Health At Every Size Principles

I sometimes post about Health At Every Size®, both the concept (which is trademarked by ASDAH) and the book Health at Every Size: The Surprising Truth about Your Weight, by Linda Bacon.  So I am pleased to see that ASDAH has updated its HAES® Principles to be more inclusive of different abilities and backgrounds. Weight bias and weight discrimination is explicitly called out.  Supporting individual choices is more explicitly encouraged. A brief framing of the Health At Every Size® Approach has been added, as well, noting that health is NOT “simply the absence of physical or mental illness, limitation, or disease.”  It also states that

[H]ealth exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.

I suggest you check the full statement on the ASDAH site.

 

Things I’m reading

Kath as a post at Fat Heffalump on the feedback from her recent interview by Jasmin Lill on news.com.au, Brisbane blogger speaks out against online bullies. Go Kath!

Closet Puritan has a thoughtful response to some of the conflation between “Fat people are more common in communities with a Walmart” and “Eating more processed food from Walmart makes people fat”.

This Adipose Rex has some musings on Christianity and the body:

This Advent I am thinking about how if my body is a temple of the Holy Spirit, then this flesh itself is sacred — this same substance worn by the God of the universe, and shaped into God’s image. If I really believe in the words I recite every week, the resurrection of the body, then this is not some temporary meat-costume I will abandon so my soul can flit off to an immaterial heaven, but the too too solid flesh that will dance in the hereafter.

This reminds me of The Unapologetic Fat Girl’s Guide to Exercise and Other Incendiary Acts by Hanne Blank, which I’ve been reading. From the introduction:

Exercise—by which I mean regular physical movement that puts your body through its paces—is crucially important because it is something that makes it possible for you and your body to coexist in better and more integrated ways. It builds a bridge across the mind-body split. [...E]xercise gives your body to you. [...] Most of all, it teaches you that your body is not just a sort of jar made out of meat that you lug around because it’s what you keep your brain in, but an equal and in fact quite opinionated partner in the joint production that is you.

And over on the HAES blog, there’s an interesting discussion on healthism & privilege.

Some links

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

Image courtesy of the Rudd Center Image Gallery

Oh wow have I been busy. But that’s not the point.  So here’s some things to read :)

ASDAH has launched a HAES curriculum for colleges, universities, and professional groups.  Check it out. :)

The story behind The Butler.

WalMart complains that lower-income people aren’t buying much.  If only there was something they could do to raise incomes…  (NY Times)

Rachel Held Evans had some thoughts about the writer as a person vs the writer as a “brand”. 

Polimicks wrote about #SolidarityIsForWhiteWomen, which was started by Mikki Kendall.  If you haven’t heard about this, check it out.

How coordinated trolling maximizes threats while limiting liability for the trolls.  (Salon)

Seen in my search terms: “mineralogical weight loss”.  (What is this I don’t even.)

 

Genetics Affect Weight

This New York Times article by Gina Kolata isn’t totally news to me. At least not this summary of a study published in a 1990 issue of The New England Journal of Medicine (bolding added):

The work fascinates Claude Bouchard, a genetics researcher at the Pennington Biomedical Research Center in Baton Rouge, La., because it might offer insight into an intriguing finding: there are genetic controls not just of how much people want to eat but also how much of what they eat turns into fat or is burned off and not used by the body. Although the common mantra is that a calorie is a calorie and 3,500 extra calories eaten equals a pound of fat on the body, that is not what happens in real life, he found.

For example, in one of his studies, Dr. Bouchard enlisted 12 pairs of lean identical twins to live in an enclosed area for 120 days so their food and exercise could be monitored while they ate 1,000 calories a day more than needed to maintain their weight. The twins in each pair gained about the same amount of weight, but the amount gained varied threefold among the pairs. Those who gained the most put on as much as 29 pounds while those who gained the least put on 9 ½ pounds.

“It is not a freak finding,” Dr. Bouchard said, adding that about 20 studies found the same threefold range in weight gain in response to excess calories.  

 …and, in fact, this isn’t news to anyone who’s read Health At Every Size by Linda Bacon, PhD.  What is new is more information about a particular gene that appears to be involved.

The mice were eating their usual chow and exercising normally, but they were getting fat anyway. The reason: researchers had deleted a gene that acts in the brain and controls how quickly calories are burned. Even though they were consuming exactly the same number of calories as lean mice, they were gaining weight. [...]

[This] may help explain why some people put on weight easily while others eat all they want and seem never to gain an ounce. It may also offer clues to a puzzle in the field of obesity: Why do studies find that people gain different amounts of weight while overeating by the same amount? [...]

[Reasearchers] are now trying to determine whether additional mutations in the gene they discovered — ones that hinder its function but do not completely disable it — might explain why some people gain weight.

This research may lead to a better understanding of why some people are naturally very large and others aren’t.  It may also be useful in helping to spread some pesky, little-known facts:

  • Body weight is strongly inherited.
  • Some fat people eat the same amount food, or less food, as some thin people.
  • In studies where people deliberately eat more than they do normally, different people gain weight at different rates.
  • Twins in those studies, who overeat by the same amount, have almost identical weight gains.
  • An addition or subtraction of 3500 calories does not automatically mean gaining or losing a pound.

If this is new information for you or you just want one link to reference when needed, it’s on the NY Times site.

QotD: Fat & Exercising

I think a lot of people look to exercise to help them lose weight, and when they don’t lose weight immediately with exercise, they quit. They return to the couch, and they basically never move again. What is lost in that is that fitness is almost certainly more important than fatness. [...]

If someone starts an exercise program and improves his fitness, even if he doesn’t lose an ounce, he will generally have a longer life and a much healthier life. It would be nice if people would look at exercise as a way to make themselves feel better and live longer and not necessarily as a way to make themselves skinnier.

Gretchen Reynolds discussing her bookThe First 20 Minutes (emphasis added)

I bolded what I did for a reason.  Like many who grew up fat, I was nagged to exercise with an emphasis on taking all the fun AND usefulness out of it.   I don’t blame anyone who doesn’t want to exercise.  But I also think facts are useful.

Exercise doesn’t have to suck.  It doesn’t have to be an obligation.  Ideally it’s a choice made from facts not hatred and rebellion.  It seriously pissed my mother off when, as a child, I played soccer and had fun and felt great and didn’t lose weight.  She’s dead now.  But somehow I think she’s still pissed off when I exercise for my own selfish reasons that have nothing to do with becoming “more beautiful” or “a better person” or “a thinner person or making her happy.  And that’s fine. 

Conflating Dieting with Eating Healthy

[Feel free to skip if you don't want to think about dieting right now.]

Image courtesy of the Rudd Center Image Gallery

Image courtesy of the Rudd Center Image Gallery

It’s January and there is the usual plethora of diet commercials extolling weight loss. Google “dieting” and up comes Special K’s “Healthy Eating Plan”!

That said, it is a bit refreshing to see someone write:

As a lifelong dieter, let me tell you from experience: A diet need have nothing to do with “eating healthy.”

[...] It’s possible to lose weight by eating more healthily. But losing weight and eating more healthily can also be two totally different goals.

The cultural conflation of “eating healthy” and “dieting” has a lot of built-in assumptions.

There’s certainly more (and I haven’t even gotten into all the debate over what “healthy eating” means).

One result of the end-of-year crunch at work is that I haven’t been eating lunch regularly.  I’m going to work on permission to eat what I want, and eating at regular intervals.  But I am still avoiding diet commercials.

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

I think a lot of people look to exercise to help them lose weight, and when they don’t lose weight immediately with exercise, they quit. They return to the couch, and they basically never move again. What is lost in that is that fitness is almost certainly more important than fatness. — Gretchen Reynolds, promoting her new bookThe First 20 Minutes.

On the one hand, this is a bit of aduh“. On the other hand, there are clearly a lot of people who don’t get it.  From the same article:

Ms. Reynolds makes a clear distinction between the amount of exercise we do to improve sports performance and the amount of exercise that leads to better health. To achieve the latter, she explains, we don’t need to run marathons, sweat it out on exercise bikes or measure our peak oxygen uptake. We just need to do something.

“Humans,” she writes, “are born to stroll.”

While I’m writing about exercise, you may have seen references to the recent study which concluded “[h]ealthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.”  If you’re interested, the full text is here.  (I also realize that not everyone cares ;)

On a different note, Seanan McGuire has a great “Dear girls of the world today” post on her blog:

Collect dolls or knives or books or interesting rocks. Watch horror movies or romances or cartoons. Run races; go to spas. Eat cake or lettuce. Buy yourself a toy light saber and make your own wooooom noises while you wave it around; build a cardboard castle and chuck plush mushrooms at your would-be rescuers. Live your life, the way you want to live it, and understand that no one can kick you out of “the girl club” for doing it wrong, because you’re not.

May is Mental Health Awareness month:

Mental health is about more than mental illness. Please don’t hear “mental health” and just think “crazy people”, or even, more enlightenedly, “people with mental illnesses”. Health isn’t only a topic for sick people, and that’s just as true in the psychological as the somatic. — Siderea

I found this lesson in illustrating wheelchairs from someone who uses one rather illuminating.

Also: May the Fourth be with you!

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.

“Peaceful” and “relaxing”?

From today’s Between Friends comic by Sandra Bell-Lundy comes this exchange….

Maeve: How’s your walking regimen?
Susan: Actually, I’m enjoying it.
Susan: Every evening I walk around the neighborhood … it’s such a peaceful, relaxing way to end the day.
Maeve, shocked: “Peaceful” and “relaxing”?
Maeve, accusing: I thought you were trying to improve your health!!


Yes, starting a new exercise program can be hard.

Yes, some people are training for a competition or rebuilding after an injury or illness or surgery. That can be hard.

But it is possible to dance or play basketball or do yoga or walk around the neighborhood and finish relaxed and happy. And it’s still exercise. Even if you your BMI doesn’t automagically register as “normal”.

Maybe if we didn’t all expect that “exercise” is a universal experience with universal results this wouldn’t be so confusing.

The Fitness Question

Suppose you exercised three times a week. Suppose you got stronger.  Suppose your body were stronger and happier, you could lift more, walk further & faster, swim more.  Suppose you had less back or shoulder or knee pain. Suppose you were more relaxed, slept better, and got sick less.  Suppose all those things…but suppose you didn’t lose weight.

Would it be worth it to you to exercise if you didn’t lose weight?  If the only benefits you reaped would be the benefits of physical activity?

 

Where did you first encounter fat acceptance?

I first encountered research on

  • Diets only working short-term
  • Yo-yo dieting leading to weight gain
  • Eating well and exercising improving your health, even if you don’t lose weight

… in the pages of the 1980s BBW magazine, along with the general idea that you don’t have to be thin to live a happy life.  I even went to a BBW-magazine sponsored fashion show at the Seattle Bon Marche (since rebranded Macy’s) in 1990 or 1991 and got to meet the editor, Carole Shaw, who coined the term BBW.

It was also in 1990 I got my first job in software and discovered UseNet, including the alt.support.big-folks community.  It was through asb-f that I learned of:

(This may also lead you to believe that I’m over 40.  This is correct! :)

How about you?  When did you learn about fat acceptance?

Research on the Health Benefits of Moderate Exercise

From an article on “what’s the best exercise” comes a concise summary of the benefits of moderate exercise:

The health benefits of activity follow a breathtakingly steep curve. “The majority of the mortality-related benefits” from exercising are due to the first 30 minutes of exercise, said Timothy Church, M.D., who holds the John S. McIlhenny endowed chair in health wisdom at the Pennington Biomedical Research Center in Baton Rouge, La. A recent meta-analysis of studies about exercise and mortality showed that, in general, a sedentary person’s risk of dying prematurely from any cause plummeted by nearly 20 percent if he or she began brisk walking (or the equivalent) for 30 minutes five times a week. If he or she tripled that amount, for instance, to 90 minutes of exercise four or five times a week, his or her risk of premature death dropped by only another 4 percent.

Yeah.  If you don’t exercise at all, working up to 30 minutes of something (like walking) 5 times a week may very well reduce your risk of death.  Increasing beyond that?  Not so much.

This isn’t always what you read in the fitness / personal improvement press. Frequently exercise is presented as something that can’t be overdone, or as an obligation to improve one’s health, or to cause weight loss.  I disagree.  Yes, moderate exercise is generally good for health.  No, that does not mean it’s a requirement, or that doing more is necessarily better.  Period.

In my case,  I have found that if I do stomach crunches regularly, my back doesn’t hurt.  I do stomach crunches.  I’ve also found that squats and leg lifts prevent knee pain for me, so I do them.  Those things matter to me.  I know people who do other special exercises and stretches to avoid injury; others love a particular activity, be it swimming or tennis or triathlons or hiking or tai chi or yoga.  (I do yoga for fun m’self.)

People tend to assume that someone who does ultramarathons is healthier than someone who walks to work.   That isn’t necessarily so.  Stronger maybe, or faster on their feet, or more practiced.  But healthier?   You can’t know.  And that’s okay.

New HAES Study

Science is not a sacred cow. Science is a horse. Don’t worship it. Feed it.
— Aubrey Eben

The new Health At Every Size paper, by Linda Bacon and Lucy Aphramor, is titled Weight Science: Evaluating the Evidence for a Paradigm Shift.   From the abstract:

Current guidelines recommend that “overweight” and “obese” individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavior change. This approach reliably induces short term weight loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality. [...] A growing trans-disciplinary movement called Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a shift in focus to weight-neutral outcomes. [...]  This paper evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.

If it isn’t clear, this isn’t reporting new research: it’s reviewing and tying together existing research on HAES, and discussing why HAES is preferable than the traditional weight loss advice.   The introduction explains the basics of Health at Every Size and the research supporting it.

Several clinical trials comparing HAES to conventional obesity treatment have been conducted. Some investigations were conducted before the name “Health at Every Size” came into common usage; these earlier studies typically used the terms “non-diet” or “intuitive eating” and included an explicit focus on size acceptance (as opposed to weight loss or weight maintenance). [...] [Only randomized controlled trials (RTCs) and] studies with an explicit focus on size acceptance were included.

Evidence from these six RCTs indicates that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures (e.g. blood pressure, blood lipids), health behaviors (e.g. physical activity, eating disorder pathology) and psychosocial outcomes (e.g, mood, self-esteem, body image) [...] (See Table 1.) All studies indicate significant improvements in psychological and behavioral outcomes; improvements in self-esteem and eating behaviors were particularly noteworthy [...]. Four studies additionally measured metabolic risk factors and three of these studies indicated significant improvement in at least some of these parameters, including blood pressure and blood lipids [...]. No studies found adverse changes in any variables.

Clicking the “Table 1” link goes to a summary of studies from 1998 to 2009.   Many of us are familiar with “Bacon et al, 2005 and 2007“, which refers to the study Linda Bacon, Judith Stern, Nancy Keim and Marta Van Loan conducted to compare a standard diet program with a HAES program and its follow-up report.  It’s discussed in detail in Linda Bacon’s book Health At Every Size: The Surprising Truth About Your Weight and in a few articles.  The other studies primarily vary in what types of outcomes they measured.

The next major section details the assumptions people make about the weight-loss paradigm.  Each of these assumptions is discussed, with an eye to showing the actual evidence (or lack thereof). For example:

Assumption: The only way for overweight and obese people to improve health is to lose weight
Evidence: That weight loss will improve health over the long-term for obese people is, in fact, an untested hypothesis. One reason the hypothesis is untested is because no methods have proven to reduce weight long-term for a significant number of people. Also, while normal weight people have lower disease incidence than obese individuals, it is unknown if weight loss in individuals already obese reduces disease risk to the same level as that observed in those who were never obese [...].
As indicated by research conducted by one of the authors and many other investigators, most health indicators can be improved through changing health behaviors, regardless of whether weight is lost [...]. For example, lifestyle changes can reduce blood pressure, largely or completely independent of changes in body weight [...]. The same can be said for blood lipids [...]. Improvements in insulin sensitivity and blood lipids as a result of aerobic exercise training have been documented even in individuals who gained body fat during the intervention [...].

This is followed by a discussion of the support for using a HAES approach instead of a weigh-loss approach; the components of HAES (body acceptance, intuitive eating, and being active); and the ethics of using a HAES approach vs a weight-loss approach.  Naturally, being an academic paper, there’s an abstract, appendix, disclosures of conflicts of interest, etc.

Overall, the discussion I’ve seen of this paper seems to reflect people’s expectations.  The paper isn’t about HAES per se, it’s about how HAES is a better approach to improving health in fat people than prescribing weight loss (assuming, of course, that health improvements are desired).   The value of the paper for me is that it:

  • Summarizes the current state of HAES evidence, with bibliography. There isn’t just one study that supports HAES — multiple researchers have had similar results.
  • Argues the case for HAES in an organized fashion.
  • The full text of the paper is freely available on the web. You don’t have to get it from the library.
  • It helps show the current holes in the research.  There isn’t a randomized controlled trial comparing a diet approach vs a HAES approach in men, for example.  Most studies did not track physiological measures (e.g. blood pressure, blood lipids) in dieters vs the HAES participants.

The ethics discussion is also interesting.  Many doctors who are asked in the media about “If diets don’t work, what do you tell patients?” tend to come back with “Well, keep trying” or weight-loss surgery (as if that’s not a diet).   Linda Bacon and Lucy Aphramor argue outright that “the HAES paradigm shift may be required for professional ethical accountability.”

Further reading:

Also: NYTimes blog post on HAES and this paper.

Surgeon General: Dance for Fun

From a recent New York Times interview with the US Surgeon General, Dr Regina Benjamin:

My thought is that people should be healthy and be fit at whatever size they are.
[...]
I want exercise to be fun; don’t want it to be work. I don’t want it to be so routine that you’re bored with it. We used to jump rope a lot and double Dutch and went to a disco to have fun and enjoy ourselves. We didn’t go to the disco because somebody said, Go dance for 30 minutes. [...] I want us to get back to doing things because they’re fun.

She also gave up some of her MacArthur Award payments to take the job as Surgeon General.