My feelings on scientific illiteracy are pretty well-known. It plays a significant role in individuals engaging in behaviours that are harmful to themselves and – crucially – others. It plays a significant role in individuals, groups and companies that financially or otherwise exploit frightened, desperate people. It plays a significant role in the degree to which we critically appraise nearly every aspect of our lives – from the food we eat to the modes of transport that we employ.
It has affected my life, and the lives of people I know. It was a contributing factor in how I got fat, and it unquestionably did so for many of the >60% of Australians who are now obese or overweight.
We don’t know stuff. We don’t know what we don’t know. And there’s plenty we don’t know.
- We’re pretty ignorant of what obesity does to the body.
As a general rule, people are pretty ignorant of the medical effects of having too much body-fat; we generally perceive it to be an inert substance which plays an aesthetic function more than anything else; occasionally, we might abstractly remember something about heart attacks and diabetes without knowing the mechanism by which obesity causes this. If you’re from my generation – and especially if you’re female – weight loss was sold to you with promises of ‘going down a couple of dress sizes’ or ‘looking good at your high school reunion’, with nary a mention of its aggravating role in PCOS, infertility, or pseudotumour cerebri. The daggy Weight Watchers weekly handouts were full of stories of women delighted to be able to run around with their kids; none that I saw ever made reference to temporarily losing vision due to diabetes, or to wounds that could not heal, or to skin chafing.
If you’re young, didn’t study biology at school or university, or don’t work in a caregiving profession, you have probably never seen what a diabetic ulcer looks like or does to a person’s quality of life. (If you’ve not, I recommend you watch the video. It is perhaps the foulest, most gory thing you’ve ever seen in your life, but I’d argue it harms you more by not seeing it.)
For me, I didn’t imagine that losing weight would have a significant impact on some health conditions I previously didn’t know were related to my weight. I was, on many markers, healthy: my resting heart rate only rarely cracked 60 BPM, my blood pressure was 96/59 most days of the week, I could easily walk 5k without exhaustion, and my blood sugar was stable. That’s pretty much the norm for many young obese people; these are problems that compound with age. You’re fine until you’re not with obesity.
It wasn’t until I was about 5-10kg down from my heaviest that I noticed benefits. For instance:
- Information about obesity negatively influencing balance would have been pretty handy to know about two years ago when I permanently damaged the ligaments and tendons in my left ankle – an injury that was only exacerbated by the four sprains of this ankle in the twelve months following the initial injury. I won’t lie; I have really enjoyed the role that not-falling-over now plays in my life and I enjoy deceiving people with how poised I can pretend to be now that I don’t have the bruises, scrapes and compression-bandaged ankles to give testimony to my clumsiness.
- Furthermore, eradicating what seemed like a superficial skin condition with some actually serious consequences has prevented skin grafts, high-dose antibiotics and real pain in the future – and I only needed to go down 5kg for this to disappear entirely.
- My migraines have decreased in both incidence and severity, which has allowed me to take fewer days of leave, reduce my intake of acetaminophen and ibuprofen (a real health benefit) and achieve more in my day to day life. Apart from writing.
For a no-cost health intervention, losing weight has repaid dividends I never thought possible.
On a mechanical and endocrinological front, fat isn’t inert; it’s dynamic and metabolically highly active. It protects our vital organs, it stores energy for lean times, it plays a factor in the storage and availability of some pretty important vitamins, it influences the production of hormones like oestrogen and insulin. It does a lot. It continues to do this when there is too much of it – to the detriment of our health. It affects our balance and proprioception, and can do good – and bad – to our skin. It can compound things that are potentially bad for people of lower body weights and make these problems extremely bad: it is harder to intubate a person with more body fat, calculating medicine doses is more challenging, it can render some forms of contraception ineffective or less effective, it can make wound healing slower which increases the risk of opportunistic infections or sepsis, and at particularly heavy weights can prevent healthcare workers from being able to safely and quickly move a person or reach every part of them. Irritating issues at a BMI of 19-27 can become emergent disasters. Independent living is significantly affected: when body size limits range of motion mechanically, it is harder to clean oneself and maintain hygiene, and toileting and showering often require assistance. In men, excess visceral fat can make penetrative sex and urination difficult or impossible.
So, why is a lot of this new information? Most of it was to me, and for someone with a doctor for a parent and a high level of education that’s pretty embarrassing, but not uncommon.
- Because many conditions which are caused by or correlated with obesity are embarrassing, most people in the public don’t see them; they’re covered up, or people remain inside.
- Because people slowly gain weight and adapt to their ‘new normal’. If people woke up having gained 30kg overnight, they could immediately notice problems with range of motion, exhaustion, pain and breathing. 30kg is more reasonably gained gradually over 5-1o years, meaning the onset of symptoms is also much more subtle.
- Because most people who are overweight or obese are only slightly so; those with BMIs of >60 are more likely to be housebound or hospital-bound than people of lower weights, and given western beauty standards it is rare to see an overweight person on screens unless it’s a reality TV show about weight loss.
- Because many popular weight loss regimes or products are sold with aesthetic motivators.
- Because larger people are primarily criticised or mocked for their lack of aesthetic appeal, rather than on the basis of health issues.
- Because younger people are less likely to have developed either the weight required to truly exacerbate these health conditions, or are disconnected from the impact they have on older people.
- Because, as with most things, we’re pretty scientifically illiterate.
So, on that last point.
2. We’re reasonably illiterate about nutrition, movement and caloric requirements.
People, as a general rule, are pretty shit at self-evaluation. The worse we are at something, the worse we are at evaluating our own efficacy and the efficacy of others. This especially translates into our awareness of our own food intake and exercise expenditure.
In truth, the literature isn’t amazing about caloric intake and expenditure because we are so bad at knowing it and we report this lack of knowledge. If we are overweight, we tend to overestimate our calories burnt and underestimate our calories consumed. We presume that our daily intake requirements are about 2000kCal (or 8700 kj) per day because that’s what’s set as the average daily energy requirements on food in Australia – despite this being heavily contingent on gender, size, age, daily energy expenditure or malabsorption conditions. Most people would be unable to guess the sort of caloric deficit that would allow a 0.5kg weight loss per week; heck, most people would be unaware of how many calories their bodies burn in a day.
For many young people, especially from geographically isolated or socially disadvantaged areas, they are removed from the process of food production and preparation and are therefore unaware of where their food comes from – and the means by which it was produced.
This is not a rallying cry for organic/non-GMO food, or going back to “the way things were in the good old days”. I’ll pass on the botulism from unsafe food preservation, lead contamination and lax safety standards. Our food is safer, more plentiful and more nutritious than ever. It is capable of feeding more of us than ever in history without poisoning us or leaving us malnourished. GMO farming has the potential to eradicate some diseases of malnutrition and thus mitigate social inequality.
The good old days objectively sucked to anyone with any sense of historical awareness, but there is nevertheless a sad paradox between our contemporary hyper-vigilance with food (especially restricting entire food groups through various fad diets that lack an evidence-base) and our corresponding lack of understanding of the basic energy that our food provides us with.
It benefits food companies when we don’t know; if we knew what the serving size on food actually was, we might be less likely to consume it. The halo effect from deceptive advertising is also particularly insidious, especially for people from low-education, low-literacy or non-English speaking backgrounds: words like “natural”, “light”, “organic” or “healthy” can persuade people to buy products which are calorically dense yet nutritionally empty. (A friend who worked in a local organic market once described her boss putting a homemade organic fruit cake on display – made from healthy organic butter, rum and sugar – claiming it was, on account of being organic, therefore healthier than the putrid non-organic filth grandma might make.)
And lest you think that diet companies have our backs, it’s sadly not the case; Nestle formerly owned Jenny Craig, and Heinz owns Weight Watchers. It’s pretty startling to think that the companies that profit so significantly from selling high-energy, low-nutrition foods then proceed to profit from the health effects caused by their products.
3. We’re unable to contend with the sheer onslaught of shit products, marketed in more manipulative and deceptive ways.
The old guard of dieting is fading away; Jenny Craig and Weight Watchers have both posted profit losses in the last few years as the new guard of nutrition gurus and products have taken hold. People are far less likely to trust a duchess than they are a cardiac surgeon with his own TV show – and this has seen a spike in ineffective and potentially dangerous products that are advertised deceptively on the internet.
Probably more obnoxiously, MLM companies and pyramid schemes such as Isagenix and It Works! have played a huge role in annoying your friends and family on Facebook AND promoting scientific illiteracy.
The role of social acceptance and pressure is a pretty significant one; when people have a financial and ideological stake in promoting a weight loss regime or fad diet, evidence flies out the window. When I was heavier, I was constantly being tagged in weight loss products/courses on social media. The targeted advertising on Facebook focussed primarily on weight loss – be it via an evidence base or not. Combine social influence, a tendency to not want to offend people, low self-esteem, and a poor understanding of how the body works, and you have a perfect storm for perpetuating weight gain and disengagement from the scientific process.
The takeaway is that we need more education, and we need better education. This education has to be culturally specific to address the concerns of people affected even more seriously by social disadvantage and lack of access to healthcare, such as Indigenous Australians and non-English speaking migrants. This education needs to be non-discriminatory in its language and imagery and divorced from the superficial motivation of weight loss programs and products in the past. It, perhaps, needs to be graphic – the headless fatty is perhaps less of a motivator to many people than that weeping diabetic foot ulcer. It needs to emphasise the evidence-base (or lack thereof) of certain behaviours and products, and the visibility of this needs to be mandated so people can make informed choices.
And, fundamentally, the education needs to go the other way: even though there are measures to make scientific communication and doctor-patient communication better, there needs to be a better understanding of why people accept being overweight, feel disempowered from changing behaviours, or choose to be large.
Which is what’s coming in the next entry.