T Nation

America's Moral Panic Over Obesity


#1

I'm not that easily offended but I actually felt outraged by this. He basically says that there is no link between being obese and having poor health, that there is no way to make fat people thin, that we shouldn't try advising fat people to lose weight, and all kinds of other absurd statements. Even if we accept his ludicrous proposition that there are no effective lifestyle interventions for fat loss, there are still plenty of drugs, which mainstream medical science usually loves to patch people up with instead of actually fixing their health problems by at least starting with, say, decent exercise, rest, and nutrition. Sure, they're all nasty but so are the statins and depression meds that everyone is seemingly on. Not advocating fat loss by drugs, just sayin'.

Oh, and the constant use of the word "thin" bugs me too. He makes it sound like the only options are being skinny or being fat.

When I read crap like this I'm reminded of how lucky I am that there are places online where everyone has their head screwed on mostly right...


#2

This would probably get more response in the off-topic section. Its not really BBing related.


#3

Dear mods,
Please move this out of bodybuilding.

To the OP, nobody gives a crap what bugs you. Unless the word “crap” bugs you. In that case crap crap crap crap.


#4

Yes, this probably belongs in a different forum.

I follow Megan McArdle, actually, and generally learn a lot from her. I’m interested in her new obesity policy kick; I think her main point is that the government shouldn’t have a policy of trying to make people thinner, which I generally agree with. (Don’t like the choice of words “fat,” “thin” and “lose weight” – I think T-Nation is right to talk instead about “lean” and “lose fat” instead, but those are the general public’s terms.)

She’s right on one thing: trying to tax or outlaw fattening foods does pose a problem for property rights and personal choice.

But people who say “diets don’t work” generally don’t take into account the fact that most people diet badly. Look at this study from the New England Journal of Medicine http://content.nejm.org/cgi/content/full/360/9/859 that put people on diets and noticed that most of them had gained the weight back after two years even though they were eating fewer calories.

What are the “diets”? – well, the highest-protein, lowest-carb of the diets was 25% protein, 35% carbs. Does that sound like a low-carb diet to you?
The subjects get 90 minutes of moderate exercise a week. Period. Is that what you would do if you wanted to lose fat?

People “on diets” eat too little protein, skip meals, don’t exercise (certainly don’t lift) and either find that they’re ravenous and quit, or they stick to the diet, slow their metabolism, and gain weight anyway.

Megan comes to the conclusion that we should stop pressuring fat people to diet. But maybe the point is that we need more penetration of good nutrition advice. The alternative to a bad crash diet is not a bad Standard American Diet.


#5

[quote]AlisaV wrote:
Yes, this probably belongs in a different forum.

I follow Megan McArdle, actually, and generally learn a lot from her. I’m interested in her new obesity policy kick; I think her main point is that the government shouldn’t have a policy of trying to make people thinner, which I generally agree with. (Don’t like the choice of words “fat,” “thin” and “lose weight” – I think T-Nation is right to talk instead about “lean” and “lose fat” instead, but those are the general public’s terms.)

She’s right on one thing: trying to tax or outlaw fattening foods does pose a problem for property rights and personal choice.

But people who say “diets don’t work” generally don’t take into account the fact that most people diet badly. Look at this study from the New England Journal of Medicine http://content.nejm.org/cgi/content/full/360/9/859 that put people on diets and noticed that most of them had gained the weight back after two years even though they were eating fewer calories.

What are the “diets”? – well, the highest-protein, lowest-carb of the diets was 25% protein, 35% carbs. Does that sound like a low-carb diet to you?
The subjects get 90 minutes of moderate exercise a week. Period. Is that what you would do if you wanted to lose fat?

People “on diets” eat too little protein, skip meals, don’t exercise (certainly don’t lift) and either find that they’re ravenous and quit, or they stick to the diet, slow their metabolism, and gain weight anyway.

Megan comes to the conclusion that we should stop pressuring fat people to diet. But maybe the point is that we need more penetration of good nutrition advice. The alternative to a bad crash diet is not a bad Standard American Diet.[/quote]

Exactly. It drives me nuts when writers use studies like this to support the notion that “diets don’t work.” It’s very clear from the study above that dieting does work. What’s also clear is that long-term outcome is poor. Long-term outcome and losing weight initially are two different things. What these writers should be asking is: Why do people initially lose weight and then gain it back? What variables contribute to that? How do we manipulate those variables for better long-term outcome?

Instead, we get writers misinterpreting data and making false statements.


#6

It is amusing when people say that “diets don’t work” when there are people who have utilized proper training and nutrition successfully. Instead of noting that “most people gain weight back after dieting,” why is nobody focusing on the few that were successful?


#7

[quote]jtrinsey wrote:
It is amusing when people say that “diets don’t work” when there are people who have utilized proper training and nutrition successfully. Instead of noting that “most people gain weight back after dieting,” why is nobody focusing on the few that were successful?[/quote]

Right - another good point.

It seems to me that the largest documented road-block when it comes to diets is compliance. People simply don’t comply with the diet. Not to get all geeky here (too late, probably), but you cannot make any statements about the independent variable in question (in this case, the diet) if compliance is poor. When compliance is poor, there is no true test of the independent variable. Therefore, one cannot make the statement “diets don’t work.”


#8

i don’t know what obesity is a bigger indicator of in the united states:

terrible health initiative and an all around sedentary lifestyle

or

wanting everyone to feel sorry for you

or

flat out stupidity

tough call, tough call.


#9

Well, that was the point Megan was trying to make, though.

If compliance is never high among most dieters (and we’re talking about most dieters, not exceptions, because the topic is health policy and the US population in the aggregate) then maybe there’s something about diets, and human nature, that makes dieting a poor treatment for obesity. If a drug is very finicky and difficult to remember to take correctly, then it’s an ineffective drug for the general population, even if it would be chemically effective on someone who’s much more conscientious than average. The argument is that instead of yelling “Everyone, just try harder!” we should accept human nature as it is and deal with the fact that most people can’t permanently drop weight from dieting.

Where I think she’s wrong is that not all diets are equally bad. Social support (i.e. V-diet forum) makes compliance easier. Food logging makes compliance easier. I tend to think that adequate protein and fat makes compliance easier and also makes results better. And it’s not just a compliance thing; for a lot of people weight loss stalls just because food intake is too low. There are smarter ways to do it.


#10

[quote]AlisaV wrote:
Well, that was the point Megan was trying to make, though.

If compliance is never high among most dieters (and we’re talking about most dieters, not exceptions, because the topic is health policy and the US population in the aggregate) then maybe there’s something about diets, and human nature, that makes dieting a poor treatment for obesity. If a drug is very finicky and difficult to remember to take correctly, then it’s an ineffective drug for the general population, even if it would be chemically effective on someone who’s much more conscientious than average. The argument is that instead of yelling “Everyone, just try harder!” we should accept human nature as it is and deal with the fact that most people can’t permanently drop weight from dieting.

Where I think she’s wrong is that not all diets are equally bad. Social support (i.e. V-diet forum) makes compliance easier. Food logging makes compliance easier. I tend to think that adequate protein and fat makes compliance easier and also makes results better. And it’s not just a compliance thing; for a lot of people weight loss stalls just because food intake is too low. There are smarter ways to do it.

[/quote]

I agree with what you said for the most part. I just don’t see compliance as a road block that cannot be overcome. It just means that we need a better understanding of what contributes to noncompliance and what contributes to compliance so that we can maximize the likelihood that people will actually lose weight. I think what you’re saying isn’t far off from that.

To me, saying that “something doesn’t work” is only a valid statement if compliance was acceptable. I could go hand out cards to people walking on the street listing diet strategies, weight them before and 10 weeks from now, and they aren’t going to lose weight. That’s in no way a true test of the efficacy of the diets, though.