walkitout (walkitout) wrote,

Book review: _Body of Truth_, Harriet Brown

Subtitled: How Science, History, and Culture Drive Our Obsession with Weight--and What We Can Do about It

I did, ultimately, finish it.

I'll start by saying something I said throughout some of the earlier posts I wrote while reading the book: if you've been participating or identified with any of the body positivity movement for some time before reading this book, the author's efforts to "identify" with "your" "weight issues" may come across as condescending, fake, triggery and/or dehumanizing. It was all of the above, at one point or another for me, culminating in a sentence that offered me the choice of (a) not being human or (b) preferring a picture of a thin model over a picture of the Venus of Willendorf.

The author describes talking to a nutritionist who works in a hospice. The nutritionist clearly worked very hard to make life as comfortable as it could be made for the women there. However, the nutritionist, according to the author, was non-plussed by women who continued to refuse to eat bread, pasta, put salad dressing on their salad, etc., out of a lifelong habit of weight control that they refused to give up, even at end of life. My sister is a nurse who has at times worked with hospice patients, and she was somewhat skeptical of this story. The obvious things have failed me in terms of determining whether I believe the author in her retelling of this story, or the nutritionist who originally relayed the story to the author.

Despite finding the author's efforts to connect with her readership harrowing and offensive (to me -- I can't speak to how other readers might perceive it. It's possible that the style works really well for some audiences, in which case, more power to her, this book just isn't for me) and my sister's skepticism about at least one point in the story, I did finish reading the book. I had picked it (and Linda Bacon's book) because it is the time of year when many people diet, and I haven't read anything about obesity/nutrition/etc. in years and what the heck, maybe there's something better out there than Paul Campos' _The Obesity Myth_.

This is not better for me than Paul Campos' _The Obesity Myth_. I really liked how Campos' engaged with the research; that research is touched upon, but the focus is much more on cultural rhetoric and the positions staked out by various authorities and their personalities. It was kinda fun watching someone go after Walter Willett that relentlessly, but I do sort of question what's the point. I certainly appreciate the author's work identifying and calling out bias in the medical profession. That desperately needs to be done! And she has a lot more data to share on the outcomes of bariatric surgery than was available when Campos' wrote his book, over 10 years ago now.

One of the reasons I quit reading in this category, is because it became really obvious to me that if you write a book about why all this diet stuff is crap, and then keep talking about food exclusively, and primarily mention exercise when people are engaged in damaging, physical activity that they find joyless in an effort to burn through calories, I don't see how you have escaped the frame. It's all well and good to talk about how we should engage in physical activity that we enjoy (I agree!), but when that comment is always in passing, you sort of have to wonder what is going on. This is a fight. I don't care about the bone they are fighting over. They can have the bone. I'm gonna go somewhere else.

I do intend to read the Linda Bacon book, however, if I do not I want to point something about about her smug description of setpoint theory. One 1970s study about _men_ in their 30s and _men_ in their 60s weighing within a few pounds of each other says nothing to me at all about anything except that was one cherry picked dataset. As for the rest of it, I see nothing -- not in Bacon, and not in the research when I search online -- about investigating setpoint differences before and after pregnancy and lactation. Not even in mice.

Really people? Half the population is female. Most of them (not all, but a lot more than half) will at some point be pregnant. Most of those will deliver at least one child and some of them will then breastfeed. Every fucking piece of art, literature and etc. suggests that women have been Up Against It in terms of returning to pre-first pregnancy body shape/weight/etc. post kid(s). And that goes back to before humans were writing shit down. That's some solid data for set point movement across this boundary and Just Not Discussing It isn't gonna make it go away. I'm prepared to take set point theory slightly more seriously after _somebody_ does _something_ to analyze this phenomena.

Second, set point theory says basically nothing about body composition. Which is weird, because set point theory exposes a basic feature of calorie restriction and weight recovery (viz. fat comes back faster than lean muscle, so you wind up weaker and fatter after each time through the cycle). So we _know_ set point theory and body composition have some kind of complicated relationship. We also know that exercise tends to result in increasing lean muscle mass without losing weight (occasionally gaining weight). The implication there is that set point theory is okay with you swapping fat for muscle -- especially since we also know that when you _quit_ exercising, the decay period on the loss of the increase in muscle mass is sort of long (I'm not talking about the cardio benefits; I'm talking about body composition), and it's possible to maintain almost all of the gained muscle mass while halving the intensity OR amount of activity used to build it in the first place, indefinitely. That suggests that set point and whatever is going on with muscle are trying to move us all in the direction of leaner body composition. But set point theory does not discuss this.

Bacon and Brown also fall into the trap of believing that relatively recently, obesity/wtf has gotten a lot more widespread, and thinking that is historically novel. That is, they don't make any effort to look at populations in the past which enjoyed a diverse and abundant diet like ours. And if you're sitting their going, but there weren't any! Well, you're wrong. There's been some interesting work on differential rates of type 2 diabetes in descendants of populations that had diverse and abundant diet earlier vs neighboring regions whose diet became diverse and abundant later. There's a lot of reason to suspect that, like the demographic transition, this "obesity crisis" is kind of a one off thing, if it's a thing at all.

One thing I noticed during this book, which was almost certainly present in earlier books I had read, but which I had not noticed, was the character of criticism parents leveled at their kids who then grew up to really have trauma associated with their body size/shape. Parents are humans who have their own problems, and some of them are kind of awful people. When I read some of the elaborate tales of putting ice cream containers back in the freezer full of garbage and a note that says, "Gotcha!", I think, that's a parent with a personality disorder, creating an invalidating environment that is odds-on going to lead to similar problems in the kid (because shared genetics). It matches with the now-grown offspring, who -- for example, like Brown -- are incredibly sensitive to negative cultural messaging around body size/shape. It's kinda cool that there are therapists who are working to help, and using forms of cognitive behavior therapy (I hate using the acronym CBT, because alas, that makes me think of something else entirely) to do so. At some point, perhaps we'll destigmatize weight and whatever we end up calling borderline personality disorder to the point where we can give parents some truly meaningful and helpful guidelines on talking to kids about food and exercise in ways that don't become lifelong triggers. And we can get parents who need it the help to step away from the all-or-nothing thinking long enough to realize that having a fat kid -- or being a fat adult -- is actually, basically, okay.
Tags: book review

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