The Obesity Myth
Oct. 6th, 2007 05:11 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
moominmuppetSome stuff I've read and watched in the past week:
The Obesity Myth is a great intro to the major problems with how fat is handled in American medicine. It's nowhere near long enough to get into the nitty-gritty as much as I would've liked, but that's also one of its strengths; at just over 200 pages, it's a good framework for starting to understand further critique on various points. Although he does go off on a few random tangents (Clinton/Lewinski), the book starts out covering the science of fat (and exactly how little evidence there is that fat itself, as opposed to other factors such as activity level and the effects of yo-yo dieting, really has major health effects), and then segues into the manner in which the current medicalization of our fear of fat gives a somehow respectable patina to the ridiculous discrimination and flat-out nastiness that fat people encounter every day (do you know that there are now companies that are refusing to hire the overweight? That wasn't in the book, but it's something that pisses me off no end). I ended up ordering two copies to buy (used, since it's sadly out-of-print), just so I have an extra to lend out. I'd recommend picking up a copy if you're tired of well-meaning but pushy family members trying to throw you at every fad diet that comes down the line. Hell, give a copy to your doctor next time they hassle you (better yet, get a different doctor). As I told my mom when I was reading it (it was great discussion material), I have a long-standing policy of absolutely refusing to feed the diet industry, or let them make their money off my back. It's deeply political for me, even aside from the general uselessness of those approaches. There's plenty I can do to improve my health. I need to quit smoking, and I should be more physically active. I'm not going to argue either of those points. There's abundant data to back them both up. But sending our society on a misguided and flatly useless wild goose chase about fat poundage, rather than focusing on those issues, is absolutely counterproductive. It leads to approaches to weight loss that don't improve health, even in the few cases in which people actually manage to keep the weight off (a miniscule proportion), and it discourages people from getting more healthy, because they feel if they're not seeing a weight drop, they can't be getting the positive effects (despite the research saying exactly the opposite). Caloric restriction is not the way to go. Diet pills and other dangerous approaches are even worse. Yes, various body types come with some increase in health risks for some illnesses. I'm more likely to have bad knees. I'm less likely to have osteoporosis or lung disorders or the most dangerous forms of breast cancer (he talks a lot about diabetes -- the results there are much cloudier than you've been lead to believe -- again, activity level and a healthy diet make the big difference, regardless of body size). Artificially changing our bodies is rarely the way to handle these varied risks, any more than trying to change someone's height or race is going to be the successful way to deal with risks that correlate to those factors. Campos makes very good arguments that a) the data is not what we've been told (definition of an obesity expert for most of our govermental panels that put out these scare messages? Someone who runs a weight-loss clinic), b) artificially trying to make a fat person into a thin person probably won't have the effects we're looking for, even if it's possible, and c) we simply don't know how to do that. Not unless 95% failure rates and steadily increasing rates of both dieting and extremely high weight are signs that we've got a plan. Recommended reading. Highly recommended.
The Obesity Myth is a great intro to the major problems with how fat is handled in American medicine. It's nowhere near long enough to get into the nitty-gritty as much as I would've liked, but that's also one of its strengths; at just over 200 pages, it's a good framework for starting to understand further critique on various points. Although he does go off on a few random tangents (Clinton/Lewinski), the book starts out covering the science of fat (and exactly how little evidence there is that fat itself, as opposed to other factors such as activity level and the effects of yo-yo dieting, really has major health effects), and then segues into the manner in which the current medicalization of our fear of fat gives a somehow respectable patina to the ridiculous discrimination and flat-out nastiness that fat people encounter every day (do you know that there are now companies that are refusing to hire the overweight? That wasn't in the book, but it's something that pisses me off no end). I ended up ordering two copies to buy (used, since it's sadly out-of-print), just so I have an extra to lend out. I'd recommend picking up a copy if you're tired of well-meaning but pushy family members trying to throw you at every fad diet that comes down the line. Hell, give a copy to your doctor next time they hassle you (better yet, get a different doctor). As I told my mom when I was reading it (it was great discussion material), I have a long-standing policy of absolutely refusing to feed the diet industry, or let them make their money off my back. It's deeply political for me, even aside from the general uselessness of those approaches. There's plenty I can do to improve my health. I need to quit smoking, and I should be more physically active. I'm not going to argue either of those points. There's abundant data to back them both up. But sending our society on a misguided and flatly useless wild goose chase about fat poundage, rather than focusing on those issues, is absolutely counterproductive. It leads to approaches to weight loss that don't improve health, even in the few cases in which people actually manage to keep the weight off (a miniscule proportion), and it discourages people from getting more healthy, because they feel if they're not seeing a weight drop, they can't be getting the positive effects (despite the research saying exactly the opposite). Caloric restriction is not the way to go. Diet pills and other dangerous approaches are even worse. Yes, various body types come with some increase in health risks for some illnesses. I'm more likely to have bad knees. I'm less likely to have osteoporosis or lung disorders or the most dangerous forms of breast cancer (he talks a lot about diabetes -- the results there are much cloudier than you've been lead to believe -- again, activity level and a healthy diet make the big difference, regardless of body size). Artificially changing our bodies is rarely the way to handle these varied risks, any more than trying to change someone's height or race is going to be the successful way to deal with risks that correlate to those factors. Campos makes very good arguments that a) the data is not what we've been told (definition of an obesity expert for most of our govermental panels that put out these scare messages? Someone who runs a weight-loss clinic), b) artificially trying to make a fat person into a thin person probably won't have the effects we're looking for, even if it's possible, and c) we simply don't know how to do that. Not unless 95% failure rates and steadily increasing rates of both dieting and extremely high weight are signs that we've got a plan. Recommended reading. Highly recommended.
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
thanks for the notes here
Date: 2007-10-06 11:17 pm (UTC)I didn't realize that you smoke. I do also. I'd also like to be able to not. Something, I picked up when I was in my early twenties and trying not to be anorexic/bulemic. I don't usually have much it feels useful to say on the fat rants because my experiences are so odd, it's hard to find good placement for them in the general posts. I have pretty strong opinions about dieting, not just money, but long term health.
More lately, I think about age as much as weight and just the way there's still pressure to to see value in a certain way. Also, what things are providing the force behind the pressure. And then that leads to other general thoughts about pressure, mostly towards women because those are the ones I feel.
Re: thanks for the notes here
Date: 2007-10-07 08:45 am (UTC)I don't, but I'll go take a look as soon as I finish this comment. I was talking to my mom during my trip to CA about why I'm so torn about whether to follow my initial goal of getting a nursing degree so I can eventually work in women's health care in the clinics. I have such a love/hate relationship with medicine (my ideals vs how its practiced here) that I'm not sure I can manage to stomach getting through the system to get where I want in order to provide the kind of care I want to provide.
I have pretty strong opinions about dieting, not just money, but long term health.
*nod* Definitely. A lot of why I refuse to give them my money is because I think they're selling me something that's fundamentally unhealthy (and the research seems to back that up) under the pretense of "helping me get healthy".
More lately, I think about age as much as weight and just the way there's still pressure to to see value in a certain way. Also, what things are providing the force behind the pressure. And then that leads to other general thoughts about pressure, mostly towards women because those are the ones I feel.
*nod* Create a system that gets us wasting all our energy obsessing about our bodies, whether in terms of unrealistic appearance goals for weight or for age, really helps with keeping us from putting that energy where it's actually going to do us some good, and change the world around us. I think it's perfectly insidious.
no subject
Date: 2007-10-07 12:41 am (UTC)I have a long-standing policy of absolutely refusing to feed the diet industry, or let them make their money off my back. It's deeply political for me, even aside from the general uselessness of those approaches.
THANK YOU! totally agreed. I just found out that a friend of mine who has a serious body dysphoria problem got a lap-band yesterday. (He's 5'9'', 230lbs!) I was really upset about this, and some of my buds didn't understand my reaction, which lead to me feeling really isolated. I needed to hear some positive words!
no subject
Date: 2007-10-07 08:38 am (UTC)One of the things that pisses me off on an almost daily basis at work is having to listen to our hold messages at the clinic, which are often pimping expensive procedures at the bariatric institute and the plastic surgery department (gotta make those sales! health care institution? what?) Listening to that shit couched in terms that implicitly base them on the trust people have in the institution as a famous hospital system that wouldn't possibly recommend unhealthy things just makes me want to start ranting every single time. Friday it was all about why women might want boob jobs. *graar*
no subject
Date: 2007-10-07 02:11 am (UTC)Yes, that. Absolutely. Agree with you 100%.
Wonderful review. Thank you for posting.
And I agree that all the stuff around type II diabetes is indeed cloudy. It frustrates me to no end that it is commonly believed that a) all fat people are going to get diabetes and b) only fat people get diabetes. It is even worse when discussing gestational diabetes. Nobody really knows why some women get GD and there are even debates about whether or not it is really a "disease". It is inaccurately, but commonly, believed that fat pregnant women get GD. Not true. So many skinny pregnany women get GD and so many fat pregnant women do not. Fat pregnant women are routinely bombarded with lies about the "risks" they ostebsibly face. It makes me so, so angry.
But I digress...
Thanks for a great post.
no subject
Date: 2007-10-07 08:39 am (UTC)Oh, amen!!
no subject
Date: 2007-10-07 06:21 am (UTC)infuriatinguh interesting to hear the opinions.Interesting stuff about BMI. I think BMI is a worthless system. At the opposite end of the scale, illness is judged by being under 17.5 (this is speaking from my personal experience, of course), which is total bullshit.
I'm putting this book on my must read list and recommending it to my advisor.
no subject
Date: 2007-10-07 08:29 am (UTC)With BMI being so problematic in general, the same critiques could definitely apply to the lower end of the scale -- that there's too much individual variation in bodies for it to tell us whether a particular body shape is unhealthy for that person at that size. Mortality rates are highest for the cohort below the current "ideal BMI" range (one of the points he makes in terms of fat paranoia is that the data as it's currently read shows that it's statistically more dangerous to be five pounds underweight than fifty pounds overweight, and that this gets no press at all, because it doesn't reflect our social fears in the same way), but although he doesn't get into the topic, it certainly seems to me that it's problematic to be making blanket statements about that group, which includes both naturally lean people and people who've abused their bodies to artificially end up in that range (and I'd expect radically different health outcomes depending on which is true, just as health outcomes at the high end vary greatly depending on whether the person has abused their body with caloric restriction dieting). Although he's looking specifically at obesity, I think some interesting writing might be possible about BMI critique from the other end of the spectrum, as well.
no subject
Date: 2007-10-08 05:35 pm (UTC)Nevermind that my current weight also includes a significant amount of muscle. I hate that these scales ignore that muscle weighs more than fat. I know I have some fat on my middle, but I can also lift 50 lbs over my head.
I would like to be more active. I hate that I'm judged by the people I can beat up.