The Candidates on Obesity

Paul covered it so I don’t have to. Yay!

Here’s the McCain quote from last night’s debate that sparked his post and this one:

The rise of obesity amongst young Americans is one of the most alarming statistics that there is. We should have physical fitness programs and nutrition programs in schools. Every parent should know what’s going on there.

As Paul notes, “the rise of obesity amongst young Americans” has already leveled off. There’s that. As for the other stuff, well, I covered what I thought of that back in July:

Free fruits and veggies for everyone! Local, organic produce for all my friends! While you’re at it, bring back gym class and train future phys ed instructors to focus on encouraging the joy of movement instead of forcing everyone to move their bodies in exactly the same way, regardless of any pain (physical and/or emotional) it causes! Subsidize exercise facilities until they’re affordable for everyone! Create more bike paths! Clean up local bodies of water so everyone can swim for free! Build cities on the scale of human bodies instead of cars, and keep the streets safe enough for everyone to walk around! Ban high fructose corn syrup! Keep fast food and soda and junk food corporations out of the schools! Raise the minimum wage and shorten working hours so people have more time to cook and be active! KNOCK YOURSELVES RIGHT THE FUCK OUT creating an environment that makes it easier for everyone to eat a variety of fresh foods and get plenty of exercise!

But don’t tell me that’s going to make everyone thin — and really, really don’t tell me that making people thinner should be the main point of such a plan.

Also, it’s worth remembering that 90% of nine-year-olds get “a couple of hours of exercise a day,” making the panic over the millions of supposedly sedentary children glued to their computers and Wiis a mite puzzling.

Paul also calls out Obama, as well he should, for featuring THE OBESITY EPIDEMIC BOOGA BOOGA BOOGA in his health care plan. The fact is, there is no politician on the national stage who’s clued in to Health at Every Size at this point, and I imagine it’ll be some time before there is one. That’s why I’ve long said I don’t even factor fat policy into my voting decisions, because everyone’s fucking policy is still that fatties are destroying America. Having said that, Obama’s plan offers one thing that stands to benefit us, even if the focus on “prevention” (which experience tells me to read as “weight loss” — just like “wellness program,” as Paul points out) makes me queasy: Under his plan, insurance companies won’t be able to deny coverage for pre-existing conditions. That could make a big difference — although it would depend on whether they’re still allowed to charge people with pre-existing conditions exorbitant prices.

Anyway, to sum up: McCain and Obama both suck on fat. McCain sucks more.

This thread is open for discussion of that and anything else that struck you about last night’s debate. I actually didn’t watch this time, so I’ve got some catching up to do.

Quick Hit: Fat Talk Free Week

This is awesome, and I’ll be posting more about it on Broadsheet shortly. Happy Fat Talk Free Week, everybody! (Video is all text, so no transcript necessary.)

Update: Karen pointed out in comments that transcripts are also for the visually impaired whose screen readers don’t read video — d’oh! of course! — and llencelyn has kindly provided one. It’s below the video, after the jump.

Update 2: Here’s my Broadsheet post about it.

 

Continue reading

From the Mailbag: Good News, Bad News

A Shapeling writes:

I am a biologist attending a large, well respected conference on insulin resistance, metabolic syndrome, and heart disease.

All the experiments were well designed, good solid data, and a lot of it correlates EXACTLY with the message of your blog, like the factoid I gleaned that fully 25% of Coronary Artery Disease cases diagnosed have no known risk factors- not high cholesterol, not obesity, not smoking, not type II diabetes. The fact that exercise and activity level is a better predictor of long term health than fat. That pear-shape fat (subcutaneous fat) releases adipocytokines that protect against metabolic disease, improve lipid and glucose metabolism, and positively correlate with increased longevity and quality of life.

The problem is the huge disconnect. It made me want to curl up into a ball and cry- which is what I did as soon as my husband joined me at the conference.

  • The slide that had a picture of an obese man with the caption “homo stupidus.”
  • The news that the AHA reclassified anyone over 27* (me!! me!!) on the BMI scale obese with the attendant scare-the-crap-out-of-you warnings.
  • The obese diabetic (ob/ob db/db) mouse model- google for images if you’re curious- which is considered a great way to model the metabolisms of healthy fat people like you and me and then tell us we’re all going to die and its ALL OUR OWN DAMN FAULT.

Sigh.

Sigh, indeed. Also, as I said to the Shapeling, HOLY CRAP, are they seriously moving the cut-off for obesity down to 27?!? Ten years ago, that was the cut-off for overweight! If this is true, people with a BMI of 26 have now gone from being a healthy weight to overweight to just shy of obese, without ever gaining an ounce.

You’d think things like that would make people wake the fuck up. You’d think.

And seriously, “Homo Stupidus”? Charming.

Anyway, Shapelings, have at it. And thanks to the sender-inner, as they say over at CO.

*Update: The Shapeling who says this in now says she thinks she must have misheard or misinterpreted this — or the presenter might have been from a different country. The Wikipedia page on BMI notes international variations in keeping with what she heard, but as far as we know, the AHA hasn’t changed anything recently. So if you’re American, you can exhale. A little.

Three to Four Hours a Day

Did y’all see this?

Maybe you CAN blame being fat on your genes. But there’s a way to overcome that family history — just get three to four hours of moderate activity a day.

Seriously. Just exercise moderately for three to four hours a day, and you won’t be fat! LIKE MAGIC. 

The best part is where they tell us that that’s really not as much as it seems, and offer the same old list of ideas that’s offered in every article exhorting us to just get twenty minutes of exercise a day, or half an hour, three times a week, or one hour, five days a week — whatever the hell the recommendation du jour is. 

Instead of watching TV for a few hours at night, take a brisk walk, he suggested. Or use stairs instead of elevators, walk instead of driving, or take up a structured exercise such as swimming.

Or, you know, just park your car farther away from the mall! Like, 15 miles away!

Seriously, we’re supposed to walk briskly or take the stairs for three to four hours? I have walked briskly for three to four hours on occasion, but only on occasion, because it’s a fucking huge time investment. People are supposed to work at least eight or ten hours a day, then go home and say, “Hi, family, lovely to see you, off for my brisk walk now! You’ll be in bed when I get back, so see you in the morning!” And that’s without getting into the fact that a whole hell of a lot of people in the U.S. don’t live somewhere where they could take that long a walk if they wanted to — unless they just did hundreds of laps around their backyards or living rooms. Today, theoretically, I could walk over to the lakeshore path and take it downtown, then turn around and come home, and that would be just about four hours of brisk walking. But when I was growing up in the suburbs, my only path from home to anywhere involved highways and no sidewalks. Also, fuck if I’m going to take that walk every night of my life, throughout the Chicago winter and the Chicago summer, instead of actually spending time with Al and friends, unwinding from writing all day. And I love walking!

Fortunately, though, the article also offers another way to get your three to four hours a day: become Amish. The study of this particular genetic variant — thought to affect 30 percent of people of European descent (so I’m not sure if people of color are off the hook or expected to exercise even more) — focused on an Amish community in Pennsylvania, where the lack of cars and modern technology means folks are pretty active in their daily lives. In that context, people with the genetic variant in question often were getting three to four hours of moderate exercise every day, and they were no more likely to get fat than people without it.

Which… bully for them. There’s a lot to be said for that lifestyle. But most of us aren’t fucking living it. 

Study co-author Dr. Soren Snitker of the University of Maryland acknowledged that it’s unrealistic to expect most people to shun modern conveniences and return to a 19th century lifestyle for the sake of staying trim.

Ya think? 

Look, I’m a fan of movement. I don’t own a car and live in a pedestrian-friendly city. I have a flexible schedule and am not working multiple jobs. But I’ll be damned if I’m going to devote three to four hours of my day to exercise unless somebody starts paying me for it. The idea that I should be doing that — that 30 percent of white people should be doing that — solely to avoid being fat pisses me off like nothing has pissed me off in… I don’t know, at least 45 minutes or so. I cannot fucking believe that instead of writing the obvious story — i.e., “people who have this genetic variant would have to do a tremendous, totally unrealistic amount of daily exercise to be thin” — they went with “people who have this genetic variant can be thin if they just work in three to four hours of daily exercise — easy peasy!” Seriously, you guys! It’s not as bad as it sounds! Just break it down to 48 five-minute sessions throughout the day! 

There was one thing that amused me about this article, right at the end:

Dr. Joel Hirschhorn, a genetics and obesity researcher at Children’s Hospital Boston, said people should not interpret the study to mean, “I don’t have this gene variant so I don’t need to be physically active.”

I love it. It’s the flipside of the inevitable, “People shouldn’t take this as a license to eat whatever they want!” that ends every fucking article suggesting that fatness is not a death sentence. What the hell is up with this assumption that everyone, fat or thin, reading articles about THE OBESITY CRISIS BOOGA BOOGA BOOGA is really just looking for permission to lie in bed all day or eat “forbidden” foods? Is that really the American dream? No movement at all and a steady diet of (baby-flavored) Krispy Kremes?

The thing that really pisses me off about this particular motif in TOCBBB articles is that it just reinforces the idea that exercise is onerous and eating veggies is gross, so the only reason any sane person would do either is to be thin. Which may have been how I felt when I was about 6 (not counting running around the backyard, tree-climbing, dance class, or swimming as exercise, of course, because those things were fun and even then I knew that Exercise Is Not Fun), but I eventually grew out of that mindset. I kinda think most people eventually do. And if they don’t, it’s probably because of the kabillion fucking articles propagating the notion that exercise and veggie-eating are miserable burdens one must undertake to avoid the dreaded sin of fatness. Way to promote “health” there, media.

Why People Hate the Gym

So, we recently got rid of the car. It’s no huge hardship in a city with good public transportation, but of course, in the first few weeks of going carless, you become aware of all the places that are suddenly much more of a PITA to get to. 

Over the last several months, I’ve been trying to pick a real gym — specifically, one with a pool — to go to. Before that it was Curves, the yoga studio, or the Pilates studio for any workouts beyond walking. But I really wanted to take a regular water fitness class and maybe start swimming laps, so I started hitting classes at various local gyms on guest passes and non-committal punch cards. I’d narrowed it down to two favorites and was just about to buy a membership at one of them. Then we got rid of the car, at which point I realized that getting to either of those two gyms would require riding at least two buses for a travel time of about 45 minutes, even though they’re pretty close as the crow flies. And I realized that realistically, that meant I would never go to the gym, especially in winter.

So I made with the Google and found a gym that’s a mile away from home, so I can walk when it’s nice and take a bus that goes practically door-to-door in 15 minutes when it’s not. Took a tour, bought a membership, done and done. It’s pretty no-frills, but that means it’s pretty cheap, and they have a pool, which is all I really care about. 

Last night, I went to my first water fitness class there. I was all excited, because this one was called “water Pilates” — but if there’s one thing I should have learned from sampling different water fitness classes at different gyms, it’s that they’re all pretty much the same. I went to one that supposedly involved an element of “water yoga,” but all that meant was that the teacher reminded us to breathe deeply a lot. Likewise, “water Pilates” means you get reminded to engage your abs a lot. That’s about it. Fortunately, I like plain old water fitness, so I can live with that, even if I am inclined to grumble about false advertising.

ANYWAY. All of that is background for the point, which we’ll get to now.

So, the instructor is friendly, the class is going along fine, and then it starts. While we’re doing arm exercises, she babbles: “It’s really easy to fatigue the triceps, because they’re smaller muscles and we don’t use them as much. You know what’s funny? We use our biceps all the time, because —” [mimes bringing fork to mouth]. “If we just did this –” [mimes pushing plate away] “–more often, we’d all be better off! Best diet in the world, and you’re using your triceps!”

Ouch.

Really? Pushing food away is the best diet in the world? But okay, a certain amount of that crap is to be expected from people out in the non-Fatosphere world, especially fitness instructors. Shake it off, Kate!

And then.

“Wow, the pool’s pretty empty today! Usually, we have to deal with lap swimmers splashing everywhere — and since the Olympics started, of course we’ve got a lot more of them! Everybody watches Michael Phelps and thinks, ‘Oh, someday, I could do that’” [makes face]. “And I’m just like, no, you couldn’t, and you don’t look as good in a Speedo, either!” 

I’m sorry, WHAT? I know you’re making what you think are innocuous little jokes here, lady, but seriously? FUCK OFF. First, you’ve got two new students in class today, including me, and you think it’s wise to give the impression that the instructors at this gym make fun of newbies for both technique and HOW WE LOOK IN SWIMSUITS? 

Second, nobody in their right mind looks at Michael Phelps and thinks, “I could do that.” Personally, I wouldn’t look at a freshman on a high school swim team and think, “Someday, I could do that.” I’m never going to get up at the crack of dawn to train for hours, let alone every day. I have zero interest in athletic competition, and even less in trying to sculpt my body to look “better” in a bathing suit. And yet, it was indeed the Olympics that inspired me to finally commit to a damned gym membership so I can spend more time in the pool. Because when I watch swimming on TV, half the time, I’m not even looking at the athletes. I’m looking at the pretty blue water and thinking how much I want to be in there

I fucking love to swim. I especially love to just splash around for fun, which is why water aerobics appeals to me, even if I’m 30 years younger than the target market. But for over 15 years, I almost never got in the water, because I was too ashamed of how I looked in a swimsuit. I could not bring myself to do something I knew to be incredibly fun and good for me, because I didn’t have the kind of body that I believed would earn me the right to appear in public mostly naked. And that’s in part because of assholes constantly commenting on how other folks look in bathing suits (or yoga pants, tank tops, miniskirts, you name it), and who has the right to wear them, and who should really just stay home until they magically become thin enough that their flesh won’t offend right-thinking people. 

For over 15 fucking years, I just stayed home. 

“Harmless jokes” like that are neither harmless nor jokes to me. 

And wait, it gets better. After class, I stopped to talk to the teacher (about the towels, nothing at all loaded). I knew I should say something about how much her remarks had bothered me — if nothing else, point out that joking about pushing your plate away being “the best diet in the world” might not be such a great idea in case she’s got someone recovering from an eating disorder in the class — but frankly, I wasn’t up to it. I do not always have the energy to confront people about this shit, and last night, I just wanted to get dressed, get out of there, and try a class with a different instructor next time.

So she asks how I heard about the class, and I say, “Well, I just signed up here because we got rid of the car, and it’s the closest gym with a pool for me. I knew I wouldn’t keep going to a gym that was hard to get to.” 

Her eyes light up, and she starts telling me how she’s actually a wellness coach — specializing in weight management! — and she’s always telling people stuff like that, how you’ve got to make it easy for yourself and get rid of all the excuses if you want to keep going. At first, I’m nodding, ’cause yeah — obviously, I agree. Then she fires off 85 other tricks — all of which I’ve heard before, and/or done myself — with the strong implication that she assumes this is the first time I have ever considered exercising in my life, and I have actually just asked her for help in learning how to haul my poor flabby ass to the gym. 

And then. AND THEN. Unbidden, she tells me more about her weight management services. “You know, I always tell people there’s no magic bullet –” OH REALLY YOU DON’T SAY “–but you have to change your behavior over time and really find a way to stick with it…” 

Fortunately for her, she did not say the words “lifestyle changes,” which meant I didn’t have to deck her. But man, did I ever want to, especially when she wrapped it all up with this:

“So, do you have any particular… concerns?”

To her credit, when I said no and glared a little, she covered — asking specifically about injuries and whatnot, stuff she should know about as a teacher. 

Me: Nope, thanks, I’m good.

Her: Okay, so you’re… healthy?

HINT HINT, FATTY! 

Me: Yep. Thanks. BYE.

So. It’s my first class at a gym where I just signed a 12-month contract, and I have to listen to pro-dieting, anti-fat, anti-FOOD commentary throughout (there were more examples than the ones I gave), AND get an unsolicited pitch for “weight management” services before I’m allowed to hit the goddamned shower. AWESOME.

Of course, there are other water fitness teachers at the gym, and I will certainly be trying out their classes. (Though it irks me unreasonably that if I don’t show up to this one again, this woman will write me off as a “typical” lazy fatty who couldn’t stick with it.) I’m also thinking of taking some swimming lessons to improve my strokes and learn how to make lap swimming seem a little less mind-numbing to me — so I can eventually get my water fix without having to interact with other human beings at all. And, if I’m feeling strong enough, I might just go back to one of this woman’s classes and tell her privately that I’m a body acceptance activist who believes in HAES, and I find her patter really troubling and alienating. To be fair, apart from everything I’ve mentioned above — which amounted to maybe 5 minutes altogether, out of an hour — she was a good teacher, and I liked her. So maybe it’s worth taking up my teaspoon for this one. I just hate having to do that, you know? I spend all fucking day reading and writing about this shit, and I want to get in the pool to clear my head, not fill it with more work to be done.

And can I just say, this is one of the many reasons why so many people, fat and thin, hate the fucking gym. It’s not because we’re too lazy or don’t like exercise; it’s because at so many gyms, the culture is all about punishing and depriving yourself, not moving for the joy and genuine health benefits — as opposed to appearance “benefits” — of it. I’m really, really hoping this woman is an anomaly and does not actually represent the culture of the gym. I’m hoping every other instructor I meet will be more of a Terry. But I’m not too optimistic, frankly. And if I do have to deal with little arrows of fat hate coming at me every time I go to a class or work with a trainer there, it is going to be a lot harder to drag my ass there on a regular basis. Not because I don’t like exercise, but because I don’t like the default assumption that any fat person who darkens a gym door hates her body, wants to lose weight, and will give up if professionals don’t take it upon themselves to “motivate” her to work harder. For fuck’s sake, SHUT UP AND LET ME ENJOY MYSELF, and I’ll actually come back here without you having to do a thing.

The Duh Truck Rides Again

Okay, every Shapeling and their grandma has sent me a version of this news, so I’d better get on it. (Thanks, everybody, and sorry I’m slow!) 

A new study suggests that a surprising number of overweight people — about half — have normal blood pressure and cholesterol levels, while an equally startling number of trim people suffer from some of the ills associated with obesity.

The first national estimate of its kind bolsters the argument that you can be hefty but still healthy, or at least healthier than has been believed.

The results also show that stereotypes about body size can be misleading, and that even “less voluptuous” people can have risk factors commonly associated with obesity, said study author MaryFran Sowers, a University of Michigan obesity researcher.

GEE, YOU DON’T SAY.

Of course, as others have noted, it’s only fucking “surprising” if you’ve ignored all the previous research saying the same thing, and continued to buy into those misleading stereotypes. Also, I left out the first line of the AP article there, which is: “You can look great in a swimsuit and still be a heart attack waiting to happen. And you can also be overweight and otherwise healthy.” Hey, thanks for leading with a reminder that even if fat people can be healthy, we still can’t look great in swimsuits*, Lindsay Tanner! 

The L.A. Times is even better. Not only does Shari Roan focus on the “visceral fat is what will kill you” angle instead of the “Fat does not equal unhealthy” one, she phrases it thusly: “You can be normal weight** and be just as bad off as old tubby next door.”

Charming. Do they seriously not teach journalists today that phrases like “old tubby” (see also “ballooning,” “packing on the pounds,” “X pounds of blubber/lard,” etc.) and commentary on folks’ bikini-readiness have no fucking place in science reporting? Or that “colorful” language like that might just suggest you have a deeply ingrained bias against fat people, and therefore are probably not the person to report objectively on studies about our health?  

Anyway. Roan’s phrasing also leaves out the pertinent point that “old tubby next door” has a greater than 50% chance of not being badly off at all, according to this research. What it actually shows is that you can be normal weight and far less healthy than old tubby. You can be normal weight and just as badly off as your normal weight neighbor. You can be old tubby herself and be better — or worse — off than another old tubby across the street. You can be any weight and healthy, or any weight and sick. You can’t tell how healthy someone is just by looking. That’s the fucking point.

Here are the actual studies being discussed, and here’s a rundown of the findings that contains somewhat less editorialization. 

From the latter link, in one study, 

Dr. Wildman and colleagues looked at a cross-sectional sample of 5,440 participants in NHANES, and stratified them according to BMI and cardiometabolic abnormalities, including elevated blood pressure; triglycerides, fasting plasma glucose, C-reactive protein, and homeostasis model assessment of insulin resistance value, as well as low levels of high-density lipoprotein cholesterol.

“Metabolically normal” = one or none of the things on that list, and “metabolically abnormal” equals anything above that. Here’s who was metabolically abnormal: 23.5% of normal weight adults, just under 50% of overweight adults, and just under 70% of obese adults.

The other study looked at “the pathophysiological mechanisms of type 2 diabetes” and found that 24% of obese patients were not insulin resistant and — contrary to researchers’ expectations — “the insulin sensitivity and the intima-media thickness [of the common carotid artery] of the insulin-sensitive obese group were similar [to] those of the normal BMI participants”. Or, as study leader Dr. Nobert Stefan says, “a metabolically benign obesity that is not accompanied by insulin resistance and early atherosclerosis exists in humans.” 

GEE, YOU DON’T SAY.

So yes, there is still a correlation between higher weights and metabolic abnormality. But as we’ve been saying all along, this does not apply to all fat people or let thin people off the hook — which is why there’s so much pants-shitting going on in the media over this. 

Also — brace yourself — you’re more likely to be “metabolically abnormal” if you’re older and sedentary. NO WAY!

They also did find a correlation, yet again, between waist circumference and metabolic iffiness — presumably because a higher waist circumference can be an indication of higher levels of visceral fat, which appears to be the baddie. (Thin people can have high levels of visceral fat, too.)

Now, every time I talk about waist circumference/visceral fat, I hear from apple-shaped folks who are quite understandably pissed off that the OBESITY CRISIS BOOGA BOOGA BOOGA heat is just shifting over to them. So let me make two points I’ve made many times before, because they’re well worth repeating.

1) My favorite fun fact ever: Sumo wrestlers tend to have low levels of visceral fat. And it’s usually sedentary thin people who have high levels of it. The evidence suggests that exercise is protective against visceral fat, even if it doesn’t make you thin — so if you’re able to exercise, there is something you “can do about it,” which doesn’t involve starving yourself or getting a tummy tuck. 

2) Risk factors are just that — risk factors, not death sentences — and we’re all stuck with risk factors for diseases that we can’t do anything about. Family history is the most obvious example — you have no control over whether your parents and grandparents had diabetes, cancer, heart disease, whatever, which is why nobody suggests you have an obligation to “do something” about those risk factors. If you’re lucky enough to get old, you’ll be at increased risk for practically everything — but nobody suggests killing yourself on your fiftieth birthday to avoid that risk factor. Likewise, if you are predisposed to be fat and/or carry weight around your middle, that’s just another risk factor you’re stuck with. For many of us, making a substantial, permanent change to our weights is just as impossible as going back in time and choosing different parents. 

And for many of us, as this research shows, being fat will not lead to poor health anyway. And as always, you can’t tell who’s most at risk by looking. Hell, I’m more hourglass-shaped than apple-shaped (though I am officially obese and my waist circumference exceeds the recommendation for women), but given my pesky family history of diabetes, I’m still probably more likely to end up in the insulin-resistant category than the “metabolically benign” one someday. It sucks, but it is what it is. 

Fat does not equal unhealthy. Thin does not equal healthy. Exercise is beneficial if you can do it and are so inclined, regardless of whether you lose weight. Getting old makes you more likely to get sick, but it’s better than the alternative. Risk factors are not death sentences. Being sick is not a personal failure.

That’s the big fucking news here. But we already knew all that, didn’t we?

*For those who missed it, that’s Fillyjonk rockin’ the swimsuit.

**I have not put “normal weight” in irony quotes throughout, because it would seriously clutter up this post, but please imagine they’re there.

Resources on Body Image and Domestic Violence?

A reader who works with victims of domestic violence writes:

After speaking with my boss, she and I agree that FA and HAES could have a big role to play in our self-care initiatives. While economic issues and pure justified fear are the leading reasons women stay in violent relationships, self-esteem is way up there. I don’t think it is any coincidence that 80% (my estimate) of our clientele is fat and I’d say 100% have negative relationships with their bodies. I was hoping y’all might know of some work that’s been done that has tied the benefits of FA to recovering from or dealing with domestic violence? There are things concerning generic body image that I’ve found, but I’d like to be able to be more specific if at all possible. Any insight you could give would be much appreciated.

Unfortunately, I don’t know of anything to suggest. Shapelings, can you help?

Michelle is Smart

Go read her latest entry on common misunderstandings about HAES.

Everyone is limited, physically or mentally, to a certain extent. HAES must work within those limitations. And because humans come in all shades of disease — from Crohn’s, to diabetes, to cancer and chemotherapy, to eating disorders, to fibromyalgia — there is no tool that can be definitively excluded from being used within HAES.

But ANY tool, no matter how innocuous and HAES-friendly it seems, if used to flagellate yourself, becomes instantly outré. Even intuitive eating. Even yoga. Even anything, if done with the slightest shade of self-hatred.

I would rather someone count calories* while truly believing in fat acceptance and HAES, than to practice intuitive eating in the secret hope that they will lose weight, and to beat themselves up when they ‘fail’ at it.

HAES is a paradigm shift, not simply a new diet. Without the beliefs, the behaviours are meaningless.

Michelle’s closed comments on that entry, which I can completely understand. I’m leaving them open here, but I’ll ask that people be even more circumspect than usual about their comments here. This thread is for asking sincere questions about HAES, discussing various definitions of “health,” talking about the difficulties of making that paradigm shift (if you’ve tried to or are interested in trying), talking about why HAES is or is not right for you, and of course, talking about how freakin’ smart and awesome Michelle is. It is not for detailing what you eat or how much you exercise, telling us all why you still think you need to lose weight (try this thread and this thread for that), insulting people who make different choices than you do, accusing people here of trying to separate “good” fatties from “bad” fatties (try this thread), or telling Michelle she is anything other than smart and awesome. Got it? Excellent. Fire away.

*If you didn’t read the whole post, which you really should, she means counting calories because for whatever reason, you need some structure to your eating habits — and because knowing how many calories you consume doesn’t trigger dieting behavior for you. She’s perfectly clear on the point that trying to lose weight is antithetical to HAES.

Cheating death

Here’s a sobering story in the NYT about a man who almost missed the signs of a heart attack until he remembered reading about the suddenness of the late Tim Russert’s death. Fortunately, the author made it to the hospital in time to get effective medical attention — and he found that he’s not the only middle-aged guy paying extra attention to his heart these days. It’s a poignant article — but I’m sure Shapelings will notice the rhetorical patterns I did: the many references to weight in the article (and, implicitly, the dangerous effects of assuming heart attacks only happen to fat, sedentary people); and the nickname for the author’s cycling club: the Cheat Death group.

This article, which is written from a personal perspective and is (I think) an effective use of anecdata, reminded me of two other things I’ve read recently. The first is Kate’s post on Broadsheet about the fact that heart attack symptoms are different for women than they are for men. If you haven’t read it yet, please do — it serves as a stark reminder that the “default” body of Western medicine is male. And while you’re at it, take a refresher course in the signs and symptoms of a heart attack. A key quote:

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Not to be morbid, but please, if you even begin to suspect that you might be having a heart attack, call 911 (or your country’s equivalent) immediately. Don’t try to talk yourself out of it: time is crucial when it comes to treating heart attacks. In the meantime, it’s not a bad idea to get certified in CPR and first aid, which you may be able to do at your place of employment (that’s what I did when I worked for a big corporation). If you work in a big office building, there might be an AED in your building somewhere, which should come with instructions and is surprisingly easy to use. Find out where it is, and make sure your coworkers know too.

Now onto more abstract musings. I read Susan Sontag’s classic essay Illness as Metaphor last week, because I’m cheerful like that, and the “Cheat Death” club reminded me of a passage I wanted to share with you all. Sontag, who had cancer herself, examines the ways in which grave, incurable illnesses (particularly cancer in the 20th century and TB in the 19th) get appropriated as metaphors for moral conditions, political events, and the like — and then the negative connotations associated with those metaphors are extended back onto the people who actually suffer from the disease. Cancer becomes a sign of moral weakness, of the wrong kind of personality, instead of a physical ailment that could happen to anyone. Sound familiar, anyone? Physical illness is psychologized to shift “blame” — from environmental hazards, the inadequacies of medical knowledge, and just plain chance — onto the individual. Here’s the passage that really struck me:

Moreover, there is a peculiarly modern predilection for psychological explanations of disease, as of everything else. Psychologizing seems to provide control over the experiences and events (like grave illnesses) over which people have in fact little or no control. Psychological understanding undermines the “reality” of a disease. That reality has to be explained. (It really means; or is a symbol of; or must be interpreted so.) For those who live neither with religious consolations about death nor with a sense of death (or of anything else) as natural, death is the obscene mystery, the ultimate affront, the thing that cannot be controlled. It can only be denied. A large part of the popularity and persuasiveness of psychology comes from its being a sublimated spiritualism: a secular, ostensibly scientific way of affirming the primacy of “spirit” over matter. That ineluctably material reality, disease, can be given a psychological explanation. Death itself can be considered, ultimately, a psychological phenomenon…

At the least, there is the promise of a triumph over illness. A “physical” illness becomes in a way less real — but, in compensation, more interesting — so far as it can be considered a “mental” one. Speculation throughout the modern period has tended steadily to enlarge the category of mental illness. Indeed, part of the denial of death in this culture is a vast expansion of the category of illness as such.

Illness expands by means of two hypotheses. The first is that every form of social deviation can be considered an illness… The second is that every illness can be considered psychologically… These two hypotheses are complementary. As the first seems to relieve guilt, the second reinstates it. Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.

The impetus for Sontag’s discussion here is the idea of the “cancer-prone personality” that was gaining traction when she wrote the essay, but I think her analysis can shed light on the OBESITY EPIDEMIC OOGA BOOGA, too. The medicalization of fat bodies is clearly an example of her first hypothesis (every form of social deviation can be considered an illness), and the relentless attempt to use shame as a weight loss motivator is a clear example of the second. First, we’re told that our fat bodies are a danger; then we’re told that your body is the legible sign of the inner you, some secret personality that’s just not disciplined enough to lose weight. This double blaming leads not just to personal fat shame, but the tragic instances of fat prejudice in medicine, which often arise from the idea that fat people cannot be trusted to describe the reality of their bodies, and that they don’t deserve adequate medical care anyway. They deserve illness, because they are fat — and if you’re fat, you’re ill by default.

Sontag begins her essay with a stunning metaphor:

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

Illness is a fact, not a manifestation of your morality. Fat is a fact. Mortality is a fact. You cannot cheat death by joining an exercise club any more than you can cheat hunger by eating only carrot sticks. What you can do is try to listen to your body, both its pleasures and its pains, and live a life that is healthy for the body and the mind that you are.