“a successful weight loss drug could potentially have huge sales”

Wow, so many people want to lose weight! Wouldn’t a weight loss drug make piles of money?  Check out this business article on the new drug the FDA approved!

In a clinical trial involving patients without diabetes, those who took Contrave had an average weight loss of 4.1 percent beyond those receiving a placebo. About 42 percent of those getting Contrave lost at least 5 percent of their weight compared with 17 percent of patients in the placebo group.

So…if a hundred women who weighed 200lbs combined Contrave with diet & exercise, 42 would lose at least 10lbs!!!  Without it, only 17 of the hundred women would lose at least 10lbs.  Wow, is that a guaranteed success in the making or what?  

Oh, and from another article,

In people with diabetes evaluated in a second trial, those patients lost an average of 2 percent more weight compared to the placebo.

2%!!!! Wow, that is definitely worth adding another medication, don’t you think?


 

Yes, at this point, I may be abusing sarcasm. I also think the FDA measurement of “successful weight loss” for diet drugs needs to be better known.  Like the NIH expectations of weight loss, the FDA’s expectations are for a much more modest weight loss than is commonly expected or promoted in the press as possible.

QOTD: Workplace Wellness

Much criticism of “employer wellness programs” have been focused on privacy concerns and angering employees.  But now we’re seeing more practical concerns (also known as “does this even work?”).

Which leads me to this quote of the day, directed at CEOs:

Suppose a vendor made you this proposal: “Pay us to take your employees off the job for medical tests that the government specifically says are unnecessary, and then send them to the doctor (at your expense) even though the Journal of the American Medical Association (JAMA) says healthy adults don’t benefit from checkups. We also want you to bribe or even fine employees to drive participation. Despite this adverse morale impact and wasted time and money, we promise you’ll reduce your healthcare spending, mostly because we’ll make up the savings numbers.” [...]

Think you’d decline this proposal? If you have a wellness program built around screenings, doctor visits, and “incentives,” you’ve actually already accepted it. Because (in addition to free gym memberships and other possibly worthwhile perks) that’s what wellness is for tens of millions of Americans.

— Al Lewis and Vik Khanna

Gee — let me think.

Tell Me Again How It’s “For My Own Good”

Lara Frater wrote about this and I wanted to boost the signal.  The Rudd Center recently came out with a study (PDF link) showing that weight stigma affects the stress hormone cortisol.

Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.

It doesn’t require being fat to have this kind of reaction, by the way. Both the lean and overweight women “were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media.”

What’s cortisol? Some highlights from Wikipedia:

Cortisol, known more formally as hydrocortisone is a steroid hormone [...] released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat, protein and carbohydrate  metabolism.  [...] Cortisol counteracts insulin, contributes to hyperglycemia-causing hepaticgluconeogenesis and inhibits the peripheral utilization of glucose (insulin resistance). [...] Cortisol can weaken the activity of the immune system.

Being fat (“excess weight”) is considered a cause of insulin resistance.  And it appears that weight stigma increases cortisol … which increases insulin resistance.  Which is the chicken? Which is the egg?

This isn’t necessarily new.  Weight stigma  has been tied to weight gain before.  What this study highlights is one mechanism.  There may be others.  We know that fat bias prevents fat people from getting jobs, from getting raises, and from getting proper healthcare treatment.   Fat people are also often paid less and harassed more than similar-qualified people who are thin.  None of this improves health.

So when I hear people saying that fat people just need more “tough talk” to lose weight “for their own good”? No, I don’t believe them.

Some Workplace Wellness Programs Work

I found it surprising too!

A study of over 67,000 people who could join PepsiCo’s “Healthy Living” wellness program found that 7 years of participation in a “disease management” program resulted in a net savings — the cost of the program was less than the money saved by reduced healthcare costs.  These sorts of programs are “aimed at helping people with chronic illnesses stay healthy, by educating them and reminding them to take medication” and “resulted in significant savings”.

Meanwhile, the wellness program’s “lifestyle management offerings, which aim to reduce health risks through programs focusing on weight loss or stress management, resulted in no net savings at all.”

As the NYTimes headline put it, “Study Raises Questions for Employer Wellness Programs.

Researchers estimate that disease management lowered health costs by $136 per member per month, mostly thanks to a 29 percent reduction in hospital admissions. Lifestyle programs, however, had no significant effect on health care costs.

[...]

Other analyses have shown cost savings for lifestyle programs — perhaps, researchers said, because they looked at older programs that were introduced when habits like smoking were more prevalent and cholesterol-lowering drugs were just becoming available, so gains from intervention were greater. Another study at the University of Minnesota, with a design similar to the PepsiCo study, also found that savings resulted from disease management programs rather than lifestyle programs.

I note this article is in the “Business” section and focuses on dollars and cents and not the utter failure of weight loss programs or the paternalism inherent in businesses that offer stress management classes while overworking employees.  I also note that a program focused on “educating people with chronic illnesses on their diseases and reminding them to take their medication” sounds a lot like actually treating the chronic illnesses so they don’t get worse.  Heck, the paper’s title? “Managing Manifest Diseases, But Not Health Risks, Saved PepsiCo Money Over Seven Years.”  What a concept!

But yeah: If  you are in a position to discuss a potential “wellness” program with an employer, here’s some research on how weight loss programs don’t save money. May be useful.

Opting Out Of The Illusion Of Immortality

Deb Burgard has a terrific post on the latest “being fat makes you die, damnit” study

Masters’ central argument seems to be that even though the repeated findings for decades of rigorous research (reviewed by Flegal, 2013) has found that BMI and mortality are only weakly correlated, and that higher BMI may actually correlate with longevity in old age, this set of findings must be wrong, because 1) fat elderly people are more likely to be unable to participate in the surveys due to being “institutionalized” more than thin elderly people (no citation), and 2) there are apparently going to be major differences in longevity between people who were fat in their 60′s in 1995 and people who will be fat in their 60′s in 2030 because of the latter group’s “longer exposure to the obesogenic environment.” I guess that is an interesting thought experiment, but if you look at current trends it would seem that fat people are more likely to be healthier in the future if we continue to improve access to healthcare and continue the progress in managing hypertension and diabetes.

Catastrophizing isn’t exactly new in writing about fat, but it does get attention, if only because it gives the fear-of-fat industry something new to write about. Deb responds to this in an inspiring way:

My body […] is not a cautionary tale, a ticking timebomb, or a battleground for corporate adversaries trying to make money on marketing to fat people (weight cycling industry! workplace wellness programs! Big Pharma!) or trying to save money by hoping fat people die  (health insurers! HMOs! Cost-of-obesity policy wonks!).

My death will not be a point for one side or the other.  I am opting out of the illusion of immortality[…]. I am going to live as well and as long as I can, and then I have to get off the bus. It is not different for any of us, and the best use of my time is to make this world a place that gives every one of us the maximum chance at happiness and well-being.

I’ve buried both of my parents. At the risk of sounding trite, it brought home the very real fact that people don’t live forever. Turning that into marketing just feels wrong.

You’re SORRY? Oh fuck you.

Dr. Peter Attia thinks about his former patient often, the woman who came to him in the emergency room at Johns Hopkins Hospital one night seven years ago.

She was obese and suffering from a severe complication of Type 2 diabetes, a foot ulcer, which required an urgent amputation. At the time, Dr. Attia admits, he silently judged her. If she had only taken better care of her health, maybe exercised more and eaten less, he thought to himself, this never would have happened to her.

But a few months ago, in a TED talk, Dr. Attia stepped onto a stage and offered a few words to his former patient: “I hope you can forgive me.”

WHAT THE FUCK?  Why should she forgive you?  You’re just another judgmental asshole in a nice long line of judgmental assholes.  Is it really such a stain on your self-image that someone might not worship you as the all-perfect person you want to be?  Why should she spend any pity or compassion on you?

“As a doctor, I delivered the best clinical care I could, but as a human being, I let you down,” Dr. Attia, his voice breaking, said in his talk. “You didn’t need my judgment and my contempt. You needed my empathy and compassion.”

Wow.   Just … wow.   He thinks his “judgment and contempt” did not prevent him from delivering the best clinical care?  Or is he admitting that the “best clinical care I could” might not be the best clinical care?

I still don’t see why he thinks an apology from just one doctor might MATTER at this point.  Maybe it would.  Maybe pigs would fly, I don’t know.

Apparently Attia’s now looking into research on whether “the precursors to diabetes cause obesity, and not the other way around“.  Interesting.  Did he read some genetic research on type 2 diabetes?

Dr. Attia’s insight was informed, in part, by the startling discovery a few years ago that despite paying close attention to his diet and exercising frequently, often for hours at a time, he had developed metabolic syndrome, a precursor to Type 2 diabetes. He had made all the right lifestyle choices, he thought, and yet he was overweight and on a fast track toward obesity and diabetes.

Oh for fuck’s sake.   Dr Perfect is SHOCKED, SHOCKED to discover his body is not 100% under his control at all times.  OMG, this is a REVELATION.

Sources:

NY Times article on Dr Attia, where I pulled most of the quotes from.

Dr Attia’s TED talk.

Why I Think Declaring Obesity A Disease is Harmful

It’s inaccurate:

It distracts from the real issues:

It’s a win for the weight cycling industry

Unfortunately, what’s good for the weight cycling industry isn’t necessarily good for patients: 

There is a Change.org petition on this – I’ve signed, have you?

In The News

The AMA has endorsed the idea that “obesity” is a disease, not a “condition”.  (Personally I consider it a characteristic.)  Forbes states that this is “a move member physicians hope will spur better reimbursement for treating overweight Americans and create better health outcomes.”  Exactly how it’s supposed to “create better health outcomes” when commonly prescribed treatments do not work long-term or create good health outcomes is not addressed.

In good things, Shakesville’s Fatsronauts 101 series continues to hit it out of the park.

The NY Times does a piece on Melissa McCarthy that doesn’t focus on her weight.  That’s allowed?

The NY Times also reminds people go get some sleep.

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 6 months of data

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

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….

Snapshot of Fitbit dash

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.

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.

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 of a fat woman talking on the phone in an office setting.

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.

Image of a baby elephant petting a cat with his trunk.

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?