Me and Dr. Shapiro

My favorite picture of Darryl and I – from the LA premiere. I’m rocking an awesome dress that IGIGI.com provided me with.

About two years ago I was interviewed for Darryl Robert’s film  “America the Beautiful 2:  The Thin Commandments”  That film is now available on Netflix Streaming (yay!). The part of the film that I’m in goes back and forth with Dr. Howard Shapiro. Dr. Shapiro is one of those people who helps me remember that Democracy is about someone shouting at the top of their lungs that which I would spend a lifetime opposing at the top of mine. (20 points if you can identify the movie reference.)

You may know him as the doctor who marketed the cookie diet (which was invented by a different doctor – 6 cookies and one meal a day for about 1,000 calories), and the “Picture Perfect” diet which is a book that shows, in pictures, that you can have a hell of a lot of vegetable soup for the same calories as a giant cookie.  Thanks dude, I had no idea!

Anyway, the back and forth in the movie is comprised of alternating bits of each of our individual interviews.  I thought that I would offer direct responses to what he said in the film since he did a good job of stating a lot of the mistakes and erroneous assumptions that people, including doctors – and perhaps especially doctors whose paychecks depend on them – make about weight and health.

Before I get started, I want to clarify:  Dr. Shapiro confuses the concepts of Health at Every Size and Size Acceptance. HAES is an optional, evidence-based, health practice where the focus is on healthy behaviors rather than weight loss as a path to health. Just like everyone else, people who choose to practice HAES can prioritize their health however they choose and pick and choose the health practices in which they want to engage with the understanding that health is not an obligation, barometer of worthiness, completely within our control, or guaranteed under any circumstances, and that many of our choices can be affected by outside circumstances.  Size Acceptance is an entirely different thing.  SA is a civil rights declaration that states that the rights to life, liberty and the pursuit of happiness are not size dependent – nor are they health or healthy habit dependent. These rights are for everyone, not just the people who act like you think they should act, or look how you think they should look.

For the record, I met Dr. Shapiro at the LA premiere and we had a short debate during the Q&A in which he reiterated most of what he said in the movie and offered no evidence to support his claims. Dr. Shapiro has picture books, a bunch of diet cookies and an active practice as a weight loss specialist.  What he doesn’t appear to have is any evidence that his interventions do any better than lack of long- term success that every study on long-term dieting has shown for intentional weight loss attempts.  But that didn’t stop him from toeing the caloric restriction party line.

His first quote:

You can’t tell me that being heavy is better than being thin.  Being fat causes you to have diseases… strokes, cancer, diabetes, we know those for sure, heart disease, we know all of that.

Fascinating.  First of all – nobody is saying being heavy is better than being thin.  We are saying that bodies come in lots of different sizes for lots of different reasons, that one body size is not inherently better than another, and that health and weight are two different things (which you can tell since there are healthy and unhealthy people of every size.)  I am also saying that, as a doctor, you should probably learn the difference between correlation and causation.  While being fat is correlated with many diseases, causality is not proven. The stress of constant stigma is also correlated to all the same diseases as obesity (see Peter Muennig’s work from Columbia University.)  Further, there are no diseases that just fat people get – thin people also get strokes, cancer, diabetes, heart disease etc.  and many fat people do not get these diseases so being thin cannot be a sure preventative or a sure cure.  As I’ll discuss in a moment, a great deal of research shows that fitness is a much better indicator of hazard ratio than is weight.

You can be healthy without losing weight for part of your life, it depends.  If you’re 40, uh, ummmm,  if you’re 28 years old, if you’re 35 years old you can carry a lot of extra weight without any medical problems, but if you carry that weight until you’re 60 you’re going to have some medical problems.  Guaranteed.  Guaranteed. [yes, he said it twice.]

I know it seems from this quote like he was choosing ages by throwing darts but if you watch the film you’ll see that there’s no dartboard in sight, so this was more of a general rectal pull sort of situation. I’ll give him credit for finding a great way to hedge his bets – choosing diseases for which age is also a risk factor and then trying to blame them all on fat.  Also, I personally know a number of fat people over sixty who don’t have health issues so, like his promises of weight loss, it seems that his guarantees also can’t be believed.

You gotta tell me if you’re heavy you’ve got problems.  You’re not comfortable. you can’t be comfortable. you can get used to it you can accept it, but you’re not comfortable.  So why would you want to live like that – because you’re too lazy to make the difference to work at it.  It takes work.

This is my favorite (favorite here having the meaning of “quote that most activates my throat punch reflex”)  First he tells me how I feel, implying that he is a better witness to my experience than I am.  Then he tells me all about me and how lazy I am.  During the Q&A I told him that I didn’t appreciate this.  He said that he didn’t say it, and that it was editing.  You can watch the film and decide for yourself but if this is editing it deserves some kind of editing Emmy award.  Calling people lazy is just an outstanding way to encourage them to take care of themselves – that’s some good doctorin’ right there.

If you had a door, that door, and you could walk out (one of these fat acceptance people) and be 40 pounds thinner or this door walk out and be the same – no work involved, walk out on the other side of the door 40 pounds thinner, or you’re the same, I’ll be you a good portion of them would go out the door where you’re 40 pounds thinner.

I wouldn’t walk through the “40 pounds less door” because that would be suggesting that the best way to cure the social stigma that I deal with is to change myself, and I am vehemently against that. I have never suffered from obesity, but I have suffered from the stigma that people like Dr. Shapiro like to put on me because of my obesity, and the cure for that is for them to stop stigmatizing me – it is not for me to try to bend and twist myself until I fit into their narrow minds.

The fat acceptance people and I have a big problem. If they want to be heavy, that’s fine with me, I don’t want to make anyone thin if they don’t want to be thin it’s up to them.  But you gotta say, it’s ok to be heavy but your risk factors for many many diseases, many many many many many diseases are increased. I don’t care what they’re telling you.  If they can prove to me and show me some legitimate studies that say it’s better to be fat than thin, I’ll buy it but I see studies that say it’s better to be thin and you will live longer.

Speaking for this fat acceptance person, we don’t have a big problem.  We don’t have a problem at all.  I think he’s full of crap and therefore I’ll never go to him for healthcare.  Other people can make whatever choice they want to make.  No problem.  Based on all the research that exists, he rarely succeeds at making people thin long-term no matter how badly they want to be thin, so though I don’t require his permission, I’m relieved to hear that he doesn’t want to work with me.  Now, seven “many’s” seems like a lot, but I’m not so worried because I have actually read the research (which, it seems, makes one of us) so I’m aware that fat is a risk factor because it is correlated with a number of diseases (not because it’s causally related,) and that simple healthy habits (movement, 5 servings of vegetables, moderate drinking and not smoking) have been shown in studies to give fat people the same health hazard ratio as thin people who participate in those habits, and a dramatically better hazard ratio than thin people who don’t if that’s something that interests you. Again, nobody is saying that one body size is better than another, but we are saying that if people are interested in prioritizing health (and they are under absolutely no obligation to do so) healthy habits, not weight loss, are our best chance for our healthiest body.  Here’s some of that evidence he has suddenly found himself interested in:

Matheson, et al:  Healthy, Lifestyle Habits and Mortality in Overweight and Obese Individuals

“Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.”

The vertical axis is hazard ratio, the horizontal axis is the number of healthy habits people participate in, the three bars in each group are for normal weight, overweight, and obese.

Steven Blair – Cooper Institute

“We’ve studied this from many perspectives in women and in men, and we get the same answer: It’s not the obesity, it’s the fitness.”

Glenn Gaesser – Obesity, Health, and Metabolic Fitness

“no measure of body weight or body fat was related to the degree of coronary vessel disease. The obesity-heart disease link is just not well supported by the scientific and medical literature”

Paffenbarger et. al. Physical Mortality:  All Cause Mortality, and Longevity of College Alumni

“With or without consideration of …extremes or gains in body weight…alumni mortality rates were significantly lower among the physically active.”

Wei et. al. Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men

Your turn Dr. Shapiro, let’s see some evidence that your interventions work long term.  I won’t hold my breath.The thing is, it doesn’t matter how many diseases are correlated or even causally related to weight, since we have no evidence that suggests that we know how to help people lose weight long term.  People with joint pain would be much better off if they could fly (as flying takes the pressure right off the joints.)  But we don’t know how to make people fly so we don’t prescribe jumping off a roof with homemade wings.  But doctors like Dr. Shapiro continue to prescribe weight loss, even though the chances of losing weight are only 5% better than the chances that the roof jump will lead to successful flying, and the other 95% of the time people gain back all their weight and often more.

I will say the good thing about him is that I know what I’m getting.  As a fat person, so often I go to a doctor for an actual health issue and they decide to be a “weight loss specialist” instead.  At least I won’t waste an appointment on Dr. Shapiro.

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Published in: on June 25, 2012 at 8:49 am  Comments (23)  

23 CommentsLeave a comment

  1. Just dropping by to leave a footprint of appreciation. I wish i could be even half as eloquent as you!

  2. Well done…I may have to keep this one as my go to definition of HAES when people ask me what it’s about.

    • There are a lot of good, built-in replies to fat haters here, too. ;)

  3. If you had a door, that door, and you could walk out (one of these fat acceptance people) and be 40 pounds thinner or this door walk out and be the same – no work involved, walk out on the other side of the door 40 pounds thinner, or you’re the same, I’ll be you a good portion of them would go out the door where you’re 40 pounds thinner.

    Honestly? If I could magically be thin, I would choose that, so that I can buy clothes at the mall instead of online, and fit into airline seats without being scared someone will make me buy two seats, and not be lectured by dumbasses like Dr. Shapiro. But 40 lbs? Pfft, 40 lbs is nothing — it wouldn’t be enough to accomplish any of those things. And for sure, I would never walk through that door without the guarantee that those lbs wouldn’t come back with many, many of their friends.

    • “And for sure, I would never walk through that door without the guarantee that those lbs wouldn’t come back with many, many of their friends.” This for me. Dieting means that everything comes back with friends. Not worth it.

    • Thanks for the reminder about the regain. I know Ragen has before said she wouldn’t be a lower weight if she magically could, I always think to myself that I would, if I could, but I always forget about the regain, you’d think I’d know better by now.

    • Yeah, losing 40lbs would just mean I had to buy a whole new wardrobe at fat stores, with fat store prices. Gee, no thanks, Dr. Shapiro.

  4. yay I’ve wanted to watch that movie for awhile. SO glad to hear its on netflix!

  5. Well said, Ragen. Man, that guy is obnoxious. But okay, to give him the benefit of the doubt, maybe the vast majority of fat people he’s had exposure to (which makes sense given his work) hate their bodies, are miserable, and are sick. Still, it’s a terrible error in logic to assume that that is *just the way it is*, that it’s somehow inherent to being fat, that societal conditioning has nothing to do with the fat experience in this culture, and that all fat people are miserable and sick or will become so.

    As for me…

    1) I’m fat and I am healthy and well. I feel good and all the middle-aged medical tests put me in the normal-to-excellent range. Therefore his assertion that “fat causes you to have disease” is incorrect. If it were true, I would necessarily have disease.

    2) “If you carry that weight until you’re 60 you’re going to have some medical problems. Guaranteed.” If his work really shows this, I can guarantee that in his work he has not separated out fatness from behavior. He is looking solely at fat people with unhealthy behaviors or particularly bad genetics. If he looked solely at thin people with unhealthy behaviors or particularly bad genetics would he surmise that thinness causes sickness, guaranteed? Of course not. That’s why this is such bad science. (Increased statistical likelihood of certain diseases does go with increased BMI looking at population *as a whole*, but that can be explained in ways that have nothing to do with a supposed intrinsic harmfulness of fat, and it does NOT follow that being fat WILL make you sick.)

    3) “You’re not comfortable. You can’t be comfortable.” Wow. He *really* believes he knows what it’s like for me to be in *my* body? That is some serious delusion. How does a person with such a deficit of critical, logical thinking ability get through medical school? Makes you wonder about the quality of instruction and assessment, doesn’t it? (For the record, I am VERY comfortable in my fat body. I love the way it feels to be in my body and to move through the world in it. It feels absolutely perfect.)

    4) “So why would you want to live like that – because you’re too lazy to make the difference to work at it. It takes work.” It doesn’t take *one bit of work* for me not to weigh more than I do. Why would I assume, then, that for a person to weigh more than I do is a result of laziness on their part? It doesn’t make logical sense. What “lazy” really means in this context is “people not doing what Dr. Shapiro wants them to do.”

    5) “If you had a door, that door, and you could walk out (one of these fat acceptance people) and be 40 pounds thinner or this door walk out and be the same…” I love being in my body, and I’m no longer concerned that people like Dr. Shapiro don’t like it. Sure, being thin in a fat-phobic culture is easier in some ways. But for me it’s a major point of pride that I am strong enough not to acquiesce to that. So no, I would NOT choose the thin door.

    6) “I see studies that say it’s better to be thin and you will live longer.” Even if that is true (and I don’t believe that it is, and I’ve seen studies too,) I don’t care. I am already living in a way that optimizes both comfort and health at the same time. Trying to make myself thin doesn’t do either of those things. We’re all going to die eventually; eking out a few more years through the misery of dieting, an unpleasant level of exercise, and obsessively hating fatness might be worth it to him, but it wouldn’t be worth it to me. That would be a lower quality of life for me, and living at a lower quality of life for the sake of a longer life seems to me the height of stupidity.

    • I think Dr Doofus has simply gotten a prejudiced view out of his medical practice. He’s a weightloss specialist– he doesn’t see healthy, happy fat people in his practice, he sees sick, unhappy fat people who want to change their bodies. Unfortunately he has confused his clientele as being representative of fatties in general. Hmmm, he kinda sounds like Dr Oz. And I really like how he gives the VFHT. He seems to be ignoring the fact that LOTS of people have health issues by the time they’re 60, no matter what their weight.

    • “1) I’m fat and I am healthy and well. I feel good and all the middle-aged medical tests put me in the normal-to-excellent range. Therefore his assertion that “fat causes you to have disease” is incorrect. If it were true, I would necessarily have disease.”

      I want to quickly say that I actually agree with just about everything you said, Linda. You’re spot on, and Dr. Shapiro is a bigoted idiot.

      With that said, your argument here is absolutely poor. Using this logic, a 60 year old who has been smoking for 40 years and doesn’t have lung cancer is definitive proof that smoking does not cause lung cancer. There are absolutely some smokers out there, and some long term heavy smokers at that, who might not have any lung disease and could still ace the medical tests they give. That does not mean smoking is not bad for you.

      Look, please don’t get me wrong here: I think Shapiro is full of crap, and I absolutely agree with WHAT you’re saying; weight does not equal health, not in the absolute slightest, and any study that shows it does is simply corollary to fitness, not causal at all. Health being about weight is total junk science. My only disagreement with you (and I’m being a jerkwad targeting you here, as I heard the same argument used in the film and elsewhere) is the way you are wording this. One person (or even a dozen, or even thousands or tens of thousands if we’re talking a big enough population) is not definitive proof of anything. In this case, your point is absolutely right, but the way you made it is absolutely poor statistically, scientifically, etc. And we have PLENTY of statistically and scientifically accurate ways to rebut the ignorance of people like Dr. Shapiro, so it is my opinion that saying things that are blissfully ignorant of statistics and science just takes away from the good stuff.

      Anyway, pleaaaaaaase understand I am not trying to offend, and I’m really not disagreeing here at all. *We* are the ones that the research and science and statistics all point towards being correct: lets not start using our own junk science/reasoning, because unlike Dr. Shapiro, WE DON’T HAVE TO!

  6. “You can’t tell me that being heavy is better than being thin.”

    Straw man argument. No one was saying that. Good job calling him out! Only one of you was presenting any real evidence in that debate.

  7. Regan, reading your blog daily is good for my mental health.

  8. Medical schools have failed the doctors. They receive 6 weeks of nutritional training in 8 years of med school as told to me by my brother in law doctor. But yet they are all experts on obesity. What a shame.

  9. I don’t have a link, but there IS a legitimate study that shows fat people survive illness “better” than thin people. That being said, I’d have to question any doctor who thinks a person has to prove their superiority, that they are “better” than others in some way, in order to deserve respect and the right to love their body.

    As far as the door thing goes. Well, how about you offer people these two doors Doc… door #1. You walk out and are 40 pounds lighter. #2. You walk out exactly as you are into a world where there’s nobody judging other people due to their assumptions based on appearances, all the same clothing options, airlines that cater to all body sizes, nobody who treats others with disrespect when they dare to enjoy their favorite form of exercise in public… or even just enjoy themselves in public period, doctors who treat all their patients with the same level of respect regardless of size… etc. etc. etc. I’ll tell you right now I’d be walking out door #2…

  10. Ugh. Is there any way you could include a trigger warning for the documentary? I wasn’t expecting headless fatty photos, and now I’m freaking out a bit. :(

  11. * immediately goes to Netflix so she can watch AtB2*

  12. Gawd, what a jackwagon this Shapiro character is. A person of ANY size is more likely to have certain health problems at 60 than they are at 30.
    Actually, I’m pretty sure that 47 year old, 295 pound me is healthier than 27 year old, 140 pound me was. At twenty-seven I smoked, (albeit fairly lightly, about a pack a week most of the time) and drank enough to float a battleship as often as I could get away with it. I had undiagnosed bipolar disorder, borderline personality disorder, and OCD. In spite of having a toddler who really needed stability, mommy was a train wreck. Healthy? I think not.
    At 47, in spite of having mild hereditary hypertension (which my brother, who is not obese, got when he was nineteen and it got him discharged from the Army) I think I’m far healthier than I was twenty years ago, although at 47 the parts have been around longer and I heal less quickly if injured than I did when I was younger.
    You know what I think would happen if all I ate was cookies, much though I love cookies? I think I would be hungry and grouchy. Shapiro’s cookies are probably crappy anyway. I remember seeing those ads and thinking “what a stupid concept.”

  13. This is the cookie diet dude?! When I heard about that diet I laughed hysterically, I thought it was something The Onion had made up. I love the constant assumption that fat equals lazy (and by love I mean hate vehemently). I’m fat and 8 months pregnant and until a stress fracture made me stop I was still walking the 2.5 miles (each way) to my doctor’s office. My doctor is continually amazed at the fact that I’m fat and have excellent blood pressure, zero complications and I don’t have gestational (or any other kind) of diabetes. At least once an appointment she tells me how I’m one of the healthiest patients she has. How funny, the fat girl is healthy. What a concept.

    • The cookie diet was started by Dr. Seigel near Miami. I went to visit him a few years ago. He is the one who wrote a lot about the thyroid. It was a bunch of crap like all the rest of them.

  14. As a BBW, I have, for a lifetime, experienced the bias illustrated here by a “well-intentioned” doctor. My mother was the 2nd of 5 children and her older sister had to have special seats in school made to fit into and her baby sister was the same size. Yes, I come from a large-sized family, i.e., my father was 6’4″ and 350 lbs and my mother was 5’6″ and 180. My mother worked hard all of her life to manage her weight and unfortuantely was the first of here siblings to die. It seems funny that the thinnest of the siblings was the first to die. My point is this – the overlooked proof is that no matter what size we are, genetic card-dealing plays the biggest part. BTW, the little fat girl who had to have special desks made is still alive and kicking at 83. LOL

  15. “The Cookie Diet” = “Fat people loooove sweet, fattening things, right? Let’s bait them all with cookies!!!”

    So many diets try to use this tactic. It’s sad.

  16. Just saw you in America the Beautiful 2.

    Your grace and professionalism completely impressed me.


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