Tuesday, July 31, 2012

On teh fattiez.

My fat ass hiking Mount Scott. :)
I wrote this for a friend who was interested, and decided to post it here as well. It's generally good info for... well, everyone.


HAES stands for Health At Every Size. The deal is that health is a real issue in our society, and we have erroneously linked it to weight. The fact is USians like being couch potatoes and 'cleaning' their plates of comfort and bored food, and that can be a problem. HAES focuses on health, rather than weight, so instead of using a scale and a calorie counter, HAES folks learn intuitive eating and enjoyable physical movement.

So if you can't do that Zumba class or ride that bike, you should probably work on that, even if you're skinny. If you binge-eat, eat for comfort, or have other issues with food, you should also work on that. People who want to be healthy should consider exploring pleasurable physical activities and learn to listen to their body's natural hunger signals. (None of that 'clean your plate' BS.) As an example of intuitive eating, menstruating women crave iron, runners crave bananas, and these things are not coincidences. So eat your cake, babe. Cake tastes good, and so does steamed broccoli. To quote one of many studies:
"When someone is disconnected from his or her internal cues of satiety, it is easier to be triggered by external triggers to eat (which can be emotions, "because it's time", opportunity, and/or perceived rules of eating.)."
Unsurprisingly, many people who choose HAES lose weight, as they shed unhealthy habits. More importantly, people who choose HAES become healthier, with fewer medical and mental issues.

On diets and 'lifestyle changes'.

Diets don't work. Seriously. They don't. Not even when they're 'lifestyle changes'. Anyway, this post is not boringly science-y, and elucidates that fact better than I could, so just go read it.

On HAES v. Diets.

Did I mention that diets don't work? I think I did. Anyway, in this study, they took white, obese, female chronic dieters, aged 30 to 45, and split them up between diet plans and HAES plans. In the first six months, 41% of the dieters dropped out, compared to 8% of the HAES folks. HAES folks maintained their weight loss and improved in all outcome variables. The dieters lost more weight at 1 year, but gained it back by the second year. The study concluded that:
"The health at every size approach enabled participants to maintain long-term behavior change; the diet approach did not. Encouraging size acceptance, reduction in dieting behavior, and heightened awareness and response to body signals resulted in improved health risk indicators for obese women."
On fat as a general health issue.

Outside fat - fat you can see, that stays within it's own cells - isn't a cause for concern. Inside fat - visceral fat and fat deposited in organs - is a huge problem that leads to cardiometabolic issues. Crazily enough, outside fat, or a lack thereof, is no indicator of inside fat. In fact, outside fat is associated with reduced cardiometabolic risk. In addition, studies suggest that weight loss increases rather than decreases the risk of premature death. Crazy, right? Science!

One of the reasons that doctors stress weight loss for health is that in the short term, weight loss plans do increase health. The question is whether or not the loss of the fat leads to the improved health, or the improved health habits that people used to lose that weight lead to improved health. One study undertook to find out by studying lipo patients, whose health did not improve. This (along with alot of other studies) indicated that the losing weight didn't cause the positive health outcome - changing the unhealthy habits did that. Another dozen studies took it farther and found that most health indicators improved through changing health behaviors, regardless of whether weight is lost or not. (And weight was not generally lost.)

Insert science talk here about how body systems respond to dieting. Essentially, your body doesn't like it. Neither does your mind. So over 80% of dieters return to pre-weight loss levels of body fatness after otherwise successful weight loss. Emerging data about surgical solutions also indicate a very high return rate, which is super sad, because surgical options rather ironically cause health problems.

The article ends by blasting the media for being stupid and not factually correct, and actually worsening the issue by contributing to food and body preoccupation, repeated cycles of weight loss and regain, reduced self-esteem, eating disorders, and weight stigmatization and discrimination.

Basically, the idea that people are fat because we eat too much and exercise too little is bunk. As any basic endocrinology medical text has pointed out for the last 70 years, weight is regulated in the body by 'hormonal processes', not by Newton's first law of thermodynamics.

On fat as a heart issue.

Guess what? Fat people live longer than skinny people. True facts, yo. Even fat people who do have heart issues live longer than their thinner counterparts. To quote a smart guy:

Dr. Paul Ernsberger, of Case Western Reserve School of Medicine in Cleveland, Ohio, led a review of nearly 400 studies that was published in the Journal of Obesity and Weight Regulation in 1987 which corroborated these results.
“The idea that fat strains the heart has no scientific basis. As far as I can tell, the idea comes from diet books, not scientific books. Unfortunately, some doctors read diet books.”
Tons of studies have been done since then as well, and they all support the fact that fat people are healthy, too. Yay, fat people!

On the 'cost' of obesity.

Obesity doesn't cost the country more money than non-obesity. Instead, attitudes about fat people cause the country money. Why? Because we overlook 'normal weight' people who need treatment and over-treat obese people who don't need treatment. That's a problem.

On the idea of natural weight.

So natural weight is the idea that we all have a genetically disposed weight. This article (while a little problematic in some ways, as most news articles are) discussed several studies. One set of studies made a series of groups of fat people live in a hospital for almost a year, controlling their weight in fairly horrific ways. Every time, they lost weight and looked like thin people, but by metabolic standards, they were starving. A few of them kept the weight off, but made staying thin their 'life's work', becoming the Weight Watchers version of alcoholics. All of the rest gained the weight back. (And most of them also got the door prize of mental health issue known as semi-starvation neurosis.) They concluded that:
"It is entirely possible that weight reduction, instead of resulting in a normal state for obese patients, results in an abnormal state resembling that of starved non-obese individuals."
Um, ya think?

Another study looked at what happens when people gain weight. Prisoners managed to increase their body weight by 20-25%. It took 4-6 months, and some of the participants had to consume 10,000 calories a day, which is insane. Once they were fat, their metabolisms increased by fifty percent. When the study ended, the prisoners had no trouble losing the weight. Within a few months, they were back to normal and effortlessly stayed there.

Next, they examined the role of environment in weight. The lead examined over 500 adults who had been adopted as infants, who had meticulous family health records. The adult adoptees were as fat or thin as their genetic parents, regardless of the weight or lifestyle of their parents. So childhood family environment had little to no effect on weight loss. Being fat is an inherited condition, and one that's just fine, health-wise.

After that, they studied twins, both identical and fraternal, who had been raised separately and together. The identical twins had nearly identical body mass indexes, whether they had been raised apart or together. There was more variation in the body mass indexes of the fraternal twins, who, like any siblings, share some, but not all, genes.

Essentially, each person has a comfortable weight range to which their body gravitates. That range can be breached, but the body resist that breach by increasing and decreasing appetite and metabolism to push the weight back to that range.

On breaking it down for other people.

This post is a good catch-all for sending to non-science fans who fat-shame you or themselves.

This post is a good catchall for sending to science fans who fat-shame you or themselves.

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