Sunday, July 17, 2011

Dieting, Feminism & Patriarchy: Treating obesity with self esteem

Dieting can be understood as a type of “patriarchal bargain” (an individual woman’s decision to accept gender rules that disadvantage women-as-a-group, in exchange for whatever power she can wrest from the system).  By strategically losing weight, we accept the THIN=BEAUTIFUL*GOOD equation (which implies FAT=UGLY*BAD), and propel ourselves into positions of greater social advantage. 
So says Kjerstin Gruys in a guest post on the blog Sociological Images. She believes that dieting — and, particularly, the diet industry – is an expression of patriarchy that is bad for women.

I agree with her, but only to a point.  It's probably one of the underlying reasons I have never "gone on a diet" that lasted longer than a couple of hours.

However, as much as feminism raises an excellent point, it's ridiculous to use patriarchy as a reason to ignore the impact of obesity on health.

Going through the comments on the blog, it is clear to me that there are plenty of apologists who subscribe to the health at every size philosophy.

I was also somewhat amused to find a link to a report of a study titled, "Health at every size - New Hope for Obese Americans?"  The premise is that many people find it impossible to lose weight, but that by building self esteem and gaining a better understanding of the body's internal hunger cues, it is possible to improve one's bloodwork and sense of wellbeing more effectively than through traditional dieting.

You are probably wondering why I find this amusing.  Well, the study is nebulous, and is a perfect example of Gary Taubes' belief that the field of nutrition is lacking in academic rigour.   I call it a study, though it isn't referenced to a peer-reviewed journal.  Not that I doubt the study was performed, but you must have noticed that I like to check the references of studies that I write about.

I also find myself raising my eyebrows at the study's M.O.  It used two groups of women, one of which was educated about a range of what it described as popular weight-loss programs, though it didn't elaborate.  The other group went to work on their self-esteem.  Nowhere does it mention that a radical reduction in carbohydrate intake was a focus in the dieting group's approach.  

We can assume it wasn't, however.  Firstly, the dieters weren't successful in losing weight over the long term as might be expected from low-carb diets.  Also, the study is reported on the Agricultural Research Service section of the USDA website.  The last thing the USDA wants is for people to turn their backs on the farmers who grow the country's grain and corn.   

By the way, you should know that the USDA's mission is to "provide leadership on food, agriculture ... based on ... the best available science.."

This is the best science available to the USDA? 

Essentially this is a mediocre study that gave participants two mediocre choices.  The outcome that is slightly less mediocre than the other is touted as a positive.  

Unfortunately, this study, and others like it, are easily used to justify not buying into the need to control one's weight.  Let's forget about the risks of type 2 diabetes, cardiovascular disease and the likelihood of debilitating arthritis as we age - concerns that are not usually at the forefront of our thinking while we are young and more concerned about intellectualizing women's issues.  Let's focus instead on feeling good about ourselves, at any weight.

By shunning the diet industry and instead consuming the garbage of carb promoters (by this I mean both their biased publications and their sugar-rich food, much of which is processed), which to a greater or lesser degree is supported by the health industry, I believe feminists run the risk of unwittingly playing into the hands of powerful and deep-pocketed organizations with vested interests.  

Arguably, these pillars of political power aren't inherently problematic from a feminist point of view, but they certainly do exist to serve their own purposes rather than the best interests of overweight individuals of both genders.  

You would think this might be of more concern to educated women who should be smart enough to worry about the impact of obesity on their own health as they age.

It certainly is to me.

Wednesday, July 6, 2011

Diet Wars - Dukan vs. Establishment

Today's news includes a report of a libel suit by the popular French low carb "weightloss guru" Dr. Dukan.  He lost his case against another popular weightloss proponent, Dr. Cohen, who argued that his method could cause serious health problems in some patients.

I haven't been able to dig up much more information about the allegations.  If you ask me what is going on, I suspect it's more about libel than the underlying science.  In my opinion, any diet can cause serious health problems in some patients, especially if they have underlying medical issues to begin with.

I am somewhat familiar with Dr. Dukan's approach, which is more structured than what works for me.  He also allows limited quantities of grains, depending on where you are in the programme.  Now that I know how inflammatory wheat is, I doubt that I will ever go back to eating it again.  But he is very popular in Europe, and there is no denying that many people have lost significant amounts of weight with his diet. 

One Dukan success story is documented with incredible detail on How Stuff Works.  The author's before and after pictures are striking.  While he lost more weight than I did, and what he used to eat was much more unhealthy than what I ever ate, I did identify with many of his comments.  For example:
If you had told me in April 2010 that I would weigh 175 in October, I would have laughed heartily. There was absolutely no way that could happen. Yet here I am....

I will never be able to go back to “the way I used to eat” before this diet, because before this diet I inhaled carbs — 3,000 or 4,000 calories worth per day. Breakfast cereal, pizza, pasta, lasagna, potato chips, fruit juices, sweetened yogurt, rice, potatoes, french fries, burgers, etc. I won’t be able to do that or I would be obese again in no time. However, the Dukan diet has educated me in a big way on the problems with high-carb diets and all the blood sugar swings that they induce.
What also grabbed my attention in his writing was the image I posted at the top of this page.  Remember what I wrote yesterday about liposuction causing fat to accumulate around the belly?  Doesn't it become more tangible when you can see that visceral abdominal fat inside the abdomen of the 250lb person above?

Tuesday, July 5, 2011

Limitations of Liposuction

There must be very few women who haven't stood in front of the mirror and wished they could have their body fat sucked away.  Liposuction seems like a too-good-to-be-true solution to this problem.

We all know that when something seems too good to be true, it usually is.  A brand-new study published in the journal Obesity looked at the fat distribution of a number of non-obese women before and after liposuction, comparing the results 6 weeks, 6 months and 12 months after the procedure.  They were instructed to make no lifestyle changes that could otherwise skew the outcomes.

Compared to the control group, after the procedure, the liposuction candidates initially had less body fat than before, but as time went on, the difference diminished.  A year out, there was no longer a significant difference in body fat percentage.

What did change was that their thigh fat redistributed itself to the belly region over time.

Besides the fact that abdominal fat is the kind that is associated with higher cardiovascular risk, who wants to replace fat thighs with a fat belly?

How many cosmetic surgeons even hint about this to their prospective patients during their pre-operative consultations, or in their glossy brochures and slick websites?

There is a case to be made for limited liposuction on problem areas that defy other reduction efforts like diet and exercise.  But it seems to me that cosmetic surgeons are playing with fire when they use liposuction to remove large amounts of fat on overweight patients.

Cosmetic surgeons undergo a pretty rigorous training, but they generally aren't well-versed in endocrinology and all the interrelated hormonal processes that take place in the body behind the scenes.  The surgery they perform is called cosmetic for a reason. 

Many of them perform surgeries and other procedures on overweight patients that they would not be so quick to perform if they didn't have sky-high office overheads and lavish lifestyles to finance.

Have you ever stood on the scale and wondered how it is that your weight can be exactly the same from one day to another?  This is what is known as the set point.

The way I see it is that the body's internal chemical and hormonal balance is so intricate that it needs a constant set point, and it will keep reverting to that same point.   Unless, of course, you make structural differences that reset that set point.  Long term, diet will do that, but crash dieting and liposuction only bring about temporary change.

Looked at in this way, the results of the study make complete sense to me.  They should be a big warning signal to anybody seriously considering liposuction, especially if they are overweight to begin with.

The last thing you need is more fat around the waist, but that is what your body will do if you try to mess with its set point.

Saturday, July 2, 2011

Hyperpalatability and the paradox of simple food

What I'm writing about today probably makes sense to you if you're following a low carb, grain free lifestyle.  If you aren't, you might think I don't know very much about the pleasures of good food. 

I'm not only a decent cook, but I've also eaten at enough fine restaurants in several different countries to know a thing or two about gastronomy.  So please bear with me.

Hyperpalatability is currently a bit of a hot topic in several blogs I'm following.  The idea is that many foods are engineered to bring you back for more, over and over again, and that this is a major underlying cause of obesity.  David Kessler wrote an excellent book on the topic several years ago.  It's titled The End of Overeating:Taking Control of the Insatiable American Appetite, and it's definitely worth reading.  His theory is that sugar, salt and fat in combination are behind the obesity crisis.

Watch this video to get an idea of what he's getting at:

Contrast this to a diet largely devoid of sugars.  When you stop adding refined sugar, wheat, potatoes, pasta, rice, etc to your plate, it almost certainly means less variety. 

To the uninitiated, this appears boring, unappetizing, and even bland.   I can see why so many people are completely turned off when they first learn about this way of losing weight.

The diet industry usually goes to great lengths to assure you that the particular diet or supplement they are selling still allows you plenty of variety.  I even notice myself doing this in some of the posts I have written.  Of course I can't speak for the diet industry, because they need to keep selling their products, and telling you that you'll lose weight by sacrificing palatability is probably not a great business model.  But I have nothing to sell, and so I can afford to be honest.

And that's where the paradox comes in.  You see, a little while after going low carb, you start realizing there is considerably more gustatory pleasure to be derived from good foods that are prepared more simply.  After you stop physically craving sugars, you realize, if anything, that the carbs are a distraction, a cheap filler.  

What is left is so enjoyable that you no longer feel the need to dress it up like you used to.  For example, in our house, we enjoy our hamburgers so much that we eat them several times a week.  Yet we make them with nothing more than a hand-formed patty of ground beef.  The pastured eggs we eat so many of are also prepared really simply.  Sometimes boiled, but more often cooked up in a quick omelette or a custard.  There's little that beats the fine texture and flavour of a piece of well-poached salmon.  We derive great pleasure from our vegetable garden.  Although it isn't huge, it provides us with plenty of fresh seasonal produce to forage.  This means we eat fewer cooked vegetables, but I often "catch" the kids with a handful of freshly picked pea pods, or a mouthful of parsley or arugula.  It's not that we never add flavourings or dressings to our food, but when we do, they too are made with fewer ingredients.

We've noticed our grocery cupboard is emptier than it used to be, but we don't feel we're lacking.  I remember frequently feeling frustrated and bored on weekday evenings, facing a full grocery cupboard and being totally uninspired about what to cook for dinner.  Why don't we feel that way any more?

This is what I think is going on:  Carb-rich foods on their own are pretty bland.  Would you be interested in eating oatmeal porridge for breakfast every morning, if you couldn't add anything to it?  What about a bowl of rice for lunch every day or a plate of potatoes for dinner?  A baked potato tastes so much better with a chunk of butter or a dollop of sour cream.  And even so, most people wouldn't want baked potatoes every day.  It seems to me that carb-rich foods are pretty boring on the whole, though dressed with proteins and fats, they quickly become hyperpalatable.  You find yourself craving more every few hours, and most of us find it hard to stop even though we know we've had enough.  People who eat a lot of fast food often experience this effect more strongly, but it also happens in households that never eat fast food.  I definitely recognize a palatability pattern in the way we used to eat.

Cut out the sugars, and your system ratchets itself down to a different gear.  Having something different or elaborate for dinner each evening no longer feels very important.  You find yourself looking forward to a dish that previously may have seemed boring or bland, and it's easier to stick to reasonable portion sizes.  It becomes much easier to say, in all sincerity, "Thank you, that was delicious.  But now I'm full."

That's why I think this is a paradox.