I’m against fatphobia because I’m thin.
I eat whenever I’m hungry. I eat until I am full. I have a Weird Undiagnosed Medical Condition that means that when I’m hungry I start crying, yelling at people, and being unable to complete such complex plans as “take food out of the cupboard and eat it”, so I often overeat if I’m in a situation where I might not have easy access to food whenever I want it. Sometimes, when I am sad, I eat food that makes me happy. When I want candy or cookies or ice cream, I have some.
Here are things I have never done: Kept a food diary. Counted calories. Weighed myself regularly. Stopped eating entire food groups for any reason other than the ethical.
A lot of the things people insist about naturally thin people seem ridiculous to me. “Naturally thin people understand portion control!” I have never controlled a portion in my life. I am as confused as anyone else about what a serving of vegetables is. (I recently discovered I regularly pour three servings of frozen vegetables into my ramen.) I just eat until I don’t want any more food. “Naturally thin people know you’re supposed to be hungry at meals!” On the contrary, I strive to avoid being hungry at meals, because nobody wants to be around a sobbing irrational person who finds that making boxed macaroni and cheese is as far beyond their capabilities as going to the moon. “Naturally thin people never eat their feelings!” Dude, if I feel like shit, and a slice of cheese is going to make me feel happy, then by God I am going to eat that slice of cheese.
On the other hand, the things that anti-fatphobia and healthy-at-every-size advocates say make sense to me. The most common claim, as I understand it, is that people’s weight naturally self-regulates at a certain “set point”. This is definitely the way it feels to me. If I eat a lot at one meal, I won’t be as hungry at the next. If I exercise really hard, I’ll probably eat more. They claim these set points are probably quite genetic, which also fits my experience. I take after my mom, who was very skinny until she had children, put on a couple of pounds with each of her pregnancies, and has been stably overweight since. I expect that I shall follow a similar trajectory.
I haven’t really seen a good explanation from the anti-fatphobia side about why people’s weights are rising so quickly. It seems clear to me that people did not suddenly acquire a willpower deficiency in the middle of the twentieth century. It seems to me like something is dysregulating our body’s natural set points, so that instead of settling at a BMI of 20 or 23 (as generally happened in the past), bodies are tending to settle at a BMI of 27 or 30. I find this fairly mysterious. (Interestingly, laboratory animals, who have very tightly controlled diets, have also been gaining weight.)
Dieting seems really burdensome to me. You don’t get to have cake! Even if you REALLY REALLY want cake, you have to resist your cravings instead of going to the store and obtaining cake! All the diets talk about all the delicious food you get to eat on them– which sometimes does make my mouth water! Nothing I love like a good Greek salad– and then they rule out perfectly normal and yummy things like cheese or popcorn or peanut-butter-filled pretzel nuggets. (Which are stupidly good, by the way.) You have to keep tracking your calories and weighing yourself and all this nonsense. I have no problem with a person deciding to diet if they want to, just like I’m okay with people deciding to do Nanowrimo or visit every continent or take up skydiving. But if someone goes around saying that everyone in the world needs to write a novel in thirty days, I would be unhappy with them. Why don’t we treat dieting the same way?
It’s not like there’s nothing fat people can do to improve their health. Fat people benefit from eating lots of fruits and vegetables and cutting back on processed food and sugar. Fat people benefit from exercise. Fat people benefit from getting enough sleep. It is not like these healthy behaviors magically stop being healthy if you are also fat while you do them.
I feel like an obsessive focus on weight loss even impairs people’s health. Exercise does not appear to help people lose weight. Studies consistently show exercise having little or no effect on weight loss, partially because most of the calories we burn aren’t from physical activity but for the basic functioning of our bodies, and partially because of compensatory behaviors. A lot of people who hear about compensatory behaviors say things like “well, then, don’t use exercise as an excuse to eat a cookie! Stupid fat people!”, but that’s only one form compensatory behavior can take. You might move around less because you’re tired, or even fidget less. There are very few people who have volitional control over how much they fidget.
I know several people who have chosen not to exercise because they’re aware it won’t help them lose weight. This is absurd! Exercise makes you live longer. Exercise is protective against depression, Type 2 diabetes, stroke, heart attack, dementia, Alzheimer’s disease, and a host of other diseases. But, you know, it doesn’t make you thin, so what’s the point?
I feel like there’s little to lose from adopting an attitude of healthy at every size, even from a “the laws of thermodynamics rule all!” perspective. Surely– if calories in calories out is the be-all and end-all of weight– then encouraging people to move more and fill up their plates with vegetables instead of calorie-rich desserts will cause them to lose weight. I mean, it’s not like the laws of thermodynamics know whether you’re taking a weight-neutral approach to health. “Oh, shit, guys, we’ve got to DOUBLE this calorie! This person’s eating vegetables because vegetables are delicious and not to limit their calorie intake!” And if it is wrong, which I believe it is, then instead of trying to get people to pursue an impossible task we can encourage them to adopt healthy lifestyle habits right now– regardless of how their weight changes.
Thing of Things 
Thank you for the link to that aeon article – it was a very interesting read!
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As someone who ate a 200g of rather dry stollen per day for the last 3 days, and yet is below average weight, I wholeheartedly agree.
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200g of what?
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Thank you so much for this post! It’s nice to get more anec-data out there to counter the overly simplistic narrative pervading our society that goes “all fat people have totally out-of-control diets while thin people don’t, and all you have to do to be thin is follow some easy diet and exercise guidelines”. All possible combinations of high/low weight and good/bad health can and do exist. I agree that the increasing average weight invites further research (though I’m sure you’re aware that there absolutely are people out there blaming it on a sudden global failure of willpower).
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“I haven’t really seen a good explanation from the anti-fatphobia side about why people’s weights are rising so quickly. It seems clear to me that people did not suddenly acquire a willpower deficiency in the middle of the twentieth century.”
The standard answer seems to be “superstimuli”. Indeed, this is the standard example of a superstimulus and may be the origin of the concept. (I agree that this doesn’t explain all the evidence, although to be fair neither does anything else.)
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I have not read any research about the causes of the overweight epidemic in America or globally, but where I live I think all the experts agree that the average dietary energy input has fallen radically in the last 100 years. It’s just that physical activity levels have fallen even more, and dietary habits are following with a considerable lag.
One hundred years ago most of the workforce was doing some kind of physical labour. Now the percentage is in single digits or below one percent. And even unpaid work is significantly less physically demanding than it was a century ago (even childrearing, since nowadays the norm is significantly fewer children than then).
I am one of those naturally thin people, by the way. I eat a lot, but I do seem to have a high baseload energy consumption, even though I’m not particularily muscular.
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The result of the economic crisis is Cuba after the fall of the Soviet Union seems to contradict the HAES position. One example of the articles you can find about this in the WP> , for those who prefer journals see here .
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That seems to me like it fits in the model. If you have absolutely no fucking choice but to exercise, and you have absolutely no fucking choice but to eat less, then you will probably lose weight. You will also be totally miserable and hungry and tired all the time, because your body feels a pretty strong desire to get back to its original set point; this is the reason diets typically fail in less coercive environments. (To quote the WaPo article: “People remember the 1990s as a time of crisis,” Franco says. “They don’t want to live the way they did then.”) I think perhaps our disagreement is that I think it is perfectly reasonable to say “I’m happy to be fat and increase my risk of diabetes if I am less fucking miserable all the time.”
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Sorry, what? You write above that exercise doesn’t help weight loss, that there are “set-points”. This goes against what is presented in those links.
And if you say “I’m happy to be fat and increase my risk of diabetes if I am less fucking miserable all the time” you are making strong assumption on the prevalence of “fucking miserable”, and then that becomes a numbers game no one can win (because tremendous lack of data on top all the usual issues with QALYs).
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I see no contradiction between existence of set points and losing weight when eating less. It just means that in order to lose weight you have to endure constant hunger. Regarding the “number game”, I think the meta-level solution is obvious: respect each person’s autonomy and don’t bully anyone into making one or other choice.
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Right. The thing that is “set” is your weight at equilibrium, where you are either eating as much as you like for the amount you are exercising or exercising as much as you like given how much you eat (whichever happens to control for you). Whatever your preferred ratio is, it’s probably locked in a way that’s very difficult (for you, anyway) to change, for the reasons Ozy discussed in the OP. If you are forced out of equilibrium, eg by a severe food shortage, your weight will change, but you will also be miserable.
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The amount of kcalories eaten on average fell to 2400 per day on average (from 3000-3200)! This is not, by far, starvation level, it is the recommended amount for adult males (if they have a moderate physical activity).
They were simply over-eating. Which I completely get, eating is pleasant, so if food is cheap (and especially if other pleasant things are hard to come by because you live in Cuba) why not indulge after all?
Sure you can reach an equilibrium if you eat a given amount (your body burns more energy the heavier it is, all other things kept equal), but there is no reason to call that a “set point”.
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This data supports set point theory. Set point theory states that individuals have a “set point” that their body will naturally stay at if it gets anywhere in the “normal” range of calories. It’s why cutting 100 calories out of your diet every day won’t do anything.
Set point theory recognizes that if calories are severely restricted (a drop of 600-800 calories per day probably qualifies), people will lose weight. But it also states that when calories stop being restricted, the weight will return rapidly and often the new set point will be higher than the old one. If you look at the Cuban data, this is exactly what happened. By 2010, the national average weight was significantly heavier. Everyone gained back the weight they lost, plus extra.
This study is probably some of the most counterintuitive evidence in favor of set point theory. An experiment was done on prisoners where they were to gain 15% to 25% of their body mass. To do so, they had to eat up to 10,000 calories per day. When they went back to eating normally, the weight fell away, and they rapidly ended up at their original weight.
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There definitely is some kind of default weight but it can change. My default when I was living in a single room in a shared house is different to when I got my own place with room to move around which is different to my default when I used to live near a kayak club and went kayaking every week.
I’m not sure that cochrane review linked to by that vox article says what you or the author thinks it does. For one the vox article doesn’t distinguish between kg’s of fat and kg’s of muscle. someone who swaps fat for muscle gets counted as “no weight loss”. Indeed the only mention of muscle’s at all is a snipe at the authors fitness instructor.
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To be fair to both me and Julia Belluz, that is also how the BMI and everyone who steps on a scale to measure their weight loss counts swapping between fat and muscle too.
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Fair, but I’d point out that “BMI is garbage” has been around in weightlifting communities since time immemorial, and is also around in HAES.
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I volunteer as a PT on what is colloquially known as “fat camp”.
Every single person who comes to the place has a shock-experience when they realise exactly how much they need to exercise in order to burn off a tiny piece of chocolate. There is definitely some lack of understanding going on.
We have a very high success rate (well over 90%, mainly because we count only the ones who complete the entire program. If we counted the dropouts, we’d be around 40%) All the dropouts are the ones who flatly refuse to believe how much exercise it takes to burn off said chocolate.
I think we get a statistically valid selection of people because where I live, you’re entitled to a total of 5 months paid sick leave at the camp once your BMI hits 30.
This is because our health administration has discovered that half a year at the camp is LOTS cheaper than all the extra surgeries and other medical cost that comes as a result of being overweight.
The main focus at the camp is life-style changes and healthy habits.
What I have learned after a quarter century of ‘overweight rehabilitation therapy’ is:
Living an actually healthy life is pretty much a guarantee of not being obese. Not being obese is in no way an indication of a healthy lifestyle.
I have no idea how this fits your definition of fat-phobia or not. I’ve never been scared by a fat person, so I’m pretty sure I don’t suffer from the literal interpretation.
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If you really sincerely believe that living an actually healthy life is a guarantee of not being obese, then you should be promoting HAES. The fat people will adopt it and then the pounds will just melt off. 🙂
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If some 60% of your clients drop out, maybe this suggests that what you’re offering isn’t a tolerable lifestyle for most people.
Also, do you do follow-ups for your clients? For how long?
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Um, 50% drop-out for an exercise regiment is pretty typical (both for gym attendance and martial arts practice).
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I’m not saying that your program is unusually bad, just that it doesn’t improve net quality of life for a high proportion of people.
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Fossergrimen, do you have statistics for 5 years out? IMHO, most diets work if you do them, but most also have fairly unfortunate relapse rates.
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@jossedley, nancylebovitz
The 40% success rate is indeed after 5 years, the program is 3 months initial stay then one-week follow-up stays spread out over the next 5 years and the program is concluded then.
Since this is tied in with the public health system, we also have data going back to the late 1980s and for the ones who make it to the 5-year mark, it’s not a statistically significant drop until retirement. (there is no statistics kept for people not in the workforce as they would not qualify for paid sick leave anyway.)
For the 25 years I’ve been there, we’ve had 5 people hitting a BMI of 30 again and returning for another stay after completing the program once. (we run 40 people x 4 times a year, so 1.25% -ish relapsing that badly.
And it is indeed not a tolerable lifestyle for some. As Ozy said above, some people will rather have diabetes than live healthy lives with a sane diet and adequate exercise.
I’m somewhat ambivalent about that. If you pay for your own health insurance, no problem, but if you want my tax Euros to pay for your diabetes treatment? Not sure.
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My claim is that a person who meets standard government recommendations for exercise, sleep, and food groups consumed, and who eats a diet such that they are neither overfull nor hungry the majority of the time, will generally reach an equilibrium weight which may, in fact, be overweight or obese. I think that limiting your calorie consumption so that you are hungry a substantial amount of the time probably reduces weight for the majority of people, but is unsustainably unpleasant for most people, and it is perfectly reasonable for them to decide not to do it. I would like to direct my tax Euros to increased research into the causes of weight setpoints increasing.
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@Fossegrimen: Links, please? Thanks.
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not sure there are any links in English. You can run google translate on the “Norwegian institute for exercise-medicine”, an introduction to the programme is at:
https://www.staminagroup.no/nimi/offentlige-avtaler/sykelig-overvekt/
for google search: Norsk Institutt for Idrettsmedisin, NIMI
They supervise all the programmes, both private and public and should have publications too.
And my memory was off, it appears to be BMI 35, not 30 for admittance.
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Google translate is very effective on that page, thank you. But that page doesn’t appear to give any data for the results that you’re talking about; it just describes, in general terms, what the treatment consists of.
Is there a link that describes the results you’ve talked about here in more detail? Average weight loss, average time of followup (the page you linked says “up to five years,” which is not necessarily the same as a five-year followup), etc?
Thank you.
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So, you admit right here that different people have to apply vastly different amounts of effort in order to maintain the same thinness. The whole point of the OP is that people should stop assuming that all thin people are thin because they’re so virtuous and hard-working (and therefore fat people are unusually lazy) rather than because they got lucky with their metabolism. In what way do these points contradict each other?
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Uh.
Ok. So, I rarely get heated at internet stuff. But, like, have a heart.
I used to be “morbidly obese”. Nowadays I am “very overweight” ( I threw myself a little party when I stopped being obese). This hasn’t been super fun, and there is a ways to go yet.
It’s not that I think thin people don’t have anything useful to share. I mean, ideas are true or not irrespective of their source. I get it.
But, like, when someone says, paraphrased “I eat whatever I want, when I want, and boy is peanut butter and chocolate delicious! I think that everyone should be happy with the weight that their lifestyle gives them!” , its kind of hard to take.
Like, hey, borrow my setup, eat that stuff, and be happy when people cross the street to avoid you. Be happy when kids make jokes in the line behind you at the all you can eat place because they think there won’t be any food left. Be happy when you croak of heart failure twenty years earlier than you otherwise would. Oh, and you’ll love the guys on the planes. All heart.
Ooh! And dating! Boy, you’d be in for a treat there.
If that doesn’t sound great, then perhaps there is something different about our respective weights, because I gotta say that borrowing your “eat anything I want whenever I want and don’t end up buying a special machine so I don’t die in my sleep” setup would really work for me.
Like, it makes sense that you’d be happy, as a thin person, at your size. But for me to be happy would require people to treat me differently, and also for physics to work differently. Neither of those things seem to be on offer, so I’ve spent a year and a half kicking my own ass and starving myself.
So, when a naturally thin person suggests that I might have saved myself the trouble by being happy at my old weight, there is definitely a component of ‘sunk cost’ to my response. Like, I may be taking some of my “God this is an endless nightmare” feelings out here.
But I also feel like I can legitimately say that until you’ve had the ‘full jabba’ experience, you might be underestimating the difficulty of the lifestyle if you think that we can be happy.
It’s like believing in Healthy In Any Abusive Home as a notion. Like, sure, exercise would still be worthwhile, and there’s nothing wrong with a positive mindset, but it kind of feels like this is a ‘solving the wrong problems’ situation.
The world is built for thin people. People are kind(er) (okay, marginally) to them. We need to get thin.
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I think it is a bad state of affairs when people are expected to starve themselves so that other people will be nice to them. I don’t blame you for starving yourself; it looks like you are making the best decision possible in your shitty situation. I blame other people for being mean to you. It is not like thin people are somehow compelled against our will to be assholes to the obese.
I’m not a big fan of the “if people are punching you, it’s your fault for looking so punchable” discourse, even though in the short run looking less punchable might be the best possible way to stop being a victim of assault.
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Walter, I wish you nothing but luck and success with your weight loss. But I hope that you don’t think your anecdotal example proves that weight-loss dieting works or could work for everybody.
It’s obvious that HAES is, in fact, often supported by people who (like me) have the “full jabba” (heh) experience.
Responding to pervasive anti-fat discrimination by dieting feels, to me, like “solving the wrong problem.”. It’s more to the point to address and discourage the discrimination.
P.S. Thanks for this post, Ozy!
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I don’t think any* HAES advocate would argue that all fat people should live by HAES even if it makes them unhappy, or that nobody should decide to lose weight for their own benefit. It’s more like, society as a whole thinks it is obligatory for all fat people to lose weight, but in fact a lot of fat people are happier not trying to lose weight because for them the negative consequences of fatness + fatphobia are less bad than the negative consequences of trying to lose weight. It sounds like you’re not one of those people, so HAES isn’t for you. But it’s not thin people who came up with HAES, after all, it’s fat people advocating for themselves!
*well okay, there are always some unreasonable people in every movement. but they are not anything like the norm.
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I question the statement that exercise does not help with losing weight. For me, it’s the only thing that works reliably. It just needs to be a habit. Doing it for a month won’t help. For me, the difference between exercising 2-3 times a week and not at all is about 30 kg (or the difference between the upper end of “normal” and “very overweight”).
One thing I notice is that I don’t initially lose weight when starting to exercise – I do get slimmer, but at first I build muscle at the same rate, or even slightly quicker. My guess is that building up muscles increases base energy consumption, which in turn reduces the equilibrium weight.
(YMMV, everyone is different, etc…)
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The statement that exercise does not help with losing weight, is based on research.
I’m glad that your anecdotal experience is different, because it seems like you’re happy with how it’s going for you. But your anecdotal experience doesn’t outweigh the general results found in studies.
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I do know that. What it does, though, is providing a reason to look very closely at what the studies do say, and what they don’t say. Maybe the effect is high variance, only works for some people or some forms of exercise, takes longer than the time these studies are usually done over, etc. Maybe there’s selection bias because most people for whom “common sense” interventions work will rarely ever become obese in the first place, and won’t stay that way for long (I don’t care enough to do that, since I have found what works for me and don’t get paid for studying it).
So in short: Don’t use these studies as an excuse not to try it. I’m willing to bet at good odds that “exercise doesn’t help with losing weight” is far from the whole truth. Partly based on anecdotal experience, which may be a minor epistemic sin, and partly based on the general quality of news articles on research, especially on health and nutrition, and especially especially if the results disagree with conventional knowledge (i.e. make for a good story), which is probably common sense.
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> The statement that exercise does not help with losing weight, is based on research.
There is a category of people who control their body weight and body composition with considerable precision—let’s call them “gym rats”, over there by the weight racks—who tend to agree that exercise is an overated way to control body weight. It’s not that it doesn’t work, it’s merely that the amount of exercise involved is annoyingly large, and it’s extremely easy to undo by eating just slightly more.
But hard core jogging addicts do lose weight via exercise. Appalachian Trail hikers who walk 12 miles a day through the mountains with a pack lose weight with near 100% reliability. Then they stop hiking and put it all back on.
Which brings us to what I suspect is the real reason that exercise and diets don’t work in the general population: a long term change in weight appears to require an equally long term change in habits. (See the National Weight Control Registry for studies.) And as a general rule, the overwhelming majority of long term changes in habits fail.
However, based on observing friends, family and gym rats, the habits required to support a long term change in weight are less onerous than the habits required to manage Type 2 diabetes or avoid a second heart attack. So for those rare people who can make long-term behavior changes stick (which I’m prepared to believe is roughly 3% of the population if anybody wants to argue that), I think there are some substantial QALY gains to be made.
Although I believe that it’s possible to control body weight with some degree of precision (and many competitive athletes do exactly that), I do not believe that this is ever going to have a significant effect of the weight of the American population at large. (I specify “American” because I don’t understand how other cultures handle these issues.)
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So in short: Don’t use these studies as an excuse not to try it. I’m willing to bet at good odds that “exercise doesn’t help with losing weight” is far from the whole truth.
Or, indeed, take Ozy’s recommendation and exercise for the health benefits, and don’t use “exercise doesn’t help you lose weight” as a reason to ignore the other health benefits.
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The issue is not that exercise doesn’t work, it’s that it is very front-loaded.
If you are already quite active, you can lose weight efficiently by exercising. I mean, a 5k done in 25 minutes will burn 300+ calories (depending on your weight), and if you can do one everyday, at equal food input you’d lose 2+ pounds per month.
If you start thinking about doing that when you are already obese and have not jogged in years, you are going to suffer a lot, you are not going to be able to exercise regularly without needing LOTS of recovery and you risk injuring yourself.
So the average overweight person who is, as the average person, sedentary and does not exercise at all, is unlikely to successfully manage his weight loss by exercising (unless they end up being an endorphin addict and keep at it for long enough to become fit).
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This does not match my anecdotal experience as a thin jock. (Fortunately. If I lost weight by exercising I’d be quite unhealthy.) After a good workout, I am (a) tired and (b) ravenous. Since I am tired, I typically engage in a lot less non-exercise movement– pacing around while I think, etc. Since I am ravenous, I eat more (or, I suppose, am unpleasantly hungry and non-functional).
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On the other hand, I’ve been able to alter my weight in the +/-5 kg range by switching around amounts of cardio and strength training (which is not burning a lot of calories) and keeping food intake relatively constant (yes, if you ignore “at equal food input” it becomes meaningless).
For me more exercise means more energy rather than ravenous and tired, but YMMV obviously.
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Courtesy of ten minutes on Google Scholar looking for meta-analyses:
“In conclusion, both exercise and diet reduce VAT. Despite a larger effect of diet on total body weight loss, exercise tends to have superior effects in reducing VAT.”
Click to access 577bb93908aec3b74336657a.pdf
“Exercise intervention reduced body mass index… body weight… body fat percentage… waist circumference… but the increase (improvement) in lean mass was trivial.”
“The current evidence suggests that exercise intervention in overweight and obese adolescents improves body composition, particularly by lowering body fat.”
http://eprints.soton.ac.uk/389421/
nb, rudimentary, cursory search, only reading the summary. On the other hand, actual meta-analyses and I didn’t find anything pointing the other way. Salt accordingly.
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ZZ’s first link suggests that exercise is not effective at reducing weight, but it is effective at reducing visceral adipose tissue (VAT), and is therefore worthwhile. (VAT is fat surrounding the intra-abdominal organs, and is correlated more with various diseases than subcutaneous adipose tissue (SAT), that is, fat in other locations.)
“During exercise training, however, lean body mass and circulating plasma volume increase, whilst fat mass decreases (21,23,25,26,33). Previous work that directly measured these factors indeed showed that an increase in lean body mass counteracts loss of fat mass after 8 weeks of exercise training (34). These opposing effects resulted in the absence of total body weight loss (34). Appreciating and understanding these effects are important to acknowledge that exercise training effectively reduces VAT, despite the absence of a reduction in body weight.”
“…the absence of a reduction in body weight after exercise training may lead
physicians to incorrectly conclude that the intervention has failed.”
This seems, to me, to support the HAES perspective. And to support the case that exercise is healthy but not especially effective at weight loss.
However, although I’d like that result to be true, the evidence here is very weak, because the vast majority of the studies cited in ZZ’s first link only followed subjects for trivial amounts of time – three months, six months. It’s possible that the changes in VAT aren’t sustained for most people. I’d like to see some research on this that followed subjects for five years or more.
ZZ’s second link also emphasizes short-term results: “Most included trials were short term (6 – 36 weeks).” No information is available on what percentage of subjects dropped out. Average weight loss was eight pounds. Subjects were all between 10 and 18 years old, which limits applicability to adults.
Almost any weight-loss plan looks good if only short-term results are examined. That’s not meaningful, because the problem with weight-loss programs is that they don’t work for most patients over the long term. A lot of weight-loss programs can be shown to “work” for a year, but studies over five years show that the weight loss is usually not sustained. This may be actually more dangerous for patients than if they had just maintained their weight, due to the dangers of weight cycling.
Vox has an overview of the research showing that exercise has only a modest effect on weight loss. (Vox is very pro-weight loss and doesn’t support HAES or even generally acknowledge that HAES exists.)
This Cochrane meta-analysis comes out in favor of exercise for weight loss, but the amount of extra weight loss with diet+exercise (as opposed to diet alone) is extremely modest – 2.5 pounds. That increased to 3.3 pounds for those using high-intensity exercise programs. And, again, none of these studies looked at weight loss over the long term.
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I think a lot of it has to do with appetite, which naturally varies to an extent (people respond differently to hunger/fullness cues), and can also be influenced by external factors (stress, medication, etc). One popular theory nowadays is that our obesity crisis is caused by modern diets, which contain simple sugars in greater proportion than 40-50 years ago. Sugar affects your insulin response, which controls appetite.
I agree that HAES is a good thing though. Regardless of your weight it’s a good idea to exercise and consume appropriate nutrients, etc.
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I’d just like to point out that HAES and fat acceptance are different things. You seem to be in favor of both, which is awesome! Me too! HAES is just about health – it’s the idea that fat people can be healthy, and that weight loss is not a reliable avenue to good health (and that most of the time it’s counterproductive). Fat acceptance is about valuing fat people as human and just as valuable as thin people. You can support one without supporting the other, though I encourage everyone to support both!
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(fyi, this is more directed at the comments than the OP. The OP seems pretty limited to the topic of HAES)
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I’m just gonna roll to disbelieve on the exercise doesn’t cause weight loss study.
I believe there are setpoints in a sense, but they can change. Obese people generally don’t have properly functioning satiation mechanisms, leading to a high setpoint. If they become metabolically healthy (which I continue to believe can be achieved through diet and exercise), they’ll have a lower ‘set point’.
Anectode, but mine changed. I had always been a healthy weight eating what I wanted. Then I quit my retail job, because I got a scholarship and wanted to focus on studying. Not realising how much exercise the job was giving me, I started gaining weight. My diet didn’t change, my level of hunger didn’t decrease now that I was getting less exercise – I just started chubbing up. If you can talk of a set point in this situation, it has to be a flexible one – one that was higher when I exercised less.
I was totally sedentary, gaining weight until I noticed (embarrassingly late – I had never paid attention before so gained a fair bit slowly without noticing). At that point, I counted calories and took up running. I run regularly now, but don’t count calories. I ‘eat whatever I want’ now, but if I’m honest, I formed good habits when I was calorie counting, and ‘whatever I want’ is waaay healthier than before, with less fat, less refined carbs and practically no sugar.
I noticed when I started running that whilst I was hungry immediately after a run, fatty meals would in general keep me full longer. This is entirely consistent with this leptin signalling business that is hypothesised to contribute to obesity, in which high carb diets and sedentary lifestyles break your ability to find fat satiating.
And in more anecdata, whenever I encounter people who ‘eat what they want’, they usually have some specific thing keeping them active. It might be walking 10 minutes each way to a bus stop each day. That’s 20 minutes of walking. When people who were previously doing that get cars and an office job, they start gaining weight.
So, I’m sorry to dismiss the science, I’m usually someone who does the complete opposite and dismisses the anecdotes flying around instead. But this one just clashes too strongly with my experience, and my priors for nutrition research being correct are pretty low to start with.
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I have lost slightly over 25% of my bodyweight and kept it off for a year. I did this via accurately tracking what I eat, and eating 500 calories / day less than I burn. My weight loss is ridiculously predictable, using the formula that 1 pound of body fat is 3500 calories, if you assume roughly 3 pounds of random day-to-day variation from water and other noise. When I was actively losing weight, I could predict my weight two months later to within 3 pounds.
The estimated gain to my life expectancy is 6 years, and I believe it’s higher if you go by QUALYs. I’ve seen cardiac ICUs and I know people with Type 2 diabetes, and I was potentially at risk for both before.
(Note that I actually count macros, and I have minimum and maximum numbers that I try to hit. If I’m below my minimum number, I will eat more until I reach it.)
I do believe that exercise is a fairly useless way to lose weight, because I calculated I need to run a fast mile to burn one Oreo, and I’m tall. The gym rat version of this is “you can’t outrun your fork”, or “abs are made in the kitchen.” You can outrun your fork, but it involves endorphin junkie levels of constant running and that will eventually beat up other parts of your body.
Now that I have almost a year of accurate data about food intake and weight, I lead strongly towards the “superstiumlus ” theory. I can eat “normal people food”, but it’s a social indulgence, because it fucks up my calorie and macro counts and leaves me hungry. If I lean more towards “real” food (relatively unprocessed animals and plants, or at least lower-fat dairy), I actually have to force myself to eat more than I want to maintain my weight. Thanksgiving dinner is actually fine, because lean turkey and giant piles of vegetables are surprisingly low calorie. Much of my weight loss effort occurs at the grocery store.
I do not recommend this approach for everyone. Weighing and measuring most of my food intake is a pain in the ass. And lots of people have weird issues with calorie counting and shouldn’t do it. I’ve simply accepted that, for medical reasons, I don’t get to have a “normal” relationship with food. I have learned, however, what every bodybuilder knows—I have very precise control over my weight, and reasonable control over my my body composition. Being more attractive is a fun bonus, and the Halo effect is alarmingly real.
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I endorse this comment and hereby increase its anecdata by one (modifications: 30-something, 30% kept off for 3 years, don’t count macros but believe they matter).
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I agree that people should treat fat people with respect, and that they don’t. I also agree that you can improve your health regardless of your current size with proper nutrition and exercise.
My problem with FA/HAES is (a) the notion that fat people are just as healthy as thin people; there’s a stupid amount of evidence that fat people aren’t and (b) the idea that it’s impossible to lose weight
I regard both of these ideas as being false and dangerous
Link for (a) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062780/
As for (b) – I went from being obese to overweight and am on my way to a healthy weight. It’s been a uneven process because everyone has a different lifestyle and has to figure out, through experimentation, what works for them and what doesn’t. What works for one person might not work for another. Intuitive eating works for Ozy, but won’t work for me because I tend to mindlessly eat over my TDEE. Merely adding some cardio to his workout works for my wrestler friend, but it won’t work for me because I hate cardio. Some people that a high-fat, low-carb diet negates their hunger pangs but it won’t work for me because I lift weights and need the carbs.
What ended up working for me was calorie counting to develop an awareness of how much I’m eating, intermittent fasting to deal with the hunger (it disappears in days!), and unlearning bad habits like buying an entire bag of chips when I visit the grocery store.
I’m not miserable all the time, I’m not hungry all the time, my appetite seems to have declined proportionately with my weight, my body isn’t demanding that we return to our “set point” of over 100kgs, it’s great.
I’m not surprised that so many people regard losing weight as being this awful awful process. If you don’t find something that comfortably fits your lifestyle, of course you’re going to be unhappy. If you really like cake that much, eat cake! If you find counting calories and weighing yourself too burdensome, don’t do it! There are dozens of strategies that you can adopt to lose weight. Experiment! Adopt one for no less than 1-2 weeks, if it you’re not miserable, stick to it, if you are abandon it.
(Side note: The reason people put back on whatever weight they lose is because they adopt a crash diet, and return to their old habits after they lose weight. The same habits that caused them to gain the weight in the same place.)
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(a) in general, the date shows that fat people are less healthy than thin people. Studies also show that overeating and failing to exercise causes weight gain and poor health. This suggests that the cause of poor health is not excess weight, but overeating and lack of exercise. The HAES movement advocates for fat people to focus on eating healthy and getting quality exercise, not weight loss, which has no proven positive effect on health (http://www.dishlab.org/pubs/2013%20Compass.pdf), and some data suggests has a negative effect.
(b) can be dismissed as anecdata. 97% of diets do not result in long-term weight loss, and over 80% result in long-term weight gain (http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA-Researchers-7832). You were one of the lucky 3%. Great. So am I (I once lost 100 lbs, and only about 50 lbs. has come back over 10 years). That doesn’t mean we did anything special. It just means we’re lucky. Our experience is not scalable.
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wfenza, I appreciate your skepticism. Here’s my current hypothesis, which I think is consistent with the science.
Observations:
1) We all know people who lost weight and kept it off for the long term. Generally, this is accompanied by a long-term change in lifestyle – they became a serious long distance bicyclist, or started running marathons, or permanently cut elements from their diet, like alcohol or sugar or whatever.
2) On the other hand, we all know many many people who dieted, lost some weight, then stopped dieting and gained it back. (The 97% recidivism rate in the meta-study you cite seems pretty consistent with my own anecdata – I wouldn’t be surprised if 97% of the non-illness related weight loss events in my acquaintances haven’t lasted 5 years.)
In the event that a given person is unhappy with their weight, there are definitely some observations about the successful 3% that would help to either increase that person’s chances, not to a certainty, but if you’re going to try to lose weight, isn’t a 6% chance of success better than 3%?
a) Permanent lifestyle changes are better than changes that a person doesn’t want to or can’t keep going even after their weight hits target. Counting calories or giving up flour and sugar will both work, but it’s better to go in realizing that’s your current lifetime strategy.
b) I think the studies are pretty good that social support and reinforcement increases your odds. One of the most stable long term groups is Weight Watchers’ employees – they weigh in regularly and need to keep their weight in range in order to keep their jobs.
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dndnrsn had a (quite thoughtful, I’m sorry about deleting it) comment deleted for containing the words “motte” and “bailey” without presenting links that show that both the motte and the bailey are supported by people in the group they are talking about. I am happy to undelete the comment if they provide such links.
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I read dndnrsn’s piece in email notifications, and I have a general reply which I’d been meaning to add to this discussion.
So far as I know, there’s no overarching research on what people do to lose weight and how it’s worked out for them.
Results range from lost weight stably (possibly with improved health) without huge effort, lost weight stably with huge effort, no weight loss/weight regained, weight gain as a result of weight loss*, and extremely unhealthy and misery-inducing eating disorders.
My guess is that the third and fourth are by far the most common.
Weight loss surgery also has mixed outcomes, and this includes devastating side effects.
If you had a medication with results like efforts at weight loss, it might be legal to precribe it, but I think there would be a bunch of warnings.
*I suspect that part of the obesity epidemic is people who lost weight three or fout times, and regained it plus 25 pounds each time.
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@ozymandias:
I apologize; I think I was aware of this rule, but had forgotten it. My error.
What would be acceptable support? I suppose the problem is that it’s hard to find people endorsing the “bailey” position in such words; on the other hand, your reason for semi-banning the term is that it is often used to make arguments along the lines of “my opponents say they believe x, but really they believe y, and you’re gonna have to trust me on this.”
Would reworking it be acceptable? I recall thinking “motte and bailey” wasn’t really the best way to put it. Trying to focus it more on “what those people believe” didn’t work when I was mostly being introspective. It’s more like this:
I 100% agree that people should stop being shitty to fat people, an active and healthy fat person is probably living a better lifestyle for themselves and for society in general than a skinny person who does unhealthy things to get that way, stigmatization is more often than not a bad way to deal with things (smoking is an example where it worked, but tobacco is different from eating food), and I am better off from finding healthy activities I could do where I was not stigmatized for being fat, with the result that I am considerably healthier and less fat. Still got a bit of chub, and am working on that, but it feels really good to grapple with a guy with abs and realize that I am stronger and have better conditioning than him – if someone saw us both shirtless they might think “oh yeah guy with the abs definitely in better shape”.
At the same time, I think there is a line, not a clear line, but a line nevertheless, between “fat but still healthy” and “too fat to possibly be healthy”. Unfortunately, Healthy at Plenty of Sizes Usually Not Considered Healthy and Also Being Underweight and Starving Yourself Are Bad and Underwear Models are Very Unusual is a clunky acronym. I recall being in denial to the point of delusion – I described myself as “chubby” when I was, by definition, obese; I would talk about people are supposed to have different body types and that’s OK and perfectly healthy; I would mention that I’d read that BMI didn’t work for muscular people (I was not muscular enough to count; I am not now).
@Nancy Lebovitz:
My experience is that losing fat has been harder than I wished, but easier than I expected. I was seriously resigned to “looks like 95% of people can’t lose weight and keep it off, oh well”. After I – not intending to lose weight, really, just thinking it would be fun to try – got into martial arts, my mindset changed to “I can be part of that 5%”.
I’ve lost weight and gained it back, but never as much as I initially lost – the overall pattern is a zigzagging downwards, and I fulfill the NWCR “lose 30 pounds and keep it off for a year plus” criterion. I’ve slowly been figuring out what works for me. I think a big part of the problem is that one-size-fits-all solutions cause people who the solution does not fit to think they are hopeless, and that frequently losing bodyfat is presented as a brief, one-time thing, instead of something that happens when a person adjusts their lifestyle to be healthier.
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Reworking it is fine (as long as you aren’t, like, saying “shmotte” and “shbailey” :P). I’d consider “support” to be a link to someone who could be reasonably interpreted as endorsing the position you call the “bailey”.
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Is there any way to recover the text? I can’t recall exactly what I wrote. I think somewhere I have a scan of a rather silly college-paper article that veers abruptly from talking about fat-shaming to implying, or maybe outright stating, that medical conditions resulting from obesity are a social construct, but honestly, it’s just one silly college paper article. I think my point works better if I don’t say people have a nefarious hidden agenda of which they may not even be aware. That’s kind of a big accusation.
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I seem to have the same undiagnosed medical problem as you do! I suspect, though, that there’s some kind of causal relationship between being thin and experiencing terrible hanger– I imagine that having little body fat leaves one’s brain more open to “I’m starving to death RIGHT NOW” cues.
Another thought: the people who are into both HAES and fat acceptance could easily be wrong about some of the scientific points and still be right about a lot of things. For example, it’s pretty clear that yelling at people to eat less and exercise more has been a total public health policy failure– even if the strategy works well for some individuals, it’s not working society-wide. Another is that essay on “The Fantasy of Being Thin”– even if losing lots of weight is possible for anybody, it doesn’t make sense to put your life on hold until you’ve done it.
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General points about fat and health: I’ve seen some claims here that everyone can be a “healthy” weight if they are careful and intelligent about their methods of losing weight. This is not proven. Even if you’ve been careful and intelligent about your methods and lost weight, this doesn’t mean every fat person has a body which works like yours.
A lot of people in fat acceptance/HAES have tried a bunch of methods of losing weight. It is simply not true that they didn’t achieve stable weight loss because they all went on crash diets and then went back to their old habits.
Some health problems get better as a result of weight loss, but not all of them. I was surprised to find that not all knee problems are helped by weight loss.
Sometimes there’s a tautology in play: as far as I can tell, a lot of health advice *defines* healthy living as living in a way which is believed to make people not fat.
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