Tuesday, 2 October 2012

The National Weight Control Registry: the gold standard in bullcrap (Part 3)

In Part 1 of this series on the National Weight Control Registry (NWCR), we looked at the pretty underwhelming response to the launch of the Registry, and in Part 2, we looked at the even more underwhelming results of 2-year follow-up. This was supposed to be a 3-part series. But as it turns out, the NWCR is just too ridiculously crap to tear apart in a mere 3 postings, without them turning into an actual book. Hey – there’s an idea. So welcome to the third instalment.

Just to recap on what we’ve done so far, in a country where over 70 million people are trying to lose weight, in nearly 10 years, a nationwide multimedia campaign managed to attract around 3000 people who have lost at least 30 pounds from their lifetime maximum weight and kept it off for at least a year, and of these, 72% were regaining weight – with most failing to lose it again.

But what’s happened since then you want to know. Well, erm, I dunno. The Registry was founded in 1994, making it nearly 20 years old. But the longest-term follow-up data published to date is the 2-year results I talked about in Part 2. I’m guessing, the researchers saw which way the wind was blowing, and decided not to pursue that avenue of research.

So they admitted the Registry had failed to provide evidence of the achievability of long-term weight-loss in the vast majority of people and moved on to bigger and better things? Did they hell! In the intervening years they have provided a steady stream of published peer-reviewed papers that have contributed pretty much nothing to the scientific debate on weight-loss maintenance. Let’s have a look at one of those papers, shall we?

In 2009, they published a paper comparing 2-year follow-up (there’s that magic number again) in people who had earned their place on the registry by losing weight following weight-loss surgery (WLS) and those who had used non-surgical (NS) methods. Of the less than 5,000 people recruited in the 13 years the registry had been running (not including those who were pregnant or had not been in the registry for at least 2 years), 105 had had WLS. These were matched 2:1 with NS participants, by age, gender, weight at entry (not BMI, so not taking into account height), weight loss within plus or minus 15.9 kg range (that’s a 70 lb range people – not how I would define ‘matched’) and weight loss maintenance duration at entry within plus or minus 2 years (so up to a 4-year difference; see above comment). So we have 315 people in total who were apparently ‘similar’ at baseline, by some interesting definition of the word ‘similar’. But overall, to be fair, those differences evened out and the two groups, if not the individuals in them, did appear pretty similar at baseline.

OK, 1-year follow up: of the 105 WLS entrants, 78 of them made it to 1 year, a dropout rate of 26%; the drop-out rate was lower in the NS group, only 18%. At 2 years, they hadn’t lost too many more WLS entrants – total dropout rate was 31%; disappearances of NS participants had shot up, making up for lost time, and were now at 35%. Now I’ve mentioned before that people drop out of studies for all sorts of reasons, but we can assume that at least some of them gained weight and were too embarrassed to participate further.

The NWCR makes no attempts to chase-up dropouts. It has been suggested to me, by a practitioner with an interest in obesity, that this is reasonable, because the ones who gain weight are not of interest to researchers. I beg to differ. These were the people who were touted, with much fanfare, as successful weight losers, and whose number, as far as I am aware, are still included in the registry total. I want to know what, if anything, went wrong. Did they stop exercising 2 hours a day? Did they go back to eating a moderately normal amount of food? Did they get treatment for their eating disorders? Or did their bodies just give up the charade and fight back? Sadly, we may never know.

But anyway, looking at the results of the ones who chose to continue to return their surveys in the pre-paid envelope each year, the first thing to notice is that method of weight loss didn’t seem to make much difference to results. The trajectory of weight/loss gain was similar between the two groups. After 1 year, this trajectory showed a small number continuing to lose weight (defined as more than 5kg (11 lbs) below baseline) – around 12% in the WLS group and 9% in the NS group, and these numbers didn’t change much over the second year. Where it gets interesting is in the other two groups. At year 1, around 60% of the WLS group and 68% of the NS group were classed as ‘maintainers’. ‘Maintenance’ is defined as being weight ‘stable’ within plus or minus 4.9kg (giving you around 22 lbs of wiggle room – we really should buy these poor scientists a dictionary). By year 2, those numbers had dropped to around 50% in both groups.

So if you’re not losing, and you’re not ‘maintaining’… ah, yes, the regainers. At 1 year, around 28% of the WLS group and 22% of the NS group had gained more than 5 kg (11 lb) since entering the registry a mere 12 months earlier. At 2 years, those numbers had increased to approximately 36% and 42% respectively. So much for the long-term ‘permanent’ weight loss associated with bariatric surgery. So just to be clear, each year, the number of people managing to ‘maintain’ their initial NWCR-entry weight dropped, and those gaining fairly noticeable amounts of weight increased. And when we look at what happened after 2 years, oh, wait, the NWCR doesn’t do more than 2 years in their publications. I wonder why.

But alright, after 2 years, around 60% were at least ‘maintaining’ their initial weight loss (actually, not really their initial weight loss for the most part, but the one that got them into the NWCR). Remember, as I mentioned in Part 1 of this series, 91% of registry members had previous ‘failed’ weight loss attempts, with the average amount of weight lost since they started trying to lose weight being 565 lbs. Some had lost over 1000 lbs before successful managing to keep off their current minimum of 30. Or 40, or 50 or whatever the average NWCR weight-loss at entry is supposed to be. And each year, more and more of them are gaining it back. Impressive, eh. And let’s not forget also that that 60% is 60% of the ones still standing at 2 years, and only 2/3 of the 315 initially entered into this particular study. If you do the analysis the way you’re supposed to (if you practice respectable science) and take into account all the people who started the study, not just the ones who finished it, only 40% are maintaining or better, even after WLS, pretty much in line with what we’ve seen in the registry as a whole.

Just as a point of interest, both groups were averaging about 1400 calories a day, and participants in the WLS group were getting significantly more of their calories from fat, eating fast food more often, and breakfast less often than the NS group. So much for lifestyle change. The WLS group were also exercising about half the amount of the individuals in the NS group (and doing about 1/3 of the amount of high-intensity exercise). To be fair (I seem to be saying this a lot – I’m trying to be fair – they’re not making it easy), the NS group were averaging over 3000 kcals per week of exercise. Or in English, equivalent to walking around 30 miles a week. And the range was huge – some were doing double this. So doing half of this amount isn’t exactly slacking. But the WLS group also reported more depression and stress at entry, and both groups showed significant increases in intensity of depressive symptoms after 1 year. These questions weren’t asked in Year 2. In both groups, the rates were much higher than community norms, with 30% of the NS group and 44% of the WLS group having clinically significant depression 1 year after entry into the registry.

But getting back to the fun stuff: for my finale, may I present to you, drum roll please, the abstract of this study. For the non-scientists among you, the abstract is like a summary of the paper that goes at the front and gives people an idea of what’s inside. It is also the source of press releases and the like. This would all be good and dandy if the abstract bore any resemblance to what was really in the paper. But let’s have a look. Each abstract includes a Conclusion, where the authors summarise their overall findings. If you are a busy doctor, or a busy press officer, this is probably the only bit you look at, after the title so it’s kind of important.  Just in case you’re interested, the title was “Weight loss maintenance in successful weight losers: surgical versus non-surgical methods”. Now I don’t know about you, but to me, that kind of suggests that weight loss was maintained and the ‘losers’ remained ‘successful’. It doesn’t say that as such, but I guess “Weight loss maintenance rates are pretty dire following both surgical and non-surgical weight loss, unhealthy behaviours are apparent at both ends of the spectrum, and the weight losers are pretty damn unhappy to boot” doesn’t have quite the same gravitas. But the title is at least more or less descriptive. And in conjunction with the conclusions, will give most people their take-home message from this study. So what were the conclusions? I’ll let the authors speak for themselves.
“Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight loss maintenance comparable to that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts.”
It’s worth noting that, again, cleverly, these conclusions do not say anything actually false. Differences were not really observed between the groups. But the way it is written, if not read carefully, might seem to suggest that significant weight regain did not occur, and that would be somewhat misleading. But not as misleading as the second, also not untrue, sentence. Yes, similar results can be achieved. But they’re still CRAP results people. Man up and admit it already! Tune in next time for more of why the NWCR is a disgrace to science and public health. I’m having too much fun to stop now!

The sad case of Mrs X, and why her husband called her a fat pig

I want to tell you a story. It's not my story to tell, but the woman in question has given permission for it to be told. I first heard about, let's call her Mrs X, about a year ago, when I was doing some training in eating disorders at the National Centre for Eating Disorders in London. We were talking about body image and weight stigma, and our lecturer told us about one of her clients.

Mrs X was overweight. Or fat, if you prefer. Not cut-off-the-side-of-the-house fat, but just your normal everyday fat that you'll see in a good percentage of women as you walk down your high street. She had two grown kids, who had left home, and she was living with her husband. Sadly, it was not a happy marriage. In fact, the relationship was abusive.

Mrs X had come to our lecturer for help with her weight, and during the course of her treatment, details of her abusive home relationship began to emerge. Her husband would call her names. Every day. He'd call her fat, tell her she was a pig, that she was disgusting. If he saw her looking in a mirror, he'd tell her that she was so unattractive, nobody would want to look at her. He'd make her cry. He refused to take her out with him to parties or work events. He said he was embarrassed to be seen with her. And he sure as hell wasn't going to give her money to buy new clothes with. He'd tell her if she wanted new clothes, or to go on holiday, or any other nice things, then she should STFU and just lose some weight. He certainly wasn't going to waste time and money on her looking like she did now. And it went on.

As our class all sat stunned listening to this tirade, our lecturer asked us what advice we would give to Mrs X if she were our client. I piped up first (being the gobby one, no surprise there) that I'd give her the number of a good divorce lawyer. Several similar comments followed. Then one girl at the front said, 'He's probably only saying what she's thinking anyway'.

This is really important. Because when people call us names, it usually only hurts if we believe them. Think of all the insults that could be thrown at a person. Then imagine them being directed at you. Some of them, perhaps based on skin colour, or sexuality, or size, may not even apply to you. If somebody said that to you, you'd probably look at them quizzically and wonder what they were on about. But if they called you something that hit a nerve, something that was already in your head, your own nasty little voice, chances are, it would destroy you. Or at least, bring tears to your eyes and hurt into your heart. As Eleanor Roosevelt said, "No one can make you feel inferior without your consent."

But coming back to Mrs X. That student at the front had hit the nail on the head. The kicker to this story, as some of you may have already guessed, is that there was no husband. At least not the abusive one described above. All of that abuse came from within - that was how Mrs X talked to herself.

Why is it that it is so obvious that this kind of talk is completely unacceptable and nothing short of abuse when we see it in others, but many of us continue to feel we deserve to treat ourselves that way, that we deserve no better, for the sin of daring to be Not-A-Supermodel. Heck, who knows, maybe the supermodels talk to themselves that way too. When did our worth become equated with our looks? When did all that was wrong with our lives become projected onto hatred of our bodies?

Today is Day 4 of the Binge Eating Disorder Association's second National Weight Stigma Awareness Week.* Take this moment to think about how you talk to yourself. And start to treat yourself as you would want somebody to treat your mother, or your daughter, or your best friend. You too are somebody's mother or daughter or best friend. You deserve no less.

*This blog was originally posted at www.neverdietagain.co.uk/blog on 27th September 2012.

Sunday, 9 September 2012

Fit vs Fat vs OMG Where Did My Head Go?

This week saw the publication of yet another study showing that fitness is more important that fatness in predicting long-term health outcomes for everything from heart disease and hypertension, to cancer mortality and death in general! It joins the likes of this, and this, and this and dozens more. One of the things that particularly annoys me is that every time a new study emerges showing that fatness is not the same as unhealthy (and lazy and morally bereft), the press treat it like it's a big surprise. Heck, the researches often treat it like it's a big surprise. Do these people not talk to each other? The volume of evidence is getting so large, when do the government and the health service and everyone else start to take notice? Anyhow, the press coverage of this particular story has been mixed. Here are a couple of examples from the online press:

Pic accompanying story by BBC Online
The BBC Online reported the study but included quotes from a BHF spokeswoman, who pretty much contradicted the entire message. It also finished with the comforting advice not to worry too much about the number on the scales. Their suggestion was to track your BMI instead. A true head/desk moment. On the plus side, the photo accompanying the story showed a genuine live fat person, exercising, with a head and everything! So kudos to the BBC for that.

    Pic used by Telegraph Online

    In contrast, the Telegraph Online reported the study pretty much as is, but failed by posting it with the picture on the right.

    After whingeing a bit online, I decided to actually put my money where my mouth is and wrote a letter to the Telegraph expressing my disappointment. 

    And here it is:

    I would like to register a complaint about a photo used to accompany a story in the Telegraph Online.
    The story in question appeared on September 5th and reported on a study published in the European Heart Journal showing that fitness was more important than fatness for determining long-term health outcome. While the story was written by Rebecca Smith, I realise that the writer is not the person likely to be choosing accompanying images.
    The vast majority of images of fat people in the media are highly stigmatising and dehumanising - most often, what we call the 'headless fatty'. No head, shown from the back, shown spilling out of their clothes, shown putting a doughnut into their disembodied mouth, that kind of thing. It is these kinds of images that have resulted in a massive increase in weight stigma, increasing body dissatisfaction and an increase in eating disorders and related problems in ever younger people. This dehumanisation also seems to promote the legitimacy of attacks on heavier people, just because of the way they look, that would be illegal if directed against somebody because of, say, their skin colour.
    The Yale Rudd Centre for Food Policy and Obesity has done a lot of research on media portrayal of fat people, and the effect of this on perceptions and attitudes. They have also created an image library for use by media outlets. These images show fat people, with heads, doing a range of everyday activities, allowing them to be portrayed as human beings. You can find more information and access the image gallery here: http://www.yaleruddcenter.org/press/image_gallery_intro.aspx
    I had a look at the stock library from which you sourced the picture used in this article. Given what you had to choose from, I concede that the image you used was actually one of the better ones! But that's not saying much.
    In the interest of more balanced reporting, I do hope you consider the impact of your image choice on the messages received by your readers, and would ask you to choose more responsibly in the future, assuming that it was not your intention to perpetuate the perception of all big people as sub-human blobs of fat undeserving of respect or compassion.
    Angela Meadows
    Never Diet Again UK.
    More of us need to stand up and call out this sort of thing when we see it if anything is ever going to change. Feel free to use my letter as a template, or if you don't feel like taking on something yourself, but feel it deserves a response, there is a facebook group called 'Rolls not Trolls' who specialise in that kind of thing - just bring it to their attention and let them spring into action.

    Sunday, 5 August 2012

    Dare to bare!

    This post started out life as a personal rant in one of the Never Diet Again newsletters but I've been thinking about it a lot since then and so I decided to post it here too.

    About a week ago, self-styled 'Etiquette Expert' and all-round stuffed shirt, William Hanson went on ITV's This Morning (a UK morning television show) to argue that women over 50 should not be allowed to wear bikinis. In fact, he added, women under 50 who didn't have great bodies should have the decency to cover up too. In the opposite corner, mature hottie Nancy Dell'Olio was arguing that you could be over 50 and still va-va-voom in a bikini. Click here to watch the old-before-his-time fuzzy cheeked Mr Hanson argue his side whilst squirming with embarrassment and trying not to look at Nancy's legs.

    What pretty much everybody seemed to be missing was that if you want to wear a bikini, that is entirely your decision, and nobody else's business but yours. Whether you are tall or short, straight up and down or well-blessed with what my hubby calls Cuddle Padding, whether you are smooth as a baby's bottom or sporting a chest full of ginger curly hair, whoever you are and whatever you look like, if you would rather spend your day at the beach in a two piece, then that is your right.

    Mr Hanson rehashed his ridiculous argument the next morning on a local radio station. If you feel like tearing your hair out, you can listen to the segment here - it starts around the 1 hour 17 minute mark. The man clearly has issues with his own body, and apparently thinks it only right that nobody else should be happy with theirs either. Or even if you are so deluded as to think you do look good in a bikini, he claims, if your attire makes anybody else feel uncomfortable, then you shouldn't do it. It's not polite. And he feels uncomfortable. And some people agree with him. So there.

    I suppose he would argue that if people are uncomfortable with two men or two women holding hands on the beach (or anywhere else) then that shouldn't be done either. Actually, he seems the sort who would be just as uncomfortable seeing a public display of affection from a 'traditional' couple. What if people are uncomfortable seeing ethnic bodies at the beach, or mixed race couples, or people with scarring. Some people might be uncomfortable seeing a group of severely disabled children on a day trip to the seaside. Clearly these people should stay at home behind closed doors for the good of common decency and not have the temerity to spoil Mr Hanson's Big Day Out.

    Of course, there's always the alternative. Look somewhere else. Or if you're that sensitive about seeing other people in less than head to toe cover up, don't go to the beach!

    On a personal note, following my first year of HAES, this summer, for the first time ever, I have gone (gasp) sleeveless! Gone are the angst-ridden frustrating attempts to buy summer clothes with sleeves. To never purchase any item that doesn't come with a cover up. This year, clothes are just clothes, and I have dared to bare. And I finally understand why most summer clothes aren't made with sleeves. No, it's not a conspiracy against fat people. It's because in hot weather, it is more comfortable not to be covered up. Mr Hanson, who looked damned uncomfortable on that sofa, should try it sometimes. In fact, in the last couple of months I have been to the supermarket, to concerts, to dinner, and just gone about my daily business in sleeveless tops. And you know what? To date, not a single person has keeled over in horror at the sight of my upper arms. Who knew?

    I'd like to leave you with the wise words of Mrs Avoirdupois on the two important steps you need to take to get a beach body.

    Number one: have a body.
    Number two: take it to the beach.

    Friday, 6 July 2012

    The National Weight Control Registry: the gold standard in bullcrap (Part 2)

     Last time we looked at the origins of the NWCR and the somewhat underwhelming evidence that weight can be successfully lost and maintained without descending into some seriously disordered ‘health’ behaviours. This time, we’re going to look at what happened to those people after they’d been in the registry for a couple of years.

    In a paper published in 2003, six years after the first, the ranks of ‘successful dieters’ had swelled to an astounding 3234. This in a country of 77 million dieters. But we have to work with what we’ve got, so let’s go with that for now. Of the 3200 people who had been in the database for at least two years, only 2400 completed their 2-year assessment. Obviously, we don’t know why the other 800+ registrants did not participate, but at least some of them are likely to have gained weight and been too embarrassed to respond. We do know that they tended to be younger than those who stayed in, weighed more at the time they entered the registry, and had reported greater weight loss. So, not to put too fine a point on it, they were fatter to start with, had lost loads of weight, and then disappeared. Hmmm.

    But that still leaves 2400 ‘successful dieters’, you say – so that just proves that it can be done. Well, one year after joining the registry, 1483 of them (66% - or two-thirds) weighed more than they did when they joined. By the end of the second year, that figure had risen to 1630 (72%). In other words, the longer you wait after your starting point, the more people gain weight. This is consistent with what’s been shown in other studies. One of the most comprehensive reviews of long-term dieting success rates reported that in one study, 23% of individuals monitored for less than 2 years had rebounded to more than their baseline weight. The figure for those monitored for over 2 years was 83%. Analysis of studies with longer follow-ups showed that the weight regain doesn't really level off either, even at 5 years.

    Getting back to the NWCR, at 2 years from entry into the registry, only 465 people had not regained any weight from their starting point. The researchers point out that this is around 21% - higher than found in typical weight loss trials. But even ignoring the fact that this is 465 of 3234 eligible registrants (or around 14%, not 21%), we’re still talking in the low hundreds – not exactly earth-shattering evidence for dieting success. And we don't yet know what happened over the next few years.

    To be fair, the researchers did analyse recovery from weight regain between year one and year two, and this is what they found. Of the 1500-odd people who regained weight between entering the registry and their one-year follow-up, only around 150 of them had lost the weight again by the end of the second year. Unsurprisingly, the more weight they’d regained, the less likely they were to have ‘recovered’. It’s true that the largest proportion of regainers (456 people) was made up of people who had gained less that 3% from their 'successful' weight. Even so, only 80 of them had managed to lose the weight again the following year. Of the 284 people who gained back between 3 and 5% above their entry weight, only 41 of them managed to lose it again by year two. A gain of over 5% of joining weight occurred in about a quarter of the respondents (575 people – this is a rough estimation of the actual numbers – between the graphs and the text, around 120 people magically disappeared). Consider the following an approximation only – don’t try and make the numbers add up – it’s an exercise in futility. So as a rough guide, of the 575 or 627 or whatever people who gained back 5% or more, only 74 of them managed to lose half of it back by year 2, and only 27 people had returned to their starting weight. Twenty-seven. There’s no information what means these rebounders used to get their weight back down to that all-important lower number, especially given that their original maintenance strategies weren’t exactly paragons of healthy behaviour. Probably best not to think about it.

    So just to sum up, in a country where over 70 million people are trying to lose weight, a nationwide multimedia campaign has managed to attract around 3000 people who have lost at least 30 pounds from their lifetime maximum weight and kept it off for at least a year, and of these, 72% are regaining weight – with most failing to lose it again.

    Having said that, two years is a relatively short time in the grand scheme of things, and the gains weren’t HUGE: the average was only about 8 lbs, although again, there was wide variation. Although other studies have consistently shown weight regain increases with time, these are the SUCCESSFUL weight losers we’re talking about. Maybe they managed to turn it around further down the line? I mean, this paper was published nearly 10 years ago; maybe some longer-term results have been published since then that give greater cause for optimism? Don’t hold your breath, either on the publication of long-term data or the improved maintenance rate. We’re still waiting on that one. But do tune in next time for the final episode of how to make massively disappointing results look like really exciting news.

    Friday, 15 June 2012

    The National Weight Control Registry: the gold standard in bullcrap (Part 1)

     Whenever anybody talks about the futility of trying to lose weight, somebody like That Awful Woman (TAW), who I won’t give more publicity to by naming, will throw the National Weight Control Registry (NWCR) in their face. See, it IS possible to lose weight and keep it off. This is the proof. You’re obviously just not trying hard enough. But as TAW seems to get all her science from the daily news, she could be forgiven for buying into this myth - it has been carefully crafted to make us believe.

    Despite reams and reams of evidence (like this and this and this) showing that NO method of weight loss leads to long-term maintenance, the NWCR continues to be held up like a beacon of virtue, giving hope to all of us failed dieters that lifetime change IS possible. Given the smug condescension with which finger-wagging 'well-wishers', who are apparently just concerned about our health, use the NWCR to belittle and castigate us poor greedy lazy fat people, it is worth looking a bit closer at just what is being touted as evidence of successful dieting. How are these people getting it right when everyone else is failing so miserably?

    Well that’s an interesting question. In fact, that’s the very reason the NWCR was set up in the first place. Back in the early 90s, researchers from Brown, Colorado and Pittsburgh universities decided to gather together a database of people who had successfully lost weight and kept it off. The idea was to study these people and find out what their secret was. Not a bad idea, really, particularly since back then we didn’t know as much as we do now about how damaging dieting actually is to your health.

    The problems started soon after when they couldn’t actually find any. Well, that’s a bit unfair. They found a few. In a country where over 70 million people are thought to be dieting at any one time, they did managed to attract a few hundred who self-reported that they had lost the required minimum of 30 pounds, and kept it off for at least a year. The first major publication from the NWCR team was based on 784 enrolees who met these criteria. 784. The paper was an analysis of what these people were doing that had helped them to qualify for the registry in the first place. In fact, some had far exceeded the minimum criteria. Average weight loss was 30 kg (66 lbs), and average maintenance was 5 years. It is these particular numbers that are most often bandied about as proof of successful dieting. So let’s look at them a little more closely.

    First, that minimum 30 lb weight loss is defined as a weight below their lifetime maximum. So if you lost 100 lbs from your lifetime max, and regained 70 lbs, you’d still qualify. Even if you’d done it numerous times before: 91% had previous ‘failed’ weight loss attempts. The ‘average’ amount of weight lost prior to their current success was 565 lbs. And there was a wide range here, with some losing over 1000 lbs before successfully managing to keep off their current minimum of 30. No information on how long previous weight loss ‘successes’ had been maintained. But enough with the cynicism. What were they doing this time that was different?

     Well, 92% were still monitoring their food intake – counting calories, fat grams and so on. The vast majority maintained a low calorie diet, through whatever means. 95% of men were getting between 1100 and 2300 calories, and for women it was between about 800 and 1800 calories a day. The average was 1700 for men and 1300 for women. About half admitted spending more time and energy thinking about food and weight than they did before. They also  definitely got a lot more exercise, on average, 2830 calories per week, or roughly equivalent to walking 28 miles. Again, the range was big, with some doing up to double this. Most continued to monitor their weight regularly, with 38% continuing to weigh daily, and 7% reporting more than once a day. Now I don’t know about you, but if somebody with a ‘normal’ BMI told me they were thinking about their food and weight a lot of the time, eating just 1500 calories, monitoring every bite of food that went into their mouths, walking over 4 miles and weighing themselves at least once a day, I’d be a bit worried about them.

    So that’s how the just under 800 success stories qualified for the NWCR. Even ignoring the well-documented harmful effects of weight cycling (yo-yo dieting), and the somewhat dubious ‘health’ behaviours used to maintain their current weight, let’s just assume that this time really was different. Tune in next time for the not-entirely-surprising results of follow-up studies.

    Wednesday, 23 May 2012

    Confessions of an ex-dieter

    Some things are almost too shocking to admit. I was talking to a fellow ex-dieter the other day (the incredible Jenny Jameson from F*ck The Diets - why oh why didn't I think of that name???), and we were discussing how our eating habits had changed since we'd given up the dieting mindset. And then I tentatively let slip something so shameful...

    'I actually really like cottage cheese...' She laughed, 'Me too'. Phew, it was like a weight being lifted. And then the flood gates opened. 'And diet coke'. Jen countered with 'oat cakes and marmite'. (Urgh) And of course, skimmed milk. I just can't drink the regular stuff anymore - it tastes like double cream to me.

    It has been playing on my mind about why we were both almost embarrassed about our continued enjoyment of 'diet' foods. The only thing I can come up with is that it goes against our new-found pride in shrugging off the shackles of the anti-obesity industry. Standing up to The Man. Defiantly refusing to buy into somebody else's rules about what we should and shouldn't eat. If we want pizza, we eat pizza dammit. Chocolate? Ditto.

    But it seems that some foods have become so associated with the diet movement that they are no longer recognised as perfectly reasonable food choices for anyone who is not trying to lose weight (without getting in to whether Diet Coke is a reasonable food choice, or even a food. I like the stuff. Get off my back already!) Jenny told me how some friends of hers had praised her for eating cottage cheese one day: 'Ooh, aren't you good!'

    So listen up folks: we're done being 'good'. We no longer seek your approbation for trying to alter our bodies into a form that society deems acceptable. We want to stand up and shout: I'm not being 'good'. I'm not trying to change myself. I value myself just the way I am. And I no longer attach any moral value to my food.

    Now that I listen to my body, sometimes it just wants cottage cheese. And that's just fine with me. But not today. Today I'm going to head out onto my balcony and enjoy the rest of this sunny afternoon with a nice glass of rose and some fresh scones with clotted cream and strawberry jam. Finally,  I can have my cake and eat it too.

    My fave cottage cheese recipe
    Take a handful of frozen blueberries and zap 'em in the microwave for about a minute, or until they're just starting to burst. Tip hot contents on top of a generous serving of cottage cheese. Sprinkle with flax seeds. Indulge. (This is a leftover from my high protein/low carb days, but it's still a fab snack.) Feel free to share your best 'diet food' recipes in the comments below.

    Sunday, 6 May 2012

    The revolutionary dry cracker and boiled water diet

    Despite making a promise to myself that I would never embark on another diet, I have this week engaged in severe voluntary caloric restriction. With the help of some mutant alien gut flora that have set up residence in my gastrointestinal tract, I have rediscovered the joys of depriving myself, for my own good, and just wanted to share this new-found revolutionary zeal with you, gentle reader.

    I call it the Dry Cracker and Boiled Water Diet, and this is how you do it:

    Preparation: Check with your doctor that you are a suitable candidate for this diet. Ideally, call him out at 2 o'clock in the morning to confirm this.

    Day 1: Let nothing pass your lips, unless it is travelling in reverse direction. One exception, during any periods of semi-consciousness, you are permitted to sip some boiled and cooled water to maintain fluids. Don't overdo it though - most of the weight loss you can expect whilst doing this diet will be due to severe dehydration.

    Day 2: You may nibble on up to three dry crackers, no seasoning, nuts, seeds, or spreads. If necessary, wash down with a few more sips of boiled water. Sleep as much as possible during the day.

    Later, a family member informs you that apple is allowed on this diet. Slice up a small apple and eat one per day. An apple will never have tasted so good! If you are too weak to slice up your own apple, a friend or loved one is allowed to help out. In the evening, even if it is your husband's birthday and you have cancelled all other plans, do NOT eat any of his pepperoni pizza. You will only regret your moment of weakness later.

    Day 3: After the zeal of the first couple of days, hunger is starting to kick in. Slice up an apple and enjoy. Half a tablespoon of honey may be added to the apple if you are feeling adventurous. If this doesn't satisfy you, you may eat up to two dry crackers. The crippling abdominal cramps you are experiencing are a sign that the diet is working. Revel in your discipline. You should be proud of these positive changes you are making for your health.

    By evening, you will be craving sweet stuff. You want a mouthful of the 'chocolate lumpy bumpy' that came with the pepperoni pizza. Succumb. Oddly, you will not enjoy it. If you are still a compulsive dieter, eat the rest of it anyway. If you have already made peace with food and your body, you may stop after one bite. Repeat this process with a cup of tea. Pay dearly for going off your diet early. Your mutant alien gut flora will thank you for this windfall. Your nearest and dearest will not. Besides, you will certainly not get results if you don't even have the willpower to see out the first week! Pull yourself together - back on the dry crackers and boiled water for you!

    Day 4: Take some overseas guests for an Indian meal. Look on smugly as they tuck into their butter chicken and think about how much healthier you are than them while you enjoy your boiled rice and dry naan bread.

    Remember to weigh yourself at least once a day so you can see how well you are doing. So far, I have lost 5 pounds doing this diet for just 4 days. As I am now 5 pounds thinner than I was at the start of the diet, I can only imagine how much healthier I must be. In fact, I don't even like to call it a diet. This is a lifestyle change for me, a whole new way of eating.

    Just think, if you are 'overweight' and therefore at higher risk of, well, nothing really, you could lose nearly three stone in just one month!! And if you are seriously morbidly culturally unacceptable, you could be NORMAL again in less than a year. Plus, if you add ridiculous amounts of exercise to your crackers and apples the results will be even more astounding!!

    This incredible plan would normally cost $695!! But today I am going to share it with you absolutely free of charge. That's a $695 value completely free. So what are you waiting for? You have nothing to lose but the prejudice of morons. Simply come round to my house, let me breathe on you, and then we can all embark on this incredibly healthy lifestyle change together!

    Disclaimer: Just in case you came to this blog by accident and are unfamiliar with my stance on dieting/weight/health, and just in case there is even the tiniest bit of doubt in your mind about the seriousness of this post, let me be perfectly clear - this is satirical. I do not mean it!! This 'diet' will not help with any health problems other than severe stomach flu. Just in case you are congenitally stupid and are seriously considering it anyway, let me perfectly clear - believe me when I say that your weight is not your problem. Please seek out professional help!

    Tuesday, 1 May 2012

    Walking the walk

    It's been about a year since I discovered Health At Every Size and my life turned upside down.

    Despite years of yo-yo dieting, compulsive eating, binges, cravings, and a generally wacky messed up history with food, the first step – normalising my relationship with food – was actually the easiest part for me. Once I 'got' legalising and made the mental switch that I could eat anything I wanted, the cravings, and my out of control appetite, stopped practically overnight.

    I had a week or two of finding myself suddenly sitting on my sofa not quite sure what to do with myself. It took me a little while to figure out what was going on, but basically, I just hadn't realised how much of my time and energy went into thinking about food and eating and weight, planning, re-hashing, self-criticism, and living my life in the future at some indeterminate size smaller than where I was now. But it was incredibly freeing. For the first time ever, eating was neither a chore nor a minefield of guilt and recriminations. Now I think about food when I'm hungry, I eat what I fancy, and then I don't think about it again until next time I'm ready to eat.

    There was a certain sadness that came with this change in me. I was finally free of my battle with food, but my weight was the highest it had been in years. For the first few months, I continued to battle with my poor body image. And rather than praise myself for the incredible change I'd made, I just couldn't help berating myself for doing it at 16 stone. How could I ever learn to love myself at this size? Couldn't I have lost 5 stone first, and THEN normalised my relationship with food?

    But eventually I conceded that history had taught me the answer to that question. In fact, I remember reading a book about the dangers of dieting and the benefits of adopting an intuitive eating approach around 5 years ago. Although the book really resonated with me, I couldn't quite bring myself to take that leap of faith. I'd just lose a bit more weight first.... Five years and around 3 stone later.... I suppose you're ready when you're ready. Maybe you need to reach that lowest point before you can finally take on such a revolutionary message.
    Me in my little black dress

    Anyhow, over the last year, I have gradually come to accept, and even like, my body. Sure, I have my moments, but mostly I think I look 'not bad', or even 'nice'!!!! I can only wonder at how 'not bad' I looked all those years when I still felt 'too fat', not good enough. I have a photo of me in my 20s in a little black dress and a pair of black thigh boots. I remember breathing in when that picture was taken and angling myself towards the camera in a flattering pose. Just another seven pounds and I'd be happy. And when I look at it now...

    This morning I was interviewed for a local paper, and I spent an hour talking to the reporter about Health At Every Size and being kind to yourself. I have been talking the talk for the best part of a year now, but when I got off the phone, I realised that I was finally ready to truly start walking the walk. This evening, I came home and started going through my closet. If it didn't fit perfectly, it went into the recycling bag. Several recycling bags actually. Years of my dieting history were hanging there in my closet, most recently my standard neutral coloured boot leg cords in gradually increasing sizes. Trousers that were too tight, blouses that gaped at the front, and even a handful of items I'd bought that were a bit small at the time, but that I thought would motivate me, and that I was going to diet into. Most still had their labels on.

    I felt a twinge of guilt about the waste. But then I reminded myself that during those years, my driving force was not greed, but despair. And at least now they were going to a good cause and would benefit other people in a variety of different ways. When I thought about how this process was an act of acceptance, the guilt was replaced by a sense of pride that I finally cared about myself enough to do what was right for me. To wear clothes that fit and make me feel good. To not have a daily reminder of all that failure and disappointment. To not wait to live my life in some imaginary future when all my 'thin clothes' would fit, when I'd like my body, and when all my problems would magically disappear. To finally just be me.

    Hubby was glad to know that while many of my trousers didn't make the cut, most of my skirts still fit fine. There were also a couple of surprise discoveries. One knit dress that I've had for nearly 20 years, and which I used to love, has been hanging in my closet for years. I just couldn't bring myself to get rid of it. Just to show hubby how much I'd changed since then, I put it on. And it fit. It didn't bulge. It looked pretty good. I'm going to start wearing it again.

    But my once overflowing overstuffed cupboards now have oodles of empty space. Once upon a time I would have dreaded the thought of going clothes shopping. Trying to find anything that fit. Buying anything that did regardless of whether I really liked it. Peeking out of the changing room while exposing as little of me as possible to ask the assistant to bring me something in the next size up. Which inevitably they didn't have. Trying to find clothes that would camouflage my unacceptable body so as not to offend anybody's sensibilities. Standing in front of the dressing room mirror in a miasma of culturally sanctioned self-loathing.

    But you know what? I don't feel that way now. I'm actually looking forward to it. I'm excited about the prospect of buying clothes not to hide myself and my shame from the world, but to express myself and my right to walk in that same world. I will no longer be dressed from head to toe in black. I can't wait to look at different styles and colours and textures. I will accessorise. I will look HOT! This is my time.

    Thursday, 26 April 2012

    They said Galileo was wrong too

    A friend of mine, lifelong dieter, and recent convert to a Health At Every Size approach, has just started out on the fun task of explaining her change of lifestyle to her nearest and dearest. This did not go down well with big sis, who was somewhat scathing. Her dismissive comment: 'Are you trying to tell me all those doctors are wrong?'

    Without getting into the difficulties of obtaining familial support for such a huge change, the question is one that will come up time and again. How can all those doctors be wrong? If overweight doesn't have to mean unhealthy, why are the government, the medical profession, the people at the gym, the media, my employer, all my friends,  and Joe Bloggs on the street, all telling us that we need to lose weight? EVERYBODY knows that being fat is bad for your health. It's obvious.

    Well, yeah, everybody knows. And once upon a time, everybody knew that the earth was flat, that the sun revolved around us, that heavier objects fell faster than lighter ones, that lead could be turned into gold, and that animals could spontaneously morph into existence. There were even recipe books to help with that last one. Just because everybody believes it doesn't make it true.

    But if it's not true, where is the evidence? Look around folks, it's everywhere. Study after study is emerging that supports the fact that fat doesn't have to mean unhealthy. So why isn't this filtering into mainstream medical practice or public policy?

    Because people see what they want to see. What they expect to see. And when they don't see it that way, they twist it until it supports their preconceived beliefs. There have been two recent studies that have suffered this fate. I've been meaning to blog about them, but every time I go back to the original papers to prepare my post, I get overwhelmed by sheer exasperation and disbelief that anybody could come to such ridiculous conclusions based on fairly decent evidence. One study showed that not all fat people were unhealthy. The conclusion? Only the unhealthy ones needed to lose weight. The other study found that BMI did not capture true health risk, and that some 'thin' people were at risk. The conclusion? BMI is not a reliable measure of health risk. OK so far. The solution? The BMI cut-off for obesity should be lowered. Again. BMI 24 is obese, anybody? Oh, and throw in a blood test or a full body scan to be sure that we're counselling the right people about weight loss. Are you f**king kidding me????

    The hype around the so-called 'obesity epidemic' has chalked up another casualty. Science is supposed to reveal the truth. If it is well conducted it does. But scientists have to keep an open mind and look for that truth without the filter of their existing agenda. On the other hand, without the hysteria, where would the research funding come from?

    Tuesday, 10 April 2012

    The Pirates! In an adventure with bigotry

    SPOILER ALERT: Major plot point giveaway ahead!

    I've just had the dubious pleasure of sitting through the movie 'The Pirates! In an adventure with scientists' at the cinema. OK, it was quite funny in parts (in particular, lots of clever anachronisms about evolution), but to be frank, I thought it was a bit laboured. Still, hubby seemed to like it.

    But to the point. The story is set in Victorian England, with good ol' Queen Victoria playing the role of number one baddie. She is manipulative, power-mad, and has a penchant for eating rare and endangered animals for fun. And she has her sights set on Polly, the Pirate Captain's beloved dodo. An ex-parrot!

    Now you'd think that would give the script writers plenty to get their teeth into, but what do they do when they want to make fun of the queen? They have their protagonist tell her that dodo is fattening, and given her already portly figure, she should probably abstain because otherwise it would go straight onto her "chubby thighs". I kid you not. In other words, it's not bad enough that she's an evil megalomaniac. More importantly, she's fat!

    Now you might think that I'm making a lot of fuss over nothing here. As hubby pointed out to me, Queen Vicky was also incredibly fit and had ninja fighting skills, she did not "wobble around". His point being that the portrayal of the queen as a larger lady was not entirely negative - in a physical sense. But this really just strengthens my point. With so much else going on, the appropriate way to diminish her prowess and attack her character was deemed to be to call her a fatty.

    It's worth noting that the Pirate Captain himself was practically bursting out of his buttons, but nobody commented on his figure. And when it is suggested that Polly the parrot/dodo might be a little on the round side, the Captain defends her by saying she is just big boned. But of course, they're the good guys. On the other hand, let's not have a go at the Queen for being a nasty, dodo-eating, villainous sociopath. We can cover the whole lot just by calling her fat.

    This movie was rated U, making it suitable for ages 4 and above. I've written before about how children as young as six already have such negative images of fat people that no-one wants to be friends with the chubby kid. Is this really the lesson that light entertainment should be teaching our kids?

    Saturday, 17 March 2012

    Too big for the beat: are our police officers too fat for the job?

    According to the front page story in yesterday’s Metro – the world’s largest free newspaper with 1.3 million copies distributed to UK commuters every morning, a large proportion of police officers in the Met – Britain’s biggest force, do not fall into current BMI guidelines for a ‘healthy weight’. Apparently, 52% are ‘overweight’ and 22% are ‘obese’. The writer further implies that these officers are not fit enough to do their jobs. In fact, he seems to suggest that the two are the same thing.

    This is not the case.

    It is entirely possible to be both fat and fit. There are a lot of people who would be deemed fat by current standards who get plenty of exercise and maintain a good level of fitness. What’s more, people who are heavy and fit tend to live longer and healthier lives than people who are thin and unfit, and have similar outcomes to people who are thin and fit. In other words, the weight has absolutely nothing to do with health or fitness. Fitness is a separate issue, and a far more important one than size.

    It may be true that larger people do tend to engage in less exercise in general. There are two main reasons for this. First, many people deemed to have bodies that do not meet culturally imposed external standards of acceptability have frequently been told that they need to exercise to lose weight. Now, exercise is incredibly good for your health and offers far reaching benefits for everything from heart health to mental health. What it isn’t good for is weight loss. Repeated efforts to sweat themselves into a smaller clothes size without any effect whatsoever means that many fat people have developed an absolute hatred for physical pursuits and have forgotten how incredibly good it can feel to move our bodies for the sheer enjoyment of it. Related to this, stigma about weight means that many people are embarrassed to be seen exercising. They think that people will laugh at them and call them names. Sadly, they may be right. But the worse people feel about their weight, the lower their confidence in their abilities, the less activity they engage in, and the less they tend to enjoy it when they do.

    This shaming has to stop. The best thing that people can do for their health, whatever their weight, is to move more. Indeed, the amount of movement needed to maintain a decent level of fitness is surprisingly low, and people who are not currently fit can experience huge gains very quickly.

    But let’s get back to our bobbies. This news story was based on a report from the largest review of police pay and conditions in 30 years. You can check out the original here. The so-called health data used in the report is seriously flawed. Even so, it does not say what the Metro says it does – that overweight officers who fail to lose weight should be sacked. What it does say is that annual fitness tests should be introduced for all serving officers. Those who fail should be given assistance to improve their fitness levels. Repeated failures may lead to dismissal.

     It doesn’t seem unreasonable that serving police officers need to be fit enough to do their sometimes physically demanding jobs. But healthy bodies come in all shapes and sizes, and approximately 80% of the size we settle at is influenced by our genes. Would anybody suggest that weight lifter Holley Mangold, who at 5' 8" and 374 pounds has just qualified to represent her country at the 2012 Olympics, would not be able to lift a body if the need arose? Or that Vince Wilfork, a pro-American footballer named to both the Pro Bowl and the All-Pro team in 2007, 2009, 2010, and 2011, would not be able to run after a criminal?
    Headlines like the one above are not only highly offensive, but they serve to perpetuate an anti-obesity rhetoric that is unhelpful, ill-informed, scientifically unsound, and would be considered extremely prejudicial if directed against other groups of society. To suggest that heavy officers are unfit for the job is nothing more than outright discrimination and doesn't belong on the front page of Britain's third largest newspaper.

    Saturday, 10 March 2012

    Where have all the good men gone?

    On Thursday I launched a facebook ad campaign for my new business, Never Diet Again UK. So far I think it's going quite well, with 56 new 'likes' in three (not yet over) days.

    What surprised me a bit was how many of them were from men. The ad simply has the business name, and a pic from my website of a very happy-looking redheaded young woman jumping in the air. That's her on the left.

    I don't know why I should be surprised. Men are increasingly being stigmatised over their weight, more traditionally a woman's curse. They too are being made to feel less worthy because their waist measurement doesn't fit the current thin 'ideal', or because their glistening firm pecs don't jump off the page in family photos like the steroid-pumped, surgically enhanced hunks on the cover of men's fitness mags. OK, some of those hunks may naturally look like that anyway (with the help of too much time in the gym and a bottomless supply of egg whites, chicken breasts and protein shakes) - like women, men's bodies come in all shapes and sizes. And that's a good thing. But weight stigma doesn't discriminate by gender, race, age, or anything else.

    So to try and speak more directly to my new male fans, I decide to check out some websites or blogs from men who were overweight, but had learned that dieting doesn't work, wasn't helping them, and wasn't the answer anyway. And you know what? I couldn't find any. Not one. Now I don't doubt that somewhere out there such a resource exists, and I'd love to hear from you if you know of any, but there is clearly a significant imbalance here. 

    I am afraid that those of us promoting body acceptance and health rather than weight are focussing almost exclusively on women. We probably feel that women are more likely to need our help. Or maybe, we as women, have been quicker to fight back against the diet industry that has disempowered us for so long, and we now want to help others like ourselves. But 30% of hits in a 3-day period tells me that we are failing an important segment of society who also need our help and support. Either that or they all have a thing for redheads!

    In contrast, the diet and weight loss juggernaut has been quick to jump on this increased body hatred in our male compatriots, as well as helping to fuel it. So this is a call to others in the HAES community. Let's not forget the boys.

    Friday, 2 March 2012

    Proof that dieting is bad for your health

    The Whiskas Diet

    I've got 2 cats. So I bought a large bag of Whiskas Biscuits at the supermarket and was standing in line at the check-out, when the woman behind me asked if I had a cat.

    On impulse, I told her that no, I was starting The Meaty Bites Diet again. I explained that it was essentially a perfect diet, the food is nutritionally complete, and that the way that it works is to load your pockets with Meaty Bites and simply eat one or two every time you feel hungry.

    It was so easy that I really wanted to have another go, although I probably shouldn't because I'd ended up in the hospital last time. But I had lost 25 kgs before I woke in an intensive care ward with tubes coming out of most of my orifices and IV's in both arms.

    Horrified, she asked if I'd ended up in the hospital in that condition because I had been poisoned by the food.

    I told her no, it was because I'd been sitting in the middle of the road licking my self clean when a truck ran over me.

    You have been warned!

    Sunday, 26 February 2012

    Where does it begin? Where does it end?

    In the news this week, Disney launches its new interactive exhibit at Epcot. Called Habit Heroes, the exhibit is designed to help kids beat their bad habits. All good and well, you'd think, but some of the bad habits have raised a bit of a stink.

    Take, the Glutton. He overeats and he eats too fast. And just look what happened to him! Or the Snacker: too much fatty processed food. And look at poor old lead bottom. He doesn't get enough exercise.

    What kind of messages were these characters sending? Weight stigma groups and people working in the area of childhood obesity have been up in arms. Some people didn't understand why - of course if you're fat you must be a lard ass glutton. Why else would you look like that? Have some self respect and pull yourself together.

    Kids who don't know what they're doing wrong are made to feel like dirt by their peers, their doctors, even their families. And now Disney wants to take a stab at them too. Never mind that the only food and drink available in Disney parks is of the somewhat rapid variety. Or that lots of thin kids eat junk and get no other exercise than to turn on their PS3s. Making judgments about people's character from the way they look tends do be frowned upon in most other populations. Unless you're fat. Then, you're fair game. You must deserve it.

    We aren't born fat phobic. Very young children prefer cuddly caregivers. But weight stigma hits young. By the age of 6, US kids will already prefer a severely disfigured child to a fat child as a friend. They describe the fat kid as "lazy, dirty, stupid, and ugly". Young girls are more afraid of being fat than of nuclear war, getting cancer, or losing their parents. College students rate overweight partners as the least attractive marriage material, after embezzlers and cocaine users, amongst others. And in one study, over half of women aged 18 to 25 thought that being hit by a truck would be preferable to being fat.*

    Where is this madness going to end? Well, there is some good news. Less than a week after this exhibit opened, the uproar in the press and on social media has seen Disney close the exhibit down for tweaking and the Habit Heroes website is offline for 'maintenance'.

    People power.

    * Note: The weight stigma stats came from a book I'm reading at the moment: Beyond a Shadow of a Diet by Ellen Frankel and Judith Matz.