A post about (shhhh….) obesity

I have not written about obesity per se in a long time.  Not because it isn’t an issue anymore.  Far from it.  I just don’t see the point of harping on it as a thing.  It’s very negative.  People struggling with their weight don’t need to be reminded or badgered or blamed or made to feel guilty and ashamed.  They know.  Some take action, mostly by dieting.  Sometimes those diets work, frequently not.  Other people have stopped trying; some of them have taken the opposite tact — defiance and body positivity.  Accept me as I am.

The people running Weight Watchers noticed this trend and rebranded the company.  WW, as it’s now called, is focused on health and wellness, not numbers on the scale.  The meetings (optional) are about supportive communities of like-minded people, not about inducing guilt or policing what people are allowed to eat.

This is all fine, as there’s good evidence that focusing on health and fitness rather than a number on the scale is a much better strategy.  In fact, some diet styles by default end up helping people control their weight without calorie counting.  The Mediterranean diet, and other plant-based diets are most notable for this effect.  Many people who switch to vegan diets end up losing weight as bonus.  There’s something to be said for just eating healthy food, and not worrying about whether a potato has 90 or 110 calories.

Nevertheless, the obesity epidemic forges ahead, and is spreading around the world, as societies become more sedentary and rising incomes allow people to eat more food.  A large survey of over 3.6 million people in Britain found that people with BMI of 30 or more had their lives shortened by 4.2 years for men and 3.5 for women.  Cancer and heart disease were the main culprits.  Interestingly, the lowest risk for heart disease mortality was at a BMI of 25; for cancer it was 21.  So being at the higher end of the normal weight range isn’t a bad thing for your health.  By the way, this study simply looked at mortality, not at existing diseases and the impact of those on quality of life.  It also didn’t look at fitness.  That would be useful.  I suspect that, even if you’re slightly overweight, being more fit would be protective.  Just as being normal (or even low) weight, but sedentary and over-fat is definitely not healthy.

It’s My Genes

These days, plenty of people plagued by excess weight are quick to blame their genes, and give up doing anything at all about their diet, even so much as adopting healthier food choices.  It’s in my genes, why bother?  In fact, that’s not correct according to a recent review of the topic.  I was even surprised at the rather bleak picture painted about the lack of good information about genes and weight.  Only two genes have been linked to obesity:

  1. MC4R, which is specifically associated with morbid obesity
  2. FTO, which is more widespread

All the other dozens or hundreds of genetic possibilities have not panned out.  In fact, it’s become clear the link between genes and weight is vastly more complicated that just identifying a couple of genes that cause obesity.  Genes are turned on or off in response to environmental cues or to other genes.  For example, a variant of FTO seems to make people more responsive to images of tempting foods.  You would expect those people to struggle more with controlling food intake, and with their weight.  But one study showed that people with that FTO variant actually lose more weight on a healthy diet compared to people without the variant.  Go figure.

Health vs. Appearance

One of the failings of public health warnings about the dire consequences of obesity is the assumption that everyone is obsessed with their health.  In fact, plenty of people who try to lose weight are more concerned about their appearance.  I’ll hazard a guess that this is the focus of younger people.  Finger-wagging about Type 2 diabetes or heart disease isn’t going to register for someone who wants to drop one or two dress sizes for a vacation.  So-called healthy diets aren’t on the radar screen if a fad diet promises you will drop 20 lbs in 10 days.  It doesn’t help that the Main Stream Media bombards us with images of stick-thin celebrities, gushing about how this or that celebrity lost weight or what fad diet the person is following this week.  Another terrible pastime: congratulating celebrity New Moms on losing all their baby weight in 2 days.

It’s not hard to see how years of diet failure combined with images of impossibly thin role models leads to a feeling of despair and hopelessness.  Why bother, nothing works.  Hopefully some of those people adopt the far more important, do-able and positive goal of just eating a healthy diet.  Basing your feeling of self-worth on the number on the scale is a terrible way to start the day.

Why do we have scales anyway?

That so many people have scales and worry about the number is actually pretty crazy.  When did this start?  Use of scales for commercial purposes dates back at least to ancient Egypt.  These were variations on balance scales, where items were counter-balanced by weights of known quantity.  Obviously this wasn’t a great way to weigh a human.  Coin-operated scales to weigh people evolved in Europe and were brought to the US in the late 19th century.  They became popular features in towns all over the country — step on the scale, drop a penny in the slot and get your weight (or an approximation of your weight anyway).  Was this the beginning or our weight obsession?  Home bathroom scales were developed in the 1940’s and the rest is history.

The mechanisms and designs have changed since then, but most still just spit out a number for body weight with some degree of accuracy.  If you’ve ever been weighed at a doctor’s office or the gym, and then gone directly home to weigh yourself on your own scale, you know they’re all off from each other.  Why is this so hard to do accurately?  To make matters more confusing, newer digital scales incorporate other measurements like percent body fat or BMI, but less expensive home scales are not accurate and could drive you just as crazy as the simple body weight readings, that go up and down randomly from day to day for no apparent reason.  Imagine seeing your body fat percent went up 3 or 4 points overnight?

If we’re going to focus more on health, I’d like to see home body assessment devices that (accurately!) combine a set of parameters and come up with a number or a grade or something that corresponds to your overall health and fitness, not just body weight.  Wearable fitness devices try to do some of that, measuring heart rate or steps, but those don’t measure weight or body fat.  Even better, the home assessment device could measure oxygen saturation, blood glucose, blood pressure and — technological advances permitting — levels of key nutrients.  Now that would be something.  Sort of like the Star Trek tricorder.

Until then, my advice for the weight-concerned person:

  • Stick mostly to a plant-based diet, low in added sugar foods and low in processed foods in general
  • Be physically active in meaningful ways every day.
  • If the number on the scale makes or breaks your day, STOP WEIGHING YOURSELF.

 

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