Tuesday, 27 January 2009

Why are thin people not fat? (And why am I fat?)

"Why are thin people not fat?" was a Horizon documentary shown last night. It's available on iplayer (possibly only in the UK). The programme followed a small group of young, naturally thin adults who were monitored for weight, measurements, body fat percentages and so on while eating huge amounts of food and avoiding exercise over a few weeks.

From memory, the following points came up:

*Naturally thin people found it difficult to put on extra weight. Two people could not manage to eat all the extra food.
*One person put on extra muscle instead of extra fat and increased his metabolic rate.
*All the participants easily lost weight at the end of the study

Meanwhile, some other obesity research was looked at:
*A virus which causes chickens to gain weight is more common in fat people
*Once laid down, fat cells don't go
*Evolution has selected for a tendency to fatness
*Small children fall into two groups - those who continue to eat when full, and those who lose interest in food when full
*People seem to have a set weight point and adjust their diet and exercise naturally to maintain that weight.
*Fat people who lose weight, have an appetite for extra food.

There was more, but that's a quick sum up.

I was particularly interested in this story, because for most of my adult life I wasn't fat. I was naturally slim - not thin, but within a "healthy" BMI range. I seemed to be very much like the naturally thin people on the programme. I didn't have any desire to overeat. I lost interest in food after I was full. I was never overweight as a child.

Now my weight has changed, but I still behave much like a naturally slim person. I have a normal appetite. I don't overeat. My house is full of chocolate and other treats left over from Christmas but I only have the occasional piece now and then - not because I'm trying to resist but because I don't want it. So the puzzle is - why am I eating as I have done for all my adult life (apart from a few misguided attempts to diet), but steadily gaining weight?

The programme didn't give any explanations for somebody like me. (Unless you count the virus idea people seem to be pooh-poohing at the moment).

Sunday, 25 January 2009

Thank you for telling me I'm fat. I hadn't noticed.

Meanwhile, here is Eamonn Holmes talking about being fat, from a male perspective.

'People slap my belly all the time, and the truth is, it really hacks me off,' he says, with quite unexpected feeling. 'It's because I'm a man. Everything's a joke when it comes to overweight men. Women have it much easier.

'No one would ever say, "Oh, you're fair piling on the beef there" or "That's some ass you've got on you". They wouldn't pat a woman's tummy or prod her thighs. But, as a bloke, I can tell you that it happens all the time. They go, "Oi, Eamonn, that's some paunch". People feel they can touch you, and I hate it. If another person lays a finger on me...'

He pulls his jacket around the midriff in question. 'The thing is that they never expect a man to be offended. They do expect women to - and know that if they said those things to a woman, she would probably burst into tears or slap them. Well, I am offended, too, even though I've done my fair share of laughing along with it. Men do hide behind jokes when it comes to being overweight. They wear it as some sort of trophy, laughing along with all those, "you'd better cut down on the beer" jibes. I hardly ever even drink beer.'

Sometimes, people try to give Eamonn diet advice while patting his belly, which is a big mistake. 'What gets me is all those people who say, "Eamonn, I lost three stone just by cutting out sugar in my tea". If one more person says that to me I will scream.

Even worse are the people who say, "Eamonn, I have to tell you that what worked for me was cutting out bread. I just cut out bread and, do you know, I lost seven stone in no time." Why do these people seek me out? I always think, "**** off!"'

We've all been there, Eamonn. Men get the more obvious comments and have to try to treat them as a joke, I suppose. But I think women know that the comments are lurking there unsaid - unless you visit a health professional, of course, and then they may not remain unsaid. I recently had to see a doctor who hadn't met me before, and it seemed inevitable that my weight had to enter the conversation. Of course, health professionals are advised to bring up weight issues, as part of their role in tackling obesity. I think there is a misunderstanding that fat people are fat because they didn't notice they were fat. And if their fatness is pointed out to them, they will then eat less and become less fat.

Health inequalities and obesity

I have just been reading this article in the Guardian:
A more effective way of combating child obesity

The article claims that "health inequalities are inextricably tied up with obesity in children". The "evidence" is the WHO report, I suppose, which tells us that a boy born in Calton in Glasgow has a life expectancy of just 53.

I'm not sure where the connection to obesity comes in there. Are they suggesting that the men of Calton tend to die of obesity? Of obesity-related illness? We're not given the causes of death. We're not even told how obese the men of Calton are in comparism to men from other areas.

I keep mentioning the men of Calton, because the Calton life expectancy figures have been much reported, but only for the men. Apparently the life expectancy for women is 20 years higher, at 73. Surely that discrepancy is worth looking into, along with the causes of death, rather than just assuming it's the result of a diet of deep fried pizza?

I'm not denying that poverty seems to be linked to health outcomes. But I'm questioning the automatic assumption that the cause of death in poorer areas is obesity.

The article goes on to say that "a quarter of children and the majority of the adult population will be obese by 2050".

"It is not simply a question of getting children, and their parents, to eat less. Compared to the late 1970s, seven- to 12-year-olds are consuming fewer calories, not more. It's about getting them to be more active."

So the increase in obesity is not caused by extra calorie intake. (And a commenter helpfully points out that it doesn't seem to be caused by lack of exercise either, because exercise doesn't prevent childhood obesity).

But as the article points out, government interventions don't make much difference to obesity either. Despite that, the aim seems to be to keep increasing government intervention, at increasing expense.

Tuesday, 20 January 2009

Half Ton Son

I watched "Half Ton Son", the (inaccurately named) documentary about Billy Robbins, the worlds heaviest teenager. It's available on Catch up TV here (in the UK), and here's a synopsis.

I don't claim to know the truth of this story. I'm very aware that these documentary programs take a certain slant on the story and that information may be omitted or misrepresented. The slant taken was that Billy was being killed by his mother's overfeeding, as she tried to deal with her grief over the death of her previous son, Matthew. It was tearful viewing, as Billy's mother Barbara struggled not only with the still raw grief over Matthew's death, but the guilt over possibly killing Billy. (I don't know if loading her with more guilt was the best way to deal with the situation. I think an overload of guilt can be paralysing and/or destructive. However, as I mentioned, we don't know what was omitted). She said that if he died she would want to die too, to get in the coffin with him. He said that he felt he was slowly killing her. At the end of the programme we were told that the two had been separated.

But one thing really was bothering me by the end of the programme. Billy's facial expressions and speech seemed just like a depressed person's. It turned out that he had been bullied at school, and so had had to be homeschooled. He apparently had no friends. He spent almost all his time in his room, with his mother visiting to bring him food or to wash him. His father seemed caring, although he didn't seem to spend much time with him. It seemed to me that depression might be a risk for anybody in those reclusive circumstances, especially if the circumstances had been brought about by bullying. Billy's sexuality is never mentioned, and he's treated like a child sometimes by his mother, but also sometimes by the other adults in contact with him, I felt. At one point, he laughs as he's given anaesthetic, and one of the medical staff mentions that it's the first time they've seen him laugh. And right enough, he doesn't seem to laugh or even smile much at all. After the surgery and some weight loss, he is back home, holed up in his dimly lit bedroom, and a showdown develops with his mother, who is trying to encourage him to exercise. She doesn't want to bury another son, she says and asks him, rhetorically, if he wants to die. Yes, he says, sometimes he does.

And that all worried me a lot. Maybe Billy wasn't depressed, but what I was seeing seemed to point to him needing assessment, at least. The bullying, the social isolation, the apparent eating disorder, the lack of smiling or laughter, the lack of motivation or energy and particularly the desire to die were warning bells for me. But, unless I missed it, Billy's possible depression was never addressed. It was as if his size dwarfed all other problems he might have. The answer to everything was for him to lose weight. And maybe it WAS the answer to everything - I just don't know. But even if it was, treating his depression may have helped with his motivation, and surely would have given him a better quality of life, before, after and during the weight loss. And surely, even, if the bullies had been dealt with and Billy had had supportive friends and a social life, his life would have been better in the first place.

It seems to me that it may be another case of people not being able to see beyond the fat. The fat is the problem. Removing the fat is the solution.

While Billy was in my mind, I read this other story about David Smith:
'Man mountain' who nearly ate himself to death loses 28 stone and becomes fitness instructor
David seems to have had a happy outcome. But again, I'm bothered by the description of his life as a fat man:

He said: 'I had been overweight all my life.

'I would have sticks and stones and dog mess thrown at me and I would be spat on.
I've had a broken arm and black eyes because people didn't like me because of my weight.

'It got so bad that I didn't want to leave the house and I didn't even feel comfortable in my own backyard until it was dark out.

'I felt like I deserved as much pain as possible and I wanted to kill myself.

Isn't that heartbreaking? What upsets me, is that he seems to judge himself for the terrible way he was treated, and again, the general thrust of the article is that his weight was the problem. He wouldn't have been so terribly bullied if he hadn't been fat. Now that he's no longer fat, he's no longer being bullied. Losing weight was the solution. The horror of people indulging in such utterly reprehensible behaviour as the emotional and physical bullying he describes is not addressed. Did the attacker or attackers who did this go to court? We don't know, and we get the impression it doesn't matter because they weren't the problem, David Smith's fat was. He was driven to an extreme level of social isolation, like Billy, and like Billy, he wanted to die. The same cycle of bullying, social isolation and depression, all being seen as an inevitable result of being fat rather than something that should be tackled.

Monday, 19 January 2009

Calorie controlled menus

Restaurants and takeaways to print calorie content on menus in bid to curb unhealthy eating

Fast food and sandwich chains will begin displaying the calorie content of their menus by the summer in an effort to help customers fight the flab and switch to healthier options....

.....The calorie count scheme proposed by the Government's Food Standards Agency mirrors a compulsory regime adopted in New York last year. This has led to an average reduction of 50-100 calories for each order placed.....

....However, the plan faces opposition from the British Hospitality Association amid claims it will add to business costs and threaten jobs at a time when small food outlets are struggling for survival.

Where to start?

The first sentence implies that the healthiness of foods can be measured by the amount of calories. To a certain extent, yes, we need calories, and therefore food which provides calories, rather than not, is desirable. But obviously, they are associating the healthiness of food with less calories, rather than more. Presumably the lowest calorie option is thought to be the healthiest option, regardless of the content. So, supposedly, one apple is healthier than two apples, one grape is healthier than a bunch of grapes and boiled water is healthier than soup.

The second part - about the scheme resulting in a reduction in calories per order placed - what does that mean, on its own? Did people go for "healthier" options, or choose less "healthy" but lower calorie options? Did the lower calorie intake at this meal mean a lower calorie intake over the day, the week, the month, the year? How was the people's health affected? Did they lose weight? Because, lets face it, if there was no measurable difference in health and/or weight, then what's the point?

Now the last bit, about the problems for small businesses. There's a list of businesses which are signing up, and they are big companies like Pizza Hut who serve pretty much exactly the same food, cooked in exactly the same way, in the same portions in all their restaurants. So it's feasible, maybe, that they could give an idea of the calorie count of each of their dishes. MacDonalds already do this, I think. I remember the paper things they put in the trays used to have the calorie count of their foods on them. But for a chef in a small restaurant, would it be so easy? I suppose you could make one portion of the dish, measuring ingredients carefully, and take it to a lab to have the calorie count tested. Or you could carefully weigh and measure all the ingredients and count their calories. But that wouldn't be terribly accurate, because often the calorie count will change during cooking (oil drains off or is not absorbed). And in both cases, you'd have to make sure that you continued to accurately measure all the ingredients each time somebody ordered a dish. No dashes of that, or knobs of this, or handfuls of the other. And your ingredients would have to be standard - if a steak was half an ounce overweight, you'd have to cut that extra half ounce off, and presumably throw it away, unless you had invented and measured a calorie controlled recipe for small pieces of steak. It sounds like a nightmare to me.

But finally, eating out isn't just about calorie intake. We could get plenty of calories cheaper at home. I eat out to be sociable, to mark occasions and for the pleasure of a meal which I haven't cooked myself and don't have to wash up after. I probably do eat a bit more when I eat out than I would at a normal meal - there's plenty of time to eat, it's slow and enjoyable, I'm not tired and flustered from cooking, and the food, hopefully, is delicious. It's a sensual pleasure, and one that I'm paying money for. I don't want to be expected to choose my food according to the calorie count.

And that's what will happen, won't it? We'll maybe be able to ignore the calorie count, but I bet that when we're out with a group of people, some are going to notice whether the fat person chooses a low or high calorie option, and perhaps make some judgment about them because of that.