Dietitians Unplugged Ep 22: There Will Be Rants

Cover2Aaron and I are kicking it solo (duo?) in this episode of ranty rantings about bad science around weight and health, celebrity weight loss pressure, and why we need our fat positive role models so damn badly. Some of my favorite Dietitians Unplugged podcast episodes are when Aaron and I get to catch each other up with what’s on our minds, and this is one of those times.

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Is There a Fat Human Biome?

fatmouseA friend of mine sent me this article about Sandra Aamodt’s new book Why Diets Make Us Fat: The Unintended Consequences of Our Obsession With Weight Loss. Check it out, she said. Lots of shares on social media.

I’m excited to read this book since Sandra Aamodt has been a pretty staunch anti-diet advocate in recent years. She first came to my attention in this Ted talk. The research discussed in the article centers on the human biome of the gut – the trillions of bacteria that live in our GI system, which is something I’ve been interested in for the last 20 years since I first discovered probiotics – and how our gut microbes might affect our weight.

The article talks about the research done on the biomes of mice and how different body sizes are produced when they alter the biome of bacteria-free mice (which are produced in the lab; bacteria-free humans or mice do not occur naturally). It then goes on to talk about the research based on children who had been given antibiotics early in life and their prevalence for overweight/obesity (the article’s words; you know I prefer “fat” as a body descriptor).  The article, however, makes some wild assumptions and conclusions, and I’m wondering how closely it hues to the tenor of the book.

I’m definitely of the mind that antibiotics have been overused and abused for the last 40 or more years and that’s one of the reasons why antibiotic resistant microbes have developed (MRSA, drug resistant TB). On the other hand, antibiotics are one of the reasons humans are living longer – even despite the supposed “obesity panic epidemic.” So I worry about this kind of information getting filtered through the fatphobic lens of our society and being turned into, “OMIGOD I cannot give my child antibiotics or she will turn out to be FAT.” I’m worried, in essence, that this will become the new iteration of the current anti-vaxxer madness. What if a baby needs antibiotics to save his or her life? Will they be withheld to prevent fatness? This might sound extreme, until you look at the increase in pertussis (whooping cough) and measles outbreaks that were most likely due to anti-vaccination hysteria.

The article closes with, “For now, we can take a couple of lessons from this research. Parents should minimize antibiotic use in children, especially in the first year of life, because changes in gut bacteria at that age can have lasting consequences. The average child in the United States receives ten to twenty courses of antibiotics before age 18, increasing the risks of asthma, allergies and inflammatory bowel disease, in addition to obesity and diabetes.” Can we really take these lessons yet? I’m not advocating for the cavalier use of antibiotics in kids with a mere runny nose, but as far as I know, there is simply not enough firm data to jump to all these conclusions (remember that correlation does not equal causation). The science is far from clear, and people still die regularly from simple bacterial infections in countries where they have no access to antibiotics. I’m afraid this kind of simplistic pronouncement is just going to panic parents more than needs to happen.

So let’s use some commonsense here, please. Yes, we shouldn’t abuse antibiotics; no, we probably shouldn’t withhold antibiotics from children if they truly need them just because there is a chance they will end up fat later on in life.

I’m also concerned about the potential for the research on the human biome to be abused by the diet industry in the name of eradicating fat people. How far will we go (read: how far will the diet industry go) in trying to change the biomes of fat people in order to make them into thin people? I’ll tell you this: I for one am not swallowing any poop pills to facilitate a bacterial transplant no matter how thin it might make me (as has already been proposed in recent research. Ew.). I already know what I need to do to be as healthy as I can be at the size I’m at now (knowing that many factors are beyond my control); I don’t need to literally swallow shit on top of everything else I do.

And what if we find out (too late, as always) that one person’s gut microbes aren’t good for someone else? Or that our personal biomes hold certain advantages for us and that changing that environment removes those advantages? Count me out, thanks.

I know that Sandra Aamodt will make the case that diets don’t make us thinner like they purport to do, and probably make us fatter in the long run. I am hoping she has used the research around the human biome to make the case that our weight is not really within our control, and that there are many complex factors that go into determining our body weight that we cannot necessarily influence.  I truly hope she advocates for size diversity and body acceptance. Because what we don’t need is another hare-brained scheme – like dieting to lose weight has proven to be – to make further assaults on the bodies and minds of fat people.

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That Intuitive Eating Study

Epic FailIn one of the most colossal failures to interpret Intuitive Eating to the masses, Gretchen Reynolds reported in The New York Times magazine on this study which concluded that intuitive eating was not any better than calorie restriction for shedding pounds.

Are you effing kidding me?! There really is nothing that will put me in a rage more than someone trying to take one of the few, weight-loss-mentality free, diet-free philosophies on earth and trying to turn it into a weight loss diet.

In case you don’t want to read the article or the study – though if you do, please come back here for a complete breakdown of how this is just so wrong from top to bottom – I’ll sum it up here. Researchers took 16 men and women and put half on a diet, and gave the other half “instructions” in intuitive eating and after 6 weeks the dieters lost around 5 pounds and the intuitive eaters, while initially losing weight, did not show nearly as much weight loss as the calorie restriction group. Neither the article nor the abstract mention average weight change for the IE group, but I suspect it was insignificant and I’ll explain why just as soon as I finish banging my head against the wall over here.

There are three huge problems that I can see with this study. The first is the fact that intuitive eating was not designed with the intention to produce weight loss. Straight from IntuitiveEating.org, it is “an approach that teaches you how to create a healthy relationship with your food, mind, and body.” Nowhere on the website is weight loss promised. It’s simply not about that – it’s about becoming a no-drama eater, unlike how most people eat while on diets (total drama). In the process, a person’s weight may stabilize as a result of eating according to inner hunger/fullness cues, but that doesn’t necessarily mean weight loss, and in some cases it might even mean some weight gain if a person has been maintaining below their natural set point. And yes, some people may lose weight, although this is not a scientifically proven outcome. Which is why the end point of intuitive eating is a relaxed, healthy relationship to food and eating – not weight loss.

So comparing intuitive eating to dieting to produce weight loss is like comparing apples and…watermelons, it’s just that different. Other than being about eating, they are not at all the same thing. But that didn’t stop the study authors from making the comparison.

The second big problem is how intuitive eating was executed (with all the accurate imagery that word evokes) in this study. All participants, including the intuitive eaters, were all weighed.  So while one of the principles of intuitive eating is not “throw out your scale,” rejecting the diet mentality is the first principle, and weighing is an integral part of weight loss dieting. Many intuitive eating practitioners I know won’t weight their clients because it is counterproductive to becoming reacquainted with their internal eating regulation. Why? Because stepping on the scale may trigger the expectation of weight loss, and that expectation, whether met or not, can mess with developing true body trust. It becomes about reliance on external outcomes, not internal cues.

But these study participants were indeed weighed. How effective, then, do you think their practice of intuitive eating during the study was? Do you think they were truly able to trust their internal signals of hunger and fullness when they stepped on a scale and were reminded of the expectations around weight change? I doubt it. I call that a big study flaw.

And the third problem is this: the participants were instructed in intuitive eating at the beginning of the study and then at the midpoint. The study was a randomized controlled trial so I’m going to assume most of the participants were new to this non-diet philosophy. Were they dieters before? Had they ever tried to lose weight? Were they chronic over- or under-eaters? Because here’s the deal: just getting some basic instruction in intuitive eating once or twice, especially if someone has been a chronic dieter, does not necessarily an intuitive eater make. For many of us, the journey from anguished eater to intuitive eater is a process – sometimes long, sometimes complicated. It can take weeks, months or years. In my personal experience, the first few weeks of non-diet eating does not feel intuitive at all. As Carly from the blog Snack Therapy writes, intuitive eating initially

“…involves a whole lot of thinking about food.   And this is true… at first.  It’s kind of like when you break up with a partner; you have bitch and moan to your friends/therapist/mom/other therapist/person handing out free samples at Whole Foods/cat in order to get over him or her and forget about your dysfunctional relationship.  It’s the same thing with food.  You have to analyze why you’re eating what, and when, and why, and how, and with whom.  You think about how you feel after certain meals.  You might spend a lot of time dreaming about what you’re going to eat tomorrow, because you’re finally allowing yourself to eat good food.  So it’s true: if you decide to start eating intuitively, it probably won’t be very intuitive at the beginning.  It’ll be a lot of checking in with yourself: (‘Carly, why did you eat that bowl of ice cream?  Was it because you were hungry?  Was it because you needed comfort? Was it because you saw a commercial for some and you had a craving?  Was it because the moon is in the 7th house?  Was it because you read that article about how some people develop lactose intolerance later in life, and so you should probably eat the ice cream now just in case you wake up tomorrow with a crippling dairy allergy?’).  It’ll be a lot of thinking.  A whole lot of thinking.”

Do you think the participants of this study, in the first 6 weeks after their introduction to IE, were really accomplished intuitive eaters? Maybe, and also maybe not. Not that it matters much to the bottom line of weight loss – because again, that’s not what we’re expecting here in the real world. But if you’re gonna call it intuitive eating, you maybe want to start with a bit more than two quickie info sessions.

So…argh.

This is irresponsible science. It’s also irresponsible reporting. The investigation in this article was pretty damn piss-poor. All Ms. Reynolds had to do was toodle on over to IntuitiveEating.org – which she referenced in her article – to see that nowhere on the website is there a promise for weight loss. Where you can see that it doesn’t even mention weight loss as an outcome. That it is obvious it isn’t another fad diet craze that is to be used as a substitute for dieting in order to get your dream body. Nope nope and nope.

While intuitive eating might not produce weight loss it can give us so much more: peace of mind, a healthy relationship to food and eating and our bodies, a weight that is right and sustainable for each one of us. Putting it in the same category as weight loss dieting? Epic fail.

 

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