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Recently, the U.S. Preventative Services Task Force recommended that doctors refer all patients with a body mass index of 30 or more to a program designed to promote weight loss. A successful program, according to the panel, combines counseling sessions with concrete weight-loss goals, nutrition advice, and education on setting limits and recognizing barriers to change.  The recommendation was met with mixed reviews from doctors and politicians involved in the healthcare debate. Some cited it as a “long-overdue” prod to physicians while others acknowledged the additional responsibility it would place on doctors who are already facing time and resource constraints.

What the debate skims over, however, and what may be the most important point is not a single study demonstrates the long-term benefits of an intensive weight loss program for health. This oversight is at the crux of the war on obesity and America’s obsession with weight loss.

One of the central misconceptions fueling the task force’s recommendation is that body weight alone is indicative of health. Many studies have indicated that weight, when viewed in conjunction with other lifestyle habits like exercise, is not related to disease or early death except in the morbidly obese. Other studies point out that equal numbers of thin and fat people exhibit unhealthy eating habits and whether or not those habits become externally apparent is largely determined by genetics. To assume all fat people are unhealthy and all thin people are healthy is prejudicial and does a disservice to both groups.

Another misconception is that everyone who is fat must suffer from some form of disordered eating. In reality many people with a BMI above 30 are healthy adults who exhibit moderate eating and exercise habits. Likewise, many people at a “normal” BMI of 18.5 to 24.9 do display maladaptive eating habits. Using BMI alone as the criteria for admission into a free counseling program both sets the stage for further discrimination against fat people and excludes many “normal” weight individuals who might benefit. In short, It is a grave mistake to assume everyone at a “normal” BMI is making healthy choices and everyone above a “normal” BMI is not.

As part of the initiative, doctors are urged to refer obese individuals to programs where weight loss is the primary goal and benchmark for success. There are many problems with this. First, weight loss programs fail for about 95% of dieters and ultimately cause more health problems from the resulting weight cycles. Second, there is not sufficient evidence linking weight loss with improved health outcomes in the long run, which the task force openly admits but appears to dismiss in another classic case of succumbing to popular culture rhetoric about dieting. The task force states that in some cases, programs include exercise sessions. From an evidence-based perspective, this should be priority number one. Research has shown dramatic improvements in health from exercise alone, and obese but fit people are as healthy as fit people falling within the normal BMI criteria. A focus on weight loss over increased physical activity gives people an inaccurate tool for gauging health.

Dr. Jack Der-Sarkissian notes that more than half of all obese patients are never told they need to lose weight, and that’s just “not fair to the patient.” Hmmm…. Let’s talk about what’s really not fair. It’s not fair that doctors assume all fat people have homogenous eating habits and weight loss is the lifesaving miracle panacea. It’s not fair that doctors assume a fat person is automatically unhealthy and on the flip side, a thin person is healthy. It’s not fair that so many medical problems a fat person encounters are attributed to weight with no further investigation. It’s not fair that people at “normal” weights are rarely offered nutritional advice, diagnostic testing, or counseling because they are assumed to be healthy. It’s not fair that so many people with diagnosable eating disorders do not get the treatment they need because they don’t meet certain weight criteria, while the government wants to the foot the bill for every fat person to a enter a weight loss program.

When will health officials come to realize that both physical and mental health are independent of body size and the people who could actually benefit from counseling fall all along the weight continuum.


DIET: that dirty four-lettered word that is so ingrained in our national vocabulary that it’s mention is akin to discussing the weather.

“What’s the forecast for tomorrow?” you ask.

“A high of 1200 calories with a slight chance of deprivation.” How gloomy.

Dieting has become as American as baseball and apple pie, that is, as long as you make it a slice of sugar free, fat free pie.

Yet despite how often we talk about dieting, very few actually succeed in losing weight and keeping it off. So why do we persist? Are we all insane, as a popular quote would suggest?

“The definition of insanity is doing the same thing over and over again and expecting different results.”

Or maybe we’ve been bamboozled by an industry that profits off of our failures, an industry that designs a faulty product and then places the blame on the buyer? Today I challenge you all to embark on a different kind of diet: the anti-diet.  Let go of all your complicated food rules and beliefs about “good” and “bad” foods and begin to trust your body to tell you what it wants and needs.

To provide you with some motivation, I’m counting down the top ten reasons to ditch dieting for good.

10. Dieting wrecks havoc on your metabolism.

Dieting slows the metabolism down tremendously, as the body enters what it assumes to be a period of famine. And while fat people who lose large amounts of weight may look similar to a naturally thin person, their bodies are actually behaving more like that of a starving person. In other words, a fat person who loses weight will not acquire the health characteristics of a naturally thin person. On average, the metabolism slows so that a formerly fat person burns about 24% fewer calories per square meter of their body’s surface area than a naturally thin person. By avoiding diets, you can ensure your metabolism is functioning at its optimal level.

9. Your body produces hormones that fight against weight change.

Your body has a natural set point for weight, largely determined by genetics, at which it feels most comfortable. Deviating much beyond this point triggers a cascade of hormones designed to resist further weight fluctuations. These hormones can stimulate or suppress appetite, decrease or increase metabolism, and encourage or discourage activity. Dieting interferes with the mechanisms that regulate set point and makes it difficult to respond to hormonal cues. Much like a broken gas gauge on a car, dieting makes it difficult to tell when the tank is full or running on empty.

8. Dieting can lead to many psychiatric problems.

Here’s a novel idea: your body, as adept as it is at carefully regulating all your bodily systems, cannot tell the difference between a diet and unintentional starvation. And starvation has been shown to cause a lot of psychological problems. In the classic Minnesota Starvation Study, healthy men were put on 1,600 calorie diets with the intention of losing 25% of their body weight. Over the course of the experiment, the men experienced what head researcher Dr. Ancel Keys came to call “semistarvation neurosis.” They became nervous, anxious, withdrawn and overly critical of their appearance and weight. Many exhibited signs of depression, losing their ambitions, interests, sense of humor, and desire for social interaction. They became obsessed with food and many developed odd food rituals. And to think this all happened on 1,600 calories per day. Many popular diets today prescribe much less!

7. Dieting wastes a lot of time and energy.

As noted by a participant in the Minnesota Starvation Study the act of restricting food “made food the most important thing in one’s life.” Whether your counting calories, weighing out just right portions, or dreaming about all the food you wish you could be eating, dieting can quickly become an all-consuming undertaking, often at the expense of other areas of your life. When we deny ourselves food we enjoy in favor of “healthy” foods we dislike, a lot of time gets spent fantasizing about that forbidden food.

6. Dieting robs a lot of the pleasure from eating and can make for more complicated social situations.

Despite what many popular diets lead you to believe, getting pleasure from food does not make you a hedonistic, weak-willed person. Eating can and should be a pleasurable experience. Think about digging into a big stack of fluffy pancakes on a lazy Sunday morning, eating a slice of cake on your Birthday, or clinking champagne glasses with friends and family on New Years Eve. Food is a part of many of social situations, and when your web of complex food rules keeps you sidelined from digging in with everyone else it can be an isolating experience.

5. 95% of dieters regain the weight and then develop a higher weight set point.

Because of the numerous regulatory checks that your body employs, in the end, dieting is more synonymous with weight gain than weight loss. It slows metabolism, increases the body’s efficiency at getting calories from food, increases appetite, decreases activity levels, lowers your body temperature, breaks down muscle tissue, and increases fat storing enzymes. All these checks ensure you are on the fast track to gaining back any lost weight. And because our bodies are programmed to protect us from weight loss but aren’t too concerned with weight gain, they settle at a slightly higher set point than they were previously at. In other words, the same amount of calories you were once eating to maintain weight X are now how many you need to eat to maintain X+10lbs.

4. Dieting and weight cycling causes a lot of the problems that excess weight is blamed for like heart disease, high blood pressure, high cholesterol, and liver damage.

It’s a classic case of what came first, the chicken or the egg? Many people see a correlation between excess weight and disease and assume weight is the cause, when in reality the relationship isn’t so straightforward. What often underlies conditions like heart disease is the damage done to the body by losing and regaining the same weight over and over again, the same cycling that leads to higher set point weights.

3. You don’t need to diet to maintain your body’s healthy weight.

Too many people are under the impression that without constant vigilance the pounds will keep piling on, when in fact, this is far from the truth. A scientist at the University of Vermont, Ethan Sims, conducted an experiment that was the mirror image of the Minnesota Starvation Study. Instead of looking at the effects of calorie restriction, Sims put men on a calorie dense diet. In order increase their weight by 20% above their natural set point the men had to eat as much as 10,000 calories for up to six months time. Sims discovered that the amount of weight the men should have gained based on a simple calories in versus calories out equation was much more than they actually gained. Their bodies fought hard to maintain their natural set point, and at the conclusion of the study they returned to these weight without effort. Your body knows the weight it is healthiest at and will fight you to maintain that weight. Ironically, you have to diet to NOT maintain your healthy weight. Watch a documentary that puts participants through a similar weight gain experiment here.

2. Being thin does not necessarily make you healthier. Moderate activity and healthy, moderate food choices make you healthier.

Fit, active people are much healthier than sedentary individuals, regardless of weight. In fact, fit obese people are healthier than thin sedentary individuals and just as healthy and thin active individuals. When fat people exercise, they reap all the benefits even without an accompanying weight loss. In other words, losing weight will not make one healthy but exercising will. Several studies also indicate that fostering an active lifestyle increases self-confidence and acceptance while dieting often has the opposite effect. Read more.

1. Dieting is NOT about loving and respecting your body.

How many times have your heard someone say (or said yourself) “I’m trying to lose weight because I want to take care of myself?” While the intention is good, dieting is a misguided attempt at promoting health and well-being. Choosing a healthy, varied diet, staying active, and accepting your body in its present state sends a lot more powerful message if you ask me. You wouldn’t tell your partner or your best friend, “I’d love you more if only you were….(fill in the blanks).” So why do we repeatedly tell ourselves this message by trying to lose weight? Love and respect come from an understanding that I am a complete, whole person as I am.

For a great resource on the research behind these reasons check out Big Liberty’s blog. Or pick up a copy of the book Health at Every Size by Linda Bacon, The Obesity Myth by Paul Campos or Rethinking Thin by Gina Kolata.

Back when my eating disorder was the dominant force in my life, I was ready to punch the next person that told me “fat is not a feeling.” I used to get into this debate with my therapist all the time. It went something like this.

Dana: I hate the way I look; none of my clothes fit anymore. I feel so fat.

Therapist: Your weight gain is right on target; no need to worry. And remember Dana, fat is not a feeling. Why don’t you tell me what you really feel: sad, frustrated, scared?

Dana: I feel like I want to punch you (is what I should have said). I don’t know (is more likely what I did say).

Therapist: Fat is a physical state; and you either are or are not fat. You need to ignore your own perception and trust me when I tell you that you are not fat.

Dana: Yes but fat is also a relative term. I feel fat now compared to what I once weighed. Therefore, relatively I feel fat.

Flash forward 10 years, and I weigh in at about 50 pounds heavier than when I previously felt “fat.” The interesting note: I have lots of days when instead of feeling “fat” I feel “normal” or “healthy.” So what’s changed? Most notably it is my perception of what is considered healthy in addition to the fact that I no longer need to use my body nor my weight as a tool for self-expression. I now recognize anorexia for what it is: a disease that distorts perceptions. I recognize extreme thinness as a symptom of the disorder. In the past, I didn’t even recognize my physical condition as a problem that needed correcting. I was healthy I thought, my life was under control and my body reflected that. If I were to gain weight, to give up the disorder, all the calm feelings would leave and my life would be in chaos.

Today I see my body less as a statement of how I am feeling and more as a source of strength, a vehicle to get me to where I am going, and only a small fraction of who I am as a person. With so many more things defining my life, I don’t rely on my body to determine my self-esteem or self-worth or to serve as a temporary fix. Today when I feel “fat” I know it’s because something else in my life is grating on my patience and my body becomes an easy target for expressing my dissatisfaction.

As much as I hate to say it, my therapist was probably right. By calling myself fat and focusing on my appearance I avoided the real issue, which often felt out of my control or too large to tackle. Losing 5 pounds, that I could handle. Resolving the anger and sadness that were building in my head, not quite as easy. Luckily I realize all this now and can act as stand in therapist when the girl I see in the mirror starts to tell me I feel fat. I now look at her and repeat: “fat isn’t a feeling Dana, why not try telling me how you really feel.”

“You are looking fatter!” To most people in the United States, this statement is wrought with a combination of disgust and sympathy. But for many women in the African country of Nigeria, it is meant as a compliment. Understanding what it means to be beautiful is a complex matter when cultural differences, unique life experiences, and the personal preferences that stem from culture and experience are taken into account.

For centuries people have been debating over what it means to say someone or something is beautiful. In Greek literature, Socrates and Plato philosophize as to whether beauty is something that must first be understood in the abstract before it can be recognized, or if one must experience beauty before it can be understood. Modern day psychology offers some insight into this debate. In a study in which babies are shown pictures of adult faces, the more symmetrical the face and the more attractive the face (an average rating is given from survey participants), the longer the baby looked at it. Because these babies are too young to be influenced by cultural standards, it suggests that humans are born with an understanding of what is beautiful. But wait… in another study, 70% of a group of college students judged a professor to be attractive when he acted in a friendly manner, but only 30% judged that same professor to be attractive when he acted unfriendly. So which is it, is beauty objective, as suggested by the baby study, or subjective, prone to changing based on a myriad of other variables like the personality of the subject? Perhaps it’s a little of both. Humans are born with a very basic concept of what is beautiful, think signs of health or wealth, and then culture and experiences expands upon that innate understanding. And then there’s Darwin who pointed out that with the amount of variety that exists among people around the world, it is hard to believe that there are many universals of physical beauty.

For most people, perceptions of beauty expand beyond the physical. As the second study I mentioned points out, whether or not a person is seen as attractive has a lot to do with the characteristics he or she displays and the feelings those characteristics evoke from the viewer. In fact, some philosophers go as far as to say that beauty is not a quality possessed by the subject, but instead an emotion felt by the viewer, kind of like in the expression beauty is in the eye of the beholder. As 18th century philosopher David Hume pointed out, when people refer to an object as beautiful the features that each one points to are often vastly different. And to Freud, beauty was defined by the sexual feelings aroused in the viewer, the greater the feelings the more beautiful the object. An interesting example of beauty being shaped by non-physical characteristics can be found in a study that looks at how people from western and eastern civilizations view pictures of fish in a tank (not what you were expecting right?). In eastern cultures, conformity, focus on the family unit, and putting the greater good ahead of one’s own good are favorable qualities to possess. When people from eastern cultures were shown pictures of either a fish swimming alone in a tank or a group of fish swimming together in a tank, the participants selected the group of fish as more aesthetically pleasing, while people from western cultures judged the solitary fish to be more aesthetically appealing. Here beauty stems from a non-physical characteristic of the fish and from the cultural lens through which each group viewed the picture.

Getting back to the cultural standards of physical beauty, a lot of variety can be found from country to country, and even from region to region within that country. Like I mentioned in the beginning, in many African countries, being fat is considered desirable and beautiful as it is a sign of wealth and power. In an recent article I read about the obesity problem in Africa, many African men and women were asked their opinion, and the overwhelming consensus was that being large was not a problem, it was a blessing. According to one man, the larger a man’s wife and children appear, the more wealth he exudes to others. Another man pointed out that with a large percentage of the population infected with HIV/AIDS, losing weight or being thin is an indicator of illness. Both men and women feel more comfortable dating a fat person because they are seen as clean. This emphasis on fatness is so pervasive that many women go to what is called a “fat house” before they are to be married to become larger since larger women are more desirable. (Note: fat houses have recently been outlawed in many areas because the practice went hand-in-hand with genital mutilation). In the United States, however, being thin is a sign of wealth and power because thin people posses the money and free time to get fit and the will power and strength to resist tempting high-calorie foods.

In many parts of the world, western ideals of beauty are beginning to sneak their way into other cultures. For example, in Korea women who are not born with a double eyelid crease undergo a procedure called blepharoplasty, in which a second crease is placed above the eye to make it appear larger. Skin whitening and injecting botox into the cheeks to atrophy the muscle for a more defined look are also becoming more popular treatments. In Fiji, a remote island that did not have television access until 1995, women were reported as having very high self-esteem and body acceptance. Three years after the introduction of television and western broadcasting, 62% of women reported dieting during the previous months to control their weight. A shift is occurring, says one women. Where people used to see beauty, power, and success when they saw a fat person, now they see someone who is less desirable.

I’m starting to feel a little lost. There doesn’t seem to be a single definition or explanation of beauty. In search of something a little more concrete let’s get technical. Psychologists have done a lot of research into what specifically makes a man or women attractive to the opposite sex from an evolutionary perspective (Note: research done primarily in western societies). According to the research a man is more attractive or beautiful when he has more masculine facial features associated with increased testosterone. These include features like heavy brows, a wide jaw, and broad cheek bones. Other features women find attractive are a V-shaped torso, a narrow waist offset by broad shoulders, an erect posture, and a hairless physique. But wait… it’s not that simple (is it ever?). These features are seen as more attractive when viewed by ovulating women. When women are in the late or early phases on their menstrual cycle, they do not prefer these masculine features. Additionally, a woman’s opinion of beauty changes when she is primed to think about long-term versus short-term partners, her own physical appearance, and her degree of gender conformity.

Understanding beauty isn’t something I am going to be able to do in one blog post. People have been asking the questions “what is beauty” and “what makes something beautiful” for centuries and we will still be grappling with that question years from now. I think the only thing that can be said with any certainty is that beauty is anything but certain. What is beautiful is subject to inborn preferences, cultural variations, preferences garnered from each person’s unique life experiences, and then the messages and feedback we get from the world around us. With such a subjective interpretation, one thing I know for certain is that each person possess a quality that makes him or her beautiful in the eyes of someone. And I am hoping that for anyone reading this, one of those “someones” is oneself.

Tell me if this scenario sounds familiar. You’re standing in the kitchen trying to plan out your meals for the day. You have set a 2,ooo calorie limit. From those 2,000 calories, 500 must come from fat, 500 must come from protein, and 1,000 must come from carbohydrates. Now, you have to remember that your meal must have at most 20 grams of sugar, no more than 8 grams of saturated fat, at least 25 grams of fiber. Also, you really should consider whether your meeting the recommended guidelines for the proper servings of fruits and vegetables… Oh, and don’t forget about creating the right balance of all the 28 vitamins and minerals the body needs on a daily basis. All of this mental math can become quite overwhelming!

I recently came to the realization that I tend to over-complicate eating, spending too much time trying to compute complex mathematical equations to find the right balance of foods that I’ve forgotten how to use a common sense approach to food. With so many diets on the market, each touting a different miracle weight loss formula, it’s easy to see where the confusion lies. One weight loss guru says to eat a 40/30/30 ratio of carbs to proteins to fat. Another says keep carbs to a minimum and focus on protein. And yet another says the focus should be on sugar and keeping it to a minimum. With all these mixed messages what is a floundering dieter to do? My first attempt at sorting through the mayhem, and one that I do not recommend, was to combine the approaches, thus creating my own elaborate labyrinth of rules to follow. This only led me to dieting burn-out. Trust me, when you’re having a hard enough time just counting calories, adding a list of 40 other things that must be counted is asking for trouble. Before you know it you’ve ditched the calculator and food scales and are sitting on the couch eating Fruit Loops for dinner. Since my brain is so frazzled from doing fuzzy math, having the word “fruit” in the title is about all it can comprehend at this point.

So what’s the solution? I’ve recently heard the expression “intuitive eating” tossed around quite a bit, and while I’ve yet to read the book, I like the general concept I believe it establishes. When dieting, it is possible, and probably easier, to achieve success if you can focus on a few simple ideas:

1) Learn to listen to your body and recognize when it is and is not hungry.

2) Focus on eating fresh, healthy foods and eliminate most processed, sugar-laden items from your diet.

3) Don’t strive for perfection; strive for balance and moderation.

How you do some of these is beyond me, hence the tendency to be to shackled to my calculator and calorie counting book, but I think it’s a noble ideal to work toward. In the meantime, I’m going to focus on splicing together the dieting rules I find accommodate my lifestyle of food preferences the best. Because in the end isn’t that what it’s about: finding out what works for you and rolling with it.

July 2018
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