Mandatory Weight Loss Surgery?

On an article I was reading, a commenter suggested that Weight Loss Surgery (WLS)  should be mandatory for anyone with a BMI over 40.  (I think that there are a lot of professional athletes who would take exception to this, but that’s another point). Ostensibly this commenter is just concerned about my health and how much money my deatfatz are going to cost the country.

As always, I absolutely respect people’s choices including their choice to have weight loss surgery. That being said, there’s some stuff I don’t get about the health thing.

First, from an intuitive perspective

Lap Band – I just don’t think that my internal organs do their best work when being cut in half by a foreign object.

Gastric Bypass – I think that my internal organs do their best work when they are left whole and in my body. I used to get horrible strep throat and my doctor said that surgery could cure it but at my age (27 at the time) is was pretty risky.  Of course, I solved the problem with non-traditional medicine, but the point is that now at 34 they are perfectly happy to give me a more complicated  surgery with a much lower track record of success.

Questionable Claims

You hear a lot that these surgeries “cure diabetes”.  I don’t have diabetes but I did just read that more information is coming out saying that the claims that the lap band cures diabetes may be completely erroneous.  Instead, studies are showing that the surgery may just mask it.  Charming.

Complications

A team of Belgian Researchers found that “as many as half their patients, followed for at least 12 years, needed to have the band removed in that period. And in more than a quarter, the band had gnawed its way through the wall of the stomach.”  There are issues with the sample size of research methods that cause this study to lack statistical significance, but when I hear “gnawed its way through the walls of the stomach” it’s enough to make me want to ask more questions.

Really, Really Bad Complications

And then there is this.  It is a poster put out by the American Society for Metabolic and Bariatric Surgery for handling surgery patients who come into the emergency room.  The first line I saw said “Bright red blood by mouth or rectum, bloody drainage”.  Yikes – they did not have me at “hello”!

Here is a very well-written blog by someone who had three WLSs and is still fat – certainly not the WLS fairytale we’re so often sold.

I keep going back to the core philosophy of my personal health plan:  Healthy behaviors have the best chance of leading to a healthy body.

So in order to evaluate WLS, I have to ask myself some questions.  (For now I’ll set aside the fact that by every conceivable measure of health I am in perfect health)

  • Do I believe that I would be healthier if I had elective surgery that puts a band around one of my internal organs to constrict its size and function?
  • Do I think that a doctor (whose stands to make 20K from my surgery) has a better plan for the routing of my digestive system than my body does?  (I once had a massage therapist who worked on a lot of ballerinas say to me “I just wish I could be there when they try to explain to their creator that they had a better idea for foot construction than the creator did”.  I feel much the same way about Gastric Bypass)
  • Do I think it’s healthy to eat an amount of food that is consistent with what we see in anorexic patients?
  • Is it a good idea to undergo major surgery which in over forty years has never been shown in proper studies to have any long-term improvements to actual health or that lives are saved or extended.   (For more on this, check out this excellent article on WLS, including links to the report that showed that “three years after surgery, the typical patient is still obese.”)
  • How do I feel about my 68.8% chance of dealing with recurring vomiting and my 10% chance of becoming a chronic vomiter (referred to as “surgical induced bulimia”)?
  • Do I want to volunteer for a surgery which causes somewhere between 2 and 6% of it’s patients to DIE in 30 days after surgery (making it the highest risk elective surgery)

No. No. No. No. No. Hell to the No.  I think that the person who commented that I should be required to have WLS  can go ahead and get it themselves and let me know how it goes, I’ll pass.

Published in: on March 29, 2011 at 8:14 am  Comments (23)  

400 Pound Athlete

You may have already heard about Kelly Gneiting.  He is a 400 pound trained sumo wrestler who just finished his second LA marathon in 9 hours, 48 minutes.  This was an improvement of more than 2 hours over his previous time. And it was no ordinary marathon – according to reports it was extremely cold and the rain has been described by some of the participants as “torrential”.

I was searching for stories about him today, and I came upon a runners forum discussion about him (WARNING:  reading this may make you want to reach for the brain bleach).  Maybe I’m naive, but I was honestly shocked to find the comments largely unsupportive.  Since I have a rule about not seeking out people who disagree with me and commenting on their blogs, I thought I’d respond here:

“At his size, this just doesn’t seem like any activity is healthy.”

You have to love a lose/lose scenario.  “I think you’re too fat, but I don’t believe that you should move your body because of your epic fatness”.  Seriously?  To me this always sounds a whole lot like “I like feeling superior to fat people, so stay where you are fatty and I’ll keep putting you down to make myself feel better”.

“I guess it’s hard for me to comprehend how a body in that shape could PHYSICALLY handle the stress when it has to deal with the stress of keeping his body going on a normal day.” and “is running in that poor of physical condition dangerous?”

You don’t know what shape he is in.  You only know how much he weighs.  THEY ARE NOT THE SAME THING.  Since you’re writing this comment after the marathon, you could certainly have chosen to respect the fact that he is an athlete of the same caliber as anyone who finishes a marathon.

“At 405 lbs he probably has a very difficult time just walking”

Not that difficult – since he just jogged and walked 26.2 miles. The truth is right in front of you, how are you missing it? Please re-evaluate your assumptions.

“The energy expended in his bid to have others qualify/validate him would be better spent improving his circumstances and his physical health.”

He ran a freaking marathon – why do you think that you should judge his circumstances or health?  Also, let’s be clear – I won’t speak for other fat athletes but when I use my platform to point out that I don’t fit your stereotypes, it’s not a bid for your validation.  It’s a courtesy to you,  I’m not asking for your approval,  I am doing you the favor of providing you with an opportunity to rethink your stereotypes.

A blog  by Rick Chandler at NBC sports (WARNING:  Sheer jackassery) said “But taking half a day to finish a marathon, and walking the great majority of it, is not really a sports accomplishment, is it? It’s just kind of a long walk to the store.”

He.  Finished.  A.  Marathon.  How dare anyone think that they have the right to dole out the title of “athlete” or try to belittle his accomplishment?  According to several sources I looked at, only 0 .1% – 1% of people in the US have ever completed a marathon.  I don’t care how much he weighs, or how long it took him – he is in ELITE company and Rick Chandler can go straight to hell.

I hope that these kinds of attitudes don’t discourage people from pursuing movement options that they love.  I hope that you do whatever makes your body happy.  If you say that you are an athlete then I believe you and I support you –   athlete to athlete!

If you are interested in a weight-neutral discussion about fitness (for people of all sizes and abilities) you can check out the Fit Fatties Forum at www.fitfatties.com.

Published in: on March 24, 2011 at 11:34 pm  Comments (42)  

Kirstie Alley, George Lopez and some Bullshit

Kirstie Alley kicked ASS on Dancing with the Stars:

So of course in his recap George Lopez  said that she was a fantastic dancer and congratulated her on her second place finish.  Just Kidding!  He said “She did a nice job, her little hooves tapping away.  Before the show she went to the market and then she had roast beef and this is her going all the way home” followed by a video of a pig. Keep it Klassy George.

And Infdaily ran with the headline ” Kirstie Alley Celebrates her DWTS Lead By Going Out To Dinner – Naturally”.  Because of course, Kirstie is the only contestant who eats.  They also said “There’s no better way to celebrate a good night than with a nice meal.  And Kirstie knows that better than any of us.”  Do you suppose they mean that Kirstie’s had more to celebrate in her life than any of them?  I didn’t think so either.

Ok, so George Lopez and infdaily can bite me.  But here’s the quote that most bothered me (from the infdaily article)

Alley may be the underdog and the oldest competitor in the show but the lady can moves those curves of hers! And if she loses the hoped for 30 pounds over the course of the competition, Kirstie’ll only get better.

NO.  No no no no no. This is bullshit, pay attention infdaily:  by this logic Kirstie could just as easily improve by gaining weight.  You see I’m a much better dancer than she is and I’m pretty sure I’ve got a good 100  pounds on her. I’m sure it’s not that I’ve been dancing my whole life, it’s got to be my weight. (The word of the day is, apparently, sarcasm.)

Kirstie will get better as she dances more and gains technique, confidence and greater proprioception and kinesthetic awareness.  If she loses 30 pounds she will simply have a smaller body while doing it.  Of course, if she experiences short term weight loss any improvement that she makes as a dancer will be credited to her smaller body and not her training, strength, stamina and flexibility work, of which the weight loss is, statistically, most likely a short term side effect.

I feel her pain, I’ve been told on several occasions:   “You’re such a good dancer, think of how good you could be if you lost weight”.  The thing is, I’d dance exactly the same.  If I lose weight, then I’ll look like they expect a good dancer to look, and that will make them more comfortable.  And while I can understand their desire to be more comfortable, it’s not really my responsibility.   You are the boss of your underpants: Question your stereotypes, get the hell over it, or live in discomfort – it’s your call.

So go ahead with your bad self Kirstie – you rocked it and I’m rooting for you. Maybe if you gain 100 pounds you’ll improve your dancing.  Or maybe, and I know this will sound crazy but stick with me here, maybe you will improve with practice.

Speaking of fat dancers… hey look it’s me!

 

I was syndicated on BlogHer.com

Published in: on March 24, 2011 at 6:44 am  Comments (36)  

Loser Like Me

My work was CRAZY last week so I’m sorry for the lack of posts and replies. I definitely missed seeing your comments in my inbox!

I’ve been struggling with the blog because I’ve been in kind of a weird place.  While I was away I got some suggestions from readers on stuff to blog about:

There’s a twitter hash tag right now called “how to piss off a fat person” where person after person says hateful mean spirited things about fat people.

A purported “wellness center” run by “healthcare professionals” has the language “Are you dealing with “man-boobs”? Or “muffin-top”? on their wellness website.

A friend told me that he was in love with me for a long time before he got married but just “couldn’t date a fat chick”.  It made me remember that there are people who reject me as a possible partner out of hand because they don’t find my body amazing and beautiful – I honestly forget that sometimes.

I had a moment of feeling some combination of sad and angry about all of it, but then I came to some realizations:

I would never, ever, spend my time writing hateful and mean-spirited things about a group of people. I’m way better than that. How broken do you have to be to think that this is a good way to spend your limited time on Earth?

I found out about the “Wellness Center” from someone who asked me what I thought, so I had the opportunity to un-recommend them and maybe save some people from their business model of taking client’s self esteem and selling it back to them at a profit (as my friend CJ Legare would say).

The fact that dating me means choosing to see beyond the stereotype of beauty is a natural screening process for cowards.  And that’s awesome, because you must be this brave to ride this ride.

And then there was Glee (SPOILERS AHEAD)

First, the speech that Blaine gave Kurt and then the amazing kiss.  I remember being in college and watching Ellen’s coming out episode and all the controversy around her just saying that she was gay.  When I see how far we’ve come as a society when it comes to being ok with people loving each other, it makes my heart so happy.

Lauren and Puck – so much yay.

And then the final song.  The icing on the cake of my crazy week.  How can you not love lyrics like

And hey, all I do is shake it off
I’ll get you back when I’m your boss
I’m not thinkin’ ’bout you haters
‘Cause hey, I could be a superstar
I’ll see you when you wash my car

You wanna be a loser like me

Then all my happy came back.  I remembered that I am one of only 2 in 10 women who actually like their bodies.  I remembered that I am lucky enough to love to doing things that I’m really good at and for which I’m appreciated.  My life is actually incredibly awesome.

Yes, horrible things are being done to fat people and there are blogs to write and wrongs to right but today I’m just going to take a breath and be grateful for a minute because plenty of people want to be a loser like me!

Published in: on March 23, 2011 at 8:32 am  Comments (30)  

Run Fatty Run

My goal is to live authentically and honestly in all aspects of my life.  Today I was reflecting on places where I still live like I have something to prove. I realized that most of them have to do with not living into the stereotypes of fat people.

What started me down this train of thought was being really physically tired and crossing the street.  I started running, even though I was really tired and everyone else in the crosswalk was walking.  because I didn’t want the people in cars who were waiting for me to think that I’m lazy because I’m fat. (This is not full proof – a couple of days ago it inspired a driver to roll down his window and yell “Run Fatty Run”. That inspired me to slow my pace to a crawl until he missed the light, then jog off down the block to my inner monologue cadence of “Wait Jackass Wait.”)

I tend to park as far away from a store as possible.  With my workout schedule I don’t need the exercise, and with my life schedule I could use the extra time that close-in parking would afford me, but I want to make sure that people see me walking so they know that I’m not lazy.

As a dancer I live in constant fear of being “heavy”.  A “heavy” follow is one who expects the lead to hold them up and move  their weight.  As someone who also leads a little, I can tell you that  it has nothing to do with the dancer’s actual weight.  In dancing you can be a 98 pound Mack Truck or a 300 pound Ferrari, it’s all about your technique. Just so you know it’s not entirely in my head –  a very famous master dancer gave a workshop that I attended.  He danced with every student in the class but me.   When I pointed it out to him (gently and in private) he apologized and said “I would have been happy to dance with you, but I have a bad back”.  What with the who now?  I am certain that the other girls in the class exacerbated his back condition far more than I would have, but he had taken one look at me and made a determination.

Most of the time I’m able to live authentically so these are exceptions,  but  I honestly don’t know how I feel about them.  In some ways I think it’s good to buck the stereotype, in other ways it bothers me that these behaviors are more affectation than authenticity which falls outside of the bounds of where I want to live.

I’m not that excited about living in a state of trying to anticipate what people might be wrongly thinking about me and figuring out a way to act that would prevent them from thinking that.

I’m curious if other fatties out there do this too, or if this is just my personal little neurosis?

Margaret Thatcher said “Being powerful is like being a lady.  If you have to say you are, you aren’t.”  Maybe this is like that?  Maybe I have nothing to prove.  Maybe if I just live honestly and authentically people will figure it out. Or maybe these kinds of blatantly non-stereotypical acts are important and help people question their stereotypes about me and people who look like me.  I don’t have the answers, just the questions.

Published in: on March 16, 2011 at 11:40 am  Comments (29)  

Fat Black Swans

So there’s this thing called “Inductive Reasoning”.  It very basically means that you make future predictions based on your past observations.  So, I observe my neighbor walking his dog every Wednesday morning at 7am,  so I assume that next Wednesday he will walking that poodle.

I’ll bet that without trying very hard you can figure out the problem with using this as a basis for making predictions.  It doesn’t matter how many Wednesdays in a row that I am awakened by the yappy little dog, it is absolutely no guarantee that I won’t be able to sleep in next Wednesday.

Mid-18th century philosopher David Hume put it very gracefully:  “No amount of observations of white swans can allow the inference that all swans are white, but the observation of a single black swan is sufficient to refute that conclusion.”

Knowing this massive weakness, the argument for the continued use of inductive reasoning is that it corrects itself overtime as we add new observations and study new phenomenon, thus bringing us closer to the truth.

So, if a scientist observes the first black swan, she starts to question all of her assumptions and conclusions about swans and she begins to ask questions:  Why are they black? How many are there? Is it possible that they actually outnumber the white swans? Can we turn the black swans white? Can we turn white swans black? and on and on.

This is important to me, you see, because I am a black swan.

The conclusion that fat is unhealthy is, at best,  inductive in nature.  Studies show unhealthy fat people, no causality can be found, but based on observation, scientists conclude that fat is unhealthy, thereby making unhealthy fat people white swans.

And yet there are perfectly healthy fat people.  Like me.  Black Swan – right over here.

So, since we’ve known about the problem of inductive reasoning since at least the mid 1700’s, upon hearing that there were healthy fat people, of course all of the doctors and scientists immediately stopped making broad-based assumptions about health and weight and started studying these healthy fat people to see where they had gone wrong in their assumptions.

Or not.

Apparently to modern science, that’s just crazy talk.  Rather than question assumptions about weight and health because those assumptions have been proven untrue in many cases, modern scientists found a loophole in the fact that all humans die.  So just say that all fat people will be unhealthy someday (you gotta love a good VFHT) and keep promoting the OMGDeathFatIsComingForUsWontSomebodyThinkOfTheChildren mess.

Why this happens  is a subject for another blog (Sixty Billion Dollar a Year Diet Industry I’m Looking at You), but what is important to know here is that people who want to run around telling us that they know for sure that fat is unhealthy are wrong based on concepts that have been clear for over 300 years.

I personally believe that if we want to stop the ridiculous obesity health panic that is used to justify a culture of fat  hate,  it’s time to call it what it is:  embarrassingly bad pseudo-science.

Published in: on March 14, 2011 at 4:25 am  Comments (14)  

Michelle Obama, What Are You Thinking?

The President and First Lady gave an address about the anti-bullying conference that they are having tomorrow (March 10) that included the quotes:

“Our children deserve the chance to learn and grow without constantly being picked on, made fun of, or worse…”

“… make our schools and communities a place where no one is made to feel alone, or afraid for being different.  Where all of our children can thrive.”

“Because putting a stop to bullying is a responsibility we all share”

I absolutely, positively, could not agree more with this.  Hell to the yeah is what I’m saying here.

Now, let’s talk about her “Let’s Move” anti-childhood obesity campaign:

First, I continue to believe that Michelle Obama has the best of intentions with her Let’s Move program. But it’s time for some accountability:  Mrs. Obama could have chosen to be FOR children’s health:  FOR fun movement options that kids enjoy, FOR healthy lunches, FOR healthy behaviors.

But she didn’t.  Instead, Mrs. Obama chose to be AGAINST childhood obesity.

The major problem with this is that you can’t be against childhood obesity without being against obese children.  Obese kids are not thin kids covered in fat, they are fat kids and the last thing that they need is the First Lady having an anti-them campaign.

But there she is, using her considerable platform and public profile to be sure that obese kids know that there is a war against them.

Both she and the President have called their own children chubby on national television.

She put her 8 and 11 year old daughters on diets.

Despite the fact that obesity is not a disease and intentional weight loss has only a 5% long-term success rate, Mrs. Obama felt comfortable saying “”This isn’t like a disease where we’re still waiting for the cure to be discovered.  We know the cure for this…this doesn’t require new technology, or, you know, new research. We have the solution in our hand.”

Thereby setting up the 95% of kids who will statistically fail to become thin for a heaping helping of bullying for being fat – because Michelle Obama says they could have been thin if they tried hard enough.

She repeatedly refers to childhood obesity as a “problem” that needs to be “fought” and “fixed”.

Yeah, that’s going to lead to fantastic treatment of obese kids.  They will in no way feel bad that the body they live in 100% of the time is a problem that needs to be fought and fixed according to this National Campaign targeted at parents, teachers, doctors, and kids.  For a kid, being told by your doctor, teachers, parents, and the First Lady of the United States that your body is unhealthy and a problem is not just charming, it’s superb for your mental health and will have absolutely no future negative ramifications.  That is certainly the kind of thing that gives kids the “chance to learn and grow without constantly being picked on, made fun of, or worse…” (sarcasm meter is a 10 out of 10 on this.)

While I’m on a sarcasm roll, apparently kids shouldn’t be made to feel “afraid for being different” unless the difference is their size.  It’s ok for everything in nature from horses, to trees, to rocks, to feet to have a wide array of sizes, but if their body doesn’t fit into a very narrow range, it should be considered a problem that needs to be fought and solved – and do let’s point that out as often as possible. It’s not about being healthier, it’s about being smaller you see.

Since the First Lady says that we don’t need any “you know, new research”, let’s go with some research that we have:

According to sources sited on the non-profit National Association of Anorexia and Associated Eating Disorders website:

•47% of girls in 5th-12th grade reported wanting to lose weight because of magazine pictures.

• 69% of girls in 5th-12th grade reported that magazine pictures influenced their idea of a perfect body shape.

• 42% of 1st-3rd grade girls want to be thinner.

• 81% of 10 year olds are afraid of being fat.

So our kids don’t need the First Lady’s help to be unhealthily obsessed about their weight – they’ve got that going for them already.

While we’re at it,  there are some compelling reasons not to put kids (like, say, for a random hypothetical example, 8 and 11 year old girls) on diets:

Again according to ANAD:

  • 91% of women surveyed on a college campus had attempted to control their weight through dieting.
  • 22% dieted “often” or “always.”
  • 35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders.
  • 95% of those who have eating disorders are between the ages of 12 and 25.8

So maybe we could back the hell off of fat kids and be a nation that is for kids and their parents having healthy options, and against telling obese kids or adults that the bodies they live in 100% of the time are a “problem” that needs to be “fought” and “fixed”.

For the record (so that I can feel justified when I mock the commenters who will accuse me of exactly the opposite of what I am trying to say):

I am for healthy kids and if Mrs. Obama’s program was also for healthy kids I would be behind it 100%.  I am against conflating health and weight and singling out fat kids when it’s completely unnecessary to the goals of the campaign, and does nothing more than create panic, fear, poor body image, and the perfect environment for bullying.

I am against bullying.  I am very happy that they’ve started this anti-bullying campaign.  However, I am also against hypocrisy and I would like them to apply their anti-bullying standards to programs like “Let’s Move” so that they are very careful not to accidentally encourage bullying when they intend to encourage healthy behaviors.

For more clarification, I talked when Let’s Move first came out:  Michelle Obama, Good Intentions Are Not Enough

Published in: on March 10, 2011 at 7:29 am  Comments (49)  

Not the King of Me

There is a song that I’ve just fallen in love with called “King of Anything” by Sarah Bareilles.

The video is posted below but the lyrics that pertain to this blog are as follows:

You’ve got opinions, man
We’re all entitled to ‘em, but I never asked
So let me thank you for your time, and try not to waste anymore of mine
And get out of here fast

I hate to break it to you babe, but I’m not drowning
There’s no one here to save

Who cares if you disagree?
You are not me
Who made you king of anything?
So you dare tell me who to be?
Who died and made you king of anything?

I think it’s important to remember that it’s within our ability to set boundaries for who talks to us about what subject and when.

Different areas of my life have very different boundaries:

When I give a talk or do a panel, I tell people that they can ask me anything and I’m serious about that.  It’s my goal to give people an opportunity to ask a question without being scared of hurting my feelings.  99.9% of the time people are intending to be respectful and the rest of the time I’m confident in my ability bring someone’s jackassery into sharp relief, while looking calm, logical and reasonable.

Outside of those talks, I have very different boundaries.  There seems to be a pervasive myth that since I “let myself get fat”, I must need someone to help me.  The truth is that  Health at Every Size is my well researched decision, my body size is a reflection of many things but is not a barometer by which you can judge my health, intelligence or decision making ability.  I’m healthy, I’m happy, and if I needed saving please rest assured that I would be yelling for help.

I actually enjoy discussing health, weight, health at every size etc., and I’m perfectly happy to have discussions about  these issues even with people who have different opinions.  However, I’m unwilling to argue about my personal health choices, especially to someone who isn’t backing up their divergent opinion with some serious facts.

Comments on this blog are another really interesting area for me.  When I started out I thought that it was important to post all the comments that weren’t overt spam because I didn’t want to censor people, and I wanted to show the kind of violent, reflexive reaction you can get when you question the status quo. Plus I’ll admit answering those people is often entertaining for me.  Recently though, I’ve decided that I don’t have an obligation to give someone an audience on this blog just because they managed to get their comment submitted correctly.

So my new comment policy is that I’ll approve comments if I damn well feel like it.  If people who are dissenting want to increase the chance of getting their comment posted they’ll resist – with conviction – the urge to state their opinions as fact, and they’ll back up their assertions with some kind of resources (and “everybody knows” is not a resource, if it were we’d all still believe that the sun revolves around the Earth).

So this song goes out to everyone whose sense of self-importance is so exaggerated that they actually think we should consider them qualified to give us health advice when they have no qualifications, are stating their opinions as fact and/or cannot separate their experience from everyone else’s.

Published in: on March 9, 2011 at 11:47 pm  Comments (8)  

The Calories In/Calories Out Myth

The idea that the body works on a simple calories in/calories out (ci/co) model is one of the most pervasive myths that I hear. This particular myth is extremely damning to us fats since the idea is that:

If  you just eat less, exercise more  and create a caloric deficit (ie:  do not give your body the amount of fuel it requires to function), you will lose weight and therefore be more healthy. If you fail to lose weight, it just means that you lack the will-power to create a caloric deficit over a long enough period of time.

I’ve already talked about the conflation of the concepts of weight and health, so today let’s just talk calories in and out.

It sounds really logical, especially if you don’t understand how the human body actually works.

First, it turns out that accurately calculating the calories out side of the equation is at best an awfully indirect science producing questionable results.

The Basal Metabolic Rate (BMR) formula is one of the most popular used to determine how many calories we burn at rest. But  the formula doesn’t account for muscle mass, which utilizes more calories than other body tissue at rest.  Except that there is controversy about just how many calories a pound of muscle utilizes – some reputable scientists say that it burns 35, some say 10.  Also, most methods used to measure muscle mass are fairly imprecise, or really expensive, so very few people have access to a correct measurement even if we could use that number to get an accurate BMR, which we can’t.

Besides which, a BMR-type calculation would be reasonable  if we were a lawnmower.  We can calculate the fuel needs of a lawnmower and then have a reasonable expectation of how much grass it can mow and what will happen when the fuel runs out.

Ready for a blinding flash of the obvious?  Our bodies are not lawnmowers.  The way that we utilize fuel (calories) and what happens when we run out is vastly different and extremely individualized and affected by all kinds of things including:

What concerns me even more is that semi-starvation is advocated based on the idea (really, the desperate hope) that a starved body will burn excess fat for fuel. That’s not necessarily the case.  Your body is really good at surviving.  It is not so good at fitting into a cultural ideal of beauty.  The body doesn’t think of calories as evil things that take it farther from an arbitrary standard of beauty, it thinks of calories as fuel to do its job. When you give your body less calories than it needs to perform its basic function it does not think “look how disciplined you are to underfeed me so that we can become smaller”.  It thinks “Holy shit, I’m starving.  I have to do something!”

Let’s go back to the lawnmower example:

If I give my lawnmower half of the gas it needs to cut my lawn, it will simply stop working half-way through. If tomorrow I only give it 1/2 of the fuel it needs, only 50% of my lawn will get cut. My lawnmower will never adapt to use less fuel,  it just stops working.

If I give my body half the fuel that it needs just to lay in bed all day, and proceed to run on a treadmill it doesn’t stop  – it adapts. My body can’t imagine a scenario in which it needs food, there is food, but I’m intentionally starving it, so it interprets this situation as  “I’m starving, there is no food, and I have to run away from something”.

If I continue to underfeed my body while making physical demands it will likely drop weight at first while adapting to function on fewer calories, even if that means performing those functions (you know: thinking, breathing, heartbeat, walking etc) non-optimally.  If I continue underfeeding for the long-term I will experience negative impacts (see below).  If I stop underfeeding my body there is a good chance that my body will maintain it’s adapted lower level, at least for a while, while possibly also resetting my natural set point to a higher weight permanently while storing anything it can as fat.  My body is trying to help me out – what it has learned is that I live in an environment where sometimes starvation happens at the same time that massive physical labor is required, so it’s storing up fuel for the next starvation/high physical activity period. If I continue to do this over time (as in the case of yo-yo dieting), then the damage to my metabolic rate, my natural set point, and my body’s functions can be severe.

And that doesn’t even touch the psychological toll that underfeeding your body takes on you. In the Minnesota Semi-Starvation Study participants who were restricted to 1,560 calories per day for 12 weeks experienced depression (up to and including serious self-mutilation), hysteria, marked food preoccupation, disordered eating patterns,  guilt about eating, decline is physiological processes, concentration, comprehension and judgment, and a 40% drop in BMR.  For many the disordered eating continued for 5 months or more after the study was concluded.

So while semi-starvation (also known as dieting) seems like a reasonable weight loss technique if you believe in a ci/co equation, I have to judge it on three standards:

Validity of Methodology

Fail.  The fact that I can’t accurately calculate how many calories my body will expend or predict how my body will respond to prolonged starvation makes this methodology invalid.

Probability of Success

Fail.  The use of caloric deficit has a success rate of 5% over 5 years – that’s within the margin of error for most studies and is an unacceptable success rate for me.

Acceptability of Risks

Fail.  I’m risking my current excellent physical and psychological health for a chance at a smaller body.  That, for me, is an unacceptable risk.

Which is why I’m sticking to my plan of engaging in healthy behaviors, giving my body the fuel it needs, and letting it determine what size it’s going to be.

Literature Review

There is not a single study in which the majority of people maintained weight loss long term, and there is definitely not a study wherein the majority of people maintained a BMI-changing amount of weight loss long term. There are plenty of studies that show that ci/co weight loss almost never works

Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J: Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer (link goes to article)

http://www.ncbi.nlm.nih.gov/sites/entrez/17469900 (link goes to study)

“You can initially lose 5 to 10 percent of your weight on any number of diets, but then the weight comes back.  We found that the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority. Diets do not lead to sustained weight loss or health benefits for the majority of people…In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.”

Miller, WC:  How Effective are Traditional Dietary and Exercise Interventions for Weight Loss

“Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr. The paucity of data provided by the weight-loss industry has been inadequate or inconclusive.”

Methods for voluntary weight loss and control. NIH Technology Assessment Conference Panel

A panel of experts convened by the National Institutes of Health determined that “In controlled settings, participants who remain in weight loss programs usually lose approximately 10% of their weight. However, one third to two thirds of the weight is regained within one year [after weight loss], and almost all is regained within five years.”

Bacon L, Aphramor L:  Weight Science, Evaluating the Evidence for a Paradigm Shift

“Consider the Women’s Health Initiative, the largest and longest randomized, controlled dietary intervention clinical trial, designed to test the current recommendations. More than 20,000 women maintained a low-fat diet, reportedly reducing their calorie intake by an average of 360 calories per day and significantly increasing their activity. After almost eight years on this diet, there was almost no change in weight from starting point (a loss of 0.1 kg), and average waist circumference, which is a measure of abdominal fat, had increased (0.3 cm)”

Field et. al Relationship Between Dieting and Weight Change among preadolescents and adolescents

“Our data suggest that for many adolescents, dieting to control weight is not only ineffective, it may actually promote weight gain”

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Published in: on March 6, 2011 at 8:27 pm  Comments (37)  

Health for Sale

If you’ve been a reader for awhile you know about the film American the Beautiful by Darryl Roberts.  It’s a film that looks at America’s obsession with beauty and “how these increasingly unattainable images contribute greatly to the rise in low self-esteem, body dismorphia, and eating disorders for young women and girls who also happen to be the beauty industry’s largest consumers.”

Last year we raised funds to bring Darryl and this film to the University of Texas at Austin.  It is an incredible film and I highly recommend it (you can even get it on Netflix).

His newest project is America the Beautiful:  Health for Sale, which “deals with our unhealthy health standards and the ensuing fallout from expecting an entire nation to fit into a ‘certain BMI.'”

That film has its red carpet premiere tomorrow today (March 5th) at the IAEDP symposium (the International Association for Eating Disorder Professionals).  I will be at the red carpet premiere, and the reason that I will be at that premiere is that I am in the film.  I was interviewed a few weeks ago to provide a response to some of the not-very-health-at-every-size interviews that he had done.

I can’t even tell you how pumped I am.  When I started this blog what I was hoping for, and what I continue to desire, is the biggest possible platform from which to give people the option of Health at Every Size, and let them decide what they want to do.

I never, ever try to tell anyone how to live (and oh how I wish that people would give me the same courtesty!) but it breaks my heart to think that there are people who hate their bodies and feel that they can never be healthy until they are thin: they are yo-yo dieting, feeling helpless and they don’t even know that there is another option.

I can’t stand that there are people who have never considered exercised for any reason other than to try to change the size and shape of their body.  There are people who think of every meal as a battle and every trip to the gym as punishment.

There are people who are treated really badly by friends, family, personal trainers, doctors, and perfect strangers, and they believe that they deserve it – that their body size determines their worth or lack thereof and that they deserve to be abused and ashamed until they are thin.

That’s fine if it’s how someone chooses to live but I think that choice means that they’ve been given all of their options and picked one.  I think that people should know that there is an option that allows them to love their body now, pursue health without also pursuing intentional weight loss, be at peace with their eating, and enjoy moving their body for the sheer joy of it.

The pressure’s mostly off me because I don’t feel the need to convince anyone else that they should live like I do.  Once they know about the option, they can choose whatever they want.

So keep your fingers crossed that tomorrow I’ll have another chance to give people an option.

My mantra:

  • Don’t swear
  • Don’t be an idiot
  • Say what you came here to say

IAEDP here I come!

Published in: on March 5, 2011 at 6:20 am  Comments (13)