October 11, 2009
Public Health Messages To Overweight People Mean?
One of the defining attributes of our era is an excessive desire on the part of our intellectuals to restrain other people from being mean to various groups of less fortunate people. In a blog post about how people like to signal their domination (no kidding, and economists have still not come up with an economic system that works while allowing everyone to feel dominant) economist Robin Hanson argues that public health messages aimed at fat people are basically cruel to those fat people.
Yet it is completely crazy to imagine that fat folks have not yet heard that fat might be unhealthy or unattractive. Believe me, they’ve heard! If they are choosing to be fat, they are doing so reasonably informed of the consequences. Our constant anti-fat “public health” messages are not at all kind – such messages just serve to put fat folks down, and lift the rest of us up. If anyone is so clueless as to need constant reminders, it is those who can’t see their own over-bearing domination, such as putting down fat folks to lift themselves up.
Being a hyper-rational economist Hanson assumes (incorrectly) that everyone knows where they stand in terms of being overweight and what consequences they face as a result. Um, no. One third of the overweight do not even believe they are overweight and the denial at the obese level is much higher.
A National Consumers League survey conducted by Harris Interactive in 2007 found that adults consistently identify themselves as being less severely overweight than they actually are. Eighty-two percent of obese people surveyed considered themselves to be simply overweight; among those who were in fact only overweight, close to 1 in 3 believed that they were normal weight.
I bet the majority of obese people can't list most of the increased medical risks that come as a result of being obese. In case you want to know, among the increased risks from obesity: insulin resistance, diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease, allstones and cholecystitis, and sleep apnea. That list is far from complete. Also add osteoarthritis and gout. Then there's your brain: increased risk of dementia and Alzheimer's Disease. I doubt most obese people know they are at increased risk of all these diseases or even most of them.
A lot of true and not nice facts need constant repetition.
It's even worse for smokers. Some of my students consider smoking a sort of social or ethical failure.
One of the major problems with obesity is that it's contagious. Your eating habits and self-image are affected by watching those around you. This means that the fattest, most over-indulgent eater can set the bar for what people around them think is acceptable behavior. I may be a little pudgy, but at least I'm not as huge as my neighbor...
"The children are right to laugh at you, Ralph."
- Miss Hoover
People who smoke or are overweight (due to lack of discipline) deserve to be ostracized in society.
I think the above poster is quite correct - both behaviors impose a social cost on others and can directly effect the health of those around them.
Like you say Randall - people are in denial - and need to be innundated with educational messages - and imho should have penalties associated with such behavior - like increased medical insurance costs (or conversely reduced costs for healthy weighted non-smokers)
Now I do not believe these behaviors should be outright outlawed - that's tyrannical foolishness - but this is the information age and there's no reason anymore to soft peddle important health advice to the proles.
I go on dating websites sometimes which have body-type designations in the profiles. The number of overweight women who pick "average" instead of "a few extra pounds" or "overweight" is not insignificant.
I'm all well and fine with castigating the obese. However there is another not nice true fact that needs to be repeated more: Our food supply sucks!
Industrial vegetable oils, process sugar, processed grain, artificial colors/flavors, food additives galore, feeding antibiotics/hormones/ground pieces of meat to cows, fruits breed to be sweeter than they were naturally, unhealthy conditions for animals, I could go on and on and on. Almost everything that most people eat is compromised in some significant health impacting way. It needs to be repeated more often that we know very little about what effect all these altered modern foods have on people. It also needs to be repeated more often that the food industries primary interest is profit. Like so many institutions, they exploit human ignorance all at the expense of health.
Randall, you frequently decry the decline in human capital in the USA. Keep in mind that one way to mitigate that problem is to improve the food supply.
I agree about fructose. I'm going to write a big post on this one of these days and feature Robert Lustig's tirade (haven't clicked on your youtube link but assume it is Lustig's 90 minute lecture on fructose as toxin). I like that Lustig gives a historical baseline of 15 grams a day of fructose for our ancestors. Gives us a number to shoot for.
What I can't find: A good chart of common foods with grams fructose per 100 grams of food. I want to include that in the post to better guide people. Know of good sources for grams of fructose in various foods?
I've cut back on ketchup and other foods that contain corn syrup. I would suggest everyone else do likewise. I'm going to use tomato paste to make fructose-free ketchup substitute.
Yes, our food supply has lots of lousy stuff in it. The problem is our evolutionary legacy where our ancestors mostly died from calorie malnutrition. Our cravings for calories combine with modern tech to yield junk foods.
Note that I have blog archives just on the brain and nutrition. See, for example, Aging Diet Brain Studies and Brain Nutrition.
I think it would make more sense to browbeat fat people if anyone had an effective therapy to offer. No one does. There are NO studies in the medical literature in which any diet, exercise, or drug therapy has been applied to a group of fat people and made a majority of them thin for a period exceeding five years. I would call that a failed therapy. Ask yourself: how many people do you know in your own life who have significantly changed their body size and sustained that change for a long period of time (meaning years)? Such people do exist, but they are exceedingly rare, so rare that most of us have never met one. For an interesting discussion of these issues, try http://www.tcsdaily.com/article.aspx?id=100704F
Michael Pollan wrote an interesting article about a month ago, effectively saying the biggest health problem we have is not with insurance, but with our diet.
"Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet."
In Pollan's book "In Defense of Food", he explains how confusing the information that's been disseminated about food has been over recent decades.
"But if real food -- the sort of food our great grandmothers would recognize as food -- stands in need of defense, from whom does it need defending? From the food industry on one side and nutritional science on the other. Both stand to gain much from widespread confusion about what to eat, a question that for most of human history people have been able to answer without expert help. Yet the professionalization of eating has failed to make Americans healthier. Thirty years of official nutritional advice has only made us sicker and fatter while ruining countless numbers of meals."
I think people would eat healthier, if they understood the importance of eating real food. But avoiding "food-like substances" is not as easy as it should be. When I started trying to eat healthier and avoiding stuff like corn syrup, I was surprised to see it's even in some whole wheat bread, as well as ketchup and many other foods. I try to make more food from scratch now, and it's really not too time-consuming. Also, I avoid eating restaurant meat. But if our food supply were better, then I'm sure our population would be healthier.
Randall: I am not fat because of ignorance, nor stupidity. You will simply have to take my word for it, that I am well aware of every health problem you mention, and have been so for a very long time, perhaps longer than you have been alive. Hanson is much closer to the truth than you are. But, that is not news either. I figured the politics of fat out back in the Carter administration, after I quit smoking.
And Lono: I guess we just won't be friends, but that is OK, because your attitude is scarcely a model of charity or humanity.
I think you are an outlier in your awareness. Smart people tend to underestimate how much smarter they are than everyone else. It is hard to imagine ignorance.
I agree, a very large number of diets have been failures. It is striking. But have they all failed? I wonder whether high protein diets work better by displacing fructose. Is fructose reduction key?
My fear is that fructose causes permanent changes in the brain that make appetite reduction very difficult.
But that doesn't mean there are no alternatives: for the morbidly obese bariatric surgery causes a net mortality risk reduction if one first survives the immediate risks of the complications. I've read that the complication rates are declining though.
High fructose corn syrup is the most problematic near as I can tell. I'd like to buy unsweetened versions of a large assortment of foods such as breads, ketchup, and sauces.
I have been obese and I have been in perfect athetic condition - and I am currently (once again) in transition from the former to the latter.
I have seen too many friends and relatives die and be injured by unhealthy lifestyles (such as smoking or overeating/poor eating habits) that resulted from poor time management or lack of discipline.
It is simply unexcusable in this day and age - if you have medical issues, certainly, you should not be judged as deficient any more than anyone else with a legitimate handicap - but any reasonable adult who does not take positive steps towards improving their mind AND body simply deserves the criticism their poor chocies may lead too.
And it is now more important than ever for the intellectual elite of countries everywhere to stand up and provide an excellent example of what civilized man is capable of - given the benefit of education and life-enhancing technology!
I never purposely discriminate against those who are obese - but the more primitive parts of my being will always favor the athletic over the unhealthy - and this is one of those instances when our primal nature is pushing us in the right direction to lead healthier, stronger, and longer lives.
Weight Watchers always works - btw - since it simply follows the well established facts of caloric consumption and elimination. The problem is - people lose the weight - and then chose to over-eat again for social reasons.
Weight Watchers always works IF you stop following your population after they have lost weight. Within five years essentially 100% will have regained all of their weight. Actually, the norm is generally one to two years, but there are a few outliers, so the five year figure is safer. It is possible to override one's genes temporarily, but eventually they will reassert themselves. Lono, it sounds as if you are familiar with this cycle. When you once again regain your weight, please remember this and try not to be too hard on yourself.
Losing weight and keeping it off, is possible even with minimal time for exercise. If there's not enough time for exercise, calories must be slowly cut, until weight-loss takes place, and kept at a level sufficient to maintain the attained weight(protein supplementation is most likely needed to maintain the required .8g per kilogram of body weight, under a low-calorie diet. Muscle mass loss, must be minimized, some resistance training may be required.). If time for exercise is available, calories can be increased, and balanced with increased exercise activity to avoid weight gain(Increased activity demands higher protein intake, which should be covered in the food or through supplementation.).
Of course, it takes strong will to do so and keep doing so. Increasing one's capacity to will this, and keep doing it, is where one should focus at. My own take, is that from time to time you have to give yourself meals or days when you're allowed to eat more freely. If you don't take a break from time to time, you're probably going to break completely and turn away from such a program.
Yes - that's it exactly - and that's why, Mike, I feel the Weight Watchers program is the only really scientific no-nonsense approach to weight loss.
One simply increases activity while decreasing caloric intake - in the appropriate ratio necessary to burn fat reserves.
If someone regains the weight it is simply because they chose not to follow the scientific formula anymore - not because the approach has any factual flaws.
Many times people simply do not realize they are taking in more calories through drinks than they are in food - or that the food they eat has an unusually high calorie count - simple (yet tastey) dietary substitutions can correct this situation - and one need not pay Weight Watchers anything to use their formula's for success.
Once one is educated on the caloric equation, balancing it simply becomes a matter of discipline, (or will), and can be accomplished by any committed individual.
If one does not have the will to succeed then perhaps that is the area that first needs more work - most Humans, however, are creatures of habit that will maintain good habits established to replace previously unhealthy ones.
Yes, thanks for the links. Along those same lines you may find this blog post interesting discussing studies that suggest that modern foods are overstimulating and thus addicting: http://wholehealthsource.blogspot.com/2008/03/superstimuli.html.
Mike Westbrook, Lono
Part of the problem is the bad information pushed by the status quo in nutrition and again, the food supply. The people that make the most sense nutrition-wise are those advocating paleo-style or traditional diets. Some of the best models for healthy lifestyles come from indigenous and traditional societies, however that is definitely not what the conventional wisdom is selling (I will admit however that the CW appears to be slowly getting better). Unfortunately few that attempt lifestyle change see through the rhetoric espoused by (largely advertising) the mainstream.
It is wrong to say all medicine has to offer for obesity is bariatric surgery. Behaviour modification programs built around ketogenic diets are very effective. They don't bring anywhere near as much money to a hospital, clinic or doctor as a surgery does so naturally the industry pushes potentially life-threatening surgery instead, and most doctors remain completely oblivious to them when they really belong as first-line medicine.
The problem is most doctors are ignorant and the vast majority of their patients are even worse than doctors can imagine. My own current obesity is an iatrogenic injury involving inappropriate prescription of an anti-depressant having weight gain as a known side-effect.
When I approached one doctor about supervising a reduction diet, he basically told me I would have to endure days of excruciatingly painful and potentially life-threatening muscle spasms before he would give me a scrip for prescription strength potassium. Such an aversive experience is hardly the way to encourage a behaviour modification program.
And I am reminded of the doctor who told a cousin of mine not to cut out anything from his diet but "just eat a normal diet" when he put him on a diabetes drug instead of referring him to a nutritionist without stopping to consider what a former meth addict would consider normal. My cousin was eating about 10 meals a day each consisting of a can of coca cola and a bag of potato chips while telling people that's what his doctor told him to eat.
For treating obesity, a really useful treatment would be anything that causes selective apoptosis of adipose cells when a formerly obese person loses weight. Once the adipose tissue grows by hyperplasia, the proliferation of nuclei, mitochondria and other organelles fundamentally alters the individual's metabolism making even relatively complex carbohydrates essentially toxic.
You say (with my emphasis added):
Once the adipose tissue grows by hyperplasia, the proliferation of nuclei, mitochondria and other organelles fundamentally alters the individual's metabolism making even relatively complex carbohydrates essentially toxic.
I read a report a year or so ago where researchers rather painstakingly tried to measure whether fat people have more fat cells. They claim they found that, no, fat people do not have more fat cells. I can't remember whether I did a post about it. I probably came across it on Eurekalert.org.
I was curious about the question because I'm curious to know whether liposuction reduces obesity. I'm also curious because fat tissue has stem cells. What for? To make new fat cells or only to make new blood vessels?
Interesting. That would suggest fat, much like muscle, grows almost exclusively by hypertrophy and not by hyperplasia. That would be a very remarkable finding requiring remarkable evidence. Has the result been reproduced?
I am also more interested in whether formerly fat people have more fat cells than normal weight individuals who have never been overweight.
Anything that reduces flab without surgery would help too.
I got lucky and found the study again. From 9-May-2008 DOE/Lawrence Livermore National Laboratory :
New technique determines the number of fat cells remains constant in all body types
LIVERMORE, Calif. - The radioactive carbon-14 produced by above-ground nuclear testing in the 1950s and '60s has helped researchers determine that the number of fat cells in a human's body, whether lean or obese, is established during the teenage years. Changes in fat mass in adulthood can be attributed mainly to changes in fat cell volume, not an increase in the actual number of fat cells.
These results could help researchers develop new pharmaceuticals to battle obesity as well as the accompanying diseases such as high blood pressure and diabetes.
A new study by Lawrence Livermore National Laboratory scientist Bruce Buchholz - along with colleagues from the Karolinska Institute in Sweden; Humboldt University Berlin, Foundation of Research and Technology in Greece; Karolinska University Hospital; and Stockholm University - applied carbon dating to DNA to discover that the number of fat cells stays constant in adulthood in lean and obese individuals, even after marked weight loss, indicating that the number of fat cells is set during childhood and adolescence.
Carbon dating is typically used in archaeology and paleontology to date the age of artifacts. However, in this application, which appeared in the May 4 early online edition of the journal Nature, the scientists used the pulse of radiocarbon to analyze fat cell turnover in humans.
Click thru and read the rest.
Interesting. Even if the cell count does not increase, weight gain must change the cells themselves affecting surface area, various receptors etc. So perhaps not apoptosis but something to change the fat cells themselves to have fewer receptors, organelles and less surface area. Either way, we don't have it yet, and I'll be happy when we do.
I know, once I became obese, I could not eat as glycemic a diet as I could previously. I have observed some of my thin friends eat diets I would find far too glycemic without gaining weight. Even after I lost weight, my body was far too efficient at clearing carbohydrates from my bloodstream. I basically have to stick with high-fiber fruits and vegetables combined with moderate amounts of high-quality lean proteins to stay thin. I pretty much have to avoid starches entirely.
As a person who has struggled with obseity for a long time, who has gone on rigorous diet and exercise programs, only to gain it all back, I have ZERO TOLERANCE for the idiots who believe that some public health messages are going to solve the problem.
A few posters here have it right - obesity is an extremely difficult disease to treat.
Those who think it's just a matter of "making choices" are either clueless or hopelessly arrogant. They should ask themselves why, if their approach was so great, there are a lot of fat teenage girls who suffer every hour of every day from the social consequences. There's a fellow I work with who had bariatric surgery some years back, and all the behavior mod, etc (I only did 5 years of behavior mod, nutrition, etc). He's gained a bunch of weight back recently.
As far as I am concerned, those who lecture us about obesity (and imagine that we don't know how bad it is, as if we just love being fat) are either friggin bigots, or, more likely, far more ignorant about the real issues of obesity than those of us who suffer from it.
Someday medicine will unravel the complexities of this disorder, but it doesn't help to imagine that it is just a matter of education or will power or the right diet or whatever.
Too those it applies to.. take your moralizing and stuff it.
Bite me! (It'll reduce my weight for a few weeks)_