Fat People are Being Fed a Lot of Shit – Prologue

Today’s post was brought on by two things I observed in the last twenty-four hours – in addition to some longer term thinking over the last few months. Both were inspired by this article by the excellent James Fell.

Scibabe reshared the article, to which she received the following remonstration from a reader:scibabecomment.jpg

I too reshared it; in doing so, I noticed that someone unfollowed me.

Despite only posting total shit to the Facebook account, my numbers remain reasonably stable. I am constantly impressed at how much shitposting it takes to get someone to unfollow. And yet this was the second one in two weeks – the first was in response to an update about some recent weight loss achieved in the name of health.

I thought I was all-things evidence based in my approach to health. I exercise, I go to the dentist, I make sure I get plenty of sleep, and I engage in low-cost yet proven preventative healthcare measures like vaccines and staying home when unwell. I bang on about all kinds of things both online and in real life that are potentially controversial and get frustrated when others don’t agree, or worse choose to endanger themselves and others due to bad logic and behaviours.

And yet addressing obesity and weight management as a cornerstone of low-cost yet proven preventative healthcare was completely remiss in this.

To fill you in on what I’ve done in the last six months, I’ve been pretty busy: I’ve had a marriage end, a parent cope with stage 4 pancreatic cancer, left a job I’ve loved for a job which was significantly more challenging (only to be poached into a new job, making that three schools in under six months), and I’m contending with an asset split and all the delightful paperwork that it entails. It’s been pretty cruisy, as you can tell, and a not-shit excuse for not posting much. But on the health front, I have done much to mitigate these stressors by following my own damn advice and doing what the evidence says: I’ve lost weight and therefore improved both my present and long-term health. More specifically, I’ve gone from class I obese to the dead middle of overweight by BMI, with the long-game being ending up in the healthy BMI category.

I could list the physical benefits I’m enjoying even with this modest reduction but the list is honestly too long. Suffice to say, there’s a painful left ankle and foot that is celebrating having less pressure on it.

The science of it really is simple: create a caloric deficit depending on how much you want to lose and how quickly you want to lose it. Create this deficit however you want: more exercise, increasing your BMR/TDEE by building lean mass, eating less. Eat fewer calories by doing whatever it is that helps you: replacing meat with more vegetables, reducing your booze, limiting sugar, moving to one or two meals a day; the mechanism doesn’t matter so long as it results in you finding it manageable, and so long as you’re eating fewer calories. Scibabe’s critic was off on a number of levels: it’s not the caloric reduction that’s responsible for weight gain or failure to maintain a loss, but patient compliance and the behaviours that contribute to this.

The psychological work I have to do, and had to do before I lost the weight, was the crushing part.

I get frustrated whenever someone decides to blurt out “just eat less than you burn” – though one imagines them also telling a drowning person “just breathe in more air than water, idiot!”. The mechanism behind weight loss is very straight forward and there are only a tiny number of things that might account for very severe weight gain. Even typical suspects such as PCOS, hypothyroidism, steroids and contraceptive pills are only responsible for an increase in appetite, water retention or the very smallest (100-300 calories per day) change in metabolism – they don’t change the very mechanism by which the body converts food into energy and fat. (And if it is, you ought report immediately to a hospital or university research centre, who will want to study you, you magnificent exception to scientific laws, you.)

For me, after a number of personal factors saw me use food as a defence mechanism and comfort, it took a solid four months of avoiding any kind of weight loss or calorie counting to learn to eat more mindfully without bingeing. Paradoxically, it took being able to order the 500-calorie burger and eat it without guilt that helped me stop eating to 60-calorie salad and then binge on 700 calories of food after it. It took buying the full-fat milk and enjoying the full splendour of a little bit of it to get to the point where I didn’t keep returning for endless serves of the lower fat stuff. It took reaching out to friends and family for support when I was perilously close to a binge and distracting myself. Even looking at the foods I binged on, they weren’t even remotely tasty junk foods – some of it was the weirdest stuff, like 2kg of mandarins in a sitting, or a box of plain unsalted crackers. I got fat because I was psychologically unwell and under extreme stress, and chose just as unhealthy a form of self-destruction as any alcoholic or darb-king.

There’s a beautiful George Orwell quote – one of his lesser known ones from ‘The Road to Wigan Pier’ – which sums up why many people overeat regularly, or engage in compulsive binge eating. I think one can extend out on ‘unemployed’ to many other categories: the depressed, anxious, socially isolated, aggrieved and marginalised:

Would it not be better if (the poor) spent more money on wholesome things like oranges and wholemeal bread or if they even, like the writer of the letter to the New Statesman, saved on fuel and ate their carrots raw? Yes, it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would sooner starve than live on brown bread and raw carrots. And the peculiar evil is this, that the less money you have, the less inclined you feel to spend it on wholesome food. A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn’t. Here the tendency of which I spoke at the end of the last chapter comes into play. When you are unemployed, which is to say when you are underfed, harassed, bored, and miserable, you don’t want to eat dull wholesome food. You want something a little bit ‘tasty’. There is always some cheaply pleasant thing to tempt you. Let’s have three pennorth of chips! Run out and buy us a twopenny ice-cream! Put the kettle on and we’ll all have a nice cup of tea! That is how your mind works when you are at the P.A.C. level. White bread-and-marg and sugared tea don’t nourish you to any extent, but they are nicer (at least most people think so) than brown bread-and-dripping and cold water. Unemployment is an endless misery that has got to be constantly palliated, and especially with tea, the English-man’s opium. A cup of tea or even an aspirin is much better as a temporary stimulant than a crust of brown bread.

People who are unhappy are, rationally, unwilling to give up the few sources of pleasure they gain in life, no matter how destructive they might be. For me, that’s ridiculously easy to empathise with. Telling them to ‘eat less and move more’ fundamentally denies basic animal psychology. More to the point, it achieves the same thing that aggressive fedora-wearing atheists do: it undermines the soundness of the premise by making it be associated with dickholery, and makes people reject it because nobody wants to be that guy. So seriously just stop plz.

Beyond reforming my own behaviour and relationship with food, I had to have other factors in my life to facilitate weight loss so I didn’t feel deprived. Weirdly enough, the biggest step towards weight loss was getting a clean, nicer-looking home. Being able to have people over (for a secret introvert like me) played a huge role in my happiness and self-esteem. It didn’t take long for me to not need food as a comfort mechanism; it was a cost I was prepared to make. Most people eat for more than mere fuel and nutrient requirements; even people with lower BMIs would do so, and food is such a crucial factor in every single human culture that to dismiss it out of hand is to reveal yourself as the very most neckbeardy of shut-ins who literally doesn’t get how people… um, people.

But it’s also fair to say in the context of debunking pseudoscience and emphasising the things that can keep ourselves and our communities healthier that there is a cost to this when done to excess. As a soon-to-be former fat person, there was never any shit I either ate by choice or had fed to me more noxious that the competing shit-show of ideas that keep people fat and disempower people from taking action for their physical and mental health:

  • The pseudoscience surrounding weight loss which violates basic thermodynamics and strips people of their money and sense of self-efficacy.
  • The bullying, discrimination, illogical gendering of weight loss issues, and poor treatment that keeps people feeling isolated, disempowered and psychologically reluctant to engage in weight loss behaviours.
  • The non-evidence based messages and flat-out fraud perpetuated by many in the Fat Acceptance community.

All three of these factors played a role in determining my own attitude towards my weight as a younger person. As an older person, armed with a Year 10 level of English and a Year 9 level of science, I’m in a reasonably good position to challenge these pseudoscientific ideas and make more informed decisions, but there are many people who don’t get exposed to them. Over the coming weeks, I want to address these three factors. Fat people are being fed a lot of shit – just as new parents are fed shit about vaccines, cancer patients are fed shit about chemotherapy, and the suffering are fed shit about them deserving their fates. Fat people – like worried new parents and cancer patients – deserve better. We all do. And like anti-vaccine and anti-chemotherapy advocacy, it arises from the same place too: scientific illiteracy, societal disadvantage and bigotry, fear, and flat-up charlatans wanting our money.

I imagine that there may be people unfollowing me after this post. I run the risk of that with every update. And yet, reversing obesity is just as evidence-based in healthcare as vaccines and chemotherapy are. I am a hypocrite for not talking about it. I can be empathetic of overweight people whilst at the same time being able to acknowledge that the community is paying a cost for obesity related conditions that we will soon not be able to afford; I don’t think you could find people more empathetic on what it is like to be overweight.

But there might be someone who reads it and for whom this clicks; whether by clicking on this to ‘hate-read’ and inadvertently finding yourself agreeing with me, or because you too are coming out of a rough life patch like I did, or because you’ve started to notice things slowing down in a pretty bad way for you.

That one person deciding to track and reduce their calories to a slight deficit while taking the steps instead of the lift is worth at least ten unfollows. Maybe even twenty.

How’s your life going to change if you don’t see my shit reposts on Facebook? Minimally, I would bet.

How’s your life going to change if you reduce the weight on your joints, prevent yourself from joining the 2 million + people with diabetes in Australia, and assure yourself a greater chance of living independently and actively into your eighties?

Phenomenally. I promise.

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2 thoughts on “Fat People are Being Fed a Lot of Shit – Prologue

  1. The thing is, what if better health awaits if you move more and eat better without the intention of weight loss?

    The info in that screenshot is supported by Level A evidence from the National Health and Medical Research Council (2012)- here’s the statement:

    ‘Weight loss following lifestyle changes is maximal at 6-12 months. Regardless of the degree if initial weight loss, most weight is regained within a 2 year period and by 5 years the majority of people are at their pre-intervention body weight’ (https://consultations.nhmrc.gov.au/public_consultations/obesity-guidelines?)

    And from the NHMRC Clinical Guidelines for the Treatment of Overweight and Obesity (2013) ‘Weight regain to pre-intervention weight occurs regardless of whether the participant has overweight or class I, II or III obesity, and in participants with normal blood sugar, prediabetes and type 2 diabetes.’ and ‘Disordered eating patterns (including binge eating and strict dietary restriction), body dissatisfaction, inflexible thinking style, and eating to regulate mood or avoid negative affect are all associated with greater likelihood of weight regain’ (https://www.nhmrc.gov.au/guidelines-publications/n57)

    The phenomenon is discussed by Ochner et al recently in the Lancet here: http://insanemedicine.com/wp-content/uploads/2015/11/Treating-obesity-seriously-when-recommendations-for-lifestyle-change-confront-biological-adaptations.pdf

    As one example, knee pain improvement is more associated with exercise than with BMI or BMI changes – meta-analysis here: http://onlinelibrary.wiley.com/doi/10.1002/art.38290/full

    Higher dietary quality (which means more core foods, not necessarily a reduction in ‘discretionary’ foods) is associated with reduced disease incidence and mortality regardless of BMI – this 2016 study has a nice summary of studies: http://www.bmj.com/content/352/bmj.i1209.full

    It sounds like you’ve been through some heavy stuff recently, but extrapolating your experiences onto the rest of humanity is exactly the same as the anti-chemo, anti-vaccinators who use anecdote to try to persuade others through emotion. You are in (definitely for want of another word – sorry :-() what is referred to as the ‘honeymoon’ period of weight loss – the bit where you feel great and your biochem looks great, before everything starts to slide back – even if your behaviours don’t slide much – thanks to normal human metabolic adaptation to weight suppression. The problem is not with the laws of thermodynamics, it’s that the energy out part fluctuates hugely between individuals and decreases significantly during weight suppression. And humans behave like humans (check out self-determination theory for a great framework which explains why people don’t like to be told what to do).

    This is my area of PhD research so I’m across the literature. The studies that associate weight loss with benefits are not incorrect, they just suffer from a combination of confirmation bias and iffy analysis practices. This is what happens when our culture endorses a ‘weight loss is always good’ sentiment. They conflate weight loss with the actual intervention (ie better diet and more exercise), analyse their data using ANOVA which essentially compares the weight loss intervention group (the ones eating better and moving more) with the control group (not the weight losers vs the weight maintainers), if people drop out of the study (as many do from weight loss studies) many use Last Observation Carried Forward which amplifies weight loss ‘success’ even though that person may have regained the weight before the end of the study. Overwhelmingly though, the problem is that the vast majority of weight loss studies – the types that look in to how to do it, and what happens when you do it – are short term and do not capture the regain (thanks to funding cycles in the least cynical appraisal of the phenomenon). Thus we have a situation where short term research is touted to prove that weight loss is possible, and the stats which show people in smaller bodies live longer than people in larger bodies are used to justify trying to make larger people smaller, despite this being a completely different research question.

    I know these are difficult things to accept. Life is hard enough as it is. I don’t mean to rain on your parade but it irks me when weight-neutral approaches are brushed off as pseudoscience. Science adapts as new findings come to light, cultural changes take longer, especially when they fly in the face of cultural norms.

    Sorry about the long post! I, like you, hope that more people take the stairs and pick up fruit and veg on a regular basis. Weight loss might result, but the long-term, sustainable benefit is in the moving and the eating.

    Good luck with the awful stuff you’re dealing with at the moment.

    Like

    • I tried the entire dietary improvement and exercise thing which was weight neutral. That was the initial premise of my blog. I initially wanted to prove that regardless of size, my health would improve with weight neutral measures.

      It didn’t. The evidence didn’t actually go that way.

      It didn’t change that fundamentally my weight was mechanically and endocrinologically doing me damage. This condition here? I had it, entirely caused by my size and how this meant my body was positioned. http://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/home/ovc-20200012

      Losing only the first 5kg meant this was completely eradicated and saved me the future need for skin graft surgery or antibiotics. A foot with arthritis and extensive ligamentous damage from historical fractures and sprains has become completely asymptomatic – and it wasn’t the 5+ hours in the gym or the healthy (yet to-maintenance) intake of food that cured this. The bowel cancer I have an overwhelming chance of developing with a family history of both sides and SPS? Less likely.

      It’s frustrating when people speak of ‘people in small bodies’ as though somehow they are separate entities. They aren’t. And frankly, mine is limiting me from doing stuff I want; when bigger, it had a narrower range of motion, I couldn’t get into position to do some of the exercises I wanted to, and frankly made my life a pain; even standing/walking for 7+ hours hours a day is far less painful, given a reduction in oedema and pressure on my joints. I would bet that this is the case for many overweight people.

      If someone’s health isn’t bothering them, that’s not really my problem. But why tell people lies about how weight doesn’t play a role in osteoarthritis and joint pain (it does – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291123/) or that weight doesn’t have an impact on overall mortality and morbidity (it does – http://press.thelancet.com/BMI.pdf)?

      That’s disempowering. And just because of the methodological flaws of follow-up for long-term weight loss success (the NWCR – one of the largest studies of people who have lost weight successfully for 1+ year is, according to many who have tried to join, actually quite onerous to participate in) or the fact that weight loss surveys are going to include people participating in all weight loss forms – including notoriously hokey ones like the lemon juice cleanse and MLM ‘fat blocker’ products, thereby skewing the results to seem less than optimistic, doesn’t mean overweight people shouldn’t seek medical and psychological assistance in losing weight.

      Liked by 1 person

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