Weekends with Womack

“Obese” is a bad word—it’s got to go

(Hi folks– sorry for the late Weekends with Womack post; technical difficulties down under.  Thanks for your patience.  Now to the post…)

We use a lot of words to describe large (or large-ish) bodies:

For instance: fat, plump, hefty, bulky, rotund, pudgy, chunky, portly, heavyset, stout—I found 46 synonyms here. Roly-poly may be my favorite one.

Here’s one I don’t think we should use anymore:

obese

Why not? In some ways, “obese” seems less pejorative and less judge-y than those other words. In fact, it’s really just a clinical word, with a precise definition; nothing to be upset about. Most adults with a BMI of 30 or higher are considered obese by medical definition. It’s also easy to determine when it applies. I can weigh myself, measure my height, consult my handy BMI chart (like the one below) and determine reasonably accurately my BMI.

bmi

So why do I think it’s a bad word? Two types of reasons, one scientific and one ethical.

The scientific reasons to get rid of “obese/obesity”: the term “obesity” applies to anyone with a BMI of 30 or higher. But why does medicine and public health use this term? The main idea is that if you are obese, you are in a medically deficient state that needs addressing. In particular, you are at increased risk of developing type 2 diabetes, heart disease, some cancers, orthopedic problems, sleep apnea, and some reproductive problems, among other things. Some of these conditions are potentially life-threatening, so losing weight and becoming non-obese is a compelling health goal. That’s the story.

But is it true? No, not as stated above. Not all BMI numbers 30 and above are created equal. In a widely-cited 2013 study, Katherine Flegal and her co-authors found that people with BMIs 30—35 did not have a higher risk of death than people with BMIs in the 18.5—24 range (called the normal range). Higher risks of death were documented in BMI ranges above 35. And lower risks of death were documented for those in the “overweight” range—25—29.

This news was not taken well; medical and public health professionals unleashed vitriolic criticisms. A Nature article on the topic discussed the problem here:

The result seemed to counter decades of advice to avoid even modest weight gain, provoking coverage in most major news outlets — and a hostile backlash from some public-health experts. “This study is really a pile of rubbish, and no one should waste their time reading it,” said Walter Willett, a leading nutrition and epidemiology researcher at the Harvard school, in a radio interview. Willett later organized the Harvard symposium — where speakers lined up to critique Flegal’s study — to counteract that coverage and highlight what he and his colleagues saw as problems with the paper. “The Flegal paper was so flawed, so misleading, and so confusing to so many people, we thought it really would be important to dig down more deeply,” Willett says.

But in fact Flegal’s results have been duplicated and even extended to show that “obesity” just isn’t a useful word to refer to a medical condition. In this article, Ann Barnes cites US data that shows that weight affects life expectancy differently in white women and black women—for black women, weight isn’t a risk factor until a BMI of 40 is reached, vs. a BMI of 30 for white women.

There is a lot more data out there showing that what we call “obesity” is not one category at all—it is a range of different categories that apply differently to groups depending on age, race, ethnicity, gender, income, geographic location, etc. One size-name simply doesn’t fit all.

There’s more to say about this (there’s always more to say…) but I’ll now turn to the ethical reasons not to use the terms “obese” or “obesity”. My friend Stacy co-wrote this fantastic article about the socio-political meanings that have been attached to the term “obesity”, and I quote from their article below:

In this… social and political sense, obesity is associated with powerful negatives, stemming from both long-standing prejudice and recent public health framing. These include epidemic threat, devastating impending costs, tragedy (particularly children routinely dying before their parents), as well as poor character in obese individuals, who are frequently implied to be lazy, to lack willpower, to be greedy, or to shirk personal responsibility. This view is used to legitimize the well-documented discrimination experienced by heavier people, especially women, particularly younger women and girls. For people above normal weight, then, public discussion of obesity is fraught.

Obesity in the sociopolitical sense also became institutionalized fairly rapidly in universities and governments in the late 20th century. There are now obesity strategies, government departments responsible for obesity, obesity handbooks, professorial chairs, university research centers, websites, Twitter feeds, and advocacy groups with the word obesity in their titles. So obesity as an amorphous but potent social and political concept now raises the stakes in many settings, engendering blame, inducing strong feelings, and providing the focus for many people’s professional roles and identities.

In short, shouting “obesity” in a crowded doctor’s office raises alarms, brings on waves of shame, provokes stern and dire warnings, and puts everyone on notice: Something. Must. Be. Done. Now.  But maybe nothing needs to be done.  Or maybe something does need to be done, but what that is will vary a lot, depending on a bunch of complex factors.  It’s not a uniform call to lose weight, come what may.

I know, we can’t solve these problems just by getting rid of the words. But getting rid of them would be a step towards acknowledging that the story about weight, health, and illness is a very complex one, and using “obese/obesity” confuses us, misleads us, shames us and blames us. So let’s get rid of it. When we need to talk about people’s weight, there are lots of other words around—let’s use them instead.

competition · diets · eating

I’m not fat, I’m fluffy: The puzzle of animal obesity

fluffy fluffyYou know that I hate Weight Watchers.

What you might not know is that for many people, going to the vet can take on rather the same flavour as a visit to your favourite weekly weight loss program. A visit to the vet, a diagnosis of canine/feline obesity and the next thing you know it’s a prescription for diet food, prescribed portions, a ban on treats, daily exercise orders, and weekly weigh ins. You can also go the medication route if lifestyle changes are ineffective. In 2007 the first drug to treat canine obesity was released.

And there are, of course, pet dieting competitions! See Pictures: Fat pets before and after slimming – BBC, photos from the annual UK pet slimmer of the year competition.

dog before and afterAccording to the Association for Pet Obesity Prevention, 53 percent of adult dogs and 55 percent of cats in the U.S. are obese or overweight. And it’s not just dogs and cats. twenty per cent of horses and bunnies are obese too.

There’s a lot of hand wringing about pets looking like their owners and about bad habits spreading and that our inactive, snack happy lifestyles are KILLING THE CUTE CATS AND DOGS! See Are you killing your pet with love? according to which doggie ill health and obesity is due to their fat, lazy owners.

Not sure if your cat is fat? Here’s a Fit or Fat? Infographic for cat owners.

(Now can you see why you might feel judged putting your pooch on the scale at the vets and finding out they’ve gained?)

This piece in the Atlantic What Are They Feeding You? 50% of U.S. Cats and Dogs Are Overweight gives you some of the flavour of the discussion if it’s new to you. It features photos of fat rabbits, before and after photos (of course!), and talks about exercise programs and personal trainers for Fifi and Fido. Sound familiar?

See also It’s Not Just Us: Even American Animals Are Getting Fatter  (The Wire).

Lack of companion animal activity and too much snacking mirrors the “move more/eat less” messaging that human animals hear. But what if it’s much more complicated than that?

It’s not just pets that are getting fatter. Lab animals are too. And that’s a puzzle.

Most intriguingly, perhaps, the laboratory animals showed more pronounced gains than those living outside a lab. This is strange because the sorts of lab animals the researchers looked at tend to be given lots of food and left to nibble at leisure. This practice has not changed for decades. That the animals put on weight nonetheless suggests the phenomenon cannot be caused solely by pet owners appeasing their Garfields, or feral rats rummaging through refuse composed of ever larger quantities of calorie-rich processed food. Dr Klimentidis is unable to pinpoint any single mechanism that could account for his results. But this does not stop his data from lending exculpatory explanations for fat tummies more credence.

Read the rest at The fat cat cometh: It is not just human beings that are getting fatter. Animals are, too (Economist).

Recently researchers have been looking at increases in animal size to help shed light on human weight gain. David Allison, a biostatistician at the University of Alabama at Birmingham was looking for a relationship between body weight and longevity in a population of marmosets but what he found made him wonder about the standard story about the causes of weight gain across all species.

The surge in human obesity is generally attributed to an increasing consumption of calories and a decrease in physical activity. “But maybe there are other things that are important — because those things can’t be acting on the marmosets, or the rats and mice in the National Toxicology Program,” he says.

See Lab animals and pets face obesity epidemic.

It’s also true for animals in zoos. See It’s Not Just All of the People Around You That Are Getting Fatter.

But while pets are on some level a reflection of the lives of their owners—they eat our food scraps and also, well, if you’re too lazy to go out and take your dog for a vigorous walk you’re not the only thing that’s going to get fat—zoo animals, whose lives are highly regimented and designed to promote health, are also growing around the middle. Chimpanzees get about the same food and the same level of exercise that they always have. And yet:

Among colonized chimpanzees, males and females, respectively, experienced a 33.2 and 37.2 per cent weight gain per decade, and a nearly 18-fold and 11-fold increase in the odds of obesity. In vervets, for females and males, respectively, there were 9.4 and 2.9 per cent increases in body weight per decade associated with 83 and 834 per cent increases in the odds of obesity. Among marmosets, females experienced a 9.7 per cent increase in body weight per decade, and a 1.73-fold increase in the odds of obesity. Among males, there was a 9.2 per cent increase in body weight per decade, and a 64 per cent increase in the odds of obesity.

Okay, so lab animals, pets, and zoo animals are often eating food that humans have produced. So maybe we could be to blame in these cases, even if we don’t exactly what we’re doing, we’re still doing something wrong. But what about wild animals? Some of them are getting bigger too.

For a discussion of possible causes–including electricity, viruses, and artificial lighting–read this fascinating essay by David Berreby, The obesity era: As the American people got fatter, so did marmosets, vervet monkeys and mice. The problem may be bigger than any of us.

eating · fitness

What’s the connection between inactivity and obesity?: It’s not as clear as you might think

Recent reports on the extremely low levels of physical activity in the Canadian population tell us that few Canadians (7% of kids and 15% of adults) are meeting recommended levels of physical activity.

Does this explain increases in percent of the population counting as overweight or obese? Not so fast. In Inactivity Does Not Explain Canada’s Obesity Epidemic  Dr Arya Sharma notes that  the real take-home message is that physical activity levels are low in all groups, not just among those who are overweight and obese.

From Dr Sharma:

…if we convert the rather modest differences in MVPA levels taking into account the increased effort required to move higher body weights, we would find almost no difference in actual calories spent in activities to account for any difference in body weights. Thus, to me at least, these data pretty much blow to pieces the widely held bias that overweight and obesity can be largely explained by lack of activity or that overweight and obese individuals are less physically active (read “lazy”) than “normal” weight individuals.

He concludes,

Continuing to link the necessary discussion about inactivity to the problem of obesity is not only scientifically unfounded but, by dangerously and unfairly reinforcing stereotypes (not reflected in the actual data), may well do more harm than good when it comes to tackling both the epidemic of obesity and the epidemic of sedentariness.

Read the rest. It’s a very interesting post.

Tea-Time

health · weight loss

Does heat make you fat? No wait, it’s cold…

Upfront confession: I have a high tolerance for headlines of the form “X makes you fat!” Posting these stories to social media. I’m often misunderstood. I’m never doing it to suggest that people stop doing X, for any value of X. Instead, I do because I like seeing that medical researchers agree that whatever causes fat, it’s more complicated, much more complicated than “calories in/calories out” or the simple formula for ending obesity that overweight people always get, “eat less and move more.”

Oh, I also hate sharing these stories because inevitably they are accompanied by a photo of a headless fat person. Oh, the shame! I lost my head. See No more headless fatties, why not use images of active fat people complete with heads instead? for my beef on that front.

Now, there are lots of proposed values of X, the list of things that cause obesity. In additional to the usual suspects (eating too much and moving too little) the list has included such things as street lighting (too much light at night disrupts our sleep rhythms), chemicals in plastics,  hanging out with fat friends, and my favourite, comfortable kitchens where people want to spend time. I just had my kitchen redone and now I think maybe I should go back to our one person-at-a-time galley thing that was falling off the back of the house.

“What a beautiful kitchen!” I hear my neighbour saying but I wonder if she’s also secretly thinking, “Too bad it’s making you fat!” Actually my kitchen isn’t that nice. Maybe just nice enough to make me pleasantly plump.

For the complete ridiculous list, see xojane’s list of 21 Things Making You Fat Right Now!

Here’s one such theory that I hear a lot. It’s central heating that’s to blame. Warm houses are making us fat.

Don’t turn up the heat! Put on a jumper! (That was the story of my youth.)

This story fits in well with my British heritage. “Jumper” should have been your first clue. I’m from the land of virtuous people living in cold houses. My family loves to retell the story of a great aunt who at the insistence of her children had central heating installed but reassured all visitors, with a smile, “I haven’t had it on yet.” I think she likely died without ever turning it on.

And truth be told, I’ve inherited a bit of that. I like cold rooms and lap blankets, warm kitchens with ovens on, and cold bedrooms with warm blankets. I even have a heated mattress pad. (My new fave feature of modern life is the smart phone app that allows me to get into bed and then turn down the heat and shut off lights. Brilliant.) I prefer hot spots in otherwise cold rooms. This makes sense as I also love old houses and these things go together.

Winters in Australia and New Zealand tested my tolerance for cold houses. I guess when the weather isn’t life threatening, you don’t see the same need for regular, reliable indoor heating.

And to add to the moralizing notes in this story, cold houses don’t just promote virtue (I think it’s because you’re not tempted to take off your clothes until after you’re under the blankets and sweaters on top of sweaters aren’t exactly the sexiest look around) they’re also better for the environment.

No surprise then that warm houses make you fat.

See Mark’s Daily Apple, Is central heating related to obesity?

See Readers Digest! 8 things that are making you fat

“Trying to lose weight? Turn down the thermostat. A cozy home could be contributing to making you fat, suggests research in the journal Obesity Reviews. When our bodies are cold, we shiver, causing our muscles to contract to generate heat—and burn calories.”

Even the New York Times weighed in Central Heating May Be Making Us Fat. And Time Magazine too, Why Indoor Heating May Make You Fat.

The authors of the new study, published in the journal Obesity Reviews, note that average indoor temperatures have risen steadily in the U.K. and U.S. over the last several decades, as central heating has become increasingly available — and rates of obesity have risen too. The average temperature in British living rooms went from 64.9 degrees F to 70.3 degrees F, from 1978 to 2008. Living rooms in the U.S. have long been heated to at least 70 degrees F. Indeed, average temperatures have gone up all throughout the house — and in the wintertime, people tend not to leave their homes much anymore, at least not unless it’s in a heated car.

“Increased time spent indoors, widespread access to central heating and air conditioning, and increased expectations of thermal comfort all contribute to restricting the range of temperatures we experience in daily life and reduce the time our bodies spend under mild thermal stress — meaning we’re burning less energy,” said lead author Fiona Johnson in a statement. “This could have an impact on energy balance and ultimately have an impact on body weight and obesity.”

Although humans are born with significant deposits of brown fat — the primary purpose of which is to regulate body temperature by burning energy for heat — those stores diminish over time. By adulthood our brown-fat stores have shrunk, having been replaced with the more familiar white fat, the stuff that hangs over belt buckles and swings from the backs of arms.

And I’d love to love this story. Yes, get out of your comfort zone, go play outside, stop burning fossil fuels. Live like our ancestors used to, etc etc.

But now, it’s cold, not hot, but cold, that makes you fat. That journal article was published in 2011, but new research published the same journal years two later says it’s cold, not heat, that packs on pounds.

See Study: turn up heating to fight fat this holiday season.

An interesting new study from the UK reveals that people who live in well-heated homes are not as likely to be obese or have a high body mass index, compared with individuals who keep their houses cooler.

The researchers, from the University of Stirling in Scotland, have shown a link between higher temperatures and lower levels of body fat by studying over 100,000 adults who rely on central heating from 1995 to 2007, in the nationally representative Health Survey for England.

Although the researchers note that scientists have recently suggested warmer indoor temperatures could be contributing to rising obesity levels in the US, Canada, the UK and Europe, this latest study suggests the opposite is true.

Back and forth, to and fro. This debate ought to be familiar. I’ve heard it before  about swimming in cold water (see here and here). And I’ve been bugging Tracy to blog about it. Swimming in cold water makes you fat! Wait, no, bathing in ice cubes makes you slim. Thank Tim Ferris for that suggestion. Read about his “ice diet” here. Um, no thanks, Tim.

Keep your house at a temperature you like that’s consistent with caring for the environment. Swim in cold water if that’s what you like.

Because we really don’t know what’s responsible for the increase in obesity rates and we’re even less certain when it comes individuals what factors are that make a difference.

If there’s something to be learned here, it’s something I got from Precision Nutrition’s lean eating program, you are your own expert. Try different things and see if they make a difference for you.

fireplace

sports nutrition

Three big pieces of nutrition news from reasonably reliable sources

1. Consuming twice the recommended daily allowance of protein protects muscle mass while promoting fat loss: “A new report appearing in the September issue of The FASEB Journal challenges the long-held adage that significant muscle loss is unavoidable when losing weight through exercise and diet. In the report, scientists show that consuming twice the recommended daily allowance (RDA) of protein while adhering to a diet and exercise plan prevents the loss of muscle mass and promotes fat loss. Tripling the RDA of protein, however, failed to provide additional benefits.” Okay fine. I’m off to re-read Tracy’s post on how to get lots of vegan protein.

2. Fruit isn’t evil, after all. Phew. So sorry Tim Ferris.  And as Tracy says, no foods are evil really. Now it turns out that some fruit protects against Type 2 diabetes. “Eating blueberries, grapes, apples and pears cuts the risk of type 2 diabetes but drinking fruit juice can increase it, a large study has found.” I’m having blueberries for breakfast with hi-protein cereal and soy milk, see above.

3. Your gut bacteria may be making you fat. “The bacteria in our gut already plays an important role in digestion. But new studies indicate that our bacteria could play a major role in whether or not we become obese.” Okay, in mice. But still worth reading about.

Blueberry_Cluster

body image · diets · eating · fat · fitness · motivation · sports nutrition

“Nutrition is the foundation of health and fitness. You simply cannot out train a poor diet.”

The quotation above is from Greg Glassman, the founder of Crossfit. I’ve been thinking a lot lately about the relationship between nutrition and fitness and thinking about where there’s room for improvement in my efforts to be the ‘fittest by fifty.’

Unlike my co-blogger Tracy who has decided that sports nutrition counseling isn’t for her and who has stepped away from the scale, I’m continuing with habit based nutrition counseling. I’m a numbers geek, I like tracking, and I’m looking forward to getting leaner in the year ahead.

It’s not about hating the body I’m got, I’m quite fond of it thanks, and it can do amazing things, but I need reminders to give it the love and attention it deserves. With three kids and a busy career, I sometimes struggle to take care of myself. I’m not quite the opposite of the food obsessed dieter but it’s true that for me, more often than not, convenience and the needs of others, take precedence over my own food choices.

Whether it’s a banana and a protein bar before Crossfit, a drive thru coffee and bagel on the way to rowing, a pizza slice post Aikido or instant oatmeal as a warm bedtime snack, some of my food choices aren’t the best. And given the demands I place on my body, I need to do better.

For some reason, for me, physical activity is easy. I love it, can’t get enough of it, but nutrition is another matter. And yet, eating well supports everything else I do. And I do a lot so I need to eat very well. So I’m setting out to work on the foundation this year, to try to pay as much attention to nutrition as I do to other aspects of sports performance. I’m trying to think of eating as part of sports training. Nutrition counseling helps serve as a reminder that this matters.

I’ve blogged here about my reasons for wanting to be leaner but I need to balance that goal with making sure I eat enough to support my physical activity.

I just did another check in at the Bod Pod this week and I’m happy with my progress so far. I’ve lost another 4 lbs overall but more importantly, as part of that overall, I’ve also gained 2 lbs of muscle since my last check in, and so my per cent body fat is down 2%. Yay Crossfit! Yippee new muscles! I’ve joined Tracy in the merely “excess fat” category, heading towards “moderately lean.”

I’m also now following the Lean Eating program at Precision Nutrition.

You’ve probably read a few wonderful rants I’ve linked to by Krista Scott Dixon. Here’s my faves:

In addition to having put together the best women’s weight lifting site on the web, and having a PhD in Women’s Studies she’s also the Coaching Program Director for Precision Nutrition.  I’m actually working with another Precision Nutrition Krista though. Krista Chaus is another woman with a pretty impressive bio.

“Since beginning her competitive career as a strength athlete 10 year ago, Krista has become one of the Canadian Powerlifting Union’s Top 20 Female Powerlifters. She is also a National champion, provincial record holder and two times Commonwealth Championship medalist.

Recently, Krista has turned her competitive attention to the physique side of the industry, capturing 7 overall finishes in bodybuilding in 2008 and placing 5th at the 2009 Arnolds Amateur Bodybuilding Championships.  She’s currently working towards a National bench press record with the Canadian Powerlifting Association.” from her PN bio

It’s not a diet, in terms of short term change. Instead, I’m trying new habits on for size and trying to make them part of my life. The first big change for me is that one will sound familiar to those who’ve been following the blog: slow mindful eating.

There’ll be no vibrating forks for me though. I’m hoping to pay more attention to my food and less attention to electronic gadgets at the dinner table.

Anyway, wish me luck.

fat · weight loss

Fear of fat more dangerous than actual fat

On my 2013 list of books to read is What’s Wrong With Fat? by Abigail Saguy, published by Oxford University Press.

What caught my was this press release from UCLA in my twitter feed.

Public obsession with obesity may be more dangerous than obesity itself, UCLA author says

“”What’s Wrong With Fat?” shows how debates over the best way to discuss body size — including as either a health or civil rights problem — do not take place on an even playing field. Saguy contends that powerful interests benefit from drawing attention to the “crisis,” including the International Obesity Task Force (a lobbying group funded by pharmaceutical companies), obesity researchers and the Centers for Disease Control and Prevention. On the other hand, fat-acceptance groups, which try to reframe fatness as a civil rights issue, are at a disadvantage because they have considerably less economic power and cultural authority, she says.”

But beyond the incomplete and misleading information on the issue, America’s obsession with obesity is itself unhealthy, she argues.

Saguy cites studies demonstrating that fat women are reluctant to get medical care for fear of being chided about their weight or treated insensitively by their doctors. In fact, research has shown that obese women are more likely to get cervical cancer because they are less likely than thinner women to get pap smears.
Meanwhile, Saguy’s own research shows that people who read news accounts of the “obesity epidemic” are more likely than people who have not read such reports to perceive fat people as lazy, unmotivated, sloppy, and lacking in self-discipline and competence.
Those attitudes have been shown to play out in a variety of socially damaging ways, Saguy says, including in increasingly widespread weight discrimination. Recent research has shown, for example, that bias against fat people in employment, education, health care and other areas is now comparable in prevalence to reported rates of racial discrimination in the U.S.
Heavier women in particular, Saguy notes, are less likely to be hired and less likely to earn a higher salary, compared with their similarly qualified but thinner peers.
“American attitudes about fat may be more dangerous to public health than obesity itself,” she says.”
The scary critters in the image above are from the first episode of series 4 of Dr Who  which features Adipose, the drug that makes your fat “just walk away.”