Tag Archives: nutrition

Everything We Know About Obesity Is Still True

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copyright (c) Laurie Toby Edison

Debbie says:

When you’ve been doing the same activist work for thirty years and more, it’s hard not to be all “Oh, well, here we are again” when someone new comes out with a hard-hitting article that says all the things you’ve been saying for years.

At the same time, each of these new articles is fresh to the writer, and fresh to many of its readers, and makes a dent in the walls around your ideas. So after one deep sigh, I really welcome Michael Hobbes’ “Everything You Know About Obesity Is Wrong,” published in the Huffington Post.

Hobbes starts with what he calls “scientific myopia,” a quick review of how hard it is to get scientists to step away from their dominant paradigm, and then goes on to make his key point: “Years from now, we will look back in horror at the counterproductive ways we addressed the obesity epidemic and the barbaric ways we treated fat people—long after we knew there was a better path.”

After that, the piece follows what fat activists will recognize as a familiar path: how much social prejudice against fat hurts people, how diets don’t work — I wish he had credited Gina Kolata’s 11-year-old landmark book, Rethinking Thin, which I reviewed as “old news” when it was published — and then gets to his first core point, which is that fat and health are not inextricably entwined. I see that every time I go to the doctor, and the medical tech is slightly surprised at my perfectly reasonable blood pressure, which goes hand in hand with my perfectly reasonable cholesterol numbers. However, Hobbes is good and clear on these points:

individuals are not averages: Studies have found that anywhere from one-third to three-quarters of people classified as obese are metabolically healthy. They show no signs of elevated blood pressure, insulin resistance or high cholesterol. Meanwhile, about a quarter of non-overweight people are what epidemiologists call “the lean unhealthy.” A 2016 study that followed participants for an average of 19 years found that unfit skinny people were twice as likely to get diabetes as fit fat people. Habits, no matter your size, are what really matter. Dozens of indicators, from vegetable consumption to regular exercise to grip strength, provide a better snapshot of someone’s health than looking at her from across a room.

He doesn’t mention the famous “nurses’ study,” which demonstrated that “moderately obese” people live longer than people whose weight is “normal” or “appropriate.”

Next on the roadmap of this kind of article is the issue of medical misuse and abuse, beginning with a profile of a fat victim. Again, Hobbes is clear-eyed and thoughtful:

Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words—“noncompliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. In one study, researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice. And that’s when they see fat patients at all: In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14 percent had barred all new patients weighing more than 200 pounds.

Hobbes gives lots of examples of how doctors misuse fat patients, and how they are taught to do so. None of it is new, but all of it is useful fuel for the fire. Then he goes on to the mental, emotional, and social toll all of this takes on fat people, again with real-life stories and useful statistics, and the obligatory quotations from therapists who work with fat patients.

The only place he goes off the rails is in his — often true — argument that

perhaps the most unique aspect of weight stigma is how it isolates its victims from one another. For most minority groups, discrimination contributes to a sense of belongingness, a community in opposition to a majority. Gay people like other gay people; Mormons root for other Mormons. Surveys of higher-weight people, however, reveal that they hold many of the same biases as the people discriminating against them. In a 2005 study, the words obese participants used to classify other obese people included gluttonous, unclean and sluggish.

Of course, this happens. But I personally know so many groups in which fat women gather to discuss our experiences, and to fight the system together, so many blogs, so many websites, so many meetups. I’m sad that Hobbes didn’t find any counterexamples to his theory, and I don’t think he looked very hard. I’d be curious about whether that 2005 study (which, by the way, looked at only 46 people!) would be different in 2018.

Then, he goes to some of the real scientific roots of both increased obesity and increased health issues which don’t relate to weight: issues of the food system. The only thing in the article which surprised me was his claim that people who eat nuts four times a week have statistically significantly lower diabetes incidence and lower mortality. More nuts for me!

And finally,

Our shitty attitudes toward fat people. According to Patrick Corrigan, the editor of the journal Stigma and Health, even the most well-intentioned efforts to reduce stigma break down in the face of reality. In one study, researchers told 10- to 12-year-olds all the genetic and medical factors that contribute to obesity. Afterward, the kids could recite back the message they received—fat kids didn’t get that way by choice—but they still had the same negative attitudes about the bigger kids sitting next to them. A similar approach with fifth- and sixth-graders actually increased their intention of bullying their fat classmates.

And here he does get to fat activism, although he still doesn’t seem to see that fat activism requires that fat activists like each other and work together. His fat activism quotations are mostly from a journal editor; I’d love to know how many fat activists he spoke to. I’m right here, and I’m hardly alone!

I salute Michael Hobbes for researching and writing this article. I hope thousands of people see it and lots of people share it and discuss it. And I long for the day when the next one of these isn’t in the pipeline somewhere, because the point has been made.

Follow me on Twitter @spicejardebbie . Thanks to @ribbonknight for tweeting this link out.

Butter? Fat? Sugar? Or Is Capitalism the Real Health Risk?

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Laurie and Debbie say:

Until recently, in the world of food science and public perceptions of food health, FAT was the villain, sneaking around trying to get into your arteries and clog you to death, while SUGAR was an ineffectual sidekick, who might make you gain weight but was otherwise harmless. Recently, those characters are being reversed: SUGAR is being shown up as more of a killer, while doubt is being cast on FAT’s crimes.

In June, PLOS ONE published a very large meta-analysis on the health effects of butter, one of the scariest of the FATS. The analysis included 9 studies

reporting on 636,151 unique participants with 6.5 million person-years of follow-up and including 28,271 total deaths, 9,783 cases of incident cardiovascular disease, and 23,954 cases of incident diabetes

In brief, the results were that butter consumption did have a “weak” association with overall mortality, even though it showed no correlation with heart disease and stroke, and a negative correlation with Type 2 diabetes (people who ate more butter had 4% less Type 2 diabetes).

Although this study got a lot of press, including from celebrity cookbook author Mark Bittman, there can be no doubt that most people still think of butter as a substantial health risk.

This month, a lot of news outlets reported on a Journal of the American Medical Association article  about how the sugar industry lied and cheated to make fat seem like a much more serious culprit in cardiovascular health, and sugar an effectively unimportant player.  Vox says:

New research, published today in JAMA Internal Medicine, shows that Big Sugar  may have done more than just advocate for favorable policies. Going back more than 50 years, the industry has been distorting scientific research by dictating what questions get asked about sugar, particularly questions around sugar’s role in promoting heart disease. …

Through an examination of archival documents, the JAMA paper shows how a sugar trade association helped boost the hypothesis that eating too much saturated fat was the major cause of the nation’s heart problems, while creating doubt about the evidence showing that sugar could be a culprit too. Sugar increases triglycerides in the blood, which may also help harden the arteries and thicken artery walls — driving up the risk of stroke, heart attack, and heart disease.

The JAMA paper and the popular articles about it that we’ve seen don’t reference the butter study. So the two topics are kept separate and reports on both of them go out of their way to offer a million versions of “but FAT is still bad for you.” That’s the “faith sentence” of the food science world.

What’s really going on, of course, is that not only are butter, fat, and sugar commodities, so is a great deal of 20th and 21st century science. As both the JAMA paper and the PLOS ONE paper note, knowing who funded a study or a group of studies is at least as important as the results. Often, you can successfully surmise who funded a study by what its results are. Funders such as the sugar industry (or the oil industry or the pharmaceutical industry) commission studies and let the scientists know what results they want and — surprise! — the scientists want to get more grants and more funding, so they all too often find the results they were asked for.

The skewed papers are published, and the media immediately picks them up: media that is funded in substantial part by the same powers-that-be that funded the studies. Then the media simplifies the story and shapes to fit the popular misinformed narrative, making it even more in line with the original funders’ intent.

Under capitalism, the big money interests own both the majority of the facts we can get our hands on, and the majority of the sources we can get our facts from. minor accomplice (like FAT) are singled out because they don’t have a big trade association protecting them. Protected villains (like SUGAR) get a free pass.

Does this sound at all like anything else you hear about in the news? Yeah, we thought so too. Privilege is everywhere.