"You've lost weight!"

That's what a colleague said to me yesterday, a woman I haven't seen for six months. A woman who is tall and broad and neither thin nor fat.

I haven't lost weight; if anything, I've probably gained a pound or two. Which is irrelevant, really, because I've had people say this to me whether I've lost or gained or stayed exactly the same.

And it's a comment I never know how to respond to, because there are so many assumptions wrapped up with those three little words: The assumption that I'm trying to lose weight, or at least wishing to. The assumption that losing weight will make me look better. That assumption that losing weight, or trying to, is a positive thing. The assumption that it's OK for someone I don't know well to comment on my appearance.

I've considered a variety of responses to this comment, everything from "Please don't comment on my appearance" to "Thanks." What I said yesterday was a simple, "Actually, I haven't."

My colleague persisted. "No, you really have," she said. "You look--" She gestured toward my body. "Maybe it's the shirt," she said.

"Maybe," I said. I walked away feeling ungracious. Should I have said thank you? In our culture, telling a woman she's lost weight--especially a woman who is not thin--is a compliment and a social offering. I like this colleague a lot; I know she meant well. Yet I'm very uncomfortable at this point with comments like this. They are also teachable moments. But, you know, sometimes I get really tired of teaching.

I'm not sure I said the right thing. I'm not sure what the right thing is. Any thoughts?

Oprah and the "brown elephant in the room"

That, according to a recent New York Times article, is how Oprah Winfrey refers to the 40 pounds she's gained over the last year or two. The piece is titled "Her Bulge, His Book and Their Plan B," and focuses on her long-term relationship with the most important man in her life: Bob Greene, her personal trainer/diet guru.

It's an interesting piece and worth reading for those who are interested in the money side of the weight-loss biz. Greene has created several hugely profitable franchises from his work with Oprah--so profitable, in fact, that he no longer charges her for consulting. (I love that--the richest woman in the world doesn't have to pay!) The recent media attention to Oprah's weight gain has been a bonanza for Greene, a fact he readily admits.

There's much to shake your head at here, but it was this quote that really got me:

Ms. Winfrey has so far accepted all the blame for her lapse, not once suggesting the fault lies with Mr. Greene or his diet plan. "This has been a wake-up call for her to let me get back to doing my thing," Mr. Greene said.

Notice anything? Oprah takes blame for gaining weight. Not responsibility. Not ownership. But blame. As in, gaining weight is obviously a moral lapse that must be atoned for. Greene's "diet plan" is blameless, as is Greene himself. Not everyone agrees: At the end of the article, another trainer comments that "any time a client falls off the wagon, the fault lies with the trainer, because it is his or her job to formulate a plan that works for the client."

Here's a radical suggestion: Maybe the fault here lies neither with the stars nor with ourselves* but with the concept of dieting, a concept we know to be fundamentally flawed because 98 percent of dieters "fall off the wagon," as Oprah put it. Maybe the real problem is the frenzy of self-loathing we are so quick to fall into, which, I submit, does more to prevent us from "living our best life" than 5 "extra" pounds, or 30, or 80.

I've been there. Just ask my long-suffering husband, who's had to talk me off the ledge of self-hatred many times. One thing I know for sure: Self-acceptance feels a hell of a lot better than self-loathing. It's not easy to pull off in this culture, whether you're fat or thin. But it's worth the effort. Really.


* I can never resist a Shakespeare paraphrase or pun.

Obesity problems--true and faux

An anonymous reader posed a question to me on another thread, which I thought deserved its own thread. He or she wrote:

I've been reading your blog on and off for about 8 months now. Do you ever recognize that there is an obesity problem in the States? Though I am on board with the message that 'fat' does not equal 'unhealthy,' and I am certainly opposed to pathologizing a group of people who have nothing wrong with them, I still believe there is an obesity-related health problem in this country.

In public, I feel I need to be an advocate for fat acceptance (or maybe, Health at Every Size), but I also want to find a way to acknowledge and distinguish the obesity-related health problem that does exist. I'd love to hear your thoughts about how to address this with an even hand.

I'm not an epidemiologist; I haven't done any studies on this question. I've read extensively, I've thought about it, I've talked to people. I'll tell you what I think, personally, and then I'd like to hear from other readers who may know more than me.

What I've read suggests that there is no obesity explosion in this country. That in general Americans are a little heavier than they were, say, 50 years ago. They are also a little taller. Some of what I've read suggests that these two go hand in hand. I know that there was a surge in obesity statistics about 10 years ago, when BMI cutoffs were changed overnight. People who went to sleep merely overweight woke up obese, and an alarming new statistic was born.

I've read research suggesting that weights went up in the late 1980s, after several years of the low-fat craze. Which brings me to the point here: While I don't think we can say with any certainty that people are fatter now and/or why that might be, what we do know is that we can't make them thinner. So let's set assume for a moment that yes, people are fatter now. Let's take it a step further and proclaim that this rise in weight is a Serious Health Problem (and I'm not saying it is; as others have pointed out very well, fat is not equivalent to poor health, and thin does not correlate good health).

Here's the thing: We can't change what people weigh. Some people lose weight for a short time by dieting. But 98 percent of them gain it back, and then some.

So diets don't work for adults. They don't work for children, either. School interventions are notoriously ineffective when it comes to making kids thinner.

Now let's go back to that assumption, that weight is a serious health problem. There is little to no evidence of this. There is a correlation between obesity and diabetes, but it's a correlation, not cause and effect. We don't know that obesity causes diabetes; maybe whatever malfunctioning metabolic shift causes diabetes actually causes obesity. In which case, trying to "cure" obesity would be like trying to "cure" OCD by, I don't know, strapping someone's hands to their sides so they can't obsessively wash them. It would be treating the symptom rather than the cause.

When it comes to other measures of health, the statistics don't bear out the notion that obesity is a serious health issue. In fact, Katherine Flegal's now-famous mortality study points to modest advantages to being "overweight," especially as people age.

So in answer to your question, Anonymous, no, I don't know that obesity is a serious health problem in the U.S., and neither do you, or anyone else, for that matter. We don't have enough information; we don't even really understand the information we've got. Losing weight sometimes raises people's risk of dying from cardiac disease, in fact. We just don't know.

While we don't really understand all the implications of weight, we do know that fitness is good. Eating a varied diet that includes (but isn't necessarily limited to) fresh fruits and veggies is good. Exercising (but not to the point of obsession) is good. Feeling good about yourself is good (and feeling bad about yourself is bad for you).

So until I know more, really know more, I'm going to stick to my guns on this one. Eat well. Live well. Move your body. And, most important, love yourself as you are right now. Not 20 pounds from now but today, this minute. Self-loathing--the kind that is a natural consequence of the current anti-obesity hysteria--is far worse for people than extra pounds. As far as we know.

What I said

Nearly a year ago I wrote a post about Oprah's public battle with weight. Back then I wondered whether anyone could "win" the "battle of the bulge," if Oprah with all her money and resources couldn't.

Now the comment is a bit different: If Oprah, with all her ups and downs, her struggles to accept herself as she is, her repudiation of her body and her appetite, can't learn to love herself, then who can?

The answer: You can. I can. Even Oprah can.

But to do that, you've got to let go of the fantasy image of yourself as you wish you were.

You've got to grieve for the vision of yourself you've held dear for so long. You've got to grieve for that perfect you, the one who floats effortlessly through the world, svelte, unsinkable, emotionally airbrushed. You've got to learn to love instead what you've got: your thighs and your big heart, your dreams and your pores, all of them part of the same imperfect and vastly more interesting package than any airbrushed toothpick-thin fantasy could ever be.

Oprah, if you're reading this, I'm rooting for you--not to lose that weight again, but to gain something infinitely more precious: yourself.

Wanted: Snappy comebacks

It's inevitable: Whenever I see people I haven't seen for a while, one or two of them are sure to say something like "You've lost weight! You look so good!" Not because I've lost tons of weight. Maybe I've lost 5 pounds, but I really don't know (and don't care) and haven't weighed myself in months. I think it's because I'm happy. Oh, and my hair is longer.

The point is, I wish I had something to say in this situation. Yesterday an acquaintance gushed on and on about my putative weight loss, and I said, "No, I really don't think I've lost a lot of weight." Her response: "I beg to differ!"

Excuse me? You're telling me about my body? I know she meant well, but it was tres frustrating. I wish I had some snappy (but not snarky) comeback to offer in this situation.

Any suggestions?

"You look great! Have you lost weight?"

I went "home" for the weekend last week--back to Madison, where I lived for 16 years. It was great to see old friends, neighbors, acquaintances, etc., and very emotional, too. It takes time, lots of time, to forge friendships. This year is rather a lonely year in Syracuse.

It was great to see those friends, but I really wish so many of them hadn't commented on my weight. The consensus seemed to be that I was looking better than usual so I must have lost weight. This conflation really, really bugs me. Why is a weight loss always associated with looking good?

I went to the doctor today and got on the scale for the first time in probably 6 months. Yes, I have lost a couple of pounds, but not, as one friend suggested, "a ton of weight!" For someone my size--five foot one and a little, 161 pounds--a couple of pounds makes little visible difference.

"You look good because you're happy," my husband pointed out. That's right. I'm engaged and invigorated by my new work and by the challenges and curiosities of making a home in a new place, and it shows.

I look forward to a day when looking good and losing weight are two separate and distinct ideas. And when we think twice before mentioning them in the same breath.

Oh for fuck's sake

I was already feeling testy when Kate Harding forwarded me a link to this abomination.

Titled "What Does the War Have to Do With Your Weight?," it's an absurd conflation of talk about terrorism and overeating. The worst part is that it's aimed at adolescent girls.

Here's a wee sample from the opening paragraph:

Are you one of the millions of teens who overeat when they are under stress? If you are, we've got some good news and some bad news. The bad news is that rarely in history has there been a more turbulent time. Since 9/11, it seems as if the problems of the world are growing larger and scarier... and looming closer than ever before. The good news is that you are not alone. Fifteen percent of Americans confessed that after the towers fell, they turned to comfort foods while another 14% reported eating more sweets. Two months after the terrorist attacks, one in ten Americans had gained weight. Anyone versed in psychology is familiar with the relationship between mood and food.

If this was a writing assignment I'd give it a big red F for conflating disparate ideas that have nothing to do with each other (9/11, eating), for catastrophizing and distortion of facts (if 15% "turned to comfort foods," that means 85% didn't--a much more significant number), for piss-poor organization (the "good news, bad news" conceit is grossly inappropriate), and for failure to show cause and effect (even if 1 in 10 Americans gained weight after 9/11, it does not prove the central point here). We'll throw in a bonus point for that last line, which does a better job of rhyming than of proving any kind of point.

Of course, the next line is pretty over the top, too:

Whether it's the war with Iraq, hard decisions abut college, or troubles with friends, some of us use food to provide the good feelings we're missing.

I don't know about you, but I often reach for the Oreos when I think of the Iraq War. Doritos, on the other hand, are my comfort food of choice when I think of Vietnam. The Korean War takes me straight to the freezer for some Ben & Jerry's. World War II? Gotta be those Jello pudding cups!

It's more than just fodder for satire, though. The site goes on to suggest 9 ways for girls to improve their eating habits, including:

1. At the moment you grab for something to eat, tell yourself you can have it if you still want it but you have to wait 30 minutes. The craving may pass, you might get distracted, you might become wise enough in that half hour to find a more life affirming way of getting rid of that creepy stress.

2. Write down everything you eat. Icky, we know, but we also know there's no better substitute (except looking at yourself in the mirror naked), that's better than tracking what goes into your mouth to get you into the habit of thinking before you eat.

I remember strategies like these from Weight Watchers. And from my own daughter's spiral into anorexia.

One of the worst parts of the site (created by Proctor & Gamble) is an unmoderated discussion for girls. Some of the comments on the site made me want to weep.

To tell P&G what you think of its site, click here. (You have to give a birthday to send feedback; I always type in a fake birth date.)

Et tu, Prevention?

It's been a while since this magazine geek has looked at Prevention magazine. What I remember from the last time--maybe 10 years ago--was that Prevention was a pretty good health-related magazine, with in-depth articles, exposés, thoughtful journalism, and some reader service--the tips and tricks kinds of articles.

This evening I looked it up online; I'd been told there was an article in the current issue I should see. I got to Prevention's home page, and was immediately assaulted by the following headlines:

Kick-Start Your Metabolism!
Flat Belly Diet! Tips to Shed Pounds Fast
Eat Chocolate to Lose Weight
Calculate Your BMI
Eat Healthfully and Fight Disease
Heart-Smart Foods
Melt Fat With Every Step
Lose Up to 15 Pounds in 32 Days
Eat Up, Slim Down

Dear editors: There's more to life than obsessing over fat and weight loss. You'd think, reading this page (and this was just the home page--there's more farther in), that losing weight was the only meaningful measure of health.

Seeing it like this was a visceral reminder of our national obsession, and just how unhealthy it is.

Of surgery and blame

There's nothing new about bariatric surgery, even in the midwestern outpost I live in (once a New Yorker, always a New Yorker!), but this front-page story in this morning's paper made me see just how mainstream it's becoming--so mainstream that health insurers here are beginning to cover it.

The good news is that the story focuses on the risks of weight-loss surgery: internal bleeding, bowel obstructions, leaks in the new pipeline, blood clots, and cardiac complications. The local hospitals that do the procedures have complication rates about the national average--between 8 and 11 percent. (I wonder how this compares with complications rates of other kinds of surgery; anyone out there know?)

What made me sick was not just the literal description of the surgery, though that was graphic and disturbing. It was the curiously familiar rhetoric that accompanied the story's generally positive view of these procedures:

". . . some doctors [say] patients are looking at the surgery as an easy solution.

'I see a lot of people who are in a miserable situation, and they 're looking for a solution, and surgery seems like an easy solution,' said Dr. Edward Livingston, a bariatric surgeon at the University of Texas Southwestern Medical School in Dallas.

'But this is a big life change. It requires a great deal of investment on the patient 's part to make it work.'"

Sound familiar? It should. Like so many other diet pills and weight-loss plans, it comes with a heaping helping of guilt and blame: You say people are miserable and are just looking for an easy solution? How dare they! They should be made to suffer.

And suffer they will, if they have bariatric surgery. If they're lucky, like the woman profiled at the top of this story, they will get to go off their meds for diabetes, sleep apnea, etc. Assuming, of course, they were on them in the first place. If they're lucky, they won't die as a result of the surgery or have complications that cause them long-term pain and disability.

And even if they are lucky, they're still likely to face buyer's remorse. "This is a lifelong commitment, and there are going to be days when you're sorry you've made this commitment," says the woman profiled in the story.

I bet. I find the word commitment to be an odd one here. What we're really talking about is a procedure that mutilates the human body, with long-term consequences like absorbing 77 percent fewer nutrients from food--for the rest of your life. That's not a commitment; it's something you endure.

But the underlying assumption, here as elsewhere, is that there's an element of choice about being obese. And that's what I find frustrating and upsetting, that our culture assumes that whenever you deviate from the cultural norms around weight, it's your fault. Whether you're obese or anorexic, you are to blame, and you are to be punished.

If I were a therapist, I'd have to ask: How does this help us? What's the secondary gain of seeing weight as a reflection of intention, behavior, and responsibility?

These are the kinds of questions that stories like this one should be asking.

Why Immanuel Kant was right

A letter in today's issue of the British Medical Journal warns that the obesity epidemic in the U.K. is so bad that action must be taken now; no more studies or research, says the letter writer. Do something now!

What does she think should be done? It's a question of infrastructure, she writes; we need to build more bike lanes and sidewalks and remove the physical obstacles to biking, walking, and swimming.

That sounds like a great idea to me. I live in a city famous for being bike-friendly. I bike to and from work when the temperature is above freezing (round trip: 6.5 miles) and walk the rest of the time, and I love it.

But I haven't lost any weight doing it, and I don't expect to. That's not why I do it. I bike and walk because I love the feeling of getting somewhere under my own steam--always have; I walked to and from high school, 2 miles each way, even though there was a bus I could have taken. My brain works better when I'm in motion, so I get a lot of my best ideas while I'm walking or biking. And the efficient part of me likes combining daily exercise with basic transportation--killing two birds with one stone.

The trouble comes when we pose such social changes as means to an end, ways to drop pounds, rather than an end unto itself. The philosopher Immanuel Kant spoke to this kind of mistake in his writings. In his view, all means to an end have a merely conditional worth because they are valuable only for achieving something else. In order to have value, something must be worth doing for its own sake.

Bingo! Let's build bike lanes and hiking paths and public swimming pools because we think there's intrinsic benefit in people biking, cycling, and swimming. Conflating weight loss with these activities just muddies the waters. What will letter writers propose when said improvements don't result in massive weight loss? I shudder to think.

Want to lose weight fast?

Carrie over at Ed-Bites has some brilliant ideas for you.*



*Please note: My tongue is inserted firmly in my cheek.

What obesity is

At least according to endocrinologist Robert Lustig: “Obesity is not a disease or a behavior. It’s a phenotype (a trait or characteristic in a subset of the population), which is a manifestation of many things.”

Lustig was talking about why there will never be a "one-size-fits-all" weight-loss drug.

Now if only he'd gone a step further, and questioned the need for a pill to change a phenotype.

This is what dieting can lead to

This excerpt from a brave, honest livejournal entry, addressed to the "pro-ana" contingent, made me cry. Of course not everyone who diets will become anorexic. But everyone who becomes anorexic goes through this. It's heartbreaking. It's lifebreaking.


"I have anorexia.

Not 'pro-anorexia,'
Not a strict weight loss obsession.

The last 6 months of my life have been hell.

I have watched everything I love slowly deteriorate around me, my own little world be turned completely on its head. I have damaged myself beyond repair and hurt those i love time and time and time again.
And I cannot control it.
Because it is a disease.
It is a condition.

And right now, it's very very bad for me.

I cannot express my frustration with those people who exploit the anorexic condition by using it to starve themselves as a weightloss strategy.
I want to eat.
I want my life back.
Anorexia stops me.
I'm fighting it, but it's hard. the hardest thing I've ever done.
How dare you all, sit there and wish for this.
Get out now while you can.
Please. I wish I could."

Gina Kolata rocks

Tomorrow's New York Times Book Review features a review of Gina Kolata's new book, Rethinking Thin. While the reviewer accepts Kolata's most relevant point--that most fat people do not get thin despite countless diets and interventions--she scoffs at Kolata's conclusion: that maybe there's nothing so wrong with being fat.

This is one book I can't wait to get my hands on. The reviewer was obviously biased from the get-go, but luckily that bias is so clear that there's no mistaking it for critical judgment. Kolata is a wonderful science writer who knows her stuff. I'm looking forward to reading it for myself.

Changing the culture, one heart and mind at a time

Last night a friend told me that since my daughter Kitty's illness, her daughter had become very outspoken on the subject of anorexia. She said that whenever other teenage girls joked about it, she "set them straight"--a commendable act of friendship.

But what really made me want to stand up and cheer was when she told me about the day her daughter--Kitty's friend--came home and headed straight for the refrigerator. Apparently someone had told Kitty's friend she looked like she'd lost some weight. "I can fix that," she said, reaching for the whipped cream.

Here's what blows my mind about that: In a culture where all of us are so conditioned to think that thin is always good (and thinner is always better), it's hard to go against the stream. We parents of anorexics are shoved right up against this cognitive dissonance when we re-feed our ill children. It took the gut-wrenching experience of watching my child nearly starve herself to death to open my eyes and change my reflexive thin=good, fat=bad mentality. But Kitty's friend, who is still in high school, is a much quicker study than I am. She's learned from Kitty's nightmare and is already applying the lesson in her own life.

Her insight and perspective give me hope that although change seems to come slowly, it does come, one heart and mind at a time.