06 June 2014

How Do You Make Healthy Changes When Those Changes Don't "Count?"

So fair warning, around here we will be talking about fat a lot.  We will be discussing me being fat, fat acceptance, the idea that "fat" is an arbitrary measure of health, the idea that one can be striving for good health at any weight (even when Fat!) and so on.  I mention this because not everyone is comfortable with throwing the word "fat" around and because not everyone is comfortable stepping outside of the "thinness axiomatically means healthiness" mindset.  If this topic is problematic for you, feel free to skip this stuff, I totally understand that this can be an emotional minefield.

With all that said I am really glad to see that more mainstream media sources are occasionally expressing the idea that making healthy choices makes you healthy regardless of thinness.  Health at Every Size is slowly creeping into the collective consciousness and for that I am grateful.  Personally, committing to this mentality has been a total game changer on my health and fitness quest.  Since swearing off dieting for 2014 I have found it much easier to stick with my fitness motivation and so much easier to feed my entire family in a healthy manner. When working out is purely to get better at something I enjoy doing, and purely so I can take that 20-30 minutes and get out of my own head, it becomes so much easier to stick with it.  Unlike the constant paradigm of weight-loss failure that accompanied my previous training plans, now I see success at every turn because hey, running for ten full minutes at "sprint pace" is a real deal accomplishment no matter what size you are.  As for the food, swearing off processed foods (as much as humanly possible given our generous, but certainly not infinite resources) means my house is full of good-for-you choices.  I eat when I feel hungry, I eat what I want and I know going into it that the food available to me in my home is nutritious so I should just eat until I feel full, then get on with my life.  And what has happened with my weight? Well not a whole lot really.  It has stayed in the same +/- 10 pound range, just as it always did while dieting and angsting about my weight, and yet, I am not spending like 90% of my mental capacity stressing about it.  When you consider that even when I lost 20 pounds on Weight Watchers (all 20 of which came back while I was still "working the program") I never lost any clothing sizes....well, I kind of wonder why I ever spent time worrying anyway.  So basically, I am feeling great, getting fitter, eating better and looking pretty much the same.  It is awesome!

With all this in mind I was initially pleased to see this article: Obesity research confirms long-term weight loss almost impossible.  

I am really glad that credible scientists are starting to say "hey, healthy changes are healthy even when you don't lose weight" or "most weight-loss isn't sustainable even when you stick to the diet, though the improvement in health certainly is."  Honestly, if you read the actual studies, as in look at the data, calculations and results*, this become quite clear.  While these studies uniformly prove that eating more nutritious foods (like more fruits and veggies) and adding in some moderate activity will improve one's health markers, these studies often erroneously assign pounds lost as the causative factor for those improvements, or even as the ONLY metric of an intervention's success. (Never mind that these studies almost always fail to address the real cause of our poor nutrition epidemic: access to said healthy foods, a pesky detail that anti-fat campaigns the world over seem to ignore.)  I am genuinely pleased that someone is calling BS on that and trying to get obesity research to remove itself from the lock-step assumption that good health only comes from thinness and/or only when interventions result in thinness.

I am likewise really disappointed that the larger scientific/medical community is basically sitting around with their fingers in their ears chanting "LA LA LA LA LA LA...can't hear you!" Now I will say I am not shocked.  One of the many reasons that I don't miss the academic side of public health is this complete cultural unwillingness to deviate from what we think we know about any given topic. Not to imply that all research is junk and that all scientist are out to just earn money by being pawns for big business, but quite often results are better verified by following the money than they are by following the math.  The diet industry, and the medical industry as a direct supporter of the diet industry, have a lot to lose if the never ending quest for a magical  BMI goes out of vogue.  Frankly, you get more support to keep doing research when your research proves a profitable status quo. 

The comments are, as always, priceless with the frantic, spittle flinging "calories in, calories out" cult followers arriving almost immediately.  I find it fascinating that most commenters either did not read the article at all, or simply did not understand the nuance of this research.  As mentioned in the footnote, I get that not everyone understands the inner working of health research, but that people genuinely believe that there could be no other conclusion than "fat=unhealthy/lazy/stupid, thin=willpower/health/moral fiber," despite the wealth of proof to the contrary, is amazing to me.  Are we as a nation incapable of critical thinking or does this merely exemplify how entrenched the fat-hatred narrative is in our culture? Probably both.  

The take home-message from all this for me is simple: as long as our leading researchers, theoretically our best and brightest experts, refuse to give up the thin vs. fat dichotomy, we as a nation are going to have a really hard time initiating changes that have a meaningful impact on our health as a whole.  Basically as long as we keep telling people that healthy changes only count if they create weight-loss, we are going to see a lot of people opting out of making healthy changes.  That is the fall-out of fat-hate. 

*I understand that this is not an option for everyone. My position of privilege, in terms of time, access and statistical training, means that this is a relatively easy task for me, while it may not be for others.  Lest anyone think I am implying that not knowing how to read statistical data is a matter of willful ignorance, this is not a "have you even read the books I've read" situation, merely a long-winded approach to taking a balanced overview of all the available research.