
Call for an urgent rethink of the ‘health at every size’ concept - DHJSH
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995323/
======
steven777400
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
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
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".

~~~
DHJSH
The HAES people don't seem to have a lot of respect for people at normal
sizes. It's less "Healthy At Every Size" and more "Healthy at MY Size".

~~~
rtl49
Perhaps so for some. The challenge for those of us who are not their size is
to empathize despite the temptation to adopt a belligerent stance in response.

------
sageabilly
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
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.

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

~~~
gmarx
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
_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
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
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

------
mcguire
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
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.)

~~~
rtl49
You haven't written anything I can show to be factually inaccurate. But the
trouble is with one word: "simply."

Unless you subscribe to a metaphysical interpretation of human behavior, the
fact that obesity is such a widespread health problem is _ipso facto_ strong
evidence that some set of environmental factors is at play.

The insistence that this large population of people bear some kind of personal
responsibility for their condition completely misses the point and is, in my
opinion, an obviously useless suggestion to make. I'm not aware of any
evidence that instilling a sense of shame in people who are obese is likely to
ameliorate their condition, and the experience of many would seem to suggest
it is likely to have the opposite effect.

~~~
DHJSH
Eating fewer calories than your body needs every day will always lead to
weight loss. Certainly it's easier if you rearrange your diet, but that's a
secondary point.

~~~
rtl49
You're not engaging with what I wrote. The trouble is with refraining from
consuming so many calories. The fact that so many people find this so
difficult is proof enough that it is not "simple" in the sense of being easily
accomplished, and that environmental factors likely contribute to its
difficulty. Thus attention should be focused on discovering and addressing
these factors, instead of applying social pressure to the obese to eat less.

