Cutting off our noses in service of our waistlines

Graphic of a nose and a strawberry, and text saying "do you have a great nose?"

As long as there is a wave of fat phobia and moral panic over body weight out there in the science journalism world, we will never be at a loss for something to write about here at Fit is a Feminist Issue.

Here’s the latest headline:

News headline: Just smelling food can make you fat, UC Berkeley study says

News headline: Just smelling food can make you fat, UC Berkeley study says

Is this true?

Graphic saying NO, of course not!

So what’s the deal here?  Well…

Graphic saying "It's complicated".

The news article (found here) summarizes the study below:

…a sense of smell can influence the brain’s decision to burn fat or store it in the body — or a least the bodies of mice.

Researchers Andrew Dillin and Celine Riera studied three groups of mice — normal mice, “super-smellers” and ones without a sense of smell — and saw a direct correlation between their ability to smell and how much weight they gained from a high-fat, “Burger King diet,” Dillin said.

Each mouse ate the same amount of food, but those with a super sense of smell gained the most weight. 

The normal mice ballooned, too — up to 100 percent from the weight they were when the research started.

But the mice who couldn’t smell anything gained only 10 percent of their weight. Obese mice who had their sense of smell wiped out slimmed down to the size of normal counterparts without a change in diet.

Riera said the study, which was published this month in the journal Cell Metabolism, reveals that outside influences such as smell can affect the brain’s functions related to appetite and metabolism.

Okay, that’s fairly interesting.  Looking at the actual article, we see that what it is really about is:

[discovery of] a new bidirectional function for the olfactory system in controlling energy homeostasis in response to sensory and hormonal signals.

That is, Riera et al. found an intriguing new piece of the puzzle of how olfactory (sense of smell) functions interact with the hypothalamus in metabolism regulation.

But it ends with a bang:

the potential of modulating olfactory signals in the context of the metabolic syndrome or diabetes is attractive. The data presented here show that even relatively short-term loss of smell improves metabolic health and weight loss, despite the negative consequences of being on a [high-fat] diet.

Whoa. Hold on a minute.  It sounds like they are suggesting that a plausible treatment for humans (that is, us) in service of weight loss would be to wipe out our sense of smell.  Is that what they’re saying? Well, yeah.

And the news article gleefully reports this:

Using the study’s methods in humans could be possible.

After eating, a person’s sense of smell decreases. So, if a person was eating with a lessened sense of smell, the brain could be tricked into thinking it’s already been fed and choose to burn the calories instead of store them, Riera said.

People struggling with obesity could have their sense of smell wiped out or temporarily reduced to help them control cravings and burn calories and fat faster.

But the article and researchers acknowledge that this “treatment” comes with risks.

Ya think?

Loss of sense of smell is common in chemotherapy, and occurs in a number of diseases and in the course of aging.  This results not only in weight loss but also nutritional deficiencies and other health problems.  In short, it’s not good.

And, it turns out, this is also true:

The mice in the study who lost their sense of smell also saw a significant increase in the hormone noradrenaline — a stress response from the nervous system that can lead to a heart attack if levels are too high.

So let me get this straight:  loss (even temporary) of someone’s sense of smell is associated with adverse health outcomes, including increased risk of heart attack.  And yet this is being considered for humans?

Yes, apparently:

“Maybe once a year you block your sense of smell for a while and then you lose the weight from the year and do it all over again,” Dillin said. “We don’t know yet. There’s a lot we still need to do.”

Yes, there’s a lot you need to do.  Like read up on the literature on the adverse health and other effects of yo-yo weight changes.  And while you’re at it, maybe read a medical ethics book too. And medical history.

My apologies for the snark, but this extreme approach to medical treatments for body weight change and maintenance is not new.  Some of you may recall that in the 70s and 80s, jaw wiring was an approved medical treatment for weight loss.

A picture of a person's mouth, open and showing upper and lower teeth on the side wired together with orthodontia

A picture of a person’s mouth, open and showing upper and lower teeth on the side wired together with orthodontia.

This was not a fringe thing.  Here’s an article in the prestigious medical journal The Lancet from 1977, studying the effects of jaw wiring in patients.  They note that patients lost weight, although

Two-thirds of the patients, however, regained some weight after the wires were removed.

Of course they did–  they were physically unable to eat solid food by the mechanical devices that clamped their jaws together.  They were literally starved.

This form of treatment has fallen out of favor (thank goodness), but hasn’t disappeared completely.  Here’s a current orthodontist website advertising this treatment, and encouraging other dental professionals to get on the jaw wiring bandwagon.

So, wrapping up:  while it is interesting to learn new features of the complicated interactive metabolic processes of mice, and see to what extent those processes are also present in humans, we need to take a big long pause before considering any treatment applications, for a host of reasons, both medical and ethical.

The nose knows a lot; let’s keep smelling.

A picture of a person's nose, smelling a slice of pink grapefruit.

A picture of a person’s nose, smelling a slice of pink grapefruit.

 

 

 

 

 

 

 

Every gram is dangerous, or the newest scary BMI news

A paper clip, which weighs one gram

Sorry to interrupt your holiday weekend (if you’re in Canada or the US) or just your placid Sunday/busy Monday (if you’re somewhere else), but I have to let y’all know that, according to the latest childhood obesity research from the journal Pediatrics, we have to watch out for risks of gaining even a few grams of potential weight gain (much less pounds or kilos).

What am I talking about here?  This headline:

Headline from CNN news story: WIll 100% fruit juice make your child gain weight?

Spoiler:  the answer is no, or at most hardly at all.

But that of course does not sell newspapers, or as they say now, result in lots of click-throughs (actually, I’m not sure what they say now.  Anyone know?  Please tell me).

This research article is about the potential weight gain risks for children of drinking 6–8 ounces (18–23 cl) of 100% fruit juice a day.  When I posted this article on Facebook, a friend commented that fruit juice is bad for kids because it’s bad for their teeth.  There’s evidence for that claim and it seems reasonable.  It’s also included in this research article on recommendations on fruit juice intake for children and adolescents.

So what does the BMI article say?

First, a few numbers, from the article:

1 daily 6- to 8-oz serving increment of 100% fruit juice was associated with a 0.003 (95% CI: 0.001 to 0.004) unit increase in BMI z score over 1 year in children of all ages (0% increase in BMI percentile). In children ages 1 to 6 years, 1 serving increment was associated with a 0.087 (95% confidence interval: 0.008 to 0.167) unit increase in BMI z score (4% increase in BMI percentile). 100% fruit juice consumption was not associated with BMI z score increase in children ages 7 to 18 years.

That is, for children 7–18 years, drinking fruit juice every day had no effect on weight gain.  None.  Zero.  Zilch. Nada.  Bupkes.

The word "zero" in white, surrounded by a numeric zero on a black background.

The word “zero” in white, surrounded by a numeric zero on a black background.

But:  for children ages 1–6, daily fruit juice intake was associated with a 4% increase in BMI percentile.  Please note, that’s not a four-point BMI increase, or 4 pounds, or 4 kilos.  What is it?  This (from the article, p.8):

As an example, consider a 5-year-old girl at the 50th percentile for weight (18.0 kg) and BMI (15.2 kg/m2). An increase of 0.046 to 0.087 BMI z–score U over 1 year translates into an increase in this child’s BMI percentile to the 52nd to 54th percentile: a weight gain of 0.08 kg to 0.15 kg over 1 year. A small amount of weight gain that is not clinically significant at the individual level may gain significance when considered at the population level.

 

Okay, let’s translate some of this.  This study would predict that for say, some 5-year-old girl in the 50th percentile for weight (for her age), could gain .08 to .15 kilos in one year (0r 2.28–5.29 ounces).  That’s the weight of about 2–2.5 Clif bars. The researchers also graciously add that this amount of weight gain is not clinically significant at the individual level.  You bet it’s not!

This amount of potential weight gain, even for small children, is tiny enough to be within the normal variance of weight over time.  That is, IT DOESN’T MATTER.  AT ALL.

Why am I bringing this up to y’all?  After all, this is a study about children, not adults.  I bring it up because it’s another example where we are directed to pay attention to minute changes in body metrics and imbue them with all sorts of alarmist meaning.  The changes that are documented here are admittedly irrelevant to the health and well-being of children.  They are statistically significant (for very small children only), but that doesn’t mean that they mean anything at all for how we should behave or act or respond or live.

Not that I’m advocating for rampant fruit juice drinking on the part of children and adults everywhere.  As I said earlier, there’s other evidence about the effects of fruit juice intake on cavities.  If you’re interested, check it out and do what you will.

Science is a big tent.  People do all kinds of research searching for connections among lots of features of our bodies, our behaviors, our environment, etc.  Sometimes they find big connections, sometimes small ones, sometimes they find nothing.  As consumers of science, especially body weight science, I think it’s important to notice when the results of scientific study are NOT alarming or NOT relevant, even when they feature dazzling metrics (and ominous headlines).

In short, sometimes we need to take our science with a grain of salt.  Which weighs 0.00067 grams (if it’s table salt).

A spoon inscribed with "take it with a grain of salt".

A spoon inscribed with “take it with a grain of salt”.

 

 

Followup on “Fit but Fat” research news

dictionary entry for the word "research"-- careful study or investigation...

This week the mainstream news media rushed to publicize a conference paper given at the European Congress on Obesity that argued that there’s no such thing as “fit but fat”. I posted Wednesday night with some immediate reactions and questions– you can see them here. Many of my questions were about the details of the study, for which we must wait until an article is published.

However, since then, I’ve been thinking more generally:  What does this mean, the idea that there’s no such thing as fit if you’re fat?  Is this right?  And how does all this affect people with a BMI >30 (like me)?  So let me address each of these questions, and you can tell me what you think about my answers.

First, questions about meaning (sorry, it’s the first place philosophers tend to go, but I’ll keep it short):  What does “fit but fat” mean?

When medical professionals say this, they’re generally talking about people with BMIs over 30 (or even over 25), who don’t have any problems like high blood pressure, cholesterol or blood sugar readings, or various markers of potential future heart disease or potential future diabetes.  That is, fit but fat people are healthy people who weigh more than the BMI scale says they should.

Just for fun, when I looked up google images for “fit but fat”, I got this gorgeous picture of two sumo wrestlers locked in a lovely balletic grapple.  Wow.  Don’t they look great?

Two sumo wrestlers locked upside down, grappling, with legs in arabesque position.

Two sumo wrestlers locked upside down, grappling, with legs in arabesque position.

But there’s the “but” to deal with in the “fit but fat” message.  Why the “but”?  Why not “and”?  “But” is signalling that someone is fit, BUT all is not well– that person is also fat (which is not normal or good or healthy or… fill in the blank here).  Even we we say it about ourselves, we are putting ourselves down, as “fat” is often associated with being unhealthy or defective or sub-optimal in some way.  So being fit but fat is not exactly a position of great positivity to begin with.  And now it’s being challenged by this study (to be fair, there are other studies with similar results– BUT there’s not medical consensus on the issue).

And it gets worse.  Saying that it’s not possible to be both fit and fat seems to mean that BMI trumps ALL other factors (genetic, environmental, psychological, etc.) when it comes to determining health and risk for (weight-related) disease.  Is this right?  No– not as stated there.

What medical researchers say holds for a population or group overall does not necessarily hold for particular individuals.  As we say, your mileage may vary.  A lot.  Here’s what the researchers said (this is from Pub Med Health, which doesn’t make money from splashy headlines; for a clear and undramatic account, check it out):

Of the 3.5 million people in the study, 766,900 (21.9%) were obese – of whom 518,000 (14.8%) were obese with no additional risk factors (metabolically healthy).

The researchers found that, compared to people of recommended weight, metabolically-healthy obese people were:

  • 50% more likely to get heart disease
  • 7% more likely to get cerebrovascular disease
  • twice as likely to get heart failure

Metabolic risk factors raised the chances of getting any of these conditions, in addition to obesity.

Compared to recommended weight, metabolically-healthy people, those who were obese and had all three risk factors (diabetes, high blood pressure or abnormal blood fats) were:

  • 2.6 times more likely to get heart disease
  • 58% more likely to get cerebrovascular disease
  • 3.8 times more likely to get heart failure
  • 2.2 times more likely to get peripheral vascular disease

The researchers say their figures were statistically significant; however they were unable to supply the full data with confidence intervals, so we can’t check this.

We don’t know if this research is largely correct.  I have a whole bunch of technical questions about the study (all of which have to wait for the data and the article to be published).  Their work coheres with some studies and conflicts with others.  As always, we will have to wait to see how things go.  Science is complicated.

Now to my last question:  how does this result affect people with BMI > 25 and > 30?

In my view, there may be good news and bad news in answer to this question.  Shall I go with the bad news first?  Okay.

Uptake of the message that you can’t be fit if you’re fat could lead to more weight stigmatization, more fat shaming of people who seem larger than some idealized notion of a person.  This could lead to eroded relationships with healthcare providers and more money spent on useless diets and weight loss programs.  But most importantly:  it could mean less physical activity in the population, which translates into generally lower levels of standard health markers and lower levels of all sorts of features of well-being.

That’s my biggest problem with the news so far.  We don’t know if these researchers got the details right, and we don’t know how to interpret them if they did.  But what we do know is this:  studies consistently show that physical activity is a great predictor of health and a great mechanism for achieving and maintaining lots of features of well-being (e.g. less depression, better sleep).  And unlike body weight, physical activity (which isn’t the same as fitness, but hear me out) is something that a lot of us have some modicum of control over.  Becoming fit (in the various ways we understand that word) has a lot of benefits.  It’s not the only useful life goal, and it’s not of interest to everyone; fair enough.  You do you.  But I don’t want to see its value drowned out amidst the shouts of studies trumpeting the importance of having a lower body weight.  Especially since medicine offers no remotely effective tools for lowering and maintaining body weight over time (except gastric bypass, which as I’ve said many times isn’t designed or an option for most people).

Now to the good news:  if it turns out that scientific consensus develops around this idea– that the main thing that matters to my health (at least some features of it) is my body weight, then this might put pressure on governments to do something about our obesogenic food systems and infrastructure.  They could, for instance:

stop subsidizing corn production;

fund and promote public transportation;

tax sugar-sweetened beverages;

restrict food advertising targeted at children (or anyone, for that matter);

to name a few.

Are any of the actions above going to happen because of one research article?  No.  But it’s worth noting that as we learn more about the science of body weight and its relation to our health, we may find that more players are involved, giving us more options for promoting health and wellness in many ways.  Hey, an aspiring to be fit feminist can dream, can’t she?

a girl in tones of blue and silver, sitting on a cloud, gazing at a blue-gray hazy mountain top and sky.

a girl in tones of blue and silver, sitting on a cloud, gazing at a blue-gray hazy mountain top and sky.

 

 

 

 

Late breaking FFI news: episode 658 of “Don’t believe the headlines”

Breaking News logo

We at the Fit is a Feminist Issue news desk are committed to bringing you up-to-the-minute news, commentary and perspective on a variety of topics– no matter the day, no matter the hour.

So when co-editor-in-chief Samantha FB messaged me to get on this story, I got straight to it (after eating my dinner, that is; you can’t do good investigative journalism on an empty stomach).

The story is– what are we to make of the mainstream news stories claiming that “Fat but fit is a big fat myth”?  This was the headline of a BBC article, out today.  What’s the deal?

Here’s the upshot: At this year’s European conference on obesity, researchers from the University of Birmingham gave a paper suggesting that the notion that people could be obese, metabolically healthy, and therefore not at increased risk of heart disease and diabetes is false.

This reporter will dig into more detail for Sunday’s blog post, but for now, I’ll tell you what the news article says, and then what questions I have (as an academic who researches and writes about this medical and scientific literature).

First, here’s what an article by the Guardian has to say about the new study (which is not even in article form, much less submitted, much less reviewed, much less accepted for publication, much less published):

Several studies in the past have suggested that the idea of “metabolically healthy” obese individuals is an illusion, but they have been smaller than this one. The new study, from the University of Birmingham, involved 3.5 million people, approximately 61,000 of whom developed coronary heart disease…

The scientists examined electronic health records from 1995 to 2015 in the Health Improvement Network – a large UK general practice database. They found records for 3.5 million people who were free of coronary heart disease at the starting point of the study and divided them into groups according to their BMI and whether they had diabetes, high blood pressure [hypertension], and abnormal blood fats [hyperlipidemia], which are all classed as metabolic abnormalities. Anyone who had none of those was classed as “metabolically healthy obese”.

The study found that those obese individuals who appeared healthy in fact had a 50% higher risk of coronary heart disease than people who were of normal weight. They had a 7% increased risk of cerebrovascular disease – problems affecting the blood supply to the brain – which can cause a stroke, and double the risk of heart failure.

The article then goes on to foment panic among health care providers and consumers.  Well, I think the tone is a little frantic.  See what you think:

Susannah Brown, senior scientist at World Cancer Research Fund, said the study’s finding, “emphasise the urgent need to take the obesity epidemic seriously.

“As well as increasing your risk of cardiovascular disease, being overweight or obese can increase your risk of 11 common cancers, including prostate and liver. If everyone were a healthy weight, around 25,000 cases of cancer could be prevented in the UK each year.”

Right.  Now, let’s all take a deep breath.  As some of you know, I’ve posted often about how real science is complicated, so we should not take sensationalist news headlines as telling the truth about new, or controversial, or counter-intuitive, or nuanced research results.  So here are some questions I have:

When the researchers talk about increased risk that people with BMIs over 30 have for various illnesses, are they showing statistically significant increases or clinically significant increases?   What I mean here is this:  a researcher can find a shift in risk that ends up being irrelevant to the real-life clinical likelihood of developing particular conditions (this is complicated but important).  We don’t know, as there is no paper yet.

What sorts of risk profiles did the researchers find for people with BMIs under 25? under 20?  When one peers at the fine print in the data tables in medical and epidemiology papers (as I am wont to do), one finds interesting and potentially reportable risks for folks who are co-called underweight–  BMI under 18.5.  Are there increased risks in those groups?  Are they comparable to the risks in the BMI> 25 and >30 groups? We don’t know.

What about the same BMI in different age groups?  How do those risks vary over the life trajectory?  It turns out that at various life stages, different BMI groups have very different risk profiles for medical conditions and death due to medical conditions.  For instance, men in their 50s with BMIs <18.5 have a pretty high all-cause mortality risk (generally from cancer).  We don’t know anything about this yet.

Then there’s how they defined their terms.  Sounds pedantic (and yeah, it is, but this is my job), but it’s important to know very precisely how the researchers defined metabolically healthy in terms of blood pressure, cholesterol, blood sugar (e.g. Hemoglobin A1c), and then what clinical end points (that is, records of diseases people in the study ended up having) or surrogate end points (e.g. blood pressure, cholesterol, blood sugar) they used.

And last (until Sunday; consider yourself warned): it seems to me (and lots of scientists agree) that the jury is out, sooooo out, on a clear understanding of the ways in which both genetic and environmental determinants of human metabolic processes contribute to body weight change and maintenance.  Topics currently being investigated include:

  • the role of body fat
  • the role of body shape
  • the role of abdominal fat
  • the role of visceral vs. subcutaneous fat
  • how visceral fat and trigliceride levels interact
  • the role of body weight variation over the life trajectory
  • what science and medicine can do about the body weight of the population (since so far medicine has come up with nothing effective other than gastric bypass, which has its own problem)
  • And much much more.

One last comment: the standard view in medicine and medical research is that having  a BMI over 25 is bad for people, and a BMI over 30 is much worse (and don’t even get me started on over 35, over 40, etc.) Studies and articles that have come out challenging that assumption have been pilloried by a lot of public health and medical experts.  But, like any scientific paradigm, there’s research on the edges, and sometimes that research gives rise to a new paradigm.  I don’t know if we’re on the way to a new paradigm, but I know that the current paradigm has left a lot of important and foundational questions unanswered.  Of course, that doesn’t make for good headlines.

Three women reading the newspaper with shocked looks.

Three women reading the newspaper with shocked looks.

 

On gaining eight pounds and hating it: A rant in two voices

TW: This is a rant in two voices. It began when Cate and I started commiserating at spin class about our unexpected winter weight gain. We don’t do much other than complain. There’s no weight loss tips here. But if complaining about weight gain makes you sad, frustrated, angry, then please look away. We’ll be back to our regular body positive programming when the sun comes out, it stops raining, and we can stop being so grumpy.



Cate and I have lots of things in common. We both have PhDs. We’re both 52 years old. We do things together, like the bike rally, canoe trips, and the Music for Lesbians concert. We have friends in common, some who blog here and others too. We share a fitness activity that’s central to both of our lives, cycling. We both ride with a sense of adventure, though Cate’s more independent and ridden in more countries. I’ve raced and ridden faster I think though I know she’s ridden further. Oh, and on the bike rally we joked about being the “old ladies.’ No parties on our camp site. We were in our tents lights out by 10.

We’re both women menopause seems to have forgotten. But perimenopause, it’s here and making us grumpy.

This year we have one more thing in common. We both gained 8 lbs over the winter doing pretty much the same things we’ve always done. We both hate it. And we both hate that we hate it. We’re grumpy.

That about get it right, Cate?

I’m blaming Trump. You?

************************************

Cate: LOL — I so want to blame Trump. And I did read that that is a thing. Even Barbra Streisand apparently blamed Trump for her weight gain.

And I think there is some truth to the sense that this winter has been kind of bruising and disorienting on a political front — and that does make me curl up on my couch and make my own blizzards with fancy ice cream and girl guide cookies, or invite people over for comfort food.

But I have had a tendency to comfort food for a long time, and I’m not eating that differently than I have been for the last 10 years. And people have been warning me forever — “your metabolism will change when you’re over 50” — and I didn’t want it to be true. And bam, almost overnight, true. I run way more slowly, and the scale has just crept up in sneaky ways to a number that I haven’t seen since before I quit smoking and took up fitness when I was 29. And it makes me feel like my body has betrayed me. And add a dose of the raging PMS I now get and I’m just ANGRY. You got an earful of that when we went spinning together on Tuesday.

************************************

Sam: It’s not just the weight gain though that’s the visible thing you can see. For me it’s also needing more sleep, taking longer to get well after I’ve been sick, heartburn (that’s new and awful), not responding well to stress, and crying. It’s like everything has slowed down and gotten sad. And yes my metabolism is part of that.

Like you I haven’t been eating differently. I’ve been working out. Those things haven’t changed but my bodies response has. It kind of looks at the good food and the workouts and goes “meh.” I’m at a loss for what to change really. In a way, eight pounds, who cares? But a) it’s a trend I’m worried about and b) I’m already over the recommended weight for the race wheels for my bike.

I broke a spoke the other day and the bike mechanic helpfully suggested sturdier, heavier wheels. I didn’t swear in the shop but I did in the car. He’s right of course. I swapped wheels. But I’m not happy about it.

************************************

Cate: It’s all tangled up for me with the invisibility thing we’ve been talking about.  I’m very short; even 5 lbs is a significant difference to me and I have a fear of looking like this high school teacher I had who was quite round and short and tottered around on high heels to try to offset it.  I don’t want to look like Mrs G!  I want to look strong and athletic and *vital*.  And even when I know I can Do Things, it all makes me feel Not Vital.  And that’s what I’m trying to make sense of.

We were talking about how the dominant advice is always “eat less, move more.”  We both move a LOT now, especially for people whose jobs are about conversations and sharing what’s in our heads.  It feels like I have to undertake a massive revolution in how I eat, and I don’t want to be that person — I want to be the person who can eat fries if I feel like it.  I RESENT IT!

What are we going to do?

************************************

Sam: I agree with you. We can’t be people who never eat fries!

But the visibility thing is tough. For both of us, it’s being seen as who we are, athletic women. I had someone offer me their seat on the subway the other day and I thought, “Really! Do I look like I need your seat? I am the oldest person on this train? What?”

I realized he was likely just being polite in a gendered, chivalrous way (I was wearing a skirt) and so I thanked him and took his seat.

And some of the time I’m happy to be the person who blows other peoples’ stereotypes out of the water. I love passing people on my bike. Moving the weight up rather than down on the lat pull down machine at the Y.

But I also want people to see me, to recognize who I am.

I hate it when someone says I should get off the bus a stop early to you know, add more movement to my life. HAVE YOU LOOKED AT MY GARMIN FILES? Oh nevermind.

So what?

***********************************

Cate:  We keep riding.  And maybe think a bit more about the fries?

Sam: And we’re definitely not getting these for our bikes!

Is body acceptance ever wrong? More chiding research comes our way

quote from Henry David Thoreau: "I stand in awe of my body".

It’s been a busy spring for body weight researchers.  I’m still working hard to catch up on the latest publications.  A recent article to come across my (virtual) desk is one from JAMA (Journal of the American Medical Association), with the intriguing title “Change in Percentage of Adults with Overweight or Obesity Trying to Lose Weight, 1988–2014”.

If you’re in a big hurry right now (maybe you’re trying to get out the door to ride or run or walk or go somewhere, in which case I promise not to delay you), here’s the takeaway:

From 1988 to 2014:

  • More American adults are overweight or obese (that is, have BMIs 25–30 and 30+).  No news there.
  • Fewer of these adults with BMIs 25–30 and 30+ are now reporting trying to lose weight. Hmmm.  Possibly interesting.
  • The authors seem very worried about this trend.  They think it’s a potentially bad thing.
  • I am not worried about this trend.  I think it might be a good thing, or maybe just a thing.

Now, if you’re not on your way outside (it’s a gentle sunny spring morning here in Boston), here are some of the details (both about what they said and what I think about it).  If you’re a data person, here are some numbers:

From 1988–2014:

  • The percentage of adults with BMIs 25–30 and 30+  increased from about 52% to about 65%– from about half to about 2/3 of the population.
  • The percentage of those adults (BMI 25 and above) who reported trying to lose weight declined from about 55% to about 49%– not a big drop, but it’s notably lower.
  • The article reports prominently that group with the biggest decline in weight loss attempts is black women, with a change from about 65% to about 55%– a 10% drop in weight loss attempts.  It reminds us that this group also has the highest incidence of BMIs 30+ (55%).
  • White men as a group also declined in weight loss attempts– a 6% drop (46% to 40%).
  • Also found in the table and in one sentence in the article is the fact that white women as a group also declined in weight loss attempts, by a bit more than 10%.

If you’re still reading (in which case, thank you; I do appreciate it), here are some messages in this article that struck me full in the face (and not in a good way).

First, the article seems really worried about the suggestion that the range of socially acceptable body weight is increasing.  They say this explicitly:

If more individuals who are overweight or obese are satisfied with their weight, fewer might be motivated to lose unhealthy weight.

Later on, they try to explain this phenomenon:

This observation may be due to body weight misperception reducing motivation to engage in weight loss efforts or primary care clinicians not discussing weight issues with patients.6 The chronicity of obesity may also contribute. The longer adults live with obesity, the less they may be willing to attempt weight loss, in particular if they had attempted weight loss multiple times without success.

Body weight misperception?   In this context it means that people think their body weight is just fine, when really it’s not. The authors suggest that people might mistakenly believe their body weight is okay because their health care provider hasn’t told them that it’s not.  And people might accept their bodies as fine because they’ve tried to lose weight, failed, and thus given up that fruitless pursuit in favor of a more profitable one, namely accepting their bodies as they are.

If body acceptance is wrong, I don’t want to be right.

But the medical literature just doesn’t agree.

While looking over this paper, I came across a 2010 article called “From ‘overweight’ to ‘about right’: evidence of a generational shift in body weight norms”.  This article seems to say that if people stop trying to lose weight and accept that their bodies are “about right”, bad things will happen.  From the 2010 article:

Such complacency among overweight and obese individuals may limit the effectiveness of public health campaigns aimed at weight reduction and associated improvements in health outcomes, including efforts to raise awareness of BMI thresholds for overweight and obesity.

In fairness, they do add:

On the other hand, there may be health benefits associated with improved body image, such as higher self-esteem and, potentially, a decline in the incidence of eating disorders.

Ya think?  Why is that not in the beginning of the article?  Why are we not celebrating and taking advantage of what could reasonably be interpreted as a nationwide increase in body positivity among lots of demographic groups?

One more point, which I can’t do justice to (I promise to address this in a future blog post):  the authors emphasize the decrease in weight loss attempts among black women, when in fact the decrease among white women is almost exactly the same.  It is true that the the black women as a group have a higher incidence of BMIs over 30 than white women as a group, which the authors also pointed out.  The implication is that this means that it’s worse (medically) for black women to be body accepting than white women.

Argh.  There’s something really wrong going on here.  To unpack the wrongs will take some time and more research.  I promise here that I’ll do that and report back.  But you’ve been alerted– the ways research like this gets reported treats racial groups differently, and that has all sorts of ramifications.  I’ll leave this here for now, but will return to it soon.

Ending on a positive note, as it’s just too pretty a day to stay negative: This blog is all about the joy to be found in celebrating our bodies, taking them out for spin, and feeding and caring for them, as we want them to work for us throughout our lives.  Body acceptance helps us function in all sorts of ways– physically, emotionally, sexually, socially, intellectually, etc.

So readers, I love you all just the way you are…

 

 

Lightening the load of heavy weight research

There’s a new study out on weight and mortality risk this week.  What is it saying?

It depends on who you ask.

If you ask the press, they’ll say this:

Carrying some extra pounds may not be good after all

Or this:

If you're overweight at any point, you're raising your risk for an early death

Yuck!  That sounds just dreadful.  Why are they saying this, what does this mean, and is it true?

First, let me fill in some back story.  In 2013, prominent epidemiologist Katherine Flegal and co-authors published a paper examining relationships between body weight and all-cause mortality (risks of death from all causes).  What they found was a lower mortality risk in the so-called overweight BMI category of 25-30, and not-increased risk in the so-called obesity I BMI category of 30-35.  Their results ran contrary to conventional wisdom (so much for conventional wisdom…).  They also unleashed a furious and very rude backlash among prominent and heretofore relatively well-behaved public health  and obesity researchers.  Here are a few reactions:

“It’s a horrific message to put out at this particular time. We shouldn’t take it for granted that we can cancel the gym, that we can eat ourselves to death with black forest gateaux.”
UK National Obesity Forum

“You’d hate to have the message get out there that it’s good to be overweight. The reality is that people who are overweight very often become obese and that’s clearly not good.”
Mercedes Carnethon, Northwestern Univ. School of Medicine

Since the Flegal et. al. 2013 article, some researchers who disagree with those findings have been trying to explain how being “overweight” (I use the quotes because I’m referring to the BMI category of 25–30 here, not any description of a person’s body) can lower your mortality risk.  Andrew Stokes, a population health researcher at Boston University, has been working on trying to tease out what’s going on with weight changes over time and mortality (death by any cause).  In a bunch of recent papers he and his coauthors have looked not just at BMIs and death rates, but at maximum BMI of individuals and possible relationships between that max, trends in their BMIs over time, and death rates.  (side note: my friend Dan and I are working on an article addressing Stokes’ work, which is in progress.  I’ll certainly blog about our work when we have results).

This newest paper looks at population data from three very big longitudinal studies and concludes that we can explain the so-called “obesity paradox” (that BMI 25–30 confers lower mortality risk rather than increased mortality risk) by looking at maximum BMI.  Those with maximum BMI of 25 or greater had increased mortality risk compared to those with maximum BMI of <25.

Ah– so being fatter really is bad for you.  Whew; public health and medicine don’t need to change all that signage after all.

a mind map of phrases connected with risks of more rather than lessbody weight

Well, maybe they do.  Looking at this article, I found some complicated and interesting results (which I’ve seen in other such articles, but aren’t splashed across the headlines.)

Interesting result one:  being “underweight” (BMI <18.5) carries a much greater mortality risk than being “overweight” (BMI 25–30).  For a lot of age/sex categories, it carries a much great mortality risk than being “type I obese” (BMI 30–35).  For instance, for non-smoking men< 70 years old, the mortality risk was almost the same for <18.5 BMI as for >35 BMI (2.89 and 3.19 respectively).  That is, people at the far ends of the weight spectrum measured both had much increased mortality risk.  Again, we are talking about maximum BMI here (just to be precise).

Interesting result two:  the mortality risks from a particular max BMI shift as the population ages.  The details are pretty complicated, but here’s an example:  if my max BMI is say, 31, then these results show how my mortality risks may go up and down as I age.  This is interesting and important for patients and health care providers.  Given some max BMI, the medical advice might be different depending on the age of the patient (and other features of her medical history).  Of course, many medical practitioners act on this already by paying special attention to many features other than BMI in caring for their patients.

Interesting result three:  the results are based on three very large samples (about 225,000 people) of white people– they made up more than 91% of the sample.  We already know that BMI distributions vary across racial categories, so these results (if they turn out to be correct), would not apply in a simple way to other groups.

Interesting result four: In the article, the authors point out that their targeted group (BMI 25–30) is pretty diverse with respect to body fat percentage and waist circumference.  They’re also going to be pretty diverse with respect to their eating and physical activity practices (like every other BMI group).  The authors think that they can use max BMI to identify who in the BMI 25–30 group is at increased risk.  But to what end?  It’s not like medical practice has any currently effective procedures for bringing about and sustaining weight loss over time (except maybe some forms of gastric bypass, which aren’t indicated for the population targeted in the article).  So, what is an appropriate response to this information from patients and providers, other than more moral panic?

For me, my response to this article is to dig into the details, talk to my colleague Dan about our article, and attend to my health-as-I-define-it in the best ways I know how.  I’m not convinced these folks are right.  And I’m not convinced that we even agree on how their being right might reasonably translate into anything medically useful or practical.  However, we all know that science, medicine and health care are super-complicated, so while we’re waiting for the fog to clear, let’s just do nice things for ourselves.  So I’m headed out for a bike ride now!