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.

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

Zero Steps Forward and Eight Steps Back

Living in New York City, I climb stairs. In my house, in the subway, at my job, and in random  places you wouldn’t think would have stairs. Two months ago I climbed the Manitou incline which was like a giant staircase. I admit when I sometimes climb to the subway (I often take an elevated train), I get winded and going up the incline I thought my heart was going to explode.

 

Every day I take some kind of stairs, an while the exercise has done wonders for my legs, it has not made me thin. Riding my exercise bike 15-30 minutes a day has not made me thin, walking at least a mile or more a day had not made me thin, my daily stretches, my yoga, my summer swimming, my walks around the office has not made me thin.

 

There is a slogan: "Nothing about us, without us." which is often used among marginalized groups. It essentially means one group decides the fate/treatment of a marginalized group without their input. Fat activists see this all the time. "Obesity" organizations which decide on policy on how to make fat people thin don't seek input from actual fat people.

 

Case in point, this:#‎ICO2014‬

I have mentioned before that there is a constant assumption that if you are fat because you stuff your face and sit on the couch all day. Some organizations try to be gentle by saying “It’s not your fault you stuff your face.” Every single treatment for fatness is always the same: eat less calories than your body needs (aka a diet). It is the same treatment used in the last forty years and still hasn’t been proved to work in the long run.

 

If the people running this International Congress of Obesity would talk to an actual fat person (and not just try to treat them), they might figure out that taking the stairs will not make us thin.

 

Ragen Chastain says it best:

When organizations pull stunts like this, the only thing at which they can possibly succeed is creating an environment that prevents people from, and shames people for, navigating the world in the way that’s best for them and their situation.

 

 

And shame on this Amanda Sainsbury who decided fat people must become thin or they will die and Health at Every Size is bad for encourage people to stay fat. But what can you expect from a person who writes diet books? (Even worse this quack is the editor in chief of the Journal of Eating Disorders).

 

While I certainly agree that it is possible to have healthy behaviours that provide health benefits at a wide variety of body sizes, I disagree that it is possible to be or to stay truly healthy at every size.

 

This is the second time I've seen someone add a Y to the end of health when referring to Health at Every Size. This, to me, changes the meaning. Even though HAES is more geared to fat people because of the discrimination we face in health care, HAES is meant for all body types. Healthy is an abstraction. You can't really define it because everyone has different ranges. My husband can get to the top of a mountain but put him in a lake, and I’m going to zoom past him. Are we both “Healthy” or “Unhealthy”?

  

It is thus not surprising that people frequently put off doing anything about excess weight until better conditions arise (e.g. when the children start school or leave home, when a better financial position or home is attained, after retirement, etcetera). The health at every size concept implies putting off doing anything about excess weight indefinitely, instead accepting a higher BMI and focusing on healthy behaviours.

 

Ironically here she accidently points out how HAES is better than dieting. People put off Dieting. They wait until January or when they have money. HAES you do every day, no putting off. No need for money. It's learning to be as healthy as you can in the body you have whether it be too fat, too thin, disabled, or suffering from a disease. You can do HAES if you walk the stairs, take the escalator, or jump up and down. 

 

Related articles

Take the stairs. Or don't.

 

Is the Faux Epidemic Over?

Fatness among 3-5 years old has dropped 43% and fat adults and kids over 5 and adults have stayed the same and have been for the past decade. Not just in the US but the world.

Paul Campos writes: As Michael Gard notes in his recent book The End of the Obesity Epidemic, data from all over the world indicate that, over the past ten to 15 years, obesity rates have leveled off or declined among adults and children.

Does this mean the epidemic is over? No, because the epidemic of fat hatred isn’t over. A few years ago I breathed a sigh of relief when multiple studies came out showing that overweight people lived the longest (longevity didn't decrease until your BMI reached 37 and even then it wasn't that bad) and the 400,000 people who died of fatness was revised to 25,814 http://www.obesitymyths.com/myth2.2.htm . For a minute I thought that we finally won. We finally proved that fat does not equal death and making fat people thin was not a cure. Maybe it was time to move to HAES(tm) and that instead of focusing on large bodies, we could focus on getting all people to eat right and find enjoyable movement.

Then the diet/medical/drug industry reared its ugly heads. We were bombarded with “studies” proving WLS cured everything; more infective diet drugs hit the market; the American Medical Association called us a disease; we are penalized for not joining “volunteer” workplace wellness. And anytime an actual study came out saying fatness is not in fact unhealthy, those studies were raked over the coals (Any study claiming fatness is bad is never questioned.) When the study came out claiming fatness among young children dropped 43% Forbes was quick to point out it went up first before going down a mere 14% (Although Paul Campos agrees with their assessment.)

Regardless of the drop, this fake war on children needs to end. There is nothing wrong with children enjoying movement and eating delicious and nutritious foods, but when you single out the fat kids, you cause eating disorders, low self-esteem and bullying. According to School obesity programs may promote worrisome eating behaviors and physical activity in kids Report: 

30% of parents of children age 6-14 report worrisome eating behaviors and physical activity in their children.

7% of parents say that their children have been made to feel bad at school about what or how much they were eating.

 

Making Safe Space in Your Body

Ending dieting and embracing HAES has helped improve my health, but it’s still hard when I’m bombarded with messages that fat is bad. I need to do more about dealing with the stigma of having a big body in a fat hating culture. If I can’t make the world a safe space, the least I could do is feel at home in my own body.

The Rudd Center recently came out with a study showing that weight stigma affects the stress hormone cortisol. This is just the beginning of showing that some "fat-related-diseases" may be more related to the stress of stigma rather than being over some arcane number.

Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful

physiological consequences of exposure to weight stigma.

Another study said that labeling fatness as a disease undermines health.

Specifically, obese participants who read the "obesity is a disease" article placed less importance on health-focused dieting and reported less concern for weight relative to obese participants who read the other two articles. They also chose higher-calorie options when asked to pick a sandwich from a provided menu.

Essentially fat people who saw themselves labeled as diseased didn't care about health when dieting and also ended up eating more.

I've mentioned it before. Dieting pushes weight loss not health as the ultimate goal. You diet, you lose some weight, then the weight loss stops and you go on a massive binge. When all that matters is being thin, health usually goes out the window.

Stigma causes stress and anxiety. Fat people face stigma either outright or even unintentionally: Small seats, labeled diseased, poor quality clothes, assumptions that you drink soda, or don't exercise.

All this could lead to body shame and a mistrust in yourself. I mentioned that when I was climbing the Manitou incline it was harder the closer I got to my goal. I didn't trust myself to make it. It disturbs me because it's been over 10 years since I stopped dieting and tried to work on loving my body and still I have doubts. I still sometimes look at weight loss “successes” (the exception, not the rule) and wonder why couldn’t I do that.

Stigma is hard to escape especially when you are bombarded with weight loss ads, and fat hatred. When you're patronized and told just to eat one less cookie. So how do you escape the stigma? Staying in your house without access to internet isn’t going to cut it.

We can, and have, changed the world to becoming more accepting that people come in all shapes and sizes. It’s slow but happening.

However in the meantime we need to think of ways to protect ourselves from fat hatred.

The best way to deal with that is improving your self-esteem. Names become meaningless if you feel you are better than them. Here are a few suggestions to help deal with stigma.

•   Love yourself and tell yourself of your achievements. Tell yourself you deserve it.
•  Write everyday things you are grateful for.
•  Meditate and do deep breathing. Try not to think about triggers. Empty your mind if possible and concentrate on your breathing.
• Take a nice relaxing bath and tell your body how much you love it. If they didn’t make a bathtub big enough for you, take a nice hot shower.
• If you are someone like me who blogs about fat hatred, give yourself a respite when you feel like you’ve had enough. Read a fat positive blog or book.
• Remember this is the only body you have. You need to trust it.

 

 

 

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.  

Stigma Hurts

This week is Weight Stigma Awareness Week. Weight Stigma often comes from assumptions. The strongest stigma is if fat people just eat less they will be become thin and healthy. It is at the bottom of every cure for fatness: diet pills, surgery, low calorie diets, lifestyle changes are all to make a fat person eat less. Bullies claim that fat people are lazy and lack willpower, the well-intentioned think it's not fat people's fault. Food is everywhere. Except that why don't thin people have the same problem?

Everywhere we are bombarded with hateful messages: (Trigger warning ahead.)

The second? Costco as much as anything else is why the land of the free and the home of the brave is also the trough of the tub o’ lard, our exceptionalism measurable by not only our G.D.P. but also our B.M.I. That’s body mass index, and our bodies are indeed massive.

So says Frank Bruni who has suffered from eating disorders and should know better.

Even when Fat people say enough, we are okay with our size, that no matter what our eating habits are, we don't deserve to be treated like shit, that some of us are healthy and fat, that many of us eat no more than thin people do, we are told we are delusional or making things worse.

Obesity is a class issue, like tobacco. People in every class used to smoke, rich and poor, educated and non-educated alike. But when tobacco was conclusively linked to disease, more and more educated people stopped, until the image of smokers reached a tipping point, and went from “cool” to “loser.”

Yes people with a lower SES are more fat, but it's more likely to do with bias in society rather than poor people eat too much. Being fat is not like smoking. Smoking is a HABIT, being fat is hugely genetic. And if the fat is a habit why do so many people fail to lose weight?

Even "Doctors" think it's okay to shame fat people. In Katz, D. L., Murimi, M., Pretlow, R. A. & Sears, W. (2012). Exploring Effectiveness of Messaging in Childhood Obesity Campaigns. Childhood Obesity 8(2): 97-105 (The article unfortunately is not available unless you subscribe) is filled with praise for programs who shame fat children. Many of the quotes are disgusting but I will share one.

Sears: Good medicine means encouraging children and giving them the tools to get lean. An occasional child might be pushed over into anorexia, but I think the situation that you mention in Seattle is an overreaction and represents unwarranted fear.

Guess what? Teenagers who were formerly fat were found to suffer from eating disorders.

These problems may not be diagnosed quickly, because parents and doctors "think it's a good thing that these teens have lost so much weight," said lead researcher Leslie Sim, an assistant professor of psychology and an eating disorders expert at the Mayo Clinic Children's Center in Rochester, Minn.

I have mentioned before that some of the worst habits I've ever picked up came from dieting. The worst being the dieting/binge cycle. Thankfully I never do less than at 12oo cal diet but I did a lot of crazy things to lose weight. I think of all the people who starve themselves or have weight loss surgery and consume less calories than a normal person needs. Why isn't this considered anorexia? Just because they are fat?

Stigma also affects health greatly. Not just from the stress of being bombarded with messages that you are less than human if you are fat, but bias in even getting your health care.

Obese people are less likely to survive cancer, and one reason may be a surprising inequality: The overweight are undertreated.

Doctors often short them on chemotherapy by not basing the dose on size, as they should. They use ideal weight or cap the dose out of fear about how much treatment an obese patient can bear. Yet research shows that bigger people handle chemo better than smaller people do.

I have written before about doctors refusing to treat fat people or giving them surgery and treatments needed. I even spoke once to a supersized woman whose doctor refused to give her an lifesaving operation (the story has a happy ending, another doctor did the surgery).

When are "Doctors" and "Journalist" going to listen? Stigma against fat is stigma against the fat person. It will lead to poor health care, eating disorders and stress.

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?

The Cash Cow -- Moo

I wouldn't know even where to start to estimate about how much money diet industry had gotten from me. From the memberships at Weight Watchers and Nutrisystem, the gym memberships I gave up after 6 months, the diet soda, the diet foods, the diet books. I am guessing somewhere in the range of 2ok probably more.

My biggest consumption was diet coke. Diet coke was my beverage of choice through almost every single diet. From the ages 15 to 27 (Low carb dieting didn't allow diet soda)  I would drink two or three 2 liter bottles a week, not to mention cans and bottles form the vending  machines. I remember my excitement when Coke released diet cherry coke. One of my writing rituals was a bowl of popcorn and a glass of diet coke by my side while I wrote (today it's water or tea.)

I gave up diet coke when my low carb diet said it was a no-no. Except when I wasn't dieting, I would go back to drinking diet coke.

Diet coke was the last dieting product I had to give up. It had been my fair weather friend for so long. It remained with me after I gave up dieting, long after my book was out, long after I preached fat acceptance. I kept it as the one diet product I wanted to keep. I didn't drink it as I once did and I thought about giving it up for good. The last occassion was December 8, 2007. I only know the date I had been in Syracuse visiting friends and taking photos. After a long day with still more to do, I found myself tired. I asked my husband to go out and get me some tea or coffee or something with caffeine. At the time I didn't drink soda because I had made the association between corn syrup and feeling nausaous. He came back with a diet coke not realizing that I was thinking of giving up. I was so tired I drank it. It had been almost a year since I had one.

I couldn't believe how bad it tasted. Did I really drink this regularly for most of my young adult life?  I realized my biggest addiction hadn't been food (once I stopped dieting, the binging on sugar/salty snacks diminished) but diet soda.

The Wall Street Journal recently published a press release that the diet industry is currently worth $109 Billion and is expected to reach 137 billion in 2017.

The North America Weight Loss / Obesity Management Market was worth $104 billion in the year 2012 and is expected to reach $139.5 billion by 2017. U.S. is the largest market, followed by Canada. The market will grow at a healthy pace in the next five years due to the increasing number of lifestyle diseases such as diabetes and cardiac problems, increasing personal disposable income, government initiatives to increase awareness of health and fitness, and technological advancements.

This market includes: commercial diets such as Weight Watchers, weight loss surgery, pills, wellness plans, nutritional counseling, diet foods, books and yes diet soda. One of the companies highlighted as a big diet industry player is Coca-Cola. (And pepsi too.)

Now why do you think this press release was in the Wall Street Journal and not say the JAMA (It might be, I haven't checked) because dieting is a cash fucking cow. There isn't any money in telling people maybe they can eat a little better or move a little more or that they are perfectly healthy outside the arcane normal weight BMI. Or simple 

Do you think with all these billions that the diet industry really wants to you to be healthy and well? Or do they just want your money?