Thursday, January 24, 2008

In Blogging, Big is In

Is bigger better? Is fat 'in'? Is there an anti-obesity hysteria? Is the 'obesity epidemic' a hype, and the best thing would be to just accept our bodies as is and move on with life, rather than dieting, exercising, and trying to change our shape?

Well, if you look at the blogging universe, all indications are yes. And it's important to note that these bloggers, many of whom see nearly 4,000 unique pageviews a day, aren't just arguing that 'big is beautiful'. They're actually arguing that the medical experts are wrong and there's no obesity epidemic, that people come in all shapes and sizes, and as long as you exercise, eat sensibly, and are healthy (a philosophy known as 'Health At Every Size'), it shouldn't matter what your physical measurements are, or what size clothing you fit into.

The bloggers argue that changes in definitions over time, along with flaws in the body mass index formula, have pushed more Americans into the “fat” and “obese” categories, and they point to provocative studies suggesting that there may be benefits to being overweight, including a large study that found that underweight Americans are more likely to die than those who are moderately overweight.

Several other recent studies on heart patients and dialysis patients have also reported higher survival rates among heavier patients, suggesting that the link between body size and health may be more complex than generally acknowledged. Another study of people over 60 found that being fit has more bearing on longevity than simply being thin.

The bloggers’ main contention is that being fat is not a result of moral failure or a character flaw, or of gluttony, sloth or a lack of willpower. Diets often boomerang, they say; indeed, numerous long-term studies have found that even though dieters are often able to lose weight in the short term, they almost always regain the lost pounds over the next few years.
These are certainly complicated and often sophisticated arguments coming from people who are both vested in their interest, and are lay people who've done a remarkable job at educating themselves in a subject that many medical professionals don't full understand. But I see several inherent dangers in the fat-acceptance movement in the blogging universe.

First and foremost is a tendency to not separate out the difference between overweight and obese - and these are terms that, in medical parlance anyhow, do have different meanings. And while these bloggers have gone and educated themselves, their issue with the concept of BMI to determine health of weight has led them to lump the reports they cite, the ones that indicate being moderately overweight might have health benefits, with those who are morbidly obese. And there is a big difference to your health and body between being 20lbs overweight and being 100lbs overweight.

I'll be the first to agree that there is a problem with the BMI scale - but also the first to point out that you'd be hard pressed to find someone whose health would not improve if they were to lose 100lbs of extra weight.

The second, and perhaps more serious, problem I see with this fat-acceptance movement is that people are notoriously bad at underestimating the amount of food they eat. It is because of this typical tendency to underestimate the calories we consume that the New York City health commissioner, Dr. Thomas Frieden, is once again pushing to have calorie information clearly labeled on menus in the City. He believes (and I tend to agree) that people will quickly stop ordering their favourite appetizers when they realize that appetizer has 2500 calories.

It's very easy to say that you eat right and exercise and cannot lose weight - but in my experience, at least, I've found that most people who make this claim (myself included) tend to "forget" a lot of the calories they consume over the course of the day, or overestimate how many calories their exercising should burn. And without a strict log of what you're eating, and the help of a nutritionist, it's often difficult to know both of these numbers.

We do need to be careful that there is not a moral judgment when talking about people's weight. Shaming doesn't work as a weight loss tactic, and people shouldn't be shunned or ostracized for weighing more than normal. But at the same time, most people who are overweight are, at least in the eyes of people who work in this field for a living, like Dr. Walter C. Willett, professor of nutrition and epidemiology at the Harvard School of Public Health, overweight because of their lifestyle and not their genetic predispositions. I think we're doing a disservice to everyone by coddling feelings and pretending that weight doesn't have the ability to negatively impact health.

Now to be clear, I don't think everyone should be a size 6, nor do I think being ultra-thin is any better than being seriously overweight. But the condemnation of the so-called "thinspiration" blogs is pretty universal; no one seems to think they are a healthy concept, no one seems to think that they are standing up against some great medical conspiracy or anti-thin hysteria. In fact, just about everyone seems to think they are very unhealthy mentally and physically, and something should be done about them. I just wonder why blogs on the other side, making the argument from a "fatspiration" rather than "thinspiration" point of view don't receive the same critiques.


Unknown said...

I love you darling, but you're missing several points.

A. No one in the Fatosphere is advocating sitting on the couch and eating donuts to the exclusion of all else.

B. The "people don't know how many calories they really eat" smacks mightily of "lying fatties, you just won't admit how much you eat."

C. Plenty of people who exercise and eat right will never be thin. FatGirlOnaBike does triathalons for fuck's sake. Check out the BMI project for what she looks like.

No one is advocating "giving up" per se. We're advocating not wasting hideous amounts of energy and worry on an unattainable goal.

If you want citations and shit, check out the JunkFoodScience blog or Kate Harding's Shapely Prose. You should be able to find it pretty easy by googling the name. Both of these sites use copious citations. There really isn't a health = thin correlation. There are incredibly unhealthy thin people, just as there are people bigger than me who can run circles around me.

Kelly Hills said...

A) Never said that they did. And as a healthy size 14/16 myself, who's probably never going to get much smaller than that, because I'd have to surgically shave down my shoulder blades ;-) , I recognize that we can't all be size 8's. But I am very disturbed by the idea of accepting something like being morbidly obese. I don't have a specific "size" cut-off in my head, since being a size 14/16 will be much different on someone who's 5'10 than someone who's 5'.

I simply think it does do a major disservice to encourage people that they can be 5' tall, wearing a size 32, and healthy. It's one of those things where I have a hard time even picturing how that could be (and is probably influenced by knowing people in that size and height range who are not healthy).

B) Which is specifically why I cited an article that talked about the general public, and the move NYC is making to require all restaurants who currently provide calorie information to provide it on the menu next to the item. It's not limited to fatties, it's an everybody perception problem. People don't realize how many calories are in a soda, for example. And there have been lots of studies, from Cheesecake Factory to the movie theatre, where researchers just ask people to tell them approximately how many calories are in the item they're eating. People almost always underestimate by a significant amount.

Again, it's not a problem with fat folks - this is just a problem with everyone. We're detached from food, from portions, and caloric concepts.

C) True - which is why I said very clearly that I don't think everyone should be a size 6. I don't - I'd be a hypocrite if I did. :-)

I'm familiar with the blogs you mention - I read them too - and they are part of the reason for the concern. Like I said, I see dangerous health correlations between thinspiration and fat acceptance - where people embrace unrealistic expectations of their bodies.

People come in all shapes and sizes, that's true. But the level of obesity in our society *is* a new phenomenon, that can be tied to things as diverse as modernization to high fructose corn syrup and poverty. And just because it's new and a third of the adult American population qualifies as overweight, with approximately 10 million statistically considered morbidly obese, doesn't mean it's okay.

The folks who do watch what they eat, to make sure they're not consuming more calories than they expend, who exercise several times a week, lift weights, and do all those healthy things people should be doing, and then level out at a larger size - they're the ones doc's run tests on and go "okay, you're healthy - still over the ideal weight, but I can't find anything wrong with your cholesterol or blood pressure or..." and etc. And encouraging people to *that* seems like a grand thing - people should be fit and healthy, and that should be the worry, not waist measurement.

But that's not what healthy at every size promotes, because it *does* give the idea that you can be healthy at *any* size - and that's just patently not true. And the sentiments being expressed in justification of it, "eat that cheesecake" and "love your fat" and "don't try to change" - these are things that are promoting health. If nothing else, healthy at every size should clearly mean make changes - get up, exercise, consider what you're eating, etc.

Children are a great example of this. Kids are getting heavier, and we know it. And we can also see a very simple correlation with what kids eat and how much exercise they do/don't get. There was a case covered locally a bit ago where a very obese 7 year old girl (I think she was around 135lbs) said that she should love her body at the size she's at and not have to diet or lose weight... the message is getting out there, and I think it's just as dangerous as telling girls they have to be Barbie-thin.

Anonymous said...

Thought-provoking post.

I think one of the major issues is that we really aren't very sure of why people become obese to begin with. Food science is extremely uncertain; there's a lot we don't know. There's nothing wrong with uncertainty, of course, but that's often not how it is presented.

It's also not entirely clear whether obesity levels are really increasing at all, especially when we segment the evidence to morbid obesity, which is what we really need to be concerned about (because it's the only kind of obesity for which we can robustly correlate negative outcomes). In no small part this is because of the arbitraryness of BMI, which you do note in the post.

And even if obesity levels are increasing, we really don't understand why they are increasing. The usual suspects: less exercise, more sedentary behaviors, actually do not stand up very well to inspection in the epidemiologic literature, which raises the question of why they are so often treated as self-evident explanations for a self-evident "obesity epidemic" which, as it turns out, is not so self-evident at all.

This is what leads many fat scholars and activists -- and I think Gard and Wright's book on this is the best, with analysis of over 1200 studies -- to conclude that ideology and stigma plays a substantial role in obesity discourse and policy.

This is why I wouldn't equate the Fatosphere to "thinspiration" blogs, though I'm not saying you're suggesting they be equated. The crucial difference is that fat is stigmatized in ways that thin is not, and accordingly, I think there is a much greater social need for fat acceptance than thin acceptance.

Finally, what bothers me so much about the lifestyle model of disease is its tendency to drill attention down to individual behavior regardless of the social and economic conditions that powerfully structure and shape individual behavior.

It's true that smoking is the leading cause of preventable death, but it's also true that smoking follows a strict social gradient, and the same is true for obesity. It's all well and good to tell morbidly obese persons they need to change their behavior, but if we pay no policy attention to the conditions that tend to produce high incidence of morbid obesity among socially and economically disadvantaged populations, not only are our policies unlikely to be effective, but we increase the likelihood of stigmatizing further already marginalized persons.

Kelly Hills said...

Oh, I agree, Daniel - it's one of those situations where any blog discussion has to skim the surface, if only because there is so much recent research.

If I actually had to place one pointed finger at the (morbid) obesity problem, I'd say it's the utter proliferation of high fructose corn syrup everywhere in our diet. Pollan makes a convincing argument for it, and for things like diabetes and weight increasing in a pretty even rate with its distribution through society. It also nicely explains just why we see such high rates of morbid obesity in the lower income brackets.

Re: thinspiration v fat blogs, while the social norm certainly is not fat, it's also not the thinspiration side of things. (And really, I'd hesitate to even call the social norm thin, since that implies a binary, and we know that there's obviously degrees of thin as well as degrees of fat, and somewhere in there must be the healthy median.)

A great pop culture example of this is that Bravo "Make Me a Supermodel", where they measure and weigh the contestants every week. They encourage most of the people to lose weight, tonne up, etc - but one girl continually is told she's way too thin, she needs to stop losing weight - and they freak out when she talks about not eating. So there is definitely pressure on the models to be thin, but once they trip a certain point, it's a bad thing.

I think the thing I'm most uncomfortable about is that fact that right now, what is too fat or too thin is a matter of a Stewartean "I'll know it when I see it." I wish we could find some way to get quantifiable results that were broadly applicable, only because it would do more to advance the idea of healthy acceptance of the body at it's natural/balanced point than anything else.