Whatever happened to the characters in the PBS documentary, “Fat: What No One Is Telling You,” that I wrote about here and here?
By the end of the film, the 300-pound 18-year-old who I described in part 1 had his bariatric surgery and, to his delight, lost 147 pounds. “I’m a whole human less in weight,” he exulted. Indeed, he had lost the equivalent of his skinny twin’s total weight. (It’s worth noting that this surgery is recommended only as a last resort. And even then, a patient should make sure that his physician is an experienced bariatric surgeon who has performed many operations. The risks are real—and harrowing. Nevertheless, for this young man, the procedure was a huge success.)
What about the former tomboy who gained 125 pounds after becoming an executive at Microsoft? Humiliated when she spilled out of her airplane seat—and onto her fellow passengers—and frustrated that she could no longer participate in the sports she loved, she became even more depressed when she had difficulty getting pregnant.
That’s when she and her over-sized husband signed up for a comprehensive program that includes doctors, nutritionists, and trainers.
They also purchased health cook books, determined to learn how to cook foods that had been foreign to their diet—such as chicken.
By the time the film was completed, they were still exercising, and dieting—though they hadn’t lost much weight. As I explained in part 2 of this post, many obese people find it all but impossible to lose weight—and keep it off. Their body fights every attempt to shed pounds as neurological signals flowing from their gut to their brain overrides their conscious will. Thanks to genes that we are only beginning to understand, they are “hard-wired” to maintain a certain weight.
This is what makes obesity a chronic disease—and a life-long struggle. Nevertheless, this couple wasn’t giving up. “You just have to keep on falling off the horse, and getting back on,” said the former athlete. And recognizing this fact is half the battle. (In part 1 of this post, I quoted a viewer who reviewed “Fat” on Amazon, saying that “It allowed me to see the issue not in terms of will power and laziness [as is all too common in popular culture as well as years of medical haranguing] but in terms of physical compulsion akin to and even surpassing opiate addiction…You'd think that learning exactly how hard it is, really, to lose weight would be discouraging, but it was exactly the opposite. After years of people, including my doctor and nutritionist, breezily tossing off advice and plans of action, I finally learned what I was up against. Then I declared war on it.”
For the couple in the film, the good news is that, by the end, they were finally pregnant. The delighted mother-to-be expressed her determination to try to remain as healthy as possible. Having a child will, no
doubt, motivate her to keep on exercising.
And when it comes to better health, exercise may well be much more important than trying to achieve the svelte figure that society holds in such high esteem. A U.K. study presented at the Society of Behavioural Medicine Scientific Meeting in Cambridge in 200 tells the tale.
The year-long study of 62 women ages 24 to 55 encouraged them not to diet but to take part in exercise classes. They were required to do four hours a week of exercise such as tai chi, aqua aerobics or circuit classes. The program also included educational sessions teaching the women how to read food labels as well as behavioral therapy to help the women respond to body cues such as hunger and feeling full. But the women were encouraged to eat whatever they wanted in moderation.
The women who took part in the study all had a Body Mass Index (BMI) over 30, which is classed as clinically obese. After a year, the average participant had lost very little weight. But the women were significantly fitter and happier with themselves.
Blood pressure, heart rate and cholesterol fell and respiratory fitness increased. Women also felt better in terms of general well-being, body image, self-perception and stress.
“People of all sizes and shapes can reduce the risk of poor health by adopting a healthier lifestyle,” Dr Erika Borkoles, exercise psychologist at Leeds Metropolitan University told the BBC. “Health care professionals need to shift their focus from weight loss to helping their patients improve their health.”
"What is important is that we don't set people up for failure,” she added referring to the fact that 95% of obese people who enter a medically supervised weight-loss program either don’t lose weight, or re-gain whatever pounds they lost. (See part 2 of this post).
Dr. Borkoles said the program, which has been set up with Leeds City Council, gave the women discounts to continue exercise classes after the 12-month project finished.
Dr. David Haslam, clinical director of the National Obesity Forum, confirmed the study’s findings: "It is quite well known that you can improve your lifestyle and reduce your risk of cancer, stroke and heart disease. You can improve fitness without losing weight as you can gain muscle and lose fat and weigh the same or even gain weight.”
But he disagreed about “shifting focus” from weight loss to exercise. “It's important to think across the board.”
Nevertheless, for those who cannot lose weight, “Exercise without weight loss is an effective strategy for obesity reduction” according to a study published in the Journal of Applied Physiology in 2005.”
What exactly does “obesity reduction without weight loss” mean? The obese men who participated in aerobic exercise, five times per week for 60 min, did not shed pounds. The study was designed to make sure that they wouldn’t: “To allow us to test the hypothesis that significant obesity reduction could occur despite the absence of change in body weight, all subjects were asked to maintain body weight, and they consumed the calories required to compensate for the energy expended during the exercise sessions,” the researchers explain.
Nevertheless, both the obese men and the control group of lean men who participated in the study watched their waist circumference shrink. Cardio-respiratory fitness increased in both groups, as did skeletal muscle with total fat was reduced.
These changes were roughly equal in both groups. But when it came time to measure abdominal fat, reductions in the obese group were significantly greater.
The researchers acknowledge that the levels of fat loss observed in this study are less than those generally observed in response to exercise-induced weight loss which includes dieting.
“This reinforces current guidelines [that a combination of exercise and eating fewer calories] is the principal therapy for overweight and obese individuals. . .” they observed. “However, the findings here extend these guidelines and provide substantial support for the recommendation that exercise without weight loss represents another strategy for obesity reduction.
“This is good news,” they conclude, “and may be used to encourage and counsel those who appear
resistant to substantial weight loss despite considerable effort. Stated differently, health care professionals should recognize that exercise without weight loss is not a failure when obesity reduction is the desired outcome. To the contrary, combined with the knowledge that exercise is associated with substantial health benefits independent of obesity exercise without weight loss is a useful strategy for reducing obesity and related co-morbid conditions: a win-win scenario.”
I would add only that our obsession with whether or not people meet cultural norms for beauty—rather than whether they are happy and healthy—fuels the prejudice against obesity that can make even physicians cruel when their patients fail to lose weight. As the public health nurse in “Fat” observes: “These are free-range fat people, just trying to do their best in a culture that hates them.”
So at the end of “Fat,” we return to the charismatic redhead who we saw at the beginning, puffing away on a treadmill. She was perspiring, but smiling gamely into the camera. “It’s not an average work-out, but I wasn’t an average weight,” she explains. “I have to do above and beyond what any of you guys would have to do. I have to try twice as hard, sometimes three times as hard—just to maintain this level of…chubbiness.” In fact, while she is attractive, probably most doctors would say that she is overweight—even though she watches what she eats, and exercises three hours a day.
As the film closes, she’s still on the treadmill, mopping her brow with a towel. “Sometimes I wonder, why the hell am I doing this to myself?” she confesses.
“Can’t I just be happy with who I am?” She explains that part of the exercises so relentlessly is “for my
career. I’m in TV –I have to look good. And so I associate myself with the number I see on the scale. I don’t know of that’s right or wrong, but it just is.”
She blames herself. “How can I ever be happy unless I can control what I put in my mouth?” she asks. “On the inside, I may feel like I’m a good person. But what people see from the outside—It stops people.”
I’m really not trying to be combative, but in Part I, it seemed you reacted negatively to the notion that over-eating could be likened to addiction, and now you’re quoting someone as saying it’s a compulsion similar to but stronger than opiate addiction.
Also, after reading all 3 parts of the series, I still don’t understand how it is that if our bodies want us to be certain weights, obesity would be such a worse problem today than it was 30 years ago. If it’s just the plentiful availability of junk food/fast food/processed food, it seems like abstaining from those foods would go a long way towards 1970s era weight levels as opposed to 2000s levels.
Has obesity become more prevalent since the ’70s or is that a myth?
There is appeal to the idea of “obesity reduction without weight loss”
Yet-I am eager to attack America’s obsession with body image(especially the need to be thin).And yet, at the same time, we need to also especially intervene with our growing epidemic of obese US children.
No simple answers here.
But this is a topic worth many more keystrokes and $ for good “uncontaminated” research.
Dr. Rick Lippin
Southampton,Pa
This movie was a paid promotional by vested interests in obesity, not credible medical research. Participating in marketing misinformation does more than discredit a medical writer, it jeopardizes lives.
Mike C–
First, don’t worry about being combative. (I only mind when people or rude,
or condescending.)
You are asking perfectly sensible questions in a perfectly civil way.
The number of overweight people (distinct from ‘obese people’) is definitely on the rise.
That could be attributed to abundant cheap junk food, sedentary lifestyles (computers, video games) and the fact that overly-protective parents (IMHO) drive their kids to school, and don’t seem to encourage them to bike around their suburban neigborhoods, play out in front of their homes, etc.
Maybe the kids don’t want to be outdoors. But I also have the impression that parents are more fearful–more concerned about the kids getting hurt.
But that doesn’t answer the question as to whether obesity is on the rise. By obesity we usually mean something like average-height women over 200 pounds, average-height men over 250–with a high proportion of that weight fat, not muscle. (I’m making those numbers up, but I think they’re in the ballpark.)
The media suggests that obesity is up too–though I’m not sure by how much. (And the media tends to blur the line between obesity and being overweight).
One reason obesity is likely to be up is because poor people now can “fill up” for just $4.
It’s hard to believe, but McDonald’s, the mother of fast-food restaurants, wasn’t widespread in teh U.S. until sometime in the late 1960s/ 1970s.
The first restaurant opened in 1940, but the franchise chain of restaurants that Ray Krok
invented didn’t start until 1955. “McDonald’s topped all previous construction records in 1963 by building 110 stores scattered all over the country. 1964 was a good year with 637 stores and was getting ready to go public . . .” (from a history of McDonalds)
My guess is that you didn’t have tens of thousands of McDonalds and other fast-food outlets all over the country–in inner-city ghettos and more remote rural areas where the poor live until the very late 1960s, or 1970s.
The other change is demographic: a larger percentage of the country is non-Caucasian, and among many Latino and Carribean cultures– as well as some African-Americans–body types, and
what is considered attractive–are different.
Cultural differences in diet (more rice and beans, for example) also contribute.
We know that Caribbean women and Irish men are among the most at risk for obesity on the blog, (The Irish also went through famines that would have led to the “thrifty gene”.
And even when there was enough to eat, many Irish people liked to have potatoes with every meal, just as many Latinos like rice and beans.)
And there are probably genetic factors involved.
Is a Latina woman who weighs more–but gets lots of exercise as a nurse in a busy hospital ER—-less healthy than a Caucasian woman who weighs 50 pounds less, but has an office job? My guess is that the answer is “no.” (see part 3)
Bottom line: The incidence of obesity has probably risen, but neither I nor anyone else is sure why. (Obesity remains a complex mysterious disease.)
Moreover, consider this: As Dr. Nortin Halder points out in Worried Sick, while the incidence of obesity seems to be on the rise–to the point that we are talking about an “epidemic.” At the same time, Americans are living longer. This, Hadler says,
“should create a certain amount of ocgnitive dissonance.”
This could be because there are, as John Edwards suggested, there are “Two Americas”–the haves and the have nots.
We have numbers showing that “obestiy” is higher in states where incomes are lower. So maybe more poor Americans are becoming obese, while wealthier Americans are living longer. (We know more affluent Americans live longer, for a cluster of reasons.)
Finally, you’re right, I avoided saying that obese people are “addicted to food” in part 1 because, while their bodies may “compel” them to eat, this is not a simple addiction like being addicted to nicotine.
With a nictone patch, you can fairly easily kick the habit, if you want ot. (It’s painful, but thousands of people do it all of the time.)
When it comes to obesity, your body is fighting you tooth and nail. This is not a simple addiction.
Also, I avoid
“addiction” becuase it carries the connotation of “dirty habit that you could kick if you wanted to.”
Obese people are not simply gluttons. There is a lot more going on.
Rene:
Pretty strong words — got any data? Usually PBS is a reliable source for information like this. In this particular case, both the producer and the director have won Emmy Awards in the past.
Rene–
I would be very interested in how any company (or group) has a “vested interest” in obesity.
Since I know the director and assitant director of this film very well, I would be very, very surprised if this were true. (The director is someone who regularly works with Bill Moyers–hardly somoeone who takes money from ‘vested interests.’)
I’m sending this charge along to the director.
Yeah, addiction is a loaded word. I remember comparing domestic violence to addiction (because of the similarity in build up of anxiety, the addictive event be it battering or drinking or whatever, then a promise to do better next time, then the build-up of anxiety) and that caused a stir because those people had a view of addiction as being something that “wasn’t the addicts’ fault”. All addiction means is that there are certain emotional and/or chemical attachments to a substance that provides compulsion towards the substance and guilt is often associated with use of the substance. I think a lot of obese and overweight people have that kind of relationship with food.
Anyway…. just like porn addiction has exploded in the past 10 years due to the easy availability of free anonymous porn online, it stands to reason that the easy availability of food for cheap would lead to an explosion in food addiction. But if you don’t understand your particular relationship with food it can be very difficult to break the cycle. That’s where I think a cognitive/behavioral approach to weight loss can or should be helpful.
“Obese people are not simply gluttons. There is a lot more going on” says Maggie Mahar below
THANK YOU MAGGIE! YOU SURE GOT THAT ONE RIGHT!
Dr. Rick Lippin
Southampton,Pa
Your work is marvelous!!
Thanks for this very informative series of blog posts … I hate to admit it, but I didn’t fully understand people who were “heavier” than I was. Giving foolish advice such as, “lose weight” always seemed futile, and here I was not realizing that I didn’t know what I was talking about.
It’s my first to be here in your blog and I had a great time reading your posts. Hope to see more updates from you.
Suzy,Larry, Rick and Mike C–
Good to hear from you.
Suzy — Welcome. And thank you for the kind words.
Larry–
You are wonderfully honest, and I’m glad to be of help.
I didn’t know most of this myself until I saw the film and then did some research.
The cultural prejudice against obese people really gets in the way of
spreading good information.
Rick– As always, thanks.
Mike C–
I agree that a behavioral/congnitive approach can cetainly work with many overweight people.
The truly obese (people who weight 250, 300 pounds and up)are much harder to help with these methods. That’s really what I’m writing about in these posts.
But clearly some do it: there are the 5% of truly obese patients who actually take it off and are able to keep it off.
Your comparison of domestic violence to addition sems to me a good one– the build-up, the guilt afterward, and the compulsion.
Chris–
Thanks, as always, for the wonderful back-up.
(The producer and director are also the people who are just finishing making a documetary of Money-Driven Medicine.)
I lost 13 lbs in only two weeks by obeying this one easy rule
http://www.officialacaidiet.com/index.php?id=One+Simple+Dieting+Rule