The stupid explodes: obesity now a disability

[Rolfe]

And it's also about portions... I have an obese colleague who is a vegan and very hands-on about her food preparation. Grows a lot of her own vegetables. The problem is that as healthy in principle as this food is, she eats a little bit more than she should is all.

And why wouldn't she? She's out there busting her ass doing all that weeding, which is hungry work. Exercise stimulates the appetite, and one of the demonstrated problems with introducing an exercise routine in an effort to lose weight is that a lot of people report it gives them more cravings, and that they need to eat more before achieving satiety, often out of proportion to the actual calories burned by exercise. She's a good example of this effect.

What is her attitude to her obesity? Is she a "happy fatty"? Does she have no health problems arising from obesity? Is she happy with the way she looks? Does she not mind the inevitable loss of mobility that obesity carries with it?

If she's happy, arguably the only reason to persuade her to change is to prevent health problems developing in future. Maybe she and those like her aren't the top targets of any change initiative.

And you're right about the exercise. Sometimes people think, well I just burned 75 calories, I can have that chocolate biscuit, so they do. And then they have another one.

 

[blutoski]

What is her attitude to her obesity? Is she a "happy fatty"? Does she have no health problems arising from obesity? Is she happy with the way she looks? Does she not mind the inevitable loss of mobility that obesity carries with it?

If she's happy, arguably the only reason to persuade her to change is to prevent health problems developing in future. Maybe she and those like her aren't the top targets of any change initiative.

We've talked about it, because she's engaged with one of the people from my old workplace as a client, and she hasn't lost weight since starting her program. Basically, she wants to lose the weight but is frustrated.

What my colleague is concentrating on now is a volumetrics approach. She loves the starchy vegetables, which I think we need to dilute more. A lot of her produce is heirloom, and USDA calorie estimates are a shot in the dark for those, so we're talking about dilution in water to make soups &c as a next step.

And you're right about the exercise. Sometimes people think, well I just burned 75 calories, I can have that chocolate biscuit, so they do. And then they have another one.

This is one of the credible mechanisms through which exercise appears to be a wash for addressing weight gain across a population. The 2nd one that has growing evidence is that we probably have a limited amount of 'oomph' per day, and if we do more exercise, we do less of other activities. (eg: kids do less playground activities in months where they have physed, it seems to be calorie neutral).

 

[Rolfe]

I'm beginning to think I must be some sort of an outlier as regards ability to stick to calorie restriction. Yes I like food, but I'm also capable of simply not eating. I've been adhering to a regimen of 6000 calories a week made up of three 250-calorie days and four 1300-calorie days, on and off for over a year. The longest I've kept it up has been about six weeks, but then after a variable period off it (anything from three days to - twice - three weeks) I've gone back on it again.

Yesterday things got a bit out of hand and I realised I only had 75 calories for my evening meal. That was on a 1300-calorie day (don't ask!) So I had a 75-calorie evening meal. Today I've only consumed 150 calories in total, and I'm about to have the other 100 calories any minute now. It's nearly 10 pm. (I usually have this at seven, to be fair.) Tomorrow, 1300 calories again.

People have said it's unusual to be able to do this. That they personally couldn't do it. I simply don't know whether they're just being a bit wimpish and they could if they tried, or whether the ability to do this is really unusual. I bear in mind that fasting has been a feature of many religions and people seem to be able to learn to do it if it's a religious obligation. All Moslems who aren't infirm are supposed to do something along these lines during Ramadan.

So does anyone know the answer to this? Is it something anyone can do with a bit of determination, or is it unusual?

 

[Skeptical Greg]

And it's also about portions... I have an obese colleague who is a vegan and very hands-on about her food preparation. Grows a lot of her own vegetables. The problem is that as healthy in principle as this food is, she eats a little bit more than she should is all.....

A bit more of ' what '? I doubt that it's too much ( non starchy ) vegetables or fruit..

It's almost impossible to gorge on vegetables and consume 300 calories in a sitting.

Also, with all the fiber that is in most vegetables, a lot of stuff gets whisked away before it has a chance to be utilized for energy or stored as fat..

 

[blutoski]

I'm beginning to think I must be some sort of an outlier as regards ability to stick to calorie restriction. Yes I like food, but I'm also capable of simply not eating. I've been adhering to a regimen of 6000 calories a week made up of three 250-calorie days and four 1300-calorie days, on and off for over a year. The longest I've kept it up has been about six weeks, but then after a variable period off it (anything from three days to - twice - three weeks) I've gone back on it again.

Yesterday things got a bit out of hand and I realised I only had 75 calories for my evening meal. That was on a 1300-calorie day (don't ask!) So I had a 75-calorie evening meal. Today I've only consumed 150 calories in total, and I'm about to have the other 100 calories any minute now. It's nearly 10 pm. (I usually have this at seven, to be fair.) Tomorrow, 1300 calories again.

People have said it's unusual to be able to do this. That they personally couldn't do it. I simply don't know whether they're just being a bit wimpish and they could if they tried, or whether the ability to do this is really unusual. I bear in mind that fasting has been a feature of many religions and people seem to be able to learn to do it if it's a religious obligation. All Moslems who aren't infirm are supposed to do something along these lines during Ramadan.

So does anyone know the answer to this? Is it something anyone can do with a bit of determination, or is it unusual?

I think anybody can learn to do anything, but they have to make choices. For me, I don't have a TV or listen to radio, so I don't see/hear food ads; it's easier for me to go through my day without triggering a hunger craving. It works for populations and individuals, but it would be a sacrifice for most people. It's unusual for it to be 'easy' like it is for me. (I grew up without a TV, so not having one is not a big deal - it would be a big deal for most people who grew up with TV I expect).

Having said that, fasting is not a great analogy, as fasting is intentionally temporary, and research on fasting suggests it is on average followed by binges that overcompensate (fat tuesday follows lent, for example - that's not a coincidence), and seems to have a net negative effect overall. Some people will find they don't overcompensate afterward, so fasting may work for them as a calorie reduction strategy.

I think what's unusual is paying attention to food at all. Most people just eat at mealtimes, finish their plate, that's the typical approach to food in the west.

 

[Rolfe]

That's an interesting observation. I also grew up without a TV and I don't watch TV now either. The only radio I listen to is a classical music station. Even when I did watch TV it was mostly the BBC where there are no adverts. (Of course there are foodie programmes!)

I think maintenance of weight loss is at least as important as losing it in the first place, and not enough attention is paid to that. I'm still thinking out what I'll do, although I'm only 4 lb from my absolute go-no-further target. Just quit the fast days and stay on 1300 calories a day to start with maybe, and introduce some relaxation like switching back to full-cream milk (which I like) and bread with more calories in a slice.

I think the ability to fast for short periods is one I'll utilise in future. My problem wasn't constant over-eating, it was failing to rein back after a defined period of feast. I have absolutely no bloody intention of getting back to the state where I can't get into the clothes I like, and I may end up simply going back on the diet for short periods now and again. (Let's face it, a month is actually no real problem and if I'd done this for a month every year for the past 15 years I'd have worn the clothes out by now.)

 

[Guybrush Threepwood]

Having said that, fasting is not a great analogy, as fasting is intentionally temporary, and research on fasting suggests it is on average followed by binges that overcompensate (fat tuesday follows lent, for example - that's not a coincidence).

I'm following this thread with interest and really enjoy your contributions. You seem to have a very in depth knowledge of nutrition.

Church calendars not so much. Pancake day is before lent. You use up the good stuff before starving.

Then pig out on chocolate eggs at Easter

 

[blutoski]

A bit more of ' what '? I doubt that it's too much ( non starchy ) vegetables or fruit..

It's almost impossible to gorge on vegetables and consume 300 calories.

Well, recall she's in balance right now. So her weight gain predated all this. At the moment, she's maintaining at about 1600 calories per day at her weight.

As to where the calories are coming from... nuts come to mind. She makes her own peanut butter from scratch, it's pretty tasty. I weighed her breakfast toast spread, it was about 450 calories right there, not including the bread (which she mills from grain she obtains in trade for her surplus vegetables).

Lentils and bulghur and other grains are another category... and olive oil... homemade pastas as well also from that flour. All raw ingredients she prepares into home cooked meals.

Anyways, the point I was making is that it's not a slam dunk that the Mennonite approach (she's Hutterite and uses her ancestors' recipes with modifications to substitute for meats) is a route to svelteness. It's vulnerable to portion mismanagement, which is where I think she struggles.

Also, with all the fiber that is in most vegetables, a lot of stuff gets whisked away before it has a chance to be utilized for energy or stored as fat..

Not sure what you mean by that. The calorie counts in the USDA take absorption into account, so WYSIWYG.

 

[blutoski]

I'm following this thread with interest and really enjoy your contributions. You seem to have a very in depth knowledge of nutrition.

Church calendars not so much. Pancake day is before lent. You use up the good stuff before starving.

Then pig out on chocolate eggs at Easter

True, sorry about that, and I'm doubly embarassed, as my adopted family is Catholic, and I've done this every year since I was about ten.

Lent is followed by Easter Sunday, which is a feast, and specifically for kids it involves chocolate binges these days.

The point being that fasting is traditionally followed by a feast.

 

[Rolfe]

I think, done right, the idea is that you maintain, you don't rebound and overshoot. But this is going to be subject to an awful lot of individual variation. My own religious tradition doesn't do fasting at all, or feasting, so I couldn't really say.

I believe Ramadan involves rather a lot of late-night binging, but people still lose weight overall during Ramadan. (Then they finish with a special feast. It's human nature.)

 

[blutoski]

I think the ability to fast for short periods is one I'll utilise in future. My problem wasn't constant over-eating, it was failing to rein back after a defined period of feast.

This is actually the current model of weight gain... that we maintain 360 days out of the year and eat an extra 2,500 celebratory calories each of the remaining 5 ("It's my birthday, what the heck."), and never get adjusted back. Year after year after year until we reach a genetically predefined plateau. If you're Samoan, that's a 350lb plateau. If you're Okinawan, it's a 165lb plateau. Such is life.

Oh, and aside from celebrations, there's lifestyle changes that seem to add weight, which research suggests are our reaction to environmental changes. eg: new place, new priorities, new distractions, it takes awhile to learn strategies for sensible eating, but by then it's already gained. An example is the "freshman fifteen" - very real, very well documented, and a good example of how environment shapes our eating habits. It's the same person who was 15lbs lighter eight months ago: same willpower, same values, &c.

So the challenge is to figure out whether it makes sense to compensate for the burst periods by establishing 360 days of slight deficit (hard to calculate, as this difference is bigger than error margin on calorie estimates) or to maybe cluster intense fasting against those periods, with special attention to preventing a post-fast compensatory binge.

I don't have an answer, but it brings another 'character' situation to mind, which is personal finance (the other life skill that I listed above as something we fall down on educationwise). People don't seem to get chronically into debt - we make a few mistakes and pay for them for decades. Obesity seems to have the same structure.

 

[Rolfe]

This is actually the current model of weight gain... that we maintain 360 days out of the year and eat an extra 2,500 celebratory calories each of the remaining 5 ("It's my birthday, what the heck."), and never get adjusted back. Year after year after year until we reach a genetically predefined plateau. If you're Samoan, that's a 350lb plateau. If you're Okinawan, it's a 165lb plateau. Such is life.

That is exactly what happened to me. I'm interested to learn that it's a recognised phenomenon.

And yet, it was only these last 15 years. For the ten years before that, I'd maintained a BMI of around 20. I don't really know what I was doing to achieve that. In fact, leaving out a blip that happened in the late 1980s that correlated with a new job and new house and new habits, and was ironed out with a very similar calorie-restriction plan (five months on 7000 calories a week but without doing fast days) I had stayed right there since some "puppy fat" melted away on its own in my early 20s.

I realised I was going wrong in 2000, but there were a lot of things going on that prevented me from addressing it. I should have introduced a "feast is followed by fast" regimen, but I didn't. I intend to remedy this.

I'd be interested to know how many other people are in the same situation. It could suggest that advising short periods of fasting especially after feast times like Christmas and summer holidays might work better than trying to get people to cut back by an impractically small amount every day.

On the other hand, someone will say that this advice might trigger anorexia nervosa in susceptible individuals. You can't win.

 

[Rolfe]

Blutoski, what's your opinion on the nutritional value of ready-meals, aside from their calorie content? We keep being told that they're bad medicine for various reasons like too much fat, too much salt and so on. These warnings worried my mother, who had a BMI of about 19 and was sometimes concerned that she was underweight, and was also on extra salt tablets prescribed by her doctor. She just heard the "these things are bad" message and couldn't understand that a bit more fat and a bit more salt really wouldn't harm her in the slightest.

I'm not convinced they're such a bad thing so long as excess calories are avoided, but to hear the public information we get you'd think they were a fast track to ill-health and heart attacks.

 

[blutoski]

Blutoski, what's your opinion on the nutritional value of ready-meals, aside from their calorie content? We keep being told that they're bad medicine for various reasons like too much fat, too much salt and so on. These warnings worried my mother, who had a BMI of about 19 and was sometimes concerned that she was underweight, and was also on extra salt tablets prescribed by her doctor. She just heard the "these things are bad" message and couldn't understand that a bit more fat and a bit more salt really wouldn't harm her in the slightest.

I'm not convinced they're such a bad thing so long as excess calories are avoided, but to hear the public information we get you'd think they were a fast track to ill-health and heart attacks.

I think that 90% are reasonable portions, but high in calories for the nutrient value, and very high in sodium; but you can shop around and find that 10% that are acceptable frequent replacements for prepared meals. The remaining problem will be variety and taste and therefore adherence.

But they're not poison. The only common ingredient I think should be 100% avoided is trans fats. And that's saying something because I regard alcohol as a toxin, but still categorize it as a 'sometimes food'.

 

[Rolfe]

Thanks for that. So, proportionately high in salt and low in (nutrients? which nutrients? protein, trace elements, vitamins, minerals?) for the calorie content.

I'd be interested to know how you can completely eliminate the consumption of trans fats though.

 

[blutoski]

Thanks for that. So, proportionately high in salt and low in (nutrients? which nutrients? protein, trace elements, vitamins, minerals?) for the calorie content.

Soluble fibre is a big missing macronutrient in most of the packages I've seen. This is because they all seem shifted toward meat and starch from refined inputs (which makes sense, it has to be resistant to spoilage). Meat and potatoes, meat and pasta, meat and rice. My rule of thumb is that my plate should be midnight to six pm vegetables minimum, six to ten starch, and ten to midnight protein. I substitute some protein for starch if the protein is tofu.

A lot of the 'meals' seem to have a token vegetable, not enough to be a consistent meal replacement.

I'd be interested to know how you can completely eliminate the consumption of trans fats though.

At the moment, there's a proposal in Canada to outright ban them from processed foods, and we already have to label them on packaging. I think the FDA has called for US manufacturers to eliminate them as well, so in a couple of years this will be moot. For unrelated reasons, I don't buy a lot of packaged foods that would include trans fats anyway (I do my own baking for example: I haven't bought a bag of cookies in probably 30 years, likewise donuts).

Although, you have a point, there's an unavoidable background concentration of trans fats in anything we eat, just from natural reactions. It's the higher concentrations from manufacturing processes that are important to avoid. The analogy is cyanide I guess: sure it's poison, but the natural background is safe.

This is another element of my approach that triggers skeptical suspicion: I agree with Pollen's rule of thumb that processed food is in general a sign of nutritional deficit. It's not a hard rule, but it's a practical heuristic. It sounds like anti-science or anti-technology, but I am addressing the reality unfortunately.

 

[Skeptical Greg]

...
Not sure what you mean by that. The calorie counts in the USDA take absorption into account, so WYSIWYG.

Googling " benefits of fiber " brings up a lot of references to the fact that
fiber interferes with the digestion of dietary fat.

I don't think the USDA calorie counts take that into account.. i.e. The calorie count for a tablespoon of butter doesn't take into account that you ate it with a cup of oatmeal..

One example:

Nutritional implications of dietary fiber

The above example has references to several other papers..

 

[casebro]

The only thing I can ad to the current discussion on pre-packedo foods is that we are learning more about micro-nutrients everyday. Maybe pretty soon we'll know what we don't know, and learn a lot. Maybe most of us overeaters don't absorb Manganese, frinstance. So we overeat just to get barely enough. Is there enough manganese in the pre-packed?

Current advice is to eat a varied diet. But maybe meat and potatoes is all I need- and rutabaga peels. Genetic variations the key?

Perhpas Rolfe's ability to fast is aided by her diet being exactly what she needs?

 

[The Norseman]

The population is composed of individuals though, and the utter inapplicability of one-size-fits-all solutions is part of the problem. So individual anecdotes about how one person has successfully tackled it, or the particular reasons why someone else feels they can't tackle it, are actually quite illuminating.

True, but in this case, there is a specific thread in FC just exactly for anecdotes of their personal weight loss/gain/maintenance. This thread is more specifically for obesity being considered a disability.

I wouldn't object, however, if someone had personal experience being on disability due to their weight and wished to share that here.

 

[Rolfe]

I think people often underestimate how much "disability" even a relatively small degree of overweight/obesity can cause. My BMI was never over 29, but the extra weight I was carrying was definitely hindering me in my day-to-day life. I couldn't walk so far, and I found bending down and standing up again quite a chore. At work, bending down to examine things on the floor was causing me distinct problems.

A small example. See this? https://goo.gl/maps/qW8qqaQsTEw It's a wooden rail surrounding a car park, with a fairly well-defined track where people take a short cut by ducking under the rail. Before I lost the weight I couldn't do that without going down on one knee in the mud and hauling on the rail to pull myself upright on the other side. It was such a performance that I preferred to walk round. The other day (BMI now 20) I went under it, wearing a dress, with my handbag in one hand and my car key in the other, without touching anything and without the slightest difficulty.

Simply having that greater degree of flexibility and mobility is a great help. If a BMI of 28.8 can put such a crimp in it, what on earth is it like to have a BMI of 35 or 40? It's not just full-on disability, it's the low-grade additional struggle to cope with even simple and ordinary things in life that's so depressing when you're overweight.