Tuesday, July 21, 2009
There's a group of us dietitians who are exploring the idea of eating competence (sort of like Intuitive eating) and health at every size... and recognizing that the research is equivocal on these issues, so we should explore all sides. This is from the NY Times, cited on the American Dietetic Association listserv email:
July 16, 2009
Tossing Out the Diet and Embracing the Fat
By MANDY KATZ
FIVE-FOOT-NINE and 184 pounds, Kathryn Griffith, a retired teacher in Oakland, Calif., counted calories for decades, trying everything from the grapefruit diet to a regimen based on cabbage soup. She also did Weight Watchers — 27 times. “I knew it wouldn’t be successful, but I went back anyway,” she said.
So earlier this year, just when Oprah, the nation’s über-dieter, renewed her resolve to snack on flaxseed, Ms. Griffith went the other way, joining a tenacious movement that is scorning the diet industry and what one pair of bloggers labels, “the obesity epidemic booga booga booga.”
This movement — a loose alliance of therapists, scientists and others — holds that all people, “even” fat people, can eat whatever they want and, in the process, improve their physical and mental health and stabilize their weight. The aim is to behave as if you have reached your “goal weight” and to act on ambitions postponed while trying to become thin, everything from buying new clothes to changing careers. Regular exercise should be for fun, not for slimming.
“Fat acceptance” ideas date back more than 30 years, but have lately edged into the mainstream, thanks in part to public hand-wringing by celebrities like Oprah, Kirstie Alley and the tennis player Monica Seles, who said she had to “throw out the word ‘diet’ ” to deal with her weight gain. (Oprah now cites her goal as being not “thin,” but “healthy and strong and fit.”)
Even television is bellying up to the bar, with Lifetime’s introduction of a hefty heroine in “Drop Dead Diva” and a show having its premiere this month on Fox that stresses the “reality” in reality TV. The show, “More to Love,” matches plus-size dates with a bachelor boasting “a big waist and an even bigger heart.” And elbowing the weight-loss guides on “health” bookshelves, is a spate of new, more diet-neutral books that track the sociology of obesity, including “The End of Overeating: Taking Control of the Insatiable American Appetite” (Rodale Books) by David Kessler, the former F.D.A. Commissioner, and “The Evolution of Obesity” (The Johns Hopkins University Press) by Michael L. Power and Jay Schulkin.
Adding credence to the “fat acceptance” philosophy, are recent medical studies that suggest a little extra fat may not be such a bad thing. Among the latest is a 12-year Canadian analysis in last month’s Obesity journal that confirmed earlier findings that overweight “appears to be protective against mortality,” while being too thin, like extreme obesity, correlates with higher death risk. Other recent studies have linked weight cycling (or “yo-yo dieting”) to weight gain, and to medical conditions often attributed to obesity.
Many appetite warriors have coalesced under the banner of “Health at Every Size” (or HAES), which is also the title of a book by Linda Bacon, a nutrition professor at City College of San Francisco. Ms. Bacon ran a federally financed, randomized trial to compare outcomes for 78 obese women who either dieted or were schooled in Every Size precepts. The results, published in the Journal of the American Dietetic Association in 2005, showed that HAES participants fared better on measures of health, physical activity and self-esteem. Neither cohort lost weight.
These pro-fat results are a trickle, admittedly, in a flood of contrary reports that condemn obesity as a health risk. But that doesn’t worry the online denizens of the “fatosphere,” dominated by irreverent sites like fatshionista.com Fat Rant and Big Fat Blog, as well as those of the “booga booga” bloggers, Kate Harding (Shapely Prose) and Marianne Kirby (therotund.com). “Fat doesn’t equal lazy or ugly or even, necessarily, unhealthy,” says another blogger, the Fat Nutritionist.
Find it all too much of a stretch? You’re not alone. Antidiet advice defies a $30-billion weight loss industry, a cultural obsession with thinness and the fundamental public health tenet that it is dangerous to be fat. In Obesity Guidelines first published in 1998, the government’s National Heart, Lung and Blood Institute blames obesity for everything from heart disease to cancer. Within a month of the Canadian mortality report, University of Wisconsin researchers announced in Science that calorie-restricted rhesus monkeys seemed to be outliving an amply fed control group.
“Virtually everyone who is overweight would be better off at a lower weight,” said Walter Willett, chairman of the nutrition department at the Harvard School of Public Health. “There’s been this misconception, fostered by the weight-is-beautiful groups, that weight doesn’t matter. But the data are clear.”
What remains undisputed is that no clinical trial has found a diet that keeps weight off long-term for a majority. “If they really worked, we’d be running out of dieters,” said Glenn Gaesser, professor of exercise physiology at Arizona State University and author of “Big Fat Lies: The Truth About Your Weight and Your Health.”
Both sides agree that regular exercise, at any size, improves health. “If you want to know who’s going to die, know their fitness level,” said Steven Blair, a self-described “fat and fit” professor of exercise science, epidemiology and biostatistics at the University of South Carolina. His research indicates that “obese individuals who are fit have a death rate one half that of normal-weight people who are not fit.”
Still, giving up dieting can be a tough sell in a society besotted with Kate Moss’s skeletal build. In “Lessons From the Fat-O-Sphere,” a new book by Ms. Harding and Ms. Kirby, the authors suggest surrounding yourself with nonjudgmental companions as an antidote, and seeking out fat-friendly media like the “Illustrated BMI Categories” photo set Ms. Harding assembled on Flickr.
So, if yo-yo dieting often leads to weight gain, does quitting ever lead to weight loss?
Anecdotal evidence suggests that many ex-dieters do slim down, especially if they are young. Even Ms. Griffith, the retired teacher who is 67, lost several pounds after quitting. Ms. Bacon, 46, ceased dieting in her 20s and wound up quite slim, as did Susie Orbach, a psychotherapist who, as author of “Fat Is a Feminist Issue” in 1978, was one of the earliest intuitive-eating proponents. (Her latest book, “Bodies,” published this year, addresses Western culture’s growing obsession with reshaping one’s body.)
But many who quit do not reduce. Ms. Harding, 34, gave up dieting five years ago. “I thought, ‘O.K., maybe I could be a size 10, and it won’t be so bad.’ As it turned out, I ended up as roughly an 18, which was exactly where I started.”
Yet, more than size-acceptance may be involved in quitting. For many dieters, “the pursuit of thinness as a dream is a place holder,” said Deb Burgard, a clinical psychologist in Los Altos, Calif., specializing in eating disorders. “It gets in the way of asking, ‘What is it I am dreaming of?’ “
A dieter may think, “ ‘If I could just lose weight, all that will take care of itself,’ so they don’t invest in getting what they want,” she said. Instead, she said, “they invest in weight loss.”