The reality of risk

Published 5.24.2017
Being “fit and fat” depends on just how fat you are and how much well your body compensates. Please note, the site in question is funded by the Laura and John Arnold Foundation, the same people who wasted a ton of money funding Gary Taubes’s effort to overturn the laws of physics via his Nutritional Science Initiative (NuSi). The Arnolds pulled their funding, when Kevin Hall falsified Taubes’s insulin theory of obesity.

This is going to be ranty, not because of the article itself, which is reasonable, but because of the comments. Linda Bacon, patron saint of the Health at Every Size™ (HAES) movement is quoted in the article, but so are others who don’t buy the (unproven) assertion that weight is unrelated to health.

Bacon, who is famously touchy— which may be why she recently lost her academic position— and does not like being challenged, shows up on the comment section complaining that her views were “dismissed.” Readers can read the piece and decide for themselves, but that is certainly not the case. Bacon’s reasoning seems to be that because others were quoted after her, in particular Yoni Freedhoff— more on that in a bit— equates to her being dismissed. It is true that the author of the piece did not choose her quote for agreement, instead her pointed to Freedhoff’s quote as the balanced one based on the evidence.

Note: I have periodically criticized Freedhoff’s statements regarding movement in relation to weight loss. I think doctors who discount the importance of movement in any way do their patients a disservice. So what if talking the stairs versus the elevator doesn’t offset eating a piece of pie? It’s still better to take the stairs— barring some medical counter-indication. Movement is essential to health and longevity, all the evidence shows this, including the Blue Zones, which I have yet to write about in detail but still plan to do so. As always, remember that I am not a medical practitioner of any sort.

Bacon and Freedhoff have tangled online before. Freedhoff, although he is resolutely against fat shaming, does not buy into health at every size. Nor does he believe that all diets fail. Freedhoff, unlike Bacon, actually works with fat patients in his clinic to help them lose weight and they keep it off. I’ve already note that Bacon doesn’t like her assertions challenged. The exchanges have occasionally gotten heated, particularly if Bacon’s commentary is echoed by a swarm of HAES fans.

“Swarm” overstates the case in this particular comment section, but the HAES flavor of the negative commentary is palpable. Much like those who look at a celebrities health choice and see fatphobia or personal betrayal, HAES believers become offended at anything other than acceptance of their viewpoint. Still, Bacon lobs an ad hominem insult at Freedhoff, suggesting that his viewpoint is based on hi salary— though she seems to believe that he is a bariatric surgeon. He's not, Freedhoff runs a weight loss clinic, which may refer patients for surgery on occasion, most do, but his focus is simply getting people to recognize the reality of the energy balance and find a way to make it work in their own lives.

The fact that thin people get [fill in disease of choice] does not change the fact that being fat raises the risk of getting the disease. Increased risk doesn’t mean that every fat person will wind up with the disease, it just means that by having excess adipose stores on their body frame, fat people have an increased chance of getting it. A bit like buying an extra ticket in a lottery that you really don’t want to win. Another analogy is the tribute selection draw in the hunger games when the older children have their names in the draw more times than the younger ones. Only no one else can volunteer to face cancer or diabetes for you.

That is a more verbose way to state Freedhoff’s position. No, not every fat person is sick, but particularly for the extremely fat, the health risks are large and real. Linda Bacon and her acolytes would pretend instead that weight and the excess adipose tissue storage that causes it are some not part of the health risk equation.

This insistence helps explain their sense of betrayal when a fat public figure faces a health issue and decides to lose weight, as I discussed recently. Because HAES followers can’t admit that a body carrying more weight than it can compensate for is going to experience health issues. Lowering the weight the body is compensating for can ease the body’s burden and improve health.

I keep writing about HAES because within the philosophy there are nuggets of truly helpful information. It is possible to improve health without losing weight, if you adopt healthier habits. Eating a healthy diet and moving as much as you can offers even the largest person a way to better health and better living. My frustration (beyond the weight and health are disassociated fallacy) is the insistence that intentional weight loss be avoided. I just don’t see anything wrong with adopting better habits with the hope that along with better health you will weigh a bit less.

I’m not a fad diet promoter, but I am a believer in the energy balance. The reality is that if eating healthier results in eating fewer calories (and it likely will if your previous diet was a chock full of ultra-processed foods) then over time, the body will settle in at a lower weight/smaller size— especially if you also begin to move a bit more. I haven't banged the "NEAT" drum in awhile (non-exercise activity thermogenesis), but movement does not have to be deliberate exercise. It can be walking a bit further in the parking lot, taking the stairs, or simply standing more during the day. NEAT is not genetically determined, though parts of it are. Some people naturally fidget, and fidgeting falls in the category of NEAT. But choosing to stand and type (or watch TV) rather than sit is not genetic. It's a choice.

Once I made the choice to try to be on my feet more than on my seat, I found that even when I choose to sit I find reasons to get up more frequently than when sitting was my norm. With that and a dollar you have 100 cents, but that was my experience. It didn't happen overnight, but over time because I had chosen to make a new habit— and I enjoyed it enough to continue. If I'd hated it, the outcome would have been different and I would have needed to find a different way to increase my daily movement.

I've noted this before, but it's worth noting agains because there can be health consequences to standing all day. I don't simply stand in one place all day. I'm constantly shifting my feet and moving, especially if i'm reading and not typing. Sometimes I read accounts of people who try standing while working who make it sound as if they were like Beefeaters, standing stock still. It might be because I've used a treadmill desk, but my legs and feet are always moving, even as I stand in front of the screen.

In any event, my choice to stand while working needn't be yours, just find ways to move a bit more that fit your lifestyle and health status.