Health and Wealth and GrownUp Stuff

Derp

The actual somewhat-paraphrased quote is in the podcast episode You're Wrong About - The Obesity Epidemic

But Michael Hobbes has written and researched pretty extensively for this particular issue. Here is his original article in the Huffington Post about it, wherein he talks about personal experiences and all of his sources and such.

But if you really want to do a deep dive on it, he has another You're Wrong About style podcast specifically devoted to diets, diet culture, the truth about obesity science, and some of the ridiculously damaging things the media and diet culture have done over the years. That one is called Maintenance Phase, and it is glorious, and kind of liberating, even if it doesn't exactly give a silver-lining propaganda style picture of Beach Body Perfection that culture would have us believe.

(Spoiler: Oprah has done some questionable shit on numerous occasions, so.)

Ganymede

@solstice said in Health and Wealth and GrownUp Stuff:

Citation? My dieting butt is genuinely curious to read this.

Probably to no one's surprise, I read Men's Health because Women's Health is mostly body-shaming nonsense.

In a recent article in Men's Health, they talked about a new diet which was essentially a calorie-dropping diet and debunked it as unsupported by data or now-embraced theories on how to best lose weight. They point out, rightfully, that if you drop your caloric count you are more likely to lose muscle than fat unless you are also working out fastidiously; and, even if you are exercising, not having the right nutrients in your body will lead to tissue destruction in a calorie-deficient environment.

What does that mean?

It means you have to be conscious of what you are eating rather than how much. Eating copious amounts of animal fat isn't good for you, but neither is eating none. General tips to follow are sticking to food that is: (1) unprocessed; (2) unpackaged; and (3) stereotypically "good for you." That means loading up on vegetables, decreasing meat, and staying away from "carb-heavy" foods.

It takes a long time too.

When I went keto over two years ago, I dropped a lot of weight quickly. That was water weight. I've kept it off because once you get to ketosis, you've cut out shit like sugary drinks, beer, and anything with added sugars. And once you cut out the added sugars, shit like stevia tastes great. It helps that I can't have dairy (lactose intolerance). But keto is unsustainable as a lifestyle diet choice, so I have transitioned to a "carb-avoidant" diet that minimizes sweet fruits (God, I miss grapes), pasta (God, I miss penne rigate), and bread (no sammies for me). But since moving away from keto, I've actually lost an additional 5-10 pounds, depending on the day (because water weight is annoying).

You can lose the weight! We can share stories about our difficulties and triumphs here. Because we're soooooo toxic.

Derp

@ganymede said in Health and Wealth and GrownUp Stuff:

You can lose the weight!

But that's the problem: the research flat-out suggests that this is mostly untrue.

Most individuals cannot lose more than 30% of their current body weight at an absolute maximum, and almost none of those will ever come close to this number due to a number of internal metabolic regulatory processes. It's not a convenient reality, but it is the reality for the vast majority of people. Most of that weight is regained and then some within 5 years, but brings with it insulin resistance and metabolic damage from the methods used that your biological processes will actively revolt against, resulting in very real biological trauma to your body's processes.

That's what these podcasts are about: looking at the various science and debunking the cultural monomyth that slim is healthy, and that everyone can be slim if they just eat right and exercise, and that pushing people to lose weight is being concerned about their health.

It's just not true. No nation has decreased its obesity rate in decades, despite a number of approaches, and the cultural alienation that this ideology causes for obese people is crushing.

So while, yes, there are certain steps you can take to improve your overall health (and should!), telling people to lose weight is extremely unhealthy for basically the whole world. It does severe biological and psychological damage to people, and pretty much ignores all of the other unhealthy habits that you can't actively see on other people. Thin people are just considered healthy by default, and overweight people considered unhealthy, lazy, and noncompliant despite weight and health not being nearly as correlated as people used to think. Doctors, in particular, are pretty terrible, and receive less than twenty total hours of training on nutrition and metabolic processes, getting just as caught up in the cultural mythos as everyone else, often giving obese patients measurably worse care than thin patients, which leads obese people to avoid doctors and healthcare in general due to the quality of care they receive.

Like -- this is a real thing, and we should talk about it in real terms.

Macha

I will retell this story until the day I die.

I am NOT and never HAVE been 'thin'. I have always been what my grandmother called 'solid'. I could run like a wild thing (and did) as a child. I hiked, biked, swam, went skiing... and was never smaller than a size twelve. Fourteen once puberty was over (Hello there, T/A and hips).

My parents did not let us have 'junk food'. Sure, there were chips or cookies on occasion, but not what other kids had. My roommate was stunned to hear in my house growing up, there were no frozen pizzas, or chicken nuggets, the nights my stepmom was too tired. We would order out for pizza a couple times of month, but.. it was meat/starch/veg every night, pretty much.

My sister lost a TON of weight when she had Ulcerative Colitis. She's not as 'solidly built' as I am, but she's not far off. And when she got lower than an 8, she.. it was not a good look for her.

I had a surgery that was terribly bungled, because the surgeon was a lazy fuck with the ego of some golden god. So I ended up with a surgical hernia that needed to be dealt with ASAP (once I convinced the PCP that no, it's not scar tissue, please let me have some sort of scan). The surgeon she sent me to (Not Dr. Ego Fuckhead), told me he'd seen the scan, but he wanted me to lose 50 lbs before he did the surgery. My intestines were literally trying to escape, and this asshole wanted me to go on a diet. I cried in my car, went home, and called my PCP - I was pissed. She called and read him the riot act. I got my surgery less than a month later. THIS is the part that I will never not be amazed at.
At the follow up, he APOLOGIZED for his comment about my weight. "Once you were opened up, you really are built to be this way. I'm sorry I thought you needed to lose that much weight." I was stunned, y'all.

I've always had doctors tell me I'm too big, after my pediatrician. He NEVER ONCE said I was fat, but he'd watched me grow up since I was a little mack truck of a kid. He had kids in my school, he saw me playing after school sports, riding my bike around town all the time. They can all blow it out their asses.

Groth

@ganymede said in Health and Wealth and GrownUp Stuff:

In a recent article in Men's Health, they talked about a new diet which was essentially a calorie-dropping diet and debunked it as unsupported by data or now-embraced theories on how to best lose weight. They point out, rightfully, that if you drop your caloric count you are more likely to lose muscle than fat unless you are also working out fastidiously; and, even if you are exercising, not having the right nutrients in your body will lead to tissue destruction in a calorie-deficient environment.

At one point in my life I followed a strict calorie-deficient diet for about a year and during that year I lost something like 35kg total. In terms of losing weight it works and I can vouch for it working.

The trouble is that losing weight is the easy part. The hard part is that whatever strategy you employ is something you can maintain every day for the rest of your life. If you rely on something like calorie counting and ever stop, you'll bounce right back up to where you were.

Right now I'm trying to practice spreading my eating out more throughout the day, eating smaller individual meals more often and trying to regularly eat very small non-carb snacks like nuts every couple of hours between meals and I'm looking into playing Badminton again now that restrictions are starting to lift where I live.

Derp

@groth said in Health and Wealth and GrownUp Stuff:

In terms of losing weight it works and I can vouch for it working.

And this is another problem: People relying on anecdata. This worked for me, or for someone I know, so it will work for everyone because all bodies must be the same and respond the same.

But again, research data largely doesn't support this. But we're so ingrained in this idea that confronting people with this information causes this knee-jerk, reflexive thing.

It works for some people. But not most people. And the anecdata 'it really works' stuff does more harm than good, in many cases.

silverfox

@groth said in Health and Wealth and GrownUp Stuff:

In terms of losing weight it works and I can vouch for it working for me

Fixed

Groth

@silverfox
Worked would be more accurate, obsessively measuring everything you eat every day requires a headspace I haven't really been in since.

HorrorHound

Beer makes me stronk, because then I can lift the heavy things up and down more, for longer. Yes.

Ganymede

@derp

Okay, let's talk about it.

Let's start with that first study. I almost feel as if you stopped reading at the abstract. Later on, it talks about the fact that patients who are able to maintain their losses long-term need to be studied further.

There are likely many factors that account for the ability of some patients to achieve and maintain large weight losses over the long term whereas others experience substantial weight regain. Unravelling the biological, psychosocial, educational, and environmental determinants of such individual variability will be an active area of obesity research for the foreseeable future.

There is also the recommendation that managing weight loss requires ongoing attention.

Long term behavioral changes and obesity management require ongoing attention. Even the highest quality short-term interventions are unlikely to yield continued positive outcomes without persisting intervention and support. Several studies show that ongoing interaction with healthcare providers or in group settings significantly improves weight maintenance and long-term outcomes, compared with treatments that end after a short period of time. The importance of long-term intervention has been codified in the obesity treatment guidelines, which state that weight loss interventions should include long term comprehensive weight loss maintenance programs that continue for at least 1 year.

Like, I don't think anyone said it was easy. I can attest that it isn't easy. But quitting smoking wasn't easy either, and I still fight that fucking addiction every damn day like a recovering heroin addict. The article contains a slew of strategies for maintaining weight loss.

And like my cigarette addiction -- I fucking want a cigarette right now -- I know that I will have to continue to fight. It is exhausting at times. And while no one strategy works for everyone -- I will say that over, and over, and tell people over and over that keto does not work for everyone -- and each strategy may require life-long maintenance, there is no doubt that obesity is linked to a lot of health problems and that avoiding it or getting away from that state of being is a good thing.

I realize that fat-shaming and dieting can cause psychological damage to those who cannot seem to lose the weight, but I refuse to believe this is a damned-if-you-do-or-don't situation. If anyone wants to lose weight, I'll cheer them on, and if they relapse I will still cheer them on because addictions, obesity, and cancer are all fucking monsters that aren't easy to beat but, dammit, I'm in your corner if you're going to give it a go.

Solstice

Calorie deficit has worked for me in the past - I'm definitely not weighing in on the larger science because honestly? Nutritional science is an oft-contradictory nightmare that I simply don't have the resources to take a deep dive into.

That being said, I did not stick to my lifestyle changes and - more importantly - my lifestyle was altered without my consent in the forms of other issues like mental health, ruining my back by deciding that working in the back room of a book store was a great idea because it would be close to books. (PS: It doesn't matter what's in the boxes if you're on a time crunch to open as many as possible, and you destroy your back doing it.)

@ganymede said in Health and Wealth and GrownUp Stuff:

I realize that fat-shaming and dieting can cause psychological damage to those who cannot seem to lose the weight, but I refuse to believe this is a damned-if-you-do-or-don't situation. If anyone wants to lose weight, I'll cheer them on, and if they relapse I will still cheer them on because addictions, obesity, and cancer are all fucking monsters that aren't easy to beat but, dammit, I'm in your corner if you're going to give it a go.

And that's the attitude I'd argue most if not all people need to take. People don't need shame or pity, just support.

Derp

@ganymede said in Health and Wealth and GrownUp Stuff:

I refuse to believe this is a damned-if-you-do-or-don't situation

But again, that's the problem. Yes, the article contains a slew of weight loss maintenance strategies. But at best, one out of five people actually manage to maintain weight loss for more than a year, and fewer than that for more than five. Many others never manage the weight loss in the first place.

And that's the received wisdom: That everyone can lose weight if they just work hard and suffer. But it's just not true. And people refuse to believe that, even though that's what the research bears out -- diet and exercise are a largely imperfect system that can be just as dangerous as not doing so, and possibly moreso due to the metabolic damage and insulin resistance caused by yo-yo style weight losses and gains. Everyone wants to believe that if you just work a little harder and eat a little less and move a little more that you'll get to a point where you can do it, completely ignoring what side-effects there might be to it or whether these lifestyles are actually even able to be maintained at all.

I didn't ignore anything past the abstract. You, yourself, quoted the part above where the researchers note that people who do manage to lose weight need further study because we don't know how or why it happens like that.

And we've known that this model was wrong since the sixties. That's the most insidious part. That this myth we've created has been so persistent and pervasive this whole time, that we've built entire industries around a concept that we know is flat-out a lie, but we want so badly to believe in it that we'll ignore all evidence to the contrary.

That refusal to believe it's out of anyone's control despite what the science says is very much a part of the stigma problem. If Susan stays fat it's because she's clearly not eating right, or exercising enough. She doesn't care about her health. She's lazy, and undisciplined. And therefore, she is unreliable, and should make less money, get passed over for promotions or employment in general. It's a moral failing on her part, not something out of her control like sex or skin color or genetic conditions or any of the other protected statuses.

Until we know how it works, expecting people to just suffer through a process that we barely understand and actively causes harm is ridiculous, especially when being overweight doesn't automatically mean that you're unhealthy.

faraday

@derp said in Health and Wealth and GrownUp Stuff:

But at best, one out of five people actually manage to maintain weight loss for more than a year, and fewer than that for more than five. Many others never manage the weight loss in the first place.

I don't disagree that there are harmful stereotypes, both in everyday society and in particular in the medical community. That's most assuredly a problem and anyone who struggles with it has my sympathy.

But I don't really understand what alternative you propose. Only 1 in 10 people who try to quit smoking actually succeed. Relapse stats on heroin addiction are equally dismal. Yet we don't just throw up our hands and pretend like either of those behaviors is good for you just because they're very hard to beat.

It's true that there is no equivalence between weight and health, but there are correlations between obesity and all kinds of other health problems. Some overweight people may be healthy; the majority are not.

I think there's a middle ground of compassion and assistance that's somewhere between the extremes of 1) stigma/shaming and 2) asking doctors to ignore a very real public health problem.

Ganymede

@derp

I love you, man. You know I do. But like faraday, there has to be a middle ground. People I feel want to lose weight, and I think we need to support those people as I said.

mietze

Smoking cessation programs often are at least partially covered by insurance. Rarely are weight loss programs. Not even nutritional counseling.

Most likely people who smoke are treated like shit by their doctors I would imagine, but they probably aren't given a pamphlet at every visit trying to drum up business for the associated hospital's program (not covered by insurance usually) where the doctor surgically removes the person who is struggling to quit smoking's hands so that its more difficult for them to keep smoking.

Fat people and smokers though are probably regularly denied competent medical care on a regular basis at every level because the physicians and staff much of the time in their 5 minutes per patient doesn't have time for background information and it's more satisfying to treat the person like they do not know they are fat/a smokers.

I lost over 100 pounds once and kept all of it off for almost 5 years until I got unexpectedly knocked up and them my life situation changed in unexpected ways (some related to that, most not). What worked for me for that long term was no longer sustainable once I could no longer afford to pay out of pocket for very specific therapy and eating disorder treatment. And an injury took me out of continuing to participate in triathlon events and training (still the most fun I've had, loved training). As is very common for huge weight loss, I also developed a secondary eating disorder as a result that also had a major impact on my muscle and bone health.

I can assure you that almost every doctor including those that I went to specifically in the hopes that they could advise me on best practices in my new reality was unwilling to let me get a word in edgewise because what they wanted to do was talk about the bariatric surgery program at the affiliated hospital. I do not qualify for bariatric surgery, even if i could afford it. Due to medical reasons that are right in my chart and I certainly will never qualify for an insurance company's standards even if that wasn't the case because I'm not fat enough!

Now not every fat person has an eating disorder but there are more than most people think. In addition while there tends to be some understanding and acknowledgement of trauma as a background in addictions, very rarely does anyone acknowledge that in weight loss or in the process of long term maintenance.

Many people who have lost significant weight always picture themselves as fat. Body dyphoria is a real thing for many people and it is a huge mind fuck at times. Many long termers I personally know (whether or not they still have maintained) developed related eating disorders as a result. I'm sure there are people who drop 20 lbs and feel great and have no issues (or more). But some people react like a drunk that's gotten sober but moves on to other addictions to cope.

When I first stared regaining I was suicidal. Pretty sure only not wanting to do that to my kids is the only reason I'm alive. To a certain degree I had to decide what mental health and emotion expenditures and finances I had to pick.

I would argue that the time needed the most support from physicians and friends is maintenance. Yet that is when everyone assumes its over because "you look great" (even though many people don't think they look great) and "you're done!"

Stopping any behavior especially when there are issues of changed physiology and also potential mental health or behavior modification issues, along with rather large inequities in quality health care access, ect...it is complicated. Dealing the intricacies and entanglements of an eating disorder has been so damned hard in my own life that I really cannot imagine what it is like to have to deal with similar issues on top of a substance addiction.

So I don't know. Maybe we could not treat people like they're stupid or just need merely the power of positive thinking.

faraday

@mietze said in Health and Wealth and GrownUp Stuff:

Smoking cessation programs often are at least partially covered by insurance. Rarely are weight loss programs. Not even nutritional counseling.

Of course that's horrible. It should be covered. We should also be developing the weight-loss equivalent of nicotine patches and such, and constantly improving those types of supports.

We have an incredibly judgey society that looks down on people with addictions, mental health disorders, etc. "If you were just a stronger person you could beat your <eating disorder / depression / ADHD / heroin addiction>..." is a common attitude that's appalling, untrue, and harmful. Sadly it spreads into the medical community as well, which is even more shameful since they of all people ought to freaking know better.

Changing ingrained behaviors will always be super hard. A modest success rate means we (as a society) have more work to do, but it doesn't mean we should just give up and accept things as they are.

mietze

Maybe "we" should focus on changing that, rather than focusing on how "we" need to change the fat people. We need to change attitudes and behaviors of almost everyone including insurance company executives and the many people who make a shitload of money in the diet/weight loss industry too.

Just a thought.

But every time someone points out issues with focusing primarily on the weakness of the fat person, or looking at how more health can be attained even in the absence of one measure people freak out. OMFG you're giving up!!! When the reality us that weight loss does not guarantee health and in fact there are some major health risks associated with it as well. Especially if the person goes into the off/on/off/on method. It is probably actually better for someone to stay modestly chunky, get more active and less sedentary, and never lose a pound rather than getting on a cycle of severe calorie deficit eating and weight cycling.

I know it is hard for people to accept that things are more complicated, and a lot of what we "know" is wrong in regards to the realities of weight loss and also impacts to health. I wish more people looked at things other than the fat people with a critical eye.

That isn't giving up, it is looking towards being able to better support people.

People often point towards actions towards the tobacco industry as something to be modeled after, but the issue with that is that when they talk about doing that for obesity they only want to focus on the generic food industry rather than the multiple billion dollar "diet" industry, and that would absolutely need to be part of a crackdown. So its complicated.

Maybe we need to hold ourselves accountable for giving up when we admonish the people who are struggling first and foremost.

Derp

@faraday said in Health and Wealth and GrownUp Stuff:

A modest success rate means we (as a society) have more work to do, but it doesn't mean we should just give up and accept things as they are.

We have a modest success rate of people winning the lottery, too. But more people fail than win. Yet we don't counsel people to buy more lottery tickets and try harder, either.

And it's not that much different here. The ones with the modest success rates have other factors working in their favor. Or they've dipped into eating habits that would be considered disorderly for anyone else, and obsessive behaviors like exercising for 2-3 hours per day 6+ days a week.

If a person is 100 lbs overweight and goes on a super restrictive calorie deficit while working out well above the normal level we cheer them on because they must be making healthy decisions. If a teenage girl does that we call it a dangerous behavior and admonish them to stop. Because we recognize that this is a dangerous, disorderly behavior, but only for people whose form we already approve of as a society.

This is the level of stigma and double-standard that we're facing. We blatantly ignore evidence and dangerous behaviors while pushing people to conform, and then wonder why the results are terrible.

Let's change the stigmas around obesity and start talking about what we don't know, what actual health markers we should be looking for, etc.

Ganymede

@derp said in Health and Wealth and GrownUp Stuff:

If a person is 100 lbs overweight and goes on a super restrictive calorie deficit while working out well above the normal level we cheer them on because they must be making healthy decisions.

That's not why I cheer them on. I cheer them on because they made a conscious decision to lose weight, for whatever reasons they see fit. Maybe they are tired of looking the way they do; maybe a doctor recommended shedding some weight; and so on.

If a teenage girl does that we call it a dangerous behavior and admonish them to stop. Because we recognize that this is a dangerous, disorderly behavior, but only for people whose form we already approve of as a society.

If it isn't clear, I don't consider this to per se to be dangerous either. If a teenage girl is recommended by a health professional to lose weight, and she attempts to do so, I'll cheer her on.

I don't hear you denying that obesity is the cause of many health problems; I hear you saying that just because you're overweight doesn't mean you're unhealthy, and I agree. Similarly, you're suggesting that dieting to "look good" while dipping dangerously underweight is a bad thing, and I concur that being underweight has its own host of issues. I don't think we disagree on much, but it sounds like we are because I think we're talking in circles.

What I think you're getting at is what faraday said:

We have an incredibly judgey society that looks down on people with addictions, mental health disorders, etc. "If you were just a stronger person you could beat your <eating disorder / depression / ADHD / heroin addiction>..." is a common attitude that's appalling, untrue, and harmful. Sadly it spreads into the medical community as well, which is even more shameful since they of all people ought to freaking know better.

This, I agree with. But, like faraday, I would add:

Changing ingrained behaviors will always be super hard. A modest success rate means we (as a society) have more work to do, but it doesn't mean we should just give up and accept things as they are.

Which comes down to this: if others make choices related to their health, e.g., losing weight, quitting smoking, etc., I'm going to cheer them on whether they succeed or fail because they are at least buying into the idea of not giving up on a goal. It's not easy to do any of this. You say that the science is not yet certain on how to do this permanently and I agree; hell, I'll even go out on a limb and say that the reason why it is tough to lose weight through dieting is because the body gets wise to what you are doing and actively rebels. This makes sense to me because bodybuilders have to switch up their routines constantly because the body starts to get wise to avoid the constant injury and healing process that is required to bodybuild. And the body and mind are motherfuckers, which is why addiction sucks.

But, yeah, I'm not giving up losing these last ten pounds I want to because I want to.

silverfox

What I'm hearing in this thread is a whole lot of "We need to stop treating this as a black and white issue."

That means that before we make a judgement about someone's health based on weight we should shut up and listen first. Likewise, if someone has told us they are trying to lose weight, we say "what can I do to help you?" and then again listen to them.

This is the same for doctors. Stop assumptions, and just listen.