Black or Red? Narrowing the Field

In Weight-Loss Maintenance on November 18, 2010 at 7:46 pm

First of all, let’s agree there is no definitive answer to the Big Fat Roulette Wheel game.  Any answer may be correct, but some strike me as more plausible than others. 

Since my last post, we’ve had five more gamblers, all placing their bets somewhere on the black side, which means the board is now tied.  “Personal choices” and “outside forces” are even.  Makes for an interesting discussion!  If you haven’t read the comments, please do.  And don’t forget the second Roulette post, with more discussion, and some great links to additional research that I’m still digesting.

Before I break the tie, let’s eliminate a few contenders:

Aspartame:  No one picked it.  I certainly wouldn’t either.  I lived on sugar-free sodas for the first five years of my maintenance.  I have only recently (and radically) cut back for reasons other than maintenance, and that action has had no effect on my maintenance – it didn’t get easier, I didn’t drop additional weight. 

It may seem arrogant to give credence to personal experiences and hunches alone, without scientific evidence, but I think in this realm, our individual experiences and anecdotes are vital.  I was delighted that many of the answers to Fat Roulette game began “In my experience . . .”  Let’s continue to wrap the most descriptive and useful language we can around our experiences, to help one another and, perhaps, to provide fodder for those in the scientific community who haven’t abdicated their curiosity and set their assumptions in concrete.   

Now, as for aspartame, it may get our sweet receptors all excited, it’s packaged with other crud that may cause us to eat, but no, it’s probably not the Boogieman.

No one chose lack of sleep either.  Perhaps that is because it is likely a symptom of some bigger cause, such as increased stress.  Sleep deprivation doesn’t help anything, but it’s hard to correct it alone, without first correcting a number of other personal and cultural conditions.  

As for the black side, half the people suspect that’s where the Boogieman lives, but in this game none wanted to commit to one square.  I will reveal now, I am a black-side supporter.  And in the end, there is one that I feel in my gut is the worst of all, but today let me talk about why I don’t think red, personal choice, is so much to blame. 

In short, we would prefer to blame ourselves because it is noble to accept responsibility, as Jen pointed out in the comments.  Moreover, it’s a way of claiming some control over a dicey problem, as Judith, Dianne and others noted.  But here’s the problem:  while the chemicals we steep in daily have increased dramatically, we likely haven’t changed our behaviors all that much.  Our memory of the past is nostalgic and inaccurate. 

We have romanticized how active we once were and exaggerated how sedentary we are now.  In the 1960s you didn’t need today’s sophisticated athletic shoes, because you could do your Jack Lalanne leg lifts in KedsTM or ballet slippers.  At the Shelly Lynn Figure Salon (my emporium of choice) you could wrap a canvas strap around your butt and attach both ends to a machine that looked like a motorcycle engine on a stick, and when you flipped the switch it would “shake your flab away.”  Then you could lay yourself down on the “manipulating table” that lifted and shifted your appendages for you, before retiring to the “tanning closet” – an actual coat closet where Miss Lynn had removed the hanging rack and screwed a tanning bulb into the overhead socket.  At the figure salon I didn’t break the kind of sweat I do when I exercise now.  For one thing, I didn’t want to muss up my mascara then.

Another common theory (and represented on the Roulette table) is that the “obesity epidemic” is the result of decreased outdoor play for children.  If that were true, however, then wouldn’t girls be less affected than boys?  The Women’s Sports Foundation reports that high school girls’ participation in sports has increased 904% since the enactment of the Title IX amendment to our federal Education Act in 1972.  Shouldn’t the increase in soccer and basketball for girls have mitigated the effects of the obesity epidemic for them?  Yet some research says girls are more affected, and also entering puberty earlier than in the past.  

I also reject the theory that we historically ate such “pure” and small foods.  We misremember the “good ol’ days” of lard, casseroles, canned fruit salad, SpamTM, VelveetaTM, baked potatoes with sour cream and butter (not salsa or nonfat yogurt), pan drippings on white bread and home-baked pies.  In the 1950s, a steak was bigger than a deck of cards and nobody ate hummus and sprouts on multigrain tortillas as people do now.  Even if some of us are eating more now than the average Joe of the 1960s, as some research suggests, is it because modern “supersized” meals taste better than Grandma’s gooey sweet, buttery pies of yore, or because the chemicals in today’s foods have desensitized us to what and how much we’re eating?

No, clearly, the culprit isn’t from the red side of the board.  Something from the black side of the board has “broken” some of us (and not affected others).   I have given you clues, and talked an awful lot for a blog entry.  I’ll be out of town tomorrow, but when I return I will name the winner of the contest, whose opinion is different from mine, and I will write about my own thoughts on the Boogieman.  Look for a post on Saturday or early next week. 

Stay tuned . . .  and keep talking.  I so enjoy the comments I read here — even when you get a little heated and bicker.  It is apparent that weight-loss maintenance is of interest to a broad and clever group of people (many as cynical as I am).  We’ve all been betrayed by cultural mythology, and piece by piece, post by post, maybe we can figure out what’s truthful and what may be rejected.  We’ll consider the thoughts of people in white labcoats, but not without questioning and measuring them against our personal experiences, which are, indeed, meaningful.

  1. Your description of the Shelley Lynn Figure Salon makes me laugh. Thanks, I needed a one from the belly. You see, my aunt and my mother both kept those pieces of equipment at home! (Sans tanner.) My aunt had married a rich man, so for her it was a simple request from my uncle. My mother probably used her Sears card, bought some expensive stuff, then strong-armed a new cashier into giving her cash upon return. Mum was crafty that way, prided herself on being an “investor”. She hoped to make the money back, plus profits, by allowing neighbor women to come down to our basement and use the equipment, for a small maintenance fee, but once that novelty wore off…well, mum was stuck with just her Tupperware gig. Ironically, by the time I was in grade school (mid 60s), the equipment (especially the “manipulating table”) finally paid off when my buddies happily paid a dime for every *ride*. Fortunately mum never saw a cent of it. 🙂 Good times.

    • Those machines were ubiquitous at the time. How quickly we forget . . . and figure out new ways to be foolish! Now, it’s Sensa powder!

  2. I believe that the answers are always more complex than people like to realize. There are biological propensities which are easier or harder to negate with environment depending on an individual’s biology and psychology. That is, we are all born on a continuum in regards to weight and there are those at one extreme end who couldn’t get fat if they tried and those who will be fat unless they try extremely hard not to be. Between them, everyone is scattered.

    People tend to believe they are “normal” or “average” and that everyone operates as they do and every body roughly operates as theirs does rather than allow for the possibility that what they do to maintain a healthy weight is far less (or more) than what someone else does. This is egocentrism at its finest, but it is very destructive thinking when it leads to judging others and their behaviors.

    I strongly believe it’s not one side of the nature or nurture equation or the other, and it’s not an equal distribution for each individual. This not only makes sense from a logical point of view, but applies to all areas of health, not simply weight. People are born with genetic propensities for cancer that others do not have, and nothing they can do will stop them from developing certain types of cancer. Recently, a friend of my husband’s developed such a cancer. She didn’t do anything wrong in her lifestyle. It simply is in her code. The same goes for weight. People further along the continuum for cancers of various types may be inclined to develop cancers of various types only if they smoke, drink, or eat (or fail to eat) various types of foods. It’s all about propensities.

    The main reason people focus on nurture is that they like to believe both in a “just world” (in which life is fair so that they can predict outcomes) and that they want to assign blame and judge (so that they may elevate themselves and their choices). The main reason people want to focus on nature is that they want to escape the suffering they feel when they experience difficulties that feel insurmountable. There is great relief in saying, “I’m fat, and it’s biological.” It’s not about escaping responsibility so much as escaping self-hate and frustration.

    Unless someone has a rampant biological problem, no one needs to be fat. However, what is required to stop a particular individual from being fat based on biology is a consuming, Herculean task. Some people because of biology will be fat unless they devote their entire lives and the vast majority of their energy to not being so. And some people don’t have to lift a finger to be slim. Most of us are somewhere in between based on both nature and nurture.

    The thing that I would implant into everyone’s head about this issue if I had such power would be to realize that the nurture element is not to be confused with personal responsibility or simple choice making. People say “it’s a choice” as if you could turn it all around by simply putting down the fork, but they don’t acknowledge or believe that the power to put down the fork is not the same for each person. Each choice in life is influenced by personal experience. Every event and experience prior to the moment you make a choice is affected by the momentum of your history. It’s not a simple black and white issue. People don’t have the same ability to say “no” to anything in life based on what uniquely came before. A rape victim can’t say “yes” to a relationship in the same fashion that someone with no history of sexual violence can say “yes”. A person who had a dysfunctional childhood with eating disordered parents can’t say “no” to food the same way someone with a healthy childhood and relationship with food can. It is necessary to recognize that choices are not isolated incidents shaped by force of will, but links in the chain of a person’s life. The “personal responsibility” question is always about blame rather than understanding, and you can’t fix a problem unless you understand it properly. It’s like beating on a broken item with a hammer rather than opening it up and fixing the real problem inside.

    • Hi, Screaming Fat. I don’t see anything in your comments I disagree with. And I may someday want to post on the notion that all bodies function identically. How unbelievable that THAT mythology lives on! We can accept that a Volkswagen Bug gets different gas mileage from an SUV, we even accept that two different Volkswagen Bugs will get different gas mileage because of their year and maintenance histories and other factors, and they’re just machines with finite mechanics. But people. We accept that all people’s bodies, even with their nuanced chemistries/biologies, require the same amount of calories to metabolize or store a pound. Huh? You’re right on.

      Here’s the big “BUT”: What NOW is different. Why in the past four decades has the bell curve moved? You’ve given a great and provocative answer as to why there is a bell curve, but why has it moved? That’s the question of the day.

    • I actually don’t agree with everything you’re saying, Screaming Fat Girl, in that I think that, literally, many fat people eat less than average and not being able to “put down the fork” is not really an issue for many fat people. They already put it down. It didn’t make them thin.

  3. I was browsing around and found another article linking genetics and obesity:

    A specific gene has been linked to a predisposition to eat more and gain weight.

    On a bit of a tangent, I also found an interesting new (black) square to add in under Genetics: Inflammation of the fat cells:

    This isn’t actually about a genetic predisposition to gain weight so it’s not exactly part of the Fat Roulette board. It’s about the association between obesity and Type II diabetes/metabolic syndrome and a possible causal link between them.

    Excerpt of the most pertinent paragraphs:

    “…However around 20 — 30% of the adult obese population remain relatively healthy despite their obesity. These are populations with a healthy metabolism but who are obese (MHO) while others are metabolically obese but are at a normal weight (MONW).

    Dr Denis said, “Studies have shown that these individuals have a reduced ‘inflammatory profile’. Inflammation caused by normal immune cells called macrophages leads to insulin resistance and Type 2 diabetes — this inflammation is typically seen in connection with obesity but it is the inflammation that is a trigger for diabetes, not the obesity itself. The mechanisms that explain this protection from diabetes are not well understood.”

    He went on to add, “Much like these protected obese humans, the Brd2-deficient mice have reduced inflammation of fat and never develop failure of the beta cells in the pancreas that is associated with Type 2 diabetes.””


    – Around a quarter to third of obese people are actually relatively healthy.
    – Some “normal” weight people are “medically obese” *snort*

    Yes, the majority of obese people do in fact develop type II diabetes. But so do a bunch of NON-obese people. And a SIGNIFICANT chunk of obese people DO NOT develop it – I would not term 20% (using the conservative figure) of a population a trivial minority. All this would suggest to me that the two factors, higher weight/body fat percentage and diabetes(Type II)/metabolic syndrome are not inextricably linked. Highly correlated, yes, but not predictive.

    And now a researcher has (accidentally, but a hey, lot of science is serendipity) found a mouse strain with a gene that unlinks the two. A gene that people have too. And knocking it out changes the nature of their fat cells – no inflammation, no diabetes. Just big, fat, metabolically healthy mice.

    Perhaps this is what’s different about that 20% of the obese who don’t develop diabetes. Or perhaps it’s something else. But it may turn out that it’s not that being fat is bad for you, just that a common genotype is more vulnerable to whatever agent is triggering the adipocyte (fat cell) inflammation that’s leading to the Type II diabetes.
    [Do you remember when they found out that gingivitis/periodontal disease significantly increased your risk of heart disease? The bacteria in dental plaque cause inflammation and can get to and damage the heart. Was the advice to everyone to go out and get all their teeth pulled to prevent or ameliorate their heart disease? Excuse me,but no. It was to treat the gingivitis and related inflammation. Well OK, maybe they did pull out the teeth in some of the more advanced cases but not as a blanket recommendation.

    Maybe one day those inflamed adipocytes can be treated and rendered harmless instead of reflexively recommending their removal from a body that is genetically coded to hang on to them. And everybody will laugh at the idea of trying to treat an inflammatory disease like diabetes simply with weigh loss. Won’t that be nice?

    • Jocetta – Just wondering what the idea that 80% of obese people will develop type II diabetes is based on. It was my understanding that the figure was closer to 20% – that 80% WOULDN”T develop it. Can you cite studies? I can’t remember what, exactly, my impression was based on, but I can look for data as well.

    • Okay. I checked my stats. According to this, which uses population-wide data, 15.1% of Americans with a BMI over 35 have been diagnosed with diabetes. Obesity is defined as a BMI of 30+. Presumably, the percentage of diagnosed diabetics with a 30-35 BMI is lower.

      Now, this doesn’t say anything about the likelihood of contracting diabetes over a lifetime, but considering the fact that people tend to get heavier as they get older, it seems unlikely that 80% of people with a 30+ BMI are going to get diabetes, when less than 15% of people that size have it. So, I’d really like to take a look at the study that statistic is based on.

  4. Forgive me, I was tired and sloppy! Thanks for digging out some accurate numbers for me. I was generalizing from the 20%-30% percent of “medically healthy obese” figure given in the article I had linked to and was quoting from. This would mean that 70%-80% of the obese population aren’t “metabolically healthy” – but not that they all have diabetes, just some condition that could be described as “metabolically unhealthy.” Oops.

    Despite this, the point I was trying to make still holds. In my rather fuzzy way I was going down the “…if what this article says is true, then this would mean that…” road although I did not make that at all clear. The statistics you’ve cited actually bolster the argument I was making. I had deliberated gone with a conservative “worst-case scenario” in assuming that only 20% of obese individuals would not, at some point, develop Type II diabetes. Given your more realistic figures, the correlation between obesity and diabetes, type II is even weaker, although still large.

    Having pointed this out, I am (rhetorically) asking why so much obesity and Type II diabetes research that I read about appears to work from the implicit assumption that obese individuals will inevitably develop insulin resistance and/or diabetes when this is manifestly NOT true for a very significant percentage of the obese population? I also note that the article states that some non-obese individuals develop diabetes in much the same way that obese people do. So, while body fat probably does play a role in the development of diabetes, there are obviously other factors in the equation. Body fat amounts/percentage is only one of the variables involved and yet it is treated as a constant.

    It’s pretty obvious that I think prejudice and unexamined assumptions are getting in the way of good science. The questions you ask and what you look at to answer them make a huge difference in what you find out. The knockout mouse with the missing Brd2 gene that gets fat without getting diabetes was an accidental development and completely unexpected; the original goal was to affect immune cell production. Serendipity is great but you can’t base a research program on it.

    Circling back to the role of genetics in body size, it’s pretty clear it was completely due to genetics that those Brd2 knockout mice were so fat since Dr.Denis & his colleagues had controlled for all other variables. This support my previous bet on the black Genetics square.

    • I agree with you there. According to various internet sources, approximately 1/3 of Americans are defined as obese and approximately 2/3 of people who have diabetes are obese, so there’s a clear association. However, diabetes isn’t that common, even among fat people. The association between diabetes and weight is much weaker than the association between smoking and lung cancer, for example. Also, type II diabetes runs in families, as does obesity. The two may be caused by the same genetic syndrome, rather than being cause-effect. I’ve actually read up on it quite a bit, since I’m fat and so is my dad, and he has type II diabetes. I’ve been fat since I was a kid (wore a size 20 when I was 11) and am now 41 and still not diabetic, but it worries me.

  5. Firstly hi, I am chesh, I am reading here because I am interested in evidence based medicine I really enjoy reading your blog.
    I am not a maintainer because I have read your and other accounts as well as some science around what it takes to maintain weight lost, and considering the cost I took the advice you would give to your freinds, to take the 8 hour a week healthier life route.
    I want to suggest something I haven’t seen much talk around 1960’s would be around the time that the first kids growning up in a vaxination and anti boitic envroment, now don’t get me wrong, I am pro med, pro vaxination, but I wonder if we are seeing changes based on bodies tuned to live with a substantial infectious disease burden (I am thinking here, chest infections, wound infections and so on) which now that it is no longer seeing that infectious disease burden is now “over storing” as protection against diseases which where evolutionarily a major factor.

    For myself personally, psych meds caused major (for me) weight gain, which I accept because my quality of life is much better when I am being treated for psych stuff, so I see the extra whatever kg as the sideeffect which is worth putting up with.

  6. Interesting thought, Chesh. Vaccines. Anti-biotics. You are clearly a black-box thinker too.

  7. Oh, the vaccination meme! Careful where that leads us. I was just reading recently about how more and more parents are afraid that vaccination causes autism. What many don’t realize is that the article in the Lancet (a respected British medical journal)that originally brought up the possibility has been thoroughly debunked and the Lancet itself published a total retraction.

    Our society has forgotten the horrors of polio, smallpox, and yes, even the measles and too many people poo-poo the importance of getting their children vaccinated to provide herd immunity.

    With respect to antibiotics, the questions might be more justifiable. Certainly, we have a problem with non-compliance (i.e. “I feel better, so I’m stopping before the course of antibiotics is over.”), which is one of the reasons why there is increasing antibiotic resistance. I am also concerned about the widespread and unneccesary use of antibiotics in animal feed. That strikes me as downright dangerous and quite possibly one of the keys to our growing girth.

    Just my thoughts…

  8. @newme I am well aware of the problems with non scientific fears around vaccination.

    But you seem to misunderstand me, your comment seem to me to suggest that my hypothesis is linked to something being wrong with how we use vaccines or antibiotics that is not what I am suggesting, what I am suggesting is that because of the wonders, and they are wonders of modern medicine our bodies are preparing for more disease that we are likely to face.

    I am currently on antibiotics, because of a nasty chest infection, in a pre antibiotic age I might have been sick for months, rather than feeling much better, 2 days after seeing the doctor.

  9. Hi Chesire,

    I have nothing, per se, against antibiotics. Used properly, they are a godsend. But pumping them into healthy animals to make them fatter faster? I think not. And I’m sure we agree on that.

    Back to vaccines…they have eliminated diseases that were the scourge of our world. What you seem to me to be saying is that, now that we have eliminated or greatly decreased the incidence of these diseases, we are now over-prepping ourselves for disease. It seems like a real Catch-22. Either the disease runs rampant, or we do too much to suppress it? Enquiring minds want to know.

  10. @newme I don’t have any evidence for this, I want to make clear, I am just wondering out loud.

    I agree that overuse use of antibiotics (both in humans and animals) encouraging antibiotic resistance is a major problem, but possible a topic for another discussion.

    What I am suggesting is some variant of the hygiene hypothesis for allergies. I am not suggesting that we stop washing our hands, or stop vaccinating, I am simply looking for things which might be part of the explanation for the weight gain on a population level in the time period.

  11. Chesire,

    Aha! We’re on the same wavelength when it comes to the hygiene argument! I believe in a bit of dirt. Apparently, children raised on farms have fewer allergies than city kids (sorry, I can’t remember where I heard that) and the one person I know who was raised by an absolutely germophobic mother in the “cleanest” environment possible suffers from a number of life-threatening allergies. Just anecodotal, but interesting.

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