In today's weight loss products to stay the hell away from, I bring you Hydroxycut.
Taken off the market in 2009 because of complaints of liver damage, it was "reformulated" and became available again. Last week, a woman who had been taking it and was sleep deprived went into a delusional, homicidal rage and killed her daughter with scissors. The original Associated Press article, Nev. mom kills daughter, 6, with scissors is propagating as we speak.
Did this horrible tragedy have something to do with the weight loss drug, or was this woman just out of her mind to begin with?
Who knows, but between the liver damage, the loss of sleep and the possible delusions, I'm thinking this is a drug to avoid.
I'm guessing that most people who read BFB are aware of Children's Healthcare of Atlanta's crap anti-childhood obesity ad campaign, ironically called "Strong4Life." There's been a lot of talk and a lot of action going on in the fatophere and in the social media opposing this campaign. Regan of Dances with Fat is creating an ad counter-campaign. Marilyn Wann has made it possible to Stand visibly against the campaign and for more positive values, and Atchka of Fierce, Freethinking Fatties has been opposing the campaign on the ground, with Children's Healthcare of Atlanta and its donors. There's also a central site with up to date information called Stand4Everybody.com. It is really been an incredible show of community power and cooperation.
However, the majority of people still don't seem to get it. Children's Healthcare of Atlanta, when challenged, keeps citing undisclosed market research which they claim proves that only a small percentage of people find the Strong4Life campaign offensive. In a recent poll, 80% of respondents seemed to think that Disney's "Habit Heroes" exhibit at Epcot, which depicted fat people as embodiments of bad habits, was just hunky-dorey.
So, as a former fat kid, I'm going to talk about the specific reactions I think this type of campaign will trigger in fat kids and the communities surrounding them.
Fat children will respond to these ads in two ways, and it won't be either/or. They will disassociate, but they will not be able to avoid feelings of shame and lowered self worth. Additionally, the campaign will affect their peers and the adults in their lives, encouraging bullying and lowering expectations.
If they know deep down that they are healthy - they are strong and active and the doctor tells them all their numbers are fine except their BMI - fat children will think that they're exceptions to the rules. They'll think (and this is one place my mind went as a kid), "None of the things they say about fat kids seem to apply to me. I don't get winded easily. I'm not sweaty. I don't eat a lot of junk food. I can keep up with my thin friends. The doctor must be wrong. I must not really be a fat kid, or being fat is not the same for me as it is for other kids."
The thing is, I wasn't an exception. The vast majority of fat kids are healthy and have normal lives; the vast majority are exceptions to the stereotypes in these ads*. Notably, the child actors in the ads are all healthy, normal kids who happen to be larger than average. I suspect that most fat kids won't be able to relate to the ads and will disassociate themselves as much as possible. However, they won't be able to escape the fact that the ads are about them; that they are being singled out.
Shame and lowered self worth
If you tell children that they're unhealthy, they won't think of themselves as healthy. They won't play as hard. They won't push their limits. They'll start to avoid physical activity. Believing that you're unhealthy is not neutral. Just as there's a clinically significant placebo effect that kicks in when people are given an ineffective treatment that they believe is real, there is a "nocebo effect." If healthy people are made to believe they're sick, then they tend to get sick.
This works psychologically as well. If you tell kids that they're pathetic, then they may start to believe it. They may pull away from their friends. They may get depressed. With their self respect and their support systems under attack, they will get bullied.
Teachers and thinner children will be looking at these ads too, and the fat kids will get bullied more than ever and will have to deal with increased prejudice and lowered expectations. As the expectations of their peers and teachers increasingly match the stereotypes in the ads, how many fat kids will be able to maintain the feelings of competence and social normalcy they need to be successful in their lives? Even if they're able to maintain equilibrium in their own minds, they are going to be treated like damaged goods. Prejudice toward fat children has existed for a long time; at least since the fifties. But never has a respected organization so clearly told fat kids, their peers, and their mentors "Fat children are pathetic and diseased. They bring shame on their families. Fat kids: your bodies are unacceptable."
It will become clear to these children what others - even adults - think of their bodies. They will start wondering if it might not be worth it to starve themselves so that their bodies won't cause others to make negative assumptions about them and their parents. Alternatively, they may rebel or stonewall. Healthier habits are frankly the least likely thing to result from this.
*Oh, and fat kids who actually do have health problems associated with their size? They deserve respect and privacy, not public humiliation and condescending pity.
Have you ever wondered what kind of images could be created if art and fashion photographers worked with models who were not tall, skinny and young or anything close to it? Used the models' unique looks as ideals - as something to be emphasized and glorified, never hidden or shoehorned into the tall-skinny-young template? How powerful images like that would be? How they could completely expand and reframe our perception of what is chic and attractive?
I have. Although I enjoy creating and looking at grass roots fashion photography, both plus sized and general, I've always had a special place in my heart for photography that does more than just capture a person wearing a particular outfit. Good fashion images can be incredibly evocative. The lighting, the styling, the setting and the pose can trigger emotions; tap into archetypes and shared memories. Naturalism has its place, but I also admire art and style in fashion photography.
In the nineties, I read Elle and Vogue until they went over the top with herion chic. I loved the first year of Mode. They were starting to do the kind of work I wanted to see, but they pretty quickly caved in to the conservative expectations of their advertisers and started using six foot tall, size 12 models who looked... well, basically like (at least some) straight sized models should look but don't. What a disappointment!
What could be better than an arty plus sized fashion magazine with high production values that really pushes aesthetic boundaries? I'll tell you. An arty fashion magazine with high production values that is truly inclusive, where there's no one "ideal" look!
That is why I am in a state of total joy right now over Velvet L'Amour's new project, VOL•UP•2. It is difficult to express exactly how much ass this publication kicks: possibly more ass than any of us are sporting.
Be aware of some of the images are not even remotely work-safe for most people.
Click the picture of Velvet to go there!
Velvet d’Amour (velvetphotography.com) is the only supersize-plus model ever to infiltrate the elite world of Parisian couture by walking the runways of both John Galliano and Jean Paul Gaultier and modeling for top fashion magazines, including French Vogue, Egoiste, WAD, Standard, and many others. Recently, Velvet was named a “Curvy Icon” by Italian Vogue. Her acting career landed her on the red carpet at both the Cannes and Tribeca film festivals for her lead in the French film “Avida.” Additionally, she raised 54,000 euros to help Missing and abused children through SOS Enfants Disparus as a result of her participation in Celebrity Farm, a popular French reality show. She has also appeared on Monique’s Fat Chance, ET!, The Insider, and CBS Sunday Morning and has been interviewed by NPR. Her photography has been celebrated internationally as refreshingly sexy, edgy and modern. As an outspoken feminist, Velvet’s insights on the role of popular notions in beauty have landed her in such magazines as Bust, on Jezebel.com and the Huffington Post as well as in innumerable blogs and online publications.
In the series on food and food processing I started by outlining the Beloved Fantasy of a Blissful Past (1), and then laid out a Framework (2) to discuss food processing itself and how we got here from there. In this post I will talk about one of the biggest drivers in the processing of food - the cost of food to the consumer, and what it meant for the development of our food environment. I will also take this opportunity to introduce one of the writers whose work I will outline to illustrate the changes over time – Ida Bailey Allen.
Those who fantasize about our Blissful Past frequently imagine some kind of pastoral utopia, where all food is produced locally, it is fresh, and Mom and Sis spend all sorts of time at home cooking from scratch and Dad and Bud sit at the table with Mom and Sis and Baby and eat this fresh food daily. Everybody looks like Katharine Hepburn and Clark Gable or Cary Grant (conveniently forgetting Mae West and W.C. Fields – but that is how selective memory works). Ummm… Not so much. Although there has been a great deal of change, that world of agrarian subsistence farming (to the degree that it ever existed) was destroyed with the birth of the Industrial Revolution. I will state this – that foods that would fall into the following categories of food processing and manipulation (categories generally considered “bad” or “linked” with obesity by the food nannies and wags) within our Framework (4) have been with us for the last 100 years (or longer in many cases):
- Canned meats and vegetables (of all types)
- Margarine (1871)
- Non-animal shortening (like Crisco) – 1911
- Dried soup or bouillon – 1908
This is just a short list. The development of each of these items responded not only to the need for shelf stability, but it also allowed the consumer to address the issue of cost in two ways. They lowered the cost to purchase the needed food (margarine and shortening are two examples as they replace both butter and lard) and/or retard food spoilage thus allowing the consumer to “stock up” when prices are lower and stabilize the cost of purchasing the food. Implicit in their use is also convenience – a home-made broth may taste better and could be more wholesome, but takes longer to prepare than bouillon. It might be more profitable (and cheaper) for an industrial worker to use the bouillon and work more hours than to spend the time making broth from scratch. So cost is an important driver of innovation in food processing (5).
The cost of food to the end consumer is of concern to everyone, because we all eat. Some of us might eat swordfish and others might eat potted canned meat, but we all need to eat so we can live. Economists pay close attention to the Consumer Price Index of which food is one component (3). Many organizations and professions pay attention to the cost of food for operational reasons (schools to budget for school lunches, and relief organizations to budget for relief operations – for example). Historians and economists who focus on the movement of consumer prices over the years look at the cost of food as drivers of human activity of all kinds. Scientists involved with food production (whether it is agriculture or food chemistry or food preservation – for instance) focus on how they can lower food costs through the use of technology. In short, the cost of food – whether in money or effort to obtain it – is a driving force in what we as humans do every day.
For the rest of this discussion, keep the following numbers in mind:
- For the purposes of discussion here, I have held the dollar in 1935 as the constant (1935 dollars = 1 dollar)
- A family budget of $9 per week for food for a family of 4 in 1935 was the equivalent of about $148 in today’s dollars
- A family budget of $20 per week for food for a family of 4 in 1952 was the equivalent of $170 in 2011
- The proportion spent on food by a family in 1952 was about 50%.
- According to the Federal Reserve Bank of Minneapolis consumer spending on food in the lowest 20% of household income was 16.2% versus 11.5% in the highest 20% income quintile (2009)
A great many things happened to the price of food in the intervening years. In fact, the proportion spent on shelter now occupies the highest percentage of expenditure, whereas in years past it was not so. The effect of the cost of food on the American home budget, and in food and diet developments is something that can be seen very clearly in the works of one woman – Ida (Cogswell) Bailey Allen (6).
Ida Bailey Allen was born in 1885 and died in 1973. During her lifetime she produced a plethora of books on cooking and home-making (even taking into account that many were new editions of previous works). Her 50 books sold 20 million copies. She pioneered cooking shows on radio and TV. She advised women on wartime cooking during both world wars, and her opinion was sought by many on topics of nutrition and diet. She was the food editor for the Ladies’ Home Journal. She established cooking schools in her youth, and home making clubs across the nation. She was the Martha Stewart of her time, lending her name to many companies such as Coca Cola, Nucoa Margarine, and The Golden Rule foods as endorsements and by editing cookbooks distributed by these companies. Her last book (Best Loved Recipes of the American People) was published in 1973 just shortly after her death.
Now, a number of writers have mentioned her role in gender-role enforcement, while others have (dismissively, I feel) short-changed her legacy. The 60’s and 70’s were not kind to her. James Beard and Julia Child took her place in the newly-affluent national food theatre, and she was said to maintain that “good home cooking was an antidote to the rising divorce rate” (7) – unflattering words which were quoted in her obituary. People – watch what you say or someone will put the silliest thing you ever said in your obituary. All of that aside, a closer look at her oeuvre belies her image either as a corporate shill, or an anti-woman crusader for what many may have considered the way things “ought to be”. She was a woman of her time, and needs to be considered within her social context.
The primary thrust of much of her work was focused on the home economy, and the proper preparation and utilization of food. Her training as a dietitian gave her the knowledge of food, its components and its utilization in the body. Her skill as writer and speaker allowed her to convey this information in ways her public could understand.
In 1924 she recommended to her readers ( 8 ) with a family income of $1,000 to $2,000 per year [$13,000 to $26,000 in today’s dollars using the Bureau of Labor Statistics (BLS) Consumer Price Index (CPI) calculator], a budget of 9 to 10 dollars per week to be spent on food for a family of four to five people. That works out to up to $520 dollars per year ($131 dollars per week or $6,840 per year in today’s dollars). That represented 52 to 27 percent of the family’s income. Today’s proportion is 25% or less. In 1935 (9), she presents a week of menus for 4 people at $9 per week. That is about $149 in today’s dollars.
In 1952, the picture changes considerably. Consider now that World War II has come and gone, but the Korean War is in progress. The pent-up demand for goods and services (including food) is working its way through the system, and the baby boom is in full swing. Food prices rise swiftly. So what starts to happen? Foods begin to be fortified, and new foods are created. Home freezers become more generally available, and commercially-frozen foods are increasingly available. At the same time, there is a rise in the availability of “convenience foods” (pre-cut, pre-packaged, and sometimes pre-prepared). Now her family food budget for a family of four is $20 to $30 per week (up to $254.65 per week in 2011 dollars). Her target families at this time were earning anywhere between $2,000 and $6,000 per year before all deductions. ($17,000 to $51,000 in today’s dollars). Most fell in between those two extremes, but as you can see we’re talking about the same social stratum here.
Her fundamental message in this 1952 book is one that would be fresh today – cook more, eat fewer convenience (pre-cut and packaged) foods, and pay attention to your food balance for nutrition. You can eat well for less. In this book, she sets forth – as is her custom – her concepts of balancing meals for optimum utilization of nutrients and calories. Yet she introduces concepts that have become business as usual for us today. For people who have very reduced food budgets, she advises supplementation (10) with Multi-Purpose Food , a soy product which was developed in 1937 to feed those who were to be refed from starving (from either famines or war – for instance). She claimed to have served it to enthusiastic gourmets at the Waldorf. She was documented to have served meals of leftovers at the Waldorf as well. These were publicity for her as well as public service efforts. Multi-Purpose food was around until 1980.
She also advocates for use of fortified flour, Cornell Formula bread (good stuff – actually), raw peanuts, and other fortification of foodstuffs either at home or purchased. She recommends advocating for food fortification in one’s area. In her milk budget section (11) (which was ‘out of control’ – her words - in some households with large numbers of children) she advocates dried milk as well as homogenized milk and milk products such as yogurt. This is also a departure from the pattern in other books, since technology had made available different milk “formats” than were available previously. For example, she talks about irradiated milk. Food irradiation was fairly new at the time. It makes us squawk with alarm, but at the time it was seen as a way to kill bacteria and pests to protect the purity of the food. Some still see it that way and advocate for it. I’m not going to reach for a warm glass of irradiated milk, but back then it was state-of-the-art for food preservation, and whether or not it is safe is really material for someone else’s web-page (though it would make for an interesting discussion).
So, the rising cost of food through the middle of the 20th Century drove changes in the types of foods available (greater number) with new developments in food science geared to maximize nutrition per dollar spent on calories. Ida Bailey Allen was not only a participant in these changes, but she advocated for the new foods in her home-making and cooking books. Specifically, and despite her advocacy of home food preparation and reduced use of prepared (pre-cut and packaged) foods, her readers also had another driver that pushed them toward the use of prepared and/or shelf-stable foods: time. I’ll discuss that in the next post, but I just wanted to leave you a treat to share with those who refuse to believe that there EVER was processed food in the past. In 1940, Ida Bailey Allen published a book entitled Ida Bailey Allen’s Time-Saving Cookbook. In it, there is a cool little recipe for Mexican Rice Timbales. They are shown as the cover art for the book. For your enjoyment, here is the picture and the recipe. It features pasteurized process American cheese: the cheese that isnot supposed to have existed “back then”. Enjoy!
(Edited to correct odd sentence and some typos and errors)
(1) In the post entitled Beloved Fantasy of a Blissful Past I noted that fat people DID in fact exist in times past, and that the question of whether or not processed food is the prime cause of obesity today is more complex than it appears.
(2) In the post entitled A Framework for Talking about Food and Processing, I laid out the following framework for the discussion:
- The reasons why food is processed
- How food is and has been processed and a definition of foods according to their level of processing as reflected in the following categories:
- Whole, Raw Foods
- Traditionally-Preserved Foods
- Home-Canned Foods
- Home-Frozen Foods
- Home-Frozen Foods
- Frozen Whole Foods (commercial)
- Shelf-Stable Foods
- Prepared Foods (includes whole meals ready to eat)
- The Hierarchy of Foods – how today’s perception of foods as being associated with a higher or lower class within society imbues them by association with a tag of “processed” or not irrespective of reality
(4) The food nannies, scolds, and wags usually go after Prepared Foods of all types, and Shelf-Stable Foods as their chief diet malefactors.
(5) War, as discussed previously, is another driver of innovation in food processing. I will likely do another post on that, because there have been some fascinating developments in the production of meals prepared for deployed soldiers.
(6) I’m a big fan of Ida Bailey Allen – I have amassed quite a collection of her books, booklets, and pamphlets. I use them for recipes all the time!
(7) From Ida Bailey Allen’s obituary in the New York Times, July 17, 1973.
( 8 ) Ida Bailey Allen, Home Partners or Seeing the Family Through. Privately printed, 1924; pp 12-13
(9) Ida Bailey Allen, Cooking within Your Income, published for F. W. Woolworth Co by W. F. Hall Printing Co. Chicago; p. 134.
(10) Ida Bailey Allen, Solving the High Cost of Eating; pp 31-33
(11) Ibid.; pp 10-16
To people who know me, it's no secret that I have arthritis in my knees and it gives me screaming fits. I went to see my orthopedist on the 14th for my yearly SynVisc shot (it lubricates the cartilage and is supposed to slow down the wear and tear). He ordered new x-rays of my knees and I got to see them - the right one is much worse than the left one, which I knew, it's the one that hurts and swells when I have to walk or stand.
I was diagnosed with arthritis in that right knee when I was 34, after I fell on it and had to have it drained because it swelled so badly (they drained almost a cup of fluid/blood out of it). In the ensuing 24 years, I've been prescribed ibuprofen, Voltaren, Naproxen, and now Celebrex. At no time have any of the doctors I've seen ever suggested physical therapy or exercises to strengthen the muscles that support my knees. They have, however, every one of them suggested weight loss. And before I found FA, I thought they might be right, and I tried their diets (and we all know where that leads, right?). I even had a nurse practitioner who suggested WLS because (according to her) no surgeon would replace my knees at my then-weight of 350 lbs (and I believed her, did it, lost weight, gained it back plus some more, and got some lovely complications to boot).
Then I realized dieting/WLS wasn't the answer, was compounding the issues with my health, and started looking for different answers. I found fat acceptance, then I found HAES, and I started reading (what else do bookworms do when they find a subject that interests them and is going to have a huge impact on their life?).
The epiphany part of this whole story comes in when my orthopedist told me that every pound a person weighs puts 7 pounds of pressure on their knees, and that losing weight would help my knees. I told him I'd already dieted my way up to where I am now, and had WLS and "see how successful that was?" I'm thinking I have to be proactive here, he's not going to come up with any suggestions to help me, so I have to think of something, so I asked him "What about exercises to strengthen the muscles that support my knees? Would those help? Would that delay having to have my knees replaced?" Can you believe it? He actually said that it probably would, and he would write me an order for physical therapy so they could show me what exercises to do and how to do them.
Now, I've been seeing him for the last 4 years, why couldn't he have suggested this 4 years ago? That's 4 years I've not been working on making my muscles stronger, and it's 4 years that my knees have been getting worse - all because the only thing he could recommend was weight loss.
I went to physical therapy on Friday, talked to the therapist, she looked at my x-rays (I also have some bone spurs in there, no wonder my knee hurts). She gave me a list of 4 exercises to do, showed me how to do them correctly, and I have to go back in 2 weeks to check on my progress and see if we need to add more. I also found out that I over-extend my knees when I straighten them - a result of the degeneration from arthritis.
I didn't know how badly out of shape the muscles in my right leg were until I started doing these exercises - my left leg is fine, doesn't hurt when I'm done. But my right leg is another story, and I'm only doing 1 set of 5 reps right now (twice a day). As soon as the pain decreases, I'll increase to 2 sets twice a day, then I'll go to 2 sets of 10 reps twice a day.
Now, I hate exercise, I have to put that out there. I've started and stopped more exercise plans than I want to count, but every one of those plans was designed primarily for weight loss and if I didn't lose weight while doing it, well, that wasn't being successful. So these exercises aren't designed with weight loss in mind - strength is the goal, less pain is the goal - those are goals that are definitely more achievable than weight loss. That's something that should have been given to me 24 years ago, when I was first told I had arthritis in my knees - strengthen the muscles supporting the knees, and there will be less wear and tear, less pain, less need for medication. Why aren't doctors telling this to fat people? Why do thin people with arthritis get physical therapy and all kinds of other advice, but fat people with arthritis get told "Lose weight, it's all we can do."?
AndyJo and DeeLeigh alerted me to this story appearing in today's New York Times:
Some of you might have heard about the combination drug talked about in this article, phentermine and topiramate. Phentermine, if you remember, was the phen half of fen-phen. That's not to impugn phentermine by association, since the major side effects of fen-phen were seen to be caused by fenfluramine half.
However, make no mistake about it -- phentermine is a stimulant, that acts to suppress appetite much in the same way as ephedra does (phentermine is a congener of amphetamine). It's speed, and carries a similar range of side effects as other amphetamines like palpitations, dizziness, heart valve damage.
Topiramate (Topomax) side effects vary, mainly neurological (like dizziness, and pins-and-needles). There have been some cases of severe ocular side effects like glaucoma.
As for how effective the topa-phen combination is, I'm having a hard time finding long-term studies that aren't paywalled. There was one at 6 months (hardly useful); another at one year -- funded by Vivus, the makers of Qnexa (also hardly useful/reliable), another at two years -- again, funded by Vivus.
Additionally, from what I'm scraping up from the studies I can actually read, the weight loss effects of topiramate may in fact be temporary. This one study, conducted on children, says that weight was regained after tolerance was achieved at about 12 - 18 months.
The NYT article itself uses the problematic language one comes to expect in weight-related articles, like the euphemistic and largely meaningless term "obesity doctor" for a person who is in fact trying to reduce the incidence of obese people (recall, 'obesity' is not a disease). It's like a women's doctor whose mission is to reduce the number of women, or a pediatrician whose mission is to reduce the number of children. Definitions and language is important -- propaganda and redefinition of terms is the grease of the wheels of a moral panic.
The most important thing to take away from the article, and from this post, is that regardless of whether the topa-phen combination is 'effective' according to whatever the arbitrary standards of the FDA regarding weight loss drugs is today or tomorrow or ten years from now, phentermine is only approved for short-term use. Phentermine is an appetite suppressant. As soon as phentermine is not taken any more the individual will eat normally and gain back most if not all the lost weight.
Starvation is not a 'treatment' for fatness, especially not short-term starvation. The only long-term 'treatment' that seems to work is daily privation and semi-starvation -- an activity that will consume as much time as a part-time job -- for the rest of one's natural life. In short, the life of an ascetic. Which is a fine choice if that's what you want. But to expect that all fat people should live as ascetics is monstrous.
What I'm most concerned with is the stamp of "FDA approval" being used as a proxy for a treatment's effectiveness or long-term safety. Basically these treatments are designed to meet the approval minimums for the minimum necessary length of time. Doctors and patients are fooled into believing something is effective because it has that FDA approval stamp -- but how often as a patient did your doctor mention your weight loss drug was only effective or safe in 1- to 2-year trials, or that it hasn't been tested in the long term at all, or after the year you take it and lose some weight you can no longer take it anymore?
Even in the article we have this story:
“I can’t tell you how many people I sent to him because they saw the success I had,” said Lynn Adams, a retired teacher, referring to Dr. Thomas Najarian, the inventor of Qnexa who opened a weight-loss clinic here in 2001.
Ms. Adams said she took the two drugs for a year and lost about 80 pounds. She has taken the drugs from time to time since then but is off them now and has gained about half the weight back.
Who wants to bet that she recommended her friends jump on this new diet drug bandwagon at the peak of her weight loss and not after she gained half of it back? And how in the heck is she still being prescribed topa-phen if phentermine is only approved for short term use?
And just so we can be very clear about the responsibility for what looks to be like the next diet drug disaster, the doctors and clinicians who prescribe topa-phen are acting like mindless pharma-pushing automatons.
Doctors are just as susceptible to corruption as anyone else. A doctor who founds his career on weight loss and eliminating fat people needs dramatic success stories to promote himself, and is much more willing to throw caution to the wind if it gets him a success story and more word-of-mouth referrals.
The main danger is: weight loss happens on a curve that bottoms out over a period of months, giving an illusory 'permanent' success that is can then be paraded around to friends. A walking advertisement that, once it's served its purpose -- getting more butts into a weight-loss doc's waiting-room chairs -- regains and fades back into the shadows. We've seen that pattern with popular diet programs. Trumpet some minor celeb's loss at the bottom of the cycle and pretend it's permanent, then ignore their inevitable regain and queue up the next minor celeb to do it all over again.
My prediction is the short-term effectiveness of the topa-phen combination (6- to 12- months) will be sufficiently pushed by Vivus studies to get FDA approval for something like Qnexa. Then, as people start regaining as they tolerate topiramate and no longer can take the phentermine (which is only approved for short-term use), they will regain the weight they lost (12- to 24- months).
It will be the same old sad story, with the same old speed-related heart valve damage in addition to neurological side effects caused by the topiramate. And the population becomes less healthy, yet again, in its quest for thinness as a proxy for health.
Readers, beware the topa-phen mixture. And tell your friends.
1. L. Vijaya. "Topiramate induced secondary angle closure glaucoma." JPGM, Vol. 52, 2006.
2. P. M. Levisohn, "Safety and Tolerability of Topiramate in Children." J Child Neurol December 2000 vol. 15 no. 1 suppl S22-S26. link
3. K. M. Gadde et al. "Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial" The Lancet, Volume 377, Issue 9774, Pages 1341 - 1352, 16 April 2011 study funded by Vivus, makers of Qnexa link
The Billboard Project has been amazing to watch: 1010 donors and $21,721.20. People came out of the woodwork to donate. Many of them commented that they didn’t want today’s children to know the pain that they knew growing up. I understand this well. Watching this happen, I’ve been remembering a lot of the bullying and attacks I experienced as a child. Let me state from the beginning – this is a good thing!!
Last week, I wrote about feeling excluded. For me, those feelings came to a head because of the Billboard Project bringing up old memories. When I became aware of those feelings, I was able to heal some old stuff from the past. And, apparently, I’m not done. Now it is time for me to face some old anger and hurt from being bullied.
I’ve worked on healing some this stuff before when I decided to get over some old resentments, namely towards my parents. However, I don’t think I have ever really faced the bullying as a whole. Since I’ve worked through such things before, though, I do have a process that works.
- Name it. I kept trying to forgive my parents and could not get there until I named my experience as child abuse (in the guise as punishment. My parents believed the Biblical line, “spare the rod, and spoil the child”). We call our childhood experiences bullying but the reality is I experienced VIOLENCE in the form of physical and emotional attack. I was hit, touched inappropriately, teased mercilessly, and humiliated. And not just from my fellow children – I had a number of teachers, namely coaches, who made fun of me in front of the class. One coach in elementary school would terrorize me during gym class, setting me up for painful and humiliating jokes.
- Get mad about it. When I first dealt with my parental issues, I tried to skip the anger part and go straight to forgiveness. It didn’t work. I had to get really, really mad and work through that anger. Anger can be scary. Many of us have been taught not to be the angry fat person. Many of us have so much anger within us that we are scared that anger will rip us apart. I was scared of my own anger – what was I capable of in a rage? But I had to face that anger and work through it.
- Forgive them. I fought forgiveness because I thought forgiving them said what they did was ok and that I deserved it. I’ve learned that forgiveness doesn’t mean it is alright. It doesn’t mean they should not experience the consequences of their actions. It does not mean I will put myself in that person’s power again. It means that I am choosing to set myself free from that anger and pain. It means that I am not willing to put any more time and effort towards those negative feelings. Now, I found forgiving my mom easy; she really did try and be the best parent she could be (she didn’t exactly have good role models). My dad, though, was a bully and a jerk. I had a lot harder time forgiving him. Along the same lines, I can pretty easily forgive the children who bullied me. Many of them were in abusive situations themselves. I have a harder time forgiving the adults; they should have known better.
Yet, I don’t want that ick inside me any longer, so I choose to forgive. I have found that forgiveness is a choice, one I can make at any time. When I choose to forgive, eventually, I will feel forgiving. I’ve made the choice to forgive those adults, though I don’t find it easy. I don’t have that forgiving feeling yet, but I know it will come in time.
- Help someone else. I have found that sharing my healing stories can be of benefit to others and make me feel better about my past. Though I hate that I went through such things, I’m glad if my experience helps you. When I offer my experience, strength and hope, I am offering another person a possible way out. You may find this process works for you as is or with a little adjustment, or you may find it completely doesn’t work for you. Whatever the answer, you may have found out a little more about yourself in the process, and, for that, I am grateful.
I have found that I need to move anger through my body; physical activity helps me work through anger better than any other process. I’ve beat pillows; I’ve gone on a power hike, stomping with every step; I’ve danced it out. Sometimes, I have to do it regularly for a time. To work through my anger at my parents, it took six months of concentrated effort. This leftover bullying stuff seems to have taken about ten days.
When I first started dealing with my childhood issues, I could not do it alone – I had too much anger inside me, overwhelming me. I needed a good therapist who understood how to work through such issues. Today, I have the tools to do it on my own.
I have heard of many ways to work through anger and heal from the past. This is the one that worked for me. Have you worked through it in another way?
I was reading an article the other day, and one of the commenters accused people who say their love their bodies of narcissism. I thought that was interesting. Is loving our bodies narcissistic?
Maybe for a few people, but body hatred is more so.
When I think about the narcissism of body love, I think of the scene in a gym locker room in Toronto, described to me by my husband: naked (and probably gay - it was the right neighborhood) men posing and flexing in front of mirrors, showing off to each other. It sounded funny; maybe even a little sweet. Made me wish I was a fly on the wall. My husband, who is a small, non-musclebound dude and was just changing into shorts to play squash, did not feel judged or denigrated. It was a fundamentally a benign show of narcissism.
Meanwhile, I was in the women's locker room. While the men were loving their big, strong bodies, the women were not. Stepping onto the scale. Looking disappointed. Hiding behind towels and changing one half at a time to avoid nudity. Can you imagine women posing naked in front of mirrors, in public, silently admiring their bodies? I can't. Because although we women are socialised to be vain, we rarely view ourselves positively and if we do, there's a stigma against expressing it.
The thing is, negativity is stickier than positivity. Loving the way you look doesn't imply hating how someone else looks. Only a sad and paranoid person would hear "I hate your red hair" in "I love my brown hair." But when someone with thinner, leaner, firmer arms than yours says "I hate my arms! They're huge and disgusting. Look how they jiggle!" then it takes a strong person and a conscious effort not to hear the logical extension of that: "if my arms are ugly, your arms are unspeakably horrible."
Yes, yes. It's your issue, not mine. You were not thinking about my arms when you said that. You see your body in a more negative light than you see others' bodies. Of course, that's how it almost always is. That was almost certainly not a passive aggressive, indirect criticism aimed at me.
And it usually isn't meant as indirect criticism, but it certainly could be.
Negativity is sticky; it's adhesive; it gets all over other people.
Although applying a set of standards to one's own body, clothing, or even achievement does not mean that those standards are meant to be universal or to relate in any way to the standards others set for themselves, the language can tell a different story. It's difficult to use negative and judgemental language - even about ourselves - without sounding self righteous as well as insecure.
But we women tend to be perfectionists, we hate it when we don't live up to our own standards, and we almost never do. We see this in our mothers and other role models; this intolerance towards self; this idea that anything less than perfection (however that's defined) is unacceptable and makes us worthless. And at the same time, we're meant to be much more tolerant and understanding toward other people.
This is not a good thing.
We could blame it on the patriarchy. It definitely weakens women. It keeps us obsessed with insignificant details, and that prevents us from being as active as we could be in business, politics, and discourse. But, it is a form of self absorption, and it is narcissistic. Who are we to expect perfection from ourselves? Is being flawed human beings not good enough? So many women are so busy; so weighed down with responsibilities. There's a need to give ourselves some personal, mental and emotional space. Why do we wrestle these precious bits of time and attention from our busy lives, only to waste them spreading around this negative, self hating muck? And demanding perfection of ourselves gives the negativity so much more power.
Loving our bodies isn't necessarily vain. I've heard that the English language has too few words for love, and perhaps people associate the idea of body love with romantic love; starry-eyed new relationship energy. That does seem a bit over the top to me. But isn't body love - self love in general - more like loving a family member or a very old friend? There's familiarity, a deep history, tolerance for quirks and foibles, steady affection, and an ability to forgive. Mature love isn't about perfection or the elevation of an idealised object. It's about respect and understanding. Don't we all owe ourselves that?
I have had an interesting convergence of experiences lately which has led me to thinking about exclusion. First off, a few things have happened which have me feeling a bit unwanted in Fat Acceptance. Secondly, I have been editing the section of my book on the conflict between death fat and in-betweenies and how both sides can feel left out. The Billboard Project has been bringing up memories of shaming and bullying from childhood. Then, in listening to Golda Poretsky’s Body Love Revolution Telesummit" – amazing stuff! – I heard Marilyn Wann talk about exclusion.
It finally dawned on me what I was feeling: that old fear of being excluded. Growing up as the fat nerd with no social skills, I felt left out so very often. Whether it was being picked last, not invited to the party or being bullied, I had so very many experiences of not being wanted as a child that I can be thin-skinned as an adult. In the Telesummit, Marilyn noted that many of us feel this way, so we can be sensitive to such experiences in the Fat Acceptance.
When I figuratively walked into the Fatosphere, I felt included. Here are my peeps! They understand me. They know what I have been through. Suddenly, I had a place where I belonged, and, feeling like I belong is such a wonderful sensation. No one was looking at my body and saying, “we don’t want you here.”
The Fatosphere and Fat Acceptance are loving communities. We accept anyone who is willing to honor the boundaries of the community (like no body snarking), even thin people. We build each other up. We support each other. We remind each other that we are worthy. And that is the kicker, because, as Marianne Williamson says, “love brings up everything unlike itself.” In other words, by loving and being loved, by accepting and being accepted, our fears and wounds will come up to be healed. And so, my fear of being unwanted has once again surfaced.
Now, I have a choice. I can run from this fear and let it fester inside me, trying to avoid having it triggered yet again. That running would mean me leaving FA and hoping to find another accepting community where, chances are, that fear will once again be triggered. Or, I can face it and work through it.
What does facing the fear of exclusion look like? I can only speak for myself, but for me it means making a choice. It means choosing to support Fat Acceptance and the Fatosphere even when I’m feeling outside the circle. It means slogging through the controversies, again, and sticking around any way. It means recognizing that I will not like everyone in the community, and they won’t all like me. It also means we can set aside those differences to work towards a common goal. It means doing my best to make sure others don’t feel excluded; yet allowing them to heal from their own wounds, even if I find watching that healing painful. As a child, I was powerless to do anything about feeling excluded. As an adult, I get to make choices.
When I made that choice to be part of this community whether I felt included or not, a sense of freedom overwhelmed me. Now, it will not matter what others do or say – I have made a choice to be included. Now, even if some people have issue with me, I can support the community. I can take part in Ragen Chastain’s Billboard project or Marilyn Wann’s STANDards. I can always choose to be supporting, whether I feel supported or not.
And the result – today I feel like a part of this community; I feel like I belong. Maybe, just maybe, inclusion comes from our own actions rather than others actions towards us. Maybe, just maybe, if we choose to act inclusively we will find inclusion for ourselves. And maybe, just maybe, that old fear doesn’t have to mess with my FA identity any more.
So, how do you deal with feeling excluded?
A quick hit today with apologies to everyone since I have been completely overcome by work lately and unable to dedicate time to writing. I hope to have everything sorted soon so that I can continue the series on food and food processing. In the meantime, I want to talk about articles in the press, and commenters who bring joy by pointing out the naked emperors in our midst.
It is both wonderful and terrible to have the Newspaper of Record for these United States as one’s hometown paper. On the one hand, there is some VERY fine reporting in the paper. On the other hand, one has to contend with the Fat-Bash Olympics on a daily basis. I have been really fed up lately with the patronizing tone of some of the writers who address topics of health. It really has been worse than usual. And yet, a new crop of commenters seem less and less willing to remain silent, so they are pointing out the birthday-suited emperors running around in academic head-dress justifying their studies by bashing fat and fat people.
Most of the time, unfortunately, I have to say that the worst of the fat bashing contenders play on the Commenters team, not the Journalists team, in the contests. What I have been seeing more of, however is, a commenter such as the one (whose comment I will talk about today) who will distinguish him or herself by calling shenanigans on one or more aspects of an article, and showing very clearly and with few words the bias which underlies it.
One such article appeared last Tuesday in the Times. You can see the article here. It was written by Jane Brody, and it references primarily the work of Dr. Richard J. Jackson, professor and chairman of environmental health sciences at the UCLA. He works in the field of analyzing how the built environment (our cities, suburbs… our living environment in short) affect health. Well, so far so good. In these pages we have often commented upon this. What is unfortunate, however, is that this Dr. Jackson seems compelled to repeat the same shibboleths of the fat-hating academic tribes to justify his pursuits. Here is an example (emphasis supplied):
“unless changes are made soon in the way many of our neighborhoods are constructed, people in the current generation (born since 1980) will be the first in America to live shorter lives than their parents do.
“People who walk more weigh less and live longer,” Dr. Jackson said. “People who are fit live longer. People who have friends and remain socially active live longer. We don’t need to prove all of this,” despite the plethora of research reports demonstrating the ill effects of current community structures.”
If one were to remove the highlighted bits (please read the full article for the context), the good work that public health professionals concerned with our built environment would still be emphasized appropriately. The justification of creating environments where movement is possible, encouraged and supported would be maintained.
Why, oh why, does weight have to play a part? Are these academics concerned that their work will be invalidated if obesity is not highlighted as “the problem”? SHOULD they be concerned that their funding will be reduced if it is NOT thus highlighted? I really want to know. Perhaps if one of you academics is reading this you can enlighten us in the comments to this post.
The Comments Section for these articles is where we can feel the zeitgeist most clearly. These were actually (on balance) not bad in the case of this article. That is actually a welcome change. One comment, stood out for aiming a strong beam of light right at the implicit fallacies. The link I provided shows the comment and the responses to it (a fine recent refinement to the commenting process). A gentleman (to judge by the picture provided) writing as Kip Hansen (who I hope keeps commenting on these topics in the future) said:
“…Compare his dreadful predictions with the fact the average lifespan in the US continues to rise, year after year. Americans are healthier and live longer than ever before.
There is always someone who can drag out some 'purpose-chosen' statistics (doesn't that sound nicer than 'cherry-picked' ?) showing how this and that disease is on the rise (usually because we're living longer, and moire [sic] of us suffer the usual diseases and discomforts of older-age)...”
Some people who responded dog-piled on his comments saying that – of course – the increase in diabetes will not show up in death stats for years, and (I am paraphrasing here) that we are all just fat pigs. Yet the gentleman’s comment stands as a very clear counterbalance of common sense to the Obesity Panic-mongering that is de rigeur amongst academics working in public health. Perhaps it is my imagination, but I seem to see a larger number of comments such as Mr. Hansen’s showing up and being recommended by readers several times.
I know a number of regular readers of this blog comment on articles in their papers or on websites. If you do… What have your observations been in terms of the number of pro-HAES comments Have you encountered any great comments that pointed out some fundamental prejudice in an article? Do you have commenters that you consider favorites? What makes you decide to comment or to withhold your thoughts on any given article?
Looking forward to reading your thoughts…
A note to those who have been following the efforts to put up billboards in solidarity with the children of Atlanta who have been subjected to odious and shaming signs depicting fat children: You can follow the progress of the donations on Ragen Chastain’s page. There you will also find links to donate a dollar (or more) in solidarity. The effort exceeded original expectations, and is extremely close to meeting the requirement for a challenge grant from the More of Me to Love folks. Thank you if you have donated, and please donate if you possibly can. Every donation counts!
Marilyn Wann's Stand for Kids Campaign is a HAES, body lib reply to Georgia's negative and stigmatizing Strong4Life billboards, which portray fat children as pathetic and inherently unhealthy.
Just a few quick updates.
- The Stand4Kids Tumblr has been moved. It is now here: I STAND AGAINST WEIGHT BULLYING. If you have a finished Stand4Kids poster, you can submit it to the Tumblr here.
- Ragen of Dances with Fat is spearheading the billboard campaign. She's set up a page for it at www.SupportAllKids.com
- Marilyn Wann is still accepting images for the first phase of the project. Submittal instructions are here, in the previous BFB summary post.
National Women's Studies Association 2012 Fat Studies Interest Group Call for Papers
November 8-11, 2012, Oakland, CA.
Papers on any topic at the intersection of women's studies/ feminism/ womanism/ gender/ sexuality and fat studies will be considered.
At minimum, your submission should fall under one of the following themes for NWSA 2012:
*Social Networks, Power, and Change
For more information on the themes, visit: http://nwsa.org/
While this is an open call, topic suggestions from last year's meeting include:
* Fat Intersections (including race, nationality, disability, sexuality, appearance/beauty)
* Fatopias/Fat Utopias
* Transnational Fat Bodies (immigration, globalization)
* Teaching Fat Studies (professorial bodies, student bodies, resistance)
* Fat Feminist Research Methods (including role of the researcher body)
* Fat Feminists Theorizing the Body
* Fat Performance/Performing Fatness/Fat Icons
* Fat activism & feminism/Fatosphere
If you are interested in being a part of the 2012 Fat Studies panels at NWSA, please send the following info by February 13, 2012 to NWSA Fat Studies Interest Group Co-Chairs Michaela A. Null and Candice Buss: (firstname.lastname@example.org and email@example.com). Please make sure one of us confirms receipt of your submission.
Your submission should include your:
*Name, Institutional Affiliation, Snail Mail, Email, Phone.
*NWSA Theme your paper fits under (and fat studies topic area/s if yours fits any of the above).
*Title for your talk, a one-page, double-spaced abstract in which you lay out your topic and its relevance to this session.
*AND a 100 word truncated abstract (NWSA requirement).
Each person will speak for around 15 minutes, and we will leave time for Q&A. In order to present with your name in the program, you must become a member of NWSA in addition to registering for the conference.
If you submit a fat studies related paper or panel, you can tag it with the keyword 'fat feminisms,' and likewise search the program for 'fat feminisms' to find relevant panels. If you submit a paper or panel on your own, we encourage you to use this keyword if your paper or panel fits the bill. We thank NWSA for adding a keyword that helps conference attendees locate fat studies panels.
Anyone who reads The Fatosphere Feed has already heard about Marilyn Wann's Stand for Kids Campaign. It's a HAES, body lib reply to Georgia's god-awful bullying Strong4Life billboards, which portray fat children as pathetic and inherently unhealthy.
Recent Fatosphere Feed articles include:
I hope I didn't miss anyone!
If you'd like to Stand with Kids, Marilyn says:
Do you want your very own Stand4Kids ad? Yes? Good!!! It's easy... Steps:
- Send me a photo (either attached to a message here or by email: marilyn-at-fatso.com)
- Tell me your "I STAND..." statement.
- Wait until I send you the ad for your approval.
- Post your ad online and change the world!
There's an effort underway to fund actual billboards with some of these images, through Kickstarter. I'll post when I hear more about it.
I haven't submitted a picture (yet!) but hopefully our fearless leader Carrie won't mind if I post her very excellent contribution.
Trigger warning: fat shaming, body snark, diet talk
(from the video)
"You look great. Have you lost weight?"
(my recommended answer)
"No, I haven't lost weight. I just look great, thanks."
This, from NPR: Obesity Epidemic May Have Peaked In U.S.
"These data basically show than we haven't seen any change probably since back to 2003-4 in obesity in any group," said Cynthia Ogden of the National Center for Health Statistics, which released the latest data and published two papers online in JAMA, the Journal of the American Medical Association. One paper focused on adults while the second focused on children.
This has been common knowledge in the fat acceptance movement for a while now. Those who are still claiming that Americans are getting heavier generally have a financial or personal stake in believing that, and are using old or suspect (if any) data.
Some researchers are saying...
"We've seen some very effective changes that are occurring in schools and at the societal level in terms of food labeling, economic incentives, behavioral strategies," says Penny Gordon-Larsen, an obesity researcher at the University of North Carolina, Chapel Hill.
Hum. I cant remember reading anything suggesting that those strategies are effective at making people thinner, though I suppose that here they're just trying to take credit for average BMIs remaining stable. It could just as easily be because people have begun to reject dieting, and dieting often leads to long term weight gain. Yes, I wouldn't be surprised if fat acceptance is playing a role in Americans' average size stabilizing.
Others are saying...
It's also possible that we're reached a kind of new normal, with the proportion of population who is predisposed to obesity having already become obese, says Harvard's David Ludwig, a specialist in treating overweight kids.
...and there may be some truth in that.
It ends with a quote from Dr. Glenn Gaesser, author of "Fat Lies."
"Most people who lose weight will ultimately regain it. If you do this do over and over and over again you develop a nation of weight-cyclers, a yo-yo-dieting society and there are risks associated with yo-yo dieting that are every bit as hazardous as the risks associated with just being fat."
Wow! It's not the usual "But fat people should diet anyway" ending. If it weren't for the headless fatties illustrating the article, it would seem almost unbiased.
Of course, if the government and medical establishment really want to play a role in lowering obesity rates, they could just do the opposite of what they did in 1999. Instead of redefining "obesity" to a lower BMI, they could redefine it to a higher BMI - one that actually reflects serious health risks and increased mortality. Better yet, they could stop trying to use body size as a proxy for health and instead treat it as one physical characteristic among many.
...and I think it's fucking brilliant. Cheers, Lillian and Matt.
Trigger warning: fat shaming, body snark, diet talk
What would you add?
- You have such a pretty face.
- Congratulations. Getting active will help you lose weight (when you've been active - and the same size - for years, and are not trying to lose weight).
- You're not fat.
Ditching Dieting* is planning a protest today, Monday January 16th, at 2:30pm until 6:30pm. The protesters are meeting under the Lion on the Southside of Westminster Bridge, by the yellow wheelie bin.
They have a Facebook page.
From the Guardian: Women plan protest against diet industry outside parliament, subtitled 'Protesters say weightloss companies wreak havoc with appetites and rely on dieters' repeated failures to make money.'
Women who say they have been failed by weightloss programmes sold to them by diet companies are planning a demonstration outside parliament on Monday to hit back at the multimillion-pound industry for "wreaking havoc with appetites and lives while it builds huge profits".
The protest, part of a campaign called Ditching Dieting, has been organised to coincide with representatives of the diet industry giving evidence to an all-party parliamentary group inquiry into the causes and consequences of body image anxiety.
Ditching Dieting's homepage is here. It's sponsored by an organization called "Species Endangered" that's planning summits in London, New York, Buenos Aires, Argentina, Melbourne, and Sao Paulo, Brazil.
I've only taken a quick look at the website, since I wanted to get this posted quickly. Here's the interesting thing about Species Endangered / Ditching Dieting. It's not a size acceptance organization. They're focused on body image and preventing eating disorders, which is all well and good. Except, it looks like regular people can't join the organization, and who's in charge? Well, Suzy Orbach is first in the list.
Suzy Orbach is well known for "Fat is a Feminist Issue," a late 1970s book that got some things right but endorsed the idea that weigh loss will naturally result for all of us once everything is hunky-dory. Yes, when we learn to see past society's bad influence and heal ourselves emotionally and psychologically, we will be rewarded with skinniness- it's a sign of mental health and enlightenment!
I wish I could say that she's learned more over the years and now has a different outlook, but that doesn't appear to be the case.
Googling support for the protest, I found groups such as Beyond Chocolate, Stop Yo-yo Dieting and Lose Weight for Good that seem to form the core. Yes, these are the "it's not a diet, it's a lifestyle change" folks. (Sorry, guys. If weight loss is a goal, then it's a diet.)
So... I would urge fat acceptance supporters in London to show up for this with the knowledge that there may be opportunities to educate your fellow protesters as well as the intended audience. It's great that Species Endangered has organized this. If they have an outlook that excludes fat women who think we're fine as we are and do not expect to become thin? Well, you've gotta start somewhere, and we do share a lot of common ground.
* For the folks who are didactic about the word "diet," in this post it's short for "weight loss diet."
Covered by the Hinterland Gazette, "a source for thought- provoking social and political commentary on issues affecting the African American community and beyond": Guy Vines Sues Panera Bread for Racial Discrimination, Saying Co. Doesn’t Want “Black, Fat or Ugly People at Register”
Also covered by NBC10 Philadelphia: Panera Doesn't Want 'Black, Fat or Ugly' People at the Register: Lawsuit, subtitled "A Pennsylvania man has filed a lawsuit against Panera, saying it has a policy that keeps black employees away from the public eye. He's the second person to file such a suit against the restaurant."
The lawsuit hasn't been resolved yet, but this sounds pretty overt and pretty heinous. However, it might be a problem with the owner of the franchise, Sam Covelli, rather than with the company as a whole. The NBC article notes that "according to its website, Covelli is the fifth-largest restaurant franchisee in the country and develops and manages the franchise rights of nearly 200 Panera cafes in northeast Ohio, western Pennsylvania, West Virginia and West Palm Beach, Fla." So, if it's the franchise owner, it's still a widespread problem. If there is a systemic problem with Covelli Enterprises, then hopefully the parent company will do something about it.
Has anyone had experiences with Covelli Enterprises' restaurants or with Panera Bread in general that would shed light on this?
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.
Another quick link.
There's a new study out in the Journal of the American Board of Family Medicine: Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals. It's from a research group at the Medical University of South Carolina. The link above leads to the full study.
Here, "Healthy Lifestyle Habits" are defined as
- eating 5 or more fruits and vegetables daily,
- exercising regularly,
- consuming alcohol in moderation, and
- not smoking.
From the abstract:
When stratified into normal weight, overweight, and obese groups, all groups benefited from the adoption of healthy habits, with the greatest benefit seen within the obese group.
This table is from page 13 of the study. At the bottom are the number of healthy habits (out of the four above) that the subjects followed. The hazard ratios along the side are the comparative risks of dying early, with a BMI 18-25 person with four healthy habits set as "1". Anything above one is a higher risk.
Two things really jump out at me. First, the more healthy habits we have, the more our life expectancy matches the life expectancy of thin people with the same habits. When we've got all four, the gap is pretty much closed. Second, it's only the fat people with no healthy habits who have a dramatically reduced life expectancy in comparison to thinner people.
This is a strong confirmation of what HAES advocates have been saying for years.