I wrote a little counterpoint piece for Consider. (Up against the Senior Dietitian for the University of Michigan Health System’s Bariatric Surgery Program — hardly a fair fight!)
But you want to read something that truly blows this out of the water? Linda Bacon and Lucy Aphramor (two women who each have a large chunk of my heart — and please note that Lucy is a DIETITIAN. Yes, fat-accepting dietitians do exist; here’s another one) have just published a piece in BioMed Central’s Nutrition Journal — which means the full text is available to everyone.
Weight Science: Evaluating the Evidence for a Paradigm Shift.
Assumption: Anyone who is determined can lose weight and keep it off through appropriate diet and exercise.
Evidence: Long-term follow-up studies document that the majority of individuals regain virtually all of the weight that was lost during treatment, regardless of whether they maintain their diet or exercise program [5, 27]. Consider the Women’s Health Initiative, the largest and longest randomized, controlled dietary intervention clinical trial, designed to test the current recommendations. More than 20,000 women maintained a low-fat diet, reportedly reducing their calorie intake by an average of 360 calories per day [102] and significantly increasing their activity [103]. After almost eight years on this diet, there was almost no change in weight from starting point (a loss of 0.1 kg), and average waist circumference, which is a measure of abdominal fat, had increased (0.3 cm) [102].
Learn it. Know it. Live it.
And have an awesome weekend.
Comments
47 responses to “Fat / counterfat.”
I really, really need to find me a fat-accepting dietician. Mine just does NOT know how to deal with me. I said “Health at Every Size?” I got deer in the headlights in response.
Sigh.
Have a delightful weekend.
If you’re in the US and need an RD who might be HAES-friendly, go to the ADA website — http://www.eatright.org — and click “Find a Registered Dietitian” and then “Expertise Area” and click the check-box for Eating Disorders to find someone in your area.
You don’t have to have an eating disorder. But RDs trained in EDs will be much more likely to know about and promote HAES. Get a list of ED RDs, and do some telephoning/emailing to find out.
Gee I’m glad you’re posting again! I may have just made a fool of myself posting a negative comment about Ms Kraus’ article over there, but she made one comment I just couldn’t let slide: “There are many exclusively obesity-related co-morbidities, including diabetes, hypertension, sleep apnea, heart disease, joint pain, and acid reflux.”
WHAT?? Did I read that correctly? She really said that all those conditions are exclusively suffered by people who are obese? If she did then I am exhibit A for why she’s wrong (or deliberately trying to confuse the issue…) My father and I have both suffered from sleep apnea most of our adult lives. Mine is mild and his is severe. Right now at age 43 I’m the heaviest I’ve ever been. My father HAS NEVER, EVER BEEN FAT. He’s thinner now in his 70s than he was at my age. So why is his sleep apnea worse than mine? Can’t really say, but it’s not because he’s fat!! Sorry, but I have to call bullshit on the important dietician.
That IS weird! I didn’t notice until you pointed it out in your comment. Good catch.
Mine has a post-editing boo-boo, too, though, that I didn’t notice until it went up on the site. We’ll see who catches it first :)
OK, so it isn’t just me that found that statement questionable. I tried to give it the most generous interpretation I could, but it seemed pretty definitive. (I’m a writer/editor by trade, and since I’ve gotten interested in FA issues I read everything written about weight loss verrrry carefully now. )
Oh, I think I figured it out — she was saying that those conditions are exclusively linked to obesity and NOT to overweight. Unclear wording, but I’m fairly sure that was the meaning, since she was trying to draw the distinction between overweight and obese.
That is still illogical, Michelle, because people who are “healthy weight” and “underweight” by BMI experience those conditions (my late father, 5’10” down from 6’1″ and 130 pounds, had all of them except diabetes).
If what she meant to say was “The only group, by weight, with a statistically increased risk for those issues appears to be the ‘obese’ group” that is a very different thing from saying that those are “exclusively obesity-related co-morbidities”—presumably the same percentage of people who are “obese” are at risk for all of those issues as the percentage of people who are “healthy weight” and “underweight” who experience them.
Not saying that what you said is illogical, but saying that what Kraus said is both illogical and misleading. I know that it’s not always simple to express oneself 100% clearly in a brief piece, but I find that a pretty serious error on her part.
No, you’re right, it’s a serious misstatement. But I don’t think she actually believes that, is all.
I know I’m biased, but I can’t get past how fact-light Kraus’ article is. It’s just “well we all know being fat is gross and uncool, so you should eat fruit and coincidentally I’ll just fail to mention my own vested interests in bariatric surgery”.
And this line just makes me giggle: “But even those who undergo surgery must still change their lifestyle significantly.” Yep, that’ll happen when you surgically alter your digestive system and can literally no longer eat the foods/quantities you used to.
Enforced lifestyle change…yup.
Though, to be totally fair, I also have a “vested interest” in health at every size, since it’s my career.
This is true, but I guess for me the big difference is that someone trying to practise HAES doesn’t have to actually purchase services to do so – so while your career does involve people accepting/pursuing HAES, it’s not like you or any other practitioners of it stand there saying “you must do X Y and Z to be healthy and whaddaya know these things involve giving me / the diet industry money.”
That’s true. DIY gastric bypass…not really the way to go.
I read the two articles in Consider and Michelle, yours is BY FAR the better one–your arguments are much more nuanced, your opinions are well thought-out and your points hold much more water than hers. This “senior dietician” person simply trotted out every debunked cliche in the book. She should be ashamed of herself and to you I say: bravo! You need to write more of these articles. Your voice is priceless.
Wow. That first article is just one long game of Fat Fear Bingo. Fat is bad because it is bad, and only bad people get this bad fat through being lazy, ignorant, or just, you know, bad, and therefore will suck up all the health care and die anyway of things that no thin person ever, ever gets. Bad, bad fatties!
I think at least eighty-seven of my brain cells committed hari kiri attempting to process that drivel.
I think I shall now go eat a good breakfast at my favorite neighborhood bistro and enjoy my meal that will keep me fueled and happy for the next couple hours.
That’ll show ’em! Or at least feel good both physically and mentally.
Ahh….Michelle… thank you thank you thank you for the link to the Weight Science piece. This week I started an on-line nutrition class at my local community college and just one week into class discussions I already want to engage in a marathon session of beating my head against the keyboard. Some of the things other students come up with in the class discussions about “health” and “weight” are unspeakably absurd. I’ve been trying to figure out the right way to broach HAES in the class discussions, but definitely need some scientific meat behind my opinions. I’m going to thoroughly read that Weight Science piece so I have a gun in the holster so to speak. I’m in utter disbelief as to some of the things my classmates have said already – I don’t know how I’m going to get through this semester with my sanity intact…. my favorite comment from class to date: “If we would just make all junk food ridiculously expensive then I’m sure obesity rates would decline”. ?!?!? Yes… but perhaps the government could just illegalize junk food…. and if they do so help me God I will single handedly spear head the most awesome Junk Food Black Market you could ever imagine. I will become an illegal twinkie dealer…..
Try the bibliographies at ellynsatter.com, too. Good luck!
I just kept shaking my head reading the first article. How is it that she can point out huge areas of discrimination for fat people and then turn around say that the solution is for the PEOPLE TO LOSE WEIGHT! Truly this just made my head hurt. Right. . . if only those fatties would just get off their arses and lose weight then all this discrimination wouldn’t exist because we’d all live in a land of unicorns and rainbows and puppies.
i pretty much just had an entire session with my dietitian about this post and your philosophy in general and it was so awesome (slash lame, since we were both on the same side jsut vehemently agreeing with each other the whole time…) so i wanted to say thank you.
:)
Thanks so much for writing the Counter Point article! I read it your piece on Friday at work. In fact, I work at UM, and the UM Student Government folks posted the publication in the hallway outside their chambers! :)
I appreciated how you used solid science, current studies, and research to substantiate your arguments. More work needs to be done in this area- disseminating the facts in a clear manner- beyond the Internet. And this was a great way to reach THOUSANDS of college students in the midwest.
I found it interesting how the UM nutritionist based her claims on often-repeated, but rarely substantiated medical phrases. In fact, she herself did not provide the studies or the figures to support these general arguments!
Thank you for writing such a clear, intelligent, and scholarly piece for all readers! With more work like this, hopefully the message of HAES and fit+fat will continue to work its way into minds of folks in all walks of life! — Kris
Wow, thanks Kris! That’s very encouraging.
I wish people like her didn’t get so much publicity. It affects so much what I have to deal with at Planned Parenthood. I even ended up with a special note in my file about weight issues because I am “too stubborn” to face their “facts.” What makes it worse is they know I am healthy since they take my blood pressure and such often.
You MUST be healthy, because if someone was doing/saying that stuff to me, my blood pressure would go way up!
I never thought of eating like this. It really puts it in a new light. Thank you.
You rock, you rock, you rock. My Gods, the drivel the mainstream people put out! And this after a discussion I read on Medscape between psychiatrists talking about how impossible it is for people to lose weight when they are on anti-depressants (I can attest to this – I gained 20# on two different ones, and my weight, which had been stable for over 5 years, has now fundamentally changed so that my set-point appears permanently raised. Thank you, pharmaceutical industry, for off-label prescribing of SSRIs for pain!).
Fat is not the enemy. Bullies and fat-phobia are the enemy, and I recall being told to “change who you are, and people won’t bully you” in school (yes, I was actually told that by a teacher, it’s seared in my brain) and realizing at 9 years old what bullshit that was. “Lose weight, and people won’t discriminate against you!” is the exact same brand of bovine by-product.
My mother told me the same thing. She told me “people are mean to you because you’re fat. stop being fat and they’ll like you.” I was 10-11 years old.
I’m still recovering from that.
Wow, that’s awful. I’m sorry.
Hello! I’ve been lurking around for a bit. I just wanted to mention that the weight loss study that you brought up coincides a lot with mine (and probably most people’s experience) where you try to exercise and at first you do a bunch of sit-ups and it’s hard and then a week from then doing like 100+ is the easiest thing in the world and you get sick of counting to 100 because it’s boring … And I’ve been under the impression that the newfangled thing to do to avoid this effect is CrossFit, which is a hardcore exercise program that invents new and different exercises every day to try and trick your body into not getting used to anything. So, I was wondering if perhaps maybe you had access to any *data* regarding this sort of approach? Thanks! :)
I think the underlying message is not that one particular type of exercise gets boring, or a different exercise program is the answer — it’s that we need to question the motivation for exercise in the first place.
If you exercise — no matter whether you do CrossFit or 1,000 crunches or just jump around in your underwear in your bedroom to Abba — because you want to lose weight? Your motivation will not last. But if you exercise, in any way, shape, or form, because it feels good to you and makes you feel good and strong? You are far more likely to incorporate that into your life for the long term. This is what the studies have shown.
*is jumping around in her bedroom, in her underwear, to ABBA*
This is the best thing ever!
Got to tell two people in the medical establishment recently that my weight was not up for discussion. It felt fabulous!
OMG yes to this – I have tried several different types of exercise and always gave up after a while (and beat myself up for my lack of will-power), but the only one that has made the biggest difference to my actual fitness is when I took up horse-riding. I now have my pony on loan and I happily spend hours “exercising” without even noticing that I’m doing it (mucking out, riding, grooming, hefting heavy bales of straw and hay, poo-picking the fields) – it is all just pure fun because I love spending time at the yard and time with my pony!
All my life up til now, I had this belief that I was NOT an athletic person, and that my body wasn’t capable of doing these sporty things, and now I’m discovering that actually I’m not a bad rider, and I’m a very good horse-woman, despite the fact that I’m not naturally athletic! Taking up riding has given me a whole new way of thinking about my body and what it can DO as opposed to what it looks like, and that has been really powerful for me.
Julia, I think you’re referring to something called “Muscle Memory”. If you keep doing the same thing over and over, and never challenge your body, then it won’t “get better” per se… Once you master an exercise, your body is used to it. Crossfit is a very extreme example to always push your body and constantly challenge it.
I’m a musician (among other things), and to me, “muscle memory” is what happens when you practice something a lot and learn it well. Once you have muscle memory, the technical aspects of a piece become almost effortless and you can broaden your attention, concentrating on nuance and musicality.
To hear muscle memory referred to as if it’s a bad thing… that’s kind of funny. Getting good at something is a negative? Challenging yourself with new things is a good idea, but abandoning things as you master them? That won’t get you far in music, sports, or life.
Have you ever seen Debra’s Just Maintaining blog? Here’s the latest article from it: http://justmaintaining.com/2011/01/31/what-is-maintenance-and-why-i-like-my-%E2%80%9Cjob%E2%80%9D-metaphor/
She is one of those rare people (3%!) that has lost weight and kept it off and it is really, really difficult– I mean, reading this shows just how much work and (I’d say) obsession goes into her everyday life. I do love that she approaches her body from a FA perspective. But basically balancing her calories and exercise is a second job, and she is lucky to have the spoons to do this.
I happen to love Debra. She’s an old-time Big Fat Blog member from waaaay back, and she’s a wonderful person (and very much a FA believer.) But, yes, she exemplifies some of the difficulty that goes into maintaining a long-term weight loss.
It’s interesting, because my experience with weight loss was brief, but I was a Very Good Dieter. Meaning, I was good at losing weight, good at doing it “right” by all nutritional standards, and I never had much difficulty with the physical aspects of weight loss — never experienced a plateau, or a regain, etc. Never “cheated” on my diet (which is actually a bad sign, as far as potential eating disorders go — this sort of strict rigidity.) I cannot know for sure, of course, but I suspect that, with a lot of devotion, I could possibly have been one of those few people to maintain a significant weight loss for a long time.
The problem was, when I thought about it, it simply was not worth it to me to invest so much time and energy into it. Even though I was an enthusiastic dieter (and one of those annoying, If I can do it, you can too! people), by the time I’d lost 30 lbs. and saw a lifetime of “maintenance” stretching before me, the idea petrified me. Because I realized how many spoons I had, indeed, given to writing down all food I ate, counting the calories and the food groups up, tracking my water intake, and getting my specified number of units of exercise per day. It had, essentially, become my life. And though I wasn’t having problems with the weight loss itself — that part was steady and consistent — I was starting to feel the most strange dysphoria with my body.
I, in fact, felt worse about my body than I had at my highest weight, because I had become so obsessed with controlling it. And I realized that satisfaction with my body and my weight was a mirage that I would never actually reach by dieting — the closer I thought I was getting, the farther away the goal would actually get. That, in addition to the physical illness and injuries I was experiencing, was really what made me start questioning weight loss — even before I was really exposed to a HAES approach. How was I going to devote all the energy and obsession to maintaining my weight loss when it came time to have an actual job or go to school? (I was a newly-immigrated housewife out in the country at that point, and had a lot of time on my hands.) What I was seeking, by losing weight, was to like my body. Why was the exact opposite happening?
At that point, I serendipitously read about fat acceptance and the idea that it was, indeed, possibly to be happy and healthy at a higher weight. I decided I would rather be fat and self-accepting than thin and obsessed for the rest of my life. Ten years later, I have to say that I think it was a good choice. And even though my career is now in HAES and fat acceptance, I’ve also taken enough time away from these things to know that my own self-acceptance maintains itself with pretty minimal effort.
By practicing self-acceptance, I actually reached the goal I was trying to reach by losing weight. I may be 100 or more pounds away from where I thought happiness with my body would actually happen, but that is pretty irrelevant to me. Because the point, in the first place, was to be happy with my body, and I am.
“By practicing self-acceptance, I actually reached the goal I was trying to reach by losing weight. I may be 100 or more pounds away from where I thought happiness with my body would actually happen, but that is pretty irrelevant to me. Because the point, in the first place, was to be happy with my body, and I am.”
~~~~~
This, exactly! I sometimes think about how odd it is that I spent so much more time ‘feeling fat’ when I was about 125 pounds than I do now. ‘Feeling fat’ is how I identified the feeling at the time.. it’s no the correct use of ‘fat’.. it was that feeling of unhappiness with my body, wanting to ‘improve’, comparing myself to others, obsessing about the numbers, feeling inadequate, feeling like I could ruin it all if I put the wrong thing into my mouth.
I don’t feel that at all anymore. Well, maybe, like, 0.01% of the time, just enough to remind me. I feel like I wanted to feel when I thought being ‘skinny’ was the feeling. (I’m not. I’m probably close to 200 lbs.)
I realized a year or so ago that I don’t think I ever actually wanted to be skinny. What I wanted was clothes that fit me in styles that I like (as opposed to squeezing myself in a size smaller and obsessing over whether I looked ‘fat’ in this or that), the right to eat full, regular, ample meals and snacks, and … the freedom not to think about it much. And just.. freedom.
I have those things now. I didn’t when I weighed 125 and was desperate to weight 115. The irony is quite mindboggling.
I was hoping you could answer me a couple of questions that have been bothering me greatly and hindering my own self-acceptance. Somehow I’ve been able to get beyond the number weight-wise and am not too bothered about what the scale says. But it’s been replaced by a nagging worry about my waist size and “all the studies” that say you should keep your waist size below 30/31/31.5/32 inches (it varies!) or something horrid will happen to you. How can I get past that? Also, saying it is better to be fat and fit than thin and sedentary is fine, but my problem is that I have CFIDS (now mild thankfully after 13 years) and exercise in any conventional sense of the word is thin on the ground. I get a half-hour walk every other day, but it isn’t brisk. (I try to get out daily but it’s coming in at every other day currently.) I do manage some housework, so that’s standing, bending, lifting, up and down the stairs quite a few times a day. I try to do some stretches to keep supple. But I feel frantic that I’m not doing enough, never will be able to do enough (wipes me out for days if I overdo things) and that if I stop food-restricting I’ll not be thin and sedentary (not that I’m that thin right now), but fat and sedentary. I look at HAES websites but they make me feel worse. Thanks for all your posts, btw.
This is hard stuff to deal with, but it’s important to assess risks accurately and in the context of one’s own individual experience, instead of blowing them out of proportion into universal rules that MUST BE OBEYED OR YOU WILL EXPLODE.
Your waist size being larger than whatever the determined “ideal” is…well, I truly think it does not matter much. Trying to achieve that ideal waist size is much more likely to hurt you, in my opinion. And here’s where the risk assessment comes in: the fact that a larger waist brings with it increased risk is, well, probably not all that relevant to the individual, definitely not without taking into account other health factors. It’s not a diagnosis of ANYTHING. This is a more epidemiological measure of risk, population-wide, and as such it is also not a proven CAUSAL relationship. There is a proposed mechanism for why abdominal fat could increase risks, yes, but nothing is carved in stone. There could be any number of reasons for why this association with risk appears, and a lot of them are out of your hands. And, given a rich, mostly-healthy population, the “risks” that these measurements define and surprisingly miniscule. You could be scaring yourself for not taking on a burdensome risk-reducing measure that, in raw terms, only has the ability to reduce a risk from 2 deaths in 10,000 people to 1 death in 10,000 people (for example.) Is it worth it?
The best thing you can do is stop scaring yourself. You are okay. Nothing horrid is going to happen to you because you do not meet an arbitrary epidemiological ideal, or an arbitrarily set exercise requirement. You are a unique individual with unique health conditions and unique life circumstances that impact all of this stuff.
Stop reading all that health stuff. Seriously — stop it. It is hurting you, and it doesn’t much apply to you anyway. Focus on taking care of yourself in a kind way, not on punishing yourself for not meeting ideals and standards that do not take your unique experience into account.
The way the standards are set, and the way health is defined at present, pretty much ensures most people will never be able to do “enough” to meet them. That is why they’re messed up at their foundation, and that is why I write this website — because the end result is that people hurt themselves, like you are, in the attempt.
Nothing matters more for you than how you feel in your body. If a certain exercise hurts you mentally or physically, stop it. It is not good for you — in fact, it is probably worse for you than being sedentary. If food restriction leaves you feeling deprived or food-crazy, STOP IT. Don’t do what doesn’t feel good, both in the immediate AND the intermediate term.
Until you get those things under control, you can’t and shouldn’t begin to fret about long-term risks. If and when you finally do get to the point where it’s more appropriate to consider them, there is a certain amount of uncertainty and, frankly, lack of control we must all accept and negotiate. Every risk-reducing measure you can take has a cost-benefit analysis that comes with it. And, for a lot of those measures and for a lot of people, the miniscule risk-reducing benefits are not going to justify the costs. And, even if you were to take ALL risk-reducing measures possible, they are not guarantees of good health. Neither is NOT taking those measures a death sentence.
You’re an angel. Seriously. Thank you so much for replying. You just helped me see I’m doing here what I do with a lot of other health related stuff (ie google it a whole lot and scare myself witless) – I honestly never realised till now. No more. “Don’t do what doesn’t feel good” – such common-sense good advice, and it’s my new mantra.
Aww, you are very, very welcome.
Yet another great post, Michelle.
I was wondering if you had read the chapter on Susan Kano (page 107), in a book called ‘Full Lives’, by Lindsey Hall. If you’re interested, that entire chapter is available to read on http://booksgoogle.com. It is basically about how Susan Kano let go of obsessive dieting, as well as her struggle to accept the 30 pound weight gain that went with it. When I read that chapter, it really opened my eyes and helped me move a much needed step closer to a fat acceptance/HAES way of thinking.
No, I haven’t, but I will definitely check it out. Susan Kano is a familiar name to me. Thanks!
Nothing much to contribute to the discussion, just wanted to mention how much I appreciate intellectually rigorous women like you, Kate Harding, Lesley Kinzel, etc. I’m turning 44 this month, and it’s such a pleasure/relief not to feel at war with my body the way I did when I was younger.
Michelle mentioned Big Fat Blog above. I’m going to out in a shameless plug for it, if it’s okay with her. It was slow for a long time after Paul retired, but I’m an administrator now (along with a Carrie and a couple of other people) and we’re trying to get it moving again by making regular front page posts. It’s been getting kind of academic over there lately, which seems like a good niche to fill. However, we’re still commenting on media coverage and making general observations as well. Members can get their posts onto the front page if they’re interested, so it’s a great place if you want to publish an occasional fat acceptance piece but don’t want to start a blog focusing on it. I know that a lot of people probably haven’t noticed that it’s been more active lately, but I hope that people who used to be active will consider coming back and that new people will join as well.
Yes, by all means, plug away. I’ve been meaning to write something about Lonie’s posts at BFB (I did read them when they first came out) but this week has been too busy for blogging.
This weblog is being featured in Five Star Friday – http://www.schmutzie.com/fivestarfriday/2011/2/3/five-star-fridays-136th-edition-is-brought-to-you-by-rudyard.html
Thank you! Sometimes I feel like a zombie bitten by the weight-obsession virus, and I keep fighting the voices in my head that tell me to shrink.