- Study after study shows that most people are unable to lose more than a small percentage of their body weight and keep it off without major surgery
- There is evidence to show that this is physiologic rather than pyschological--it is nearly impossible for very heavy people to simply "eat less and exercise more" to a "normal" weight (given that 2/3 of the country is overweight or obese, normal weights, aren't.)
- The fact that this often operates through the appetite system does not mean it's "all in their heads" or a lack of willpower. Appetite is a signal as powerful as thirst or pain. Most people can't ignore it.
- The largest environmental determinant of this trend is probably simply cheaper, tastier calories, which will be very hard to reverse
- Much of the panic about the obseity epidemic comes from lumping all weights together--everyone over a BMI of 30 becomes an obese people with high relative risks for various diseases, even though the whatever health risks exist among the lower overweight ranges are not anything like the dire health effects of morbid obesity
- At the moment, it's unclear whether there are any adverse health effects associated with overweight or even mild obesity, and to the extent that there are adverse effects, it is also unclear whether they are a result of the body fat, or a proxy for fitness levels and eating habits
- The emphasis on the visible proxy (obesity) is counterproductive in promoting healthier eating and exercise. Health has simply been approximated as a euphemism used by those pursuing society's ever-more-unrealistic expectations about weight. No matter what they say about being healthy, most people exercise to get thinner/more cut. If they don't get thinner, they may give up.
- The emphasis on the visible proxy may actually encourage counterproductive behavior. Upper class young women still smoke to stay thin (or go back when they gain post-quitting pounds); people take dangerous diet pills. There is some evidence that weight cycling (yo-yo dieting) leads to higher mortality, either directly, or because it increases your likelihood of becoming morbidly obese.
- The difference in observable mortality between people fifteen pounds apart (which seems to be at the edge of sustainable weight loss) is not large enough to merit either the hysterical headlines about America's weight gain, or really even dieting unless you're already afflicted with diabetes and heart disease.
To me, that screams "do more research!" But the researchers couldn't . . . quite . . . bring themselves . . . to suggest that we might want to look into this further before continuing to recommend that people go on highly restrictive diets that they probably won't stick to.
So we shouldn't tell people to stop dieting--we should tell them to stop regaining the weight! Why . . . it's so simple! How could we have missed it?More in general, the majority of epidemiologic studies on weight cycling and mortality have been carried out on either non-obese or only mildly obese subjects; the two studies that stratified sample by BMI showed that weight variability was more strongly related to mortality in lean than in obese subjects.4,6 Therefore, weight cycling may not have significant effects in a sample of obese subjects, about half of whom were morbidly obese, like the sample in the present study.
In conclusion, the present study shows that when examining the various components of weight cycling separately, weight loss has no adverse effects on cardiovascular risk factors that are associated with weight regain. Thus, patients should not be discouraged from trying to lose weight as for claims from the lay press,21 but the importance of avoiding weight regain should be stressed.
If 99% of the time the actual result of the course of action you recommend is that people diet, and then regain a bunch of weight, you need to take this into account before issuing further such recommendations. It doesn't seem like simply proclaiming that they shouldn't go and gain the weight back again is quite enough.
After all, people who have lost a bunch of weight are presumably aware of how they did it (and if not, they need to talk to an oncologist, not an obesity researcher). They are thus presumably also aware of what will cause them to gain it back. Nor are they usually uninterested in staying thin. They've usually worked very, very hard to lose all that weight, and are really quite desperate not to gain it back again. The idea that all that was missing was a doctor telling them that no, seriously, they should really keep that weight off--an incentive obviously far more powerful than, say, the horrific way that America treats fat people--has sailed beyond arrogant into fantasyland.
This really is a pattern that you see over and over again in obesity research. It's as if researchers are terrified to say anything that might be viewed as giving people license to get fat. The CDC researcher who sharply revised downward the estimates of deaths from obesity, finding that overweight was actually healthier, fell all over herself proclaiming that of course, this didn't account for quality of life. Because we know that a woman who weighs 160 pounds couldn't possibly have a decent quality of life . . . ?
This is also a partial answer to those who ask "Well, would it hurt to try?" Of course, in their minds, none of this trying has costs, or at least, not any interesting ones. I mean, sure, maybe it's a huge infringement of property rights, but those are sucky and archaic anyway, and no one cares about them except right wing nut jobs who don't deserve to have anything they want. And okay, maybe people want to live in the suburbs despite ample warnings from the television that driving is making them fat, but they must not really understand this, and at any rate, once we've made them all skinny they'll be so happy with their new flat-front capri pants that they won't even notice they have a 45 minute train commute and have to go grocery shopping every day.
Etc.
Would it hurt to have massively intervened in property rights, free markets, and personal liberty, and then find out that oops, it really was just cheap calories? Shall we outlaw those too? Millions of dollars for kale, but not one red cent for donuts?
I know, I know . . . it's for the children! I am very fond of children. But I do not actually think that they are some sort of master race in whose name anything at all can be justified. And if I did, I'd be a lot more worried about, oh, abortion, than McDonalds ads.
Two final points. Everyone likes to focus on their favorite boogeymen. To read a left-wing blog, you'd think that about 95% of the leading cause of obesity was agribusiness, chain restaurants, and automobiles. To read a right-wing paper, it's all the infamous lack of self-control displayed by the poor.
But in fact, most of the things effecting kids are side effects of other efforts a lot of people are rather fond of. Processed foods and chain restaurants have exploded in the last two decades because Mom spends more time outside the home, generating more market income, and less time for home cooked meals. Kids exercise less not because crime is higher, or even because we've become more suburban, but because they're no longer allowed to operate unsupervised until they're quite old, and Mom and Dad both work. Schools don't have P/E because they're using the time to teach kids to read. Maybe those were bad tradeoffs. But they're not irrational tradeoffs, and switching them back is not costless.
The other is that while I do buy some of the arguments about hyperpalatable food like Doritos (though I personally find Doritos eminently resistable most of the time), the fact that a really attractive food combination has been cooked up by food scientists does not mean that you get some kind of free pass to deny it to everyone. Whether a dish was dreamed up by Mario Batali or the staff at the Cheesecake Factory, preventing people from having it "for their own good" still represents an actual hedonic loss, as well as an actual loss of freedom. You may think they have some meta-self which will thank you later, but their current self has still had both its liberty and its joy restricted. Invoking the demon food scientists of agribusiness does not actually relieve you of the obligation to prove that intervening in the liberty of both the customers and the company is morally pressing.
To be sure, even I, the pessimistic libertarian, do not see any actual means for the government to prevent food processors from making their food taste very good. (Thank God). I just suspect that more than one of my interlocutors is casting around for just such a means.
The government could raise the price of fat, salt, and sweeteners, processed food, and restaurant meals. But I very much doubt that if our legislators actually enacted a food tax adequate to prevent obesity, they would get much thanks from anyone except the sort of people who ask each other, with wide eyes, if anyone else has noticed how disgustingly fat all the people are at the mall--and never eat at Cheesecake Factory. So I think that this, too, is unlikely.
Ultimately, the answer to "what could it hurt"? is that all actions have costs, which you cannot assume away on the grounds that those costs don't interest you. But they should interest you, because not least among those costs is the simple fact that the government cannot do everything well. Making all sorts of changes in the name of obesity means not making others that might be more important, because we have limited political and bureaucratic bandwith. Do you want obesity intervention, cap and trade, or health care reform? You may not be able to have any of them. But you probably can't have all three. And if you did, you'd make it more likely that the government would screw all of them up.
So in your research, have you come across any really convincing arguments about why people are putting on weight? And why it seems to have at least a somewhat cultural component?
Not to sneer at the poor fatties, but you really don't see as many hugely obese people at upscale places, and you do see a lot more at WalMart (and I shop there, so I'm not putting them down.)
You made some comment on another post about your own lifelong diet. Is it impossible for other people, from other subcultures, to manage this? And again, what has changed?
The point isn't that people aren't putting on weight, it's that the perception of the problem and the reality of the problem aren't the same. Until you're morbidly obese, you don't really have the kinds of health-care problems that are associated with being overweight; except if your weight yo-yo's. And right now, the advice people are given by doctors and magazines and blogs all encourage yo-yo lifestyles.
Additionally, the misperceptions of fat distract us from real problems and finding the solutions that could make a real difference in health-care costs.
Megan,
Thanks, it's nice to see someone discussing obesity without simply ragging on the fatties. Much of what you said is pretty reasonable. If anything, the data seems to suggest there is more justification for policies that encourage people of all weights to go back to higher levels of exercise than to focus on calorie reduction. And the notion that overweight people simply haven't clued in that maybe there are some health consequences or that maybe apples are healthier than Doritos is just laughable.
By your own admission, though, this is a very serious issue for the morbidly obese or those with conditions like diabetes. Those aren't rare cases, though, it's precisely where you're seeing really dramatic increases in rates of incidence. The skyrocketing rates of Type II diabetes in the under-35 population is particularly terrifying. Those individuals will be at dramatically higher risk for heart disease and other complications, and even if after time they reduce their weight, they will already have incurred permanent damage as a result of the years of hyperglycemia and it's not clear that weight reduction alone will eliminate the diabetes once you've progressed that far.
If this issue were only about nutrionists scolding the moderately overweight to eliminate desert, you'd be right on. But with generation of 20 year old diabetics emerging, the problem is rather more serious. Doesn't make it any easier to solve, but it is a problem.
New study of children identified vitamin D deficiencies as part of the problem; not enough time in the sun without sunblock. Health problems linked to lack of D include diabetes, hypertension, unhealthy cholesterol levels, rickets, etc. (From a report last night on PBS, I'll find a link if you like.)
Point is, assuming that fat is the problem means you're not looking for the other problems.
But has vitamin D intake in children's diets dropped dramatically over the past 25 years (or are they wearing too much sunscreen)? The prevalence of obesity in the USA has doubled in that time, and the prevalence of diabetes has doubled along with it.
The report I saw didn't say; just that the incidence of rickets due to vitamin D deficiency increased, provoking the research. And kids lack of time in the sun was the primary cause.
There aren't many good dietary sources of vitamin D -- oily fish, being primary. The researcher also said that milk fortified with Vitamin D wasn't enough, a child would have to drink a quart a day to get enough.
10 to 20 minutes of sun-block free sun every day, she said, with the darker the skin tone the longer time required.
Most people don't get vit D from their diet but from the sun and sunscreen use has increased dramatically, and time outdoors has decreased. So - yes could be.
No hard numbers, but my sense is that kids are outside less today than 20 years ago, because as we all know there are sex predators hiding behind every fence. In the 80s, my parents actively encouraged me to go out and play in the Florida summer without sunscreen.
I wonder just how expensive nudge-taxed foods would have to be to actually have a significant effect on obesity rates. The implied assumption seems to be "not that much", but I'm no so sure.
I'd like to see a study with some overweight participants who are given a food budget and can buy any generally available food items that they wish, but at the hypothetical nudge-taxed/subsidized rate. "I'd like a Double-Whopper with Cheese!" - "That'll be 92 bucks pal!" - "Oh..., how about a nice green salad with light dressing then?" - "Only 10 cents!"
At least then we'd not only have some indication of whether this will actually work, but a good measure of how much marginal benefit we get out of each incremental addition in government intervention.
My guess - it would take something of the magnitude of the satirical hypothetical above to accomplish much.
Good point - fast food prices have exploded in the last 5 years, but consumption seems to be increasing. Seems to be somewhat insensitive to price.
Also, it is also curious to look at the quantities of fast food consumed. In the 1960's, a McDonalds burger was about 1oz of meat, and there were only small fries. Now, a big burger has around 6 oz of meat, the fires are 4x as large, and the soda has free refills with a 3x volume cup.
From anecdotal memories from friends who were around in the 1960's (I'm too young), people used to be happy with a small burger fries and coke. It wasn't cost that kept people from eating 6 burgers in a sitting, they just ate the potion they were accustomed to, and it made them full. The question can be posed, is the rise in fast food sizes (with relative price increases) a response to customer demand, or a player in creating new demand?
It seems to me that potion control is really the answer, and you are correct that prices would have to rise incredibly to be a sufficient dissuasion to people accustomed to eating a lot.
It would seem plausible to me that the portion size people are accustomed to, instead of some natural weight that has been steadily increasing, dictates how much people eat. Though I have no policy ideas about how to get people to slowly start eating smaller portions, or even if this concept has been rigorously studied.
There are people who believe that all the fatties out there just need to suck it up and eat less and exercise more and they'd be thin and happy. These people usually believe that fatties just need to decided to do this and then it will happen. These people will not be dissuaded of this.
As one of these fatties, I will tell you (to deaf ears) that it is REALLY HARD to lose weight. Really, really hard. Eating makes me happy. I don't want it to make me happy but it does. Eating crappy food when I'm not very hungry makes me happy. Eating sweet, fatty foods makes me even happier. I can only imagine that it's how alcoholics feel when they drink alcohol. I have to actively choose NOT to eat ALL THE TIME. It gets tiring.
Unlike alcoholics, I can't go cold turkey and I can't avoid situations where food is present. My company sometimes gives ice cream to employees in the afternoon. Friends are always wanting to go out to tasty restaurants that serve huge servings of fattening foods. Friends and family insist on occasionally throwing parties where delicious, unhealthy food is served along with sweet, delicious deserts. The grocery store (where I must periodically go) continues to stock the shelves with scrumptious cookies, heavenly chocolate desserts, greasy bacon, pre-prepared foods full of fat and cheese and starch, and other foods that I should not eat if I want to get thin.
Those of you who aren't all that interested in food or who really like the taste of fresh vegetables but aren't all that turned on by bacon or hamburgers or fried chicken are lucky. You aren't constantly tempted to eat things you shouldn't eat. Consider that, instead of patting yourself on the back for having such strong willpower, you should be thanking your lucky stars that your appetite is relatively weak compared to others.
(And yes, I am exercising and getting in better shape but still not really losing weight)
I am disabled and look like a wreck, so I couldn't care less what you look like. I understand that the health effects of minor obesity are minor.
On the other hand, as someone who is a bit jealous of healthy people (I've been in a wheelchair since I was a kid), it constantly annoys me to see potato-shaped people walking around. It's like they were born rich (health-wise) and threw it all away.
But putting that aside, what I would really like to understand is what has changed? I don't think it's right to just say "oh well" and push for fat acceptance without knowing the reason why obesity has increased.
I also think this kind of thing is cultural and runs in families. If as a kid, you are at McDonalds all the time, or eating a big southern-style dinner every night, it will be very hard to change and very hard to lose the weight once you pack it on.
If like Megan and others, you grow up constantly watching your weight, that will keep you from ever becoming obese in the first place. And I do think that would be better than becoming hugely obese.
Sure there's a middle ground, but which way are we heading?
And BTW, I like all those foods you list (and eat almost no veggies), but I don't eat a lot of them. I eat fried chicken once a week, not every night. So it isn't just a matter of thin people not liking food much, or only eating "good for you" stuff.
Those of you who aren't all that interested in food
I'll give you an example - my old college roommate - he used to force feed himself cheesecake and protein shakes in an attempt to gain wait.... it never worked. Today, he's 6'1" 165 and he doesn't eat breakfast or lunch and for dinner he stops and Wendy's gets a #2 and eats about 1/2 of it. That and a couple cokes a day is all he eats. He's not skinny because he has a huge amount of will power he's skinny because he doesn't like to (and often forgets to) eat.
Earnest,
I think it fair to acknowledge that few have it harder than the suck-it-up junkie. Some of us may be tempted by food, or drink, or cigarettes or worse. But imagine that your temptation is to criticize human fallibility! Everywhere you turn, there's another person whose life would be better if only he or she were as smart, refined, graceful and disciplined as you, and you try to hold your tongue but, but, you just can't help yourself from telling people that there only real problem is that they're just not as sublime as you are. It's a real problem. And while it's tempting to get irritated by these people, we should try to realize that they need our understanding and our sympathy, for they are no better able to cope with their addiction than we are with ours.
Earnest,
As someone who has been through Al-Anon and sat in on AA (for close family members not myself) it is remarkable how closely what you describe resembles what most alcoholics describe as their feelings before they hit bottom. And expanding on your points about cold turkey, I imagine there is no real bottom to hit with eating.
I wonder if the psychological process with food does not mimic alcohol or gambling for some people. If so, it might give an idea to avenue of treatment, since AA seems work for some people. The funny thing is from what I observe, that community understanding, acceptance and support seems to be much more powerful than community scorn when dealing with addictions.
If AA is an effective treatment for alcoholism then there are effective treatments for obesity. The problem comes down to what you consider to be an effective treatment. As far as I know, there is even less evidence for effective drug treatment than there is for effective obesity treatment (if we are using Campos's notion of effective).
wibbles,
You fail to realise that to end up 100lbs overweight in 5 years you would only need to eat 166 extra calories per day. I little over a tablespoon of olive oil.
Your theory that you need to eat an extra fried chicken or two per day just isn't the case.
jmo3,
Doesn't your analysis leave out the simple fact that any movement/exercise you do with 100lbs added is going to burn substantially more calories? For example, if you went from 150lbs to 250lbs you would expend 1.66 times as much energy climbing a set a stairs. Even if the calories directly consumed by fat cells is low, extra weight will still mean extra calories burnt. Unless any weight gain is accompanied by a drop in physical activity.
You're probably still losing some fat though, because pretty much everyone ends up losing at least a little fat and sometimes water if they really up their activity level.
As for the food, it is really a bit misleading to pretend that eating huge amounts of fattening foods is an addiction. You can have that piece of fried chicken, but you don't actually need all eight pieces (they come in 8-packs here at the grocery store) in one sitting. Fattening foods are not actually terribly fattening in the amounts that, oh, many americans used to eat them in-- modest amounts.
This, perhaps, is something that warrants study-- why some people feel they MUST eat an entire cake (or chicken, or pie, etc), while others are content with a slice or two. I have actually not been able to do feats like eating an entire chicken in one sitting since my teens. Once my 20s rolled around, I couldn't overeat even if I'd wanted to. So it is quite mysterious to me how anyone looks at a big wedding cake and is like 'i really feel i've got to eat all of it, NOW'.
wibbles, have you ever sat in on an AA meeting? If not I suggest you do just once ( I suggest everyone does just once, it will change your outlook on many things.) 8 pieces of chicken vs. 8 shots of vodka is not that different, base on how Earnest has described it. Especially since many alcoholics (notably in early to mid stages) aren't physically addicted, but still can't control their consumption.
Sorry, but 8 oz of alcohol isn't going to fill my stomach and make me uncomfortable from the stuffed feeling. It will probably make me throw up (drinking that much at one time), but the simple amount of liquid is not the same.
That's why I find food 'addiction' so odd-- I cannot physically force my stomach to expand until a point near rupture through eating lots, and I don't understand why anyone would be motivated to feel that level of discomfort recurringly.
I think we are missing each others points. your point is a fair one, and you are fortunate not to have compulsions that are uncontrollable. Likely because discomfort is a more driving motivation for you than whatever pleasure an addict gets - which I don't understand personally either, but I strongly believe exists in many and also agree that it would be a worthwhile avenue of study.
I was responding to your assertion that it is misleading to pretend eating large amounts of food is an addiction. My point is simply that it seems to me, without having done research, to appear similar to the compulsion of some alcoholics who would be considered addicts, despite not having a true physical addiction (yet.)
I'm really replying to wibbles who said:
(I posted in the "Thining Thin" thread about having lost 27 percent of my body weight last year.)
I used to do this -- probably not "until a point near rupture" (I stopped before I got to the wafer-thin mint) but I used to regularly eat past the point of discomfort. It was not unusual for me to eat an entire medium pizza. (I am a woman under five feet tall.) I usually ate 3 or 4 plates-full of dinner. Most of what I ate, by the way, was "healthful" -- plenty of fresh vegetables, whole grains, not much sugar at all, lots of fish and legumes. All real, whole food, not junk: There was just too damn much of it. I simply managed to constantly convince myself that I needed more food. All day long, and at every meal.
Perhaps it wouldn't be amiss to call this an eating disorder, and to assume that it's one whose incidence is growing in the population, for a variety of reasons. I still consider myself to be a recovering binge eater, because I recognize the thought patterns that urge me to binge -- they still recur. I have learned that the impulse that whispers "You need more" is almost always incorrect, but I still experience it.
Earnest,
There is hope. I am increasingly convinced that obesity is not a failure of willpower, it is a mental illness, and a curable one. I say this as someone who has lost 132 lbs since Dec 24, 2008 (in other words a little over 7 months ago).
The key thing is to get your head clear. I used to be exactly where you are. I used to feel *compelled* to eat fatty, sugary, unhealthy foods. I even *knew* I'd feel awful after eating them and I still felt compelled.
But on Jan 11 I finally got my head clear. I finally cleared away that last little bit of the mental illness that made it so hard to control my eating. I became a raw foodist and have been feeling amazing ever since.
My suggestion to you: look into yoga, kundalini yoga, and EFT (Emotional Freedom Technique). Those are the tools that helped me get my head clear. I don't fight food cravings anymore (OK, that's not quite true, I have an unhealthy obsession with various fruits, vegetables, and delicious raw food dishes, but it's manageable :) ).
I wish you success. I just want you to know there's hope :)
Yeah, and I did it without having to become a raw foodist, so there's even more hope. :-)
Seriously, I think I'm in hagbard's camp. "Curable mental illness" is not a bad way to look at it. The cure is not easy and nobody really agrees on what it is, and maybe it's got to be highly personalized. But that's very much what it felt like to me: it felt like I was kind of crazy before, and now I'm sane. Saner, anyway. At least measured by how I eat.
(I admit that I do have a lingering obsession with watching my weight that I have to be careful doesn't swing me in the other direction.)
Megan, you're my hero for these posts.
So, on behalf of my very beautiful, slightly overweight friend who always gets a bit tipsy at public events because she's afraid to be seen putting food in her mouth, thank you.
most people are unable to lose more than a small percentage of their body weight and keep it off without major surgery
Oh... I don't know about that. It goes by the brand name Desoxyn and it's extremely effective. I would be really interested to see what controlled doses of Desoxyn combined with Sustanon and Deca Durabolin could do for the average American fatty.
Now, you might say - crystal meth and steroids? Are you insane?
Well, I honestly think people should have the right to trade a few years of retirement for a 50 or 60 years of being thin and attractive... I know I would.
You should be careful Megan. What if it turns out that Ezra was exempted from freshman comp thanks to AP tests? You'd probably feel pretty silly then.
This is perhaps the best post of a very good series on obesity. This is an issue that I'd really like not to see politicized, and I think Megan is, so far, doing an excellent job on this. Of course, the abortion cheap shot could have been avoided (I believe Megan is aware that some people actually believe a zygote or an embryo is not a child).
Megan makes a very good point concerning hedonic losses. Restrictions on food, as in smoking or (other) drugs, have a cost in pleasure. Maybe hard to estimate it, but it shouldn't simply be dismissed.
But I also think pleasure is an argument for stronger legislation on calorie information. While labels on caloric content may not be effective in fighting obesity, at least you can use the info to maximize your pleasure bang for caloric buck.
I'll drink to that.
It's interesting to compare this graph:
http://healthyamericans.org/reports/obesity2009/
with this one:
http://www.usatoday.com/news/health/2008-04-21-life-span-study_N.htm
If "moderate obesity" (BMI 30-35) reduces life expectancy by 3 years, and many new people are entering that category, isn't that a basis for concern?
Not to say there's a public solution, but behavioral patterns that slice 3 years off of life expectancy sure seem like a problem to me, even if it's not "anything like the dire health effects of morbid obesity". The overall tone of recent posts here seem to indicate otherwise.
but behavioral patterns that slice 3 years off of life expectancy sure seem like a problem to me
It all depends on what people are getting in exchange for those three years. It's like smoking - it takes 10 years off your life! But, they are the last 10 and who wants those anyway?
Without looking at the raw data, for studies like this, it's typically a Gaussian curve centered at 75 (male) or 81 (female) yrs shifting to the left. So it's likely a mixed bag in terms of the quality of years missed.
Your point is valid, although an ancillary effect of these studies is that many people conclude that weight gain is wholly unpreventable.
It's worth noting that these studies have a selection bias in that they involve people who have allowed themselves to reach an overweight condition in the first place. A notable percentage of the population are differently motivated individuals who select lifestyle habits and patterns that avoid the state in the first place. When the pants get tight, they immediately adjust habits as opposed to going shopping.
From reading the first study Megan linked I don't come to the same conclusions. From reading it, one of the caveats is that there was no control, untreated population being studied. If the untreated population gains weight over the same period, then the impact of the diet is understated. In fact, they did cite evidence that this may be the case.
In certain programs, the 5y average weight loss was 15lbs. That's pretty significant weight loss for most people, and if you lose a significant amount of weight up front you were most likely to keep even more off. They also suggest that exercise may be one of the keys to long term weight loss as well.
The final point is the one brought up last time, is that these studies are likely taking a higher percentage of people who can't lose weight by themselves than the general population. Who joins a weight loss study, if they were already successful doing it on their own?
I'm not saying losing weight is easy, it's extremely difficult, but for Megan to act like losing an average of 15 pounds over five years is minor seems a bit wrong.
Look at the dropout rate on that study . . . the higher the dropout rate, the better the results.
That's still about 60% of the people in the trial, 15 pounds after 5 years is pretty good in light of all the other caveats that come with obesity studies.
Also these studies tend to rely on exercise styles and methods that demonstrably don't work for weight loss and don't do exercise monitoring. In at least two such studies, participants exercised 'when they felt like it', and this was recorded as if they'd been regularly exercising or increasing their activity level. Also, based on the calorie totals given for many of these studies subject exercising, the exercising being done is very, very, very low-impact (around 6-7 calories/minute, which is *not* a weight-losing level of activity if done occasionally throughout the week)
That's what is so shocking to me-- that people keep taking these studies seriously when the researchers don't expect the participants to actually exercise regularly at all, but yet the data is used to 'prove' that regular exercise and diet cannot provide long-term weight loss and maintenance.
Also caloric intake is very complicated. Just straight-line reducing is not very effectual-- caloric intake must be modulated on an individual level.
Obesity research is incredibly dishonest, which is hilariously sad given how much they dislike the idea of people carrying an extra 20lbs of fat. But then, there are people whose bodily composition has changed radically from increased exercise who think they didn't lose weight because they lost fat and it was mostly replaced with muscle, so there was very little numeric change.
Good points. Out of an engineer's curiosity, does anyone know if a rigorous exergy study has been conducted on people of different weight? I.e. calories in vs. calories out for a representative sample of the population?
It would be theoretically possible that heavy people absorb more calories per calorie consumed, and are thus more likely to put on weight. If you couple that with an assumption that once a person's metabolism becomes accustomed to a higher calorie level it becomes very hard to reduce that, it could make a reasonable theory of weight increase. In the past, when portions were smaller by convention/need/availability, people were thin. Now that calories are cheap, people with a certain characteristic gain weight easier, and once weight is gained it's very difficult to take off for physiological/psychological reasons.
Of course this is an off-the-cuff hypothesis by a non-expert, so it might be unreasonable/obviously incorrect.
Another engineer who thinks it'd be interesting to see some energy analysis applied to obesity research. A quick energy balance for the human body would go something like this.
differential weight gain=calories consumed*body's efficiency in converting those calories to energy - work done/efficiency of muscles - heat loss to surrounding environment (discounting the heat generated by movement, since that is accounted for in the efficiency)
Is there anything I'm leaving out?
I'd also like to see a more rigorous definition of metabolism. Most people throw it around as a sort of magic spell to make weight gain/loss seem more sensible. Exactly what physical traits does a high metabolism correspond to? Does that mean one's body burns more energy breathing/pumping blood/maintaing cells?
Hydrogenated oils are linked to insulin resistance, among other nasty things. Anyone care to do a cost benefit analysis on eliminating them?
I think the bottom line is that there we have a fundamental lack of information regarding:
1) The effect of weight as an risk factor independent from confounders such as amount of food, quality of food, amount of exercise, central vs. overall obesity (ie waist to hip ratio), lipid profile, insulin resistance, blood pressure, etc. It is difficult to control for all of these factors, and we don't know if obesity just happens to commonly present with these risk factors, or if obesity is an independent risk factor in it of itself.
2) We say that overweight and perhaps mild obesity doesn't lead to increased mortality, but nobody knows the cutoff point where, on average, weight DOES independently increase mortality. Everyone agrees that there is a cutoff point, but no one knows what it is. Compounding the problem is the fact that the cutoff point may even be different, for each individual, based on other variables. For example, it's possible that someone who's overweight and exercises has the same mortality risk as someone who's thin and exercises, but someone who's overweight and sedentary has increased mortality risk over someone who's thin and sedentary. In other words, several variables may effect one another, which makes it difficult to determine any "cutoff."
I suppose I agree with Megan that, in the absence of clear information, we should bias toward less interventions that directly target overweight. Perhaps we should instead focus on associated risk factors, such as increasing amount of exercise, controlling blood pressure, etc.
To me most obesity researchers advocate for all of us to do the same thing over and over again, but somehow come up with different results: eating right and excercising and somehow this will magically make most very fat people thin.
But to quote a favorite fat activist Kate Harding:
"It’s not because we think being thin is a crime, or that the desire to be thinner, for any number of reasons, is at all difficult to understand. It’s because the methods we currently have for losing weight DON’T F'ng WORK, and yet both society in general and the medical community insist that we must keep trying those things again, again, again, again...If the gazillions of dollars being poured into weight loss research ever turn up something that will really help suffering fat people lose weight permanently, without the risk of death or disability — and, importantly, if it turns out that losing weight really does help those people physically — I will get right behind that."
http://kateharding.net/2007/10/29/reality-vs-relativism/
Some context above: she's talking about the extremely fat, 400 lbs. and above. This is what I'm talking about too.
So: what if obesity researchers left behind the obsession with methods that don't work permanantly and started being innovative with their research? I mean some research focused on the super-obese for instance, where WLS gets peddled as a solution that is actually quite risky. And I'm not convinced either (as Paul Campos) that the merely chubby and the merely fat have as many health risks as the CW seems to think exists. Would it be worth it to do govt. research into something else on something that works (not dieting, not WLS) something we don't currently have in existence right now? Just curious.
Some fat people eat a whole lot. Some don't. Some love fried foods. Some don't. This constant insistence that all fat people or even most, eat unhealthy foods a lot of the time is simply not true. I am making the radical proposal here that simply by looking at someone, you cannot tell exactly what their eating habits are. Period.
Obesity researchers should try doing studies in which they apply the weight loss methods and dietary changes of people who are successfully maintaining significantly lower weights for years (100+ pounds of fat loss, for example) to a population of participants. Or even just use people successfully keeping 30-50 or 50-75 pounds of fat off after 3,4,5 or more years. There are numerous such people, but they don't generally eat high-carb, high-glycemic index diets (and sometimes not even calorie-reduced diets), nor do they find increased activity making them gain weight, and thus are magical unicorns to both fat-positive folks and obesity researchers.
They are "magical unicorns" because they are so incredibly rare, compared to the vast majority of people, not because they are mythical or don't exist, like "magical unicorns" don't.
Oh I don't know, but I know quite a few fat people that hate eating because of the trauma of stigmatization (especially in public). The implication in your post that the majority of people who fail at dieting are in fact eating "high-carb, high-glycemic index diets" is really not true.
But we don't actually know how rare they are because by definition they are NOT represented in obesity research (since they did the work independently and are maintaining their weights independently).
It's really hard to say what the majority of people who fail at dieting do as a whole, because they appear to at the least not exercise enough or eat enough (at least based on the failures in the badly designed, useless studies, not the universe of people who started and failed to lose fat or weight).
The majority of fat people I know eat a lot and don't move around much. What they eat is mostly carbs and high-GI ones at that (although again, even there you have complexities that need to be considered because eating carbs is a delicate matter).
Also, a lot of people lie about binges, drinking and 'just one bite i won't record'.
I'm always interested in people who are fat (more than even 20 pounds above the highest number for their age/height/gender)while being engaged in near-constant physical activity. I have yet to actually meet or hear of one. I know people who are muscular with a layer of fat, but they aren't that physically active-- it is just that their activity tends towards short bursts of concentrated strength.
Again, I don't know any fat waitstaff who are in constant motion 8-10 hours per day except diner waitresses and sometimes catering waitstaff (who are not). Also no fat people working at car washes (very physically intensive labor).
I don't understand why people want to argue that physics doesn't apply to them when it comes to weight and activity. We can have tolerance of fatness of varying levels and accept that people can be healthy and still have fat on them without just flat-out denying that diet and exercise can reduce and/or maintain weight over the long term.
I would be very interested in study of 400+lbs people, since past that weight many of them are carrying around liquid (but it is not clear that it is water, though it certainly could be) and that means putting them on 800 calorie diets to lose fat is insane for completely different reasons than the common mythos claims (which is that they aren't full of fat, not that diet and exercise are useless endeavors to reduce weight).
Can't reply to wibbles back below so I'll do it here.
Actually there are many studies done that do show how rare it is for people to keep it off 5 years or more"
-------
"One study of dieting obese patients followed them for varying lengths of time. Among those who were followed for fewer than two years, 23 percent gained back more weight than they had lost, while of those who were followed for at least two years, 83 percent gained back more weight than they had lost, Mann said. One study found that 50 percent of dieters weighed more than 11 pounds over their starting weight five years after the diet, she said.
Evidence suggests that repeatedly losing and gaining weight is linked to cardiovascular disease, stroke, diabetes and altered immune function. Mann and Tomiyama recommend that more research be conducted on the health effects of losing and gaining weight, noting that scientists do not fully understand how such weight cycling leads to adverse health effects."
And the info above got the information from a study of studies, here are the details:
"Mann and her co-authors conducted the most comprehensive and rigorous analysis of diet studies, analyzing 31 long-term studies."
http://www.sciencedaily.com/releases/2007/04/070404162428.htm
This was all done at UCLA by the way.
You know your experience of fat people and mine are both correct. That's the thing about human beings: we are not robots. We have a variety of experiences and yes, some fat people eat a lot, some fat people don't because like any other group of people, they do not deserve to be stereoytped into one behavor or another.
The truth about the old "calories in-calories out" binary is that it is far more complex than, just eat right and excercise you will be thin! It depends on how fat are these people that we are talking about? what is their lifestyle? how tall are they? what is their genetic makeup?
No one is saying: eat junk food and never excercise. Quite the contrary. Even a de facto fat activist such Paul Campos has reached the conclusion that excersing and eating healthy is good for everyone, regardless of their starting weight. It's just not true that doing those things, in and of themselves, is going to result in thinness, for many people. If you "needed" to lose 15 lbs. (what Megan has cited as just bein) and you lost the weight and kept it off, you probably weren't that fat to begin with.
Also there is set-point theory. Please read about it. Gina Kolata's book as well. And Megan McArdle's posts especially her interview with Paul Campos and her post about "thinning the thin" a couple of days back.
Wibbles,
I'm always interested in people who are fat (more than even 20 pounds above the highest number for their age/height/gender)while being engaged in near-constant physical activity.
You've never worked construction? You see tons of guys with huge arms and huge beer bellies who work physically demanding jobs as carpenters, masons, plumbers, etc. and are heavy. They may get a lot of exercise but they also eat and drink a lot as well.
"I mean, there's no better established empirical proposition in medical science that we don't know how to make people thinner. But apparently this proposition is too disturbing to consider, even though it's about as well established as that cigarettes cause lung cancer. So all these proposals about improving public health by making people thinner are completely crazy. They are as non-sensical as anything being proposed by public officials in our culture right now, which is saying something." -Paul Campos in his interview with Megan.
Wibbles:
You noted: "I know people who are muscular with a layer of fat, but they aren't that physically active-- it is just that their activity tends towards short bursts of concentrated strength.
They are out there. A female friend of mine was an avid athelete -- running several miles daily, triathalons, aerobics, etc., and eating lightly, but could not shake some mild fat on her thighs and other locations. She wasn't overweight, but was certainly 10-15 pounds heavier than you'd expect her to be.
She was so dead set to lose the thighs that she cut back further on food and ended up having hypoglycemia and fainting spells while running, but didn't make a dent in those 10 extra pounds. Her docs told her to live with it.
Thank you for this very good piece.
I know first hand the struggle with obesity and its hypertensive/hyperglycemic complications. Always "overweight" and yo-yo-ing, I spent 20 years (1987 - 2007) with a BMI over 40, peaking out in February of 2007 at 47. I was on seven prescriptions to control blood pressure and diabetes. My doctor simply told me "You're going to die, if you don't change your ways."
I accepted the accountability he demanded (turning in my 4X daily glucometer readings every two weeks) and discovered the diet that has successfully taken me down to a BMI of 26 and a weight of 210 for my 6'2" frame.
By eliminating flour, sugar, rice, pasta, and potatoes from my diet, eating fruit sparingly, protein sufficient for my lean body mass, and using healthy fats for the majority of my calories, I no longer have to take prescription medication and my last two A1C readings have been 4.6 and 4.9 respectively.
The USDA food pyramid is misguided as is the AHA in its restriction of fats and the promoting of carbohydrates.
Diet and exercise can work when coupled with sufficient accountability, encouraging support, and a diet which takes you off the glycemic roller coaster.
Exactly. I did much the same as you, preachermantim. Four years ago, at 6'2" I weighed 275 and my blood pressure was 200/110. In six months I lost 100 pounds on Atkins. Now I weigh 178 and my blood pressure is 120/75. Most notably, I eliminated beer from my diet. I have never regained the weight.
But marketing works. This morning I visited my local convenience store and noticed that the last of the few healthy dietary staples were gone. Now everything in the store is prepackaged junk. Normal, healthy foods have lost the competition for shelf space. Increasingly, the same is true in the supermarkets, which have increased prices on non-mass marketed items to justify keeping them in the store. I have to walk past, it seems, half a mile of junk food to find the diminutive shelf containing the cottage cheese.
I believe a notable study showed that children, given the opportunity to eat anything they wanted in any quantity, adopted a healthy diet and did not gain weight after the first two novel weeks of bingeing on favorite items. So we can infer that environmental influences are at work in obesity rates. To the discussion, I would add consolidation of food providers yielding domination of available shelf space, marketing, and also stress as an appetite stimulant. I think stress is the link between poverty and obesity.
More than just the obesity issue, I am struck by Megan's statement that "all actions have costs, which you cannot assume away on the grounds that those costs don't interest you." This seems to be a general argument for stasis and inaction, even if current policy is misguided and expensive. Regulating tobacco had a political cost, but government did it anyway. Undoing market distorting agriculture subsidies will have a cost, but it would also certainly have benefits. One of these might be to level the playing field, price wise, for calories from--ok, I will use Megan's extreme example--kale instead of donuts.
This seems to be a general argument for stasis and inaction, even if current policy is misguided and expensive.
No, it's an argument for being a lot more sure than we are on obesity policy before making significant changes in national policy. You can call it stasis and inaction; I call it common sense. With tobacco, we were a lot more sure of its detrimental effects and the ability of people to not start smoking.
Sorry for the long quote, but a recent New York Times Op-Ed by Roger Cohen underscores the kind of language people use when talking about overweight people. He talks about a child as if she is literally a hideous monster that causes him physical "discomfort." He keeps talking about his sense of terror, that I am almost afraid that he and his daughter might bully the girl or "kill the beast":
"It was one of those images that definitely should not be allowed to fall into the hands of America’s enemies: a family of five, carrying a lot of fat, each with a nine-inch turkey leg, gnawing through the meat and gristle in a frenzy of biting and slurping.
The little girl, perhaps seven, was particularly riveting, perhaps because her features had already surrendered to the glutinous march of obesity, disappearing into a pinkish and undifferentiated swelling, punctuated only by two small eyes and a very active mouth at work on the reddish-brown meat.
The horror was such that not even the delights of Disney’s Hollywood Studios, where I found myself with my 11-year-old daughter at the time, could quickly dispel my discomfort, although the wonders of Toy Story Mania! and the spooky, stomach-churning Twilight Zone Tower of Terror came close."
Megan,
Two of your beliefs about obesity contradict each other
1) Weight is nearly impossible to lose. Under-eating results in hallucinations/unbearable cravings/etc
2) Cheaper food is the main driver in weight gain
If both of these are true, why has obesity only risen dramatically in the last 30 or so years. In terms of maximizing calories, people have been able to afford the calories necessary for obesity for quite some time. If their current weight levels are what they are genetically programmed for and staying too far away from that level results in strong physical cravings (akin to those of an alcoholic), shouldn't obesity have risen as soon as overeating was economically feasible? Have alcoholism rates changed much since the early 20th century? If an alcoholic/drug user will devote the majority of his income to the addiction, why didn't this happen with obesity-prone people in the past?
The only plausible way I can make these two statements work is assuming that there is no physical driver for weight gain in most people, but once the weight is gained those mechanisms kick in. This would make sense, but it doesn't seem likely. However, it would have completely different implications than your case. Items like removing PE from public schools and portion sizes at restaurants would become vastly more important.
While I'm of the opinion that most of the science on obesity is unsettled (and I'm being generous in labeling it science), the most interesting possible explanation of obesity to me is the rise of artificial ingredients, in particular artificial sweeteners. I've read of research with rats showing a correlation between artificial sweeteners and increased appetite.
Losing significant amounts of weight is very hard, obviously because if it was easy too many people would accidentally starve to death. Now the question is: how exactly does your brain determine the amount of food you need to eat to keep you at your weight? The most sensible mechanism seems to be the taste of the food. It's very possible that the rise of engineered foods has left our evolution-driven tastebuds back in the dust. If the brain is biased towards overeating due to evolutionary pressures, perhaps some people respond to this disparity in what they taste versus the nutrients/energy it brings in by eating more.
There's an article this month in Scientific American about the rise of Celiac's disease and the rise of agriculture. When people first started eating grain-based diets it put enormous evolutionary pressure on those whose digestive tracts could not handle it. Could the modern day rise in obesity be something similar. Instead of dying at a young age, people who aren't suited for the new man-made foods have to deal with weight gain and any undesirable social or physical effects that follow.
Megan, Two of your beliefs about obesity contradict each other
1) Weight is nearly impossible to lose. Under-eating results in hallucinations/unbearable cravings/etc.
2) Cheaper food is the main driver in weight gain.
~~~
There's no contradiction, just an unstated but hard-to-avoid implication that weight gain and inability to lose weight have different causes -- weight gain has a social cause (is not physiologically driven), while inability to lose weight has a physioligical cause.
We see the same thing in life around us all the time. People start drinking, smoking and using cocaine and whatnot entirely voluntarily because the price is right and the social returns are enticingly "tasty" -- then they find they can't stop, for physiological reasons.
The implied argument is that consuming extra calories leads to calorie addiction.
But if one is going to imply it so strongly one might as well come right out and say it.
The implied cause implies a remedy.
Megan, I'm putting this in here because I was out of the country when you raised it in a previous post.
Re: Ballerinas and Long Distance Runners and Weight.
You are committing the same phallacy that you ascribe to modestly overweight people who have lost (say) 15% of their body weight and believe that it extrapolates out to the morbidly obese who need to lose 50% of their body weight. Even the "fat" ballerinas and long distance runners are right at the borderline between normal weight and underweight. I don't know about the former, but I have lived and trained with competitive runners, and the latter generally eat whatever the hell they want, at least most of the time. If you're a mid-20s-to-early-30s male running 15-20 miles a day, your total calorie burn is probably close to 5000 per day. It's hard to eat that much, especially when you don't feel like eating most of the time (because you are running or have just finished running). Heck, I'm a good-for-a-rec-runner runner (i.e., a 2:50 marathoner), and I never even come close to an "overweight" BMI -- and I was technically obese in my mid-20s before I started running again.
The point is, the notion that strenuous exercise doesn't affect body weight is poppycock. If you run (say) 90 minutes a day, you are going to lose a crapload of weight and maintain it as long as you keep the mileage up. The problem, of course, it is wholly unreasonable to expect any appreciable portion of the population to actually do that. It's just as farfetched as expecting a majority of the people to engage in a diet that leaves them hungry all of the time for years on end.
Now. A lot of runners (and presumably ballerinas) do have to diet, often to the point of developing eating disorders. The reason is not that exercise is insufficient to help them achieve a normal or even lowish weight. All of them are there already, mostly due to their astronomical calorie burn. It's just that going a few -- or even several -- pounds below THAT is often beneficial. The oft-cited figure is that every extra pound adds a second per mile. That means a 5 pound weight loss will cut your marathon time by over two minutes. That can be the difference between an Olympic Trials qualifier or not.
I've found myself guilty of this. I usually start a marathon training cycle around 160 pounds (I'm 5'9"). I usually finish it around 140 pounds. If I'm slow a month in, I start to diet -- most of the time, the extra weight is what is killing me. Seriously, the effect is almost linear. But I'm not even close to obese absent the dieting -- I'm just not borderline underweight.
"... core propositions:
" * There is evidence to show that this is physiologic rather than pyschological--it is nearly impossible for very heavy people to simply "eat less and exercise more" to a "normal" weight ...
" * The fact that this often operates through the appetite system does not mean it's "all in their heads" or a lack of willpower. Appetite is a signal as powerful as thirst or pain.
" * The largest environmental determinant of this trend is probably simply cheaper, tastier calories, which will be very hard to reverse.... "
~~~~
So people happily lived at lower general weight levels than today 40 years ago, 30, 20, even 10. Then they got heftier mainly because "calories got cheaper and tastier".
What that adds up to is people get physiologically addicted to eating more food, much as they get addicted to cigarettes or cocaine.
I.e., people can live an entirely happy life without cigarettes and cocaine, and start using them only to be social and because they are affordable and "tasty" in their way -- but once they start they find it very difficult to stop for physiological reasons.
The argument certainly appears to be that's the case with today's extra calorie consumption compared to the lower consumption of only a modest number of years back (and to lower consumption on other societies, such as Japan, today.)
If that is the case, then the remedy (if really needed) is simply to teach the younger generation to be happy eating fewer calories as people used to do -- and like they are trending to smoke less and drink less hard alcohol. Don't get addicted in the first place.
BTW, I find it striking that you still totally omit the clear societal decline in physical exertion from the "core propositions", in spite of it plainly being a significant factor and of studies such as Philipson and Posner finding it to be so. When did Posner become such a dolt as to be dismissed without even a hand wave?
" * At the moment, it's unclear whether there are any adverse health effects associated with overweight or even mild obesity, and to the extent that there are adverse effects"
If so, this supports Posner's hypothesis that as calories have become cheaper, and as exercise that burns them has become more expensive, people have quite rationally re-set their preferred body weights higher.
Because it doesn't explain the spike in the last 30 years, and definitely doesn't explain the spike in the last 10. Our rate of activity isn't decreasing that fast by now.
"Because it doesn't explain the spike in the last 30 years"
I don't know why you keep saying this, it certainly does cover the period from the 1960s to the 1990s, which is most of that time, and most of the "era of weight gain". What time period do you think Posner was writing about?
Where's the evidence that the move to sedenatariness, or whatever the word is, actually has lessened since then?
But even if that were true, a major contributory factor to the first 30 years of the process shouldn't be ignored as irrelevant!
In response to an earlier comment along the line of:
'I don't care about the 40-year trend, I want to know why people have put on so much more weight in just the last 15 years, during which life hasn't become more sedentary [allegedly]'...
~~~~~~~~
"Intellectual Work and Obesity"
"... In the study, groups of students were made to perform three differents tasks -- sit in a resting position, read a text and write a summary of it, perform a computerized task. After 45 minutes of each subjects were allowed to consume unlimited amounts of food...
"After reading text and writing a summary students consumed 203 more calories compared to after the rest period, after the computerized task the students consumed 253 calories extra. This resulted in a 23.6% and 29.4% increase in calorie intake respectively...
"Insulin and glucose levels were measured and found to fluctuate signifcantly during the thinking tasks. The researchers believe [after the intellectual tasks] the individuals tended to eat more to restore glucose balance ...
"-- Jean-Philippe Chaput, Department of Social and Preventative Medicine, Laval University, Quebec, Canada."
There's the final answer explaining the last decade at least: Thinking and using computers cause obesity. I.e., blogging and reading blogs. So turn off your computer and go get in a softball game or something.
Or at least watch re-runs of the Beverly Hillbillies on Nick at Night instead of using your computer. It doesn't require any thought at all, and society was a whole lot thinner back in the days when that show was rated #1.
The Seth Roberts hypothesis is actually more about consistency than hyperpalatability, though they do tend to flock together. Our world has lately more and more been filling up with foods that always taste *exactly the same* as they did the day, the week, or the year before. Whether a company makes takeout hamburgers or packaged cupcakes or whatever it is, they are going to tweak that recipe scientifically until they've found a significant local maximum then they will brand it and having branded it they will invest whatever resources it takes to *keep* that food tasting *exactly* like their customers expect it to - at every store, at every outlet, throughout the world - for the next century.
Seth's taste/calorie association theory says that having access to any food that provides a perfectly consistent taste and a perfectly consistent associated kick in the blood sugar...makes you hungry for more food. Because your brain recognizes this *exact* taste, your body is *certain* that this particular food won't make you sick and will provide calories.
But suppose we add a little variation to the mix. The seasoning isn't quite the same, the burger is more or less well-done than you are used to, the bun changed from sesame to poppyseed, the whole combination is just *different* in various ways - even subtle ones - than the last burger you ate - and your body isn't quite so sure what to make of it. The less familiar the tastes are, the more your stomach wants to hold off, have "just a taste" and declare itself full in short order. You'll wait and see how this goes down rather than being immediately tempted to eat more.
If he's right, the decline of home-cooked from-scratch meals and rise of "food engineering" were among the factors contributing to obesity. If the government wanted to save us using his theory, they could force food manufacturers to vary their foods again. Tasty is okay, but not the *same* tasty. And when you bought a box of oreo cookies, no two consecutive fillings or cookies would be allowed to taste alike. :-)
My goodness, what a serious discussion. Not that I am in any way knocking it, but ....
PEDANTRY ALERT
"But in fact, most of the things effecting kids are side effects of other efforts a lot of people are rather fond of."
Megan meant "affecting" of course, but I can't help thinking that the statement is perhaps even truer as written.
In a perfect world, you could tax the cheap, unhealthy calories and rebate the money back to people through reduced paycheck withholding for the working and increased welfare for the non-working.
If the environmental problem is that Burger King and Doritos have gotten very cheap relative to fruit and vegetables, one solution would be to make those foods more expensive relative to healthy foods and give people the money.
(Yes, in the real world, this would create unfair transfers from people who disproportionately ate cr_p after the tax went into effect, and there would be deadweight losses, but it's nice to think about).
'Appetite is a signal as powerful as thirst or pain. Most people can't ignore it.'
This fatalistic argument is without merit; the same can be said about any form of bad behavior you choose to name.
"Oh, lazy can not help themselves, the desire to avoid work is just as powerful a signal to avoid thirst or pain." Or better yet "rapists can not help themselves, the desire to sexually dominate a woman is just... too powerful a signal"
It's like... like... telling a fat person not to eat. THAT is how hopeless it is. *rolls eyes*
Megan,
I think you, and probably many obesity researchers, dance around an important distinction that you never seem to acknowledge, the micro-level of a person and the macro-level of a population. I pretty much agree with everything in your bullet list at the beginning. I despise the BMI. I've been considered overweight on the BMI since I was 13, but up until some recent weight gain, my doctors were more worried about what I would have to do to get my weight within the "healthy" range. I think it is pretty well proven that for an individual skinny doesn't necessarily equal healthy. I think the idea that for an individual fat doesn't equal unhealthy is gaining ground. The human body is too complex for such simple reasoning. So, on the micro-level I think you are more or less correct.
However, when one zooms out to the macro-level and looks at a population, I'm not so convinced. (This is true of quite a lot of ideas and it goes both ways, what works on the macro level may not work on the mircro level.) Mostly, I'm not convinced because government policy already contributes to what you label as "The largest environmental determinant of this trend is probably simply cheaper, tastier calories". As you correctly state everything has costs. Agriculture subsidies have costs and one of them is to make certain foods cheaper than they should be. Ending agriculture subsidies isn't some kind of cure all or even a "solution" to the overall problem. It probably won't help me lose weight. However, it would be a helpful correction to our current state which in and of itself changed the way certain parts of our society eats.
Hmmmm . . . average weight has been increasing for a number of years, and dieting doesn't, on average keep the weight of any one individual down. So any 'reasonable' sort of 'government interference' is doomed to failure. Have I got Megan's logic right on this one? Let's try it on something else: On average any individual smoker's chances of quitting are about the same as a heroin addict voluntarily kicking the habit when their drug of choice is cheap and readily available. It follows then that no sort of 'government interference' will ever get the smoking rate down, and people in the U.S. smoke with about the same prevalence as they do in France, which matches the U.S. circa the 1960's, if I recall correctly.
Something seems wrong here, though I can't quite put my finger on it . . .
SoV,
According to CDC, the price of cigarettes went from $0.38 per pack of 20 in 1970 to $3.16 per pack in 2000. According to this inflation calculator, the 1970 price corresponds to a price in 2000 dollars of $1.69. In other words: between 1970 and 2000, the cost of a pack of cigarettes increased by 87%. In addition, there have been a large number of what you might call time, place, and manner restrictions on the act of smoking itself.
As you somewhat snidely note, these massive cost increases have reduced the incidence of smoking in the US substantially: across the same time period, US per capita cigarette consumption fell from 3,985 (in 1970) to 2,049 (in 2000), a reduction of about 49%. Now, here's my question: does your reference to the success of the American anti-smoking programs suggest that you're prepared to fight obesity by nearly doubling the cost of food, and using the law to radically curtail the times, places, and manners in which Americans consume food?
It's actually worse than that -- cigarette smoking is down from decades ago not only because active smokers are quitting, but also because more people are simply choosing never to take up the habit. Unfortunately, you can't take that fact pattern and try to apply it to food -- deciding that you're never going to start eating isn't really a viable choice.
Similarly, many smokers manage to successfully quit by going cold turkey -- they have their last cigarette and then never have another one ever again. Those that give in to the urge for "just one more" somewhere down the line frequently find themselves back into the old 4-packs-a-day habit. But unfortunately, cold turkey (pardon the pun) isn't really an option for people addicted to food -- you have to eat or you'll die.
It strikes me that asking someone to break a food addiction is a bit like asking an alcoholic to break their addiction by drinking two beers a day, but no more. As an alcoholic who was only able to give up drinking by going cold turkey, I can't imagine the kind of iron willpower it would take to "moderate" my consumption but not eliminate it. I wouldn't have a prayer.
All of the above a long-winded way of saying that yes, there is something wrong with comparing a smoking addiction to a food addiction.
It's interesting Megan, I see that you have attributed major weight gains in this country, to mostly cheaper high-caloric food. I also have seen that in your posts you don't cite cite stress and lack of sleep as being contributors to weight gain in people...
" Researchers at the University of Chicago have found that partial sleep deprivation alters the circulating levels of the hormones that regulate hunger, causing an increase in appetite and a preference for calorie-dense, high-carbohydrate foods. The study, published in the 7 Dec. 2004 issue of the Annals of Internal Medicine, provides a mechanism linking sleep loss to the epidemic of obesity."
http://www.sciencedaily.com/releases/2004/12/041206210355.htm
Also
"Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior"
E Epel, R Lapidus, B McEwen, K Brownell - Psychoneuroendocrinology, 2001 UCSF
Perhaps this is part of it? It seems to me that you have alluded to multiple factors that have contributed to weight gain amongst some people, including the genetic. What about cortisol levels too and sleep deprivation?
And for people who insist on blaming fat people for their fat because they are "lazy" I will say this: you cannot hate people for their own good. "Hating" here defined in terms of a continual insistance on attributing negative stereoytpical behavior to fat people, in the face of scientific evidence that suggests otherwise, such as mentioned in Megan's previous posts, especially "thinning thin" and in her interview with Paul Campos.
When we're talking about the rise in obesity over the last 30 years, I think it's important not to overlook potential causes of weight gain which aren't directly related to food and exercise trends.
Smoking rates have dropped from 32% to 21% since 1981, so not only are fewer people using smoking for weight control, but millions of people have actually quit smoking and faced the associated weight gain. Antidepressant usage has gone from nearly zero to 10% of the population, and weight gain's a well-known side effect. Hormonal birth control usage has also increased dramatically, not just BCPs but also forms like Depo-Provera and Mirena. Even prenatal nutrition and weight gain recommendations have changed -- mid-century mothers were encouraged to tightly restrict weight gain to 10-15 lbs to produce smaller babies for easier deliveries, but now we encourage a higher weight gain to help prevent prematurity and prenatal complications, and higher birth weights are associated with later obesity. Finally, the population's age distribution has shifted significantly as the baby boomers have moved from young adulthood to menopause.
All of those changes (except the age thing, which is unavoidable) are actually positive things. While they may not be the only causes of the obesity "epidemic", they are in the aggregate certainly responsible for some portion of it.
These are extremely good points, which I had not considered. I think you're on to something.
Increased drug usage imposed disproportionately on women when the known side effects are bad (not the weight gain, but the bleeding, mood issues, and unknown long-term chemical impacts on the brain, among others) is not good. Gaining a little more weight while pregnant is possibly good, but it must be weighed against the ridiculous c-section numbers and against 'pitocin to stress' medical practice designed to force c-sections or vaginal deliveries with extensive medical intervention.
Medicalisation and drugging of the population is not good, and that it causes weight gain is just another symptom of a larger sociocultural problem.
Whatever you think of the CS numbers, it's undeniable that they are better than the stillbirths due to intrauterine growth restriction, the increased risks of preterm labor and subsequent prematurity, neonatal problems common to smaller babies like jaundice and temperature maintenance issues, and lactation failures. They shift the risks and complications to the mother instead. I'm not minimizing those complications (I experienced some myself), but lowering the risk of the terrible infant outcomes is important too.
The previous recommendations of 10-15 lbs actually amounted to pressuring the mother to lose weight, since the baby and associated support structures (placenta, amniotic fluid, increased maternal blood volume) actually weigh 20+ lbs. The current recommendation for normal-weight women is 25-35 lbs, which includes a few pounds of maternal fat stores. Overweight/obese women are still currently told to restrict weight gain to 10-15 lbs, or even to no weight gain at all, without much good evidence.
Sorry, 30+ percent of all pregnancies are not 'problem pregnancies'. In some locales, the C/S rate is over 80 percent, for ordinary, problem-free pregnancies.
Sadly, it would threadjack even more than already to start throwing up links like gang signs, but the C/S rate has very little to do with maternal health and is in fact directly responsible for worse maternal health AND fetal outcomes, not better ones.
Googling John Edwards c-section will probably turn up a reasonable assemblage of relevant links to sites for natural childbirth and statistics on maternal health as it relates to VBAC, C-sections and pregnancy interventions more generally.
I really hate the level of unnecessary c-section, hysterectomies, and other surgical interventions that american women are subjected to disproportionately compared to many other countries.
Fetal weight gain is not the sole driver for those incredibly high CS rates, though. Obesity panic plays a part in that all obese women are assumed to be high risk and have gestational diabetes, and there's certainly some fear of fetal macrosomia. However, when you see rates as high as 80%, you've got several other factors going on like VBAC bans and continuous fetal monitoring lawsuit fears, which are beyond the scope of this discussion. (I'm well aware of John Edwards' contribution to this area -- this is a pet interest of mine, since the last couple years of my life have been devoted to racking up obstetrical complications.)
If you have to make a choice between lower weight gain and increasing CS rates, I do believe that CS rates are the right option to pick. I will choose the postpartum infection or the hemorrhage or the baby with TTN over the preterm labor at 24 weeks every single time -- and I've actually had all of the above, most in the pregnancy where hyperemesis prevented me from gaining enough weight. The new weight gain recommendations are undeniably an excellent thing for mothers and babies, especially given the way the previous recommendations were enforced (i.e. with amphetamine prescriptions for mothers who failed to lose enough bodyfat). Ideally, we shouldn't have to choose between CS and IUGR at all, but if we do, the association between prenatal complications and poor weight gain is pretty hard to ignore.
@Emma:
Women can socially persuade other women to gain more weight against doctors' orders (doctors are not the drivers for more informed and less invasive deliveries, after all). Women can't keep the doctor from performing the c-section in the same ways, unfortunately. So no, I'll take doctors making a foolish recommendation that I can as a doula or midwife or mother myself explain is foolish over invasive surgeries any day.
Just wanted to also mention this side note, from an article on an unrelated subject (pretty much unrelated, the author is arguing against Megan's earlier post on medical research and universal healthcare, not about her posts on obesity...his mention of obesity is almost a coincidence...and I only mention this article for the below paragraph. Don't want to thread jack.)
"As a side note: If you want to understand why in 1998 the medical community suddenly decided that you were overweight at a body mass index of 25 instead of 27.8, taking the WHO view (based on the BMIs of Africa and other developing nations as opposed to the long-held U.S. definition) and suddenly making 30 million Americans “fat,” just look at the makeup of the advisory panel — Pharma pushed this decision through, which had the effect of instantly adding millions of customers..."
http://newledger.com/2009/07/how-medical-breakthroughs-happen-a-response-to-megan-mcardle/
"obesity rates have skyrocketed over the last 30 years"
Wasn't it right about 30 years ago that Congress decided to get into the nutrition and health business, when the 1977 "Dietary Goals for the United States" was released? When Congress recommended that Americans reduce their intake of saturated fat, and eat more carbohydrates? Because the feeling was, even if there's no real proof that reducing fat will make people healthier (and lets be honest, there was NO proof of it at the time, and still isn't), how can it hurt?
The government - especially our government, which can't even manage to educate themselves on issues they actually are SUPPOSED to know something about - simply has no business passing any laws regarding nutrition and diet. There is no consensus on the science. Eat less, exercise more doesn't work for most people. The type of foods eaten are clearly far more important to weight and health than the total calories consumed, but there's no definitive answer as to exactly what those foods should be.
Obviously fresh veggies are good, but what about meat? Lots of evidence out there that a lower carb, higher protein diet is optimal. But conclusive, slam dunk evidence? No. What about fat? More and more science shows that saturated fat doesn't cause heart disease, and that vegetable oils like soybean, canola and corn - you know, the heart-healthy oils that we were encouraged to use in place of sat fats - are worse for you because their Omega 6 ratios are so high. Dairy? Calcium and Vitamin D need fat for proper absorption. How much damage have we done by encouraging families to drink lowfat or nonfat milk and dairy?
I think the American people have had enough of being guinea pigs due to diet policies set by politicians who have no freaking idea what they're doing. No more!
I'm an "expert" on this topic in several ways.
First, I grew up morbidly obese. I was the fattest kid in school. I weighed more when I was nine years old than I do now. In my early twenties, I went on the first diet of my life and lost 150 lbs, getting down to a then size 4 (now a zero). Iow, perfect weight for my height. The first 6 months of my diet was stupid. I did everything you're supposed to. Really, I never cheated once. After 6 months and only 20 lbs lost, I was bitterly unhappy. I felt betrayed. Desperate, I sold my car which forced me to bike everywhere (25+ years later, I'm still biking which could explain why I haven't gained (much of) it back. Well, that and a vegetarian diet. I wish I knew the secret because neither of those are it. I wish I could say I have consummate self control but that's a bigger fatter lie than my body ever was.
I'm concerned about obesity professionally as well. I work in the garment industry. Since sizing is a social construct that fluctuates according to the ever evolving mean (there is no such thing as "vanity sizing"), clothing sizes have become untenable. The costs in infrastructure are considerable. Our materials come in fixed widths, our spreading tables sized according to materials. If humans are getting wider, the very machines needed to weave fabrics will have to be widened. Our tables too. Even were these changes to be readily and inexpensively made, there's still the matter of scale. Humans arms are only so long. While we use machines to cut, it's still done manually and arms aren't growing long enough to reach into the middle of an increasingly wider fabric spread to cut. This in part should explain the continual entropy of fit and usage of knits to stretch ever wider body parts. The future is dismal for our industry and resultant consumer satisfaction. Worse, due to the increasing girth of the mean, those who are hgt/wgt proportionate will have increasing difficulty finding clothing that appeals and fits them. It *is* a problem now if you're over 25.
I'm also a pattern maker, an engineering function. It is difficult to design garment patterns to be flattering on heavier bodies because as they get farther from the mean, given proportions change unevenly. When people are slender, the differences are -comparatively- negligible. However, with obesity, some women will get large bellies, yet another woman will instead have a large bosom or large arms. Yet another woman is heavy bottomed but relatively slender elsewhere. It is impossible to design a garment to fit the gamut of possible variations of proportions -unless you're designing something like a big sack. This is the real reason there is such great dissatisfaction among consumers of plus sized apparel. Many heave umbrage at manufacturers but honestly, it is nigh impossible to fit the huge range of proportion disparities among the obese.
While I don't resent, dislike or blame fat people, it is inappropriate to blame me or my industry for the consequences resultant of obesity. In short, I lost my weight but even if I had not, I'm not to blame for the limitations of market choices and consequences of anyone else's weight problem.