Let me subtitle this blog post as: Excuse me while I jump off a cliff.

Whatever your feelings on the passage of the Health Care Reform Bill this past Sunday (and I have many of them), I read the following in an AP Newswire article this evening:

A requirement tucked into the massive U.S health care bill will make calorie counts impossible for thousands of restaurants to hide and difficult for consumers to ignore. More than 200,000 fast food and other chain restaurants will have to include calorie counts on menus, menu boards and even drive-throughs.

Like I said: excuse me while I jump off a cliff.

My annoyance and irritation at this is mainly related to the fact that all throughout my recovery, my treatment team has drilled into my head that I shouldn't be obsessively counting calories, that my body doesn't need to count calories in order to maintain a healthy weight, and that one meal out is one meal out and if I want to have a burger and fries, I should have the burger and fries. Dammit. So if what my team is telling me is true, then what the hell is this push for calorie labels on everything?

Do I still count calories? In a more existential sort of way, yes. I am acutely, painfully aware of how many calories are in the food I eat. I might not always tally everything up like I used to, but I'm aware. I remain very wary of restaurants because I don't know what's really in the food I'm eating. I don't know how it was prepared, and I don't know exactly how many calories it has or what ingredients were used. Generally speaking, my tactic has been to order the item on the menu that seemed like it had the fewest calories. I'm pretty good at this. It's still my default menu scanning effort- any butter or cream sauces mean "loaded with fat," fried is also bad, sauteed could be dicey, broiled or grilled is okay, pasta and cheese are not good...and on and on it goes.

Yet again, my treatment team has tried to convince me that I don't need to scrutinize the menu for "hidden" calories and the minutiae of how my dish is prepared. Does it sound good? Okay, then.

The idea with placing calorie counts on the menu is that they will (in theory) change what people order. (For the record, research shows that it really hasn't changed ordering habits.) Taking the idea further, the idea is that if people knew how many calories were really in that dinner they ordered, they would order something different. Which, okay, fine, but shouldn't your criteria for what to order include a little more information that just calories? Are we really that stupid that we need to be (ahem) spoon fed our health and calorie information like this?

If some of my friends and relatives are to be believed, this healthcare reform bill may have saved us from dying of TEH FATZ only to help us die of TEH SOCIALISMZ. I'm not necessarily anti-government, but I'm just scratching my head over the wisdom of this idea. Our culture is more obsessed than ever with food and weight, and that hasn't seemed to change our average BMI by very much. And really, if the only reason people were fat was because they were stuffing their gullets with Big Macs at McDonald's, then I think we would have figured that out.

Another issue is that this law is aimed at chain restaurants, which tend to be (on average) cheaper and more affordable than swanky, upscale joints. Research has already shown that the higher your socioeconomic status, the lower your risk of obesity, and a Scientific American article last week pointed out the connection between obesity and food stamp recipients. In a sense, these rules imply that poor people are just too stupid to figure out what (and how much) to eat. Maybe eating fast food is the lack of better alternatives. Maybe it's being too damn tired to cook. Maybe it's all the food your kids know because it's the only restaurant in your area. Regardless, simply adding labels to the menus won't help if there's nowhere else to eat.

I'm just...annoyed. Irritated. And unsure what to make of it all.

Companies that are hawking diets and other weight loss products claim to be interested in your health. Really? They're interested in your wallet. Ditto for "reality shows" that feature competitive weight loss. And there is a growing awareness that these products and programs are futile at best and dangerous at worst.

A great editorial titled "Weight-loss industry masks its economic interests with bogus health concerns," writes about the realities of our thin-is-in culture, with a focus on the new academic field known as fat studies.

For several decades, scholars in the social sciences have shown that when it comes to people’s attitudes about weight in the United State, thin is good and fat is bad. Fat people suffer from harassment and discrimination; thin people live in fear that they will gain weight and lose status...Fat studies scholars ask why we oppress people who are fat and who benefits from that oppression, arguing that weight, like height, is a human characteristic that varies across any population. Fat studies, then, resembles other academic disciplines that question discriminatory practices based on race, ethnicity, gender or age.

Essays like this have helped open my eyes to the fact that most diets really aren't about health, they're a form of status-seeking. And this status-seeking can only exist if larger people are considered second-class citizens. It's no different than discrimination based on gender or skin color.

Of course, there's a lot of money to be made in keeping people as second class citizens, as long as they can strive to become like the "rest" of us. And one of the most onerous examples of this is the show "The Biggest Loser." I've never seen the show and have no real desire to see the show- I've lived it. Basically, the show is based on the notion of "competitive weight loss," and shaming and starving people into losing weight. A great article in the New York Times took a long, hard look at whether this show was endangering the health of the contestants.

The series also highlights the difference between the pursuit of engaging television and the sometimes frenzied efforts of contestants to win, perhaps at the risk of their own health. Doctors, nutritionists and physiologists not affiliated with “The Biggest Loser” express doubt about the program’s regimen of severe caloric restriction and up to six hours a day of strenuous exercise, which cause contestants to sometimes lose more than 15 pounds a week.

At least one other contestant has confessed to using dangerous weight-loss techniques, including self-induced dehydration. On the first episode of the current season, two contestants were sent to the hospital, one by airlift after collapsing from heat stroke during a one-mile race.

{snip}

Medical professionals generally advise against losing more than about two pounds a week. Rapid weight loss can cause many medical problems, including a weakening of the heart muscle, irregular heartbeat and dangerous reductions in potassium and electrolytes.

“I’m waiting for the first person to have a heart attack,” said Dr. Charles Burant, a professor of internal medicine at the University of Michigan Health System director of the Michigan Metabolomics and Obesity Center.

“I have had some patients who want to do the same thing, and I counsel them against it,” Dr. Burant said. “I think the show is so exploitative. They are taking poor people who have severe weight problems whose real focus is trying to win the quarter-million dollars.”

The contestants were also required to sign waivers that said "no warranty, representation or guarantee has been made as to the qualifications or credentials of the medical professionals who examine me or perform any procedures on me in connection with my participation in the series, or their ability to diagnose medical conditions that may affect my fitness to participate in the series."

What perhaps absolutely gobsmacked me (though really isn't that surprising, when you think about it) is how the show essentially muzzles any prior contestants who might criticize the show.

Shortly after a reporter started contacting former contestants to interview them about their experiences, a talent producer on the series sent an e-mail message to many former contestants reminding them that “serious consequences” could ensue if they ever talked to a reporter without the show’s permission.

To do so could subject them to a fine of $100,000 or $1 million, depending on the timing of the interview, according to the e-mail message, which was obtained by The New York Times. The show’s producers did provide an opportunity to interview several former contestants, but the interviews were conducted with an NBC publicist listening in.

I don't know about any of you, but this sure sounds like a cult to me. Each time we watch the show or buy the products, we're encouraging such insanity. And I think it's high time that we stopped.

I was watching NBC earlier today, and there was a preview for the newest season of "The Biggest Loser." The ad copy said something along the lines of "the best of competitive weight loss."

And all I could think was: this has to be one of the most idiotic phrases I've heard.

For what other medical condition (if obesity is, indeed, a real medical condition) do we use competitive treatments? What's next? A chemotherapy competition titled "The Smallest Tumor" where higher and higher doses of chemo are administered in an effort to get the smallest tumor by the end of the show? Will there be oncologists telling the vomiting and balding cancer patients to stop being such babies, and if they want the smallest tumor, they need to suck it up and deal? Or how about a diabetes competition titled "The Lowest Sugar"? You might fall into a coma and die from all that insulin, but it's a small price to pay, right?

This fantastic little tidbit titled "Scare yourself skinny" is almost inconceivably wrong. The blog is about pretty much what it sounds like: how anti-obesity campaigners can use fear to scare people thin. The idea comes from the use of warning labels on cigarette packets. Before the labels, cigarettes were cool and hip. Now, they're cancer sticks. The labels and warnings may very well have prevented me from starting smoking, but I'm not sure they would have been enough to get me to quit. It didn't work that way with my eating disorder, and I don't think it would work that way for smoking or weight.

Still, it's a popular tactic, as evidenced by the recent New York City Health Department campaign in favor of calorie counts on menus and subway posters titled "Pouring on the Pounds." (h/t VoiceinRecovery for pointing out the posters to me several weeks ago). You can even adopt a five pound piece of pet fat to help remind you of that icky icky fat you just don't want to have (all for only $149.95 plus shipping!). I personal prefer the little fuzzy adipose cell at Giant Microbes, and have adopted one myself to remind myself that fat isn't all bad.

There is the minor detail that fat molecules line all of our cells, and help conduct nerve impulses. It makes our hair and nails shiny and healthy. It provides padding against injury and daily wear and tear. It helps keep us warm. It's not all that bad.*

The author of the blog post cited several studies that showed how fear tactics can work to change behavior. And if you were just considering the short-term, I would tend to agree. But even I, Anxiety Freak Extraordinaire, become inured to risk and fear. Serious ED symptoms rapidly stopped frightening me. It was just the way things were. Fear tends not to change things long-term.

There's the small fact that people aren't fat just because they're not scared enough of it. Our culture is awash in this fear. I can't believe that people aren't aware of it. Then there's the fact that some people aren't fat because they drink too much Coke and too little "water, seltzer, or low-fat milk." Some people are just fat, and no amount of fear is going to make them lose weight.

Weight has an environmental element, true. So does height. Where, then, are the articles titled "Scare yourself tall"? Shouldn't you be scared of your decreased salary? Shouldn't you?

(EDITED TO ADD: I just found a great piece in Slate tackling the politics of the "soda tax" called The Growing Ambitions of the Food Police.)

*Yes, I'm trying to convince myself of this, too.

I don't have much to say about this study, as the results kind of speak for themselves:

Common body mass index-associated variants confer risk of extreme obesity

"Our results suggest that [genetic] variants influencing BMI also contribute to severe obesity, a condition at the extreme of the phenotypic spectrum rather than a distinct condition."

So basically, genes have a lot to say about what you weigh. Not that environment has no effect whatsoever; that's not how genes work. But high weight may not be pathological at all. It may just be like being really fair (like me, who wears makeup in the shade of "ghost") or really dark-skinned. There are risks associated with each (skin cancer and rickets, respectively), but the skin color itself is relatively inconsequential.

Same with weight. It exists along a normal distribution, which means that although most people cluster around the average weight, there are people in either extreme. That's just the way the statistics work. Does our current environment of abundant food mean that the "average" weight hasn't shifted a bit? Not necessarily. It might have. But the distribution is the distribution, no matter where you pick "average" to be.

Weight ≠ pathology, obesity ≠ disease.

(h/t Gene Expression)

Once again, the Onion nails it. This time, it was the piece titled "Study: Abstinence-Only Lunch Programs Ineffective At Combating Teen Obesity," which managed to poke fun not only at many of the anti-obesity initiatives, but also at abstinence-only sex ed. And it really drove home the point that food is the new chastity belt.

Some highlights from the article:

"There's no evidence to suggest that instructing teens not to chew, swallow, or even think about food is actually going to stop them from eating," Sebelius told reporters. "Let's face it: Kids are already eating. And not only during lunchtime. They're eating after school, at the mall, in their parents' basements. Pretending like it's not happening isn't going to make it go away."

"After all, they're teenagers," Sebelius continued. "Eating is practically the only thing on their minds."

[snip]

Perhaps more troubling, students who completed the abstinence-only program were reportedly unable to answer the simplest questions about their own digestive systems, and some as old as 17 still believed they could catch high blood pressure from their very first Snickers bar.

"Kids need to know the truth about food," said Sue Weber, a nutritionist. "It's irresponsible for these schools to fill their students with misinformation about the devil working through trans fats, instead of just saying to them, 'Look, I know eating that entire box of Cheez-Its might feel good now, but when you're older, you're going to wish you had gone for the salad.'"

[snip]

"I'm never ever going to eat, because eating is wrong, and I'm worth more than a chicken sandwich with asparagus and rice pilaf," Woodbridge seventh-grader Tracey Holmes said. "I heard Jennifer Hines eats all the time, like 50 times a day. I heard she eats all her ice cream upside-down, though, so she doesn't get fat. That's how it works."

Food and fat have almost replaced sex in our cultural repertoire of Things That Make Women Bad, so the comparison to abstinence-only sex ed is more than spot-on. Thankfully, I'm no longer a teenager (and I have less than one year left in my 20s), so I can't tell you from experience whether this is true or not, but when I was in high school, the big freak-outs were over STDs and teen pregnancy. Certainly things like "healthy eating" were mentioned and discussed, but there were also cupcakes for birthdays and Coke in the vending machines.

Now it seems the obesity epidemic has almost overshadowed all those worries. Maybe in another ten years, we'll find something else to freak out about. In the meantime, read the article and enjoy.

(Image courtesy The Onion)

Via the Academy for Eating Disorders' email listserv, I found out about an upcoming game for PlayStation 3 called "Fat Princess."

From the text of the email:

The purpose of this game is to prevent the princess from being kidnapped by making her too fat to carry. To do so, the characters must navigate through a castle avoiding enemies and obstacles to find cake. They then must bring the cake back to the princess and feed her. When the characters feed her a piece of cake she significantly gains weight (as the announcer in the game preview states, she is no longer her light airy self).

As I am sure is obvious to each of you, the premise of this game sends a myriad of dangerous message to the general public as well as those at risk and suffering from eating disorders and/or body image concerns. It clearly does not promote the notion of size acceptance. Furthermore, advertising for the game has welcomed all sorts of puns such as "Fat Princess Worth the Weight" and "Fat Princess Let Them Eat Cake."

You can watch a brief 30 second trailer of the game below:



It is the longer preview of the game with its accompanying commentary that is the most inappropriate (with the highlights coming at 1:50 or so):



I will be contacting PlayStation directly, and am encouraging you to do so as well.

Sony Computer Entertainment America
Human Resources
919 East Hillsdale Boulevard, 2nd Floor
Foster City, CA 94404

The content of this game is inappropriate, discriminatory, and frankly inaccurate. It sends the wrong message to anyone that a single piece of cake will make you noticeably fatter, and that skipping the cake will turn you back into your "airy self."

So I'm attending my cousin's wedding in NYC, and we get to the hotel early today--early enough that we got lunch in the city as opposed to along the way. We ended up at a national chain restaurant because it was near the hotel, and I sat down and opened my menu, and...

I totally forgot that calorie counts on menus were mandatory within New York City. Totally forgot. At first, I shook my head a little and tried to clear my vision, hoping that it was some mistake or maybe the little numbers just accompanied some of the dishes.

Oh no. Every appetizer, every entree, every sandwich, every dessert, every beverage had a calorie count next to it.

My head started spinning and hasn't stopped, nearly twelve hours later. Numbers swam in front of my face. I didn't look at what the food was- all I could see was calories, calories, everywhere the calories. I don't remember anything on the menu, except what I ordered. Thankfully, I have a meal plan from my dietitian that helped me focus a bit, and I did pick something reasonable.

I struggled the rest of today. All I could think when I ate was "How many calories would be listed on the menu for this? How many calories are in this bite? How about this one?" It's bad enough for the numbers to be buzzing in my head all the time, but to see them in front of my eyes, in black and white, when eating at restaurants is hard to begin with, was a little too much. If my obsession with calories and numbers is supposedly a Bad Thing--and given the effects this obsession has had on my health and my life, I can see how my treatment team might think that--why are there calories on the menu? If calories could turn into a life-threatening obsession for me, couldn't it turn into an obsession for others?

I understand, to some extent, that the purpose of printing calories on menus is intended to be positive, a way to empower people to make better choices. I get that. But all of that empowerment! and knowledge! and health! might not be what goes through people's minds when they order. Even before the ED, I would be self-conscious about ordering something too "high calorie." I would feel guilty. I wouldn't want to call attention to myself. What would the other people think?

Here's the less-than-pretty corollary to the above: I would compare myself to what others ordered. If I ate something "healthy" and they had the cheeseburger and fries, I might very well have felt virtuous that I was "better" than them. I mean if eating a salad is a so-called "good" choice, and eating lots of fries is a "bad" choice, then it would make me "better" because I had the salad. Right?

For the record, I had a sandwich, not a salad. My mom offered to read me the menu choices and/or decide for me, which would have been a good thing had I not already seen the calorie counts by the time my mom figured out that I was silent not out of awe for the spectacular menu choices but that my brain was spinning from all of the calories. By then, the damage was done, and I simply found the first thing where the number didn't totally freak me out, that wasn't on the diet menu, and also fulfilled most of my meal plan requirements. And then I snapped the menu shut and stared off into space.

As I was staring off into space, calorie counts clicking through my head on a frenetic abacus, all I wanted to do was to find the person who first had this bright idea and introduce them to the madness in my head. I want them to understand what it is like to be me. I want them to understand that good intentions can have very bad effects. I want to explain to them that people making "healthier" choices because they feel guilty eating what they want isn't really any better.

Wouldn't someone take about 30 seconds out of their day and think about the "downsides" to this obesity hysteria?

The Obama Administration, it seems, has finally gotten around to picking itself a Surgeon General in the name of Dr. Regina Benjamin. A good chunk of the coverage about her nomination, after Pretty Boy Sanjay Gupta turned the job down, is not about her credentials, or how she runs a non-profit rural family health clinic that was destroyed twice (twice!) by hurricanes. Some mention was made of her as-yet-unclear views on abortion, but a lot of the articles focused on Dr. Benjamin's weight. Dr. Benjamin ain't thin, and people wonder if this "Big Lady" can handle the "Big Job" of scaring people about obesity.

The Surgeon General is the head of the US Public Health Service, and besides putting warning labels on cigarettes and liquor bottles, the Surgeon General plays more of a symbolic role than anything with teeth, and is generally thought to be a spokesperson to advise America on health issues. And you can't mention "health" without mentioning obesity. The general consensus is that Dr. Benjamin had better concern herself with the size of our thighs, and fast, lest our lard take over the world.

Some have responded that President Obama was irresponsible to pick a fat woman to be Surgeon General, that Dr. Benjamin can't give advice on losing weight if she so clearly can't take it herself. One commenter opined that s/he "refuses to let fat become socially acceptable," and believes that Dr. Benjamin's appointment is doing just that.

I wonder if this commenter ever thought about the parallels between refusing to accept Dr. Benjamin's weight and accepting her skin color. Many people would be (rightly) appalled if someone said they were going to refuse to let black become socially acceptable, but they feel absolutely just fine to say it about weight. But they're not prejudiced, you see. Oh no. They're concerned about "health." Well-meaning? Maybe. Prejudiced anyway? You betcha.

One blogger from MSNBC tried to take a swing in support of Dr. Benjamin, but kind of clubbed himself over the head instead. Maybe, he writes, Dr. Benjamin would be really good to get us to Shape Up and Lose Weight because she's fat just like us! Wouldn't more people take her seriously that way? Her size, however, is no excuse for us to declare a truce in the War on Obesity. He writes:

I am not saying we give an inch on the war on blubber. Obesity is an epidemic in the U.S. and growing quickly around the globe.

But people need to relate to the surgeon general, and if she can battle her weight on the job, she will do more to curb obesity then all the salads added to the menus of burger joints everywhere.

Why the need to "battle her weight"? I mean, if you're fighting yourself, you're pretty much bound to lose one way or another. Maybe she will bring some insights to issues such as size prejudice- I hope so. Our culture sure could use it.

To be fair, the MSNBC blogger ends wonderfully:

I don’t know about you, but a doctor who chooses to care selflessly for the poor and who has the respect of her peers as a good clinician is a doctor whom I am willing to listen to — even if she wears a plus-size lab coat.

The NY Times addressed this in a story this week called "When Weight Is the Issue, Doctors Struggle Too," in which a pediatrician muses over how to discuss obesity with children when she isn't exactly svelte herself and finds it hard to take her own advice. I'm not saying that encouraging moderate exercise and fruits and veggies is bad, but maybe the problem is with the advice and not the taking of it. When a diet fails, we blame ourselves. The problem, however, is the diet itself.

I'm fairly certain that Dr. Benjamin will have seen failed diets, and will have seen the connection between socioeconomic class and obesity. Will her own personal experiences give her a unique insight on this? Probably. But this woman is so much more than her size. Positive or negative, it's time to take size out of the picture.

Low blood pressure and orthostatic hypotension (a massive drop in your blood pressure when you go from sitting to standing) frequently accompany eating disorders, and I am no exception to this. A recent letter my dad received from our health insurance company provided such a fantastic cure that I had to share it here:

Step One: Get initial blood pressure reading.

Step Two: Read first paragraph.
"As a valued customer of [Health Insurance Company], we want to inform you of an exciting new contest. [Health Insurance Company] is committed to [this state's] health through our unique mission and believe in supporting healthy lifestyles. That's why we're proud to join forces with [local TV station] and The Parade Company for the Biggest Loser: [Big City] Edition.

Step Three: Repeatedly use four letter words and contemplate ripping letter into small shreds and igniting it on the grill when you make s'mores as part of your new anti-anorexia healthy lifestyle. Your face may turn red- this is a normal side effect of rising blood pressure and should be expected.

Step Four: Read second paragraph.
"The contest is simple. Anyone can enter at [website] by telling us their story and why they want to change their life through healthy weight loss. The deadline to enter is July 24. [Health Insurance Company] and [local TV station] will then select six contestants and track their progress towards a healthier future. One of the six contestants will go on to be named [state's] Biggest Loser, win some great prizes and ride on a float during America's Thanksgiving Parade."

Step Five: Feel face turn from red to crimson. Some veins may emerge, especially on the forehead and neck. Again, this is a normal side effect of increasing blood pressure.

Step Six: Read last paragraph.
"It's about eating well and exercising to lose weight, and [Health Insurance Company] is looking forward to helping people take the first step towards a healthier lifestyle. We encourage you to check out the contest details at [website] and spread the word to your employees."

Step Seven: Get another blood pressure reading. Higher? Congratulations! You've cured your low blood pressure. Now it's time for some matches.

Of course, I would like to send the health insurance company links to educated, informed opinions about the general ineffectiveness of dieting (yes, it's still a diet whether you call it a "lifestyle change" or a "contest") and of the health risks of the Biggest Loser in particular. I would love for them to read in detail about my own former workplace's Big Fat Loser contest and how I wound up quitting to save what little sanity remained after being inundated with posters tallying people's weight loss and signs saying "Nothing tastes as good as thin feels."

I would also really REALLY like this Health Insurance Company to know that there are many different aspects to a healthy lifestyle, such as, I don't know, not having an eating disorder. The jury is still out as to whether obesity significantly raises mortality risk; it's not for eating disorders. A girl with anorexia is ten times more likely to die in the following year than a classmate without anorexia. This is the same douchebag insurance company that refused to cover a DIME of my last residential treatment stay because they said it "wasn't medically necessary" or that the facility I went to wasn't in-network. It depends on which denial letter you read, but the results are still the same. Never mind, of course, that I was in and out of the ER several times a week with hypokalemia, was in ketosis, had irregular EKGs, and was underweight and still dropping rapidly.

Committed to healthy lifestyles, my anorexic ass. They're committed to paying out as little money as they possibly can, and they think that by supporting crash dieting, they will save money in the long run and look good in the short run.

Have I cured your low blood pressure, too? Writing this sure cured mine!

I saw this link on Tiptoe's blog and let me just say: I love it, I love it, I love it!

This should be required reading for any health journalist who uses the letters "BMI" in a story--which is basically all of them.

In its entirety (because it's just that good) is the "Top 10 Reasons Why the BMI is Bogus":

1. The person who dreamed up the BMI said explicitly that it could not and should not be used to indicate the level of fatness in an individual.

The BMI was introduced in the early 19th century by a Belgian named Lambert Adolphe Jacques Quetelet. He was a mathematician, not a physician. He produced the formula to give a quick and easy way to measure the degree of obesity of the general population to assist the government in allocating resources. In other words, it is a 200-year-old hack.

2. It is scientifically nonsensical.

There is no physiological reason to square a person's height (Quetelet had to square the height to get a formula that matched the overall data. If you can't fix the data, rig the formula!). Moreover, it ignores waist size, which is a clear indicator of obesity level.

3. It is physiologically wrong.

It makes no allowance for the relative proportions of bone, muscle and fat in the body. But bone is denser than muscle and twice as dense as fat, so a person with strong bones, good muscle tone and low fat will have a high BMI. Thus, athletes and fit, health-conscious movie stars who work out a lot tend to find themselves classified as overweight or even obese.

4. It gets the logic wrong.

The CDC says on its Web site that "the BMI is a reliable indicator of body fatness for people." This is a fundamental error of logic. For example, if I tell you my birthday present is a bicycle, you can conclude that my present has wheels. That's correct logic. But it does not work the other way round. If I tell you my birthday present has wheels, you cannot conclude I got a bicycle. I could have received a car. Because of how Quetelet came up with it, if a person is fat or obese, he or she will have a high BMI. But as with my birthday present, it doesn't work the other way round. A high BMI does not mean an individual is even overweight, let alone obese. It could mean the person is fit and healthy, with very little fat.

5. It's bad statistics.

Because the majority of people today (and in Quetelet's time) lead fairly sedentary lives and are not particularly active, the formula tacitly assumes low muscle mass and high relative fat content. It applies moderately well when applied to such people because it was formulated by focusing on them. But it gives exactly the wrong answer for a large and significant section of the population, namely the lean, fit and healthy. Quetelet is also the person who came up with the idea of "the average man." That's a useful concept, but if you try to apply it to any one person, you come up with the absurdity of a person with 2.4 children. Averages measure entire populations and often don't apply to individuals.

6. It is lying by scientific authority.

Because the BMI is a single number between 1 and 100 (like a percentage) that comes from a mathematical formula, it carries an air of scientific authority. But it is mathematical snake oil.

7. It suggests there are distinct categories of underweight, ideal, overweight and obese, with sharp boundaries that hinge on a decimal place.

That's total nonsense.

8. It makes the more cynical members of society suspect that the medical insurance industry lobbies for the continued use of the BMI to keep their profits high.

Insurance companies sometimes charge higher premiums for people with a high BMI. Among such people are all those fit individuals with good bone and muscle and little fat, who will live long, healthy lives during which they will have to pay those greater premiums.

9. Continued reliance on the BMI means doctors don't feel the need to use one of the more scientifically sound methods that are available to measure obesity levels.

Those alternatives cost a little bit more, but they give far more reliable results.

10. It embarrasses the U.S.

It is embarrassing for one of the most scientifically, technologically and medicinally advanced nations in the world to base advice on how to prevent one of the leading causes of poor health and premature death (obesity) on a 200-year-old numerical hack developed by a mathematician who was not even an expert in what little was known about the human body back then.

Note: if you click on the story link, you can listen to the NPR segment as well.

I didn't think MeMe Roth could get any worse. I really truly didn't. This is, after all, a woman who threw away children's ice cream toppings. But besides the alarming visual similarities to conservative shrill Ann Coulter, MeMe Roth now has a bunch more verbal ammunition to make the similarities known.

This little piece in Jezebel (h/t Libby) absolutely blew me over: Anti-Obesity Activist MeMe Roth Compares Eating to Rape

Roth says:

The defense has been made in the case of sex criminals that there is pleasure on the part of the victim. The same is true with what we're doing with food. We may abuse our bodies with food, but it's incredibly pleasurable. From a food marketer's point of view, when your quote unquote victim is so willing and enjoying of the process, who's fighting back?

Yes, you read it right. When a fat person eats, Roth thinks they are effectively raping themselves. So if I tell her go to f*ck herself, is that like asking her to lick her elbow?

The Jezebel piece is actually an excerpt from an article in the British newspaper The Guardian titled "The Woman Who Hates Food," which I think is an interesting choice of headlines. I don't know if Roth hates food, but she does hate people who eat food. Which is basically everyone, including (considering she's still alive) herself.

Though Roth protests she's never been anorexic, she has some decidedly unhealthy attitudes toward food. She insisted on meeting interviewer Gabby Wood "after lunch," whereupon the following dialogue ensued after Wood asked Roth what she actually ate:

She squirms visibly. "You're taking me where I don't want to go ... What works for me doesn't work for a lot of people."

Well, you've said that, I insist, so taking that into account: lunch? Roth hesitates. "I discovered when I was in college that I work best when I get a workout in and eat after that. Sometimes I'll delay when I eat until I get a workout in. But I don't let a whole day go by without running four miles."

OK, I go on, but supposing you couldn't work out until four o'clock in the afternoon - would you not eat until after that?

"I might."

I look at my watch. It's 3.30pm. Alarm bells start to ring in my head. How about today, I ask. Have you eaten at all today?

Roth is a little quiet.

"No," she says.

There is a pause.

"But I feel great!"

In the end, Anna N* at Jezebel says it best in her article:

Roth may not be anorexic, and she may not think of what she does as dieting, but if "what works for her" is not eating anything until after 3:30, she's right that it's not going to work for most people. Nor should it. To liken the pleasure one gets from food to something as toxic as sexual assault isn't just illogical and insensitive — it also demonizes something that nourishes, brings people together, and produces some of the greatest and most uncomplicated joy in life. Rather than accept food for what it is — something that, like many good things, is wonderful in moderation and problematic in excess — Roth wants people to think of it as some kind of evil rapist who will make us fat and therefore shameful. It's a judgmental, unhealthy, and ultimately unsustainable way to live.

*Who linked to my piece on Daphne Merkin's story on depression last week and sent about a bazillion people my way- thanks!

With the never-ending dangers of obesity seemingly appearing around every corner, coupled with an encouragement of dieting and unrealistic looking celebrities, I'm almost astonished that anyone has an accurate view of what they look like anymore. For teens especially, when notions of self are forming yet still so fragile, self-perception can easily become distorted. And this body image distortion can be very dangerous.

A new study found that teens who think they're overweight (regardless of their actual weight) are much more likely to report suicidal behaviors than those teens who thought they were of normal weight. This effect was effectively limited to females, which doesn't really surprise me as women have always been first in line for diet/weight/health/appearance invectives from society at large.

The study revealed that body dissatisfaction had a strong impact on all suicidal behaviors for girls and was generally insignificant for males. For instance, any perception of being overweight by girls raised the probability of suicidal thoughts by 5.6 percent, the probability of a suicide attempts by 3.2 percent, and the probability of an injury causing suicide attempts by 0.6 percent...

"The prevalence of body dissatisfaction, among special populations of youths such as non-black girls, is significantly higher than the general youth population, even when the underlying weight is in a healthy range," Inas Rashad, an assistant professor of economics at Georgia State University, said. "Interventions that identify and assist these youths and educate them regarding a healthy body image will succeed in lowering suicide attempts."

My problem is with Rashad's statement that "the risk of suicide by adolescent females could potentially add about $280 to $350 million to the costs of adolescent obesity, which includes the direct cost of illnesses and associated health care and indirect costs such as productivity losses, reduced income and premature mortality" is wrong on so many levels. Adolescent obesity isn't the issue here, it's the distorted body image that is being fostered by obesity prevention programs.

I'm not going to hold anti-obesity programming solely responsible for distorted body image among teenagers- that's too simplistic, and body image issues have been around long before the health/weight zeitgeist of the previous several decades. But clearly, it's not helping. If you're going to promote healthy body image, telling a teen that she can only have good body image if she conforms to certain standards essentially defeats the purpose.

I do support programming that helps kids move around for fun and eat a wide array of foods, but let's take the "weight" aspect out of the equation, shall we? I don't think it's helping.

Those of you who have been reading this blog from the beginning know firsthand of what happened when I returned to work after a six week leave for severe depression and anorexia and stumbled upon a workplace weight loss contest. For several months (until I quit in protest), I lived with calories, fat grams and sugar grams labeled on the coffee creamers, having the bowl of chocolates I kept on my desk forcibly removed (by vote no less! And might I add that I did not get to vote in this Survivor-esque "election"), and as much food/weight chatter going on outside my head as there was inside. Charts of pounds lost hung in the break room, but I did succeed in having those removed. I also removed the label on the coffee creamer, but the damn thing kept reappearing. And I kept removing it.

Keep in mind, I worked at a health department, who really should know that rapid weight loss is the least likely to be maintained. And these contests are only becoming more popular, not the least thanks to the popular show "The Biggest Loser."

But nowhere in the NY Times coverage was any dangers of losing too much weight, even when one of the men interviewed said that he went a little overboard. The article said this:

“I wanted to win, and I blew everyone away,” said Christopher Fallon, 36, a medical sales representative from West Orange, N.J. Mr. Fallon participated in a three-month diet bet with nine other colleagues, everyone contributing $100 to a winner-take-all pool. At a sales meeting a few weeks before the end of the bet, Mr. Fallon’s fellow bettors realized that he was way ahead.

“When I saw Chris at the gym at 6 a.m. looking skeletal, I knew it was over for me,” said one colleague, Carolyn Kramaritsch.

Mr. Fallon admitted that he enjoyed vanquishing his peers even more than losing the pounds. “I didn’t even need to lose much weight,” he said, “but when I saw everyone else, I thought, ‘I just won $900!’ ”

And that won't even pay for one day of inpatient or residential treatment for an eating disorder, so Mr. Fallon was lucky, indeed.

Why won't anyone say how dangerous this is? No one appeared remotely concerned that this man lost too much weight, just that they might lose their bet. Raise your hand if this makes you proud of humanity... I can't tell you how many stories I've heard from men and women with eating disorders whose illness was triggered by a pact to lose weight or eat healthier. Yet dieting and exercise are treated as if they are fail safe and no ill can possibly come from a group of people trying to see who can lose the most weight. People on pro-anorexia sites do this, and people judge these "silly girls" who are no different from anyone else. It's not healthy, period.

“It makes life easier if everyone around you is cutting calories, and the amicable competition keeps people driven. You are less likely to eat bad things from the candy jar,” says nutritionist Joy Bauer.

Yeah, except if you're the person who realizes that dieting is a) futile, b) stupid, and c) not likely to increase your health in the long run and then you realize you are completely shut out of this. To me, that was the worst part of the workplace diet bonanza: I had nothing to discuss with my co-workers. All they would talk about was food, weight, and exercise, and I couldn't or wouldn't participate. I was totally isolated and desperately lonely in a time when I really needed the support.

Nor does this "diet betting" address the really sticky issue of weight loss: how to keep it off. Figuring out how to lose weight has proven much easier than figuring out how to keep it off. A lot of it is, I'm guessing, the body defending its set point weight. But even if it weren't the case, a crash diet is unlikely to involve real and lasting weight loss and even less likely to make you healthier.

You just never read about that.

As a science writer, a variety of press releases on the latest research--from physics to neuroscience--cross my desk each day. But when I saw a press release for the following article, I knew that media outlets around the world were going to have a field day:

Evidence of gender differences in the ability to inhibit brain activation elicited by food stimulation

More than the study, what interested me was how the subject was going to be twisted by desperate reporters the world over. They did not disappoint.

The study itself was based on PET scans of the brains of 23 "normal-weight" individuals who fasted and

then either focused on a favorite food or used a technique called cognitive inhibition to suppress thoughts of hunger and eating. When the subjects focused on their favorite food, the hunger and desire for food increased at a similar rate in both sexes, as shown in brain scans using positron emission tomography (PET). Although cognitive inhibition decreased hunger in both sexes, the technique significantly lowered desire for food only in men. PET brain scans showed that men using cognitive inhibition techniques showed a decrease in brain activation in the regions involved in emotional regulation, conditioning, and motivation. These regions are known to play a role in processing the conscious awareness of the drive to eat.
(from the original press release)*

The headlines, however, told a very different story. Some of the top ones?

Hunger Control: Women the Weaker Sex? (WebMD)
Why Saying No to Foods May Be Harder for Women (Washington Post)
The secret of successful dieting is in your gender (The Independent, UK)
Women Can’t Say No to Their Favourite Food! (eFlux Media)
Women No Good At Resisting Food Temptations: Study (E Canada Now)
Weak-willed women give in to food cravings (Healthcare Republic)
Why Men Are Better Dieters Than Women (Time)
Revealed: Why women find it so hard to diet (Marie Claire UK)

Appalling doesn't even begin to cover the implicit assumptions in the headlines (Women have out of control appetites that must be curbed! Women are weak! Women have no willpower!), nor do they really reflect the content in the paper. Scientific American had a pretty decent summary (and non-offensive headline!), and even looked at the study's limitations, such as a small number of subjects and that the subjects were not actually given the choice whether or not to eat- they were just asked to convince themselves they weren't hungry. And there are plenty of limitations of brain imaging studies, though they also yield fantastic information.

Blogger Sandy Szwarc of Junkfood Science has written several times on the dangers of science by press release. I don't think press releases are going to go away. Most newspapers don't have a science section and fewer still have any health reporters- the Washington Post doesn't. They borrow from other sections for their stories. And most writers don't have the time or expertise to plow through the thousands of research journals out there. However, they should know better than to parrot a study's grand claims without further investigations (wouldn't happen in any other field).

*The original press release isn't openly available online, but if you're really interested, I have a copy saved on my desktop. And please, for my privacy, if you know how I stumbled across this information, please don't mention it in the comments. I'm a professional science writer- 'nuff said.

Now that the holidays are essentially over, Diet Season is officially open. Considering that weight loss is the most common New Year's resolution, we can look forward to being inundated with the following:

• ridiculously expensive fitness equipment
• diet programs galore
• ridiculously expensive diet food
• gym memberships
• weight loss articles galore
• how we're all fat and going to die* of obesity

I hate this time of year. And given our current culture, it's not going to get any better anytime soon. The worst part is that it's almost impossible to escape it. No matter what I do or where I go, the diet mentality follows me. I don't want to be a part of this, but I don't know how NOT to. I try to stay away from it as much as possible, but even just reading the "Health" section of the New York Times, there's almost always an article on weight loss/obesity/fitness. Nutrition is more about weight loss than nourishing your body properly.

Honestly, as much as I preach about it on my blog, I still feel incredible guilt when I buy "junk" or "snack" foods, or items that are full-fat. I get that my recovery means I have odd caloric needs, and that these foods are healthy for me. I also get that these foods aren't inherently unhealthy. Yet at this same time, that mentality is SO PREVALENT that it still worms its way into my brain.

I worry what the other shoppers in the supermarket must thing as they look at my cart: are they judging me? They must be. I have too much food, not the "right" foods, not "healthy enough" foods. And the stupid checkout boy. He sees so much food, so many choices. How do mine stack up? Can I do better? Yes. Yes, I can do better. I must.

It really screws with my head, and I don't know what to do about it.

*I initially typed "diet of obesity" which is almost certainly true.

Let the statistics tell the story:

What's worse, being obese or suffering from anorexia nervosa? People we asked on the street responded "being obese."

But that's not true.

Medically, more people die from anorexia: 20% of people die from the psychological disorder where as an obese woman at 25 still only has a .01% risk of death.

And there's all of this hysteria about obesity and not a whole hell of a lot about eating disorders, which really makes me scratch my head. You're 2000 times more likely to die from anorexia than obesity. An eating disorder triggered by misguided "obesity prevention" efforts isn't a side effect, it's not an acceptable casualty.

It's deadly.

I write more than my fair share of headlines, between my blog, my job, and my freelance work. Yet the real news seemed buried in this little item.

Obesity is a family affair

I clicked on this headline with a bit of trepidation, and learned that yes, a child's weight is linked to their parents via genetics, but also via lifestyle. Which isn't really all that shocking. Any physical trait (known as a phenotype) has input from both genes and the environment, and weight is no different. Neither is height. The study was published in the American Journal of Sociology and you can read the abstract here.

The story was typical of the hysterical reporting on obesity that parents are going to kill their kids of TEH FATZ because Mom and Dad didn't go for a jog every evening. The two largest environmental factors affecting a child's weight was time spent watching TV/video games and number of meals eaten per week.

Whether or not a family regularly skipped meals had a large (sorry!) impact on a child's weight. The more skipped meals, the higher the child's weight. Author Molly Martin had this to say in the news story:

She said there are multiple reasons that children miss or skip meals. One is that the family may simply not have the resources to have three square meals a day, she said. Another is hectic family lifestyle, where the family could be missing a meal because they just don't have the time. Or, for some teens, they may be deliberately skipping meals in a misguided attempt to lose weight.

Whatever the reason, Martin said that when you miss a meal, you'll likely end up hungrier later and may overeat then.

"I think the importance of family meals is something that should be underscored," added Andrea Vazzana, clinical coordinator of the pediatric weight management program at the New York University Child Study Center in New York City.

"Kids that sit down with their family tend to have a more normal weight. Parents can provide structure for the meal, and the meal tends to be more well-balanced. Parents can also set limits around food," explained Vazzana, who added that when parents eat with their kids they can let them know that it's not a good idea to have two helpings of dessert first and then forgo the vegetables.

I just wish this portion had been highlighted more. But the Health Day article was the only one that even gave the importance of meals more than a passing mention. Of all of the media emphasis on "lifestyle factors" in regards to obesity, they could have started out with the importance of regular meals, rather than everything else.

I'm just doubtful that most people will hear about this and pick up on it.

I stumbled across an article yesterday that asked "Are we feeding a fear of fat?"

All I can say is: damn skippy we are.

Far more than freaky thin models (which most people can see as unrealistic, even if they want to look that way), the hysteria over obesity and fat is triggering eating disorders. And the really scary part is that so few people can really see it.

"What's wrong with encouraging a healthy diet and exercise?" people might ask. Well, nothing in particular, but it's the type of diet and exercise that's being encouraged, along with the premise that there's no such thing as too few calories and too much exercise and too many pounds lost.

Kids are being caught in the crossfire, internalizing these messages of fat=bad and thin=good, of dieting=morality and overweight=sinful, of exercise and lettuce being virtuous and relaxation being slothful. Nowhere in these messages are the dangers of malnutrition, the problems of the female athlete triad. Many anti-obesity activists seem quite willing to tolerate a few triggered eating disorders in the name of obliterating fat from the landscape. It's tragic, they say, but obesity is such a pressing problem that it's a necessary evil.

From the Times Online article:

At a recent conference of the British Dietetic Association, Claire Mellors, a dietitian in childhood and adolescent eating disorders for the Nottinghamshire Healthcare Trust, described how “a real fear of obesity is an emerging and worrying trend” that is causing a dramatic rise in the number of children with eating disorders. “From my clinical experience I would say that as healthy living messages have become more prevalent, there has been a corresponding rise in referrals for children with disordered eating,” Mellors says. “We have no hard facts to back this up yet, but it is clearly happening.”

It is difficult to escape the bombardment of public campaigns that encourage children to lead more active lifestyles. From schools to supermarkets and from cereal packets to chocolate wrappers, the overwhelming message is that being fat is bad - very bad - while being thin is all things admirable and good. At the checkout in Sainsbury's you are handed vouchers for its Active Kids campaign, designed to combat obesity, and the chain also has teams of food advisers to deliver dietary advice in schools...

...But, for all their good intentions, these and other campaigns have become so pervasive in society that they have prompted a worrying shift in perspective about weight and exercise. Whereas it was once an integral part of daily life for children, physical activity is now billed as a means to an end, that end being slimness and a low BMI. To anyone who grew up in the 1970s or 1980s, compartmentalising exercise into periodic bouts of sweaty effort is something alien. Back then, being fit, even being fat, was not a concept that readily entered the conscience of a child of school age.

Like I said, the scariest part of this hysteria is how rational it seems- to people with eating disorders and the people who love them. Being obsessed with food and weight is normal, so spotting an eating disorder can be difficult. Where do you draw the line?

And what is the next generation going to be like?