Maybe we really should just be listening to our bodies (Day 58)

I think about health topics more than I want to. To paraphrase someone else, I could have learned three foreign languages in all of the time I've spent thinking about, reading about, agonizing over, and trying to practice good nutrition and exercise. I did make a big breakthrough in my thinking and practice of exercise last year, and I've felt better since then, but I admit that food continues to wear me down. This is due in large part to my food sensitivities, but that's not all.

I consider myself mostly immune to trends around eating. Frankly, when my sensitivities have limited me as much as they have, I don't have room to play. The only "choice" I'm making these days is not eating meat, and since that's been the case since I was sixteen (other than the period I was bullied by my college boyfriend), I'm not apologizing. Since it's accepted that eating meat does a lot of really bad things to you, yeah, I don't feel like I'm being indulgent. I'm a vegetarian because I want to be; I'm a vegan because eggs and dairy make me ill, and I can't eat wheat or soy because those set me back for a week.

And it's not just food sensitivities--there is nothing like an experience of cancer, particularly colon cancer, to make you sensitive about your diet. I am never consuming alcohol again, and since I've never liked it in the first place, why should I? I go out of my way to eat legumes and whole grains as well as fruits and vegetables--and nuts and seeds--and avoid coconut products and refined sugar--because of all of the evidence around mortality, cancer, and general health. It's not my fault I developed cancer--my diet was still pretty good by modern American standards--but I think it's understandable why I prioritize things that give me a better chance of living longer.

So my behavior isn't about trends--with the exception of time restricted eating. That was something recommended to me by my acupuncturist a few years ago, and all of the research I did on it showed no ill effects. In fact, it was mentioned as one of the only effective "dieting" strategies, and it also is said to good things for blood sugar and cholesterol. What was the harm? I mean, other than the fact that I can't eat large meals (thanks to a very small but manageable hernia between my stomach and duodenum), and that being hungry at night was sometimes just depressing?

I don't know what or why, but today the American Heart Association released results of a study that showed that time-restricted eating may yield short-term benefits but may have long-term negative effects; at the very least, it's not shown to have long-term positive effects. This isn't a perfect study and more work needs to be done, but for now it's enough to make me think that maybe I don't have to try to force feed myself and that maybe, just maybe, it's okay to go back to eating five or so small meals over the course of the day.

I'm reminded of something Dalia Kinsey, the author of Decolonizing Wellness wrote. Your body's reaction to hunger is going to be hoarding fat; even if you're not trying to lose weight, that's not a good outcome. More importantly, only you know how much your body needs of anything, regardless of what is advised for a serving or a number of servings. And while that may sound touchy-feely, that was one of the most profound messages out of Ultra-Processed People by Chris van Tulleken, and yes, he had plenty of scientific evidence to back it up.

Listening to our bodies can be really hard when we're subjected not only to ultra-processed foods but also marketing (see Raj Patel on that one), which is why it's important to do our best to break from both. I can tell you it's much easier to break from ultra-processed foods than marketing, no matter what kind of media you choose to consume. But it's worth the effort, however imperfect. Take a deep breath when your experiences contradict claims, and maybe cross your fingers that if you're in alignment with most of the best scientific research, you might have some grace around the rest of it.

Deb in the City

Support your local businesses during the Coronavirus crisis

As soon as I heard that there was an outbreak of an infectious disease in China, I knew it was only a matter of time before people would start looking at Chinese Americans like they were all carriers. I also suspected that it would be bad for some businesses, particularly those in Boston's Chinatown. I heard a story on the radio last week that confirmed my suspicions, and with that in mind I brought one of my fifteen year olds to Chinatown last Tuesday to show our support.

Even with my deep cynicism, I was shocked.

This is one of the busiest grocery stores in Chinatown, and usually I'm stepping out of everyone's way, regardless of the day of the week. As you can see, I could have danced through the produce aisles and no one would have said anything.

This is Hei La Moon, a well-known restaurant in Chinatown. This angle makes it look emptier than it was; in reality, there was one table of customers. However, there were still more waitstaff.

We also went to get boba tea - my son loves it - and then lunch at a restaurant called Pho Pasteur. For some reason, being a Vietnamese establishment didn't matter; as was the case in the boba shop and the above restaurant, there were still more waitstaff than customers.

I came back home shaken, and my son and I agreed that Chinatown was now a ghost town. So imagine my relief when I received an email from Boston City Councilor Michelle Wu inviting me to dim sum at China Pearl this past Saturday for ten dollars at the door. My husband, son, and I jumped at the chance. (We also contributed a little extra, because I knew they would eat much more than that.) Here's what that looked like.

This is what it should look like.

I wanted to violate only so many people's privacy, so there's only this one picture, but the place was packed, so much so that I started worrying that we should leave so other people wouldn't have to wait for a seat in the cold lobby.

I was heartened to hear Councilor Wu describe the event as part of an effort to support local businesses while combating racism and misinformation. My favorite place to buy housewares is in Chinatown, but I am always wary of admitting that. "Buy Local" conjures up images of buying artisanal, handcrafted products made in a local workshop, but it also includes buying imported products from a locally owned business. And yes, some of those businesses are owned and operated by recent immigrants, and they need your dollars as much as any other local business.

When we walked back to the car after dim sum, I noticed that at least one newish business was shuttered. New businesses in Boston, especially restaurants, have a tough road in store for them, but they don't usually fold in that area in under a year. It pains me to think about what losing that business cost the people who were planning on running it.

Before I go, let me say that people are absolutely right that they should be taking precautions with their health, because there is a very real, very frightening public health problem now: the flu, which thus far has killed at least 14,000 people in the United States. Please follow whatever advice your medical provider has offered. And in case you're wondering, as of this writing, only fifteen cases of the coronavirus (COVID-19, to be exact) have been confirmed in the US.

Deb in the City

An interview with Mike Schatzki, author of "The Great Fat Fraud"

Mike Schatzki, author of The Great Fat Fraud, agreed to chat with me about the obesity "epidemic", fitness and public health.  (Please see my review of his book.)  

At a time when we are blaming childhood obesity on bad mothering, perhaps Mr. Schatzki can help inject a little common sense into the conversation.

What is the fraud you refer to you in your book? 

The fraud is that fat and obesity are diseases.  They are not.  However, it is very much in the interests of the $60 billion weight-loss industry to continue to perpetuate this fraud. 
 

Why are you an authority we should listen to about this? 

I am the tour guide to the experts.  Over the last 20 years scientists and researchers have conducted hundreds of experiments involving hundreds of thousands of people in order to develop a clear understanding of how the body responds to weight and fitness in terms of morbidity (illness) and mortality. 

The results of those experiments directly contradict all the prevailing myths surrounding the so-called “obesity epidemic.”  However, these researchers are far more skilled at understanding how the body functions than they are in publicizing their work.  As a result, their findings have been overwhelmed by the massive propaganda efforts of the weight-loss industry. 

The purpose of The Great Fat Fraud was to bring together in one place, in an easily accessible and readable format, all of the research that has been done that exposes the fraud of the “obesity epidemic.” 
 

You make it pretty clear in your book that, with very few exceptions, weight and even BMI is a vanity issue, not a health issue.  However, you still talk about dieting and weight loss.   

There are really two very valid reasons why people might want to lose weight.  The first is that some people are simply not happy with the way that they look when they are heavy.  I am not sure I would use the word “vanity” since that tends to have some negative connotations.  I would prefer to say that people have every right to make “aesthetic choices” about how they look. 

The second reason is that there’s some pretty convincing research showing that people who are heavy experience wage discrimination in the workplace.
 

For both of those reasons I felt that it was important to discuss weight loss and some of the myths and misconceptions that have surrounded it.  The research is fairly conclusive that: 

1.  Exercise and fitness alone will not result in weight loss for the great majority of people.  To lose weight, you still have to diet.

2.  Without a continuing fitness regimen, the overwhelming majority of people will, over time, regain whatever weight they have lost.
 

I've met a number of people who genuinely do have trouble losing weight, even with a fitness-focused plan like the one you suggest.  They will lose some weight, but not very much- easily less than ten pounds over the course of a year.  Are those the kinds of "results" people should expect? 

The research is pretty clear that for most people fitness alone will not result in weight loss.  The reason is that the body’s set point recognizes the calorie deficit created by fitness activities and increases one’s hunger level so that they compensate by eating more.  So even with a fitness program, most people who want to lose weight will have to consciously diet. 

It is also true that some people have enormous difficulty in losing weight.  People who find themselves in this situation should seriously consider the precepts of the Health at Every Size movement.  Health at Every Size emphasizes body acceptance and intuitive eating among other things.  However, even with Health at Every Size, fitness is a critical component of being healthy.
 

It's very hard to dissociate health from appearance.  When we see someone who is "heavy", many automatically assume that they are unhealthy and/or a drain on our public finances.   

It is critical here to make a distinction between individuals who are sedentary and individuals who are fit.  People who are fit do not have a health problem regardless of their weight.  However, high levels of weight when combined with a sedentary lifestyle is a lethal combination. 

A thin person who is sedentary has twice the mortality risk of a person who is BMI 30 but fit.  A person who is BMI 30 and sedentary has three times the mortality risk of a person who is BMI 30 and fit.  And since fitness can be achieved either through exercise or through a 10,000 steps per day walking program, it is a lot easier for most people than losing weight. 

And even if someone still holds firmly to the position that fitness is all well and good but you still have to lose weight to be healthy, they’re still going to have to embrace fitness because without fitness, whatever weight someone loses is surely going to be regained.
 

There's talk about instituting higher insurance premiums and taxes on those with high BMIs.  Not coincidentally, we're also talking about taxes on sodas and candy.  How do we "decriminalize" the un-thin? 

Someone who is heavy and sedentary is most definitely going to have higher health claims costs than someone who is thin and sedentary.  But someone who is heavy and fit is going to have substantially lower health claims costs than someone who is thin and sedentary. 

It would be massively unfair to penalize someone who is fit but heavy when that person is likely to have half the healthcare claims experience of someone who is thin but sedentary.  Corporations who impose or are planning to impose obesity penalties must have a fitness exception.  People who are heavy must be given an opportunity to prove that they are fit with a simple treadmill test, and those who are fit must not be penalized.
 

I live in Boston.  We have banned the sale of sugary drinks and we have a campaign called "Don't Get Smacked By Fat".  In addition to showing teenagers literally getting fat thrown in their faces, it states this: "health costs of obesity in the United States are $147 billion annually".  Is this true? 

The $147 billion annual cost figure comes from a study entitled "Annual Medical Spending Attributable to Obesity: Payer and Service-Specific Estimates."  The major flaw in this study, like in so many similar studies, is that the population data base being analyzed (in this case the Medical Expenditure Panel Surveys) is not separated into fit and sedentary groupings.  If it were, we would undoubtedly see that those who are heavy and fit impose no additional healthcare costs on the system.  We would also see that those who are sedentary impose substantial healthcare costs on the system with those costs escalating as weight increases. 

Lack of fitness, not obesity, is the primary public health issue for the 21^st century. 

For a first person perspective on being overweight or obese, please visit My Body Stories on My Body Gallery.

The Great Fat Fraud by Mike Schatzki

The Great Fat Fraud by Mike Schatzki helps untangle the issues around fitness, weight, diet, surgery and the weight loss industry.  By the end of the book, the reader should walk away with the understanding that fitness does not equal thinness and that achieving weight loss is much simpler than Weight Watchers, Jenny Craig and LA Weight Loss would have you believe.

Within the first six chapters, the author cites the work of three large, long-term studies (some going back to 1953) that show conclusively that the most reliable predictor of mortality isn’t size but fitness and activity level.  (Although many define “fitness” differently, for this purpose it’s a measure of how well the body can use oxygen.)  An active, fit person has a significantly lower risk of mortality than a sedentary person- regardless of body mass index (BMI).  If mortality is the primary concern, activity is the answer.  Numerous studies have shown that walking 10,000 steps per day is the target for the majority of people to achieve optimal fitness levels.

The next chapters discuss losing weight.  For most people, fitness activity will not result in very much weight loss, if any.  In order to achieve lasting weight loss, people have to 1) reduce their food intake (in other words, diet) until they hit a weight plateau and then 2) follow that up with activity- ie, 10,000 steps per day.  This combination will prevent the body from going into starvation mode and hoarding fat, which is what it does when deprived of calories (ie, dieting).  Weight loss is doable- and in fact, most people on diets have done it before they regain some or all of their weight- but the author takes pains to note that for most people weight loss is an aesthetic choice, not a health imperative.  In these chapters he also cites a study that showed that people who focused on body acceptance improved their health (lipid levels, blood pressure, activity, etc.) more than those who focused on dieting and, not coincidentally, felt better about themselves.

Schatzki spends a brief chapter each on stomach reduction surgery (because of the risks, it’s only appropriate for the most unhealthy 1 or 2 percent of the obese), weight loss drugs (which, unlike other drugs, trick a healthy body into malfunctioning) and weight loss programs (most of them can help you take the weight off, but you won’t keep it off... unless you’re active).  However, the most damning section of the book deals with what he calls the “researchaganda” that promotes the idea that obesity is a public health threat when in fact is not.  

By 1998 the World Health Organization (WHO) and the Obesity Task Force of the National Institutes of Health (NIH) had been manipulated by the weight loss industry to the point that the BMIs for overweight and obese had been lowered (to 25 to 30 and over 30, respectively).  In 2004, the Center for Disease Control (CDC) published a report that obesity was responsible for 400,000 deaths every year.  

Although the CDC study was debunked shortly after it was published (by everyone from the Wall Street Journal and Science Magazine to the Government Accountability Office), the damage had been done.  The media now had a story: fat isn’t just something people didn’t find attractive, it's a dangerous public health issue, and there is nothing modern media loves like a story that scares people- even if it's not true.  

At the end, Schatzki asks readers to take up the challenge to spread the real story about weight, fitness and obesity and offers links to the information cited in his book.

Both well-researched and accessible, this is a short, easy read that debunks obesity hysteria.  Recommended for anyone with an interest in health issues.