The Fat Pack Wonders if It's Time to Slim Down

[melkor]

To a certain extent, that's a good thing. However, separately, the diagnostic threshold for type 2 diabetes has been lowered over time, such that people are being diagnosed with diabetes today who -- even if tested and evaluated -- would not have been diagnosed as such in the past. Those people -- the ones in the 140 to 126 mg/dL category -- are not being well served by diagnoses of type 2 diabetes, metabolic syndrome, etc., and especially not by the attendant drug regimens.

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But they are being well served if early detection and treatment can help ward off more severe disease and complications. The truth, though, is that those people are rarely started out on drug regimens. They are usually treated with dietary modifications.

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One of the things I love about the internet is that it provides a platform for someone with no background on a topic to argue at length about it with people who have made that topic their life's work. Personally, if a bunch of doctors and nurses tell me the bulk of the work they do every day is directly related to obesity, I'm not going to argue what the threshold should be for diagnosing diabetes. You don't need to be diabetic to have weight related health issues, being obese is bad for the rest of your body also, it isn't limited to kidney problems. We've got a nurse posting in this topic that she's seeing patients regularly who have festering sores in their fat folds...

[jgm]

I think it's a bit like burying one's head in the sand to dismiss a lot of what medical science has discovered over the past 30 years linking diet and lifestyle to things like obesity and diabetes

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In my opinion, a big part of the problem is the mis-reporting, or perhaps just overzealous interpretation, of the scientific results, which then leads people to mistrust science in general. In science we find a lot of correlations, but can seldom draw a direct causal link. There are a lot of variables at work, and health is a very complicated issue. We also see a strong trend of "fear-mongering" among a large part of the mass media: they seem to love telling us that this that and the other thing will kill us any day now. There is usually a grain of truth hidden in the mountain of hyperbole... I think it is a mistake to simply ignore health advice from scientists just because our understanding of the human body is incomplete.

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While essentially I agree with you, one of the problems is that there is so much advice and information being tossed around, it's very difficult to know what to believe. One of the studies that caught my eye a few weeks ago, discussed a finding that was a surprise to even the scientists conducting the study: people who have one diet soda a day (or more) have more of the risk factors associated with heart disease than those who have no soda. (I hope I have paraphrased that correctly.) They don't understand why. Is it because of something in the soda, or do soda drinkers simply tend to have other eating habits which produce the risk factors? One physician in my community says that 8 glasses of water a day means 8 glasses of water, and not water with 'stuff' in it -- such as diet soda, Crystal Light, Kool-Aid, etc. Another doctor says 8 glasses of any liquid is fine. Another doctor says 8 glasses is crap; somewhere around half that is probably fine. All three are highly-respected physicians. There is so much information out there, and a significant portion of it is contradictory. How do you choose?

Refocusing a bit... I, too, fight the weight battle. This entire discussion is near and dear to my heart. I find it helps to become a "food snob" (a term I hate) and only eat the best. Myself, if I can't get really good chocolate, I don't want any. If I'm going to eat a piece of cake, it won't be from a mix. If I'm going to eat a piece of pie, it'll probably be from my own kitchen; certainly none of the restaurants in these parts makes pie that's worth the calories. And I am finding good fruits and vegetables to be just as delectable as a good cut of meat. To me, a really good bowl of lentil soup is definitely preferable over a mediocre steak. And there's nothing wrong with eating pork belly. But you can't eat it more than a very few times a year, and on those occasions, don't eat a bunch of other fatty stuff with it. Delicious food is delicious, period. It doesn't always have to have a ton of fat in it. Think about the transformational experience you have when you bite into a really good apple or a really good pear. To me, that's a perfect experience that is at least on par with a great steak.

Just like Julia Child and many others have said: all things in moderation.

Jenny

[Fat Guy]

One of the things I love about the internet is that it provides a platform for someone with no background on a topic to argue at length about it with people who have made that topic their life's work. 

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It's not my position that the diabetes epidemic is actually an epidemic of diagnosis. I didn't invent it. I read it. It's the position of diabetes researchers -- you know, people who have made it their life's work -- as reported in their published work.

As for people with no background -- people who haven't done the reading, haven't done any critical thinking, and are not the slightest bit skeptical of conventional wisdom -- making authoritative statements with no basis, I agree that's pretty funny.

[hummingbirdkiss]

I LIE !!! about once a year or so I buy Tims Alder smoked chips...shhhhhhh....

[Busboy]

With all due respect, asserting that a condition is underdiagnosed is a logical impossibility. The only way to obtain facts to back up such a statement is to have, well, diagnosed the condition. In which case . . .

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Wouldn't Perlow be an example of an undiagnosed case of diabetes? Dude thinks he's healthy, starts feeling crummy, talks to a doctor who says "Surprise, your 400 pound self has diabetes!". How many people like that are walking around under the impression that everything is fine?

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Perlow has been diagnosed.

ETA: Underdiagnosis might be asserted had Jason gone for a checkup and been told that he didn't have diabetes when in fact he did.

A suspicion that a condition is underdiagnosed is just that -- a suspicion. If you prove "that it exists, you remove the underdiagnosis. The Flegal study demonstrates that diabetes was underdiagnosed in the past, but it could only do that in light of historical statistics. The Flegal study also suggests that what people are calling an epidemic is in reality a correction in observation. The same proportion of people had diabetes in 2002 as they did 14 years earlier. All that changed was that in 2002 we knew about them, and in 1988 we didn't.

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If you do a study of an appropriate population and find that x% of the population has Condition A, and yet the Center For Disease Control tells you that (say) only .8X of the population has been diagnosed with Condition A, you can say, within a certain confidence interval, that the condition is underdiagnosed. That's like statistics 101.

If you are a doctor and you see a large number of people coming to you for unrelated problems and you find out that they also, unknowingly, had Condition A, you can also say, with (less statistically certain) confidence that the condition is underdiagnosed. That's common sense 101.

One thing that struck me about the article were that it wasn't a discussion of people who were somewhat overweight and the incremental statistical challenges they might face -- none of this "at 30 pounds overweight you're 6% more likely to become a diabetic" stuff. Perlow was 400 pounds. I never me the guy, so he may be seven feet tall, but at 6'4" I'd consider myself 170 pounds overweight if I was tipping the scales at 400 pounds. Not being judgmental, but there's no getting around the fact that that kind of bodyweight is a dangerous thing to be carrying around. This kind of knocks down the "predisposition" argument -- people might have "heavy genes" but getting above a certain weight takes effort.

The other, given Perlow's (and FG's and my and everybody on this board's except a few communist vegetarian types ) delight in pizza, hot dogs, tater tots and other processed foods, was the new Pollan book In Defense of Food (maybe I should get around to reviewing it here, no that I've finally read most of it). He talks about a dentist who went around the world looking for populations that were untouched by modern food processing, trying to find an ideal diet. And what he found was that groups with vastly different diets were very healthy -- vegetarians, blubber-eaters, Swiss mountain men, Pacific tribesmen. Great teeth, too. The only real common thread was exercise and an almost complete lack of processed foods.

And so, Pollan comes to a couple of conclusions, among which are that you should "never" eat anything with more than five ingredients, and never eat anything with an ingredient you can't define. Maybe the choice isn't really between pork belly and early death on the one hand and brown rice and a ninth (boring) decade on the other. Maybe it's an easier choice than we like to admit (though, I'm going to miss those Tater Tots).

[JohnnyH]

I LIE !!! about  once a year or so I buy Tims Alder smoked chips...shhhhhhh....

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Ha!

[hummingbirdkiss]

honestly when I take a close look at my patient's diets the ones who suffer the most are living on refined crapfood carbs ..not pork belly ..in fact I think for some folks if they upped the natural fats in their diets and reduced the amt of processed carbs then they would find a medium to live with ...some Dr's and I have had huge arguments over this whole low fat thing ..but honestly I think that fat can be good for you and keep you healthy in the right way when NOT combined with processed carbs but with fresh fruits and vegetables ..heretic that I am ...

[hummingbirdkiss]

I LIE !!! about  once a year or so I buy Tims Alder smoked chips...shhhhhhh....

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Ha!

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Yeah I am hanging my fat head in shame

[pax]

I'm really in no way trying to make anyone feel guilty...and I know that there are people who try to lose weight and make good choices, and still "can't" lose weight. But I guarantee to you that if they counted every single calorie they took in for two months and subtracted the calories they burned up, if there's a positive number they will gain weight, and if there's a negative number they will lose weight.  I don't think our bodies can manufacture weight without the calories.

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I'm sorry, I didn't mean to imply that you personally were trying to make anyone feel guilty. And I agree completely about in/out. So we're good there, I hope.

No, what I was supposing was this; in the same way people are more or less susceptible to alcohol or caffiene or sugar, overweight people have their own individual sensitivities or susceptibilities that lend themselves to packing on more fat than a less sensitive person would from the same food, that's all. I am a bit muddly on cold medicine, so if I can't make myself clear, I'm sorry. And it really is just a supposition.

[melkor]

One of the things I love about the internet is that it provides a platform for someone with no background on a topic to argue at length about it with people who have made that topic their life's work. 

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It's not my position that the diabetes epidemic is actually an epidemic of diagnosis. I didn't invent it. I read it. It's the position of diabetes researchers -- you know, people who have made it their life's work -- as reported in their published work.

As for people with no background -- people who haven't done the reading, haven't done any critical thinking, and are not the slightest bit skeptical of conventional wisdom -- making authoritative statements with no basis, I agree that's pretty funny.

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You're picking a small detail in the larger discussion and focusing on it as if it were relevant. Being obese is a huge health problem, it doesn't matter if you're diabetic or not. They don't call it morbid obesity for no reason. For the sake of the argument, lets say the number of people with diabetes is decreasing rather than increasing. That in no way means that there isn't a massive obesity problem in this country. Friends that work as EMTs have collected an overweight person who bled to death having had their toilet colapse under their weight. Who cares if they were diabetic or not, if they were 100 pounds lighter, that wouldn't have happened. The doctors and nurses in this thread have said their biggest issue on a daily basis is obesity, aside from an article about the number of people with diabetes - what exactly suggests that having a BMI of 50 is a good idea?

You're welcome to believe whatever you want to believe, but it sounds like your family history with heart disease is similar to mine and frankly mine scares the shit out of me.

[melkor]

honestly when I take a close look at my patient's diets the ones who suffer the most are living on refined crapfood carbs ..not pork belly ..in fact I think for some folks if they upped the natural fats in their diets and reduced the amt of processed carbs then they would find a medium to live with ...some Dr's and I have had huge arguments over this whole low fat thing ..but honestly I think that fat can be good for you and keep you healthy in the right way when NOT combined with processed carbs but with fresh fruits and vegetables ..heretic that I am ...

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Every time I've tried eating low fat stuff I've gained weight. Each serving may be lower in fat and calories but if it isn't satisfying I for some reason need to eat more before I'm full. I'm a big fan of the animal fat, cream, butter, cheese, and wine diet - but for it to work those things need to be a smaller part of an overall healthy lifestyle.

[docsconz]

honestly when I take a close look at my patient's diets the ones who suffer the most are living on refined crapfood carbs ..not pork belly ..in fact I think for some folks if they upped the natural fats in their diets and reduced the amt of processed carbs then they would find a medium to live with ...some Dr's and I have had huge arguments over this whole low fat thing ..but honestly I think that fat can be good for you and keep you healthy in the right way when NOT combined with processed carbs but with fresh fruits and vegetables ..heretic that I am ...

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This doctor agrees with you, just don't eat too much of it like don't eat too much of anything. What is "too much" is probably different for different people as well as the same person at different ages.

[fischwlu]

I forgot to note that for those of us who are still relatively "young" you can't put off eating healthy until you are older. My husband was hospitalized around Thanksgiving with pancreatitus and the doctor said it was because he was overweight, ate too much, exercised too little, and drank too much... and he is only 29!

So now he is 45 pounds lighter and much more energetic and happy, yet we probably have had more "gourmet" meals since last November. We just cut out the cheap sub shop type foods, a lot of the processed stuff, focused on adding more fruits and vegetables, and try to drink mostly water throughout the day.

This whole experience has been an eye opener, because I think people somethimes think they can eat (and drink) what they want while they are young and worry about making up for it later... but maybe the damage will be done by then.

[melkor]

This doctor agrees with you, just don't eat too much of it like don't eat too much of anything. What is "too much" is probably different for different people as well as the same person at different ages.

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Doc,

While you're giving out permission to eat stuff, see what you can do about making bacon Kosher, would ya?

Edited March 19, 2008 by melkor (log)

[hummingbirdkiss]

YAY a Dr agrees with a nurse in public even!!! (kidding I adore the Dr's I work with but it is constant back and forth about this) fat provides some satiaty in life ...refined carbs make you want more and more and more ...when companies took the fat out of food they added more starch and sugar that is why you dont loose wt ..I dont read a lot of science I have to be honest when I say I just call it as I see it ..and this is how I have seen it ..the more we eat crap the more harm to our bodies...food is not crap!!! crap is crap!!! here on this board there are tons of wonderful ideas for eating very well and staying healthy ..

Edited March 19, 2008 by hummingbirdkiss (log)

[docsconz]

This doctor agrees with you, just don't eat too much of it like don't eat too much of anything. What is "too much" is probably different for different people as well as the same person at different ages.

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Doc,

While you're giving out permission to eat stuff, see what you can do about making bacon Kosher, would ya?

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Unfortunately, that is out of my area of expertise!

[Lindacakes]

I heard about the article on NPR this morning and I couldn't believe it. Just finished reading it. And I am absolutely amazed.

It's an article about food and cooking and dieting and weight management. And it is, with some small exception, an article about men.

Well, welcome to the pressure, guys! Come on in, we've been waiting for ya!

[hummingbirdkiss]

I heard about the article on NPR this morning and I couldn't believe it.  Just finished reading it.  And I am absolutely amazed.

It's an article about food and cooking and dieting and weight management.  And it is, with some small exception, an article about men.

Well, welcome to the pressure, guys!  Come on in, we've been waiting for ya!

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wow thanks you made a great point!!!! I did not even get that until you posted ..but you are absolutely right!!!

[annecros]

YAY  a Dr agrees with a nurse in public even!!! (kidding I adore the Dr's I work with but it is constant back and forth about this)  fat provides some satiaty in life ...refined carbs make you want more and more and more ...when companies took the fat out of food they added more starch and sugar that is why you dont loose wt ..I dont read a lot of science I have to be honest when I say I just call it as I see it ..and this is how I have seen it ..the more we eat crap the more harm to our bodies...food is not crap!!! crap is crap!!! here on this board there are tons of wonderful ideas for eating very well and staying healthy ..

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What amazes me, is that the whole "Low Fat" movement ignores the fact that essential fatty acids make the brain function:

Essential Fatty Acids and the Brain

Sheesh, your heart won't beat if the brain isn't firing.

The fatty acid composition of neuronal cell membrane phospholipids reflects their intake in the diet. The degree of a fatty acid's desaturation determines its 3-dimensional structure and, thus, membrane fluidity and function. The ratio between omega-3 and omega-6 polyunsaturated fatty acids (PUFAs), in particular, influences various aspects of serotoninergic and catecholaminergic neurotransmission, as shown by studies in animal models.

Speaking of which, I have to give Busboy a big thumbs up for noting that the individual whose eyes are now open to the health hazards of obesity, weighed in at 400 pounds. The doctor would have been silly not to run blood glucose. That doesn't happen overnight, and it had to have been noticeable to himself, his family and friends. 400 pounds is definitely out of the range of overweight, and falls into the range of obese. You can't help but notice when you are walking, talking, even when you are cooking. But, as docsconz pointed out, people are able to wrap themselves in denial over any number of things.

Not blaming the victim, and wish him every success in his weight loss efforts. I also hope that he is able to enjoy good food every day.

The gender thing, well I need to think about that...great observation though.

[slkinsey]

It's not my position that the diabetes epidemic is actually an epidemic of diagnosis. I didn't invent it. I read it. It's the position of diabetes researchers -- you know, people who have made it their life's work -- as reported in their published work.

If I may, I think some of the current disagreement isn't disagreement, but rather stems from insufficent recognition and acknowledgment of a crappy quotation in the original article:

Some of [steven Shaw's] views about diet and health border on the extreme. "I think the whole diabetes thing is a major hoax," he said. "They are overdiagnosing it."

I assume that what you were responding to in saying this was something along the lines of: "What about the diabetes epidemic and the huge increase in diabetes we're seeing these days?"

I agree that there is convincing evidence that the "diabetes epidemic" -- the dramatic increase in diagnoses of diabetes and related disorders over the last 40 -- is, for the most part, a result of increasing diagnosis rather than increasing incidence. In this sense could be described as a "hoax," since I think most people assume that incidence has dramatically grown over the latter 20C.

Your quote, followed by the statement that you think it's overdiagnosed (implying that many people are being diagnosed with diabetes who don't really suffer from this disorder -- for which I think there is not so much support) creates the impression that you think diabetes itself has become a "hoax" because doctors are telling everyone they have diabetes when really they don't. I gather that this is not really your viewpoint.

[Fat Guy]

honestly when I take a close look at my patient's diets the ones who suffer the most are living on refined crapfood carbs ..not pork belly

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I made this point repeatedly to Kim Severson during our interview, however I guess there wasn't room in the article to note it.

[Fat Guy]

(implying that many people are being diagnosed with diabetes who don't really suffer from this disorder -- for which I think there is not so much support)

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I think the defining down of the diagnostic threshold for type 2 diabetes -- as well as several other diseases and conditions -- is indeed a hoax. A good explanation of this position can be found in a 2007 essay in the New York Times, titled "What's Making Us Sick Is an Epidemic of Diagnoses." (I'm quoting New York Times articles mainly to demonstrate that my positions are only as extreme as what has already been published in the newspaper that said my positions border on extreme -- but all the underlying information is available from a variety of secondary and primary sources.) A few excerpts from an article that's well worth reading in full.

Expert panels constantly expand what constitutes disease: thresholds for diagnosing diabetes, hypertension, osteoporosis and obesity have all fallen in the last few years. The criterion for normal cholesterol has dropped multiple times. With these changes, disease can now be diagnosed in more than half the population.

. . . . .

No one should take the process of making people into patients lightly. There are real drawbacks. Simply labeling people as diseased can make them feel anxious and vulnerable -- a particular concern in children.

But the real problem with the epidemic of diagnoses is that it leads to an epidemic of treatments. Not all treatments have important benefits, but almost all can have harms. Sometimes the harms are known, but often the harms of new therapies take years to emerge -- after many have been exposed. For the severely ill, these harms generally pale relative to the potential benefits. But for those experiencing mild symptoms, the harms become much more relevant. And for the many labeled as having predisease or as being ''at risk'' but destined to remain healthy, treatment can only cause harm.

[heidih]

Great discussion. I am absolutely convinced that the takeover of our diets by "fake foods", ie. over-processed, additive ridden, way far from the earth "products", is an enormous factor in obesity and poor health in general. People are willing to pop a gazillion vitamins per whatever the latest health article says will save you, but would not let an unprocessed colorful vegetable pass their lips.

Some of it is economic, but alot of it is the fact that people do not have a clue about cooking. I have seen young mothers who are astonished by what some simple kitchen prep can accomplish. Their only point of reference being fast or microwaveable food or cup of noodles/instant ramen. I truly think that those of us who are (just a bit) food-centric and who can cook, can have a healthy enjoyable food experience. I sometimes feel like I want to go home with some of these people in the grocery store and show them how simple good food can be when I see them flitting about in serious angst at the prospect of cooking.

[hjshorter]

Monday: Lentil soup for lunch, buttermilk fried chicken, corn bread, blackened green beans with aioli, icecream for dessert. 2 1/2 hours at the gym.

Sunday: Went to the Thai temple for lunch - som tam, fried chicken, jungle curry, fish and eggplant stirfry, khanom krok, stickyrice and mango.  Taco truck for lunch (cabeza tacos and horchata). 2 1/2 hours at the gym.

Friday: Tuna sandwiches and salad for lunch, Pakistani restaurant for dinner (naan, tandoori chicken legs, bhuna gosht, chicken karahi, palak paneer, nihari, rice, mili juli subzi), 3 hours at the gym.

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(my emphasis) 2-3 hours a day, how many times a week? I'm curious - do you have kids? That's a lot of time.

I try to walk everywhere, and watch my portions, but to a great extent my weight is what it is since I don't have a metabolism anymore (complete thyroidectomy and I-131 treatment 2 years ago). We eat lots of fruit and veg, and fish.

I have found that a good way for me to not overeat at restaurants is to avoid tasting menus.

Edited March 19, 2008 by hjshorter (log)

[JasonTrue]

I've managed, even as a relatively health-conscious yet food-loving vegetarian, to find my weight going up beyond what one would consider healthy several times in my adult life. (My BMI has not been worse than about 28.5, but it's been above 24 more often than not). I love cooking at home and I love eating out.

There's absolutely no question that I have more energy and better health when I'm closer to an appropriate weight for my height. I've been in both places, and I know that my physical fitness has more to do with my health than my age or genetics (and I say this as a person with running-induced knee injuries).

We easily rationalize unhealthy behavior when we just want to continue doing things the way we're used to, and it's easy to explain away obesity and excess weight and related health problems as genetic predisposition, but really most of us do just eat too much and move too little.

Especially in the US, It's not too hard to overindulge regardless of dietary habit, and my weakness for sweets, cheese, butter and really good olive oil coupled with minimal interest in sports, makes striking a balance important.

Portion size when eating out (and to some extent when eating at home) is way over the top in the US, to a degree I never experienced living in Germany and 16+ visits to Japan. I'm fairly sure I even ate more modestly in China, where we always, always over-ordered. Most of us are incredibly bad at judging what a "normal" portion size is.

I'm not even convinced that corporate fast food is the worst offender. A week ago, I had a burrito at a regional "healthy" chain and, conscious of its heft, estimated the calorie count at an extravagant 800 kCal. I've taken to ordering the "half size" version with a side of chips because I found the default one too much of a gut bomb; I estimated that one at about 600-650 kCal.

Out of curiosity I looked at the company's web site and found that the "standard" size I had just consumed was actually about 980 kCal of food. The non-veg versions topped out at about 1200 kCal. (My estimate for the half-size with chips and salsa was closer to correct). Instead of getting that standard size burrito, I would have been better off eating a big mac and fries (about 700 kCal), assuming it kept me satiated as long. (I haven't had one in about 17 years, so I don't really know)

Even that Egg McMuffin is lower in calories than a typical bagel & cream cheese or coffee shop muffin.

Going out to eat at even my favorite style of restaurant, with several small plates and a little wine, it's easy to shovel down 1500-2000 kCal while thinking that I've just had a nice light meal.

My body, at 215 pounds, needs no more than 2400 kCal per day, unless I'm doing massive amounts of exercise. Most people need something between 1500-2500 kCal per day to maintain their weight.

Before we married, my wife was shocked at how quickly she gained weight in the US even while maintaining a fairly aggressive exercise routine. We ate out 2 or 3 times a week, even though I cooked most of our meals at home from ostensibly healthy minimally-processed ingredients. Portion sizes are just off the charts here.

In the US, without trying very hard, I regularly eat too many calories to maintain my weight, and exercise too little to balance that out. However, I've had absolutely no luck with "cutting out" foods when it comes to reducing body fat. I like good food, and liking good food means, on average, that I'll eat too much of it before I feel full.

I've only been truly successful maintaining or losing weight by adding frequent (5+ days a week) physical activity, generally eating only until I feel about 80% full, and consuming an afternoon snack to avoid overeating at dinner. It doesn't even seem to matter what I eat; I managed to continue losing weight my last several months in Germany while drastically increasing consumption of fried foods, butter and cheese.

In Germany I managed that because it was easier to walk 25-35 minutes to school than it was to wait for a bus that took about the same amount of time to get where I was going, and I had a daily minimum of 50 minutes walking. I also had almost no money to go out to anything but Turkish Imbisse and bakeries, and bought very little processed food.

Strangely, even when constantly eating out on business or personal trips to Japan, I regularly find my weight goes down measurably (usually about 5-6 pounds) and my waistline measurably shrinks after being gone for just a week or two. I snack more often, eat more restaurant meals, drink more bottled drinks and alcohol, and generally think far less about what I'm consuming, but still end up walking so much and eating smaller portion sizes at each sitting, that things just work out in my favor. And it takes only a few weeks to get it back once I come home and resume my normal routine.

It's absolutely possible to eat indulgent food without over-indulging. But there are some basic mindset problems that would have to change. We have to stop thinking that we're getting a good "value" just because we've paid a little bit for a lot of food. (Every time I see a restaurant review that complains about or celebrates portion size I wince). I've found it helpeful to serve just enough of something that we crave a little more, and not so much that we eat "mindlessly" because it's still there.