The Latest in Mixed Messages
Just by way of an update, the All-Party Parliamentary Group into body image has now published the report of the inquiry discussed above. Considering this a Government document there's some really good, groundbreaking stuff in there, including acknowledgement of the limitations of the BMI, the role of constant media discussion of the obesity epidemic as being key to fuelling fear of fat in children, the prevalence and effects of weight stigma, the potential harm being caused by the National Child Measurement Programme, the need to re-frame the emphasis of public health messages away from the current focus of weight and obesity and even (and perhaps most controversially) the potential for legislative action against discrimination and prejudice based on appearance, effectively making weight a protected class in terms of access to employment, housing, goods and services.
On the downside (and not entirely surprisingly) the recommendations place a disproportionate focus on the role of the media over and above that of central / local Government and their often ill-advised NHS / Education Department campaigns which deliberately target children and problematise fat at an increasingly younger stage. They also take claims that there is an obesity epidemic or multiple crises of public health for granted and avoid examination of the evidence base for these, instead regurgitating the 'accepted wisdom'. Some of the language also leaves much to be desired. But all in all, it's a good start.
However as the group's primary targets the mainstream media, has unfortunately and almost without exception attempted to downplay, dismiss and put a negative spin on the group's findings in a thoroughly spiteful and apparently co-ordinated attempt to ensure that after a flurry of animosity toward fat people the report ends up being quietly forgotten about. The worst culprits were (as usual) good old Auntie Beeb with a piece which focused exclusively on the recommendation that public health messages be presented in weight-neutral language and twisted it into being about 'banning' the use of the 'overweight' and 'obese' labels (again).
Of course all these articles have comments enabled and if one were to take the balance of opinion expressed within at face value (which I long ago learned never to do) you'd be mistaken for thinking that denying the great British Public their right to bully and shame fat people was up there with ID cards and road pricing in the list of unpopular Government suggestions; as such expect to hear little more about it. When the UK press and media bare their teeth, woe betide anyone who resists.
"What is right is not always popular and what is popular is not always right" - Albert Einstein
This article in MedPage Today is so frustrating. Richard Kahn, PhD, who was the chief scientific and medical officer of the American Diabetes Association for nearly 25 years, said that community programs are ineffective at achieving weight loss. No shit, Sherlock, what was your first clue? He told this to public health advocates and diabetes researchers at the Health Affairs briefing Tuesday, which was a stark contrast to the "prevention works" message of the event's other speakers.
Kahn -- who now teaches medicine at the University of North Carolina at Chapel Hill -- said that just sustaining significant weight loss, even with intensive dieting, exercise, and coaching, "requires near-heroic measures" in the face of a "very hostile food environment."
He outlined his views in a paper published in the January edition of Health Affairs, in which he wrote that there are two ways to dramatically reduce the toll of diabetes: One is to detect diabetes early and then treat it so effectively that complications from the disease are practically zero. The other is to prevent diabetes before it even happens.
Thousands of public health campaigns are aimed at prevention, and for diabetes, that generally means losing weight. But people have the "fundamental problem" of not being able to maintain weight loss, so preventing diabetes in a person at high risk for the disease is extremely difficult, Kahn said.
So, they're saying that community programs are ineffective at achieving weight loss, but for preventing diabetes, pretty much all they recommend is losing weight. Sounds to me like they're dooming people to have diabetes if that's all they can come up with (and I happen to know there are other solutions to delaying/preventing the onset of type 2 diabetes that don't entail weight loss, depending on your genetic risk factors for it).
His paper looked at diabetes prevention studies, including the large Diabetes Prevention Program, in which patients lost an average of between 4% and 6% of their body weight (but gained about 40% back by the end of the nearly three-year trial). It also looked at the government-funded Look AHEAD trial, which found that intensive lifestyle changes resulted in a major reduction in cardiovascular risk factors, but the effects greatly diminished after four years when many participants gained weight and lost their improved fitness.
Kahn said those studies, along with the Finnish Diabetes Prevention Study -- in which the greatest diabetes prevention benefit occurred in people who lost at least 5% of their body weight -- suggest that "without substantial, sustained weight loss, progression to diabetes will probably resume." Progression to diabetes may be delayed for a few years, but the long-term effects are uncertain, he said.
So, losing weight helps, but it can't be maintained in the majority of cases (tell us something we didn't know about maintenance) and the benefits of weight loss disappear when the weight returns. Doesn't sound like such a good recommendation to me.
"The main argument is that implementing a nationwide community intervention program is not going to do anything, I believe, except waste resources," Kahn told MedPage Today.
Kahn said that there are too many unanswered questions about how weight loss works that must be answered before a national program would ever succeed in preventing diabetes in the long term.
"We really need to know what is going on with this complex system we have," he said. "What is going on in our physiology that precludes us from losing weight and keeping it off?"
Another issue that prevents people from keeping weight off is the ubiquity of the "cheap, widely available, delicious food that we eat again and again."
He suggested "painful policies" as the solution -- such as raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums.
He acknowledged those aggressive policies likely would be unpopular among members of Congress and doctors.
Those "painful policies" are going to be unpopular among members of Congress and doctors? What planet is he living on? Congress won't give a shit about raising the price of all food except fruits and vegetables, or penalizing fat people with higher insurance premiums. If it isn't going to affect the pocketbooks of the members of Congress personally, they don't care. As for offering financial incentives to people who can keep weight off, that will be one of the cheapest programs to finance, what with the success rate of diets, as Kahn well knows.
The disconnect between Kahn saying " community programs are ineffective at achieving weight loss" and "raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums" is staggering. Does he realize how two-faced he sounds? Does he realize what an asshat that kind of thinking makes him? "Weight loss is nearly impossible, but if you don't lose weight and keep it off, you're going to pay more for your insurance, even though it's not your fault and there's nothing you can do about it, we're going to fuck you over anyway because you're fat and we think you should be thin because only thin people are healthy."
He added that the best doctors can offer right now is to suggest to overweight patients that losing 4% body weight and keeping it off can reduce the risk for serious complications of diabetes by 15% to 20%.
The best he can offer? Even though he knows it's damn near impossible to keep the weight off, he still recommends losing weight as the best way to reduce the risk for serious complications of diabetes. Kahn, I have some suggestions for you - carb counting, controlling blood glucose, regular exercise, and regular check-ups with an endocrinologist who is well-educated about type 2 diabetes will go farther to reduce the risk of the complications of type 2 diabetes than losing weight ever will. Pull your head out of your ass and wake the fuck up before you do more harm than you already have.
Teaching Tolerance is a Project of the Southern Poverty Law Center. It is aimed at primary and secondary teachers and includes a magazine, professional development materials for teachers, classroom activities, and a teaching kit. What a great way to spread the message of civil rights and gender equality to the nation's teachers and to the upcoming generation!
The newest issue of Teaching Tolerance concentrates on an issue close to the hearts of many fat people, especially those of us who have fat children or were fat as kids: physical education. Game Changers focuses on a gym teacher who does many of the things that have been suggested and endorsed when we in the fat acceptance community have discussed our experiences with school gym classes.
Dorr taught Tim’s class five days a week, including 20 minutes in the classroom teaching about the connections between health, fitness and diet. Tim dressed every day and joined his classmates in compiling their personal fitness data. He took part in class: aerobic exercise, strength building, skill development and playing cooperative instead of competitive games.
Tim measured his progress using charts, graphs and a journal. He also noticed how supportive his teacher and classmates were of him and each other. Kids would finish their laps, then circle back and walk alongside him. They cheered when a classmate graduated from one push-up to five. “There’s only one way kids can get in serious trouble in my class,” Dorr says. “Only if they’re unkind.”
Fair enough. Kindness is good, and maybe Tim is tracking progress in his running times, the number of sit-ups he can do, and the weight he can lift.
This article features a Weight Loss Fairy Tale™.
The sophomore shed 45 pounds during the semester.
“One day, I heard screaming from the other side of the gym,” Dorr recalls. “And there’s Tim with his arms above his head. He was shouting and the other kids were clapping and cheering. He had just taken his body weight and fat index and had reached his personal goal.”
...and then it goes into the gym teacher's other job as a weight loss coach.
Now, many people do lose some weight when they become more active. But, the main benefits of being active do not necessarily include weight loss. Being stronger, more coordinated, having more stamina, being more physically confident and competent; those things are immensely valuable in and of themselves.
This Weight Loss Fairy Tale™ bothers me for two reasons.
First, I am sick of physical fitness - and especially physical fitness being taught competently in the schools - being treated as if it's about weight loss. Even fat kids who never get thin deserve to learn how to use their bodies effectively - not to mention kids with disabilities and kids with no interest in sports. They all deserve a physical education course that actually teaches them useful things.
Second, it just doesn't ring true. I find it doubtful that the anyone would lose 45 pounds because of a semester of gym class, and also it's really hard for me to imagine a teenager who showed a defiant attitude at the beginning subsequently making his weight into a public spectacle. As someone who was a fat teenager, I can say very confidently that having my weight made public in this type of gym class would have been at least as humiliating as being one of the last chosen for teams in a traditional class. In fact, it's hard to overstate the lengths I would have gone to in order to avoid being forced into a gym class that resembles a public Weight Watchers meeting with an audience of thin peers.
Many of the things that are discussed in this article have come up over and over again in discussions of school gym classes in fat acceptance circles. The importance of non-competitive activities and a supportive atmosphere. Teaching all the students how to stay healthy and active throughout their lives rather than concentrating on competitive sports and the kids who excel at them. But, the most important part of the Perfect Gym Class is tolerance, and the foundation of that tolerance is acknowledging that different children have different types of bodies, different talents and different interests. This type of class should not be aimed at trying to make all the students fit the same mould. Success should be measured in physiological knowledge and physical performance and improvement, not in pounds. The main difference between this gym teacher and your standard hard-assed sports coach is that she's patronising and focused on weight loss rather than demanding and focused on tangible accomplishments. That is not an improvement.
How could a magazine called "Teaching Tolerance" get it so wrong?