Dispelling nutrition myths, ranting, and occasionally, raving


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The irony of #fatlogic

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A few days after my post about the insanity of some government workplace “wellness” initiatives I noticed that I was getting a lot of traffic from a subreddit. Out of curiosity (yes, I never learned from the cat’s misfortune) I clicked on the link to see what it was all about. I discovered a whole little world that I never knew existed. Something called “fatlogic”. Maybe I’m out of the loop (it’s been known to happen) but I’d never heard of fatlogic before.

As far as I can tell this fatlogic is basically the opposite of HAES (Health at Every Size). People who ascribe to this position seem to think that fat shaming is an acceptable way to “encourage” people to lose weight. It’s not just thin people who think this way, there seem to be a number of people who are overweight, or who were overweight, who are staunchly opposed to the notion that people can be healthy and overweight and believe that insulting people who are overweight (or who advocate for HAES) is appropriate.

It was nice of this group to keep their insults to themselves (i.e. voicing them on reddit rather than in the comments on my blog). I was pretty amazed at the vitriol of many of the members of the group. According to them, I clearly had no idea what I was talking about and was a brainwashed moron for believing that weight is not the best indicator of health. The subreddit also went off on a little tangent from what my primary point was. Everyone became fixated on my comments about BMI not being a very good measure of body fat. Herein is one of the clear flaws of their logic. I mean, besides the fact that it’s ignorant and discriminatory. One person mentioned that BMI is a measure of body fat, interpreting that a BMI of 18.5 equates to 18.5% body fat, below which one would be classified as “underweight” according to the BMI. The thing is, BMI doesn’t measure body fat. That 18.5 is not a percent; it’s technically kg/m2. BMI is a body mass index intended to classify people as underweight, normal weight, overweight, and obese based on ranges of this index. Someone with a BMI of 18.5 could have 8% body fat or 30% body fat. This is one of the reasons why BMI is widely considered to be an inaccurate tool for measuring weight (and health). You could be very fit and lean and have the same BMI as someone who leads a sedentary lifestyle and has a significantly higher percentage of body fat.

I know that it goes against the basic tenets of the Internet but wouldn’t it be nice if people actually knew what they were talking about before they attacked others? Ever notice how it’s generally those who are the most vocal who know the least?


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Licence to eat?: My thoughts on classifying obesity as a disease

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Sometimes I need a little time to percolate on a subject before I weigh in. This was one of those times. A couple of weeks ago the American Medical Association decided to classify obesity as a disease. This, of course, created quite an uproar. On one side, there are the people who are saying that this will lead to a decrease in personal responsibility for the condition as well as those who believe that it will mean those of us who are not obese will be footing the bill for surgeries and new obesity drugs (1). On the other side, there are those who believe that this will lead to increased efforts to curb rising obesity rates and may be beneficial to those who are suffering from obesity (2).

Personally, I’m not sure that calling obesity a disease will lead to any improvements in obesity rates but I certainly don’t see it causing any harm. Considering how well we’ve being doing reducing obesity rates thus far I figure that classifying obesity as a disease is worth a shot. While I agree with the point made in the Globe article that the current use of BMI to measure obesity is highly flawed I would also like to point out that there are other measurements of obesity being developed (e.g. the Edmonton Obesity Staging System) and perhaps the classification of obesity as a disease will lead to wider use of these more accurate tools.

I also take issue with the notion that classifying obesity as a disease will lead to people throwing up their hands and saying “not my fault, I have a disease” and then going for a big mac meal deal. When alcoholism was classified as a disease in 1956 did alcoholics cheer and say “now I have a licence to drink!”. No. The classification raised served to raise awareness that this was a serious medical condition and increased treatment availability and options.

Did anyone else notice the photos of headless obese bodies accompanying the news articles? I hope that this classification will lead to increased sensitivity toward those who are obese.

My concern is not with the classification of obesity as a disease (keep in mind that over weight is not the same thing as obese and that individuals who are over weight may indeed be healthier than their “healthy” weight counterparts but yes, I am concerned that this classification may detract from the notion of health at every size) it’s with our current medical model in North America. Our focus is on treatment when it should be on prevention. This goes for all diseases, not just obesity. In Canada, our system will cover many treatments once you’ve fallen ill but will not cover most preventative measures. We need to start covering (at least some of) the cost of things like dietitians, certified personal trainers, gym memberships, sports equipment, etc. regardless of disease state. In the long-run it would be a lot less costly to keep people healthy in the first place rather than waiting until they become ill to provide medical and professional supports.

Yes, there is much more than our medical system that needs to be involved in preventing and curing obesity. Our food systems, environment, and societal structure are major contributors to our current high levels of obesity. However, as we’re talking about the AMA classification today I wanted to focus on the medical side of the issue.

So, these are some of my thoughts on the subject. I’ve seen many other thoughts out there as well, mostly from medical professionals and the media. What I’d really like to see are thoughts from those who are most likely to be directly affected by the classification of obesity as a disease. If any of my readers, or anyone you know, is currently (or was ever) obese and would like to share your thoughts on the recent classification of obesity as a disease by the AMA I would love to hear your thoughts on this subject. Please email me at dmc555 [at] gmail [dot] com to let me know what your thoughts are. With your permission, I will share your thoughts in a future blog post.


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Man vs food industry

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A recent “article” – actually a “commentary” which apparently does not need to be grounded in reality – by Patrick Luciani refuted the view that the food industry is at the root of the obesity epidemic.

He begins by pointing out that BMI is flawed (which is true) but this does not mean that we don’t have an excess of overweight and obesity in Canada as Mr. Luciani would have us believe. Just because the measurement tool isn’t accurate doesn’t mean that we don’t have a problem.

Luciani continues by suggesting that some people choose to be fat and are content with their weight. Yes, there certainly are people who are overweight and are perfectly content and healthy. However, there are also many others who are unhappy with their weight and who are suffering negative consequences both social and health.

His third argument is that humans have always been gluttons and that the onus is on us as individuals to control our eating; not on the food industry. These three arguments don’t seem all that cohesive to me.

I certainly agree that the food industry is not entirely to blame for the state of obesity in our country. It’s got many different causes and the food industry is but one of them, albeit a large one.

For once I was really impressed with the comments on this article. Rather than rephrase them I’m going to share a few below:

1. The writer is promoting a harmful line of thought when he says:

“And modern medicine has made it easier to carry around that extra weight. Cholesterol-controlling statins, diabetes and blood-pressure medications and bariatric surgeries have lowered the medical costs of those few extra pounds.”

What we take from this is that an unhealthy life-style is no problem – just take some pills.

The treatments he casually mentions have their own limitations and side effects. Aside from this, many older people are suffering from weight exacerbated joint problems that severely impair their mobility and/or require costly surgery.

 

2. Some of us like the way we are just fine. Some of us don’t.

I didn’t…

 

3. Such paper thin arguments piled up to justify the author’s agenda. The BMI is flawed (which it is) so there is no obesity epidemic? There were some overweight people 300 years ago so we can ignore the things that are leading to so many of us being overweight now. There was a poorly designed tax in another country that didn’t work so we should just give up on broader solutions. People are overweight because they simply choose to eat more and that’s uninfluenced by our evolutionary drives, our upbringing, or our environment that encourages overeating (research would beg to differ).

The insinuation that public health advocates are inflating the crisis for their own benefit is a typical projection by those who do view the world from a “what can I gain” perspective, not the “how can we best help people help themselves” approach advocated by those who want to do something.

It’s no wonder the author’s book was nominated for a Donner Prize as it furthers the Donner Foundation’ agenda to denigrate what communities and governments can do and put the blame on the individual.

 

4. This author’s opinion is truly a stretch. What percent of the population do professional athletes make up? Definitely not enough to impact the overall obesity statistics. There are many, many reasons for people gaining weight, but all age groups are getting heavier and this needs to be addressed. In our current lifestyles making the healthier choices is the more difficult choice and any way we can change this is worthwhile. Trying to deny or explain away the obesity statistics is not helpful.

 

 


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The best weight for longevity

Counteracting many of the resolutions surely made earlier this month was the release of a study showing that being overweight is linked to greater longevity. This study was actually a meta-analysis of previous studies. While meta-analysis may seem to be a great way to reach a conclusion (how can compiling the results of many other studies not be beneficial?) this is not necessarily the case. There are a number of concerns regarding meta-analyses. Flaws with this particular meta-analysis may include the inclusion of studies with very small sample sizes, potentially heterogeneous results (if the results of the studies were quite different, drawing a conclusion based on these studies is inappropriate), there may also be publication bias (if studies with conflicting results are not being published then they can’t be included in the meta-analysis).

Beyond the problems with using meta-analysis, there are additional concerns regarding the present study and the resulting news reports. Despite the study clearly demonstrating that all classes of obesity were associated with “significantly higher all-cause mortality“, reports tend to gloss over this fact. Even if the finding that lower risk of mortality is associated with overweight, there is still higher risk associated with obesity. We also know that correlation does not equal causation. There may be another common factor causing increased longevity in overweight individuals.

While there has long been an associated found between underweight and mortality causation is difficult to argue. Thus, the current study may merely be observing the fact that when people are ill they lose weight and are more likely to die.

Classification by BMI, as was done in this study, is also not particularly useful. BMI is not an accurate representation of health. It would be interesting to learn what the results would have been had the studies utilized the Edmonton Obesity Staging System.

Further to the last point, this study does not take into account health-span. That is, just because a person lives longer does not mean that they are necessarily healthy for those extra years – if it is even years, the study simply found that during the study period, those who were overweight were 6% less likely to die than were “normal” weight people this percentage is so small that it may even be due to chance. We know that overweight and obesity are associated with increased risk of a number of health problems, such as, hypertension, diabetes, heart disease, gout, and some types of cancer.

Meta-analyses like these can’t tell you what’s best for you as an individual. Everyone is going to be at their happiest and healthiest at different weights. It’s up to you to decide what that means for you.