DIEts are doctor-approved eating disorders

I have thought about printing up stickers that say:

Diets are doctor-approved eating disorders.

Stop obsessing about food and boycott the multi-billion dollar diet industry.
Get plenty of exercise.
Learn to love your body.
Health is more than a number on a scale.

Then, any time I saw flyers for dangerous fad diets or propaganda about how fat Americans are and how they’re going to die young, I'd pepper them with these stickers.

Not only do I think that diets are useless, I think they are counter-productive. There is good evidence that chronic dieting makes you less healthy and actually often makes you fatter.

I realize that the following may annoy or anger people on my friends list who are currently dieting or who still believe in the diet mentality. I'm not trying to piss you off or sabotage your efforts to get healthy. I just want to put down in writing how my thoughts have evolved over time.

First, to avoid any confusion, I am not saying any of the following things:

1. People who are fat should sit around loving their bodies and do nothing to improve their health.
2. Body fat has no relationship to health.
3. Weight loss is, in and of itself, bad.
4. Diets didn't work for me, so they're bad and wrong and you're bad and wrong for trying them.
5. Making any dietary changes at all (adding fruits and veggies, eating whole-grains to get more fiber, drinking lots of water) is bad or useless.

OK, so on to what I DO think.

1. Calorie reduction and/or weight-loss diets don't work. There is ample evidence of this. I've NEVER known anyone who went on a diet, lost a significant amount of weight, and kept it off for more than a year. Most people I know go on diet after diet and are chronically weight cycling up a few pounds and down a few pounds. Statistics show that about 90 to 95 percent of dieters gain all the weight back, and the majority of those people add on some additional pounds. Furthermore, studies have shown that the earlier girls start to diet, the MORE obese they tend to end up as adults.

2. Strict diets CAUSE compulsive eating behavior. I know that when I was dieting from ages 9 through about 27, all I could think about was food. What could I eat that fit the plan? How many servings were in that package of crackers I was looking at? I was a bad person for eating, and I was good and virtuous when I didn't eat, even if my stomach was rumbling. Think about the things most diet programs tell you to do: measure portions fanatically, weigh yourself regularly, down to the fraction of the pound, restrict fat (or carbs, or whatever the current fad is) at all costs. These are exactly the sorts of things my friends who are thin/average and who have eating disorders do. This is what I mean about diets being "doctor-approved eating disorders." If a doctor recommended the techniques included in most diet plans to a thin person, he or she would be accused of encouraging an eating disorder. It's no different to suggest these destructive, compulsive eating patterns to a fat person.

People who have been on diets for years and years develop extremely unhealthy relationships to food. They rationalize eating crap and beat themselves up for it afterward. All dieting ever did was make me fatter and crazier. There are studies to support the fact that people who diet chronically have lower quality of mental health than non-dieters.

If you've ever known a skinny person who "can eat whatever s/he wants," it's probably because they DO eat whatever they want. When we deny our bodies' natural "full" and "hungry" signals and learn to eat at prescribed mealtimes or because everyone else is eating, or because we're at a party, we are disrespecting our bodies and teaching ourselves not to listen to our own bodies' wisdom.

I realized several years ago that I was not eating out of hunger most of the time. I ate for psychological reasons. I ate because it was a holiday and you're "supposed" to stuff yourself silly. I ate because it was "all you can eat" and I wanted to get my money's worth. I ate because I was depressed, stressed, or bored. NONE of those is a good reason to eat.

Since I've been trying to trust my body, I eat when I'm hungry and I stop when I'm full. The last three years, with this approach, are the only times in my entire life when I maintained a steady weight. In fact, over the last 14-15 months, my weight slowly declined by 10 pounds. It's not a lot, but it just shows that if you trust your body, you will NOT go hog wild and balloon up by 100 pounds. Many people who are chronic dieters and who have picked up compulsive eating habits DO gain some weight when they try demand feeding. This is because they have felt deprived for years and years, and their bodies are making up for lost time. But after a week or a month of stuffing yourself silly with formerly "forbidden" foods, almost everyone will return to more normal eating habits. I know if I eat a lot of sugary, starchy foods over the course of the day, I literally crave things like salad and steamed vegetables.

For more on the demand-feeding method of addressing compulsive eating habits, visit: http://www.overcomingovereating.com.

Next, more on food, more on body image, more on exercise.

The war on obesity is based on overblown rhetoric and not facts

More on food, body image, and exercise:

I mentioned in my last entry that dieting makes you FATTER. This article notes that dieting, especially when started early in life (before age 14), leads to weight GAIN not weight loss:

http://www.berkeley.edu/news/media/releases/2004/06/09_fatdi eting.shtml

To continue with what I've come to believe about food, body image, and exercise:

3. Yo-yo dieting and weight cycling is much more destructive than being moderately overweight.

There is mixed evidence that being fat leads to Type 2 diabetes, but good evidence that chronic dieting is a factor in developing diabetes. Much of our new "diabetes epidemic" is due to better diagnosis and not increased rates of diabetes. Over the course of the 1990s, the incidence of Type 2 diabetes incrased from 8.2 to 8.6 percent while the "obesity" rate rose by 61 percent.

There's no strong evidence that being overweight is a major risk factor for coronary heart disease, but much better evidence that chronic dieting is a factor in heart disease. People who are fat but have steady weights have much lower incidences of heart disease than thinner people who have cycled up and down in their weight. Furthermore, yo-yo dieting is linked to poor heart health:

http://www.med.umich.edu/opm/newspage/2003/yoyodiet.htm

Yo-yo dieting is also linked to poor immune system function and poor mental health:

http://www.msnbc.msn.com/id/5613222/

4. Physical activity level is much better correlated with health and mortality rates than how much you weigh.

-A study in Norway followed 1.8 million people for 10 years and found that the highest life expectancy was found among people with BMI figures between 26 and 28, all of whom are overweight according to current US goverment guidlelines. The lowest life expectancy was found among those who were about 5 pounds "underweight". Those with BMI's between 18 and 20 (currently defined as "ideal") had worse life expectancy rates than people who were 60 to 75 pounds "overweight."

-Another study at Cornell University found that the mortality rate for non-smoking white men in the supposedly ideal BMI range of 19 to 21 was the same as those with BMI's of 29 to 31.

-The data linking obesity to cancer deaths is really shaky. Adults with BMI's of 18.5 to 24.9 had a mortality rate from cancer of 4.5 deaths per 1,000 subjects while those with BMI's of 25 to 29.9 had a rate of 4.4 per 1,000. People who were 35 to 70 pounds "overweight" had a mortality rate of 5.1 per 1,000.

-Contrary to hysterical reports in the media, fat doesn't always, or even often, lead to cancer. At least nine studies have found an association between *increasing* weight and *lower* mortality from cancer of all types. An example, the landmark Seven Countries Study which followed 13,000 men for 40 years found that risk of dying from cancer decreases with increasing weight. The study itself says that "the risk of dying from cancer decreased with increasing relative weight".

-In other studies, the association between *less-than-average* weight and a *higher* overeall cancer mortality remains even when controlling for smoking and for "occult wasting" (i.e. weight loss brought on by a preexisting diesease). Other studies, like the one in the New England Journal of Medicine from 2003 which is often cited in linking fat to cancer, has rather ambiguous results, with only a slighty elevated risk among only the fattest of the subjects and no elevated risk for the moderately "overweight".

-An American Cancer Society Study in the early 1990s showed that weight loss was associated with higher mortality even after screening out smokers and all deaths that took place within a few years of an individual's entry into the study (to screen out people who were losing weight because they were sick with an incurable disease). A follow up to the study found that obese women were better off if they didn't lose weight. Healthy women who intentially lost weight over the span of a year or longer suffered an increased risk of premature death from cancer, heart disease and other causes that was up to 70 percent higher than that of healthy women who didn't intentionally lose weight. A 1999 report on men found similar results.

In conclusion, when you factor out activity levels, obesity itself isn't particularly well correlated with any health condition with the possible exception of putting extra strain on the joints. You're protected from certain conditions and diseases by being slightly HIGHER than average weight (i.e. BMI of 25-28 which is the high end of normal to "overweight"). People with a BMI of 25, which is at the high end of normal, have better mortality rates than those who are at the low end of normal. People who are in the "obese" range of BMI have better mortality rates than people who are 5 pounds underweight.


5. The majority of our dieting obsession is focused on looks and NOT on health.

In 1986, the National Institute for Health panel on obesity ignored nearly all of the data presented to it and declared obesity a health threat, despite presentations showing that people who gained weight as they aged reduced their risk of premature death and that obesity was not related to hardening of the arteries. In 1996 when the FDA held hearings on the weight loss drug fen-phen, they were relying on data from a small trial of the drug that was paid for in part by the drug's manufacturers. Long-term human studies show that almost all of the excess risk associated with obesity can be accounted for by the higher incidence of weight cycling (going up and down) in obese people, and that obese people with stable weights have very little excess risk.

When fen-phen was approved, it was already known that it was linked to fatal lung conditions in many people, but the average weight loss of 7 pounds from taking fen-phen was deemed worth the risk. Later, of course, fen-phen was recalled after dozens of people died or developed permanent heart and lung problems. I hope those people burn in hell.

Even very mainstream dieting organizations have policies that, when examined closely, show that the emphasis is on looks, not health.

For instance, at Weight Watchers, you establish a "range" that's ideal for you. For me, the first time, it was 108 pounds to 128 pounds. Their policies further said that if you were at least 5 pounds over the LOW end of that range, they would help you lose those last 5 pounds. So if I'd come in weighing 115 pounds, they would have helped me lose down to 108 pounds, actually LOWERING my life expectancy, statistically speaking. If they were really interested in health and not taking your money and exploiting your body image issues, they'd tell a 115 pound woman to go away, keep eating healthy, and get some counseling about her distorted body image.

6. Medical studies on inactivity are often misinterpreted to reinforce the idea that being of a higher-than-average weight, in and of itself, is unhealthy.

-"Consider... the claim that fat kills 300,000 Americans per year, and is thus the nation's second leading cause of premature death, trailing only cigarettes. (T)he evidence for this claim is so slim as to be practically nonexistent. (T)he supposed source for this claim was a 1993 medical study that made no such assertion. That study attributed around 300,000 extra deaths per year to sedentary lifestyle and poor dietary habits, not to weight, which was not even evaluated as a risk factor. Indeed the authors of the study, Michael McGinnis and William Foege, became so frustrated by the chronic incorrect citation of their data that in 1998 they published a letter in the New England Journal of Medicine objecting to the misuse of their study."

http://www.opinions3.com/junk_science_about_obesity.htm

-Glenn Gaesser (an obesity researcher) notes that numerous studies-- more than two dozen in the last 20 years alone-- have found that weight loss of this magnitude (10 to 30 pounds) leads to an *increased* risk of premature death, sometimes by an order of several hundred percent. By contrast, during this same time frame only around four studies have found that weight loss leads to *lower* mortality rates."

-Recently, it was noted that the CDC methodology for estimating the health effects of obesity is flawed: A reporter from the Wall STreet Journal originally broke the story about the obesity stats being arrived at incorrectly.

The CDC plans to revise its figures by 9 percent.

http://usgovinfo.about.com/od/healthcare/a/cdcbadstats.htm#

-For more on the debate about "can you be fat but still fit," check this out:

http://www.forbes.com/lifestyle/health/feeds/hscout/2004/09/07/hscout521087.html

The study found that exercise, regardless of weight loss, improved heart health, but exercise without weight loss didn't affect diabetes or blood sugar levels. My criticisms are as follows:

This is a study of correlation, and we can't be sure of causation. Gaining body muscle is associated with your body handling sugar and insulin better, so I would be really surprised if people who exercise but don't focus on weight loss don't also reduce their risk of developing diabetes.

From an abstract on the diabetes/obesity study linked above:

The multivariate-adjusted HRs were 1.15 (95% CI, 0.83-1.59) for normal-weight inactive, 3.68 (95% CI, 2.63-5.15) for overweight active, 4.16 (95% CI, 3.05-5.66) for overweight inactive. . .

The rates for "overweight" people weren't that much higher than people of "normal" weight, until you reached the "obese" category-- then it jumped up quite a bit.

I would not argue that being at a BMI of 35 or higher is healthy for you, but I think people are far too freaked out about being 10-15 pounds over their "ideal" weight.

I also wonder if the study separated out people who only did cardio work from people who did weight-training, since building muscle mass is associated with your body handling insulin and blood sugar better. I also wonder if a higher rate of yo-yo dieting among the bigger participants could be a factor they didn't control for. Many studies show that rapid weight cycling is a better indicator of developing certain health conditions (heart problems & high blood pressure, for instance) than being overweight but maintaining a steady weight.

Glenn Gaesser is skeptical that obesity in and of itself has a great deal of impact on diabetes, when you factor out activity level. He cited a study in one of his books in which two groups tried to get their diabetes or borderline diabetes under control. One group (A) focused on losing 10 percent of their body weight. Another group (B) learned how to make better food choices and were encouraged to exercise. Almost no one in the B group lost any weight, but both groups improved their blood sugar levels. Almost every in the A group gained back the weight, and lost the blood sugar benefits. Most of the people in the B group kept exercising and maintained their gains in that area.

A link to an article by Gaesser asserts that the medical risks of obesity are greatly exaggerated (not non-existent, though). He also notes what I've commented on previously, that there's good reason to believe that traditional calorie-counting dieting promotes weight GAIN. There's also a reference to the study I mentioned that showed that increased activity DID have a strong impact on blood sugar levels, independent of weight loss.

http://www.hhpr.org/currentissue/fall2003/gaesser.php

Staying active DOES work

You'll notice that while I believe that your weight, in and of itself, is not a good indicator of health, I do believe that your activity level has a lot to do with health.

I'm a convert. I used to be a couch potato, and I hated vigorous exercise. But I finally did it long enough that I am at the point that I feel bad if I don't get daily exercise.

The problem for a lot of people is that the word "exercise" is a turn-off, and exercise can become unhealthy and compulsive just as easily as dieting can, for some people.

That's why I prefer to think of it in terms of "moving your body" or "being active."

Lots of research points to the fact that increasing your activity levels, REGARDLESS OF WEIGHT LOSS, improves your heart health, blood pressure, and ability to handle sugar. It is also linked with lower rates of depression and anxiety.

In fact, my long-term difficulties with anxiety are almost completely under control when I make sure to exercise at least 90 minutes to 2 hours a week. A recent study showed that people who got at least 3 hours of vigorous cardio exercise every week improved their depression as much as people on anti-depressants. They found that people who only got about 80 minutes of cardio a week didn't experience any difference, though.

Many people feel discouraged about getting regular exercise for a variety of reason. Here are my encouragements to help you overcome any excuses you may make for not getting regular exercise:

1. I can't afford a gym.

Phooey! Walk outdoors or in the mall. Buy a used stationary bicycle and ride while you watch your favorite TV shows. Take a yoga class or a martial arts class. Buy inexpensive hand weights and train at home.

2. I don't have enough time.

The good news is that studies have found that breaking your workouts into smaller 10-minute sections produces almost as good a result as longer 30-40 minute sessions. And sprinkling in 10-minute blocks of exercise throughout your day may keep your overall metbolism higher than doing it in one, larger block.

3. My neighborhood isn't good for exercise. It's too hilly/too dangerous/etc.

Get a walking buddy. Drive to a nearby park with walking trails. Walk the stairs in your apartment building. Find a place near where you work or go to school that's pedestrian friendly and walk on your coffee break or lunch break.

If you're really serious about committing to improving your health, make exercise a priority. I promise you that you'll be glad you did. On the other hand, don't beat yourself up if you miss a day or don't feel motivated and skip a whole week. Guilt is not productive. Just start up again where you left off. Find something fun you like to do: dance, take water aerobics, take tennis lessons, learn a martial art.

Whatever you do, keep moving your body, because it's really unnatural for you to sit in a chair in front of a computer screen for hours every day. Our bodies were meant to move.