The Fitbit

I’ve been seeing pedometers discussed a bit lately.  In some ways, they get a bad rap; we’ve seen them [mis-]used in “wellness” programs and that accuracy varies.  Although they can be amusing, as noted by one NY Times commenter:

Fitbit has a clip on model that I attach to the waistband of tights or to the center of my bra. I’ve had this one for a year and it’s gone through the laundry and still works…though it did count the washing and drying as 37 flights of stairs.

- comment from Karen in Chicago

Ana Mardoll, meanwhile, uses one to be sure she doesn’t walk too much.

As it happens, I’ve had a Fitbit Zip for about 6 months now.  What does it say?

Graph showing daily average steps for every 7 days

The above graph the daily average steps for each week.  There’s some variations, but it varies between 2400 and 5500 per day.

Daily average steps per month

The daily average per month graph, however, shows a much smaller variation – from 2950 to 3400.  That’s a fairly narrow range.  On average, the Zip says I’m walking about the same as I did six months ago.

What has changed?

I have become more aware of how much I walk.  I thought I was more active on the weekends because I walk around the house more frequently than the office.  Wrong!  The house is more compact; I have to make an effort if I want to walk as much on the weekends as I do by just going to work.

I am more consistent in my walking routine.  I had noticed before I got the Zip that varying between “not walking much” and “going on a hike” would leave me with aching knees.  Now I have a higher “minimum” and I have a LOT fewer problems.

For the curious, the Fitbit Zip is pretty much a pedometer.  It doesn’t do flights of stairs or track my sleep, like other models do.  It uploads data to a website for long-term tracking.   The website can be used with or without one of the trackers, if you’re into manually entering things.  (Personally I just use the Zip.)

One gripe I’ve had about the “dashboard” is that it assumes I want to track my weight, calories, etc.  No, I don’t want to log food. I don’t want to track my weight. I don’t care how many calories you think I’ve used….

Bonus reminder my Fitbit doesn’t track stairs.

There’s also a beta for a new dashboard, which is better at letting me hide what I don’t care to see.

Example new dashboard.

Personally I prefer the new one.

Overall, if you’re the sort of person who learned to disconnect from and distrust your body, this kind of tracker may be a useful tool.  But like many things, your mileage may vary.

Around the web

Image courtesy of Rudd image gallery.

A useful discussion of how to say the right thing to someone in hospital (or other bad situation.)

Christianity Today wonders if antidepressants keep people from God.  Fred Clark at Slacktivist responds:

No pious jackasses sit around pondering “Should Christians Take Insulin?” No insufferably holier-than-thou idiots pretend it would be deeply spiritual if they said, “Rattlesnake anti-venom can help, but it can also hinder our reliance on Christ.” Or “An emergency appendectomy may sometimes be beneficial, but only if we’re careful not to allow it to overshadow our true savior.”

Obesity Panacea debunks the latest “Paying people to lose weight is the ticket!” study, noting that the weight was regained during the 3-month follow-up:

Over the course of the 4 month intervention individuals in the incentive groups earned an average of approximately $300, in contrast to $0 awarded to those in the control group. Interestingly, the average weight loss achieved by those receiving a financial incentive was significantly greater as compared to that of the control group (13-14lbs vs. 4 lbs, respectively). Furthermore, only 10% of individuals in the control group versus approximately 50% of those in the incentive groups achieved the target weight-loss of 16lbs.

However, during a subsequent 3-month follow-up, study participants gained back much of the lost weight after the cessation of the financial incentives – a finding which is common to most, if not all, weight-loss intervention studies.

[...]

[I]ts a cute and gimmicky approach to providing incentive for weight loss, and the idea makes for great headlines (as recently illustrated). I’m sure financial incentives can work for some, but this is no obesity panacea.

(emphasis added)

At ASDAH’s HAES Blog, Fall Ferguson has an interesting question about the opportunity cost of society’s obsession with weight & thinness:

[W]hat do we forego as a society when we allocate precious social, economic, cognitive, emotional, and physiological resources toward pursuing and maintaining our weight-based paradigm of health?

Some of the damages discussed are to public health, proper health care for many thin and fat people, productivity, fun, creativity, self-esteem, and happiness.  I know many who’ve found that abandoning weight loss efforts provided more time and energy for LIFE, such as school and work.  (In our current culture, it can also mean accepting difference.)  But it’s worth thinking about: What could be accomplished if we weren’t wasting so much effort on weight?

Things to Read

A clear explanation of why  New York’s fat hatred is much more harmful than the soda ban from Melissa McEwan:

People do not die of “obesity.” Some fat people die from complications of what are commonly known as “obesity-related diseases,” like heart disease and diabetes, but those diseases have only been shown to be correlated with fat, not caused by fat. (Which is why thin people have them, too.) So it’s not even accurate to assert that obesity kills indirectly.

This, however, is a thing that is accurate to say: Fat hatred kills people all the time.

And speaking of correlation, an explanation of causation vs correlation at The New York Times makes use of a correlation between ads for junk food and fatness:

The problem is that their policy recommendations rest on a crucial but unjustified assumption: that any link between obesity and advertising occurs because more advertising causes higher rates of obesity. But the study at hand showed only an association: people living in areas with more food ads were more likely to be obese than people living in areas with fewer food ads. [...] In fact, it is easy to imagine how the causation could run the opposite way (something the article did not mention): If food vendors believe obese people are more likely than non-obese people to buy their products, they will place more ads in areas where obese people already live. [...]

This is not an arcane statistical point or a mere technical criticism of one academic article. Too often, relationships that are far from being understood are assumed to reflect a particular, strong causal connection, leading to no end of regulatory mistakes. 

(Emphasis added)

And from a woman’s story of getting fat after marriage:

I missed the husband who loved me no matter what, not the new anti-fat crusader he had changed into. But he felt the same way: he’d fallen in love with a plump-but-not-fat woman who wanted to be thin, and now he had a fat wife who’d “given up on herself.” And Ihad given up: given up on dieting, given up on the idea that my body needed to be fixed.

 I already wished I hadn’t spent so many years beating myself up for being fat; I wasn’t going to stay in a marriage where my husband did it for me.

The article is good, and bonus points for a photo of the author in scuba gear with the caption “Cage diving with great white sharks: more fun than dieting”.

Weight Loss Myths

Shakesville posted about this Gina Kolata NY Times piece already, but I wanted to highlight this:

David B. Allison, who directs the Nutrition Obesity Research Center at the University of Alabama at Birmingham [...] sought to establish what is known to be unequivocally true about obesity and weight loss.

His first thought was that, of course, weighing oneself daily helped control weight. He checked for the conclusive studies he knew must exist. They did not.

“My goodness, after 50-plus years of studying obesity in earnest and all the public wringing of hands, why don’t we know this answer?” Dr. Allison asked. “What’s striking is how easy it would be to check. Take a couple of thousand people and randomly assign them to weigh themselves every day or not.”

Yet it has not been done.

And, in the meantime, you have parents, doctors, families, and friends advising people to follow these myths. You have weight-loss companies making money from these myths.  And they don’t work. Or, they work for some people. Or, they work temporarily before all the weight comes back (plus more).  Feel like hitting one of the lying liars who lie and mislead people into putting all that time and energy and work and money into eventually gaining even more weight yet?

From Allison’s study abstract: 

Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.

What sort of myths?  Back to Gina Kolata, here’s some weight loss ideas that have been proven to not work, yet are commonly preached to people everywhere:

• Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.
• Set a realistic goal to lose a modest amount.
• People who are too ambitious will get frustrated and give up.
• You have to be mentally ready to diet or you will never succeed.
• Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Kolata also highlights some ideas that have not yet been proven true OR false:

• Habits in childhood set the stage for the rest of life.
• Add lots of fruits and vegetables to your diet to lose weight or not gain as much.
• Yo-yo diets lead to increased death rates.
• People who snack gain weight and get fat.
• If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

…and yet, again, these are in diet books, diet programs, and in the last, calls to change how cities are laid out.  (Not to say that bike paths, jogging trails, sidewalks or parks are bad. Just that they won’t automagically make people thin.)

Why is this?  Doctors believe that being fat is terribly, horribly bad.  They want to give people something concrete to do.  And, often, doctors aren’t educated about nutrition or obesity research.  We end up with these myths being repeated over and over, endlessly, and people blame themselves when they don’t work or don’t work long-term. Or they figure it probably works for most people, just not me.   Even the list of “Facts – Good Evidence to Support”, which starts with “Heredity is important but is not destiny”, makes me wonder how much of it suffers from the “must hold out hope of weight loss!” bias.  Especially when the article notes that losing 10% of their weight is typical, and very few lose more.

Overall, the NEJM paper is a call to improve the research.  Even so, they’re not tackling the big “weight loss improves health” idea, or how much of its support comes from short-term studies that include exercise as a component (and never mind that exercise can improve health on its own, independent of weight loss).  Even the reference to most weight loss being in the 10% range will likely not burst the FOBT.

As Liss notes, “What a different culture it would be if fat people weren’t a problem to be solved.“

Happy New Year!

Image courtesy of the Rudd Center Image Gallery

Hello and welcome!  I’m back at work with my new cartoon-a-day calendar (New Yorker cartoons) and new wall calendar (Pacific Northwest landscapes).  I even cut off some of the photos from last year’s wall calendar to decorate my cube.  Ready to work!  (Yes, I know it’s Wednesday, but today feels like Monday to me.  Yay four-day weekends! )

I adjusted the layout, let me know if you can’t find things.  Also, let me know if you have additional topics or questions you’d like me to write about.

As for resolutions, well, there’s resolve and then there’s Resolve the carpet cleaner, (Two Lumps).  There’s also ASDAH’s Resolved: Addressing Weight Bias in Health Care Project, collecting health care stories in video or written form.  Please see their site to see what they are asking for and the submission methods.

 

In the meantime, some things to read / discuss if you wish – warning for fat hate:

People are living longer! I thought this would be a good thing. Oops! As Fatties United discusses, some people aren’t happy with this.

Since so many fat people have had the audacity to keep on living instead of dropping dead on schedule, Dr. Mokdad is predicting that all these fat folks will be old sick fat folks and require lots and lots of medical treatment.

Study results show that “normal weight” folks don’t live longer than overweight folks? (Again?) Oh noes, must include lots of fat panic in the news coverage!

Charlotte Cooper writes about The UK Royal College of Physicians and their concerned about obesity!  Oh dear.

Reading the report is like a journey into Opposite Land. The work is well-meaning, but it exists with a framework that is profoundly problematic. For example, it is hard to disagree that current service delivery for fat people is really poor, particularly for those who undergo weight loss surgery, and that there needs to be proper auditing, quality control and monitoring of all obesity treatments.

But the report, as is typical in a medicalised discourse of fat, is entrenched in a view that regards weight loss as the universal solution to the problem of fat people and health. The authors throw about “severe complex obesity,” a term they’re obviously pretty proud of, coming soon to a healthcare provider near you, and bound to further medicalise and stigmatise fat people. They make the crucial mistake of failing to question the effectiveness of weight loss at all, so it’s not weight loss surgery that ruins fat people’s health, it’s the fact that the care pathways surrounding the surgery need tweaking. This ties them up in all kinds of knots, looking for answers in the wrong places, for example suggesting that the UK needs a Michelle Obama figure to galvanise the population against obesity, even though her crusade in the US has been disastrous in re-stigmatising fat kids, and even though we’ve already seen Jamie Oliver screw things up over here.

Anyway, let’s be careful out there. Now, I’m going for a walk.

Things to Read

From Paul Campos discusses the failure of a “sophisticated and expensive attempt” to validate the hypothesis that “significant long-term weight loss improves health outcomes”:

It will probably come as a surprise to most readers to learn that this hypothesis remains almost completely unconfirmed by the medical literature – in part because we simply don’t know how to produce significant long-term weight loss in a statistically significant group of people, so the hypothesis has been impossible to test.

The study, called Look AHEAD, has been covered elsewhere.  Participants lost 5% of their body weight and maintained that loss for over 11 years.  Yes, the researchers considered a “significant” weight loss to be a 5% loss from baseline.  Not “reducing BMI to “normal”".   Losing 5%.   If losing 5% of your weight would put you in the “normal” BMI bracket, it’s likely you’re there already.

And the study found that maintaining that “long-term, significant” weight loss didn’t improve health outcomes.

Lesley Kinzel discusses “glorifying obesity” with sarcasm and smarts.

If reminding folks that fat people are people first — that they are individuals and not some monolithic amoeba of disease rolling itself over the planet, and that their bodies are not shameful, not ugly, not embarrassing, not immoral, but as worthy of acceptance as every other body is — if THIS is the same as glorifying obesity, then bring on the glory. I will carry the banner. I won’t be sorry, not for my part in changing our culture around bodies in general and not for my own body that I live in, right now — I won’t be sorry, and I won’t apologize. Neither should you.

And if you want a smile, you should read Jess Zimmerman on Moses, the baby elephant, and his adoptive family.  Moses also has a blog maintained by his human family.

Some Things To Read

The Fat Nutritionist has an excellent, and sadly useful, post titled “A little 101 - I get to exist.”

It is okay to be fat, because fat people already exist.

Fat people have existed for a very, very long time.

Even if all of us tried, not all of us would become permanently thin.

Fat people exist. We have existed. We will continue to exist. So to say that it’s not acceptable to be fat is to deny our right to exist.

Fat people exist.  Even if we want to become thin, it often doesn’t work. Which brings me to another thing to read: Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer (PDF) by UCLA reviews 31 studies on diets and recommended that Medicare not cover diet programs because they are not effective enough to be worth Medicare coverage.  News articles summarized these findings here and here.  A quote:

Reviews of the scientific literature on dieting (e.g., Garner & Wooley, 1991; Jeffery et al., 2000; Perri & Fuller, 1995) generally draw two conclusions about diets. First, diets do lead to short-term weight loss. One summary of diet studies from the 1970s to the mid-1990s found that these weight loss programs consistently resulted in participants losing an average of 5%–10% of their weight (Perri & Fuller, 1995). Second, these losses are not maintained. As noted in one review, “It is only the rate of weight regain, not the fact of weight regain, that appears open to debate” (Garner & Wooley, 1991, p. 740).

Even the American NIH, which is not exactly a fat-accepting organization, admits that weight loss is often limited:

“How much weight does the patient expect to lose? What other benefits does he or she anticipate?” Obese individuals typically want to lose 2 to 3 times the 8 to 15 percent often observed and are disappointed when they do not.  (p22)

It is certainly possible have “a successful weight loss” of 5-10% and remain fat.

Getting individuals who are obese down to a normal weight isn’t realistic: Research shows that most people can’t expect to lose more than 10% of their body weight and, more important, to maintain the weight loss over time.

I am all for bodily autonomy. I am also in favor of recognizing reality.  That which doesn’t go away?  Is reality.  Fat people exist.  Fat people  aren’t going away.  Deal with this fact.

Soda Ban?

I’m sorry if this offends anyone, but I don’t necessarily care about New York’s proposal to ban larger-than-16oz-sugary-sodas.  Partly it’s because I’m not affected; I live in Seattle and haven’t even sampled non-diet pop* in years.

I am skeptical that it would make fat people thin, naturally, but I think it would be more likely to affect the budgets of folks who are grabbing lunch or dinner between work shifts than anything else.  Having to buy more drinks will cost more, and water isn’t always free in delis or restaurants.

And that, I think, is what people aren’t realizing.  Preventing people from buying large pop servings isn’t targeted at fat people.  It’s targeted at poor people, at workers, at kids.

---

*I’ve occasionally had sugar or corn-syrup sweetened pop at parties over the last few decades and ended up with headaches.  I haven’t drunk “real” soda regularly since 1985.  Currently I drink water, diet Pepsi and coffee with half-and-half and Splenda most days.

Junk Food In Schools Doesn’t Correlate To Fat

Remember how banning junk food in schools was supposed to make fat kids thin?  Guess what?  No,  it doesn’t.  At least not according to “Competitive Food Sales in Schools and Childhood Obesity: A Longitudinal Study” in Sociology of Education (January 2012).

But of course we should’ve thought it would, right?  It’s not like “Snack food intake does not predict weight change among children and adolescents” was published in International Journal of Obesity in August 2004, right? And there wasn’t any studies about “energy-dense snack food” not being correlated with weight gain in adolescents either…right?  Wrong.

Once again, America is continuing to do the same thing (that didn’t work) to try to prevent fat kids.  And yet, fat kids exist.  Time to ban fat marriage?

Quick Question

About adding apple slices to Happy Meals (and reducing the size of fries):

Also, for those who are over age 12: Is there any toy which would entice you to buy a Happy Meal for yourself?

US Obesity Rates Level Off Again?

Oh, not again.  Still.  They’ve been level for years, but this time the Journal of the American Medical Association noticed. There’s discussion as to why, such as “people are getting healthier”.  Given how dieters often gain weight in the long term, I thought this perspective a bit more realistic:

Dr. Ludwig said the plateau might just suggest that “we’ve reached a biological limit” to how obese people could get. When people eat more, he said, at first they gain weight; then a growing share of the calories go “into maintaining and moving around that excess tissue,” he continued, so that “a population doesn’t keep getting heavier and heavier indefinitely.”

That’s not what my mother told me.  She was convinced that if I wasn’t actively dieting I would continue to gain weight for the rest of my life.  Yet when I finally quit dieting my weight … leveled off.  Huh.

Furthermore, Dr. Ludwig said, “it could be that most of the people who are genetically susceptible, or susceptible for psychological or behavioral reasons, have already become obese.”

Gee, y’think?

Things to Read

As others have noted, Paul Campos’ piece on how the US “Let’s Move” campaign aids and abets bullying is worth reading.  Besides noting that advocating for “child obesity to be eliminated” paints a “pick on me” sign on anyone who isn’t model-thin, Campos also cites studies that have tried healthy interventions with children in the past.  Result?  The kids got healthier.  They didn’t get thinner.

Consider the first lady’s major policy goals: She wants children to eat a healthy balance of nutritious food, both in their homes and at school, and she advocates various reforms that will make it easier for kids to be physically active. These are laudable goals in themselves, but there is no evidence that achieving them would result in a thinner population. Indeed ambitious, resource-intensive versions of Mrs. Obama’s initiatives have been implemented on a smaller scale, for example by the Johns Hopkins University Pathways program, which attempted to improve the diets and increase the activity levels of Native American children in three states, while educating their families about health and nutrition. The program had some success in all these areas, but it produced no weight loss among the children as a group. The same basic results, improved health habits but no weight loss, were obtained in the Child and Adolescent Trial for Cardiovascular Health, a similar program involving thousands of ethnically diverse children in four states. Pursuing comparable initiatives at a national level might be worthwhile—these programs did, after all, result in improved health habits among the children who participated—but there is no reason to think the kinds of reforms Mrs. Obama is advocating will make American children thinner. The perverse result could be that an initiative that might have been judged a success had its primary focus been on producing healthier children will instead end up being used as another example of a failed Big Government program, simply because it did not produce thinner ones.

[Links from the original; emphasis added]

Campos also points out that dieting is often linked to long-term weight gain.

…and on a less serious note, Seanan McGuire wrote a brief description of sci-fi conventions and 10 tips on how to cope with one.  Whether you’ve been to a con or not, it’ll likely make you smile.

QOTD: Why Stigmatize Fat Kids?

From Pattie Thomas’ post at Psychology Today in response to a “Cease to be obese crusade” billboard on how kids should exercise:

Why do you have to promote weight loss in order to promote exercise? If you really believe in the calorie in/calorie burned model, promoting exercise and healthy eating for every one would automatically solve the “obesity” problem, would it not? Is it necessary to promote hatred of a fat  body in order to get someone to lose weight? Is it not important to promote play, movement, and sportsmanship among all all kids? Why single out obese kids?

I think the most telling thing about those who are promoting the “healthy children” initiatives that this billboard represents is that the promoters do not trust the calories in/calories burned model.

Pattie Thomas also goes on to note that if it’s really about health, good nutrition and exercise should be the point.   Apparently it’s not.

Things to Read

This is kind of a mishmash ;)

If you’ve seen comments about “dickwolves” and PAX and wondered what it was about, JetWolf has a nice summary.

Author Seanan McGuire addressed why fixing the US healthcare system is so terribly, terribly important this week.  Seanan has discussed why she needs health insurance here and here.

Seanan’s new CD, Wicked Girls, is available for ordering at CDBaby.

Alternet has a well-done piece by Judith Matz on “Why dieting makes you fatter”.  It references Linda Bacon’s Health At Every Size study, Traci Mann’s survey of diet studies, and other research.   If you’ve been into fat acceptance a while it’s mostly things you know, but it’s good to see getting wider play.  It might also be a useful “FA 101″ piece.

A 3-part Q&A with Linda Bacon is over at PyschCentral, too.

Ragen at Dances With Fat has a great post on respecting others’ choices while discussing Fat Acceptance and HAES.

Anything else?

On Decoupling Exercise and Weight Loss

From obesity researcher Travis Saunders comes this excellent post on how Canadian public health efforts to increase activity work against their own aims by tying exercise with weight loss:

[T]he average weight loss in response to a moderate increase in physical activity levels is very modest, and it’s likely that many people would see no weight reduction of any kind.   Even if it’s in the range of 5% of body weight (which is unlikely over the long-term), it’s probably substantially less than most people are hoping for. In which case the individuals who are only exercising for the sake of losing weight are going to get discouraged pretty quickly [...]

Further, this overwhelming focus on the relationship between inactivity and obesity may lead some lean individuals to conclude that they have no reason to be physically active since their body weight is already in a normal range. [...]

[A] single session of aerobic exercise results in measurable improvements triglyceride levels, HDL (good) cholesterol, and insulin sensitivity, even though it has no real impact on adiposity.   Further, it has been noted that mortality levels are lower among obese but fit individuals, as compared to lean but unfit individuals, suggesting that we really do need to be promoting physical activity as a healthy behaviour for everyone, not just those who are overweight or obese.

Travis writes at the Obesity Panacea blog.  Obesity Panacea focuses on the science (or lack thereof) behind popular weight loss products and discussions of the latest news and research regarding obesity, nutrition and physical activity.   It isn’t an explicitly size-acceptance space.

[Bolding and links within the quote are from the original.]

On Fat and Eating

From Hanne Blank:

Truth is, it is totally possible to be a fat person eating “healthy” and “sustainable” and “locavore” and “balanced” and “nutritious” and “organic.”  This fat I have on my hips here?  That’s some locally-grown, sustainable, artisanally crafted, homemade fat, right there, practically glowing with seventeen kinds of early 21st-century middle-class white American foodie pride.

From Lesley at Two Whole Cakes:

[M]any behaviors seen as damaging and dangerous in thin people are outright encouraged in fat people. The specific example above is purging, but the sentiment is the same for many disordered eating patterns. Fat people are often supported in hating their bodies, in starving themselves, in engaging in unsafe exercise and in seeking out weight loss by any means necessary. A thin person who does these things is considered mentally ill. A fat person who does these things is redeemed by them. This is why our culture has no concept of a fat person who also has an eating disorder. If you’re fat, it’s not an ED — it’s a lifestyle change.

A few links

Marilyn Wann launched a new HAES site at  http://2011revolutions.blogspot.com/, focusing at replacing diet resolutions with a revolution.

Jezebel: If You’re Fat-Phobic, You’re Also An Ignorant, Bigoted Idiot and Biggest Weight Stories of 2010.

“I don’t eat a hamburger and large chips every day!” A qualitative study of the impact of public health messages about obesity on obese adults. From the abstract:

Personal and contextual factors influenced the ways in which individuals interpreted and applied public health messages, including their own health and wellbeing and perceptions of stigma. [...] Many described feeling stigmatised and blamed by the simplicity of messages and the lack of realistic solutions. Participants described the need [for] messages recognise the complexity of obesity and focus on encouraging healthy behaviours for individuals of all sizes.

You may recognize co-author Dr Samantha Thomas, who blogs at Discourse.