Fat Chicks Rule

New Diet: Deny Drugs you need for Drugs that Don't Work.

The worst doctor I ever saw was an endocrinologist. I went to her thinking that I might have a thyroid condition as I was tired all the time. 

When I finally got into see her, I began to give her the talk about my dieting history, only to have her interrupt to insist I be tested for diabetes. When both my sugar levels and thyroid came back normal, she blamed my fatigue on being fat. (Apparently carrying around weight makes you work harder and tire out faster.)

Another horrible endocrinologist out of Boston is Dr Caroline M Apovian (I will refer to her as "Dr. A" from now on)  who has a horrible idea. Take potentially needed prescription drugs away from fat people until they lose weight with lifestyle changes and weight loss drugs.

I am not kidding.

Use of approved weight-loss medications is endorsed for people with a body mass index (BMI) of 30 kg/m and above or at least 27 kg/m with one or more comorbidities. The document "shifts the paradigm" by advising physicians to target the obesity itself first and thereby diminish its related complications — such as hyperglycemia, dyslipidemia, and hypertension — rather than aiming first to treat the comorbidities caused by the excess weight, she said.

Which means to me if you have hypertension, you should just have a stroke if you refuse to take diet pills (which is ironic considering that diet drugs in the past have caused heart disease related deaths.)

Now I'm not against trying actual lifestyle changes first before taking medications. I lowered my cholesterol with dietary changes and an increase in exercise, and if you watch America the Beautiful 2: the Thin Commandments, the director also avoided taking certain medications by becoming an active bike rider. In my case and his, indicators improved with miniscule weight loss. 

This is not the case with everyone, and sometimes people have to take medications. Dr. A not just against using medication for high cholesterol, hypertension, or hyperglycemia, she's against mental health drugs that make you fat.

For patients already taking insulin, sulfonylureas, thiazolidinediones, beta-blockers, or certain specific selective serotonin-reuptake inhibitors (SSRIs) like paroxetine — all of which can lead to weight gain — the document provides advice on how to taper patients from those medications and switch them to alternative agents that don't increase weight.

In my opinion, changing around a person's mental health drugs so they don't get fat is dangerous and a malpractice suit waiting to happen.

But what Dr. A does have for you is  diet pills.

"Medications do not work by themselves, but they can help people maintain a healthy diet by reducing the appetite. Adding a medication to a lifestyle modification program is likely to result in greater weight loss," said Apovian, who is also professor of medicine and pediatrics at Boston University School of Medicine.

And why is Doctor A. peddling dieting and diet drugs?

Dr Apovian serves on advisory boards for Amylin, Merck, Johnson & Johnson, Arena, Nutrisystem, Zafgen, Sanofi, Orexigen, and Enteromedics. She has received research funding from Lilly, Amylin, Aspire Bariatrics, GI Dynamics, Pfizer, Sanofi, Orexigen, MetaProteomics, and the Dr Robert C and Veronica Atkins Foundation. Disclosures for the coauthors are listed in the article.

Study Accidently Finds Out Dieting doesn't Work.

Researchers at Duke have put together a study to find out which diet (including drugs but excluding Weight loss surgery and Medifast, Optifast, and Slimfast) gives you more bang for the buck.

Finkelstein and research assistant Eliza Kruger first conducted a literature review to identify high-quality clinical trials of commercially available diet/lifestyle plans and medications with proven weight loss at one year or more. Weight loss was measured in terms of absolute change in kilograms lost compared to a control group in which patients underwent a low cost/low intensity intervention, or a placebo in the case of the pharmaceutical trials.

 The results for diet programs found that Weight Watchers gives you the best weight loss for your money and the drug Qsymia was the best drug. Jenny Craig had the most weight loss but it was the most pricey.

However,

Average weight loss at one year ranged from 2.4 kg (about 5 pounds) for Weight Watchers to 7.4 kg (16 pounds) for Jenny Craig. Those on Orlistat lost 2.8 kg (a little more than 6 pounds) whereas those on Vtrim and Lorcaserin both lost an average of 3.2 kg (about 7 pounds). Weight loss for those on Qsymia averaged 6.7kg (a little less than 15 pounds).

Essentially, weight loss on the diets they measured were about  5-16 pounds. Making Weight Watchers the cheapest at about $75 a pound.  I gain and lose five pounds during my period. I don’t need to pay for the privilege.

The authors tried to save face by comparing it to quality adjust life year (essentially saying that the whole five pounds you lost is worth it because now you are “healthier” and that five pounds will save you for the horrible diseases to kill slowy) but really all it proves is you spent a lot of money and didn't lose a lot of weight. The study doesn’t examine weight cycling which I believe to be more dangerous than being fat or does it look at weight loss five years from now. Weight loss diets tend work in the short term.  If you measure success in a year with a small amount of weight loss, than I’ve been successful on almost every diet I’ve been on.

The commercial diet industry is rapidly losing money to non-dieters and DIY diets and is desperate to make the money it formerly did. This is why it's focusing at pushing for coverage under the Affordable care Act and workplace wellness. No health insurance in its right mind would cover a program with a 95% failure rate that isn't even shown to be good at weight loss!

Oh and btw

Finkelstein (The author) has been a paid consultant for Jenny Craig, Weight Watchers, Takeda, Orexigen, and Vivus, Inc

Dr. Oz, Snake Oil Salesman

I watched exactly one episode of Dr. Oz. I found him and his show to be superficial tripe. I watched the episode solely because Dr. Glenn Gaesser (A proponent of fit and fat) happened to be on.

Recently Dr. Oz was called in front of congress and chastised for his role in pushing diet products that don’t work in the long run. He was unapologetic about it.

Oz insisted he believes in the supplements he talks about on his show as short-term crutches and even has his family try them. He said his job on the show is to be a "cheerleader" for his audience, one who offers hope even if that means looking to alternative healing traditions and any evidence that might support them.

Dr. Oz pushed a diet product Pure Green Coffee on his show which later the FTC investigated for making false diet claims.  Dr. Oz scolded Dr. Gaesser for promoting fit and fat, but there are plenty of studies showing you can be fit and fat and as far as I know no study showing green coffee working in the long run (I found one short term study of 22 weeks where 16 people lost about 18lbs).

The weight-loss industry is an area where consumers are particularly vulnerable to fraud, Mary Koelbel Engle, an associate director at the FTC, testified at the Senate hearing. She said the agency conducted a consumer survey in 2011 and found that more consumers were victims of fraudulent weight-loss products than of any of the other specific frauds covered in the survey.

I don’t think people turn to snake oil salesmen because they’re stupid,  (I was dieting including fad ones long after I got my second master’s degree) I think they do it because they are desperate. We live in a world that preaches that thin is everything and that we must fit into a magical number of BMI 18.5 to 24.5 or we will die a horrible lonely death. Something Dr. Oz’s show often conveys.

And let’s not even talk about the fat suit.

 

All Fat is Acceptable Fat.

Stacey Bias recently put out a rad comic about Fatty Archetypes. Including such fatty types as healthy fatties, rad fatties, fat athlete, work in progress (i.e dieting fatties), etc. These are fat people are “acceptable fat.” The point of the comic is to leave no one behind and communicate that we shouldn’t have to squeeze into an archetype.  

 

I talk a lot about health in my blog. Mainly because I think a lot of us fatties are denied health because we live in a fat hating world that preaches “Get thin or else”. We are penalized at the doctors where our fat is treated rather than our ailments, our insurance tries to charge us more for being fat, even at the clothing store we can’t get the sizes, styles, and quantity available to a thinner person. All  because we don’t fit into an arcane BMI number.  

This to me is more important than eating right and exercise. I believe that people of all sizes need to do their best to eat right and exercise. I believe we have the right to exercise without being harassed like Ragen Chastain was while she was running.  (I doubt something like this would happen to a thin person).

However not every fat person fits in the acceptable archetype. Some people are fat and don’t eat right or exercise. They are not a rad fattie, they don’t have a disease that makes them fat, they don’t shop at Whole Foods (Granted, no one should) or do Zumba and they’re not a fat unicorn (Which would be awesome). They are just fat. Guess what? They should have all the same rights and privileges as any other fattie.

This comes on the heels of research that I've been saying in my blog for 9 years. Long term weight loss is nearly impossible. Sure you go on a diet (or lifestyle change) and lose 20 pounds, but for most people that weight will creep back usually bringing the friend of additional weight gain.

 As incredible as it sounds, that's what the evidence is showing. For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear. "It couldn't be easier to see," she says. "Long-term weight loss happens to only the smallest minority of people."

So no matter what kind of fattie you are, there is no proof that you make it into the arcane number. 

Nope, still not a disease.

Every once in a while, I get an email asking if I would host  a guest blogger or if I would be interested in this infographic. Usually the blogger or infographic is completely inappropriate for my blog such as the evils of obesity, or has nothing to do with fatness at all. Depending on mood I will ignore or engage. When I engage, my response is usually "Have you even read my blog?" or "Why would I want your fat hating infographic?" Usually I never hear anything again and I assume this was spam. A mass email hoping that a few bloggers will post whatever product they are selling. When I got the last one (from a plastic surgeon service no less) I wrote back "Are you a spammer or an idiot?" expecting not to hear anything back.

 

I got a message not three hours later.

 I am a spammer nor an idiot… (I think this was a Freudian slip.)

Obviously you are bitter though and not as optimistic about your disease as your blog leaves one to believe.

Best of luck with that shining attitude in the future.

The issue here is not this idiot or spammer (or both). But this damage the AMA just did to fat people by labeling all fatness as a disease. Even this moron thinks I have a disease. There is nothing wrong with getting help to fat people with diseases, but to just tell someone they have a disease when they are perfectly healthy is ridiculous.

The New York Times seems to think this is a good idea because it "supposedly" reduces body shame.

On the positive side, we found that the obesity-as-disease message increased body satisfaction among obese individuals, probably because it removed the shame of obesity as a moral failing.

However...

 Suggesting that one’s weight is a fixed state — like a long-term disease — made attempts at weight management seem futile, and thus undermined the importance that obese individuals placed on health-focused dieting and concern for weight.

The gist is, calling fatness a disease meant that people felt less ashamed because they had a disease rather than a moral failing. However since the cure for this disease is the same shit they've been touting for 50 years, people give up on any kind of weight management.

I don't mean to be a conspiracy theorist but since "Obesity experts" use correlation with causality, let's try it with the diet industry. Even though the diet industry still makes a good 20 billion, that shift is moving away from commercial dieting to Do it Yourself. DIY breaks up that massive pie in to tiny pieces. Meaning the big companies are not getting the money they once did. Weight Loss Drugs have been failing miserably for the last 10 years. Weight Loss Surgery is making a lot of doctors wealthy. So calling Fatness a disease means new money comes into these "Cures". Cures that I might add don't work for most people in the long wrong and can cause more harm than good.

Health at Every Size has no real profit margin and helped try to improve quality of life. It works to help people of all sizes enjoy eating, moving, and loving their body again. Nothing in HAES calls you a disease or says you have a moral failing if you didn't get a chance to exercise.

The best thing I ever did to reduce body shame and to work on my health was to stop trying to be thin.

And if any young fat activist wants to do a guest blog, I’m okay with that. If you want to sell your “Fat is bad product”.  Go fuck yourself.

More reasons that dieting doesn't work at all

Market Watch has a top ten list of what the Diet Industry won't tell you.

#2 is dieting makes you fat.

While the point of a diet is to lose weight, often the reverse happens: We end up fatter than when we started. “Diets don’t work long-term,” says psychotherapist and eating coach Karen R. Koenig...

I have been blogging for almost 10 years where I have repeatedly said dieting makes you fat. I have always believed that if I had HAES instead of a diet,  right now I would weigh less and love my fat body more.

The constant pressure to diet does nothing, and can even makes things worse. The only purpose of dieting is to lose weight. People don't go to Weight Watchers, Jenny Craig, do the Paleo diet or Atkins because they want to stay the same weight. They go to lose and when the weight loss stops, so does the diet.

Meanwhile Health at Every Size removes the weight loss component and focuses on health. Health can't fully be identified. As ASDAH defines:

The Association for Size Diversity and Health (ASDAH) affirms a holistic definition of health, which cannot be characterized as simply the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual. 

ASDAH has updated the definition of HAES to further remove healthism (Healthism is the bias against a person because they don't fit the "picture of health". For fat people, a fat person who eats right and exercise is defined as morally superior to a fat person who doesn't).

The Health At Every Size® Principles are:

1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

As I mentioned last week (And many other times), the stigma fat people get just trying to exercise. Making fun of someone who is slow or can only manage a walk around the block does nothing to help them by healthy.

Still not a disease

As I talked about a few months before, the American Medical Association decided that fatness is a disease, whether you're healthy or not. They are ignoring all logic and science. Some fat people are metabolically healthy while in some people fat is a symptom of disease. The gist is they want to try to impose same solution "Make the fat person eat less" that has never worked in the long run.

Why would the AMA do that? Could it be that the Affordable Health Care allows treatment of fatness that includes paying for diets, diet pills, and surgery.

Defining obesity as a disease should encourage more doctors to offer treatments like surgery and medication, Hamdy says. Two new obesity drugs, Qsymia and Belviq, were recently approved by the FDA

Qsymia is an appetite suppressor. It goes back to same fucking "cure" of eating less. And it has a mile long list of side effects. Of course you can say all meds have side effects. They do. However, why take a drug with terrible side effects that won't work? 

And Belvig was proved to not work even before it was released. 

The AMA's classifying the fatness as a disease opens up a lot of money to the diet industry. It will continue to work on the faulty assumption that we must make fat people eat less. The weight loss/gain cycle will continue. 

Even this doctor in this TED video who is  not being fat positive agrees that the issue isn't EATING TOO MUCH but metabolic issues that cause fatness in SOME but not all people.

Essentially stop trying to cure the fatness, instead cure the actual disease.  

Maybe we're just normal.

I remember when Leptin was touted as the hormone that would cure fatness forever. There would be drugs to fix fat and you would become slim, trim, and be able to live like a first class citizen. 

When it turned out that Leptin wasn't the fat hormone but the starvation hormone, and  only worked in a small amount of people it, vanished as a miracle cure. Although if you search Leptin in Google, you'll find a bunch of leptin diets.

Now the new leptin is gut bacteria. Researchers took gut bacteria from two twins, one thin, one fat and injected it into lab mice . 

Researchers found pairs of human twins in which one was obese and the other lean. They transferred gut bacteria from these twins into mice and watched what happened. The mice with bacteria from fat twins grew fat; those that got bacteria from lean twins stayed lean.

The thin mice were then adored about their mouse peers as being healthy despite all the cheese they ate. 

The next step, transferring thin people's shit into fat people.

“I’m very excited about this,” he added, saying the next step will be to try using gut bacteria to treat obesity by transplanting feces from thin people.

I had to double check to make sure the article wasn't the Onion. New York Times? Check. Written by Gina Kolata check. Based on a study in Science, check. 

Zoe Williams of the Guardian points out the crazed obsession  with "curing" fatness as a moral issue:

Other people's weight became all our problem when we started a) calling it an "epidemic" and b) totting up how much it costs the NHS. This is illogical.Malnutrition costs the NHS significantly more and yet no moral judgment accrues around people who are too thin or, for reasons of incapacity, aren't being fed properly by the people who should be caring for them...

 

Except there is one more issue. The mice with the thin bacteria were put on diets. 

The team also showed that a “lean” microbial community could infiltrate and displace an “obese” one, preventing mice from gaining weight so long as they were on a healthy diet.

Diets usually work in the short term. This is no different than diet pills. All of them require you to also do a low calorie diet and pills will help you lose a little more weight. But none have proved to work in the long run.

Sometimes it gets tiring to be experimented on. To be given pills, surgery and shit in hopes that I conform. Instead of treating all disease as  weight loss, why not look into actually curing the disease?

I have a social disease

For days I couldn't believe my ears. My anger was so strong that I had to take a breath before I could say anything. 

The American Medical Association, in their infinite "wisdom" despite warnings from their science advisory board against the decision has doomed (trigger warning) all fat people with a BMI of 30 and above, regularless of their health, as having a disease. 

You can teach aerobics classes, swim, walk, run, eat your vegetables, only eat 2000 cal a day, be in perfect health but if your BMI is 30 and above, you have a disease.

Granted some diseases can cause you to gain weight (such as sleep apnea, diabetes, PCOS and hypothyroidism) and some diseases can cause you to lose weight (hyperthyroidism, cancer, some autoimmune diseases such as Crohn's and Celiacs) but in these cases being thin or fat aren't the disease they are a SYMPTOM.

Abigail C. Saguy points out: 

Yes, there are certain health risks associated with having an elevated BMI, such as Type II diabetes and heart disease. More broadly, a higher BMI is associated with a greater risk of cardiometabolic abnormalities, as measured by blood pressure, triglycerides, cholesterol, glucose, insulin resistance and inflammation. Nonetheless, almost one quarter of “normal weight” people also have metabolic abnormalities, and more than half of “overweight” and almost one third of “obese” people have normal profiles, according to a 2008 study. 

 My biggest issue isn't AMA's stupidity (actually it is), but that in the end they will push the same cure that doesn't still doesn't work and that is Dieting (Big d), diet pills and surgery.  In the end that this will lead in more pressure for fat people to get surgery, take diet drugs, do commercial diets such as Weight Watchers. Even though none of these have been proved to work and help in the long run for the majority of people (sure you're always going to find people who went from fat to thin and stayed that way, but they are the exception not the rule.)

This all goes back to one thing, the billion dollar industry. It really is the money. The biggest medical association saying obesity is a disease and giant check to the dieting, pharma, and bariatic surgeons.

As Marilyn Wann says:

This year, Americans will waste $66 billion on weight-loss products. The "weight-loss" industry is a misnomer: nearly everyone regains lost weight and up to two-thirds gain back more than they lost. Repeat customers are the business model of the weight-regain industry — an industry that expands every year, even during recession. (Which wouldn't happen if their products worked, right?) 

Marilyn has a petition urging the AMA to change their decision.

 

Not a Glutton

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) Version 5 will be out in the Spring of 2013.  In it Binge Eating Disorder (BED) will be added for the first time, defined as this: 

• Criteria include frequent overeating—at least once a week for three months— combined with lack of control, marked feelings of distress, and are associated with three or more of the following:
• eating much more rapidly than normal
• eating until feeling uncomfortably full
• eating large amounts of food when not feeling physically hungry
• eating alone because of feeling embarrassed by how much one is eating.

Dr. Allen Frances of Psychology Today lists the 10 worst issues in DSM 5 and one of those issues includes BED: 

Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder.

For an MD, Dr. Frances appears to know very little about eating disorders and more about giving moral judgements upon overeaters, essentially calling them gluttons. 

BED isn't overeating at a fine restaurant or at a great meal, it's compulsive overeating past the point of fullness, without taste or enjoyment. It's similar to bulimia but without vomiting. 

Now as far as BED being listed in the DSM, I have mixed feelings. On one hand, having suffered from BED, it's nice to see it acknowledge as something real instead of "Stop eating so much, fattie." However I am wary that its being added opens up a psychological issue to diet drugs. Something I have repeatedly mentioned never work.  And I worry because the American Psychiatric Association which is not known to be fat positive is adding not adding BED because how it affects the self esteem and well being of the person, but because the worst case scenario is they might become fat.