Fat Women Fitter Than Fat Men?

I am unable to access the full article, but several holes appear just in the abstract. The men were older, heavier (2 BMI points), and had higher percentages of fat than the women (yet women naturally have higher percentages of body fat). The study participants were all selected from a hospital-based intensive weight management program. The notes about dysfunctional eating also indicate they were probably especially severe dieters, which could also explain the findings. The study participants (only 22 men and 34 women!) are not typical of active, healthy fat people. It's more piling on looking for bad things about fat people, this time men. Most endocrinologists don't put credibility to "prediabetes," as just as many people with blood sugars in these normal ranges go on to get type 2 diabetes as not. At least one of the co-authors (I didn't check them all) is with the Endocrine Society. CSPI notes that it is sponsored by at least 18 different pharmaceutical companies, and several drug company reps sit on its Board. This group has made obesity one of its key governmental policy agendas for this year. [see: http://www.endo-society.org/publicpolicy/index.cfm] They sponsor ObesityinAmerica.org which links right back to this URL and promotes weight loss, WLS, CORE, anti-obesity initiatives such as America on the Move, and hypes the medical dangers of obesity and what obesity is "costing" society. Interestingly, in their study objectives these researchers talk about bariatric surgery. While oxygen/lung capacity can play a role in anesthesia during surgeries, helping to build a case of medicalizing fat in men could also serve to increase the numbers of men seeking these surgeries, since most WLS patients to date have been women.

My first instinct is that, if you're taking your sample from people who choose to enter a weight management program, the men you sample are going to be further from the mean than the women, because women are encouraged to take part in these programs more - men can "get away with" a level of fat that women can't.

I'm just wondering whether they found out why the unstoppable eating was occurring. Was it physiological or pscychological? And has anybody tried to address these issues? It strikes me that if these people have uncontrollable eating, whether physiological or psychological, that hasn't been addressed, then they shouldn't be in the queue for WLS. Not that WLS is a terribly good option anyway, but surely addressing eating issues, whatever they may be, would be easier than mutilation? Still, it doesn't say. And I do NOT think you can possibly make any judgements about the relative health of fat women and fat men from this survey. The pool of participants is way too likely to be unrepresentative.

Absolutely Jeff! I doubt it was a truly random sample. Women are much more likely to do it for cosmetic reasons (although they may convince themselves otherwise) while men may be motivated for health reasons. (Not that their weight is necessarily causing their problems, but weight loss would be seen as the pop universal panacea.) As to the body fat distrubution angle, Gaessar and others have pointed to small clincical studies that shows there MAY be something to it. I am sorry if "apples" take umbrage, but considering that the health insurance industry wants to rip us off by charging us more, I personally want all angles explored.

I have noticed that in my own extended family (my grandmother's two sisters married two brothers and that "wing" of the family has almost universal type 2 diabetes) is that the men fare less well after diagnosis. Just 8 months ago my 59 year old uncle died of NIDDM while his sisters are struggling on with it and I have a THEORY (not saying this is "the reason", just an observation). In my experience, most white American women grow up knowing how to diet. I don't know anyone who wasn't aware of calorie counts by age 11, whether they were fat or not. When the diabetes diagnosis came to these aunts and uncles upon middle age, the women treat is as just a new diet, and because they are so accustomed to restrained eating, and to barring foods that are decided to be "forbidden" they are able to maintain a certain homostasis and low glycemic diet. The frequent complaints about their brothers is that they "just don't follow the diet recommendations" and continue to eat as they have all their lives, which in our family means high glycemic foods. Some believe that controlling sugar intake can help control type 2 diabetes and if that is so, it is not too difficult to see how in this example the women are able to acheive what is to them just another diet while the men are less able, as if they have more of a bewilderment toward "diets" and feel more entitled to eat to satisfaction. This is just an observation, so correct me if you think it is probably offbase. I still don't know a lot about type 2 diabetes or whether the current diet recommendations are really helping or not. I am just beginning to study it.

1. I think Jeff has a point. I think a lower level of "fatness" is judged as "unacceptable" (and therefore, fodder for WLS) in women than in men. 2. I realize it's anecdotal evidence, but in my limited experience, when men and women both try to lose weight, it's usually men who have more success - at least, early on in the game. (Whether or not they regain it in the end is another matter). Unfortunately, I don't have a link to share, but a couple days ago here, on his "radio moment" Dr. Dean Edell made some kind of a comment about how people tend to put on fat after dieting - that when they regain, it typically winds up in what are regarded as the "less healthy" areas of the body (also true, he said, of former anorexics who gained weight - that they put it on in the abdomen first). He didn't quite go so far as to say "dieting makes you fat" but he did suggest that diets probably weren't the way to go in the long run...

I'm very interested in this: "They were also all treated with antidepressants used to remedy the psychological effects of bulimia." I'm interested because I'm pretty sure I'm not the only person who gained weight very rapidly after starting to take SSRIs (I was fat before that too, but not as fat). I wonder how antidepressants contribute to weight gain?

It seems to me that the difference in fat-distribution patterns causes a double whammy for women: because women tend to put on fat directly under the skin (subcutaneously) where it's highly visible while men tend to put on fat around their abdominal organs (viscerally), a woman will *look* "fatter" than a man with the same BMI. And then combine that with the lower social tolerance for "looking fat" in women as compared to men. The result is going to be that the men in such a study are going to be much more obese than the women, and also more likely to suffer problems because of it (virtually all the metabolic problems claimed to be associated with excess body fat are actually associated mainly with visceral, not subcutaneous, fat). The study looks like it's been completely spoiled by "clinician's error," the tendency to categorize a group by its extremes because people at the extreme end of the spectrum are more likely to seek medical help. For example, a significantly fat person who's weight *isn't* causing him/her problems is less likely to show up in a clinician's experience than someone who is having problems, even if there are actually a lot more of the former. It's similar to the "tech support fallacy"; lots of people cite their experience working tech support as evidence that the majority of computer users are clueless, mistakenly assuming that because they don't get many calls from clueful users there can't be many of them instead of realizing that the clueful users have little reason to call tech support.

[i]Dr. Dean Edell made some kind of a comment about how people tend to put on fat after dieting - that when they regain, it typically winds up in what are regarded as the "less healthy" areas of the body (also true, he said, of former anorexics who gained weight - that they put it on in the abdomen first). He didn't quite go so far as to say "dieting makes you fat" but he did suggest that diets probably weren't the way to go in the long run...[/i] Beakergirl - thanks for posting that comment by Dr. Edell. He's also said on his program (several times) that fat people are often fitter than people think. He says that because they are carrying so much weight they are often building muscle underneath the fat just by carrying that weight around all the time.