DebraSY

Why We Are at War and What to do About It

In Weight-Loss Maintenance on January 26, 2011 at 11:14 am

I am still plodding through Taubes’s Why We Get Fat.  It’s slow going, because his language remains alienating.  He insults me with his word choice and tenor, and by asking me to throw out my narrow assumptions and replace them with his narrow assumptions.

First, his language.  He repeatedly refers to “the overweight and obese.”  Hasn’t he been in this field long enough to know how dehumanizing it is to define people this way:  to say you don’t have adiposity, you are your adiposity.  In this book, he’s writing for the lay audience, not the medical and scientific community whose brains are presumably immune to the influence of such short hand.  Because of this broad audience, it would simply be polite (I won’t marginalize it with the phrase “politically correct”) to talk about people, not conditions or characteristics who happen to walk, breathe, think, eat and poop.

His language is tinged with an anger that smacks of a martyr complex.  Apparently, his ideas are not venerated to his satisfaction, so, he believes, everyone who disagrees with him either lacks imagination, is ignorant and not very well read, is biased to believe that fat people are gluttonous and slothful (and he may have a point there, but not enough to justify his intense outrage), or is stuck in a post-World War II mentality that will not permit the equal consideration of ideas from scientists of German origin.  Huh?  Get real.

Taubes obviously feels like he’s in a war of ideas.  I wish I could say he’s unjustified in his feelings, but I think that attitude pervades this area of study.  And how unhelpful!  The losers of this war aren’t scientists who stand shamed amongst the ruins of their false theories.  The losers, the victims, in this confusing war of words and judgment, are we, the dieters, the serial dieters, the failed dieters, even the “successful” dieters and the steadfast and stalwart non-dieters who have the misfortune of being fat in this war-on-obesity culture.  Nobler people in this debate should rise above this war mentality, and call a truce, to everyone’s benefit.  There is nothing to prevent Taubes’s ideas from existing peacefully with others.    

It gets back to assumptions.  I’ve said the NWCR needs to re-examine its assumptions but, in fact, everyone in this field needs to review their assumptions regularly.  Here, enumerated, are a few of the many dangerous assumptions that clearly need to be re-evaluated, the first two most important:

Assumption 1.  Obesity is a single condition:  calorie imbalance or carb sensitivity (circle only one).

Revised assumption 1:  Obesity may be several conditions.  (The variety of body shapes that obesity creates and the range in human appetites suggests there are more than one or two.)  Science can help society by defining these different conditions.  Taubes insists it’s all about insulin, but then describes a system of fat metabolism in which insulin must interact precisely with dozens of other enzymes, proteins and natural chemicals.  I’m not a scientist, but I see how disturbances in those interactions could manifest as a variety of complications, each suggesting different interventions (or none at all, other than acceptance).  And he doesn’t even begin to address how modern environmental toxins may throw a wrench in the machinery.

Assumption 2:  Obesity has a single cause.  Circle it:  bad or lazy character, toxic food environment, congenital endocrine imbalance, emotional imbalance, genetics, a virus, environmental poisoning from (pick only one):  pesticides, hormones in drinking water, neuro-toxic food additives, livestock antibiotics or growth hormones, OR anything else we discussed when we played Roulette.

Revised assumption 2:  Obesity may have several causes.  Science can help by isolating them, and the type of obesity condition that they create (see revised assumption 1). 

Assumption 3:  All obesity over a certain BMI is “morbid” and, in as much as science undergirds medical practice, doctors should encourage people over that BMI to lose weight through diet or surgery.

Revised assumption 3:  Some types of obesity are harmless (see revised assumption 1).   All fat people should be evaluated as individuals.  In no event should fat people be taken as fair game for dangerous scientific  experimentation (and I’m thinking here about gastric mutilation).

Assumption 4:  Even if an individual’s excess weight is not dangerous, and even though diets routinely fail long term, it doesn’t hurt to encourage people to keep trying to lose weight through dieting.

Revised assumption 4:  Many people will attempt to lose weight in patently dangerous ways.  Moreover, all yo-yo weight cycling, even when using “healthy tactics,” may endanger the immune system, gall bladder or heart.  Finally, even if it is later proved to be harmless physically, yo-yo weight cycling is demoralizing.  Maybe doctors should put a moratorium on prescribing weight-loss dieting until we know more about what the different types of obesity are and what causes them (return yet again to revised assumptions 1 and 2).  We who insist on dieting are doing so despite evidence (and our own experience) of its significant failure rate.  Many of us know that already.  It would be affirming, not discouraging, if our doctors and the scientists who supply them information would acknowledge that reality.  In lieu of weight-loss dieting, doctors should prescribe healthy behavior – exercise, increased vegetable consumption, etc. – which may also result, as a side effect and social bonus, in weight loss.

With his book title, Taubes asks two questions:  why do we get fat and what should we do about it?  I give him extra points for discrediting the assumption that we get fat or regain weight because we are lazy, stupid or emotionally imbalanced.   On the other hand, his one-size-fits-all answer that we get fat eating carbs and should counter that by not eating carbs (but eating fat), strikes me as incomplete.  Before we arrive at more answers and more broadly useful answers, scientists need to regularly examine and recraft their basic assumptions.  And maybe we need to stop referring to “obesity” all together, and start talking about “obesities.”

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  1. From your description and analysis, Taubes is writing for a mass audience that suffers from all-or-nothing thinking. (Nuance and uncertainty is not welcome.) What gets published is what is predicted (based on market analysis) to sell the most copies, garner the most bookings on talk shows, and, hence, make the most money. The language, therefore, is carefully groomed to be inflammatory. To. Increase. Profits.

    What I don’t understand: How is it possible that so many people still have expectations otherwise? (I wish I could remember what that worldview felt like. I’m pretty sure I was even angrier back then!)

    About the language *Taubes chose*.

    First, one must define “overweight” and “obese,” and I have yet to see any logical definitions for those (that were not based on prejudice or inaccuracies). So, how would Taubes refer to people’s size (repeatedly) without using discriminatory language? People who have obesity? People who weigh too much? (What do those descriptions mean, anyway?) If he goes by BMI, he should be doing a lot more research. If he’s just talking about people weighing more nowdays, compared to the 50s or 70s, well, um, so? How is that fact relevant? Maybe most people didn’t weigh ENOUGH in those days. *Shrug.*

    Is he talking about a group of people who have so much body fat that…? (Ah, yes, the deathfatz dilemma.)

    *eye roll* at Taubes

    Like you suggested, he can’t get away with saying “people who eat too many carbs”, because there are millions walking around who eat carbs all day long, decade after decade, and remain skinny. (My husband, exhibit A.) Frankly, I wouldn’t want to try and come up with appropriate terminology, while somehow avoiding sizism (how?), because I doubt THAT book could get published (without ending up at half.com, for a buck fifty per copy.)

    The language of health *care* is also partly at fault. We often still see “diabetics” used in medical literature instead of People. Who. Have. Diabetes. We say alcoholics, instead of People. Who. Have. Alcoholism. Space on the page=money.

    How could one expect to write a book on *the subject*, get it published, and not have it turn out Half-Assed? (The answer is contained in the question.) 🙂

    Actually, of course, I don’t have the answers. I just want to read his book, pick apart his rhetoric, mock his word choices, question his premises, point out his logical fallacies and sneer at his research failures.

    Seriously.

    Isn’t cultural criticism, at this point, half the fun in life?

    I’m probably snarkier than usual because you beat me to the fun. And did such a masterful (mistressful?) job!

  2. I think you’re right about what publishers demand regarding tenor these days: everything has to be a fight. But I think Taubes is also naturally self-righteous.

    With regard to “the overweight and obese,” I would have been okay with “overweight and obese people,” a net gain of three letters, in the contexts that he uses the words. I don’t expect people who aren’t in the size acceptance movement to feel at ease with “fat people,” a net loss of 14 characters. In terms of defining “overweight and obese,” you are right about that conundrum.

  3. This is picky, but the whole “fat people have a calorie imbalance” assumption makes no. sense. at. all. (I know you don’t agree with it and were just using it as an example of a fallacy.)

    People who are gaining or losing weight could be said to have a calorie imbalance. People who are staying the same size, whatever that size, do not.

  4. Well, I ordered the bleepin’ book. Nothing sells like controversy, and alleged self-righteousness. Too bad I’m just naturally ambivalent.

    *shifty eyes*

    @DeeLeigh: good point! (or restatement of the fallacy)

    I remember the first time I found a reference in my Med-Surg textbook, for which I looked up and found the actual Cochrane review of over 100 studies. The text book reference was about patients who have head traumas, and what kind of diet is best for them during the first few weeks, post trauma. The text book authors (or editors), at least for that chapter, apparently did not even read the Cochrane conclusion, although they cited it. (And even put it in bold, in a special, brightly colored, “evidence based” chapter highlight taking up almost 1/4 of the page.) However, they came to a conclusion that was written no where, or even hinted at, in the original research.

    So I though, “Hmmm.”

    From then on, I started looking up other references from various text books. Same doggone thing. “My God,” I thought. Many, if not most, of the references I looked up seemed to be based on interpretation of the research reports (plus, maybe, wishful thinking?)

    And these were my nursing school text books.

    Not popular non-fiction (LOL, that) targeting the masses.

    Expectations dashed anyone?

  5. I guess I’m misusing “imbalance”; I should say caloric surplus, and Taubes says it more like this: Yes, fat people have a caloric surplus. Their bodies are more crowded with fat (caloric energy) than that of lean people. So what? That doesn’t answer “why.” If someone asks you, “Why are there so many people crowded in this dancehall?” she wants you to answer to the effect “Because Bono is coming here to sign autographs.” She doesn’t want you to say, “Because more people have entered the room than have left it!” (Wizenheimer!)

    Now, Taubes’s answer to why fat people have a caloric imbalance is that insulin is permitting too many carbs to enter our fat cells (part of the metabolic process) and convert to fat (another part), without then exiting (another part). He postulates that by eliminating carbs (Bono fans), you don’t cue the insulin (his PR manager and body guard) to play the “trap the carbs” game. (Note that I am severely editing and projecting my own metaphors.) Okay, perhaps Taubes is right.

    I’m saying that the process of eliminating carbs long-term, for most people, is going to cue other powerful endocrine. My BIL did not drop his low-carb diet for lack of discipline, for a deep-seeded desire to return to the “fat lifestyle,” etc. Something powerful had to drive him. He was painfully aware he was regaining weight. He knew a low-carb diet had taken it off, but returning to that diet was untennable. That’s my big “why” back at Taubes.

    Insulin may be the girl responsible for getting people (carbs) to the chemical cotillion, and persuading them to stay (to convert to fat and wait patiently for their Bono autographs), but she’s not the only girl on the committee, and she has friends who will help her get her carbs there. In other words, there are redundant systems. If she can’t get Bono to sign autographs, for example, and the fat molecules all break up and leave their cells, then she (and her minions) will get those Bono fans, or others, to return to the dancehall some other way. This is soooooo much more complex than Taubes (a lean man, himself) understands. Taubes thinks fat people should just drop carbs like cigarette smokers drop cigarettes, and so what if it’s hard! That is no different then, than telling people they just should white-knuckle calorie balance their way to and through an accepatable BMI, and who gives a shit if it’s hard.

    (Note: edited for metaphorical clarity. Then edited more for accuracy. Wow. Maybe I need to rethink this one entirely.)

    • I guess I’m misusing “imbalance”; I should say caloric surplus, and Taubes says it more like this: Yes, fat people have a caloric surplus. Their bodies are more crowded with fat (caloric energy) than that of lean people.
      Fat stores in the body aren’t the same thing as caloric intake, though.

      I prefer this metaphor: Fat is like a savings account; an emergency fund, or like saving heavy gold coins, if you prefer. People who have been poor in the past or whose families have been poor often feel very insecure living paycheque to paycheque, while people who have never been poor worry less about money. Also, some people are just naturally frugal while others are spendthrifts no matter what their history.

      So, these formerly poor people and these naturally frugal people only feel comfortable when they have an emergency fund of a particular size – and the size of the account they’re happy with varies. My body is happy with the energy savings I have at a BMI of 30-35. It won’t spend anything that would put it below a 30 BMI unless it absolutely has to, for survival. If I start getting above a 35, it will feel wealthy and spend freely, providing plenty of heat and always wanting to move.

      The common wisdom these days says that bodies that like to have a nice energy emergency fund are unhealthy, overweight, abnormal, and unacceptable. I think it’s a perfectly natural response to undependable food supplies that people have experienced in their own lives (though food insecurity or dieting) or have passed down in their families.

      • I think you’re theory applies to many people, especially those of us who get evenly fatted when we expand. But Taubes rightly points out that there are people (and laboratory rats) whose fat will take primacy over muscle and organs. When they are starved they do not draw on fat stores first or even primarily. They can literally die of starvation while still having fat stores — muscles and organs wasted away. Using your metaphor, it’s like the bank won’t let them make a withdrawl of their own money to pay basic bills. Again, it gets back to the first assumption. Is obesity (or fat) a single condition? I don’t think so.

    • FYI Gary Taubes started writing about how carbohydrates effect weight loss because he lost weight (40 pounds I believe) using a low-carb diet and was surprised that it worked given the conventional wisdom of the time (this was before his Science magazine article and the NY Times article “What if it’s all been a Big Fat Lie”). This lead him to investigate the accepted premise that eating fat is the culprit in weight gain and that controlling fat and calories lead to long-term weight loss and maintenance. That is a long way of saying that even though you might assume that Gary Taubes is a lean man, he’s like the rest of us maintainers–searching for answers to the mystery of weight-loss and maintenance. I personally think that Gary glosses over a lot of contributing factors, but there is truth in what he has to say. And like another post about the ketogenic diet for epilepsy working for some but not all epileptics, if low-carb works for you it can be like a miracle–but if it doesn’t work it’s just another false hope. I’ve had the miraculous experience that I can lose weight and maintain without hunger and excessive exercise (but not without constant vigilance and work) by employing first Atkins and now more Paleo strategies. When I first lost the weight I thought I had found *the answer* but have come to realize that it doesn’t work for everyone and I just need to STFU unless I’m in the company of people who actually want to discuss these things:). That’s one of the reasons I love reading this blog–it’s a great place to read and discuss these things without boring my friends to death!

  6. Although amusing, I find your metaphor (the Bono autograph signing) a wee bit hard to follow.

    What I do find crystal clear is the white knuckling–be it a carb-free diet or caloric restriction. The fact that pure will power cannot control the powerful urge to reach a certain weight (and for lean people, that may mean losing weight to get back to the “right” weight for them) leads me to believe that things are so much more complicated than simply quitting carbs like you quit cigarettes.

    The “X food (usually carbs) = cigarettes = poison” metaphor just burns my butt (pardon the pun). I can understand that highly refined foods (like white flour, white rice, sugar) in large quantities might not be the best things to subsist on. They have only recently entered the human diet and our bodies are perhaps not particularly well suited to metabolizing them successfully (unless you’re a lucky “leaner” like Taubes or Jian Ghomeshi) but for pity’s sake: they’re food, not poison. The Fat Nutritionist very wisely points out that even Jello can serve a positive nutritional role for some extremely ill patients. As far as I know, you can live for years on carbs while a diet of cigarettes only would see you dead within a few weeks.

    I wholeheartedly agree with RNegade (as I’m sure you and all your readers do). The Taubes book takes an “all or nothing” approach–something that sells well, particularly, I believe, in North America. Not to go out too far on a limb (though I believe that I am among friends, here), but this is why Fox News is so popular. It’s vastly easier to present a simple lie than a complicated truth…AND THE TRUTH IS ALWAYS MORE COMPLICATED. Sorry I resorted to caps, but this is what makes me so mad!!!

    Now, I have to go and prepare for tomorrow’s assignment and let my blood pressure reach a lower, calmer number.

  7. Now I know why I never liked those girls on the cotillion committee. I haven’t read this new one by Taubes, except to pick it up at the Coles Book Table: and to request “Good Calories, Bad Calories” from the library. I waded through several chapters of the last third of the book, “Obesity and the regulation of weight” –enough to know you have understood him correctly and described what he thinks extremely well. (Bob Greene, I believe, also makes the carb/insulin connection and advises against carbs when wanting to reduce body weight.

    Thank you for the Gina Kolata recommendation. I finished Rethinking Thin a few days ago and I’m afraid it has completely depressed me. I’ve stopped my workouts and making the effort to eat extra veggies. That’s contributing to my black cloud, too, though, so just by stating it, I may be ready to snap out of it. We’ll see.

    What interests me is the question, why has my body chosen to “rest” at this particular number? It was only introduced to this number a few years ago: my body had been quite loyal to another number, a number fifty pounds less than the current one for many many years. (Until I quit smoking. Then all bets were off. I was told that smoking increased my metabolism 7%. I was also told that I *needn’t* gain weight when I quit. Hah. But I digress.)

    What should I do? I was thinking about losing 10% (which would be 25 lbs) and then just maintaining that for a while. It seems like such a teeny tiny return for the effort. I’m not even sure it will work. I don’t know why I am *asking* you–I guess I just want a bit of encouragement–or a “look out, danger ahead” from one who has been there and done that.

    Regardless, thanks again for your thoughts. It’s a pleasure to read you.

    • @Alana in Canada: In November 2010 I read “Rethinking Thin” and a similar book, the title of which escapes me now, and I had an initial reaction of disappointment. (“So…it’s true after all.”)But then I remembered my experiences with *evidence based research* in nursing school, and I sort of said “Eff it all.”

      At about 300 lbs, I started walking. Daily. Just before dawn, so I could look at the starry night sky first, and then watch the sun rise. (Also, almost no traffic that early!) I wore Crocs in the dead of winter because my feet hurt too much to wear anything else. Crocs with wool socks. 🙂

      I walked every day for about 6 weeks. Gradually increased my distance. Then I weighed myself, to compare.

      Nada. Zip. No difference in weight.

      But.

      Something had happened. I felt different inside. Hard to describe. I decided that the walking could not be about my weight. I was going to do an experiment to see if regular exercise changed anything, in a significant way. It did. I got stronger. My endurance and stamina increased. I started sleeping better. Walking became a great source of pleasure, sensual pleasure. It felt good to feel my legs swing out in front of me. My anxiety level gradually decreased, in spite of some very stressful events.

      I reconnected with my body.

      Honestly, I believe that part of the benefits were (are) related to walking out doors, rather than inside.

      I’m not a fan of relying on intuitive eating (for myself), but in many other areas of my life, I trust intuition to nudge me along. A big part of that, ironically, involves trusting my body. It *knows* what it is doing. It is not sabotaging me. It performs beautifully.

      Now here is the potentially disappointing news: the benefits of walking did not kick in, full force, until after about 8 months. Before that, it was iffy. I imagined things were changing for the better, but I couldn’t be sure. I think I kept with it out of sheer stubborness. Also, I had a walking buddy, and we depended on each other.

      I say, experiment. Find movement(s) you enjoy, or someone you enjoy being with, and start moving your body regularly through time and space. Just see what happens. Taking pleasure in it, not forcing it on yourself, whatever you choose, seems to be key.

      • RNegade,

        Thank you for this story.

        Personally I didn’t get much out of Rethinking Thin but I do like Kolata’s Ultimate Fitness, which is about the disconnect between the fitness industry and fitness research. Thanks to Ultimate Fitness it’s a lot easier to ignore the snake oil claims and focus on exercise that improves my life.

        (I think part of why Rethinking Thin was disappointing to me was that I read it after Big Fat Lies, Health Risks of Weight Loss, Fat?So!, and other books. When you keep thinking “Not bad, but _______ made the point in a much more compelling fashion” or “This would be stronger if you’d included study ___________” then it’s probably not the right book for you. 😉

  8. Oh, Alana. Hug. Hug. Reality bites, doesn’t it?

    That said, eat your veggies, and get back into exercise. The exercise, especially, will keep your mood from dropping and will prevent insomnia from adding its ugly presence to your troubles. Veggies can’t hurt you, either, and will probably help. Shoe-horn joy into your health routine. Some thoughts: If you have a little spare change, go to the Richard Simmons website and spring for one of his goofy DVDs (I recently got #5). The “Boogie” one is even better. Another good video is the original Dancing with the Stars workout. That Maxim is great eye-candy. If you enjoy Jazzercise, consider re-upping a membership there. If you’ve never done Jazzercise, try it out (just spring for an individual class and see if you like it). In my town, at any rate, the clientele have a variety of body shapes and the atmosphere is generous with regard to adapting the routines however the heck you want to for your own good. The Y is also a good place to belong, generally. More “real” people, fewer gym rats trying to impress one another than at many gyms.

    Regarding weight, I’d recommend you dig in your heels where ever you are (yo-yoing is the least healthy thing to do), and immerse yourself in the size acceptance community, on line and/or in your community. Then be the healthiest you that you can be. A few posts ago, we were talking about Ellyn Satter v. “pure” intuitive eating. Ellyn Satter, to my thinking, wins out. Less guilt and obsession. Easier to wrap your brain around.

    Here’s the deal: This is January and the trees are barren and we’re trapped in our homes, and everything looks bleaker and our weight is a more daunting issue than it ought to be, strictly because of the time of year. Dig in your heels, find some exercise-related joy and shoe-horn it in, and I promise, EVERYTHING is going to look better and brighter three months from now. Then you can decide whether you want to experiment seriously with your own body. Maybe you will have gotten so deep into size acceptance that it won’t matter so much to you. Or not. Regardless, don’t make decisions in January. Wait till you’re in a better frame of mind.

  9. I’m having a similar dilemma as Alana – do I really want to try to lose that 10%? Would it help reduce the risk of the diabetes that runs in my family or just make me more likely to yo-yo? (I’m not actually asking you, since you are not my dr. 🙂 )

    I’ve already lost 10 lbs that I gained when I had to stop running due to leg pain (fixed the pain, also did more biking and got back into swimming). So part of me suspects that a little more might come off pretty easily because of the increased exercise.

    I’m lucky that I love fitness – plan to do a triathlon or two this summer. So that helps. And I’m hoping that refusing to go hungry will help too. If I’m hungry, I eat; if i’m craving something, I eat it. My plan with counting calories is to figure out what to eat and when to keep from being hungry. I’ve been the cranky hungry dieter before and I don’t want to do it again.

    • Hi, there, No1, welcome to the blog. Your plan sounds good to me, speaking only as an observer and not a doctor ;). Any reasonable and measured increase in exercise that one does for health reasons is a fine idea. Weight loss and maintenance are something separate. They are experimental. Sadly, cultural mythology doesn’t acknowledge the high failure rate and regard it that way. Those of us who practice loss and maintenance discover its true nature pretty late in the game. Some choose to immerse in the zippy “lifestyle” culture, and that works for them, but is unfair, I think, to suggest that it may be embraced by the vast majority of people. Many of us just feel it’s “brightsiding” (thanks for the vocab, Barbara Ehrenreich). I guess what I’m saying is that you are right to proceed with skepticism and caution. What you plan to do with your calories is very similar to what I do, if that’s affirming. I have never set a bottom lower than 1,600 calories, even during my loss phase, I don’t entertain hunger gladly, and I eat enough treats that I’m not edgy (though probably fewer treats than most people eat).

    • You know, I’m not convinced that being fat actually causes diabetes. Yes, it’s an observed risk factor, but that doesn’t mean is =causes= diabetes, just that there is a correlation that a higher percentage of fat people get diabetes.

      If it’s a correlation, and not a causation, then if you’re a naturally fat person, losing weight does not reduce your risk of diabetes. You would still have the same chance of developing diabetes, you would just be moved into the column of “thin people who get diabetes” (who do exist, let me assure you).

      It’s like, I believe that they have recently discovered that having a certain kind of ear lobe is an indicator that you have an increased risk of heart trouble. I believe that there can be that correlation, but I doubt that having plastic surgery to get a different kind of earlobe would reduce your risk of heart trouble.

      Not to say that a person shouldn’t try to lose weight for other reasons (knees, back, anyone?) but I’m just saying that I’m not convinced about the diabetes connection.

      • Teri, I’m not convinced about the weight-diabetes connection either. My thinking often runs along the lines that there might be something(s) that causes or leads to both fat and diabetes, and that if I’m losing fat I’m reducing that something so it won’t give me diabetes too.

        On the other hand, my thinking also often runs along the lines that whether or not fat has anything at all to do with diabetes, all the women in my family get both and I will too, no matter what.

  10. Man, by the time I get through all the interesting comments on your blog, I forget what I was going to say. I do want to say that I loved your answer to Alana. I second those thoughts.

    And I wanted to say that I have noticed that in my minimal experience, doctors generally DON’T try to tell people to lose weight. They DON’T tell them that their back and/or knee pain would improve with weight loss, or that their heart disease, high blood pressure or diabetes might just benefit by a change in diet habits and exercise. I always wonder why. Anyway, that’s been what I have observed.0.

    • Debby, if you yourself are a big gal and haven’t gotten the weight-loss lecture, that is quite unusual. It is much more common that fat people are prescribed a diet no matter what ailment they might come in with. (There is a fathealth website which documents a great many distressing cases of this.) And many are all too eager to suggest diets and exercise without knowing or caring about or even believing the patient’s side of the story.

      • Hey, Mulberry. Allow me to introduce you. Debby is one of the maintainers here, with an impressive history. She’s also an RN (which I have speculated has made her better at executing this experiment than most). I highly recommend her blog, which currently has a pictorial of her African Safari.

        And Debby, meet Mulberry. An astute member of the size acceptance community. Comes here by way of Big Fat Blog, a size acceptance community well worth a lurk.

    • I am heartened that your experience with doctors is that they DON’T focus on weight loss, but I’m saddened that you say they also disregard the benefits of exercise and healthy eating. It’s probably a combination of two things: 1. The disease model of medical practice — find the problem and fix it. Promoting health is someone else’s job. AND 2. The stats (and HAES PR) are getting through. . . but only partially. They see that loss and maintenance are rare and that yo-yo weight cycling is demoralizing to their patients, and they’re kind enough to not hang the awful “N” word on them, “Noncompliant,” so the doctors say nothing. They don’t know what to do, really, and, in fact, promoting health IS time consuming, moreso than prescribing meds or performing procedures.

    • Hi Debby, and thanks for the introduction, Debra. If the doctors you work with are’t harping on weight loss to fat patients, they are quite unusual. Given that the stats for weight loss are quite dismal, except maybe for maintainers in this group and their ilk, I’d say that shows uncommon good sense. As for back or knee pain, shouldn’t physical therapy be tried first? PT would have a far better chance of relieving pain than dieting, which, even if it worked for them would be substituting one pain for another. And it would be quite arrogant (that doesn’t stop some doctors, unfortunately) to assume you know what your patient’s diet and exercise habits are without at least asking them.
      Since you are a nurse, you probably already know that fat alone (or even sugar) doesn’t cause diabetes, that high blood pressure may be genetic or associated with stress or with weight gain (which is more likely when one loses much weight), and that fat heart patients have a better prognosis than thinner ones.

  11. Hugs accepted RNegade and DebraSY. Thank you so, so much. You know, both of you are so right about the exercise. When I’m done, I wear the biggest grin on my face for at least an hour. My body loves it–it was even craving it there for a little while until I shut it up with homemade brownies (or some such thing).

    Crocs! Outside in the snow! Oh my. I’m having shoe troubles, too. It’s a lovely image, though. Crocks stepping in the snow as the sun rises. I’m picturing pink, or blue, or orange. Maybe purple. The sunrise on your feet. Lovely.

    Thank you again.

    • Alana, I just read an interview that Jack LaLanne gave right before his 90th birthday. He said, “I work out for two hours every morning, seven days a week — even when I’m traveling. =I hate it.= But I love the result! That’s the key, baby!”

      I was so happy to see that. Jack LaLanne hates exercising! That was so inspiring! Mr. Exercise Himself hates exercise. I’ve been exercising and hating it, and I thought there was something wrong with me . . . apparently not!

      So now when I walk a mile twice a day, instead of growling that “I hate exercise” I sing “Jack LaLanne hates exercise” and it makes me content. I actually found myself enjoying it yesterday. Believe it or not.

      Wait, that’s a different show . . .

  12. I haven’t read Taubes book and probably won’t so thank you for your great analysis. I agree with your thoughts completely. Why we get fat is multifactorial and I have a real problem with people (Taubes and others) who try to reduce it to a one-trick pony, in this case carbs, and cherry pick reductionist studies to support their view. Haven’t we been there and done that? I remember way back (30 years?) when Atkins was BIG and everyone tried it. Most had the same issues with maintenance and compliance that they do today. So, in the 90s, the pendulum swung the other way and once again, we were given the one-trick pony answer: this time it was FAT that made people fat. Those authors, too, had plenty of cherry-picked studies to support their view. Ornish still insists a very low fat/high COMPLEX carb diet is the answer and he’s got studies to show it. Well, the 90s turned out to be like the 70s-80s and again maintenance/compliance seemed to be the sticky widget. Now the pendulum swings again – back to carbs.

    I for one am sick of it. The causes are multifactorial. The solutions therefore will need to be multifactorial. It’s not as simple as removing a certain macronutrient. If it was, we’d all be thin because so many of us have tried what Taubes proposes. We can spend from now until eternity focusing on single factors and it won’t get us anywhere.

    I did it Taubes way and did not lose weight. Granted at the time I was only 15 pounds overweight, but still, it did not result in loss of fat stores for me even though I combined the eating plan (South Beach) with vigorous exercise. This is probably because I’m not insulin resistant (although Taubes and others seem to think such people don’t exist).

    I maintained a 30 lb. weight loss from the time I was 28 (I’d been overweight since babyhood) until my first child was born at 36. Believe it or not, I did it the low fat way combined with exercise (after reading Covert Bailey’s Fit or Fat) and a helluva lot more NEAT (non-exercise associated thermogenesis) than I get now.

    At this point, I’m starting to lean towards NEAT being a crucial factor. The huge decline in the amount of manual labor people do in their day-to-day lives has to play a role. Our lives have never been so sedentary. Even exercisers can be quite sedentary while away from the gym. The conveniences of modern life have reduced our caloric expenditure drastically. I’m sitting here writing on a computer burning probably 70 calories an hour. My grandmother, on the other hand, had no such luxury. Until the day she died, she actually washed clothes in a drum washer (no spin cycle), wrung them out by hand, then fed them through a crank roller system to squeeze out the remaining excess water. She ate white rice every day of her life (a typical Hispanic diet in fact) and she was not overweight. I could go on an on about how her daily life was filled with busy activities we now see as drudgery and for which we’ve invented either machines to do the work for us or pay someone else to do. Even in my mother’s time, there was no such thing as lawn services for the “common man.” Only the wealthy had that. Now, everyone in my development hires someone to mow the lawn.

    We all live in a very obesogenic environment with bodies that have adapted to live in the exact opposite environment. I’m so sick of the carbs argument and the demonization of the banana I could scream.

  13. Alana, As a fellow Canadian, I suggest you go for something a bit sturdier than Crocs in the winter. I just discovered Blundstones (originally Australian, now made somewhere in Asia, of course). Like Crocs, they have a wide toe-box and are incredibly comfortable. They’ve got a good, sturdy sole that grips the snow and apparently they now offer a lined model. My Blundies are not lined, but with an extra pair of socks, they’re just as warm as any other boot I’ve tried.

    Walk! It’s the best.

  14. Speaking of one-trick pony diets, does anyone remember “Fit For Life”, the diet that banned the mixing of proteins and carbs? Before noon, you were only allowed to eat fruit (that would make Taubes’s heart palpitate!) and then all other meals had to be either veg and carb or veg and protein. Nuts were in some sort of netherworld–not quite good, not quite bad. Fruit always had to be eaten alone. You had to wait a certain number of hours before switching from fruit to carbs to proteins.

    Let me tell you: it works, because you have to wait so long between changing food categories. Yeah, it works, just as long as you keep following the g-d rules…Like any other diet.

  15. @NewMe (and Alana)

    I beg your pardon. This is starting to sound like a competition. Ahem! 🙂 Please let me assure you: Idaho winters are nothing to sneeze at, particularly last year’s winter. Brrrr….

    Crocs were CHEAP, I was poor (still am), but I also was gifted a nifty pair of YakTrax, those handy dandy little devices that are like snow tire chains–except designed to strap over one’s shoes. I walked on white ice, black ice, and red ice (you don’t want to know how the latter became red, suffice to say it wasn’t from ME falling on my face!) Yep, Crocs, YakTrax, and thick wool socks.

    I didn’t even have a winter coat so I…well, that’s a different story. LOL.

    Okay. Now I’m really starting to brag, aren’t I? 😉

    It’s just that I’m so tickled to have changed my life for the better in so many ways, especially at such an advanced age, under horrid personal conditions…oh crap, bragging again.

    *me stepping off*

    I guess my point is: you never know where positive change(s) will come from, or when it will happen, or how, or why…

    All my best to you both!

  16. Not to beat a dead one-trick-pony, but ALSO…walking just before dawn is strangely still, almost never any wind. I asked a scientist friend of mine for an explanation, and an hour or so later he summarized his whole speech (which blew directly over my head): “So, it’s all about energy. And movement. And potential energy.”

    Um, okay. Alls I know is the time just before and after dawn is a kick ass time to be outside, alive, and moving about. You see creatures, too, that you don’t see any other time of day/night.

  17. no1interesting: – I don’t mean to discourage you from trying to lose weight, sorry if it sounded like that.

    I had three very fat grandparents. My grandfather’s nickname during the Depression was “Fats.” He was very generous with that famine-resistant gene. 😉

  18. Hi all, I’m very new to this maintenance gig and I’d like some advice. What do you all regard as “maintenance”? For those of you who are daily weighers, what do you regard as acceptable weight fluctuation? My body seems to jump around a bit from day to day within about a 2 pound range. Should I expect to ever hop on the scales and see the same number from day to day?

  19. For me, it’s a three-pound weight range. I like to see the middle number a couple of times and the bottom number at least once a week, or I grow concerned it’s not just water fluctuation. If I don’t see that bottom number, or if I’m getting my top number day after day after day, I try to add a five or ten minutes to my exercise for a few days or stay closer to the bottom of my calorie range. If I go a pound over my weight range — that’s my panic weight (Barbara Berkeley calls it scream weight) — I push a little harder. I’ll add twelve minutes to the exercise and stay within 100 calories of the bottom of my calorie range till I’m back in my weight range. (Lots of range thinking. Hmmm. But not free-range thinking.)

  20. As someone who has spent the last month on a strict low-carb, calorie-restricted diet, with limited success (basically, a near-complete stall after a promising first week), I call bs on Taubes’ Assumption 1. Unless 20-30g of carbs (from veggies and limited dairy) are too much, or 900-1000 net calories (after subtracting calories burned in workouts) leave the body in a caloric imbalance/surplus. Otherwise I’ll have to insist that there’s something else going on. Cutting carbs seems to work for many people, but for myself – and many others I’ve found online recently – it’s not the holy grail Taubes and the Atkins crew insists.

    Regarding the weight/diabetes link discussed in the comments above: here’s a great compilation of peer-reviewed literature on the topic. The literature reviewed here pretty conclusively demonstrates that *both* types of diabetes have a strong genetic link, and while it’s difficult to determine causation, most of the available evidence points towards diabetes causing weight gain rather than the other way around.

    • @viajera: There is also a strong correlation between diabetes and oral (gum) inflammation. Several researchers believe there is a two way causation, meaning diabetes makes gum disease worse and gum disease (inflammation) contributes to other inflammation in the body (related to heart disease, diabetes, and so forth.) Sorry I don’t have a citation. I’ve put all my studies away for awhile.

      If you look around at http://www.unnaturalcauses.org you will get an eyeful of the links between social policy and a wide variety of physical diseases, indicative that health disparities also have roots in wealth inequalities, physical environments (housing, working sites, product exposure, etc), discriminatory practices, inadequate resources for child care, problems with education, food insecurity, and lack of universal health care. All of these may increase the rates of diabetes in populations (genetic factors aside.)

      As for the high fat/low carb/adequeate protein diet I now follow: I would have been driven to abandon it long ago if I judged my progress by weight. Weight can fluctuate wildly, from day to day and from week to week, making the bathroom scale completely useless for some people (me), EXCEPT for the value it provides me by reminding me that 1) each day’s weight means nothing outside of a much larger context; 2) plateaus come at any time, are very real and helpful equilibrium processes (physiological) necessary to maintain health; 3) what matters are weight trends over many weeks and months, not days, month by month weigh ins (or even every 6-8weeks) are far more accurate an indication of progress with weight loss. (Although I like to weigh 3-4 time a week, just to remind myself that my weight does its own thing…up 5 lbs for seemingling no reason from one day to next, and it doesnt mean I’m not progressing). I often have gone weeks without losing, then suddenly the scale shows a drop of several pounds and remains there again.

      In the past, on various diets, the day to day hunger would drive me to abandon my eating plan out of resentment, anger, discouragement and hopelessness. Now, as long as I get enough fat consumption, hunger remains manageable. Also, I have much more energy, in general, and I think much more clearly (more focused) when my fat intake remains high.

      Since childhoold I have had ADD , a disorder of brain neurotransmitters apparently, and was not properly diagnosed until middle age. I suspect this change in diet has helped my brain function and my metabolism to normalize. I’ve been eating this way for almost a year, and I am still tweaking it from month to month while continuing to read as much research on the topic as I can wrap my head around. 🙂

      I’m not advocating for anyone else. Just sharing my own experience.

      • RNegade, thanks for the info – on both the diabetes info and your personal experiences w/ low-carb diets. I’m sticking with it, at least for now, because it’s working for me in other ways – I’m not as hungry as I would be on a higher-carb diet of similar caloric levels, and it’s easier to maintain, especially when going out to restaurants (something my partner and I love to do). But I was hoping for more weight loss early on, which sometimes (as in the time I wrote this comment, obviously!) leaves me frustrated. We’ll see.

  21. I believe your experience RNegade. My husband’s weight can bounce around by five pounds in a couple of hours, if he sweats enough. I, on the other hand, maintain within a three-pound range, day after day.

  22. If carbs=cigarettes, then my BMI-just-under-21 partner is the equivalent of a four-pack-a-day smoker.

    I’m sympathetic to arguments that some of us are not as well equipped to process carbs as others. However, what I really don’t get is the lack of acknowledgement (by Taubes and other smug fat-hating buttcysts) out there that different bodies process food in radically different ways. (Oh, and that not everyone loves to get up at 4 AM to spend 2 hours in the gym, or has the coordination and endurance to ride bicycles every day in the snow and rain, or finds a spirulina shake to be a filling lunch. But that’s a separate rantlet.) I know for sure that there are people half my size who eat twice as much (of whatever) as I do, and people twice my size who eat half as much (of whatever) as I do. Why is that so hard to understand?

    Sorry, Gary, but the only way people are going to quit carbs entirely is to make it a capital crime to sell, possess, or grow them. And even then, there’ll probably be contraband chocolate that costs $200 an ounce. Unlike nicotine, your cravings for the stuff will NOT dissipate with more time away from them; quite the contrary. (Even that Paleo Diet guy, Loren Cordain, seems to know that, and allows three “free choice” meals a week.)

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