Not the King of Me

There is a song that I’ve just fallen in love with called “King of Anything” by Sarah Bareilles.

The video is posted below but the lyrics that pertain to this blog are as follows:

You’ve got opinions, man
We’re all entitled to ‘em, but I never asked
So let me thank you for your time, and try not to waste anymore of mine
And get out of here fast

I hate to break it to you babe, but I’m not drowning
There’s no one here to save

Who cares if you disagree?
You are not me
Who made you king of anything?
So you dare tell me who to be?
Who died and made you king of anything?

I think it’s important to remember that it’s within our ability to set boundaries for who talks to us about what subject and when.

Different areas of my life have very different boundaries:

When I give a talk or do a panel, I tell people that they can ask me anything and I’m serious about that.  It’s my goal to give people an opportunity to ask a question without being scared of hurting my feelings.  99.9% of the time people are intending to be respectful and the rest of the time I’m confident in my ability bring someone’s jackassery into sharp relief, while looking calm, logical and reasonable.

Outside of those talks, I have very different boundaries.  There seems to be a pervasive myth that since I “let myself get fat”, I must need someone to help me.  The truth is that  Health at Every Size is my well researched decision, my body size is a reflection of many things but is not a barometer by which you can judge my health, intelligence or decision making ability.  I’m healthy, I’m happy, and if I needed saving please rest assured that I would be yelling for help.

I actually enjoy discussing health, weight, health at every size etc., and I’m perfectly happy to have discussions about  these issues even with people who have different opinions.  However, I’m unwilling to argue about my personal health choices, especially to someone who isn’t backing up their divergent opinion with some serious facts.

Comments on this blog are another really interesting area for me.  When I started out I thought that it was important to post all the comments that weren’t overt spam because I didn’t want to censor people, and I wanted to show the kind of violent, reflexive reaction you can get when you question the status quo. Plus I’ll admit answering those people is often entertaining for me.  Recently though, I’ve decided that I don’t have an obligation to give someone an audience on this blog just because they managed to get their comment submitted correctly.

So my new comment policy is that I’ll approve comments if I damn well feel like it.  If people who are dissenting want to increase the chance of getting their comment posted they’ll resist – with conviction – the urge to state their opinions as fact, and they’ll back up their assertions with some kind of resources (and “everybody knows” is not a resource, if it were we’d all still believe that the sun revolves around the Earth).

So this song goes out to everyone whose sense of self-importance is so exaggerated that they actually think we should consider them qualified to give us health advice when they have no qualifications, are stating their opinions as fact and/or cannot separate their experience from everyone else’s.

The Calories In/Calories Out Myth

The idea that the body works on a simple calories in/calories out (ci/co) model is one of the most pervasive myths that I hear. This particular myth is extremely damning to us fats since the idea is that:

If  you just eat less, exercise more  and create a caloric deficit (ie:  do not give your body the amount of fuel it requires to function), you will lose weight and therefore be more healthy. If you fail to lose weight, it just means that you lack the will-power to create a caloric deficit over a long enough period of time.

I’ve already talked about the conflation of the concepts of weight and health, so today let’s just talk calories in and out.

It sounds really logical, especially if you don’t understand how the human body actually works.

First, it turns out that accurately calculating the calories out side of the equation is at best an awfully indirect science producing questionable results.

The Basal Metabolic Rate (BMR) formula is one of the most popular used to determine how many calories we burn at rest. But  the formula doesn’t account for muscle mass, which utilizes more calories than other body tissue at rest.  Except that there is controversy about just how many calories a pound of muscle utilizes – some reputable scientists say that it burns 35, some say 10.  Also, most methods used to measure muscle mass are fairly imprecise, or really expensive, so very few people have access to a correct measurement even if we could use that number to get an accurate BMR, which we can’t.

Besides which, a BMR-type calculation would be reasonable  if we were a lawnmower.  We can calculate the fuel needs of a lawnmower and then have a reasonable expectation of how much grass it can mow and what will happen when the fuel runs out.

Ready for a blinding flash of the obvious?  Our bodies are not lawnmowers.  The way that we utilize fuel (calories) and what happens when we run out is vastly different and extremely individualized and affected by all kinds of things including:

What concerns me even more is that semi-starvation is advocated based on the idea (really, the desperate hope) that a starved body will burn excess fat for fuel. That’s not necessarily the case.  Your body is really good at surviving.  It is not so good at fitting into a cultural ideal of beauty.  The body doesn’t think of calories as evil things that take it farther from an arbitrary standard of beauty, it thinks of calories as fuel to do its job. When you give your body less calories than it needs to perform its basic function it does not think “look how disciplined you are to underfeed me so that we can become smaller”.  It thinks “Holy shit, I’m starving.  I have to do something!”

Let’s go back to the lawnmower example:

If I give my lawnmower half of the gas it needs to cut my lawn, it will simply stop working half-way through. If tomorrow I only give it 1/2 of the fuel it needs, only 50% of my lawn will get cut. My lawnmower will never adapt to use less fuel,  it just stops working.

If I give my body half the fuel that it needs just to lay in bed all day, and proceed to run on a treadmill it doesn’t stop  – it adapts. My body can’t imagine a scenario in which it needs food, there is food, but I’m intentionally starving it, so it interprets this situation as  “I’m starving, there is no food, and I have to run away from something”.

If I continue to underfeed my body while making physical demands it will likely drop weight at first while adapting to function on fewer calories, even if that means performing those functions (you know: thinking, breathing, heartbeat, walking etc) non-optimally.  If I continue underfeeding for the long-term I will experience negative impacts (see below).  If I stop underfeeding my body there is a good chance that my body will maintain it’s adapted lower level, at least for a while, while possibly also resetting my natural set point to a higher weight permanently while storing anything it can as fat.  My body is trying to help me out – what it has learned is that I live in an environment where sometimes starvation happens at the same time that massive physical labor is required, so it’s storing up fuel for the next starvation/high physical activity period. If I continue to do this over time (as in the case of yo-yo dieting), then the damage to my metabolic rate, my natural set point, and my body’s functions can be severe.

And that doesn’t even touch the psychological toll that underfeeding your body takes on you. In the Minnesota Semi-Starvation Study participants who were restricted to 1,560 calories per day for 12 weeks experienced depression (up to and including serious self-mutilation), hysteria, marked food preoccupation, disordered eating patterns,  guilt about eating, decline is physiological processes, concentration, comprehension and judgment, and a 40% drop in BMR.  For many the disordered eating continued for 5 months or more after the study was concluded.

So while semi-starvation (also known as dieting) seems like a reasonable weight loss technique if you believe in a ci/co equation, I have to judge it on three standards:

Validity of Methodology

Fail.  The fact that I can’t accurately calculate how many calories my body will expend or predict how my body will respond to prolonged starvation makes this methodology invalid.

Probability of Success

Fail.  The use of caloric deficit has a success rate of 5% over 5 years – that’s within the margin of error for most studies and is an unacceptable success rate for me.

Acceptability of Risks

Fail.  I’m risking my current excellent physical and psychological health for a chance at a smaller body.  That, for me, is an unacceptable risk.

Which is why I’m sticking to my plan of engaging in healthy behaviors, giving my body the fuel it needs, and letting it determine what size it’s going to be.

Literature Review

There is not a single study in which the majority of people maintained weight loss long term, and there is definitely not a study wherein the majority of people maintained a BMI-changing amount of weight loss long term. There are plenty of studies that show that ci/co weight loss almost never works

Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J: Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer (link goes to article)

http://www.ncbi.nlm.nih.gov/sites/entrez/17469900 (link goes to study)

“You can initially lose 5 to 10 percent of your weight on any number of diets, but then the weight comes back.  We found that the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority. Diets do not lead to sustained weight loss or health benefits for the majority of people…In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.”

Miller, WC:  How Effective are Traditional Dietary and Exercise Interventions for Weight Loss

“Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr. The paucity of data provided by the weight-loss industry has been inadequate or inconclusive.”

Methods for voluntary weight loss and control. NIH Technology Assessment Conference Panel

A panel of experts convened by the National Institutes of Health determined that “In controlled settings, participants who remain in weight loss programs usually lose approximately 10% of their weight. However, one third to two thirds of the weight is regained within one year [after weight loss], and almost all is regained within five years.”

Bacon L, Aphramor L:  Weight Science, Evaluating the Evidence for a Paradigm Shift

“Consider the Women’s Health Initiative, the largest and longest randomized, controlled dietary intervention clinical trial, designed to test the current recommendations. More than 20,000 women maintained a low-fat diet, reportedly reducing their calorie intake by an average of 360 calories per day and significantly increasing their activity. After almost eight years on this diet, there was almost no change in weight from starting point (a loss of 0.1 kg), and average waist circumference, which is a measure of abdominal fat, had increased (0.3 cm)”

Field et. al Relationship Between Dieting and Weight Change among preadolescents and adolescents

“Our data suggest that for many adolescents, dieting to control weight is not only ineffective, it may actually promote weight gain”

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Health for Sale

If you’ve been a reader for awhile you know about the film American the Beautiful by Darryl Roberts.  It’s a film that looks at America’s obsession with beauty and “how these increasingly unattainable images contribute greatly to the rise in low self-esteem, body dismorphia, and eating disorders for young women and girls who also happen to be the beauty industry’s largest consumers.”

Last year we raised funds to bring Darryl and this film to the University of Texas at Austin.  It is an incredible film and I highly recommend it (you can even get it on Netflix).

His newest project is America the Beautiful:  Health for Sale, which “deals with our unhealthy health standards and the ensuing fallout from expecting an entire nation to fit into a ‘certain BMI.'”

That film has its red carpet premiere tomorrow today (March 5th) at the IAEDP symposium (the International Association for Eating Disorder Professionals).  I will be at the red carpet premiere, and the reason that I will be at that premiere is that I am in the film.  I was interviewed a few weeks ago to provide a response to some of the not-very-health-at-every-size interviews that he had done.

I can’t even tell you how pumped I am.  When I started this blog what I was hoping for, and what I continue to desire, is the biggest possible platform from which to give people the option of Health at Every Size, and let them decide what they want to do.

I never, ever try to tell anyone how to live (and oh how I wish that people would give me the same courtesty!) but it breaks my heart to think that there are people who hate their bodies and feel that they can never be healthy until they are thin: they are yo-yo dieting, feeling helpless and they don’t even know that there is another option.

I can’t stand that there are people who have never considered exercised for any reason other than to try to change the size and shape of their body.  There are people who think of every meal as a battle and every trip to the gym as punishment.

There are people who are treated really badly by friends, family, personal trainers, doctors, and perfect strangers, and they believe that they deserve it – that their body size determines their worth or lack thereof and that they deserve to be abused and ashamed until they are thin.

That’s fine if it’s how someone chooses to live but I think that choice means that they’ve been given all of their options and picked one.  I think that people should know that there is an option that allows them to love their body now, pursue health without also pursuing intentional weight loss, be at peace with their eating, and enjoy moving their body for the sheer joy of it.

The pressure’s mostly off me because I don’t feel the need to convince anyone else that they should live like I do.  Once they know about the option, they can choose whatever they want.

So keep your fingers crossed that tomorrow I’ll have another chance to give people an option.

My mantra:

  • Don’t swear
  • Don’t be an idiot
  • Say what you came here to say

IAEDP here I come!