About that whole obesity epidemic thing: Australian scholar Michael Gard points out in his new book, The End of the Obesity Epidemic, that over the last decade obesity rates among both adults and children have leveled off or declined all over the world, including in the United States. In 1998 35 million Americans went to bed a healthy weight and woke up fat thanks to a commission of scientists with ties to weight loss programs and drugs who successfully lobbied to have what is considered a “healthy” weight lowered.
But try to calmly enter this information into the discussion and you’ll often find yourself shouted down by people yelling – I see fat people everywhere and I didn’t before! 65% of people are fat and it’s growing! I see fat people everywhere and they are all [fill in the blank with a negative stereotype]! This may be a good time to remember that observation, while part of the scientific method, is not science in itself, here’s why:
First, there’s a principal called Confirmation Bias which explains that people tend to favor information that confirms their preconceptions or hypotheses, regardless of whether or not the information is true. They also tend to interpret ambiguous results as supporting their point of view. (Interestingly, this is why it took me so long to choose a Behavior Centered Health approach – I was certain that I had to lose weight to be healthy and it took a while for the facts that were staring me in the face to set in). Back to our world overrun with fatties… we must accept the possibility that it’s not that there are a ton more fatties, or that every fatty fits into negative stereotypes, but rather that our confirmation bias is driving us to seek out evidence to support our conclusion and ignore that which does not. Similarly, when someone posts a comment on one of my dance videos saying how lazy I am they are ignoring the evidence in front of them because they are letting their confirmation bias run away unchecked, or because they are a jackass. Actually, the two aren’t mutually exclusive. At any rate, this is something that we all have to be aware of – especially if we are reviewing and interpreting data.
The second issue is frame of reference. I’ve heard more than one doctor say “I know that obesity causes health problems, every obese person I see has health problems!” Well, you’re a doctor – do a lot of people stop by your office to say that they feel great? When told my story (about being a healthy, active fat woman) a therapist specializing in binge eating disorder told my friend that “It’s my experience that someone that size probably has binge eating disorder”. Perhaps that’s because her experience is with fat people coming to her to deal with binge eating disorder. It’s like a podiatrist saying that every person with feet has foot problems. If all you’ve got is a hammer, every problem can start to look like a nail.
Next we have sample size. Your cousin’s fat wife who eats nothing but McDonalds does not a statistically significant sample size make. You can’t use one or a few people to draw conclusions about the world of fat people. If you, or your sister in law’s best friend’s nanny’s aunt, lost weight and kept it off for 5 years then you are a statistical anomaly, if you were on TV the bottom of the screen would read “Results Not Typical”, you are not proof that weight loss works for the majority or even the minority of people.
The next thing to think about is meaning. Even if it’s true that there are tons more fat people than there used to be, do we know (and I’m not talking about “everybody knows”, I’m talking about evidence-based knowing) why it’s happening or what it means? We are also taller than we used to be but nobody’s freaking out about the tallness epidemic. The hysteria around obesity and its healthcare costs (which, despite popular opinion, have been shown to be minimal) has somehow made it ok to skip the steps where we look dispassionately at why a phenomenon happens and what it means and instead we’ve jumped right to “We’re gonna die we’re gonna die! Quick, shame the fatties!!!”.
Finally, we have to look deeper. I heard someone say the other day that they were at a hospital and most of the people there were fat, thus proving that fat people are less healthy. All of the issues from above apply but let’s look deeper. According to research out of Yale, in this culture fat people have a more than 50% chance that when we go to the doctor, she or he will view us, and treat us, as if we are awkward, unattractive, lazy, weak-willed, and unlikely to comply with treatment. Even when fat people do go to the doctor they are often humiliated and receive sub-par care. Without so much as touching us, let alone using proper diagnostics, doctors diagnose us as fat, give us a treatment protocol of weight loss and send us on our way (People have relayed in studies having been prescribed weight loss without even being touched by their doctor for sudden onset intense back pain that turned out to be ruptured discs, abdominal pain that turned out to be a cancer, and abdominal pain that turned out to be gallstones that required emergency surgery). So many fat people have horrible experiences that lead to them to avoiding the doctor, and when we go we often get subpar treatment. Both of these things can lead to us not getting proper early intervention, thus finding us in the hospital for situations that a thin person would have had solved by their doctor in its early stages because they are listened to with more respect and given a treatment plan based on proper diagnostics. You can’t just accept things at face value if you want to get to the truth. You have to ask yourself: Is this statement true? If it is true what might it mean? What is might be causing this
Observation can be powerful but we have to be careful about drawing large scale conclusions based only on what we can see. This is something that researchers struggle mightily with. You know how when you paint a room the painting is easy but the set up is a pain – all that taping and prepping, laying down the tarp, etc.? That’s how setting up research is – actually performing the research is the easy part. The difficult part is in setting it up – making sure that you have a statistically significant sample size, extrapolatable to the population of interest, deciding what variables to control for and how to control for them etc. Good researchers go to great pains to do this well, and they always state their limitations so it’s foolish to think that we can look around and get information that’s just as good.
I DO think that we’ve gotten fatter on average. When I watch a film from the 70s, I am always amazed how slim people are. Also, people that I had thought are really, really fat in the 80s, now just look a bit overweight to me. BUT: I blame that mainly on the dieting industry. Almost every fatty I know has a history of yoyo dieting, me included. I think I have been on at least 15 different diets since the age of 11(!), and each one has left me fatter than I was before. Yet, doctors still think it’s a promising approach to put overweight people on diets. What’s wrong with them?
The only thing I really cannot understand is the hysteria over obese children, at least not here in Germany. Every time I see a number of school children on an outing, or on their way to school, there are usually at most one or two chubby children among a group of ~20. And that’s about how it was in the 70s when I was a child. The only place where I always see a significant number of chubby children is, strangely enough, the public swimming pool.
Ossi,
To be clear, you cannot use film as a measure of what a population looks like because films so often select for a cultural standard of beauty which is often very difficult to achieve. If I watched the films that came out this weekend I would think that every America woman was a size zero. It is possible that we have become fatter but then the questions that are interesting to me are – if so, by how much? Are we still on the same distribution that we were before and everyone has just gone up, or has the actual distribution changed? What is causing this? (and if it’s true than dieting may have a lot to do with it). These are things that have to be studied, we cannot look around and make a determination.
~Ragen
In fact, when I look at magazines from the ’60s and ’70s (it’s very noticeable in “men’s magazines”), I see a wider range of women’s bodies than in current ones. Playboy models from the ’60s could now be in a fashion spread on how to camouflage your “problem areas.” Part of the “oh no, everyone’s so fat now!” perception might be because the “ideal” figures in the media are so much smaller.
This is just a random observation, not based on science at all, but old films do seem show that bodies have changed hugely. (Old films meaning newsreels as well.) The very wiry type of body that used to be prevalent in the UK seems to have disappeared – if you look at WWII films, nearly all of them were lean and wiry. I see that same body type in news reports of the Middle East now. Broader and taller soldiers from the UK and the US tower over the locals.
Interesting observation about magazine spreads from 40 years ago. It’s the same with James Bond girls – the body shapes are wildly different than now and didn’t seem to demand the rock hard muscles required today.
What i think is awful is that the ideal of beauty has become very narrow, and with botox and plastic surgery everywhere, all the celebrities seem to have the same face.
I know, Ragen And of course I also know that my observations don’t have any scientific value. But I happened to be around already in the 70s, and I think this very slim, wiry body type (thanks, Alexie) was far more prevalent then, at least in Germany. Let me give you another example: I recently stumbled across a motorcycle magazine from the 70′s that my husband has collected. There was an ad for a moped, with a group of youngsters (~17) standing around it, and each one was used to advertise one of the selling points. One of them was a little chubby, and the ad mentioned that the moped has enough horse powers to move his unbelievable 75 Kilos (~165 lbs) … o_O
I’m totally with you that we have to look at the reasons for this … and as I said, I mostly blame it on dieting. I really work very hard to keep all this dieting and nutrition frenzy away from my 2yo daughter, because I sincerely believe that the more you restrict food, the more likely it is to cause an eating disorder. But it’s really hard. When I arrive at the daycare (where she gets breakfast) once in a while with her eating a cereal bar (because we got up already 2 hours earlier and she happened to be hungry when we left), the other parents look at me as if I’m a child molester.
People have also gotten way taller everywhere in the industrialized world. But that is seen as a benign demographic change, not an excuse for zillions of scary editorials about OMG THE HEIGHT EPIDEMIC!
The “thin, wiry” people you are remembering from the 1970s were probably also several centimeters shorter than their counterparts today. Who are, as a group, longer lived.
OK before I start let me say that this comment is not supposed to be insulting or anti-fat. If anything it is to express certain frustrations I feel with a movement which I admire in many ways (i.e. FA) but cannot fully get behind becasue of certain attitudes that seem to be prevalent.
Confirmation bias is not only found in the “mainstream” world but is also hugely prevalent in the FA movement. Criticizing the world at large for this while ignoring it in the FA is hypocritical. So many FA blogs talk about “negating fat people’s experiences” and about how, after having their eyes opened by the FA movement, bloggers see all the fat hate around them. Confirmation bias almost certainly plays a role in how FA activists see the world. Fat hate is real but if you look for it you will find more of it than is actually out there.
Confirmation bias especially plays a role in how FA activist read the science behind weight. Over and over I have noticed that FA bloggers cherry-pick facts from studies to support a certain viewpoint (though of course they are not the only ones). I have also repeatedly seen people in the FA that have no background in science talk about how the science is on their side despite lacking the qualifications to evaluate research. Yes, I am aware that there is some work by people such as Dr. Bacon (and she may be complete right in her hypotheses about weight) but there are other researchers that disagree with her and it remains to be seen who is correct. Immediately jumping on Dr. Bacon’s work and saying “see we were right!” is textbook confirmation bias.
As a fat woman (and I am actually fat, not Hollywood fat, well over a size 14) and a scientist I have mixed feelings about the FA. On the one hand the social aspect is great. I would love greater accessibility to clothing, more space in enclosed places like planes without the judgement, better health care, and an end to the social stigma fat people face. But some of the FA’s attitudes toward research and science (mostly that is is so easy that anyone can evaluate research) is a real turn off. It takes years of training (and usually some specialized expertise in the field in question) to be able to evaluate research. I see little difference between drawing conclusions from observations in your life and choosing to believe only studies that support your view and ignoring all others, especially if you are not qualified to evaluate the research in question.
First, thank you for your comment. Before getting into the meat of your argument I would like to make a clarification between my understandings of Size Acceptance (a term I prefer to Fat Acceptance because I think size bias can happen to people at all sizes) and Health at Every Size. I believe that Size/Fat Acceptance is a civil rights movement – it says that people’s size should not be a barometer used to judge their value or worth and that they should not face discrimination or stigma for their size. As a civil right movement I don’t believe it requires evidentiary support – civil rights are not up for debate, and are not determined by majority vote and we are not required to prove that we deserve them. I don’t think it’s valuable to argue generally about if we find more size discrimination than is actually there because I don’t think that there should be any to find.
Health at Every Size is a health practice that people may choose for themselves or not after an evaluation of the evidence. Those of us who believe in HAES are absolutely subject to confirmation bias. Many of the people I know in the movement, including me, are trained researchers and therefore our training included our need to be aware of confirmation bias. Many (not including me) are Ph.Ds. I believe that the evidence base pointing toward HAES as an effective health practice with less downsides that intentional weight loss is quite strong and I point that out in this blog but I never try to tell anyone what they should do with their health and I always encourage an evidence-based discussion.
My belief about Health at Every Size is that, based on my review of the evidence that exists, it makes much more sense than dieting as a health practice, which is why I chose it. The issue that I deal with in this blog is that I don’t believe that we are having an evidence based discussion about it in pop culture right now because the voice the we hear loudest is the voice making 60 Billion a year selling us something without a lot of evidence to support it. (I am always open for an evidence-based discussion so if there are specifics that you want to discuss I’m totally in for that.) I try clarify what may have been obfuscated (like the media truncating a quote from the CBO to make healthcare for the obese sound like a financial issue when the CBO clearly said it wasn’t. Or like Weight Watchers claiming success because people maintained a 5 pound loss over 2 years); show research that has trouble fighting its way to the top of the pile, and ask repeatedly for an evidence-based discussion. I also think that as trained researchers we should make every effort to make research accessible (either our own research, or that of others by analysis) – explain what was found and the limitations of what was found clearly and plainly – rather than making it deliberately unclear, groaning under the weight of non-connotationally significant jargon, and then clutching it to our chests because the average person can’t understand it.
Thanks,
~Ragen
amen. Ragen.
EVERY group will have fanatics who put their head in the sand for the cause. But Ragen is not one of them.
Honestly I have been having a lot of these same thoughts, but I never quite knew how to put it into words without offending the people of size acceptance, so I withheld, but you put it tactfully.
I’m a skeptic about the whole “there’s more fat people” here than ever thing. People like to use old movie clips and documentaries to show how thin “nearly” everyone was back in the day. Except, haven’t they ever thought that maybe there was editing involved to do just that so that only the conventionally attractive could be in there.
Also, the whole Headless Fattie thing they do on television to promote hysteria. I recall a man who tried to do the same thing as an experiment, where he tried to film death fats that were supposedly “everywhere” due to the obesity epidemic and it actually took him hours to be able to complete filming because it was hard to look for death fats.(I wish I remembered his name!)
Also, another thing to think about in the “I see everyone is fat” rhetoric is the fact that so many people have perceptions on weight skewered. That person could possibly see a size ten woman as “huge.”
With respect some of us go back far enough to have seen things unfold before our own eyes. I really hope we are not going to have a tiresome non discussion about how we are somehow hallucinating or delusional.
I respect questioning and share skepticism, frankly outright dismissal of much ‘obesity’ related garbage, but I’d be absolutely astounded if we were not fatter now than in the last 30 years.
That’s an interesting point (about us older folks seeing things “unfold before our own eyes”) — in addition to the confirmation bias, there’s also a general tendency for many individuals to put on some weight as we age (it’s sometimes daringly considered healthy for women, as fat has some kind of estrogen relationship that I’m vague on the details of…).
I know that my anecdotal “evidence” & my perceptions include bigger people because my old college buddies have all gotten middle-aged, had kids, etc. and so, yes, as a population, *we* are fatter. But I wouldn’t claim to be seeing the demographic spread of the whole society.
I can see where you’re going with this and thank you for your reply. I was not intending to say that everyone is deluding themselves or anything such as that, and I’m sorry for my poor wording to have made it come off like that.
I’m not stating that we’re NOT heavier than we were in the decades ago, but I am saying that I think body image has worsened in certain areas and I feel that that seeps into a lot of the rhetoric of some people saying that all they see are fat people wherever they go.
The doco you’re thinking of might be Fat Head, which was a response to SuperSize Me.
over the last decade obesity rates among both adults and children have leveled off or declined all over the world
I can believe they’ve leveled off but certainly a lot of countries like for instance the UK are definitely fatter than we’ve ever been. That includes people who are still deemed slim, more of them are near 25 and in the “overweight” category.
I’d love to see any country that has sent fatness into a decline, as opposed to reducing/stemming the extent of it’s growth.
its like when you find out you are pregnant and then all of sudden you see tons of other pregnant women – were they around before? probably.
The beauty of HAES (and your blog) is its made me questions LOTS of stuff I never have before – I mentally “follow the money” on EVERYTHING now and its totally changed my mentality for the better!
We have to remember that in countries where fatness is either accepted or prized, the health statistics for fat people (especially fat women) show no difference in mortality or incidence of illness between heavier people and slimmer people. Before we can obtain any kind of “real” statistics for the (questionable) effects of fatness on health, we have to either a) control for stigma (however that can be done) or b) erase the stigma.
Also – if we as a nation are getting taller and older, it sort of follows that we might be getting heavier. (And that should be checked too, free of bias and stigma and any preconceived notions about fat and obesity). So yeah..the fat people are out there. Maybe, just maybe because of the wonderful work of NAAFA and ASDAH and other size-acceptance/liberation organizations,we are not as afraid to show their faces and bodies as we were before.
*Show our faces and bodies..
I recently read about a study that other countries are starting to become fatter as a result of their food becoming more Americanized. I’ll have to see if I can find that article.
I’ve also read that as a country has a larger middle class it’s general population will become heavier. Supposedly it is due to an abundance of food, whereas before there were food shortages. Although I have no idea if ANY of it is true, it makes me think about how my feet are bigger than my mother’s and her feet are bigger than my grandmother’s and it has been speculated to be a result better nutrition.
It is all very interesting and I’m so glad we are having these discussions!
~ManDee
My aunt was about 5’10 and 325 lbs. When she went into the doctor because she couldn’t walk across the room without losing her breath, he told her she needed to lose weight and did no further testing.
She died 3 days later from a pulmonary embolism. Had he even bothered to ask what kind of stuff she had been doing leading up the the dyspnea, he would have found out that she recently traveled a great deal, which puts people at risk for PEs.
Oh how awful! I’m so sorry for your loss.
Oh, Amanda. :::hugs:::
I relate so strongly to this. About 5-6 years ago, along with some menstrual issues, I was having this same kind of thing. Doc (at the time) was all about the death fats. Even I was beginning to believe it, no matter the fact that before, I had NO problems walking even at the same weight.
Fast forward to this year and a great eye doc who suspected (because of recurring eye inflammation) something systemic. I have recently discovered that I have sarcoidosis, an auto-immune disease that affects my lungs causing things like shortness of breath–nothing at all to do with my weight.
I am so sorry about your aunt.
I’m so sorry.
My grandmother went in to see the doctor (this was years ago) because she had horrible headaches. She went in many times. She was told it was all in her head.
The doctor was, after a fashion, correct. She died of brain cancer.
Which is to say, doctors are perfectly capable of being clueless dolts even if you’re slim. Being fat increses the likelihood. So does being a woman.
I actually see very few fat people. I am a college instructor (while I work on my Ph.D. in a non-science field) and I am actually surprised how the vast majority of my colleagues and students are conventionally-acceptable weights. If I were going to extrapolate this into some sort of “findings” I might argue that it proves that diets are the cause of weight gain: younger people have possibly not been on as many and thus are thinner. And that fat prejudice is so prevalent that it has prevented a lot of heavy people from being able to pursue higher education either because their self-esteem was too low to try or because they were rejected due to their weight. OR I could just assume that the BMI numbers really are “average” and normal, and the occasional fat person is really the unusual freak compared to everyone else.
However, I wouldn’t make those assumptions, because you know, that’s flawed research that even someone not trained in science could recognize. =)
I just did the same thought experiment around my office (~100 people, science-oriented) and came to the same conclusion: most of my coworkers are of ‘average’ weight, to my eyes, and there are only a couple very large folks. I wonder, however, if you actually measured them and calculated their BMI how the distribution would fall out. We’ve all seen the illustrated BMI flickr pool; people who look absolutely normal are overweight or obese according to their BMI.
So I guess the follow-on question is: which needs adjusting, our eyeballs or the BMI scales?
I noticed the same thing just this week; my college-student son and I went to lunch together and he needed to stop by the campus and pick something up, so I walked to the Administration building with him (more fun than sitting in the car). Most of the kids were, to my eyes, quite thin (and the skinny-jeans thing emphasizes it), and I don’t think I saw a single one I would consider fat. I hadn’t thought much else about it until I saw your comment.
However, driving past the high school my kids attended is another picture: plenty of chubby kids and some quite fat, and far fewer really thin ones.
For whatever that’s worth.
I am more likely to believe people have gotten fatter and not just because I read more and more articles and studies that suggest this, and not just because I now see at least 6 out of every 10 people on the street who are more round than slender, where I don’t remember seeing that many as a kid… but because we know for a fact that food has become more fattening and processed, and that today we live in an age of convenience. We choose quick and easy although unhealthy meals to a healthy home cooked meal. Of course, not everyone does, but I’m talking about the average “busy, working American.” If people aren’t becoming fatter from all this convenient fast food (now thicker and juicer than ever!) than I will also be surprised.
On the other hand, it’s also easier to get fresh veggies year-round, and things like brown rice & tofu are now stocked in regular grocery stores. I can get Thai food delivered to my house; in my childhood it was only pizza!
I’m way more likely to eat a salad now than I ever was in my childhood. But ‘salad’ in my childhood was iceberg lettuce, tomato and cucumber, all of which I personally loathe – anything much beyond that was ‘exotic’, and in the UK, for a family of our class and income, expensive. Now that you can get mixed leaves, bell peppers and a variety of other vegetables at most supermarkets, I’m way more of a salad eater. I’m fatter than I was back then, but I’m betting that has a lot more to do with being forty-three rather than, you know…twelve.
Just because fresh veggies are available year-round does not mean that most people are buying and eating them. Same with brown rice and tofu. Yes, we can get Thai food delivered, with refined white rice and who knows what kind of cooking oil. Ashley is talking about the real issues–that our food supply is so highly processed. This is not to sound judgmental about people who are eating processed food. Most people don’t realize what they are doing; it is so mainstream, and it is what people have time for in our busy society. Also, people can be thin or fat or anywhere in between while eating all these processed, health-depleting foods.
So your beliefs about the badness of modern food are an important part of why you think everyone is now fatter. Do you think those beliefs leave you more inclined to credit signs that obesity is on the increase (newspaper articles talking about the ever-increasing obesity epidemic, noticing fat people more because you’re expecting to see them, etc.) and less inclined to credit signs that obesity isn’t on the increase (such as studies showing almost no increase in obesity rates for the past decade)?
For what it’s worth, based on the evidence I’ve seen, I’m inclined to believe that 1) over the past few decades people have been getting heavier, on average, 2) when you factor in the aging of the baby boomer generation and the statistical increases in height, the increase in weight becomes much less dramatic, and 3) chronic dieting has led to some people becoming much heavier than would otherwise be the case. I don’t know enough about foods such as HFCS to know how much of an impact that would make on weight gain. I think some of it might connect with longer hours in office jobs where people are increasingly expected to put in ten-hour days at a desk. I’m intensely skeptical of any claim that people have suddenly become collectively lazier, more gluttonous, or otherwise morally worse.
The other thing I wonder about is how much weight gain is caused by some common prescription drugs.
A lot of people might argue that college students are thinner anyway because they are still young enough. People often gain weight as they get older, whether they diet or not. Nearly all of my thin high school and college classmates are now fat, usually because they either settled down into relationships/marriages and don’t really take as much care of their fitness, their metabolisms have slowed, or they have had children and never lost the baby weight. That fat ones from school are now even fatter as well. It could also be argued that college students are put into a “privileged, healthy lifestyle” category, so they are likely to be thinner than their lower income counterparts that never tried for a high education than a high school diploma.
^ In response to Rebecca
Here’s why you might be seeing thinner college students:
“The authors observed that along with the psychological and social consequences of prejudice and exclusion, obese students suffered lower rates of college acceptance, with obese women gaining college admission less frequently (31 percent) than obese male applicants (42 percent). They also found that normal-weight college students received more financial support from their families than overweight students, and overweight women were least likely to receive financial support.”
Read more: Legal Political and Social Issues of Overweight and Obesity – Weight-based Discrimination – Obese, Bias, People, and Health http://www.libraryindex.com/pages/1224/Political-Legal-Social-Issues-Overweight-Obesity-WEIGHT-BASED-DISCRIMINATION.html#ixzz1ewQgLUSM
This is all very interesting.
I really do concur with the lack of interest in medical issues and problems. This also occurs in mental health issues as well.
So if you’re fat, nearly every time you go to the doctor they tell you to loose weight and everything will be magically better.
If you’re depressed or suffering with severe anxiety (as I once was), any time you go to the doctor you are imagining it… I had an ear infection for 9 months, my doctor wouldn’t even look at my ear and said I was just having a panic attack. It took my husband going to appointment with me to get anything done.
The same is also true of my experience of being overweight and going to the doctor. I have Degenerative Disc disease in my back. I begged for an MRI for two years and was just told to lose weight.
So I lost 84lbs. I then went back to the doctor and complained again about my back. He then suggest it was still my weight. I retorted at that point and said, I’ve just lost 6 stone (84lbs) and my back is getting worse. If this was directly related to my weight it would be getting better. Now effing do something!!!!
They finally did and found out I have the same condition as my father. I am now getting proper treatment. That’s only taken 4 years in total!
I also had remarks about my weight when I was pregnant from my sonnographer about it was difficult to asses the foetus due to the high BMI of the mother… And he only said that because of his pride being wounded that he was unable to sex the baby, therefore he had to make it my fault!!!! And yes I was obsese at that point, not including the fact there was a small wriggly creature inside me, but there is no need for such rudeness.
In my opinion, weight has become the next big socio-economic situation. An easy show of the haves and have nots. My child goes to a free nursery school on the edge of a well known city centre estate (a ghetto basically) in London. You can walk along the streets from where we live and as soon as you cross over the main road and into the estate you can see that everyone is fatter, not necessarily overweight or even obese, just bigger than the waifs that live in my building. The streets are also less clean, i.e. covered in dog matter, the leaf matter and rubbish are not cleaned away and you are more likely to get mugged.
Why is this? Yes sure we have access to “healthy foods” all year round but vegetables and fruit are expensive, and very expensive if you don’t know how to cook large pots-o-stuff… If you don’t have the money you are left with low price, high sugar, fat and salt processed foods that destroy our insulin control and tend to make people fatter.
So the rich thin people pervade and I am still the fattest young mum in my building of 185 flats… (I also seem the happiest of them ironically, not sure why that is or if it is weight related or just randomness…)
I don’t think I am in any way FA. I am how ever HA (health accepting), is this the same as Health at every Size?. If someone is healthy at their size and happy then that’s cool. But I do feel that we owe the rest of the world the contract of trying our best not to be a burden on the system or our social networks etc…
This works in many ways, only using the social welfare when it is truly needed and in turn provision by the government to get people off social welfare in a way that makes them productive in society. If our weight, over or under, can be directly linked to a health issue then we should resolve it in whatever way necessary.
This of course is just my own views from walking around. There are definitely not obese people everywhere in Central London. There are normal to overweight people in the estate but even then, very few obese people. It’s just that the rich people can afford to pay for gyms and trainers and better food…
I am also not a research scientist of any kind. But yet I do know that you can prove anything with statistics…
My personal opinion, health is now a class issue. Class has dissolved into who has the money and who doesn’t.
Rant over, feel free to get savaging, lol…
Why is this still listed as awaiting moderation please?
Because I spent 14 hours yesterday driving to Taos to visit my family and didn’t get a chance to approve all the comments in the queue.
~Ragen
Being “health accepting” as you explain, is very different than Health at Every Size. HAES is an individual health practice, “health accepting” seems to be an attempt to tell other people what they should do or be with their own bodies. I personally feel that health is not a moral, social or personal obligation – everyone gets to choose how highly to prioritize their health and what path to take. Otherwise we end up with people thinking personal responsibility means that I’m personally responsible for doing what someone else thinks is best for me, and that they have a right to dictate how far I should go to do that thing. Your use of the phrase “in whatever way necessary” is very concerning for this reason. It’s also a slippery slope. Do we stop people from running Iron Man Triathlons and climbing Everest because that doesn’t prioritize their health? Where does it stop?
~Ragen
We have longitudinal analysis of incidence of overweight/obesity that uses consistent definitions of these terms. For instance: Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008 at http://www.cdc.gov/nchs/data/hestat/obesity_adult_07_08/obesity_adult_07_08.htm.
This shows significant increases.
I clicked on the link and saw Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008.
Looking down into the first paragraph shows that they used BMI to determine the level of fatness, and used the post-1998 delineations. There is no mention that I could find of whether the historical data was in BMI or raw height/weight format.
There are several problems with the study based on just the above factors.
1) BMI is not a health tool (as Regan has expounded on several times).
2) The form of the historical data could have an affect on the comparison with modern data due to shifts in scale (think the inflation adjustment that is made for movie ticket revenues when comparing to older movie releases).
3) Poor handling of data for charting. Two points does not an extrapolation make. The line charts over time are pulling data 10 years apart as the first two points, the second point follows the 1998 BMI adjustment.
I didn’t say it was a health tool: the discussion was about whether there are increases in incidence of overweight and obesity, and the objections were a) anecdotes aren’t data (true!) and b) redefinition of the terms. This is data and it uses consistent definitions of overweight and obesity.
The graph data comes from six large-scale, multiyear surveys, not two. You will see the data if you scroll further down. You could also look at the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) – it’s annual and it says the same thing.
There is no BMI adjustment here. They tell you what definition they use and it is the same throughout.
We have longitudinal data that shows increases in scale weight across populations. We also have longitudinal data that shows increases in height across populations.
The question I have is this: why do public health folks use the same rubrics for evaluating height:weight ratios for morbidity/mortality risk as they did in the early 20th century, when a) both height and weight distributions have increased significantly, and b) the morbidity/mortality results generally suggest that the “overweight” group is at the lowest risk?
I’m also sceptical about the supposed fattening of UK children. I simply am not seeing all these fat kids around, unless they’re all hiding indoors from the shame of being societal outcasts (which, sadly, wouldn’t surprise me). I have also heard UK teachers saying they’re not faced with all these fat kids in class every day like the media says they are, and teachers should know. That said, it’s fairly likely that a lot of very average looking kids are ‘overweight’ or ‘obese’ on the charts; indeed, there are stories about this in the British press every so often, where the parent of a very un-fat looking child gets a letter sent home from school telling them the kid’s overweight. None of this being at all relevant to any child’s actual health.
It’s actually quite revealing to take a closer look at those percentile charts, especially in comparison with your own known past. Our NHS chart says the 50th percentile for 14 year old girls, today, is a BMI of 19.5. Yet back in the balmy, pre-obesity-epipanic 1980s, when I was 14 and at an all-girl school, I doubt very much if 50% of us had a BMI of under 19.5 – that is pretty thin, and a lot of us, me included, had reached our adult heights by then. If I haven’t misunderstood how percentiles work, shouldn’t a heavier population of kids equal a higher BMI being at 50th percentile? And if not, how come?
Yes, that’s how percentiles work. But the charts aren’t normed to the current UK population: http://www.nhs.uk/Planners/birthtofive/Pages/Yourchildsweightandheight.aspx
Well, if it’s an ideal, we were already heavy compared to that ideal in the supposedly thinner 1980s, is my point. A BMI of 19.5 was thin back then
In regards to the people who say they see more ill fat people, all of your statements are so right on Ragen. Personally, I believe in the hypothesis that fat is often just another symptom of the illnesses and health issues people try to associate with it rather than the cause. Also, I think people tend to overlook the simple fact that when you are ill it is more difficult to get the same level of physical activity you might normally get because you feel so terrible.
I eat more healthy now than when I was young. My diet consists of mostly organic unprocessed foods. I eat fast food maybe 5 times a year when things are particularly hectic, as opposed to the 3 or 4 times a week back when I was young and average size. I eat far smaller portions than I did when I was young. When I was 16 and average sized (5’6 150 lbs) I often ate an entire medium pizza all to myself on a Friday night and I would fill two whole plates on Thanksgiving without feeling sick. Now, I usually eat two slices of pizza on the rare occasions that I do indulge, and I barely finish one plate on T-day, yet I am twice the size I was back then.
If I made generalizations like some people tend to do based on my own experience and observations, I would say that obviously fast food and eating ridiculously large servings makes you thin and organic health foods and small portions makes you fat, I could also throw in some random factor like the fact that I wasn’t married and I didn’t have children back then and now I do, So obviously having children and a spouse and having to do housework makes you fat and it has nothing to do with what you eat at all.
I read in a history book in sixth grade that it was once “scientifically proven” that it was unhealthy for women and minorities to be educated because it lead to a high mortality rate. I’m pretty sure Science has been used to try to support racism and bigotry throughout history. While I think it is cool that scientists try to prove things to support size acceptance and HAES, Like you said in one of the comments above, in the end none of it really matters. It all comes down to civil rights. No matter what size people are or how they came to be that size WE ARE HUMAN BEINGS and we deserve equal treatment and respect. PERIOD. To tell you the truth these statement about there being “more fat people” sound frighteningly similar to things my nauseatingly racist grandfather would say about minorities in his neighborhood and on television.
(and please note those statements about fast food, children, and spouses are all meant to be completely sarcastic, silly, and stupid and not at all serious. Just my sad attempt at humor in order to ease my frustration over some of the things people say and accept as truth about fat people that I find equally ridiculous.)
I know this is anecdotal and therefore, probably invalid. Last year, I went to a family reunion and they had pictures of my dad’s grandma and all her siblings on the tables. I looked at the pictures of my family from the so-called thin past and they weren’t thin. My great grandma, her sisters, and their daughters looked like me. Maybe a little bigger. I’m built like my dad’s family. So many of my female cousins are my size. Is it because we are all unhealthy eaters who don’t control their weight? Or is their something more at play? Others may disagree, but what I see is a genetic predisposition to be a certain size or shape.
Today’s post was right on. It’s like when you buy a red car, suddenly you see red cars everywhere. People who are afraid of Satan see his influence everywhere. And people who are afraid of fat people think there are more of us than there used to be. You see what you expect to see. Human nature.
I see a lot of dithering about asking if we are actually getting fatter. Let’s say we are. Does that necessarily mean our health is declining? If the number of diagnoses of a disease increases, does that mean that more people have it, or is it simply being better detected?
If the primary consequence of a fatter society is that people find their walk down the street less aesthetically pleasing, well, I have some choice words about that.
Agreed. If the most prevalent problem is “I see fat people, and I don’t like looking at fat people,” the solution is pretty simple: Get over yourself, or shut your eyes.
There are a couple of real data charts I’d like to see made:
Rates of Obesity vs. Rates of Malnutrition
Rates of Obesity vs Average Height (including one Standard Deviation above and below the average)
Taller people tend to be heavier. People who haven’t spent a good portion of their lives on the brink of starvation tend to be taller and heavier.
Re that second point: people who experience malnutrition in childhood tend to gain more weight at a faster rate later on, if and when nutritional conditions get better. Look up, for example, the effects of the Dutch famine of 1944, which are still being seen in the grandchildren of the survivors. It tallies quite well with what we know about dieting – people who’ve been on lots of diets, especially at an early age, tend to end up heavier.
It is a valid general point, though. Widespread malnutrition in the developing world; many people reliant on food banks in the developed world; and if you’re lucky enough not to fall into either of those categories, then you’re among one of the first few generations in the history of humankind to have had enough food on a regular basis. Add the fact that the dieting industry kicked in almost at the point where this started to happen, if not before, and you can see that we might not even have reached the point yet where we can judge what range of weights is ‘normal’ for an adequately fed population. (Assuming anyone thinks that kind of judgement is a good idea anyway.)
As I get older, I think that I see that everyone is getting fatter. Now I realize it’s really that because I’m older, all my friends are older. We’re all holding ourselves to the ideal of a waif-like (pre-)pubescent teenage body, trying to project the “idealized” form of ourselves — at 15! — onto our adult bodies.
It’s much like hating myself because my hair is curly after puberty, even though it was stick-straight as a child. Is curliness now a sign of my moral failings?
Older people are fatter than younger people. We’re less active, our metabolisms are slower. We need the cushion to protect our aging bones and organs. We bounce back slower from illness, making the storage of fat a matter of survival. We’ve had children, health problems, the onset of various digestive issues that radically change our bodies and systems. And yet we persist on pretending that time has stood still, that we ought to have the bodies of teenagers and people in their early 20s.
The population of the world is older. We’re poorer than ever, and most of us don’t have the time to cook balanced meals — if we can even afford to buy the food to do so in the first place. Our food is loaded with additives and corn syrup and salt — things that bloat us and cause inflammation.
Yet we’re all fat because our moral failings — even though the population of the world is just as fat or thin as it’s always been. We’ve gotten older — we’re not in the same place we were in the time we consider the “good ol’ days.” Of course, it’s probably also the case that we idealize those days — tending to remember the good instead of the bad. We remember the pin-ups and the movie stars, not the fat lady next door we never really talked to or the kindly old kindergarten teacher with two chins that wobbled when she laughed… and she laughed a lot.
I’m very tired of apologizing for aging, for existing in a body that changes as the years march on. There’s no amount of self-control and dieting that will stave off the march of time. It’s really time to stop deluding ourselves.
hear, hear!
A lot of the ‘fat people are unhealthy’ rhetoric leaves out the simple fact that a lot of the time, the weight gain is a SYMPTOM of the problem, not the CAUSE of the problem.
My cousin had some issues that caused her to be less active and caused her to be put on a medication that screwed with her metabolism. She gained a hundred pounds in a short time. Suddenly, the bone and joint pain that had been the cause of her lack of activity/need for medication was suddenly caused by her being The Fatty and the solution to all her problems was to lose the weight.
Re: the “I saw tons of fat people in the hospital, therefore being fat put them there” comment addressed in the post I would add that probably a large number of patients became fatter BECAUSE OF the condition they are being treated for. If you have emphysema, a bad hip, or multiple sclerosis you probably aren’t exactly jogging a mile every morning, and with chronic pain and staggering hospital bills you probably aren’t cooking yourself nutritious meals three times a day either. Also people in the hospital tend to be older because our bodies become less and less resilient, and we naturally gain weight as we age. And I second what you said about the medical industry’s disservice to fat people and, as a commenter mentioned, prescription drugs causing weight gain. While I do actually believe, based on evidence, that weight can cause some health problems in some people, most indicators in this scenario don’t point to fat landing you in the hospital.
People could easily figure this out; it’s not like I’m a rocket scientist. But they don’t because the narrative of crime and punishment is so delicious: becoming fat is a crime, and your just punishment is ill health/death. It’s like in horror movies where the teens who have sex die first, to the delight of the audience, except we’re talking about the beliefs of a large segment of our educated, grown adult population. So frustrating!
Ooh, I re-read that and I didn’t mean to imply that people with disabilities don’t or can’t live healthy lifestyles. Apologies!
Oh, you’ve conceded the point, we are fatter even though you had to make me out to be stupider than you are to do it.
Pure class.
Okay, a little background, first. I’m currently working on a PhD in Neurobiology. I have also worked and published in biochemistry, and have formal training in nutrition and metabolism. (The switch over to neuro is because at the moment I’m somewhat more interested in biomechanics and recovery after injury than I am in biochemistry, but it’s a really close things and I may well continue to move around.) Oh, I also teach both neurobiology and anatomy. (And have been invited to teach physiology, but time, it is limited.)
I don’t, by the way, think that a huge amount of specialized training is needed to interpret the results of scientific studies. You need to have at least a reasonable background in the terminology and the field. And you need to at least have a basic background in statistics. Any reasonably intelligent person can get those for themselves – though it sure helps to spend time around people who are used to interpreting and critiquing studies. For whatever reason, many people don’t, but there you have it. (I’m a proponent of teaching stats in highschool. *Way* more important than calculus, and I love calc, too.)
It is probably more useful to read review articles if you’re just getting into a new area, as they will deal with a lot of different studies and try to provide context.
There have been enough studies done on changes in weight (normed for height) over time that I don’t think there really is any question that people in the US are getting proportionally heavier, even for their heights, over the last many years. (BTW, Michael Gard does not seem to be a medical researcher. This is not to discredit his work – actually, I’m debating now wheter I might pick up one of his books. But doing a lit review, it appears he’s more or a medical researcher once removed. He studies medical research rather than doing it, and he’s way more published in the popular press than in, say, peer reviewed academic journals.)
What is much more up in the air is two things – why people are getting fatter, and what that means. There are correlations between fatness and worse health – even when you remove other risk factors like high blood pressure. The correlations are relatively small, and I don’t think it’s particularly helpful to freak out about it. (And, for instance, I’m certainly willing to consider that a bunch of it is inferior medical care.) There are way more important things about people’s health than whether they’re fat, and there’s way too much of people playing into their own prejudices regarding other people’s fat.
The first point, though, that we don’t know why people are fatter, is, I think, the one I personally find the most heartbreaking. Because while I think there might even be something to looking at this all as a public health problem (I’m really thinking more of metabolic syndrome than “obesity”), what has actually come out of this is a lot of shaming and blaming. I mean, think about it – we don’t know why this is happening, but our idea of a response is largely to go out and tell people it’s because they’re lazy and stupid. This makes me livid.
Especially because we know that changes in exposure to light just by themselves can cause obesity in mice. And we know that there are environmental changes in hormone exposure. And we know that increases in stress hormones (that can be caused by all kinds of things, including dysregulation of one’s sleep and light exposure, chronic pain, etc. etc. as well as the more conventional emotional stress) will not only cause general lethargy and craving of rich foods, and a general increase in weight, but will also cause an increase in fat around the waistline. (And more than one study has noted that abdominal fat is increasing disproportionately to other measures of obesity.)
I’m not saying that any of the above is the answer. And I’m generally fond of people eating well and being active, whatever their sizes.
(Oh, yeah, time for another bit of disclosure. I’m not fat. Oh, yeah, I have a BMI of about 27, but I’m also very muscular – I’m a martial artist and martial arts instructor, runner, yoga partictioner, etc. I’ve also been fat. I’ve lost almost a third of my body weight from my highest point, though not through dieting or focusing on losing weight. And it’s complicated – I was training a lot and eating pretty decently for a long time before I lost the second half of that weight, but most of that has been off for about four years now – though I recently dropped another sevenish kg, possibly as a result of minor dietary changes. I suspect getting my pain from a spine injury better under control was a big part of it. And becoming not married. And maybe becoming vegan. BTW, I am also not saying that a vegan diet is optimal in the general case. And FWIW, I do terminal animal experiments. As I said, it’s complicated, and this part is just about what has gone on with me and my body.)
I am saying that it really bothers me that we aren’t talking more about environmental changes. I feel like we’ve created a world wherein it’s a lot easier to get fat, and then we tell people that they’re bad when they do. That really sucks. I feel like we talk about obesity being a public health issue… and then talk about it like it’s a moral issue. Because really? We don’t know how to treat it in the general case, and it’s easier just to blame folks.
I do suspect, that for many people being fat is a symptom of other things that aren’t working with their body. Certainly, there are a number of medical conditions that tend to lead to people being fat. I suspect this was the case with me. But hey, anecdotal evidence theatre.
I do feel very strongly that it is bad practice to decide that being fat is a medical problem without admitting that it’s one we don’t know how to treat, usefully, in the generally case. (I’m not saying that it necessarily is a medical problem in the general case. Just that even if you allow that it is one, the latter is a major issue.)
Just for fun, I’m leaving y’all with a few recent articles pulled from a casual pubmed search. Some but not all are freely available, and all the abstracts are available. My point, if I have a particular one, really is that pubmed is a great tool, and it’s well worth your time to play around with it. There’s a big difference between how issues of obesity are portrayed in the popular media, how they’re portrayed by the government, how they’re portrayed by the public health community more generally, and how they’re portrayed by the scientific community.
Changes in the amount of food consumed (not really what I was looking for, but pretty interesting nonetheless):
http://www.ncbi.nlm.nih.gov/pubmed/21738451
Trends in BMI values over the last century and some:
http://www.ncbi.nlm.nih.gov/pubmed/21561815
Comparison of both BMI and Waist Circumfrence (I find this one interesting in part because I suspect distribution of fat may well be changing – and there is a fair bit of evidence that at least suggests this might be linked to hormonal changes):
http://www.ncbi.nlm.nih.gov/pubmed/20559295
More discussion on how we don’t know why kids are getting fatter:
http://www.ncbi.nlm.nih.gov/pubmed/21119669
More obesity in children:
http://www.ncbi.nlm.nih.gov/pubmed/19560993
BTW – my reply above was as much or more to the other comments as to the original article, which I thought rocked pretty hard.
http://www.psychologytoday.com/blog/i-take-space/201107/lesson-in-cause-and-effect
In addition to the biases described by this article, I’ve pointed out in other places, data is interpreted and reported and thus, we have to be ever vigilant in our use of it. I know lots of people complain about HAES(r) movement as data-mining (another method of bias), but the truth is that we know very little about fat, weight gain, intentional weight loss and co-morbidities of BMI and/or dieting and/or weight loss, because so much has been based upon data correlations of snap shots of the population rather than well-designed studies. Science is always evolving. Even laws of physics have been revised, continue to be revised.
So even for those who are well-trained and have some understanding of data interpretation, keeping up can be difficult. What the average person can do, however, is pay attention to the rhetoric of public discourse.
Be wary of words like “cause,” “prove,” “know. (and, of course, their synonyms). In science, you make a case for a theory or hypothesis and then someone else tests it and either weakens or strengthens your case. If they find something significantly different, they may offer their own theory or hypothesis, which in turn is tested by others.
No single study can prove a cause and effect. You cannot read a single study and know a fact. Scientific knowledge is almost always probabilistic. So anyone discussing the science of HAES, just like anyone discussing all health science, would do better to discuss it in terms of “probably” rather than “certainty.”
But on an emotional level, I often want to scream “You First!” to the minions of people, both professional and lay, who “just know” that fat is bad, unhealthy, unfit, everywhere and so forth. On a cognitive level, I know that we really know little because this particular branch of science has been corrupted by monied interests and cultural biases. (Which, BTW, seems to be true of almost any branch of science these days, but that is a topic for another time and place.)
“The suppression of uncomfortable ideas may be common in religion or in politics, but it is not the path to knowledge, and there’s no place for it in the endeavor of science.”
– Carl Sagan
I just wanted to add, instead of looking at ‘the past’ I think it’s worthwhile looking at tribal societies, specifically those actually living the ‘hunter-gatherer’ lifestyle and not eating ‘junk food’ to see if they’re significantly thinner/have less ‘fat-related’ diseases etc.
I know this is anecdata, but I’ve certainly seen plenty of fat tribe members. Who are probably waaaaaaay fitter and healthier than me (skinny white woman living in UK with chronic health conditions).
I think I disappeared my first attempt, so here goes again:
I would be beyond honored if you would read my article about Cushing’s syndrome at http://medtopicwriter.com/2011/11/28/surviving-cushings-syndrome-a-personal-account-by-nellie-sabin/
I had all the symptoms of Cushing’s for YEARS and went to many fancy pants doctors in New York, but all I got was lectures for gastric bypass. Every doctor just assumed I was a glutton. All they see is fat – and they don’t even wonder why it’s there.