Why do I read advice columns?

Probably the same reason some people watch reality TV.

From the Washington Post’s Ask Amy:

DEAR AMY: I am a 27-year-old single mom. I’ve never been small, but I am a healthy, strong, well-proportioned size 12.

My problem is with my mother. She’s extremely fat-phobic, and starts to freak out and call herself horrible fat names when she gets over a size 6. She also makes nasty comments about my weight going back to childhood, such as, “I’d kill myself if I had to wear a size 12.”

I’ve learned to accept that. What I can’t and won’t accept is when she makes fat comments about my daughter. My baby is 14 months old. Her pediatrician says she is the picture of a healthy toddler, with no weight concerns.

My first thought: Thank goodness she’s a size 12 and not bigger; she’ll get uncomplicated, sensible advice about the fatphobia her mom is emanating.

From Slate’s Dear Prudence:

In the past year, my husband has taken up running, and it’s been great! He’s lost 65 pounds and I couldn’t be prouder. But Prudie, he constantly wants to talk about running, his workouts, and losing weight.

This bit of Prudie/Emily Yoffe’s response is darkly humorous to me:

Keep in mind all this is new for your husband, and he also is replacing a focus on food with a focus on fitness.

Yes, he constantly wants to talk about losing weight, but it was BEFORE that he had a focus on food! Dieters who want to discuss their diets all the time definitely don’t have a focus on food! We didn’t learn from the Minnesota Starvation Experiment that people losing weight have a preoccupation with food! (I don’t think it’s a big leap to assume that a significant chunk of the “losing weight” discussion is about eating/not eating.)

[The rest of her response boils down to, give him some time and he'll probably stop being so obsessed with it. If he doesn't, ask him to knock it off.]

Then there’s the fact that many of the people who do manage to keep weight off basically make it their mission in life. Expecting her husband to maintain his weight loss means expecting the statistically improbable, but expecting him to stop obsessing over it may make it even more likely he’ll regain. And then of course he will be blamed for it.

Musings on Water Aerobics

I recently started going to water aerobics, mostly in solidarity with my mom, who is also going.

I like that, in contrast to a lot of other fitness classes, I’m not one of the fattest people in the class, and the instructor is also fat; I don’t feel like I stand out or like I’m out of place.

I don’t like that most of the small talk centers on weight loss/weight management.

I’m surprised that I don’t float as well as most of the people in the class, including ones significantly thinner than I am. (Fat is lighter than water.) If I take a deep breath and close my mouth and eyes and relax in deep water, my head goes under water (the water just covers the top of my head). About 10-20% of the women are like me and need to use a floaty-noodle-thingy when we’re in the deep end of the pool. The one time I saw a man at the class, he had to use two floaty-noodle-thingies. Like me, he was fat but not unusually fat. Men tend to have less fat and more muscle (and I think more bone mass) at a given weight than women.

I think I used to float better in the past. I think when I dog-paddled before, my mouth was usually safely above the water. When I dog-paddle, my mouth is just barely above the water. Being low in the water feels different. It makes me think of crocodiles.

I like to pretend I’m a crocodile.

Crocodiles don’t spend most of their day swimming, but then, neither do I.

101: The difference between “everyone knows” and research

“Don’t you realize that fat is unhealthy?” is often asked by concerned people/concern trolls in FA spaces. I came upon a variation of it that’s worth addressing as the first comment here. The commenter responds to Tanteterri’s criticism of “everyone knows” assumptions by saying,  “Academia is a cumulative effort. Current research is based on old research. If every older point of data suggests that being overweight is unhealthy, why not start on that foundation?”

In other words, aren’t “everyone knows” memes* about fat based on solid research?

Well, no, not always.

Unfortunately, stuff that “everyone knows” is often not seen as worth studying, or if it is studied, not all interpretations of the results are looked into because we “know” what explains the results. Often, researchers and doctors assume that these “everyone knows” facts have been studied even though they have not. See, for example, the NY Times article and NEJM article linked to by Ragen here.

From the NY Times article:

Dr. Allison [director of the Nutrition Obesity Research Center at the University of Alabama at Birmingham] sought to establish what is known to be unequivocally true about obesity and weight loss.

His first thought was that, of course, weighing oneself daily helped control weight. He checked for the conclusive studies he knew must exist. They did not.

“My goodness, after 50-plus years of studying obesity in earnest and all the public wringing of hands, why don’t we know this answer?” Dr. Allison asked. “What’s striking is how easy it would be to check. Take a couple of thousand people and randomly assign them to weigh themselves every day or not.”

Yet it has not been done.

If these “everyone knows” memes hold up to scientific scrutiny, there’s nothing wrong with scientists using them**. If they’re just folklore and have never actually been tested, they have no place in science.

*Used in Dawkins’ “unit of information” sense, not the “thing that gets passed around on the internet” sense.

**Using them for what is another question. If they find a particular practice does help people lose more weight or lose weight faster, but have not figured out a way for most people to maintain that loss, that practice has limited utility to the general public. On the other hand, that knowledge might lead to a better understanding of the system the body uses to regulate weight, which is a perfectly good use of that information.

Remembering Ann Rabson

One of my favorite musicians, Ann Rabson, died recently. The reason I’m writing about this here is that she occasionally sang fat-positive songs (and was fat herself).

Photo of Ann Rabson from the 2009 North Atlantic Blues Festival, taken by my dad, at the merchandise table.

 

Japan, Low-Fat Paradise, Has No Calorie Limits on School Lunches

A recent article from the Washington Post is about Japan’s school lunch program. It sounds like a great program, actually. But because anything about our current moral panic seems to draw eyeballs, of course BMI must be discussed:

Japan’s system has an envious payoff — its kids are relatively healthy. According to government data, Japan’s child obesity rate, always among the world’s lowest, has declined for each of the past six years, a period during which the country has expanded its dietary education program.

Based on the description of the program, it probably is healthier than most school lunch programs in the world. But that may or may not be contributing to the disparity between Japanese and U.S. obesity rates. There are an awful lot of differences between the two countries (both genetic and in the social environment), and lunch is only one meal a day. But it seems that just about any difference between two populations with different BMI distributions is pounced on breathlessly by the media. “Could this explain the difference?” the headlines ask. If the answer is, “Maybe…” it’s fit to print!

At least there’s no reason to think that our new, problematic calorie limits for school lunches are necessary, even for people who think that school lunches are the key to returning our BMIs to those of The Golden Age:

Though Japan’s central government sets basic nutritional guidelines, regulation is surprisingly minimal. Not every meal has to meet precise caloric guidelines. At many schools, a nutritionist draws up the recipes — no bureaucratic interference. Central government officials say they have ultimate authority to step in if schools are serving unhealthy food, but they can’t think of any examples where that actually happened.

It also sounds delicious:

Officials at Adachi Ward, in northern Tokyo, say they run a “fairly standard” school lunch program in the ward’s 71 elementary schools and 37 middle schools. And because this is food-obsessed Japan, those standard meals are restaurant-worthy; in fact, the ward publishes a full-color cookbook based on its best school meals.

Abigail Saguy on Health Care Provider Bias

There’s a great article in The Washington Post about bias against fat people in the medical community. It’s good to see someone pointing out the inferior medical care fat people receive after hearing all the people, in the wake of the latest BMI and life expectancy study, saying that fat people must live longer because they receive better and more aggressive medical care. (It’s hard for your doctor to prescribe an “aggressive” treatment plan for your diseases if you avoid going to the doctor at all!)

Grasping at straws: Rushing to dismiss the latest ‘Overweight people live longer’ study

I think I first heard from Brian/BStu/Red No. 3 the observation that if a study seems to show benefits to being thin, it’s accepted at face value, but if a study seems to show benefits to being fat, it’s always questioned and people attempt to explain it away. (Also, people try to explain away studies that show disadvantages to being underweight or in the thinner half of ‘normal’.)

I think after this latest study, we can say with confidence that the conclusion that ‘overweight’ people live the longest is not going away. But people are rushing to explain it away. William Saletan runs down the list of explaining-away explanations that have been proposed.

Fat is bad for you, right? That’s what doctors tell us. But a review of nearly 100 studies, published this week in the Journal of the American Medical Association, confirms previous indications that the story is more complex. Being overweight or even mildly obese, as measured by body mass index, doesn’t make you more likely to die than a person of normal weight. It makes you slightly less likely to die.

How can this be? Is fat good for you?

That’s the wrong conclusion, according to epidemiologists. They insist that, in general, excess weight is dangerous. But then they have to explain why the mortality-to-weight correlation runs the wrong way. The result is a messy, collective scramble for excuses and explanations that can make the new data fit the old ideas. Here’s what they’ve come up with…

Interestingly, although it seems clear that Saletan isn’t too impressed with most of these explanations, the promotey-graphic-thingy at the top of Slate’s page where they put the featured stories made it look the opposite. I should have done a screen-capture of it, but IIRC it said “Do overweight people live longer? Why it’s not that simple”, or something to that effect. I’m pretty sure of the “not that simple” part, anyway.

Anyway, I can’t see any good reason to try to explain away the reduced death risk* for ‘overweight’ people but accept at face value an increased risk of death in BMIs >35 (the start of the ‘class II obesity’ category). If you accept that some BMI categories increase risk of death, I don’t think you can make exceptions for the ones you like better.

Some of the things on the list aren’t even examples of explaining the results away, though; they’re admissions that being ‘overweight’ does lower your risk of death.

4. The dangers of being underweight hide the dangers of being overweight. A JAMA editorial notes that people in the thinner half of the “normal” BMI range have a higher mortality rate than those in the plumper half. This thinner subset inflates the normal-weight group’s mortality rate, which makes the mortality rate among overweight and obese people look good by comparison. The solution is to shift the whole scale to the right, so that these thin people are recognized as underweight, while people presently labeled overweight are redefined as normal weight. Once we’ve completed this reallocation, it will be clear once again that overweight people—now defined to include many whose BMI would previously have put them in the obese category—are at higher risk of death than the newly reclassified normal-weight people are. The value of weight control will be reaffirmed, but the thresholds will have changed.

So, the result is still that people with a BMI between 25 and 30 are at a low risk of death compared to those with a ‘normal’ BMI.

7. Fat protects you against injury. Many old people die from falls. Chubbier people “have more padding to protect the bones should a patient take a tumble, lowering the risk of a life-endangering hip fracture,” notes the Los Angeles Times.

Once again, this does nothing to contradict the finding that people with a BMI between 25 and 30 are at a low risk of death. This only supports the idea that being in the ‘overweight’ category is good for you. I don’t see any reason to decide that diseases for which obesity is a risk factor ‘count’ but diseases for which obesity lowers the risk don’t.

*Yeah, I know, “risk of death” sounds weird given that everyone is at a 100% risk of death eventually. What it means is the risk of dying within a specific time period–whatever time period a particular study is looking at.