Like many of my readers, I’m sure, I’ve had an ongoing battle with weight, but I also have done extensive reading on the subject. I’m not just talking about diet books, but also studies, articles, and interviews, debates, etc. on diet, nutrition, health, and even anthropology. I can’t call myself a scientist because I don’t have the hard-core grounding in proofs and research skills, but I can at least claim to be somewhat educated on the differing points of view surrounding these topics, in addition to simply being a fairly good observer of attitudes of those around me regarding this stuff. That being said, I thought I would ramble a bit about what I see as the issues we face but more importantly how to try to get around them. It’s a multifaceted topic to say the least. If it were simple we might have already nipped it, but it is complex and fraught with confusing contradictions and competing interests. I hope this litany will at least start to delineate individual items of attention and separate some of the major areas to work on.
The Issues:
1) Mind over Matter? As many of us know from countless attempts to lose weight, only to regain it later, the goal of losing weight and keeping it off is a very challenging one. For those who haven’t had to deal with obesity, a very easy assumption may be to blame the dieter for simply being too “lazy.” There are certainly those who can overcome the desire to slack and keep weight off for extended periods, so these exceptions to the rule are held up as the paragons that everyone could and should strive to emulate. However, despite the desire to simplify issues (which I’ll examine more closely below), it’s not always simply a matter of personal responsibility or will power. This isn’t an effort to make “excuses” but to look at the reasons why things have become so difficult.
a. One part of this is the so-called evolutionary argument that it is in our genes to overeat whenever possible. Hunter-gatherer ancestors dealt with a constant threat of starvation. Up until the agricultural age when humankind learned to preserve food with salt, and eventually bottling, canning, refrigeration, vacuum packing and irradiation, the only way we could “store” food was to eat it and have it accumulate in our personal biological “stores” of fat tissue. Because of this, some would say, we are compelled to eat as much as we can even though there is no threat today of starvation. Some of us have been able to override this urge most of the time, but given the opportunity, as with the “all you can eat” buffets, it can often be incredibly challenging not to stuff yourself.
b. Part of this may be due to simply not doing it “right.” In other words, the effort to work hard at losing may be there, but the results do not show. This may be because the dieter is doing something that they were TOLD was the correct way to eat and/or exercise, but it turns out to actually be deleterious to their goals.
c. Yet another issue is societal and cultural realities. Current U.S. (and perhaps at least some other westernized countries) suburban culture creates lifestyles that make it extremely hard to eat healthfully and get a decent amount of exercise. The car culture of the U.S. makes regular exercise something that one has to make time for instead of being an integral part of one’s day, and the busy lives of many makes this increasingly difficult. The prevalence of fast-food makes it much more appealing than the more time-consuming method of preparing one’s meals from scratch from whole foods, and such meals are not readily available ready-made, or when they are, they are considerably more expensive than the less healthy alternatives. Finally, while we have come to have a much greater awareness as a society of dieting these days, there is still a great adherence to eating things based only on what tastes best regardless of how healthy it is, and this can help erode the will of any dieter.
2) Simplicity
a. We crave simplicity – easy answers to complex questions. We hear about laziness a lot when it comes to people not wanting to do the “hard work” of exercise and eating right that are supposed to make weight loss possible. While there may be a very small subset of those who simply don’t want to do anything “hard,” I think much more prevalent is laziness when it comes to thinking about how to lose. Part of this is an educational issue where people unquestioningly accept whatever crap they read, whether it’s in a supermarket tabloid or the New York Times, without doing any critical thinking of their own. Many simply don’t have the tools to go about such thinking, but others do and simply decide to believe in one dogma or the other without questioning it or trying different approaches.
b. One Size Fits All – thankfully this attitude is slowly starting to change, but it is still something that most people believe applies in one way or another. Certainly we can agree that there are some universal truths that certain things are healthy for 99.9% of us and other things are unhealthy for a similar percentage. But the field of genetics has shown us that people do metabolize foods differently and have sensitivities and other issues particular to their ethnicity/genetic makeup. Instead we are given guidelines that are supposed to work for everyone. Even given one individual, they will react very differently to the same diet and exercise plan at different periods throughout their life based on many factors, such as how many times they have dieted in the past, what kind of health issues they have developed or haven’t, or simply their age. These concepts seem to be too confusing for many, or at least those who write books or articles have decided that they are too confusing, and so they dumb everything down into simple rules that over time harden into unchallengeable “fact” when they are really nothing of the kind.
3) Business and Government
a. We exist in a capitalist society where the “free market” reigns. Many of the large companies in such a system operate with the goal to get bigger which increases their stock and makes them and their stockholders wealthier. In doing so, altruistic motives often become of secondary concern and then only when they can coexist with the goal of making more profit. This situation can lead in more notorious cases to companies like the cigarette companies that profit on the addiction to harmful substances, but just as much to food and beverage companies that profit on the addiction to sugar, fast food, and junk food.
b. The U.S. Government is seen by those on the right and the left as being a spoiler in this area and others. For the right, the Government should have no place in telling people what to eat or how to spend their money. It should not be a “nanny” because it should be up to the individual to exercise their free will and be responsible for their own decisions when it comes to diet and health. For the left, the government is little more than a facilitator for big food companies, giving them corporate welfare and subsidizing huge factory farms that produce way more in the way of food then we can eat or even give away to countries in need. The smaller farmer interested in sustaining the land, producing a product that is healthier and more humane, gets marginalized if not eradicated.
4) Medicine and the Medical Industry
a. Pharmaceuticals have become a huge sector of the economy and due to the realities of the healthcare and insurance industries, the marketplace, litigation, and government regulations; they have turned into monstrosities of a sort. At the same time that they create drugs which prolong life for cancer patients, and even so much as cure other diseases, their drugs are increasingly seen as not having been adequately tested. They basically bribe doctors into prescribing as much of their drugs as possible with the unspoken threat that perks of free dinners and vacations will go away without high enough sales numbers. They need these huge sales numbers in combination with high drug prices that are ultimately paid for by health ever increasing health insurance premiums and the government (and thus your tax dollars), in order to make up for the huge costs of developing drugs and the potential risk of having a dud, or worse something that ends up eventually harming people and thus causing countless legal expenses.
b. Doctors have been accused of not understanding nutrition, and not wanting to pressure patients into eating healthy because they feel their pleas will be ignored. While there are certainly exceptions, many doctors have expectations for patients that are so low, they would rather prescribe drugs or even surgery over really urging a patient to eat better or exercise. Their slavery to the pharmaceutical industry makes it even harder for them to resist the temptation to simply prescribe a drug for a given symptom. Many patients are afraid to do the hard work of figuring out what the underlying cause of a symptom is and experiment with possible solutions (although this is getting easier with the internet and being able to communicate quickly with those who have similar issues), but doctors have much more background in science that should enable them to do this work faster and more efficiently. However, again the realities of the profession mean that it is a lot easier and more profitable to see a patient for a few minutes and sign a prescription for something that will allay some symptoms for a while as opposed to getting to the bottom of the problem.
5) Dieticians, Nutritionists, and “Experts,” oh my!
a. Our growing problem with obesity and obesity-related health issues has not only created a huge market for what most recognize as the today’s charlatan snake oil salesman equivalent of this diet pill or that fad diet, but it also creates a market for those with more recognized certifications and ostensible respect in the professional community. These so called experts dole out advice with confidence and do this in the place of the medical doctor who has largely given up this role.
b. Dieticians and nutritionists, and even personal trainers have generally been giving the public what they have been asking for. An expert to tell them what to do and how to do it. Unfortunately, these professionals practice a “science” which is not hard and fast the way, say, physics is (quantum mechanics not withstanding!). The theories behind weight loss and healthy eating aren’t as simple as these experts make them out to be. Very little if anything has been “proven” in studies, but these studies all the same are used as “proof” to back up the standard party lines. These lines become more solidified and more rigorously defended over the years. As it’s been said, if you repeat anything for long enough, it becomes accepted as fact. When dieters follow the advice of their “expert” but do not see any improvement, the patient is often the one who is blamed for doing something wrong, or even for cheating. Even if the patient convinces their expert otherwise, instead of causing the expert to question their foundation of knowledge (assumptions), they patient is labeled an anomaly (usually genetically speaking these days) and told to pursue a remedy in prescription form. Since their standard advice is useless and they cannot suggest something that goes against that advice.
Solutions
Ok, so, as you can see, the situation is a complicated, convoluted mess. Can we make any sense out of it? As cynical as I may sound above, in the sense of the upcoming New Years’ resolutions, here are just a few personal and collective goals I can suggest. Some of them will be hard, if not all but impossible but I don’t see anything wrong with having such goals as long as there are others that are more achievable or achievable faster. The harder ones give you something to work towards after all the easy things are out of the way!
Suggestions for the individual:
1) Stop following and start thinking.
a. This really relates to a lot of the issues above. Really all I mean is to not just listen to what the so-called “experts” are saying, but to do your own thinking. Think about what makes sense regarding what they tell you, and what doesn’t. You’re smart enough and at least have common sense to know that some things that “experts” tell you to do don’t make sense, or at least don’t for you.
b. Get other opinions. Just as with politics, diet, nutrition, and exercise have their fare share of differing camps. Low carb vs. low fat vs. calorie counting, aerobics vs. weights, etc. Read about the different approaches, but more importantly try them out. If something doesn’t work, after giving it a fair chance, try something else. Is this going to be hard for some people? Sure! But there are plenty of communities on the internet that will help you understand the different issues. Instead of relying on a “expert” to tell you what to do because that’s been drilled into them as a party line, talk to your peers and ask them what works for them. Get suggestions and have a dialogue, not a one-way list of orders that you can’t stray from at the risk of dire punishment.
2) Don’t listen to the Government.
a. At least don’t listen to what they tell you as far as dietary advice. Our society, economy, and government are centered on money and commerce. Officials rely on campaign contributions from wealthy individuals or large companies in order to get reelected and so are lobbied incessantly and successfully by factory farms and big food companies, and even by non-profit special interest groups, who all have their own agendas. The part of the government that currently makes dietary guidelines (the much-maligned food pyramid included) is the USDA. That is the US Department of Agriculture. Agriculture as in farmers. The USDA’s raison d’etre is to promote the interests of farmers and the agricultural industry in the U.S. There seems to be an inherent conflict of interest here!
b. The current administration is very pro-big-business at the moment and so they have a bias towards promoting things that help those big businesses, whether they are big food and beverage companies, pharmaceutical companies, or fast-food chains. So we will necessarily see recommendations and even laws supporting these businesses right now. That doesn’t mean you have to support them as well.
3) It’s not simple!
a. It’s not all about weight. Most experts would have you believe that weight is the paramount issue here, but that simply isn’t the case. Excess weight may be perfectly healthy if it is in the form of muscle and not fat. Most scales only measure total weight, at least until recently, and that one measurement has also been simple and convenient for the “experts” to obsess about. Body fat percentage is a much more telling measurement. Even with excess fat, there’s some evidence to suggest that maintaining a steady, albeit above average weight (with that excess weight being fat) over the long haul (especially if regular exercise is part of the picture) is much healthier than gaining and losing over and over even if half of your time is spent at some mythical “ideal” weight.
b. Don’t let the scare tactics get to you when it comes to cholesterol. Very often doctors will urge their patients to go on cholesterol medication because their LDL is too high or even just their total cholesterol is too high. However, there are pleanty of layman, scientists, and even doctors who have come to the conclusion that the current standard methods of measuring cholesterol are at best misleading, and at worst completely meaningless. Given the risks of taking serious medications like the cholesterol-lowering Statins, it’s extremely important to know whether there is a really good reason to take these.
Suggestions for the medical industry, dieticians, etc:
I’m not sure whether such suggestions (even coming from someone other than myself who has credentials and real influence) could ever affect significant numbers within these professions because of the inherent forces within them that have caused the current status quo. Perhaps the only way of changing things in some cases would be to create competing bodies or professional associations that could somehow challenge the more mainstream ones. Such bodies exist currently in some forms, but sometimes these have their own issues because they are blinded by their own ideology as opposed to real science. In any case, here are my suggestions:
Look at the opposing point of view and look at it dispassionately. Those in the medical industry are supposed to be practicing science, but like scientists in other fields, a status quo is developed and anyone who challenges the ideas of that status quo is ridiculed, but, if their ideas truly have merit there may eventually be grudging acceptance and finally adoption into the accepted tenets of that science. Scientists are supposed to weigh (no pun intended) things dispassionately, but they are still human and as such unavoidably have biases and turfs they feel they need to defend. The growing amount of litigation and cost of insurance only make it harder for Doctors to go against the grain, and the “standard of care” solidifies this practice. But I would argue that doctors also need to look really hard at their Hippocratic Oath and ask themselves whether doling out pills and not suggesting anything that goes against standard orthodoxy is really helping patients, and if it’s not helping patients are you are in fact hurting them because you are preventing them from getting the advice that really would help?
Likewise, nutritionists and dieticians need to look beyond their training which accepts only a narrow dogma with little flexibility. Admitting that things we thought were true are subsequently shown to be false is much less painful than clinging to an argument that has really been proven false over time. It smacks of fear of losing one’s place as an authority and one’s job. With adherence to dogma comes inevitability of obsolescence since with progress we often learn new things that contradict what we thought we knew. Refusing to accept new evidence staring one in the face will only worsen an individual’s or entire profession’s reputation and hasten it’s demise. An old guard defending itself is never to be trusted to advance the interests of anyone but its own.
Finally, to the medical industry, I would suggest creating studies that actually mean something. So many of the “studies” that come out today really don’t prove anything. Part of the fault here goes to the mainstream media who sees a preliminary study on mice and extrapolates it to be proof or at least a strong suggestion of how things work in humans. But scientists should know this and refrain from talking to the mainstream press about studies they know are only going to get hyped into ridiculous simplified generalizations. Even aside from animal studies, there is simply a lack of good human studies especially when it comes to diet and health. Many of the studies I’ve seen are with very small groups for short periods of time, or they aren’t even studies themselves but rather “meta studies” which simply look at other studies and try to argue a point based on hand-picked literature that supports their cause – while ignoring those that don’t. If we really and truly want something approaching objective “proof,” we need to spend lots of money, and not the money of special interests. Perhaps a large fund, like that of Bill and Melinda Gates, could support something that would not allow for special interests to influence the results to any significant extent. Doctors would have to resign themselves to any conclusion, instead of starting with a conclusion in mind and writing off an unexpected result as some anomaly. The numbers of participants should be very large – in the thousands or even tens of thousands. All variables should be plotted, not just weight, height, gender, and age, but body fat percentage, previous dieting and exercise experience, ethnicity, medications, smoking, etc. Ideally participants would have to be confined to an area where there would be a fair degree of confidence as to what the participants reported were true. In other words, all exercise could be monitored and all food intake as well. Not just monitored so much as allocated. Different levels of macronutrients would be allotted to different groups. There wouldn’t be just a “standard group” and a group that differed to a moderate extent in one of their macronutrients like carbohydrates. Instead you would have a group that took in 80% of their calories as carbs, 10% as protein, and 10% as fat, another group which took in 5% of their calories as carbs, 65% as fat, and 30% as protein, and all the different combinations in between. The study would also follow the individuals over at least a three year period, but as many as seven years. As I implied, this would not be an easy or a cheap study, but satisfying all or most of these strictures will be the only thing that will convince the majority of people (experts and laypeople alike) that a particular method of weight loss works best for a person given their very particular makeup (ethnicity, dieting experience, medications, etc.). Perhaps computer modeling and genetic profiling will take a lot of the work out of this in the future, but for now, anything short of this full-on approach will be, as it has been in the past, meaningless except as something for scientists, doctors, universities and/or hospitals to get their names in print.