Separating Fat from Fiction: Exploring Myths, Realities, and Assumptions

Ellen Perrella MS, ATC, CSCSHead Athletic Trainer

Mount Holyoke College

Sobering Statistics 116 million

adults dieting

80% US teenage girls have dieted

Age 13, 1/2 girls unhappy with bodies

‘Unreal’istic Images Average model, dancer, or

actress is thinner than 95% of population

A generation ago models weighed 8% less than avg. woman; today,23% lesshttp://www.dove.us/#/feature

s/videos/default.aspx[cp-documentid=7049579]/

Women, weight, and feminism

Is Obesity a disease? Is body fat pathological? Who benefits from obesity being

considered a disease? Scientists and academics researching

obesity Pharmaceutical companies Bariatric surgeons Public health establishment

Is Obesity a disease? Is body fat pathological? Who benefits from obesity being

considered a disease? Scientists and academics researching

obesity Pharmaceutical companies Bariatric surgeons Public health establishment

$50 Billion Diet Industry

Fat Phobic Society Diet Drugs

Usage among female adolescents(Journal of Preventive Medicine Feb. 2007)

Fen-Phen Fiasco

Fat Phobic Society Diet Drugs

Usage among female adolescents Fen-Phen Fiasco

Bariatric Surgery: Liposuction Elective surgery, high mortality rate. Hospitalization rate doubled in the year post-

surgery compared to year prior to surgery. At Least 20% will need more surgery.

Health benefits? (Klein, Samuel, M.D., 2004)

Fat Phobic Society Diet Drugs

Usage among female adolescents Fen-Phen Fiasco

Bariatric Surgery: Liposuction Elective surgery, high mortality rate. Hospitalization rate doubled in the year post-

surgery compared to year prior to surgery. At Least 20% will need more surgery.

Health benefits? (Klein, Samuel, M.D., 2004)

Bariatric Surgery: Gastric Bypass AHRQ (w/in 6 months); 4 in 10 13-15 years out Post surgery-3 ounces fills stomach 800-1200

cal/day.

MYTH #1: Eat Too Much; Exercise Too little?

Food environment Increased portion size, Snack-foods heavy on refined

sugars and saturated fats. Most studies: overweight people eat fewer calories

than those of normal weight. (Nat’l Academy of Sciences, Diet and Health, 1989)

MYTH #1: Eat Too Much; Exercise Too little?

Food environment Increased portion size, Snack-foods heavy on refined

sugars and saturated fats. Most studies: overweight people eat fewer calories

than those of normal weight. (Nat’l Academy of Sciences, Diet and Health, 1989)

Physical environment Technology has stripped our lives of natural exercise. Screen time=video games, computers, TV 1970’s Fitness Revolution SES, income, and education are inversely related to

obesity. Poor people more likely to work in physically

demanding jobs, yet have much higher obesity rates.

MYTH #1: Eat Too Much; Exercise Too little?

Food environment Increased portion size, Snack-foods heavy on refined

sugars and saturated fats. Most studies: overweight people eat fewer calories

than those of normal weight. (Nat’l Academy of Sciences, Diet and Health, 1989)

Physical environment Technology has stripped our lives of natural exercise. Screen time=video games, computers, TV 1970’s Fitness Revolution SES, income, and education are inversely related to

obesity. Poor people more likely to work in physically

demanding jobs, yet have much higher obesity rates.

The relationship between exercise and food and obesity is not clear.

Intervention school studies

5,106 3rd graders from 96 schools 56 schools-2 year Intervention:

healthy foods, nutrition instruction, extra physical activity.

Students decreased fat in diet, exercised more, …

No difference in weights from 40 control schools Nader, PR., Stone, EJ, Lytle, LA et al.

What is the cause of obesity? Intrinsic metabolic, enzymatic, or

hormonal abnormality induces + caloric balance…..fat accumulation.

Defect of fat metabolism; hormonal and metabolic, release of fat is impeded, or the deposition/synthesis of fat is promoted.

Appetite and weight regulation have strong biological underpinnings.

Myths and Misconceptions People can control their body

size; they can lose weight if they really want to.

Myths and Misconceptions People can control their body

size; they can lose weight if they really want to.

You will lose weight when you exercise Heritage Family Study (Wilmore, Jack H. , et al)

500 men and women; 20 weeks, stationary bicycle 3x/week

55%-75% of VO2 Max; 30-50 min. Lost < 1 lb.; % body fat < 1%

More Myths

People are thin or fat based on a simple relationship between ‘calories in and calories out’ “no basis in medical science” Overfed 12 sets of identical twins 1,000

cal./day, 6 days/week, 12 weeks identical levels of physical activity 7 weeks later; weight gain among 24

men varied 300%, from 9-30 lbs. (Bouchard, C., Despres, J.P., Nadeau, A., et al. )

More Myths

People are thin or fat based on a simple relationship between ‘calories in and calories out’ “no basis in medical science” Overfed 12 sets of identical twins 1,000

cal./day, 6 days/week, 12 weeks identical levels of physical activity 7 weeks later; weight gain among 24

men varied 300%, from 9-30 lbs. (Bouchard, C., Despres, J.P., Nadeau, A., et al. )

Obesity causes poor health and increased mortality

Obesity is a poor predictor of:

Hypertension. No history of dieting; 125/79 History of yo-yo dieting (5 + weight

losses of 10 + pounds last 5 years);147/90

BP positively correlated with total lbs. yo-yo-ers had regained.

(Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al. 2000)

Obesity is a poor predictor of: Hypertension.

No history of dieting; 125/79 History of yo-yo dieting (5 + weight losses of

10 + pounds last 5 years);147/90 BP positively correlated with total lbs.

yo-yo-ers had regained.(Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al 2000)

High Cholesterol 31 obese women put on 6 month aerobic

program. most lost avg. 6 lbs.; 11 gained 6 lbs Both gainers and losers improved cv

fitness the same amount Also improved cholesterol levels and

insulin sensitivity (Lamarche, B, J-P Despres, M-C Pouliot, et al. 1992)

Obesity is a poor predictor of: (continued)

Atherosclerosis (“clogged arteries”) 1960 (Int’l Atherosclerosis Project). 23,000

autopsies; concluded “no association”.

1991. Dr. Applegate (U. of Tenn.) 4,500 angiograms of middle aged and elderly. Fattest people had cleanest arteries.

NOTE: individuals that are overweight/obese and have atherosclerosis have lower risk of heart attack, stroke or early death.

Obesity is a poor predictor of: (continued)

Type II diabetes: condition improves with changes in diet and exercise, independent of weight changes Insulin resistance (IR)is the most

important metabolic factor relating to weight, diet, and health.

Obesity and diabetes: consequences of the same underlying defects; hyperinsulinemia and IR

Weight and Cardiometabolic Abnormalities

5440 subjects; 1999-2004 Wildman, R.P. et. al. 2008

“A considerable proportion of overweight and obese US adults are metabolically healthy, whereas a considerable proportion of normal weight adults express a clustering of cardiometabolic abnormalities.”

Correlation is not Causality “The mere presence of 2 or more

variables in the same individual does not infer an inherent causal relationship.”

Dr. Glenn Gaesser “…it is absolutely unjustifiable to equate behavioral patterns (poor diet and physical inactivity) with a physical characteristic (obesity).”

Myth: Obesity Kills Cooper Institute for Aerobics Research

1970. 26,000 men; 8,000 women (ages 20-90) Being heavy did not increase the risk of

premature death = fitness levels being overweight better than

being underweight Obese fit men and lean-fit men: similar low

death rates -1/2 that of lean-unfit men-

Myth: Obesity Kills Cooper Institute for Aerobics Research

1970. 26,000 men; 8,000 women (ages 20-90) Being heavy did not increase the risk of

premature death Fitness levels being overweight better than

being underweight Obese fit men and lean-fit men: similar low

death rates -1/2 that of lean-unfit men-

Harvard Alumni Study 17,000 men who attended Harvard between

1916-1950 Who has the best chance of living a long life?

BMI vs. Relative Risk of DeathFlegal, Katherine, Graubard, Barry, Willamson, David, et al. 2005

Diets: Atkins to Zone

Dieters: 18x more likely to develop an eating disorder

Diets: Atkins to Zone Dieters: 18x more likely to

develop an eating disorder

Recidivism rate from 90-98%

Diets: Atkins to Zone Dieters: 18x more likely to

develop an eating disorder

Recidivism rate from 90-98%

Needs deprivation leads to overcompensation Dieting begets bingeing. Dieting intensifies preferences for

high-fat and sugar-loaded foods. Starving……… Stuffed.

Landmark diet study Keys Study (1944)

32 conscientious objectors 24 weeks caloric restriction/one-half of

what they were used to eating All lost weight, all gained it back

plus some (avg. 10 lbs.) Men were irritable, depressed,

apathetic, preoccupied with food

Landmark diet study Keys Study (1944)

32 conscientious objectors 24 weeks caloric restriction/one-half of

what they were used to eating All lost weight, all gained it back

plus some (avg. 10 lbs.) Men were irritable, depressed,

apathetic, preoccupied with food

What do Treblinka and Jenny Craig have in common?

Diet is a four letter word

Emotional toll: disheartened, disillusioned, and depressed

Diet is a four letter word

Emotional toll: disheartened, disillusioned, and depressed

Body conserves energy/survival mechanism BMR (basal metabolic rate) accounts for

60-70% of total energy used by body BMR drops within 24 hrs. of food

deprivation, may reduce 20% in 2 weeks

Diets Improves body’s

ability to store fat and limits ability to burn it Increases lipogenic

(fat-storage) enzymes

Decreases lipolytic (fat-releasing) enzymes

Decreased muscle-used for energy and reduced to lower metabolism

Diets Improves body’s

ability to store fat and limits ability to burn it Increases lipogenic

(fat-storage) enzymes

Decreases lipolytic (fat-releasing) enzymes

Decreased muscle-used for energy and reduced to lower metabolism

Ideology reinforces split between dieter’s mind and body.

Yo-Yo, Uh Oh Weight loss begets weight gain - serious

health consequences

Framingham Heart Study

Yo-Yo, Uh Oh Weight loss begets weight gain - serious

health consequences

Framingham Heart Study

Harvard Alumni Study (follow-up 1998) Men with stable weights vs. those who

had lost and gained the most pounds: 80% higher risk of heart disease 123% higher rate of type II diabetes

alumni who dieted frequently (compared to non-dieters): 2x risk of diabetes, hypertension, and

coronary heart disease

Consequences of weight loss/gain cycling The observations confirm…a basic

relationship between starvation, re-deeding diet, and cv disease.

(Univ. of Illinois, 1964)

“Weight cycling is associated with lower HDL cholesterol in women of a magnitude … associated with an increased risk of cardiac event”.

(Marian B. Olson, MS 2000)

Athletics

Scales are scarce

Educate the coaches/staff

Mandatory Programming for athletes

No weigh-ins or % body fats

Athletic Traits vs. ED Symptoms

Mental toughness Commitment to

training Pursuit of

excellence Coachability Unselfishness Performance

despite pain

Athletic Traits vs. ED Symptoms

Mental toughness Commitment to

training Pursuit of

excellence Coachability Unselfishness Performance

despite pain

Asceticism Excessive exercise Perfectionism Over compliance Selflessness Denial of discomfort(Thompson and Sherman 1999)

Ready, Set Point, Go

“Home” weight; where your body feels at home (homeostasis)

Natural weight

Ready, Set Point, Go

“Home” weight; where your body feels at home (homeostasis)

Natural weight

Vermont State Prison. Set out to make thin men fat. Concluded “marked difference in their ability to gain weight”.

Ready, Set Point, Go

“Home” weight; where your body feels at home (homeostasis)

Natural weight

Vermont State Prison. Set out to make thin men fat. Concluded “marked difference in their ability to gain weight”

70% of our weight is genetically determined

Location, location, location

Upper-body fat (abdomen)

More prevalent in males

Visceral (or deep) body fat-metabolically hyperactive, high levels of FFA (free fatty acids) released in the bloodstream, etc.

Increased risk for atherosclerosis and diabetes.

Location, location, location Lower body fat (hips and thighs)

More prevalent in females

Subcutaneous fat

Associated with a lower risk of heart disease and diabetes Stanford University, 1991. 133 men and

130 women, ages 25-49. Fatter thighs = lower heart disease risks (low LDL, high levels HDL, i.e. blood fat profiles).

Popular Torture Devices

Discrimination…...Humiliation

Acknowledge the anxiety, pain, and grief this issue elicits for so many.

150 Science Studies: noted stigmatization of obese adults by employers, educators, health care providers, the media, etc.

(Rudd Center for Food Policy and Obesity/Yale)

Weight bias is a social injustice as well as a public health issue.

See Cynthia’s words (handout)

HAES (Health At Every Size) Accept and respect the diversity of body

shapes and sizes.

Health and well-being are multi-dimensional including physical, social, spiritual, occupational, emotional, and intellectual aspects.

Promoting all aspects of health and well-being for people of all sizes.

Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure.

Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise focused on weight loss.

New Year’s Resolutions

#1 wish every year-to lose weight

New Year’s Resolutions

Drink more champagne.

Watch more sunsets.

Listen to more music.

Climb a mountain.

Suggestions, Solutions, Solace Marcia Germaine Hutchinson,

“Feminist Perspectives on Eating Disorders”, “So what does it mean to have a healthy body image?....”

Suggestions, Solutions, Solace Marcia Germaine Hutchinson,

“Feminist Perspectives on Eating Disorders”, “So what does it mean to have a healthy body image?....”

What if??? What if everyone collectively woke up tomorrow morning and was happy and content with their bodies?

More Suggestions, Solutions, Solace Substance over image.

More Suggestions, Solutions, Solace Substance over image.

Redefine beauty. Accept your size.

Challenge the images/media.

More Suggestions, Solutions, Solace Substance over image.

Redefine beauty. Accept your size.

Challenge the images/media.

Be critical consumers of information. Influence of the weight loss industry Food industry and nonprofit health

organizations

More Suggestions, Solutions, Solace Substance over image.

Redefine beauty. Accept your size.

Challenge the images/media.

Be critical consumers of information. Influence of the weight loss industry Food industry and nonprofit health

organizations

Avoid mentioning weight.

Peace with food Shift focus: weight & dieting

enhanced quality of life & health. Reject diet mentality

Unconditional permission to eat

“Enjoy a variety of real food, primarily plants” Linda Bacon “Gentle Nutrition”

Intuitive Eating Honor your hunger

Intuitive Eating Honor your hunger

Feel your Fullness

Intuitive Eating Honor your hunger

Feel your Fullness

Eating with Pleasure

Intuitive Eating Honor your hunger

Feel your Fullness

Eating with Pleasure

Respect your BodyAccept your genetic blueprint

Wonderful Websites

www.bodypositive.com www.naafa.org (National Association to

Advance Fat Acceptance) http://www.sizediversityandhealth.org

(Association for Size Diversity and Health) www.bbwmagazine.com www.melpomene.org http://www.haescommunity.org www.healthyweight.net http://loveyourbody.nowfoundation.org/

Resources Bacon, Linda. Health at Every Size: The Surprising Truth

about your Weight. Dallas, TX: Benbella Books, Inc. 2008.

Bouchard, C., Despres, JP, Nadeau, A., et al. The Response to Long-term Overfeeding in Identical Twins. New England Journal of Medicine. May 1990. 332 (21): 1477-1482.

Campos, Paul. The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health. New York, New York: Gotham Books, 2004.

Diet and Health: Implications for Reducing Chronic Disease Risk / Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences, National Research Council. Washington, D.C. : National Academy Press, 1989.

Flegal, Katherine, Graubard, Barry, Willamson, David, et al. Excess Deaths Associated with Underweight, Overweight, and Obesity. Journal of American Medical Association. 2005. 293(15): 1861-1867.

Resources (Continued...) Flum, DR, Salem L., Broeckel Elrod, JA, Dellinger P.,

Cheadle A., Chan, L. : Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures. Journal of American Medical Association. 2005; 294:1903-1908.

Gard, Michael and Jan Wright. The Obesity Epidemic: Science, morality, and ideology. New York, New York: Routledge, 2005.

Gaesser, Glenn A. Big Fat Lies: The Truth about Your Weight and Your Health. Carlsbad, CA: Gurze Books, 2002.

Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al. Risk factors for hypertension in obese women. The role of weight cycling. European Journal of Clinical Nutrition. April 2000. Vol. 54: 356-360.

Kater, Kathy. An Effective Model for Preventing the Full Spectrum of Body Image, Eating, Fitness and Weight Problems. The Renfrew Center Foundation Perspective. Winter 2006: pgs. 15-18.

Resources (Continued…) Klein, Samuel, M.D., Luigi Fontana, M.D., Ph.D., V. Leroy

Young, M.D., Andrew R. Coggan, Ph.D., Charles Kilo, M.D., Bruce W. Patterson, Ph.D., and B. Selma Mohammed, M.D., Ph.D. Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease. The New England Journal of Medicine. June 17, 2004. Vol. 350: 2549-2557.

Kratina, K. A Compassionate Alternative to the ‘War on Obesity: Clinical Applications of Health At Every Size (HAES). Lecture: Feminist Perspectives and Beyond: Hungers, Health, and Healing. Renfrew Center Foundation Conference for Professionals. Philadelphia, PA. November 4-7, 2004.

Kolata, Gina. Rethinking Thin: The New Science of Weight Loss-and the Myths and Realities of Dieting. New York, New York. Farrar, Straus, and Giroux. 2007.

Lamarche, B, J-P Despres, M-C Pouliot, et al. Is body fat loss a determinant factor in the improvement of carbohydrate and lipid metabolism following aerobic exercise training in obese women? Metabolism, Vol. 41, 1992, pgs. 1249-1256

Resources (Continued) Lewis, Katharine, Man, Lynne. Overweight and Obesity in

Massachusetts: Epidemic, Hype or Policy Opportunity? The Massachusetts Health Policy Forum. 2007.

Matz, Judith, MSW, LCSW, Frankel, Judith MSW, LCSW. “Attitudes towards Disordered Eating and Weight: Important Considerations for Therapists and Health Professionals.” The Journal of Health at Every Size, Volume 19, No. 1. Spring 2005.

Nader, PR., Stone, EJ, Lytle, LA et al. Three-Year Maintenance of Improved Diet and Physical Activity: The CATCH Cohort. Archives of Pediatric Adolescent Medicine. 1999; 153: 695-704.

Oliver, Eric. Fat Politics: The Real Story Behind America’s Obesity Epidemic. New York, New York. Oxford University Press, Inc. 2006.

Romero-Corral, Abel, Victor M Montori, Virend K Somers, Josef Korinek, Randal J Thomas, Thomas G Allison, Farouk Mookadam, Francisco Lopez-Jimenez. Lancet 2006; 368: 666–78

Resources (Continued) Sherman, R. T, & Thompson, R.A. (2001) Athletes and

Disordered Eating: Four Major Issues for the Professional Psychologist. Professional Psychology: Research and Practice, v32(1), 27-33.

Sherman, R. T, & Thompson, R.A. (2001) Athletes and Disordered Eating: Four Major Issues for the Professional Psychologist. Professional Psychology: Research and Practice, v32(1), 27-33.

Seid, Roberta Pollack. Never Too Thin: Why Women Are at War with Their Bodies. New York, New York. Prentice Hall, 1989.

Spake, Amanda. Stop Dieting. US News and World Report.January 16, 2006: 61-66.

Taubes, Gary. Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease. New York. Random House, 2007.

Thompson, RA, Sherman, RT. Good Athlete Traits and Characteristics of Anorexia Nervosa: Are they Similar? Eating Disorders: Journal of Treatment and Prevention (1999), 73: 181-190.

Resources (Continued) Tribole, Evelyn, Resch, Elyse. Intuitive Eating: A

Revolutionary Program that Works. New York. St. Martin’s Press, 2003.

Waterhouse, Debra. Outsmarting the Female Fat Cell. New York. Hyperion, 1993.

Wildman, R.PhD, Muntner, P. PhD, Reynolds, K. PhD, McGinn, A. PhD, Rajpathak, S. DrPH, Wylie-Rosett, J., Sowers, MR, PhD. The Obese without Cardiometabolic risk Factor Clustering and the Normal Weight with Cardiometabolic Risk Factor Clustering: Prevalence and Correlates of 2 Phenotypes Among the US Population. Archives of Internal Medicine. Volume 168 (15). August 11, 2008: 1617-1624.

Wilmore, Jack H. , et al, “Alterations in Body Weight and Composition Consequent to 20 Weeks of Endurance Training: The Heritage Family Study, “ American Journal of Clinical Nutrition 70, no. 3 (1999): 346-52.

Resources (Continued) Yoho RA, Romaine JJ, O'Neil D. Review of the liposuction,

abdominoplasty, and face-lift mortality and morbidity risk literature. Dermatol Surgical. 2005 Jul;31(7 Pt 1):733-43; discussion 743.

Young, M.D., Andrew R. Coggan, Ph.D., Charles Kilo, M.D., Bruce W. Patterson, Ph.D., and B. Selma Mohammed, M.D., Ph.D. Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease. The New England Journal of Medicine. June 17, 2004. Vol. 350: 2549-2557.