New study: Being fat does not make you die earlier

Please read this and pass it around:

Mortality risk for overweight and obese is no greater than for ‘normal’ when hypertension and diabetes are controlled for, (Anthony Jerant, Peter Franks. “Body Mass Index, Diabetes, Hypertension, and Short-Term Mortality: A Population-Based Observational Study, 2000–2006” J Am Board Fam Med July-August 2012 vol. 25 no. 4 422-431)

It’s been added to the Truth About Fat page.

A quote:

Methods: This was a population-based observational study of data from 50,994 adults aged 18 to 90 years who responded to the 2000 to 2005 Medical Expenditures Panel Surveys. Cox regression analyses were employed to model survival during up to 6 years of follow-up (ascertained via National Death Index linkage) by self-reported BMI category (underweight, <20 kg/m2; normal weight, 20-<25 [reference]; overweight, 25-<30; obese, 30-<35; severely obese, ≥35), without and with adjustment for diabetes and hypertension. Survival by BMI category also was modeled for diabetic and hypertensive individuals. All models were adjusted for sociodemographics, smoking, and Medical Expenditures Panel Surveys response year.

Results: In analyses not adjusted for diabetes or hypertension, only severe obesity was associated with mortality (adjusted hazard ratio, 1.26; 95% confidence interval, 1.00–1.59). After adjusting for diabetes and hypertension, severe obesity was no longer associated with mortality, and milder obesity (BMI 30-<35) was associated with decreased mortality (adjusted hazard ratio, 0.81; 95% confidence interval, 0.68–0.97). There was a significant interaction between diabetes (but not hypertension) and BMI (F [4, 235] = 2.71; P = .03), such that the mortality risk of diabetes was lower among mildly and severely obese persons than among those in lower BMI categories.

Conclusions: Obesity-associated mortality risk was lower than estimated in studies employing older BMI data. Only severe obesity (but not milder obesity or overweight) was associated with increased mortality, an association accounted for by coexisting diabetes and hypertension. Mortality in diabetes was lower among obese versus normal weight individuals.

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Fat Double Standards

Really quickly — because I’m actually supposed to be writing my novel right now — here’s a hilarious addition to the double standards in weight reporting.

Early-Stage Alzheimer’s Could Make People Lose Weight

According to EurekAlert, scientists looked at 506 people ranging from those with no memory problems to those with full-blown Alzheimer’s. They found that people who had markers of Alzheimer’s called beta-amyloid plaques in their brains — even if they had no symptoms — had a lower BMI on average than those who had no markers. This means Alzheimer’s, even in its early stages, might be doing something to make people skinnier. Says study author Jeffrey M. Burns, “These results suggest Alzheimer’s disease brain changes are associated with systemic metabolic changes in the very earliest phases of the disease. This might be due to damage in the area of the brain called the hypothalamus that plays a role in regulating energy metabolism and food intake.”

So hey though, I’m sure you remember that study done not too long ago that concluded people with higher BMI were at greater risk for developing Alzheimer’s. Cuz yanno — fat causes ill health period. This is ignoring the fact that greater fatness is correlated with and may be causes by conditions that are known to be risk markers for development of dementia later in life (like insulin resistance, thyroid issues and diabetes). Again, we have the chicken-and-the-egg problem that plagues weight research: the assumption that weight always comes first, that it’s most always controllable, and that correlations having anything to do with higher BMI mean a prescription of weight loss.

Do you see the double standard in the above article? Thin people with a higher prevalence of Alzheimer’s means that Alzheimer’s causes thinness (and researchers are willing to do all that’s necessary to prove that particular conclusion, not to mention assume it from the outset without proof as such). But fat people with a higher prevalence of Alzheimer’s means that — wait for it — fat causes Alzheimer’s! And researchers (on the GlaxoSmithKline/Eli Lilly/Johnson&Johnson/etc dole) will do anything they can to prove that particular conclusion, not to mention assume it from the outset without proof as such.

Show Your Fatty Papers

Recently I got mud on my boots in a popular feminist news blog. The topic was a new weight loss drug, and far be it for me to leave that shit alone.

I mocked its promised 11% weight loss (in the short term, since that shit gives you kidney lesions and can’t be taken long term) and brought up the 40% – 80% hereditary nature of body weight (which I got by scouring Google Scholar one weekend. I suggest you try it, it’s fascinating. Turns out I was underestimating – it’s more like 65% – 85% (see here and here)).

The response? I was asked how I ‘knew’ that my body weight was genetic. Did I get a genetic test done or something? Really. The commenter really wanted to know, guys, honest.

I asked how the commenter ‘knew’ their eye color, nose shape, and height were genetic. Did they get a test done? Really. I wanted to know.

The point of this is that body weight is highly heritable, as heritable as height, and so on. We know this. We’ve known this for nigh on fifty years now. It’s not even a little in question. But this obesity moral panic is so advanced, so strong, has so penetrated popular culture with its toxic propaganda and lies, that people find the generally genetic nature of body weight so unbelievable they demand our fatty ‘papers’ before we’re allowed to say our body weight is genetic.

If this isn’t proof enough that size discrimination and fat loathing has nothing to do with facts or science, I don’t know what is.

Big Calorie Brother is Watching You, Fat Kids

In the annals of creepy monitoring of calorie counts, this expensive taxpayer-funded measure to study the calorie intake of children via photographing their lunch trays and ‘their leftovers’ is way up there:

Calorie Camera: Schools Photographing Students’ Lunch Trays

Health officials trying to reduce obesity and improve eating habits at five San Antonio elementary schools unveiled a $2 million research project Wednesday that will photograph students’ lunch trays before they sit down to eat and later take a snapshot of the leftovers.

Parents will receive the data for their children, and researchers hope eating habits at home will change once moms and dads see what their kids are choosing in school. The data also will be used to study what foods children are likely to choose and how much they’re eating.

Okay, fine, so this is just a study, right? Surely this isn’t about trying to socially engineer a marginalized class of people to conform to the ‘better’ characteristics of the elites, right? Wrong:

Researches selected poor, minority campuses where obesity rates and diabetes risk are higher. Among those is White Elementary, which is just off a busy interstate highway on the city’s poor east side, on a street dotted with fast-food restaurants and taquerias.

I like how they say “obesity rates and diabetes risk” are higher. You know they wanted to put “incidence of diabetes” is higher, but instead they had to use a redundant statement to get the word DIABETES in there. Because we all know that despite a very low real incidence of Type II Diabetes in children DIABETES is the bread-and-butter scare-word used to frighten parents and get concerned public activists in a righteous huff over the ‘childhood obesity epidemic’ (which isn’t confined to childhood, nor does ‘obese’ have much meaning since the growth charts are all comparative, and which isn’t an epidemic by any stretch of the imagination).

However, the article does have this refreshing insight which, in the context of the article, would seem to suggest such an expensive taxpayer-funded project in these dark times of deep deficits is short-sighted to say the least:

Researchers warn that obesity is not always the result of children eating too many calories. A previous study by the nonprofit center reported that 44 percent of children studied consumed calories below daily minimum requirements, but nearly one-third were still obese. Seven percent screened positive for type 2 diabetes.

If you as a parent don’t want to consent to having your child’s food photographed and nitpicked? Well, you’re just stupid and ignorant, says the school’s principal (who was very sure to get his name/school in the national news, I’m sure):

Mark Davis, the school’s principal, said getting consent from parents hasn’t been a problem. He suspects the small number of parents who withhold consent don’t understand the project, perhaps thinking it limits what their child can eat at school.

My prediction: next study will be recording the BMIs of students as well as the contents of their eaten lunch.

More Healthist Doublespeak

The language of Healthism is so intertwined with notions of moral value that we tend to take its dicta as fact. This can lead to unfortunate reporting of scientific results, both by researchers in ‘conclusion’ sections, and by health reporters.

The most recent example of this is a study (h/t Regan at Dances with Fat) that shows people eat more calories after looking at pictures of larger people than say, a picture of a lamp or a person of ‘normal’ weight. This was translated by the study researchers and health reporters to suggest that people exhibit ‘unhealthy’ behaviors after exposure to fat images, with a not-too-subtle additional suggestion that fat images are harmful and fat is contagious through the power of bad example. Typical paranoid fodder for the moral panic.

Let’s just assume that the conclusions were sound, that people indeed do, in a vacuum, eat more calories after viewing pictures of larger people than they do after viewing pictures of ‘normal’ sized people or lamps. How can we deconstruct what’s going on? And how might we suggest that this kind of behavior isn’t, shockingly, necessarily a bad thing?

Let’s try a thought experiment. Let’s suppose we take a group of chronic dieters who self-report to hate their bodies and fear fatness.* Subject them to a slideshow of people who are even thinner, and who aren’t shown eating. As a bonus, the imagery is presented in a way as to suggest that thinness is what makes these models attractive and worthy of love and the good things in life. Directly afterwards, ask the study participants about their feelings towards their own bodies, and see how many candies they take from a bowl.

My guess, based on the literature of similar studies and good old-fashioned logic? They’ll feel even worse about their bodies, and will tend to restrict their eating more than usual.

Then, show the same group of people a slideshow of images from, say, Adipositivity and some fatshion blogs. Show them fat people in attractive poses and lighting, in pictures meant to suggest that they are attractive, and worthy of the good things in life. Would it be any surprise if the study participants, post-slideshow, felt better about their bodies, and tended to relax their chronic restriction a tad?

What I want to know: why is the second scenario supposed to be the ‘unhealthy’ one?

The power of Healthist language and concepts is much more pervasive than we think. Its stranglehold on common sense and higher reason — its doublespeak — ties even those who make a living researching these things into knots of contradiction.

*I chose this group to make the comparison clearer. It applies to a more general group of participants since the majority of women in Western culture have dieted, and are inundated with messages about how thinness is the same as healthiness, godliness, and worth. Men are increasingly being marketed to in a similar way, and more men diet now than ever before.

The Fat Balancing Act

This is a post initiated by Raznay’s “Some Studies Show Fat Is Bad… Mmmkay?” on the never-ending oodles of studies trying in every which way to investigate just why “fat people are so disgusting.” It discusses the implications of the mindset which is generated by assumptions made in these studies — that is, how fat people are commanded to strike an impossible, delicate balancing act in order to be granted the respect and dignity accorded axiomatically to their non-fat peers.

Like Raznay points out, this is often to the detriment of more deserving topics, like cancer research. Then again, many obesity researchers (not all — hi, Dr. Samantha! 🙂 ) I’ve run across in real life, in comments on blogs, and on their own blogs/articles, are convinced that fat cells and hormones are absolutely causing or triggering fat-related diseases in the predisposed.

But I think two major factors are never accounted for in most of these “fat is bad go mutilate yourself/starve your body/feel like a drain on society” studies: dieting history, and current dieting status of participants.

See, lots of fat people diet. In fact, we make up the larger proportion of dieters. (My ‘normal’ -sized stepdaughter would say, “Ew, diet! Why would I ever want to go on one of those? They sound awful.” — but that’s nurture as well as nature, there.)

And those of us who’ve dieted for any length of time know:

  1. Dieting makes brain fuzzy. Huh? What about the food I can’t eat now? Oh you were actually asking a math question? Mmm, math. (Homer drool)
  2. Dieting is very stressful. So is living in a fat-hating world. Researchers are finding out more and more about the deleterious effects of stress on physical health. What they find might account for some the more specious claims correlating cognitive decline and fatness — that is, it might be about anxiety, at bottom.

There are a great many novelists, scientists, and all-around smart people who are big. Some of my most beloved writers are big people. One of my favorite politicians puts Taft to shame. They’re all extremely smart. And they’re not outliers — in fact, I’m willing to wager that intelligent, capable people, correcting for the stress and side effects of a life time of dieting and social stigma, are present in fat populations to the same degree they are present in non-fat populations. If I could commission a study, I would.

Here’s one tweet from the #thingsfatpeoplearetold hashtag which rings particularly true with my own experience of being fat and mingling with ‘intelligentisia.’ —

“Fat people are stupid. If they weren’t, they wouldn’t be so fat.”

I’ve especially gotten this impression from intelligentsia who are/were themselves fat and take it upon themselves to expound on their diet/reduction techniques:

“Oh, it’s easy, I just bag up smaller portions and do all my meetings on the treadmill. I rigged a laptop stand and I can just exercise all day if I want to!”

Of course, they’re smart, but they nevertheless don’t seem to make the connection between their twig-like human garbage disposal of a colleague who hasn’t seen a treadmill in forever, and metabolism and predisposition. If all it takes is living on an exercise machine and having bags of carrots and grain around, whose kind of lifestyle are you living? Your thin colleague’s — who is “better” because he is thin — or a horse’s?

And why the hell should fat people have to live like livestock in order to get the most basic kind of respect freely granted to the naturally-thin? (no insult intended to horses or livestock, of course)

Many fat people who’ve played this game long enough know that we’re expected to conduct a very delicate balancing act every day, seven days a week, until we die. We are supposed to “have it all” — aspire to the high-powered position, parenthood, hobbies, and community involvement — while still paying 15+ hours/week of penance on a treadmill, powered by a handful of carrots, oats, and apples. And advertising, of course, since fat isn’t okay unless you’re ‘doing’ something about it. Then you’re a go-getter! But not if you stay fat for too long!

Sound familiar? It’s chasing the dollar on a string. The dollar is basic human respect and dignity; the string is a tool of oppression, that with which we’re controlled and kept in our place. The man working on his treadmill, surrounded by plastic baggies of veg — is he free? And what is he chasing after? Is it thinness, or is it basic human dignity and respect, despite the fact that he is otherwise an example of success? Perhaps he runs to deserve his success in some intangible way unavailable to a person of his size unless human sacrifice is made? And is this the Puritan work ethic rearing its ugly head yet again, or is it something else?

Being seen as a successful, respectable fat person is a delicate balance, one which I’m not sure most people can strike. But should we have to? When do we get to step off of our treadmills, abandon our baggies of ‘good’ treats, and enjoy the world? When do we get to start being more than second class citizens? Isn’t this world — love, drama, beauty, art, travel, science, family, pleasure — isn’t it our world, too?

Food Addiction the Next Focus of Obesity Epipanic

In a study posted online that will appear in the August print issue of Archives of General Psychiatry, researchers used functional magnetic resonance imaging (fMRI) to study the response of 48 healthy young women in response to cues signaling impending delivery of a highly palatable food (chocolate milkshake) vs. a tasteless control solution; and consumption of a chocolate milkshake vs. a tasteless solution.

The women ranged from lean to obese and had been recruited for a healthy weight maintenance trial. Their eating behavior was assessed using a food addiction scale developed by lead author Ashley Gearhardt, a doctoral student at Yale University.

“Similar patterns of neural activation are implicated in addictive-like eating behavior and substance abuse and dependence,” Gearhardt noted in the study.”Food and drug use both result in dopamine release in mesolimbic regions [of the brain] and the degree of release correlates with subjective reward from both food and drug use.”

Gearhardt and colleagues found that participants with higher food addiction scores showed more activity in brain areas linked with craving. “These findings support the theory that compulsive food consumption may be driven in part by an enhanced anticipation of the rewarding properties of food,” the authors write. “Similarly, addicted individuals are more likely to be physiologically, psychologically, and behaviorally reactive to substance-related cues.

The researchers said that if certain foods are addictive for some people, that could explain in part why they find it so hard to lose weight and keep it off.

While researchers have speculated that an addictive process may be involved in obesity, the authors said that this is the first study to identify distinctive neural or brain activity in people with addictive eating behavior.

In addition, Gearhardt said, ”If food cues take on enhanced motivational properties in a manner analogous to drug cues, efforts to change the current food environment may be critical to successful weight loss and prevention efforts. Ubiquitous food advertising and the availability of inexpensive palatable foods may make it extremely difficult to adhere to healthier food choices because the omnipresent food cues trigger the reward system. (PsychCentral) (emphasis mine)

First, this is clearly a press release — the article doesn’t even come out in print until August. If I know anything about scientific publishing (and I know a little from my day job), it’s obvious that the ink was barely dry on their paper before they released it online, making sure to alert the major channels as soon as they hit “Upoad Article.”

Here’s the link to the online article. Naturally, the full text is behind a paywall. Any of my Fatosphere buds out there got an Athens login?

So this is what we have to go on without even knowing anything about the methodology beyond the statements released by a co-author.

First of all — 48 women. Not a giant sample size. Second — they weren’t all overweight or obese, and they were recruited from a “healthy weight maintenance trial” (if some were obese, and obesity is considered an ‘unhealthy weight,’ then does that imply the obese and possibly overweight women were dieting?) A natural question to ask is if this is going to be another round of ammunition against obese people in the grand moral crusade, how did these addictive responses correlate with BMI? This wasn’t mentioned in the vast majority of statement press-releases (nor in the article quoted above). I dug around and found one person at Consumer Reports who actually read the damn study (shocking, I know, most science ‘journalists’ can’t be bothered to actually read studies), and she said:

The researchers also found that a high score for food addiction didn’t correlate with having a high BMI. You can be lean, but still have an addictive relationship with food. They speculated that this might put lean individuals at an increased risk of future weight gain, unless they can develop behaviors to compensate and keep control of their food addiction. (emphasis mine)

Naturally, BMI isn’t mentioned in 95% of the articles except to implicate this as some factor in the Obesity! Epidemic!

Third — well, where to start. I’ll sketch my ideas, below, my first and later impressions.

First Impressions

As long as they use this study for what it actually shows — that some women out of a tiny sample with higher “food addiction” scores have higher activity in some brain areas linked to reward — and don’t try to generalize to all fat people or fat women, we’re good.

However, it’s unlikely that will happen, given the sensational nature of the science-illiterate press. Also, the co-author herself makes concluding remarks about how this might shape efforts to make people (excuse me, encourage!) lose weight. I.e., change the “current food environment” and restrict “availability of inexpensive palatable foods.”

Well, that’s a funny thing! How would we restrict availability of inexpensive palatable foods? Oh, by levying unpopular food taxes, you say? And you say that if we create a scare, make people afraid of fatty foods by suggesting the foods themselves are dangerous addictive toxins and — horror of horrors! — these are foods readily sought after by especially children and poor people, they might be more in favor of food taxes?

Yeah. Because it’s not like we can just stand by while poor people are actually able to afford energy-dense food, and might even — gasp! — feed it to their children.

Now onto the issue of ‘food addiction’ as an actual phenomenon parallel to addiction to substances like heroin.

When it comes down to it, an “addiction” to food is a silly idea, since it’s not a foreign substance that we can just quit. If someone exhibits higher pleasure or expectations eating food, then it would seem the real root of the issue is why? That ‘why’ is what needs to be discovered and addressed.

Also, food isn’t inherently addictive because there are people who eat loads of fatty, sugary, salty, etc food without experiencing an attachment beyond that being their regular diet. The issue is much more complex than the drug-addiction model, and simplifying it to that point loses precious information about what’s really going on.

I wonder how many of the women who scored high on the “food addiction” scale were former dieters or were currently dieting? I recall items like milkshakes, pizza, etc holding MUCH more fantastic interest when I was dieting (and I’ve heard many, many other dieters talk about this food-fantasy effect, and Keyes did a study years ago that shows it’s a side effect of one’s body experiencing famine). Could it be their wiring is a bit shot, or sensitive, because they’re restricting or have restricted in the past and a bit of their ‘famine’ mindset is still at work?

Final Impressions

This is why a lot of these studies are little more than junk reinforcing cultural biases against fat people or people who overeat. There are so many obvious questions that go unanswered, because all they want to do is generate a quick correlation for a press release. The medical research looking into body size is rife with these kinds of examples.

I took screenshots of a Google News search to prove this thing was an unabashed press release, intended to be — in a very calculated way, mind you — a seminal work in the war against obese people (excuse me, obesity). Some of the article headlines:

  • Heroin vs. Haagan-Dazs: What food addiction looks like in the brain (healthland.time.com)
  • Freakonomics: Another Obesity Explanation: Food Addiction (freakonomics.com)
  • Craving a milkshake? You might be a junk-food addict (Globe and Mail)
  • Can people be addicted to food? (CBS News, 20 hrs ago)
  • Compulsive Eaters May Have ‘Food Addiction,’ Study Finds (BusinessWeek, 14 hrs ago)
  • For Some, Food ‘Addiction’ Similar to Substance Abuse (PsychCentral, 1 hr ago, complete with pic of Sad Addicted Fatty)
  • For Food Junkies, Brains React to Milkshakes Like Drugs (LiveScience.com, April 4, complete with pic of Bad Woman Inhaling Chocolate)
  • ‘Tempting foods as addictive as cocaine’ (Times of India, 11 hrs ago)

What do you think about this study?