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TW for discussion of dieting and, in the comments, eating disorders.
Let us grant for a moment that being fat is unhealthy. (I’m not really sure whether it is, as I haven’t looked into the subject, so I’m stuck with the heuristic of “well, a lot of people with impressive-looking degrees say one thing, and a lot of people with blogs say the other.”)
The thing is that sustained weight loss is really hard. Of the people who have lost more than thirty pounds and sustained it for more than a year, 90% exercise at least one hour a day and 78% weigh themselves at least once a week. I think that overweight and obese people could very reasonably look at these results and say “actually I would rather not exercise that much, thank you, I’ll take the health risks.”
At the same time, focusing on weight loss means that some people will choose demonstrably unhealthy methods of losing weight, such as juice fasts, fad diets, eating so few calories that they’re literally starving themselves, smoking, etc. On a less disastrous level, a weight loss emphasis also results in really terrible advice about diet in women’s magazines (“eat candy canes, not cheese, candy canes contain fewer calories!”– this is not a straw man, this is an actual article I read).
On the other hand, a lot of advice typically given as weight-loss advice is still good for you even if you’re not looking to lose weight. It is not like eating lots of vegetables, cutting down on your sugar consumption, and exercising regularly are suddenly bad ideas if you happen to do them and still be obese afterward. For that matter, it’s not like eating nothing but cupcakes and refusing to exercise are mysteriously good for you if you happen to be thin.
So I am puzzled about why we continue to emphasize weight loss as opposed to “eat more plants and less sugar and do some form of exercise on the regular.” Why do we say “do X to lose weight!” as opposed to “to live longer” or “to be stronger” or “to be healthier” or “to be happier”? Other than diet industry profits, of course, because people trying and failing to lose weight buy lots of diet books and unused gym memberships. Which is just sad.
Thing of Things 
I would guess that mass is a quantity that can be measured easily, and thus serves as a rough heuristic for attractiveness and health.
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Weight Loss is emphasized because thin people are attractive, and attractiveness is the main or at least an important side-reason for most of what most humans do.
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Did you really just like your own post?
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Sometimes that happens by accident clicking stuff. I’ve done it before.
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Yeah, I click that stupid button all the time; but I don’t have a WordPress account, so it doesn’t do anything interesting in my case.
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I think the cliche doctor advice is to exercise more, eat healthily, etc. They probably mention the health risks of poor diet and exercise,
And then because eating better and exercising are associated with losing weight, which is a cultural beauty norm, all the advice on reaching the cultural beauty norm is dressed up in a veneer of “it’s good for your health!” so as to provide a degree of authenticity and legitimacy.
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One of the stranger quirks of modernity is the idea that aspiring to be attractive is illegitimate. If attractiveness makes people happy (it does), then why is it a less worthy or meaningful goal than any other?
The idea seems to be that because beauty standards are culturally determined, they can be eliminated by conscious effort; and because being unattractive makes people unhappy, we should all undertake this effort. But there are some pretty obvious problems with both the premise and the conclusion. “Culturally determined” does not mean “arbitrarily malleable” (as Marx put it, we make our own history, but we do not make it just as we please), most adults probably can’t voluntarily modify our own preferences to any significant degree, and the coordination problems in such an enormous social-engineering project are surely insurmountable even if everyone agreed it was worthwhile, which we don’t.
The alternative of just giving people advice on how best to meet their local standards of beauty is simpler, more popular, and even more ethical, from a pragmatic perspective.
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I put a great deal of thought and effort into my appearance and it’s always bothered me when people either diminish the importance of appearance (for whatever reason, say to not appear “superficial”, as though that were bad) or when I ask for input, say some unhelpful platitude about being fine the way I am.
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“The thing is that sustained weight loss is really hard. Of the people who have lost more than thirty pounds and sustained it for more than a year, 90% exercise at least one hour a day and 78% weigh themselves at least once a week” – that can mean several things:
1. Hard exercise is crucial for weight loss, and increase one’s chances to lose weight so significantly that almost everyone who did it successfully, did it by exercise.
2. Hard exercise is not crucial for weight loss, but is nonetheless done by most people who did it. That can be due to the fact that it’s the standard advice, that most people would follow, or due to them being already motivated to make big lifestyle changes.
3. Hard exercise is neither crucial for weight loss, nor done by most people, but those who do it are overrepresented in the survey. For example, those who are enthusiastic about healthy lifestyle may be more motivated to register there, and take other steps to participate in the community. Or, since exercise is considered a virtue, they may be more motivated to report it.
A weak data point for (2) or (3) is myself: I lost about 40 lbs, and continuing to do so – sometimes more successfully, sometimes less – without actually going to the gym, and lately even rarely riding a bike. If we assume that the distribution of exercising among people who are losing weight is at least somewhat smooth, and are given the information that 90% exercise at least an hour a day, then we would expect something like 99.9% of them exercising at least an hour a week. If this hypothesis is true, then I’m extremely special – the idea which I generally penalize for unlikelihood.
Also, as far as I understand, the role of exercise in weight loss in particular, as opposed to general health benefits, is just to artificially increase the energy consumption, and train the organism to sustain this high consumption level over time. Thus, I expect it to be possible to achieve the same result by lowering the energy consumption by the same amount.
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I probably should stay the hell out of this. Trigger warning for vaguely pro-anaish sentiments, I guess.
From a practical perspective I think this solution makes sense (it seems likely to actually make people healthier, which is good). But. The increased mortality risk from obesity is significantly greater than the increased mortality risk from being dangerously underweight. I’ve been trying to find something that lets you compare directly (i.e., which BMI has the same health risks as a BMI of 16? Probably around 35, but no one publishes this directly). But the general comparison is made quite explicitly here: http://www.medicine.ox.ac.uk/bandolier/booth/hliving/bmiwords.html
There are weights at which you really can’t be healthy. Even if you are eating healthy foods and exercising, you are unhealthy because you are at a weight that your body can’t handle, that puts excessive strain on all your body systems, that is going to kill you young. That’s true on both ends of the spectrum. But when you’re too thin the response is intensive, sometimes involuntary treatment to get you to a healthy weight. If you say ‘yeah the cost-benefit just doesn’t come out in favor of weight gain’ this is treated as a symptom of your mental illness. And I think this is probably correct? Most people who arrive at that conclusion are undervaluing their lives and underestimating the risk of death. Gaining weight is torturously hard. But the alternative is a mounting pile of catastrophic health risks that stand a substantial chance of killing you. So the system makes you do the hard thing.
But if the body positivity people are right, if people are valuing their own lives correctly and the system is overvaluing health because of ableism and it’s okay to just listen to your body even when where that guides you is to a weight that dramatically increases your mortality risk…
…then it has to apply both ways, right? It has to apply to us too. I mean, what’s the difference?
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I think this is a good point. It’s also worth mentioning that some medical interventions (especially surgery, especially if anesthesia is involved, which it usually is) become much more dangerous for seriously obese people. In that respect, there are risks which can be directly associated with obesity itself, in addition to the risks of of an unhealthy diet (which, as Ozy points out, not all obese people have).
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I’d also like to add that I wish people had more appreciation for this fact: “Gaining weight is torturously hard.” Not for everyone, of course; for some people it’s all too easy. But for me… well, I’m not anorexic or anything. I can’t imagine what that would be like – much worse, I’m sure. I’m on the low end of a “healthy” BMI, but by the standards of male attractiveness, I am still “too thin.” I’ve been trying for years to gain more muscle mass, but I also have a gastrointestinal condition which makes it very hard to work out as often as I need to, and to get all of the protein and calories necessary to build muscle even when I am working out.
I don’t really have a point here. I just wanted to thank you for stating a fact that I feel is not recognized often enough.
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Possible justification for heightened scrutiny of underweight versus overweight people (in the case of eating disorders): the underweight are at a greater risk of dying in a limited time if their ED gets worse. The overall mortality might be the same (depending of your cutoff values for under/overweight here), but the risk due to the ED and its stability is probably not the same.
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“The increased mortality risk from obesity is significantly greater than the increased mortality risk from being dangerously underweight.”
I don’t think the study you cite matches what more recent studies have found. See this 1995 CDC study, for example, which found that underweight individuals were at slightly higher risk of dying than obese people (except the most obese category), and a much higher risk than “normal” or overweight people.
If you limit the results to non-smokers, however, underweight individuals were at a much higher risk of death of dying than all other categories except the most obese, with whom they had an equal risk.
(Look at table 2 in the linked study for data supporting all the above claims).
Other studies have replicated what this CDC study found. I’d say it’s a more reliable study than the one you linked for two reasons. First of all, it doesn’t rely on self-reported weights, instead using three large datasets of peoples whose weights were measured by researchers. Second of all, the study you linked used data from 1983, but medical care (and thus life expectancies) for the obese have improved significantly since the 1980s. (Or so I’ve read.)
” But when you’re too thin the response is intensive, sometimes involuntary treatment to get you to a healthy weight.”
This sounds as if you’re saying this isn’t a response commonly given to those of us who are fat. If that’s your claim, you are mistaken. (Although involuntary treatment is generally only an issue with underage people, among fat people.)
Finally, I’d say whether or not intense efforts to gain weight are worthwhile is an empirical question. If a very thin person can eat healthy, exercise, and still not gain any weight; and if gaining weight is difficult to maintain; then it seems unlikely to me that extraordinary efforts to gain weight could be justified.
Oh, and Ozy: The study I linked shows that, for both smokers and nonsmokers, being “overweight” is associated with living a bit longer than being “normal” weight, and being “obese” has only a small effect except among the most obese. And the study was written by “a lot of people with impressive-looking degrees,” none of whom has a blog (that I know of). 🙂
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From your link:
“Of the 111 909 estimated excess deaths associated with obesity (BMI ≥30), the majority, 84 145 excess deaths, occurred in individuals younger than 70 years. In contrast, of the 33 746 estimated excess deaths associated with underweight, the majority, 26 666 excess deaths, occurred in individuals aged 70 years and older.”
An important confounder in the comparison of BMI and mortality is the fact that, in old people, low BMI is associated with illnesses. See here , at “Limitations of BMI in Older Adults”, for example.
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Thirqual, point well taken. Thank you for pointing that out.
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@thirgual: I am not sure if you wrote your comment in order to dispute Ampersand’s statement. In any case, if this was the intention than your point invalid. You have to consider base rates of both, obesity and underweight. The raw numbers don’t tell you anything in terms of risk.wer underweight people…
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> Second of all, the study you linked used data from 1983, but medical care (and thus life expectancies) for the obese have improved significantly since the 1980s. (Or so I’ve read.)
This badly mischaracterizes study cited by theunitofcaring. No mortality study in based on a single-year snapshot–that doesn’t even make sense.
theunitofcaring’s study is based on 14 years of follow-up starting from 1982, so it is based on the environment from 1982-1996.
Your study is based on “National Health and Nutrition Examination Survey (NHANES) I (1971-1975) and NHANES II (1976-1980), with follow-up through 1992, and from NHANES III (1988-1994), with follow-up through 2000”, so the most recent cohort was based on the environment from 1988-2000. This is not a dramatic difference versus 1982-1996.
> Oh, and Ozy: The study I linked shows that, for both smokers and nonsmokers, being “overweight” is associated with living a bit longer than being “normal” weight, and being “obese” has only a small effect except among the most obese.
Yes, but people’s intuitions about how obese they are have become skewed. “The most obese” in your study is BMI >= 35. At 5’5″, an average height for a woman, that is 210.3 pounds, not something that most people nowadays would think of as that large. I suspect that a typical 5’5″, 220-pound woman would not think that she is “among the most obese” and that you are talking about her, but you are.
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A few thoughts:
Because people want to lose weight. Our society equates thinness with all kinds of desireable traits such as attractiveness, competence, self-respect, etc. Living longer, being stronger, and being healthier are comparatively less important to people, and most people who think of themselves as overweight think that they would be happiest by losing weight.
So, if you’re cutting calories enough to lose weight, you are literally starving yourself. That’s why you’re losing weight. Your body is getting fewer calories than it needs. And if your body is burning fat for energy (which is one of its last choices), unless you’re doing a ketosis-style diet plan, then your body is getting massively fewer calories than it needs. Most diets are starvation. It’s just slow.
Also, I’m about 75% certain that fatness and poor health are not causally related except that it puts more stress on things like knees and such. Fatness is positively correlated with lots of nasty things, but my understanding is that anyone who has studied the issue has shown that fatness and poor health are both often caused by lack of exercise and poor diet, but fat people who eat well and exercise tend to remain fat, but be in good health.
Also, the failure rate of diets (often estimated at 95%, but those numbers are suspect) suggests that even if being fat is unhealthy, encouraging people to lose weight is just going to create shame and stigma, not thin people.
Some background:
http://www.jabfm.org/content/25/1/9.abstract?etoc
http://archinte.jamanetwork.com/article.aspx?articleid=770362
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Seems like this is being a bit too strong. Yes, you are LITERALLY starving yourself, but the difference between a small deficit and Auschwitz is obvious.
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This is kind of tangential to the question you asked at the end of your post, but one thing I want to point out about the statistics you linked:
“94% increased their physical activity, with the most frequently reported form of activity being walking.”
So, while 90% of registered participants exercise at least one hour a day, the majority of that exercise may be walking. Walking for an hour a day is not hard unless you have a disability that prevents you from doing so. (In fairness, if you’re already morbidly obese, then walking would for an hour would indeed be very difficult.) It is time-consuming, yes, which puts people with busy schedules at a disadvantage. This might especially apply to poor people who have to work longer hours to make ends meet, and additionally can’t afford healthy food. But on the other hand, low-paying jobs often involve lots of standing and/or walking, so some of those people could get most of their exercise on the job.
To summarize, I don’t think the requirement to exercise for an hour a day (assuming, for the sake of argument, that it really is a requirement) is as big a hurdle as you make it out to be. I think it’s probably a bigger issue that fatty, sugary, high-calorie foods are often more affordable than healthier alternatives because of the backwards way food subsidies are allocated in the US.
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Sleep varies but the average person sleeps at least 7 hours. 1 hour a day is then 1/17th of a person’s life. This is an extremely large price to pay for anything.
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That would depend on how much life expectancy is decreased by not exercising. After all, 1/17th of 80 years is a little less than 5 years. Then you may have to factor in morbidity.
Whether having 1/17th more each day versus a few years more is more valuable is not self-evident to me, so I’m not sure this objection is very solid.
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In addition to thirgual’s response, I’d add that it’s not as though you can’t do anything else while exercising. I don’t exactly enjoy exercising, but I can listen to music or podcasts or audiobooks while doing it, so it’s not a total chore. If you’re just walking, you could probably even read a book while doing so!
That said, I agree with your point that there’s a trade-off here; you can never know how many extra years of good health you’re buying yourself by staying fit, so for some people it might really not be worth it. I have nothing against people who consider the statistics and make that determination. But claiming that you can exercise OR do something else with that 1/17th of your life is sort of a false dichotomy.
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@StarGirlPrincess: I haven’t followed through to the sources, but LessWrong hosted an article last year that claims that moderate levels of exercise produce a net gain lifespan. (And that’s before taking into account quality of life).
http://lesswrong.com/lw/jrt/lifestyle_interventions_to_increase_longevity/
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‘So I am puzzled about why we continue to emphasize weight loss as opposed to “eat more plants and less sugar and do some form of exercise on the regular.” Why do we say “do X to lose weight!” as opposed to “to live longer” or “to be stronger” or “to be healthier” or “to be happier”?’
My guess would be that it’s because BMI is easy to measure. Instead of having a long checklist of lifestyle habits that you need to evaluate on a case-by-case basis, you can just say “a healthy weight is between x and y pounds. My weight is between those two numbers, therefore I am healthy.” Sort of like how instead of focusing on a bunch of nebulously defined actions and character traits, we can just say “I donate 10% of my income to buying malaria nets and don’t commit felonies, therefore I am a Good Person.”
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Yeah, but both of those heuristics are highly incomplete when looking at particular people rather than populations in aggregate. If I were studying the overall health of a population or the overall morality of a population, I would probably be fine with a heuristic like that. But as an individual person who tries to be healthy and also tries to live a moral life, I also have to look at things like how much I sleep and my cholesterol level and whether I’m routinely mean to people or manipulate or take advantage of them, etc. And I expect my doctor to look at more than just my weight, too.
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I never said it was comprehensive or well thought out just that it’s simple enough for people to grab onto.
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Since usually simplest explanations are where to start to look for answers, maybe the answer to
“why we continue to emphasize weight loss as opposed to [X]”
is that most people don’t care as much about health as about perceived attractiveness, and so those overweight care more about weight loss than health.
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But the entire reason why this issue is controversial is that many fat people do not care more about attractiveness than health.
So, when people jeer at them on the streets (especially common while exercising!), and then a doctor advises them to lose weight without investigating other possible causes of their symptoms, it feels like society is saying, “we don’t care about you as a person, but we will apply an arbitrary amount of pressure to force you to change your disgusting body”.
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“So I am puzzled about why we continue to emphasize weight loss as opposed to “eat more plants and less sugar and do some form of exercise on the regular.” Why do we say “do X to lose weight!” as opposed to “to live longer” or “to be stronger” or “to be healthier” or “to be happier”? Other than diet industry profits, of course, because people trying and failing to lose weight buy lots of diet books and unused gym memberships. Which is just sad.”
Because most people want to get laid. Being physically fit (in most cases, thinner) makes a person more attractive to a greater number of people. When you put “be sexy and get laid” up against “live longer (but get laid less)”, or “be healthier (but get laid less) etc, the first will always win out.
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Okay, then, but someone *really* needs to tell all the people who justify their fat-shaming with “but your fat is unhealthy!” If it’s just a matter of aesthetics, then there are literally zero arguments in favor of such behavior (except the slightly dubious one that everyone has a moral obligation to be hot to fat-shamers).
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While I agree that fat shaming (actual fat shaming, like calling people names or otherwise going out of your way to make them feel bad) is bad, it doesn’t mean the concept of “fat is unhealthy” is invalid. I just think wanting to be more attractive is a more powerful motivator than wanting to be more healthy or living longer.
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But if everyone agreed that while fat may be unhealthy in the general case, although this is confusing (see Amp’s comments earlier in the thread), dieting is very hard and sensible humans may decide it is not a reasonable tradeoff to make, and regular exercise and a diet containing lots of vegetables and very little processed food is good for you whether you are fat or not, then they would maybe stop criticizing their fat friends and start criticizing their friends who eat candy for dinner and don’t exercise.
Like… I’m underweight (which is uncontroversially bad for health), I was sedentary for years, and my diet *still* sometimes involves candy for dinner. I have basically *never* been criticized for any of those things, because I am thin. And yet my fatter friends get criticized constantly about how unhealthy they are– even when by any sensible measure they are more athletic than me! Either this is a result of health, in which case I should be criticized, or it’s a result of appearance, in which case they should shut up because other people’s appearances are really none of their business.
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I have no idea, so my opinions are worth nearly nothing, but here are some possibilities:
1) That without some level of fat shaming, more people would be fat. We know that in a fat shaming environment, the people who are fat anyway (which includes me) are not very good at losing the weight, but we don’t know how many people are successfully thinner now than they would be in a fat-accepting environment.
2) Fat shamers are a-holes and like to bully outgroups.
3) Lots of aesthetic fashions are basically unfair. I’d much rather be taller and at the same BF% than my current height but lower BF. Unlike white teeth or desirable hair, I can’t even buy height. I at least have a chance of being thinner with enough effort. Which isn’t to say that fat shaming is morally acceptable, just that it seems to be part of a larger human tendency towards sin.
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I would expect that whether people talk to you about is controlled by at least two factors. One is how bad your condition is, but the other is how much public awareness has been raised about it. And whether public awareness has been raised depends partly on how common the condition is.
So more people are obese than are underweight, which raises public consciousness about obesity, which means that more people criticize obesity.
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My posts seem to be getting eaten.
What I tried to post was pointing out that whether people comment on your condition depends not only on the severity of your condition, but also on the level of public awareness of the condition. Since obesity is more common than being underweight, that leads to increased public awareness, and the increased public awareness also leads to increased awareness of any individual instance of obesity.
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It didn’t get eaten this time and I can’t figure out what I’m doing that causes WordPress to randomly eat my posts.
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*Grumble*. It apparently did get posted the first time but somehow didn’t update. Now it’s updated both of them after I posted the second time. This is odd.
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> Like… I’m underweight (which is uncontroversially bad for health), I was sedentary for years, and my diet *still* sometimes involves candy for dinner. I have basically *never* been criticized for any of those things, because I am thin.
Being criticized for being underweight is strongly affected by gender. I lost a lot of weight a couple of years ago. While I wasn’t even close to underweight (i.e., BMI was 21ish), and had not been losing weight too quickly, I had at least 4 people ask me to assure them that I wasn’t planning on losing more weight as I approximately reached the point that I was done (which I’d decided long in advance, so it wasn’t causally affected by their concern: they weren’t actually being helpful). This is because I’m male and being a trim runner is a less gender-conforming way to lose weight than something that builds more muscle. I’m not very social, so 4 people is a lot (i.e., I think it would have been much more if I were more social).
I don’t have any non-binary friends, but I suspect that if you have polite friends, they probably avoid criticizing you unless they would apply the criticism to both men and women (as opposed to criticizing you if they would apply the criticism to either men or women), so I suspect that you will receive the treatment that women do: no criticism for being underweight unless it is really frightening looking. But this is NOT what men experience–I wasn’t even underweight!
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I would guess the reason people don’t say anything to you is that you can still attract the partners you want.
I agree with you, though, Ozy. It’s pretty clear “fat is unhealthy” is just a justification many horrible people use to bully people they can get away with bullying (regardless of the correlation between adipose tissue and health).
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> So I am puzzled about why we continue to emphasize weight loss as opposed to “eat more plants and less sugar and do some form of exercise on the regular.”
I believe that emphasizing “exercise and lose weight mostly by eating less” is substantially superior general health advice than yours for several reasons.
1. Your advice supports by implication the increasingly common belief that being fat is not unhealthy per se (which is false by stipulation). In fact, I would go a bit beyond your stipulation and claim that that not being fat is much more important for health than exact diet composition is, for a large majority of people (but I don’t believe that is true about being fat versus not exercising).
2. Weight is an objective metric that avoids self delusion. Out of the population of people who make a real effort to eat healthy and think that that matters more than their weight, how many think that they’re failing? How many tell their doctor that they don’t eat healthy? How do you think this compares to the true numbers?
3. Using weight as a metric avoids confusion about eating healthy. Many people have quasi-mystical beliefs about healthy eating. They have a nearly binary view of good and bad foods, and don’t really worry about healthy portions. I think it’s helpful for obese people who eat only home-cooked organic food (or whatever) to realize that they eat an unhealthy amount (for their activity level).
4. Being fat has predictive value. I think many fat activists wish that doctors would just monitor their blood work and tell them to eat more vegetables if there’s a problem. However, loads of obese people have perfectly fine blood pressure and glucose and cholesterol, etc., when they’re 25, but then when they’re 40 it’s much much worse than it could have been. People in general are not good at long term decision making, but in most other such situations the left-wing policy position is to help them with that (such as promoting social security over leaving people purely to their own private retirement planning).
This is also why it’s good to encourage people to at least take control of their weight even when it’s just something “cosmetic” like 25 pounds. If you just wait until you’re 100 pounds overweight or something, OF COURSE losing weight will be hard, much more than it could have been.
> Why do we say “do X to lose weight!” as opposed to “to live longer” or “to be stronger” or “to be healthier” or “to be happier”?
If, for example, “eat more vegetables to lose weight to be healthier” is too long, “eat more vegetables to lose weight” is better than “eat more vegetables to be healthier” because the other alternatives obscure the fact, which people are increasingly reluctant to believe, that almost the entire point of eating vegetables is a good calorie/nutrient ratio that makes it easier to attain or maintain a healthy weight while still getting proper nutrition. You don’t have a numeric health counter that’s incremented by vegetables and decremented by candy. If you’re getting fat on vegetables and exercise, you really need to reexamine your diet, and if you’re staying thin on candy and exercise, that’s not as terrible as you personally seem to think unless it’s such a large part of your diet that you’re getting anemia or scurvy or whatever.
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> At the same time, focusing on weight loss means that some people will choose demonstrably unhealthy methods of losing weight, such as juice fasts, fad diets, eating so few calories that they’re literally starving themselves, smoking, etc.
Tack “(but at most two pounds per week)” onto the health advice to avoid most of this. I think that very, very few people smoke to lose weight because they want to be healthy rather than because they want to be attractive. And some unhealthy fad diets are not “unhealthy methods of losing weight” because they’re not “methods of losing weight”.
I also think that people are typically very confused about “eating so few calories that they’re literally starving themselves”. People literally complain online that they can’t lose weight while eating 500 calories per day. This is basically impossible: it just shows that they’re counting calories extremely inaccurately. (People who would dispute this: do you really think that evolution wouldn’t notice an ability cut resource requirements by 66-75%?) Obviously, literally starving themselves is a thing that people sometimes do, but if someone thinks that they can’t lose weight without literally starving themselves, they almost certainly shouldn’t worry about it unless they’re losing much more than two pounds per week.
> On a less disastrous level, a weight loss emphasis also results in really terrible advice about diet in women’s magazines
I would again attribute this to wanting to lose weight to be attractive rather than to be healthy.
Of course all the commenters saying that “we” (as a society) emphasize weight loss in very large part because we want people to be attractive are correct as a causal matter, but that doesn’t mean that emphasizing weight loss as a health matter is bad. In the US in particular, I get the impression that people are increasingly losing sight of how overweight they are because many other people are also severely overweight.
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> I think that overweight and obese people could very reasonably look at these results and say “actually I would rather not exercise that much, thank you, I’ll take the health risks.”
Similar to other commenters, anecdotally I lost more than twice that much weight while exercising less than half that much. Weight loss is 80% diet, and in particular portion control. (If you have trouble losing weight, buy a food scale.)
All that said, I don’t really care enough to second guess people’s informed decisions in general, including decisions not to bother trying to lose weight, but I personally feel like that’s me kind of being a sociopath (in the staggeringly inaccurate way people use that word).
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P.S. Of course, we’ve all been using “weight” to mean “body fat”. I don’t think that in reality there’s a problem with genuinely very muscular people feeling social pressure to lose muscle. They may sometimes experience insurance problems with BMI or something, but that seems tangentially to your post.
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I’d question this premise. If you do these things and still don’t lose weight, it’s presumably because you’ve added something else to replace the sugar. Depending on what you’ve added, and on the bias of the particular nutritionist making the judgment about it, this could easily be a net loss. Some would say that animal fat is at as bad as sugar, possibly worse depending on the details. Some would say that other carbs are as bad as sugar, and depending on the pattern of consumption, could be worse.
In my own experience, I did at one point cut down on sugar and increase my exercise and consumption of vegetables. And I did lose weight, which wasn’t the goal, but my blood sugar and lipids (where were the goal) got worse (until I started replacing nuts with fruits and whole grains and shifting the time pattern of my carb consumption).
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Maybe one reason we focus on weight as a proxy for health is just a Searching Under The Streetlight effect. We can gauge someone’s BMI somewhat accurately on sight, but in most situations it is a faux pas to biopsy someone’s liver.
(Of course this is only one of the reasons, and probably not the most important.)
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A lot of studies show that, for seriously overweight people, simply losing weight, no matter how it is lost (eating only twinkies, for example), improves a lot of the indicators like cholesterol, blood pressure, insulin sensitivity, etc.
Now once you’re at a normal weight or close to it, you may be at the point where it is important to emphasize that fruits and vegetables are better for you than candy canes and bacon grease, but if you are obese, and literally the only way for you to lose weight is to eat candy canes and bacon grease, I think many, if not most doctors would say, “okay, eat candy canes and bacon grease.”
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Do those studies distinguish between the effects of losing weight versus the effects of changes in diet or exercise? And do they actually follow patients for a long enough time (4 years or longer) to be able to tell if any improvements are sustainable?
If so, could you please provide citations to some of these studies?
I’m not sure what “many, if not most doctors” say is very meaningful, unless what they say is also supported by solid empirical evidence. Doctors are not magically free of prejudice and error.
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I’m far closer to onyomi’s side than your side in this debate, but I’m suspect what he’s thinking of are anecdotes, not studies. Here is an example:
http://www.huffingtonpost.com/2014/01/08/mcdonalds-diet_n_4557698.html
In that anecdote, exercise was not held constant. I think I’ve seen one where it was, but I don’t care enough to find it because I’d have to agree that it’s of low evidential value anyway.
I don’t think that this is the sort of thing that anyone is going to run a study on, because no one is seriously claiming that losing weight on McDonald’s is easier than losing weight on vegetables (it will be less filling on an isocaloric basis, etc.). Rather, it’s something that people do to prove a point. (But since it’s just a few random individuals doing uncontrolled things, it is not strong evidence of the point.)
In my view, the point of emphasizing weight loss is not that it’s important to recognize losing weight on a junk food diet as healthy, but rather that it’s important to recognize failing to lose weight on a “healthy” diet as unhealthy, and a sign that one should monitor the _amount_ that one is eating more closely.
The unhealthiness of failing to lose weight is a stipulation here: Ozy is arguing that we shouldn’t emphasize weight loss even if being fat is unhealthy per se. Nonetheless, I will provide a recent study on this topic:
http://annals.org/article.aspx?articleid=1784291
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I agree with Ozy; even if we stipulate that, emphasizing weight loss still isn’t the right thing to do.
But I wouldn’t stipulate that.
The study you link really doesn’t support your case well.
Most importantly, it didn’t include exercise as a variable; therefore it can’t say anything about how well or poorly fat people who exercise regularly do. (I think exercise is probably the most important factor for most fat people who would like to stay as healthy as they can).
It doesn’t include diet as a variable. Therefore it can’t say anything about how well or poorly fat people who eat a healthy diet do.
It doesn’t include either attempting to lose weight, or actually losing weight, as a variable. Therefore, it cannot show that losing weight is desirable for fat people, contrary to what you seem to think.
However, the study did show that among the people who were “metabolically unhealthy” at the start of the study, “normal” weight people did worse over time than either overweight or obese people. It also showed that it’s much better to be obese and metabolically healthy than it is to be “normal” and metabolically unhealthy – which, if anything, would suggest that it would make more sense to be concerned with metabolic health than with being fat.
In contrast, I’ll quote a report describing a study that was published in 2013 in European Heart Journal:
“Dr Ortega and his colleagues found that 46% of the obese participants were metabolically healthy. After adjusting for several confounding factors, including fitness, the metabolically healthy but obese people had a 38% lower risk of death from any cause than their metabolically unhealthy obese peers, while no significant difference was seen between the metabolically healthy but obese and the metabolically healthy, normal weight participants. The risk of developing or dying from cardiovascular disease or cancer was reduced by between 30-50% for the metabolically healthy but obese people, and there were no significant differences observed between them and the metabolically healthy, normal weight participants.”
This study used (if I’m understanding the two studies correctly) a more stringent definition of “metabolically healthy” than the one you cited, and more importantly, took fitness as well (measured by a treadmill test) into account.
The study itself can be read here (pdf link).
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> (I think exercise is probably the most important factor for most fat people who would like to stay as healthy as they can).
I agree. It’s just that I think that losing weight is a very strong second.
Regarding your study, I will change my mind and admit that there are some obese people who shouldn’t worry about losing weight, but I will make a bunch of caveats.
1. “Adjusted for fitness” in the study means adjusted for actual perfomance on a treadmill test, not hours of exercise per week or something. So the study only predicts the same risks for a metabolically healthy obese (MHO) person and a metabolically healthy normal-fat person if they perform the same on the test, not merely if they exercise the same amount.
2. An MHO person in their 20s should not assume that this study applies to them. The mean age in the study is 44, std dev is 10. Almost everyone is metabolically healthy in their 20s, so it’s not warranted for metabolically healthy young people to blithely assume that they will remain so, especially if they are obese (the study doesn’t in any way deny that obesity is a risk factor for metabolic syndrome–for the study, it doesn’t matter WHY some people are metabolically healthy and some are not).
3. A severely obese person should not assume that this study applies to them. The study separately uses two criteria for obesity: BMI and body fat %. The mean BMI of MHO by the BMI criterion is 32.4 and the mean BMI of MHO by the BF criterion is 28.1 (seriously!). The std dev of the BMI for the overall sample is 4. You noted elsewhere in this thread that health risks aren’t really significant except “among the most obese”, and I don’t particuarly disagree–but I pointed out that people may not realize that a “severely obese” BMI of 35 is a low bar by contemporary standards.
Basically, I think your study reflects the controversy around BMIs of 25-35. That is where you will find some fit obese people who don’t need to worry about their weight if it’s remaining stable.
4. Metabolic health is a product of exercise, weight, genetics, and diet. If exercise is already someone’s first priority, and they want to focus on metabolic health as their second priority while ignoring their weight, all they can really do is cut the saturated fat and avoid spiking their blood sugar.
But note that losing weight can help if someone has bad genetics! It’s abdominal obesity that’s particularly unhealthy: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0026621 (and for that matter, look at the 3.5 cm or 5.5 cm difference between metabolically healthy and metabolically abnormal obese in your study). And it’s widely recognized that where you gain weight is genetic. But if someone loses enough weight or avoids gaining it, it’s likely irrelevant where they’re disposed to gain weight.
Anyway, I want to wrap this up, so I will say that I naturally have difficulty knowing exactly how difficult it would be for someone else to lose weight, so ultimately I must accept that even severely obese people deciding not to try to lose weight might be making the right choice for themselves, but I hope that the decision is informed. And I imagine you recognize the phenomenon where someone who lost weight and kept it off doesn’t want to make people feel bad and yet they want everyone to know that losing weight is the Best Thing Ever.
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I agree. It’s just that I think that losing weight is a very strong second.
Do you know of a weight loss method that has been shown to be sustainable for a majority of obese patients (including drop-outs) for at least five years, for a significant amount of weight, in a study published in a peer-reviewed journal?
(Actually, it would be better if it had been replicated a few times in peer-reviewed studies, but even one would be interesting.)
But note that losing weight can help if someone has bad genetics!
The study you link doesn’t compare people who have lost weight with people who have not lost weight; it therefore does not support the claim you made.
…so ultimately I must accept that even severely obese people deciding not to try to lose weight might be making the right choice for themselves,,,
Thanks.
And I imagine you recognize the phenomenon where someone who lost weight and kept it off doesn’t want to make people feel bad and yet they want everyone to know that losing weight is the Best Thing Ever.
Yes, I do. I try to smile and nod and be nice about it. :-p
Seriously, I’m glad you’re happy. But you obviously realize that your experience is not generalizable to all fat people. That makes you a rarity among people who have lost weight, frankly. 🙂
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> Do you know of a weight loss method that has been shown to be sustainable for a majority of obese patients (including drop-outs) for at least five years, for a significant amount of weight, in a study published in a peer-reviewed journal?
No. A typical meta-analysis result with significant weight loss will be that patients regain most, but not all of the weight. I suspect that structured medical programs are worse than self-help for sustainability, because patients have to manage a transition from supervision to self-help that is non-existent in the pure self-help case. But obviously I have no strong evidence of this, since all evidence about self-help is cumulative anecdotal evidence.
But even modest weight loss (5% of initial body weight) can be medically helpful: http://europepmc.org/abstract/med/12055705
So, “significant amount of weight” is a high bar for success.
> But you obviously realize that your experience is not generalizable to all fat people. That makes you a rarity among people who have lost weight, frankly. 🙂
Thanks
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Sorry for commenting on a really old post, but I scanned through the comments and at least didn’t see my point anywhere. What struck me about your question at the end is, at least for me, it has an obvious answer: weight loss is measurable in a practical, realistic fashion, where long life isn’t. If someone says “Do XYZ to lose weight,” and I try it, and in two weeks I’m exactly the same or higher weight, I will generally feel justified in saying “Yeah, no, doesn’t work,” and doing something else. (And I don’t feel I’m being unreasonable there – the methods I actually use, which are basically a mild form of portion control, work in two -days-.) If someone says “Do XYZ to live longer,” I have no way to tell if it works except by trusting them, and I would much rather have something I can test myself than something where I’m trusting strangers.
You might not unreasonably argue that “to be healthier/happier” doesn’t have that problem, but it is pretty vague, hard to measure (at least for me), and, in the case of happiness, suffers from a whole lot of confounds. You might also argue that setting a goal that is completely different from my actual goal – but measurable! – is kinda missing the point entirely – to which I would respond that as far as I can tell, as long as I am losing weight in a healthy way, it correlates quite strongly with my actual goal, and I’m pretty sure this one is causation since I’ve adjusted the former variable and seen the latter adjust to compensate. (As much as I can see it, but I at least feel better, seem to have fewer Generic Getting Tired problems, etc.)
And overall, in something as complicated and personal, where what works for one person emphatically doesn’t for another, as details of weight loss and/or diet, I would really rather have something I can straightforwardly measure as the variable I’m testing. Because in my experience at least so far, something can work amazingly for a friend – or family member! – and not work* at all for me, or vice versa.
*Note I’m defining work as including being sustainable. If it would in theory lower my weight but it makes me thoroughly miserable, it doesn’t work.
And finally in response to your overall point – yeah, it seems perfectly plausible to me that some people don’t have any mechanism that works for them. I am lucky that I do. I’m not debating that – but you were asking why “weight loss” should be a goal other than Society Being Horribly Messed Up, and here’s a reason why.
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