Americans Are Fatter Than They Think!

I tweeted this, but I’m just not sure how to fully express the snark this deserves, so I thought y’all might want to give it a try.

See, a study has discovered that…drumroll…BMI can be inaccurate!!!!  Really!!!  You might be fat and not know it!!!  (eeek!)  And since most people who are “overweight or obese” aren’t actually very fat, increasing the number of people who think they need to lose weight can increase customers for the weight cycling industry.

….

I keep thinking I’m missing something here.  Got anything else?

Ripping off the Yay! Scale

For years, Marilyn Wann has created and sold Yay! scales, used them in anti-diet activism, and written about them online and in her book FAT!SO? : Because You Don’t Have to Apologize for Your Size. Others have mentioned Yay! Scales in books as well, including Health At Every Size.

Now Kellogg’s is using a very similar scale to sell their “Special K Challenge”. According to The New York Times:

In a new commercial, women in Times Square reluctantly agree to get on scales in public, then are pleasantly surprised when, instead of numbers, the scales display words including satisfaction, pizazz, confidence and moxie.

The commercial, part of campaign by the Chicago office of Leo Burnett, part of the Publicis Groupe, will be introduced on Jan. 2, high season for weight-loss companies.

“We’re trying to change the conversation from one that’s always focused about deprivation to one that’s focused on motivation,” said Doug VanDeVelde, senior vice president for cereal marketing at Kellogg.

Let me get this straight.

The entire point of a Yay! Scale is that you get compliments instead of a number.

Because the number isn’t important.

Because so many people in this society measure their worth by their weight.

Because it’s about changing the conversation. 

It’s about yanking away that all-important number and suggesting other things might be more important than weight.

It’s about making people smile instead of feeling judged.

It’s about changing the focus to life instead of weight. It’s about getting a life instead of yet another a diet.

And here’s Kellogg’s acting like they invented a scale that gives compliments, only it’s to encourage dieting.   Maybe no one at Kellogg’s knew about the Yay! Scale, but … you know what the first hit Google gives me on “scale compliments”?  A post about … a Yay! Scale.

Remember when Weight Watchers ads claimed that diets don’t work (because somehow Weight Watchers isn’t a diet)?   It’s co-opting the language of fat acceptance, but twisting it to support dieting.

Weight Cycling Industry

From Deb Burgard comes this amazing post on weight cycling:

Why do we call it the “weight loss industry” when what we really get for our time, sacrifice, and money is weight cycling? 19 times out of 20, what we are really purchasing is the experience of weight loss and regain.

Imagine if we called it the “weight cycling industry,” and “weight cycling programs.”  Would you participate in Weight Cyclers at work?  Buy food from NutriCycle?  Hire a trainer from the Biggest Weight Cycler?  [...]

Because that is what we are doing, folks.   Better face the facts:  Of 100 people trying to lose weight, the vast majority of people will regain weight. Some significant group – perhaps a third – will gain more weight than they lost.  Some tiny number (7? 5? 3?)  will maintain their weight loss, and of that group, some number from 0-4 of them will be flirting with, developing, or fortifying an eating disorder.

People ask me why I don’t diet anymore.  I don’t lose weight “for good” — my weight goes down in the short term  and up in the long term, ending up weighing more than when I started.   So yeah, “weight cycling” is more descriptive than “weight loss”.

And yet, people ask, “what about health“?  As Deb points out in the same post:

It is the practices that people adopt in the pursuit of weight loss that are the problem, because for the 95 out of 100 people who regain weight during a diet, when the practices are not sustainable they lead to more physical and psychological illness.

The Health at Every Size® model is weight neutral.  People using this approach are not pro- or anti-weight loss, but they are mindful that the pursuit of weight loss is usually harmful, unlike the cultivation of sustainable practices that feel life-affirming and support your health.   In keeping with the “truth in advertising” theme, the Health at Every Size model does not insist that everyone is healthy at every size, or that anyone anytime is necessarily the size that optimizes their health.  “Health” in this context means that whatever size you are, there are practices that will support your health.

As I’ve written before, I don’t consider myself perfectly fit.  But I refuse to frame exercise or healthy eating or getting enough sleep as “something I’m doing for weight loss”.  What matters is the effect is has on me.  Getting enough sleep makes me feel good.  Lifting weights makes me feel strong.  Walking increases my endurance.  That’s why I’m doing it.

It’s not the diet. It’s YOU.

From a discussion of celebrity endorsements of diet plans comes this gem from Nutrisystem exec Stacie Mullen:

“The dieting public understands that the dieter has a responsibility to comply with the program,” said Ms. Mullen, adding that if the dieter fails, “I don’t think the public blames the program the dieter was on.”

And from Zalmi Duchman of the Fresh Diet:

“If they don’t do good on it, it doesn’t mean the product doesn’t work,” Mr. Duchman said. “It just means that they’re not sticking to it.”

This perception really helps diet companies stay in business.  I’m sure diet programs REALLY don’t like this:

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)
—Traci Mann et al [emphasis added]

Most dieters regain their lost weight. It’s not that “they didn’t stay with the program.”  It’s that most dieters regain. Period.  The few who maintain significant weight loss long-term are a very small minority.   But as long as they trumpet “Anyone can lose weight!  Just pay us!” they can drown out the downer research that shows how unproven and full of lies their programs are.

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

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 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.

Quote of the Day: Healthcare Providers and Expectations

From an article on healthcare providers stigmatizing fat patients:

Healthcare providers also need to readjust their expectations. 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. Instead of viewing that as a treatment failure and growing discouraged with patients, doctors and nurses need to recognize that even relatively small changes in weight represent real progress and can have very important implications for health.

I’ve written before that the US National Institutes of Health (NIH) guidelines for treating obesity recommends a 10% weight loss goal.  Not to diet down to “normal weight”, or even to just “overweight”.   Ten percent.    I also noted that I never had a medical professional (or parent or teacher) be satisfied with a 10% weight loss.   I was still fat, so obviously 10% wasn’t enough.

Just to be clear? If a 10% weight loss puts you in the “normal weight” category, you weren’t in the “obese” category.

Most readers know I disagree with the emphasis on weight loss; not only are most losses not  maintained in the long term, but dieting is associated with long-term weight gain.   I do believe in bodily autonomy, though, and that those who choose to diet should use resources like the NIH guidelines and the observations of others who are maintaining losses to maximize their chances.  And I get angry that someone could work hard to lose 10% of their body weight, could work hard to maintain that loss, and still have a healthcare provider berate them for being fat.  Or refuse to treat them, just because they’re fat.

Skip the fat shaming.  It doesn’t help anyone.

(Checking out Health At Every Size doesn’t hurt either.)

Dieting Changes How Bodies React To Stress?

At least that’s what seems to happen in mice.  As summarized in US News and World Report,

Shaving calories triggers molecular changes in the brain that make mice more susceptible to stress and binge eating long after the diet ends, researchers report in the Dec. 1 Journal of Neuroscience. The finding could explain part of the yo-yo dieting phenomenon, in which people repeatedly diet and lose weight but then subsequently regain even more than they lost.

Researchers found that the dieting mice were more stressed than the non-dieting mice.  They also found that even after ending the “diet” and regaining the weight, the former-dieting mice were more susceptible to stress than the non-dieters.

The team traced lower activity of the gene that makes CRF to a chemical modification called DNA methylation.  DNA methylation and other modifications to genes help to regulate gene activity. Dieting mice had lower levels of methylated DNA near the gene for CRF than did animals that continued on the high-fat diet or ones that ate as much regular chow as they wanted. This change was essentially locked in for the dieting mice. It did not increase even two months after the diet ended—a long time in the life of a mouse, and equivalent to years, maybe even decades, for a person.

Researchers mildly stressed the mice for a week with things like damp bedding, cage swaps or putting a marble in the cage—mice are not big fans of change—so that the animals didn’t know what was coming next. Under this mild, but chronic, stress the former dieters snarfed down far more of the high-fat food than the nondieters. And the ex-dieters also had higher levels of hormones that prompt eating.

I DID find it rather eye-rolling that the article suggests that “dieters may need to cut stress as well as calories”, given that being fat is itself stressful.  And, of course, it remains to be seen how much of this applies to humans.  But this may help explain the mechanisms by which dieters so often regain the lost weight.

Abstract is here.

Oh, CNN

This blog post got my hopes up with “Dieting gets you nowhere” and then dashed it with the “but it works for kids!” ending.  No, people, turning off the TV or passing up a Happy Meal will not automagically turn a fat kid into a slender one.  Sorry.

Meridia (sibutramine) being removed from the US market

From CNN:

Abbott Laboratories has agreed to take its obesity drug Meridia (sibutramine) off the market, the U.S. Food and Drug Administration announced Friday.

The company voluntarily withdrew the drug because clinical trial studies showed there was an increased risk of heart attacks and strokes in people who used the drug. [...]

Approved in 1997 for weight loss, the original data on the drug showed that people who took Meridia lost at least 5 percent more of their body weight than people who were on a placebo and relied on diet and exercise alone.

The FDA requested the company withdraw the drug, after reviewing data from a follow-up study known as the Sibutramine Cardiovascular Outcomes Trial (SCOUT ). It showed there was a 16 percent increase in the risk of serious heart events, including non-fatal heart attack, non-fatal stroke, and death, in a group of patients given Meridia as opposed to others given a placebo.

Hopefully the increased risk of heart attacks and strokes will return to normal if the drug is discontinued.

Things to Read

From Marianne Kirby at The Rotund:

FA represents a long chain of people coming to the realization that the diet roller coaster is, to mix my metaphors, a sucker bet. The diet industry – when you get down to the bare, capitalist bones of it – has quite a lot of profit to be made from making people, especially women, feel awful about their bodies and their weight. If we all felt awesome about ourselves, they would go out of business.

From Nudemuse on some recent posts about fat and feminism:

[T]here seems to be some gap in a lot of feminist thought when it comes to granting fat women the same agency they might give to a woman who wants to do something else with her body.
[...]
No one likes being told, hey you might enjoy bread but you can’t have any because I think it would be best for you.

Now, I don’t know about you folks but my first reaction to that kind of condescension is to say, oh really, okay fuck you.

Maybe people with this mind set are trying to come from a loving place. If you are trying to come from a loving place think about it this way; if it was your life your body how would you feel about some stranger telling you what’s good for you in this manner? If it would upset you, don’t fucking say it.

And April at Round is a Shape on setting a boundary with her mother:

One phrase that I uttered early on in the day when my mother started to bemoan the fact that she was so hungry (after an early morning and only a granola bar she was feeling guilty for daring to feel famished by noon after driving 1.5 hours to see us!) and relay her guilt about going for a piece of bread or another pierogi: “This home is free of food judgments”.  And, happily, this was the last of self-recriminations that we really heard or voiced all day.

:)

Another HAES Quote

This quote on Health At Every Size is from Michelle, aka The Fat Nutritionist.  Links within the quote were added by me.

[D]ieting purports to make all people lose weight, permanently. Because 80-95% of the people who engage in it do not lose weight permanently, dieting fails as an intervention. It fails to achieve its stated directive, and it also doesn’t seem to help people permanently pick up healthier eating/moving behaviours.

Whereas HAES does not purport to do *anything* to a person’s weight. It purports to encourage healthier eating and moving. And while only a few people might lose weight, just like in dieting, HAES succeeds as an intervention — because the goal was to engage in healthier behaviours, not to lose weight, in the first place. Evidence has shown (in Linda Bacon’s study) that HAES does actually succeed in getting people to adopt healthier eating and moving behaviours that stick around for the long-term.

I realize that this is not always an either-or.  But for many fat people, it’s assumed that either you are actively trying to lose weight through eating “better” or eating less or exercising more … and the weight not coming off, or not staying off, is then a reason to quit the healthy behaviors.

Thanks Frances at Corpulent for linking to Michelle’s post on Health At Every Size.

FDA Advisory Panel Recommends NOT Approving Qnexa

In an update, the FDA advisory panel reviewing the weight-loss drug Qnexa has voted to reject it.

The final FDA decision will not be issued until October, but the advisory panel’s decision is usually key to their decision.

In a 10-6 vote, a Food and Drug Administration advisory panel said they were concerned that Qnexa was too experimental. [...] Approving the drug would be “a huge public health experiment,” said panelist Elaine Morrato of University of Colorado.

[...] Vivus is seeking FDA’s green light to sell Qnexa to adults to use once a day to slim down in it hopes could become the first prescription diet drug in a decade. The company told advisers its pill offers a safe option for shedding pounds and improving their health.

There is little doubt the drug works, but panelists said potential side effects such as depression, memory loss, increased heart rate and birth defects are a worry.

Panelists were also concerned since patients may take Qnexa for years but Vivus only studied it for about 12 months.

Qnexa is a combination of phentermine and topiramate aka Topamax.  I also posted about the drug a few days ago.

Diet Drug Side Effects

Let’s do a poll!

More information:

Alli side effects

Alli possibility of liver damage

Fen-phen

FDA review of Qnexa (PDF)

Limitations of adverse effects reporting

New Diet Drug: Qnexa

Patients on the highest dose of Qnexa lost an average of 8.9 percent of their weight after adjusting for the effects of a placebo. More than 60 percent of patients on middle and high doses lost at least 5 percent of their weight, compared with 20 percent for those getting a placebo.
— NY Times

Recall that the National Institutes of Health states that a “8-15% weight loss is often observed” from dieting.  So losing an average of 8.9% doesn’t seem all that to me. It is enough for the FDA to consider it an effective weight loss treatment, though, because the FDA requirements are:

[A] drug will be considered effective if at least one of the following criteria is satisfied after one year of treatment:

1. The difference in mean weight loss between the active-product and placebo-treated groups is at least 5 percent and the difference is statistically significant
   or
2. The proportion of subjects who lose greater than or equal to 5 percent of baseline body weight in the active-product group is at least 35 percent, is approximately double the proportion in the placebo-treated group, and the difference between groups is statistically significant

5% of baseline weight on average over a placebo.  For a 200lb person, that’s 10lbs. That’s what’s required to be an effective weight loss drug.

I think that says something pretty damning about the supposed ease of weight loss.

Meanwhile, the risks of Qnexa include suicidal thoughts, problems with thinking, birth defects, speeding heart rates and acid buildup.   I wouldn’t want to risk taking it.

Does this sound worth it to you?   Or do you figure it’s at least better than Alli?

More info: FDA review (PDF)

7/15 Update: FDA panel rejects Vivus weight-loss drug Qnexa

Expectations (and Risks) of Weight Loss

Lots of folks have been quoting the new paper in the International Journal of Obesity -

Weight loss of 15% or more from maximum body weight is associated with increased risk of death from all causes among overweight men and among women regardless of maximum BMI.

“Associate”, here, appears to mean “correlate”.   The 15% piqued my interest because it echoed this bit* from The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, from the US National Institutes of Health (NIH) guidelines on “obesity treatment”:

Obese individuals typically want to lose 2 to 3 times the 8 to 15 percent often observed and are disappointed when they do not.  (p32)**

Correlation does not necessarily mean causation, but this leads me to wonder whether, on average, a more than 15% loss requires more extensive changes to diet and exercise, that in turn can result in more muscle loss and other damage?    Nobody knows.  It’s not clear whether the correlation is a strong one (3000% more likely?) or a weak one (100% more likely?) or if it will actually mean anything in the end.   But I do think we should focus more on health than on weight.

I also note they did find one group where weight loss reduced risk of cardiovascular disease:  obese men who lost between 5% and 15% of their max weight.  I also note that reducing risk of cardiovascular disease can be done by increasing exercise and other such changes, without focusing on weight loss.

---

*Posted about here.

**For convenience, I’m using PDF page numbers, which can be entered into the PDF viewer to go directly to the page in question.  These do not map to the printed page numbering.