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.

Slow, Fast, or Steady, diets don't work.

No blog post next week. I will be away.

I've done all kinds of diets including lose weight slow and lose weight fast ones. They all ended up the same way. I'd regain all the weight plus more. Eventually I dieted myself to an extra 70 pounds.

A study in Australia showed that dieters who did crash diets (a very low calories one) not only lost more weight but stuck with it longer, compared to the ones who did plans with slow weight loss. Essentially in the race to lose 12.5% of your body weight, crash diets won!

However, the new study shows that "achieving a weight loss target of 12.5 percent is more likely, and drop-out is lower, if losing weight is done quickly," Purcell said.

12.5% is 15lbs if you weigh 200 lbs.

But before you makers of crash diets pat yourself on the back, the study found out one other thing.

 People in both groups regained about 71 percent of their lost weight by the end of three years, regardless of how fast they had slimmed down, the researchers said.

The gist is a crash diet resulted in quicker weight loss than a slow and steady one but 71% of both diets caused weight regain of all their weight within three years (and I bet that percentage will be higher within five years).

 Diets do not work in the long run for most people. It doesn't matter if you do it slow, fast, or on alternative Saturdays.

Diet Drugs Still Don't Work

Bupropion aka Wellbutrin is an anti-anxiety/depression drug and Naltrexone is an alcohol and drug dependency (opioids) drug. Put them both together and we have another useless diet drug: Contrave

Ignoring the stupid and fat hating graphic of this article (A fat head eats a hamburger but resists pills), the author tries to figure out why people are not flocking to take Contrave or the other diet drugs on the market. (Except sales are projected to be 200 million)

Maybe people don't want to take diet drugs because you know heart valve disease and primary pulmonary hypertension.

Much of the resistance to the weight-loss medications stems from the disastrous safety record of diet drugs pulled from the market in the 1990s.

Or maybe it just doesn't work.

In clinical trials, for example, nondiabetic patients taking Contrave lost only 4.1 percent more weight than those taking placebos

Or maybe it has crazy side effects and a black box warning

The diet pill Contrave can also cause seizures, raise blood pressure and heart rates

CONTRAVE can cause serious side effects of suicidal thoughts or actions…(Read the entire three paragraph warning if you want at the Contrave website.)

Or maybe you still have to diet while using it.

All patients received lifestyle modification that consisted of a reduced- calorie diet and regular physical activity

Or perhaps there are no long term studies that Contrave causes you to be thin forever. The original study ran for only one year.

Or perhaps it works on the flawed presumption that all fat people are fat because we eat too much.

So Contrave is of the same bullshit as any other diet drug. It doesn’t really work in the long run and barely works in the short. My only hope is that it doesn’t kill people like Fen-Phen and Meridia.

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

Fat? Fit? Myth? Or Something else.

I mentioned last week another study proving fit and fat. Literally on the heels of that study was another one that the media including NPR screamed "No, that's wrong. If you are fat down the line you will die of something."

This new study said that fat (only those with 30 BMI or over) people who were metabolic healthy were 24 percent more likely to be metabolically unhealthy 10 years later.

Of course when the media picks it up, they assume this must mean that you cannot be fat and fit. 

Except.

The study didn't include physical fitness. The study didn't take into account fat people who were physically active. This means that they don't know if metabolically healthy fat people stayed that way if they were physically active. I have mentioned before on this blog that there are barrier to fat people exercising. Bikes aren't weight rated, fat people get starred at the gym, fat people exercising are told they aren't "Graceful" or how miserable we look.

That means NBC's headline -- "New Research Disputes Fat But Fit Claim" -- is simply wrong because the meta-analysis didn't take physical fitness into account, so "fat but fit" (where fit means being physically fit) was never actually tested.

The study also didn't include chronic dieting. Every single fat person I know (And I know a lot) except for one has a history of dieting. Before I did the Atkins diets, I was metabolically perfect. After Atkins my cholesterol went up to 232. To the point I had a doctor want to put me on drugs for it. Only through healthy eating and exercise was I able to bring it to almost normal with  no weight loss. I find it terrifying that dieting history is often overlooked or ignored when doing studies on fatness.

"The study is silent on the health impact of pursuing weight loss, because it does not compare people who were fat who lost weight to people who are still fat," she (Deb Burgard) wrote. In fact, she continued, fat people who repeatedly try to lose weight are more likely to yo-yo diet, or weight-cycle, than they are to maintain weight loss permanently. And because weight-cycling has been linked to cardiac disease and other problems, overweight people who are metabolically healthy could increase their risks of the very diseases they tried to avoid in the first place if they lose weight and gain it back again.

It all goes back to the Flegal and similar studies. This study proved that people with normal and overweight BMI had the same risks. 

NPR's is just inaccurate; in fact, the meta-analysis showed that overweight, healthy people's risks were so similar to the control group's risks that the difference was statistically insignificant.

 This study only strengthens the Health at Every Size argument. You can make countless studies showing fat is evil and bad but with no method of weight loss proved to work in the long run for most people, it would be better to focus on increasing physically activity.  Another study shows a change of healthy habits not weight loss is responsible for improvement in health indicators.

What’s more, the few health benefits they found appear to be the result of participants adopting specific healthy habits such as exercising and eating more fruits and vegetables. Weight loss—or lack thereof—was apparently not the defining factor. 

I much prefer when "Obesity experts" focus on reducing stigma. You shouldn't have to be thin to exercise and you shouldn't have to eat less than what your body needs. 

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?

UCLA and Duke are late to the HAES Party

UCLA school of nursing has done a study showing that fat and thin children when doing lifestyle changes rather than dieting improved their health with very little weight loss. 

"These findings suggest that short-term lifestyle modifications through changing diet and exercise can have an immediate impact on improving risk factors such as cardiovascular disease and diabetes," said Christian Roberts, an associate research professor at the UCLA School of Nursing and the study's lead author. "This work underscores the need to focus on changing lifestyle as opposed to focusing on body weight and weight loss.

Duke, instead of the usual banter of either get thin or die or lose just 5-10% is now on the "Just maintain." 

"Many people go to great lengths to lose weight when their doctor recommends it. They may try a series of diets or join a gym or undergo really complex medical regimens. The complexity of these treatments can make it difficult for many to lose a sufficient amount of weight," said lead author Gary Bennett, an associate professor of psychology and neuroscience and global health at Duke who studies obesity prevention.

Neither are exactly Health at Every Size (HAES™). Duke completely misses the boat by still focusing on weight rather than health.  While both bring  us closer to HAES as the removal of weight as a health indicator, the weight factor is still there especially with the Duke study. People sometimes gain weight from stress, aging, hormones, and certain medications. For the UCLA study, it assumes that being unhealthy leads to being fat (Although there is a little disclaimer that perhaps it is metabolic issues that cause fatness not the other way around). 

Unhealthy lifestyle factors that begin in childhood, such as physical inactivity, lack of exercise training, and diets that are high in refined carbohydrates and fat, contribute to both the development of obesity and other chronic diseases, but it is unclear whether obesity itself or the associated lifestyle factors are underlying causes of cardiovascular and metabolic dysfunction and the related development of chronic disease.

Instead of telling people to just maintain, or lose a little or focusing on weight at all, they need to remove weight completely as a health indicator. This means that everyone, fat, thin, young, old, learns to listen to their body, give it the foods it needs (without a moral implication of it i.e. good vs bad foods), and love it without worry that it doesn't fit in the ever changing society norms.

Finding blame and paying more

At one of my physicals, the nurse taking my vitals wanted to weigh me. I don't get weighed at the doctor's office and told her so.  (If the doctor really wants to know my weight, I'll be willing to be weighed by him in private as long as the number doesn't go into the chart. That hasn't happened.) She said that some insurance companies want the number. I told her that that was one of the reasons I didn't want to get weighed.

I get my insurance through my job and at the moment there are no extra charges for perceived health issues. There are discounts to diet programs and gyms. I worry constantly that this will change. Other places already are looking to hit people while they're down.

For the past few years, companies have experimented with tying health insurance premiums to people's health. Here's how it works: Employees go through medical and biometric testing as part of their health insurance open-enrollment process. They are weighed, their height and blood pressure are measured, and their blood is drawn. Those with high scores on cholesterol, glucose and blood pressure -- or with chronic conditions like diabetes -- are told they will have to pay higher premiums unless they actively try to address any risky conditions.

One of the reasons I am very pro-universal health care is that when we have for-profit system of health care, people who tend to be genetically prone to certain diseases will be charged more or denied coverage. It's a slippery slope that this will condemn all fat people regardless of their health.

Meanwhile UCLA Professor Abigal Saguy points out in her op-ed about fat prejudice.

Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their weight for any health problems they have. 

Health insurance isn't like car insurance. Driving a car isn't a right: you need to demonstrate your competency through your actions. Health insurance means that you don't go broke for an illness, acute or chronic. I don't get the logic of telling people they need to get healthy before being allowed access to health care. 

The good news (for the US) is that in 2014 you cannot be denied health insurance based on health status. It also means there are affordable health care options. This is good news for fat people who often are either denied health insurance or given outrageously high priced options.

Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography.  Basing premiums on other factors will be illegal.

 

New England Journal of Medicine - Don't help.

Recently the New England Journal of Medicine came out with a "Study" showing seven myths and six assumptions about "obesity" Although not a single one is a myth or presumption about fatness, say how the obesity epidemic is overblown, how being fat doesn't affect your mortality except for the supersized, or how everyone ignores the rise of dieting came with the rise in fatness. Instead every single one is about weight loss/ dieting. Some of it is fairly harmless like sex only burns about 14 calories compared to 300, or that breast feeding doesn't make your kids thin. Please don't stop having sex or breastfeeding because of this study as both have health benefits. Others aren't as helpful, that gym classes don't make you thin. That's right they don't, regular exercise for most people despite their size makes them healthy, not neccessarily thin. 

Normally I would say this is a positive article because it shows that healthy habits don't actually mean weight loss. 

Until I got to one of the myths.

Within weight-loss trials, more rapid and greater initial weight loss has been associated with lower body weight at the end of long-term follow-up

Essentially the "Myth busted" is that rapid weight loss works better than steady weight loss. The authors point out that some people have been successful at it. Depends how you define success. In 1999-2000, I was a success. I lost 35-40 pounds (I was still fat) in about 6 months and while I never got to a goal weight, I kept the weight loss for another year. But a year after that I was back to my original weight. A number that I've hovered within 10 pounds of for the last 10 years. I never said people can't lose weight, I said they can't keep it off in the long run. Whether they lose it slowly or quickly. 

Rapid weight loss can lead to gallstones, and loss of vitamins and minerals.  Most rapid weight loss comes from very low calorie diets either liquid diets or weight loss surgery which means you aren't eating enough for your body to function properly. 

I think Marion Nestle hits the nail on the head on the reason for this "study".

"I think it’s weird.  I don’t get it," said Marion Nestle of New York University. "I can’t understand the point of the paper unless it’s to say that the only things that work are drugs, bariatric surgery, and meal replacements, all of which are made by companies with financial ties to the authors. " She noted that the researchers who signed the paper also provided a long list of companies they have been paid to work with. 

If you read the affliations, you get big food, big pharma, and the diet industry. As mentioned last week, the diet industry is expected to make 66 billion in 2013.

Not surprising that they want you to not eat healthy food and exercise (To be honest they don't actually say that) and instead to take drugs, get surgery, and go on crash diets.