Is our attitude on obesity more dangerous than obesity itself

Great Debates
101

This is an interesting question because it gets to the root of our society’s values. In general, weight loss is perceived as the carrot at the end of the stick, not good health. I can attest to this personally. When I exercise, the thing that motivates me is not the knowledge that running improves my circulation, bone density, and immune system; it is the feeling that I’m burning off last night’s dessert so that it doesn’t deposit itself on my abs. Is it wrong that vanity as opposed to health is the driving force behind my lifestyle choices?

It’s probably not ideal, but I don’t think my attitude is necessarily wrong. Human beings tend not to always do what is good for them just because it is good. Let’s be realistic: The desire for good health is not always enough to encourage strenuous hours on the treadmill or abstinence from tasty food. That means something other than health has to compel some people to eat right and excercise, and that’s where vanity comes in. I value having a trim, agile form that can wear clothes easily, and that is what keeps me going to the gym or foregoing that extra donut. Although I rationally know the connections between health and good lifestyle choices, those connections have fuckall to do with why I read nutrition lables or feel guilty when I don’t take the stairs. I don’t care about cancer or diabetes. I just don’t want to get fat.

The question is why is this so wrong? I don’t smoke not (only) because it elevates my risk for cancer, but also because I don’t like the cosmetic side-effects of the habit. Is this also wrong? Is it better to have the attitude that smoking is bad because it impacts against health, than it is to believe that smoking is bad because it makes one stink and develop premature wrinkles? Why is it better to value health over vanity, even though both concerns lead to the same outcome (e.g. healthy behaviors)?

102

However (and I’ll try to find the study, but it wasn’t online), research suggests that those people who lose weight, eat better, exercise, etc for health reasons, have a much easier time, and much higher success rate at maintaining the weight loss, healthy food choices, increased exercise, than those who lose weight for vanity reasons.

So while both are good at the start, promoting health is much better in the long run.

Now let me go see if I can scare up that study…

103

Probably because those who lose weight for vanity reasons tend to crash diet or starve themselves, while those who lose weight for health reasons will usually go about it in a more healthy manner. That doesn’t mean that losing weight (or keeping it off) out of vanity is inherently more dangerous or unsound than losing weight for health reasons; it just means that the people who are motivated out of concerns about appearance tend to want quick results with little effort.

The OP may see this as proving his point, but actually it doesn’t. The medical community can preach all day about the health virtures of a balanced diet and exercise–irrespective of weight–but that will likely not convince people to change their ways. The reason that weight, diet, and exercise are so frequently packaged together in the selling of healthy lifestyle choices is probably because the most visible outcome to poor diet and lack of exercise is obesity, a condition that not only has health ramifications but also social and psychological effects that diabetes, cancer, hypertension, and cardiovascular disease do not.

A doctor who says that a poor diet can lead to diabetes and cancer without talking about obesity is not only presenting an incomplete picture of what a poor diet can do, but he is failing to point out the one outcome that will most likely encourage patients to get themselves into shape. That is not to say that obesity is not a health issue in and of itself–because it certainly is–but most people fear obesity because it brings with it social and psychological handicaps. Truth be told, the medical community needs to seize upon this common aversion in order to stimulate people to make healthy choices. Simply selling the message “Eat more vegetables and you will live longer!” or “Exercise a day keeps the tumors away!” doesn’t always cut it. If people care more about the taste of hot fudge than they care about living a long time, are those messages going to do much good? Change the message to one that appeals to their values (e.g. looking good) and you may see more people saying no to the fudge and yes to the treadmill. Whatever works, I say.

Not necessarily, I say. “Promoting health” will do little if the people receiving the messages don’t truly value their health in the first place. I think we take it for granted that everyone thinks good health is worth making great sacrifices for. But that isn’t the case.

104

DSeid, you have provided a lot of interesting commentary and I agree with much of it. But on one of the most fundamental parts, I don’t:

In my opinion, these healthy lifestyle choices seem to be relatively easy for some people to commit to and literally impossible for others because of body chemistry and the ways that our brains are wired. I haven’t seen reference to this anywhere in this thread. I will have to resort to the anecdotal, but maybe you can provide more information from a medical standpoint.

Like picunurse, I was on Optifast and lost a considerable amount of weight. I was so successful and pleased with the program that they allowed me to stay on the all-liquid, extremely low calorie diet for six months. I think my caloric intake was something like 475 calories a day.

What surprised me was that after about three months, I began to forget to drink the shakes. I lost my appetite – even though the shakes were good. I would have been perfectly content to never have returned to eating regular food again. My body chemistry had changed and whatever food additions I had were gone. It wasn’t a matter of will power.

Eventually, they made me “refeed.” After about two or three weeks, all of my old compulsions about food returned. Again, it was not a matter of will power. I had no more choice about it than I did about breathing. I know that is hard to understand or believe. I don’t know how to explain it except to say that my body chemistry was different.

Within a couple of years I weighed 300 pounds. I am 5’3" tall.

(Note to Brickbacon: Was I lazy? I don’t know. It’s hard to tell if a person carrying 170 extra pounds is lazy or just unable to move easily. How lazy would you be with 85 pounds strapped to your front and 85 pounds strapped to your back?)

On Fat Tuesday in 1998, I had a gastric bypass. I lost over half my body weight, but began to regain because of compulsive eating.

My therapist told me about a medication that had been used for treating seizures. It had been found to have the side effect of causes weight loss because it interfered with compulsive behaviors. It also helps with depression. I’ve been on that medication for at least a year or more and I’ve lost the weight I regained. I don’t eat compulsively and don’t think about food much at all. I’m down from a pack a day to about 7 or 8 cigarettes. And I’ve stopped compulsive shopping too.

There is more to “will power” than meets the eye. Each human body and psyche is different.

picunurse, you just knock me out, friend. That’s twice this week, you know.

Wesley, this is one of your best threads ever. The exchange between you and DSeid has been well worth the read.

105

This is actually what makes anorexia so easy, once you’ve started. When you’re starving yourself, eventually the brain shuts off its “feed me” vibe. You’ll stop thinking about food or feeling hungry - this is an automatic response to starvation.

Please see the above point for why this was a good idea. :slight_smile:

And this I think is the crux of the problem, at least in my mind - when someone is compulsive about food in that they DON’T eat, Drs., health professionals, psychiatrists, psychologists, etc. will quickly recognize that the person has a psychiatric disease that is preventing them from eating, and take quick, sometime extreme steps to intervene. However, when someone is compulsive about food in that they overeat, most just assume that the person has no willpower, is lazy, is bad, etc. Obviously, this is not the case - obsessions and compulsions come in many stripes, and I firmly believe that the compulsion to overeat and an obsession with food is a form of mental illness in exactly the same way that anorexia or bullima are, and should be treated as such.

Zoe - I think it’s great that you’re having success with your medication both in regards to weight as well as smoking/shopping. Good job getting help, and being able to recognize that you had a problem with food - honestly, according to most statistics, many people with eating disorders never recover - nice to see someone on a good path. :slight_smile:

106

Zoe, allow me to also congratulate you on finding your way to effective help.

Some commments though. As previously stated I am not a huge fan of “diets” at all, let alone the Very Low Calorie kind such as Optifast. Where they fail is in preparing people for a healthy rest of life lifestyle.

Healthy diet: Eating several servings of fatty fish a week, ample high fiber foods, plenty of fruits and veggies, good lean meats (including game), good fats (including olive oil, plant sterols/stanols, Enova), nuts and beans, soy protein foods (preferably 25 g a day), and dishes spiced up with healthy ingredients like tumeric and garlic, etc. is plenty tasty and plenty filling. One can obsess quite a bit over how to get all those into your diet each week, rather than obsessing over what one is deprived of.

Exercise: Exercise to maintain weight loss is hard to do. For health a little less so. But finding fun things and keeping at them, a variety of them, running, swimming, biking, dancing, yoga, DDR, team sports, classes, competitions, whatever, is pretty easy to maintain. Knowing that you are fitter than before is a kick. Just taking the stairs more and parking such that you have to walk more can help and is just a matter of new habits

Would it have help you avoid the return of your compulsions? I don’t know. But most do not have compulsive disorders.

107

alice_in_wonderland, I had never thought to compare what I had experienced on Optifast with anorexia, but I can understand now. I have the world best therapist, but I was already seeing him because of depression and teacher burn-out. He is a psychiatrist who looks a truly workable solutions for individuals.

I could not agree with you more about dieting! Optifast did try to prepare me for healthy eating. I worked with a nutritionist on their program to prepare me for that time when I would be refeeding. I knew what to eat and why and I exercised with a trainer. But I could not control the compulsive eating. Dieting leads to weight gain for me in the long run.

Exercise made me feel good and was helpful for depression, but with depression, of course, comes the symptom that Brickbacon labels “laziness.” And certainly I tend to be inert (for more than one reason). Exercise did not seem to affect my compulsions. I haven’t seen any studies on whether or not they affect seisures, but I would be curious.

Most what? Most active people? I think there is a good chance that most morbidly obese people are compulsive in their eating habits. That is not based on any studies I’ve read – only experiences with people I’ve met through weight loss programs over the decades.

I expect to be on the anti-conconvulsant/anti-compulsion medication indefinitely.

BTW, I grew up in a household where the only spices were salt, pepper and cinnamon. I have been “born again”! I will put Indian spices on just about anything!

108

Well the “most” I was referring to was most overweight and obese individuals. I don’t know about the morbidly obese.

The question originallly posed by wes, you with the face was and is whether the benefits of the focus on fat (and as you note, the use of vanity and societal prejudices as a motivator) are greater than the potential harms.

Interestingly the US Preventative Services Task Force just published an evidence based guideline in Pediatrics this month and found that the evidence for or against identification is lacking.

I believe the focus must be on improved primary prevention by improved promotion of healthy lifestyles in the first place. This is a systems problem for our society as a whole; we need to figure out the ways to change our society so that lifestyles associated with obesity are not the easy default option. I just don’t know how to do that without imposing onerous regulations.

109

I’m on my parents computer right now ($300 emachines with a dial up modem). As a result I can’t really intelligently reply to this thread as it takes about 25 minutes to do the level of reading and research I could do in 5 minutes on my computer back at my apartment. Plus I remember writing a really long post and having the thing time out and losing it. So I’ll reply either tomorrow or the day after tomorrow.

I still do not see and substantial evidence that losing weight is a safe, effective or necessary medical intervention. I will explain more in depth later on though.

110

I think Boo Boo Foo hit the crux of the matter in an earlier post:

As individuals, we all need to make our own choices about eating and lifestyles, combining concern for our own health with respect for other people’s choices. As a society, we need to focus on practical ways to reduce the problem of obesity. And the best way to do that is probably to concentrate on promoting healthy lifestyles for kids, for whom obesity can easily become a lifelong handicap, and good diet and exercise habits can become a lifelong blessing. (Moreover, reductions in obesity and its associated health burdens will help ease the crippling rise in Medicare and Medicaid costs for future generations. We need to remember that increased mortality isn’t the only health consequence of obesity: expensive and burdensome obesity-related illnesses like diabetes are also a serious problem.)

IMHO the most important tactic is to stop commercial junk-food floggers from leaning so heavily on children. School sponsorship deals where snack companies pay for school equipment in exchange for providing their junk in school cafeterias and vending machines—sometimes with specific consumption quotas to ensure that the kids will eat at least a set minimum of the junk—should be right out. “Astroturf” (fake grassroots) groups like the Center for Consumer Freedom, which basically fronts for junk-food producers, shouldn’t be taken seriously in their rhetoric about “food liberty” and “voluntarily choosing weight gain”.

We also have to set up our communities and buildings so that exercise is an easier, more natural option. Housing developments without sidewalks, towns without playgrounds and bike paths, shopping centers without pedestrian and bike access are all dumb ideas when it comes to discouraging sedentary lifestyles for kids.

Boo may be right that the present generation of adults has been hit by a largely irreversible obesity epidemic brought on by economic and cultural forces, whose consequences we’ll just have to live with as best we can. But that doesn’t mean we have to resign ourselves to future generations suffering the same thing. After all, we starting inoculating kids against smallpox even if their parents were already scarred by it, in the hope that the new generation would wind up healthier. We can do the same in attempting to “inoculate” against obesity, poor diet, and sedentary lifestyles.

111

I said I’d write a reply so I will but before I do I want to say that I am sick of obesity and debating the subject. When I first learned about this subject I was reading 60 hours a week of articles and books, and carrying on multiple debates simultaneously all over the internet and through email. But now I’m sick of this subject, the same way that a person who eats lobster 3 meals a day for a month gets sick of it and just wants to eat something else. Because of that fact I haven’t replied as of late to this thread. Its not because I am cowed by the replies of my detractors, its just burnout. However I feel that I owe a reply since I started this thread. I can’t say my forays into fat acceptance weren’t enlightening and fun, but man I am so burnt out right now.

Before I start I am not going to have 30+ cites in my post as much of the info comes from various sources that I will have to take a long, long time to dig up. I am writing this whole post out of memory to save time. If anyone has any questions just quote the thing you are wondering about and say ‘cite’ and I’ll try to dig up where I originally read the statistic.

This thread will be long as hell. Sorry about that. I will provide a synopsis at the end to whomever wants to avoid reading the whole thing.

Ok, the stereotypical argument of someone who supports the war on obesity goes something like this
“People used to eat healthier diets and exercise more and they were thinner. Now we are eating worse, eating more and exercising less so we are getting fatter. OBesity is a major health risk that we have to fight and eliminate. Making fat people thinner drastically improves their health and is a necessary medical intervention”

VIrtually every one of those beliefs is wrong.

First off, medical science doesn’t know for sure why people are fatter. Medical science can’t make fat people thin and they can’t make thin people fat. They think they can, but by and large they have no idea how to encourage weight gain or loss of more than maybe 5-10% of bodyweight. Essentialy, we do not know why one person can eat at mcdonalds every day and not exercise and have 9% bodyfat while another person can eat a healthy diet and exercise and have 40% bodyfat. The reality is the medical community understands very little about adipose tissue (if they understood how it worked, we wouldn’t have any obese people as we’d have competent interventions that worked) given the fact that hormones like Leptin or Ghrelin were only discovered 10-20 years ago. Given the fact that the medical community doesn’t understand how adipose tissue works, how are they going to know ‘why’ obesity rates are going up? Its a simple question, but it is something worth pondering. If you don’t understand how something works, you can’t know for sure how something works.

That is not to say that westernization plays no role whatsoever in obesity rates. It obviously does but obesity rates vary. Canada has half the obesity rates of the US despite similiar geography, diet and lifestyle. In the US & UK obesity rates have doubled in the last 20 years but in other western countries they have only gone up by 20-40% or so. Why the discrepency?

If you ask a proponent of the obesity war why the rates are so different they will say ‘diet and exercise’ in one form or another. However this is a negative stereotype.

All disliked subgroups have negative stereotypes about them.

Blacks are considered lazy, stupid and primal
Women are considered emotionally out of control and irresponsible
Jews are considered wily and greedy
Fat people are considered lazy, weak willed and gluttonous.
etc.

If you examine the ‘reasons’ for the obesity epidemic given by the media and medical community all of them are nothing more than thinly veiled negative stereotypes about fat people. Since the medical community understands so little about adipose tissue (as I said, if they knew how it worked we wouldn’t have fat people) they rely on negative stereotypes to explain things. Look at the reasons given.

More sugar in the diet
more video games
more TV
more fast food
higher fat diet
less exercise
less blue collar work
bigger portion sizes
more candy
less healthy food

All of these imply that the reasons obesity rates are going up is because people are lazier, unable to resist temptation and gluttonous. All of them. Just think about it for a minute.

Its no different than if you sent a racist into the ghetto to examine why blacks have a higher unemployment rate and the reasons given by the racist always come back to the idea that blacks are lazy, stupid and primal. Or if you sent an examiner 150 years ago to study why women didn’t have as many science jobs as men and all the reasons came back to the idea that women had no emotional control or responsibility. The medical community doesn’t understand how adipose tissue actually works so they have to use negative stereotypes to fill in the education gaps.

The reality is there never was a ‘good old days’ in regards to obesity, that is just conjecture. THe reality is the only reason people were thinner 80 years ago is due to malnourishment and not having a choice in the matter. The average WW2 soldier was a little shorter than a modern teenage boy, so yeah they were thinner, but they were also stunted and malnourished. The average WW1 soldier was even shorter by an inch or two. Being stunted and malnourished to be 20% thinner is not a good bargain.

In the 1960s fat made up about 42% of diet. That is either equal to or more than the percent than you’d get in a fast food super value menu of sandwich, fries and a drink. Now fat makes up about 33% of the diet intake. So yeah sugar intake has gone up, but it has gone up in part to compensate for the fact that fat intake went down so its not all bad.

Again, that isn’t to say these things (westernization) have no role, but we don’t know for sure what role they play. Assuming they are the only reason is nothing more than pure speculation being made my a medical community that doesn’t understand how adipose tissue works anyway.

Here are some other factors that do play a role in rising obesity rates.

Age - people over 30 are twice as likely to be obese as people under 30 (rates are something like 15% vs 30%). The baby boomers started hitting 30 in 1976 so we now have a population with more people over 30 and less under 30 than we did 40 years ago (pretty sure).

Race - race plays a big role in obesity as blacks and mexicans are more likely to be obese than whites and far more likely to be obese than asians (blacks have obesity rates about 400% higher than asians). In the last 40 years blacks and mexicans started making up larger percentages of the population.

Smoking - smoking rates have dropped from about 50 to 25%, and quitting leads to weight gain. The average smoker gains about 10 lbs when they quit so about 25% of the population gained 10 lbs in the last 40 years. 25% of the population gaining 10 lbs is nothing to be sneezed at.

Dieting - Dieting leads to obesity. I read one study that showed extreme dieting increased the risk of being obese by 300%. Meaning those who dieted extremely were three times more likely to end up obese than those who didn’t bother with dieting. Its just common sense when you think of it, starving yourself will cause your body to respond by getting fatter. Dieting rates have gone up dramatically in the last 40 years. In the book ‘the beauty myth’ the author says something like in the 60s only about 1/4th of women dieted, nowadays its closer to 1/2-3/4 of women. So people are getting fatter due to dieting.

Sleep - sleep deprivation is tied into changes in ghrelin and leptin hormones (two hormones involved in appetite). What happens is the less you sleep the more your hormones tell you to overeat. One study said that those who got 2-4 hours sleep a night had obesity rates about 70% higher than those with 7-9 hours sleep a night. Those with 6 hours had rates 23% higher than the 7-9 hour group, those in the 10 hour group had rates about 11% lower than average. essentially the more you sleep, the less obese you are. In 1960 people slept 8.5 hours a night on average, now they average a little less than 7 hours a night.

So yeah, westernization plays a role in rising obesity rates but so do changing demographics, smoking rates, sleep rates and dieting rates. IN fact the medical community encourages dieting and not smoking, so they are partly to blame for the obesity epidemic. The reality is we don’t know for sure what to do about it or where it comes from, why a place like France may have 1/3 the obesity rates of the US or why blacks have four times the obesity rates of asians.

Now onto the idea that losing weight is good for health. Well, when you examine the death statistics from obesity usually about 80-90% of tye deaths are due to either cardiovascular disease or cancer.

However between now and 1992 cardiovascular death rates are down about 26%. They are down a third since 1985.

Cancer rates have been dropping at about 1% a year since 1990.

So where are these deaths? In the same time period (1985 to today) obesity rates have doubled, but the main killers of obese people have dropped dramatically. Is that to say obesity plays no role in health? No, but medical science seems to be able to handle the excess risk pretty competently. Its not really an epidemic if the disease and death rates keep going down, more like a cultural panic.

ANother factor is the idea that losing weight will improve cancer rates is conjecture. There haven’t been long term studies on weight and cancer risk because weight loss is so rare. This is conjecture.

There have been studies showing weight loss and attempted weight loss increase the risk of death by cardiovascular disease.

Weight loss and attempted weight loss can also be damaging to people psychologically as it can run the risk of increasing depression rates or rates of eating disorders.

Combine that with the fact that dieting and weight loss fails about 90% of the time and can make obesity worse. Assume your doctor said this to you

“alright, you have hypertension. I have a pill here that fails to work 90% of hte time, and that is proven to increase the risk of death from cardiovascular disease. It may also give you some psychological problems. There is also a good risk that it’ll make your hypertension worse than it was before. Hell, you may not even have hypertension and not even need the pill. But I still want you to take this pill. Naturally I have other treatments for hypertension that are more effective, safer and that are proven to work but I’d rather use this one”.

Any doctor who said that would be considered a dangerous quack but that is essentially the situation with weight loss right now. An ineffective medical intervention that fails 90% of the time, that can make the underlying condition worse, that isn’t proven to help cancer, that is proven to make cardiovascular disease worse and that is probably unnecessary is treated as a competent medical intervention. The reality is there are endless interventions you can make for cardiovascular disease and cancer that don’t fail 90% of the time, that don’t make the underlying condition worse and that are proven to work. The main ones are

Healthy diet
exercise
not smoking
complimentary medicine
regular medicine

I have read the ACS say that 2/3 of cancer deaths could be avoided if people didn’t smoke, ate better, exercised & got screened properly. Since these interventions probalby have a compliance rates of higher than 10% and do not lead to making the condition worse (exercise doesn’t fail 90% of the time and doesn’t run the risk of making someone more sedentary the way dieting fails 90% of the time and runs the risk of making some fatter) why are we bypassing competent medical interventions in favor of useless, dangerous ones?

Same thing. Doctors encourage a treatment with a 90% failure rate that can make the underlying condition worse that can be unnecessary (many people who are encouraged to lose weight have no symptoms whatsoever of cardiovascular disease, cancer or diabetes)

ALright, what about the argument that doctors aren’t encouraging weight loss, they are encouraging healthy eating and exercise? This isn’t true, they are discouraging healthy eating and exercise since they tie these things into weight loss.

  1. Eating healthy and exercise is a reasonably new method of weight loss. Doctors used to and still do encourage protein fasts, atkins diets, pills, etc. Eating healthy and exercising is just one of many weight loss tools doctors & society uses and is a reasonably new one at that.
  2. Not everyone is overweight/obese and is willing to admit it. Since being overweight is considered socially bad most people won’t admit it to themsevles. I’ve read that only about 20% of americans think they are overweight, despite 65% of us being that way. So factor out all the poeple who aren’t overweigth and who aren’t willing to admit to being overweight and who wont eat healthy since they feel the risk doesn’t apply to them.
  3. The levels of healthy eating & exercise necessary to lead to weight loss can be too restrictive for many people to follow, creating an ‘all or nothing’ mindset. The reality is walking 2 hours a week and eating a little more fiber and fruits and vegetables can make major health improvements, but they probably won’t lead to massive weight loss. The level of exercise and diet (as quicksilver points out) can be far too excessive for anyone but the most dedicated minority to actually carry them out.
  4. When science figures out how to make fat people thin w/o effort people who eat healthy & exercise solely for weight control will stop doing it.

So there you have it. By tying healthy eating into weight loss the medical community is telling 60-80% of people (people who aren’t overweight or who can’t admit to themselves that they are overweight) that they don’t need to exercise or eat healhty since they aren’t ‘fat’. Of the remaining 20-40%, they are getting the idea that the level of exercise & diet is so severe that only a tiny minority will be able to follow it while the rest just give up and do nothing. And when science invents drugs that work for obesity the people who eat healhty & exercise for weight loss will stop.

A smarter intervention is telling everyone regardless of weight that they should eat healthier and exercise, and that even small changes matter and it doesn’t matter if it leads to weight loss. Eating 3 slices of high fiber bread a day will give an extra 14 grams a day of fiber. Walking 2 hours a week will make major health improvements. You don’t need massive changes to improve health.

ALso, by tying the benefits of healthy eating & exercise to weight loss you make the rewards too intangible. People aren’t going to do something that is extremely likely to not work, or to not start working for months. YOu should emphasize the fact that healthier diet and exercise lead to several improvements not only in physical health but also in regards to depression levels, sleep, stress levels, a stronger immune system (less sick days) etc. I started out eating healthy & exercising to lose weight but now I do it just because I prefer the way I feel when I have stable blood sugar and a stronger immune system and I don’t care if I lose weight anymore.

The latter intervention will work better than the former, and people won’t quit when medical science invents obesity drugs in the next 20 years.

112

But you may say ‘well, bodyweight is still a major health risk’. Potentially yes (even though death rates of cardiovascular disease are down about 33%, cancer rates are down rougly 20% and severe diabetes complications have gone down by about 60% in the last 10-20 years even though obesity rates doubled), but so are alot of things. According to a study in Norway in the 80s morbid obesity in women cuts about 5 years off of life expectancy. HOwever

Being gay can cut 20 years off of life expectancy
Being poor can cut 10 years
Being a child of divorce can cut 4 years
Not getting married can cut 5 years
Being an athiest can cut 6 years.
As far as obesity, a recent study claimed 2-5 years, but when pressured the author admitted it was closer to 4-9 months.
So the reality is a poor person who is thin has a lower life expectancy than a fat person who is middle class. A thin athiest has a lower life expectancy than a fat religious devout.

If you are going to nag fat people to change their lifestyle for ‘health’ reasons you should also nag athiests and single people to join a religion and get married. ALl are important for health and life expectancy. WHo draws the line saying one is ok to nag about and the other is not? Some people dont want to live a restrictive dietary lifestyle and that is ok even if it is unhealthy. JUst like some people don’t want to get married or believe in Jesus or find a way to earn $45k a year, even though these are unhealthy lifestyle choices too.
Synopsis of several points I’ve made in this thread…

  1. The ties between bodyweight and health are tenuous and could be due to an endless number of factors other than bodyweight itself including race, income, sleep rates, diet content, dieting acts, exercise, etc all of whice are coorelated with obesity rates. Studies are contradictory and open to interpretation as some show risk, some don’t.
  2. If the ties exist, they are reserved for the minority of obese people (the most obese 8% or so). The majority of ‘overweight people’ have BMIs in the 25-35 range.
  3. We don’t know how to make large numbers of people lose weight and keep it off so why bother with the issue anyway?
  4. Short term studies on weight loss are contradictory as to health benefits. Some show lower mortality, some show higher mortality
  5. No long term benefits on the health benefits of weight loss exist due to point 3, nobody can get large numbers of people to lose weight and keep it off to run a study on the theory. The idea that getting thin and staying makes you healthier is pure conjecture. A fat person who loses weight is essentially just a fat person with smaller fat cells, not a totally different person.
  6. People can experience major health benefits from healthy eating and exercise even if these things do not lead to signifigant weight loss
  7. If people lost weight they may lose the benefits of extra weight
  8. Obsessing over weight and our love of thinness and loathing of fatness is tied into smoking, self esteem problems, mistreatment by medical professionals and the public at large, etc.
  9. Even if weight is an independent health risk, and assuming we knew losing weight improved health, the endless negatives of encouraging weight loss greatly outweight the benefits, and weight loss is one of the most inefficient, destructive and useless medical interventions that can be made. There are other interventions with fewer side effects, higher compliance rates and more proven benefits when dealing with cancer and cardiovascular disease than weight loss. Probably diabetes too. A person who gets screened properly, takes medications, has access to competent medical care, keeps their cardiovascular risk factors in check and eats a healthy diet and exercises may not lose weight but will be a lot healthier than a thin person who doesn’t do any of these things.
  10. Most of the explanations for the rising obesity rates are just insulting negative stereotypes about fat people. Things like dieting, smoking, sleep and demographics play a big role in rising obesity rates just like dietary content do.
  11. People don’t know for sure why people are fatter nowadays, and there never was a ‘good old days’ in regards to weight. People in the the developed world up until 50 years ago (and currently in the developing world) were thinner, this is true. But they were also stunted, malnourished and suffered from several vitamin and mineral deficiencies. There may have never been a time in human history when large numbers of people were both extremely thin and healthy simultaneously (well, maybe in parts of Europe and asia). There is a time that people are fat and healthy (ie today) though. As far as the idea that lifestyle is totally responsible for weight, developed countries have varying rates of overweight and obesity. Canada has half the obesity rates of the US even with similar activity and diets and nobody knows why.
  12. The level of personal responsibility we expect from the fat is grossly unfair and would revolt anyone but the most extremist libertarian if put in another context. Most diseases and problems in life are due to ‘laziness’ and not trying hard enough to avoid them like cancer, AIDS, poverty, rape, etc. It is unfair to insult fat people for not losing weight when we live in a society where our hands are held by the government and poor people and people who get STDs and cancer are given sympathy. The idea that obese people should be expected to violate billions of years of evolution isn’t fair to them in a developed society
  13. Our loathing of fat violates the norms of civilized society. You are not supposed to judge a person’s character strictly by appearance, to condemn their lifestyle if it doesn’t harm anyone else, and you are supposed to tolerate diversity.
  14. Numerous medical interventions that are safer, more proven and more effective than weight loss already exist and should be taken up instead of weight loss
  15. The rates of death and complications from the disease associated with obesity like cardiovascular disease and cancer have kept going down even as obesity rates keep going up.
  16. Things like atheism, divorce and income have a bigger effect on life expectancy than bodyfat.

I know I’m forgetting a lot of points I wanted to make but that is what I have so far. If I remember the other stuff I’ll add it. Plus there is a 20k character limit per post so I had to make 2 posts.

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I’m all for healthy eating & exercise. But as I said above, tying these things into weight loss does alot more harm than good.

As far as diabetes, cardiovascular disease & cancer you can drastically cut the rates of these diseases without losing weight. Diabetes can be cut by 58% even if you are still obese but lead a healthier lifestyle. Cancer can be cut by 60% with healthier lifestyle. Besides death rates of CVD and cancer keep going down as obesity rates go up.

And ADHD costs more than obesity to the medical profession. I don’t have the stat on hand but I read something about adult ADHD costing something like $2k a year in excess medical expenses. Obesity costs about 1k extra.

So my advice is similiar to yours in regards to changing diet & exercise, we just have different goals (ie weight loss isn’t important to me)

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I agree we should encourage healthy eating & exercise, I just don’t feel we need to encourage weight loss at the same time. I also feel encouraging healthy eating and exercise as vehicles for weight loss does alot more harm than good.

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Wes,

Several of your listed “facts” are just not true, and we’ve covered that all ready to the point of fatigue, but your bottom line is something that I can mostly agree with. I also feel encouraging healthy eating and exercise exclusively (or even primarily) as vehicles for weight loss does alot more harm than good.

My take is that this is a four-legged stool with each leg contributing to supporting our long-term health:

[ul]
[li]Genetic predisposition[/li][li]Non-obesity[/li][li]Healthy diet[/li][li]A non-sedentary lifestyle which includes at least moderate exercise.[/li][/ul]

Now you can’t change the potential of your genes. And achieving non-obesity is best addressed by dealing with the other two remaining legs, not by attacking it head-on. Head-on attacks on weight often are not only ineffective, they may end up with exactly the opposite than the intended outcome. Clearly the focus should be on the last two with a hope for the best that non-obesity follows as well.

But we do like to measure things. The last two are difficult to measure; weight is not. The temptation is to therefore use weight as a de facto measure of achieving the other two. And for populations at … ehem … at large … it does serve as a useful screen for those who need closer looks for modifiable risk factors and potential improvements of lifestyle choices. Moreso the fact that our society as a whole (and in particular our chidren) is increasingly obese, does serve to reflect how poorly our society supports healthy lifestyle choices.

Can we agree to that point at least?

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Thanks. I learn from the best.

That is pure crap. Doctors have tried jaw wiring, drugs, atkins, starvation, pills, etc. To say healthy eating is synonymous with weight loss is like saying Ford Taurus is synonymous with cars and I won’t let you get away with that kind of thing. This is one method of weight loss, and a reasonably new one at that.

I’m too lazy to research the issue right now. Maybe later.

Bariatric surgery has benefits, but it is a very extreme method of promoting health. Competent pharmacology, healthier diet & exercise can have dramatic benefits too and aren’t neaerly as expensive or risky as surgery.

Some studies show health benefits of weight loss, some show no benefits, some show more deaths. However with other interventions like exercise virtually all studies show benefit.

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I don’t see it that way. The bible condemns homosexuality, but does it very sparingly. The bible (I think) encourages stoning of family members more than it condemns homosexuality. So you have to ask why do fundamentalists focus only on the parts of the bible that condemn homosexuality when the bible condemns other things more harshly. The reason is socialization, people have always used legitimate authority sources (medicine, religion, etc) to justify their personal and social values by saying ‘its not me, it medicine/religion that doesn’t like this thing’. Same thing with obesity.
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Yes it was. It was in the US 100 years ago. Not morbid obesity, but BMIs pushing 30 were acceptable in the 19th century. Back then being fat meant you had enough money to eat well.

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Pure fakery. I guess 2-3 studies aren’t enough.

http://www.mediascope.org/pubs/ibriefs/bia.htm

Studies also show that a third of American women in their teens and twenties begin smoking cigarettes in order to help control their appetite…Studies have also found that boys, like girls, may turn to smoking to help them lose weight. Boys ages 9 to 14 who thought they were overweight were 65% more likely to think about or try smoking than their peers, and boys who worked out every day in order to lose weight were twice as likely to experiment with tobacco.

http://www.smokingprevention.co.uk/smoking%20doesn’t%20reduce%20weight%20in%20young%20people.htm

“Every day, many young Americans begin smoking believing that it will help them lose weight, but these results demonstrate that smoking does not help control weight, and only after decades of smoking do we see a difference in body weights of smokers and non-smokers.”

http://www.dimensionsmagazine.com/news/dc_shape_u_1.html

While the survey finds that half of all respondents have smoked, both overweight and normal weight women reported greater reluctance to quit because of fear of weight gain as compared to thin women who smoked (22% and 18% versus 8%, respectively, among women who have smoked at some point in their lives).

Not to be a jerk but if 5 or 6 studies isn’t enough to convince you of something you don’t want to believe then this debate is going nowhere. Is everyone lying but you? I personally can accept that obesity can be dangerous, but I am of the opinion that there are safer, more effective and more proven interventions than weight loss we should be trying and that statistics from the 70s showing obesity rates are dangerous are worthless as medicine advances rapdily in 20-30 years.
Earlier in this thread you used the ‘nurses study’ which was run from 1976-1989 (something like that) to show obesity causes cancer & heart disease. However CVD deaths are down a third since 1985. Cancer rates are down dramatically too since the 80s. Using 30 year old statistics to show something is dangerous is meaningless since medicine advances so rapidly that the threats may not exist anymore (Imagine if the march of dimes in 2005 used statistics from the 1940s to show polio was a major problem). However, to be fair, I used old statistics too in my posts.

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Where is this public health epidemic? I don’t see one. Even if 30 year old statistics show obesity causes CVD, cancer & diabetes why focus on the most dangerous, least effective & least proven method of treating these diseases?
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I guess that explains why rates keep going down even as obesity rates keep going up, because obesity prevention is the best method of preventing these diseases.

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Fine and good. I don’t know enough on the issue to comment, I am just going to say there are numerous safe, effective interventions that can be used instead of weight loss.

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Thats good. I am still of the opinion that we don’t understand where obesity comes from or what to do about it though.

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And what is the goal? To use negative stereotypes to explain something doctors don’t understand? To allow rampant bigotry and double standards which are just attempts to enforce a cultural prejudice to run rampant in the medical community?

Do you encourage your patients to get married and not get divorced for life expectancy purposes, being single and getting divorced is becoming more and more common too? Do you rely on statistics from 1950 to explain to your 10 year old patients that they may get heart disease in 2050? Just think about that for a minute. Even if statistics from 1950 show obesity is dangerous to assume that over the course of a century medicine won’t advance (you are using the same risk factors from 1950 to predict risk factors in 2050) is really out there. You might as well ask someone from the 80s to predict how many Commodore 64s it’ll take to control the Mars launch in 2020.

Hypertension rates are down, CVD deaths are down, cholesterol levels are down, cancer rates are down, diabetes complications are down. And obesity is going up, doubling and even tripling in the last 40 years. Where are these epidemic deaths that we have to focus on for the sake of the children?

117

Again, this makes no sense. Yes, at the end of the day obesity is due to calories in, calories out and what your body does with those calories.

However hundreds of factors go into that equation. A short list of hormones and neurotransmitters that effect obesity rates would include insulin, estrogen, progesterone, testosterone, leptin, ghrelin, PYY, dopamine, norepinephrine, serotonin. Just to name a few.

Literally hundreds of things affect the cherished ‘calore in/calorie out’ equation. The study I posted earlier showed that in Sweden 40% of non vegetarians were overweight while 25-29% of vegetarians were. I don’t know the obesity rates, however that is not a magic change.

The study I listed in my OP showed that with healthy diet & exercise people may not lose any weight (the HAES study)

The study on diabetes showing a 58% decline involved people only going from a BMI of 34 to a BMI of 33. So healthy eating again isn’t guaranteed to lead to weight loss.

Sleep deprivation can almost double the risks of obesity (if you compare those who sleep 3 hours a night vs those with 10 hours a night of sleep). Race plays a huge role in obesity.

The point is endless things affect the cherished ‘calorie in/calorie out’ equation. And overcoming biochemistry is a very uphill battle. If you don’t believe me then drink a pint of vodka and try to do calculus, your willpower will be trying to do calculus but your biochemistry will be trying to stop you. See how far you get with your biochemistry fighting against your willpower.

If you ask me waht we should do is this

The medical community should encourage size acceptance in everyone in the hopes that this will cut down on psychological disorders, eating disorders, dangerous diet drug use (phen/fen), weight gain and smoking. Then explain to obese people that even if they are at higher risk that that just means they have to take safer, more proven, more effective measures to cut their risk of CVD, cancer & diabetes. Things like pharmacology, exercise, healthy diet, complimentary medicine, not smoking, etc. Encourage everyone to make changes irrelevant of their role in obesity rates.

Then wait about 20 years until medicine figures out how to make fat people thin in a way that doesn’t fail 90% of hte time, that doesn’t run to risk of making people fatter and that doesn’t increase the risk of psychological disorders. Then we can encourage people to stop being fat again. But by then medicine will probably be advanced enough that even if obesity is dangerous competent medicine will be able to deal with the risks.

You seem to assume that the health risks of obesity exist in a vacuum. They are not. Even if there are risks to obesity, losing weight is not the only way to deal with those risks. There are other interventions including exercise, screening, complimentary medicine, not smoking, various pharmacological drugs (glucophage, statins, etc). Why focus on the most dangerous, least proven, least effective medical treatment?

118

We’ve both been a little rude in this thread but I can agree with about 80% of what you’ve said.

I am just of the impression that trying to make fat people thin is a dangerous, unnecessary, unfair & losing battle. If the medical community took the effort it spends trying to encourage weight loss and instead spent it on promoting unconditional body acceptance for everyone (to cut psychological problems, smoking rates, etc), encouraging everyone (regardless of weight) to try at least some healthier lifestyles and encouraging people to visit physicians for competent medical interventions to prevent diabetes, cancer & cardiovascular disease we’d be a much mentally and physically healthier nation as a result.

119

Ah well, so much for trying to find some consensus. And so much for your burn-out, eh?

Smoking. Well hard for me to take cites that cite Teen magazine surveys as a basis to seriously but my brief attempt at doing a PubMed search shows that the data on any correlation of weight concerns and males is mainly no correlation but that there does seem to be a correlation of weight concerns and smoking in teen girls. Please note, this is a correlation, not a causation either way. It merely says that the same girls who start to smoke are also trying to lose weight above the mean. Now one possible interpretation is that they are smoking in order to lose weight. Another is that these are girls who are insecure and subject to trying to “look cool” … whether that means lighting up or attempting to lighten up. Personal experience with teens leads me to suspect that the latter is a more likely explanation. You may reach a different conclusion. Fine.

As to people continuing to smoke … again I personally interpret the data as that addicts will hang to any convienent rationalization that they got. But it is really irrelevant: the media portrayal of fat as undesirable does not equal the public health “War on Obesity”. They are independent items. The health concerns of obesity are very recent and are predated well by societal disapproval of fatness.

I never aid that healthy eating is synonymous with weight loss. I have said that the main effective weight loss approach is healthy eating and exercise. Can not understand the difference between those statements?

I am not going to waste my energy re-citing all the studies that show a clear association between overweight/obesity and various morbidities. The data there is rock solod and has been quoted before. The data between obesity and mortality is also rock-solid and has been reviewed.

Without a doubt medicine has made lots of progress. We have medicines to treat many of the morbidities associated with being overweight and they work. Smoking is down among adults (funny that, given that decrease correlated with the public helath war on obesity, which you believe causes smoking), and so on. We do it at huge expense however (already cited). How much better to avoid being hypertensive or diabetic or dyslipidemic in the first place?

As to the rest of your comments - well you are attributing to me positions that I have been very clear that I do not have. I will not fight on behalf of straw men. Try re-reading my posts because I can’t find a way to say it any more clearly. If you stopped swinging a while you might realize that we agree more than we disagree. We disagree on whether or not obesity is an independent risk factor for both mortality and morbidity and whether overweight increases morbidities even as the mortality rate is decreased. We very much agree that battling current obesity as a goal in and of itself is more likely to cause harm than good. I would not go so far as “size acceptance” if that means ignoring the established health risks, but I’d endorse focusing on lifestyles as much more effective for promoting health. It would be foolish not to recognize that obesity is associated with increased risks and therefore the need for more attention. We agree that making the changes in society needed to increase heathy eating and non-sedentary lifestyles are important, even if my view that obesity will be prevented by that and that such is a good thing is not a POV that you would endorse.

And on preview I see that you are seeing how much we agree. Hopefully you can respect my POV that putting more energy on the highest risk individuals makes some sense.

120

Wesley, I’ve read your entire thread. (Really.) And I agree with your points, wholeheartedly.

To which I will add.

  1. The ‘obesity’ research itself, and how it is interpreted, is SEVERELY biased by personal, emotional attitudes toward obesity.

  2. People who have never been obese, who may be naturally thin, simply do NOT understand being obese. They do NOT get it, no matter how much they may claim otherwise. They say, “Eat less, excercise more. Simple.”

Okay. For everyone who is NOT obese, and is ‘naturally’ slender, I suggest the following:

Write down your average daily caloric intake for the past month. The amount you eat ‘naturally’ day in, day out. The amount that maintains your weight just were it is. The amount you eat without consciously controlling it.

Next, write down your quantity of ‘exercise’, either formal activity in a gym, hard physcial labor, or sports participation. The stuff you normally do, month after month.

Now. Cut back your calories 15%.

And, while you’re at it increase your exercise 15%.

Continue for the rest of your life.

And report back in three years. How did you do? Were you lazy, undisciplined? Did you FAIL? Do you feel better? Did you slip back into your old habits? Why?

That is what obese people experience when following your prescription to ''Eat less, exercise more." Now shut up.
3. What SHOULD be done about the ‘obesity problem’? Nothing. Nothing at all.
No amount of official clucking and tsking and pointing to statistics is going to cause obese people “make a thousand decisions a day, each one counter to instinct and desire and natural inclination.” Ain’t gonna happen. ESPECIALLY if the solutions are designed by thinner people who don’t get it.

And no, I don’t know how to encourage people to eat more natural whole foods, and to move more, either. People have been scolding over such things for at least 150 years. No one has found anything that works consistently. Which suggests to me there IS no good solution. Except individual by individual, for personal reasons.