Tuesday, October 11, 2011

Who is the biggest loser?

My freshman composition class just wrapped up a unit of readings about food. We read a wide variety of articles and essays: classic Michael Pollan fare ("Eat food. Mostly plants. Not too much."), arguments for vegetarianism as the most environmentally friendly way to eat, advocates of conventional industrial agriculture, articles about America's obesity crisis, and arguments for genetically modified plants as the future of sustainable agriculture. We also watched Food, Inc. and had a local organic farmer visit our class as a guest speaker.

Our readings on food discussed several perspectives on obesity. Some encouraged better individual eating choices as the solution to unhealthy bodies. Others pointed fingers at US food policy that subsidizes overproduction of corn and thus floods the market with cheap corn-derived foods. Some noted that while cheap, unhealthy food isn't good for our bodies, it is deeply enmeshed in the American economy and thus will be hard to change.  

Last class, I did an activity about reducing excess wordiness, which I called "The Biggest Loser." I had never seen the TV show before, so I did some "research" and watched a few episodes. I found myself simultaneously fascinated and cynical. It was incredible to see the physical transformations the contestants undergo. Despite the annoying reality TV genre, I still felt motivated when I heard the contestants' success stories. You can do it! Rah rah rah! At the same time, I felt cynical because only a tiny minority of people struggling with excess weight have access to a team of personal trainers, dietitians, and physicians--not to mention an all-expenses-paid stay at a weight-loss camp. "The Biggest Loser" both inspired me and deepened my skepticism.

Obesity has its own controversies in the world of maternity care. On one hand, maternal obesity is associated with many pregnancy & birth complications. But we don't know how much of this is simply self-fulfilling prophecy and/or care provider bias and how much is due to inherent risk of obesity itself. Should we strive towards fat acceptance and the concept of being healthy at any size? Is there some kind of reasonable BMI benchmark we should encourage women of childbearing age to reach? Will focusing on individual choices make more of a difference than trying to change systemic failures? Or will it just make overweight women feel more guilty?

Links to articles you'd like to share?


  1. Follow the money. Body shaming makes BILLIONS every year in this country.

    I am a fat women who has had five healthy pregnancies and births and I feel very, very strongly about this topic.

    Is our modern, subsidized food system a mess? yes. But demeaning fat people or shaming millions with the anti-obesity stuff doesn't help. I have my feet firmly planted in both camps: whole foods and HAES

    Health at Every size is where its at. Intuitive eating, joyful movement and accepting your body.

    I blog about it here http://rubyslippersx3.blogspot.com/2011/08/you-have-my-permission-to-love-your.html
    and here about biggest loser:

    the best book to read is Linda Bacon's:

  2. PS. an obese body is not an "unhealthy body" and a thin body is not a "healthy body"

    In supersize me the men interviewed that said they lived on fast food daily were all thin.

    You can make terrible choices and still fit the accepted standard.

    Or you can be me and be "morbidly obese" but an active healthy eater.

    here is a good post by Ragen Chastain - Public Health is not public thinness:


  3. Well, Janie said pretty much what I was going to say!

  4. With respect to 'The Biggest Loser,' I watched this show for a while, and while I agree that it is superficially inspiring, I also think that it is terribly insidious and tends to damage the body-image of those who watch it regularly, even if they are at a healthy weight.

    I am at a healthy weight. My body is not perfect (whose is?) by is quite reasonable. My BMI is in the healthy range and I am physically active. I have never had an eating disorder and have generally been fairly happy with my body. Nevertheless, when I was watching 'The Biggest Loser' I was less happy with my body. I found myself hating on the parts of my body that aren't perfect and felt that I needed to lose weight. I chose to stop watching it because I felt it was bad for my mental health, however not everyone will recognize why they have started feeling worse about their body. Notably, I have read a case report of a 10-year-old girl with anorexia where it appears to have been triggered by watching 'The Biggest Loser.' Given my experience, I suspect that that case is not unique.

  5. I have problems with the Biggest Loser, too. I dislike the fact that the weight loss is encouraged to be so rapid. One year when they checked back in with a winner, he had gained it all back after going home. I definitely know that feeling! I guess I'm what they call a yo-yo dieter. I never realized that I was because I imagined that meant bouncing around in a 10-15 pound range, and I can lose 50 pounds and gain it all back in half the time. This kind of weight instability is extremely unhealthy for your body, and I am right now intentionally trying to lose weight slowly and focus more on my health than on the scale.

    As for the size issue in maternity care, I feel the same as I do about all maternity care issues. Evidence-based care is the only kind that I'll accept. No health care provider can tell that I will have complications just by looking at me. In fact, I gave birth at home just 8 weeks ago with no complications. I happen to be healthy, but I did choose to do some routine tests and monitoring to make sure everything was healthy. For me, this included dietary changes, weight monitoring, blood pressure monitoring, and glucose screening. I was given a choice for every one of those procedures and treated with respect by my wonderful midwives.

  6. Largely what Janie said. All this focus on obesity leads to horrible treatment of anyone who's not thin. I'm barely fat. BMI 31, dress size 14, and yet I still get harassed about my weight on a regular basis, especially when pregnant. Part of the reason I homebirth is because my midwife actually treats me like a person instead a tub of fat.

    And I'm not even that fat!

    Back when my weight started rising (thank you PCOS) I learned just how crazy those BMI standards are. I was a size 8 and officially overweight, only 15 pounds away from being obese. Because of this I categorize anyone larger than a size 6 as fat (in a non shaming way). Which goes to show you crazy that standard is.

  7. I'm overweight, but "healthy"...low bp, good cholesterol, middle-of-the-road blood sugar, my heart does what it's "supposed" to do while resting or recovering from activity. But I lose about 30lbs in my first trimester each time I'm pregnant. Sounds pretty scary, right? But I have to push for treatment each time because my care providers aren't worried because they look at me and say, "she needs to lose the weight anyway."

  8. I think of high BMI as a symptom, not a cause. I don't think the solution is to get the BMI down, but to address the issues that make a BMI high. Are they muscular? Is it hormones? Allergies/gut issues? Hereditary? Age? Pollutions in the environment? Also, if it is compulsive eating, then a mental health professional is going to do more than a PCP telling someone, "You need to exercise and eat less." The root issues need to be addressed and I don't think that happens enough.

  9. TopHat, I largely agree, but even if you address the cause of the higher BMI it doesn't necessarily bring weight down. My fatness is caused by insulin resistance, which caused all sorts of fun symptoms that ruined my life. I'm now on medication and no longer ill, but I haven't lost a pound. I'm very healthy and feel better than I have my entire life, but I'm still fat.

    I don't consider that to be a failure of treatment.

  10. Great discussion. I have been all over the map in terms of how I feel about this topic. I used to be an avid Biggest Loser watcher. And like genniemom, I have lost over 50 lbs many times in my life. Several years ago, I just got burnt out and luckily discovered HAES and Intuitive Eating. It gave me a break from all the abuse I’d doled out in the name of “getting healthy”. That’s when I stopped watching TBL. That time really helped heal a lot of the emotional damage I’d done, but my weight kept climbing and I felt worse and worse physically. So I went searching again for some more information. I’m now follow a whole foods approach to eating and have made my peace with food. (The Paleo Solution is a good book outlining what I do now). I found out that a lot of what I was eating, even the stuff I thought of as healthy, was causing me to overeat, feel lethargic, and therefore, gain weight. Since changing my diet, I have lost over 40 lbs this year without weighing, measuring, or counting anything. It is such a relief. The process is super slow but it’s working, leaving me energized and happier than I’ve ever been. I’m also hoping to start having children soon so I am glad to be getting this stuff sorted out before then.

    I agree with Ashley that what our society deems fat is ridiculous and also that making healthy changes does not always lead to someone achieving a “normal” weight on the BMI charts. I don’t envision ever approaching that standard, which is just fine with me. My body will know when it’s ready to settle at a healthy place for me and that will be it! I also don’t disagree that someone can be fat and also be perfectly healthy. It is for each of us to determine this for ourselves.

  11. Like Linda Bacon says - Health at every size does not mean every size is healthy: "HAES doesn’t contend that everyone is at the weight that is healthiest or best for them. It supports people in adopting good health behaviors, regardless of where they are on the weight spectrum."

    The beauty of HAES to me is similar to natural childbirth - I don't need a 'system', I follow my body's cues. For me that is enjoyable. slow eating,from-scratch cooking, walking and bike riding, no hormonal birth control - which has always caused weight gain and depression, and finding healthcare providers who will see me as I am not as I weigh.
    Not easy since I was turned down by 5 homebirth midwives.

  12. I just like to say that I like the positive direction all the comments are going.

    I'm only 22 (no where near ready to have kids) but I enjoy reading this blog.

    I've struggled with my weight since I was in elementary school due to emotional issues. My mom is bipolar and wasn't diagnosed until I was 10-11 years old. I bore the brunt of most of her severe depression, her out bursts and other things. All through out my time in school, I was ridiculed at home and by my peers at school. I ate my feelings. I couldn't stand it. (I should also mention that I'm ADHD and I have depression as well) By time I was out of high school, I weighed 320lbs. I was able to finally receive mental help and fix things with my mom. Now, not everything is peachy keen with her, but things are better than before. In the last three years, I've lost 90-100lbs and I'm now in my third quarter at the local community college getting my AA. As TopHat was saying, weight gain should be looked at as the symptom. I'm 5'7'', have great BP, good blood sugar, good cholesterol. I would never do BL. It's just ridiculous.

  13. While pregnant with my son, I gained 26 pounds, and lost all of it almost immediatly. My body wasn't in shape however. I didn't get motivated until after my son's first birthday when I saw photos of my body. After 8 months of working out and eating a more healthy diet, I was in better shape than I was on my wedding day. I soon was once again expecting, and at my first prenatal appointment, I was told that based on my height, my current weight put me in the 'obese category', and I was 'warned' about gaining too much weight so as not to cause any harm to my unborn child. I went home crying. I had worked SO hard to get into shape, and these numbers on this 'magical' chart I found so insulting. For me, I do take into consideration each individual. I seem taller than I am, and I'm extremely long waisted. When I loose 5, 10 or even 15 pounds, it all seems like it is from my face. I can have my "mom tummy" sticking out, yet my husband tells me to eat something because he says my face looks skeletal. I don't weigh myself anymore. Just try to stay healthy enough to keep up with my kids. The more I excercise, the better I feel and the happier I am.

  14. I don't know if my previous comment got eaten by the post monsters but I wasn't being factious! I really am always happy to see Dietitian spelled correctly... LOL!

    Anyhow. I will have to say I LOVE the Biggest Loser. It's totally inspiring to me in terms of physical activity and achieving what you set your mind to. A lot of people get on to the show about the rapid weight loss and I have to say, yes it would be dangerous under normal circumstances but in the show they are not in normal circumstances they are working out for most of the day, following a strict diet plan by a (behind the scenes...much to my chagrin) Dietitian and of course are extensively medically evaluated to make sure they are staying on track. The show *is what it is* and I have watched several seasons (4 or 5 although none recently) and the show DEFINITELY makes the point that... 1)This is how the show works and 2)This is how you can translate it to REAL LIFE... you won't get there as fast as the contestants will, but you will get there! It's such an inspiring show to me and I'm a skinny mini.

    I guess I do believe in what a PP says (apparently quoted from someone named Linda Bacon of whom I am not familiar with) ... I do believe in "Heath at every size does not mean every size is healthy". I know for a fact there are some overweight people who are healthier than me, but I do know significant weight levels added on to a frame that can only support so much is not healthy.

    And A LOT of people get super wrapped up in BMI. BMI is SIMPLY A TOOL and a STATISTICAL MEASUREMENT and should literally just be taken as such. I really don't believe anyone should take a BMI of overweight or obese as a judgement unto themselves but just know that STATISTICALLY being in a certain BMI bracket DOES place you at higher risk for developing certain conditions and that is it plain and simple it's up to each person how they want to take that information. Unfortunately physicians (and of course some Dietitians even I'm sure!) will use that to negatively pressure their patients but like I said... just take it as ONE PEICE of information about your health that has limits just like ANY other ONE PEICE about your health. If you get one bad blood pressure reading or one sky-high blood glucose level... of course you wouldn't take it as a gloom-and-doom situation, you would just take it into consideration and see what you want to do and it's the same with BMI. If a BMI level gets someone to reevaluate and think about their health and decide they want to more aggresively seek a healthy lifestyle then that is awesome! If someone chooses not to act on a BMI level then that is fine too, like I said, it's simply one tool.

  15. If you love BL please read my post on it or the original article where I go my info - they are abusive to the contestants and misleading the viewers. And people like Jillian Micheals is a verbal abuser who profits off her terrible behavior.


    And if you are not familiar with Linda Bacon - her work is excellent. http://www.lindabacon.org/

  16. Heather Richins10/13/11, 12:24 PM

    BMI is nuts on both ends. A 'healthy' weight for his height is 180-190, but there is no way he could go below 200 without starving himself, as he has very broad shoulders, kind of a football player build.

    I, on the other hand, am told by the BMI that I need to GAIN 10-15 lbs, and that I am very underweight. I have had my thyroid and other things checked, and they are all normal, but to gain that much weight I would have consume milkshakes and candybars.

    I eat a healthy diet (vegetables, legumes, whole grains and some meat), my husband eats a healthy diet, we both are pretty active, but neither of us is a 'healthy' weight because of an outdated, inaccurate scale of measurement.

  17. Epigenetics, anyone?

    I think we may be missing the point if we only focus on maternal health with regards to obesity during pregnancy:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710391/?tool=pmcentrez

    New studies are showing the impact of pregnancy nutrition on the immediate and future health of the baby.

    "Healthy whole grains" are anything but if you are insulin-resistant. Obesity is positively correlated with insulin resistance. A low-carb, grain-free, whole foods diet can reverse insulin resistance.

    Here is the diet I recommend to all the pregnant moms (and dads!) I work with:http://www.primaltoad.com/primal-pregnancy/

  18. I've wondered a couple of times if I'd have had a c-section if I weren't "obese" pre-pregnancy -- I've read in a couple of places that the c/s rate for "obese" people is around 50%, and you can't convince me most of that isn't care-provider bias. I was VERY healthy pre-pregnancy, I ate better, I exercized more, my BP and resting heart rate were fantastic.

    I'm about a pound and a half away from a "normal" BMI now, and a big part of my motivation is just to get that monkey off my back -- I know I'm not as healthy or strong as I was pre-pregnancy, but I feel like most care providers really only care about that number.

  19. Rixa, it sounds like the class is going great! Hooray!

  20. Former opera singer here... and straight theater actress. And due to that, former annorexic and bulimic. I have worked hard to be happy and healthy where I am -- 5 feet 2 in and 180 lbs. I lost 20 pounds after my first pregnancy and have kept it off.

    I have problems with BMI as a researcher. It can be way off as a measure for non-white women and those who exercise - often more than 15% off. We would not accept that elsewhere, so why is it ok for making health judgments about bodies?

    Risks of obesity are largely mitigated by exercise and healthy eating -- the same mantras that get lost in the weight loss craze. I know diabetics that are fat and some that are skinny -- health is NOT a straight obesity-related risk factor. I would like to see more effort put into working on making us all healthier -- through industry and lifestyle changes sure.

    However, we also have to realize that when we are working full time with two or three kids, a household to manage, and a 45 minute commute -- time is a precious commodity and we may not be able to fit some of these things easily into our schedules.

    For me, as a FT student, FT mom, working 26 hours a week ... my choices are more sleep or more exercise. At 5 hours of sleep a night and still nursing, the health benefit of sleep overrides the health benefit of exercise, hands down!!!

    Wish I could take your class Rixa!

  21. Before I got pregnant, I was of a "healthy" BMI, but apparently needed to gain about five pounds to be at my "ideal". Needless to say, I don't put much credence on those things.

    Some people still have the nerve to comment on how thin I am, never mind that I'm almost halfway through this pregnancy, and my midwives all think I'm doing just fine!

  22. I think it's important not to presume someone's eating habits based on looking only at their body size. Just because someone is thin doesn't mean they are healthy or eat well; it just means they won the genetic lottery on weight and body size tendencies. And vice-versa for people of size.

    And don't forget PCOS, which I'm currently writing about on my blog. It's probably from an inborn "defect" in how we produce or process androgens, insulin, or both. Is fatness in PCOS women really from irresponsible behavior or just bad luck in the genetic lottery? How much is fatness *really* changeable?

    I think what holds us back the most are the underlying assumptions and judgments most researchers have about fat people and how we "must" behave to be fat. I think it's hard to uncover real ways to mitigate risk when one assumes that if fat people would just do X or Y, they'd all become thin. I don't think research supports this at all.

    The standard for weight loss success is losing the weight AND keeping it off for a minimum of 5 years. Yet almost no study meets this standard. They cook the books to make themselves look successful by following participants only for a year or two, if that. But most regain this, and more. Is that really beneficial in the long run?

    Mann 2007 http://www.ncbi.nlm.nih.gov/pubmed/17469900 reviewed long-term wt loss research and found very little success. They also found that 1/3 to 2/3 of dieters will regain MORE weight than they lose. Is emphasizing weight loss helping or harming?

    Weight loss and severe wt cycling also has risks that must be considered, including increased risk for mortality (http://www.ncbi.nlm.nih.gov/pubmed/20212495; http://www.ncbi.nlm.nih.gov/pubmed/17676383), not to mention more risk of gallstones, kidney cancer, etc. (http://www.ncbi.nlm.nih.gov/pubmed/10075614, http://www.ncbi.nlm.nih.gov/pubmed/17615089).

    Like others, I prefer the HAES approach, Health At Every Size. It promotes health through healthy behaviors without unrealistic weight loss goals. For some people that will result in a small wt loss, but for many it won't drop their weight at all....but it will make them healthier overall.

  23. Quoting from "Weight science: evaluating the evidence for a paradigm shift" by Bacon L, Aphramor L, 2011, www.pubmed.gov/21261939:

    Current guidelines recommend that "overweight" and "obese" individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavior change.

    This approach reliably induces short term weight loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality.

    Concern has arisen that this weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences... This concern has drawn increased attention to the ethical implications of recommending treatment that may be ineffective or damaging.

    A growing trans-disciplinary movement called Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a shift in focus to weight-neutral outcomes....

  24. Thanks for your work Well rounded mama - you are amazing!!
    I'm not good at the details I just know what I've lived and I'm happier and healthier with HAES than I ever was during the years of self hate, weight watchers and the like.

  25. As to being "fat" and pregnant...I went through this. At 5'4 and 197 lbs when I found out I was pregnant, the OB I saw to confirm the pregnancy (while I searched for a midwife) came into the room and bluntly said. "You are obese. You are at risk for gestational diabetes and a large baby." She did not look at my body type or even discuss it in a humane way. Just..."hey, your fat."

    On the other hand, my midwife never said a thing about it. I had Hyperemesis gravidarum and ended up loosing about 25lbs the first half of the pregnancy. The day I birthed my son I weighed in at 197lbs. Right where I started.

    I never had any issues during the pregnancy and had a "small" baby at 6lbs 1oz.

    I think that doctors need to learn to take weight and pregnancy on a case by case basis and make sure that the mother knows that it is not an automatic risk to her or her babies health.


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