QUACKING LIKE A DUCK

(This is one of those extra-special read-it-all-before-bitching posts. Reading comprehension is important here.)

Matt Roth wrote a Baffler piece nearly a decade ago that stands as one of the best things I've ever read ("Living the Delayed Life with Amway"). Unfortunately it's not online, but it details the struggling freelancer's personal experience with Amway – the notorious "direct marketing" company that was the Next Big Thing in the 80s/90s and has been criticized for its cultishness and uncanny resemblance to a pyramid scheme. While the FTC has ruled that it is legitimate, as the majority of its revenue comes from the sale of products rather than from member fees, Roth makes a compelling point: if Amway isn't a scam, why does it feel so much like one?

This is an elegantly restated version of the Duck Test idiom ("If it walks like a duck…) Our perceptions are not always 100% correct but if something meets all of the criteria for being a scam, you're safer assuming it is than to assume the opposite.

The introductory analogy complete, this is the part of the post wherein I bring up the actual topic. If the recent surge in interest, academic and popular, in "fat studies" – research purporting to show that mainstream medicine's conclusion that obesity is unhealthy, or that obesity is even a condition, is wrong – is not basic science denialism along the lines of anti-vaccine theories, climate change denial, or "creation science", then why does it have all of the characteristics of denialism?

STOP. Here are some things I'm not talking about here: fat shaming, stigmas about weight, the media-driven obsession with thinness, or any other aspect of size/weight/appearance as a social phenomenon. Neither am I suggesting that people should/shouldn't lose weight, or gain weight, or anything else. My point is simply that the supposed evidence underlying the idea that the current medical consensus (obesity = bad for one's health) is wrong has all of the trappings of an argument that in another context would readily be identified as total bullshit.

First, it is based largely on a selective or distorted interpretation of evidence. Recently an article flew around the internet with eye-catching titles like "Overweight People Live Longer". It is based on a study published in the Journal of the AMA. The sole finding of the article is that BMI (Body Mass Index) has a small positive effect on lifespan, irrespective of cause of death (so the sample included, for example, people who died in accidents). But for the past 20 years, Fat Activists have been telling us that BMI is a load of crap. Why is BMI suddenly a valid measure of weight/health/obesity? Oh, because the results of the study are telling you what you want to hear. Cool.

Second, it makes wild assumptions backed by scant, shoddy evidence and ignores mountains of evidence to the contrary. The idea that people cannot lose weight, or cannot keep it off after it is lost, is supported by one or two dubious studies. The converse – that healthy weight loss is possible and can be maintained – is supported by decades of research. Why is the one study that supports your argument the only one worth considering?

Third, it borrows heavily from the climate denial/anti-vaccine movements in its belittling of "so-called experts". This recent Guardian (UK) column illustrates the point nicely. Did you know that doctors are not to be trusted? That they're just a bunch of know-it-alls whose opinions are no better than yours? Beware the "beady eye of a disapproving GP" who doles out the "type of medical finger-wagging (Academy of Medical Royal Colleges) advocates." The National Health Service has a plan to "pester patients about their weight in every encounter," which is not what doctors should do (in the opinion of people like the author who seem convinced that obesity is not inversely related to overall health and longevity).

Fourth, there's a conspiracy. From the same article:

AoMRC's proposals are not about health promotion, but contribute to a narrative of blame, punishment, prejudice, stigma and anti-fat scapegoating that is horribly familiar. The only thing that looks healthy in this context is the twinkle in the eye of the diet industry CEOs, who are laughing all the way to the bank.

Ah, yes. The diet pill industry, and the pharmaceutical industry in general. These are the same people who are pushing all those unnecessary polio vaccines on your kids for profit. Aside from the fact that this makes no sense – pharma would make money by encouraging doctors to keep patients obese/unhealthy so they'll be stuck on more meds, and certainly the trillion-dollar pharmaceutical industry can outgun the "diet industry CEOs" – why is the Fat Activist not equally skeptical of the role of the trillion dollar junk food industry? Surely it's in McDonald's interest to push the idea that eating garbage is not detrimental to health. I guess skepticism only works in one direction.

This is not to say that Fat Activists, as they self-label, make no valid arguments or, to reiterate, are not entirely correct about the social dimensions of obesity. But their overriding problem is that the attempt to uncouple obesity and health/well-being/longevity has the same goal as that of global warming deniers: to convince you that the vast majority of evidence, as well as the medical and scientific consensus, is wrong. The only way to make it look wrong is to engage in the same tired rhetorical tricks and logical fallacies that have underlain quackery and denialism for centuries. Something that bears such a striking resemblance to bullshit should be treated as such until conclusively proven otherwise.

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82 Responses to “QUACKING LIKE A DUCK”

  1. Middle Seaman Says:

    People deny everything. The crazies hate science. Congress and the executive branch believe that our problem is the deficit and not unemployment. It's fat's turn.

    BMI is way too strict. It classifies way too many people as obese.

  2. FMguru Says:

    That Amway article was one the greatest things The Baffler ever published (and they published a lot of great things), second only to "Interns Built The Pyramids".

    Your modified duck test reminds me one of the sharpest things I ever read on the internet: Daniel "D-Squared" Davies's depressingly prescient criticism of the rush to war with Iraq – concluding that "Good ideas do not need lots of lies told about them in order to gain public acceptance" so if something is being sold to you with a bunch of lies, it's almost certainly a bad idea. So simple, so obvious, so completely ignored by people you'd think would know better. Full piece here: https://dsquareddigest.wordpress.com/2004/05/27/108573518762776451/

    He also said of a particularly odious warblogger he got into a slapfight with: "Remember that living well is the best revenge. A simple corollary of this is that maintaining an anime blog is the opposite of “living well” and thus the worst revenge, so if you are in a pissing match with someone who does spend all his time protesting to the Internet that he really does shut his eyes when the naked cartoon children are on screen, honestly, then all you really have to do is sit tight and wait for history to rack up enough points on your side."

  3. grumpygradstudent Says:

    The argument from the fat acceptance movement is not that fat has no negative health consequences whatsover, but that many of the negative effects are found in studies failed to control for activity level. Because the two variables are (obviously) correlated, failing to control for activity level will bias the estimates. The conclusion from at least a substantial "body" (ha!) of peer reviewed literature is, net of exercise level, fat itself, while not ideal, probably isn't that big of a deal. To put it another way, fat people who exercise regularly are probably AT LEAST as healthy as thin people who don't exercise.

    People should exercise and eat healthy food. And not smoke. If you do those three things are are still fat, you're probably pretty healthy and aren't at that much of a higher risk for developing diseases.

    If you think this is bullshit, I suggest you do more research.

  4. FMguru Says:

    There are many, many problems with BMI, but the biggest is that it doesn't account for fitness. If you're 20 pounds overweight but go the gym every other day and put in 45 minutes on the elliptical, your health outcomes (diabetes, heart attack, high BP, etc.) turn out much better than someone who's exactly the right weight for their height but exercises by clicking their tv remote. Being overweight is bad mostly because it's usually coincident with being sedentary. Activity is the key.

  5. grumpygradstudent Says:

    Better research methods=new conclusions. The scientific establishment is slow to accept them. It's not a vast conspiracy theory; it's how science works.

  6. Duckbilledplacelot Says:

    Spend a while perusing First Do No Harm's posts, wherein fat folks are routinely humiliated and denied adequate or even reasonable medical care on the grounds that they're fat (are you having an asthma attack right now, in the office? You should lose weight and come back! Is only one of your knees swollen and purple and you're complaining of severe pain, after a car accident? Eat only vegetables for six months, that will totally clear up your car-crash injury!) , and then wonder why a significant portion of fat people don't trust the medical establishment. Also, weight loss surgery, which is one of the stupidest, most harmful medical practices on offer today with insane complication rates and horrifying nutritional outcomes. On purpose!

    How about both/and, Ed? There is probably a significant amount of wishful thinking in the movement that fatness will have no adverse effects on health, AND fatness has been overrated as a health badness/moral wrong and the medical profession can be, you know, prejudiced and shit. But until that latter one has been cleared up, shouldn't nice people err on the side of being, well, nice to people who get the shit end of the stick a lot? Unlike anti-vaccers, fat people aren't hurting you.

  7. Both Sides Do It Says:

    I FJM'd the post but ended up scrapping it since the above comments get to the heart of the matter.

    Suffice it to say that the characterization of evidence/established science in the post is completely wrong. And that sentence mentioning the polio vaccine might be the worst thing I've read on G&T.

  8. Lekkers Says:

    I have read many, many pieces in reputable outlets quoting reputable sources that assert that the growing scientific consensus is that it is extremely difficult for adults to maintain (not achieve) significant weight loss due to a complex web of physiological and psychological factors. In light of this, I would like to see you cite sources that demonstrate otherwise, with "maintenance" defined by at least a five-year follow-up. Because if it sounds like bullshit, the bullshitter should be the one to provide the evidence.

  9. wetcasements Says:

    Calories in, calories out.

    Is it hard to lose weight and keep it off? Hell yes it is, especially if you're born with a crappy metabolism.

    Is it rocket surgery? No. You eat less and you exercise more and you do this every day for the rest of your life and you will not be fat.

    I feel like I've earned my cred as a committed leftie, but goddamn if the wars over fatness and health aren't tedious as hell. Yes, some people don't lose weight as quickly as others when we exercise, and some people put it on more easily, but there's no escaping the immutable laws of biology and physics — calories in, calories out. Have less of the former and more of the latter. The end.

  10. Part-time Jedi Says:

    @wetcasement
    When you consider that low socio-economic status and obesity are highly correlated, the "have less of the former and more of the latter" that you speak of gets a hell of a lot more complicated than you make it seem.

  11. wetcasements Says:

    Sure, but that's an education and class problem, not an immutable law of nutrition one.

  12. Talisker Says:

    The writer and activist Greta Christina had some interesting things to say about this. Basically she was overweight, got plenty of exercise, and was active in the "fat-positive" movement. Then she suffered a knee injury, and medical advice was that she had to either lose weight, or potentially lose the ability to walk. This is a pretty clear question of physics: More weight = more stress on joint. However, the fat-positive community were… less than sympathetic.

    For details, see: http://gretachristina.typepad.com/greta_christinas_weblog/2009/08/open-letter-fat-positive.html

    @Duckbilledplacelot:

    shouldn't nice people err on the side of being, well, nice to people who get the shit end of the stick a lot?

    There is no excuse for being rude and cruel to overweight people. Or anyone else, for that matter.

    That said, if there *are* sound medical reasons to believe that someone's health would be improved by losing weight, then for a doctor to avoid telling them is the *opposite* of nice. Type 2 diabetes, for example, is not nice.

    Unlike anti-vaccers, fat people aren't hurting you.

    Indirectly, they are. Other people's taxes and/or insurance premiums are paying for their medical treatment. But it's not just a question of money. I'd prefer to live in a society where people are happy, healthy, and not in physical pain, regardless of what it means for my finances.

    Happy and healthy overweight people are not a problem for me, but unhappy and unhealthy ones are. And not all the negative consequences of being overweight are a result of social stigma. Coming back to Greta Christina, sometimes there are just inevitable health consequences.

  13. c u n d gulag Says:

    I don't mean to sound glib, but has anyone looked at the size of our doctors and nurses recently?

    I've seen nurses who look like they outweigh me, and I'm overweight at 6 foot 1, and over 250 pounds.

    And a large part of the problem in this country, I think, is that the foods most of us can afford, are not nutritious.
    So we eat more.
    And we eat way too many processed foods – but when both parents work, sometimes 2 or more jobs each, there's not much time for one or the other, or just the one single-parent, to cook a nutritious meal, with "fresh" ingredients.

    And as for those "fresh" ingredients, I've read articles by nutritionists who advise people to buy frozen fruits and veggies, since their "fresh" counterparts at the supermarket, have almost no nutritional value. They are grown in other parts of the country, or the world, and then picked before they're ripe, and sprayed to stay that way during shipping, and then sprayer to ripen quickly when they arrive at a distribution point. The frozen ones are, for the most part, picked when ripe, washed and cleaned, and frozen near where they were picked.

    Too many foods labelled 'Organic," aren't, and those that are, are very expensive.

    And "Buy local," sounds great, until you realize that that's not always possible – especially in inner cities.

    And the meat we eat, is often full of growth hormones and steroids. Does THAT not have an effect of people's weight?

    So, in this new America, we have two problems at the same time:
    -a lot of hungry children
    -and a lot of overweight adults.

    We need to rethink the way we as a nation grow, distribute, and sell our foods – and the prices those foods are sold at.
    Big Agra is making a fortune growing and selling food that has less and less nutritional value.

    Having said all of that, I know that I still need to go on a diet.

  14. Tim H. Says:

    Science is all about probabilities, as knowledge is refined, outcomes look different. I tend to suspect the presence of "Rodalians" in the more extreme examples of the anti-obesity movement, kinda' sweet that they still think people are perfectible.

  15. sluggo Says:

    @ cu
    We are the exact same size. I'm 6'1" 252lbs. I too, am overweight. But neither one of is obese as that damn BMI chart says we are.

    BMI does not take into account a lot of things besides activity level. Age is one thing, I am 49 and probably should be compared to others in my age cohort. Another factor is body frame. i wear an xl hat and had a 17 inch neck in high school when I weighed 170. I am literally big boned. I could spend a year in Somalia and still weigh over 200 lbs.

    I read this article this morning and looked in the mirror. Middle aged—yes. Overweight—-yes. Obese??? Not an chance, per eyeball test and the duck test!

    Ed,

    Sorry. I did read it, you make interesting points, but putting BMI in front of me is like showing a bull red.

  16. Monkey Business Says:

    Allow me to stroke my non-existant Friedmanesque Moustache of Understanding for a moment.

    Surely there's some middle ground between the Fat Acceptance's "Morbid obesity is OK!" and conventional wisdom, including BMI, which says "If you don't look like a model you're a fat fuck.". After all, conventional wisdom is only conventional until it isn't.

    To go in another direction, wouldn't we be better served addressing the underlying socio-economic factors that contribute to our collective obesity? We lead increasingly sedentary lifestyles with little work-life balance. Our food, collectively, sucks. The poorer you are, the worse it gets, until you can't afford food at all.

  17. Misterben Says:

    This is a rare (very rare) example of a G&T post that I found to be less than perfectly clear. My fault, really: I was unaware that there was any movement to reject scientific conclusions about obesity. So I was confused when this post jumped right into criticizing that movement. But I think the post would have been more clear (to me, anyway) if it had opened by laying out the scientific conclusions about obesity, and then reviewing the attempts to deny those conclusions, and then made the point about why those denials are bullshit.

  18. Laurent Says:

    Hi Ed,
    You obviously touched a nerve. This is a topic where the semi-hard health sciences interact with social norms and politics with often disastrous results. A bit like what we see with poverty debates and the just world fallacy.
    I appreciate your willingness to dip your toes into that pool even thought he water is not the best.
    Also, a general remark I have about the comments so far is that I believe public policy should not be based on anecdotes, hence, no one should take this personally.
    Thanks for your blog, sometimes depressing but almost always interesting.
    Laurent

  19. c u n d gulag Says:

    sluggo,
    When I moved to NC, I used to joke, that at my size, when I lived in NY City, I was fat,* when I lived in Upstate NY, I was overweight, but here in the South, I'm svelte!
    And that people would soon start to call me "Slim."

    When I was ordering some chairs for our call center in NC, I insisted that about half of the chairs not have arms, because there were a lot of people whose @$$es would never get in the chairs – and if they did, it might take "The Jaws of Life" to get them back out.

    *I was never that big when I lived in NY City, partly because I was younger, but also because I walked everywhere, since I didn't have a car. I had to walk quite a ways to get to either a subway or bus.
    Here in the suburbs, you have to drive everywhere, since walking on busy roads with no sidewalks is dangerous to the point of being suicidal, and the buses don't run very often, or on too regular of a schedule.

  20. negative 1 Says:

    To all of the BMI folks — the supposed problem is in the paradox that muscle weighs more than fat. So theoretically Mr. Atlas will show up as fat because he weighs 210 when in truth he's fit as hell. But in reality, how much of the population does this affect — .5? .05? For the rest of us, no it's not perfect but it's easy to measure and works as a pretty good proxy. So everyone complaining about it is really feeding the argument for the duck test.
    If it's harassment for your doctor to tell a person that their weight is unhealthy, is it harassment for them to tell you to quit smoking? Heck when I was smoking "concerned citizens" told me all the time that I was killing myself. For some reason I just shrugged them off rather than starting a movement to assert my rights to be unhealthy.

  21. Kevin Says:

    Calories in, calories out is an over simplification, especially on the calories in side. It doesn't account for ease of digestion, the role that individual gut bacteria plays, insulin response, etc. Calories out is fairly straight forward. Also keep in mind that those measurements on the food labels are estimates at best. Insulin seems to play a larger role in hunger than the amount of calories you're eating.

    At the risk of oversimplifying after I just finished complaining about it, I think the problem is the amount of calories Americans intake in the form of processed carbohydrates. I'm not one of these Atkins fat and protein only people; I eat a whole lot of carbs in the form of non-starchy vegetables. As soon as I cut WAY back on the starches and sugars, the weight started to come off and I also stopped feeling the need to snack frequently. Where I used to get the shakes if I hadn't eaten in 10 hours, I've unintentionally gone 16 hours recently with only a little stomach growling. Food that takes longer to digest provides a slower, steady stream of energy, regulates insulin, and helps with weight control.

    If you have access to a farmer's market, use it! I spend $20/week on as many vegetables as my girlfriend and I can stuff down our throats before they go bad. This is about 1/3rd of what we'd pay at the supermarket. For meat go to whatever grocery store has the best sale in a given week, but a lot, and freeze it. I've also learned a great appreciation for my Instant Pot (google it). The pressure cooker is great when I haven't thought ahead, and the slow cooker function is great for making large batches of stuff to eat throughout the week.

    It is possible to eat healthy and cheap, but it requires some planning (and transportation).

  22. bb in GA Says:

    Testimony is not science, but my youngest son who is built like me, big boned and solid weighed about 230 @ 6 ft 1 when he was about 17 -18.

    He adopted a simple philosophy – 'Don't eat so damn much' and a 'Move yo' ass.' running program . Over a period of about a year he got down to about 170 lbs. This month he will be 30 and he weighs about 175 and is very fit.

    No more moon pies and R-ah C Co-colas for him. uh huh…

    //bb

  23. grumpygradstudent Says:

    I think Kevin is right. What's unhealthy is constant insulin spiking from eating processed (i.e., easily and quickly digested) carbs. That's what's gonna give you diabetes, not being fat.

    Kevin is also right that calories in-calories out misses the strategic responses that our body takes to compensate for calorie deficits. For instance, there's good research to suggest that exercising in the morning often fails to induce caloric deficit, because bodies compensate during the rest of the day by not moving around so much during our regular work lives.

    Muscle has a higher resting metabolic rate than fat does. If you induce caloric deficit, often the body will respond by reducing its muscle mass, which lowers your overall resting metabolic rate.

    So yes, it's possible to lose weight by constantly monitoring yourself and enforcing caloric deficits by eating less and doing more. It's also really goddamn hard to do because your body thinks it's dying and will fight against you.

  24. negative 1 Says:

    Calories in, calories out may be an oversimplification but it still works. Your body will do all sorts of short term things to generate energy but in the long run its either storing calories or burning them, and you, like every other piece of matter in the universe, is subject to the First Law of Thermodynamics. I only mention this because I think a lot of these discussions are generally a hinderance to people who want to lose weight. It doesn't take a physiology degree. Eat less calories than you use.
    @grumpygradstudent — it's hard to do, sure. However hunger is largely psychological and often regulated by insulin levels, not caloric intake. This is important because it's why Kevin's nutritional advice above works better against hunger than people think if they give it a couple of weeks.

  25. Mo Says:

    We've all watched Robert Lustig's lecture about the different metabolic pathways of fructose and glucose, amirite? You remember, the one where he explains the biochemistry wherein insulin mediates glucose distribution to the cells, but fructose goes right to the liver and is processed into fat.

    Also of interest is sugar's relation to dopamine and addiction.

    This puts a twist into the tail of the suspiciously simple "all-carbs-are-equal-just-limit-intake" mantra that floats around. The eat-less-exercise-more meme is 'way too smug and simple-minded.

    It also should call the snack food industry onto the carpet for creating tasty shit with salt, fructose, and starch. Poisoning the population in exactly the same manner as pushers everywhere and everywhen.

    Addiction and diabetes. Wotta way to go! And now I must take a break to eat my breakfast of beer and cupcakes [Just kidding - swore off sugar after watching Lustig's lecture, and haven't looked back. Twenty pounds have mysteriously melted off, and I continue to gradually thin without noticing and without exercise.]

  26. CaptBackslap Says:

    Grumpy: So does that mean that those of us who are trying to add muscle rather than lose fat should work out in the morning?

  27. Ed Says:

    Motivated reasoning still works, I guess.

  28. Brian Says:

    Fat activists simply want to redefine beauty to include the things they have, but not the things they don't have (how many of them still buy nice clothes and wear makeup – the concept of "big but beautiful" would make no sense if they didn't retain other, non-weight related "unfair" beauty standards". No attractiveness standards are "fair" in the strictest sense and as soon as a fat activist who makes 6 figures dates a homeless man, I will stop thinking lean women with a 7:10 hip waist ratio (a universal measure of female attractiveness with roots in biology) are attractive.

    If everything is beautiful, nothing is. It isn't "the media" that convinces men that a relatively low BMI and a 7:10 hip waist ratio (or convinces women that a high shoulder to waist ratio is attractive in men), it is a preference implanted by natural selection, just like female cardinals like red ones better than bland ones.

  29. Nick Says:

    Careful, Ed. You're going to make fat people kill themselves again.

  30. JazzBumpa Says:

    I'm just a poor boy
    Though my story's seldom told
    I have squandered my resistance
    For a pocketful of mumbles
    Such are promises, all lies and jest
    Still a man hears what he wants to hear
    And disregards the rest.

    — The Boxer [emphasis added]

    I guess skepticism only works in one direction.

    Of course. Cherry picking and confirmation bias. Where would we be without them?

    JzB

  31. J. Dryden Says:

    Many different factors lead to obesity, some of which do not thereby lead to heart disease, Type II diabetes, etc. Income level, nature of employment, geography, gender, race, family–not all people get fat the same way, and thus not all people can lose weight the same way, since many of the factors are inescapable. There is therefore a lot of variety to the science of the causes and the nature of obesity, and thus a lot of room for different people with different agendas to come to different conclusions.

    Keller's REFLECTIONS ON GENDER IN SCIENCE is worth mentioning here–she makes a compelling case that even in something as 'objective' as the observation of simple organisms, who we are and what we value determines both what we look for and what we see and how we interpret it. Not that objective fact doesn't exist, but it's far less common than we believe.

    Am I saying that the Fat Activists are just seeing what they want to see? Yes. Yes, I am. But I'm also saying that the views of the 'mainstream' scientists need to be scrutinized as well for, if nothing else, a desire for a simple answer to a complex question.

    It is worth pointing out, though, that, regardless of aesthetics, nobody on any side of this debate is arguing that a diet composed primarily of lean proteins, fruits and vegetables, and a lifestyle that includes regular exercise are not medically preferable to the alternative. The way I see it is: eat as much of what's good for you as you can afford, and get some walking in. If you do that, you'll feel better and be healthier than if you don't. And having done that, tell the world to fuck off. We need to stop worrying about fat/thin as the mark of failure/success…

  32. mothra Says:

    People should exercise and eat healthy food. And not smoke. If you do those three things are are still fat, you're probably pretty healthy and aren't at that much of a higher risk for developing diseases.

    Basically what my doctor tells me at my yearly visits after I mention to her that her nurse has cautioned me that I am nearing the "danger" zone on the BMI chart.

    Sure, but that's an education and class problem, not an immutable law of nutrition one.

    Well, yes, maybe on the class thing, but picture this: You live in a shithole innner city neighborhood. You KNOW you need to eat better food: crisp dark greens, lean meats, fresh fruit, not a lot of sugars, etc. But you don't have a car and the bodega nearby sells shit. But you gotta eat. So you buy the shit. Now, you would love to go on an exercise regime, but you can't afford the gym. Going on pleasant walks in the neighborhood is out because your neighborhood is not really all that pleasant, there is risk of drive-by shootings or muggings, etc. So in your house you stay.
    Or picture this: you live in a holler in Kentucky in a trailer. You have an idea that you should eat better but you have to borrow your meth-addicted cousin's car to get to any decent grocery store and he gets tweaky if you're gone too long, so you just go on down the street to the Circle K so you can get back right quick. Exercise? Yeah, sure. There are no sidewalks in the holler. You could maybe go on a hike in the holler, but there are some paranoid folks living around there and anyway, you can't really afford hiking boots. Forget the gym. Even if you could afford it, what gym?

    So, you see, it's not as easy as just not eating as much and moving more. For a lot of people.

  33. mothra Says:

    Oh and all to all the above that when you have a fucked-up, hopeless life, goddamn it, the least you can do is eat food that you like. Even if it is deep-fried ten ways to Tuesday.

  34. witless chum Says:

    Isn't the real problem people have identified with BMI that it's designed to work on a population level, so it's pretty accurate when you've got a big sample, but doesn't really account for the variability of human bodies so you can't trust it on an individual level. So believing it when it's used in a study like what's described in the post would be okay. You're just not supposed to care what your personal BMI is.

    FMguru nails what I think is the kernel of truth that the anti-anti-obesity folks have identified. Activity levels seem to be what the research is actually showing and it intuitively makes sense that we're most healthy when we do what we evolved to do, ie, walk lots. It's understandable that weight is what gets focused on, because it's incontrovertible and I'm sure people lie shamelessly to their doctors about their actual activity level.

    I think that the fact that our media presents people with pictures of impossibly (for someone who doesn't make abs their full-time job) sculpted bodies all the time means that when the doctors and public health campaigners say "exercise and lose weight" a lot of people hear the "weight" part seven times as loud because we're constantly presented with the idea that fat= bad while we are much less often presented with the idea of inactivity= bad. The media latches on to anti-obesity campaigns because the moral disgust people feel for hugely fat people activates viewers and click throughs, while people feel much less moral disgust with inactive people.

    Blaming weight rather than activity level is also easier because (and this a hobbyhorse of mine) the implications of activity being the thing are much more destructive to the current concept of how we organize our world. Living in car dominated suburbs and working at a desk all day are bad for you health is much more difficult to implement the implications of than you should just eat less is, so people prefer the later. That's what I think the dsquared-style insight is here.

  35. ladiesbane Says:

    If the logic is sound, can we plug in a similar situation and come to the same reasonable result? Analogy is a slippery slope, but it's a way for people to check themselves and others when the topic is emotional as hell.

    Part of our problem as Americans is that, for all we proclaim our individualism, we are desperate for authority to back our opinions. Between our cherry-picking the Bible and applying good science to inappropriate situations, we seem to have forgotten how to argue rationally. Sometimes we come through on "this is what I like, and I don't need to justify myself to you," or even "I don't give a damn and you can't force me to care."

    Weight's tricky, since something within personal control still deeply affects health insurance premiums for all. Remember when people (certain policyholders and carriers) tried to prevent smokers from getting coverage? Take a look at what happened there and then we'll talk.

    For me, saying, "I would change the way I am but it's just not possible" only flies when it's true. Sometimes it is. I would be 6'7" if I could be, but it's honestly not within my control. I also know that each person is up against something different and I have no idea what those challenges might be.

    Even if I do, it's not my job to determine whether that person is bullshitting himself or herself. I'm kept quite busy judging my own self, thanks.

  36. Ellie Says:

    "To all of the BMI folks

  37. Ellie Says:

    Well, I tried to post a comment saying BMI was useless and why, but it didn't take.

    Summary: BMI is beyond useless, and continuing to take is seriously undermines the whole discussion.

  38. John Says:

    As an obese adult that is steadily losing weight via a modified diet to take in fewer calories in a more nutritionally-complete way than before, the very concept of "Fat Activists" repulses me.

    Yes, there are biological factors involved. Some people have a harder time losing weight due to a number of physiological reasons beyond their control, but it can be done. It is entirely possible for an overweight person to be eating healthy, exercising regularly, and generally be in good condition while packing some extra pounds of fat.

    That is not the case for the VAST majority of overweight/obese people.

    The vast majority of them eat crappy food, lead sedentary lives, and are in very bad places health-wise. I know, I was one of them. My trigger for getting serious about weight loss was the realization that having to huff and wheeze and catch my breath after walking out to my car after work every day was a Very Bad Thing. I had tried self-dieting before, starving myself out by removing everything from my diet except for carrots, apples, and plain oatmeal. They were of course disastrous. So I finally broke down, dropped by a local weight loss center, and got on the program. There are no magic diet pills, no special formulas, just a structured and organized plan of managed caloric intake with proper nutritional balance, and a couple of supplements to provide the vitamins/minerals necessary for proper nutrition that won't be gotten in the proper amounts with a reduced caloric intake diet.

    Within a week I was no longer huffing and wheezing when I got to my car. Within two weeks I started walking routines of a mile or more, when before the very idea of having to walk 50 yards was enough to get me to reconsider an activity. The weight is coming off at a steady, healthy rate and I can sustain this plan indefinitely, because it's not "nothing but vegetables for six months", it's simply the proper amounts of fruits, vegetables, lean meat proteins and complex starches.

    Not everyone can afford to do that. That's not a problem with the process of weight loss or the science of weight loss/management. That's a problem of socioeconomics that needs to be resolved. "Fat Activism" is nothing more than people making excuses for their unhealthy lifestyles.

  39. MS Says:

    The difference between a very fit person and a very unfit one might be 20 pounds of muscle. So if you're fat, but you think you're also fit, well, you can subtract at most 20 pounds from your weight and run the BMI again. Are you still fat according to the BMI? Then you're still fat.

    The real problem here is that there's a well-known psychological phenomenon called ego protection. Whatever you do, it must be good, because otherwise you're bad. So as the population gets fatter, more and more people will be psychologically motivated to defend fatness – they aren't fat, fat isn't bad, actually fat is good, etc. Brain psychology is much stronger than abstract ideas like "believing in the science" – it will win every time.

    So not only do we have a significant amount of fat-denial, we can expect it to continue to increase for the indefinite future to protect people's egos.

  40. hardcastle Says:

    Holy fuck, all of you.

    "STOP. Here are some things I'm not talking about here: fat shaming, stigmas about weight, the media-driven obsession with thinness, or any other aspect of size/weight/appearance as a social phenomenon."

    "This is not to say that Fat Activists, as they self-label, make no valid arguments or, to reiterate, are not entirely correct about the social dimensions of obesity."

    ITT: Mostly comments about the shit that this post is not about.

  41. grumpygradstudent Says:

    So if I exercise 1 hour per day (the generally recommended amount of exercise necessary to maintain weight loss), that's 7 hours per week. That's 364 hours/year. If you assume 16 hours of waking time during a day, that's 22 days per year out of my life devoted to one of the most boring uses of time imaginable (arbitrary and pointless physical movements). I don't think it's unreasonable for someone to make the conscious choice to give up time at the end of their lives in exchange for having that extra time now to do more enjoyable things. Not everyone gives a shit about living until they're 95.

  42. grumpygradstudent Says:

    No, most of the responses are about whether losing weight is realistic possible and whether fat is unhealthy. In other words, they are directly relevant to the post.

  43. Major Kong Says:

    @grumpygradstudent

    It's not so much trying to live to 95, it's trying to make sure that I have decent quality of life when I'm 65 or 70.

    I don't want to spend my last years crippled due to losing limbs to diabetes – just for example.

    How you treat yourself today determines how you're going to look and feel in 10 years.

  44. Major Kong Says:

    @bb

    Please explain the origin of the "RC Cola and Moon Pie" saying that I've been hearing since my first trip to the South circa 1984.

    Everyone, and I mean everyone, down there seems to say that.

  45. Jak the Yak Says:

    I've got to agree with you here Ed. I think it's difficult for people to separate the social dynamics from the medical science, especially in this case.

    Also, doctors can't always all be trusted with all topics, it's true. Just going to a new doctor until you find one who says things you like is not a solution, nor does it help foster an environment of evidence based medicine. Maybe you need to find a new doctor if your current doctor makes you feel actual SHAME about your weight, but a medical professional must be able to point out to you things you could do to improve your health without it being a personal attack.

    Certain ratios of yellow fat to overall mass are absolutely correlated with higher rates of heart disease and other life-shortening and quality-of-life reducing conditions. BMI isn't a great indicator of these things, percent body fat is much better. BMI, again, is not a good indicator of overall health. That is to say, neither positively nor negatively.

  46. bb in GA Says:

    @major kong

    I don't know fer sure, its been around a long time (I'm 66)…

    but if you were aware in the late 1950s and early 1960s then you likely encountered the performances of one Brother Dave Gardner.. He was very popular below the Mason-Dixon and had some national following.

    His tag line was 'Rejoice, Dear heats, Brother Dave is here…'

    He popularized the 'Moon Pie…' line in his comedy routines.

    //bb

    P.S. – one thought I try to remind myself of frequently (especially here)…

    'Don't let your alligator mouth, overrun your hummin' bird ass.'

  47. Hazy Davy Says:

    Is the problem that fat people don't understand science?

  48. bb in GA Says:

    @major kong

    I think the expression predates the song, but Bro Dave used to use it in his act:

    http://www.youtube.com/watch?v=9E-arRWZ5wc

    //bb

  49. sluggo Says:

    @ bb

    Now I am convinced that you are Hershel from the Walking Dead!
    – Georgia, Farmer, mid-sixties.

    Way too many coincidences for me…….'if it walks like duck………..'

  50. Todd Says:

    Like a lot of the commentors here, I think you're wrong on this one Ed. You're not understanding the arguments being made. I suggest reading this: http://soursaltybittersweet.com/content/fatness-strongly-influenced-genetics-how

  51. negative 1 Says:

    @Ellie –
    I'll save you some of the trouble of recreating your argument and agree with you to some extent. I just want to highlight one thing in my original post that it looked like you were quoting — that BMI is easy to calculate. You can find it on the internet. Easy things to find reasonable goals help everyone.
    Like I said, yes the muscle/fat thing is a paradox but I just don't see that many people who are so muscular that they're throwing off the curve, and that number decreases the further you go up the age scale. For every muscle-bound 60 year old who has a 7% bodyfat make-up throwing off the BMI curve, I bet you can find like 1,000 or so in hoverounds who got that way by being too heavy for their joints.

  52. Both Sides Do It Says:

    "Now I am convinced that you are Hershel from the Walking Dead!
    – Georgia, Farmer, mid-sixties."

    Left out "badass".

  53. bb in GA Says:

    @sluggo and BSDI

    I don't mess w/ zombies and I once got beat up by a girl (she was 12 and I was about 8).

    My 'badass' merit badge was recalled.

    //bb

  54. ladiesbane Says:

    If the real conversation here was supposed to be about why it's cool to question, ignore, or deny some sorts of science but not others, I would say it comes down to values.

    Consider stem cell research and gene therapy. Most of my liberal friends are fine with these things, because they imagine positive outcomes such as diseases cured and birth defects prevented. Yet these same liberals freak out about seeds genetically modified to be blight resistant, cloning, food irradiation, and other scientific advances. They may not always be able to explain the science behind it, but they know from experience that Monsanto is not a non-profit agency trying to find a way for grain to remain wholesome during transit to the refugees in central Africa. So, values.

    We also have seen that the public is a guinea pig for drug companies, that conventional wisdom (what it means to quack like a duck) changes over time, that most issues have not been utterly finalized for all time — if they were, why are there still studies being done? If you wait long enough or read widely enough, there is a scientist somewhere who sounds good and says stuff that jibes with your own experience and beliefs. Even if you are not ignoring the peer-reviewed journals to choose stuff from the John Birch Lending Library, this is true for certain issues.

    If you are not a scientist yourself, you are taking what scientists say on faith, and most people find the science that matches what they already believe. It's the same with religion: good people find scripture to support being good, and evil people find holy authority for their evil.

    The important thing is for people to learn how to check themselves for rationalizations and wishful thinking. Learn how to apply Occam's Razor. Test things that sound attractive as well as things which sound awful. Try to cultivate common sense, or what used to be called "thinking about it for a bloody minute". And above all, be honest.

    Unfortunately, asking "what do I know and how do I know it?" leads honest people to admit they can't be truly certain of much. We just do our best to make sense of the world.

  55. Xynzee Says:

    Ed,

    Effectively people are – dare I say it – "sinful". I chose that word as it goes beyond "lazy", but is a wanton disregard what is right.

    People do not want to change, stop what they're doing, to over come an unhealthy practice. So will look for signs in their environment that affirm their choices.

    So a person cheating on their spouse will find things to justify it (they're cold, distant, old, wrinkly, fat, etc etc) rather than putting in the hard yards to rekindle the spark.
    Someone selling meth will say it puts food on the table or whatever.
    People who want to smoke pot will ignore the research and tell you about all of "benefits" (food, fibre). Bullshit, you don't care about the planet, you just want to get high.
    People would rather believe/tell a lie than know/speak the truth.
    People would rather say it's "not their concern" or "they had it coming" rather than taking a principled stand on something.

    The list is endless. To recap people will believe and look for things in their environment to support their world view because otherwise they have to admit they're wrong. If they admit they're wrong, then they will have to change their behaviour to stop what they enjoy doing or admit they're not perfect.

    Change requires effort.

  56. bb in GA Says:

    @ladiesbane

    Huzzahs and Amen…

    I think a major problem in addition to your observations is the politicization of science. We've always had it as you can read any history of scientific inquiry that there were political/social/and or religious agenda being worked.

    In this media drenched age the level has been jacked wide open where we have issues of great public import being propagandized by every damn body.

    We are expected to make policy decisions and laws through our representatives on subjects where we are thoroughly 'lay people.'

    Cue the hired guns from whatever lobbying or interest group and 'fire for effect.'

    //bb

  57. eau Says:

    I reckon we could pretty accurately calculate the BMI of the individual participants of this conversation based purely on the enthusiasm with which they attack the worth of measuring BMI.

  58. Xynzee Says:

    @ladies (& bb):

    A highly accurate analysis of the point Ed was trying to make.

  59. Nan Says:

    You guys do realize skinny people die, too, don't you?

  60. Andrew Says:

    "You guys do realize skinny people die, too, don't you?"

    If I go, I'm taking you with me.

  61. sluggo Says:

    @Nan,

    But until the day they die, they will still expect my fat ass to lift heavy shit for them.

  62. Jak the Yak Says:

    Being too skinny is just as bad as being too fat. I think that the healthy range of weight is probably larger than the socially acceptable range of weight. I do think that our culture has an unhealthy obsession with thinness, but that this exacerbates the existing problem with lots of people being overweight to an unhealthy extent, rather than just to an un-cosmetic extent.

    I don't like people ignoring science. I don't hate GMOs or modern pharmaceuticals per se, but like any technology can be abused, and the profit motive isn't doing a great job of checking that. Quite the opposite. Diet pills are bad, companies who'd rather you stay sick but treatable forever rather than cure you are bad, and saturating farmland with millions of gallons of Roundup is bad. These are all things that can be accomplished with the same technology which could also cure cancer, end hunger, and help people be as healthy as possible in general…so it's not the technology, nor the actual research that I dislike or distrust, it's those who stand to make a buck.

  63. wetcasements Says:

    "The eat-less-exercise-more meme is 'way too smug and simple-minded."

    And yet, I can guarantee you that if a person eats-less-and-exercises-more for _a prolonged period_, he or she will lose weight.

    That's simple-minded, but it's also true. Why do you also think it's "smug"?

  64. ladiesbane Says:

    @bb: thanks, and I agree about the politicization of science. The part that really scares me is how polarized people can get over ideas they don't understand very well. Taking sides based on feeling is the opposite of science, and once you start advancing your position based on feelings, you stifle honest thought. Especially when those feelings *are* relevant to the problem.

    Fat is a really divisive issue, which makes this both a very good and very bad example. Kind of like abortion, another topic with an extremely high emotional index. The science is nigh irrelevant to most people's decision-making on the subject. Forcing another human to stay pregnant against her will can't be done in a free society, but on the other hand, baaaaabies. Most people are too squeamish to approach the boundaries of the issue, and too emotionally convicted to want to. Possibly afraid it will change their minds, or make their decisions harder. There is more to the abortion debate than just science. And there is more to the topic of obesity than the medical aspect.

  65. Jim B Says:

    My only question, When the population of the world became so fit? Did more healthy people stop dying? did the overweight people regain their health? A few odd statistics, not the numbers that you want. I'm 67, I've lived longer then 2/3 of the people in the world. And if you will notice, past 65 is becoming rarer. Is that because they are "healthier". If we are healthier, why are there not more of us then of previous generations. I am over 65 because of more likley, different genetics. Not better food, not better health care, nor "cleaner" enviroment. But simple genetics.
    But I will say, those with a smaller BMI number are dying sooner in the hospitals, then those with high numbers. Something to do about recovery ability.

  66. Drewbear Says:

    Disclosure: I'm 5'10" and weight about 380 pounds. There are now people automatically dismissing everything I'm about to say as biased. Congratulations on that, by the way. Note that I don't have diabetes, my cholesterol is great, my blood pressure is actually better than average, and my only chronic health concerns are entirely unrelated to my weight.

    To all the people who say "calories in, calories out" is the only/best way to do it: Yes, that's insanely oversimplifying it. A few years back, when I was desperately poor, I had to severely restrict my food intake and stop using my car (couldn't afford gas), so I walked everywhere. I lost 50# in 3 months. I was also constantly starving, constantly dizzy, and so weak and lacking in energy that when I walked someplace I would have to take rests about every 100 feet. Not because I was winded, mind you, but because I felt like I was going to collapse from weakness.

    As soon as I could afford food again, I regained 75 pounds in 2 months. I was actually eating LESS than I was before the poverty/starvation occurred, but my body was still in starvation mode and it totally f***ed my metabolism to the point that everything I ate was turned straight into fat.

    Additionally, I have to take a daily medication which has as its primary side effect "weight gain". I have steadily gained up to between 1-5 pounds a month every since I went on it.

    Would I like to lose weight? Sure! Would my doctor like me to lose weight? Sure! But the physical and mental costs of what would be necessary to do so would be more dangerous and damaging to my health than staying fat is.

    Also, multiple studies, including ones by the NIH, have shown that SUSTAINED weight loss, defined as maintaining it for a minimum of 5 years, is incredibly rare. Someone may lose a bunch of weight in the 3 months to a year, but typically regain most/all of it over time. They found that the most "successful" weight-loss program for sustained weight loss (5 years or more) was Weight Watchers, which resulted in an average weight loss of 5%. Yes, that's right: a 200# person losing and keeping off 10 pounds was the best average outcome.

    Frankly, if you want to fix the "obesity epidemic" (which is an entirely problematic designation, since it equates obesity with contagious disease and I have yet to see some catch fatness off of me) is to prevent people from getting fat in the first place. Congratulations to those of you who have lost weight and kept it off, but you're freaks. In a good way, but you do NOT represent the average person or overall populace when it comes to the lasting success of weight loss.

  67. Drewbear Says:

    As a side note: fat people are constantly attacked for using their own experiences as support for their arguments (as I expect I will be here), but keep in mind that people talking about their successful weight loss are just making anecdotes as well. If you want to claim that your personal experience means that everyone can do it, then I get to use my personal experience to say, no, not everyone can do it. You don't get to have it both ways.

  68. Pat Says:

    Wow. Last week you blogged about parenting, and this week you're blogging about whether there are health consequences to being fat? You're a braver man than I am, Gunga Ed, Gunga Ed. You're a braver man than I am….

  69. Alan Says:

    Okay, I wasn't going to leave a comment, but after a day of mulling it over I just can't help myself.

    There seems to be a subtext here that anybody who challenges the conventional medical wisdom is some kind of nut. And while it's far easier to paint caricatures with a broad brush, those strokes obscure a lot of details, some of which are sometimes important.

    Conventional wisdom is that an individual is "overweight" or "obese" if s/he has a BMI in excess of 25 or 30, respectively. That conventional wisdom has been adopted not just by the uninformed masses and the collective knowledge of Wikipedia, but also by many or most general medical practitioners.

    And that conventional wisdom is wrong. C'mon, Ed, you do CrossFit; just look at the dudes on the podium after last year's games. Froning (5"10, 195) and Panchik (5'9, 190) are "overweight," while Chan (5'10, 210) is "obese." Yeah, what a lard-ass.

    Commenting on the fact that BMI is an inaccurate measure of obesity at the individual level is not a rejection of science. Rather, it's a criticism of the intellectual laziness of those who refuse to acknowledge the limitations of applying an (admittedly useful) epidemiological tool on an individual level.

    That's not to say that all criticism of the conventional wisdom is well-reasoned or well-founded. You can find lunatics, connivers, and well-meaning idiots on any side of any discussion. And while evocation of conspiracies is almost always a sign that somebody falls into one of the aforementioned categories, asking questions about motivation does not make one a conspiracy theorist.

    So, long story even longer: yes, there are "fat studies" types who fit right in with the birthers, the anti-vaccine types, or the climate change deniers. But that doesn't change the fact that the correlation between morbidity and body weight (as well as fat percentage, diet, and activity level) is complicated, and tends to be oversimplified.

  70. quixote Says:

    I've had the same incredulous reaction as Ed to some of the fat positivity I've seen. The puzzling thing to me was the rejection of the concept that there is a difference between what was once called stoutness and what the medical profession calls morbidly obese. I mean, there is a difference. Why deny it? As far as I could tell, it was mainly due to the quite justifiable rejection of all the social BS laid on fat people. The rejection just hits more than the target.

    But what I really jumped into comments for was to add a biologist's perspective to the calories-in:calories-out argument. Every aspect of digestion, assimilation, storage, and metabolism is under precise control and every step has its genetic component. In some extreme cases, regulation can be skewed so far toward storage that there is not enough circulating glucose to sustain metabolic functions. Fat is deposited while the person is literally starving.

    We aren't all made alike. Before assuming that "all it takes is not overeating," don't eat for a day or two and then tell yourself to skip the next meal. That's how it is for some people. Drewbear's comment earlier describes somebody with a storage-oriented system.

  71. Julie Says:

    I have to disagree with this statement: "The idea that people cannot lose weight, or cannot keep it off after it is lost, is supported by one or two dubious studies. The converse – that healthy weight loss is possible and can be maintained – is supported by decades of research." There are actually many studies that show that most people who lose weight will gain some or all (or additional weight) back–especially those studies that follow weight-losers for several years.

    I wish that more American doctors would adopt the Edmonton Obesity Staging system that is described on Arya Sharma's blog. It grades obesity according to bmi plus risk factors such as high blood pressure, blood sugar, cholesterol etc, and does not recommend targeted obesity treatment for those in the lowest (fat but healthy) category.

    Another problem that results from focusing so much on weight, is that doctors tend not to ask thinner people about their eating/exercise behaviors even though they could be very unhealthy. At least, that has been my personal experience as someone who has been both fat and thin.

  72. blahedo Says:

    In the news just this week: https://www.nlm.nih.gov/medlineplus/news/fullstory_134667.html

    Short version: Americans are ingesting less calories but getting fatter anyway.

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