The pitfalls of one-size-fits-all measures

According to the National Institutes of Health, the man on the left in this photo is obese. I wouldn’t doubt the one on the right is, too.

I don’t really have time to write an in-depth post on this today, but Ezra has a good post today about an article in The New Republic by Paul Campos that was just brought out from behind the subscription wall (you do need to register to read it).

The gist of the article is that the “obesity crisis” is largely manufactured, and what’s behind it is both a diet industry that funds a lot of the research and stands to make a lot of money offering “solutions” as well as just plain visceral disgust of seeing fat people:

Obesity research in the United States is almost wholly funded by the weight-loss industry. For all the government’s apparent interest in the fat “epidemic,” in recent years less than 1 percent of the federal health research budget has gone toward obesity-related research. (For example, in 1995, the National Institutes of Health spent $87 million on obesity research out of a total budget of $11.3 billion.) And, while it’s virtually impossible to determine just how much the dieting industry spends on such research, it is safe to say that it is many, many times more. Indeed, many of the nation’s most prominent obesity researchers have direct financial stakes in companies that produce weight-loss products. (When they are quoted in the media, such researchers routinely fail to disclose their financial interests in the matters on which they are commenting, in part because journalists fail to ask them about potential conflicts.) And the contamination of supposedly disinterested research goes well beyond the effects of such direct financial interests. As Laura Fraser points out in her book Losing It: False Hopes and Fat Profits in the Diet Industry, “Diet and pharmaceutical companies influence every step along the way of the scientific process. They pay for the ads that keep obesity journals publishing. They underwrite medical conferences, flying physicians around the country expense-free and paying them large lecture fees to attend.”

This situation creates a kind of structural distortion, analogous to that which takes place in the stock market when analysts employed by brokerage houses make recommendations to clients intended to inflate the price of stock issued by companies that in return send their business to the brokerages’ investment-banking divisions. In such circumstances, it’s easy for all the players to convince themselves of the purity of their motives. “It isn’t diabolical,” eating-disorders specialist David Garner told Fraser. “Some people are very committed to the belief that weight loss is a national health problem. It’s just that, if their livelihood is based in large part on the diet industry, they can’t be impartial.” Fraser writes that when she asked one obesity researcher, who has criticized dieting as ineffective and psychologically damaging, to comment on the policies of one commercial weight-loss program, he replied, “What can I say? I’m a consultant for them.”

What makes this structural distortion particularly insidious is that, just as Americans wanted desperately to believe that the IPO bubble of the ’90s would never burst–and were therefore eager to accept whatever the experts at Merrill Lynch and on The Wall Street Journal’s editorial page had to say about the “New Economy”–they also long to believe that medical experts can solve the problem of their expanding waistlines. The reason for this can be summed up in six words: Americans think being fat is disgusting. That psychological truth creates an enormous incentive to give our disgust a respectable motivation. In other words, being fat must be terrible for one’s health, because if it isn’t that means our increasing hatred of fat represents a social, psychological, and moral problem rather than a medical one.

The convergence of economic interest and psychological motivation helps ensure that, for example, when former Surgeon General Koop raised more than $2 million from diet-industry heavyweights Weight Watchers and Jenny Craig for his Shape Up America foundation, he remained largely immune to the charge that he was exploiting a national neurosis for financial gain. After all, “everyone knows” that fat is a major health risk, so why should we find it disturbing to discover such close links between prominent former public health officials and the dietary-pharmaceutical complex?

None of this is to suggest that the war against fat is the product of some sort of conscious conspiracy on the part of those whose interests are served by it. The relationship between economic motives, cultural trends, social psychology, and the many other factors that fuel the war on fat is surely far more complex than that. But it does suggest that the conventional wisdom about fat in the United States is based on factors that have very little to do with a disinterested evaluation of the medical and scientific evidence, and therefore this conventional wisdom needs to be taken for what it is: a pervasive social myth rather than a rational judgment about risk.

Basically, what Campos is arguing is that fatness matters less than fitness when the data are crunched, and that the one-size-fits-all measures like BMI or weight charts do more harm than good because weight is used as a proxy for health, regardless of other factors.

In addition, we’re an incredibly schizophrenic society when it comes to weight and fat. We’re told how sinfully rich desserts are, but cautioned against appearing as though we actually ate them. The messages start early: young kids are developing more and more eating disorders as they absorb culturally fucked-up messages about fat. Teenage girls who frequently read magazine articles about dieting are more likely to use extreme forms of weight loss, such as vomiting, later on than girls who don’t. At the same time, the media gets a bug up its ass frequently about The Childhood! Obesity! Epidemic! and runs scaremongering stories like this one — reporting a study in which researchers reported a link between teenage obesity and middle-aged death. Oh, and a second study about weight loss in teens using Meridia (hey! there’s that diet-industry involvement again. I suppose the 14 pounds lost on Meridia beats the average on Xenical. You remember Xenical — “I lost 6 pounds on Xenical, and all I got was this oily anal leakage”).

I do need to wrap this up, but be sure to read the comments at Ezra’s. The fat-bashing starts early, and the “But — but — diabetes!” comments aren’t too far behind. And then go read Amanda’s and Scott’s and Shakes’ posts on the subject.

47 comments for “The pitfalls of one-size-fits-all measures

  1. car
    January 3, 2007 at 3:00 pm

    I just watched Little Miss Sunshine last week, and the diner scene almost made me cry. For those who haven’t seen it, the family is in a diner on the way to a beauty competition for a 7 year old. She orders ice cream, and her father starts in on why she shouldn’t have it because it will make her fat. Her mother tries to help in a completely wrong way by saying she can choose to be fat if she wants, and then the other family members try to show her that ice cream is good, all while the girl looks around completely confused. It’s a complete encapsulation of the mixed messages girls get about food and self-image.

    The really weird part about it was that I also listened to the writer’s commentary, and he had NO IDEA that this scene would be so powerful. He was simply trying to have something happen at that point, and thought that would be a good way to show the general caring but jerkness of the dad. He said that the response he got after Sundance was overwhelming, and he had absolutely no clue that he had hit on what he called the third rail of American psyche about weight. I was struck by how on earth he could be so clueless about the general state of girls and food in society – then again, he’s male; do they really not notice it??? How could someone write a scene like that and not realize what it meant?

  2. Rhiannon
    January 3, 2007 at 3:20 pm

    I have a “BMI” of 29.5 which is apparently almost obese but everyone who sees me says I’m petite, which I am. So I know the BMI is a load of bull. When I tell them that I’m “supposed” to weigh 130 lbs, they look shocked and exclaim “you’d disappear if you weighed that little!”

    That’s how I spread the word about the bogus BMI. I shock people with my own.

  3. January 3, 2007 at 3:38 pm

    I was struck by how on earth he could be so clueless about the general state of girls and food in society – then again, he’s male; do they really not notice it???

    Oh some do. Mostly the fat ones.

    America’s love/hate relationship with food is second only to its love/hate relationship to sex. Good boys and girls are thin and never overeat (unless they can and stay thin), and they don’t have too much sex (unless they can get away with not getting caught).

  4. Holly
    January 3, 2007 at 4:03 pm

    After BMI the next measurement you often see used by health care authorities is “WC” or waist circumference. In fact some doctors are saying that it’s better to use WC to predict risk for things like cardiovascular disease. Which is again, totally weird — now it’s just one number and it’s basically your waist size. This seems suspciously like falling back to “common sense” to me. And at this point we all should know how useful common sense is!

    Oh but wait, at least WC is gender-segregated: men can have WC up to 40″ and not be at risk, women up to 35″. Apparently this is partly because anyone with a relatively “apple-shaped” body is at higher risk for heart disease vs people with “pear-shaped” bodies. But still, this seems like shoving a whole lot of diferent bodies and sizes and people into some narrow (and unsurprisingly, gendered) boxes.

  5. zuzu
    January 3, 2007 at 4:10 pm

    At least with waist circumference, there’s an acknowledgement that where the fat is on your body has a lot to do with how harmful it is. Belly fat may be visceral, meaning around your organs, while butt fat is just butt fat.

  6. Anna
    January 3, 2007 at 4:14 pm

    Hey cool I think New Zealand might have a bit of a jump on you guys. This is the Push Play campaign
    http://www.sparc.org.nz/pushplay/overview

    I remember the tv adds featured people of all shapes, sizes and ages doing relatively normal things like walking the dog. All they’re pushing for is 30 minutes of activity a day and obesity or fat aren’t mentioned once.

  7. January 3, 2007 at 4:23 pm

    I read that article yesterday and came away thinking about how being fat and happy is actually a radical act in America.

  8. Carol
    January 3, 2007 at 5:01 pm

    Okay, sorry I just need to get this off my chest. It’s a pet peeve of mine the way people dump on Body Mass Index as a health measure. BMI is not a perfect measure of health or bodyweight. But it’s not such a bad measure either. It’s correlated with a large number of other, better health measures. BMI is generally used to say something about groups of people, not individuals. And when you are trying to collect information on a large number of people (think 1000’s to 10,000’s) it can be the easiest most cost effective way to get an imperfect measure of health. Some people will be inappropriately tagged as fat, but realistically, how many people do you know look like Sylvester Stallone at his buffest?

    Oh, and car, I burst into tears at that scene in Little Miss Sunshine and probably cried for a good 10 minutes. All I could see was a confident little girl suddenly learning to distrust herself. So sad.

  9. January 3, 2007 at 5:48 pm

    car & Carol: word to the Little Miss Sunshine scene. so painful to watch. so brilliant.

  10. Frumious B
    January 3, 2007 at 6:10 pm

    while it’s virtually impossible to determine just how much the dieting industry spends on such research, it is safe to say that it is many, many times more.

    … which in no way will prevent us from speculating wildly and making unsupported allegations.

  11. tzs
    January 3, 2007 at 6:41 pm

    Speaking as a writer, I wouldn’t put the screenwriter’s non-realization at the time as evidence of anything. There’s a heck of a lot of stuff that will come up out of the subconcious and you won’t realize how powerful it is until you go back later and reread it (or in this case, see it as filmed.) I’d say something in his head knew damned well what he was tapping into.

  12. Mnemosyne
    January 3, 2007 at 7:34 pm

    It’s a sticky puddle (I just got yelled at, like, a million times at Pandagon) so I’m going to step more carefully this time.

    I do think that Americans have a weight problem. I think it comes from multiple causes — one I rarely see mentioned is the aging of our population, and weight gain usually accompanies aging.

    I guess what I’m saying is … I blame the Baby Boomers. They’re making the rest of us look bad.

  13. ellenbrenna
    January 3, 2007 at 8:08 pm

    Fitness does matter more than fatness but fatness matters to me when it comes to staying fit. I have been many weights and sizes and I have found it much easier to injure myself when I am carrying more weight. It defintiely puts more strain on my knees and back just because of the way my body is shaped.

    Being injured discourages exercising as my busted hip (bike crash) and lazy self can attest to since August.

    I

  14. January 3, 2007 at 11:33 pm

    Belly fat may be visceral, meaning around your organs, while butt fat is just butt fat.

    Thank god.

    I do need to wrap this up, but be sure to read the comments at Ezra’s. The fat-bashing starts early, and the “But — but — diabetes!” comments aren’t too far behind.

    But, see, fat people might not know that being fat is really really really bad for you! And unattractive! And it means you’re lazy! Thinner people are just trying to do fat people a favor by reminding them that being fat means that you’ll drop dead of diabetes and a heart attack by age 40. And you’ll hate yourself. After all, it’s not like the media or doctors or advertisers ever lecture fat people on the errors of their ways, right?

  15. January 3, 2007 at 11:38 pm

    And I just want to point out a comment from Paul Campos at Ezra’s:

    I would hope that people on a progressive blog would consider just why the public health establishment and the media are spending so much time focusing on the very weak correlation between weight and health, rather than on, say, the vastly stronger correlation between not having health insurance and increased medical risk.

    Word. Where’s the moral panic over denying people healthcare?

  16. Mnemosyne
    January 4, 2007 at 12:21 am

    Being injured discourages exercising as my busted hip (bike crash) and lazy self can attest to since August.

    Ay-up. I think I’ve been to the gym exactly once since I tore my ACL a year ago (and had it replaced 8 months ago). At least I only gained 15 pounds back and not everything I’d lost.

    Which is why I gave an obscene amount of money to a personal trainer last weekend to start getting my ass back in gear. Have I returned her call to set up our appointment? Uh, no. Soon. I swear.

  17. TheKiti
    January 4, 2007 at 12:34 am

    Word squared, Jill.

    And what’s with so many people being stuck on the meme of “there wouldn’t be any fat people if everyone ate and exercised right.” The calories in-calories out theory is the equivalent of the tooth fairy for adults, it seems. People just don’t want to let it go, although it’s been shown over and over and over again that “lifestyle differentials” like calories consumed and exercise routines differ not by BMI, but by socioeconomic status.

  18. ellenbrenna
    January 4, 2007 at 1:42 am

    Jill if there was no moral panic over people being denied health coverage we would all be Republicans.

  19. Bolo
    January 4, 2007 at 3:27 am

    My BMI is 30.3 right now and was as high as 32.3 before I started exercising. People didn’t describe me as being fat when I weighed 245 pounds–although the standard for men is admittedly a little more lax.

    I’ve played with the numbers before out of curiosity and found that I would need to reduce my body fat down to around 5% (ballpark) to qualify as “normal weight” by the BMI’s standards. That’s obviously not healthy. BMI just doesn’t take into account the full range of body types–I’m just on the “large-frame” end, but I’m sure the exact same problem is encountered by those on the “small-frame” end.

  20. penny lane
    January 4, 2007 at 9:18 am

    Part of the article was making the point about BMI being a highly misleading indicator and it is. I was at my healthiest weighing around 132 when I went to a doctor for a routine visit. She suggested I lose weight and was skeptical when I told her how much I was working out (training for triathlons up to 4 hours a day plus yoga). I freaked out about being fat, started dieting and wound up with an overuse injury (plus headaches, fatigue, insomnia). My sports doctor laughed when I told him I was trying to lose weight. He offered to give me a body fat test which came out to around 11%–very low for a woman. So taking an aggregate number and attaching it to individuals can be dangerous.

    But the bigger point was about the problem of using weight as a proxy for health. Doesn’t make sense. And tagging individuals as fat and lazy is a lot easier than dealing with our screwed up health care system, poverty, and other more serious threats to our health. Nope, Personal Responsibility is the solution to everything.

  21. zuzu
    January 4, 2007 at 10:33 am

    But, see, fat people might not know that being fat is really really really bad for you! And unattractive! And it means you’re lazy! Thinner people are just trying to do fat people a favor by reminding them that being fat means that you’ll drop dead of diabetes and a heart attack by age 40. And you’ll hate yourself. After all, it’s not like the media or doctors or advertisers ever lecture fat people on the errors of their ways, right?

    Of course not! Fat makes your mind like a sieve.

    Mnemosyne, call your trainer. And ask for the free weights.

  22. January 4, 2007 at 2:56 pm

    There are so many myths around how us fat people get fat, like we eat too much, or don’t exercise, or take antidepressants that make us fat and we should get off them. SO simplistic. I’ve been on psych drugs for eight years (if I go off I get suicidal or manic, so quitting is not an option), and I got up to 220 just before I quit one of my worst meds. Also while I marched up to 220 pounds, I was living in the inner city, unemployed, lucky if I ate even one meal a day, my body was in starvation mode (meaning lower metabolism, meaning any fat is stored for emergencies which always happen), and through all that I still walked an hour everyday because I couldn’t afford public transit. Didn’t make a damn bit of difference until now, when I can actually afford to eat on a regular basis and am employed.
    Besides that, fat looks really good on some people, and I even read a report a few years back that the majority of people prefer sexual partners who are slightly to a lot overweight, they just feel so much pressure to hate fat that they deny their attraction to plump folks. Kind of like gay bashing closet cases.
    My two cents.

  23. Tom
    January 4, 2007 at 5:51 pm

    Part of the problem with the eating disorder epidemic vs. the obesity epidemic debate is that it’s often seen as a zero-sum game–that is, that eating disorders and obesity can’t both be a problem at the same time. There is a diet industry pushing obesity scare statistics, of course, but the snack and fast food industries obviously have a dog in the fight, as well; they lost a lot of money during the recent Atkins craze.

    Things that get lost in this tug-of-war paradigm are notions like looking at body composition rather than BMI, which is used a lot simply because it’s easy to determine rather than because it’s a truly accurate universal measurement of fitness; or that the placement of fat within the body (most reports that I’ve seen say that a real danger sign is the amount of fat within the abdomen, behind the belly muscles, rather than simply waist size), and, as others have stated, the level of exercise for that person. A gym that I used to go to would loop a PBS special on the obesity “epidemic”, and near the end (interesting placement, that), they had a segment on a chubby fellow who would be considered out of shape by most people, perhaps even by indicators like BMI, but who regularly participated in triathlons. He didn’t win them, mind you, but he was healthier than some natural ectomorph who never exercized.

  24. January 4, 2007 at 7:07 pm

    A gym that I used to go to would loop a PBS special on the obesity “epidemic”, and near the end (interesting placement, that), they had a segment on a chubby fellow who would be considered out of shape by most people, perhaps even by indicators like BMI, but who regularly participated in triathlons. He didn’t win them, mind you, but he was healthier than some natural ectomorph who never exercized.

    I’ve mentioned this before, but I’ve taken a few triathlon training classes, and had class with a woman who most people would consider “chubby” and who probably appeared to be in worse physical shape than I was, if we’re judging “shape” by a person’s size. Anyway, she kicked my ass every day.

  25. Mnemosyne
    January 4, 2007 at 7:09 pm

    Mnemosyne, call your trainer. And ask for the free weights.

    Fine. Fine fine fine. I called. I’m seeing her on Monday.

    When I’m trying to lift my arms above waist level on Tuesday, I will think of you. ;-p

  26. zuzu
    January 4, 2007 at 7:13 pm

    Good! Another convert to iron.

  27. Dr Kate
    January 4, 2007 at 8:38 pm

    BMI is not a perfect measure of health or bodyweight. But it’s not such a bad measure either. It’s correlated with a large number of other, better health measures.

    Um, Carol, you missed a MAJOR extra piece of information in that sentence if you want your “assertion” to be true.

    A more accurate statement would be: It’s correlated with a large number of other, better health measures IN POPULATIONS OF TENS OF THOUSANDS OF PEOPLE.

    That’s POPULATIONS not INDIVIDUAL PERSONS.

    As a PhD epidemiologist, I can tell you true that BMI is one of the most misinterpreted statistical constructions in all of healthcare. In a huge population, comparing BMI SUMMARY statistics with RATES of morbidity and mortality makes sense because individual differences in body composition and percentages of body fat given BMI average out in the summary predictor of risk.

    In an individual person, BMI calculations accurately predict the percentage of body fat less than half the time. In children, about 25% of the time. In persons of African descent, it’s an accurate estimator only about 25% of the time.

    FURTHERMORE, certain racial and ethnic subgroups experience offsets of risk of diabetes and heart disease. Mexican Americans and Native Americans have higher risks of diabetes at lower BMI than whites, while African Americans have lower disease risks for given BMI levels – possibly because of the poor predictive value of BMI in this group.

    So remember: we are people, not populations. If BMI “works” for you as an indicator of fatness, you are very average. In general, it is a very poor predictor of risk in an individual, and is vastly poorer than various ways to directly measure biomarkers of cardiovascular and diabetic disease – e.g. blood sugar testing, blood pressure, resting heart rate, cholesterol, etc. Doctors usually get these tests done for their patients anyway. Their predictions of risk are much more reliable, as they are measuring things related to disease pathology.

  28. Carol
    January 5, 2007 at 11:18 am

    Dr. Kate,

    Your right. The point I was trying to make, and failed because I left out an entire sentence, was that BMI is an adequate population measure but not a good individual measure. The problem is not BMI, it is, as I think has been stated above, that family doctors rely on it too heavily and don’t consider individual circumstances.

  29. deep6
    January 5, 2007 at 2:23 pm

    The diet industry SHOULD push people to lose weight IF they’re not fit due to overweight. So long as the weight loss is gradual, while the person is on a healthy diet and exercise plan, it’s a win-win. Overweight certainly isn’t the only factor in health but it elevates risk factors for disease and the kind of body strain that can seriously impact your mobility and the health of your joints and muscles.

    What I wanna know is, who is gonna teach kids from early ages through adulthood that it’s wrong to harass, hurt and ostracize people because of their size? I think we all agree, fitness is the goal, not necessarily slimness, but people (especially kids) are just ruthless to the overweight. I’m still in therapy because of my food issues and how they affected my health. There needs to be a social consensus that if we can’t (or won’t) isolate ourselves from the message “thinness = good”, that we should at least insulate ourselves from the message that “fatness = bad”.

  30. January 5, 2007 at 3:05 pm

    Sorry, deep6, there is no advantage in dieting to improve health. None. Not only does dieting not lead to permanent weight loss, but in itself it is a much stronger marker for morbidity and mortality. There is no such thing as “a healthy diet”. People are fit or not. People are fat or not. People who are not fit should be encouraged to get more exercise, they should not be harrassed about their food intake. Overweight does not elevate any risk factors for disease. On the contrary, some weight gain with aging appears to be the healthiest.

    If we all agree that fitness is the goal can we just shut up about the weight?

  31. ellenbrenna
    January 5, 2007 at 3:13 pm

    No one should be pushed to lose weight. Period. End of sentence. You should be pushed to exercised more. You should be encouraged to eat healthy food. That is it.

    Focusing on aesthetic issues is counterproductive and encourages people to use methods, to acheive a weight loss goal, that are detrimental to their health in the long term.

  32. deep6
    January 5, 2007 at 5:18 pm

    It’s a very positive idea to encourage people to eat well and exercise more. Everybody should do that. Some people actually need to lose weight though, like my aunt who is morbidly obese, for whom it was a health emergency. Insurance covered her stomach stapling (so I was told) and she’s since lost 45 lbs, which is more than she was ever able to lose with healthier eating habits and exercise.

    Kaethe – I didn’t use the word “dieting”. That implies the yo-yo and fad food regimens that, as you say, don’t contribute to weight loss and actually work against long-term health. I’m talking about “diet”. A lifestyle change. A healthy food regimen that combines reduced calorie intake with increased fruit/vegetables, lower-fat proteins, and a sharp decrease in saturated fat. Someone can have a diet that is healthy, without “dieting”. Many overeaters, however, may consider a switch to a healthy diet to be “dieting” because of the significant drop in calories and reevaluation of food as fuel, rather than as comforter/stress-reliever or whatever its addictive purpose is for them. That’s not how I mean to use the term though.

    I think Weight Watchers, Jenny Craig, Atkins, South Beach, the grapefruit diet and all the others have screwed up the term “diet” to mean something it doesn’t. Really, it’s just a food regimen. I’m not sure where your information is coming from, that overweight does NOT elevate risk factors for disease. Maybe I should have said that it’s an additional risk factor for disease. That would have been a better way to state my case. But this is commonly believed among the medical establishment. Just personal experience, when my mother got a whole new kneecap, they told her to lose weight. When my stepfather was diagnosed with type-2 diabetes, they told him to lose weight. When my grandmother went into the hospital with chronic pulmonary disorder they told her she needed to lose weight (and cut down on the sodium). When I was told I had fatty spots around my liver, I was told I needed to lose weight. For years at my health exams I was told the same things: stop drinking, stop smoking, find something to alleviate your stress and lose weight or you could end up having a heart attack.

    About the harassment – I totally agree. It’s inappropriate and rude and is counterproductive and emotionally damaging to people who need positive reinforcement, not judgment and criticism. My distaste for this behavior was the whole point of the second paragraph.

  33. Mnemosyne
    January 5, 2007 at 5:20 pm

    Overweight does not elevate any risk factors for disease.

    Osteoarthritis that results in a hip replacement isn’t a disease?

    True, the osteoarthritis isn’t caused by being overweight, but being overweight complicates the osteoarthritis to the point where a total hip replacement becomes necessary.

    To say that being overweight is never a risk factor for disease, or never causes other conditions to be more complicated, is just stupid. Sorry. You can argue that the effects of being overweight are exaggerated, but to try and claim there aren’t any elevated risk factors associated with being overweight is ridiculous.

  34. ellenbrenna
    January 5, 2007 at 6:50 pm

    Emphasis on losing weight instead of on the lifestyle changes that can result in losing weight in some people but that improve health in all people is counterproductive. Partly because everyone’s body is different and the same exercise is not going to have identical results for everyone.

    Healthy attitudes toward food are more relaxed not necessarily more permissive. You just have to focus on how food makes your body feel: how it looks on the plate, how fun it is to eat, how it smells when you cook it, eat slower, stop eating when you feel full, eat a healthy snack when you are hungry again. Pay attention to your body when you eat something if it makes you feel terrible, eat less of it or don’t eat it at all, don’t feel guilty when you do eat things that give you pleasure. It does not have a damn thing to do with monitoring, rules, rituals or diets in the usual sense. I changed my entire attitude toward eating, I exercised and yes I lost weight but mostly I got into better physical condition and I felt better. It took many years to change my attitude but mostly I had to accept my body and start to enjoy it first.

  35. TheKiti
    January 5, 2007 at 7:31 pm

    To the people who compare fatness to smoking, or to alcohol or drug abuse, and want us all to get thin nownownow or diediedie, let me ask you this:

    Suppose there was overwhelming evidence that the vast majority of people who attempted to quit smoking or any other abusable substance actually wound up using it more, and that their health further deteriorated with every failed quitting attempt? (This is not actually true as far as I’m able to determine.) Would you be so keen that they try to stop nownownow?

    Well, that’s how it is with fat, folks. There are a lucky few who can lose a substantial amount of weight without preempting the rest of their lives to do so, and keep it off for good with nothing but roses resulting from it. Bully for them, I’m jealous that it was such a piece of celery for them. The rest of us get nothing but a big shit sandwich for trying over and over and over and over again.

    I’ve done the eat-less-exercise-more thing. I gained weight, and no, it wasn’t from stopping, it was while I was doing it. I am absolutely 5000% not bullshitting you. Certain medications will do that to you (and have you considered that there are also far more weight-gain-inducing meds on the market now than 20 years ago?).

    What part of “we are all different” is so hard for people to understand? Even if we aren’t as perfectly healthy as the rest of you fabulously vice-free skinnies, what’s it to you? Lefthanded people have worse health and lesser longevity than righthanders, gays worse than straights, atheists worse than regular churchgoers. Does that upset you nearly as much as the apparent recalcitrance of Teh Fat, with our apparent refusal to literally kill ourselves trying to conform?

  36. ellenbrenna
    January 5, 2007 at 9:15 pm

    What makes you think the other people discussing this issue who have slightly different opinions than yourself are skinny? or virtuous in the moralizing, propaganistic sense that gets pushed on us from the dominant culture? For example when I said I lost weight I went from being a size 18 to a 14 hardly a member in good standing of American system of Fat oppression.

    Nearly everybody who has been advocating fat acceptance has reacted in a most unaccepting manner in various fora when people have said “I started to exercise for X reason and found I lost weight” or “I changed my diet when my attitude changed or to improve my health and then I lost weight”. Please try not to confuse what we are saying with the messages from the diet industry or pop culture.

    We all grow up with this completely destructive puritanical notion that food is seductive and sinful and will destory your body if you give into it. It is not unlike the messages we get about alochol, drugs or sex which are all simultaneously demonized and glamourized. The difference is you have to eat everyday. You can’t not give in to it. That is a completely unhealthy attitude toward food and it underlies a lot of the discussion of this issue right now on our lovely internet.

    Add to that our sedentary lifestyles (brought about by car dependence, urban planning etc), sugar processed foods and misinformation about dieting and you have a recipe for making people miserable, confused and fat. People in other industrialized countries are not like us, their bodies vary as human bodies inevitably do but they are not as big and fat as Americans.

    Because it is pervasive and complex and seems so normal the easiest thing to do is to blame fat people and declare them immoral and weak. Can we give this system a name? Fatriarchy has a nice ring to it. A pervasive system in which all we think about is fat instead of actually enjoying life and food the way human beings are supposed to, which paradoxically just makes us more unhealthy and fat.

  37. zuzu
    January 5, 2007 at 9:42 pm

    To the people who compare fatness to smoking, or to alcohol or drug abuse, and want us all to get thin nownownow or diediedie,

    Who are these people?

    Even if we aren’t as perfectly healthy as the rest of you fabulously vice-free skinnies, what’s it to you?

    And who are these people?

    What’s so hard to understand about the fact that the rules of physics don’t change when you’re fat? If you burn more calories than you take in, you lose weight. If you consume more calories than you expend, you gain weight.

    Where people differ is in the number of calories they expend. There are any number of factors involved in this, from medications to age to activity levels. That one person has difficulty losing weight does not change the basic equation. Nor does it mean that nobody can lose weight. I get sick to death of hearing that.

    Acknowledging this simple fact does not mean that one is a “vice-free skinny” or being judgmental. If anything, it allows us to acknowledge that people are in fact different, that what works for one person isn’t going to work for another, and if someone has a low metabolism or insulin resistance or has to take meds that cause weight gain, it is not a reflection on that person’s character.

  38. TheKiti
    January 5, 2007 at 10:27 pm

    I’m not necessarily referring to any remarks made in this thread when I talked about the smoking/fat-alcohol-drugs comparison. However, I do see it all the time. I’ve had protracted arguments with people on Salon, for example, about just that.

    And speaking just for myself, I never said “nobody could lose weight and keep it off.” Or that nobody should try, ever, if they really have a burning desire to do so and it’s physically realistic for them. Some people can do this, although it’s a lot more rare than media hype would have it, and I do understand the dream to fit in, be accepted, be respected, be paid. (And how sad that we give women in this society a zero-sum choice between having a relaxed attitude about eating and having a highly paid career, unless they are one of the rare genetic lucky duckies with a hummingbird metabolism.) If I could “slim down for life” and still have a life, maybe I’d join you.

    But I daresay you’ll encounter the opinion, “Everyone can and should be thin, and all it takes is a little effort, which you fatties are too selfish to make,” a lot more often than you’ll encounter, “Not everyone can be thin and not everyone needs to be thin.” Even on sites supposedly with “progressive” or “feminist” viewpoints. So if you’re tired of hearing/reading that you can’t have what you want (a thin body for life), how tired do you think I must be to get slammed over and over again with the idea that I can’t have what I want (respect at whatever size I am)?

  39. ellenbrenna
    January 6, 2007 at 12:34 am

    “So if you’re tired of hearing/reading that you can’t have what you want (a thin body for life), how tired do you think I must be to get slammed over and over again with the idea that I can’t have what I want (respect at whatever size I am)? ”

    So who is this sentence arguing against precisely, I’m confused. I want to feel good, I want to be healthy. I want other people to do the same because it adds to human happiness and progress. For me a side effect of those things for me was that I lost weight (until I fell off my bicycle and busted my hip that is). It does not mean it will be that way for everyone, it certainly won’t mean we will all be thin but in all likelihood based on the real world experiences of people I know well Americans would not be as fat on average. They would also be less anxious, sleep better and be less depressed because they would be eating better and exercising.

    Actually what I am tired of is getting slammed for holding opinions I don’t hold.

    What does that have to do with you not getting respect? How does a desire for health and a more positive and less moralistic attitude towards food deny you respect?

  40. Raging Moderate
    January 6, 2007 at 7:39 am

    Sorry, deep6, there is no advantage in dieting to improve health. None. Not only does dieting not lead to permanent weight loss, but in itself it is a much stronger marker for morbidity and mortality. There is no such thing as “a healthy diet”. People are fit or not. People are fat or not. People who are not fit should be encouraged to get more exercise, they should not be harrassed about their food intake. Overweight does not elevate any risk factors for disease.

    Ya see, this is one of “those” comments. Glad to see it didn’t go unchallenged this time.

  41. zuzu
    January 6, 2007 at 11:22 am

    I’m not necessarily referring to any remarks made in this thread when I talked about the smoking/fat-alcohol-drugs comparison. However, I do see it all the time. I’ve had protracted arguments with people on Salon, for example, about just that.

    Is this Salon?

    Do us a favor and limit your response to what’s being discussed here, unless you link or quote something someone said elsewhere and label it as such. Because you’re tilting at windmills over here.

  42. ellenbrenna
    January 6, 2007 at 5:42 pm

    There is such a thing as a healthy diet there is no such thing as healthy dieting.

  43. Lorelei
    January 6, 2007 at 6:02 pm

    the thing is, people who say that fat people need to lose weight so that they aren’t unhealthy or depressed or sleepless or whatever other *nonsense* do not point out how skinny everyone should be to be ‘healthy.’

    what BMI? what height/weight ratio? what pant size?

  44. ellenbrenna
    January 6, 2007 at 7:20 pm

    Except I did not say fat people need to lose weight. I said Americans need to be healthy and exercise so they aren’t depressed and sleepless. For some people increased activity and less prepackaged bullshit food would have the side effect of them losing weight. Not making them skinny or “perfect” just slightly less fat on average then they are now.

    There is no one type, size, shape or ideal but to argue that the shape and poor health and yes fatness that Americans are in right now was inevitable is utter nonsense. There are a lot of factors that have gone into it and none of it has to do with the moral quality of fat people but to deny the relationship between what we as a country eat, how we as country live and travel and what we as a country now look like is preposterous.

    (None of which is nonsense BTW Americans are depressed and sleep deficient and stressed out and there are many factors contributing to this but one helpful thing for depression and stress is exercise. People would be more inclined to exercise if there was not an impossible weight loss goal attached to it and it was presented as fun instead of labor in service of an aesthetic)

  45. Lorelei
    January 6, 2007 at 9:21 pm

    what i said was nonsense was some sort of correlation between depression/sleeplessness and fat.

  46. ellenbrenna
    January 7, 2007 at 12:20 am

    Sorry for the confusion but the “they” in my original sentence did not refer to fat people who were depressed or anxious but all people who were depressed or anxious and then began to exercise and eat better.

    The point is that the health benefits of exercise are not limited to long term prevention on major disease it also improves mental health and quality of life.

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