Tag Archives: weight loss

The 1% efficacy rate and weight loss as a prescription

Prescription

Talk to nearly any person over a size 12 and chances are, they have run into a doctor or medical professional who recommended that their health would improve if they would only lose weight.  Whether that person went to a podiatrist for help with their feet or a gyno for a pap smear or an optometrist to get an eye exam, chances are at least one of these medical professionals has stated that the solution for these health woes is that the patient simply lose weight.

Let’s take a look at that prescription for just a moment.  Just how likely is it that one of these people is going to lose any kind of significant weight (and keep it off for any period of time)?  A recent study, conducted by a team at King’s College suggests that this prescription is pretty unlikely to be successful.  For moderately fat people (BMI 30-35) the chances of returning to a “normal weight”  (heavy airquotes here) and staying there for a year is one in 124 for women and one in 210 for men.  For very fat people (BMI 40-45), the chances drop to 1 in 677 for women and 1 in 1290 for men.  The chances for losing only 5% of body fat were greater (one in 10 for women and one in 12 for men) however the majority of these folks gained the weight back within 5 years.

Keep in mind that there is no evidence that this very tiny percentage of people who had lost weight lived any longer or healthier than those who had not lost weight.  While there is some correlation of people who have always been thin and certain health benefits, there is virtually no statistical evidence that the microscopically small group of people who manage to maintain a significant amount of weight loss over the long term enjoy any health benefits at all over the people who don’t.

So, can we talk?  Can somebody tell me why, exactly, medical professionals are suggesting a “treatment goal” which in the very, very most optimistic scenarios can be achieved by 10 percent of those who try it and on the low end has a less than 1 in 1200 chance of being achieved?  And can anybody tell me why we recommend this strategy when there is virtually no evidence that in the rare case it will be achieved it will do any good?

Let’s talk about this in terms of a pill.  We tell the patient that they have somewhere between a 10%  and a .1% chance of even being able to ingest the pill.  And in the long term, so few people are able to keep this pill down long enough to test, that we don’t have really any convincing evidence that the pill does any good at all.  The side effects from even trying to take this pill range from frustration to eating disorders to weight gain, to poor nutrition to death.  So what on this God’s green earth is the point?

I think it’s time to recognize that weight loss is not a behavior–it’s a condition.  And that weight loss as a prescription is probably not worth the paper upon which it is printed.

Love,

Jeanette DePatie AKA The Fat Chick

P.S. Want me to come speak at your school, office, organization or group?  Learn more about my speaking at http://www.jeanettedepatie.com.

Docs Admit Diet and Exercise Don’t Equal Weight Loss, Then Jump to Wrong Conclusion

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An article hit my feed from LA Times today and it seemed to offer some refreshing news.  It seems 4 doctors, weight-loss specialists set out to say what so many of us have been saying for so long now.  They admit that for the vast majority of obese children and adults in this country, telling them to eat less and move more is a prescription for failure.

They acknowledge that once a fat body begins to lose weight, a whole lot of processes, hormonal and otherwise kick in.  Hormones increase hunger signals.  Metabolisms slow down.  The body struggles to maintain the weight.

Furthermore, the 4 weight loss experts admit that a body that has lost weight are biologically quite different from bodies that have never been fat.  One states:

“Few individuals ever truly recover from obesity,” the authors wrote. Those that do, they add, “still have ‘obesity in remission,’ and are biologically very different from individuals of the same age, sex and body weight who never had obesity.” They are constantly at war with their bodies’ efforts to return to their highest sustained weight.

So far, so good.  Many of us have been pointing out the studies that show these results for years.  So after this, those docs recommend a behavior-based approach where we focus on exercising and eating well for their own sakes (as both have been demonstrated to improve health regardless of whether or not they are accompanied by weight loss), right?  Right?

Well, as it turns out, no not so much.  The docs are suggesting that we simply increase awareness of other tools for weight loss (pills, potions, surgeries and devices) and turn to them sooner.  They suggest we increase fear mongering in the overweight to help keep them from becoming obese.  They suggest a greater focus on weight maintenance for those who have lost weight in order to help them keep it off.  (They somehow neglect to tell us how this is going to work or how it will help.)

The funny thing is, that the doctors see the stigma.  They see how telling patients to just eat less and move more is cruel, since it for the most part doesn’t work.  They see how stigmatizing fat patients and simply labeling them as non-compliant isn’t the answer.

But they simply substitute in another bad answer.  And this bad answer is likely to drag along much more devastating side effects than the original bad answer.  At least suggesting people move their bodies more and eat more nutrient-dense foods is likely to improve health, regardless of whether or not it leads to the holy grail of weight loss.  While pills and potions and surgeries and devices are slightly less ineffective than diet and exercise alone for weight loss, these methods can also carry significant dangers like increased heart rate, higher blood pressure, heart defects, permanent disfigurement, malnutrition, depression, suicide and death from other causes.  And there is not much evidence that in the long run, the few people who do sustain weight loss from the pills and potions and surgeries and devices end up any healthier than the people who stayed fat.

Meanwhile, there is ample evidence that eating well and exercising have a positive impact on health regardless of whether they are accompanied by weight loss.

So why on earth are we not just focusing on healthy behaviors here?  Why do we insist on focusing on weight loss at all?  Well these docs do label themselves as weight loss specialists and that may have a lot to do with it.  And as a society, we do love to blame fat people for stuff.  So I guess they took a few steps out into the light and then fell into a deep, dark hole.

Oh well.

I for one am going to continue my focus on living the best life I can in the gloriously wondrous body I have now.  So if you’ll excuse me, I’mma gonna get on with it.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want me to talk about evidence-based medicine and wellness at your school or organization?  Learn more HERE.

Belty at CES: Comfortable Technology or Uncomfortable Community Rorschach Test?

If you follow the technology news at all,  you know that Vegas hosted the annual Consumer Electronics Show (CES) this week.  And if you follow the news at CES at all, you’ve probably heard about a new gadget from France that has been one of the darlings of the media this week.  This gadget, called Belty, is a smart belt.  Following the wildly popular electronic wearables trend, this digital belt adjusts to you–loosening or tightening to keep a steady grip on your waist.  So for example, if you stand up, the belt tightens.  When you sit down, and your tummy is slightly squished it loosens.  If you eat a meal, it loosens slightly.  If you come back from your high colonic, it tightens slightly.  Get the idea?

The belt also functions as an activity tracker and buzzes gently to let you know if you have been seated and sedentary beyond a certain set limit.  The belt is not yet for sale, nor is there a clear indication when it might be.  The product is kind of silly and the name is ridiculous.  So one might wonder just why it has garnered so much press.

Well some have speculated the media attentions stems from the fact that it is new, and extremely visual and lends itself to iPhone video shots of the belt developer/model’s crotch.

But I think the real reason this thing is in the media so much is that it provides an opportunity for everybody to weigh in on the “obesity crisis”–often while utilizing extremely bad puns.

Stuff tv’s headline is simple and accurate.  “Hands on with Belty–The smartbelt that adjusts itself to your waistline.”  Simple and factual.  Thumbs up for Stuff TV.  USA Today says that “Belty wants to make losing weight a cinch!” Get it?  See what they did there?  CNBC calls the product “A smart belt that knows when you are getting fat.” (Sort of like Santa Claus, it knows when you’ve been eating…) Yahoo Health says “World’s First Smart Belt Self-Adjusts to Signal Daily Weight Fluctuations”.  Well okay, it does tell an app on your smart phone when your waistline changes in either direction.  Some have suggested that the app shames its wearers with headlines like “Adjustable belt shames you into exercising more”.

Actually the belt does contain fitness tracking information.  It does buzz gently if you have been “sitting too long”.  But there is little evidence that the app does any shaming of any kind.  It tracks your waistline, but unlike other apps I’ve reviewed, it doesn’t call you names or  yell at you.  It buzzes gently, but it doesn’t give you an electric shock like the pavlovian bracelet I’ve talked about before.

In fact, all the while that some are touting the weight loss benefits of the product, others are criticizing it for “promoting obesity”.  To be clear, it doesn’t appear that the product plays happy theme music when your waistline increases (although that would be kinda cool).  There’s no “fat cat” feature that deposits money in your bank account as your girth gets larger.  Some have suggested that by the very fact the belt ever loosens, thus making you less miserable when your pants are too tight, encourages people to pile on the pounds.

The amazing thing to me isn’t that there’s a big, clunky, digital belt that gets bigger and smaller by itself.  The amazing thing to me is the sheer range of value judgements we impose on such a piece of tech.  The level of emotional stuff that the media and people in general are willing to heap on any product that has anything to do with body size, waist size and weight is remarkable.

Look people, sometimes a whirring clunky digital belt is just a belt.  Let’s just reclaim our collective minds and move on, okay?

Love,

Jeanette DePatie (AKA The Fat Chick)

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Body Love is not a Pant Size

Let me be clear.  I think people should learn to love their bodies, full stop.  I don’t think they have to wait until they lose ten pounds to love their bodies.  And I CERTAINLY don’t think they should “love their bodies enough” to lose ten pounds.  If you want to lose ten pounds and you can safely lose ten pounds and it makes you happy then you should go for it.  I mean, it’s your body and you should do whatever you think is best.  But let me be clear.  I don’t think body love means fixing up your body in a way that is more socially acceptable and then grudgingly deciding it’s okay.  And I don’t think insisting that other women do to their bodies exactly what you chose to do to your body in order to learn to love their bodies is okay either.  I think body love means being grateful and happy for your body the way it is right now.

Let me be clear about another thing.  Loving your body isn’t always easy.  We are surrounded by images and toys and directives and advertising that convinces us that we can only love our bodies after certain conditions are met.  We are told we can love our bodies after we get rid of stretch marks and cellulite and age spots and wrinkles and back fat and rolls and achieve a perfect thigh gap.  In fact we are encouraged to love our bodies ENOUGH to spend the gobs of money and time purchasing creams and potions and pills and exercise torture devices and DVDs and costly and painful medical procedures to ensure that our body no longer has cellulite or wrinkles or stretch marks or age marks or chubby thighs and is finally, eventually (for the moment) acceptable.

And  loving our bodies isn’t always easy, because as we age, our bodies change.  We sag in places we didn’t.  Strange marks appear on our skin.  Our bodies are sometimes less able to do things they could before.  We have to pee all. the. time.  And sometimes we get sick.  And if we get sick, there are plenty of people including medical professionals, large multinational companies, friends, families and complete strangers eager to tell us that if we had only tried their procedure or exercise or potion or pill or program or cleanse we wouldn’t have gotten sick in the first place.  They tell us if we had loved our bodies enough to fix our bodies the way they said we should, everything would have been okay.   So sometimes it’s hard to love our bodies.

Body love can be a rewarding but often frustrating and deeply confusing process.  That’s why I get so angry about companies and experts that are taking the “body love” theme and turning it into a tool to sell their “body improvement” messages, products and other crap.  Because that ish is NOT OKAY.  If you want to sell body improvement.  Sell that.  Sell the heck out of it.  But don’t make body acceptance conditional on the thing or the process or the potion or pill or exercise torture device or major surgery you are selling and then call it body love.

There have been some striking examples of this in the past.  One that immediately comes to mind is Kellogg’s and Marilyn Wann.  You see, my dear friend Marilyn Wann came up with this amazing idea.  She makes bathroom scales that say positive words like “sexy” or “beautiful” instead of numbers.  Go to about 1 minute in to the video below to see what I mean.

Now a while after Marilyn’s wonderful Yay! Scale was released for sale, Kellogg’s released a scale that looked pretty darn similar.  What’s wrong with that?  Well aside from the fact they seem to have “borrowed” an idea from an inventor without giving credit or compensation, they were using their scale to promote the idea that you should replace meals with cereal in order to lose weight.  And the promotion around the new scales had the tagline, “What will you gain when you lose?”.  Check it out in the video below:

This strongly implies that those words on the scale will apply to your body only after you lose weight using their products.  You see the difference between the two messages?

Look, I don’t think loving your body means that you stop doing things to care for your body.  I don’t think loving your body means you can’t change anything about your body.  But I don’t think body acceptance should be conditional on those things.  It’s the difference between “I’ll love my body after I”, or “I love my body enough to change it” and “I love my body.  Oh and I’ll do this too.”  It’s subtle, but it’s important.

It’s important because we are seeing other companies and special interest groups using the power of the body love movement to dress up body improvement products and schemes.  And that’s not only confusing, but dishonest and wrong.

Love,

Jeanette DePatie (AKA The Fat Chick)

 

New Study Finds that Losing Weight Won’t Make You Happy

 

In the past I’ve talked about how fat people can be happy without losing weight.  Now a new study confirms something else I’ve known for quite a while, that losing weight won’t necessarily make you happy.  The study, while still managing to pontificate about the “health benefits” of losing weight, points out that fat people who lost more than 5% of their body weight tended to be more depressed than those fat people who didn’t lose more than 5% of their body weight.  In fact, after adjusting for health issues and major life events (like losing a spouse) those who lost more than 5% of their original body weight were more than 50% more likely to be depressed than the group that lost less weight.

The study press release goes on to suggest that of course you should still lose weight because it’s good for your health.  And the study is careful to suggest that correlation is not causation, so we don’t know that the weight loss causes depression.  (BTW this is a good practice that is curiously absent in many press releases about the health risks of obesity, but I digress…)  And the study suggests a few possible reasons why this depression might be happening.  They use a lot of flowery language, but it boils down to:

1.  Constantly dieting and not eating what you want and weighing and measuring every morsel of food you put in your mouth takes a lot of energy and kind of sucks.

2.  When you win the weight loss lottery and your life is not as wonderful as promised, it can be a major letdown.

And I suspect both of these suggested reasons are totally true.  Constantly fighting the fact that your body is HUNGRY and you want to eat takes a lot of energy.  Watching your friends eat fabulous stuff while you order the fish (steamed please, no butter) and vegetables (steamed please, no butter) and salad (dry with cruets of vinegar and oil on the side) gets old really fast.  And don’t even get me started on weighing and measuring and obsessive point/calorie counting.

And let me remind you about the big fat cycle.  One of the major triggers for the big fat cycle of weight loss and gain is fantasy.  We are taught that when we are thin our lives will be perfect.  We will be beautiful.  We will be like movie stars.  Men or women (depending on your preference) will be standing in line to take us out and buy us fabulous stuff because we are gorgeous.  Our health will magically be perfect.  We will be pain free.  We will climb mountains and become CEOs of multinational corporations because that’s what thin people do.  Look out for me, baby!

Then we (at least temporarily) get  thin.  And we are the same.  Our lives are much the same.  A few people who weren’t interested in dating us before may become interested.  But instead of feeling elated about that, we feel hurt and kinda pissed off.  We wonder why we weren’t good enough to date before.  And we wonder about the fear of dating somebody who will drop us when we gain some or all of the weight back.  People tell us how fabulous we look now.  And again, it kind of hurts.  We wonder what they thought about how we looked before we lost the weight.  We still feel pain.  We still get sick.  We fail to climb mountains or climb the corporate ladder.  We are simply smaller versions of ourselves with the same frustrations, insecurities, problems, challenges, frustrations and crud in our lives as before–except without cookies.  No cookies are anywhere.  And people wonder why weight loss can be accompanied by a side of depression?

This is why a behavior-based approach to health is so much better.  There is no before and after.  There just is.  I feel better when I exercise, so I exercise.  I don’t have to do something I hate.  I don’t have to do things that feel like punishment.  I don’t have to build up some ridiculous fantasy about how my life will change when I do it.  I find exercise that I like.  I know I feel better when I do it.  So I do.  It’s pretty simple really.

I know that when I eat too much of certain things, I feel kinda icky.  So I don’t usually eat too much of certain things.  Sometimes I do.  Sometimes I know I’m going to feel kinda icky and I eat it anyway and I enjoy it.  But I don’t like feeling icky so the next day I probably won’t eat too much of that thing.

I know when I eat a lot of fruits and vegetables, my body feels better.  I don’t count servings or weigh or measure my broccoli.  I don’t eat fruit or vegetables because I won’t allow myself to eat anything else and I’m starving.  I just kinda know I feel better when I eat fruits and veggies so I do.  I eat the ones I like when I am hungry for them.  I don’t imbue them with magical powers.  I am not suddenly going to grow taller or develop forearms like Popeye because I’ve downed a little spinach.  Fruits and veggies feel good, so I eat them.

It may seem revolutionary to some.  But I think when we stop focusing on how our bodies look and start focusing on the messages our bodies are sending us, we feel better.  And I don’t really know if I need a study to tell me that.

Love,

Jeanette DePatie (AKA The Fat Chick)

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Skinny Scientists and Pseudoscience and the New Scientific Method

This week was kind of a bad news good news week for the science of fatties.  On the good news front, Dr. Oz got a very public spanking in Congress for continually touting snake oil “miracle cures” for weight loss.  Claire McCaskill, Chairman of the Senate’s consumer protection panel, brought Dr. Oz to task for presenting a variety of supplements, potions and cures as effective methods of weight loss without having any,  you know, science to back it up.  When grilled by McCaskill, Dr. Oz admitted that some of the “miracle” weight loss cures (like green coffee beans) do not pass scientific muster to be presented as fact.  But he insists that he has studied them himself and recommended them to his own family.  He says he recommends stuff to his audience that he would give his own family.  Which is cool, except he is not described on TV as “Papa Oz” or “Uncle Oz”.  He’s touted on TV as “Dr. Oz”.  And TV watching people are gullible.  If a TV doctor tells them that green coffee supplements will make them miraculously thin, many people believe it is so.  And they think that if a doctor recommends something, there’s a little more scientific proof that it works than “my cousin tried this and it was awesome”.

The fact that Dr. Oz underwent this very public spanking is in some ways very encouraging.  It is in line with many other efforts by the FTC to bring “miracle weight loss” companies to task for making a whole lot of money from lying to people about the effectiveness of their products.  But if Dr. Oz behaves in a way remotely similar to these other weight loss companies (including Jenny Craig and Weight Watchers) we should be prepared for some “bobbin’ and weavin'” in the boxing ring.  After huge fines were levied by the FTC, Weight Watchers and many other competitors have started to put a tiny asterisk after weight loss claims and the teeny-tiny mousetype on the bottom of their ads says “results not typical”.  Which is a start.  But let’s face it.  When you have three glorious examples of anecdata with startling before and after pictures, that little asterisk has to work pretty darn hard.  The FTC said as much in “Gut Check” their new spotters guide to weight loss fraud.  Dr.  Oz will have to begin including his own “asterisk” regarding his “miracle” weight loss cures.  But the guy has his own TV show.  He has writers and editors that are extremely talented.  I have no doubt that he will find a way to appear to follow the letter of the law regarding truth and weight loss, while leaving the spirit of the law firmly behind.

And in this same week, I came across this piece by budding scientist Rachel Fox.  In the piece she describes why she has decided she can no longer pursue a career in science.  She has been told in no uncertain terms that she cannot be a scientist because she is fat.  And being a scientist and being fat just don’t mix.  In the piece, Fox describes the discrimination, both subtle and overt she has experienced as a budding scientist.  At one job interview for an exciting student researcher position at  a prestigious lab, Fox was told that the work was “collaborative” and that the lab didn’t want anybody on board who “was going to eat more than their fair share of the pizza”.  Fox describes other incidents where fellow researchers are appalled that she doesn’t seem to understand the “calories in, calories out” rules of nutrition.  And as we’ve seen with Dr. Terrible earlier this year, scientists and academics seem think they are free to draw whatever conclusions they like about fat and self-discipline because you know, science.

It’s important to understand that science is subject to prejudice and politics just like any other field.  Scientists expressed beliefs about the flatness of the earth and geocentric nature of the universe long past the sell by date of these notions  not because they had evidence, but rather because it was politically prudent to do so.  Modern scientists may not find themselves in an actual dungeon.  But I’m sure many other scientists like Ms. Fox can attest to the notion that doing science while fat can lead to “The Inquisition”.

So, as much as I wish I could jump up and down with glee over Dr. Oz’s trip to the Congressional Woodshed for “making stuff up” to give us fatties “some hope”, I am simply saying let’s wait and see.  When you’ve got a guy with an audience with millions of adoring fans, his own TV show, his own writers, editors, makeup people, lawyers and PR firms, we can expect a whole lot of fancy dancing, and very little scientific fact.  In fact, make it up and make it look good on TV might just be the 21st century scientific method.

 

Love,

Jeanette DePatie (AKA The Fat Chick)

Study Proves “Not all Fat People are Unhappy”–Follow up to indicate Papal Affiliation With Catholicism

PopeCatholicSo I got a notice in my inbox this week that a study has been announced that indicates “Not All Fat People are Unhappy.”  And honestly, my first thought was, “Duh.”  I mean it seems quite obvious to me that not all Fat people are miserable, much as it seems obvious that the Pope is Catholic.  But apparently the notion that not all fat people are sick, miserable, about to die and ready to throw in the towel is something we need to prove again and again.

But you know, before I cast to many aspersions on the study, I think maybe we really just need to look at the headline drawn from the study results.  Because there are actually quite a few interesting things indicated by this piece of research.  Let’s look at a few:

1.  Your happiness seems to have a lot more to do with homogeneity than body size.  If you are a fat person who lives in a town with lots of other fat people, you tend to be more happy than if you live somewhere with no other fatties.

2.  The study creators speculate that being fat does not in itself make people unhappy.  In the accompanying press release, study co-author Philip M. Pendergast states:

“In that light, obesity in and of itself, does not appear to be the main reason obese individuals tend to be less satisfied with their lives than their non-obese peers. Instead, it appears to be society’s response to or stigmatization of those that are different from what is seen as ‘normal’ that drives this relationship.”

3.  Women tend to pay a higher emotional price for being fat than men do.  The study creators speculate that this is because women face more social stigma based on body size then men do.  In the press release Pendergast also says,

“Think about the advertising we see on television or in magazines—we are bombarded by images of thin women, and we are told that is the ideal,”

So here is yet another study that seems to indicate that how we feel about our size may have a lot more to do with our actual health and wellness outcomes than what we weigh.  It follows on the heels of many other studies we’ve talked about on this blog regarding stigma and health outcomes like this one or this one.  And all of these studies lead me to ask one very important question.

Even if we knew how to make people permanently thin (which we do not) should we ask them to change their body size to fit in?  If being different leads to social stigma, and social stigma leads to poor health outcomes, should we encourage everybody to be the same for the sake of their health?

Even if we knew how to make people all be the same size (which we categorically do not) it seems to me that the answer is to deal with stigma rather than to make a completely homogeneous society to reduce stress on everyone involved.  What if we actively worked to fight stigma based on body size?  What if we actively worked to help people accept their own differences?  What if we could feel better about our bodies?  Might we be singing a song like this magnificent lady right here?

I mean just check these fabulous lyrics:

I looked in the mirror
What did I see a brand new image
Of the same old me ohhhh
But now I wonder why should I be surprised
I like the things about me that I once despised

There was a time
When I wished my hair was fine
And I can remember when
I wished my lips were thin

Makes no difference now y’all
How you may feel
I’ve done reached the point
Where I wanna be real
I’m tired of living living in disguise
I like the things about me that I once despised

Let’s face it, Mavis Staples has got it going ON!  But she leads me back to my original question.  Why can’t we take some of this time, money and energy that we are currently spending on stigma-inducing ineffective advertising that convinces people that they not only must be thin, but may easily obtain this state of grace by eating yogurt, and spend it on something that might actually help people feel better?  It will help them feel better emotionally, and it will help them feel better physically.  Why can’t we take some of the time, energy and money we are spending driving wedges into our society, by creating classes of otherness which we can blame for all our problems from the high cost of airplane tickets to soaring healthcare prices and spend it on something that teaches us to celebrate our differences.  It will bring us together.  It will help us live and breathe as a community rather than a simple pile of competitors in a winner-take-all, Victoria’s Secret model competition.  When will we reach the obvious conclusions?  Bears poo in the woods, stigma doesn’t help people, and yes, the Pope is indeed Catholic.

Call me captain obvious if you like.  I’ve stopped spending on diets and weight loss schemes and self hatred because I like the things about me that I once despised.

Love, Jeanette DePatie (AKA The Fat Chick)

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