health at every size

Yesterday, my good friend Derek posted his thoughts about the show The Biggest Loser in relation to Rush Limbaugh's recent attack on Michelle Obama's health initiative. He referenced some discussions we'd had about the show and then I made several comments sharing my thoughts and experiences on this issue. I'd like to put those together in my own post so I can explain why I've decided to embrace a different paradigm of weight control.

Obesity as entertainment

I've never much liked "reality" TV, but I used to watch The Biggest Loser. I was making a strong effort to lose weight and I thought the show could motivate me. I watched it every week while working out and charting my food intake. I downloaded past seasons and watched those, too. I thought the show was a rare example of good television — overdramatic, obviously, but still, these were real people taking control of their lives, changing for the better. Certainly it got me thinking, "I could do that."

The show purports to teach the contestants to make their own meals with wholesome ingredients while training in reasonable exercise. A very worthy goal. And the results are amazing. It's not uncommon to see contestants lose half of their body weight — over 150 pounds in some cases. Many scientific markers for health improve as well. So it would be easy to look at TBL and say, "It's effective! Anyone can do it!"

Still, I grew to despise The Biggest Loser. I was never very comfortable with the shaming, hateful behavior aimed at the contestants. These people identified themselves almost entirely by their weight. They felt that every aspect of their lives was colored by their weight. They couldn't get married, or stay married, or be happily married, because they were fat. They couldn't be good parents. They couldn't keep a job. They couldn't feel comfortable around their friends. They didn't even want to be seen in public. And everything they heard on the show reinforced this belief system. They were ugly, disgusting, and selfish because they were fat. They were a burden on the whole of society.

I'm not obese, but I've thought of myself this way, too. I thought I couldn't be a good parent as long as I was setting the bad example of being overweight. I thought I couldn't be attractive to my partner. And there are many, many days when I didn't want to leave the house because I didn't want to be seen looking like this. Certainly I believed that I was unhealthy, by virtue of the number on the scale.

Most of the time, I caught up on the show after the kids were in bed, but they did watch it with me a few times. I was harboring some doubts when Isaiah began making disparaging comments about fat people, and even worrying that something he was eating (which was certainly never junk food) would make him "fat and sick." That's when I had my little lightbulb moment and stopped watching the show.

Fat = sick?

Here's the thing. Obesity is not a disease. Obesity will not kill you. Obesity is not costing our health care system a staggering amount of money.

What is costing our country a staggering amount of money is drug treatments and surgery for heart disease, diabetes, stroke, and cancer, all diseases which are inextricably connected to personal habits. And obesity is a symptom of those habits. Obesity is not the disease causing heart disease, diabetes, stroke, and cancer. Instead, the same habits causing heart disease, diabetes, stroke, and (some) cancer may also contribute to obesity.

A person who is fat but has a healthy heart is not a burden on anyone. A person who has heart disease is weighing on the health care system regardless of his or her weight. Heart disease is the disease, not the person’s weight. And lifestyle changes that address heart disease are useful regardless of whether the person loses weight.

If that person is obese because s/he consumes a lot of processed food and is not active, s/he may very well lose weight when switching to whole foods and taking up enjoyable exercise. But it’s quite likely that s/he will stay at least overweight, if not obese. Is that person still a burden on the health care system if s/he has reversed heart disease or lessened dependency on insulin but is still overweight? Just by virtue of being overweight? I don’t think so.

I’m thinking of my dad here. He had a heart attack at 45. He was "overweight" (a fairly arbitrary qualifier) and had been smoking for most of his life. He quit smoking, adopted a healthier diet (though I still have to fight him on the definition — no margarine, Dad!), and became active. Four years later, his blood measures and stress tests are perfect and he’s cut way back on his medications. But he’s still "overweight" according to the BMI. Should he become more strict with diet and exercise to address that? His doctors think this will create unnecessary stress in his life, and I agree.

Health at Every Size

Health at Every Size is a lifestyle philosophy that points out the losing battle against obesity and the lack of research affirming the cultural perception that being overweight signals ill health and a shortening of the lifespan. HAES emphasizes healthy, normal eating habits and pleasurable, voluntary physical activity instead of rigid diets and punishing workouts. The foundation of HAES is a recognition of the inherent worth of every human body, an appreciation of a natural range of shapes and sizes, and the belief that with better habits a person will naturally settle at their individualized weight, which is healthy simply by virtue of the person living healthfully.

This seems simple, and many people respond intuitively to this concept. But I've struggled to embrace it. I appreciate the sentiment of loving one's body as-is and not killing yourself to conform to an impossible ideal, but I couldn't entirely get behind the prospect of accepting an unhealthy body as-is. And being fat is unhealthy. Being fat will kill your ass. Everybody knows this. Obesity is the number one burden on our health care system, right? Right up there with smoking. And if you're truly eating well and exercising, as HAES promotes, then you should not be overweight. Right?

Well... maybe not. 

Weight is connected to health — just not as much as we like to think. If you are sedentary and consume a great deal of processed food and also get poor sleep and have unrelieved stress, you will most likely gain weight, and be very unhealthy. And this is the case for most of us, as evidenced by widespread obesity and ill health.

However, once you’ve gained that weight it may not simply “melt away” even after you change your lifestyle. Hormones, metabolism, organ function, neurotransmitters — all are affected by a diet packed with the government-supported junk that has saturated our food supply. Some people may never return to an "average" weight — and least not by healthy, sustainable methods. For this reason, the calorie-in calorie-out model is dangerously simplistic. People starve themselves, lose weight, then gain it back, plus a little more, and instead of examining this paradigm they blame their lack of willpower and hate themselves for being fat. This is why HAES is such a positive philosophy, especially for women, and it is better supported by research than any diet plan in existence. (See, for example, here, here, and here.)

Why we gain weight

Our cultural perception is that fat people are fat because they are lazy and eat badly. Nowhere is this better evidenced than on The Biggest Loser. The early episodes are packed with black-and-white slow-motion video of the person stuffing him- or herself with triple-decker nachos, two-handed cheeseburgers, or ice cream right out of the carton — usually in front of the television. Ah, so. We've figured it out! They may have dieted, which is good, but then they went back to their old nasty ways, which is bad.

We assume that fat people must fall into a bucket of KFC every night when in fact they may be nearly constantly cycling through various diets. Our cultural perception is that this is the right behavior while falling off the wagon of calorie- or macronutrient-restriction is not. But increasingly it seems that dieting sets people up to fail and stereotypical consumption of junk foods is merely the natural consequence of coming down off the ledge of perceived starvation.

The contestants on The Biggest Loser are a perfect example. These folks walk onto the show saying, “I’ve tried everything to lose weight." But what they mean is, “I’ve tried every calorie-restrictive or drug/supplement-based or macronutrient-specific diet in the book and somehow I still gained weight.” Have you ever heard these people say, “I consumed whole foods that I like just to the point of fullness and I adopted a simple exercise program of routines I enjoy and somehow I still got to be 400+ pounds”? Of course not.

People adopt extreme diets, lose a bit of weight, lose their momentum because the diet has unpleasant side effects or is, in itself, unpleasant, and then biology kicks in and they regain the weight, plus a little more because their bodies have freaked the hell out from a perception of starvation. In other words, instead of being lazy and stupid, people may become obese by trying to take care of themselves, however misguidedly.

Of course the contestants on The Biggest Loser say they “tried everything.” That’s probably why they’re so unhealthy in the first place. So do they go on the show and learn to adopt healthy, normal eating habits? Of course not! The Biggest Loser diet and exercise program is emblematic of a textbook eating disorder. The contestants work out for many hours every day — sometimes up to 8 hours a day — sometimes in a sauna-like environment — while consuming severely restricted calories, around 1200. This is a starvation diet, plain and simple, and there's no way it would be manageable for the average person.

Even assuming that it was, can it really be healthy to drop more than 100 pounds in 12 weeks? Rationally, we know it’s not. Rationally we know this is extreme — the most extreme of the extreme. This dynamic does not make weight loss accessible for most people. It simply reinforces the existing paradigm — that fat people are disgusting sub-human lard-buckets and the best way to lose weight is to starve yourself and stress your body with extreme exercise.

 Off the hamster wheel

Almost every health issue can be improved by regular exercise and healthy eating habits — which may or may not result in weight loss. The studies I posted above demonstrate that scientific (not cultural) health indicators improve with exercise and intuitive eating regardless of whether or not one loses weight.

Weight loss isn’t a magic wand. HAES highlights the fact that most people (estimates run from two-thirds to 95%) who diet and exercise to lose weight eventually regain it, and then some. Those are not good odds, and yo-yo dieting has its own health implications (especially its impact on metabolism).

Instead of focusing on the scale it would be healthier (physically, emotionally, and culturally) to emphasize whole-person health indicators such as blood levels, endurance, flexibility, digestion, sleep, and so forth. The newest research is demonstrating this quite clearly. If weight loss happens as a side effect on the road to wellness, that’s wonderful, but if it does not, that doesn’t mean the person is not healthy.

Another reason to consider HAES is because it's healthier to feel good about yourself than to hate your body — physically as well as emotionally. Studies indicate that adolescent girls who have positive self-image are more likely to be active and conscientious about what they eat, are less likely to gain weight as they enter adulthood, and are more likely to make positive lifestyle changes even if they don't lose weight. This makes complete sense within the context of HAES. If you feel good about yourself, you’re not going to be so desperate to change your body that you’ll engage in extreme dietary practices that ultimately cause you to gain weight and/or become severely unhealthy.

Of course, if this is true we might have to consider that it’s not such a good idea to shout at fat people about how repulsive and disappointing they are, what a burden they are to their families and society at large and how they’re responsible for basically the entire health care crisis, not to mention higher airline costs, excess fuel consumption, and the impending downfall of Western civilization. Which would basically nullify the existence of The Biggest Loser.

Giving the finger to my scale

Now, let me tell you why this interests me. A few months ago I came out about compulsively overeating. This is a problem I've had for most of my life. But since I "named the problem" I've seen improvement in my food habits. In the four months since I wrote that essay, I've dropped way back on those nights of abusing myself. Even when I do commit myself to massive carbohydrate consumption, I am rarely able to go through with it.

I've also become much more active in the past few months. I work out nearly every day. I walk or lightly jog several times a week. I lift weights and stretch and practice yoga. As a requirement of my Therapeutic Nutrition class, I've been tracking my calories and finding that I rarely consume more than 1500-1700 calories a day.

And even though I said I wouldn't, I've been weighing myself. Just out of curiosity, you understand. In the past four months, of working out and watching my calories, I have not lost a single pound of weight. I've actually gained three. If I tabulated every single calorie I put in my mouth and ramped up my exercise program to two or three hours a day, I've no doubt I would lose weight. Prob'ly buckets of it. And as soon as real life interfered with a weight-centered existence, I'd regain it. That's not the way I want to live.

I'm trying to accept the distinct possibility that even if I keep up exercising nearly every day, adopt a profession of manual labor and keep up my good eating habits, I might always be just one size into plus. That might be where my body settles after twenty years of abuse. But it's just too easy to do good things for myself all week and then step on that scale and feel that the work was for nothing, because I didn't lose weight. And that is not healthy. Definitely not.

Finding balance

I can think of only a handful of women friends who have seemed to be happy with their weight. And by "happy" I mean that they weren't trying to lose any and they didn't seem to worry about gaining any. The vast majority of women I've known (and not a few men) are unhappy with their bodies and seemed to be, like me, nearly constantly worried about being overweight, gaining weight, counting calories, avoiding "bad" foods, "working off" whatever they've eaten, and otherwise punishing themselves for violating unrealistic (and quite unhealthy) standards of beauty.

We all know we're being manipulated to hate ourselves so we'll feed into massive corporate empires. We all know how much we're appreciated by the people who love us. But we do it anyway. We diet even though we know the odds are against us. We exercise in ways that provide us no pleasure. And this, we consider healthy.

Remember, obesity is a symptom, not a disease. If you adopt a healthier lifestyle and don't become thin, it doesn't mean you're sick. If you are overweight because you are currently unhealthy, then it is beneficial to adopt healthier habits, which does not include dieting. But if you have eliminated significant risk factors in your habits and still remain overweight, then maybe it's time to accept that as it is rather than staying on the hamster wheel and substantially increasing your risk of ill health.

Makes sense to me. How about you?