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June 20, 2012

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Hello St. Louis!

Or at least the part of St. Louis that watched KSDK this afternoon and was curious enough to find out what the hell that fat guy was ranting about.

Here at Fierce, Freethinking Fatties, we discuss the issues surrounding weight, including health, culture and politics. It’s a complicated issue that has been oversimplified by society and, particularly, the media. So, I’m incredibly grateful to Art Holliday and the staff at KSDK for taking the time to cover this issue from a different perspective.

Believe it or not, many fat people are actively trying to improve their health and, despite their best efforts, remain fat. In fact, immediately following my discussion with Mr. Holliday, a woman named Shirley approached me to share her story.

After years of battling her weight through daily exercise, sometimes for hours at a time, and maintaining 1,200 calorie diet, she’s still weighs more than society says she should. On top of that, her metabolic indicators are still high. By society’s standards, she’s doing all the right things, and yet her body is still not responding to those efforts.

She said she’s been advised to eat more calories, but has not done so because when she does, her weight rises. But as I explained to her, the famous Minnesota starvation experiment subjected 36 conscientious objectors from World War II to slightly less than 1,600 calories a day with exercise, and it resulted in worse health, not better, for those men.

But because the public health message tells all of us that the only thing that matters is maintaining a low weight, Shirley has continued to maintain this challenging lifestyle to prevent even the slightest weight gain.

Health at Every Size® (HAES) seeks to disconnect weight from health, and turn our focus instead toward those behaviors known to improve health. If you want a detailed explanation of the evidence, and the principles of HAES, I always recommend Dr. Linda Bacon’s book, Health at Every Size, which is available on Amazon for $10 or on Kindle for just two bucks!

If you’ve followed the prescription eat less, move more, yet your body remains heavier than you want it to be, then it’s time to re-evaluate your understanding of health.

And it begins by re-evaluating your understanding of weight.

First of all, to clear the air,  I’m not only fat. I’m obese.

Morbidly obese, in fact.

At 5’7″, 265 pounds, that gives me a BMI of 41.5, which is just over the cusp of morbid obesity.

Considering  the amount of attention society spends on morbidly obese people, you’d assume people my size are a pretty common sight. And if you ask the average person what percentage of the population is composed of fatties my size or fatter, you’ll get quite a sizable range. All you have to do is mention Disney World and people imagine Wall-E with rollercoasters.

But the fact is that people of my size, or larger, comprise just 6.3% of the population, according to the most recent data from the National Health and Nutrition Examination Survey (NHANES)*. There are obviously differences by race and gender, but according to NHANES, just 6% of the population is morbidly obese.

To put that in perspective, guys my age and weight are in the 95th percentile, according to NHANES. But for me to be in the 95th percentile for height, I would have to be either 6’2″ (at the tall end) or 5’4″ (at the short end). So, have you noticed an “epidemic” of men who are as tall as Ron Perlman, Arnold Schwarzenegger, Jim Carrey, or Mitt Romney? What about men who are as short as Seth Green, Michael J. Fox, Rick Moranis, or Davy Jones?

Probably not.

That’s because we haven’t had a decade worth of government and media messaging to single out all the really tall and really short men out there.

NHANES, which both tracks height and weight data, is considered the gold standard of obesity statistics, since the Center for Disease Control and Prevention (CDC) sends out a team of researchers in medically-equipped trailers to perform in-person measurements and health examinations across the country. And NHANES has found that obesity rates leveled off in 1999 for women and children, and in 2004 for men, as discussed on NPR and in Time magazine.

And if you want to hear this information straight from the source, check out my interview with Dr. Katherine Flegal, the woman who has led the NHANES team for decades, and was one of the first people to raise the alarm on rising obesity rates.

Yes, obesity rates rose noticeably between 1980 and 1999, but the weight of the nation is by no means “out of control.”*

Although C. Everett Koop first declared War on Obesity in 1996, the current incarnation of the War began in earnest eight years later when Richard Carmona, Director of the CDC, testified before Congress on childhood obesity in March 2004. In August 2004, the National Institutes of Health (NIH) pledged $1.2 billion over three years to fighting obesity. The press release said Tommy Thompson, Secretary of Health and Human Services (the cabinet that oversees the CDC and NIH), had “targeted obesity as a major priority of the Department.” Thompson was quoted as saying, “There is no doubt that obesity is an epidemic that must be stopped. This plan gives us a clear focus for confronting obesity with science-based research approaches.”

Congratulations Tommy Thompson, you’ve stopped obesity before you’ve even begun.

But there’s no stopping a panic once society’s been sold. That’s why, in a May 2004 article for the New York Times, author Dinitia Smith noticed an increase in attention being paid to the fat man:

Almost every day, it seems, there is another alarming study about the dangers of being fat or a new theory about its causes and cures. Just this week, VH1 announced a new reality show called ”Flab to Fab,” in which overweight women get a personal staff to whip them into shape.

In fact, The Biggest Loser, my arch-nemesis, even launched in October 2004.

So, even though obesity rates leveled off across the population, we’ve been told for the past eight years that a tidal wave of fatties is drowning this nation in illness and debt.

And since 2004, local, state and federal agencies have spent billions of dollars in efforts to “stop” obesity. Well, it’s already stopped, so you would expect these programs to move the needle back down, yet that hasn’t happened either. For all the negative attention paid to fatties; for all the wellness programs and increased education about exercise and nutrition; for all the hand wringing and brow beating, what has it gotten us?

Exactly squat.

We’re still fat and we’re still clueless how to fix it.

Because the fact is that reducing obesity rates is far more complicated than the CDC or the NIH are willing to admit. And at the same time, the overarching goal of these agencies (preserving and protecting the health of this nation) is far simpler than they are willing to concede.

Let’s start with reducing obesity rates, since that’s still the primary goal of the CDC and the NIH.

First off, even the staunchest anti-obesity researchers, such as Eric Finkelstein, Associate Research Professor for Duke University’s School of Economics, agree that weight loss programs don’t work. Finkelstein was lead author on the recent estimate that obesity rates will rise to 42% of the population by 2030, as well as lead author on the study that estimated obesity costs the United States $73 billion in productivity.

At a press conference on the population estimate, Finkelstein summed up the quandary when he said, “By and large, what we see with all weight loss programs is you see a short term effect. Long term sustained weight loss is still largely elusive.”

Now, I know what you’re thinking: fad diets don’t work. In fact, I bet you’ve got a diet you think I haven’t heard of that will, with commitment and willpower, result in permanent weight loss. Or perhaps you’re just thinking “Eat less, move more.”

Whatever sensible advice you have, I assure you, it’s been studied and dissected and found wanting.

For instance, the “eat less, move more” approach is best summarized by Kelly Brownell’s LEARN Program, which hospitals describe as “the most scientifically tested and widely used weight loss manual in the world.” But when research compares the outcome of LEARN to low-carb or low-fat programs, the long-term weight loss results are just as disappointing for the “eat less, move more” approach.

While Atkins led to an average weight loss of 11 pounds after one year, LEARN resulted in a loss of 6 pounds. For those people who reach their weight loss goal, the fight is far from over. And more time elapses from the time you reach that goal, the more weight is regained, until an estimated 95% of the people have regained the weight they lost, and then some.

This is known as weight cycling, or yo-yo dieting. Weight cycling is linked to the exact same metabolic damage as obesity. Furthermore, research finds that the more severe the weight cycling, the greater the long-term weight gain. Research also finds that the heaviest people are also the most severe weight cyclers.

So, we don’t have a long-term solution for weight loss, and when we try to lose weight repeatedly, we do more damage to our bodies. This is why weight loss, in and of itself, does not need to be a part of our efforts to improve health.

Which brings me to the greater point: good health is easier to achieve than we are led to believe.

In my interview with Dr. Steven Blair, he explains how his four decades of research on tens of thousands of men and women of all shapes and sizes has proven that sedentary lifestyle, regardless of weight, is a risk factor for poor metabolic health and mortality. Likewise, an active lifestyle, regardless of weight, has a profoundly positive impact on metabolic health and mortality.

In other words, fat and active people are just as healthy as thin and active people, while thin and sedentary people are just as unhealthy as fat and sedentary people.

The key to metabolic health is to get some movement into your life (by way of guidelines, the recommended amount is 150 minutes moderate exercise or 75 minutes vigorous, plus strength training twice a week). Whether that movement makes you thin does not matter. The health benefits are yours to keep.

Likewise, we have a good idea of what foods are healthiest (whole grains, lean meats, veggies and fruits), but it’s more about incorporating those foods into your diet, rather than throwing out everything labeled “junk” and restricting your calories severely. Perhaps you’re able to become a vegetarian and live off the land, great! Perhaps you still rely on convenience foods, but begin including more fresh fruits and veggies into your meals, great!

Everyone has a different ability to alter their lifestyle, but finding something that works for you and being consistent is more important than doing all the “right” things, only to get frustrated when the scale doesn’t cooperate and throw out all your healthy behaviors.

Finally, you have to love your body as it is now, without exception. Nobody takes care of something they loathe, and the same goes for your body. The human body is an exquisitely engineered machine, and can do amazing things. Self-care is about treating your body with kindness and gentleness, and doing the things you need to do (within your abilities) to keep it in good, working condition.

That kind of self-care does not require you to monitor your weight. Instead, find a new metric that actually affects your health. The most important metrics are your metabolic indicators: blood sugar, blood pressure and blood lipids. Find a physician who will support your quest for health without harping on your weight. Monitor those indicators and adapt your behavior to move those numbers.

When my doctor told me I had borderline high cholesterol, I adapted my lifestyle to incorporate strength training on top of the cardio I had already been doing. I also began to change my eating habits. As a result, 10 months later my total cholesterol dropped 11%, or 26 points; my HDL (or “good”) cholesterol raised 11%, or 4 points; and my LDL (or “bad”) cholesterol dropped 18%, or 31 points.

My weight? Still 265.

I’m by no means done with my journey to health. But I’ve found a balance of nutrition and fitness that fits my hectic life, squeezing what time I have for self-care between my 40-hour work week, my two-hour round-trip commute, my wife and three kids, and whatever free time I have left for hobbies.

Over time, I’ll continue to add behaviors that will contribute to my improving metabolic profile, but until then, I refuse to let my weight take precedence over my health. I’m doing the things I am capable of doing and have reaped the rewards for doing so.

I would urge anyone who has exhausted themselves in the pursuit of weight loss to reconsider your priorities and to learn what is, and is not, necessary to improve your health. That’s exactly what I’ve been doing since I started this blog two years ago and I’ve been shocked by the amount research supporting HAES that is widely available, but not well-known.

Since this is a new paradigm in health, we understand that there will be some curiosity about it, or even hostility toward it. So feel free to ask questions or challenge any points I’ve raised and I will try to respond in a timely manner (but, again, time is a limiting factor for me). I wish you the best of luck in your quest for health and I hope you’ll stick around to see what Fierce, Freethinking Fatties is all about.

*Recent predictions that obesity rates will continue to rise are based on telephone surveys going back to 1990. When asked to compare their projections with the plateau of the past decade, Eric Finkelstein, lead author of the projection, struggled to explain in a recent CDC press conference.

David Brown of The Washington Post asked a rather pointed question about the data disparities:

I guess, that Dr. Ogden [lead author on NHANES] showed convincingly across almost all ethnic groups, races, sexes, everything that it’s basically leveling off or it’s going up so marginally that it’s effectively level. Why should we not believe that is the trend that is going to continue on?  Its actual data rather than this modified linear extension from a point in which we know the trend that you’re — that is the trajectory set we know has changed.  You know, the slope has changed from the one that you are using.  It seems to me that there’s no way to really square what she showed and what you are predicting.

You’ll have to read the full response to get the complete context, but Finkelstein said, “[I]f you did our exact model with exactly as you described it the last couple years of the BRFSS data, because it’s showing a slightly greater slope than NHANES, I think you guessed what we have, regardless.  Now, it doesn’t take much of a difference between the slopes of the NHANES and the BRFSS to go from 34% to 42% in 18 years.”

4 Comments leave one →
  1. vesta44 permalink
    June 20, 2012 6:05 pm

    Personally, I think the only way obesity rates will rise is if people continue to yo-yo diet. But I also think that people are finally beginning to wise up to the diet industry and their repackaging of diets (one example is the way Weight Watchers has changed their diet plan over the last 40 years – they’ve had how many different ways to count calories now, without actually calling it “counting calories”?).

    • June 21, 2012 2:25 pm

      I considered that possibility, but then with the increased push of the last decade, you would expect obesity rates to have risen. So, my thought is that the rise in rates that occurred in those two decades was already influenced by weight cycling. How much of an influence, we’ll never know. But I think that all of the things that changed about our cultures food, exercise and weight loss systems occurred in the mid-70s, and we saw the effects through the end of the century. Unless there’s another significant shift in those areas (which I don’t foresee), we’re just going to adjust to these new levels. And although the emphasis has increased during the past decade, in terms of weight loss strategies there’s nothing new under the sun, as you said.


  2. June 21, 2012 11:51 am

    I’m so thankful that I saw a link to your news spot and then a link to your blog post. I read HAES recently and it made sense. I’ve been mentally spinning out of control though in the last few weeks because I’ve been struggling to exercise because of an injury (that a lot of people would say was partially weight related), and I stupidly continue to watch the scale as it goes… up. I needed this reality check. I needed the encouragement that the box full of fruits and veggies on my counter, the exercise that I HAVE been able to get in, and my really good health numbers (cholesterol,BP) are more important than that stupid number on the scale and the media’s messages about how they think I should feel about my body at it’s size. THANK YOU.

    • June 21, 2012 2:21 pm

      This post made my day. Shirley expressed the same frustration and I hope that she, too, keeps her eyes on the real prize and off the scale. I believe that people of all abilities can find some form of movement, such as chair aerobics or, my personal favorite, water aerobics. I doubt either one will lead to serious weight loss, but the cardiorespiratory effects cannot be understated. If you haven’t heard my interview with Dr. Steven Blair, be sure to do so. His message is simple: anything is better than nothing.

      I’m so glad the news segment reached you and I wish you the best on your path to health, including a speedy recovery!


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