


I work in the fitness industry and I have to tell you that weight loss is incredibly weird and complicated, as the article (and the very good podcasts that are related) outlined.

I also want to say that so many people (parents of students usually) sheepishly tell me that they would like to try the kind of fitness we offer, but they can't until they lose weight. But absolutely people can do it, and have, and the fact is - EVERYONE has to modify our curriculum, or at least, every adult, so it's not like we have an "overweight" curriculum, we have modifications for big bellies, inflexible backs, bad knees, bad shoulders, etc.

But the shame that society has placed on people who are carrying more weight is so huge, and of course it's also hard -- again due to our society, not due to individual failings -- to sit with the idea that simply modifying something like a kick is a "failure" and not just...a modification. It's so difficult that people end up expending their energy a lot on just getting in the door and staying for the whole class and fighting feelings of failure the whole time.

It's so toxic. And that's just a fitness class! I have a close friend who /broke her tailbone/ and it took a long time to get help because the first doctor she went to treated it like she was complaining of pain because she was overweight. That's messed up!!!

This is an absolute blight on society because there can be, for a lot of people, a lot of joy in moving their bodies. People who are carrying extra weight are really strong in a lot of , because they are carrying it - but we don't recognize that as strength and we impose shame. It's horrible.

And it has no relation to anything but the attitudes we all carry - obviously people like doctors and public school gym teachers carry more responsibility but we need to stop focusing on diet advice when discussing this and start focusing on our attitudes.

I could go on but I think it is really on everyone to refocus here, please, I beg you.
posted by warriorqueen at 6:23 AM on February 17 [36 favorites]


The thread: but why don't people just try not to be fat? Here's one weird trick...


This doesn’t characterize this thread to me at all and I think ignores a lot of thoughtfulness. I see a lot of people, like me, who have been overweight and have tried various things related to weight loss / diet and are acknowledging good and bad experiences. It’s very personal and lonesome, as the article describes, because of our broad society. And talking about what has worked for someone is this weird space of “here’s something I’m proud of, but also it comes from some pretty deep shame experiences.”

The idea that weight gain globally is a bigger part of the story points to just how bullying and cold American society is to blame it on the individual. There is kindness; broadly there’s the same meanness I experienced as a kid being called a “fat ass” almost daily as a six year old.
posted by glaucon at 6:23 AM on February 17 [17 favorites]


It's odd to think of animals both decreasing in population and increasing in size. I hope that this gets more publicity; perhaps it can decrease the amount of shame and stigma attached to weight.
posted by Trifling at 6:26 AM on February 17 [4 favorites]


The thread: but why don't people just try not to be fat? Here's one weird trick...

Not really, though. When people share their personal experiences about their personal fat in their personal bodies, that's really not the same thing at all. I mean, one of the things I love about threads on this topic is hearing what worked for people. The science part can be interesting, occasionally, but if science's answer is just "nothing's ever gonna work, you're doomed!" then...well...probably science hasn't tried hard enough to solve the problem.
posted by mittens at 6:27 AM on February 17 [16 favorites]


TheProfessor - the article does briefly discuss global diet change. It does so near the end. But as you said none of this is unknown, we can't even talk solutions because we can't get anyone with power to agree that obesity is not a problem of self-control.

Discovering fat acceptance was one of those sea change moments for me. It was so discouraging to see body positivity co-opted as an empty marketing term. It goes beyond loving my body, it means nourishing my body in every dimension - food, movement, intimacy. It means occupying the space I need. It means demanding equality in health care.
posted by muddgirl at 6:29 AM on February 17 [12 favorites]


The article: science has proven time and again that obesity is a result of something external to individual habits, diets, lifestyles, and efforts. We're not sure what it is, but it effects nearly everyone. Even animals with fixed diets and lifestyles.

The thread: but why don't people just try not to be fat? Here's one weird trick...


We know that the distribution of weight has been shifting as a whole, not just for one society but globally and as you say there's evidence for animals as well. That being the case, it's bananas to look to individual explanations for a population level trend.

What's more likely: that there was a population level change in collective willpower (lol) towards food? At the same time that every other thing that might be a proxy for ability to defer gratification has been showing people being more disciplined? That's magical thinking. Or that something in our environment has changed.

I will note that if it was literally anything else, nobody in their right mind would be interested in individual level data to address a population question.

I will say that I am both an example of someone who permanently lost weight (it was 9 years ago and has been maintained so well past the usual horizon) and an excellent example of why, on a population level, that just doesn't happen.

In my early 20s, I tried lots of different things. I changed my diet, I exercised more, all the classics. Result, the weight was lost and then regained, start next cycle.

In my 30s, the same cycle but in a narrower range and oscillating around a point about 15kg lower despite doing basically no dieting?

Difference: I moved halfway around the world to a different country, one where people are generally slimmer than the one I was in before.

Needless to say that "move to London" is not a prescription that I expect everyone is going to follow.

So either there was a change in me between 22 and 35 that actually changed my metabolic response to food in such a way that I stored less fat (not likely), my willpower around food changed (why would it? Also not likely), or... the key determinant of weight is environmental and the best that individuals can do is move up or down in a distribution that is out of their control.

"Why don't you walk as much as your neighbour" may be down to personal behaviour but "why do people in LA not walk as much as people in London or Paris" sure isn't.
posted by atrazine at 6:35 AM on February 17 [21 favorites]


Talking about weight loss diets in response to an article which argues we need to care way more about health than weight is a derail. This article is all about shame and diet talk can trigger people who have been shamed and bullied about their weight.
posted by muddgirl at 6:35 AM on February 17 [41 favorites]


At the risk of sounding "woo," I try to appreciate my body for doing what evolution has shaped it to do: protect itself from the elements, infection, and starvation. I happen to be in a weird historical period where due to the color of my skin and the relative wealth of my ancestors, those three things aren't likely to kill me off, but my bod doesn't know that; it takes the food and does its best. I do my best in trying to feed myself good stuff - lots of fruit, yogurt... more fruit, more yogurt. Y'all, I am just on a hell of a smoothie kick right now. Not because of a diet, but because it's hitting my stress eating notes (sweet, rich) and helping me feel sated without making me feel gross in a low-activity period.

and tbh, that's what I'd like to say to anybody who is encountering this article's info for the first time (myself as a younger person): weight loss is not a thing. Intuitive eating is a much better and realer thing. Exercise is a thing. Once you get into that cycle, you will crave the things your body needs (exercise and, sometimes, smoothies). It will be clear and you will be pleased to hearken to it. I promise.

Most of my weight-related angst nowadays is about wardrobe. I don't want to gain weight because buying a plus sized wardrobe is the worst. The selection is bland and the experience terrible. Most "premium" brands don't even try, or chicken out at US16/18. The Netflix show Nailed It! is a revelation for the well-fitted AND FUN wardrobe for Nicole Byer.

articlecommenting: oh my god, the photography in this article fucking slams. I love the subject-directed staging and especially their reflections. The dude in a comedy club with fog over his face? The Black CEO? All the snaps from me.
posted by snerson at 7:00 AM on February 17 [6 favorites]


>> bioethicist Daniel Callahan argued for more stigma against fat people. [...]
>> Shame helped him kick his cigarette habit, he argues, so it should work for obesity too.

> A bioethicist. That is so fucked up.

A PhD philosopher arguing that one personal propter-hoc anecdatum concerning a vaguely related health issue identifies a mechanism for solving another health issue for everyone else. That is so fucked up.
posted by merlynkline at 7:03 AM on February 17 [2 favorites]


What amazes me that many doctors don't dive into patients individual metabolism rates, their hormone balances etc... they go for the obvious - reduced calories and increased exercise. There is SO much more to it than calorie counting. Are you suggesting general practitioners do actual work for the money they are given? That's not why most doctors go to medical school.

Are either of you suggesting that bean counters stop breathing down the necks of doctors who spend more than 15 minutes with a patient? That's not why most administrators went to business school.
posted by basalganglia at 7:21 AM on February 17 [20 favorites]


So, I did start listening to the Maintenance Phase podcast, even though it was late and I needed to get to bed, and holy crap--the whole thing with the marketing of the green coffee bean extract stuff was just... I mean, damn.
posted by Halloween Jack at 7:27 AM on February 17 [1 favorite]


I'm studying qi gong, and the system I'm using has the 70% rule-- only use 70% effort, and much less if you're sick or injured. This is partly because the goal is to have less tension but pushing yourself beyond a comfortable limit adds tension, and partly in order to avoid injuries and burnout-- the 70% rule applies to mental as well as physical effort.

It's amazingly difficult for me to not push too hard-- I'm affected (though less than I was) by the cultural idea that forcing yourself is the proof of virtue.

A bit of a sidetrack, but the belief that willpower is the solution isn't just about weight loss.
posted by Nancy Lebovitz at 7:28 AM on February 17 [19 favorites]


I have never successfully dieted because for whatever reason food restriction makes me panic (even though I've never experienced food insecurity). I've actually thought a lot about food and diet in my life, I used to be fascinated by anorexia stories. My mother dieted constantly, my sister had bariatric surgery, my fairly athletic and active brothers both struggled with their weight as they aged. In the end, we all ended up looking about the same.

We are clearly missing something. I think a lot about that study that showed how starvation in your grandparents affected your metabolism. My grandfather's family nearly starved during the depression. I think a lot about how obesity and inflammation seem to be related, how allergies are on the rise, maybe due to pollution or maybe due to not carrying parasite loads. Speaking of pollution, we apparently all ingest plastic..what does that mean for us?

Some of us don't move enough but there are plenty of overweight people working physically demanding retail jobs.

We are in the dark ages when it comes to understanding our own bodies.
posted by emjaybee at 7:30 AM on February 17 [21 favorites]


I find the article interesting and yet problematic in the same way that these articles often are. It is, in a way, correct to say that obesity is the result of something external to individual habits. But I think it's noteworthy that the article doesn't dispute that obesity is affected by what we actually eat. The body does not conjure mass from thin air.

The article does a fantastic job of exploring some of the sundry reasons we are in this situation. Fatphobia is pervasive and appalling. Corporate interests push unhealthy lifestyles across the board. But the reporting begs questions that the article does not answer. If losing weight is impossible, why does it matter that there's corn in everything we eat, or that nobody has time or money to eat better? Twinkie diets all around!

Calories in vs. calories out affects body composition. As noted in the article, the calories-out side of the equation is difficult, if not impossible, to control, varies widely across individuals, and changes due to myriad external factors we have barely begun to understand. Also as noted in the article, the body has mechanisms that try to up the calories-in side when we try to lower it, and external factors likewise tend to push that number up. But these are not insurmountable barriers. Hard as hell to overcome, sure, but that doesn't mean we should just throw up our hands and declare it impossible—especially not given that capitalism-driven pushes toward poisonously unhealthy food are not some immutable, natural constant. Obviously I'll never get back to what I weighed before binging through four years of college, but for years I've kept at least 20 pounds down from when I worked ludicrous hours at an enormously stressful job. And what of preventing obesity in the first place? The body does not rally to preserve fat that it never had.

I agree with the article that focusing on weight is pointless, indeed counterproductive. But that cuts both ways. We should not try to cut a deal with capitalism that comes down to "stop being shitty to us about our weight and we'll let you carry on as you have." We should demand that, if governments are so concerned about us having healthy lifestyles, they do something to enable us to have healthy lifestyles. Nobody has time to cook, because everybody has to work harder and commute longer with each passing year. Nobody has money for healthy food, because wages are flat and government services are cut back to appease the demon god tax cuts.

The article recognizes these points, then suggests a new paradigm of "just give up and be happy." Thanks, I'll pass.
posted by sinfony at 7:54 AM on February 17 [16 favorites]


I think if would be more accurate if doctors simply said they have no idea what to do re: weight vs health, because every stat presented in this article is context less, and not useful as anything other than anecdotes. Also assigning one medical deficiency (whether it's diabetes or high cholesterol, or whatever) and then declaring someone 'healthy' or 'unhealthy' is shaming. You have to look beyond and look at actual quality of life characteristics. For some people, diabetes (for example) is a minor inconvenience, for others it's life-threatening.

"A 2016 study that followed participants for an average of 19 years found that unfit skinny people were twice as likely to get diabetes as fit fat people"

"People who eat nuts four times a week have 12 percent lower diabetes incidence and a 13 percent lower mortality rate regardless of their weight. "


All these stats about diabetes are as much 'shaming' as mocking weight is. Apparently alcoholism and diabetes are both diseases you can get yelled at for having. (sorry Mitch Hedburg). [ I don't include weight in this joke because I don't believe having a higher weight is automatically a 'disease' even if you are more liable for some (again, contextless) health complications percentages based on some chart.]

"two years of getting kids to exercise and eat better didn’t noticeably affect their size but did improve their math score"

"44 international studies found that school-based activity programs didn’t affect kids’ weight, but improved their athletic ability, tripled the amount of time they spent exercising and reduced their daily TV consumption by up to an hour. "

And then this:
"The cardiovascular risks of sedentary lifestyles, suburban sprawl and long commutes are well-documented. But rather than help mitigate these risks—and their disproportionate impact on the poor—our institutions have exacerbated them."

I'm all for more walking and less 'sprawl', but it's common medical knowledge that you can't exercise calories away, so walking more is great but it's not going to cure anything. I walk ~10 miles a day, I still have high cholesterol, and I guess therefore am 'unfit skinny', even though I can run and have no specific quality of life issues associated with it yet. Walking so much doesn't help me lose or really maintain weight either. That's 100% dietary choices.

I find the article interesting and yet problematic in the same way that these articles often are.

A perfect way to describe this article.
posted by The_Vegetables at 8:02 AM on February 17 [3 favorites]


Just ignore my derail. Please. I’ve flagged it as a derail. I was using it to frame some new policy change in Canada but I think, most people may be using the new policy to lose weight which is a mistake.

As for my “method” it’s supposed to sound insane. I “lost” weight with most of the bad health implications that this article writes out and keeping it off requires me to train like an endurance athlete.

I knew the science before I started. But the stigma was (and still is for others) just so bad. It gave me constant panic attacks. I told people that, scientifically, weight loss was impossible and a serious health risk and no one took it seriously. Not even my own family (like a lot of people in this article). I felt particularly alien living in a town full of athletes, and I didn’t even feel comfortable at pride. It was like the stigma was just smothering every other aspect of my identity.

So don’t do what I did. Follow the advice of the article. And hopefully, Canadian doctors will be less judgemental as a result of the new policy.
posted by Pseudology at 8:02 AM on February 17 [5 favorites]


Well, I can confidently say I have a new weight-loss secret that has given me a clean jawline and protruding collarbones for the first time in over a year, shrinking my clothes size while I ate whatever I liked. It's the ancient secret of hyperthyroidism!

Seriously, it's not cool. I feel bitter about it -- I thought it was a nice healthy lifestyle change I had made; then the doctor did some bloodwork after my rapid weight loss, and now I have to take a day trip out of town for an endocrinologist. At the same time, I had thought I was lazy this past year and needed to work out more because I get winded going upstairs and have trouble getting out of chairs.

Which is to say: I thought my weight loss was a reward for virtue, and I thought my weakness was the result of vice. Even now, I take pleasure in my new size, the result of a real illness. The Western weight pathology is as deep in me as my toilet training, and I probably took it in at the same time, too.

We watch a lot of My 600-lb Life at this house. Dr. Now is curt, sharp, and does not show much empathy. Has he ever had a weight problem? Who knows; he doesn't act like someone who has much knowledge of the trouble. I watch it for the lives of the patients, almost all of whom were sexually abused as children or at the very least abandoned. I want to see them get better and enjoy their lives more. Sometimes they do; I don't see much of Dr. Now's work in those moments. It's the therapy and support that gets them there.
posted by Countess Elena at 8:09 AM on February 17 [18 favorites]


I think it's so bizarre that obesity is widely seen as purely an issue of willpower. For whatever reasons, I've been very slowly but steadily gaining weight my entire life, from underweight as a child to slim/average as a young adult to crossing the overweight threshold around 30. If this keeps up at the same rate I'll probably cross into obese by 40. My willpower and discipline haven't changed at all (staying basically nonexistent) that entire time, and I eat much healthier now than I did in my 20s. I don't really know why I keep gaining but I assume it's some combination of slowly becoming less active and my bad eating habits from childhood (food insecurity meant excessive overeating whenever I had the opportunity) slowly catching up with me.

People who are actually able to start diets and heavy exercise routines have way more willpower than I'll ever have, even while many of them outweigh me. It's so clear that much more is involved than the ability to self-torture.
posted by randomnity at 8:29 AM on February 17 [2 favorites]


For me, anyway, one of the real benefits of these kinds of discussions - the linked content and this thread - is that they encourage seeing my ideas and actions regarding health have a much richer context than numbers like "weight" and "BMI". They give me license to understand how my notions about health are always developing, both because I am changing over my lifespan and because the science and our cultural attitudes about health are always in flux.
posted by Caxton1476 at 8:34 AM on February 17 [4 favorites]


Let this thread be free from "right sure, science is as certain as it gets that the vast, vast majority of people cannot influence their weight... but here's the fad diet/lifestyle that worked (so far) for me, so maybe give that destructive cycle one mo' go 'round."

Amen. Weight is clearly not under voluntary control.

But even the original article still goes back into the trope of "eating healthy", as if some magical combination of blessedly perfect foods or nutrients would somehow return weight to voluntary control.

2020's "Eating healthy" is just another way of saying "willpower"
posted by Dashy at 8:51 AM on February 17 [3 favorites]


I lost about 75 pounds ten years ago and the thing which makes me laugh now (I think half of the weight is back, which is fine) is that even at that new weight, which was less than I graduated high school at, I was still fat. I mean my BMI was good, but I still had a paunch. I've always had one, even as a teen, and I will always have one. My body is set up in such a way that "roll around the middle" will always be part of me. I walk six to ten miles a day and I'm still jiggly. It's just the way it is.

I would like to see a world where the privileged don't try to advise those without. So rich people don't counsel the poor about money, skinny people don't counsel overweight folks about eating, etc., etc.
posted by maxwelton at 9:22 AM on February 17 [11 favorites]


The sum total of my (possibly former) doctor's weight management guidance to me has been: "Just eat less". I say former because - during COVID-19 - he's shuttered his office, disconnected the phone and appears to be working full-time for the consult-by-webcam services that the province has approved at unknown extra expense. I think we can tell where his allegiance lies.
posted by scruss at 9:57 AM on February 17 [3 favorites]


I have nothing to add except that as someone who's coming up on their Metafilter 20th anniversary, I'm pleased to see this conversation going the way it is, because there was an entire decade, plus some, where it would have been very different.
posted by gnomeloaf at 9:58 AM on February 17 [17 favorites]




A study published recently in the journal Obesity Research & Clinical Practice found that it’s harder for adults today to maintain the same weight as those 20 to 30 years ago did, even at the same levels of food intake and exercise.

Obviously, there's some factor other that diet, exercise, and willpower. Or multiple factors.


I haven't eaten processed food for 30 years. And my diet has been balanced for maybe 25 years (actually forever, but consciously since then). There was a while when I was trying to put on weight, about 20 years ago, when I drank a lot of Coca Cola, but it didn't work and I gave that habit up long before I began taking on weight. I feel my weight-gain has to do with stress/depression/anxiety, and the hormonal changes related to whatever that is.
posted by mumimor at 10:07 AM on February 17 [3 favorites]


It's this video:
NY Subway stairs.

Not everyone trips. Some people happen to be looking down, or happen to be faster with correcting their stance, or whatever else.

But *many* people trip. Should we blame the people who trip? Obviously not, even if their individual characteristics do contribute to them being one of the trippers instead of one of the not-trippers. Systematically, more people trip, because the *stairs* are wrong. Instead of yelling at/shaming the trippers, we should just ...

Fix the stairs.


Of course, until the stairs are fixed, it seems totally fine to warn other people going through that subway station: be extra careful on the stairs, here. But there's a giant difference between warning and shaming, and no amount of shaming people is going to move that stair the one inch it needs to be moved.
posted by nat at 10:12 AM on February 17 [15 favorites]


To conform to current scientific understanding, the analogy would be that nearly everyone trips, nobody actually knows why, and the well-meaning person would have to say:

"Watch out for... well, just don't trip."

"Oh good, I hate the tripping all the time! What did you say to watch out for?"

"Uh, well nobody knows. We do know there's probably nothing you personally can do to stop tripping."

"Oh. Well thanks, I'll... look out for nothing, I guess." *trips*

That's why lifestyle and diet advice in threads like this make no sense and implicitly reinforce an anti-scientific idea of personal responsibility for obesity which is wrong and leads to needless pain.
posted by thoroughburro at 10:42 AM on February 17 [24 favorites]


Difference: I moved halfway around the world to a different country, one where people are generally slimmer than the one I was in before.
Have been living outside the US in countries where people are slimmer than the US. I have gained weight. Living in a country where people are slimmer is no guarantee that you will be.

I often wonder about the virus question. When I was a child, I was skinny. Not kind-of skinny, "lady feed your kid more or we'll bring in child services" skinny. (She tried!) In one year, I went from dangerously underweight to obese. You can see it in the school pictures; it's wild. I was going to the same school, eating the same things, playing with the same kids. But BOOM.

I also wonder if it may have something to do with the world converting to plastic packaging for food. Polypropylene and PET containers became common in the five years preceding that 1980 surge. If you look at a timeline of packaging innovation, PET appears over and over again around this period.

I am extremely skeptical of the "US overuse of corn = obesity" theory. I'm allergic to corn and have had to eat mostly whole foods for well over a decade. This has not changed my weight one iota. (In fact, early on I gained weight.)
posted by rednikki at 10:49 AM on February 17 [13 favorites]


It feels to me like US culture (parts of it, anyway) still think it is okay to use slurs about fat people and disabled people. (For sure, the 45th president made obvious racist commentary more acceptable as well.) The thing that resonated with me most about the article were the many wonderful/sorrowful images and their captions, plus the overall thing about asshole health care workers.

One of my fat relatives has been treated badly, her whole adult life, by health-care workers. I think even a therapist was an asshole about my relative's weight and I promise you, that is not the reason they were seeing a therapist. People are happy to go out of their way to be jerky toward you even in retail, it turns out. Years ago I went along with a young relative and their parent to shop for a sweet-16 party dress that had to be ordered in advance.

After the dress was settled on, the salesperson told us that the teen should order a smaller size if they planned to lose weight. I didn't say anything at first, as this was not my kid. The salesperson was generally ignored but then the salesperson brought it up again, more forcefully: A smaller size should definitely be ordered if the teen planned to lose weight for the party. And I lost my shit. I did not scream but I explained, briefly and forcefully, that there was nothing wrong with the teen, they were perfect as they were, they would absolutely not be losing any weight for the party, they would be ordering the size of outfit they wore right this minute, did the salesperson understand??? I guess so. She shut up, anyway, about the dress size.

Fat people of MetaFilter, I am sorry about all the shit everyone gives you all the time both personally as as a culture. JFK, I cannot imagine the collective pain and trauma. I just know it's terrible and each one of you deserve and deserved better.
posted by Bella Donna at 11:06 AM on February 17 [27 favorites]


I often wonder about the virus question. When I was a child, I was skinny. Not kind-of skinny, "lady feed your kid more or we'll bring in child services" skinny. (She tried!) In one year, I went from dangerously underweight to obese. You can see it in the school pictures; it's wild. I was going to the same school, eating the same things, playing with the same kids. But BOOM.

I wonder about this as well. I was painfully underweight in my teen years. Then I had a bad bout of mononucleosis. After that, I started gaining weight and eventually developed hypothyroid. Correlation doesn't equal causation, of course, but it was striking to me that *something* had changed and relatively quickly, and I've not been able to account for it by any other reason.
posted by Preserver at 11:59 AM on February 17 [4 favorites]


Diets are a fuck, from top to bottom. Some work for some people at some times, others don't work for anybody ever, and everything in-between and beyond. Obsessing to the point of obsession over what you put into your body is a waste of processing power, because there's always going to be That One Other Thing.

I will suggest, however, that physical movement to maintain or even improve your body's range-of-motion and/or strength is something that is worth obsessing over. This can take just about any form imaginable, from simple stretching to Peak Human Performance (tm)-type stuff. The results of this are something you can feel and measure, and it is something you can derive immense satisfaction from, with every small improvement or correction. As opposed to a diet, which is a religion of dissatisfaction.

Fitness and health are what your body is capable of doing, not how it appears.
posted by turbid dahlia at 1:52 PM on February 17 [26 favorites]


turbid dahlia - describing diet as "a religion of dissatisfaction" is genius. What a great articulation! Flagged as fantastic.
posted by rogerroger at 2:25 PM on February 17 [5 favorites]


I have lots of feelings about this article (I was a skinny child with an overweight mother, I gained a bunch of weight in my 20s, lost 60 lbs about 10 years ago, gained all of it back, and now also I'm dating someone very heavy who has had some truly awful experiences with both family and medical providers), but this particularly stuck out to me:

"fifth- and sixth-graders [given information about fat stigma, actual causes of obesity, etc] actually increased their intention of bullying their fat classmates"

can we just agree that fifth and sixth graders are actually kind of the worst?
posted by epersonae at 3:01 PM on February 17 [12 favorites]


But even the original article still goes back into the trope of "eating healthy", as if some magical combination of blessedly perfect foods or nutrients would somehow return weight to voluntary control.

It actually doesn't. It suggests that eating healthy will help you have better health even though it will do nothing for your weight. That may or may not be true although it seems plausible, but the main premise of the article as I read it is that the best thing to do as an individual about being fat is to reduce your fatphobia towards yourself (and by implication, others).
posted by plonkee at 3:08 PM on February 17 [12 favorites]


Thanks for the post. I thought the article was excellent.
posted by thelonius at 3:52 PM on February 17


I'm restricting my eating to the point where I lose weight. This has required repeated adjustments downward of the number of calories I'm allowed to have in a day. It feels horrible, and has for a year and a half, now. I know that, scientifically, I'm doomed to eventual failure, where "success" means continuing to feel horrible indefinitely. I'm not expecting it to get much better, or much easier, than it already has. I just hate going out into the world as a fat person. I hate looking into the mirror as a fat person.

It's all stick, and very little carrot. It's life.
posted by tigrrrlily at 7:08 PM on February 17 [6 favorites]


Great article. Love Michael Hobbes and “Maintenance Phase.” As an obese lady, I’d love it if we could have a thread about obesity that is not just a bunch of subtle weirdly tonedeaf humble brags about what diets have worked for people and how much weight they’ve lost.

Because it still feels kind of blamey for the rest of us (the vast majority of us?) for whom they don’t/won’t. I’ve spent like thirty years of my life (I was put on my first diet when i was 7 years old) being made to feel like I was a failure with no willpower who just didn’t want to be happy or successful or loved. I’m in my 40s now, still fat, but trying to figure out how to get comfortable/okay with the notion that I might actually always be a fat person and how i can live the best, happiest, healthiest life I can as a fat person. Because maybe that’s really and truly not a thing i can change.

And if it IS the case that my experience is not so unique (as it does not appear to be), why can’t we talk about how to make the most of the bodies we have instead of “but actually this one diet works”
posted by thivaia at 9:34 PM on February 17 [26 favorites]


Oh god, I can't with this thread.

For people who've lost weight: that's great, good for you. Go talk about it in one of the 80 billion places online where weight loss is praised, and leave this thread, this one bloody thread, for us to talk about the obesity myths.

(I lost a lot of weight in 2019! Due to anorexia, and it nearly killed me! And fatphobia played such a huge part of it, and I am tired, so very tired, of the relentless promotion of weight loss even in safe spaces).

I DO NOT WANT TO READ ABOUT YOUR WEIGHT LOSS. I WOULD RATHER HEAR ABOUT YOUR STINKY POOP HABITS.
posted by daybeforetheday at 11:06 PM on February 17 [31 favorites]


Also: for people talking about how this is a unique American problem- we have fat people over here! In similar numbers! We don't even put corn in many things!
posted by daybeforetheday at 11:07 PM on February 17 [6 favorites]


Oh god, I can't with this thread.

For people who've lost weight: that's great, good for you. Go talk about it in one of the 80 billion places online where weight loss is praised, and leave this thread, this one bloody thread, for us to talk about the obesity myths.


daybeforetheday, as the one who has watched tigrrrlily suffer from feeling shitting about her body at times over the years, and watched her suffer from what she's putting herself through right now, I'm disappointed in seeing Metafilter being a place where she's not feeling supported.

She was talking about the body dysphoria she feels when she's at various places in her life's journey dealing with exactly the issue people are talking about here - the constant struggle with the lack of effectiveness of dieting.

This is a place I come to for compassion and understanding. So do you, and so does she. Please don't take that away. This isn't one of the 80 billion other places. This is our home, and yours. This is Metafilter.
posted by Flight Hardware, do not touch at 10:04 AM on February 18 [12 favorites]


This is a place I come to for compassion and understanding. So do you, and so does she. Please don't take that away. This isn't one of the 80 billion other places. This is our home, and yours. This is Metafilter.

This is my home too and if I want to talk about my personal experiences I will.
posted by atrazine at 2:30 PM on February 18 [12 favorites]


From the article: All of our biological systems for regulating energy, hunger and satiety get thrown off by eating foods that are high in sugar, low in fiber and injected with additives. And which now, shockingly, make up 60 percent of the calories we eat.

It feels like this is key.
posted by valdesm at 10:35 AM on February 21 [3 favorites]


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