Fat and Fit?

by Christine Gary

Her last name is Bacon, and yet, she’s a nutrition professor at City College of San Francisco, an associate nutritionist at the University of California, Davis, and a private consultant for health care professionals. That name-career combo made me laugh, but it’s rather apropos, considering the message of her recent book and consequent social movement, both titled “Health at Every Size” (H.A.E.S.). For Dr. Bacon, there is no forbidden food, no dieting, and no calorie counting.

From food and body preoccupation to self-loathing and eating disorders, Dr. Bacon preaches that our obsession with the number on the bathroom scale has done nothing to further our health. Compelling us to rethink our war on obesity, proponents and followers of H.A.E.S. refer to themselves as fat-acceptance activists (reclaiming the word “fat” much as gay right activists have embraced the word “queer”).

The adoption of healthy lifestyle changes simply for the sake of well-being, rather than weight control, may be liberating. But does it have any scientific backing? Dr. Bacon knows that for her message to be taken seriously, it must have clinical credibility. She enrolled 78 obese women into a federally financed, randomized trial. Half of them dieted. The other half were taught H.A.E.S. precepts. The findings, published in the Journal of the American Dietetic Association in 2005, showed that neither cohort lost weight. But thanks to sustained healthy behaviors, the H.A.E.S. participants improved measures of cholesterol, blood pressure, physical activity and self-esteem at the two-year follow-up. Meanwhile the only variable that changed for the dieters, among whom there was a 40% drop-out rate, was a decrease in self-esteem.

Adding further credence to the “fat acceptance” philosophy is a 2008 report from the Archives of Internal Medicine. They found normal blood pressure, cholesterol, triglycerides, and blood sugar in half of overweight adults, and in one-third of obese individuals. This means a normal risk for heart complications or diabetes – conditions for which excess fat is considered a major risk factor.

This begs the question of whether epidemiological studies linking fat and disease fail to adjust for non-weight-related risk factors common in fat populations (poverty, fast food diets, sedentary lifestyles, minority-group status, the stress of being marginalized, nonjudgmental medical care, or complete lack of health insurance). Perhaps chronic disease is caused less by fatness itself, and more by confounding variables that afflict predominantly lower socio-economic groups and overweight communities.

Furthermore, findings in a 12-year Canadian analysis in Obesity Journal defy any correlation between weight loss and longevity. They suggest that being either extreme, too obese or too thin, may convey a higher death risk, but that being merely overweight would seem protective against mortality.

That one can be healthy at every size is welcome news for those who find no successful combination of diet, exercise, or willpower in lowering weight. In an interview with The New York Times, Dr. Rudolph Leibel, of Columbia University’s Medical Center, exonerates failed dieters. He alleges that not everyone is capable of lower weight ranges. “The severely obese have some underlying genetic or metabolic difference we’re not smart enough to identify yet.” He continues, “It’s the same way that a 7-foot-tall basketball player is genetically different from me, at 5-foot-8.” According to him then, genetics is responsible for food cravings, levels of physical activity, areas of fat accumulation, and an individual’s natural weight range.

More recently, Dr. Bacon teamed up with Lucy Aphramor, a National Health Service specialist dietitian and an honorary research fellow at the Applied Research Center in Health and Lifestyle Interventions at Coventry University in England, to publish a 2011 paper in Nutrition Journal. They reviewed nearly 200 studies to arrive at a conclusion with which frustrated yo-yo dieters are already all-too-familiar. Dieting brings weight loss initially, and weight regain inevitably thereafter. Bacon and Aphramor implore the health care community to endorse strategies for public-nutrition that “encourages individuals to concentrate on developing healthy habits rather than on weight management.”

Still not convinced? You’re not alone. Since 1998, the Obesity Guidelines put forth by the government’s National Heart, Lung, and Blood Institute have used obesity as the scapegoat for a range of chronic disease. Walter Willett, chairman of the nutrition department at the Harvard School of Public Health, believes that “virtually everyone who is overweight would be better off at a lower weight.” In an interview with The New York Times, he explained, “there’s been this misconception, fostered by the weight-is-beautiful groups, that weight doesn’t matter. But the data is clear.” He believes obesity-acceptance findings are merely a trickle next to the waterfall of obesity-condemning results.

Further scientific inquiry is required to clarify conflicting results. For instance, a month after the Canadian mortality report, Science announced results from researchers at the University of Wisconsin that showed calorie-restricted rhesus monkeys lived longer than their amply-fed counterparts. Although, this study was conducted in animals and thus makes it difficult to extrapolate the findings to humans, the study pokes holes in the H.A.E.S. theory.

So, in the minds of some, it remains unresolved whether a war on obesity need be waged. But there is common ground between opposing camps. Science reliably debunks dieting as a futile endeavor. It’s more effective to instill lifestyle changes. Tenants of Linda’s book supported by both sides include advancing an intuitive eating approach: Eating when hungry, choosing nutritious alternatives to junk food, and ultimately honoring your body. Exercise, rather than being an ends to a (slimmer) means, is encouraged for its emotional and physical benefits.

Many dieters operate on the misconception that if they could just lose weight, all other areas of their life would fall in line. Their problems would whittle away along with their waistlines. They use weight loss as a distraction, and a placeholder for their ultimate desires. It’s far better to uphold a positive body image. Prioritizing loving yourself at any size frees you to act on ambitions you may otherwise put on hold until you attain your “goal weight.” – everything from investing in a new wardrobe to switching careers. Why focus on weight, when you can focus on your dreams?

Christine Gary is completing a Masters Degree in Nutrition Communication at the Tufts Friedman School of Nutrition. She’s an international marathon runner devoted to raising funds for charity: http://www.christinegary.com

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