The War on Obesity: A War Worth Fighting?

A few days after the FNCE (the American Dietetic Association’s annual conference) dust has settled, I still find my emotions riled up about the very first session I attended. John Foreyt, renowned obesity research and Linda Bacon, Health At Every Size (HAES) clinical researcher and advocate stood head to head to duke out their views on the “obesity epidemic.” John Foreyt staunchly defended his position that the war on obesity is a war worth fighting and Linda Bacon asserted that this war we are waging is ineffective, misguided, and even harmful.

I cannot escape the fact that I write this post from a very biased point of view. I simply cannot give a neutral, objective review of the debate because my feet stand so strongly in the HAES camp. I use a non-weight focused approach in my nutrition counseling and I am a certified Intuitive Eating (IE) Counselor (which means I teach my clients how to respond to internal cues of hunger/fullness rather than dieting).

So, I questioned whether to write this post at all, knowing I don’t currently have access to a recording of the debate and my memory seems to have only held on to the pieces of Dr. Foreyt’s arguments that I found uniformed, inaccurate, and downright offensive. So despite all of this, I sit here writing my two cents, which are heavily influenced by my flawed memory, passion for a non-weight focused approach to health, and personal experience in my own clinical work (and in my own life).

I cannot adequately re-cap the 90 minute debate. But I will recount my top 5 assertions that Dr. Foreyt made that I whole-heartily disagree with. If you are interested in learning more about HAES and Linda Bacon’s perspective, keep reading. I’ll share some fantastic resources at the end of the post.

Top 5 Unscientific, Unsupported, Inaccurate Assertions made by Dr. Foreyt:
1. There are no negative side effects to yo-yo dieting and weight regain (except “some bad feelings like depression for some people.”)

If Dr. Foreyt had properly done his homework, he would have known that dieting is the #1 PREDICTOR OF FUTURE WEIGHT GAIN! See here and here for two examples. And I think it’s a bit crazy for him to undermine the negative mental health consequences that are a by-product of weight cycling. Anxiety, depression, and chronic self-esteem issues are serious concerns. He treated them like nothing more than a pesky skin irritation, when in fact mental health problems are like a deadly form of cancer; challenging a person’s ability to live with a quality of life everyone deserves. We cannot minimize the effects of re-bound weight gain and mental health challenges.

2. Some of your clients will be failures and some will be successes. That’s no reason to stop trying to diet and lose weight. Just keep trying.
Whoa, hold it right there. I cannot stomach the notion that anyone I work with is a failure. But I suppose if there is only one way to measure success that might be the case. If there was a chemotherapy treatment that created more cancer than it eliminated, would we keep using it? No. So why do we keep using the same methods for weight control when the research shows that a weight-focused approach leads to more weight gain? I have learned something magical in my work. When I take the focus off the scale it allows me and my clients to work on core issues which affect body weight, food choices, and self-esteem.

3. Intuitive Eating is a cause of today’s obesity epidemic. Intuitive Eating doesn’t work.
#1 I about jumped out of my chair when Dr. Foreyt stated this. How on earth can he say that Intuitive Eating contributes to obesity when virtually no one in the US practices it?!? Not practicing Intuitive Eating is THE REASON most people struggle with food and many carry more weight than they naturally would.
#2 The principles of IE are often misconstrued or improperly applied. Dr. Foreyt, have you read the book or the research on IE? It is not eating with reckless abandon. No, quite the opposite. It is eating what you want in response to physical cues for hunger/fullness, while attending to emotional needs without using food. I cannot fathom how this can lead to increased rates of obesity.
#3Please see the IE website, where there is research showing the effectiveness of IE.

4. Dieting does work.
Unfortunately, every long-term clinical trial aimed at reducing body weight by placing clients on a specific diet that I’m aware of results in the lovely “J-Curve.” The J-Curve illustrates rapid weight loss, followed by creeping weight gain over time. The LOOK AHEAD trial, led by Dr. Foreyt is an interesting example. Like all obesity research, interventions like a healthier/reduced calorie diet and exercise protocols are given. Consequently, weight decreases but a whole slew of other parameters improve (ie blood sugar, fitness levels, cardiovascular health). What's really fascinating is that the decrease in weight is sometimes quite small, like less than 10 pounds. But the researchers always cite the improved parameters secondary to weight loss, rather than a natural consequence of eating healthier and moving more. Why the focus on weight loss?

 
Many people love to cite the National Weight Control Registry as an example of permanent/lasting weight loss. Dr. Bacon informed us that weight loss must only be maintained for 6 months in order to be added to the registry, with no clear way to have your name removed if you have re-gained your weight. Dr. Bacon shared a story of a student whose name is on the registry, but has since gained back more weight than she lost and hasn’t been able to remove her name from the list. The weight loss research we have shows the majority of lost weight gained after two years. So the National Weight Control Registry may not be a reliable measure of successful "losers."

5. It’s better to be skinny than fat.
Again, Dr. Foreyt needs to check the research because it actually shows that the life expectancy for a person who is categorically overweight but exercises regularly is longer than someone of a “normal weight” and doesn’t exercise. Having dedicated my career to working with eating disorders, I can promise that it is better to be healthy inside and out regardless of your body weight. Being thin is absolutely no guarantee than you are healthier or “better” by any standards.

Please let me make myself clear. I am an advocate for HEALTH. This means I am an advocate of:
1. Eating a balanced, nutritious diet that includes all foods
2. Eating when hungry and stopping when full MOST of the time
3. Learning to cope with emotions without using food
4. Learning to eat in a way that leaves you feeling energized and satisfied
5. Eating by your own rules and no one else’s
6. Incorporating exercise in a way that keeps your body strong (this can only be done if you are eating well first)
7. Eating guilt and stress free
8. Enjoying and finding pleasure in what you eat and how you move your body

And I believe that this is possible at any weight. I stand with Linda Bacon when she says that “fat” is not the problem, it’s the war on fat that is making us sicker and more miserable.

Finishing remarks:

My regret is that the session left a divided group more divided. If we are going to figure out how to create a nation of healthier people, those of us in the eating disorder field have got to come together and truly dialog with those in the obesity field. And until then, the war will certainly continue.

This is a controversial topic. What are your thoughts?

Linda Bacon's FNCE Handout

Validity of Claims Made in Weight Management Journals

Weight Science: Evaluating the Evidence for a Paradigm Shift

*Picture Source

Does This Uterus Make Me Look Fat?

E! News 6 Part Series: "What's Eating You"

E! will be running a new documentary on eating disorders. Below is a clip from their press release.  And here is a link to an article with a bit more information on what the series will feature.

E! Explores Extreme Eating Disorders In The New 6 Part Series "What's Eating You" (Los Angeles, CA, August 18, 2010) - E! Entertainment Television brings viewers into the often misunderstood world of eating disorders with the premiere of "What's Eating You," a six-episode television event. The show chronicles the challenges of women and men whose lives are at risk as they battle not only their distorted body images, but also self-created, life-threatening food rituals and compulsions. As participants share their true stories of food, fear and obsession, "What's Eating You" reveals the severity of eating compulsions on levels never before seen on television. "What's Eating You" premieres October 13 at 10:00 PM, ET/PT.

I am glad to see E! address the issue of eating disorders, rather than solely glamorizing the thin ideal ( which we see constantly portrayed all over the media).  But reading the article I linked to above has left me a bit skeptical.  My fear is that E! will simply glamorize the world of eating disorders.  I guess we'll see.  

If you tune in, I'd love to hear your thoughts.
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Food For Thought: Omega-3s and Brain Health

I am fascinated by the connection between the fuel we put into our bodies and how it affects the way we think, feel, and act.  I am a believer that how we nourish ourselves plays a huge role in not only our physical health but also our mental health.  Yes, our diet has an impact on our mental and emotional well-being!

Because nearly all of the clients I work with struggle with an eating disorder (or some form of disordered eating) many of them are fearful of high fat foods.  Additionally, the majority of my clients (and let's be honest, the majority of Americans!) struggle with depression and/or anxiety.  Turns out that a diet that is too low fat in fat can actually exacerbate symptoms of depression and anxiety.

Interested in learning more about how healthy fats can improve your brain health?  Check out this fantastic interview: Food for Thought: Omega-3s and the Brain.  It is very cool stuff.
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Nutritious Eating on a Budget

Today I'm appearing on the Money Matters Network Radio Program at 2:00.  You can tune in live here or listen at WBNW AM 1120 Boston.

I will be mentioning a handout: Nutritious Eating on a Budget. Click here to access the handout.  And to those of you who tuned in and listened- thank you!

Feel free to call in and ask me an easy question. :) 888-205-2263.
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Marci RD on the Radio

Hey Friends,
I will be making my first radio appearance this Friday at 2:00 on the Money Matters Radio Network.  You can tune in live here or listen at WBNW AM 1120 Boston.

I'll be talking about nutrition myths and facts relating to eating healthy on a budget, dieting, and metabolism.  So get your questions ready!  You can call in to  888-205-2263.  I'd love to hear a friend on the other end of the line. :)

Wish me luck!
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Protein Drink Dangers

Watch CBS News Videos Online
I thought this news clip was really interesting.  Another testament to the value of eating whole, non-processed, real food!
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Oprah: Says She'll Never Diet Again

In March I wrote a blog post about Oprah's interview with Geneen Roth.  And just last week, she had Ms. Roth on her show.  Unfortunately I missed the show but have been thinking a lot about her vow to never diet again.  And several questions came to mind:

* How many billions of dollars will the dieting industry lose now that Oprah has hopped off the band wagon?
* How many women will decide that they are tired of going on/off diets?
* If not dieting, what will Oprah have time to think about instead?
* What will happen to Bob Green, her nutritionist?
* She may not be dieting, but is she dealing with her emotional/compulsive need to eat?
* How do we define dieting and are all diets bad?
* What's the difference between dieting vs. embracing a healthy/balanced lifestyle?
* Does giving up on dieting mean total self-indulgence?

One of my colleagues noted that Oprah is heavier now that she has decided to "stop dieting."  I will just say that there is a big difference between ending a diet and actually dealing with the underlying issues of emotional eating.  Oprah may be feeling less emotional stress now that she doesn't have the stress of dieting in her life, but she will likely continue to gain weight if she isn't dealing with the triggers which encourage her to reach for food.

I fully believe that Oprah, along with anyone else who can identify with her emotional connection to food, can work through this emotionally painful stuff, learn to cope without food, and begin to embrace a much physically and emotionally healthy way of living.  

And most of us will be interested to watch her along the way. Let's hope that she is on to something permanent this time.
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Food Inc on PBS

Save the date!  A fabulous food documentary, Food Inc will air on PBS April 21st.

It changed the way I think, buy, and prepare my food. 

Below is a summary from the PBS website, but click here for the full article.

In Food, Inc., filmmaker Robert Kenner lifts the veil on our nation's food industry, exposing the highly mechanized underbelly that's been hidden from the American consumer with the consent of our government's regulatory agencies, USDA and FDA. Our nation's food supply is now controlled by a handful of corporations that often put profit ahead of consumer health, the livelihood of the American farmer, the safety of workers and our own environment. We have bigger-breasted chickens, the perfect pork chop, insecticide-resistant soybean seeds, even tomatoes that won't go bad, but we also have new strains of E. coli — the harmful bacteria that causes illness for an estimated 73,000 Americans annually. We are riddled with widespread obesity, particularly among children, and an epidemic level of diabetes among adults.

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Calorie-Free Chocolate?

So I am a chocolate LOVER. And I was intrigued by an article introducing a new product- Le Whif.  It's an inhalable, calorie-free chocolate.  It was developed by a Harvard professor (the same guy who brought you breathable insulin).  Here's a short article and interview with the product developer.

Le Whif is already being sold in France and Japan.  But what do you think?  If it was available in the US, would you buy it?  Do you think it would help tame your chocolate cravings?  Does it have the potential to heighten cravings?  What about causing chocolate binges when the calorie-free version isn't quite satisfying your sweet tooth (I'm thinking back to the Snackwell's binges from a decade ago).

I have to admit, I'm a total skeptic.  I can't imagine taking a puff of chocolate tasting air would fix my need for chocolate.  I get total satisfaction from taking a bite out of some high quality chocolate (no Hershey's for me!) and savoring it.

I'd love to hear your thoughts. :)
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