Lessons from the fatosphere

Originally published 2.15.2015; reformatted 7.19.2016
I am traveling as I begin to type this, heading west to watch my daughter dance. That being the case, these meanderings may be delayed in publication. Given my history here, that’s hardly anything new. Nonetheless, I will note that so far for 2015, at least on this site, I have managed to get more content up on a more regular schedule. This post began as a quick notes update, but turned into a treatise on the fatosphere. In the update, the title was changed accordingly.

Can weight loss be DIY?

The obvious answer is yes. DIY stands for do it yourself, and this rant is inspired by this Dr. Sharma blog post. I read Dr. Sharma’s obesity blog relatively frequently. Occasionally, he highlights research that I don’t see anywhere else. But the good doctor also infuriates me because he insists (well, it IS his job) that obesity is a medical condition rather than the result of choices. In the linked blog, he reports on a meta-study of DIY weight loss programs. Given the broad range of weight loss options available, there is no way that this study isn’t comparing apples and oranges. But the bottom line was that based on statistics, DIY programs are no different in terms of success than a diet industry plan. Although maybe these DIY or (unmanaged) plans are the diet industry plans. Doing Atkins after all, is something that you can do on your own. (I do not recommend the Atkins plan, or any other branded plan.)

This is the abstract of the study. I don’t have access to the entire article. There is no real description of what kinds of diets were included, and Sharma didn’t list them either.

This meta result does not mean that diets don’t work. Because diets do, as Larry Wilmore noted February 2, 2015 on the The Nightly Show on Comedy Central. All diets work, until people go back to their original habits. That isn’t a semantic argument. If you are a 300+ pound women to maintain that size you eat more than I do at less then half that weight. You just do. I eat less than I did when I was 30 pounds heavier. I eat the amount required to be the size I want to be. If I go back to eating the amount I was eating back then (or go back to being sedentary) I will put the weight back on.

I get that Sharma works with obese people all the time who tell him that they just can’t lose weight. And I understand why he can’t simply tell them the unvarnished truth because they will leave and not come back. The authors of the study, despite the dreary stats they present are still up beat at the end about DIY programs. Sharma disagrees and says DIY is useless. Sure, doc, I’ll come in and pay you big bucks to help me eat less and move more. Because in the end THAT’S what it takes.

Changing my mind perhaps

I am beginning to come around to the addiction theory that I’ve mentioned previously. Not because I think it’s caused by a chemical hook, but because I’m beginning to think that addiction isn’t chemical at base. It’s a way to self medicate, in other words a choice. And until a person is willing to make a different choice, there isn’t much to do for them. Obesity as a disability was a topic on The Nightly Show’s obesity show. I don’t think obesity is always a disability. I think becoming obese is a choice. I do think however that choice results in disability if the abuse is great enough. I’m not wedded to this view, but I am beginning to think that it has merit.

HAES and the truth

This is a link to the text of a 2011 paper Linda Bacon authored paper about Health at Every Size or HAES. In the abstract they admit that weight loss is achievable with diet and exercise modification. It seems to me therefore that they admit defeat at the get-go. Because then the question isn’t how to lose weight, it’s how to not gain it. And the failure there is NOT the energy balance, it’s recognizing why you got fat in the first place. And I think it makes the argument for the method that I used to lose (and yes maintain) the weight that I lost. Which is to say, choose an amount of calories for the size you want to be and the level of movement you can do for the rest of your life (because you can be slim and sedentary) and then do it. For. The. Rest. Of. Your. Life. Because to be a smaller sized human, you require less food (energy, measured in calories).

People need to face the reality that as humans age, their metabolism slows- particularly if they’re sedentary. I also think Bacon is sloppy (deliberately so) with terminology when she talks about weight loss efforts. One does not need to adopt a fad diet to lose weight. One can in fact, adopt very HAES friendly habits and lose weight. And if you continue following these new habits, the body will establish a new set point (mine certainly has) at the new, lower and yes, healthier weight.

The body compensates, until it cannot.

I may have written this before, but one of the things that I have learned from the fatosphere is just how amazing and adaptive the human body can be. The human body is able to withstand intensive, long term abuse and survive. A similar lesson about the ability of bodies to adapt to stress can be learned from other intense endeavors, for example ballet or football. Elite dancers and professional football players push their bodies beyond its normal limits, and for awhile the body compensates and adapts, with the result that we can observe and enjoy the fruits of their efforts. Bodies will withstand intense stress, until they cannot. At that point, injuries, endocrine anomalies begin to overwhelm the bodies compensation. Excess weight is not different.

Reading through the fatosphere, as I have been doing for about two years now, I have learned that the human frame is able to support far more weight than I thought possible. However, it is also plain that there is a limit to each body’s ability to compensate, and once that limit is reached, very bad things begin to manifest. That’s why the conflation of overweight and obese annoys me so much. I can accept the HAES premise that 30-80 excess pounds may not render someone unhealthy. That number is higher for men than women, because men have larger frames. But there is a limit. You cannot be healthy at EVERY size.

But no one need take my word for it. I was barely tipped past obese on the BMI scale at my highest non-pregnancy weight. Here, however, are the words of a five hundred pound woman. She writes well and with painful honesty. According to “Peep,” 350 pounds (159 kg) is the line between fat and disabled. Quoting directly:

I remember crossing that 350lb mark, that is definitely the mark where normal life ceases, I know for me this is when being able to walk a mile definitely went by. Before my massive fast weight gain, I used to love to walk to, and a mile was nothing. Stairs too become hard in the mid-300s. You are right about the extremely overweight or underweight levels being unhealthy, the body is destroyed. Denied by the HAES people is that there are disease processes that include weight, ie hyperthyroidism and luckemia[sic] are illnesses that strip off weight while others put it on.

Here is the Peep in response to the Weight of the Nation:

Ever have thin friends? I have plenty of them. I also have been every size this world has to offer. People know that going from even 150lbs to 190lbs means there are losses. At 150lbs you may be able to walk a couple miles and not feel detrimental effects, at 190lbs, you are getting a little bit tired. Yes there are other factors, health, stamina, fitness, constitution. Even among the 500lb set that varies, I saw a man around my size able to traverse a large grocery store without a scooter, but then I know many are bedbound, but no one at 500lbs is running a marathon.

Peep’s site can be a tough read because she is truly suffering from a myriad of issues, not all of which have to do with her weight. The woman was afflicted with a monstrous family. Nor is Peep a case where simple prescriptions (eat less and move more) will work. Her body is too damaged at this point. Medical interventions are the only option (poor though they may work based on her writings) are the only option. This fact doesn’t mean the energy balance doesn’t hold, however. It just means that the damage to her body has so impacted the terms of the energy balance that altering it is no longer a simple proposition.

When Fatties leave the fold

So what happens if a figure in fatosphere decides (for their own health reasons) to lose weight? Suddenly they can admit that their eating and exercise habits were the reason they were the size that they are. A common theme is that they begin to have knee or other health problems that force the issue, which was also the case for this woman. And suddenly the “belief” that weight loss is impossible (to do or maintain) is shown to be complete and utter bunk. And they face a backlash.

The note that the fatosphere no longer accepts her. She’s still on board with much of fat acceptance (FA, now more commonly called size acceptance or SA), though she obviously has disagreements too. She obviously thinks weight loss is possible (because she successfully did it and maintained it) AND she also thinks that obesity is related to health. But she still identifies as fat, even if the fatties don’t want her.

The author no longer blogs on fat acceptance, and has moved on to writing about atheism. The first piece linked above a VERY long piece. In it, eventually she gets to the reaction in the FA community, which she still supports, but they want no part of her. Many of her complaints are similar to mine. Weight IS a factor in health and it CAN be changed. The opposite of both of those statements are taken as articles of faith in the FA community, and to dare assert otherwise is heresy. But here are her own words on the topic:

When I first started blogging about my weight loss, I was met with a faceful of extremist denialism, concern trolling, and outright hostility from many FA advocates, in both blog comments and private emails. The health benefits of successful weight loss were denied. The extremist attitudes of many FA activists were denied. Connections between weight and health were denied, and medical researchers publicizing these connections were called "crusaders." I was told that all diets fail everyone. I was told that there was no way my weight loss would work in the long run; that I might succeed in losing the weight initially, but would almost certainly fail to keep it off over time. I was told that weight loss is never the right decision for anyone, and that there is no health problem that could appropriately be dealt with by weight loss. I was told that there are no serious health risks caused or exacerbated by being fat, and that health problems that appear to be caused by fatness are always really caused by something else. I was told that weight is entirely controlled by genetics, that eating/ exercise habits have absolutely nothing to do with it, and that weight management is therefore a complete waste of time. I was told that it was okay to incidentally lose weight as part of a "healthy at every size" eating and exercise plan, but that deliberate weight loss was horribly unhealthy... even if the "conscious weight loss" plan was identical to the "healthy at every size" plan in every way. I was told that even when weight loss is successful, the harm done by it -- physical, psychological, or both -- is terrible: so terrible that, in all cases, it completely outweighs the benefits

She was treated as a traitor when she started writing about it. And as she’s still slim, she puts the LIE to their claim and that it can’t be done and that it’s “dangerous”. She, in fact, resents the fact that they were very concerned about the damage “calorie restriction” was causing her, less so about the fact that she was losing mobility. She frames it in terms of feminism.. in that it’s not feminism to deny someone the right to make decisions about her own body. In other words, if you are fat and happy with yourself and your body, good for you. But if you’re not, you CAN change your body, and that choice should be just as respected.

There are other examples as well. This former female marine who writes this blog was fat and now is not. As a marine, not surprising that she takes no prisoners. Then there’s this woman who is eating well and exercising and gee look at that, losing weight. And she thinks that the fat acceptance community is doing real harm. None of these writers are special snow flakes or are endowed with miraculous will power, but each has lost or is losing weight by changing their eating and moving habit— that is eating less and moving more. None are using fad diets or programs, they have simply chosen to stop abusing their bodies by routinely consuming more than they need.

An apple rots from core.

Linda Bacon is VERY prickly and brooks NO criticism, however mild it might be. (Note: The Fierce Freethinking Fatties site apparently no longer exists, but I am leaving the links here in case it is resurrected— which believe it or not does sometimes happen.) I only vaguely remember his review of her book, but I do remember that he asked some questions, because he thinks that small health changes do matter on a personal scale. This link goes to Bacon and co-author’s comment on his review.

Apparently Bacon wanted him to delete the entire review. When he refused to do so, the second author refused to by interviewed by him.

So let’s get this straight. This would be a FRIENDLY interview environment. The dude is on board with HAES and is both fat and fat friendly. But even so, NO questions allowed— not even friendly ones? That’s not science folks. That’s cultish. You drink the koolaid without question, or you’re out. And then he goes on to talk about another book— which includes an interview with a mainstream obesity expert. And apparently that so injured (not-so) little Marilyn Wann, she had to put the book down. Blind obedience to the ideology or you’re out. That’s not a healthy movement. It’s a cult.

Quoting the blog:

As a result of Wann’s criticism, multiple commenters said they would not buy Weinstein’s book. As a de facto gatekeeper of Fat Acceptance, Wann’s disendorsement directly discouraged people from supporting a project that serves as a powerful testament to the damage of mainstream views on fat kids.

Bacon also refused to read the book because of the chapter on science.

The Fierce Fatty writing is rightly concerned by this censoring.

Instead, the attack on Weinstein’s work seems like petty sabotage that has literally impacted the livelihood of a longtime promoter of FA and HAES. Does the context of Weinstein’s history mean nothing? Does a single perceived misstep really justify the social media equivalent of the stockade?

It’s this kind of reactionary litmus test that drives people away from FA and HAES. Can you imagine investing hundreds of hours of time conducting interviews and going through the painstaking writing and editing process, only to have one of the most influential fat activists essentially give you the hook?

The added bolding is mine. The site, Fierce Free Thinking Fatties, exists, in part, because the author (who is male) has found it difficult to have discussions on other forums. Questioning the logic of HAES, even by someone who supports it, is not permitted. That bolded sentiment is beginning to show up in one form or another throughout the fatoshpere as people tire of being told they are “doing it wrong.”

The definition of HAES is changing.

HAES must now be considered in a “social justice” context? Apparently the acronym HAES has been trademarked, and the owner, the Association for Size Diversity and Health, has so decreed. It’s clear that not everyone in the fatosphere agrees that this is a good thing. The link directly above is to a discussion arranged by the owner of the site Fierce Free Thinking Fatties.

Bacon’s latest book includes “social determinants of health” (SDH) which is another step to say that weight is outside the control of the individual. (This would be the book that her coauthor refused to discuss with him as mentioned above.) But many people came to HAES for the personal health reasons (ie. personal wellness, healthy habits, self-love, etc) and are not happy that now HAES is a political movement.

The problem, according to those who want to change the definition, is that HAES can be considered “healthist” Meaning that health IS a personal thing that can be controlled with habits. But some object to that because they are choosing to be fat and unhealthy and that’s supposed to be okay. So HAES can’t just be size acceptance/intuitive eating/joyful movement it must also have socio-politically aware framing— according to those who are pushing the change (among them Bacon and her co-author). In the course of the discussion, Lucy Aphramor (Bacon’s co-author) basically disowns the HAES definition that She and Bacon created (or at least popularized) because now she wants to build a society, not just help fat people be happier and healthier.

To read the whole lengthy discussion, go to the link I provided above. Among the objections to the new framing of HAES is the belief that too much is being crammed into the HAES banner. Fat people would benefit if healthcare was less weight-centric and HAES has made some strides here. If they now change the definition of what HAES means, that progress will be lost.

Reading through the discussion, it becomes clear that the effort is to make health (weight) “beyond the control” of the individual. No one has complete control and no one knows the future, but an individual can make a difference. The fear is that the current slant of the HAES message removes individual agency. It’s no longer a matter of making individual habit changes to gain better health, it’s all society’s fault. On comment that was made that HAES has not taken hold in among people of color (POC) but if it had the SDH component it would. I have no idea why POC wouldn’t benefit from making changes to their eating and moving habits.

It will come as no surprise to anyone who has read much of anything I’ve written here, but I was glad to see the pushback on the message shift. There are good aspects of HAES. The idea of making changes to habits that improve diet and get someone moving is a very good one— and one that I endorse here. My problem with HAES has always been it’s interpretation of the science of weight loss. And now the powers that be have moved the goal posts. In some ways it’s an argument between theorists and people who actually try to help people daily. This bears watching.

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