Monday, June 10, 2019

"Fat logic" Is As Dangerous As Obesity

"Fat logic" has a mean ring to it, which is a shame.  For many people who struggle with their weight, the words "fat logic" evoke a sort of high school bullying narrative that immediately turns them off.  It's far less friendly than, say, "Healthy at Any Size."

But fat logic is a concept worth examining and one that helped me a lot over the last few years as I shifted my lifestyle toward a healthier and more conscientious way of eating and exercising.  And I'm not the only one; for people who are dealing with the very difficult, uphill battle that is weight loss, peeling back the veil of fat logic can be eye-opening. Weight maintenance has been on my mind; I lost between 30 and 40 pounds last year, but now that I'm pregnant, I'm seeing a noticeable gain.  Weight gain in pregnancy is normal, to an extent; I'm aware that I'll be 20-40 pounds heavier at the end of this endeavor.  But I'll be damned if I'm going to let that be a permanent gain.

Today I'm going to break down (some of) the elements of fat logic and why they're not only incorrect, but also dangerous and harmful.

In short, "fat logic" is any of the excuses people make for being fat.  Favorites include genetics, "diets don't work," and "I may be fat but I'm healthy."  Fat logic is any time someone justifies or excuses their size and, more worryingly, does so in a way that absolves them from losing the weight.

In America, over 1/3rd of people are now obese, and there's been a backlash of people who are trying to stay fit.  Then there was a backlash to the backlash: the fat acceptance movement.  "Fat activism" seems empowering on the surface, but it's anything but.  For one thing, it's riddled with terrible and incorrect advice.

Recently I saw someone claiming that "95% of diets don't work."  This is a very, very common bit of fat logic that, like the "statistic" that you swallow 8 spiders every year in your sleep, is utter bullshit, yet gets repeated constantly by people desperate to absolve themselves of responsibility for when their diets fail.

Disclaimer: I definitely do not drink two liters of water a day.  However, I also don't drink anything laden with sugar.

Here's the reality.  Diets don't fail.  People do.  That's a harsh and unhappy truth that lacks any of the feel-good platitudes of most fat logic.  And the statistic about 95% of diets failing is patently false.

That "statistic" is from a very small study (n = 100) that was done in 1959. The group being studied were obese people who had been admitted into a inpatient treatment program and the conclusion of the study stated that "Most obese persons will not stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it." They regained the weight after leaving the program and returning to their old diets, without actually altering eating habits or behaviors.

Current research shows long-term maintenance is achievable, especially for those who also exercise. About 20% of people who decide to lose weight are able to keep it off; the single biggest factor is behavioral, not physiological. People with more support tend to do better. For example, people in programs, registries, or taking exercise classes who have a social support network to help them maintain activity succeed more than 50% of the time. (Analysis here on how people "succeed" at their diets.)  On average these registry members maintained a 67-pound weight loss for five years. And between 12-14 % had maintained a loss of more than 100 pounds.  (Also of note: "Once these successful maintainers have maintained a weight loss for 2-5 years, the chances of longer-term success greatly increase.")

In other words, losing weight is like quitting smoking.  (In fact, people who lose weight and keep it off is, percent-wise, similar to the percentage of people who try to quit smoking and are successful.) It's hard, and a lot of people fail initially, but it's absolutely possible. It's just a matter of sticking to the right behaviors and ensuring that the program you've chosen is actually sustainable.

Mind you, the definition "diet" itself is a little tricky here.  "Diet culture" does exist and diet products do tend to believe people will fail.  They're designed to cater to those whose weights yo-yo.  My hot take?  All "diet" products are shitty. They are preying on people who want a quick and easy solution to a very serious and complex problem. The reality is, there's no easy solution to weight loss. Diets must be made sustainable and there's no magic pills, shake, or wrap that will give you a perfect body without you having to put in a ton of work. Considering how widespread and devastating the effects of obesity are, I think products that take advantage of people trying to better themselves are downright evil.

Weight loss aside, diet products, like all "supplements," have piss-poor regulation and make unfounded medical promises to people. People who consume these products as vitamins or for "energy boosts" or whatever are typically genuinely trying to be healthier and the companies that market them are scamming people with products that have zero proven value.

Regrettably, the 95% statistic often gets falsely "proven" over and over again, by people who claim they're on a "diet" but who fall off the wagon and regain the weight.  (For example, in this New York Times article about how ANY weight lost can be beneficial, it mentions that only 5% of people sustained weight loss of over 20% over the course of a year.  But it also states that any amount lost is better than nothing.)  (An excerpt: "Compared to people who maintained less than a 5 percent weight loss for one year, those who lost 5 to 10 percent lowered their risk for metabolic syndrome by 22 percent. A 15 to 19 percent loss was associated with a 37 percent lower risk, and those who maintained a loss of 20 percent or more had a 53 percent lower risk.")

In a way, you could argue that "diets," referring to short-term fad diets, do not, in fact, work.  This would be true.  What works is sustainable and permanent behavioral changes.  And, sadly, most people don't associate that with a "diet."

I'd like to take a minute to give a shout-out to /r/loseit, a weight-loss support forum, for helping people to stay on track and provide the sort of support necessary to actually manage one's weight in a long-term and sustainable way.  This forum, along with /r/fatlogic, were two of the forums that most helped me as I regained control of my weight following my motorcycle accident.  But, again, not everyone is ready for the bluntness that comes with revealing "fat logic."  I have been accused of being "fatphobic" two or three times now on social media.  And the funny thing is, they're not wrong.

While the term "fatphobic" is typically used in the same way as "homophobic," to describe bigotry rather than actual fear, I would argue that I do have fatphobia in the literal sense.  I am afraid of being overweight and of losing my mobility and my health.  I am scared of being in pain and of being at risk for things like cancer and diabetes.  These are legitimate fears. 

And, speaking of the obesity epidemic, did you know that the state of Mississippi has both the highest rate of obesity and the lowest life expectancy?  Also, Mississippi, most obese state in 1995, was thinner than the thinnest state now (Colorado).

This is not to say that I revile fat people; this isn't to say that I believe fat people are somehow "lesser."  I believe people have inherent value and we should not judge them based on appearance.  But the simple reality is, being fat isn't healthy.  And "healthy at any size" is a lie.  People who are fat and claim that their health is otherwise "perfect" may be telling the truth.  Their health may very well be great... until it isn't.  Fatness is a risk factor, like smoking, and you may be fat and healthy for a while.  But as you age, the longer you carry excess weight, the more likely you are to start succumbing to the inevitable side effects.  Even if you aren't counting your calories, your body is.  That extra weight is hell on your joints and your cardiovascular system, and sooner or later, you'll have to reckon with it.

The worst part is that the "fat activism" movement is targeting the most disenfranchised and high-risk categories of people.  I'm heavily involved in the queer community, and weight is a huge topic of discussion there.  Lots of people think it's "woke" to glorify obesity.  The feel-good rhetoric masks a darker reality.  And worse, I've seen people who champion "body positivity" put down people who are fit or slender.  (For example, I saw someone claim that others shouldn't share "before and after" photos because it promoted an "ideal" body.  Fuck that bullshit.  People should share any photo that makes them feel beautiful, and for those who worked hard to achieve the body they desired, they should absolutely celebrate it.  Telling others that they should not share a photo of their own body that makes them happy is the exact opposite of "body positivity!")

Here's a prime example of fat logic (from my own Facebook page!) Last year, I posted an article from LiveScience titled "40 Percent of Cancer Cases in US Linked to Obesity."  To me this is some very important information.  No one shared it, and no one liked it.  (This is compared to the 20+ likes I typically get from posting, say, an Avengers meme.)

However, I did have three people comment expressing disbelief.  All three are overweight and they purposefully twisted the information in the article.  Let's observe...

Person #1: So what you're saying is, 2/3rds of cancer AREN'T caused by obesity?
Yes, correct.  You can lower your overall risk of cancer by losing weight.

Person #2: So you're saying being fat is MORE healthy?
No.  I'm saying you can lower your overall risk of cancer by losing weight.

Person #3: But have they established causality?  Does reducing weight actually do anything?
Yes.  You can lower your overall risk of cancer by losing weight.

Person #3 actually brought up some good points and instead of screenshotting my responses and forcing you to read them as a .jpg, I will copy-paste them here.  This has the added benefit of giving you some more links to resources.

One of the major things the study looked at to rule out mere correlation was YOUNG people who got cancer who were already overweight; naturally, aging causes obesity and also ups your risk for cancer, so several of the demographic studies focused on people in the 20-40 age range. You could make the argument that obesity could cause a condition (such as fatty liver) would would in turn cause a cancer (such as liver cancer) and is therefor not a DIRECT causation.

Obviously you can't control for every metric and so the study did not focus on any individual cancer by itself, so it's entirely possible their statistics are elevating the risk. That being said, I think it's been well-established that obesity is a risk factor for other conditions and that, if you are obese, losing weight is generally considered a good thing.
  (Note that the study focused on obese v. "normal" individuals.  I suspect if you looked at underweight people you'd also get some interesting findings; we already know that bulimics are at increased risk of esopageal cancer. Ultimately nearly any dietary or metabolic abnormality has negative consequences.)

Person #3 then stated: "There’s a lot of studies showing that obesity correlates with a wide range of conditions, but my understanding (admittedly from a third person not through reading the literature myself) is that studies showing causation and studies showing that losing weight actually reduces the risk are pretty sparse." 

Oh, ho ho ho ho.

This particular study didn't go so far as to state that reducing weight once you're already obese reduces risk.

HOWEVER, there is AMPLE literature that DOES say that.

Let's look at breast cancer. Adipose tissue stores estrogen (a major factor in the growth of breast cancer). And here's two studies that found that losing AND gaining weight had a clear effect:

Here's one about obese women who underwent bariatric surgery and decreased their risk of cancer. That establishes causation. Also, the most common cancer the obese, non-surgical control group got? Endometrial, ovarian, and breast cancer. All of which are influenced by estrogen.

Here's another bariatric study (compared 6,000 obese patients who lost weight with 9,000 who didn't), in which patients who were obese and then lost weight via the surgery reduced their risk of cancer by 46%.

I don't know who told Person #3 that losing weight doesn't reduce risk, but they're dead wrong. The literature has been extremely consistent on this.
Guess which Avenger died young vs. which one lived to be 100 years old?

Sadly, some of the loudest voices in the "fat acceptance" movement are people who struggle with eating disorders. 

I remember right after I lost a bunch of weight, speaking with my tattoo artist, who said that she was "more healthy now than I ever was when I was dieting."  She went on, at length, about having an eating disorder.

Regrettably this is at the core of a lot of people who believe in "body positivity."  They have an eating disorder, or a disordered relationship with food, and the feel-good rhetoric of "body positivity" preys on that.  Being "happy" with being obese doesn't mean that your eating disorder has been cured; it means that you have a different kind of eating disorder.  And both obesity and anorexia will kill you.

There is more than one way to be "healthy."  There's physical and mental health and, if you have an eating order, they are intricately tied together and require professional intervention to maintain.  "Body positivity" is not a "cure" for anorexia.  There's a whole weight range between obese and skeletally underweight where the body operates at its peak, and that is where people should aim for.

Being a healthy weight isn't just about physical health, mobility, or comfort, though.  It's about self-love.  If you've read this far, that's probably because you already agree with me.  People who believe in fat logic won't get through this, because they will have already left, claiming that I'm wrong.  At its very center, fat logic is all about dismissing scientific and medical evidence, as well as common sense and observable effects, in order to absolve oneself of responsibility and maintain the fat.  Most people don't shed their fat logic, or the fat itself, without a wake-up call.  And that saddens me because I don't want people to have to have heart attacks or get diabetes in order to realize that they need to start caring for themselves.

But I know that people who are already enmeshed in the "body positivity" culture won't read this, so this isn't for them.  It's for people who are flirting with the idea.  It's for people who only just discovered it and thought, see, what an empowering and wonderful and uplifting movement!

Beware.  The body-positivity and "healthy at any size" movements are neither positive nor healthy, and their long-term consequences are dire.  These movements feed into people's insecurities (pun not intended) and do grave harm to their followers.  Don't wait for a wake-up call.  Find ways to manage your weight now.  Your body will thank you.  You're worth it.

No comments:

Post a Comment