7 ms·

Call for an urgent rethink of the ‘health at every size’ concept

42 points by DHJSH 11y ago

sbierwagen 11y ago
(2014) The authors followed up this article with a subsequent article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039050/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039050/
vox_mollis 11y ago
In modernity, hurt feelings are the ultimate sin, public health be damned.
- astazangasta 11y ago
  Not surprising in a world that is increasingly virtual; the space of subjective reality supersedes objective reality.
- rtl49 11y ago
  On the other hand, self-acceptance by those we dislike is often derided, to the detriment of finding solutions to these social problems instead of assigning blame. For myself, I've found suppressing my initial feelings of hostility toward people who promote incorrect ideas and providing an emotionally neutral answer is a more useful approach than derision, sarcasm, and other such behaviors.
- duaneb 11y ago
  Really? I thought chocolate cake was sinful.... Health, and especially weight, are very moral issues to Americans.
- gmarx 11y ago
  Hurting peoples feelings does not improve their health. My guess is (I don't know you) looking down on fat people is one of the mechanisms by which you make yourself feel worthy. You are not doing it from their benefit. Believe me, it is a vanishingly rare person who is fat and doesn't mind it. The fat acceptance movement is about feeling helpless and just wishing people would stop giving you a hard time on top of it
  - vox_mollis 11y ago
    My guess is (I don't know you) looking down on fat people is one of the mechanisms by which you make yourself feel worthy I can correct your guess, here. Looking down on my fat former self is one of the mechanisms by which I keep myself healthy.
    - rtl49 11y ago
      We quickly lose sight of what it was like to have been a certain way. Whatever the origin of your unhealthy weight, and whatever purpose a negative evaluation of your past self serves, I think most would agree that derision is unhelpful as a tool for reducing obesity. On the other hand, its prevalence and the language many use while doing it seem to suggest that they find it gratifying. Some consider this a problem in itself.
      - gmarx 11y ago
        I definitely think almost all of them find it gratifying but admitting to such is shameful, thus the pretense and alternative explanations like they care about healthcare costs for society
steven777400 11y ago
This is significant as well in that it points out that people can legitimately struggle with overweight eating issues as the brain adapts and makes people more hungry. I struggled a lot with losing weight and continue to struggle with keeping it off. It's frustrating when some folks (presumably, who have never struggled with weight and eating, and the psychology issues with eating, such as eating to feel good and then feeling depressed because of overeating) say simplistic things like "just don't eat so much" or "try having a salad". It's not that being big is healthy; it's not. It's that breaking the cycle of being big is hard (for some).
- rtl49 11y ago
  I agree. Earlier this year I read an article highlighting just how extraordinarily rare it is to overcome morbid obesity in adulthood and maintain this progress indefinitely without medical intervention. Ultimately, we need to accept that our bodies, including the organ which gives rise to our behavior, are physical systems subject to occurrences entirely beyond our conscious control. I've not dealt with obesity personally, but I would speculate that many of the people who enjoy "fat shaming" are unfamiliar with the experience of having internal conflicts which lead one to take actions that are obviously irrational, even to the person performing them. This is an area where more empathy would lead to greater mutual understanding and perhaps increase the probability of finding solutions. (Of course, finding this empathy is perhaps a similar challenge.)
  - Frondo 11y ago
    I think you're touching on the heart of the tension behind the "health at every size" movement. I know a couple of people who are big advocates of it, and surprise surprise, they're all pretty fat. They're still wonderful people, and I of course don't respect them less because they're fat. You know, for me, it's like..who cares? It's not my body. I'm even pretty sympathetic to how much difficulty they have doing basic stuff, just for having their joints and muscles carrying around an extra hundred pounds. But it really seems to me that what's going on is that they're reacting to the constant onslaught of fat-shaming and moral judgments with this ideology of "health at every size". There is a constant moralizing about fat people in our culture, like if you're fat you're lazy or bad or whatever, none of which is warranted. But I think that's where things get muddled--culture turns fatness into a moral failing, wrapped under a sheath of health concern trolling. Reaction to the moral judging is to try and take away the health claims, when that's really kind of missing the point. What would be appropriate, I think, is to push for "human dignity at every size," you know, and leave the moralizing to stuff that matters. But that's not so catchy or easy to distinguish, I guess... As for the actual health claims, I, for one, don't buy it at all, it seems obvious to me that carrying around excess weight is going to cause a number of immediate problems (joint strain, etc), to say nothing of the strain on your organs for being encased in excess fat. But the health stuff is separate from the moralizing, and I don't know how you'd get the larger culture to separate out "you're fat and it's hurting your body" from "you're fat and you're lazy/stupid/etc".
sageabilly 11y ago
Nutrition is such a vast science, one where new theories and ideas are coming almost every month and one where the general public is either completely uneducated or working off of decades-old assumptions (such as following the surgeon general's dietary guidelines from the 70s or 90s). It's no wonder to me at all that a vast majority of people regardless of their current size have zero idea what to do to eat healthily. I became interested in the Health At Every Size movement during its inception as part of recovering from an eating disorder and, at its core when it was first started, it had a very positive message- essentially "Hey, everyone, let's promote the idea that we all should eat healthy food and get exercise and do fun active stuff regardless of if we're fat or thin or old or young or tall or short." It was a direct challenge to the idea that you had to be a particular size to be active or to go to the gym or to do active hobbies. However very soon after inception it was perverted into a message of "It is entirely possible to be healthy regardless of how fat you get and if you are fat and your doctor says that you are not healthy because you are fat then it is your doctor who is wrong because it's never, ever wrong to be fat, ever." Message #1 was great as it was all about promoting eating healthier regardless of your size, getting regular exercise that was fun and that you enjoyed doing regardless of your size, and about being gentle with yourself during that process- so stepping away from hating yourself because you were fat and instead doing something productive with that brainpower. Message #2 corrupted that into "You are perfect because you are fat and if anyone tells you that you should be less fat then they're trying to abuse you and make you change to suit them." I'm extremely excited about the nutritional research that's coming out regarding gut microbes and their potential impact on our health and weight because I imagine how awesome it'd be to go to your doctor, spit in a cup, and have it tell you what all you should and shouldn't be eating (due to genetics, microbes, etc) as well as recommend which probiotic you should be taking to get your gut bacteria in line.
- rtl49 11y ago
  I've long disliked the amount and kind of attention the mainstream media devotes to covering research in nutritional science. Not only does it confuse people, even those with scientific training, its vacillation also undermines the public's confidence that science is a valid approach to understanding the world. Still, I'm not convinced that public confusion on the subject of nutrition is a leading cause of widespread obesity. An environmental or social explanation seems more probable than simple ignorance. After all, obesity is less of a problem in many less educated societies, despite an abundance of food.
mcguire 11y ago
If you're interested, Dr. Amanda Sansbury-Salis[1] has a book out, The Don't Go Hungary Diet: The Scientifically Based Way To Lose Weight And Keep It Off Forever[2]. You can read the first chapter on her website. [1] http://www.dramandaonline.com/ http://www.dramandaonline.com/ [2] http://www.amazon.com/The-Dont-Go-Hungry-Diet/dp/1863255230 http://www.amazon.com/The-Dont-Go-Hungry-Diet/dp/1863255230
DHJSH 11y ago
300,000 people die every year from Obesity. It's our #1 killer. And it can be solved by eating less. See this study in the NEJM: http://www.nejm.org/doi/full/10.1056/NEJM199212313272701 http://www.nejm.org/doi/full/10.1056/NEJM199212313272701 Discrepancy between Self-Reported and Actual Caloric Intake and Exercise in Obese Subjects Of all the "diet resistant" subjects studied, ALL of them (100%) were grossly underreporting actual calories consumed and overexerting physical activity. Some of the people in this study were on medication because doctors had believed their self-reported numbers and believed they may have had thyroid or other metabolic problems. Remember that "bariatric surgery" is just a way to get people to eat less by making it physically impossible to overeat. (Of course, people still manage.)
- thatswrong0 11y ago
  Except _what_ you eat has a big factor in how much you eat. Some foods are more satiating than others. Some are more addicting than others. So eating less may also require eating different.
  - cookiecaper 11y ago
    Yes, and the problem is that our food supply is optimized to be more addictive, because it allows everyone in the supply chain to make more money. Quite literally every commercial entity is against an individual eating filling, low-calorie foods, because it means they're spending less money on food in general. This is on top of the evolutionary forces that already make our bodies crave super-high-calorie food. It's a lot for someone to fight. Experiment: go to Wal-Mart and try to buy maple syrup (actual maple syrup; mostly what they call syrup at Wal-Mart is literally just water, corn syrup, and dye). Now try to buy canned pears without any added sweeteners (if you find one without sugar, it has Splenda). Now try to buy a loaf of bread without any added sugar (most loaves contain brown sugar). Almost everything in almost every conventional grocery chain in the U.S. is loaded with sugars, sweeteners, and other addictive substances. Even if you try really hard to buy healthy foods at a normal grocer, you are going to have a hard time. Not everyone with a weight problem is shoving 50 Snickers down their gullet every day, and that characterization has to stop if we're going to realistically address the issue.

42 points by DHJSH 11y ago

(2014) The authors followed up this article with a subsequent article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039050/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039050/

vox_mollis 11y ago

In modernity, hurt feelings are the ultimate sin, public health be damned.

astazangasta 11y ago
Not surprising in a world that is increasingly virtual; the space of subjective reality supersedes objective reality.
rtl49 11y ago
On the other hand, self-acceptance by those we dislike is often derided, to the detriment of finding solutions to these social problems instead of assigning blame. For myself, I've found suppressing my initial feelings of hostility toward people who promote incorrect ideas and providing an emotionally neutral answer is a more useful approach than derision, sarcasm, and other such behaviors.
duaneb 11y ago
Really? I thought chocolate cake was sinful.... Health, and especially weight, are very moral issues to Americans.
gmarx 11y ago
Hurting peoples feelings does not improve their health. My guess is (I don't know you) looking down on fat people is one of the mechanisms by which you make yourself feel worthy. You are not doing it from their benefit. Believe me, it is a vanishingly rare person who is fat and doesn't mind it. The fat acceptance movement is about feeling helpless and just wishing people would stop giving you a hard time on top of it
- vox_mollis 11y ago
  My guess is (I don't know you) looking down on fat people is one of the mechanisms by which you make yourself feel worthy I can correct your guess, here. Looking down on my fat former self is one of the mechanisms by which I keep myself healthy.
  - rtl49 11y ago
    We quickly lose sight of what it was like to have been a certain way. Whatever the origin of your unhealthy weight, and whatever purpose a negative evaluation of your past self serves, I think most would agree that derision is unhelpful as a tool for reducing obesity. On the other hand, its prevalence and the language many use while doing it seem to suggest that they find it gratifying. Some consider this a problem in itself.
    - gmarx 11y ago
      I definitely think almost all of them find it gratifying but admitting to such is shameful, thus the pretense and alternative explanations like they care about healthcare costs for society

steven777400 11y ago

This is significant as well in that it points out that people can legitimately struggle with overweight eating issues as the brain adapts and makes people more hungry. I struggled a lot with losing weight and continue to struggle with keeping it off. It's frustrating when some folks (presumably, who have never struggled with weight and eating, and the psychology issues with eating, such as eating to feel good and then feeling depressed because of overeating) say simplistic things like "just don't eat so much" or "try having a salad". It's not that being big is healthy; it's not. It's that breaking the cycle of being big is hard (for some).

rtl49 11y ago
I agree. Earlier this year I read an article highlighting just how extraordinarily rare it is to overcome morbid obesity in adulthood and maintain this progress indefinitely without medical intervention. Ultimately, we need to accept that our bodies, including the organ which gives rise to our behavior, are physical systems subject to occurrences entirely beyond our conscious control. I've not dealt with obesity personally, but I would speculate that many of the people who enjoy "fat shaming" are unfamiliar with the experience of having internal conflicts which lead one to take actions that are obviously irrational, even to the person performing them. This is an area where more empathy would lead to greater mutual understanding and perhaps increase the probability of finding solutions. (Of course, finding this empathy is perhaps a similar challenge.)
- Frondo 11y ago
  I think you're touching on the heart of the tension behind the "health at every size" movement. I know a couple of people who are big advocates of it, and surprise surprise, they're all pretty fat. They're still wonderful people, and I of course don't respect them less because they're fat. You know, for me, it's like..who cares? It's not my body. I'm even pretty sympathetic to how much difficulty they have doing basic stuff, just for having their joints and muscles carrying around an extra hundred pounds. But it really seems to me that what's going on is that they're reacting to the constant onslaught of fat-shaming and moral judgments with this ideology of "health at every size". There is a constant moralizing about fat people in our culture, like if you're fat you're lazy or bad or whatever, none of which is warranted. But I think that's where things get muddled--culture turns fatness into a moral failing, wrapped under a sheath of health concern trolling. Reaction to the moral judging is to try and take away the health claims, when that's really kind of missing the point. What would be appropriate, I think, is to push for "human dignity at every size," you know, and leave the moralizing to stuff that matters. But that's not so catchy or easy to distinguish, I guess... As for the actual health claims, I, for one, don't buy it at all, it seems obvious to me that carrying around excess weight is going to cause a number of immediate problems (joint strain, etc), to say nothing of the strain on your organs for being encased in excess fat. But the health stuff is separate from the moralizing, and I don't know how you'd get the larger culture to separate out "you're fat and it's hurting your body" from "you're fat and you're lazy/stupid/etc".

sageabilly 11y ago

Nutrition is such a vast science, one where new theories and ideas are coming almost every month and one where the general public is either completely uneducated or working off of decades-old assumptions (such as following the surgeon general's dietary guidelines from the 70s or 90s). It's no wonder to me at all that a vast majority of people regardless of their current size have zero idea what to do to eat healthily. I became interested in the Health At Every Size movement during its inception as part of recovering from an eating disorder and, at its core when it was first started, it had a very positive message- essentially "Hey, everyone, let's promote the idea that we all should eat healthy food and get exercise and do fun active stuff regardless of if we're fat or thin or old or young or tall or short." It was a direct challenge to the idea that you had to be a particular size to be active or to go to the gym or to do active hobbies. However very soon after inception it was perverted into a message of "It is entirely possible to be healthy regardless of how fat you get and if you are fat and your doctor says that you are not healthy because you are fat then it is your doctor who is wrong because it's never, ever wrong to be fat, ever." Message #1 was great as it was all about promoting eating healthier regardless of your size, getting regular exercise that was fun and that you enjoyed doing regardless of your size, and about being gentle with yourself during that process- so stepping away from hating yourself because you were fat and instead doing something productive with that brainpower. Message #2 corrupted that into "You are perfect because you are fat and if anyone tells you that you should be less fat then they're trying to abuse you and make you change to suit them." I'm extremely excited about the nutritional research that's coming out regarding gut microbes and their potential impact on our health and weight because I imagine how awesome it'd be to go to your doctor, spit in a cup, and have it tell you what all you should and shouldn't be eating (due to genetics, microbes, etc) as well as recommend which probiotic you should be taking to get your gut bacteria in line.

rtl49 11y ago
I've long disliked the amount and kind of attention the mainstream media devotes to covering research in nutritional science. Not only does it confuse people, even those with scientific training, its vacillation also undermines the public's confidence that science is a valid approach to understanding the world. Still, I'm not convinced that public confusion on the subject of nutrition is a leading cause of widespread obesity. An environmental or social explanation seems more probable than simple ignorance. After all, obesity is less of a problem in many less educated societies, despite an abundance of food.

mcguire 11y ago

If you're interested, Dr. Amanda Sansbury-Salis[1] has a book out, The Don't Go Hungary Diet: The Scientifically Based Way To Lose Weight And Keep It Off Forever[2]. You can read the first chapter on her website. [1] http://www.dramandaonline.com/ http://www.dramandaonline.com/ [2] http://www.amazon.com/The-Dont-Go-Hungry-Diet/dp/1863255230 http://www.amazon.com/The-Dont-Go-Hungry-Diet/dp/1863255230

DHJSH 11y ago

300,000 people die every year from Obesity. It's our #1 killer. And it can be solved by eating less. See this study in the NEJM: http://www.nejm.org/doi/full/10.1056/NEJM199212313272701 http://www.nejm.org/doi/full/10.1056/NEJM199212313272701 Discrepancy between Self-Reported and Actual Caloric Intake and Exercise in Obese Subjects Of all the "diet resistant" subjects studied, ALL of them (100%) were grossly underreporting actual calories consumed and overexerting physical activity. Some of the people in this study were on medication because doctors had believed their self-reported numbers and believed they may have had thyroid or other metabolic problems. Remember that "bariatric surgery" is just a way to get people to eat less by making it physically impossible to overeat. (Of course, people still manage.)

thatswrong0 11y ago
Except _what_ you eat has a big factor in how much you eat. Some foods are more satiating than others. Some are more addicting than others. So eating less may also require eating different.
- cookiecaper 11y ago
  Yes, and the problem is that our food supply is optimized to be more addictive, because it allows everyone in the supply chain to make more money. Quite literally every commercial entity is against an individual eating filling, low-calorie foods, because it means they're spending less money on food in general. This is on top of the evolutionary forces that already make our bodies crave super-high-calorie food. It's a lot for someone to fight. Experiment: go to Wal-Mart and try to buy maple syrup (actual maple syrup; mostly what they call syrup at Wal-Mart is literally just water, corn syrup, and dye). Now try to buy canned pears without any added sweeteners (if you find one without sugar, it has Splenda). Now try to buy a loaf of bread without any added sugar (most loaves contain brown sugar). Almost everything in almost every conventional grocery chain in the U.S. is loaded with sugars, sweeteners, and other addictive substances. Even if you try really hard to buy healthy foods at a normal grocer, you are going to have a hard time. Not everyone with a weight problem is shoving 50 Snickers down their gullet every day, and that characterization has to stop if we're going to realistically address the issue.