The Brass Tack

Let's get down to it.

Yes, obesity matters. Freedom matters too.

Posted by srconstantin on August 4, 2009

Megan McArdle, who lately has done a lot of thinking about obesity and society, has a rambling and interesting piece on all things fat-related. I agree vehemently on some points, but not all. Here, she talks about a study showing the detrimental effects of yo-yo dieting on health:

Take this paper on weight cycling, which summarizes much of the literature regarding weight cycling, acknowledging both papers that say it adversely impacts mortality, and papers arguing that those papers suck. The paper says the evidence is equivocal, though it asserts that whatever effect weight cycling has on mortality probably comes because those who diet and regain end up gaining more weight than those who don’t.

To me, that screams “do more research!” But the researchers couldn’t . . . quite . . . bring themselves . . . to suggest that we might want to look into this further before continuing to recommend that people go on highly restrictive diets that they probably won’t stick to.

If 99% of the time the actual result of the course of action you recommend is that people diet, and then regain a bunch of weight, you need to take this into account before issuing further such recommendations. It doesn’t seem like simply proclaiming that they shouldn’t go and gain the weight back again is quite enough.

After all, people who have lost a bunch of weight are presumably aware of how they did it (and if not, they need to talk to an oncologist, not an obesity researcher). They are thus presumably also aware of what will cause them to gain it back. Nor are they usually uninterested in staying thin. They’ve usually worked very, very hard to lose all that weight, and are really quite desperate not to gain it back again. The idea that all that was missing was a doctor telling them that no, seriously, they should really keep that weight off–an incentive obviously far more powerful than, say, the horrific way that America treats fat people–has sailed beyond arrogant into fantasyland.

If I may go on a little nutritional rant, diets usually fail because people usually diet badly. They eat too little (especially protein), they skip meals, and they ruin their metabolisms so they can’t help gaining weight back. Kate Harding notes that in a recent New England Journal of Medicine, most participants on a diet gained weight at the two-year mark despite eating less than they did at the beginning. That sounds like a slowed metabolism to me. And what are these people eating? Let’s see. A 750-calorie deficit from baseline, which is fairly harsh, and nutrient breakdowns of 20% fat, 15% protein, and 65% carbohydrates (low-fat, average-protein); 20% fat, 25% protein, and 55% carbohydrates (low-fat, high-protein); 40% fat, 15% protein, and 45% carbohydrates (high-fat, average-protein); and 40% fat, 25% protein, and 35% carbohydrates (high-fat, high-protein). My idea of a high-protein diet (which is what I eat, though I’m not “dieting”) is 35% protein, 50% fat, 15% carbohydrates; that difference sounds like splitting hairs, but it makes a profound difference in what’s on your plate and how well you feel. And what are the participants doing for exercise? 90 minutes of moderate activity a week. That’s … one game of tennis. So to recap, these people are not eating very much, not eating much protein or fat, and barely exercising; doesn’t sound great. And, anecdotally, I think that’s how most people do diet. The medical establishment could be giving better advice on this.

Megan McArdle makes two points: one, that the rise in obesity is correlated with some things we like, such as women working outside the home (and thus having less time to cook meals or take their kids out to play) and two, there are pesky things like property rights and personal liberty that get in the way of preventing people from eating empty calories. I agree wholeheartedly.

I’m not for a war on obesity, for those reasons. I don’t want to make life difficult for those on tight schedules or budgets by making cheap, convenient food harder to get. And I don’t want, in the style of Michael Pollan, to privilege a time-consuming, virtuous lifestyle of home-cooked meals, where the burden frequently falls on working women. Amanda Marcotte has the feminist angle. (I try to cook for myself, but I do often wind up eating out or buying packaged food. As Amanda knows, a smooth eggplant salad is a rare delight, but you do need a broiler, time to salt and drain the eggplant on a foil-lined cookie sheet, and a good stick blender.)

I am, though, for giving people better opportunities to eat what they really want, and weigh what they really want. More bike lanes. More sidewalks. An end to the HCFS and sugar subsidies. More grocery stores in poor neighborhoods — including Walmart, which, because it has a produce section, causes weight loss when it moves into a neighborhood. If people were as dead set as Megan thinks against losing weight, why would they flock to the fruits and vegetables? The same libertarian reasoning that says we should assume people genuinely want to eat the foods they choose, the reasoning that (rightly) condemns government programs that try to know citizen’s desires better than they do themselves, should also acknowledge that people often eat cleaner when they have the opportunity, and many have an honest preference (not “false consciousness”) to be leaner than they are. Why shouldn’t we remove some of the impediments that make it unnecessarily difficult for people to make their own choices? (Some things that aren’t commonly recognized as “food policy”: anti-development laws meant to keep out “big box” stores that actually keep out cheap vegetables; housing policy that favors owners over renters, and therefore suburbs over cities.)

I’m on the fence about the calorie counts in New York restaurants. On philosophical grounds, they’re not a big deal — no more coercive a regulation than, say, liquor licenses. On a personal level, I’m ambivalent. They do signal “Uh-oh, you have now entered status-crazy Manhattanland.” But it is a convenience to know what’s in what I’m eating.

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6 Responses to “Yes, obesity matters. Freedom matters too.”

  1. grandmute said

    I am, though, for giving people better opportunities to eat what they really want, and weigh what they really want.

    What happens when these wants are incompatible? As I see it, most Americans are not living in an urban ghetto and working two jobs as a single parent. Most Americans could change their diet and exercise habits to get leaner, should they want to do so. (And the huge profits of the diet industry attest that they do in fact so wish.) What stands between them and their ideal figure is not a Siegfried Line of material obstacles, but their own laziness and ignorance. In short, they want to eat one way, but look as if they ate another.

    Consider the gym. At the gym, everyone is obviously well-off enough to afford using the facility; and, presumably, motivated to attain some physical goal. Yet how many gym-goers exercise in a way that, put simply, actually makes a difference in their physiques? I’m sure you know the scene: cardio theater full, squat rack empty. Why? Ignorance and laziness. People don’t know how to exercise to meet their goals, and if they do know, then they still tend to shy away from the hard, consistent work that this entails.

    So it goes with food, too. Even otherwise intelligent and well-educated people (e.g. this man) don’t actually want to let go of their Standard American Diet. They’d much rather go on a crash diet that promises quick and easy weight loss, then return to eating as usual. I mean, how many people are even willing to keep a food log to discover what their diet is? How many people – who by their own admission “have tried everything to lose weight” – educate themselves on even something as basic as macronutrient ratios?

    Point being, we cannot assume, for policy purposes, that people will eat cleaner “when they have the opportunity.” They do, by and large, have said opportunity, and those that do generally do not avail themselves of it. Should we strive to open the possibility of fitness and healthy eating to everyone, regardless of how much they make or where they live? Absolutely. But let’s not kid ourselves that such measures will push people to surmount the two greatest obstacles to physique changes: ignorance and laziness.

  2. thebrasstack said

    Fair enough. People aren’t great at self-control.

    I was trying to stake out where I stand on obesity policy: more activist than Megan McArdle and Kate Harding, but much less activist than those who want extensive food regulation. I think we should take away any artificial obstacles to desired weight loss. The major obstacles are for the urban poor (who have no grocery stores) and for the suburban middle class (who are publicly subsidized, in many ways, for living in a place that requires getting around by car.) I think that anyone who knows about nutrition and exercise should promote it aggressively and hope to overpower the inaccurate party line (which is everywhere — read a few major newspapers and look at the magazine rack in the CVS and every single comment on diet is a bad idea).

    Beyond that, I don’t think we should have a policy of forcing people to be thinner or legislating away fattening foods. It may not work; it may be damaging in unexpected ways (by encouraging crash diets, which are indeed bad for people). Like addictive drugs, sodas are bad for you, but the costs of trying to eliminate them can outweigh the costs of the vices themselves.

  3. grandmute said

    The inaccurate party line[,] which is everywhere…

    No kidding.

  4. digdeeper2 said

    And yet another point of view –

    For one person to assume what another’s intentions or goals are when they put a piece of food in their mouth, step on an eliptical machine or go on a squat machine is a lofty attitude to take. I don’t think you are alone in your view because I do think the majority of Americans “know” what other people’s goals are because we are constantly being bombarded with what they “should be” in the news… see my blog for more ramble about that if interested.

    It sounds like there are some interesting points on both sides of the pendulum. In terms of public health issues – there has been note of lack of adequate grocery stores in urban areas, lack of safe places to walk/play, our ever “advancing” food supply and whether or not it is really beneficial for our communities and the fast-pace adult lifestyle that also impacts our latch-key children. On the other side, the points of would people change their habits if these things were changed anyways?

    I don’t want to pretend to have an answer, but in my journey as one who has followed the “non-diet” movement, I have learned that even within that movement, there are many different variations and levels of “sitting on the fence”, that I never had anticipated. There are those who believe in a non-diet approach to lose weight and then there are those who believe in full-blown “competent eating” which was founded by a Registered Dietitian/Social worker, that states that a person’s body will find the weight that is right for them, once they learn how to eat competently; meaning peaceful, mindful eating.

    Their weight may go up, their weight may go down, but it will be the weight that their body is meant to be at. This particular concept came about as a result of many of the very same points thebrasstack initially made – the impacts of yo-yo dieting, this ever-evolving need to “control” peoples’ weight. The problem with the control/medical-model that wasn’t mentioned above, is that while people are able to follow a “regimen”, they never know how to pinch hit, roll with the punches, deal with things when they are out of their comfort zone.

    Competent eating focuses on providing structured meals and snacks consistently at certain times of the day – the idea is to plan – and while this may not be the answer for everyone, this is a lot of what our society lacks in terms providing themselves with food – they plan around their workday, their clubs, their sports, their meetings, etc. with food often being an afterthought – they will eat – wherever, whenever and whatever is convenient for them.

    There is no doubt this is a controversial topic and it is likely to spark some comments, which I hope it does, because I want to hear it.

    One last note before I go – more information about why I feel it is not only undesirable, but wrong to control, is because I feel it is the control model that got us into the mess we are in today. HOW? You might ask. Well think about it – try to set everything you know about weight and diet aside.

    Say there are two children in a family one is larger than than normal/chubby/fat and the other is average-sized. What is the typical parental response that many of us are familiar with? They try to control the type and portions of food provided to the larger child, while the average-sized child is able to eat whatever they want and how much of it they want. What happens to the larger child? Do they succumb to the “logic” of their parents start eating less and lose weight or does this often result in power-struggles, negative feelings and low-self esteem – incompetent eating where the child has no sense of internal regulation due to external interference.

    Now, this is the part that is going to take some thinking about – say there is a child of average weight, however the parent has heard that there is a problem with the obesity epidemic and in their attempt to prevent this issue from occuring within their own family, they start to restrict their average sized child with what they eat and how much they eat. How do you think that child is going to respond? Again, will they succumb to their parent’s logic and follow their direction or will they find themselves so hungry and irritable, that this also becomes a power-struggle resulting in decreased trust not only with their parents, but with themselves and their ability to regulate their appetites internally?

    I realize this is a lot to take in – it took me a while to understand it, but I do believe this is a large part of our society’s problems. A blessing of the information age is that we have access to anything a person could possibly wish for, the unfortunate part is that there is so much sensationalism about weight, the obesity epidemic and this ever-chaotic situation spiralling out of control, the society’s first instinct has been to control weight through portion and type of food.

    My fear is that the more our society attempts to impose these controls, the worse the problem is going to get.

    I would like to just make a couple more statements I have heard from Registered Dietitians I have the utmost respect for:

    – the key is not to teach children to eat vegetables at a meal (the result of a power struggle), it is to teach them how to eat and enjoy vegetables for a lifetime. – the Registered Dietitian/Social Worker mentioned above

    …by exposing children to foods, allowing them to experience and test out new foods and realizing it may take several introductions for them to feel comfortable eating a “normal” portion of a new food is paramount to helping them learn how to deal with the world around them – how they will approach new things and accept them

    … in respect to the poor adults who were never taught this, this Registered Dietitian refers to them as the “dieting casualties”, they have to relearn how to trust themselves and their relationship with food in order to eat competently.

    – control and regimen is important and necessary for some things in life – balancing a checkbook and budgeting money, working, etc., but not in how to deal with food. – A Registered Dietitian in private practice who counsels eating disordered and “obese” clients.

  5. digdeeper2 said

    Addendum to the first family scenario above – the “average-sized” child’s weight remains average and grows up to be healthy because their internal regulator has never been disrupted.

  6. wriggles said

    If 99% of the time the actual result of the course of action you recommend is that people diet, and then regain a bunch of weight, you need to take this into account before issuing further such recommendations.

    It’s just keeps coming when you are ready to stop lying.

    The idea that all that was missing was a doctor telling them that no, seriously, they should really keep that weight off–an incentive obviously far more powerful than, say, the horrific way that America treats fat people–has sailed beyond arrogant into fantasyland.

    What can I add?

    BEAUTIFUL.

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