People with underlying health issues more likely to run into health problems. Amazing journalism.
this post was submitted on 12 May 2024
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Well, with respect to everyone, there's a group of folks who believe in "health at any weight". That's an issue
So the movement you’re referring to is “health at every size” and various studies have shown that following it leads to overall better physical health outcomes compared to “traditional” weight loss/dieting. Here’s a short article with links to various studies: https://education.nationalgeographic.org/resource/health-every-size/#
The movement isn’t promoting that everyone is healthy at every size but that weight and health may not be causal as people seem to believe (research shows they can be correlated but the methods behind it have also been quite flawed and do not consider a vast majority of covariates that have been previously identifed as having negative relationships with health). Unfortunately, we live in a society (mostly US but also all Western nations) that pushes the idea that only one body type is “healthy” and that our body shape/type is largely within out control and neither of those are previous statements are true. In fact, these ideals have been shown to be negatively correlated with physical and mental health and can be a major contribution to disordered eating and associated symptoms/behaviors.
Also encouraging fat folks to improve their health where they can is far better than chanting cico and attempting to shame them. Shame is bad at motivating people. Except to eat, shame is great at getting people attempting to lose weight to eat an entire pizza in a sitting. But instead by encouraging a healthier diet and to increase movement you help them lose weight, and more than that you help them keep it off.
Obesity is a serious risk factor for many, many conditions. It is not always the cause, but it never helps.
Folks with obesity need better healthcare, which is massively underserved in the west (and everywhere, for everyone).
Nothing beats CI/CO ever, no excuses, nowhere in the universe. It's thermodynamics.
The primary issue is mental health, and it is a very serious issue Indeed.
Obesity can be a risk factor for certain individuals but more research has been pointing towards family history, genetic, and even environmental effects to explain more of the variance for health outcomes over obesity as a standalone variable. It can definitely makes things more complicated but isn’t the single point of health as we’ve made it out to be.
As for the CI/CO, that has also been disproven quite some time ago and continues to perpetuate because it is a simple way to try and understand weight. Here’s another short (non-scientific) article to dive into that: https://immattersacp.org/archives/2021/06/understand-obesity-before-treating-it.htm#:~:text=Treating%2520obesity%2520isn't,be%2520OK%252C%E2%80%9D%2520she%2520said. In short, individuals vary in how their bodies store and utilize calories and calories themselves vary depending on the source. Some bodies do fall under the fairly simple ci/co addage but the majority do not and continuing to understand it from that lens maintains weight stigma, which we also see as a major contributer to negative health outcomes in individuals living in larger bodies.
While I agree that mental health is a primary issue (it is literally my field of study, practice, and research), I also like to try and share some of the more recent findings and understanding in our field, especially as we continue to learn and correct old findings. I apologize that you’re getting so many long messages but I just find it important to try and speak out where I can, especially after working with and treating folks with eating disorders.
How has cico been disproven? The mental health component is the real issue. As in, for very legitimate reasons, humans can't maintain the diet, due to failing to maintain discipline. Disproving cico would mean humans create perpetual energy.
If you lock someone in a room and give them only water, they will lose weight. (Set aside vitamins)
Then try a single spoonful of rice a day. Still lose weight.
Continue to increase food, you'll find eventually they maintain a consistent weight.
Continue to increase food and eventually they will gain weight, as they will be consuming more calories than they burn.
Ci/co as a thermodynamic rule hasn’t been disproven but it works in a vaccum with no other factors considered. Humans are complex and vary in their biological processes that change how calories are utilized, processed, stored, etc. Two people can be put on the exact same diet and exercise plan and have completely different outcomes, that’s where the simplified idea of ci/co has been “disproven” as far as it is commonly understood.
As far as the mental health piece, it is one part of the puzzle but its not necessarily the main component, and also cannot be simplifed to maintaining discipline. Basically, all I’m trying to say is people are complex and just saying an individual needs more discipline or needs to lose weight really reduces the nuances between the relationship of weight and overall health.
Discipline is mental health. Mental health is the real issue.
Edit discipline is not the only relevant mental health topic here, just replying to that in particular.
Am I misunderstanding something or is that article saying "it's not CI/CO, it's actually CI/CO"? The incorrect assumption people make is that somehow the only change to energy intake and expenditure is food and exercise (which we have known for very long to not be the case and it's insane to me that people believe that), not that the law of conservation of energy somehow doesn't apply. If you expend more energy than you take in, you will lose weight. But measuring either of these things properly is close to impossible and certainly not as simple as "put your height and weight and what you eat and how much you exercise into a calculator".
No, that’s the correct interpretation, essentially we’ve simplified the “formula” to be easily digested (ci/co) and people have a tendency to understand it as an easy cut calories or expend more. But as you’ve noted, it’s extremely complex and doesn’t take into account individual needs or variability which makes the generalized health advice of “just lose weight/diet/exercise” pretty unhelpful. Especially as we have no true recommended options that contribute to weight loss with long term maintenance.
Nothing beats CI/CO ever, no excuses, nowhere in the universe. It's thermodynamics.
I got something that beats CICO. And it's called addressing your specific health concerns instead of just dieting.
You've got poor heart health? Cardio will help you more than fasting.
You've got diabetes? Limiting sugar intake will help you more than restricting everything.
You've got depression? Antidepressants or going outside will help you more than losing weight.
You've got a broken arm? Rest and a sling will help you more than losing weight.
HAES is about actually fucking treating your health problems at whatever size you're at, instead of blaming it on your weight and continuing to fail to lose weight.
CICO ain't worth shit if the patient can't lose weight. And if you're thinking "it's just a matter of willpower", well tough shit, people have limited willpower. And being sick doesn't help willpower either. It's way more likely for someone to get healthy at their current size, see a willpower increase, and then lose weight, than it is for a sick and suffering person to stick to a diet, lose weight, and then get healthy. HAES is about doing it the right way around, the way around that actually works.
None of that beats cico, it addresses other concerns.
I clearly identified mental health as the critical issue, and to restate: the reason people fail at cico is due to mental health. People can't create energy and therefore weight from thin air.
Okay so what's going on in this thread is that I assumed the point was to help people, and you assumed the point was to lose weight. And I think that illustrates what Health at Every Size means perfectly. HAES is about helping people, and the people complaining about HAES aren't interested in helping people, they only want people to lose weight.
Well, I want people to get good mental health, but I also am aware of the risk obesity causes.
So 2 topics, which both matter. Obesity is a dangerous condition.
Edit Losing weight, when weight is significant enough.to cause risks is helping people.
You started this conversation saying Health At Every Size is bogus and harmful. Now you're saying both topics are important. I agree. I'm going to assume you've changed your mind and now understand the benefits of Health At Every Size at improving people's health regardless of weight, and also that HAES makes it easier to lose weight if that's what they also want.
No, I'll be quite clear: being obese and lacking mental healthcare are both harmful. I've been consistent on that.
There is not "health at every size".
What I can extract and appreciate about that movement is that it champions the need to holistically address the many needs of folks with obesity, beyond simple calorie management. I've been consistent about that too. I believe every CICO content I've made mentioned mental healthcare.
Obesity is a very dangerous condition that should be removed with great urgency. But I acknowledge that CICO alone will likely not result in long term success.
Health is relative. Health isn't an absolute boundary between healthy and unhealthy, that's silly. Health is a polydimensional spectrum. If you want to categorise health "objectively", well then seeing as men live shorter than women, we'd be forced to classify maleness as an illness and put every man in the world on estrogen pills. And that's ridiculous. No, health isn't a single standard that's the same for everyone.
Health isn't a point, it's a direction. Like South. South is a direction. I see Americans say all the time that they're from the south. They mean Texas. But I live in Australia. From my point of view, they're from the north. But it's not like they're lying. In terms of America, they're from the south. It's true.
Health is like South. If you've lived your entire life overweight with poor health, then getting healthy can mean a lot of different things. If you start jogging once a week and get healthier, well congratulations, you got healthy. It's relative. It's unreasonable for you to demand somebody in that situation meet the ideal of human health. If you do that, if you belittle their progress and say the best they've done in their life isn't good enough, you'll kill their motivation and ruin what little health they've achieved.
And if you go around saying there's no such thing as health at every size, well then I'll tell you there's no such thing as men's health, because being a man is unhealthy. The two statements are equally ridiculous.
Being obese is a version of being without health. Getting rid of excess weight is a critical need.
Acknowledging mental health as a critical component of achieving a health body weight is not accepting being overweight as "ok". Identifying being overweight as "not ok" does not mean devaluing those with that condition, or making light of their needs.
Okay you're still saying someone can't be overweight and healthy, so like I promised, I'm gonna assert that there's no such thing as men's health. Being male will make a man die sooner. We need to give all men estrogen pills immediately and make sure they stick to the regimen. Being male is not okay, it's bad for you and it's driving up insurance costs for the rest of us. It's selfish. Making bad choices out of stubbornness and pride while everyone else pays. That's not okay.
Please note these are not my actual views, I'm just applying anti-HAES logic to other parts of our bodies in the same manner.
Gender is intrinsic to a person. Weather they've been born as their gender, or not, they are what they are, and are valuable as such.
Being obese is like say, having diarrhea. Every effort should be made to undo the situation, with the acknowledgement that there may be underlying causes that need to be addressed first. (Food poisoning, food allergy, etc)
Being obese is a condition, not an intrinsic identity. Gender identification, and gender dysphoria are not conditions to be discarded. Being a gender is not a condition. I would no even hypothetically suggest someone should change their gender due to an external force,... beyond their own personal journey and choice, as that is bigoted speech.
Folks ARE the gender they visualize, or are born with. Gender affirming care, or confidence in your chosen gender are not up for discussion.
Folks HAVE obesity. It's a condition. Even while having this condition, they are valuable, and important.
To throw your analogy in the gutter: the elderly also require more healthcare and support, and their age is intrinsic. They cannot change it.
Neither gender or age can be "fixed". Obesity can, and should. CICO is how it mechanically happens, mental healthcare is how it lasts.
Men and women tend to be different sizes, as I'm sure you've noticed. Body size and shape is part of gender. Trans people who are too big or too small to fit their ideal body shape suffer dysphoria. And in cis people, the symptoms of obesity bear an eerie similarity to stress symptoms. Part of the unhealth of obesity for many cis people is gender dysphoria. They have a body shape that doesn't make them happy, it stresses them out. However, not everyone in the world is a man or a woman. There are other genders, and some of those genders have an ideal size that is larger.
You say gender is nothing to cure, but then you say obesity is always a problem. And you say it to the face of an enby who gained weight on purpose and saw a reduction in physical dysphoria as a result. I didn't feel comfortable taking pictures of myself until I was what the BMI scale calls overweight. When I was thin, the face in the mirror didn't look like mine. It looked like some ugly person I'd been told my whole life was me. I've grown happier and more confident, and I have fewer suicidal ideations
And I still pursue physical health at my current weight.
Good for you. Your gender is not to be fixed. Your perception of weight validating your gender is for your mental health care professional to review. Not me.
Your general care doctor will of course encourage you, but if asked about obesity specifically, will guaranteed recommend a healthy body weight to avoid risk factors and complications. Consider COVID hospitalizations, as one example.
Actually, my GP gave me medicine to help my appetite even though I'm clearly obese. I was struggling to finish meals and asked the doctor for help. Doctor checked that I understood the risks, made sure I knew the warning signs of diabetes and what to do about them, and gave me appetite pills. I have had my prescription renewed at various different GPs and none of them ever made an issue of it. Turns out, doctors are actually very supportive and attentive to the patient's individual needs, and it's only assholes on the internet who make a big deal out of weight. Americans' mileage may vary because their healthcare system is three insurance companies in a trench coat.
The question is, how many people are nonbinary like me, and feel pressured to live unhealthy lives because of people like you? If I hadn't transitioned from male to female, then I wouldn't have the socio-political literacy to have this conversation about gender with you. And that's most people. How many people are assigned thin woman at birth, are actually fat woman on the outside, but don't know shit about gender politics because they're not traditionally trans? It could be a few, it could be a lot. But I guarantee the people who are like me are suffering because of the judgement of those who say there's no such thing as Health At Every Size.
Like spam emails, it worked. People have likely clicked, and here we are talking about it. As long as it continues to work, they will remain in business... :-(
What bugs me about it is that it's The Guardian, from which I tend to expect better. Therefore, I went ahead and clicked it, and am tremendously relieved to see that mostly it's just an overly simplistic title - it would have read much better as something along the lines of "measuring the economic impacts of obesity" imho - though the article itself is still somewhat slim.
Globally the costs of overweight and obesity are expected to soar from $1.96tn in 2020 to $4.32tn by 2035, according to the World Obesity Atlas published last year.
The way I see it, us non-overweight people need to get a better work life balance and take more sick leave!
Because the obesity and their bad health likely has a single cause. Whether it's neglect, bad mental health or something else, it all increases the likelihood of obesity and being otherwise unhealthy. This headline seems to paint the fat people as leeches of the system, while they are often already sick and obesity just one of their symptoms.
Conflating fat people with bad people is pretty standard fare unfortunately.
I’ve struggled with my weight my entire life; I have a long history of being physically active while also being overweight. For example: I have a black belt in martial arts, which means I spent a decade of my life in a dojo three to five times a week exercising… while still fat. I don’t eat terribly either. My body just holds onto every fucking calorie.
But many many people have made shitty assumptions about me based entirely on my weight. The “personal responsibility” people are particularly obnoxious.
I was a kid in the 90s when every TV show had a stupid lazy fat guy as a cheap joke factory. That was super cool for my self esteem.
Taking BMI as gospel is another problem, to be considered in an ideal weight, I'd have to weigh as much as when I was 17 and that was when I was the most active in my whole life (walking to and from school, PE at school, going outside with friends daily, etc.) No chance I can cut to that weight at 35 in a healthy way.
It is my opinion this article is a symptom of the current culture that being fat is some sort of moral failing. The fact that they can tie it to some vaguely tangible monetary cost is the justification.
Also what if someone wants to be fat? "No, you're not allowed to look how you want to look. You have to change your appearance to fit in because uhhhhhh you need to go produce more labour value for Capital.
Fuck that shit. It's fashy as hell. Also transphobic vibes tbh.