Getting steadily more pissed off about fat/fit/health issues

After doing a lot of fat activist blogosphere reading, joining the Big Fat Blog (ain’t commented yet, though) with full disclosure as to my relationship with Hanne Blank, the great evil-doer of the Fickle Finger of Fat blog, and of course being and staying on course for increasing my own personal level of fitness-related activities and examining and being careful about my diet (and my “relationship to food”), I find myself Very Pissed Off.

(read on for some of my details, including an enumeration of some of the top issues I have with what people say about how diets work and how science works)

Why? A conflation of things. Partly it’s because of the really chilly knee-jerk reception Hanne got to her effort to talk about the issues here, and also, almost paradoxically, I agree with most folks’ (from the fat-acceptance-activist crowd/blogger community) assertions that “diets don’t work”.

Hanne and I both set out to change our level of fitness, and change our diets to be more compatible with our health issues. Allergies, asthma, gastric reflux, glucose levels, blood pressure, cholesterol, and other issues were all things we wanted to address. The reason Hanne got nearly (or completely, depending on who’s talking about it) thrown out of the fat acceptance activist community was because she had the temerity to say that losing weight wouldn’t be a huge horrible thing for her personally, mostly because of some joint pain/joint strength issues she’s been dealing with.

Personally? I’d like to stop gaining weight (which I seem to have succeeded at) mostly for the pragmatic reason of not wanting to have to buy new pants for any other reason than simply wearing them out.

Anyway, in our own established styles, we approached/are approaching the issue by doing a lot of research. We both have a lot of background in disciplines related to healthcare and doctorin’ and biological science, so we can do that kind of work. We read medical journals. We use PubMed to look studies up and then we go to medical libraries to read full-text.

I read Junkfood Science for further pointers to interesting studies and for one look (of many) into the synthetic interpretation of collections of studies. For my part, my investigation included research into my doctor’s recommended statins and other “cholesterol lowering drugs and therapies”, since my doctor is banging that drum at me, as well as into high blood pressure diagnoses and therapy strategies. I’ll leave it to Hanne to discuss her own related issues and research if she hasn’t already.

I also read some of the other more issue-centric fat acceptance discussion blogs and do my best to keep up with the lay of the land between folks who think fat folks should be treated more decently by health care professionals and other people in general, and the diet industry and most of the rest of us (i.e. first world humanity, at least) who seem to feel (or lend tacit agreement by not disagreeing) that fat people are fat because they deserve it and that deserving it indicates all sorts of moral failings related to our old moral standby – puritanism-driven self-improvement.

One of the ways I’d like to try to ameliorate feeling pissed off is by saying some things about diets, science and how they do or do not work:

1. Diets don’t, as a rule, work. Why? Because the complicated issues surrounding genetics and metabolism in the human body are so variable, diverse and crazy that the same rule never works for different people. We all know folks who never eat a god damned thing and who exercise all the time and who are still fat. As well as we know folks as tiny as a fly who eat 5 entrees a meal and never gain weight. We also know a whole heck of a lot of people who eat “normally” and have “normal” bodies, as well as other freaks who eat abnormally and have abnormal bodies. In general when folks go on long-term dieting methodologies, progress plateaus in 3 years and for a large proportion of the population, the lost weight is regained by 5 years. In some cases, the metabolism seems to recalibrate to such an extent that more weight is put on by the end of 5 years than when the person originally started.
2. Correlation is not the same as causation. If a huge meta-study that surveys 30 or 40 other studies establishes a statistical correlation of an increased risk of horrible symptom X with an increase in physical aspect Y, it does not mean that physical aspect Y causes horrible symptom X in any individual, nor even in the entire population sample (nor yet even in the entire world).
3. Statistics must be analyzed ethically. A lot of studies these days that establish an increase in horrible symptoms or syndromes X, Y and Z are funded by or carried out by folks with an agenda. Often this is a money-driven agenda. They want to “prove” that some condition whose cure they promise and sell is tied to something their cure is guaranteed to or at least can be sold to fix.
4. Statistics as a whole and especially “relative risk” must be analyzed meaningfully. I blogged a while back about how it’s starting to look like (in the past 10 years or so amongst the more ethical statisticians and scientists) meaningful findings of “relative risk” need to be up around 2000% (or “20 times” in normal numbers) to be diagnostically meaningful and that the kinds we’re seeing a lot in diet/health related findings these days are really more like 200% – 300% (or just “2 times” to “3 times” in normal numbers).
5. Science “proves” nothing. Good science only disproves hypotheses. Excellent science remembers that theories are hypotheses that ain’t been disproved yet. Amazing science remembers that every theory is under permanent probation and that we should be ready to abandon the theory if it doesn’t seem to be working out. Human nature is to try to figure things out and latch on to things that make sense as “the truth”. Good scientists remember that there is no “truth”, and the closest we get is theories that haven’t been disproven yet and postulates that cannot be proven.
6. All of this said, and this is what pisses off the fat acceptance activists I know (including me), there are folks who, for one reason or another, utterly change their overall life, including drastically changing how they eat, what they eat, and how they exercise, who seem to be able to make long-term, “permanent” changes in their body shapes. Sometimes the change is toward gaining weight, sometimes toward losing it, and in weird cases, gaining or losing height or some other dimension. In scientific terms, this is what is known as “anecdotal evidence” that is not systematized or standardized and it is very difficult to account for within the greater sense of trying to find diagnosis and treatment protocols that work for “everybody” or at least for large segments of the population such that scientists and medical professionals have a chance of doing good for their patients. In personal terms, though, I think this very strongly ties in with the “truth” that everyone wants to believe they know, which is that despite all evidence to the contrary, we really are in full control of our bodies and they way those bodies present, every step of the way.

Given all the uncertainty, and given how fuzzy the whole situation of health/fat/fitness/diet is, I’d really like to see us build bridges and have discussions about how to change medicine and science for the better, not focus on identifying who is really on and off the bus and seeing to throwing them off it when they commit an infraction.

Most folks seem pretty moderate about sharing the space and the fight, but if I’m talking about you, you probably already know I feel that way about you, and if not, you should.