walkitout (walkitout) wrote,

Kolota, _Rethinking Thin_ and a big ole rant

I got _Rethinking Thin_ by Gina Kolota (yeah, yeah, yeah -- everyone's made the joke already about that name; she said on the Colbert Report it didn't occur to her until after her marriage. Hmmmm.), and it was an interesting read but I'm glad I didn't spend the money. The first half, largely historical, was an above-average survey of the history of dieting to adhere to conventional ideas of what a body should look like/be/do. Covers all the usual suspects and gives a bit more information about some of the characters (Fletcher was from _Lawrence, MA_?!? And could do almost a double century on a bicycle at the turn of the 19th century?!? Holy mastication!).

The second half, an overview of current research/science on how appetite/weight control/etc. interact, is less good, and it's an artifact of her approach. I'm actually really sorry to say this, because this book is _exactly_ the kind of non-fiction I love. She got interested. She found experts. She stalked them. She took ample notes. She shared the results with us. Unfortunately, she didn't pick the best experts (violating rule 1: don't talk to anyone at the CDC under Julie Gerberding. Duh!). Then she did not check out some important assertions. She got Williamson at the CDC (first name escapes me; book has been returned) to tell her in an author interview that as a nation we are not less physically active than previous generations. I could weep from frustration and anger. He -- and she -- did nothing to investigate this, and there has been study after study after study to the contrary AND showing how that connects to weight gain (people who move to the suburbs gain weight). There've been some neat analyses of the impact of changing parenting norms -- and rules about who gets bussed and who doesn't -- have virtually wiped out kids walking to school, and the impact that has on kids activity levels.

There is nothing -- absolutely nothing -- in this book about body composition, and very little about waist measurements and how they are a better measure of health risk than either raw weight or BMI.

Nevertheless, for its many flaws, it is an interesting and compassionate look at anyone who has struggled to maintain or achieve a particular weight/shape, and why various strategies are doomed to failure. She also does a nice job of exposing (once again) that the overweight range is the best for morbidity and mortality, and the statistical shenanigans engaged in to show otherwise would never be tolerated in other medical communities (say, cancer -- and it's not like I think their statistical manipulations are above reproach, either, but that's not relevant now).

Since I'm also reading the excellent _The Wisdom of Crowds_ (review to follow some day; thanks I.! Great book!), I'm going to rant a bit about why weight/shape control is so difficult. True, many chronic dieters have completely insane goal weights. But that explains why they don't achieve their goal; it doesn't explain why they get so discouraged at the difficulty of losing any weight, or what happens when they "plateau". I think the problem lies in the value attached by most of us to weight gain/weight loss/weight stability. It's a little complex.

The biggest problem is that we have difficulty perceiving the truth. We believe we lost three pounds, even though we should realize that in fact, we're down a quart or so, or possibly the scale lost its calibration. We see that we gained a pound, but believe it's just that we haven't taken a dump lately. We think we're weight stable, unless we're confronted with substantial evidence to the contrary -- we'll assume the jeans got put in the dryer on hot, say, and avoid the scale for weeks on end. And I've met people who don't own/use a scale assert they know their weight because that's what they weighed months ago at the doctor's office, knowing full well their weight changes from year to year.

Even when we do perceive the truth, we do not value weight stability. In a country in which most people's weight creeps up inexorably, we (including apparently everyone Kolota speaks to) assumes we're stable unless shown otherwise. The medical community used to sign off on this, but about a decade ago, they stopped doing so (around the same time the definition of overweight jumped down the scale and started seriously misrepresenting the actual mortality/morbidity risks). A person who hasn't been weighed in months who goes on a diet may have no idea that he was gaining a pound a month. Just not gaining that pound during the first month of the diet would be a success. But no one acts that way. No one talks that way. No one feels that way. (Okay, someone does. Congratulations! You don't suffer from this problem. Please allow me to return to my rhetorical flourishes.)

Despite repeated statements that losing a pound or two a week is the fastest sustainable weight loss, and that losing 10% of one's weight and keeping it off constitutes a huge success, few dieters have internalized these beliefs. If we understood this as homeostasis, we would expect it to work this way. Slow weight loss, broken at intervals by plateaus while the losses are understood as the "new normal" would not disrupt homeostasis, and not trigger mechanisms in the body to restore "normality". Alternatively, if it felt good to be stable, better to lose weight, and worse to gain weight than either of the above, I don't think we'd have trouble finding and maintaining a slow but steady loss to an appropriate (not arbitrary!) weight. But in practice, losing weight isn't actually fun. Losing weight fast is horrible. It triggers all those mechanisms to restore "normality". It is a relief to regain the weight.

Finally, our ability to understand our own level of physical activity has been utterly compromised. We have a whole lot of cars. Our environment does not support walking much less stairclimbing. It's difficult to find time and companions to engage in recreational physical activity. As a result, when I went to J. Jill some years ago and tried on a pair of Borns (not punctuated correctly), I asked the saleswoman how they were to walk in. She did not understand. I said, well, I have shoes I can barely walk a mile in. I have other shoes that I can easily walk six or eight miles in. Where does this pair fit. She just stared, and eventually said she didn't think she'd ever walked a mile or more other than in sneakers. The Borns were _lace up oxfords_. They are a _walking shoe_. WTF.

But it is mostly true that few people will spontaneously go for a walk (on level, paved ground, even) of a mile or more, without changing into special clothing or at least footwear. And most footwear is so inappropriate for walking that it will cause blisters or worse if you _do_ spontaneously go for a walk of a mile or more. I know for an absolute fact that this was not the case thirty years ago, because I can remember that far back. This is insane.

Another data point: I participate in the National Weight Control Registry because I lost thirty pounds and kept it off for over a year. I was very excited to participate in this study. The first thing to throw me off was when they sent back a questionnaire I had filled out. They didn't care for some of my answers. One was how many flights of stair do you climb a day, and I said 20 or more. They seemed to find that incomprehensible. I'm still a little surprised that this was outside their reasonable range. Between laundry in the basement, kitchen/TV on the main floor and bedrooms/office upstairs, that was a _low_ estimate. But the most obnoxious part was the section where they ask about future goals pertaining to weight. I said I planned on getting pregnant and anticipated I would gain a substantial, unknown amount of weight with that pregnancy, and that I would apply the techniques I had used in the past afterwards to achieve and maintain an appropriate weight. They insisted I fill out that section as if I were not planning on getting pregnant. Who does _that_ help?

Kolota's book -- and others like it that have shown up over the last few years -- are putting good information out there that can be genuinely helpful. But it would be so much more helpful if people could really manage to make the connection between daily physical activity/exercise (a minimum of 2000 calories/per week) and the experience of appetite and its impact on weight management. If you aren't getting that minimum of 2000/week (about 300/day, or a three mile walk on level ground for most people), your appetite mechanism will work differently than people who _are_ getting that minimum. Right now, people treat exercise as a way to burn calories (which it does do, but so does sleeping. And farting. And everything.), when what it really is is a crucial part of maintaining basal health. If you treat that minimum as weight maintenance (therefore not getting that much exercise means you'll trend up), and exercise over and above that as contributing to weight loss, we'll see much better results for exercise-as-a-weight-management tool. Of course, we also have to take the body composition thing seriously. While you are converting fat to muscle, you can't really expect to be losing a lot on the scale, but it should be detectable somewhere.
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