Why Does Health At Every Size Work?

We know that non-weight-loss, body acceptance approaches to health (sometimes called Health At Every Size) can work in terms of helping people at a range of weights achieve better markers of physical health. For example, several randomized controlled trials have shown improvements in cholesterol and blood pressure in “overweight” and “obese” women using these approaches. But how?

Generally these approaches don’t cause weight loss — they’re not designed to cause weight loss, and the focus is on body and self acceptance. One answer may lie in the lifestyle improvements women in these studies made. Various studies found that they became more active, and/or ate a higher quality diet, and/or engaged in less binge eating. So maybe it’s simply those positive changes that caused the physical improvements.

For hypertension especially, though, I wonder if some improvement was due to the effect of body acceptance interventions on either self-esteem, body image, or experiences of anti-fat bias and discrimination. The link between exposure to racial discrimination and hypertension among African-Americans (who are at relatively higher risk for hypertension) is well known, and researchers have learned some interesting things about that relationship. For example, internalized negative attitudes towards African-Americans are even more strongly predictive of poor heart health among African Americans than perceived discrimination. In addition, perceived ethnic density — that is, reporting that you live in a community with lots of other people of your ethnicity — may buffer some of the effects of racism on health in general among minority communities.

Perhaps connecting to a community of other higher-weight folks who are practicing body acceptance, standing up to size-based discrimination, and challenging their internalized anti-fat bias is what leads to some of these improvements, not just better eating and exercise.

Posted in Uncategorized | 1 Comment

People Dancing (Part 1 of a series)

In case you need some models for some aspect of your own life that feels impossible to you now, I’m starting a People Doing Things series on this blog to help you visualize or locate people who look like you doing things you’d like to be doing. I’m aiming to illustrate human diversity, but each post — of course — will not be comprehensive. Pingbacks are permitted on this blog, so feel free to link here if you have an example on your own blog of People Doing Things, and I will update the post to show your suggestions!

To begin with, let’s look at photos, videos, and blogs of people dancing!

That’s Ragen Chastain dancing, by the way. You can read her dance blog here.

Listen to Big Moves’ NPR Interview

Visit Big Moves dance studio for classes, shows, etc.

Trailer for the movie Everyday Dancers

The UK’s Ballet Black:

PSA for the scholarship program of the City Ballet of Los Angeles:

Trailer for a show by the UK’s StopGap Dance

The Prometheus Dance Company’s Elders Ensemble

That’s Kim Tanri, artistic director of the Japanese-Malaysian performing arts group Taihen, which I think is pictured here:

Cuba’s Danza Voluminosa:

(Hat tip to Body Impolitic for the pointer both to Danza Voluminosa and Taihen)

The Black Swan Diaries

Wheelchair Dancer:

Los Hermanos Macana do tango:

Tango with three dancers

A lone dancer practicing in hir studio:

Posted in Uncategorized | Tagged

Research Round Up Part 3: Weight, Shape, and Mortality

So, you’re with me thus far: Diets don’t work to help people lose weight. “Healthy lifestyle change” doesn’t help people lose weight (nor is it clear that it helps people get healthy, actually, but more on that later). Your failure to feel better by changing your body shape or size may be beginning to make sense in context: You can’t do it, because apparently it can’t be done.

But what about your health? No less an authority than the Centers for Disease Control is standing ready to persuade you that obesity is a terrible public health epidemic. One would think that getting or staying thin must be a prerequisite to a long, healthy life.

Let’s look at that idea a bit more closely. To do that, we start with your BMI, your Body Mass Index. The BMI is a measure of body size that is less crude than a simple weight measurement in that it corrects for expected variation in weight due to height. (I said it was less crude. I did not say it was elegant.) Research done on obesity often uses BMI as its outcome measure.

Here, let’s calculate your BMI.

Mine comes out at about 27, which puts me in the “overweight” category. If you run the widget, you’ll see it places you into one of four categories.

  • underweight (BMI < 18.5)
  • normal weight (BMI 18.5-24.9)
  • overweight (BMI 25-29.9)
  • obese (BMI >= 30)

Researchers usually also distinguish between

  • mildly obese (BMI 30-34.9) and
  • moderately/extremely obese (BMI >= 35)

Click here to see if you can put these categories in order by risk of mortality. Which category has the highest mortality risk? Which has the lowest?

Are you surprised by the correct answers? All of the large, epidemiological studies of which I am aware on this topic have ALL come up with this same rank ordering of mortality risk.

So if “longevity “is a decent proxy for “better health,” then the fabulous “mildly obese” Kate Harding

is “healthier” and can expect to live longer than the apparently “normal-weight” Beyonce:

And the “moderately/extremely obese” fashion icon Lesley Kinzel

is in better health and can expect to outlive apparently”underweight” Angelina Jolie:

A quick note: In looking at these photos, I encourage you to check your body policing urges at the door. I am not claiming that any of these prominent women is or is not healthy, or does or does not lead a “healthy lifestyle” (whatever that means), as I don’t have any data to address those questions and am not inclined to police the private, personal behavior of individuals even if I did. I set these pictures side-by-side as vivid illustrations to encourage you to challenge your stereotypes about body shape and health and marvel about the inaccuracy of the messages you might have received about that. They’re not here so you can trade one set of unrealistic expectation about what is “healthy” for another.

Posted in Uncategorized

Does “Healthy Eating” Lead to Body Change? Research Roundup, Part 2

Of course, even Weight Watchers claims that “diets don’t work; weight watchers does.” Diets may not work, you might be thinking, but what about “healthy eating” or “healthy lifestyle change”? Surely if you eat right you will lose weight, right?

Not so fast. The Women’s Health Initiative Dietary Modification Study was the largest, most extensive, experimental study of “healthy eating” ever conducted. More than 48,000 older women (ages 50-79) were randomly assigned to either eat their usual diet, or eat a low-fat, high fiber, diet with lots of vegetables, fruits, and whole grains — the essence of what most people think of as “healthy eating.”(They chose older women because they wanted to be sure there would be enough incidence of disease among the participants to detect differences between the groups after several years of follow up.)

The women in the intervention group had intensive, state-of-the-art support to maintain their diets  — an intensive initial group treatment led by nutritionists, followed by a long-term maintenance intervention group that met regularly over the course of the study, individual counseling, and personalized feedback on their dietary targets and progress.  They ate this diet and continued in the intervention program (and were compared to their control-group counterparts) for an average of 8 years of follow up.

They weren’t perfect at maintaining their target diets, of course, but they were pretty good: As Sandy Szwarc notes, The women in the healthy eating intervention group cut their total fat intakes down to 24% of their calories and 8% saturated fat the first year — well below the control group eating about 38% total fat and nearly 40% more saturated fats. By the end of the study, the “healthy eaters” were still averaging 29% fat, compared to 37% in the control group. The “healthy” dieters also ate about 25% more fruits and vegetables, grains and fiber than the typical American diet of the control group.”

So, what do you suppose were the benefits of the healthy diet these women maintained faithfully for 8 years?

These women successfully changed their eating lifestyles for 8 years: more fruits and vegetables, more whole grains, less fat, less calories. Classes, nutrition groups, hearing feedback about how they were doing. (“Couldn’t you cut out the chocolate, Ann-Marie?”) Yet they didn’t do better in terms of cardiovascular health, or cancer. They lost only a pound, for 8 years of effort. Would that be worth it to you?

(Sandy Szwarc has an excellent series on this study if you’d like to read more about it.)

Posted in Uncategorized | 1 Comment

It’s Not Just You: A Research Round Up, Part 1

If you feel like a failure in your efforts to change your body, lose weight, and achieve happiness, you’re not alone.

Efforts at weight loss and body change, especially through dieting, are common: nearly 50% of men and 75% of women report dieting at some point. Americans spend about $35 billion — more than $100 for every man, woman, child, and infant — every year on weight loss products, according to this article from CBS news. Researchers have also gotten in on the act: The National Institutes of Health spent $147 million on obesity research in 2010, more than it spent on breast cancer, lung cancer, and stroke combined.

But all that scientific, entrepreneurial, and ordinary human effort expended hasn’t achieved much more than your own efforts have. If you’ve tried, and failed, to lose weight, it isn’t your fault.

There is little evidence that any weight loss diet — even the state-of-the-art scientifically supported diets that are generally studied in randomized controlled trials — is effective over the long term. In fact, as many as two thirds of dieters in clinical trials regain more weight than they lost on their diets. Also, weight loss research is biased toward showing successful results, so clinical research on weight loss probably underestimates the extent to which dieting is counterproductive.

The news may be worse in non-laboratory, real-world situations. Among adolescent girls, self-reported dieting, exercise for weight control, and dietary restraint actually predicted weight gain and the onset of obesity over long-term follow up, a finding that’s been replicated in several studies.

As Kate Harding said, diets don’t work. (And no, “lifestyle change” doesn’t work as a weight loss tactic, either. That’s part 2. Coming attractions.)

Posted in Uncategorized | 1 Comment

Happy Anorexics

So, did you figure out why? What are the reasons you have engaged in a struggle with your body? Do you want to feel better about yourself? Do you hope to feel more confident, less self-conscious, sexier, more accomplished, more energetic, more optimistic, happier?

So: How’s that working for you? How far have your efforts brought you to these positive feelings? Maybe you already know that they have not in fact brought you closer either to solving the problem or achieving happiness — that in fact your problem has become larger and your self-hatred and unhappiness more intense.

But that’s only because these strategies haven’t worked, right?

If only you could have the body you dream of…

If only you were thin

Then, then you would be happy.

You may not know how to get there, but you know that if somehow you could, your life would begin.

But consider the situation of people with anorexia. People with anorexia, by definition, have been successful at achieving thinness. One stringent definition of Anorexia Nervosa requires sufferers to have a BMI of 17.5 or less.

A BMI of 17.5 or less is not necessarily what you may think of as “emaciated.”

Toronto model Caroline Savage has a BMI of 17.5:

Puerto Rican model Ana Delia D has a BMI of 17.5

Toronto model Sara Balint has a BMI of 17.5

U.S. model Kelli Kickham has a BMI of 17.5:

People with anorexia often look like supermodels. They’ve achieved what you may be imagining. And yet, despite having achieved a supermodel-like ideal of thinness, they are not happy. In fact, people with anorexia are more likely to die by suicide than people with any other DSM-IV mental disorder, including depression and schizophrenia. If being thin and having a model’s figure worked to bring self-confidence, happiness, and self-esteem, eating disorders treatment centers should be filled with happy anorexics.

This is a new, and lovely, eating disorders treatment hospital. Does it look like a place of happiness to you?

Achieving thinness doesn’t bring happiness. Indeed, the evidence suggests it may bring misery.

Posted in Uncategorized

Cinderella Ate My Daughter!

Fantastic review of Peggy Orenstein’s new book and an interesting historical overview of how children got color-coded at About-Face.

Posted in Uncategorized