Obesity Reclassified as a Disease
June 19, 2013 7:00 AM Subscribe

The A.M.A. has officially recognized obesity as a disease.

Obesity-as-disease paradigm discussed previously.

posted by astapasta24 (332 comments total) 27 users marked this as a favorite

Well, this won't cause a shitstorm at all
posted by mightygodking at 7:01 AM on June 19, 2013 [22 favorites]

"Damn it, Otto, you have obesity."
posted by komara at 7:03 AM on June 19, 2013 [40 favorites]

How could this be even remotely controversial?
posted by Avenger at 7:04 AM on June 19, 2013 [5 favorites]

If it means I can get Disability Living Allowance and a full-time carer to fetch my chocolate, I'm all for it.
posted by PeterMcDermott at 7:08 AM on June 19, 2013 [8 favorites]

How could this be even remotely controversial?

The second paragraph of the article

In making the decision, delegates at the association’s annual meeting in Chicago overrode a recommendation against doing so by a committee that had studied the matter.

I am still reading, but I'm assuming that the objections of the committee are further explored.
posted by muddgirl at 7:09 AM on June 19, 2013

Why are so many doctors so fucking stupid? (see also, DSM 5)
posted by OmieWise at 7:09 AM on June 19, 2013 [2 favorites]

Yeah. I can hear the small town talk now - "You know, she got that obesity and he just run off and never come back She couldn't afford her doctor bills after that."
posted by PuppyCat at 7:14 AM on June 19, 2013 [4 favorites]

Some people with a B.M.I. above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat and metabolic problems associated with obesity.
posted by hydropsyche at 7:16 AM on June 19, 2013 [17 favorites]

If this kills the ubiquitous bariatric surgery insurance riders I'm all for it.
posted by playertobenamedlater at 7:18 AM on June 19, 2013 [1 favorite]

Obesity Epidemic.
posted by cjorgensen at 7:19 AM on June 19, 2013

BMI is part of the problem - it's a louse indicator for a lot of people.
posted by PuppyCat at 7:19 AM on June 19, 2013 [12 favorites]

Only time will tell if this reduces the stigma associated with being overweight in our society, or increases it.

Also, perhaps this will finally raise awareness of the many potential causes of obesity for those who blame all its forms on a lack of willpower or some other such shaming nonsense.
posted by zarq at 7:24 AM on June 19, 2013 [13 favorites]

If you'd asked me yesterday about the odds of this happening, I would have said fat chance.
posted by fairmettle at 7:24 AM on June 19, 2013 [13 favorites]

My biggest concern as an obese person is that this is an excuse to medicate a symptom and not care about the rest of the health of the patient.

I have a BMI in the low 30s. It is statistically more likely that I develop Type 2 Diabetes than someone with a BMI in the low 20s. This leads people to argue that obesity itself is a disease. But, as a woman, I am statistically more likely to develop breast cancer. Does this mean that being a woman is a "multimetabolic and hormonal disease state?" That's certainly an argument I could make.
posted by muddgirl at 7:27 AM on June 19, 2013 [28 favorites]

The danger here is of course the same danger as with ADHD - all to easily used in SOME CASES as a get-out clause and an excuse to get someone onto expensive meds, and to avoid dealing with the actual lifestyle issues behind it.

Care to elaborate on this more? I'm not really following your lifestyle comparison of ADHD to obesity.

My biggest concern as an obese person is that this is an excuse to medicate a symptom and not care about the rest of the health of the patient.

The best thing that can come out of this is that the bariatric surgery riders get killed off allowing persons that are currently insured to have the option of weight loss surgery instead of having to finance it out or try (and potentially fail) to lose weight on their own.
posted by playertobenamedlater at 7:31 AM on June 19, 2013 [3 favorites]

An ex boyfriend of mine is one of the healthiest people I've ever known--super active, biked 60+ miles every weekend, went to the gym every day, lots of cardio, etc.

He's 5'4" and was usually between 150-160lbs, nearly all muscle. Built like a gymnast.

According to his BMI he is overweight. To an unfeeling actuary table/insurance review board who has never met him, he's unhealthy.

In order to classify anything weight-based as a disease, it needs to be evaluated against a whole host of comprehensive tests and measures, because otherwise healthy people (of any size) are going to be adversely affected.
posted by phunniemee at 7:31 AM on June 19, 2013 [13 favorites]

Fat is a phenotype, not a disease.
posted by edheil at 7:33 AM on June 19, 2013 [8 favorites]

The best thing that can come out of this is that the bariatric surgery riders get killed off allowing persons that are currently insured to have the option of weight loss surgery instead of having to finance it out or try (and potentially fail) to lose weight on their own.

Yes and no. Bariatric surgery is great for many people (including my dad, who lost a lot of weight and has kept it off after struggling with obesity for more than twenty years), but it’s no walk in the park, either. Many people have surgical complications, and even those who don’t still have to watch what they eat, and exercise regularly.
posted by roomthreeseventeen at 7:34 AM on June 19, 2013 [1 favorite]

“The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes,” the resolution said.

But - mostly - isn't obesity caused by overeating and/or inactivity? (Please note I say this as a greedy lazy chubby person.) That's not to say there aren't reasons underlying the overeating or inactivity, from emotional trauma, loneliness, depression, social exclusion, lack of edcuation around nutrition, etc. But I'd rather see those issues addressed instead of medicalizing it so more companies can sell more drugs. I always thought of obesity as a symptom, rather than a disease. Also from a body image point of view, if we disregard the health aspect (I know "obese" healthy people and "skinny" unhealthy people) I'm not sure what message fat=diseased sends out.
posted by billiebee at 7:36 AM on June 19, 2013 [4 favorites]

isn't obesity caused by overeating and/or inactivity?

That's generally as far as the analysis goes when it comes from a thin person, yes.
posted by flabdablet at 7:38 AM on June 19, 2013 [40 favorites]

Now please excuse me. I have to get on with circumcising my declawed Israeli-Palestinian cat.
posted by flabdablet at 7:39 AM on June 19, 2013 [90 favorites]

There was a whole Simpsons episode about this, at least 13 years ago, back when I was still watching it.
posted by Melismata at 7:40 AM on June 19, 2013

Does this mean that being a woman is a "multimetabolic and hormonal disease state?" That's certainly an argument I could make.

I guess now would be a good time to mention that all disease is socially defined -- or at least socially mediated. Viruses and bacteria themselves aren't diseases per se -- your intestines are filled with bacteria and nobody says "your intestines are filled with disease" -- society (with no input from science) defines what is the normal and abnormal functions of the human body and defines anything "abnormal" as disease.

So, yes, it's possible to imagine a society that defines masculinity as "normal" or "baseline" and consequently defines femininity as an abnormal or diseased condition, and then seeks "scientific" cures for it. (19th Century America and Britain were arguably very close to this Sci Fi scenario)

This is not to say that medical science or medicine itself is wrong or quackery ... but merely that society and culture is the final determinant of what is healthy and unhealthy. The AMA is fulfilling their role as cultural mediators to define obesity as a disease. I tend to agree with this decision. We, as a society, tend to value longer and pain-free lifespans and obesity is strongly correlated with shorter and more miserable lifespans. The AMA recognizes that and is redefining obesity accordingly.

But, no, there is no empirical science involved in the redefinition. Because disease isn't defined by science. And that's ok.
posted by Avenger at 7:40 AM on June 19, 2013 [32 favorites]

This will have massive repercussions.
posted by The 10th Regiment of Foot at 7:40 AM on June 19, 2013 [1 favorite]

Bariatric surgery is great for many people (including my dad, who lost a lot of weight and has kept it off after struggling with obesity for more than twenty years), but it’s no walk in the park, either.

No doubt, but having the option to have it covered by your insurance instead of financing it out or just giving up is a good thing. Whether or not you use it and have success with it is secondary to me.
posted by playertobenamedlater at 7:40 AM on June 19, 2013 [4 favorites]

Imagine all the people insurance companies can now deny coverage to because of their "preexisting condition".
posted by Gin and Comics at 7:42 AM on June 19, 2013 [11 favorites]

The thing is, I don't really want doctors paying more attention to my obesity. They already pay plenty of attention. "You've got arthritis--have you tried losing weight? You've got the flu--have you tried losing weight? You're crazy--have you tried losing weight?"

My fatness is already viewed as the cause for literally everything that's wrong with me. So I can't say that I'm too excited about having it now be not only "Hey, you're fat; you'd be magically healthy if you were skinny" but "Hey, you're fat IT IS A DISEASE, YOU KNOW, YOU ARE GOING TO DIE OF FAT."

The idea of a rush to "treat" obesity makes me uncomfortable, as well. Does this mean that diet pills and weight loss surgery are going to become insurance-paid options for people? Because there are some pretty major ramifications and potential complications to those things, and to suggest that a relatively healthy and happy fat person Get Treatment just because they're fat makes me pretty uncomfortable. If someone's cholesterol, blood pressure, etc, are normal, they're able to move comfortably and in the ways they desire, and it's only their weight that's a problem, should they be pushed into "treatment"?

I also fear that this will have a negative effect on people who require medications that tend to prompt weight gain. I've been on some mental health meds (thanks a lot, Seroquel) that really packed on the pounds--fifty pounds in a year from that one, and I've yet to manage to lose any of it. (And the meds didn't ultimately work for me. Not that I'm bitter.) But for some people, that medication is what's going to keep them stable and (relatively) sane. I'd rather be fat and stable than thin and crazy--but will my doctor agree? I think that the social stigma associated with being fat is more than the stigma of being moderately mentally ill, at this point--would my doctor rather have a crazy patient than a fat one? How will that affect my treatment? I can't imagine that it's going to be a positive impact.
posted by MeghanC at 7:43 AM on June 19, 2013 [62 favorites]

But - mostly - isn't obesity caused by overeating and/or inactivity?

The resolution you quoted isn't arguing against that. It's saying that it doesn't matter if (note, I said if) many cases of obesity are caused by voluntary choices or not, just as it doesn't matter if lung cancer is caused by a voluntary choice to smoke cigarettes. The resolution is arguing that obesity, like lung cancer, is a condition of the body with significant negative health consequences and that condition is treatable and therefore it should be regarded as a disease.

To a certain extent this is "if all you have is a hammer" at work. For the most part, doctors aren't social workers or policymakers and so have limited influence on the broader causes of obesity. But they can treat it on an individual level, which is what the AMA has resolved to do. The main difference is that now obesity itself will be regarded as a disease rather than as a risk factor or complication for other diseases (e.g. diabetes, arthritis).
posted by jedicus at 7:43 AM on June 19, 2013 [7 favorites]

Imagine all the people insurance companies can now deny coverage to because of their "preexisting condition".
posted by Gin and Comics at 7:42 AM on June 19 [+] [!]

That will be zero people starting on January 1st of next year.
posted by Avenger at 7:43 AM on June 19, 2013 [41 favorites]

GallonOfAlan: "The danger here is of course the same danger as with ADHD - all to easily used in SOME CASES as a get-out clause and an excuse to get someone onto expensive meds, and to avoid dealing with the actual lifestyle issues behind it.*"

This isn't new. Look at antacids. Many are no longer being marketed as a temporary relief from pain until a person can see a doctor of improve their behavior. Pharmaceutical companies have been running since at least the 90's that tell people not to worry about eating spicy food, because they can take an antacid.

The goal shouldn't be to eliminate antacids. Or to keep people from getting the help they need. We need to educate people and help them be healthier. The US has a severe obesity problem. Some of that is our diet, and that often ties in directly to economics. Some obesity is caused by diagnosed and undiagnosed medical problems.

The first step in addressing the problem is we need to acknowledge that many factors can cause obesity, and they differ in men and women. And then we need to go one step further and encourage people to go to the doctor and have blood tests, so they determine if and how their BMI relates to their health.

From there, they can learn to address the problem themselves of with medical assistance if necessary. People can go their entire lives without realizing they have conditions that create hormone imbalances that affect their weight, for example. PCOD. Thyroid disease. Etc.

When it comes to our health, knowledge is power. And in our increasingly politically correct society, one of the very last acceptable targets of humor and shame are fat people. We really need to decrease society's stigma surrounding obesity, and not destroy good intent over a concern that people are going to take shortcuts.
posted by zarq at 7:43 AM on June 19, 2013 [2 favorites]

Whether or not you use it and have success with it is secondary to me. Whether a treatment is successful and its success relative to cost should certainly be relevant to the way its insured and how the rest of us feel about that, I think.

---

I found it really interesting that one of the primary arguments cited in the article against classifying obesity as a disease was that it "medicalized" the issue and would discourage people from seeking lifestyle changes. Coming from a completely different medical community (autoimmune disease) I have a fair amount of experience with the conflict between medical treatments and lifestyle treatments for disease, and I can tell you that whether it's called a disease or not, doctors are woefully unprepared to counsel patients on making any kinds of lifestyle changes. This is not a knock to doctors -- I truly think we need a new class of health counselor that specializes in prescribing lifestyle changes, working in conjunction with doctors and medical treatments, but completely outside that ecosystem (and economy).
posted by telegraph at 7:45 AM on June 19, 2013 [10 favorites]

Imagine all the people insurance companies can now deny coverage to because of their "preexisting condition".

Beginning January 1, 2014, preexisting conditions will (in theory) be a thing of the past. That was a major part of the Affordable Care Act.
posted by jedicus at 7:45 AM on June 19, 2013 [8 favorites]

So, yes, it's possible to imagine a society that defines masculinity as "normal" or "baseline" and consequently defines femininity as an abnormal or diseased condition, and then seeks "scientific" cures for it...

But, no, there is no empirical science involved in the redefinition. Because disease isn't defined by science. And that's ok.

I just wanted these two statements to be moved closer together. What is "OK" is also socially-defined. Should it be OK to label people with an XX chromosome as diseased? What about tall people? Dark-skinned people?

is a condition of the body with significant negative health consequences and that condition is treatable and therefore it should be regarded as a disease

I disagree with most of this sentence. Does obesity itself have significant health consequences? Is it actually treatable in the long term?
posted by muddgirl at 7:46 AM on June 19, 2013 [1 favorite]

My uncle had to be obese for 30 years before it finally put his body in a position that it was falling apart fast enough that he could get disability for the secondary issues of diabetes, degraded joints, sores that turn into infections, falling down and shattering limbs, etc.

Not sure it would help if it's considered a disease though. Beyond the fact that it would have been better if there was a medical intervention earlier. He may finally be getting his stomach stapled which _may_ help. Also if it is something that would allow him to get therapy more easily, which is probably what he's needed, than I'm all for it.

I just hope this doesn't reduce the world supply of BBW.
posted by Napierzaza at 7:47 AM on June 19, 2013 [3 favorites]

Whether a treatment is successful and its success relative to cost should certainly be relevant to the way its insured and how the rest of us feel about that, I think.

Obviously the current system of "have you tried to lose weight" and the plethora of weight-loss books/scams/reality television have the corner on successful methods, right? My point is whether or not people use the tool (bariatric surgery) to change their life and improve their health is of no consequence to me, that they have the option to try it and have it covered is.
posted by playertobenamedlater at 7:48 AM on June 19, 2013

perhaps this will finally raise awareness of the many potential causes of obesity

I think it will obscure how the structure of our society contributes.
posted by the man of twists and turns at 7:50 AM on June 19, 2013 [7 favorites]

But - mostly - isn't obesity caused by overeating and/or inactivity?

Mostly, HIV is contracted through unsafe sexual activity*, does that mean it's not a disease?

*Actually, without looking up the stats, this may not be true any more. Has congenital or mother-child transmission HIV surpassed sexual transmission?
posted by The 10th Regiment of Foot at 7:53 AM on June 19, 2013

If this helps to change the agro-industrial domination of our food delivery systems and consequent relentless onslaught of "inexpensive" unhealthy and fattening food toward everyone from childhood forward, I'm all for it. But I think that's unlikely.
posted by bearwife at 7:55 AM on June 19, 2013 [10 favorites]

There is an awful tendency to blame the victim in a disease, whether it's consumption, cancer or AIDS. Finally recognizing obesity as a disease is a great thing.
posted by bhnyc at 7:55 AM on June 19, 2013 [8 favorites]

Has congenital or mother-child transmission HIV surpassed sexual transmission?

Not in the U.S. When HIV is diagnosed before or during pregnancy, perinatal transmission can be reduced to less than 1% if appropriate medical treatment is given, the virus becomes undetectable, and breastfeeding is avoided. Cite.
posted by roomthreeseventeen at 7:55 AM on June 19, 2013 [2 favorites]

muddgirl: " I disagree with most of this sentence. Does obesity itself have significant health consequences?"

It can. Depending on the degree, carrying extra weight on one's frame can put a strain on many of the body's systems which can have a deleterious long-term effect. They include the cardiac/circulatory, respiratory and digestive systems. Being overweight can also affect the joints, potentially accelerating cartilage and bone damage.

Is it actually treatable in the long term?

Depends on the cause. If a woman has PCOD, then often yes. If someone has a thyroid or adrenal condition, then often yes. If a person needs to be on a restrictive diet, or have lap band surgery in order to help them control certain behaviors, then yes.
posted by zarq at 7:56 AM on June 19, 2013 [1 favorite]

Does obesity itself have significant health consequences?

Yes, if you use a slightly circular definition of obesity (i.e. "excess body fat that is likely to cause significant health consequences").

Is it actually treatable in the long term?

At the moment, only for some people. But there is reason to believe that a safe, low side-effect, general purpose fat reduction drug can be found.

I just hope this doesn't reduce the world supply of BBW.

Ick. Women of any description do not exist for your pleasure.
posted by jedicus at 7:56 AM on June 19, 2013 [13 favorites]

Does this mean that diet pills and weight loss surgery are going to become insurance-paid options for people? Because there are some pretty major ramifications and potential complications to those things, and to suggest that a relatively healthy and happy fat person Get Treatment just because they're fat makes me pretty uncomfortable.

However, many of those things are currently in a scary medical gray area, where some of it is prescription and a lot of it is scammy, fly-by-night crap. Treating it as a serious disease would, I hope, encourage both funding and regulation of medications and give people options that don't involve woo or dangerous untested herbal concoctions or doctors with degrees from Hollywood Upstairs Medical School.

As with depression, there are real benefits to being able to say "I have a disease" rather than believing that you are just a messed-up, weak, stupid person who can't stop doing this destructive thing. That doesn't mean abdicating personal responsibility, any more than taking antidepressants does.
posted by emjaybee at 7:58 AM on June 19, 2013 [11 favorites]

Has congenital or mother-child transmission HIV surpassed sexual transmission?

Not in the U.S.

Thanks! Any idea about world-wide? Sorry- total derail!
posted by The 10th Regiment of Foot at 7:58 AM on June 19, 2013

If I didn't treat my eating disorder as a chronic medical issue requiring daily assessment and feedback, I'd still weigh 370 lbs. If I wasn't dead. But since using clear metrics to drive small, sustainable changes to my everyday choices, a big dose accepting reality as it is, and not as I'd wish it to be, and a tool or two I've put together to support it, I'm down about 140 pounds.

I'd like to also credit the discussion about pre-diabetic conditions and intermittent fasting. Going to a 16/8 IF pattern really broke a whole lot of bad habits.

But "disease model"? I echo the "is anyone surprised?" sentiments.

The real key is getting over your own hang-ups, of course, so that you can do the mechanics of sustainable weight management.... That's where the research dollars are needed imnsho...
posted by mikelieman at 8:00 AM on June 19, 2013 [10 favorites]

The ADA just classified something as a disease to "raise awareness" among doctors, the people with professional awareness.

Could someone explain the real reasons behind this? Financial interests for example?
posted by Teakettle at 8:01 AM on June 19, 2013 [1 favorite]

Mother-child transmission has been drastically reduced, even in Africa. We know a lot about how to prevent it now and it's fairly cheap to deploy those practices.

Sorry for the derail.
posted by telegraph at 8:02 AM on June 19, 2013

Thanks! Any idea about world-wide? Sorry- total derail!

More info here. Without intervention, between 25-40% of babies born to HIV-infected mothers in the most severely affected countries are also infected.[6] With appropriate interventions, transmission rates can be reduced to less than 1%.
posted by roomthreeseventeen at 8:02 AM on June 19, 2013

Mostly, HIV is contracted through unsafe sexual activity*, does that mean it's not a disease?

Pregnancy is also contracted through unsafe sexual activity, and it can have significant, potentially deadly impacts on the health of the mother. Does that make it a disease?

Avenger is right - we can't look at this scientifically, because it's not a scientific decision. Personally, I am against medicalizing bodies that seem icky to us.
posted by muddgirl at 8:03 AM on June 19, 2013 [4 favorites]

The bad moral habit of yesteryear (gluttony/sloth) is the bad health habit (overeating/lack of exercise) of today; the assumed fault is read backwards from the perception in both cases, without regard to specific conditions or socioeconomic causes.

And honestly, a lot of obesity is mere perception, not a diagnosis. Even some commonly-cited "metrics" like BMI have a lot of problems, since they tend to treat all body mass above a certain threshold as fat, and rarely look at body type or any of the innumerable variations of any given body. The obese and the thin body are more constructions of shared perception than of medical investigation.

Could someone explain the real reasons behind this? Financial interests for example?

i imagine they're complex reasons. Some of the desire is to show that a high percentage of body fat has functional effects on lifespan, joint wear, skin infections, blood circulation, and so forth. Some of it is about fitting treatment and diagnosis into the regime of insurance payments and laws about medical leave and disability. and some of it, no doubt, it simply to reinforce the social power of MA statements.
posted by kewb at 8:04 AM on June 19, 2013

If I didn't treat my eating disorder as a chronic medical issue requiring daily assessment and feedback, I'd still weigh 370 lbs. If I wasn't dead. But since using clear metrics to drive small, sustainable changes to may everyday choices, a big dose accepting reality as it is, and not as I'd wish it to be, and a tool or two I've put together to support it, I'm down about 140 pounds.

But I'm guessing you're an educated, working professional that has the capacity to make those changes. Imagine being someone that's not highly educated, properly insured, gainfully employed, or self-aware enough to face reality and make those changes on their own?
posted by playertobenamedlater at 8:06 AM on June 19, 2013

Personally, I am against medicalizing bodies that seem icky to us.

It's disrespectful and reductive of cumulatively millions of research hours to imply that obesity has been classified as a public health problem or disease merely because some people think it's "icky." You and many others may be perfectly healthy at high BMIs, but some people get sick and die because they have too much body fat. It trivializes those issues and discourages the ill from seeking treatment when we spread the mythos that real health problems are merely social stigma.
posted by telegraph at 8:07 AM on June 19, 2013 [39 favorites]

Is it actually treatable in the long term?

I'm currently down from 157kg to 152 after a month and a bit of 5:2. I'm 51 years old and after Reductil got withdrawn I had pretty much given up on finding an eating pattern that would both keep me healthy and be sustainable for the rest of my life. I'm finding 5:2 as easy to live with as Reductil was and can easily imagine sticking with it indefinitely. Plus it doesn't cost me $100/month in prescription drugs.

Memail me in a year and I'll let you know about the medium term results.
posted by flabdablet at 8:08 AM on June 19, 2013 [4 favorites]

muddgirl: "Personally, I am against medicalizing bodies that seem icky to us."

"Overweight and Obesity: Health Consequences
The primary concern of overweight and obesity is one of health and not appearance.

PREMATURE DEATH
* An estimated 300,000 deaths per year may be attributable to obesity.
* The risk of death rises with increasing weight.
* Even moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged 30 to 64 years.
* Individuals who are obese (BMI > 30)* have a 50 to 100% increased risk of premature death from all causes, compared to individuals with a healthy weight.

HEART DISEASE
* The incidence of heart disease (heart attack, congestive heart failure, sudden cardiac death, angina or chest pain, and abnormal heart rhythm) is increased in persons who are overweight or obese (BMI > 25).*
* High blood pressure is twice as common in adults who are obese than in those who are at a healthy weight.
* Obesity is associated with elevated triglycerides (blood fat) and decreased HDL cholesterol ("good cholesterol").

DIABETES
* A weight gain of 11 to 18 pounds increases a person's risk of developing type 2 diabetes to twice that of individuals who have not gained weight.
* Over 80% of people with diabetes are overweight or obese.

CANCER
* Overweight and obesity are associated with an increased risk for some types of cancer including endometrial (cancer of the lining of the uterus), colon, gall bladder, prostate, kidney, and postmenopausal breast cancer.
* Women gaining more than 20 pounds from age 18 to midlife double their risk of postmenopausal breast cancer, compared to women whose weight remains stable.

BREATHING PROBLEMS
* Sleep apnea (interrupted breathing while sleeping) is more common in obese persons.
* Obesity is associated with a higher prevalence of asthma.

ARTHRITIS
* For every 2-pound increase in weight, the risk of developing arthritis is increased by 9 to 13%.
* Symptoms of arthritis can improve with weight loss.

REPRODUCTIVE COMPLICATIONS
* Complications of pregnancy
* Obesity during pregnancy is associated with increased risk of death in both the baby and the mother and increases the risk of maternal high blood pressure by 10 times.
* In addition to many other complications, women who are obese during pregnancy are more likely to have gestational diabetes and problems with labor and delivery.
* Infants born to women who are obese during pregnancy are more likely to be high birthweight and, therefore, may face a higher rate of Cesarean section delivery and low blood sugar (which can be associated with brain damage and seizures).
* Obesity during pregnancy is associated with an increased risk of birth defects, particularly neural tube defects, such as spina bifida.
* Obesity in premenopausal women is associated with irregular menstrual cycles and infertility.

ADDITIONAL HEALTH CONSEQUENCES
* Overweight and obesity are associated with increased risks of gall bladder disease, incontinence, increased surgical risk, and depression.
* Obesity can affect the quality of life through limited mobility and decreased physical endurance as well as through social, academic, and job discrimination.

CHILDREN AND ADOLESCENTS
* Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to those with a healthy weight.
* Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Overweight and obesity are closely linked to type 2 diabetes.
* Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese.
* The most immediate consequence of overweight, as perceived by children themselves, is social discrimination.

BENEFITS OF WEIGHT LOSS
* Weight loss, as modest as 5 to 15% of total body weight in a person who is overweight or obese, reduces the risk factors for some diseases, particularly heart disease.
* Weight loss can result in lower blood pressure, lower blood sugar, and improved cholesterol levels.
* A person with a Body Mass Index (BMI) above the healthy weight range* may benefit from weight loss, especially if he or she has other health risk factors, such as high blood pressure, high cholesterol, smoking, diabetes, a sedentary lifestyle, and a personal and/or family history of heart disease."

posted by zarq at 8:08 AM on June 19, 2013 [48 favorites]

*quietly sets down the Snickers*
posted by billiebee at 8:13 AM on June 19, 2013 [6 favorites]

And naturally skinny people who eat junk food and aren't active have those health problems too, right?
posted by MisantropicPainforest at 8:14 AM on June 19, 2013 [3 favorites]

Personally, I am against medicalizing bodies that seem icky to us.

What if the patient's body seems icky to them and they desperately want their "icky body" to be medicalized so that they have access to new, affordable, safe weight loss options that will actually work? Saying "no, you're not allowed to control your body's appearance in a safe, effective, affordable manner" seems like a pretty serious denial of personal autonomy to me.

And let's be frank here: for many people the only way they are going to be able to control their appearance is with medical treatment*, and the only way a safe, effective, affordable treatment will be available for them is if the medical profession supports it.

Instead, I say we level up instead of leveling down. Instead of saying "no medicalization for anybody because some people might have it forced on them or be looked down upon," I say "medicalization only for those that want it and education for everyone so that society better understands health, obesity, body image, and personal autonomy."
posted by jedicus at 8:15 AM on June 19, 2013 [3 favorites]

I have a lot of respect and sympathy for the Health At Every Size (HAES) movement, and I think it has actually done a lot of important work in moving obesity out of shameful-moral-failing territory and into the realm of "physical fact about a person's appearance that says nothing about their character and so shouldn't be used to discriminate."

But. Heart disease is all over my family, both sides. I fully expect it to get me, because my bad eating (as in, crap foods my family bought/cooked/ate) started early and even if I lose a lot of weight immediately, not all that damage is going to be reversible. I'm already doing better than my parents were at my age; I don't smoke, I eat better, I sure as hell feed my kid better. But that genetic bullet is probably still coming for me.

And heart disease and obesity seem to share a really close connection. Maybe both are caused by some immune-system gut problem, for all I know. We are just barely beginning to understand the mechanisms of heart disease, much less those of obesity. I welcome any research at all that would help me and especially my kid be able to untangle, avoid, and treat the bad genetic hand we've been dealt in any way we can.
posted by emjaybee at 8:16 AM on June 19, 2013

But I'm guessing you're an educated, working professional that has the capacity to make those changes. Imagine being someone that's not highly educated, properly insured, gainfully employed, or self-aware enough to face reality and make those changes on their own?

Well, 'educated' in the sense that yeah, I understand science so that the need for relevant metrics is clear. And that I could select the ones which ( I feel ) are key ( Daily Rate of Weight Change -- which John Walker popularized in 'The Hacker's Diet' back in the 90's... )

Insurance never came into it, neither has employment really, other than as an opportunity to develop the web based implementation of the tools I find helpful.

Self awareness is the key. In the balance, 90% of the challenge is getting over our own perceived limitations, and moving forward out of our comfort zones.
posted by mikelieman at 8:17 AM on June 19, 2013 [5 favorites]

Coming from a completely different medical community (autoimmune disease) I have a fair amount of experience with the conflict between medical treatments and lifestyle treatments for disease, and I can tell you that whether it's called a disease or not, doctors are woefully unprepared to counsel patients on making any kinds of lifestyle changes. This is not a knock to doctors -- I truly think we need a new class of health counselor that specializes in prescribing lifestyle changes, working in conjunction with doctors and medical treatments, but completely outside that ecosystem (and economy).

Quoted for truth - there are all the same problems for other chronic diseases (osteoarthritis, diabetes, etc). Doctors are trained to treat things medically, not with lifestyle changes. The best learn how to counsel their patients about lifestyle issues (which isn't just "lose weight" but talking through real strategies for improving health), and/or work with other health professionals. But they are still rarer than they should be.

/just got off editing a report for health researchers stressing the importance of support for lifestyle changes in arthritis.
posted by jb at 8:21 AM on June 19, 2013 [5 favorites]

Even some commonly-cited "metrics" like BMI have a lot of problems, since they tend to treat all body mass above a certain threshold as fat, and rarely look at body type or any of the innumerable variations of any given body

BMI is a population-level measure.* Any physician who uses BMI on an individual level for anything important is foolish, lazy, or both. Body fat percentage, while still imperfect, is a much better metric. No doubt even better models could be devised that accurately capture people whose weight is or likely will be a health problem while excluding those whose weight is or likely won't be a problem.

* And not a very good one at that, but only because it tends to significantly underestimate obesity in the US. When body fat is used as a statistical measure, America's obesity problem is much worse than when BMI is used.
posted by jedicus at 8:22 AM on June 19, 2013 [6 favorites]

Well, and this is one more way the AMA divorces themselves completely from the food problems in this country - which is too much of the wrong kind. After watching Forks Over Knives, I have started implementing changes in how my whole family eats, at least at home. We can't go full on 100% vegetable protein without mutiny, but I've stated relying a lot more on beans and veggies.
posted by PuppyCat at 8:23 AM on June 19, 2013

I don't understand why the reaction is always to look at the outlier whenever the issue of obesity is brought up. Yes; there's always going to be the man-made-out-of-muscle with a high BMI, but realistically, most people with a high BMI are carrying fat, not muscle. Yes; there are people out there whose natural inclination and body shape is fat and are exceedingly fit - but the majority of fat people aren't fit nor unable to lose weight. There is a staggering amount of evidence to show that obesity is correlated with many, many health issues and at an alarming and preventable level too, so it's hardly a flimsy, relative, up-in-the-air measure. I feel that the fact that we can't talk about the medical effects of obesity without always speaking about the "fat-but-super-fit" outliers speaks to the stigmatization of obesity - the medical impact of obesity is a reality for so many people, so why do we always try to minimize these quality of life issues?
posted by Conspire at 8:24 AM on June 19, 2013 [33 favorites]

Pregnancy is also contracted through unsafe sexual activity, and it can have significant, potentially deadly impacts on the health of the mother. Does that make it a disease?

Considering that women (pre-ACA) paid higher insurance premiums than men for the same coverage, I'd say at least some people consider it so, even if they won't come out and say it...
posted by like_a_friend at 8:24 AM on June 19, 2013 [4 favorites]

Telling fat folks about the health dangers is like telling a smoker they are risking lung cancer. They mostly know already, and they are scared even as they continue in counterproductive behavior.

A lot of them will have dealt with it since they were kids. They had parents and teachers and doctors all bringing it up out of love or concern. They also had a ton of little shits mocking the hell out of them for their appearance. They live in a society that basically condones that. There are people that argue that mockery is a helpful way to change bad behavior!

So, in that climate kids can end up extremely miserable from the bullying and all that concern at home may come from a good place but it just feels like there is no escape from the mockery. You have to think about being fat all day instead of getting home to find some relief. Schools should help kids to learn mocking people for their weight is not so different from mocking a kid for being in a wheelchair or being bald from chemo. It poisons the ability of people with real concern to communicate that.

Anyway, a couple random thoughts on the subject. It might help if the only intoxicant we legalized was not a massive calorie bomb. People want to get high, alcohol can be a terrible and dangerous way to do it for a lot of reasons. People talk about potheads hitting the junkfood, but I've found it makes it easier to appreciate healthy food with more subtle and complex flavors and even if you do binge a bit you are probably taking in less calories than you would with some beers.

Also, most of the exercise people seem to have time to do on a regular basis is really boring. Most of us played organized sports as kids, it would be super if as a society we could make time for that as adults even for those at low skill levels. I'd love to play some tackle football with pads and the whole deal. Competition is fun and helps motivate a person.
posted by Drinky Die at 8:27 AM on June 19, 2013 [11 favorites]

Being old isn't a disease but there are many health consequences which come from living past a certain age. Ill health might arise from being old, or being obese, but I don't see them as diseases in themselves.
posted by billiebee at 8:27 AM on June 19, 2013 [1 favorite]

BMI + waist/hip ratio + body fat percentage test (a real one) ought to be enough to tell if a person is "obese" or not, I'd say. But I guess it's easier to just pretend that height, weight, and a constant are all you need to use.
posted by thelonius at 8:28 AM on June 19, 2013

Folks, lets drop the BBW thing already.
posted by cortex (staff) at 8:30 AM on June 19, 2013 [5 favorites]

Insurance never came into it, neither has employment really, other than as an opportunity to develop the web based implementation of the tools I find helpful.

Self awareness is the key. In the balance, 90% of the challenge is getting over our own perceived limitations, and moving forward our of our comfort zones.

Most people aren't self-aware though and aren't going to make those changes on their own.
posted by playertobenamedlater at 8:30 AM on June 19, 2013 [1 favorite]

BMI is a statistical measure.* Any physician who solely uses BMI on an individual level for anything important is foolish, lazy, or both.

FTFY (bold). You realize when a doctor does this, they likely also have the results of physicals and can observe the patient? They aren't being emailed just BMI and making a judgement. They could observe when someone is an outlier. Give them some credit.
posted by Bovine Love at 8:30 AM on June 19, 2013 [1 favorite]

MisantropicPainforest: And naturally skinny people who eat junk food and aren't active have those health problems too, right?

Cite?
posted by IAmBroom at 8:31 AM on June 19, 2013 [1 favorite]

Most people aren't self-aware though and aren't going to make those changes on their own.

Well, I did mention earlier how I thought the best return on research investment is in how to get people out of their comfort zones...
posted by mikelieman at 8:37 AM on June 19, 2013 [1 favorite]

I was asking a question, hence I don't have a cite for my question. But if you want more information on the subject, I learned a lot from reading Paul Campos' writing. See here for example.
posted by MisantropicPainforest at 8:37 AM on June 19, 2013

Imagine being someone that's not highly educated, properly insured, gainfully employed, or self-aware enough to face reality and make those changes on their own?

This is usually the kind argument that is used to justify things like slavery and colonialism.
posted by the jam at 8:41 AM on June 19, 2013 [2 favorites]

zarg, isn't everything you list better explained not by obesity, but by bad eating habits and inactivity? Active fat people that eat healthy don't have those problems to the same extent as non-active fat people who eat unheathily.

Sadly, no. Carrying extra weight is stressful for your body - it contributes significantly to osteoarthritis (the most common type of arthritis) through pressure on weight bearing joints, and diabetes due to reduced circulation to the extremities - both of which are very common chronic diseases. You can help both with exercise, but to really help you need to reduce your overall mass.

(I don't know much about heart disease and it's relationship to weight as opposed to eating/exercise - perhaps someone else could contribute?)

I'm saying this as someone who has been somewhat overweight the whole of my life. I have close family members who have been very obese for decades. I know that it's damned difficult to lose weight. It's not just a matter of "eat a bit less, exercise a bit more", because our bodies are perverse and they fight us on losing weight. You have to make radical changes to your life that, frankly, few people who have always been thin understand or would be able to do themselves.

But watching the people I love suffer and have premature disability due to obesity is heartbreaking. Having a stroke at 54, most likely due to excess weight and diabetes - this sucks, and it can leave you disabled for the rest of your life.

We must have a conversation about the serious health consequences of obesity and overweight without being either judgemental or cavalier about the challenges that people face in losing weight.

That said, there is something I will totally judge: the fucked up way that our jobs (esp the sedentary ones), our working hours, our city planning have contributed to the increase in obesity. We don't seem to give a shit that people work long, stressful hours sitting (itself very bad for your health), and then are stuck travelling long hours in cars or on public transit. For a lot of lower income people, gyms are financially unfeasible even if they have time to go (and if you have kids, you probably don't have time). Our entire economy and society in the west is also stacked against us - I know that I've only lost weight since being unemployed and having the time to exercise 2-3 hours a day. And even then, my only social support in exercising are the free classes offered by an awesome local community centre - something a lot of people don't have access to.
posted by jb at 8:43 AM on June 19, 2013 [29 favorites]

FTFY (bold). You realize when a doctor does this, they likely also have the results of physicals and can observe the patient? They aren't being emailed just BMI and making a judgement. They could observe when someone is an outlier. Give them some credit.

Yes, your correction is valid, but in my experience BMI (or more accurately the combination of height and weight) is just about all the doctor has to go on. The physical exam usually does not include information needed to more accurately determine body fat (e.g. no direct body fat measurement, no waist/hip ratio or neck measurement). The doctor may be able to see the patient (often clothed), but that's a pretty error-prone way to determine how fit someone is or isn't.

And then there are cases where doctors are specifically directed to make decisions solely based on BMI, like the prescribing rules for Qsymia [pdf]. It's indicated for adults with a BMI of 30 or more (i.e. obese) or 27 or more with one or more of a list of comorbidities (e.g. type 2 diabetes). That's it. There's nothing there about making a judgment based on other information or the possibility of outliers. They took a population-level measure and turned it into an individual-level decision-making tool. Lazy and foolish. Now, one hopes that doctors will effectively prescribe it off-label as a result, but who knows how many will take their chances.
posted by jedicus at 8:43 AM on June 19, 2013 [1 favorite]

I find the messages about obesity somewhat confusing. I feel like a lot of people claim it is not about diet and exercise, but then at the end of the article we have this:

“The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes,” the resolution said.

This looks like a pretty clear parallel regarding causes, no?
posted by Hoopo at 8:44 AM on June 19, 2013

This is usually the kind argument that is used to justify things like slavery and colonialism.

Not my intent but I can see why you would say that. My point is that most people are looking for a quick fix (obese or otherwise) and aren't capable of that level of introspection. If introspection, self-awareness, and a can-do attitude is all it took to get obesity under control Jillian Michaels would be hustling blowjobs on off ramp in Glendale instead of yelling at desperate people on the "Biggest Loser and the "diet" industry would be looking for a new pool of folks to sell miracles to.
posted by playertobenamedlater at 8:48 AM on June 19, 2013 [3 favorites]

I'm saying this as someone who has been somewhat overweight the whole of my life (though not medically obese most of the time). I have close family members who have been very obese for decades. I know that it's damned difficult to lose weight. It's not just a matter of "eat a bit less, exercise a bit more", because our bodies are perverse and they fight us on losing weight. You have to make radical changes to your life that, frankly, few people who have always been thin understand or would be able to do themselves.

Bull-fucking-shit. I've lost 85 lbs so far this year, and I plan on losing another 20-40. You know how I did it? I ate less and exercised more. It really is that simple. Do you think calories are magically exempt from the laws of thermodynamics?
posted by entropicamericana at 8:48 AM on June 19, 2013 [9 favorites]

It might help if the only intoxicant we legalized was not a massive calorie bomb.

Man, I think about this all the time. Have you ever stopped to look at the advertising around "bad" (sugary/greasy, but mostly sugary) foods? We treat them exactly like drugs, like something to take the edge off, make you forget your troubles. We celebrate anyone who comes up with a new type of calorie bomb, by frying something that's never been fried, or baking multiple desserts into one. Cake-decorating is a major sport (though maybe you could argue most of that isn't all that edible). The more we understand how bad sugar is for us, the more we worship it and are lured by aura of the forbidden. I do wonder if the health consequences of a pot habit wouldn't be preferable to those of a massive sweet tooth for lots of people.

And I would bet hard cold cash that I'm not the only person who, in despair over their weight, didn't wonder whether it would be worth it to take up smoking for its appetite suppressant abilities. But then, there are plenty of fat smokers too.
posted by emjaybee at 8:48 AM on June 19, 2013 [10 favorites]

Any physician who solely uses BMI on an individual level for anything important is foolish, lazy, or both

I don't know what physicians do or don't do, but our health plan was going to use solely BMI to put people in the normal plan or the fatties-n-smokers plan. Physicians are, unfortunately, not the only people making decisions on the basis of this data.
posted by thelonius at 8:49 AM on June 19, 2013 [1 favorite]

It really is that simple.

...for you. Congratulations. For many people it is not simple.
posted by roomthreeseventeen at 8:49 AM on June 19, 2013 [33 favorites]

Bull-fucking-shit. I've lost 85 lbs so far this year, and I plan on losing another 20-40. You know how I did it? I ate less and exercised more. It really is that simple. Do you think calories are magically exempt from the laws of thermodynamics?

Didn't flag but might. Come on, now. Don't be an asshole.
posted by josher71 at 8:51 AM on June 19, 2013 [16 favorites]

Hoopo: Obesity is, for most people, a matter of diet and exercise. But there is also a genetic component. Two people can live the same not great lifestyle; one will become obese and the other will not, depending on their metabolisms, etc. Is the skinny teen who lives off pizza and soda more moral than the overweight teen who eats the same things? The former has just won a genetic lottery.
posted by jb at 8:51 AM on June 19, 2013 [1 favorite]

You know how I did it?

I don't care, and neither should public health officials. You are not a population.
posted by MisantropicPainforest at 8:53 AM on June 19, 2013 [35 favorites]

"Bull-fucking-shit. I've lost 85 lbs so far this year, and I plan on losing another 20-40. You know how I did it? I ate less and exercised more. It really is that simple. Do you think calories are magically exempt from the laws of thermodynamics?

Don't break your arms patting yourself on the back there hoss. I've lost (and kept off) almost 150lbs over the past four years and it has been the biggest struggle of my life. I had an easier time stopping hardcore drug use than losing weight.
posted by playertobenamedlater at 8:53 AM on June 19, 2013 [38 favorites]

Bull-fucking-shit. I've lost 85 lbs so far this year, and I plan on losing another 20-40. You know how I did it? I ate less and exercised more. It really is that simple. Do you think calories are magically exempt from the laws of thermodynamics?

You seem to be confusing a problem for which the solution is known with a problem for which the solution is simple. They're not the same. Exercise more, eat less is the solution for everyone, but implementing that solution is really hard for some people. I guess it wasn't hard for you, but that's you; you aren't everyone.
posted by Bulgaroktonos at 8:55 AM on June 19, 2013 [7 favorites]

Maybe this is more of a MetaTalk thing, but in the spirit of MetaFilter being a self-policing community: Individuals have a responsibility to make their points in constructive ways—but when somebody phrases something unnecessarily jerkishly, there's also a group responsibility not to let it derail the thread.

It wasn't a great comment. Let it die, and move on with the conversation.
posted by cribcage at 8:56 AM on June 19, 2013 [4 favorites]

Okay, I can see how this is going to go and I'm not going to get drawn into this argument. Let me just say this: I've been there, I've done it, it's easier than you think, and you are stronger than you think.
posted by entropicamericana at 8:57 AM on June 19, 2013 [1 favorite]

To be fair, they said simple, not easy. There are lots of simple things which are surprisingly difficult, and some not so surprisingly. Quitting smoking was simple; I didn't have to do anything, but man was it hard.

That being said, it was an inflammatory way to say it.
posted by Bovine Love at 8:57 AM on June 19, 2013 [4 favorites]

I tried to lose weight on various diets for years and nothing worked until I had gastric bypass. Sure, there are lots of things they don't quite understand about WLS and hormonal response etc., but the bottom line was that I couldn't eat more than 800 calories a day. That would have been impossible if I hadn't had the vast majority of my stomach cut off.

I have a BodyMedia armband which reports that I burn a paltry 1800 calories on a GOOD day. 1800 calories is a dieting level of food for most people.
posted by elsietheeel at 8:59 AM on June 19, 2013 [1 favorite]

I've lost 85 lbs so far this year, and I plan on losing another 20-40. You know how I did it? I ate less and exercised more. It really is that simple. Do you think calories are magically exempt from the laws of thermodynamics?
posted by entropicamericana

I am deeply impressed by your achievement, and I hope that you will be able to maintain it.

I know someone who lost 50 pounds by eating less and exercising more. And when they had achieved their goal weight, they started eating normally and kept exercising normally - and gained back 70 pounds and was in worse health than ever. Your body changes when you lose very large amounts of weight - and the only person I know who has managed to keep it off have had to keep up a lifestyle where they exercise a great deal more than the average person, because he is underemployed and he can go for long bike rides every single day.

I really hope that you are able to beat the odds and keep the weight off. But I know that for most people that is not an easy journey.
posted by jb at 8:59 AM on June 19, 2013 [8 favorites]

Bull-fucking-shit. I've lost 85 lbs so far this year, and I plan on losing another 20-40. You know how I did it? I ate less and exercised more. It really is that simple.

So I suppose that I've never been 100+ lbs overweight because I've always been eating properly and exercising lots, right?

Or maybe some bodies just grow differently and respond to stimuli differently than others.
posted by phunniemee at 8:59 AM on June 19, 2013 [9 favorites]

Bull-fucking-shit. I've lost 85 lbs so far this year, and I plan on losing another 20-40.

And, (iirc) statistically you are more likely to gain back the weight than follow through on the rest of your plan. I don't mean to discourage you because, AWESOME job, but most people do make progress before falling back. The complex part is keeping your lifestyle changed.
posted by Drinky Die at 9:01 AM on June 19, 2013 [2 favorites]

And, (iirc) statistically you are more likely to gain back the weight than follow through on the rest of your plan. I don't mean to discourage you because, AWESOME job, but most people do make progress before falling back. The complex part is keeping your lifestyle changed.

And boy is that hard. I've lost as much as the person you quoted and gained it all back after I slacked off on my heavy, heavy exercise just a little bit.

EVERYONE IS DIFFERENT. I can't stress it enough.
posted by Malice at 9:02 AM on June 19, 2013 [3 favorites]

I've asked the mods to delete my comment, stop the pile-on, and get this thread back on topic. I apologize for posting my opinion.
posted by entropicamericana at 9:03 AM on June 19, 2013

Well, at least we can say with confidence that eating too many Big Macs causes a disease.
posted by unSane at 9:05 AM on June 19, 2013 [1 favorite]

Okay, here's my EXTRA long take on weight loss. It's been working for me, and might work for you. I call it the Equilibrium. Here's the TL;DR:

There are two basic things to remember:

1. Eat enough to stop feeling empty, not to feel full. Then your body will slowly but surely work its way towards equilibrium.
2. Don't work out *until* you've reached equilibrium. Working out is *not* for losing weight: it's for maintaining fitness.

---

Our bodies want to reach a state of equilibrium. What this means is that they tend towards a balance -- when we take in the same amount of calories we burn with moderate exercise and a proper diet. The point of this "plan" (so to speak) isn't to Lose Weight Fast; it's to allow our bodies to reach that state of balance. First, we have to do a few things to get ourselves to that point. Once we've done this, the very habits that got us there help us maintain it.

This has actually, so far, been quite a successful endeavor for me and my wife. And a few other people I've encountered who have done the same thing (albeit without my influence). And we've all found it's not that hard to lose the weight once we've allowed our bodies to take charge. And believe me, we've lost a bunch of weight. But we didn't starve or deny ourselves, or work out until we hate physical effort, or any other of the countless "tips, tricks, and cheats" that people employ in commercial "health" efforts. And it's not that we, as people who have lost this weight, are outliers, per se; it's that everyone else out there who gains the weight back or never loses it is, more often than not, trying to *force* their bodies to be/do something. Doing this plan the right way means *allowing* your body to do what it should, making us stop being obstacles to our own health because we're trying so desperately to become something and to see results *right now*. Which is why weight-loss diets and workouts are such nonsense: they're attempting to solve a problem, not teach us good habits. Also, they're almost always engineered to make somebody some money.

Some may call this sort of this a diet or even the phrase of the last two decades, a "lifestyle change". I kind of hate the term "lifestyle change" for a couple of reasons. But I prefer to think of it as a "change in outlook, not lifestyle". I changed my mind more than my life. By looking at things differently, by shifting expectations, by simply being more mindful of things, I was able to get healthier by getting out of the way of my body's natural tendency toward equilibrium. Of course, none of this is overnight. But the dead simple "secret" is that it's actually *easier* than it looks.

## BALANCE
### The right amount of the right things.
Make sure every meal contains a decent amount of all four of the REAL food groups: fat, protein, fiber, and carbohydrate. No one category should outweigh the others significantly. Eliminating all carbs or fats from your diet is not only not a good idea, it can be downright dangerous. Your body needs (and craves) all of these -- so make sure each meal has plenty of each. And if you're in a mood for a larger portion of one, balance it out with a larger portion of another. When I know I'd prefer a larger steak, I'll have twice as much veggies.

Then there's snacks: when you *do* snack (and you will), lean heavily on protein and fiber. The reason? The thermic effect of food, which describes the phenomenon in which certain types of food are easier or harder to break down by the body in order to get to the calories inside. The harder to break it down, the more stored calories the body needs to burn in order to digest -- which creates, to an extent, a net caloric intake that is reduced from what you'd normally think of. The body breaks down simple carbs (which includes sugar) almost instantly (and fats only a little slower), because they're so simple... and this is why those are our biggest culprits when it comes to snacking. Balance your meals, but lean on protein- and fiber-heavy snacks (beef jerky, fruits, veggies). Avoid processed sugar when feasible. If you do it enough, you'll find a lot of foods with processed sugar just don't taste as good and you'll avoid them as a matter of preference.

## GUILTLESSNESS
### Enjoying food isn't a crime.
Don't guilt yourself one way or the other about the exceptions (occasional Big Mac, what have you). One of the biggest problems when it comes to losing weight is that when we do indulge, we're so culturally trained to feel like we've failed somehow: either we'll tell ourselves "I'll be good tomorrow!" or we feel like idiots for having done it in the first place. Eating the foods we like (regardless of the nutritional value) should never be a point of guilt or pain. SO you ate some cookies. So you want an ice cream sandwich. So you're craving a cheeseburger. SO GO EAT IT. If you're not making it a regular, all-the-time thing, why should you give yourself a hard time? "Being good" as a concept with eating implies some sort of moral issue involved. It's food, not morality! If you don't enjoy food, you will naturally rebel. Which is why people tend to go off their diets in the first place.

## MINDFULNESS
### Pay attention to your food and your body.
Ever notice that after a while when you're eating chips, candy, or some other "junk" food, the last chip isn't nearly as tasty as the first few? Kind of a diminishing returns thing? Try to figure out the point where the snack is no longer as tasty, and stop there. you still can snack on this stuff, but you'll optimize your flavor experience, because the only snacks you eat will be tasty. Also, employ this rule with Rule One: portion control is a matter of taste, too. Two tons of meatloaf isn't as good as a couple of pieces. Once you get used to stopping the snack/food at the point where the flavor Bell curve drops, you then know how much of that snack/food you like in one sitting. Make the most of your food; don't cheapen the experience with giant mounds of stuff.

Plus, it's practically nature's way of having your body tell you "I've had enough". Also, slow down the eating. Let your stomach settle. It takes a bit of time for your stomach to send the "I'm full" message to your brain (slowest damn message in the human nervous system, I bet). That way you don't stuff your face because you still think you're hungry. In addition, this leads to the magic idea of portion control. That takes some getting used to, but once you do it, you get a better idea of how much you can eat. This is a matter of simple math, which is the heart of losing weight: burn more calories than you need to take in, so your body is forced to use the stored fuel (AKA fat).

## FRICTIONLESSNESS
### Don't exercise to lose weight.
If you increase physical effort significantly, you increase your body's need for additional fuel. This is just like driving a car: the faster you drive, the more gasoline it burns, and therefore, the more gasoline it *needs* to burn. Then what happens when you give it all that extra fuel, but you stop -- even temporarily -- going fast?

You accumulate fuel. And fast.

And if you accumulate even more because the need for fuel (our old pal Hunger) fools us into thinking we need to, then, even as we work out, we're gaining weight.

One of the simple and easy mistakes we all make (I was guilty of this as much as anyone) is that when we're *really* hungry, we think we need *more* food, when what we really need is a normal amount of food immediately. So naturally, misinterpreting this, we stuff ourselves. And consequently, we gain weight. All because we created an additional need for fuel. It seems a bit counter-intuitive to hear "Don't exercise or you'll gain weight!", but what I'm *really* saying is "Don't WORK OUT or you'll create a situation where it's *easier* to gain weight."

In addition to the increase need/hunger, falling into common traps seem to become more frequent when we work out: we "reward" ourselves with a latte, or we drink sugar-laden energy drinks or sports drinks. As a matter of fact, the human body isn't particularly well-geared towards burning all of the fuel intake -- in fact, it's quite inefficient compared to many other species -- and it's more likely to store fuel than burn it right away.

Keep in mind: I am not saying don't exercise. I would never advocate a sedentary lifestyle. I'm making a distinction here: working out can and often is counterproductive for losing weight, but moderate daily exercise is an absolute must. Regular movement is great for your overall health. A regular workout is not necessarily. According to multiple studies (the article at `http://www.time.com/time/magazine/article/0,9171,1914974,00.html` points to several), regular moderate exercise is probably better for human beings than working out. If you move regularly (and remember: moving around matters!), you'll keep moving. If you work out, you will be sore, and that will make you not move around as much. Even if you work out every day, you won't move around as much when you get home. And the calories your body demands as a result of the workout increases dramatically. What happens when you've gotten your body used to an additional 500 to 1000 calories... and then you turn an ankle? Pull a muscle? Just feel plain tired? You're going to be taking in those extra calories -- without an offsetting activity -- and your body is now storing all the extra. It'd be better to just walk around more, take the stairs, and not have lazy days when you sit still on the couch. Back to the car analogy: it's better for the long-term health of the automobile to drive it a moderate amount on a regular basis. But taking out and putting in intense driving less frequently is, well, not as good an idea.

And speaking of offsetting the extra calories, that aforementioned inefficiency in fuel consumption (and super-efficiency in fuel storage) that humans have? It bites back. Hard. As the author of the above *Time* article puts it, "a pound of muscle burns approximately six calories a day in a resting body, compared with the two calories that a pound of fat burns. Which means that after you work out hard enough to convert, say, 10 lb. of fat to muscle — a major achievement — you would be able to eat only an extra 40 calories per day, about the amount in a teaspoon of butter, before beginning to gain weight." That's not really an offset at all. All that work just to let me have an extra three ounces of Coca-Cola?

The plain and simple fact is that working out is not good for losing weight. It's meant to help you get and stay fit. As someone recently quoted to me, "get thin in the kitchen, get fit in the gym." Damn skippy.

## Summary
The basic idea is to do these things consciously until they become habit. It's basically conscientious eating. It adheres to my preferred philosophy of Taoism: frictionless and balanced. And, once again, you do this enough, it's habit. That way, you don't have to have the calorie-counting or the diet guidelines or the homework that commercial weight-loss plans require. This is just good eating, kind of like good posture makes your back feel better, helps your gait, etc. Think of this as proper food posture.

Taoism is a belief in a natural process called "The Way". This is the Way to Eat Right. The Way is described as "the One, which is natural, spontaneous, eternal, nameless, and indescribable. It is at once the beginning of all things and the way in which all things pursue their course." This fits good eating habits. Eat natural foods, stuff your body is able to process. Learn how your body (specifically and individually) processes the food, and follow its dictates. Wu-wei is a concept defined as "effortless action": the very heart of this 'diet'! Whereas traditional foodie-ism is, like Buddhism, about enlightenment and transcendence, this is about balance.
posted by grubi at 9:06 AM on June 19, 2013 [23 favorites]

Forgive me if it feels spammy; it's not meant to be. My basic point is that this is simple, but not necessarily easy.
posted by grubi at 9:07 AM on June 19, 2013

Pregnancy is also contracted through unsafe sexual activity, and it can have significant, potentially deadly impacts on the health of the mother. Does that make it a disease?

Pregnancy no, but the significant, potentially deadly impacts may be, just as smoking and sex are not diseases but cancer and HIV are.
posted by The 10th Regiment of Foot at 9:10 AM on June 19, 2013

The complex part is keeping your lifestyle changed.

This is why the "Diet" industry needs to die a quick, painful death and never be heard from again. When I was 19 I got up to 360lbs after hovering around 250lbs throughout high school. I decided to work with a dietitian and, in a year and half, was down to 200lbs. I stayed around 200-250lbs for over five years before I slowly started putting the pounds back on. Within two years (seven years from my original weight loss) I was back up to 350lbs and would top out at 500lbs before I made some serious changes.

What I never realized is that I have to change my lifestyle and stick with it if I want to keep the weight off. If I had gastric bypass surgery this is easier (particularly if you go with an invasive procedure instead of a band) but it's something I'm always going to have to work at and keep in mind. Most people that are "obese" feel like they have to reach some magic number (whether on the scale or on a dress/pants) but the truth is you need to change your lifestyle and adjust as needed to stay on the right path. Diets end, you're always going to have to eat and you're always going to have your body.
posted by playertobenamedlater at 9:10 AM on June 19, 2013

2. Don't work out *until* you've reached equilibrium. Working out is *not* for losing weight: it's for maintaining fitness.

I totally disagree with this. Working out has many benefits in addition to fitness. It's a huge fighter of depression, it helps you sleep better, feel better and look better, it changes your appetite in good ways, it moves weight from fat to muscle, and it increases your overall metabolic rate. Losing weight while working out is FAR easier than losing weight while not working out simply because you can reach what you term 'equilibrium' while eating the same number of calories as you did previously, because you are burning the excess.

Plus, you get fitter.
posted by unSane at 9:10 AM on June 19, 2013 [11 favorites]

Telling fat folks about the health dangers is like telling a smoker they are risking lung cancer. They mostly know already, and they are scared even as they continue in counterproductive behavior.

But the solution is NOT to just suddenly start blasting the opposite as a counter-message. Just because our society is fatphobic does not mean we need to start throwing out decades of obesity research and pretending that everyone who's fat is just that way by "genetics" and thus "fit the way they are." It's not just a body image issue, it's a public health issue as well.
posted by Conspire at 9:13 AM on June 19, 2013 [5 favorites]

unSane: when you're obese, a full-on workout makes things worse. EXERCISE is necessary, a WORK-OUT is not. And several studies (see above) have shown that vigorous exercise is not as important as regular moderate exercise.
posted by grubi at 9:13 AM on June 19, 2013

You added the words 'full-on' and 'vigorous' which I did not use.
posted by unSane at 9:16 AM on June 19, 2013

But - mostly - isn't obesity caused by overeating and/or inactivity? (Please note I say this as a greedy lazy chubby person.) That's not to say there aren't reasons underlying the overeating or inactivity, from emotional trauma, loneliness, depression, social exclusion, lack of edcuation around nutrition, etc. But I'd rather see those issues addressed instead of medicalizing it so more companies can sell more drugs. I always thought of obesity as a symptom, rather than a disease. Also from a body image point of view, if we disregard the health aspect (I know "obese" healthy people and "skinny" unhealthy people) I'm not sure what message fat=diseased sends out.

it's a LOT more complicated than that.

from a public health standpoint, obesity is often caused by environmental factors - things in the social and food environment, including poverty, lack of access to good preventive health care, lack of access to education, lack of meaningful access to good food.

obesity is very complicated, but there is a growing acknowledgement that this is not about a person's decisions, but rather, about how their surroundings affect their decisions and their health.

basically we have a sick environment and obesity is a symptom.
posted by entropone at 9:17 AM on June 19, 2013 [3 favorites]

unSane: working out IS vigorous exercise.
posted by grubi at 9:18 AM on June 19, 2013

Telling fat folks about the health dangers is like telling a smoker they are risking lung cancer. They mostly know already, and they are scared even as they continue in counterproductive behavior.

But the solution is NOT to just suddenly start blasting the opposite as a counter-message. Just because our society is fatphobic does not mean we need to start throwing out decades of obesity research and pretending that everyone who's fat is just that way by "genetics" and thus "fit the way they are." It's not just a body image issue, it's a public health issue as well.

I don't disagree. The most pressing solution is to stop the mockery and shaming and replace it with real concern and help where appropriate.
posted by Drinky Die at 9:21 AM on June 19, 2013 [3 favorites]

First, the number one thing you can do to lose weight is to be broke. All the time. Not "It's hard to live in Manhattan on $250,000 a year" broke. Like, my rent is $750 a month and I'm living on a $900 pension broke. Next: Do you have a car? You can't afford insurance or gas, so better sell it. Or just give it to a friend—the money from selling it could buy a hell of a lot of nutella and heavy cream. Now, in my experience, being poor generally leads to eating garbage food 90% of the time. I mean, it's possible to stretch a meagre food budget by shopping in the right places, buying the right grains and legumes in bulk, but remember, you're doing all this on foot! It's a 30 minute walk in each direction to the food bank on Tuesdays, and even in a progressive town like this one you're going to be coming back with a lot of canned shit that most people wouldn't recognize as food. That, and a lot of bread. Bread makes you fat you say? What! Well don't worry, you won't be eating enough of it to worry about that. If you're lucky, at some point you'll somehow be making enough money to not live like this, but at that point your attitude towards food will be so warped by a life of not having enough of it that you will effortlessly yo-yo back to being your fattest self.

Poor people don't generally have the luxury of applying a deep philosophical regimen to their diet, and it's another element of the "It's so simple" standpoint that ought do be considered.
posted by Lorin at 9:25 AM on June 19, 2013 [12 favorites]

That would be true if poor people weren't more likely to be obese. Food is cheap. Especially terrible food.
posted by 2bucksplus at 9:26 AM on June 19, 2013 [4 favorites]

The meta-analysis in Campos' op-ed talks about decreased mortality rates from overweight individuals which can be sign of healthiness in seniors but presumably with a lot of other complicating factors that can correlate with being overweight.

The conclusion of that study, the one that Campos says should be used as the keynote for redefining all obesity states

Both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

Presumably obesity being classified as a disease would be in reaction to the mountains of epidemiological data that shows an increased mortality rate in seniors with obesity paired with the large amount of data that's enough to convince the Surgeon General to put up that awareness page that zarq linked to.

I don't know for sure but I think there's two assumptions that advocates of the anti-anti-obesity campaign make. The more popular one is that anti-obesity is about body image more than health complications. It's true that there are a lot of institutions that enforce a particular identity of what it means to be healthy. Parks and Rec's Chris Traeger is a satiricial representation of the therapist-seeing, ultra-happy-but-not-really, supplement ingesting, 20-mile bike-rides-a-day character. In a way, the spoof is like any other spoof on religion: people believe that over-exercise and dietary fads will make them happier but it's pretty clear that a lot of supplements and nootropics are just distortions riding on the wave of how faddish neuroscience and exercise science have become.

While true in that regard, the comedy is false because it flies in the face of actual biomedical evidence demonstrating that obesity does impair your quality of life. One of the things about ADHD and anxiety programs is that they all pretty much suggest daily exercise as the first course towards self-treatment. And while that's less about obesity, it does imply that maintaining an active and fit lifestyle is ideal for your mental and physical health with enough proven, peer-reviewed data that it's a widely dispersed and relatively consistent suggestion.

The other assumption is echoed by Philip Alcabes in both his blog and Dread:

In the risk-free zone of America as envisaged by the public health industry, only the insane and the uninformed would engage in “risky behavior.”

Nobody, in risk-free America, does anything because it feels good, knowing it might be harmful. Nobody overeats because it brings her pleasure, nobody screws without a condom because it turns him on, nobody smokes because she had a bad day or a good day or because the day hasn’t started but it looks unpromising, nobody rides her bike without a helmet because she likes the feel of the wind in her hair. It’s risky. We all know better.

The libertarians think it’s big government you give up your private choices to, and the progressives think it’s big business. But really, it’s neither — or both, working together. And the public health and medical industries are complicit. It’s not a conspiracy. It’s more like religion.

In a nutshell, public health is an institution for enforcing behavioral control. They are the Big Brother that will rule your everyday acts from smoking to eating too much. It's true in a lot of ways. For every cholera outbreak in the 18th century, there was an argument to be had about masturbation and impurity. And in modern times, we now require particular ways of disposing of our waste matter with nothing but disdain and dehumanization for those people and those animals who do it improperly.

But this is one of those times when the Foucauldian criticism of society as a construct runs into things like quality of life and actual disease. Avenger pretty much summed up the counterargument to this:

This is not to say that medical science or medicine itself is wrong or quackery ... but merely that society and culture is the final determinant of what is healthy and unhealthy. The AMA is fulfilling their role as cultural mediators to define obesity as a disease. I tend to agree with this decision. We, as a society, tend to value longer and pain-free lifespans and obesity is strongly correlated with shorter and more miserable lifespans. The AMA recognizes that and is redefining obesity accordingly.

Additionally, complications correlated with obesity run up our healthcare costs by quite a bit. That the ACA is concerned with preventative health is partially in reaction to how expensive it is to treat someone who has already developed diabetes as a result of his or her lifestyle versus getting someone who is overweight and consuming large amounts of sugars to stop because he or she is headed down that first path. There is an economic cost to obesity; classifying it as a disease broadens the ability of insurance companies and politicians to promote preventative health measures. It also allows plenty of space for the social critique entropone brought up in the same way that acknowledging the existence of AIDS post-Reagan invigorated pharmaceutical R&D and helped create a lot of the support networks for those who already have the disease.
posted by dubusadus at 9:26 AM on June 19, 2013 [2 favorites]

They aren't being emailed just BMI and making a judgement

Oh, yes they sometimes are. My GP is not the brightest bulb and looks at my BMI and lectures me to lose weight. I have dense body tissue, but according to her charts I am obese. Which I am clearly not. A little overweight, yes, but not obese. She gives me the same lectures about the same topics every year, without actually asking me how I'm doing or anything like that.
posted by Melismata at 9:31 AM on June 19, 2013 [1 favorite]

That would be true if poor people weren't more likely to be obese. Food is cheap. Especially terrible food.

Indeed. Well, take the first part to be based on my personal experience and the last sentence to be what I took away from that.

Poor people don't generally have the luxury of applying a deep philosophical regimen to their diet, and it's another element of the "It's so simple" standpoint that ought do be considered.
posted by Lorin at 9:32 AM on June 19, 2013

First, the number one thing you can do to lose weight is to be broke. All the time.

Except calorie dense food is cheaper and easier to find than calorie-rich. The stuff that gets reduced in supermarkets at the end of the day tends to be cakes and pork pies, not kale. If you work as, say, a cleaner in one of the offices round here, you have the choice to go and spend £5 on a sushi meal, or £1.99 on a burger and fries from McDonalds, or an 89p meat pasty from Greggs; if I didn't live in a big city, but on a council estate where the only supermarket I can get to is a fairly expensive convenience store light on fresh food, I'd be eating pretty badly - I've lived with only access to a Tesco Express for supermarket shopping and my grocery budget shot way up and I ate more processed food than I really wanted to.

When I was unemployed I took advantage of living in an urban area, with lots of Asian food shops, by buying very cheap vegetables from the stalls there and eating lots of them. If I hadn't had access to these, I would have been eating mostly potatoes. And that's with living in a country/city where it isn't remotely unusual to take a 20 minute walk to the supermarket and back.
posted by mippy at 9:35 AM on June 19, 2013 [4 favorites]

Poor people don't generally have the luxury of applying a deep philosophical regimen to their diet

Oh, I completely get that. But as much as I assign a "philosophy" to this idea, it's really just a matter of Pay Attention.
posted by grubi at 9:36 AM on June 19, 2013

Grizzly bears may have diet lessons that can be helpful for humans

The zoo’s nutritionists took away the processed dog food, ground beef, loaves of bread, supermarket oranges, bananas, mangoes and iceberg lettuce that the bears had been eating.
Instead, they provided plants and animal protein that were seasonal and more closely resembled what grizzlies find in the wild. (As Natterson-Horowitz pointed out, there are no banana or mango plantations in the Canadian Rockies.) They chose vegetables and fruits such as kale, peppers, celery, heirloom apples — all more fibrous and seedy than the bears’ previous diet. And they replaced the hamburger meat with whole prey, such as fish and rabbits, which the grizzlies had to work harder to disassemble and eat.

posted by the man of twists and turns at 9:53 AM on June 19, 2013

What if the patient's body seems icky to them and they desperately want their "icky body" to be medicalized so that they have access to new, affordable, safe weight loss options that will actually work? Saying "no, you're not allowed to control your body's appearance in a safe, effective, affordable manner" seems like a pretty serious denial of personal autonomy to me.

well, yes, but the way obesity is medicalized is not along the lines of an individual making a body choice because their body "feels wrong" subjectively; it's done via weight/height ratios applied to entire populations. Obesity is always a *public* health issue, not a *private* health issue.

This of course makes lifestyle approaches harder to talk about except via gross generalizations, and invariably adds culturally based moralizing to the mix. Because obesity is always a public health issue, the obese and overweight are somehow "bad" or "faulty" and we assume that they make bad choices. There are good normal bodies, a few supererogatory "fit" bodies, and a range of "bad" bodies. The health effects of obesity stop being part of the conversation, as does any especially useful definition of obesity.

The other option would be to ask whether our society functions at cross purposes with physical health, but then you're talking about huge changes and looking at intersectionality with class, race, etc. That discussion unsurprisingly gets derailed in popular commentary into complaints about advertising and fights about sedentary work without ever getting all the way up to a critique of what we might call an "obesity economy" or a class-health intersection.

Statements like the AMA's are part of the logics of the same political economy that thrives by producing, representing, and shaming obese bodies rather than thinking about the nature of 21st-century obesity and trying to help people who want or need help.
posted by kewb at 9:54 AM on June 19, 2013

Last time I dropped 60kg I did it by eating enough less (especially cutting carbs) and exercising enough more to sustain a steady 1kg/week loss rate for the first forty weeks and a steady 0.5kg/week loss rate for the next forty. That was my simple twenty years ago plan, and it worked well, and while some weeks were easy, others - especially the last ten - were stupid hard.

The fact that two decades later I now mass more than my previous peak of 150kg says something important about the unsustainability of that simple and direct hacker-diet approach to weight loss.

At 51 I find it much harder to tolerate the daily restrictions necessary to achieve any given loss rate by conventional means than I did at 30. I'm also a parent now, and don't have anywhere near as much luxurious me-time now as I did then. So I've been in dire need of a simple and easy and sustainable approach to eating for quite some years now.

For a while there I was getting excellent results with sibutramine. Then sibutramine went away. But so far I'm feeling at least as positive about the prospect of sticking with 5:2 for life as I ever did about sibutramine.

What I've been enjoying about 5:2 is that the 5kg I've already lost on it is actually a side effect, not my main motivation for trying out the diet. I'm doing that to find out whether intermittent fasting improves my health in its own right, as assorted respectable research suggests that it might.

I'm sure that such weight as I've already lost on it results from the fact that near-fasting two days out of seven is in fact an "eat less" plan for me. I've personally confirmed the research-predicted result that I don't eat enough extra food on the five unrestricted days to offset the lack of it on the two restricted ones.

I no longer have a weight loss goal or a target weight; I've come around to believing that such an idea is actually counterproductive. My aim is to find a simple, sustrainable eating pattern that isn't actively trying to kill me, and so far it looks like 5:2 might well be one such.
posted by flabdablet at 9:59 AM on June 19, 2013 [2 favorites]

I know eat less/move more sounds logical, and in theory it should work, but it if it were that easy, we wouldn't have an epidemic.

For many, if not most, there is nothing easy about eat less/move more. Eating less typically means retraining decades of training and habit. Moving more means altering lifestyle significantly in many cases; most people do not make the time or engage in activities that would move more. It takes a concerted effort to do either, and a lot of will power.

Again, it is simple, but not easy. And, for some people, the amount of "less" and "more' can be quite significant.
posted by Bovine Love at 10:00 AM on June 19, 2013 [1 favorite]

Again, it is simple, but not easy.

Exactly. If it was easy, I wouldn't still be overweight. But I'm better than I've been in a long time.
posted by grubi at 10:03 AM on June 19, 2013

It seems to me that in many cases, obesity is a symptom, not a disease.
posted by windykites at 10:05 AM on June 19, 2013 [2 favorites]

Have we even gone into the fact that soda is addictive, really fucking bad for you, and Americans drink an average of 50 gallons per year?
posted by entropone at 10:21 AM on June 19, 2013 [2 favorites]

I'm comfortable with viewing my own obesity as a disease, of which the symptoms include but are not limited to frequent fatigue, frequent and intense joint pain, tendon damage, loss of stamina and a tendency to break bathroom scales.

I'd be interested in hearing about the experiences of any thin person who cares to try living with similar symptoms without being similarly diseased. Should be pretty easy to arrange: strap on a backpack containing 60kg of housebricks and don't ever take it off for, I dunno, ten years ought to do it.
posted by flabdablet at 10:24 AM on June 19, 2013

And wear it on your front, at the waist. Backpainward ho!
posted by grubi at 10:25 AM on June 19, 2013 [1 favorite]

I'm ok with viewing this as a disease, because it is clearly a preventable disease. Maybe we will have obesity prevention classes in schools now, that would be fine with me too. Maybe school cafeterias will improve the quality of the food they serve, also a fine idea.

The bottom line is, some people would rather rail on about moral failings, blame the obese for their problems, and leave them to their own devices. What that does is help perpetuate obesity as parents who have (in many, if not most) cases made some poor choices in terms of nutrition continue to make poor choices for their kids, who become obese.

And yes, exercise is a huge part of it; turn off the damn XBox and go outside. As parents, you are allowed to say that to your kids.

By addressing obesity as a disease rather than a moral failing, we have the opportunity to mitigate some of the tremendous harm that comes with obesity (cardiovascular disease, diabetes, joint disease, psychological issues, etc.), and that's a good thing for obese people, for insurers, for Medicare, for everyone. So let's do this.
posted by Mister_A at 10:37 AM on June 19, 2013 [4 favorites]

One of many problems with this, for me, is that it reinforces the idea that you don't have to worry about healthy eating and exercise except in the context of being skinny. I hear all the time about a coworker who regularly (like, daily) eats burgers and fries "oh, he can do that, he's skinny". Or someone will say, 'butter is not less healthy than olive oil, right? I mean, they both have the same number of calories". I hear "oh, you can have that extra cupcake, you run all the time".

I am constantly hearing the calorie count of a food being equated with its healthiness. I work among people who generally know a decent amount about nutrition, they're just more concerned with being skinny than with being healthy.

To me, if you frame obesity as a disease, it encourages framing of its 'treatment' as a treatment for disease that people who don't have that disease don't need to worry about. If you have, say, gout, or celiac disease, or an allergy, there are foods that you should stay away from that other people don't need to worry about staying away from. And of course I'm not saying that people are en masse going to start saying, 'oh, I'm not fat, I can eat whatever I want', but I think that it encourages the kind of thinking that healthy diet and exercise are important for some people but not others. If sugar/red meat/whatever are bad for you, they're bad for you whether you're skinny or fat or in between.

Eating healthy and moving regularly aren't a treatment for disease; they are a good idea for everyone (to the extent possible, lots of people have all sorts of limitations that make these more difficult or impossible). It's a good idea if you're fat. It's a good idea if you're skinny. The focus (as is frequently brought forward in these conversations) should be on behaviors, not weight. This classification centers the conversation, IMO, in the wrong direction-- away from behaviors, and towards weight as a determinant of health.
posted by matcha action at 10:37 AM on June 19, 2013 [6 favorites]

Here is to hoping that the science around obesity improves.
posted by iamabot at 10:40 AM on June 19, 2013 [2 favorites]

I am constantly hearing the calorie count of a food being equated with its healthiness.

That's a shame. Obviously calories have nothing to do with healthiness. THey do have to do with weight. That's why I like the idea of paying attention: eat healthier calories and fewer overall.
posted by grubi at 10:40 AM on June 19, 2013

And anyone who thinks that weight loss can be summed up in a simple equation for everyone should take a look at Michael Pollan's article in the NY Times, previously linked here, about our microbiomes-- particularly stuff like this:

We’ve known for a few years that obese mice transplanted with the intestinal community of lean mice lose weight and vice versa.

which was extremely surprising to me, but if also true in humans, would explain a lot about factors surrounding weight in this country.
posted by matcha action at 10:43 AM on June 19, 2013 [4 favorites]

What's the significance of this? Some sort of loop holes in some laws regarding disability funding or discrimination or something? Can you get handicap parking passes because of that now?
posted by Nelson69 at 10:43 AM on June 19, 2013

I hope so. I'd love to watch Abercrombie & Fitch forced to make plus sized clothes while Mike Jefferies weeps.
posted by dr_dank at 10:46 AM on June 19, 2013 [4 favorites]

Just about anything that makes Mike Jeffries weep is fine by me.
posted by grubi at 11:03 AM on June 19, 2013 [1 favorite]

which was extremely surprising to me

Shouldn't have been. Microbes get first crack at everything that passes through the gut; the idea that your internal microflora and mine might present different leftovers to our gut walls seems pretty intuitive to me.
posted by flabdablet at 11:06 AM on June 19, 2013 [1 favorite]

just gonna throw this out to anybody reading in the hopes of winning converts; i had extreme success with weight loss after setting up a positive feedback loop. i started bicycling, loved it, hated dieting, but loved riding bikes more as i dieted more successfully. my whole sermon, prayer, and benediction is that you can change how you behave towards food if you have a fun reason to do it.

please forgive the off-topic, metagods.
posted by gorestainedrunes at 11:08 AM on June 19, 2013 [4 favorites]

gorestainedrunes: I agree. Which is why I formulated the thing I outline above. I felt that guilt (and pain) were part of some weird Catholic/Calvinist philosophy built in to traditional weight-loss ideas: if it doesn't work and you don't feel bad about yourself, then how are you becoming a better person? I threw all of that out and made it so I was *enjoying* food more.

And now I can enjoy other things, too.
posted by grubi at 11:12 AM on June 19, 2013

I don't disagree. The most pressing solution is to stop the mockery and shaming and replace it with real concern and help where appropriate.

Given the parallel this was drawn from, it would be equally nice if people did the same for smokers.
posted by Hoopo at 11:21 AM on June 19, 2013 [1 favorite]

Actually, I think that if restaurants would just friggin reduce their portion sizes a lot of the epidemic would go away. At the ice cream store, a "small" is way larger than any "large" that I grew up with.
posted by Melismata at 11:26 AM on June 19, 2013 [2 favorites]

I bought myself a lovely bicycle (a Big Dummy with an N360 hub) and have indeed been enjoying riding it. Unfortunately at 150+kg it doesn't take many riding hours to make my arse hurt for days on end even with a really nice saddle, so I can't yet use it for all the trips I'd like to.

Really looking forward to dropping a bit more weight.
posted by flabdablet at 11:28 AM on June 19, 2013

Actually, I think that if restaurants would just friggin reduce their portion sizes a lot of the epidemic would go away

I totally just almost bought this donut/cupcake contraption, but then decided against it and picked out a smaller one. Thanks, thread.
posted by roomthreeseventeen at 11:30 AM on June 19, 2013 [3 favorites]

roomthreeseventeen, that's kind of amazing. (The picture that is, not the fact that you showed good judgment.)
posted by Melismata at 11:31 AM on June 19, 2013

It would be better with a second tiny cupcake atop the tint donut, with a cheerio-sized donut on top of that.
posted by elizardbits at 11:34 AM on June 19, 2013 [5 favorites]

MATURE DEATH is the name of my future mid-life crisis metal band.
posted by Eideteker at 11:35 AM on June 19, 2013 [4 favorites]

It would be better with a second tiny cupcake atop the tint donut, with a cheerio-sized donut on top of that.

YOU SEE? IT'S THINKING LIKE THAT WHICH MADE US ALL FAT!

sorry. just so hungry.
posted by grubi at 11:36 AM on June 19, 2013 [1 favorite]

I might eat something like that tomorrow, if I feel like it. But not today: today is a fasting day.

If I were to eat something like that tomorrow, I could do so without feeling the least bit troubled by it. 5:2 is good that way.
posted by flabdablet at 11:41 AM on June 19, 2013

Seeing pictures like that cupcake donut thing make me wonder not why I'm overweight, but why I'm not more overweight. I mean, Jesus. I guess I should be grateful the baroque desserts you see nowadays tend to start at 6.00/pop or so, reducing my temptation.

I wish people would stop using desserts to express their frustrated artistic longings or desire to shock. Doesn't anyone just fucking paint anymore?
posted by emjaybee at 11:48 AM on June 19, 2013 [7 favorites]

Today was not supposed to be a cheat day but then my period happened so I had chocolate ice cream with potato chips for lunch.
posted by elizardbits at 11:53 AM on June 19, 2013 [8 favorites]

Same, except with apple strudel and Hershey's Kisses.
posted by elsietheeel at 12:01 PM on June 19, 2013

I'm not sure what difference it makes if a part of reddit think obesity is a disease.
posted by srboisvert at 12:31 PM on June 19, 2013 [5 favorites]

But what if I think parts of reddit are a disease?
posted by phunniemee at 12:34 PM on June 19, 2013 [4 favorites]

Same, except with Twizzlers and Hershey's kisses, and not actually having periods.
posted by IAmBroom at 12:45 PM on June 19, 2013 [5 favorites]

srboisvert: I'm not sure what difference it makes if a part of reddit think obesity is a disease.

I'm not sure why you're bringing up Reddit in a discussion about the A.M.A.
posted by IAmBroom at 12:52 PM on June 19, 2013

I believe it was a joking reference to /r/AMA.
posted by cortex at 12:57 PM on June 19, 2013 [4 favorites]

playertobenamedlater: "If this kills the ubiquitous bariatric surgery insurance riders I'm all for it."

First you don't let them ride airplanes, then you don't let them ride bariatric surgery and now you're all for killing them!

(yes, I'm being facetious in case someone thought I was actually that stupid).
posted by symbioid at 1:08 PM on June 19, 2013

I don't disagree. The most pressing solution is to stop the mockery and shaming and replace it with real concern and help where appropriate.

Given the parallel this was drawn from, it would be equally nice if people did the same for smokers.

Slightly different situation. Smoking has been seen as cool for a long time, it's the reason I started. The peer pressure was in favor of smoking but against being fat. (Yes, smoking did help me make friends with the popular kids, drugs too!) So, some of the mockery is aimed at breaking down that image. In general though you're right, mockery is not a particularly good way to get someone to change personal habits for the better.
posted by Drinky Die at 1:09 PM on June 19, 2013 [1 favorite]

I really, really wish that people would stop bringing up BMI in these threads as though there is no obesity problem in much of the world today and it's only a matter of bad definitions. It's a way to avoid addressing the problem because it makes us uncomfortable. But it's bad for society and, yes, bad for individuals to gloss over the issue like that. So, BAM, BMI no longer exists. I have declared it so. Let's move on to the actual problems now?

Other things people bring up without actually knowing what they're talking about: It isn't being fat that is the problem, it is eating wrong and not exercising. Well, no. Both are bad. It's better to be fat and exercise than to be fat and not exercise. But it's even better to be a healthy weight and exercise. Second one: Being slightly overweight is better than being a normal weight because mortality is slightly lower! No. No no no no no. This is a fundamental misreading of the statistic.

Ugh.
posted by Justinian at 1:41 PM on June 19, 2013 [4 favorites]

last august i hit 296 lbs, at 5'5" tall i qualified as morbidly obese. my bmi was just a couple of points short of where the insurance company would have paid without question for the surgery recommended by my doctor, and i am so grateful for that. instead, they recommended, and i enrolled, in a medical weight loss program.

in september i went on a 800-1000 calorie per day diet of mostly protein, kept a diary of everything i ate, and as the weight began to fall off i found that i could engage in some moderate exercise. the diet ended around new year and as i transitioned to real food i continued to lose weight.

my diet now consists of raw and cooked fruits and vegetables, chicken breast, pork chops, eggs, cheese and the occasional steak. today i weigh 196, exactly 100 pounds less. i walk 1.25 miles every day after work. and i continue to lose weight.

i attribute this to having eliminated all wheat and refined flour based products. i don't eat bread, pasta, crackers or sweets of any sort. (i practically existed on that stuff before). i sleep like a rock, no apnea any longer. blood pressure meds to 25% of what they were, statins and other type 2 diabetes/cholesterol drugs eliminated totally.

i'm so glad i didn't end up having surgery. now if i could just remember where my right hand went...
posted by quonsar II: smock fishpants and the temple of foon at 1:54 PM on June 19, 2013 [9 favorites]

I'm fat again. I lost seventy pounds, and I've got it all back, and then some. The whole cycle took a little over six years.

Here's what nobody mentions about dieting.

You're going to be in pain for the rest of your life.

You see, being fat isn't about seeking pleasure; it's about avoiding pain. Hunger, to me, is pain. It freaking hurts. It's not waffle-headed-hammer-on-thumb pain, but it registers at a decent day-ruining-headache level. There's no objective pain measurement device, but I'd put it at somewhere around two days after throwing your back out, or a few seconds after a good charlie horse.

I'd bet that a lot of people don't register hunger the same way. But I'm always hungry. And hunger fucking hurts.

It doesn't go away once I've been dieting a while, either. It doesn't get worse, particularly. But what does happen is that I start losing my edge; I've been in pain for so long that I can't concentrate. My thinking gets fuzzy. It doesn't help that I'm too hungry to sleep a lot of the time, which adds to it, but my brain stops working quite as well as it normally does.

But I did it; it took a bit over a year, but I got my BMI down to 24. I looked great. I felt awful. But it was over, right? I mean, I went through all of it, my doctor was all proud of me, and now I could go back to being a normal human being, right? I'm not talking about pigging out, I'm talking about just eating enough to not be freaking starved all the time anymore.

Nope.

Still hungry. Still fuzzy-headed. Still feeling that gnawing, grinding pain whenever I was between sensible, healthy meals. Still just counting down to the minute I can get to the fourteen almonds I'd carefully parceled out for my midday snack.

If you've ever been in constant, long-term low-grade pain, you know. It sucks all of the joy out of your life, it makes time revolve around the moments where you can just feel normal for a moment; where it stops hurting long enough for you to forget about it. Everything revolves around that pain, everything gets ruined by it. Moods, moments, work, play... it takes the color, the fun, the meaning out of everything and makes it a grey sludge which almost nothing can emerge from.

I put up with it for a couple of years, but I couldn't live like that. I started eating when I was hungry. Nuts. Vegetables. Hard boiled eggs. I stayed away from junk food, tried to keep my portions under control. For the first time in over three years, I wasn't in pain. And the weight came roaring back.

I can choose to live in pain. Or I can choose to be fat, and face the long-term consequences. I'm exercising, I'm eating good things, I'm staying stable at a lot more than my ideal weight, but at least I'm not constantly miserable anymore.

Pain is relative; different people register pain in different ways. For me, hunger isn't a warning indicator; it's not the Check Engine light blinking on, or the gas gauge getting low. It's full-on, don't-ignore-me physical pain. Making the pain stop is always just a short walk or drive away.

If this was chronic back pain, or chronic pain of any other sort, I'd be medicated for it. Since it's hunger, it's ridiculed. But I sincerely believe that there's something different about how people with weight problems perceive hunger; I've talked to enough of us that it's obvious that we're always hungry, and the hunger comes through as pain.

This is obviously a medical problem, and I'd love to see a medical solution for it at some point. For now, keep in mind that I'm not choosing between being skinny and gorging on Cheetos for fun; I'm choosing between being fat and being in pain all the time.
posted by MrVisible at 2:04 PM on June 19, 2013 [50 favorites]

i attribute this to having eliminated all wheat and refined flour based products.

I'm guessing it had to do with eating 800-1000 calories a day, myself! You may have found that much easier to do by eating lots of protein though.
posted by Justinian at 2:09 PM on June 19, 2013 [1 favorite]

I guess now would be a good time to mention that all disease is socially defined -- or at least socially mediated. Viruses and bacteria themselves aren't diseases per se -- your intestines are filled with bacteria and nobody says "your intestines are filled with disease" -- society (with no input from science) defines what is the normal and abnormal functions of the human body and defines anything "abnormal" as disease.

...

This is not to say that medical science or medicine itself is wrong or quackery ... but merely that society and culture is the final determinant of what is healthy and unhealthy. The AMA is fulfilling their role as cultural mediators to define obesity as a disease. I tend to agree with this decision. We, as a society, tend to value longer and pain-free lifespans and obesity is strongly correlated with shorter and more miserable lifespans. The AMA recognizes that and is redefining obesity accordingly.

But, no, there is no empirical science involved in the redefinition. Because disease isn't defined by science. And that's ok.

This isn't actually true.

First, disease is not something simply defined by social convention. The more heinous a disease, or the more innocuous a condition, the less society can do about our views about it. A society can try all it wants to convince people that a disease that causes a short, unfulfilling life of horrible pain is perfectly fine, normal, healthy...it may even be successful sometimes...but the fact of the matter is that a condition that makes the body function abnormally in a way that is bad for the individual is a disease.

Society isn't the "final determinant" of what is healthy and unhealthy. If substance/condition x makes you live a longer, more vigorous, pleasant, fulfilling, active (etc.) life, then, other things being equal, it is healthier than substance/condition y which makes you miserable, stupid and short-lived. A (deranged) society might deny this, and, again, it might even convince some people (you can fool all of the people some of the time...)...but that does not entail that "society is the final determinant..."

Finally, there is all sorts of empirical science involved in the redefinition--empirical science can tell us, for example, what the consequences of being overweight are. (Note that some analyses, incidentally, suggest that being slightly overweight is healthier than being skinny...) Also, empirical evidence is strongly involved in determining what is healthy, even at the personal, common-sense, non-scientific (in the narrow sense) level. Being fat might, after all, be healthier and more attractive...whether or not it is is a largely empirical question...

The big point here is: it's easy to radically exaggerate the importance of society. Pretending that society controls everything is very fashionable on the left, but it simply is not true.
posted by Fists O'Fury at 2:20 PM on June 19, 2013

in september i went on a 800-1000 calorie per day diet...

i attribute this to having eliminated all wheat and refined flour based products.

I'd attribute this to having eliminated the calories from the wheat and refined flour-based products.
posted by grubi at 2:27 PM on June 19, 2013 [5 favorites]

This is obviously a medical problem, and I'd love to see a medical solution for it at some point.

There is, and I've just been released from the hospital after recieving it. Surgeons carve away all of your stomach, save for a thumb-sized pouch. The glands responsible for regulating appetite go with it, in essence resetting your hunger instinct... well, part of it. The appetite response hardwired into you elsewhere, particularly the brain, also needs to be controlled, hence the thumb-sized pouch replacing your stomach.

Even so, if the operation is a long-term success, I will stabilize at somewhere near 40% of my overweight... Not 40% of my weight, just the overweight. I'll still be fat, but I'll be less than half as fat as before the proceedure. Bariatric surgery isn't to make you thin and beautiful, it's to keep you from dying of hypertension, sleep apnea, diabetes, heart disease, etc, etc.

I once lost 60 lbs dieting. I was also an all-weather bike commuter. Diet and exercise work in the short term, sure. But once you start feeling the hard-core physiological effects of weight loss on an ongoing basis, all bets are off. It's exactly as MrVisible says... you are constantly battling with a body that demands you eat more, every waking moment.

There are some drugs that can help, but their side effects long-term make them less suitable than butchering your innards. Lots more research needs to be done here, and tha AMA decision should hopefully help facillitate that.
posted by Slap*Happy at 2:47 PM on June 19, 2013 [2 favorites]

I'm guessing it had to do with eating 800-1000 calories a day, myself! You may have found that much easier to do by eating lots of protein though.

that diet lasted only 12 weeks and i lost 55 pounds. the rest has come off since january, eating regular food (and plenty of it!)
posted by quonsar II: smock fishpants and the temple of foon at 3:26 PM on June 19, 2013

Well, yes, but that doesn't mean you still aren't eating fewer calories than you used to eat. It's a lot easier to eat too many calories in pasta than in chicken breasts if you see what I mean.
posted by Justinian at 3:31 PM on June 19, 2013 [3 favorites]

Remember that climate change post yesterday where we had the discussion about whether "personal piety" would be as effective as implementing society-wide policies?

I kinda think we could have a similar conversation here.
posted by MrBadExample at 3:45 PM on June 19, 2013 [2 favorites]

I wasn't obese when I started losing weight last year, according to BMI and stuff, but I was edging that way. I've shed about 25 pounds since, slow and steady, by doing at least 200 minutes of cardio per week, and continuing to eat well if less, and radically reducing stuff like bread and pasta (but not eliminating them entirely: I like those things). And continuing to enjoy my Friday beer, because cold dead hands.

I've come to enjoy the exercise, and miss it when I can't do it, and I cherish my weekend minor food indulgences.

I want to drop another 20 or so, and get under 200 pounds, and I think I will, inevitably. I'm not in a huge hurry or anything. For me it's more about the health aspects as I approach 50, and feeling good, which I do, these days: so much better. It's a bonus that I look better, too, at least to myself, which is all I give a damn about.

Everyone, if they do manage to get things under control, finds a slightly different path, which is only as it should be. I wouldn't be able to do follow the regimes some of the people describe upthread, nor would I want to, but I understand when you're 100 or 150 pounds or more overweight rather than the 40 or 50 extra pounds I'd been having to deal with, more radical steps might seem necessary.

But I will agree with one thing upthread: I do think that it's simple but not easy. Sometimes (and often in the early stages), it has taken more willpower than I thought I had to eat less, have a salad instead of my once-staple bowl of spag, get on that exercise bike when I'd had a bad day or whatever. It's hard as fuck, and hell, I still eat calorie-dense foods on the weekends and drink my beer on Fridays, so it's not like I've entirely given up my oral pleasures.

But I decided last year -- and maybe this was the mental trick I needed to perform -- that I'd be doing this for the rest of my life, so I'd best convince myself that it was something that made me happy. That trick has gotten a lot easier as I've lost weight, felt better, and enjoyed looking at myself in the mirror a bit more.

Is obesity a disease? I don't know. I'm sure there are good arguments in both directions. But for people who are able to drop weight and get healthier -- and I know, for various reasons, there are some people who just aren't -- obesity and its entourage of health problems are something that can be prevented and reversed, and the rewards of doing so are manifold.

Congrats to everyone who's mentioned that they've been able to make health improvements, and strength to those who haven't succeeded or are planning to try. If you need to follow a regimen, do it. If counting calories works for you, do it (it doesn't, for me, at least at a granular level. I find the micromanaging exhausting and enervating.) But my advice, for what it's worth, is that it's better to educate yourself, figure out what your personal meat sack needs and wants, and act accordingly, rather than following someone else's instructions. At some point, if you've tailored the way you live to your own body and mind well enough, it becomes natural, and hard to imagine doing things differently.
posted by stavrosthewonderchicken at 4:16 PM on June 19, 2013 [20 favorites]

Oh, and I guess it's obvious, but given the way things are these days: I think it's vitally important to avoid packaged, processed food, for weight loss and health in general. If more than like 20 or 30% of what you eat comes in a can, bag, box or bottle, then, well, I'd suggest a change.

I understand this is hard for people to kind of get their heads around a bit, especially in countries where packaged, manufactured food is the norm, but I think it's very important. So much of what people consider food is, these days (and not to put too fine a point on it, but) toxic chemical filth.

The usual objections to eating (for lack of a better expression) real food are that it can be more expensive and it is time consuming to prepare. I understand these, even if my initial ungracious kneejerk reaction is 'you're doing it wrong,' but even if it is more expensive and time-consuming: it is worth it.

A simple salad or some rice and beans or something are never going to be as delicious as a burger, and per calorie, are wildly more expensive, sure. But the idea is to sate hunger with fewer calories. Food technology has gotten so good that we have become used to olympian levels of deliciousness that have rewired our brains in destructive ways, I reckon. It's hard to dial that satisfaction-reaction back a few notches.

In terms of time, well: there are ways. During the week, I am home for about 2 1/2 hours a day total when I am not exercising or sleeping or showering or whatever, and I manage, but I admit that I usually eat very simply indeed.

Everything's a trade-off. The Great Task is deciding what's more important.
posted by stavrosthewonderchicken at 4:57 PM on June 19, 2013 [6 favorites]

I can choose to live in pain. Or I can choose to be fat, and face the long-term consequences. I'm exercising, I'm eating good things, I'm staying stable at a lot more than my ideal weight, but at least I'm not constantly miserable anymore.

I so know where you're coming from. That's been my fundamental position for the last three years.
posted by flabdablet at 5:05 PM on June 19, 2013 [1 favorite]

Telling fat folks about the health dangers is like telling a smoker they are risking lung cancer. They mostly know already...

So we can get rid of warnings on cigarette packets, gruesome advertising on television and anti-smoking campaigns because at this point we are just "smoke-shaming" people who already know the health risks into not smoking cigarettes?
posted by smithsmith at 5:46 PM on June 19, 2013 [1 favorite]

No.
posted by Drinky Die at 5:54 PM on June 19, 2013

People don't actually need to consume any cigarettes in order to stay alive, so a simplistic "using these will hurt you" message is appropriate.

Food demands more nuance than that.
posted by flabdablet at 5:57 PM on June 19, 2013 [6 favorites]

I agree that nuance is required but there's a world of difference between nuance and total laconism. The OP I responded to was claiming that informing people about the health risks of obesity was unnecessary because they already know. I'm sure most smokers also know the health risks associated with smoking but that is no reason to desist in health measures and campaigns.
posted by smithsmith at 6:47 PM on June 19, 2013

I like how even when the AMA says obesity is an actual disease, people are still like "Are you suuuurrre it's not a moral failing? Really?"
posted by Uther Bentrazor at 6:55 PM on June 19, 2013 [6 favorites]

The OP I responded to was claiming that informing people about the health risks of obesity was unnecessary because they already know.

It really wasn't. Health warnings are good, they helped me quit smoking even though I was aware of the risks before I started. If you keep reading that comment you will note the problem I bring up is health warnings in regards to obesity can have their effectiveness sabotaged by the shame and mockery coming from other sources.
posted by Drinky Die at 6:58 PM on June 19, 2013

And where are you going to put your obesity warnings? McDonald's wrappers? Coke bottles?

Big Tobacco's lobbying power is puny compared to Big Food's.
posted by flabdablet at 7:06 PM on June 19, 2013 [1 favorite]

It's puny now. It used to be among the most powerful lobbying groups in the nation. Not that I think warning labels on food is the way to go.

Maybe this is an opportunity for Big Tobacco to get back in the game! Smoking helps you lose weight!
posted by Justinian at 8:07 PM on June 19, 2013

On that note I'm a little surprised that there hasn't been a comeback in prescribing amphetamines off-label for obesity. That's another huge market for Adderall. Or maybe it is used that way but it is kept on the down-low to avoid any messy, ah, legal entanglements.
posted by Justinian at 8:14 PM on June 19, 2013

IDK why they would bother with Adderall when dexies still exist, though.
posted by elizardbits at 9:09 PM on June 19, 2013

Quasi-legal diet amphetamines you say?
posted by Uther Bentrazor at 9:31 PM on June 19, 2013

Eh. Ephedra are to amphetamines like advil is to oxycontin.
posted by Justinian at 9:49 PM on June 19, 2013

And where are you going to put your obesity warnings? McDonald's wrappers? Coke bottles?

Not necessarily. What about television and print ads advising of the health risks of obesity? How's about setting up something similar to a "quit line" that can offer people free advice on nutrition and exercise? Stopping targeted advertising towards people under 18 might also be a start. There's a plethora of things that could be done.
posted by smithsmith at 10:30 PM on June 19, 2013

Every single fat person I know, myself included, has already been made aware of the health issues ad nauseam. I can't see how an advertising campaign could possibly cause enough extra public awareness to justify its cost.

I like the "quit line" idea, so long as every single person who works on it and for it has been morbidly obese. With the best will in the world, people who have never been fat simply do not understand how it is to be fat.

I don't need you to tell me about the nail. Because I know something about nails that anybody who wastes my time telling me about mine clearly doesn't: if you just yank those fuckers out, bigger ones grow right back in their place.

Stopping targeted advertising toward people under 18 would completely undermine the processed corn industry's customer loyalty strategy. They'd never let it happen, but I would certainly salute the attempt.
posted by flabdablet at 4:02 AM on June 20, 2013 [2 favorites]

Bull-fucking-shit. I've lost 85 lbs so far this year, and I plan on losing another 20-40. You know how I did it? I ate less and exercised more. It really is that simple. Do you think calories are magically exempt from the laws of thermodynamics.

Most people are capable of losing weight with dietary changes and exercise, however, statistically speaking, the vast majority regain all the weight they've shed within five years. By, "vast majority", I believe it's between ninety five and ninety eight percent. So, whilst I agree it appears a relatively simple equation, the reality is, should you maintain your new svelte figure throughout your lifetime, you will be one of the few exceptions.
posted by Nibiru at 5:18 AM on June 20, 2013 [5 favorites]

Eh. Ephedra are to amphetamines like advil is to oxycontin.

IDK what ephedra is, but I'm talking about prescription Dexedrine, as in dextroamphetamine.

oh right, i missed the question mark link, nvm.
posted by elizardbits at 6:45 AM on June 20, 2013

however, statistically speaking, the vast majority regain all the weight they've shed within five years.

That's because the root causes of the issue are generally located somewhere between the ears and behind the eyes, and unless those are resolved first, everything else is orders of magnitude more difficult.
posted by mikelieman at 6:53 AM on June 20, 2013 [4 favorites]

Diet and exercise work in the short term, sure. But once you start feeling the hard-core physiological effects of weight loss on an ongoing basis, all bets are off.

This is very, very true. I'm in year four of my weight loss journey and I've hit the wall (or plateau) several times. At some point (unless your stomach has been medically shrunk or banded) your body is going to start demanding that you feed it more and that's when you either brace yourself for a six month to a year long holding pattern or you start slipping back into bad habits. What makes obesity so difficult is that, unlike drugs or alcohol, your body must be feed to function and it's a tiger you have to let out of the cage up to three times a day. That there is so much cheap, shitty, sugary foods available in the United States really makes keeping that tiger tamed that much more difficult, doubly so if you're over 30.

That's because the root causes of the issue are generally located behind the eyes, and unless those are resolved first, everything else is orders of magnitude more difficult.

Probably the best thing that's been posted here and the biggest problem for people that are obese that want to make changes to their life to lose weight and be healthy. It's taken me 30 years to finally get to the point where I feel I can stop binge eating but that's been the result of years and years of therapy, numerous 12 step programs, outpatient eating disorder rehabilitation, and hitting rock bottom by landing in a coma. It's always going to be a struggle and, much like drugs and alcohol, there's always going to be the potential for a fall off the wagon but I'm finally at a point where I think I can withstand the temptation for "one last hurrah". Only time will tell if I'm successful or not.
posted by playertobenamedlater at 7:07 AM on June 20, 2013 [1 favorite]

That's because the root cause of the issue is generally located behind the eyes, and unless those are resolved first, everything else is orders of magnitude more difficult.

In my (not so) humble opinion, education is also a key issue. I don't know about America, but in Australia, we're instructed to look to, "The Healthy Food Pyramid" to make healthy food choices. The bottom layer (eat the most of) contains pictures of bread, rice, cereal and pasta. Carbohydrates. Carbohydrates are saccharides/sugar, and too is the only, "nutrient" which the body does not actually require produce energy or maintain vitality. I am not a scientist, but the logic of recommending a diet rich in saccharides/sugar completely escapes me.
posted by Nibiru at 7:17 AM on June 20, 2013 [1 favorite]

the logic of recommending a diet rich in saccharides/sugar completely escapes me.

same in usa. there is no logic at work there, only money. wheat/flour/starchy products often have a higher glycemic index than table sugar. they cause blood sugar to surge dramatically and when it drops you feel the need to eat again. the cycle continues.
posted by quonsar II: smock fishpants and the temple of foon at 8:09 AM on June 20, 2013

MrVisible: You see, being fat isn't about seeking pleasure; it's about avoiding pain. Hunger, to me, is pain. It freaking hurts.

MrVisible, that was a very sad post to read, and I hadn't realized that some others had that reaction to hunger. I can also assure you that some fat people don't have that reaction; many are like me in that hunger is an unpleasantly distracting signal, but not painful at all. For people like me (and including a fat friend who's very honest with me about their upbringing and its lingering effects), food = reassurance and comfort. I also use other comfort blankets, and am "only" obese; but for others its a far stronger component.

You have my sympathies. I don't know that anyone's path is "easier", but until your post I wasn't aware of this bodily reaction.
posted by IAmBroom at 8:53 AM on June 20, 2013 [3 favorites]

the root causes of the issue are generally located behind the eyes, and unless those are resolved first, everything else is orders of magnitude more difficult.

Absolutely. Which is why the beginnings of my "diet" idea were "how can I stop feeling awful about enjoying food?" and "how can I feed myself without feeling doing so responsibly is a chore at best and a punishment at worst?" The answer was simple: eliminate guilt. Stop giving myself hell for liking food. But conversely, pay closer attention to how the food tasted.

It began when, one day, I was eating a bag of potato chips. I love potato chips (a lot), but I suddenly realized: the last chip in the bag is never as good as the first one. Somewhere between the first and last chip, there was a point where it stopped being a tasty snack and became me simply stuffing my face with mediocre-tasting food. There's a point of diminishing returns. I also realized that no matter the quality of the food I ate -- junk food, candy, healthy food, gourmet food -- it all, at some point in the meal or snack, stopped tasting as good.

I decided then and there to be more attentive to how the food tasted. "Not awful" isn't good enough. "Tasty" is. Believe it or not, that made a huge difference. I would eat as many chips as I wanted -- but I would be more aware of when I actually stopped wanting them.

In addition, I became more aware of a sort of counter-intuitive notion: human beings don't need, in this modern age, to be full. We're actually "engineered" (as it were) to be frighteningly efficient when it comes to storing calories and horribly inefficient when it comes to burning them off. But since so much of modern food (even the good-for-you stuff, to some degree) is packed with more calories per ounce than at any other time in our history as a species, we're filling ourselves with more and more. Which of course, leads to being fat. Like me.

Keeping that in mind, I realized that I don't need to be full. Being full is completely unnecessary, and quite often, just wrong. How many times had I gotten full -- even with pretty good, hearty fare -- and I regretted it? And was in some sort of physical discomfort? (Answer: a lot. Eesh.) What if I just ate until I was un-hungry rather than full? I'd still get necessary calories (and fewer extra calories), I'd be less likely to feel logy and disgusting after a meal, I'd be less likely to eat an entire bag of Lay's Barbecue Potato Chips... and oh, right, I'd lose weight.

Granted this is hard to get started, because the human ability to sense when we're not hungry lags severely behind our eating pace. All part of that "SAVE EVERY CALORIE; THERE'S A FAMINE INEVITABLY COMING" human evolutionary trait leftover from nomadic wandering days. And because there's this delay (popular culture describes it as "your brain doesn't get the 'I'm full' message from your stomach for up to 20 minutes"), I began to pace myself. I would count three to four forkfuls, then put down the fork for two minutes. I had to force myself at first (habits is habitual!), but eventually I learned a new habit, one that allowed me to savor food.

The fourth big thing i had to was unlearn my habit of seeing food as a something I had to compete for, something I had to grab a lot of, and something I could never refuse. I had traditional notions of "don't waste the food; people are starving!" that all of our parents drilled into our heads. Being the descendant of someone who lived during a famine or the Great Depression creates a near-permanent attitude of EVERY BITE IS PRECIOUS which makes us feel guilty about pushing the plate away. Or even worse, when our bodies are telling us "I'm full! You can stop!", we keep eating because Mom's voice in our head is still admonishing us to clean our plates. I had to move past this. I had to make it okay in my mind to leave some food behind.

Essentially, I had to switch my thinking, and completely overturn notions of food that were ingrained by thousands of years of evolution in additional to cultural views on hunger and waste. I:

1. paid attention to when snacks and food stopped being as tasty;
2. paid attention to the moment I was un-hungry and stopped there;
3. slowed down my eating; and
4. got over the cultural taboo against pushing away (or even, yes, throwing away) food.

The first idea kept me from eating beyond what I really wanted, the second kept me from eating beyond what I really needed, the third kept me from losing control, and the fourth kept me from eating food out of a sense of duty. Yeah, it's work, but once you've really gotten these habits down, they become easier and easier. And food tastes better. And, as a nifty built-in incentive (beyond the joy of weighing less) is that you can realistically eat whatever you want to eat! As I've been putting it lately: Eat as much as you want and need, but no more and no less.

Naturally, this may not work for everyone the same way, and there are plenty of folks for whom good eating habits will never be enough (exceptions always abound). But for the vast majority of us, this really is it. Like my doctor said when I showed her these ideas "This is everything we've been trying to tell patients since forever!"
posted by grubi at 8:59 AM on June 20, 2013 [5 favorites]

bread, rice, cereal and pasta. Carbohydrates. Carbohydrates are saccharides/sugar, and too is the only, "nutrient" which the body does not actually require produce energy or maintain vitality.

True, but potatoes, cereal, bread, and rice have more nutritional value beyond the carbs. I'm not saying that means you can eat all you want, but a potato is plenty healthier than sugar.
posted by grubi at 9:06 AM on June 20, 2013 [1 favorite]

Also, I try to remember this little grid:

   GOOD   |  BAD
-------------------
  protein |  fat
          |
  fiber   |  carbs
-------------------

Protein-rich foods tend to be higher in fat, and many of our favorite fiber-rich foods are also higher in carbs. The best snacks tend to be high in the first column and low in the second (my favorites are beef jerky and carrots).
posted by grubi at 9:12 AM on June 20, 2013

I'm a public health professional and I've been following this conversation quite a bit, and I think that a lot of people are missing the mark when they talk about individual weight loss interventions as the byproduct of this whole "obesity as a disease" situation.

This isn't really about making people aware of certain health risks - in fact, education interventions are often remarkably poor at producing lifestyle behavioral change. What works? Systematic, environmental changes.

Ideally, obesity-as-a-disease will make it easier to implement systematic prevention and treatment interventions. Limiting the amount of Shit Food like highly processed nonsense, SSBs, and Double Downs that make their way into our collective foodstream; developing cities and towns where people can walk, ride bikes, and safely recreate instead of sitting in their cars (fact: average car commute distance is correlated with levels of obesity); etc. IE, incorporating healthy food and activity into our society. Because after all, this really isn't about individual behavior. It's about collective health, social environments, and the conditions that do and do not lead to significant numbers of people to become obese.
posted by entropone at 9:31 AM on June 20, 2013 [7 favorites]

By, "vast majority", I believe it's between ninety five and ninety eight percent.

Essentially every single reference I can find for this figure is people saying "everybody knows" or "it has been shown". I can't actually find any cities for it. And, in fact, the studies I do find show that while many people regain the weight they loss, the numbers are not anything like 98%.
posted by Justinian at 9:33 AM on June 20, 2013 [1 favorite]

My $0.02 - They classified obesity as a disease to sell obesity drugs... The reason people are obese is because of the massive shift in diet and the change to a mostly sedentary lifestyle over the last 40 years - industrial farming, HFCS, fast food, junk food etc. Unless families start focusing on eating real food again, it will just get worse. We all know obesity is not really a disease... it's a side effect of living in this culture. Obesity rates fluctuate wildly from north to south and east to west - is there something in the water in Mississippi?
posted by weezy at 9:37 AM on June 20, 2013 [1 favorite]

grubi, serious question here: what's bad about fat (the macronutrient, not "being" fat)? Aside from it being calorically dense, that is?

Well, fat in general is not necessarily bad all by its lonesome. It's the caloric density added with the fact that foods high in fat are VERY high in fat. Which means LOADS of calories.

Plus, I'm pretty sure fat is implicated in heart disease. :-)
posted by grubi at 9:40 AM on June 20, 2013 [1 favorite]

But keep in mind with that chart, I'm not saying Never Eat Fat or Carbs. I'm saying those are the ones to be careful about eating too much of. It's a lot harder to eat Too Much Protein or Too Much Fiber. But eating Too Much Fat and Carbs... that's criminally easy to do.
posted by grubi at 9:42 AM on June 20, 2013

disease: A disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury

There is absolutely no reason why obesity cannot be classified as a disease. Other diseases can be caused by lifestyle as well, including heart disease. You'll note the definition just excludes direct injury. Outside of that, cause is not a factor.

I think, reading a lot hear, people seem to associate "disease" with cause. It is not.
posted by Bovine Love at 9:46 AM on June 20, 2013 [1 favorite]

My $0.02 - They classified obesity as a disease to sell obesity drugs...

I cannot disagree with this hypothesis. The Diet/Industrial Complex has a lot of clout. Consider the failure rates of so much of what is 'recommended'. It's almost as if they really don't want anyone to succeed.

I might suggest that isn't necessarily Evil, as much as a side effect of the reality that MOST PEOPLE DON'T WANT TO SUCCEED. Making the needed ( small, continuous, sustainable ) changes to our diets shoves you right out of your comfort zone. People don't want that, either consciously or subconsciously.

Most of the other issues with sustainable weight management are worked out. Even how to use different metrics and CBT to get around all that bookkeeping in counting calories ( which is a huge turn off, too )

But you offer it to people *for free* and they run the other direction.
posted by mikelieman at 9:52 AM on June 20, 2013 [1 favorite]

the root causes of the issue are generally located somewhere between the ears and behind the eyes

Not so sure about that.

Given the extent to which brain activity is regulated by hormones originating in the gut, I'm sceptical about the "root" cause of obesity being brain activity alone. I think there's more to it than that.

Toxoplasmosis can make rats fall in love with the smell of cat piss. Would it be any weirder than that to find out that some kinds of gut flora have worked out ways to make us want to keep them well supplied with sugary drinks and pizza?

It may well turn out that obesity is in fact a communicable disease.
posted by flabdablet at 10:04 AM on June 20, 2013 [4 favorites]

Not all fats are created equal.

Transfats = Bad. These are the ones primarily implicated in heart disease.
Poly unsaturated fats = Generally good. (In moderation. (Do I really need to say this?))
Mono unsaturated fats = Generally good. (In moderation. (Do I really need to say this?))

Right. But if you use the guideline of "more protein, less fat", then you're pretty much going to do the right thing, don't you think?

Not to excuse any behavior here, but breaking down all the good and bad fats is one more form of "homework", which is part of the problem that makes weight loss such a damn chore for so many. Some people have literally decided it's too much work. I don't think it's a bad idea to simply say "avoid fats in general".

And well, yes, too much of ANY type of food (protein, fat, carb, fiber) is bad. Moderation is always the key. But 2 oz of protein may be moderation and 2 oz of any fat may be excess. I've found the best way to get that block (which I describe as 'mental overhead') off our shoulders that makes it difficult to do the tasks necessary is to find the simplest feasible rules, but no simpler. Living by the idea of "lean on proteins and fibers; ease up on carbs and fats" will, in the long run, get you plenty of good fats.
posted by grubi at 10:11 AM on June 20, 2013

the root causes of the issue are generally located somewhere between the ears and behind the eyes
Not so sure about that.

Given the extent to which brain activity is regulated by hormones originating in the gut, I'm sceptical about the "root" cause of obesity being brain activity alone.

Hence the use of the word "generally". "generally" <> "alone".
posted by grubi at 10:12 AM on June 20, 2013

I fake out those guys by using 3/4 cup of Stevia-in-the-Raw to one packet of unsweetened Kool-Aid.
posted by mikelieman at 10:13 AM on June 20, 2013

I am not of the mind that fat should be really avoided (except for trans fats, yikes), but it should be eaten with the awareness that you're eating more than twice as many calories per gram of it than with other macronutrients.

And even moderate amounts of transfats are the evil people make them out to be. But yeah, if you throw this knowledge in as part of a balanced diet, you'll generally (GENERALLY!) do fine.

My idea of balance (and this works for me, so YMMV) is that if I feel like indulging a little more in some "bad" stuff (fat and carb), then I have to put twice as much of the good stuff on the same plate.

And when I have a choice of snacks, high protein and fiber. :-)
posted by grubi at 10:15 AM on June 20, 2013

find the simplest feasible rules, but no simpler.

This is as simple as I've been able to make them for myself.

If my Daily Rate of Weight Change is negative, I'm losing weight. Repeat what I did yesterday

If my Daily Rate of Weight Change is positive, I'm gaining weight. Do something different today.

Although, Dan Simmon's idea of:

"Choose Again"

has its appeal.
posted by mikelieman at 10:16 AM on June 20, 2013 [2 favorites]

mikelieman: I like it! My wife has been following our food rules (above) for a bit over six months. She's lost more weight than she has in a long time -- and has been keeping it off. She's healthier than she's been since she was a vegetarian (meaning her Type 2 diabetes is so under control, her blood sugar is actually normal and has been so for months; her blood pressure is normal; her sleep apnea has disappeared; she just feels better). And her favorite part of this experience has been (in her words): "It doesn't feel like work. I don't dwell on what I did or didn't eat. I don't give myself crap about it. And, as a result, it's not difficult to keep it going." She's done weight loss programs, the aforementioned vegetarianism (which helped her lose a lot of weight but was very hard to maintain and she missed her favorite foods), and it all ultimately failed. Mostly because none of those were long-term solutions. This way of thinking changed that because it's not work in any traditional sense: it's designed to be mindless. ANd mindless healthy eating beats mindless junk foodery any day, right?

Think of it like Einstein's paraphrase of Occam's Razor: "Everything should be kept as simple as possible, but no simpler."
posted by grubi at 10:24 AM on June 20, 2013

Right. But if you use the guideline of "more protein, less fat", then you're pretty much going to do the right thing, don't you think?

Generally.

Not to excuse any behavior here, but breaking down all the good and bad fats is one more form of "homework", which is part of the problem that makes weight loss such a damn chore for so many. Some people have literally decided it's too much work. I don't think it's a bad idea to simply say "avoid fats in general".

Mmm, yes and no. I understand it seeming like work, but I've seen a lot of people interpret "avoid fats in general" as "don't eat any fat ever." I think a better rule would be "eat whole food, avoid processed foods." A lot of low-fat foods replace the fat with sugar, which is a lot worse for you than eating fat. Fats are tasty, they are filling. I've enjoyed ribeyes and peanut butter and whole-fat yogurt during my weight loss. But yeah, one serving of peanut butter has a ridiculous amount of calories, so you've got to be careful.

And well, yes, too much of ANY type of food (protein, fat, carb, fiber) is bad. Moderation is always the key. But 2 oz of protein may be moderation and 2 oz of any fat may be excess. I've found the best way to get that block (which I describe as 'mental overhead') off our shoulders that makes it difficult to do the tasks necessary is to find the simplest feasible rules, but no simpler. Living by the idea of "lean on proteins and fibers; ease up on carbs and fats" will, in the long run, get you plenty of good fats.

Right. The reason a protein and fiber diet works is because it tricks you into eating fewer calories because these foods are less calorically dense.
posted by entropicamericana at 10:26 AM on June 20, 2013

I've seen a lot of people interpret "avoid fats in general" as "don't eat any fat ever."

Well, then shame on them for getting it wrong.

you've got to be careful.

I'd phrase it as "Be careful but don't stress." :-)

The reason a protein and fiber diet works is because it tricks you into eating fewer calories because these foods are less calorically dense.

Indeed. But I wouldn't advocate a strictly (or even highly-emphasized) protein and fiber diet. OTher stuff is necessary. The quick and dirty rule I use is "Balance during meals, lean on protein and fiber during snacks." I'm not perfect about it, but it's easier than counting calories!
posted by grubi at 10:32 AM on June 20, 2013

"It doesn't feel like work. I don't dwell on what I did or didn't eat. I don't give myself crap about it. And, as a result, it's not difficult to keep it going."

The 'binary' nature of the rules is from the visualization I use for the Daily Rate of Weight Change. Gauge points left, Everything's A-OK. No Worries. Points right? Need to trim sails a bit. One thing is that it's all "Post Metabolism". Instead of trying to control the calories in, I pay attention to the results of the prior 24 hours' choices, and make my choices today based on the actual numbers from yesterday.
posted by mikelieman at 10:33 AM on June 20, 2013

Yes. Very nice. That's why I liken it to philosophical Taoism: difficulties with losing weight seem to come from forcing our bodies to do a thing, when what we should do is enable our bodies to do what they wish. OUr bodies want to hit an equilibrium (with some exceptions out there; so please, nobody hit me with "I KNOW THIS GUY"), so we kind of have to get out of the way, so to speak. Your method seems to echo that: if your body reacts poorly, you don't do the same things again. If your body reacts well, then you keep it going. Mindfulness leads to frictionless leads to mindlessness. It sounds like hooey, but it's more about cultivating good habits by simply being aware.
posted by grubi at 10:37 AM on June 20, 2013 [3 favorites]

Very astute. You could say that my style is a fusion of Jon Kabat-Zinn and John Walker and wouldn't be too far off. Larry Wall and Jerry Garcia are in there somewhere, too.
posted by mikelieman at 10:44 AM on June 20, 2013

Heh. Interesting you mention a programmer: I've been reading a bit about Unix and the Unix philosophy lately and it strikes me as kind of similar. Wikipedia describes it as "The Unix philosophy emphasizes building short, simple, clear, modular, and extendable code that can be easily maintained and repurposed by developers other than its creators."

I mean, short, simple, clear, modular, and extendable food rules: that's this whole thing!
posted by grubi at 11:41 AM on June 20, 2013

We all know obesity is not really a disease...

No, smarter people than you have established that it is. This is the ENTIRE point of the linked article and subsequent discussion.

Stop saying this now.
posted by Uther Bentrazor at 11:45 AM on June 20, 2013 [3 favorites]

Not just the rules. The tools are "free as in speech" ( John Walker's The Hacker's Diet ebook ) and "free as in beer" ( Google Spreadsheets / my Rate of Weight Change Visualisation tool )
posted by mikelieman at 11:47 AM on June 20, 2013

FREE/FREE is why I've been developing that thing I wrote up there that I call the Equilibrium as a full book to give away. I don't want to make money from it -- I want people to give it a try without thinking "He's just trying to sell me something." ("as in beer") -- and I hope to make it a sort of living document, in that as new research comes out, it can be modified ("as in speech"). Plus, I'd love to see some folks come up with their own personal variations with items that accommodate individual contexts.

However, give me credit, Internet! GNU or CC license forthcoming!
posted by grubi at 12:02 PM on June 20, 2013

stav: But I decided last year -- and maybe this was the mental trick I needed to perform -- that I'd be doing this for the rest of my life

So true, and exactly my experience. I realized I wasn't going to "go on a diet", I was going to change the way that I eat, permanently, for all the positive things I was going to get in exchange for giving up indiscriminate eating.
posted by benito.strauss at 12:04 PM on June 20, 2013 [2 favorites]

"implementing that solution is really hard for some people"

Lots of worthwhile things are hard for some people. Do we medicalize those things? I don't think the AMA is working to accept HAES or anything else other than more ways to make money from people, insurance companies and the government.
posted by Ideefixe at 12:08 PM on June 20, 2013 [1 favorite]

I figure if someone truly is suspicious of the AMA and "Big Pharma" and "Big Diet" and "Big Workout", it might be a good idea to work on losing the weight so those big bads can't get at you. If you're in shape, how can they SOAK YOU FOR MONEY?!! </sarcasm>

Or, I suppose, go the other way. But damn.
posted by grubi at 12:12 PM on June 20, 2013 [1 favorite]

TFA says right near the top that we have no established definition of a disease. So it's an odd kind of debate.
posted by thelonius at 12:18 PM on June 20, 2013 [1 favorite]

YOU'RE an odd debate!

zing?
posted by grubi at 12:25 PM on June 20, 2013 [1 favorite]

The strange thing about this is that it really doesn't matter one bit whether obesity is a disease or not. Pick one definition, it is; pick another, it isn't. It doesn't change a single thing about what obesity is or what obesity means.

Any reasonably philosophical health care provider isn't going to pay any attention to whether obesity is a disease or just a risk factor. Either way, you treat it, to the best of your ability. Weight is already medicalized. That ship sailed like forty years ago. More than that.

The only reason this matters is because of bizarre and arbitrary regulations made by people who didn't really think through the uselessness of "disease" as a category. Insurance companies, medicare, some others. The rest of it is just weird non-sequitur perceptions, like "this will keep it from being seen as a moral failing" (it won't, any more than it did for syphilis) or "this implies an inappropriate value judgment that it's wrong" (again, it shouldn't, any more than it does for polio), or "this will promote the perception of obese people as pitiable and ineffectual" (it won't, any more than it's done for people with hypertension). Popular perception of obesity will be what it is, and there's probably nothing that the AMA can do about that.

I have a BMI in the low 30s. It is statistically more likely that I develop Type 2 Diabetes than someone with a BMI in the low 20s. This leads people to argue that obesity itself is a disease.

I'm quoting this because it's a great demonstration of how useless "disease" is as a category. Obesity is a risk factor for diabetes. But why is diabetes (type 2) a disease? Because it is a risk factor for other diseases. Diabetes itself has no symptoms. (Hyperglycemia does, however. Should we argue against making diabetes a disease?)

You'll note the definition just excludes direct injury.

And you'll want to keep in mind, that if you check a few other definitions, even direct injury isn't excluded. (It would be impossible, in any case, to draw the line as to what was direct and what was an indirect result of the injury. Contusion? Ruptured spleen? Hypovolemic shock? Health, injury, disease, is a continuous transition of one bad thing into the next, with no real lines between the two. Our vocabulary is insufficient to describe it fully.)

The council said that obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index, is simplistic and flawed.

I'm wondering if the council has bothered to review the criteria for a whole bunch of other stuff that's popularly considered disease? Diagnostic criteria for osteoporosis, for instance, stands out for being totally arbitrary (take a number, look at an arbitrarily chosen range of outliers). The truth is that many diseases are not either/or but continuously more/less; many diagnostic criteria rely on arbitrary cutoff points, and markers that are probably not primary, but only good enough markers based on statistical measures. (And for critics of BMI as a method, keep in mind that the majority of the research showing the risks of obesity are about BMI, making that the best measure-- don't make the mistake of thinking physiology is well enough understood that we can abandon statistical measures!-- but that doctors are such that, doubtlessly, each will come up with their own reason to think you are at higher or lower risk of problems from obesity than can be inferred by your BMI alone.)
posted by nathan v at 12:52 PM on June 20, 2013 [4 favorites]

"The nation's leading physicians organization took the vote after debating whether the action would do more to help affected patients get useful treatment or would further stigmatize a condition with many causes and few easy fixes."

So rather than focus the debate on whether obesity did in fact fit the definition of disease, the question in the end was how it would make people feel or act. There are undoubtedly underlying factors that could be classified as disease for a lot of obese people, but obesity itself is a symptom of something.

It's a bit like ignoring cancer and calling "tumors" the disease.
posted by chundo at 1:06 PM on June 20, 2013 [1 favorite]

The label "fat and happy" returns to common usage.
posted by Cranberry at 1:24 PM on June 20, 2013

Weight loss advice from anyone who's had short-term loss but has not kept it off for five years is basically useless. Short-term loss, conditions allowing, is not hard to produce. But it is not the same as permanent weight management without significant regain. And that's really the bigger challenge of obesity: not regaining over the long term.

Once again we've been ably misdirected from causes in the contextual environment to causes in the individual. I'm not much interested in how much is physiological and how much is psychological. It is not an accident that our country's food producers produce far more calories than our population needs and work very hard to find ways to get us to consume them. I'd a lot sooner see us tackle this by:

-ending subsidies for corn, soy, and wheat to help readjust the food price structure to correlate better with health. "Subsidies favored some foods over others, with corn and soybeans taking the lead....advances in industrialized farming have spawned overproduction that has reduced the prices of subsidized commodities and thus changed the price balance for all foods."
-transferring some portion of those funds to those who grow "specialty crops" (ie, food and vegetables). " The government recommends that a third of one’s diet should comprise fruit and vegetables, yet only 5 percent of USDA funding goes toward programs supporting fruit and vegetables. "
-regulating food commodity markets
-regulating when and where empty-calorie processed foods can be offered and sold
-removing processed foods from school cafeterias and other noncommercial settings
-improving SNAP benefits further to allow more access to fresh foods and create less dependence on junk foods

In short, what we mainly have is a public health problem caused by an economic context, which can be addressed with public health solutions - changes in policy and economic structures.
posted by Miko at 3:13 PM on June 20, 2013 [8 favorites]

Okay, Miko, but what do we do with all the fat people we have now? End the subsidies, regulate markets, etc etc. How do you address the issue of the horses already outside the barn door? That's where the individual effort comes in and how it's dealt with. The AMA isn't going to be able to end those subsidies or regulate those markets; they have to address obesity as a medical issue, not an economic one. ANd since this is a threat *about* the medical community's approach and stance on obesity, providing a laundry list of political and economic solutions kind of wanders outside the point.

But, hey, that's how I see it.
posted by grubi at 4:22 PM on June 20, 2013

End the subsidies, regulate markets, etc etc. How do you address the issue of the horses already outside the barn door?

I don't know; before we decide it'll never work, let's try it and see what happens!

Some people smoked themselves to death. Some saw things changing and decided to quit smoking. Some just got fed up paying $7.50 a pack which you can only smoke outside, even if it's 20 degrees and sleeting. There are various outcomes. Ultimately, I'm not as worried about individuals as I am about the aggregate. If public health approaches make a change in the aggregate, then great. Let's do it. Some individuals may find it easier to change in the new environment. Some may not.
posted by Miko at 6:32 PM on June 20, 2013 [1 favorite]

Some saw things changing and decided to quit smoking

And legislators did their damnedest to outlaw public consumption of tobacco, stigmatizing and marginalizing the users, too. But I don't think the same approach is appropriate for eating disorders.
posted by mikelieman at 6:37 PM on June 20, 2013

Quasi-legal diet amphetamines you say?

Ephedrine can be purchased over the counter at CVS/walgreens/etc. as Bronkaid or Primatene (which also contain the expectorant guaifenesin). It's often combined with caffeine in an "EC stack," which is an effective appetite suppressant/fat-loss aid.

That's because the root causes of the issue are generally located somewhere between the ears and behind the eyes, and unless those are resolved first, everything else is orders of magnitude more difficult.

It's my understanding that current trends in obesity research tend to view the brain as the primary regulator of fat mass. This is the specialty of Stephan Guyenet, who writes the blog Whole Health Source, and he's written a lot about it on his site, including in a recent article, where he discusses the second half of the equation for obesity that I think you neglected to mention above: the food environment.

The fundamental concept this leads to about some of the major causes of obesity is that, over the last 30 years, sensory stimulation produced by the taste, smell, texture and appearance of food, as well as its availability, have increased dramatically, yet the satiety signals produced by stomach distension, satiety hormones, etc. have remained essentially unchanged, so that the effect on the brain's control system for appetite is to lead to a net average increase in the reward value and palatability of food which over rides the satiety signals, and contributes to the tendency to be overstimulated by food and to overeat.

A similar sentiment from last year on the subject of obesity-as-disease on the blog Weighty Matters:

Personally I'd describe obesity as the natural consequence of placing a collection of truly ancient genes, genes forged over millions of years of incredible and constant dietary insecurity and upheaval, into an insane, calorific, modern day, dietary utopia. In other words? Obesity and overweight are our bodies' normal, natural, responses to the world they find themselves living in.

Carbohydrates. Carbohydrates are saccharides/sugar, and too is the only, "nutrient" which the body does not actually require produce energy or maintain vitality. I am not a scientist, but the logic of recommending a diet rich in saccharides/sugar completely escapes me.

"Sugar" typically refers to mono- and disaccharides, e.g. sucrose (table sugar, made of fructose and glucose) and HFCS (same thing), as opposed to the starches at the bottom of the food pyramid, which are polysaccharides. The brain requires glucose to function, which comes from dietary carbohydrate, although it can be synthesized when no dietary carbohydrate is present. But all of the healthiest and longest-lived populations consume carbohydrate as the predominant macronutrient.
posted by ludwig_van at 7:11 PM on June 20, 2013 [2 favorites]

legislators did their damnedest to outlaw public consumption of tobacco, stigmatizing and marginalizing the users, too.

I'm not advocating that we use the same methodologies used to end smoking. I'm saying that a public health approach acknowledges that some individuals will have "left the barn," but doesn't let that become an obstacle for changing the basic context for others who have yet to develop problems.
posted by Miko at 7:22 PM on June 20, 2013

Those who do intermittent fasting : don't you get hungry?
posted by bq at 8:41 PM on June 20, 2013

It's my understanding that current trends in obesity research tend to view the brain as the primary regulator of fat mass.

Sure. But I still think it's worth looking at what regulates the brain, and I really won't be at all surprised if it turns out that gut flora have more influence than we currently give them credit for.

Those who do intermittent fasting : don't you get hungry?

Yes. But the thing that makes intermittent fasting work for me is that the hunger becomes tolerable and manageable. For me, intermittent fasting ties in beautifully with what grubi's been saying about making things as easy as they possibly can be.

For more than forty years, I've had a fairly stark choice in my relationship with food: I could (a) let habit and bodily demands regulate the amounts I ate and the times at which I ate, and slowly but steadily put on weight; or (b) regulate that stuff by willpower and suffer chronic, nagging hunger in order to lose or maintain weight. And I have faced that choice regardless of whether I choose the type of food mindfully, or mindlessly grubi-style, or just mindlessly.

As many people have already pointed out, (b) works - but as a permanent lifestyle it's a depressing, dispiriting grind. Every lapse in willpower (the occasional succumbing to the charms of the Cinnabun, or the enjoyment of a relaxed restaurant meal with friends) becomes an occasion for gloomy contemplation of the extra concentration and deprivation that will be needed over the next few days to stop the weight from ratcheting up. MrVisible's eloquent exposition of life in (b) mode resonates strongly with me. There are ways to make it less foully unpleasant (going low-carb works for me) but it's never actually good, and the older I've got the harder it's become.

Only when I eventually experienced Reductil (sibutramine) did I really understand how thin people relate to food. For thin people, or for fat people on sibutramine, (a) works too! And having experienced that fundamental shift, it suddenly became clear to me why so many people see obesity as a moral failing. From the thin man's point of view, the fat man must have got that way by deliberately and wilfully stuffing his face - because that's the only way the thin man can see himself ending up in the fat man's position.

With intermittent fasting I still get the hunger, but only for one day at a time. The pangs are actually no worse, and only slightly more frequent, than those I get from eating slightly too little per choice (b). But the huge, huge difference that makes them easy to tolerate is that I know I won't have to do that tomorrow. I'm OK with feeling deprivation symptoms as long as I won't need to do so for every single day for the rest of my life. For five days out of every seven I'm now living the same kind of happy (a) life as I was living every day while gaining weight or losing it on Reductil, and my weight is going slowly down rather than slowly up, and life is good.

The other thing to know about the 5:2 regimen is that the fasting is not particularly hardcore: I can have up to 600 calories on a fasting day and still have it work. Like Michael Mosley, I've gravitated toward a pattern of monitoring my mood and tailoring my fasting-day eating patterns accordingly. Fasting days are harder than a normal (b) day but not by very much; the tradeoff is more than worth it.
posted by flabdablet at 10:45 PM on June 20, 2013 [1 favorite]

Those who do intermittent fasting : don't you get hungry?

I occasionally do intermittent fasting and I definitely get hungry, but I've also learned to read my body and appetite much better as a result. Hunger pangs (at least in my experience) tend to be brief and come in cycles. What is amazing is that if I push through them the discomfort might last 10-15 minutes at the most and then they are gone for hours, however if I surrender to them and have a handful of nuts or an apple they last for much longer and with greater intensity.
posted by smithsmith at 10:48 PM on June 20, 2013

if I surrender to them and have a handful of nuts or an apple they last for much longer and with greater intensity.

Yup.

The pangs I get from partial satiety are much more obnoxious than those from a stomach that's actually empty.
posted by flabdablet at 11:01 PM on June 20, 2013

Those who do intermittent fasting : don't you get hungry?

16/8 Daily I/F for the past 556 days. I 'fast' ( It's a guideline, not a religious thing... ) between 8pm and Noon. In practical terms, I drink coffee from when I get going in the morning and my first food is at lunchtime.

Yeah, I get hungry in the morning. But that's just my stupid brain fucking with me, and since I *KNOW* I don't have medical blood sugar issues. When I know that I'm going to eat whatever I want for lunch, it's easy to just move forward and put them aside.

Since I eat a satisfying lunch, I'm not motivated much to snack before dinnertime.

Since I eat a satisfying dinner, I'm not motivated much to snack after 8pm and before bedtime.
posted by mikelieman at 3:08 AM on June 21, 2013

mikelieman, are you able to point me in the direction of any research on expected bodily effects of that fasting pattern? Also, what changes have you noticed in yourself over the past 556 days?
posted by flabdablet at 3:13 AM on June 21, 2013

I 'fast' ( It's a guideline, not a religious thing... ) between 8pm and Noon.

I lived most of my adult life doing this because breakfast just made me nauseous. I never considered it fasting as much as the normal way to live.

For the last 8 months or so, though, I've eaten a single boiled egg in the morning (as opposed to nothing other than coffee, ever, generally), and it has made my energy levels and hunger so much smoother and more manageable through the morning and early afternoon. I'm mildly amazed that there is a regimen of some sort (sorry, I don't understand the shorthand in your first sentence there at all) that advocates what I now consider to be a bad habit.

Everyone's different. I reckon advocating specific diets is pernicious for that very reason. I wish people wouldn't do that. Hell, dieting as a concept is pernicious, for that matter.

Do what works for you, but.
posted by stavrosthewonderchicken at 3:26 AM on June 21, 2013 [1 favorite]

I guess I did a version of the fasting idea. For years I only ate supper, or sometimes lunch, most days... so one meal a day, usually, because that's how much I felt like eating, and it was okay, and I wasn't hungry and didn't have a weight problem. Then something changed around perimenopause age, and I became hungry. I'm hungry around 10 am, around 3 pm, and around 9 pm. Very. Hungry. (according to Google, SCIENCE says that apparently this is a thing.) I'm not amused that getting rid of period pain and backaches and migraines means I now want to eat all the things. (witness two currently open windows in my browser: What is your go-to salad? & Everyday Chocolate Cake. *sigh* I've become a cliche.)

I really do continue to feel that for the general population that doesn't happen to be dealing with (naturally) plunging hormones, though, there is a lot more at play than just "no willpower," and "more sedentary lifestyle." I know of quite a few teenagers who are very active (– far more so than my generation at that age, perhaps because a lot of organized sports and fitness-related classes like martial arts, swimming, dance, etc., have taken the place of a lot of freeform stuff we did when the world felt like a safer place) yet who are a lot heavier than a typical kid when I was young, and I feel like it's related to a constellation of factors: HFC and sugar added to just about everything, the ubiquity of fast food, soft drinks, sure... but even more. Much more, I think. See "obesogens" ("dietary, pharmaceutical, and industrial compounds that may alter metabolic processes and predispose some people to gain weight") for example (Metafilter post), and the interesting observation mentioned in that article about how animals in human-influenced habitats are reflecting the same sort of weight gain. From a link from corvid in the mefi thread to an abstract of a study: "Surprisingly, we find that over the past several decades, average mid-life body weights have risen among primates and rodents living in research colonies, as well as among feral rodents and domestic dogs and cats. The consistency of these findings among animals living in varying environments, suggests the intriguing possibility that the aetiology of increasing body weight may involve several as-of-yet unidentified and/or poorly understood factors (e.g. viral pathogens, epigenetic factors)."

Whatever it takes to research and address all these complex and multivarious issues sounds good to me. Is obesity-as-disease one way to get there? I hope so.
posted by taz at 4:55 AM on June 21, 2013 [5 favorites]

At the risk of continuing the IF derail, I feel like it's worth mentioning that there appear to be differences in how men and women respond to intermittent fasting, which I feel tend to be glossed over by both scientific studies and the online paleo/IF community. This is something I haven't done a lot of research on but there's more information at paleoforwomen.com.

In regards to glucose tolerance:

“Another diabetes risk factor that has shown a sex-specific effect is glucose tolerance. After 3 weeks of ADF, women but not men had an increase in the area under the glucose curve. This unfavorable effect on glucose tolerance in women, accompanied by an apparent lack of an effect on insulin sensitivity, suggests that short-term ADF may be more beneficial in men than in women in reducing type 2 diabetes risk. ” The opening line of their discussion reads: “Alternate day fasting may adversely affect glucose tolerance in nonobese women but not in nonobese men.”

Most of the
posted by matcha action at 5:15 AM on June 21, 2013

Imagine all the people insurance companies can now deny coverage to because of their "preexisting condition".

That will be zero people starting on January 1st of next year.

Only for health coverage. Life insurance is not subject to PPACA or HIPAA nondiscrimination rules.
posted by Pax at 5:43 AM on June 21, 2013

flabdablet: mikelieman, are you able to point me in the direction of any research on expected bodily effects of that fasting pattern? Also, what changes have you noticed in yourself over the past 556 days?

Sorry, I have no actual research into this handy. I'm over 130 pounds down from about 266 to under 230 this morning. I'm HAPPY about what I eat and they way I eat it. I don't 'count' *anything*. And I don't feel like what I'm doing to actively manage my chronic eating disorder is any sort of burden or hassle.

What I've done is gained a sorta-intuitive understanding of what I can eat at lunch and dinner and how that's going to affect my weight going forward without making myself crazy ( crazier? )

stavrosthewonderchicken: I lived most of my adult life doing this because breakfast just made me nauseous.

I think we just looped with back December 2011.. It was the overwhelming outpouring of people saying , "Hey, I don't like breakfast either" which kicked this off in a lot of ways...

For the last 8 months or so, though, I've eaten a single boiled egg in the morning (as opposed to nothing other than coffee, ever, generally), and it has made my energy levels and hunger so much smoother and more manageable through the morning and early afternoon.

There is, indeed, more than one way to do it. I'll keep that in mind. One of the benefits for me of the I/F thing is that it really broke a bad 'grazing' habit I had. I'd roll into work at 8am, go get a 'breakfast sandwich' at about 9:30, and then since I was downtown and everywhere decent closed at 2pm, I'd *have to* go get something at 1:30. It was just a mess, and going to 16/8 IF just *stopped* that shit cold. Maybe there is something to be said for adding "breakfast" at a strict time ( like I have lunch AT NOON pretty much... ) in with my other schedule. A bowl of oatmeal at 6am isn't going to end the world.

Of course, those calories need to then come from lunch and dinner. Not that I'm counting, but that's a basic principle of biophysics, Having a decent caloric balance divided by two has really made picking what I want for lunch and dinner trivial. Adding another meal makes it just a little less trivial. I dunno. This is something outside my 'comfort zone'. Maybe that's all I need to HAVE TO try it!
posted by mikelieman at 6:38 AM on June 21, 2013

Sorry, was writing that last comment while trying to leave for work. The last line was just a reformatting issue (I was moving sentences around), not information that I left out.
posted by matcha action at 6:53 AM on June 21, 2013

I'm sorry, mikelieman, I don't understand what you're saying very well, I guess because you're using specialized abbreviations and vocabulary related to... weightloss culture? Is that a thing? I don't know.

But it's time for bed, so.
posted by stavrosthewonderchicken at 6:58 AM on June 21, 2013

I'm over 130 pounds down from about 266 to under 230

Based on your earlier comment I'm guessing you meant 366, which is a scary number. Good on you for finding something that works for you, and good on you for going the extra mile and making resources available for others who might want to try something similar.

I don't understand what you're saying very well

16/8 IF is intermittent fasting on a daily cycle where eating is restricted to an 8 hour window. Mikelieman has chosen to open his window at noon and close at 8pm.

5:2 is intermittent fasting on a weekly cycle: on any two convenient days in any given week, food intake is limited to a maximum of 600 calories for men or 500 for women. The other five days are completely unrestricted.
posted by flabdablet at 7:50 AM on June 21, 2013

before we decide it'll never work, let's try it and see what happens!

I never said don't try it. I'm saying that the medical issue is one that this thread is primarily about.
posted by grubi at 8:16 AM on June 21, 2013

Eesh. I never fast on purpose (body needs fuel and all that). But generally I don't tend to eat breakfast (habit, and the fact that first thing in the morning my stomach isn't in the mood), and lunch is something I enjoy but sometimes I forget (yes, I can forget to eat. I have ADHD and my medication helps me focus so much that I don't tend to realize I haven't eaten until near the end of my work day). But even if I don't eat much all day, I try to be sensible when I finally do have a meal.
posted by grubi at 8:21 AM on June 21, 2013

Also, I realized something else when coming up with this stuff: our natural inclination when we are especially hungry is to eat extra food. Of course, that's overeating and is bad for you. Hunger pangs aren't your body saying "FEED ME MORE"; they're your body saying "FEED ME NOW." There is a major difference. Keeping that in mind helps foster better habits.
posted by grubi at 8:23 AM on June 21, 2013

my medication helps me focus so much that I don't tend to realize I haven't eaten until near the end of my work day

It's not focus, it's loss of appetite. It's one of the side effects of amphetimines and other stimulants used as ADHD medications. The appetite is suppressed, so it doesn't pierce through your concentration on activities at hand. If it wasn't suppressed, regular hunger would come to your attention.

In some cases in the past, that effect wasn't considered "side."
posted by Miko at 9:33 PM on June 21, 2013 [1 favorite]

For some of us at least, the FEED ME NOW messages actually intensify as soon as we begin to eat, and don't let up until we're overstuffed; until I tried Reductil, I had always found having a half-full stomach to be a more miserable experience than having an empty one. So there do exist people for whom the difference you've just identified makes no difference.
posted by flabdablet at 9:37 PM on June 21, 2013

From TFA:

The council said that obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index, is simplistic and flawed.
...

“Given the existing limitations of B.M.I. to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes,” the council wrote.
...

Supporters of the disease classification also say it fits some medical criteria of a disease, such as impairing body function.

Those arguing against it say that there are no specific symptoms associated with it and that it is more a risk factor for other conditions than a disease in its own right.

I'm very pleased that the AMA's House of Delegates displayed a bit of common sense and rejected the bogus conclusions of its Council on Science and Public Health.

It's perfectly clear to me that a disease state exists and that I'm in it. If BMI is not a hard and fast indicator of the presence of that disease state, then maybe it's time to look at extending the official definition of obesity using additional diagnostic criteria, such as the presence of enough body fat to cause abnormal difficulty with normal daily activity.

No specific symptoms? My arse.
posted by flabdablet at 10:38 PM on June 21, 2013 [1 favorite]

It's not focus, it's loss of appetite. It's one of the side effects of amphetimines and other stimulants used as ADHD medications. The appetite is suppressed, so it doesn't pierce through your concentration on activities at hand. If it wasn't suppressed, regular hunger would come to your attention.

I'd agree, but for two things: my doctor told me the weight loss/appetite suppression effect isn't that strong in adults, and that when I wasn't on the meds, I was known to forget to eat quite frequently.

I suppose that the meds make it easier to ignore any hunger, at least easier than before.
posted by grubi at 12:16 PM on June 24, 2013

So there do exist people for whom the difference you've just identified makes no difference.

Well, yes, but I have been saying all along that there are always exceptions. These "rules" are of general purpose. If you've found yourself an exception (after giving them a try), well, then, so be it.
posted by grubi at 12:18 PM on June 24, 2013

I'd agree, but for two things

Sure, maybe. My SO lost 40 pounds on his ADD meds without evening trying, and after quitting, he gained it all back without even trying.

Not eating breakfast, though, is not associated with long-term success at keeping weight off.

I'm saying that the medical issue is one that this thread is primarily about.

If it's OK to say "but the issue is not medical, it's psychological," then it's OK to say "but the issue is not medical, it's social."
posted by Miko at 12:19 PM on June 24, 2013

Sure, maybe. My SO lost 40 pounds on his ADD meds without evening trying, and after quitting, he gained it all back without even trying.

Not eating breakfast, though, is not associated with long-term success at keeping weight off.

Sure. However, I've been tracking my weight loss. The sharpest loss occurred well before any medication. My weight loss has slowed considerably since that time, and has even slowed more since increasing the dose.

Also, I'm not sure of anywhere in which I've said it's not medical. I've only been describing the mental portion one has control over. The medical portion mostly provides those exceptions we've been discussing. Mind over matter... for the most part. :-)
posted by grubi at 12:26 PM on June 24, 2013

I've only been describing the mental portion one has control over

I've only been talking about the social conditions we have control over.

As for your success, talk to me in 5 years. I'll listen then to everything you've learned about weight loss, I promise. Good luck to you.
posted by Miko at 12:35 PM on June 24, 2013

Fair enough. The only thing I can point to in my defense before then is nothing in my recommendations is bad for someone. There's no such thing as eating "too moderately."
posted by grubi at 12:42 PM on June 24, 2013

And remember, grubi, if you fail: You tried your best, and you failed miserably. The lesson is, never try.
posted by entropicamericana at 1:14 PM on June 24, 2013 [1 favorite]

Heh.
posted by grubi at 1:16 PM on June 24, 2013

559 days without breakfast so far...
posted by mikelieman at 1:53 PM on June 24, 2013

No, the lesson is never assume you've figured it all out when you haven't. It's a consistent habit with the newly evangelized.
posted by Miko at 2:44 PM on June 24, 2013 [2 favorites]

5:2 is the Messiah! And I should know, I've followed a few.
posted by flabdablet at 4:14 PM on June 24, 2013 [1 favorite]

559 days isn't 'newly' anything.
posted by mikelieman at 7:33 AM on June 25, 2013

No, the lesson is never assume you've figured it all out when you haven't. It's a consistent habit with the newly evangelized.

Cool, so you can tell me which part of my plan is horribly flawed and will bite me in the ass, right?
posted by grubi at 7:59 AM on June 25, 2013 [1 favorite]

yes, 559 days is new. I'm here to tell you; I've been there, back, and there again, and this is consistent with the experience of a majority of weight losers. A lot of people can be successful at keeping weight off for a year, two years, three years. It is far more challenging as the years go on, because the focus , priority, and routine changes as people go through life changes. This is a reality. Some proportion of people are successful at losing a large amount of weight and maintaining a healthy weight thereafter for five years or more - and they are in the minority. I don't say this to encourage people to give up. I say it to remind people that the struggle is not a simple fix, a "just eat like I do!" recommendation, but a lifetime's project that needs to adapt and change as life changes. The most discouraging thing for those who are engaged in a lifelong battle is to hear "it's so easy!" from people who have not yet been there and done that for 5 years, 10 years, 15 years, until death, through kids, losses, job changes, moves, health emergencies, etc. The novelty of progress and triumph does lose its potency. This is not a cut-and-dried project, and it is not honest, or realistic, to characterize it as simple.
posted by Miko at 9:00 AM on June 25, 2013 [2 favorites]

So you *haven't* read what I posted, then.
posted by grubi at 9:05 AM on June 25, 2013

the struggle is not a simple fix, a "just eat like I do!" recommendation, but a lifetime's project that needs to adapt and change as life changes.

QFFT.
posted by flabdablet at 9:12 AM on June 25, 2013 [1 favorite]

The most discouraging thing for those who are engaged in a lifelong battle is to hear "it's so easy!" from people who have not yet been there and done that for 5 years, 10 years, 15 years, until death, through kids, losses, job changes, moves, health emergencies, etc. The novelty of progress and triumph does lose its potency. This is not a cut-and-dried project, and it is not honest, or realistic, to characterize it as simple.

I went through a phase of being discouraged by that.

These days I just remember how purely and strongly I too used to believe that this time I'd finally sussed it, and that all I had to do was stick to $PLAN and I'd be OK for life; and I look at people who still think that way and get a little misty-eyed with nostalgia.

They're young.

They'll learn.
posted by flabdablet at 9:33 AM on June 25, 2013

it is not honest, or realistic, to characterize it as simple.

Not sure you know the difference between "simple" and "easy". The thing I outlined above is rather simple. It sure as shit ain't easy.
posted by grubi at 9:49 AM on June 25, 2013

I say it to remind people that the struggle is not a simple fix,

I would suggest that once one's root-cause emotional issues are addressed, that it is in fact, a 'simple fix' of non-trivial net-caloric-deficit == weight loss.

Of course, if you never actually address the root cause of the eating disorder, you will see exactly the failure rates you're concerned with. Which is, I believe why my initial comment was specifically about how the real challenge is addressing the emotional aspect.

And there's an entire industry predicated upon that treat the symptom, not the cause style.
posted by mikelieman at 9:58 AM on June 25, 2013 [1 favorite]

The thing I outlined above is rather simple. It sure as shit ain't easy.

And you haven't worked with it over time. It's never easy. It's what is working for you right now and that is about all that can be said.

once one's root-cause emotional issues are addressed

You know, these don't always exist. My most recent gain was not a result of emotional issues, but of changing from a partially walking/outdoor job to a 9-to-5 office job and starting graduate school at the same time. Every circumstance in my life, including my metabolic rate, underwent a great deal of change as a result of a compressed schedule and a changed physical activity level. I don't need therapy for this; I needed to make adjustments in my routine, which took some time to discover and integrate.

Not all weight gain is caused by disordered eating, and not all disordered eating is caused by emotional problems. Believing that is a prejudice.
posted by Miko at 10:47 AM on June 25, 2013 [2 favorites]

What do you need to do to lose weight: Simple: eat less, exercise more, preferably both. Note this may need to be repeated (it isn't one time advice): you may eat less and lose today but not next year, when you may have to eat even less. Note also the amount you should eat is not necessarily the same amount someone else should eat. Also, how much reduction you need to do may or may not work as effectively (in either direction) as it does for others. Biology does, indeed, differ as well as change over time. So the magnitude may not be simple, but the general advice is.

However: Why aren't you eating less and/or exercising more? Well now that right there can be very very complex, bound up in your entire life. That is the killer question, both short and long term (with quite likely different answers short, mid and long term).

It is tempting to conflate the two: since the secondary things (magnitude, reasons) are complex and difficult (or impossible for some aspects) to control, we tend to complicate the core concept. However secondary complexity is not the same as primary complexity, and mixing the two up can result in chasing things like atkins or paleo; these things can be useful to change your diet, but you must remember that what you really need to change are the secondary causes, so that when your done your atkins you will still be good, or when you tire of paleo you can keep it off. Any diet which restricts food choice can help in the why, but only for a period: then you need to really address the why, and hopefully tweak it. It might be emotional, or it might be just eating out too much. It will be unique to you.

I think it is important to remember the basics are simple and quite worrying about the mechanics of how to lose weight, and focus on what we need to do to eat less and exercise more.
posted by Bovine Love at 11:02 AM on June 25, 2013 [1 favorite]

It's what is working for you right now and that is about all that can be said.

Please go read what I posted. It feels like you simply haven't and are just dismissing it out of hand.
posted by grubi at 11:11 AM on June 25, 2013

grubi, maybe back off. This thread isn't about you. You've said your piece.
posted by unSane at 11:20 AM on June 25, 2013

What are you talking about? I'm asking someone to not dismiss my remarks out of hand. Why is that a problem?
posted by grubi at 11:24 AM on June 25, 2013

grubi, why does it seem so hard for you to recognize that other people's hunger/satiety feedbacks don't necessarily work the same way as yours, meaning that a lot of what works for you simply doesn't work for us?

Believe me, I understand how exciting it is to crack your own code and get yourself doing something that really works for you. And more power to you for doing that. But the simple fact remains that I can look at what you're recommending and say "yes, been there, done that, didn't work very well for me".

Specifically, this:

Ever notice that after a while when you're eating chips, candy, or some other "junk" food, the last chip isn't nearly as tasty as the first few? Kind of a diminishing returns thing?

Nope. It's all every bit as good until my stomach is full.

Miko has a long history of making thoughtful, apposite comments here and I strongly doubt that "not reading it and dismissing it out of hand" is anything like what she's doing either.
posted by flabdablet at 11:26 AM on June 25, 2013 [2 favorites]

grubi, people who have read what you have posted can reasonably disagree with you. There are many people who could follow what you wrote exactly (and perhaps have done something very similar to what you have posted for years) who are considered fat/overweight/obese.
posted by matcha action at 11:28 AM on June 25, 2013 [1 favorite]

grubi, why does it seem so hard for you to recognize that other people's hunger/satiety feedbacks don't necessarily work the same way as yours, meaning that a lot of what works for you simply doesn't work for us?

What specifically are you referring to? I've not said This Is How It Works for Everyone. But you've decided that I'm wrong. Are you critiquing a specific remark I've made or a sentiment you have a problem with?

Miko has a long history of making thoughtful, apposite comments here and I strongly doubt that "not reading it and dismissing it out of hand" is anything like what she's doing either.

And yet, I've not received any specific critique from Miko, just general hand-waving.
posted by grubi at 11:29 AM on June 25, 2013

grubi, i for one, was not dismissing your remarks. There are 287 comments in this thread. Lots of us provide perspective without necessarily disagreeing with others.
posted by Bovine Love at 11:30 AM on June 25, 2013

grubi, people who have read what you have posted can reasonably disagree with you.

Sure, I don't have a problem with that. I have a problem with someone telling me how wrong I am without providing any actual criticism. If you think a remark, passage, or item is wrong, then all I ask is you articulate why. It's getting tiring seeing people just go "not everything is for everybody" when a comment like that indicates they ignored what I actually said.
posted by grubi at 11:31 AM on June 25, 2013

Or, perhaps, they weren't disagreeing with you. Perhaps they -- as was I -- are adding information and thought, not disagreeing.

Personally if I disagree with a specific person, I always quote them to make sure they understand it is directed. I had no issue with your method. It is quite possible Miko doesn't as well; the remarks came off as more generic then directed.
posted by Bovine Love at 11:35 AM on June 25, 2013 [1 favorite]

Nope. It's all every bit as good until my stomach is full.

My wife says the same thing. Which is why she prefers to pay attention to the "eat til you're un-hungry rather than full" bit. She's modified the "plan" to her individual tendencies. And it's worked.

See, none of what I said is dogma. I wish people would stop acting like I said it was.
posted by grubi at 11:35 AM on June 25, 2013

I feel like this has gotten a little heated just out of a kind of abstract momentum more than anything. Can I suggest everybody just sort of take five?
posted by cortex at 11:37 AM on June 25, 2013

It is quite possible Miko doesn't as well; the remarks came off as more generic then directed.

That's fair. Then I would ask Miko (and whomever) to read my remarks and see if they still feel their criticisms apply to those remarks. I'm eager to discuss this.
posted by grubi at 11:37 AM on June 25, 2013

Of course I read what you wrote. Why else would I be addressing it? I just don't agree that your system is going to work for everyone, or for the long term. It does not appear to be science-based ("our bodies want to reach a state of equilibrium" - that is not a scientific idea) , and is wholly idiosyncratic. You do at least preface it with "it worked for me and might work for you," and that, as I said, is what it's good for. You start with the disclaimer, yet present everything as though it's hard fact. You've worked out something that works for you. Your strategies about mindful eating have been helpful for you right now, because the reasons you're overweight right now have had to do with thoughtlessness and reactivity. But you write about it as a prescription for others, even though others aren't dealing with your exact set of causal factors. So no, your approach is not going to work for everyone, and I will be interested if you find it even works for you beyond the horizon of 4-5 years. That is unknown.

I agree that it is great when you hit your stride and find a routine that is yielding the results you want (even if you don't really know why). But when conditions change, you will likely find that your prescription no longer holds even for yourself.

I am particularly sensitive to this because I was a proponent of similar ideas not so long ago. I've learned a lot since then. You are doing the right things in terms of paying attention to your health and trying strategies that may work to improve your health. Some are science-supported, some not so much. Other people may use some overlapping strategies. But you haven't discovered a secret key that will work for others, and not only that, you should recognize that, at best, you're in the middle of the experiment, not at the end. No long-term conclusions are available here.

It's true that I understand the quoting mechanism. It's not that I object to any single strategy that is working for you. I object to the overall, generic idea "it's all figured out." It's not. Science has not figured weight loss out. No one has. The best we can do is adapt a changing array of individual, personal strategies to our changing life conditions, and (I believe) advocate for an overall better food supply and healthcare system.

This is all making me seem like more of an asshole than I really want to be, but the simplistic, prescriptive nature of much of this kind of highly personally based advice is an overall negative for people who need, more than anything, good health outcomes over the long term.
posted by Miko at 11:38 AM on June 25, 2013 [1 favorite]

Some are science-supported, some not so much.

So let's talk about that. What's not science-supported? The ideas about the human body or the suggestions on what to do? I'm not looking to set up a defense of my ideas; I'm genuinely trying to find what's right, then adjust my point of view based on that.

For what it's worth, I have shown this to my primary care physician and she said this was exactly the advice she's been giving the majority of her overweight patients for years (the suggestions, not the body notions). I discussed the idea of body wanting to return to equilibrium and she didn't seem to have an issue with that, so I wonder what you think is inaccurate or false about it.
posted by grubi at 11:43 AM on June 25, 2013

That's great! More power to you. Mazel tov.

I'm not going to have the fight you want to have. It is tired. I request only that you stop communicating that your personal strategies represent a solution for others, and recommend that you reserve reports of their success until you have evidence of long-term maintenance.
posted by Miko at 11:51 AM on June 25, 2013

I'm not looking to have a fight. I'm looking for feedback. I'm sorry you misunderstand that; maybe I didn't communicate that fully. But if you're not interested in providing that feedback, fine.
posted by grubi at 11:55 AM on June 25, 2013

I'm genuinely trying to find what's right, then adjust my point of view based on that.

There is no objective "right". That's the entire point, and it's what makes "eat less, move more" such completely dispiriting, empty, useless advice. Obviously that's what needs to be done. The question that will have a different answer for every single person is exactly how that's to be done.

My best advice to you: stick with the beliefs and practices that are working for you right now for as long as they keep on doing so. Miko's point is that in ten or fifteen years you will most likely need to find other things that work for you then. Some of what you're using now might still work; some of it probably won't. Keeping obesity at bay is an ongoing, adaptive process and sometimes life unfolds in ways that mean the adaptation can't happen fast enough and we get fat again and have to start over.

From my own perspective as one who no longer subscribes to the "equilibrium" idea: it's one of those things that sounds very plausible until you look back over the last five years and realize it must have stopped working at some point.

she prefers to pay attention to the "eat til you're un-hungry rather than full" bit. She's modified the "plan" to her individual tendencies. And it's worked.

See, at this point I could get all pissy about you not having read a word I wrote about how for some of us there is no subjective difference between "un-hungry" and "full", and we could talk past each other for another dozen comments.

But if you're not interested in providing that feedback, fine.

That's really easy to misread in a kind of huffy tone. Let's not?
posted by flabdablet at 12:07 PM on June 25, 2013 [2 favorites]

for some of us there is no subjective difference between "un-hungry" and "full"

So are you saying that the only way to stop feeling hungry is to fill your stomach entirely? Or am I misreading that?
posted by grubi at 12:10 PM on June 25, 2013

That's what I'm saying.

If I have hunger pangs and I ignore them, they go away in maybe ten minutes and don't surface again for an hour or so. When I start to eat, they crank right up and they don't let go again until my stomach is either full, or has digested what I've eaten and emptied itself again.

That's why intermittent fasting works so much better for me than everyday portion control.
posted by flabdablet at 12:16 PM on June 25, 2013

Interesting. Do you do the thing where you eat a little, wait a little, etc etc, to see how you feel? I ask because everything I've found is that the "fullness signal" doesn't hit our brains quickly enough. But if you're doing that and you still feel hungry the whole time until you're full (which I'm not doubting; just making sure I'm not missing any information), then I'm wondering how all that works.

The human body is weird, man.
posted by grubi at 12:20 PM on June 25, 2013

Do you do the thing where you eat a little, wait a little, etc etc, to see how you feel?

Have done. It's a pretty reliable way to mess up the enjoyment of a meal.

Feeding a hunger pang is an absolute pleasure. Stretching one out is absolutely not.

Look, I know the kind of "fullness signal" you're on about; I've experienced it while using sibutramine. I found the experience of ceasing to feel hungry before feeling physically full to be novel, weird and pleasant. Understanding how all those thin people work was nifty. Totally cool drug.

But I can't have that any more, and 5:2 is the next best thing and it's cheaper than pharmaceuticals and the research suggests it's health-promoting in its own right, over and above its weight loss effect. And unlike any other unassisted eating plan I've ever used, I can easily see myself doing it for life. So that's my present plan.

In another 15 years - who knows?
posted by flabdablet at 12:37 PM on June 25, 2013

The human body is weird, man.

Yes. And variable. The human body is a complex system. And it behaves like one.

The main thing I objected to is the idea of "equilibrium" and the thought that the body "wants" it. The body is a physical system - it doesn't "want" anything (that's the role of consciousness). The body responds to present conditions. "Equilibrium" as a single desired state is a concept that is too simplistic a model to apply to biological systems and even more so to psycho-social-biological systems.

Any individual body functions in a set range of ways in a given set of conditions. If nothing changes in the external or internal environment, it can function in that set range indefinitely. Many conditions may vary, even extremely, and as long as they do not exceed levels which overwhelm the stable functions of the system, the system remains in that set range. But as conditions change, some of those factors do exceed usual limits and the body (like all biological systems) can be pushed across thresholds into alternative stable states.

When you are working at losing weight, you are engaged in a consciously-driven effort to amplify conditions that create feedbacks in the resilience factors of your body to push your system across one of those thresholds into what you hope is a future, desired stable state of leanness. You are engaged in a dynamic process of attempting to manipulate variables. The hope for weight losers is that once in that new state, they will then maintain their systems in alternate stable state of leanness indefinitely. However, because the factors may have been amplified through strategies that consume a large amount of conscious energy, through external conditions that may be out of the individual's control, through diminishing returns as the body adapts to specific strategies, etc., it takes constant tinkering and vigilance to keep monitoring and adjusting for the factors that might cause the system to roll back over the threshold into weight gain.

And obesity is, in fact, also an alternative stable state. It may not be a desirable one, but a system can function within it for a very long time before failing, just as a lean or underweight system can. It takes far less effort to maintain, meaning it is quite likely for untended factors or changes in internal or external environments to push it back over the threshold into the state of obesity, which takes less energy and attention to fine-tuning to maintain and is more resilient than leanness.
posted by Miko at 12:44 PM on June 25, 2013 [2 favorites]

@flabdablet:

I see I need to do some reading about this 5:2.

@Miko:

Hmm. Something to contemplate. I don't have any questions or response other than you've given me something to think about.

But for reference: I don't necessarily mean "want" in the conscious sense. It was just shorthand. But I see what you're saying.
posted by grubi at 12:48 PM on June 25, 2013

... it's what makes "eat less, move more" such completely dispiriting, empty, useless advice. Obviously that's what needs to be done.

I've been told, over and over again, that eat less move more doesn't lose weight. No, it was the carbs, the gluten, the fat, you name it. It was some medical secret what caused weight, not too much calories for your burn rate. In fact, I would hazard that most people I know who have an opinion on diet are of the opinion that eat less, move more doesn't work, period; not that they can't achieve it easily -- that I understand -- but that it doesn't work, period. It is not at all obvious that achieving that will lose weight.

It is not empty useless advice; it isn't advice at all. It is a goal, and a mechanism and most certainly not a given. If you can't agree that it is the final mechanism or goal, then you are going to have a hard time working up good advice on how to achieve it.
posted by Bovine Love at 12:55 PM on June 25, 2013

I've been thinking about this a lot lately because I am a good example.

I was thin as a smoker. Then I quit, and got fat, because conditions had changed and my standard diet, once it lacked nicotine, was no longer able to keep me thin. Then I started running. Last time I got down to my absolute fighting fit weight, where I stayed for many years, I was doing triathlon and eating in a way I thought was really healthy. It was, for me, at the time. I did much of what grubi recommends, preferring proteins as snacks, eating fewer overall calories. I limited breads and sugar for calorie reasons and chose whole-wheat versions, etc. I had the perfect system down pat, and was fatuous about it. If only everyone did like me, we'd all be thin and healthy. Look at me, I did it. Simple.

Also, I was trying hard. I was concentrating. I was thinking about eating and exercising and health every day, and was praising myself a lot and rejoicing at all my new goals met. A lot of psychological energy went into this project, and there were many psychological rewards too.

Then, as I said my life conditions changed. I put a bunch of weight back on, very slowly, over the past 3 1/2 years, as I moved twice, started a new job, and started school, among other changes. Disruptions change conditions. My mental energy needed to be deployed elsewhere so that I could stay employed and pay the bills, advance my career, etc. The psychological rewards of being fit'n'thin dimmed over time - I got used to being at a lower weight, and the excitement and happy brain chemicals of continuous progress wore off.

Now, I'm losing again. But I have found, to my frustration, that I can't do it the way I used to. I am having to totally avoid most grains (even whole) and sugar. Not because grains and sugar are magical foods that make you specially fat (though some scientists do think so), but because their glycemic index - even in whole grain form - is too high, and it is raising my blood sugar. I have been in close consultation with my doctor about it. That didn't happen when I was younger, because when I was younger I did not yet have insulin response fatigue. I do now -- partly because I relied on a good insulin response to get me through my low-calorie, health, varied dietary choices for so very long. That means that my body no longer handles incoming foods the same way it used to.

So I can't lose weight on the same diet any more. I have to take a totally new approach and, somewhat amusingly, am finding diets I used to consider "gimmicky" (high protein, minimal carbs, all complex) are the ones that are working for me while preventing me from incurring further medical risk and, I hope, getting me out of the negative feedback loop that is insulin resistance.

In addition, since I don't have time to triathlon train, I don't have that regular fantastic cardio burn, which means I don't have the margin to absorb racing fuel. I enjoyed doing a lot of cardio because eating more fuel was fine, and pleasurable, and because I loved racing and loved working toward personal records and doing the intense workouts and being really physically fit - and I did need to fuel that effort. But I can't eat that much fuel any more, since I don't have time to use it, so the diet I need now is further reduced, calorie-wise. There is a lag effect at which the metabolic rate you achieve if you do a lot of cardio for years will hold on for some time without resulting in much weight gain. It took a long time for my metabolic rate to climb back from my old "leanness" threshold to a sluggish one again, but it happened.

And one more thing:

If you do it enough, you'll find a lot of foods with processed sugar just don't taste as good and you'll avoid them as a matter of preference.

Now that I eat almost no sugar, when I do decide to have a dessert, I find it tastes fantastic.

This is just one person's story, but it's an illustration. The relationships between obesity, activity, consumption, and body systems are complex. Complex means there are many variables, and the variables can change and can affect each other. No one approach or set of habits will work forever, or for every person. I can no longer use the same strategies I used in 2003, any more than I can sensibly go back to smoking, to solve the issue. I need to adapt a new set of strategies to who I am today, and what my life and body systems are like today. And knowing why the earlier approach eventually stopped returning results, and changing factors pushed me over the threshold into another state is only helpful; having someone say "use my approach, it works!" is unhelpful if it is identical to my earlier approach. Knowing that in a dynamic complex system like the body, habits and approaches work until they don't is a vital basic principle for long-term healthy living.
posted by Miko at 1:31 PM on June 25, 2013 [3 favorites]

I've been told, over and over again, that eat less move more doesn't lose weight

Of course it does, ultimately. Nobody can gain or maintain weight while literally starving. Breatharians are fooling themselves.

If you can't agree that it is the final mechanism or goal

For many people, it doesn't actually need to be. Not every calorie that goes in your mouth ends up in your bloodstream. There are changes you can make to what and when you eat that encourage more of it to end up in the sewer.

For some people, methods leading to overall reduction in food quantity are appropriate. Others can get good weight loss results without reducing food calories eaten; for them, it really is all about the carbs, the gluten, the fat, the fibre, the timing, you name it. Still others find it virtually impossible to lose weight on any plan they can actually endure living with.

Obese people have been hearing "eat less, move more" thrown at us for our whole lives, in tones that make it perfectly plain that the person giving that advice considers us morally inferior for our obvious and ongoing failure to take it. It doesn't help. Not even a bit.

At 151kg I'd love to "move more", but doing so hurts. I'm already flat out moving as much as I do.

Now, after a year on 5:2 I expect I'll be moving a lot more. But if this happens it will be largely a result of losing weight, not something I'll be doing in order to lose weight. Because quite frankly, although I'm currently enjoying the weight loss I've been experiencing with 5:2, that's not what I'm doing it for.

I've given up trying to lose weight. It's too fucking hard. I'm doing 5:2 because I think it will be good for my heart and good for my bloodwork numbers. If it keeps losing weight for me as well: great. If it stops doing that and I'm still obese: que sera sera, and anybody who still tells me I need to eat less and move more can still just fuck off.

Present company excepted.
posted by flabdablet at 1:38 PM on June 25, 2013

having someone say "use my approach, it works!" is unhelpful if it is identical to my earlier approach.

It's especially galling when it comes from a young'un whose body has not yet reached my own's state of genteel decrepitude :-)
posted by flabdablet at 1:42 PM on June 25, 2013

I will have to tell my 72-year-old cyclist friend who has logged 6000 miles so far this year he shouldn't be moving around so much.
posted by entropicamericana at 1:49 PM on June 25, 2013 [1 favorite]

That's really not helpful, entropicamericana. I'm glad your friend is enjoying a healthy and active seventh decade. I can think of a bunch of people his age whose chronic arthritis, cancer, memory impairments and the like wouldn't allow that kind of activity, but great for him. He has luck and good health. What a wonderful single data point he is.
posted by Miko at 1:56 PM on June 25, 2013

Now that I eat almost no sugar, when I do decide to have a dessert, I find it tastes fantastic.

Ooh, that is a good point. I've done something similar: it's kind of like now that I've not made super-sweet stuff such a regular thing, it even *tastes* more like a treat. I'm not as used to it, which means the sweet is sweeter.

Must remember to write that down!
posted by grubi at 2:00 PM on June 25, 2013

At 151kg I'd love to "move more", but doing so hurts. I'm already flat out moving as much as I do.

Yeah, I bet. I had to stop doing anything physically vigorous (and I was about 127 kg/279 lbs at the time) because of the wear-and-tear it was having on my back and joints, as well as the overall huffy-puffy tired feeling it gave me. I found out that we've have been essentially getting it all backwards: you shouldn't exercise so you can lose weight; you lose weight so you can exercise! I didn't really change my exercise habits in my daily life (I despise working out), but I'm kind of a hyper individual as it is (I have a hard time sitting still for extended periods, and nearly all of my extended conversations with people involve me pacing), so I was already hitting what doctors would consider "moderate" rates of movement.

But yeah, increased weight makes it near impossible to exercise (or even move) the way we traditionally thing we're supposed to.
posted by grubi at 2:05 PM on June 25, 2013

It's especially galling when it comes from a young'un whose body has not yet reached my own's state of genteel decrepitude :-)

How young? I'm turning 40 in March. :-)
posted by grubi at 2:05 PM on June 25, 2013

Now, after a year on 5:2 I expect I'll be moving a lot more. But if this happens it will be largely a result of losing weight, not something I'll be doing in order to lose weight. Because quite frankly, although I'm currently enjoying the weight loss I've been experiencing with 5:2, that's not what I'm doing it for.

I should have read it all; my above remark about having it backwards just repeated this. (I'm so quick on the draw to remark sometimes. Oof.)
posted by grubi at 2:07 PM on June 25, 2013

Obese people have been hearing "eat less, move more" thrown at us for our whole lives, in tones that make it perfectly plain that the person giving that advice considers us morally inferior for our obvious and ongoing failure to take it.

I'm certainly not going to tell you that some of those people didn't feel morally superior. But I am going to tell you that lots of people approach things from various angles; for me, I will almost always approach something from basic principles. I think weight loss, I start from "eat less, move more", then figure out from there. If I say it, it isn't because I think you're inferior, it is because it is the way my brain works. It is an insult from some people, but that doesn't make it an insult from everyone. Just because assholes do X, doesn't make everyone who does X an asshole. Well, not in this case, anyway.

I am not obese, but my family (parents and up) are, and were my entire life. I started gaining weight also when I quit smoking and started a long term relationship, seriously changing my lifestyle and -- likely -- my chemistry. Also got older and got more responsibilities. Even reducing my very moderate level of overweight has been hard, and getting harder as life introduces more distractions. I know it is hard. I'm just re-enforcing this because it is important to stress that not everyone who takes a particular approach to dieting (and life) necessarily feels that other approaches are morally deficient. Understanding of point of view is important.

We'll have to agree to disagree on whether the nature of calories is a major factor in the physiological aspects of weight loss (I certainly agree they are emotional/sociological/behavioural issues though). I'm waiting for a lot better research on that score.
posted by Bovine Love at 2:12 PM on June 25, 2013 [2 favorites]

Then I started running. Last time I got down to my absolute fighting fit weight, where I stayed for many years, I was doing triathlon and eating in a way I thought was really healthy. It was, for me, at the time. I did much of what grubi recommends, preferring proteins as snacks, eating fewer overall calories. I limited breads and sugar for calorie reasons and chose whole-wheat versions, etc. I had the perfect system down pat, and was fatuous about it. If only everyone did like me, we'd all be thin and healthy. Look at me, I did it. Simple.

Miko, I'm wondering if what contributed to your re-gain was this workout regimen. Working out demands more calories, and then if you stop working out (due to those situations changing, as you mentioned) once you're used to eating that increased amount, you're bound to put on weight. Which is why I mention not working out when trying to lose weight -- multiple studies have shown it to counteract the effect of weight loss, long- and short-term. If that's not it (for example, as we've been discussing, individual variations in weight gain/loss), let me know. Just putting it out there as a possibility; I'm eager to learn more.
posted by grubi at 2:13 PM on June 25, 2013

This is a fascinating article on a few of the various contributors to weight regain in those who have undergone significant weight loss.

The main reason why we have a greater-than-expected decrease in energy expenditure with weight loss is because we become less active. This doesn’t mean we exercise less, either, as exercise is a conscious choice. It means we unconsciously reduce our NEAT and spontaneous activity. It also means we become more efficient in the activity we do; we expend less calories for the same movement. In fact, 35% of the decrease in activity energy expenditure can be attributed to an increase in efficiency. Overall, we move around less, and we become more efficient at the movements we perform. Combined with a decrease in resting metabolic rate, we end up burning over 400 calories per day less than you would expect for someone of our same height, weight, gender, and body composition. This is not only why weight loss eventually plateaus, but also why weight is so easily regained.

posted by ludwig_van at 2:58 PM on June 25, 2013

Miko, I'm wondering if what contributed to your re-gain was this workout regimen.

1. I did not ask for your advice or analysis of my workout regimen. (I almost contacted the mods to remove my post as soon as I made it, because I realized that you would probably consider it an intellectual challenge to find out what I was doing "wrong.")
2. You have idiosyncratic ideas about the purpose of working out. As I said, I worked out because I loved it and it made me feel good. I don't agree that working out is a bad idea.
3. "Once you're used to eating that increased amount, you're bound to put on weight." Duh. If you don't change your diet, yes. Do you really think this is not obvious to me? Also, I did not say that I continued to eat a training diet while not training - I think you made that leap. In fact, I explicitly said that I recognized I could no longer eat that much fuel as I am not in training.
4. I also don't think that you know more about fitness, training, diet, and sports nutrition than I do.

Giving you the benefit of the doubt, I am sure you are attempting to be helpful and kind. Notice that again, though, you're instead assuming you have figured out something that I haven't. I don't need or want that.

I think you may be still missing the message, and I'm sorry I offered myself as a case study now.
posted by Miko at 5:00 PM on June 25, 2013 [2 favorites]

"I'm glad your friend is enjoying a healthy and active seventh decade."

Eighth.
posted by Eideteker at 10:47 PM on June 25, 2013

I would suggest that the issues with regain is because the "Weight Management Strategy" they're using isn't sustainable FOR THE REST OF THEIR LIFE. Obesity is a chronic medical issue, and if you don't manage it EVERY DAY, you're going to have problems.

There is no objective "right".

Let's take this back to first principles. What CAN we say which is objectively right?

Chronic medical issues like obesity require frequent assessment and monitoring.

You can measure your Daily Rate of Weight Change (DRoWC) with well known tools, giving useful metrics for assessment and monitoring of obesity on a daily basis.

If your DRoWC is positive, you're gaining weight.

If your DRoWC is negative, you're losing weight.

Now, from where I sit, that's about where 'objectivity' breaks down, since TMTOWTDI. Or should I say, "There's More Than One Way To Induce A Net Caloric Deficit.", and that's why so many diets 'work', and yet don't 'work' for other people. Pretty much anything works. The keys are 'how much of a pain in the butt is it?" and "is it sustainable?" ( which is very much linked to the pain-in-the-butt factor. )
posted by mikelieman at 12:25 AM on June 26, 2013

I found out that we've have been essentially getting it all backwards: you shouldn't exercise so you can lose weight; you lose weight so you can exercise!

When I did it at 30 years of age, you'd better believe I exercised to lose weight.

Twenty years on and I still have a fair bit of the strength I built then. At 151kg I can cope with walking the 1km round trip down to the shops and back up the hill, now that my Achilles tendinopathy is mostly under control; twenty years ago at my peak mass of 150kg I was a puffed and sweating wreck after a 150m walk along a flat street from work to the lunch shop.

Twenty years ago, my exercise plan was: (1) no extra exercise until I'd dropped from 150kg to 130kg, then (2) swimming 1km per day until I'd dropped from 130kg to 110kg, then (3) swimming 1km three times per week and using my bicycle instead of my car for my daily 30km (round trip) commute.

This is actually a really good example of something you don't believe in now that worked incredibly well for me twenty years ago. It wouldn't work today; I'm a parent and a landowner and I now live 30km from my workplace, and if I do anything high-intensity I get very sore very quickly and stay sore for days on end. It's a pain in the arse (literally). But I've been riding my bike occasionally regardless, and I'm still looking forward to being able to ride it more regularly again.

You can measure your Daily Rate of Weight Change (DRoWC) with well known tools, giving useful metrics for assessment and monitoring of obesity on a daily basis.

Yeah, I was doing that ten years ago (pqlier is me). I eventually gave it up. Having lost about 20kg, the huge difference in quality of life between the unrestricted eating patterns that had me gaining ~100g/week and the disciplined feedback-driven patterns I found necessary for weight loss or even just maintenance was pushing me into a pretty nasty depression. At the time, I remember thinking that if I was going to kill myself I'd rather do it slowly.

When I look back now at some of my old contributions, I'm struck by the zeal and the sense of conviction my then self shares with the ~40-year-olds here. It's a little embarrassing. I was such a mansplainer.
posted by flabdablet at 1:28 AM on June 26, 2013 [1 favorite]

I don't find monitoring my daily rate of weight change to be any sort of burden. Maybe it's the tools, maybe it's the way the tools are used? But getting on the scale to feed the computer data, and reviewing my daily progress to manage my obesity is a whole lot less burdensome than managing a case of adult-onset-diabetes.
posted by mikelieman at 5:33 AM on June 26, 2013

Pretty much anything works. The keys are 'how much of a pain in the butt is it?" and "is it sustainable?"

And also, "is it promoting positive responses in my body?" and "does it provide the required energy for my daily activities?" and, for some of us, "is it ethical?"

I'm struck by the zeal and the sense of conviction my then self shares with the ~40-year-olds here. It's a little embarrassing. I was such a mansplainer.

Well, I'm still an ~40yo and I am already embarrassed by my pronouncements from a few years ago. I've been thinking a lot about forms of privilege which relate to this issue. Health privilege is a real thing: the 72 yo who is an avid cycler is awesome - a lot of us hope to be that person. And yet there is a real divide among people whose non-diet-related health issues will simply not allow that kind of activity. Inviting comparisons is odious, because we are comparing someone who has combined effort with a lot of good luck which they did nothing to earn. Then, too, there are external factors in people's lives - family commitments, time, access to information, money, access to food supply - that impact the ability to easily monitor and adjust diet for weight. The ability to do all those things is also a form of privilege. We all use our forms of privilege, don't get me wrong, but I find it inappropriate to presume that your privileges match perfectly onto others' lives, so they should find it exactly as hard or easy as you do to do the behaviors you do that help you control factors that determine your weight.
posted by Miko at 7:36 AM on June 26, 2013 [2 favorites]

And that, I realized only yesterday, is what really angers me about weight moralizing. Walk a mile.
posted by Miko at 7:40 AM on June 26, 2013

Giving you the benefit of the doubt, I am sure you are attempting to be helpful and kind. Notice that again, though, you're instead assuming you have figured out something that I haven't. I don't need or want that.

No, honestly, I'm seeing your experience as a valid argument against my point of view. If you had indeed take into account all those things I was describing, then my point of view is wrong and needs to be adjusted.

I'm not looking to be proven right; I'm looking to learn where my point of view is flawed.
posted by grubi at 8:00 AM on June 26, 2013

My point was not about how I regained weight; that's simple enough and I really did not intend to invite you to speculate about it (though almost everyone who loses weight will experience it, so it is good to know, in general, why it occurs). My point in response to you was that I needed different strategies for losing weight at different times in life, and different strategies still for maintaining weight through a lifetime of metabolic shifts and changes in the external environment. No one set of rigid strategies about diet composition, activity, etc., will continue to be productive forever.
posted by Miko at 8:10 AM on June 26, 2013

Understood. I'm just curious where my approach might be flawed -- even for me and my wife right now. Other folks' informed input is valuable for that.
posted by grubi at 8:15 AM on June 26, 2013

I think your approach promises to work well for you in the short term at least. I just think you will want to qualify it, especially when recommending it to others, with the knowledge that weight loss and then weight management takes constant monitoring and adaptation to control weight, and there will probably be times you are not succeeding as well as you'd like until you discover what the next set of changes need to be, and are able to make them.
posted by Miko at 8:39 AM on June 26, 2013

Well, how am I supposed to know what to adjust if people aren't telling me what worked for them? I don't see why discussing that is a problem.

And I'm really not looking to qualify anything. This stuff is in a constant state of flux, ready to re-edited. If something's just not right, I'd like to know what and how sooner rather than later.
posted by grubi at 8:43 AM on June 26, 2013

What are the good tools for tracking daily rate of change of weight? That filter out the noise I mean.
posted by unSane at 8:47 AM on June 26, 2013

What are the good tools for tracking daily rate of change of weight? That filter out the noise I mean.

Just use an app like LoseIt or MyFitnessPal, weigh yourself daily at the same time under the same conditions (i.e. first thing in the morning, after urinating and before drinking/eating anything), and look at the overall trend line on the graph.

People have also posted their spreadsheets of various levels of complexity/obsessiveness on the loseit subreddit, so search for "tracking spreadsheet" there if LoseIt or MyFitnessPal is not your bag.
posted by entropicamericana at 9:14 AM on June 26, 2013

To make it a little simpler, we use a WiFi scale with mobile app. It supports multiple users as long as they are not too close in weight. Step on, step off, go about your business, check your mobile app to see the readings/trend etc. We use the Withings wireless scale. We don't measure daily, so some issues of usability could arise in that case that I don't know about, but it works great for our more weekly-ish readings.

If you want to get even more all self-quant, you can (as I have) get something like an UP band to track movement and integrate its app with the scale, if that is your bag. You can get kinda crazy with that stuff.
posted by Bovine Love at 10:00 AM on June 26, 2013

My point in response to you was that I needed different strategies for losing weight at different times in life, and different strategies still for maintaining weight through a lifetime of metabolic shifts and changes in the external environment. No one set of rigid strategies about diet composition, activity, etc., will continue to be productive forever.

I would suggest that the STRATEGY of sustainable weight management doesn't necessarily have to be variable, but it's the tactics used to control caloric balance which change.

Consider my strategy of using my daily rate of weight change as my metric for assessment. By itself, it does nothing, but when I introduce a tactic to change my caloric balance, or maintain it there exists a feedback loop between the particular tactic and my overall strategy.

TACTICS change, but the STRATEGY of treating my chronic medical issue as a chronic medical issue -- using the best available metrics for assessment and feedback -- remains constant.
posted by mikelieman at 10:29 AM on June 26, 2013 [3 favorites]

What are the good tools for tracking daily rate of change of weight? That filter out the noise I mean.

The math is built-in to every spreadsheet program. I started with a google docs spreadsheet, really liked one of their visualizations ( a gauge ), so ended up rolling my own which I run on a VPS instance.

There's an overview here, and there's a free signup link on the site's homepage.
posted by mikelieman at 10:35 AM on June 26, 2013

would suggest that the STRATEGY of sustainable weight management doesn't necessarily have to be variable, but it's the tactics used to control caloric balance which change.

Consider my strategy of using my daily rate of weight change as my metric for assessment. By itself, it does nothing, but when I introduce a tactic to change my caloric balance, or maintain it there exists a feedback loop between the particular tactic and my overall strategy.

TACTICS change, but the STRATEGY of treating my chronic medical issue as a chronic medical issue -- using the best available metrics for assessment and feedback -- remains constant.

Ooh, I like the way you've put it. This makes a lot of sense to me. It also allows that my tactics may work temporarily, but that when they fail, it may be because they're no longer serving the strategy. Or it may be that I've lost sight of the strategy. Or something else. But in any case, it's a good way of critiquing the method without losing the goal. Big ups.
posted by grubi at 10:37 AM on June 26, 2013

And someone else's tactics may not be appropriate for you, and your tactics may not be appropriate for others, and may need to change through time. Yeah, you said it better, mikelieman.
posted by Miko at 12:28 PM on June 26, 2013

How Junk Food Can End Obesity
posted by yeoz at 7:50 AM on July 10, 2013 [1 favorite]

Fascinating! Thanks for the link, yeoz.
posted by grubi at 1:03 PM on July 11, 2013

And the riposte: War on Foodies: The hypocrisy behind the Atlantic’s call for better junk food.
posted by Miko at 12:01 PM on July 18, 2013

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Obesity Reclassified as a Disease June 19, 2013 7:00 AM Subscribe

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Obesity Reclassified as a Disease
June 19, 2013 7:00 AM Subscribe