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livGrr, I got most of the way through drafting a long post about this article on brain sex differences when I discovered that the article in question had gone behind a paywall between my starting my post and being ready to publish it. Somebody posted it on Twitter, I think gool_duck but now I can't find the link I was looking for, so perhaps it was somebody else?
My point was going to be that I think it might be an interesting starting point for discussion with people who justify sexism because sex differences have a supposedly innate or biological basis. Eliot doesn't sound as polemically feminist as people like, say, Cordelia Fine or Deborah Cameron, both writers I strongly admire, but that's coming from the standpoint of someone who basically accepts their conclusions already. But since the article has now been hidden from public view, I can't discover whether I'm right that it might be more persuasive to a skeptical reader. Most annoying; I really do hate charging readers for access to scientific papers.
Anyway, the bit of my post that I'd already written compared Eliot's article with the NYT article about dieting that everybody was linking to at the end of last year. So I've put the half-written post behind the cut since I think the topic is still at least somewhat interesting even without the key point I wanted to make.
A couple of interesting articles picked up from Twitter recently. I want to make a note of them because I think they may be somewhat useful in communicating two issues that are important to me to skeptics. They're not going to convince conspiracy theorists or people whose whole identity depends on not accepting the relevant point of view, but I think they are likely to be more persuasive than activist polemic to people who are willing to examine the evidence with an open mind, but start out from being inclined against the conclusions. Also, both are good examples of summarizing a whole raft of scientific data in a concise article.
The first is the NYT article The Fat Trap, which pretty much everybody has been retweeting. If you're already on board with fat acceptance / Health At Every Size, you probably don't need this article and may even find it offensive (thanks,![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
j4). But I think it may be acceptable by an audience who are inclined to accept the conventional wisdom that being fat is unhealthy and everybody must try to lose weight at any cost. It doesn't really challenge that paradigm at all. Harding's article contains many of the same facts as Parker-Pope's, but it will scare off readers who aren't already on side, because it questions cherished assumptions, and also it's written in Harding's characteristic combative style. Parker-Pope takes it for granted that weight loss is medically and socially desirable, yet she reports clear evidence that sustaining significant weight loss is extremely hard for the majority of people, and that previously fat people who have lost weight do not have exactly the same health profile as people who were thin to start with. There is such a thing as a natural set-point for weight, and it is partly influenced by genetic factors.
Conventionally, everybody "should" be as thin as possible. And conventionally, "all" fat people have to do to achieve this thin ideal is to stop being so lazy, eat less junk food and give up sugary fizzy drinks. The first view is very hard to challenge without sounding like an extreme political activist, because it's such a widely accepted concept, in the medical establishment as much as in the media. However, the second can more readily be countered with facts such as those presented in Parker-Pope's article:
I hope that people who believe in a moral obligation to lose weight can at least accept the body of scientific data showing it's a pretty major undertaking. There are plenty of people who fall somewhere on the spectrum between irredeemably greedy and lazy, and committed enough for an hour's exercise every day coupled with watching every calorie and keeping yourself constantly hungry. For a naturally thin person, simply eating reasonably and not being a total couch potato may well be enough to keep them thin. So it's easy to assume that all fat people get that way by stuffing their faces constantly with sugary, fatty food and never doing any exercise at all. In fact, for a naturally fat person, simply leading a generally healthy lifestyle with a reasonable diet will probably keep them fat; they need to follow quite an extreme regime to get and certainly to stay thin.
gool_duck but now I can't find the link I was looking for, so perhaps it was somebody else?My point was going to be that I think it might be an interesting starting point for discussion with people who justify sexism because sex differences have a supposedly innate or biological basis. Eliot doesn't sound as polemically feminist as people like, say, Cordelia Fine or Deborah Cameron, both writers I strongly admire, but that's coming from the standpoint of someone who basically accepts their conclusions already. But since the article has now been hidden from public view, I can't discover whether I'm right that it might be more persuasive to a skeptical reader. Most annoying; I really do hate charging readers for access to scientific papers.
Anyway, the bit of my post that I'd already written compared Eliot's article with the NYT article about dieting that everybody was linking to at the end of last year. So I've put the half-written post behind the cut since I think the topic is still at least somewhat interesting even without the key point I wanted to make.
A couple of interesting articles picked up from Twitter recently. I want to make a note of them because I think they may be somewhat useful in communicating two issues that are important to me to skeptics. They're not going to convince conspiracy theorists or people whose whole identity depends on not accepting the relevant point of view, but I think they are likely to be more persuasive than activist polemic to people who are willing to examine the evidence with an open mind, but start out from being inclined against the conclusions. Also, both are good examples of summarizing a whole raft of scientific data in a concise article.
The first is the NYT article The Fat Trap, which pretty much everybody has been retweeting. If you're already on board with fat acceptance / Health At Every Size, you probably don't need this article and may even find it offensive (thanks,
j4). But I think it may be acceptable by an audience who are inclined to accept the conventional wisdom that being fat is unhealthy and everybody must try to lose weight at any cost. It doesn't really challenge that paradigm at all. Harding's article contains many of the same facts as Parker-Pope's, but it will scare off readers who aren't already on side, because it questions cherished assumptions, and also it's written in Harding's characteristic combative style. Parker-Pope takes it for granted that weight loss is medically and socially desirable, yet she reports clear evidence that sustaining significant weight loss is extremely hard for the majority of people, and that previously fat people who have lost weight do not have exactly the same health profile as people who were thin to start with. There is such a thing as a natural set-point for weight, and it is partly influenced by genetic factors. Conventionally, everybody "should" be as thin as possible. And conventionally, "all" fat people have to do to achieve this thin ideal is to stop being so lazy, eat less junk food and give up sugary fizzy drinks. The first view is very hard to challenge without sounding like an extreme political activist, because it's such a widely accepted concept, in the medical establishment as much as in the media. However, the second can more readily be countered with facts such as those presented in Parker-Pope's article:
to lose weight and keep it off, a person must eat fewer calories and exercise far more than a person who maintains the same weight naturally... [People who maintain a 30lb weight loss for more than one year]
are incredibly vigilant about maintaining their weight. Years later they are paying attention to every calorie, spending an hour a day on exercise. They never don’t think about their weight.
I hope that people who believe in a moral obligation to lose weight can at least accept the body of scientific data showing it's a pretty major undertaking. There are plenty of people who fall somewhere on the spectrum between irredeemably greedy and lazy, and committed enough for an hour's exercise every day coupled with watching every calorie and keeping yourself constantly hungry. For a naturally thin person, simply eating reasonably and not being a total couch potato may well be enough to keep them thin. So it's easy to assume that all fat people get that way by stuffing their faces constantly with sugary, fatty food and never doing any exercise at all. In fact, for a naturally fat person, simply leading a generally healthy lifestyle with a reasonable diet will probably keep them fat; they need to follow quite an extreme regime to get and certainly to stay thin.
(no subject)
Date: 2012-01-04 10:33 pm (UTC)Thanks for your mention of the wide, wide spectrum in-between.
I do not even come close to knowing enough about metabolic processes to even participate in a proper debate. And yet, while I'm a Health At Every Size proponent, I'm also baffled: What happened to what used to be the majority of people, i.e. those neither skinny nor fat? I realise this is dearer to my heart than it should be -- for objective reasons; we're just not part of the debate because we're no target group at all, in no direction -- but I'm surrounded by people who neither starve themselves nor watch their weight (or their food intake) at all without being thin. So what I wonder about are the usual factors: intersections of race and class, for example; this is not a topic I can escape here in my country specificially...
(no subject)
Date: 2012-01-05 11:43 am (UTC)Or are you talking about the fact that over the whole population, BMI is has tended to increase over the past several decades? That trend does seem to be plateauing recently, but anyway, I have seen various different explanations for it and all of them seem to be pretty speculative. It could be to do with additives in food and a class-related lack of access to adequate high-quality food, for example, but that's only one possible explanation.
(no subject)
Date: 2012-01-05 12:12 am (UTC)This is a personal testimonial so I've hidden it
I was that person for three years. Inborn OCD helped me stick to weighing everything I ate, and ingesting nothing but herbal tea for all the times I wanted to eat otherwise. I was pretty pleased at the weight I lost, but even then I felt "fat." There was no weight at which I'd feel OK about my body.
So I read the Fat Nutritionist and I've gained around 20 pounds back and I'm almost feeling OK. (Well 42 other things are verklempt but my weight isn't that problematic.)
(no subject)
Date: 2012-01-05 11:50 am (UTC)<span style="color: #ffffff; background-color: #ffffff">Your comment goes here</span>, then people (using visual browsers, at least) will have to highlight it to read.It's really interesting though that you were in the exceptional group who were able to keep weight off. I am so impressed that you have managed to move away from such an obsession and accept your body; that's a very tough thing to do in our society. I do really <3 the Fat Nutritionist; her best posts are stratospherically awesome.
(no subject)
Date: 2012-01-05 09:14 pm (UTC)Yeah, I was pretty amazed at keeping the weight off, and it was only after listening to folk slike the Fat Nutritionists that I realized that panicking because I ate three more nuts was a waste of time, energy, and soul-juice.
(no subject)
Date: 2012-01-05 10:22 am (UTC)Reporting of this stuff in the popular press sucks and you shouldn't believe those stories saying that "scientists have shown that men are better at parking because it would have enabled them to hunt antelopes on the savannah", not least because the scientists concerned probably didn't say that. Then again, there are people who will deny there are any brain differences because of their ideological commitments. There's a sort of feminism which has it as an article of faith that everything is a social construct, say: recently I ran into one blog where mentioning evolutionary psychology in the comments was banned by the comment policy, not that I wanted to, but still... there's little difference between those people and creationists.
Not sure what I think of the fat thing: the fact that it's hard to lose weight for some people must be orthogonal to the question of whether fat is intrinsically unhealthy, no? If it were true that fat was intrinsically unhealthy and it was hard for some people to maintain a healthy weight, that'd be unfortunate, but the world might be that way.
I guess I'm suspicious of activism where the belief is that "the medical establishment are wrong". Not because the medical establishment are always right, but because it's unlikely that any given set of activists knows more than the best doctors and other researchers. Is there a good way to distinguish the "health at any size" aspects of fat acceptance from anti-vaxxers, for example (assuming we're both agreed that the latter are wrong)?
(no subject)
Date: 2012-01-05 10:47 am (UTC)I'm a bit suspicious of "medical establishment is wrong" activism; but on the other hand I am really really in favour of activism aimed at telling people to stop bullying other people. Most of the "health at every size" stuff I have read is not-so-much about claiming that being fat is healthy; but much more about claiming that if you are fat there's not much you can do about that so lets move on and work with what you've got.
(no subject)
Date: 2012-01-05 01:25 pm (UTC)(no subject)
Date: 2012-01-08 08:02 pm (UTC)The problem is that you're up against the halo effect: people who look pretty are assumed to have other good qualities, and the reverse is true as well.
thermodynamics
Date: 2012-01-17 11:22 am (UTC)I definitely agree that some of the reasons why losing weight is hard (not impossible, just hard) are psychological as well as physiological. It doesn't help at all that lots of commercial diets and weight loss programmes are broken by design; a successful weight loss programme means no more income from the now-thin ex-customers! So lots of people try to lose weight in ways that are clearly unsustainable such as attempting really drastic changes in eating habits suddenly, or hating yourself forever if you eat one mouthful over your intended limit. I am not sure that addiction is quite the right metaphor, but I definitely agree that there are loads of social and psychological pressures against long-term weight loss, and I definitely agree that bullying is not the answer.
Good point about the halo effect; fat people are assumed to be lazy and undisciplined because fat people are perceived as ugly. It seems like the attitude that bullying is morally justified for the sake of health will probably amplify this problem by adding to the perception that fat people are disgusting.
gender
Date: 2012-01-05 12:17 pm (UTC)Partly because of the field I'm in, partly because of the circles I move in, I see a lot more of the problem that the popular press is awful about reporting studies of sex and gender differences, than the problem that there is a pressure against research into such differences because of fear of being accused of sexism. I agree entirely that refusing to entertain the idea that differences could exist is anti-scientific and medically harmful. I mean, comment policy, whatever, a lot of the people who talk about evolutionary psychology on the internet are ignorant jerks trying to make a case in favour of rape, and it's perfectly reasonable not to want to have to refute that "argument" every time you talk about anything. But that's a very different thing from scientific journals and funding bodies being resistant to research into gender differences.
Eliot is also very clear on the concept that just because something is physically measurable, that doesn't make it innate, "hard-wired" (I vote to ban that phrase from any discourse claiming to be scientific!), independent of culture or immutable. There is a big difference between research showing that there is a reproducible difference between brain structure, chemistry or activity between men and women, and the claim that that difference completely explains the gender pay gap or means that women are just biologically inferior and no amount of political feminism can change that. It seems like pushback against the latter is spilling over into creating an environment where data showing the former is somewhat suppressed, and that's a problem. I just don't know how big a problem it is, relatively speaking.
fat
Date: 2012-01-05 12:45 pm (UTC)To an extent, yes. But it's actually quite important whether weight is a modifiable or a non-modifiable risk factor. To take an extreme example, there's no controversy over the fact that men have shorter life-expectancies than women, but nobody goes around suggesting that all men should undergo hormonal and surgical sex reassignment in order to live longer!
If losing weight is near-impossible, or can only be achieved by means of interventions that are themselves more dangerous to health than simply being overweight, then it might possibly be better to accept that weight is essentially a non-modifiable risk factor, and concentrate on things you can (reasonably) do to improve your health: eating a balanced, nutritious diet, doing adequate physical exercise, not smoking, moderating your alcohol intake, reducing stress in your life etc. I agree that this possible (and to me, likely) scenario is somewhat unfortunate, but we don't go round wringing our hands about how unfortunate it is that height, genetic inheritance, sex and economic status are realistically unmodifiable risk factors when it comes to health.
The other thing is that there is just very little evidence out there suggesting that a fat person losing weight brings the same health benefits as being at a medium weight to start with. What little evidence I've seen suggests that in most cases, this is in fact not true. In Type II diabetes it is arguable; the evidence seems to be about balanced between: losing weight improves prognosis, versus: controlling blood sugar properly improves prognosis independently of whether better diet is accompanied by weight loss. In cardiovascular disease nobody's ever been able to show a beneficial effect of losing weight, even though people who were at a medium weight to start with have a relatively lower risk of what we call serious cardiovascular events (heart attacks and stroke, basically).
Part of the reason why there isn't much evidence that losing weight helps is precisely that very few people actually do it! So to start with you have a very small population of people who started out fat, went on intense reducing diets, got into the healthy weight range and stayed there long enough to do any long-term epidemiology on them. As the NYT article I linked in my post points out, these people tend to be fairly exceptional for lots of reasons, so it's not even clear that you can generalize from them to the rest of the population.
Meanwhile there is a serious body of evidence that fluctuating weight is a worse health risk than maintaining a high but stable weight long term. And most diets cause weight fluctuations; there is weak evidence that the 1 in 20 people who lose weight this way will be healthier, but there is strong evidence that the 19/20 people who end up with weight fluctuating (and in many cases, higher on average) as they go on and off diets will be less healthy. So statistically, it seems like one is better off not dieting in the first place! That's on top of the fact that dieting is not without cost, both to the individual and to the health services.
assessing HAES
Date: 2012-01-05 01:21 pm (UTC)That's really an excellent question, and I appreciate it. I think part of the issue here is that there is a confusion between scientific and moral questions. Scientifically, we can examine the evidence about whether weight loss brings health benefits (my view is largely no, other than in specific circumstances), whether being overweight is a risk to health (my view is largely yes, but it is probably an unmodifiable risk and it is confounded by other factors such as social discrimination against fat people), etc. But whatever your conclusion from the evidence about the relative risks and benefits of being a particular size, and the relative risks and benefits of losing weight by reducing calorie intake or any other means, there still remains a moral question: supposing fat people really are objectively less healthy than thin people on average, does that make it morally right to discriminate against fat people, to stereotype them as disgusting and lazy, to sabotage their attempts to improve their health? In my opinion, bad treatment of fat people based on their body shape is morally wrong, even if their shape is a result of their (historical or continuing) bad choices. It's also pragmatically ineffective; if a fat person is mocked and humiliated when they try to exercise, in most cases that's going to make them less healthy than if they were encouraged and supported.
The fat acceptance movement is almost entirely a morally motivated movement. Their view is that discrimination against fat people is wrong and they are activists against that. This moral position is pretty much independent of the scientific evidence around fat and health. However fat activists do sometimes rely on some scientific data; a bit like the LGBT activists who make a point of claiming that sexual orientation is pretty much innate, as a way to combat homophobia, fat activists may try to get a better deal for fat people by pointing to the evidence that body shape isn't really a choice either. You may or may not accept their synthesis of the evidence; I agree it's a fairly controversial question.
Also they are sometimes against the medical establishment because they see the medical establishment as treating fat people badly. Sometimes this is the case, like people who have life-threatening diseases being sent away to lose weight when actually they need emergency treatment, or that awful case of the paramedics who left a patient to die because they were so disgusted by his fat body. Again, though, that's a moral question, not a scientific one, and honestly I don't know the extent of the problem.
The HAES movement, by contrast, is a movement that is taking a position on the facts. (Many people believe in both fat acceptance and HAES, but they don't necessarily go together.) Some of them are nutcases who believe in conspiracy theories at least as ridiculous as anti-vaxxers. Some of them are taking the almost completely uncontroversial line that weight loss at any cost is not a healthy behaviour. It's not healthy to refuse to give up smoking because ex-smokers typically gain a couple of kilos in weight when they give up, for example! It's not healthy to abuse laxatives or amphetamines in order to lose weight. Anorexia and bulimia are not healthy, though they often do lead to weight loss.
Just about any scientist or medical professional would agree that some methods of weight loss do more harm than good; I guess the question is, where do you draw the line? Do diet pills like Alli do more harm from side effects than good from weight loss averaging about 3kg per year (in conjunction with a reducing diet)? Does weight loss surgery, which has a high failure rate and is one of the forms of surgery with the highest fatality rate, do more harm than good in terms of reducing the subject's weight (and often not by all that much)? Does repeated dieting, often including quite extreme calorie restriction, do more harm than good given that 95% of dieters are the same weight or heavier a year after starting a diet? Do high-protein diets like Atkins do more harm in terms of kidney damage than good in terms of weight loss?
The other claim that the HAES movement makes is that doing plenty of exercise and eating a balanced diet are good in themselves, even if they don't lead to weight loss. This claim seems to be pretty well supported by evidence, and doesn't seem terribly controversial to me. However there is a popular belief that anyone who does eat well and exercise plenty will eventually be thin, so maybe this claim is irrelevant because it refers to a case that never happens.
My main way of distinguishing scientifically sensible HAES people from conspiracy theorists who automatically repudiate the medical establishment, is that I trust the ones who compare the results of scientific studies to the conclusions and when they contradict, choose to believe the data rather than the interpretation. I think that's a pretty useful method for a lay person to evaluate scientific claims. It's not uncommon to see studies which show barely measurable effects of dieting, but then conclude that of course everybody should still diet to lose weight. And that's even before you get to how these studies are reported in the popular press, of course! That's not a hard-and-fast rule, but basically it rules out HAES claims based on "it's published in Nature, and Nature is part of a horrible evil conspiracy against fat people so we shouldn't trust anything they say", but accepts HAES claims based on "hm, this study published in Nature appears to have conclusions that over-state or even contradict what its data actually shows, so let's base our decisions on the data" Does that make sense?
(no subject)
Date: 2012-01-09 12:12 am (UTC)Of course (in the West) people will tend to be heavier than our ancestors were in the current cheap calorie/low-exercise-required environment. We evolved in an environment where you would do 8+ hours exercise a day to farm/earn low-calorie-density food, so it's not surprising that we need to do more than an hour's exercise a day to avoid getting fat. Very few people throughout history and in the contemporary world have had the privilege of being able to get away with doing just an hour's hard physical work a day.
I don't think there's a moral obligation to lose weight - it's just that at some point (which is probably on the chubby side of many societies' aesthetic ideals, and certainly over my current weight), weight tends to be correlated with ill health.
In other words, both of these propositions can be true:
1. It's hard for most people eating a Western diet and doing Western levels of exercise to avoid gaining weight.
2. At some point, if you gain too much weight it isn't good for you.
(no subject)
Date: 2012-01-17 11:49 am (UTC)My personal experience has been that I see healthcare professionals about something totally unrelated (asthma, contraception, what have you), and knowing nothing about me except the fact that I weigh 80 kg (and by eyeballing, I'm short-ish), they start on their "health promotion", which means telling me I should eat less and exercise more in order to lose weight. They don't stop to check if I have any history of metabolic problems or even eating disorders, they don't assess biochemical or physical markers of my risk profile, they don't even ask what I'm eating or how much exercise I'm doing already. So I infer that pretty much anybody who walks in through the door (and isn't already thin) would be advised to lose weight.
Similarly if you read any medical literature on related topics, it will be taken as a given that "obesity" is a big health burden which should be reduced. It's rare to see any breakdown of the difference between "being fat is correlated with health problems" (which I've never denied), and "dieting will make you lose weight and losing weight will make you healthier". The latter doesn't actually follow from the former at all, but it's very frequently assumed.
I'm not sure your picture of human evolutionary history is completely accurate, but yes, we certainly have access to more calories than most of our ancestors did. But you should note that our life-expectancy as affluent 21st century Westerners is longer than that of pretty much any human in any place or time. Yes, some people would have died from now-preventable or treatable infectious diseases, but a great many people in your imagined healthy, natural olden days would have died of starvation or hypothermia (which is often related to inadequate calorie intake).
I agree with your numbered propositions, and I agree that they don't contradict each other. But what doesn't follow from 2 is that losing weight will completely reverse the negative health effects of gaining too much weight. Also, because as in prop 1, avoiding weight gain is "hard" (and I contend that weight loss is even harder than avoiding gain), it is not at all clear that the health benefits of losing weight are worth the hardship and expense and possible health risks. As you imply by saying it's not a moral obligation, it's at least partly up to an individual to decide where the balance is. Obviously it helps if people are well informed of the scientific data recorded about the actual magnitude of the various risks and costs involved.
(no subject)
Date: 2012-01-17 01:29 pm (UTC)I'm glad we agree about my two propositions.
It's rare to see any breakdown of the difference between "being fat is correlated with health problems" (which I've never denied), and "dieting will make you lose weight and losing weight will make you healthier". The latter doesn't actually follow from the former at all, but it's very frequently assumed.
If you accept that being fat is correlated with health problems, then surely you accept that as a matter of public health, it would be a good idea to try to stop the population getting fat.
You've bundled together two propositions which "don't follow" from "being fat is correlated with health problems". "Dieting will make you lose weight" doesn't follow, it's true, because it seems that faddy dieting isn't effective for most people, because they are compelled by their evolved love of fat and sugar to break the diet, or just compensate by increasing their calorific intake after the diet is over. But if we can find sustainable ways to increase exercise levels and reduce incoming calories closer to the environments we evolved in, that will reduce most people's weight. Presumably you accept that if I was suddenly compelled to be a farm labourer or live under WW2 British rationing, I would lose weight.
You then deny that "losing weight will make you healthier", or, as you later put it, "losing weight [won't] completely reverse the negative health effects of gaining too much weight". That's another straw man - it doesn't have to completely reverse the effects, all that is necessary for it to be a good idea for doctors to encourage us to lose weight is that the benefits of losing weight outweigh the risks.
If someone was obese in their 20s, but then a "medically recommended" weight from their 30s on, I'd imagine their subsequent medical risks would be much closer to someone who'd been a recommended weight all their life than someone who stayed obese all their life. I mean, presumably you're not claiming that if someone's overweight at any point in their life, losing weight isn't going to affect their medical risk at all? Is there any research showing that?
(no subject)
Date: 2012-01-19 10:35 am (UTC)For example:
Not necessarily; correlation is not causation. There are certainly some circumstances where ill health causes weight gain, though it's hard to know how frequent that situation is. It also seems very likely that there are common underlying causes which lead to both weight gain and ill health; that doesn't mean that the weight itself is responsible for the negative health effects.
I also personally have a much stronger position on losing weight than avoiding weight gain. To start with it's critical to understand that they are not the same thing. My understanding is that preventing weight gain is both desirable and possible at least to some extent; reversing weight gain once it's happened is very difficult and the benefits are really quite unclear.
No, I don't accept that. I know nothing about you; I infer from how you've argued that your lifestyle is relatively sedentary at the moment. But I don't know anything about your body or its tendency to change fat storage patterns in response to changing activity levels and / or calorie intake. In general population trends are next to useless for predicting individual outcomes. Probably if everybody suddenly became a farm labourer with a restricted diet, the average BMI for the population would be lower (as indeed we see by comparing population statistics for the 1940s with today). But if you did, I can't predict what would happen to your weight. And that's exactly my point; these kinds of individual predictions aren't valid, and spurious arguments are being made based on these flawed premises. By the way, though you didn't state this explicitly, I also can't predict whether you would be healthier in this alternative reality which you regard as .
Not obviously false either. As I mentioned to
For people in general? For "healthy" people (ie those who don't already have underlying risk factors)? It's really far too complicated to give a definitive statement.
Is there research showing no effects of weight loss on general health risk? Yes, some, but it's always hard to prove a negative. A lot of the time what the research shows is that the correlation between weight and health disappears if you remove confounding factors such as socio-economic status, activity levels etc. There is also research showing beneficial effects of weight loss. However, a large proportion of what's out there conflates weight loss with being at a medium weight to start with, or simply assumes that weight loss improves health and doesn't test that hypothesis.
(no subject)
Date: 2012-01-19 11:07 am (UTC)As far as I can see, the problem is not that faddy dieting isn't effective, it's that no dieting is effective. I mean, in order to get the 5% long-term success rate, you have to restrict your analysis to the kind of diets that are sensible enough to get discussed in the medical literature. I'm not talking eating acai berries, wearing magnetic bracelets and practising divination on your poop, here. On top of which, most studies which demonstrate that 1 in 20 people can lose weight and keep it off long term exclude all the subjects who drop out of the diet programme. In my mind, a health regime has to be feasible and sustainable to be counted as effective.
Parker-Pope is also arguing that weight regain isn't caused by compensatory increases after the diet. It's caused by metabolic differences in formerly-fat people compared to always thin people. Parker-Pope assumes that these differences are caused by dieting; I don't think that's necessarily a valid inference, they may equally well be caused by the same underlying issue that caused the weight gain in the first place.
Of course, the evidence presented in the article could be wrong or misinterpreted. But you're arguing against it purely by stating the opposite forcefully.
Similarly, you claim
For one thing I'm not sure that there are any sustainable ways of doing this (at least not without fixing loads of complicated social problems which go way beyond just putting fat people on sensible, non-faddy diets). I also don't know for sure that this hypothetical intervention would lead to weight loss in people who are already fat, though I think it's highly likely that it would reduce the numbers of people who become fat in the first place.
I disagree that . In fact, for this to be good medical advice, it is also necessary that the improved quality of life justifies the costs. For 19 out of 20 people, there is at very best no benefit, so why should they devote lots of time and effort to a futile attempt which will just make them feel bad about themselves when they fail? For the 1 in 20 people who are able to lose weight, the costs are very significant, and the benefits are, well, surprisingly elusive.
I would think it's a much better idea for doctors to encourage us to do plenty of exercise and eat healthy, balanced diets, and not care about the effects on weight. Improving your habits is hard but possible, especially if you measure success by how much your habits have improved rather than by some outcome that is only partly related. And the health benefits are much better evidenced than those of weight loss. That's why I believe in HAES, basically.
On thinness/fatness
Date: 2012-01-09 04:34 pm (UTC)Also, and I can only speak for diabetes and cardiovascular disease risk here but the situation is probably similar for many other things, there is definitely a genetic component to these sorts of risk factors but even if you're in the highest genetic risk category, if you eat well and exercise well then you can reduce your risk down to a fraction of what it would be if you didn't. I'll see if I can find a graph, this is easier to explain with a good diagram ;-)
Re: On thinness/fatness
Date: 2012-01-17 11:56 am (UTC)And yes, of course you can mitigate (or worsen) genetic risk through lifestyle. Some people do seem to be very resistant to the idea that there's a genetic component to long-term health, because they're afraid that it might give people an "excuse" to live unhealthily. I think this is kind of irrelevant, but it seems to be a fear that people have. Graphs would be lovely, I'm a very verbal person but this kind of thing is almost certainly better represented visually.