Reading Assignment

All day, I’ve been thinking I was going to write something intelligent about the results of The Women’s Health Initiative Dietary Modification Trial, the biggest dietary intervention clinical trial evah. $400+ million, 8 years of follow-up, almost 50,000 subjects.

Haven’t heard of it? That’s probably because the upshot was pretty much this: “healthy eating” doesn’t mean squat in terms of your cancer or heart disease risks.

$415 million, that cost.

Anyway, the day is expiring, and my intelligence has not yet come for a visit, so instead of tackling this topic myself, I’m just going to insist that you go read Sandy’s post about it. Harriet’s got a shorter version here, if you’re pressed for time.

Then come back here and discuss.

Posted in Fat

55 thoughts on “Reading Assignment

  1. I happened to read Sandy’s take just two days after spending part of my weekend covering a retreat for women with cancer. While most of my experiences there were surprisingly positive and uplifting, there was one woman there that I just can’t get out of my mind. She had been cancer-free for more than five years, but some healthcare provider had convinced her that the key for her to stay that way was to get from the “obese” category into the “overweight” category. To that end, she was eating “healthy” with Weight Watchers (hah!) and exercising literally hours every day. From what I could see, she was beating herself up for still being “obese” and punishing herself daily to prevent the cancer’s recurrence.

    This culture’s totally fucked-up belief that illness–all illness, any illness–is the fault of the person who is sick just boggles my mind.

    Carpe goddamn diem, people. Nobody gets any guarantees. One of my very best friends died of a heart attack at 31 after working out. He was a tall, thin vegetarian with a gentle spirit and hundreds upon hundreds of people who loved him. He didn’t bring his death on himself, and neither do the vast majority of the rest of us.

  2. Sometimes I feel that in FA and HAES circles, people are always looking for reasons that lifestyle doesn’t influence health. In my opinion, the diet compared a very bad diet with a slightly better diet. 25% more vegetables in the better diet? 25% of almost nothing is still almost nothing.

    The China Study is a huge study with significant differences found in disease rates because the diets were significantly different, in a way that is maybe not possible to do in this country (we are much more homogenous compared to that study).

    Look, just because lifestyle affects health, doesn’t mean it’s your fault if you get a disease. And it doesn’t mean it’s your fault if you’re fat. But yes, lifestyle is going to affect risk of disease. It doesn’t mean *any* guarantees, one way or the other. But, yes, it does affect it. Otherwise we would change HAES to “don’t try a damn thing for your health because it won’t affect you”. I don’t think most people would find that very convincing, though it would be convenient for people who have given up on themselves. The FA movement can do better.

  3. OK, if we took that $415,000,000 and used it to pay home health care workers $25,000 a year (a raise, in most cases), that would be… 16,600 more home health care workers and/or aids. Don’t know the savings, but it would be considerable, since home health care is far more effective, and wicked less expensive than hospitals or nursing homes, and the decided preference for most patients, and, you know, sane.

    I’m just saying.

    My reaction to the study otherwise is, to tell the truth, that I’m a little scared. Not so much of heart disease or cancers — que sera sera, there — but of Type 2 diabetes. I have a 50:50 chance (parentally speaking) of eventually getting the disease, and I’d really rather not go there if I don’t have to. So, I’m actively seeking out lifestyle stuff that might actually help me evade that particular demon (or, at least until I’m 80, at which point I’m going to start smoking again and drinking the good brandy and having casual sex with rock musicians into old chicks anyway, so what the hell). Some useful advice would be welcome, but we can’t even get that through all the marketing & spinning and smoke screening.

    And, this is not the first time I’m heard of a cancer patient convinced s/he made him/her self ill. Like, all you need when you’re dealing with cancer is GUILT.

    THIS IS MESSED UP!

  4. In my opinion, the diet compared a very bad diet with a slightly better diet. 25% more vegetables in the better diet? 25% of almost nothing is still almost nothing.

    Where do you get that from Bobette? The control diet wasn’t bad, it was simply completely unrestricted. Some people in the control group would have eaten ‘badly’, some would have eaten ‘well’ because that was what came naturally to them, and the grand majority probably ate pretty normally – a range of food for sustenance and food for enjoyment.

  5. Sorry to rain on your parade guys, but I’m note so sure how I feel about this. I don’t think it says what you think it says. It’s only looking at postmenopausal women. Postmenopausal women are SUPPOSED to gain weight as their body slows down – it happens naturally. Also, not finding a huge difference between dietary groups in an age category that is prone to heart disease as it is isn’t very indicative of what the difference might be in younger people – it isn’t clear why we should be able to extrapolate this to people in other phases of life. Looking at “healthy” eatings effects in a younger age group, that isn’t prone to cancer or heart disease due to age might help to clarify this.

    Like I said, sorry to rain on the parade, but if you don’t look carefully at what studies like this are actually saying we end up sounding like a bunch of creationists.

  6. The last paragraph of the article:

    In summary, the results of this longterm
    trial of diverse postmenopausal
    women demonstrate that long-term recommendations
    to achieve a diet lower
    in total and saturated fat with increased
    consumption of fruits, vegetables,
    and whole grains, and without
    focus on weight loss, do not cause weight
    gain. Long-term effects of this dietary
    pattern on other health outcomes will
    be available after confirmation of end
    points and data analyses are completed,
    and long-term weight-loss studies
    designed to compare hypocaloric diets
    of varying macronutrient intake will
    be needed to establish the relative merits
    of different weight-loss regimens.

    Meaning: Nobody was trying to lose weight. That wasn’t anyone’s goal with this.

    By the time you are post-menopausal, most of the damage to your body has already been done. Other studies have shown that being severely obese (BMI>50) as a 20-something or 30-something adult can take 10-20 years off your life.

  7. Sandy’s blog:
    ‘The “healthy” dieters also ate about 25% more fruits and vegetables, grains and fiber than the typical American diet of the control group.’

    The typical American diet is very low in vegetables. Most people aren’t doing the intuitive eating where sometimes they feel like vegetables and sometimes other things–most people are just plain not eating many vegetables, and notoriously overreport. I have seen this in my job as a nutrition educator, but the big NHANES surveys that look at dietary habits of Americans will tell you the same.

    I do also agree that the age of the women is key. This doesn’t look at the effects of eating over a lifetime. Understandably, that is very expensive and difficult to do. I do think it would be better to help people be the healthiest they can be instead of doing all these huge, expensive studies (increasing access to cheap fruits and veggies, for example). That would truly be HAES-promoting.

  8. I was thinking about what I wrote and wanted to clarify.

    What this study says is: in women prone to gain weight and develop heart disease and cancer, eating “healthily” does not PREVENT weight gain or disease.

    What this study does not say is: what you eat has no effect on your health.

    There we go. Much more concise.

  9. Other studies have shown that being severely obese (BMI>50) as a 20-something or 30-something adult can take 10-20 years off your life.

    Yeah, and the percentage of the population with a BMI greater than 50 is virtually nil.

    And Amanda, the whole point of this study was to look at a group that is prone to cancer and heart disease, because if you did it with younger people, you’d end up with no statistically significant results — not enough people would get heart disease or cancer either way.

    Bobette, Downside-up already covered what I had to say to you.

    Finally, I’d like to ask everyone to read this part of Sandy’s post again:

    When we enjoy a variety of foods from all of the food groups — as most everyone naturally does when they’re not trying to control their eating — and trust our bodies, we’ll get the nutrients we need to prevent deficiencies. And that is the only thing that nutritional science can credibly support. The rest is dietary religion.

    .

  10. Bobette, I think you’ve missed something. The “slightly better diet” was straight off the food pyramid — low-fat, high-fiber, five fruits and veg a day, the whole nine yards. Not to mention careful oversight and “behavior modification.” That the unrestricted diet only contained 25% fewer fruits and vegetables doesn’t tell us that the “healthy” eaters didn’t eat enough; it tells us that the “unhealthy” eaters ate a fair amount actually.

    I agree on the postmenopausal thing… what were they thinking? If they were actually intending to show the effects of healthy eating, full stop, you’d think they’d use a more varied sample. Perhaps they were planning to do younger women next, and then younger men, and then older men…

    That said, I’m absolutely not willing to throw out the results of this study just because they apply to a specific group. The study was only on postmenopausal women, but it completely contradicted the status quo. In what scientific universe is that call for us to discount it, instead of, you know, doing another study?

  11. the whole point of this study was to look at a group that is prone to cancer and heart disease, because if you did it with younger people, you’d end up with no statistically significant results — not enough people would get heart disease or cancer either way.

    That makes sense too, but I still want to see the follow-up studies in other populations. Mostly because I suspect they’ll be much the same.

  12. That makes sense too, but I still want to see the follow-up studies in other populations.

    Me too — and I’d especially love to see study that followed this many people from, say, ages 20-70. unfortunately, that would no doubt cost in the billions, and we’d be dead before we learned the results.

  13. The food pyramid is influenced by the food industry and is not actually that great. Marion Nestle has written about this in depth. The recommended 5 fruit and vegetable levels are much too low when you look at what a portion size is–I went over those amounts before I was done with my lunch, just eating what I normally eat (not any “plan”). Low-fat says nothing about the quality of fats. High-fiber doesn’t say anything about the quality of grains. I could go on..has no one else read the China Study? It is a truly compprehensive study with really interesting results and HUGE differences in disease rates between populations with various diets. Some diseases are virtually non-existant in certain areas of the world until the Standard Western Diet gets to them–then heart disease and cancer skyrocket, so it’s not just genes.

    This does show that the food pyramid is not preventative for this cohort, I would agree. But it doesn’t show that a healthy way of eating doesn’t prevent disease–it shows the pyramid way of eating probably doesn’t prevent disease.

  14. So, I’m actively seeking out lifestyle stuff that might actually help me evade that particular demon (or, at least until I’m 80, at which point I’m going to start smoking again and drinking the good brandy and having casual sex with rock musicians into old chicks anyway, so what the hell).

    Would you mind starting a database of rock musicians who are into old chicks? For future reference, I mean.

  15. Guy, I happen to have a BMI of 59, and my BMI has been over 50 for the last 35 years. I’m still healthy and going strong despite repeated weight loss attempts and a failed WLS. So I don’t think my excessive fat is going to kill me any time soon (I’m 54, and every one in our family, both sides, has lived into their 80’s and 90’s in spite of being fat). If my BMI is an indication that I’m going to lose 10 to 20 years off my life, well, so be it. There isn’t a lot I can do to alter my weight permanently (been there done that), so I’m not going to worry about maybes and mights. And I’m post-menopausal too, with no signs of cancer or heart disease. I know my case is anecdotal, but I’m betting there are other fat people out there in a similar situation to mine, but there aren’t enough of us to make the news (not to mention that no one wants to know that extremely fat people can live for a long time and be healthy doing it).

  16. By the time you are post-menopausal, most of the damage to your body has already been done.

    It seems a bit disingenuous to use this as an argument against the study, since one of the main tenets of the low-fat diet is that it doesn’t matter what state your body is in, you can always improve your health by switching to low fat food. Even if the study as a whole doesn’t show conclusively whether eating low fat food from early in life makes a difference to later health, it does at least disprove the particular dogma that says switching to low-fat food will ALWAYS make you lose weight and improve your risk factor for breast cancer and heart disease.

  17. downside-up,

    I can totally get on board with that last statement. The study implies that the diet the “powers that be” have been pushing isn’t helpful. I just want to make clear, I don’t think we should make the mistake of saying that healthy eating can’t impact your risk of disease. That disempowers us (and we can’t affect everything in our lives, but we can try and affect the *chance* of something happening), and also makes FA people look like they just want to eat Cheetos all day (which is your right if you want to, but not the best for your health).

  18. First… I remember hearing about this study when it first came out… specifically I clearly remember reading about it in the NYT and I think my local paper (The Oregonian).

    Like Bobette I think it is noteworthy that they didn’t study the quality of fat, only the quantity, and also didn’t note consumption levels of highly processed white flour and sugar based foods.

    I mean, it still makes a good point that the conventional decrease-fat-eat-a-little-more-veggies diet will not work miracles (or maybe work… anything). But I don’t think the point of these results is “eat whatever you want, que sera sera” not that anyone was saying that.

  19. The message I always get from Western Medicine is, “Eat well, and you will be disease-free and live forever!” I think this doesn’t consider the bazillion other factors in the world that might cause disease…like, say, stress, pollution, chemical additives in everything we eat/touch/shower with/wear/etc., power lines, radio waves. (And I’m not saying that any of these things DO cause disease….just saying I think there might be lots of contributing factors that aren’t what I eat, and that we may not have a full understanding of all the intricacies at this point in human history.) Not even to mention genes.

    So, you know, no matter how well I eat and exercise and follow The Lifestyle Plan To Be Healthy….I could still get sick, or not. I think that’s the point from this study that I like.

  20. Bobette I think it’s important to distinguish between healthy eating for general good health and healthy eating to prolong life and prevent serious illness. What this study doesn’t cover (at least in what I’ve read thus far) is day to day health. I for one wouldn’t dispute the fact that eating a lot of junkfood for a period of time makes me feel less healthy. I get headaches, low energy, dull skin that doesn’t heal well. I get more colds and flus. By comparison, eating a balanced (not low fat) diet makes me feel mentally and physically stronger and more energised. However, much of the dogma around the low fat diet isn’t to do with that day to day health, it’s to do with avoidance of serious illness and achieving long life, and that, I think, is what is called into question. It doesn’t totally negate the reasons for engaging in healthy dietary habits, but it does say that the reasons may not be the long-term health benefits we’ve been led to believe. Furthermore, since some people, myself included, feel sub-par on a strictly low fat diet, if there are no long-term benefits, there are really no benefits at all for those of us who feel that way.

  21. But I don’t think the point of these results is “eat whatever you want, que sera sera” not that anyone was saying that.

    Lexy, are you saying that it’s not a license to eat donuts??!?

    :D

  22. FJ, we should develop a longitudinal study on the effects of images of donuts on weight-loss researchers. My predicted results: the mere picture of a donut causes immediate dementia.

  23. downside-up,

    Point well take, I especially like how what you said about how we feel on a day-to-day basis–the quality of life. I would suspect that what makes us feel better day-to-day is also good in the long run, but it is true there is no proof of this (and I don’t think you *could* measure this).
    Still, there *are* studies that show longevity and disease to be influenced by diet (any study that tracks a population over time as they switch from traditional to the Standard Western Diet, for example–including immigrants as well as people in their own countries); but as this study shows, the USDA food pyramid probably is not one of those diets.

  24. This is a bit off-topic, but I just found this hilarious article on exercise and weight-loss, check out the first two:

    http://www.msnbc.msn.com/id/21185850/

    They just couldn’t tell the person–You might never lose weight, but you will feel a lot better, so pick a way (various ways! many, many different ways!) of moving you love and can stick with. Nope, gotta set them up for failure, so they drop the exercise if nothing happens (or if they do lose weight, they’ll stop once they get there). It’s so ridiculous.

  25. Isn’t it interesting how people always separate out calories from foods they perceive as ‘bad’, as in that article;

    An average-weight person will burn about 100 calories walking a mile. So it will take a lot of steps to burn off a 300-calorie candy bar or 600-calorie plate of pasta.

    Even if you are convinced you can lose weight according to a calories in/calories out type arrangement, this is SUCH an irrelevant measurement, since it assumes that basically anything that isn’t vegetables or fruit must be ‘surplus to requirements’. Even if the nutritionist making the statement understands that’s not the case, simplifying it as such completely misrepresents what a large proportion of daily caloric intake actually goes towards keeping us alive and functioning. It’s just one of so many ways that society builds up this completely faulty idea of how fat (both dietary and body) function.

  26. FJ, If one needs a license to eat donuts I’m in big trouble… what’s the ticket from the food police for eating without a license?

    Bobette (and others)… it seems like the answer to all those questions is “you may already be at your set-point weight”

  27. Lexy, funny enough, I made almost that same joke in another thread, and someone suggested that we actually draw up a food license… I guess I’m gonna have to do it. Just a little card you can laminate and pass out to your dieting friends. I’ll draft one at work tomorrow.

  28. I looked up the study and glanced at the full text and the graphs of weight over time were pretty fascinating. Basically, both groups deviated from the starting weight for awhile (how they id varied by ethnicity) and EVERYONE ended up back at the starting point by the end of the study.

    Set point? What set point?

    I hate the idea that anyone who takes interest in seeing things like these, who wants to disprove that it’s “calories in, calories out, until the day you die and no more calories in or out for you,” must be looking for license to eat donuts and cheeseburgers all day.

    I don’t even like donuts or cheeseburgers, but 1) nobody needs license or excuse to eat anything and 2) having “license to eat” something does not mean it is better or worse or tasty or less tasty. Jesus christ, it’s just food. We don’t weigh and measure when we breathe or go to the bathroom. Why should breaking down any other necessary bodily function into measurable units be a good idea?

    Also, the abstract comes to the conclusion that a healthy diet does not lead to weight gain. Which, um, last time I checked is the same as not leading to weight loss.

    It’s not that I don’t think eating vegetables and whole grains etc etc are good things. Hell, I get fairly regular comments on how healthy I eat. But I like vegetables and feel physically gross when I don’t eat the way that’s right for me. But will it grant me immortality? Hell no. I am so tired of that attitude and the presumed right that people seize to tell others what to do.

    /slightly off-topic venting.

  29. An interesting article on causes of the ‘obesity epidemic’

    http://news.bbc.co.uk/2/hi/health/7047244.stm

    Particularly this bit:
    Obesity, the authors concluded, was an inevitable consequence of a society in which energy-dense, cheap foods, labour-saving devices, motorised transport and sedentary work were rife.
    In this environment it was surprising that anyone was able to remain thin, Dr Susan Jebb of the Medical Research Council said, and so the notion of obesity simply being a product of personal over-indulgence had to be abandoned for good. “

  30. The problem I see with studies that follow what happens to various ethnic populations when they start eating a “Western”, non-traditional diet either in their country of origin or because they’ve moved is that all they’re really ‘proving’ is that that specific population may have problems with a Western-style diet. People of European ancestry seem to do quite well with a balanced Western-style diet. Maybe that doesn’t work out so well for people of, say, northern Chinese origin. But what would happen if Moroccan nomadic tribespeople ate a tradtional Pacific Islander diet? Do Filipino workers in Dubai have any health differences from eating an Arabian peninsula type diet? How about Greek people eating a traditional Japanese diet (which, as an aside, has a lot less soy in that most people think)? Or to bring it in closer, southern Italians eating a Norwegian diet? How about me, who typically eats chicken tikka, pho, lamb kofta, pesto and vege pasta, nori rolls, and Greek salad? What about, say, Chinese populations that have lived in California and Australia since the early-mid 1800s? I have a million questions.

    The question of diet’s relationship to health is more convoluted than most people care to believe. Perhaps eating a diet close to ‘traditional’ (how is that even judged anyway? multiculturalism’s not new) for your ethnic background will bring you optimal health for you. Perhaps not. Maybe you’re Thai but allergic to peanuts and cocount. Maybe you’re Lithuanian but you hate fish and rye bread.

    I’m in agreement with Sandy Szwarc that a balanced diet of foods you actually enjoy is probably the best way to go. I’m all for local, seasonal produce too.

  31. *peeks in thread*

    So I’m a bit off topic, but I’m the chick who suggested the food license…unfortunately, I suck at photoshop and couldn’t get the thing to look like the picture in my brain.

    So maybe I’ll make one out of construction paper instead. :-)

  32. Kate-

    Yeah, and the percentage of the population with a BMI greater than 50 is virtually nil.

    It’s 1/250 in the U.S. currently, and has quintupled from recent years. That’s a lot of years lost.

  33. But I like vegetables and feel physically gross when I don’t eat the way that’s right for me. But will it grant me immortality? Hell no. I am so tired of that attitude and the presumed right that people seize to tell others what to do.

    Entangled, your comment is not off topic at all.

    Also, the part of your comment that I quoted is awesome. I think most of this “healthy eating” stuff is about the fear of death and you summed it up beautifully.

  34. @ La ti da – that’s a valid question – some of the genes that have been suspected to be under some heavy selection are metabolism genes (this is coming from Voight, 2006 – I can’t remember which Journal). They seem to be specializing for each region – but this was a fairly broad study looking for specific signals of selection. I don’t honestly know what’s come out since then, but is a decent start :)

    @ Kate – thanks for pointing that out – it IS a very valid point that there would be a lower risk for disease and cancer in younger people, making the study almost worthless. I’m thinking a better approach to what I said before would be to follow a group of people from young age to old age, but as already been pointed out, this isn’t exactly feasible. *sigh* I’ll take it for what it’s worth.

    I still like HAES so much better than sitting on my ass all day :)

  35. Guy: That means the number of people with BMI > 50 used to be 1/1250%, and is now 1/250. We are still talking tiny tiny fractions. And think about what might have contributed to that increase. What are people with BMI > 50 most likely to have spent their lives doing since they could hold a fork? Hint: It starts with a D, and has 7 letters. IOW, the relentless trying to slim down can very well make a person much fatter than she would otherwise be.

    Also: What Vesta44 said. And Kell. Both of them are in the Instant Death BMI Range, but if you’re looking to dance on some fatty’s grave, maybe you’d better try different ones from the ones in this group. Most of us aren’t ready to jump into the hole you’ve dug for us just yet. That’s what happens when you quit apologizing for breathing while fat. People who don’t hate themselves with a purple passion generally last longer.

    Anyway, why do we assume that if people “ate what they wanted,” they’d just pig out on chips and doughnuts and forget about feeding themselves foods with actual nutrients? A few people do that. They have eating disorders, or some other illness or condition that severely limits their range of intake. (Ever check out the diet of a newly recovering alcoholic? Hoo boy.) Most of us are what ED specialists call euphagic — we eat a little of this and a little of that, in moderate amounts, when we don’t have someone forcing chlorophyll-bearing substances down our throats.

  36. “Yeah, and the percentage of the population with a BMI greater than 50 is virtually nil.”

    It’s 1/250 in the U.S. currently, and has quintupled from recent years. That’s a lot of years lost.

    Well that’s good to know Guy. But what are you expecting anyone to do about it, since if that 0.4% of the population lose weight, 95% of them will have gained it back, and possibly more, in five years time? Would you have that 0.4% live in a constant and pointless state of starvation? (as well as anyone a bit close to the cutoff presumably?) Will you also name and shame all the women with a BMI of 17 or less, whose life expectancy is just as bad, or worse, than those at the other end of the scale? And is there actually a moral imperative that says people should strive to live as long as possible? Perhaps I’m missing your point, but from your comments here, it seems more likely that you’re missing ours.

  37. Gee, Guy, thanks so much for being so goddamn concerned about telling me how to live my life, especially since your self-serving advice has cost me a whole hell of a lot more years and disease risk than staying my normal FAT (and, in this case, thinner than now) self ever would have.

    Check it out, you ignorant jerk. Every single fat person on this planet knows MORE about fatness than you do. We know more about weight loss, we know more about nutrition, and we also know bullshit when we step in it.

    I’m calling troll.

  38. Kell, I wish I could help you know that all of the scaremongering about diabetes is exactly like all the other scares we’re being given (even following the money leads to the same places). No lifestyle factor causes diabetes. Even by eating gobs of sugar no one can give themselves diabetes. Try not to worry that by being bad somehow diabetes (or cancer or heart disease or being fat) is your fault, or that your parents did anything wrong to give themselves diabetes, either.

    Just as you said, like all you need when you’re dealing with cancer (or diabetes or heart disease) is GUILT.

  39. And of course, much depends on whether people can afford to eat what their bodies are asking for, or whether it’s made available to them. Fat people who live in poverty already have a double whammy against them.

  40. Meowser –

    Great point. I think that extends to culture as well. When people bring up things like the lifespan in Okinawa (sp?) or statistics regarding cultures before and after switching to a western diet, they neglect some important things. For one thing, there’s more difference between cultures than food and more changes that occur with westernization than just McDonald’s and Starbucks. For another, how long have we been tracking this stuff? Until we’re comparing apples to apples, statistically, you can’t just say “oh, noes, I see donuts!” and make it mean anything.

    Nutrition is only one variable among a WHOLE LOT of noise. I’m not saying there’s no way it has any effect, but it should not be held up as the holy grail. A friend once said to me that I’m not going to get breast cancer because I was vegan for years and eat a lot of fruits and vegetables. Somehow I think that my mother’s two separate premenopausal occurances (fortunately, she’s fine now) will have more impact on me than eating beets and tomatoes and eggplants.

  41. This is such an awesome discussion.
    Meowser, as usual, hit a nail with the idea of what we can afford to (or even find to) eat.
    The concept “you are what you eat” is more spiritual or metaphysical than it is a biological reality — it’s so much more complex than that. Our bodies are amazing things — Life itself is amazing — that plants can metabolize sunlight and combine it with air and soil and create amazing reproductive pods which we then eat or feed to other animals — I mean, like, WOW.
    That a great cook can then fashion these products into something delicious like chocolate cake or yakisoba (two of my little one’s favorite foods) — that’s also, like, WOW.
    I did spend a little time last night creating a “license to eat” and posted it on my blog. Feel free to take it and make something much better.

  42. I agree with a lot of the comments already made here. I wish the study had considered all age groups (or that there would be follow-ups that do) and although I am not sure I would “agree” (or perhaps it is more accurate to say I don’t know enough to form an opinion), there is a point to be made that “increasing grains” and decreasing fat is no longer considered all that good of an idea. Don’t get me wrong, I personally am inclined to believe whole grains are good for you, but just “increased grain” intake in combination with a low-fat diet (rather than emphasizing protein and “good fats”) would be considered by many as actively detrimental to someone’s health rather than a marker of an unimpeachably “healthy” diet.

    Just to be clear, I personally am not on board with the idea that the Food Pyramid is total crap (and jumping from “Well, the low-fat diet doesn’t work but now we all know that it’s good fats and low carbs that is best!” strikes me as sort of a desperate need to believe that *some* diet must be the key to health, and also seems founded on current “common knowledge” rather than established fact–if that didn’t improve people’s health either then what would you do next?), but I think that is a legitimate complaint that people could make about the study. So large and well-designed though it may be to answer the specific questions it was asking, I’m not sure this study is anything like the last word on the role of nutrition in health. I certainly agree that many of us have gotten this regrettable idea somewhere that we can eat our way to immortality (and, conversely, into an early grave) which is certainly wrong. You can’t control how your life goes based on what you eat. I feel horrible for people who think this way and then get sick, because the guilt and feelings of betrayal must be crushing. The way the mainstream media reports on nutrition is largely to blame for this IMO.

    The weight component of the study, however, is REALLY interesting. These women were eating 361 kcal/day less than they had previously, over a period of 8 YEARS, and their weight DID NOT CHANGE? This is probably not something most of us here are surprised to see, but it would be HUGE if society as a whole would really take it in and sit with it for a while. I agree with Amanda that it is probably natural for post-menopausal women to gain weight, but most obesity “experts” fight that concept tooth and nail these days and assure us that you don’t “have” to gain weight as you age and in fact if you do, it is all your fault. Why, just 50 calories a day (they insist) is enough to make you put on a pound a year [or whatever], you gluttonous pig! By contrast if you “burn off” those 50 calories or skip the cream and sugar in your morning coffee, presto, you can avoid the weight gain altogether!

    This always struck me as highly suspect because–like with the “5 lbs overweight is a health risk” claim–how can you really believe you know your “needed” food intake to the nearest 50 calories? But here is some concrete evidence that this line of reasoning is NOT TRUE for women in this age group. Calories in/calories out should be looked at from now on with extreme skepticism for postmenopausal women (well, and for everyone else too probably, but at least this age group based on this study), but people apparently find it too “depressing” or something when they are no longer able to believe that they are thin just because they have incrementally more willpower than their neighbor, or that they can control their weight to the gram if they just eat perfectly, or that they alone know the “50-calorie-a-day secret.” So I doubt this will ever get much attention and if it does it’ll be “Well, if they had eaten low-carb [low glycemic/South Beach/Mediterranean/even lower fat/vegan/etc.] it would have worked!” People just don’t want to hear this kind of stuff. Personally I would think they’d be thrilled not to have to feel so unrelentingly bad about themselves all the time, but whatever.

    Entangled, I love (hate?) the image of people comparing the contents of their breath or excretions in a social setting. It makes about as much sense as thinking you can 100% control the outcome of your weight and health based on how many grams or calories you eat of this or that.

    Person 1 [breathing into a portable analyzer]: Oh, I am so DISGUSTING today. My CO2 levels are up by 0.02. I am so LAZY. If I really wanted to get into the ideal range I would just work harder. I don’t know what’s wrong with me.

    Person 2: YOU’RE disgusting? I peed 5 mL less than I wanted to yesterday, and I had been so GOOD so I was really hoping to see a good number. I’m pretty sure my husband is going to leave me for his secretary. That bitch’s urine is always PERFECT!

    God, we are all crazy.
    :)

  43. Oh, and I LOVE the license to eat, wellroundedtype2! I love “No restrictions apply.” It is awesome. I think I will make a Michigan one. I wouldn’t want to be unlicensed in my state of residence. :P

  44. SCG, cleaned up your double post… and don’t worry, we’ll have a generic eating license posted here in a minute, just have to upload the files.

  45. I just want to say that I agree with everything Entangled has said. I was going to post something, but she said most of it already.

    The study was about prevention of chronic diseases in the future. HAES is about feeling and functioning well now.

    And, I actually don’t believe that people all over the world are necessarily switching to a western diet as they are exposed to western culture. What else comes with western culture? High stress levels. Materialism. Extreme self consciousness. Relationships becoming less central to people’s lives. I think those are more likely to be affecting people’s health any change in their eating habits.

  46. Dee said: And, I actually don’t believe that people all over the world are necessarily switching to a western diet as they are exposed to western culture. What else comes with western culture? High stress levels. Materialism. Extreme self consciousness. Relationships becoming less central to people’s lives. I think those are more likely to be affecting people’s health any change in their eating habits.

    Amen, exactly what I was thinking when I was reading the comments about “But what about people getting less healthy when they switch to the Western diet?”

  47. I love the license!!

    Kate’s point she made yesterday at 9:24 is critical to understand in how clinical trials are designed. Not to mention, it makes a good point for us to remember whenever we’re tempted to believe our foods are hurting us. It’s so popular to believe that a single bite or small % of something “bad” will hurt us, yet we are to believe that a decade of eating “good” stuff (even if not perfectly) will still not show any health benefits? I think not. And neither did these hundreds of nutritional experts at the 40 centers across the country who designed and conducted this study. If they’d believed otherwise, then the entire country should be demanding our $415 million back! And, it’s heartbreaking to think that all of these women gave up 8 years of their lives for science, only to have it all disregarded.

    PS. These women were not that old! :-)

  48. To be fair (and I’m sure you guys aren’t talking “to” me here, but since I was one of the people who brought up the age of the subjects, I wanted to respond) I didn’t say (and certainly didn’t mean) the subjects were “old,” just that the study was designed to look at a certain age group that may not be representative of the rest of the population. Or more to the point, I really think you would have to compare a “nutritious” vs. “bad” diet for many more years and starting much younger (or continue to follow these women basically until death) to really understand. And obviously that is impossible (at $415M for this extensive study, I can’t even fathom how much that would cost), so I am certainly not saying they “should have done better” with the study or anything like that. It seems it is about as airtight as any study can realistically be. If anything the remaining questions just point up the limitations of any study no matter how well designed and executed, definitely no judgment on this one in particular.

    Sandy, I “agree” with your analysis (or I should say, “makes sense to me!” because I am certainly no expert in this area), appreciate the care you took in examining the study findings, and take your point that eating “right” for 8 years should certainly have dramatic health effects if popular beliefs about nutrition were true. Of course immediately people (like in this thread) look at these results and start going “but it’s too late, they already ruined their health by the time menopause rolls around!” I do think some kind of pie-in-the-sky cradle-to-grave study would be the only way to really know whether this is true or not, because maybe it is… but by no means should that kind of evidence-free hypothesis be brought forward as proven fact. People just really, really need to believe that they can orchestrate their health outcome by being “good.”

    I definitely agree that if being fat and eating poorly were as bad for you as the public believes (though that is likely not possible since NOTHING could be bad enough to warrant the current mass hysteria) then a study like this should have no problem producing clear-cut, scary results. The results can be nitpicked but it seems that nutrition is at the very least much less significant to health than the public thinks. Not that most people will be willing to consider this possibility.

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