Oh, Matron!

On “Health at Every Size”

Oh boy. I don’t think I’ve ever written a post outside of the realms of aggressive atheism that I knew before I even started was going to be such flame bait. That said, I will try to keep this sensible and not bash any particular demographic. My goal here is to state facts, not to tease obese people. I’m even going to add a disclaimer: I am a chubby fat-ass. Oh yes. But I’m not kidding myself about the impact that has on me.

Health at Every Size (HAES), from their own website, ”acknowledges that good health can best be realized independent from considerations of size. It supports people—of all sizes—in addressing health directly by adopting healthy behaviors ”.

That’s a good goal, and it’s one you have to approve of. Getting anybody to be healthier is a good thing; getting somebody who’s very unhealthy to be healthier is even better. So I don’t want to take issue with that. But I really do take issue with some of the methods it advocates and the messages it sends. I’ll get on to those in a moment.

So: Who invented Health at Every Size? A lady by the name of Linda Bacon (save the jokes, people), who to be fair holds a lot of qualifications in a lot of disciplines. However, while she does have a PhD in physiology she’s not a medical doctor, and that makes me a little wary of putting too much weight in her opinions about something as important (and medical) as obesity and overweight. It’s also interesting to note her list of peer-reviewed published works: Not extensive, and nothing in any of the big, high-impact journals. She calls herself an ”internationally recognized authority on weight and health”, but honestly I see nothing in her public profile that backs up that assertion, and I’m cautious about people who proclaim themselves to be internationally recognized. If it’s true, they shouldn’t need to say it themselves because other people are saying it for them – I read widely in medical and care journals, and until I started looking at the HAES website, I’d never heard of Linda Bacon.

The HAES website lists three principles that I want to talk about.

First: ”Accepting and respecting the natural diversity of body sizes and shapes.”.

Yes. Totally with you on that. We do come in all shapes and sizes, and it is nobody’s place to make judgements about an individual’s weight. There is a huge amount of body dysmorphia in the Western world, mostly thanks to media depictions of absurdly “perfect” (I use the word guardedly) bodies, faces and teeth. Anybody who doesn’t look like Beyonce or Brad Pitt* is made to feel like they’re inferior, not good enough, second class. And that’s a bad thing. So I have no bone to pick with this point at all.

Second: ”Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.”

…Aaaaand then again, there’s this one. Oh boy. How much is wrong with this one? First of all, Western diets (particularly among poorer demographics, who are also – non-coincidentally – more obese) mostly use fat and sugar as flavours. It’s a general rule of thumb that any processed food proclaiming itself to be low in fat is likely to be high in sugar, and any processed food proclaiming itself to be low in sugar is likely to be high in fat. The problem with fat and sugar (particularly sugar) is that they are incredibly calorie dense and are digested and absorbed by the human body very, very easily. A tablespoon of sugar contains 45 calories and no nutrients whatsoever except pure carbohydrate, and your body will absorb all of those calories immediately. On the other hand, a large bowl of salad will come in at less than 50 calories, not all of which will be absorbed by your body, and a shedload of micronutrients that a healthy body really does need.

The reason that this is such a problem is that sugar triggers the pancreatic feedback response, dumping insulin into your body. Insulin does two things in this context: First it enables cells to absorb glucose in your blood quickly and easily so that your sugar levels (which have already risen rapidly at this point) drop rapidly back down, and it stimulates your body to store fat. That’s right. Sugar makes you fat. It also has an addicting effect; when the sugar rush is followed by the sugar slump, your body wants more sugar. And that’s more high-density calories that your body just does not need.

The “Too Long; Didn’t Read” version of this is: Processed foods and beverages are addictive, calorie dense, habit forming, nutritionally crap, and don’t satiate hunger. They trigger a pleasure response, but it takes way, waaaay too much volume of them to fill your stomach and satisfy your appetite.

And chances are, if you’re already overweight, obese or super-obese, the foods that you respond to hunger cues with and get pleasure from are foods that you really, really shouldn’t be eating.

On to principle three: ”Finding the joy in moving one’s body and becoming more physically vital.”

Or, as it’s otherwise known, ”Doing exercise and getting healthier, which as a side effect will cause you to lose weight”. Do I even need to add anything here? Of course better cardiovascular health through exercise is a good idea. Anybody who tells you otherwise is a moron.

Now I’m going to move on to some things that come from Linda Bacon’s own promotional website.

”MYTH: Fat Kills. REALITY: On average, ‘overweight’ people live longer than ‘normal’ people.”

How can I put this? It seems to me that this quote is misleading. It seems to me that a layperson probably doesn’t know the distinctions between overweight, obese, morbidly obese and super-obese. It seems to me that Linda Bacon might be deliberately using the word “overweight”, knowing that it’s probably the word most people in all of the above brackets would use to self-describe. It also seems to me that The New England Journal of Medicine (one of those big, high-impact journals I mentioned earlier) has published research which disagrees strongly with this point. It seems to me that a reasonably unbiased, well informed, outside observer might look at this point on Linda Bacon’s website and consider it to be very cynical and manipulative indeed.

Moving on.

”MYTH: Lose weight, live longer. REALITY: No study has ever shown that weight loss prolongs life”

Well this is just flat-out wrong. I can only charitably assume that Linda Bacon doesn’t know about Google Scholar, because it took me all of about ten seconds to find a study which evidences a link between losing weight and living longer. I assume that Linda has Athens access. Because I do. And there is more than one study that says the same thing.

”MYTH: Anybody can lose weight if he or she tries. REALITY: Biology dictates that most people regain the weight they lose, even if they continue their diet and exercise programs”

(Emphasis mine).

And physics dictates that this point is utter bullshit. It’s really simple: Your body cannot create mass or energy out of nothing. Therefore, if calories in equals less than calories out, your body converts mass to energy to make up the difference. Conversely, if calories in equals more than calories out, your body converts energy to mass to store the excess. This is not rocket science. I would love to know what research Linda Bacon has to support her assertion here, because I guarantee you if there is any it’s based on self-reporting by study participants – Because people routineliny underestimate their own calorie intake by A LOT, while simultaneously overestimating their own physical activity levels.

I’d like to throw one more point in here before I close. Life expectancy is going up, even amongst high BMI populations. But that isn’t because high BMI is healthy; life expectancy is going up despite increasing BMI levels. The fact is, if you have a high BMI, your life expectancy is still much lower than it would be if you have a normal BMI.

The danger in the HAES movement lays in the fact that it’s impossible to take a general rule of thumb and apply it to a whole demographic. While it’s entirely possible to be both fat and healthy, it is very rare to be both fat and healthy, and everybody thinks they’re the outlier, the exception to conventional wisdom. The problem is, most of them are wrong.

The HAES movement is popular amongst what is known as the “Fat Acceptance Movement” (or self-styled “Militant Fatties”). This is a demographic that has already made up its collective mind to ignore evidence and reality in favour of confirmation bias.

That is a group of people who nobody is ever going to convince that they are harming themselves with their lifestyle choices. When their knees collapse and have to be replaced, when they’re on BiPAP at night so they don’t die of sleep apnoea, when they’re on mobility scooters to go to the shops, these are people who will insist that all of those things are coincidental, that they’re nothing to do with their weight. Ultimately, though, when they have a serious cardiac event twenty or thirty years before their healthy BMI contemporaries and lay dead on a mortuary table, they’ll still have been just as wrong.

*Disclaimer: I think she looks like a blow-moulded Barbie doll and he looks like a skinny manlette, but whatever.**

**Disclaimer 2: Yes, I just judged two people on their appearance. I’m a hypocrite. Deal with it.

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