I’ve got some bad news for you…

In the USA, my home country, consumption of fruits and vegetables is plummeting. Consumption of red meat is soaring, as is sweetener consumption. Obesity rates keep going up. Americans are getting less and less exercise. Deaths from heart disease keep going up.

April Fool!

In actuality, compared to levels in 1985, fruit and vegetable consumption has gone up, red meat consumption has gone down, and consumption of sweeteners is about the same. The obesity rate hasn’t changed since the early 2000s. Americans have increased their exercise since 2000. Age-adjusted deaths from heart disease are down by more than half compared to 1950.

If you find any of that surprising, consider why that is. Remember that the media has a bias toward sensationalism and bad news. Don’t forget to take health news stories, and science journalism generally, with a grain of salt.

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Look AHEAD vs. DPP?

One of the articles I came across when researching my last post was called “Diet, Diabetes, and Doubt: Is Preventive Medicine Lost In Space?” by David Katz. I wanted to make a few quick points about it.

Dr. Katz writes:

The AHEAD methodology also helps account for the putatively disappointing results of the long-term study. Diabetes requires treatment—so all patients in AHEAD were treated. Those in the lifestyle intervention group reduced their reliance on medication, while those in the control group took more. But since failing to treat diabetes with state-of-the-art medication is unethical, everyone was provided that. The study was actually comparing feet and forks to pharmacotherapy. When both intervention and control groups are being treated, differences between them diminish, an occurrence known in research as “bias toward the null.” This exerted a profound effect in the AHEAD trial, making the positive findings more noteworthy still.

In other words, the difference between the groups would be greater if neither group had modern medical treatment–but why is that even a relevant question? Are we trying to find out what kinds of benefits people with diabetes would experience if they followed a program similar to those in the intervention group of Look AHEAD compared to normal treatment by their doctors–a practical question–or are we trying to prove that fat=bad? The goal of the study was not to find out how best to treat diabetes in areas with little or no access to medication, or how to treat diabetes in people with bad/no health insurance.

Still, the fact that the study looked at people who already had well-controlled diabetes even before the start of the study and who had access to appropriate medication is an important caveat for people who have poorly-controlled diabetes and/or do not have good access to appropriate diabetes drugs–or for people who are having trouble finding drugs with tolerable side effects. Even if, like me, you are aggressively skeptical about the magnitude of the contribution of BMI to health in order to correct for societal bias in the opposite direction, I think at least the exercise portion of the intervention would be helpful to people with poorly-controlled diabetes.

Also (as implied by Katz’s later words that “both intervention and control groups are being treated”) the study was not comparing “feet and forks to pharmacotherapy”, they were comparing feet and forks plus pharmacotherapy to pharmacotherapy alone. While the intervention group needed less medication, they still benefited from medication in this study.

“But to the extent that the negative results, with regard to cardiovascular event prevention, remain both surprising and disappointing, there is a fundamental explanation for them: too little, too late. What works for prevention may not always work nearly as well for treatment.”

This article’s overall point is not wrong–the Look AHEAD study doesn’t necessarily overturn the results of the DPP study, and an intervention may work for prevention but not treatment. (Remember when the protagonist’s mom in 50/50 wants to give him green tea? [relevant part starts at 1:50]) But there’s more to consider: how do the two studies compare in rigor? And what about the publishing bias towards positive findings? A study finding no effect of a lifestyle intervention on preventing diabetes isn’t going to be cited by “virtually every clinical and clinical research diabetes paper”. (See Ioannidis’ “Why Most Published Research Findings Are False”.)

In fact, although both the DPP and Look AHEAD were fairly rigorous studies involving thousands of participants, the DPP only lasted an average of three years of study per participant. A followup, DPPOS, looked at the longer-term benefits of the initial intervention; they were still present but attenuated. This suggests that, although DPP’s intervention is often described as “preventing” or as “preventing or delaying”, it would be more accurate to describe it as “delaying” diabetes. And delaying is great! But not only does “delaying” not fit into our black-and-white thinking that you’re either healthy or you’re not, nor into our moralizing “if you act right/repent of your wicked ways, you will be healthy forever until you peacefully die of old age at 100″, nor our related, just world theory-inspired “health is under your complete control and genetic factors are trivial”, it just doesn’t make as good a headline.

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The Look AHEAD study: a rare long-term weight loss study

I’ve blogged before about the Look AHEAD Type 2 diabetes study, but mostly focused on the effect of the weight loss on cardiovascular events, which is what the study was designed to measure, as well as comparing the amount of calorie restriction to some reference points. I was looking at it again recently and thought I would examine it as a study of weight loss itself, as it is by far the longest-running study of weight loss that I have seen. According to Dr. Thomas Wadden, the lead author of the study, “This is the largest and longest controlled evaluation of a behavioral weight-loss program to date.” It was also a fairly large study, with 5145 participants.

(The Fat Nutritionist has a good, more general overview of why diets tend to fail in the long term. David Spero has a post about Look AHEAD worth reading on Diabetes Self-Management.) Continue reading

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Historical Fat and Not-Thin People, Part 4: “Stagecoach” Mary Fields

Mary_Fields“Stagecoach” Mary Fields was not exactly fat: at 6′ tall and ~200 lbs, she had a BMI of about 27, the middle of the overweight range. Probably, based on accounts of her life, a lot of that was muscle. But I couldn’t resist featuring her because of her story. This post by Kristen Majewski is one of the best online biography I’ve found of her; this one at the Toledo Blade is also very good and contains some reflections from the archivist for Toledo’s Ursuline Convent (where Mary Fields worked for part of her life), Sister Kathleen Padden, as well as some of the nuns there before her. According to the Toledo Blade:

Miss Fields arrived by train in 1878. As Mother Amadeus helped her old friend get settled in her new quarters, she asked if there was anything she needed.

According to the book Working for the Ursulines, Miss Fields answered, “Yes, a good cigar and a drink.”

Continue reading

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Historical Fat (and not-thin) People, Part 3

I recently came across some more examples of historical fat people! (Part 1 here; Part 2 here.)

In the first one, we finally get a fat POC! The exhibit Gordon Parks: Back to Fort Scott is made up of images of people from the 1950s who went to (black segregated) grade school with the photographer, and their families and friends.

gg0010_standard

Second, going back further in time, we see some fat and not-so-thin people, both men and women, in Charles Dana Gibson’s drawings. (There are five sections, but the two linked contain the most examples.) The Gibson Girls themselves are universally slender, but many of the people surrounding them are not. (The lady near the center of the women in the background, just barely out of the shadows, looks plump. There are other, more clearly fat people in some of the other drawings in the set.)

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Eric Garner and Mike Brown: adding insult to injury

Rep. Peter King of New York has blamed Eric Garner’s death on his weight. Well, on his weight and asthma, but he’s emphasizing the weight more,probably because his weight is perceived as something that’s his own fault and therefore King can hold Garner partially responsible for his own death. Unfortunately, this meme has spread to some people I know who work for DHS, who were saying that he died “because he was 400-something lbs” (the Atlantic article says 350) and that the autopsy showed that his trachea wasn’t damaged (the Atlantic and some Fox news sources [these two people were Fox fans] say there was hemorrhaging in Garner’s neck, evidence of compression). I tried to avoid joining in the conversation, but after being asked what I thought and telling them once, “You don’t want to know what I think”, I told them.

Talking to them further–well, mostly one of them, the one who’d asked what I think–caused her to admit that pretty much anyone can begin having problems breathing if they are lying on their stomach with someone on top of them, although both their own weight and the weight of the person on top of them affect how quickly it will become a hazard. (She also admitted that, as annoying as she found Al Sharpton, he probably wasn’t a truly one of the biggest contributors to the race problems in this country, as she had said earlier. In turn, I said that although the statistical disparities between races in killings by police are a bigger problem than Al Sharpton, it can be hard to tell how much race/racism affects any one case.) Then she and the guy she was talking with started going off on a tangent about how fat people are used to carrying a lot of weight around and can throw you around and can be dangerous, even if they’re not “on something.” (Then they started going off on a tangent about how a guy who was only 150 lbs who was on meth was throwing around 3 or 4 people.)

Which demonstrates another way that being fat (or even just sort of fat) can work against people in general and black men in particular. Mike Brown was the same height as Darren Wilson but outweighed him by about 80 lbs–and Wilson said of Brown, “I felt like a 5-year-old holding onto Hulk Hogan”. Hulk Hogan’s billed weight was 302 lbs, more than either Brown or Wilson. A typical 5-year-old is, what, 40-50 lbs?

When it’s convenient for the people talking about them, fat black men are “big and strong”, and when it’s convenient, they are weak and on death’s doorstep.

See also:

the HAES® files: Murder at the Intersection of Fat and Black

Soul’s Breath

Too Fit Not To Acquit

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Ridiculous holiday eating advice

Today I was waiting for my husband at the doctor’s office. I looked through a little mini-magazine that said “WebMD” and “Diabetes” on it. One page had some advice for holiday eating, including the strangest such advice I’d seen in a while:

Wear something snug: In a big, flowing dress or loose pants, you won’t be able to tell when you overeat. Instead, Weisenberger suggests wearing slimmer-fitting clothes. That way, you’ll feel the tightening the moment you’ve had too many hors d’oeuvres.

This Weisenberger character may be surprised to learn that humans have built-in sensory mechanisms that can tell them how full their stomach is.

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