Afternoon Inquisition 9.14

aka: My Big Fat Skepchickal Dillema

I would like to lose 35 pounds. I know you can’t tell it from my avatar, but I’m not actually thin. According to my BMI, I’m borderline obese. Frankly, that’s a crock. I’m chubby, not fat. My weight has been stable for almost a decade, so you’d think I’d be used to it by now. But I still worry about my health, and to be honest, I liked the way I looked better when I was thin. (Of course, I was also 20 years younger at the time, so that could contribute to looking better.)

My question for the day is: Should we accept being fat as normal and even healthy?

There’s a movement of “fat acceptance” going around (believe it or not, there is a National Association to Advance Fat Acceptance), in reaction to alleged discrimination against fat people. The movement says that being fat is not unhealthy. Read the info below the fold and then weigh in with your opinion.

Here’s a quote from an interview with plus-size model, Velvet D’Amour:

The general reason one gets as to why there is not more representation of curvier folks within modern media is that inclusion would be equivalent to acceptance, and acceptance would then equal condoning, which would mean they support alleged ill health. The odd dichotomy is that whilst people like myself are banned due to the purported notion we will somehow ‘promote’ being unhealthy, we are besieged with media saturated with imagery of Britney Spears, Nicole Richie, Paris Hilton, Kate Moss and Lindsay Lohan. How these women represent good health is somewhat beyond me.

Fat is so much where it’s at that a couple of very popular knitting books full of patterns for “big girls” have come out over the past couple of years.

More Big Girl Knits cover

Big Girl Knits features twenty-five unique patterns for women size 14 and up. From flattering pullovers and sexy tees to sleek skirts and fun accessories, this book is overflowing with options for knitting up an entire wardrobe to compliment your shapely shape.

Part knitting instruction, part fashion guide, Big Girl Knits is packed with expert advice to help you make the most of the three Bs: Boobs, Belly, and Butt. All the garments and accessories featured in the book are proportioned to fit and flatter a big girl’s body.

I don’t eat fast food or drink soda; I walk three miles most mornings; in good months do additional exercise three days a week. My blood pressure and cholesterol are normal. But I don’t want to have to think of myself as plus size or a big girl.

I certainly don’t hate fat people (except, sometimes, my chubby self), nor do I think the overweight should be discriminated against. But I don’t want to accept being fat, I want to get off my fat ass and lose 35 pounds. I can’t help thinking that the idea that being fat is normal and healthy is just stupid. What do you think?


Donna Druchunas is a freelance technical writer and editor and a knitwear designer. When she's not working, she blogs, studies Lithuanian, reads science and sci-fi books, mouths off on atheist forums, and checks her email every three minutes. (She does that when she's working, too.) Although she loves to chat, she can't keep an IM program open or she'd never get anything else done.

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  1. I have to say, after reading many excellent scientific books and blogs on the issue, most notably Rethinking Thin by Gina Kolata and the evidence seems to support the idea that regular exercise and healthy diet are much more important than actual weight in determining health. For many people exercising and eating well will cause them to lose some weight, but based on twin studies and adoption studies for most people their weight is genetically determined to around a 30pound / 14 (or so) kilo window. In fact it is equally difficult for naturally skinny people to gain weight as it is for naturally heavy people to lose weight. Alot of the popular media’s discussion of weight problems has the tone of a moral panic, like that surrounding alcohol before prohibition or marijuana in much of the twentieth century. That alone should make us especially skeptical. I encourage people to critically look at the two sources I mentioned and others before coming to a conclusion.

    PS: you posted this in the morning not afternoon, doh. I guess I will be the only commenter for awhile.

  2. You know what that means?

    We’re about to come into the Prohibition of the Scales. Either that or we’re going to outlaw Kilos and Pounds, and Stone…

  3. Actually, this is a subject close to my fat-clogged heart.

    While I do not think that anyone should be discriminated against for being overweight, I do not think it should be considered normal or healthy. Because it isn’t.

    I have been thin, and I have been obese. And I have been both fat and out of shape, and fat and in shape.

    The fact of the matter is that carrying an excess of 20% of one’s weight as adipose trissue is extremely unhealthy. It makes it difficult to move, it makes one more susceptible to diseases like diabetes, cancer, and various forms of cardio-pulmonary disease, and joint problems.

    I do like the idea of acceptance as far as not being cruel to the fat. Cos from personal experience, I know it only exacerbates the problem. But being fat is not something that it is safe or healthy to be. –And I speak as a fit fat man, who is able to clean and press more than half his weight, and is a fair martial artist.

    My best mate and I have actually done a website that addresses this, and other, issues. It’s (Yeah, I know; It’s a bit of a shameless plug– But don’t we all here want to get our health and fitness information from a rational, skeptical source?).

  4. I believe that there are very few naturally (genetically) fat people. In America, obesity levels are significantly higher than they were fifty years ago, or even twenty years ago. The genetic makeup of the populace has not changed that much that quickly, but rather, their eating and exercise habits have. People eat significantly more fattening foods, and get significantly less exercise. In places where people either eat less, or exercise more, you do not see the same incidence of obesity. Most of Europe and all of the developed Asian countries have drastically lower obesity rates than America. Certainly, not all of this is attributable to genetic factors.

    My personal view is that unless you have a serious medical condition, there is no reason or excuse for you to be obese. If you are, then either:

    A: You aren’t exercising enough


    B: You are eating more than you need to.

    Or both. You either need to burn more calories or take in less, or combine the two. I used to weigh 203lbs. I am not a very large or tall man, so the extra fat really stood out. Other people noticed how chubby I had become. Eventually I decided that enough was enough. I started walking about 4-6 miles every day, and also started performing some basic aerobic workouts every day. I also examined my eating habits. I cut back drastically on my candy and coke intake. Instead of three slices of pizza with a glass of coke, I took one piece with some salad and a glass of water. When I walked by a package of donuts, I kept going without taking one, even if I wanted to very badly. The result is that now weigh 165lbs, and have kept it that way for years now.

    So no, I say we should not accept being fat as being normal or healthy, because it is not normal for someone who is eating normally (i.e., taking in only enough food to properly support their body’s needs). Nor should it be accepted as healthy, because it isn’t. Sometimes you may find a fat person that is healthy, but that does not invalidate all of the evidence that links obesity to increased risk for heart disease, diabetes, stroke, high blood pressure, and even cancer. And even if those things don’t happen to you, the extra weight is still very hard on the bones, you could end up getting osteoarthritis.

  5. Hi, I’m a member of the fat acceptance movement and a follower of the FA blogopshere.

    The point of the FA movement is not to say that “all fat is healthy,” but instead to argue that being thin is not necessarily the only way to be healthy, which is generally the implication in the mainstream media. Many fat activists also hope to change the general dichotomy where “fat” is immoral and “thin” is moral, and to promote Health at Every Size and intuitive eating, where there are no “good” foods and no “bad” foods, and where you shouldn’t feel bad for eating a cupcake sometimes.

    What we also want to do is promote the idea that fat people are not ALL FAT because they eat too much and they don’t get enough exercise. Some people are Just Fat. Some people are fat because of health issues that aren’t related to diet. Some people are fat because of issues related to exercise. Not all fat people are fat because all they do is eat chips and candy and sit on the couch.

    The reason I’m a part of the movement is because I’m a fat kid who has been told, in no uncertain terms, all my life, that I am not worth as much fat as I would be thin. My mom would think I was so much prettier if I was thin. Boys would like me. My career would be so much easier (someone once told me it would be easier for me to go into radio – I want to be a broadcast news anchor). My clothing companies tell me there is a Right Kind of fat that I don’t fit into because my body is shaped funny. Every other clothing company I WANT to shop at tells me I’m not welcome there because they don’t sell things that come in my size, or that I’m not worth good quality clothing or stylish cuts and fabrics. These are also issues the Fat Acceptance movement deals with.

    So I want to help spread the word. Sometimes fat people are just fat, and nobody should feel bad about being fat, and everyone should have access to healthy foods and fresh fruits and vegetables (socioeconomic status is also an issue when it comes to fat activism, as the less income you have, the harder it is to eat healthy). Fat Activism is helping me overcome my eating disorder and helping me stop hating myself because I’m fat. I don’t think any fat activist would automatically tell me that I’m healthy – I’m not – but it’s nice to have a place where the other issues with my health are acknowledge as Legitimate Issues, and not something that would all be solved if I lost thirty or forty pounds (my last GP usually insisted this was the case – I have celiac sprue and bipolar disorder, neither of which are related to weight).

    I’m just tired of being told that being fat is the problem I have instead of acknowledging there are other issues at hand.

    Here are some of my favorite FA blogs for the curious:

    Shapely Prose
    Big Fat Blog
    Big Fat Deal

    Not specifically FA, but tangentally related:
    Junk Food Science

    There’s a lot to the movement outside NAAFA and the “omg they don’t want anyone to think fat people are unhealthy!” idea (which isn’t true, btw, we just want people to stop assuming all fat is bad, and that all unhealthy fat is directly related to eating too much/never exercising). So hopefully these links can help. There’s also an aggregate feed, Notes from the Fatosphere … I read it on google reader, I’m not really sure how to link to the aggregate. It comes up on google. :x


  6. Also, here’s info for the Health at Every Size movement. Like I said, it’s about helping people how to learn to eat what their body’s telling them to eat – by learning that the reason I crave potato chips a million times a day is because I want starches, and eating something starchy that isn’t a potato chip instead, like a good rice pasta dish, which will fill me up and get to the root of the problem better than not-so-healthy chips. And then if I’m still hungry maybe having a couple potato chips too.

    It basically just wants to teach people to learn how to feed themselves properly, and to encourage “joyful exercise” – fun forms of movement because you WANT to move, and not because you feel guilty about eating any potato chips and absolutely must get to the gym right that second to walk them off. Joyful exercise can be all kinds of things – taking a walk around the neighborhood, riding your bike to the store, playing DDR for ages, playing badminton or soccer with your kids or nieces or nephews. People used to get out for “fun” exercise a lot more before we started with the whole 9-5 life-sucking desk job thing, so the Health at Every Size movement is encouraging people to get back to that instead of/in addition to just going to the gym to do the same stuff all the time by yourself.

    Health at Every Size

  7. @LunarDelta:
    i disagree with the idea that few people are genetically predisposed to be fat. The selective pressure on our ancestors to retain fat was very high. It is only in our current environment where high fat foods are so cheap that we observe the underlying genetic makeup. Being fat is a byproduct of our evolutionary history that is most evident in high food environments.
    However, our weight does not have to be determined by our genetic makeup.
    I don’t think people care overly about weight in the majority of cases. I think that people care mostly about a person’s health and they use weight to estimate it.
    So blame evolution while remaining healthy.

  8. When I said “I believe that there are very few naturally (genetically) fat people”, I meant that if all other factors are optimal (such as food intake and level of activity), there are very few people that are “just fat”. A lot of people like to use the genetics excuse as a cover for own bad habits and lack of self-control, and I don’t buy it, not for a second.

    A person that is otherwise healthy, eats normally, and gets a good amount of exercise, should never put on weight or remain obese.

  9. The problem, as I see it, is that, regarding food, our bodies are at war with our minds. Our bodies don’t say, “Oh, I only get x hours of exercise a day, so I only can eat one twinkie”, they say, “I don’t know where my next meal will come from, so I better stock up…”. As LunarDelta pointed out, other countries have a lower incidence of obesity – why? not because of genetics or better “willpower”, but because of logistics and supply. Food is not as readily available (no McD on every corner) and they have to exercise more to get around. A recent study showed that people in cities were healthier than people who lived in the country for this very reason. So the best solution for weight loss is to move somewhere that requires a lifestyle change. If that is not possible, then you are faced with a rigid diet/exercise regimen (walk 4-6 miles a day – I wish I had the time!). That being said – the people that love you will love you regardless of your weight and us Skepchick fans will still tune in! Take some time to find out what you really want and put a plan into action – get support whever you can (even from these humble comments).

  10. I agree with Zambiglione. Junkfoodscience is a great blog. I think Sandi does a great job avoiding logical fallacies and always has links to her raw data.

  11. @rationalista: Or instead of worrying about the 4-6 mile walk (or in my case, run, cuz I just do that), one could do 1 to 2 miles, or just do the simple things like dietary changes (which shouldn’t take up that much more of a person’s time, when it comes to fast food, choose Subway over McD’s and select from their under 5grams of fat menu) park further away from the store/place of work/etc. forcing oneself to walk further to get where they are going, take the stairs instead of the elevator/escalator etc. It won’t necessarily cause as dramatic of a weight loss as a daily 4-6 mile walk but every bit helps.

  12. @LunarDelta:

    I used to weigh 203lbs. I am not a very large or tall man, so the extra fat really stood out. Other people noticed how chubby I had become. Eventually I decided that enough was enough. I started walking about 4-6 miles every day, and also started performing some basic aerobic workouts every day. I also examined my eating habits. I cut back drastically on my candy and coke intake. Instead of three slices of pizza with a glass of coke, I took one piece with some salad and a glass of water. When I walked by a package of donuts, I kept going without taking one, even if I wanted to very badly. The result is that now weigh 165lbs, and have kept it that way for years now.

    Did something similar myself. I was up around 210, I’m nearly 6ft tall, so it wasn’t nearly as noticeable, but not completely hidden either. I just started running lots (2mi on days I’d weight lift, between 3-6mi on days I didn’t, except saturdays when I’d do interval runs, and sundays when I do my long distance run which is typically about 7miles but can be up to 10), lifting weights and making serious changes to my diet. I stopped drinking coke and pepsi both because of the issue of weight and also because it is bad for your teeth. I get at least 3 servings of dairy a day (this, according to my research, helps in weight loss) and just an all around change in everything else. I currently am at 175ish, which is good.

  13. I have a hard time swallowing that “fat is where it’s at”. There aren’t any girls busting down the doors at White Castle because their jeans don’t make their butts look big enough.

    Getting fat is not healthy, but you’re not going to run into any size 6 women in the buffet line loading up their plates with extra bacon bits because they just bought a new size 18 dress that they need to fill out before their high school reunion next month. There’s still more than a healthy amount of pressure to get thin.

    But the reality is that once you are already fat, chances are there’s not a whole lot you can do about it. Diets don’t work. Pretty much everyone who loses the weight they want to lose, gain in back again (often with a few extra pounds). And yo-yo dieting is more dangerous than being fat.

    Whatever size you are, the healthiest thing you can do is accept whatever size you are. Don’t start a diet and exercise program that you’re probably not going to be able to stick with.

    As for plus-size clothing, I’m a big girl, a size 18 (sometimes even a 20). I need clothes. I don’t want to wear mu-mus with sequins and glitter. I don’t want to wear sweatshirts with plaid cats stitched onto them. I want to wear clothes that make me feel attractive. Because, you know what? I am attractive. I am incredibly grateful that there are stores out there like Lane Bryant. I don’t think having nice clothes that fit is too much to ask.

    No amount of ugly grandma clothes is going to shame me enough or make me feel stupid enough about being fat to make me lose 100 lbs.

  14. “…but because of logistics and supply.”

    Personally, I think it goes even deeper than that. Logistics and supply may be part of the reason, and exercise too, but I believe a primary factor in why the thinner countries are so is because the people living there have a much healthier relationship with food and eating than people in the U.S. or other countries with obesity problems. People tend to eat much smaller portions, and much more slowly. Food is seen as something to be enjoyed and savored. People here, on the other hand, tend to scarf down large amounts of food very quickly, before they even realize they are full. A lot of people develop bad habits, such as always eating at specific times, or when their favorite TV shows come on, even if they aren’t actually hungry. Many people also tend to view food as something that is bad or forbidden, which leads to cravings and ultimately to a distorted perception of, and behavior toward, food and eating.

    The truth is that you can eat anything you want, as long as you only do it when you’re hungry, and eat slowly enough to realize when you are full. This is the primary concept behind intuitive eating. The people in thin countries seem to have a good grasp on this. The same can’t be said for many in the U.S.

  15. I don’t think being overweight is healthy. It will shorten your lifespan. Anorexia and bulimian aren’t healthy either. As several other people have said the biggest thing is to eat a balanced and healthy diet and exercise regularly. If you are really doing this you will end up losing weight to a much healthier you. Part of the problem is looking at your lifestyle and honestly seeing what you do. I drink way to much, don’t exercise at all my eating is spotty at best. I know that to get back down to the 190 to 200 pounds that is healthy for me means I need to drink a lot, lot less, etc.

  16. I don’t think that weight is the issue with health. Yes, obviously there are the studies that show that blood pressure and cholesterol are more powerful predictors of cardiac events, but that’s not what I’m talking about.

    The issue is how fat people see themselves. I swear, it’s almost like they think they are the domestic pets of anyone they (the fat, ugly, etc) people) deem to be more worthy. Well, good god, that preemptive strike against sharing would cause anyone to become spiteful and self piteous.

    I’m sorry, if you are fat and going to be fat then you just get over it. You’re apart of our societies and groups just as much as anyone else. I know – you look at the norms and feel rejected; frell that. It isn’t supposed to be easy, but it is possible. Stop being pleasant and start being who you are.

    And, if you are trying to loose weight, make sure you’re loosing it for the right reasons. Make sure you’re loosing it for you. If you don’t, you’ll continue to have the same problems being alienated from your culture as you’ve always had. But stairs will be easier.

  17. I think the tricky part in all of this is defining ‘fat’ and ‘healthy’ – the BMI is a pretty lousy indication of who’s overweight and who isn’t, but it gets used a lot ’cause there doesn’t seem to be anything better.

    There are all types of body shapes and metabolisms – some people are predisposed to being really thin, some to being bigger. But there’s a limit on both ends (I’d bet it’s bell-shaped).

    Yes, as long as you’re ‘healthy’ then it’s okay to be ‘fat’. What’s healthy?

    Being heavier than you need to be stresses all of your body systems. It’s harder on the joints, harder on the lungs, harder on the heart, harder on everything. For the sake of your bones, circulation, etc., you should be light as possible.

    I feel like I’m rambling here, and I’m trying not to, so I’ll come to my point. Most people who I know who are (what society would call) overweight are not (what society would call) healthy. I’m definitely overweight (5’8″, 200 lbs), but other than being inflexible, I’m in great shape (good strength, good stamia). Most people whom I know who are ‘fat’ are not.

    Be in good shape, first – there shouldn’t be any activity you want to do that your level of (changeable) health prevents you from doing.

    As for Fat Acceptance – good luck with that. I’d also like to see Short Acceptance, Bald Acceptance… and probably some others as well.

  18. @Zoltan:

    I think the tricky part in all of this is defining ‘fat’ and ‘healthy’ – the BMI is a pretty lousy indication of who’s overweight and who isn’t, but it gets used a lot ’cause there doesn’t seem to be anything better.

    That simply is not true. There are actually better methods, they are just often either more difficult to do, or more intrusive, and are still problematic.

  19. so many things to say on this topic… but anyway, my understanding of the fat acceptance movement isn’t to say that every fat person is healthy. It isn’t to say that if you’re fatter than you want to be, you’re automatically the healthiest you could possibly be. Instead, it’s that you don’t have to be thin to be healthy.

    Also, BMI sucks and is used far out of proportion to its usefulness- if you exercise a lot, gain muscle you could end up going from the normal to overweight category(for instance) which doesn’t make sense at all.

    The other important part of the movement, is, as someone pointed out in a previous comment, that fat shouldn’t be seen as immoral while thin is moral, that if the first thing you say/think of when discussing a fat person is OMG so unhealthy!! then that’s missing the point-and you have no idea how much exercise that person does, how they eat etc.

    Also, ideas that fat=unhealthy and thin=healthy can be problematic because sometimes rapid weight loss indicates a serious medical problem which can sometimes be overlooked. If that’s the case, the patient really doesn’t need to be told how wonderful they look for losing weight. Plus, some medications allow people to live active, happy lives not in pain but could cause them to gain 30 pounds. Should they be in pain all their life so they can fit our standards of beauty?

    One thing that’s also really important is disability and class issues. If someone’s disabled, well maybe they can’t exercise enough to make them acceptable to society’s beauty standards-and they sure as hell shouldn’t beat themselves up over it even if society wants them to.

    Also, I hate the argument that goes like “but people weren’t obese in the past! So everyone should magically get thin or they’re just making excuses!” Our society has changed so much in so many ways that it really doesn’t make sense to judge people today by 100 years ago standards. Is it really feasible or desirable for everyone to start living like the Amish so that they can look thinner? And as far as class issues-what if someone can’t afford a treadmill, and can’t casually go running near their house/apartment because it’s too dangerous or there are no good walking paths? What about, say, a single mother working or spending time with her kids all day who doesn’t have time to exercise or prepare healthy meals? It doesn’t help that in America, the cheapest and easiest food to eat is also the most fattening and unhealthy. I would invite anyone who thinks all fat people should “just” lose weight to investigate their own privilege a little and consider that they may have substantial exercise options, in terms of time and places to go, as well as money, time and education to eat healthy food and that those can be contributors to weight. That, and when you see a fat person you have no idea of their individual circumstance.

  20. I doubt everyone is “supposed” to look exactly like little Leonardos, but I also doubt that overweight people were more likely to survive on the African savannah. From my (admittedly limited) knowledge of medical consensus, a moderate weight is considered healthy. While in society at large there may be a pathological ideal of anorexia, especially in the modeling and acting communities, this push to accept “big” as healthy stinks to me of “postmodernist” relativism.

  21. @covertvector: Depends on what her goals are. very few if anyone is saying that being what is generally considered fat to be necessarily unhealthy, but for those who are trying to lose weight, eating less and exercising more is going to be their best option.

  22. So, Cheryl Haworth just needs to eat less and exercise more, right?

    No, but I probably do. Whoever mentioned that living in different places and having different lifestyles makes a difference is right. I lost 10 pounds in Europe this summer, and I ate out almost every day, including eating a lot of ice cream. I guess it’s because I walked even more than normal and the meals in restaurants are so much smaller than what’s served here and there’s that American thing about cleaning your plate….

  23. @writerdd: I had a similar experience while in Israel. It wasn’t quite the major weight loss that you had (I think it was only 4 or 5 pounds) but then I was already getting pretty skinny at that time.

  24. To a certain extent, your weight should be what you are satisfied with and what you can maintain. There have been a lot of comments on both sides that make sense and are probably “factual”. Genetics plays a definite role. I’m blessed/cursed with a genetic makeup that allows me to be obese to even borderline morbidly obese and still have a healthy vitals such as blood pressure, cholesterol, heart health, etc. You can see this in the last several generations in my family. But as we get older, the extra weight is hard on the joints and bones, and that is where we run into problems. I’ve lost weight over the last few years going from well into morbidly obese to borderline overweight/obese based on BMI (which as several have pointed out means little overall). For me, this was a necessity if I don’t want a lot of artificial parts in the next decade. While being “fat” may not have been an evolutionary advantage, having a slow metabolism and being able to store energy efficiently definitely was. Unfortunately, we, particularly in the U.S., have an easy access to the worst kind of food at bargain prices. It is somewhat expensive and time consuming to eat really healthy meals all the time. But it can be done.

    Also, as a male, it was easier for me to “pass” being obese than it is for a lot of women. Sad but a fact. Men and women are both more critical of women who are “overweight”. I never found very thin people attractive or healthy-looking. Some of my friends who were really thin accomplished it with lots of cigarettes and coffee. Some of them are no longer around. Thin does not equal healthy.

    So as they say, “do what you will”. Stick-thin may not be healthy. Round and plus-size may be. You have to be where you feel comfortable and happy. That’s the bottom line.

  25. I doubt most Americans even realize how many calories they actually take in during a day, or how much excercise they actually get. So I think writerdd the question is do you feel healthy? I come from the opposite side of the same coin. At 5’5″ and 135lbs I am not the average size of most men, but I am healthy.

    If a person is big and does not get regular exercise and has problems whenever moderate exercise comes up, then that person should be concerned. From what you wrote originally that doesn’t sound like you. Not all big or small people are unhealthy.

  26. There’s a big difference between “obese” and “not thin”. If you are 100 pounds overweight, you have a medical problem, and for sure you’re at greater risk of heart attack, diabetes, you name it. If you are 15 pounds heavier than you think you should be, it’s probably not going to do you any harm – the problem isn’t medical, it’s cultural.

    I’m all in favour of healthy eating and exercise, and writerdd, I am there with you. But like PopeCayote said, healthy lifestyle does not necessarily equal rail-thin supermodel.

    @Covertvector, that photo gallery is an awesome example of how different our body types are and how useless BMI is in individuals. Two out of those seven elite athletes would be obese on the BMI scale, and I think at least the marathoner would be underweight.

  27. To all those advocating Sandy Szwarc’s Junkfood Science blog, please read Mark Hoofnagle’s criticisms of her here: He claims she is an obesity denialist crank. He is not the only one who levies this criticism.

    As for the healthiness of obesity, Mark H. had some great pearls of wisdom in one of his comments:

    Ugg, it’s the same crankery as always about diet.

    Yes, people selling diets are totally full of shit. Yes, most people don’t lose weight. Yes, in studies (usually with obesity as a secondary focus) obesity doesn’t appear to affect mortality.

    However, as we’ve said time and again, it’s about primary vs secondary prevention. Obesity is unhealthy but the negative effects can be largely managed with good medical care. The problem? Not everyone gets good medical care or can afford it, the drugs are expensive, not everyone is compliant, etc. It’s better to just avoid the high blood pressure, diabetes etc in the first place by not gaining too much weight. It is questionable whether it’s worth any great effort to convince the overweight to lose weight as a physician. It is far more important to control the morbidities of obesity rather than trying to convince the overweight to constantly torture themselves with diets.

    Bottom line, obesity does lead to ill health effects, but don’t kill yourself with diet. There are other treatments.

    I would suggest reading Barry Glassner’s The Gospel of Food (as featured on The Skeptics Guide). Here are a few money quotes by Micheal Shermer in his essay “Eat Drink and Be Merry”:

    Glassner quotes the former editor of the New England Journal of Medicine, Marcia Angell: “Although we would all like to believe that changes in diet or lifestyle can greatly improve our health, the likelihood is that, with a few exceptions such as smoking cessation, many if not most such changes will produce only small effects. And the effects may not be consistent. A diet that is harmful to one person may be consumed with impunity by another.”

    And my favorite quote:

    We have wrongly embraced what Glassner calls “the gospel of naught,” the view that “the worth of a meal lies principally in what it lacks. The less sugar, salt, fat, calories, carbs, preservatives, additives, or other suspect stuff, the better the meal.” The science behind this culinary religion, Glassner says, is close to naught.

  28. As a physician, I think embracing obesity is a crock.

    It’s not about the cosmetics people. Those who are socially against people who are heavy are no better than those who express disdain based on color, race, creed, etc etc etc.

    But there should be bias against visceral fat.

    BMI is not my favorite indicator. If one is in the gym and is muscular, often BMI fails to tell the story.

    Visceral fat is that fat around your organs ( apple, not a pear , people ). It acts as an endocrine organ unlike subcutaneous fat ( which carries the marketing, fake ,of cellulite – which is benign ). Visceral fat secretes resistin, inflammatory cytokines such as the interleukins, free fatty acids, arthrinogen, and a TPA inhibitor. Respectively, these are contributors to the pathophysiology leading to hypertension, beta cell death in diabetes, insulin resistance in diabetes, hypertension again, and heart attack. This is a pertial list of bad stuff.

    The best measure of visceral fat is autopsy. Next is an MRI ( try to get insurance to pay for that!). Tied for third with about a 65% correlation to autopsy findings is CT SCAN and the simple measurement of waist circumference ( better than WC/hip circumference ).

    Men with WC greater than or equal to 40″ have a high risk for metabolic consequences of obesity.

    For white and black American woman it’s 35″.

    It’s less for asian and if you live in Europe.

    Normal American readings are 37 for men and 32 for female. These are your targets if obese.

    Most physicians do use BMI. Most insurance companies also use BMI. But it’s visceral fat that’s the HEALTH enemy.

    Other stats: an obese person who loses 5% of his body weight begins to reduce his risk of heart disease. More is better, of course.

    So, what are one’s goals? If your pants feel loose and your weight is decreasing , you’ve done well.

    How low can one go?

    It’s determined by:
    1. exercise basal metabolic rate changes, which is influenced best by aggressive weight training ( heavy or light isn’t the issue, pushing to fatigue is ) and secondly by interval cardiovascular training (as opposed to steady state )

    2. genetically determined metabolic rate, body type, body fat, and muscle composition – but remember, genetics determine potential, genetics determine ranges of destiny, usually not absolute destiny ( diet will not alter brown eyes )

    3. dietary determined metabolic rate – equal calories divided over more meals ( because it takes energy to utilize the digestive system ) raises the basal metabolic rate

    4. absolute calories in

    5. absolute calories out

    Absolute calories in minus absolute calories out are a key determines net calories during those activies, but exercising aggressively and effectively and eating 5-6 meals/day burns caloies beyond the active activity because it raises metabolic rate.

    I am thrilled if an obese, apple shaped person can reduce his/her total body weight by 5-10 % , complimented by a WC decrease. Realistic goals, lifestyle changes, priortization of oneself , and finding enjoyment in your changes are the keys to maintaining weight loss and fitness.

    I couldn’t care less if my patients look good in a bikini or a speedo – that’s the trainer’s job. But I do care a great deal that you become more fit.

    Improvement and maintainance of fitness goals is something we all should strive for. Perfection … not so much.

  29. My dad used to (half-apologetically) repeat an old saying: “There are no obese people in concentration camps”.

    I see that a society’s patterns fluctuate based on abundance of resources. The standard of living improved markedly during the 20th century, and this was seen in terms of rising consumerism and plentiful food for the rich and poor alike. You could say that America gorged itself on its new-found prosperity, like a kid who found the cookie jar when mommy and daddy weren’t home. Like anything, a balance needs to be struck. I think that as the debate and public awareness continues an equilibrium should be found between ultra-skinny and ultra-fat, and between healthy and unhealthy living.

    At a personal level, even though you might not feel yourself to be over-eating, you probably are due to the fact that your daily intake has increased and become the new ‘normal’. We all know how to lose weight: eat less and exercise! Yet for some it is, admittedly, a lot harder. The reasons are many and varied, but mostly it is because you are standing on the wrong side of mount improbable (to borrow a term) facing a sheer rock face, when you should be starting on the other side where it is a nice steady slope.

    I’ve successfully used a diet from the pharmacy that brings on kitosis, the body’s natural mechanism for burning fat when it doesn’t get its expected resources from food intake. It runs for 6 weeks, and you have 3 meals a day, with light snacking (I mean *light*; carrots and celery). The meals are specially formulated shakes and soups for breakfast and lunch, and a calorie controlled dinner. I lost 10kg (22lbs) in the 6 weeks. Since then, my metabolism has been altered and I no longer need as large meal portions as I previously did. A little pain in the beginning with food cravings, but now, I have found a new ‘normal’ that is adjusted for the age bracket I now find myself (25-30).

    Now to get that buff body I’ve always wanted, haha. Off to the gym!

  30. It’s not chubby. It’s cuddly.

    In some cultures a larger frame is a sign of prosperity and wealth. Someone who is large has the resources to eat, not just healthily, but excessively. To display your wealth in this way and by gifts of food to others in the form of feasts is an indicator of great power.

    The fact that you live in a wealthy nation and enjoy the benefits of readily available food is no cause for shame. In fact, you imply that you have been about the same weight for 20 years. Surely this is an indicator that you have been consistently consuming the amount that you use.

    I would say that you have nothing to worry about concerning your weight. However you may wish to improve your level of fitness with more exercise or by changing your diet. Improving your fitness is worth doing as it may extend your life and improve the quality of your life, particularly in later years.

    Exercise may actually cause you to gain weight though. Muscle weighs more than the equivalent volume of fat and additional exercise will require a greater amount of energy that may prompt you to eat more.

  31. There is a false dichotomy here, but it’s buried a little in all of the social baggage that surrounds the “fat vs. healthy” debate.

    Being *fat* is not being healthy. I say this as a fat person who is losing weight largely for health considerations.

    However, our society has this false dichotomy: if you’re over the ideal weight, you’re “fat”. It’s ridiculous. There’s a tremendous individual variation in body shape and ideal weight, and applying something like the BMI to every individual is a bit… well… Procrustean.

    The best advice I ever got (from a personal trainer, no less), is to focus on healthy lifestyle — that is, fitness, healthy diet, and stress management — rather than weight or fat. Being on-weight and entirely unfit is no more healthy than being fat and unfit.

  32. Donna,
    The fat movement groups (big fat blog, etc) are mostly cranks & denialists. They have been taken to task at a variety of respectable blogs/websites/etc.

    I think it’s funny that a few people have mentioned it’s hard to find clothing if you’re a larger size. That same exact problem exists on the other side of the spectrum.

    And no, we shouldn’t accept fat (clinically fat, not “looks fat”) as being healthy, because the data strongly suggests otherwise.

  33. halincoe makes some very good points above on this sensitive topic, as do others.

    Well, one must also consider that both the restaurant/fast food and diet businesses are BIG, heavily promoted businesses in this country. One pumps (pimps?) food into the population with endless advertising and fast, easy availability. The other plays off of that by telling the population (especially women) that they “should all look like supermodels.”

    The result is an epidemic of obesity, anorexia, binge eating and other problems, because we did not evolve for the endless availability of high-calorie food. Our bodies evolved for a “feast and famine” lifestyle. When we eat as if there were the probability of no food tomorrow, and food is indeed easily available tomorrow, we end up obese.

    Yes, some people are naturally large. Yes, some people have more efficient metabolisms than others. The conclusion is that, once again, we must use our intelligence to monitor ourselves. And, yes, it’s WORK to do so!

    For the record, I’m 5’11” (1.80 meters), almost 51, not as active as I should be and weigh about 230lb (104.32 kilos) on a “football player’s” frame.

  34. QA,
    You seem to be implying that we’re all mindless victims suffering from the evils of advertising, and that’s bullshit.

    Everyone has the choice to take personal responsibility for their life or not.

  35. mxracer652,

    IMHO, many people act as if they were mindless in our culture. Victims? No – the personal responsibility is still there, but the manipulation is quite real. Do you think advertisers would spend hundreds of millions of dollars on advertising if it didn’t work?

  36. thanks, halincoh. I was reading along on the thread wondering when and if someone was going to talk about the different kinds of fat, and how important that is.
    The beautiful women in the photos with this post don’t appear to have a fat “problem.” They’ve got cellulite in relatively healthy places, from what I understand.
    BTW, I struggled for much of my life with the mirror opposite problem — being a thin man who had to work like hell to gain a few pounds or even keep pounds on. Skinny (thin and not muscular) guys seem to be considered counter to the masculine ideal as much as fat women are considered “un-feminine” by some.

  37. Over a period of fifteen years, I “dieted” my way up from 125 pounds to 240 pounds. Over the last few months I have FINALLY lost about 32 pounds and am continuing to gradually lose the weight.

    As far as whether or not fat people should be discriminated against – well, no-one “should” be discrimiated against. But it happens, it is part of life, and we can debate it all we want. It’s not going to change. I’m ashamed to admit that I personally feel uncomfortable around fat people – and I am one. That’s not to say that I actively discriminate. I do have control over my reactions. But my first thought is often ewwww. Sorry, it’s the way it is.

    I can’t say whether all fat is healthy or not. I can say that even losing the first 30 pounds has made a HUGE difference in knee and back pain, energy level, sleep requirements, and mood for me.

    From having been fat for a lot of years, I can say that in NEARLY every case, excuses for being fat are just that – excuses. There are people with genetic stuff going on. There are people on medications that make them gain weight. But most people who are overweight are overweight because they either eat more than they should, excercise less than they should, or both.

    I saw some good questions about “what about the single mother who doesn’t have time to excercise” and “what about someone who can’t walk safely in their neighborhood”. My opinion is that it honestly can be harder for some people than for others. I don’t have a personal trainer or a chef, therefore it is harder for me than for someone who is wealthy and doesn’t have to work for a living. It’s harder for someone who is poor than it is for someone like me.

    But I’ve been poor. I’ve lived in a homeless shelter. I know that it can be difficult to get access to healthy food. I know all about eating all you can right now because you don’t know when you’ll get food again. But for all but the most extreme cases, it is possible to maintain a healthy weight. It’s not fair that it’s harder for poor people – but most things are. It sucks, but it’s the truth.

    So, my rambling all comes down to the fact that I am so much happier now that I am losing weight. I have no excuse not to. To answer what I believe your original question is – don’t just accept fat because it’s easier. If you are even asking the question, you are probably not ideally happy with your weight. So do something about it.

  38. I hate myself fat. The real reason I posted this is that I’m sick of hearing all the “big and beautiful” and “fat is where it’s at” and “you’re not fat, your voluptuous” bullshit trying to make me like myself fat. I think it’s better to hate yourself fat because at least that is an incentive to do something about it. I have no intention of ever accepting myself fat, even if that means I hate myself for the rest of my life. I like many things about myself that irritate other people, so it has nothing to do with pleasing anyone else. Mr Writerdd doesn’t even think I am fat at all. So sorry for whining. For those of you who may like yourselves fat, I have no problem with that. But I still don’t think it’s healthy, either. I can’t imagine how anyone who is 100 or 200 pounds overweight can accept themselves that way when I feel like shit being 35 pounds overweight. I don’t think fat is sexy or beautiful. Of course, that’s just my opinion. It’s fine with me for other people to think fat is beautiful and sexy, but don’t try to tell me that I should just accept it and love myself this way. So that’s what pissed me off and instigated this post. I am not really looking for advice either. I’ll get off my fat ass and exercise more and eat less or I won’t. I’m not ignorant about what I need to do.

  39. writerdd,
    I think you’re on the right track here. It’s OK to be angry at the situation that you are in. Just don’t end up hating yourself over it. That’s self-destructive. There’s more to everyone than their appearance.

  40. @writerdd:
    I am sure that this must be boring but I agree with you again. I don’t think fat is sexy. I have been with a few fat women but it wasn’t the fat that made them sexy. It was their very intersting minds. I will say that I have kicked a few women out of bed because they were dumb, they were thin and beautiful but that doesn’t make up for dumb. I’ve never kicked a smart but fat chick out of bed. Smart wins everytime.

  41. I heard a radio segment on the Fat Rights movement. I was impressed with the segment, and disturbed by the realization that I did carry in me a prejudice as described by the activist being interviewed. Her argument was that we have been trained to associate fat with unhealthy, when there is not necessarily a solid foundation for that. She pointed out how offended or outraged people tend to get when you suggest otherwise. She also pointed out how doctors tended to not try to diagnose her in any rigorous way beyond telling her to lose weight. That was one of her complaints – that the medical community gave very poor treatment to those who are fat. Her complaint was that they wouldn’t check for physiological indicators of health beyond “you’re fat”.

    Another interesting claim was that the trend in America towards “thin is good” came not originally from health, but from sexual prudishness. That it was an idea of physical self-discipline. You must control your urges. Control desire for sex. Control desire for food. Thinness was a sign of both. This was supposedly advocated by Kellogg (though I haven’t checked up on that claim).

    Now, if you want to lose weight (or more precisely, lose fat) here’s my very strong advice: weight training. Most people focus on cardio as “weight-loss exercise,” but what got me from my post-college heaviest weight back to my freshman waistline was weight lifting. Not “toning” with light weights, but serious training with significant weights. Muscle burns more calories than fat, so as you build muscle, you start to burn more fat when you’re just sitting around doing nothing. And don’t worry about “bulking up.” Women, especially, aren’t wired to develop big, manly muscles. Hell, I’m a man, and I’m not wired to develop big muscles. When I was lifting heavy, I found it almost impossible to get big. But I burned fat like crazy.

    Seriously – few people try this route to weight loss, but I firmly believe in it. A body with more muscle burns more fat. Just don’t pay too much attention to the scale – muscle weighs more than fat, after all. But I’m convinced that weight-lifting is key to getting rid of unwanted fat.

  42. @anyvainlegend:

    Be very careful. Ketosis may be a natural state, but it is not a safe one. Ketosis can lead to kidney stones, gout and organ failure.

    Please make sure your doctor is properly monitoring you during your weight loss.

  43. Oh I don’t know why this just occured to me but it did. I think it is a lot harder for women to lose weight than it is for men. I think you all evolved to have more weight. Probably something about having reserves to help you stay alive during lean times so you could raise the offspring.

  44. Please avoid gimmicks people. Elyse comments about ketosis is correct. Avoid quick fixes and bizzare diets. Lifestyle changes must be a forever thing. Raise metabolic rate, if you are physically capable, as I detailed above. Embrace fitness. Embrace portion control. Embrace nutrition. Low carb diets are effective, but please do not become obsessive with this. Eat smaller, more frequent, diverse diets rich in protein, minerals, vitamins, complex carbs, and limit animal fats but do not necessarily exclude it – and do not fear a treat. Just make it an exception, not a daily thing. Look at calorie reduction over the long haul. 3500 cal less per week equals a 1 lb weight loss. Don’t go for FAST weight loss as your body’s homeostatic mechanisms may work against you ( Dr Jeffrey Friedman’s work at Harvard ). Slow is good. Understand that your genetics will set a reasonable range of weight for you. Do the best you can to fall into the lower to middle range. Enjoy your lifestyle changes. Make this a positive thing. And embrace the positive results , even if it’s not a miracle transformation, because you took responsibility.

    Good luck all. Kick ass!

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