Wednesday, December 28, 2011

The Mind Trap - Paradigms Re-Found

I'm actually pretty encouraged in some ways by Tara Parker-Pope's blog post today on the New York Times website. She writes about the incredible difficulty of maintaining permanent, significant weight loss through dieting or any other mechanism, and about new and existing research showing that dieting, in particular, changes people's metabolism to the point where regaining the weight is nearly a mathematical certainty.

One weight-loss doctor finally decided to try and figure out why his patients just seemed inevitably to regain weight after being on his starvation diet of 500 calories per day for eight weeks. ("special shakes called Optifast and two cups of low-starch vegetables, totaling just 500 to 550 calories a day for eight weeks" - how could anyone fail to keep weight off after realizing how satisfying that could be?)

Anyone who has felt a diet transform herself (or himself) into a food-obsessed, irrational wreck can attest to the fact that your body and brain get messed up by the process.
A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. For instance, a gastric hormone called ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. Another hormone associated with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels. It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.
Almost resisting the temptation to say "Well DUH," I read on. Ms. Parker-Pope comes to the conclusion that I have reached myself in the last little while. "This translates into a sobering reality: once we become fat, most of us, despite our best efforts, will probably stay fat." Right! So this is the end of page 1 of an 8-page post. What more could you possibly say for 7 pages? How about: "So quit being mean to yourself and/or other fatties and focus on being healthy and happy in the body you have"? Would that be too simple?

Apparently. Ms. Parker-Pope brings out some really good stuff, some studies showing that some people seem genetically inclined to put on weight more easily and retain it more stubbornly. And then she gets into the National Weight Control Registry, an organization which I hold to be more than a little insidious. The NWCR purports to show that long-term weight loss maintenance is possible. Many researchers and people with common sense believe it shows the opposite. The NWCR has a few thousand "success stories" in its roster. Here's what Health At Every Size (HAES) researcher and writer Linda Bacon has to say:
First, the data they gathered is hardly long term: It includes individuals who have maintained a thirty-pound weight loss for one year or more. Studies show that two-thirds of weight regain happens within two years, and at five years all the weight has been regained.So some of the individuals in the NWCR registry haven’t even made it past these danger points. And even among this elite group, 72 percent are regaining!*
Ms. Parker-Pope then interviews a woman who lost a lot of weight and has kept it off for years. This woman's regimen includes minutely detailed food and weight journaling; constant weighing and measuring of every mouthful (she knows, for example, that lettuce is about 5 calories per cup); researching menus and performing calorie calculations before any meal outside the house; avoiding all foods with white flour and sugar; and exercising 100-120 minutes a day. “It’s one of the hardest things there is,” she told the Times. “It’s something that has to be focused on every minute. I’m not always thinking about food, but I am always aware of food.”

I find that "I'm not always thinking about food, but I am always aware of food" has just the faintest odor of semantic self-delusion to it. Hey, if that's how she wants to live, that's how she can live. But I sure as shit don't want anyone telling me that her way is the only way to achieve health just because it has reduced her body weight. What the interviews with NWCR survivors tell me is that the people who keep large amounts of weight off long term are obsessing in a way that would be unhealthy for me if I were doing it.

Ms. Parker-Pope clearly gets a hint of this too: "Just talking to Bridge about the effort required to maintain her weight is exhausting," she writes. And then there's this great, great sentence:"If anything, the emerging science of weight loss teaches us that perhaps we should rethink our biases about people who are overweight." YES! YES, YES! YES! Tara Parker-Pope, it's not your fault you haven't been able to keep weight off despite repeated attempts.

Tara is still bummed, though: "In most modern cultures, even if you are healthy — in my case, my cholesterol and blood pressure are low and I have an extraordinarily healthy heart — to be fat is to be perceived as weak-willed and lazy. It’s also just embarrassing." Well, it's only embarrassing if there is widespread social stigma and you also agree to be stigmatized. How 'bout we work to eliminate the social stigma instead of buying into it?

But no. 'Cause here's how Tara Parker-Pope ends her post:
"And even though all the evidence suggests that it’s going to be very, very difficult for me to reduce my weight permanently, I’m surprisingly optimistic. I may not be ready to fight this battle this month or even this year. But at least I know what I’m up against."

Here's the thing, Tara - and I think we can be on first-name terms now because we're talking about some deep-down stuff here - you are healthy according to your metabolic indicators. You are a writer for the New York Times, the most prestigious newspaper in the United States. I infer from your writing that you have a family of your own. You state that you enjoy exercising for 30-40 minutes at a time, which experts are finding is the single most important thing you can control for your health. You might have an awesome life! How about you get ready to fight a different battle in 2012? How about battling to spread the word that people can be just fine without losing weight at all? How about posting a pic of yourself so that the world can see that a widely-read, respected health writer isn't thin? I'll get behind that.

Meanwhile, thanks for sharing some good research.

*Bacon, Linda (2010-02-02). Health At Every Size: The Surprising Truth About Your Weight (p. 145). Perseus Books Group. Kindle Edition.

Friday, December 23, 2011

Tell "Health Experts" They Are Tools This Christmas

The National Obesity Forum has told the BBC and presumably other compliant hacks that you should "Tell loved ones they are overweight this Christmas." I am, alas, not kidding. At all. I believe that the next article recommended in the sidebar on the Beeb's website -- which is not open for our irate comments, BTW -- would be "My loved one served me a hot steaming mug of Shut the Fuck Up," followed closely by "How to Repair the Psychic Damage You Did This Christmas."*

"Christmas may be a time of indulging for many, but health experts believe it is the perfect time to tell a loved one they are overweight." That's right. At the time when you want to nestle all warm and cozy in the bosom of your family, feeling the glow of peace on earth and good will to all beings that you think are important? Dr. David Haslam, Chair of the National Obesity Forum, wants your family to tell you, "sensitively," that you are fat.

This is fucked up on so many levels that I hardly know where to begin. First of all - does the National Obesity Forum think that fat people don't know they are fat? When our culture spends so much energy telling them that every single day? So we're not only fat but completely moronic? Or does Dr. Dave think that instigating hateful, misguided, and shaming (to those who will allow themselves to be shamed) conversations at this festive time will just flick on the switch? "Oh, that's what's been going on all these years! I thought the rest of you were just shrinking in the wash."

Dr. Dave says, "Suggesting to someone that they should consider losing a few pounds may not be a comfortable conversation to have. But if someone close to you has a large waistline then as long as you do it sensitively, discussing it with them now could help them avoid critical health risks later down the line and could even save their life."

But here's the deal, Dr. Dave: nope, it won't. And why is that? Because, in the words of Dr. Linda Bacon, who reviews and conducts real research on metabolism, dieting, exercise, and psychology: "Not one study has ever shown that diets produce long-term weight loss for any but a tiny number of dieters. Not one." Furthermore, there's actual scientific research showing that it is perfectly possible to be fat and healthy. And lots and lots of research showing that weight cycling or "yo yo dieting" is downright bad for you. And you know what else is bad for you? Being stigmatized, bullied, and stereotyped at every turn as lazy, stupid, undisciplined, and lacking in self-respect.

Right. So let's see just who this National Obesity Forum is, behind the benign-looking website oozing concern for the state of all us poor sick fatties and the costs of trying to keep us from killing ourselves with whipped butter souffles topped with lard.

Well, Dr. Dave is the "Acting Editor
of the National Obesity Forum Newsletter Advisory Board of 'WLS' Weight Loss Surgery patient support group." Weight Loss Surgery, huh? Well, clearly he has no vested interest. He claims that
bariatric surgery "is among the most clinically effective, and cost effective procedures in any field of medicine.” Uh-huh.

Who else is on the NOF Dream Team? Well, there's Dr. Matthew Capehorn, NOF's Clinical Director who was, get this, a
paid shill for a – get this – weight loss SPRAY product!!! They think fat people are too stupid to know they’re fat? How about being so stupid that you'll endorse a spray-the-fat-away product?

Then there's pharmacist Graham Phillips, who
promoted making Orlistat (Xenical) available over the counter to anyone with a BMI over 28. Orlistat is notorious for its gastrointestinal side effects (anal leakage, anyone?). Phillips also owns a chain of pharmacies in Hertfordshire.

And who funds the National Obesity Forum's website?
  1. Pharma giants Sanofi, who have pulled at least two weight loss drugs from the market amid claims that they make people so depressed they kill themselves.
  2. Mega-pharma giants Roche – they make Xenical. Surprise! Oh. No. No surprise.
  3. Giant pharma giants Abbott – they pulled their weight loss drug Merida off the market.
Makes you think it’s not an obesity epidemic, it’s a lust-for-unconscionable-profit epidemic. At least it's comforting to know that the Brits, in this as in many other areas, actually are not classier than us.

Happy Festivus!

*I normally don't swear on this blog, since I post it in places where people can see it. But this story makes me so mad that I am whipping out my profane vocab. If this offends you, try not reading words beginning with "f."