Rethinking Thin

You can hardly turn on the radio or pick up a magazine these days without hearing about the obesity crisis. We’re told that people are getting fatter and fatter and all their fat will surely lead to death, with a guaranteed spell of diabetes and heart disease to usher them there. All these unsightly fat people are increasing everyone’s insurance rates and taking up all the space on airlines. Don’t they know how fat they are? Why can’t they stop eating those six hamburgers and two bacon sundaes a day and go for a walk? Apparently, the fat is their own fault, and if they (by which I also mean we) would only exercise a little self-discipline and will power, they would get thin and stay thin. And also be guaranteed perfect health until the day they die. Which they won’t do until they are very very old.

Or so the story goes. In Rethinking Thin¸ Gina Kolata, a science and health writer for the New York Times, offers a much-needed alternate narrative. Kolata tells the story of how weight standards have changed over time, shares research on the causes of obesity, and reconsiders the link between weight and health. She intersperses these chapters with a narrative about participants in a two-year weight-loss study designed to determine whether the then-popular Atkins diet or a low-calorie diet was more effective. (The book was published in 2007, not long after the Atkins diet was at the height of its popularity.)

This is an excellent book, one that I’d like to hand out on street corners and give to every single weight loss guru and everyone who says weight loss is as simple as eating less and exercising more, cutting out all carbs and/or sugar, or taking on a “lifestyle change” that involves weighing and measuring every morsel of food you ever eat for the rest of your life. Kolata debunks myth after myth, showing that weight loss is far more complicated and difficult than profit-seeking diet companies would have us believe.

The early chapters focus on the history of dieting, weight loss, and fat stigma. Kolata shows that few of today’s supposedly revolutionary diets are new. What is new is that the standard for a healthy weight has gotten lower. This is all very interesting, but it’s the last half of the book that offers the meat of her research.

When Kolata gets into current research into weight loss, she starts calling into question all those things about weight that “everybody knows.” For example, when discussing the psychological factors that might cause overeating, she reveals that obese people’s psychological profiles are no different from those of thin people. Obesity is not, in fact, a sign of mental problems. When psychiatrists look at the mental health profile of fat and thin people, they cannot tell the difference. Kolata sums up the findings:

There is no psychiatric pathology that spells obesity. And there is no response to food that is not shared by people who are not fat. You can’t say you got fat because you, unlike thin people, are unable to resist temptation. Both fat and thin people are tempted by the sweet smell of brownies or the sight of a dish of creamy cold ice cream. You can’t say you got fat because there is a lot of stress in your life. Thin people are just as likely to eat under stress. You can’t say it was because you used food as a reward. If that is the reason, then why do thin people, who also use food as a reward, stay thin?

Research also shows that obesity could, to a great extent, be genetic. Studies of adoptees and of twins raised separately show that children of obese parents tend to be obese, even when they are raised apart from their parents, which rules out the common notion that fat parents teach their kids poor dietary habits. Studies of rats and mice have revealed that when certain genes that govern feelings of satiety are not present or when they don’t function properly, it can be impossible to ever feel full. People who have this genetic abnormality feel their hunger more and feel their fullness less. So for these people, the advice to eat only when you’re hungry and stop when you’re full is pointless.

An additional complication is that fact that fat people who have lost weight are physically different from people who are naturally thin. A formerly fat person who now weighs 130 pounds must eat fewer calories than a person who got to that weight without dieting (or making a “lifestyle change” that involves calorie restriction). Physiologically, a fat person who has lost weight is not so different from a person who is starving. When people say weight loss is as simple as “eating less and exercising more,” I’m not sure they can actually conceive of how much less food and how much more exercise a formerly fat person requires to stay thin.

Especially interesting to me was the discussion of the starvation experiment conducted with conscientious objectors during World War II. When the participants were put on a starvation diet, they eventually began fantasizing about food, exchanging recipes, and obsessing about every meal. I read a book about this experiment last year and, as striking as this behavior was, I hadn’t connected it with my own food obsessions when I’m on a diet. When I’m consciously watching my calories, it’s hard for me to think about anything but food. If there’s a plate of cookies on a table in a meeting, my mind will drift to them almost constantly. If I’m not dieting, it’s easier to ignore them. This connection also got me thinking about whether the rise in “food porn” and popularity of food shows could be linked to our dieting culture. Does dieting make us think about food more? And is that a good thing?

Probably the most important chapter may be the one on what Kolata calls the “fat wars.” In this chapter, Kolata discusses the possibly false link between weight and health. I’ve long questioned whether this link is as strong as headline writers and diet gurus would have us think. I know from my own experience that I was not at my healthiest when I was at my lowest weight. I weigh more now than I did when I was eating far less healthily and exercising less. The shocking thing about this chapter was not so much that studies have shown that the link between weight and health is tenuous, but the fact that the research has been so thoroughly quashed, sometimes by researchers who have a stake in the weight-loss industry. As a nonscientist reader, I worry a little whenever I encounter competing scientific claims, because I don’t have the knowledge to analyze them properly. But Kolata makes a good case for the studies that downplay the link between weight and health and offers a pretty good critique of the studies that emphasize that link.

I could go on and on about all the important things I learned from this book. Kolata discusses so many things I haven’t even touched on. There were a few holes, and the writing is sometimes dry. The first few chapters really didn’t do much for me, partly because of the focus on fad diets, which I’ve never been a fan of. Any diets that I’ve undertaken have been of the “lifestyle change” variety, along the line of Weight Watchers. But the last half is essential reading. Even if the book doesn’t convince you that the obesity crisis is overblown and the insistence on the necessity of weight loss is ridiculous, it should surely cause you to question the conventional wisdom that seems too often to go unquestioned.

Some readers might find this book discouraging because Kolata doesn’t offer any hope for long-term weight loss. For me, however, it’s profoundly hopeful because it tells me that my own lack of success at losing weight and keeping it off is not my own fault. What’s more, it tells me that the fact that I’m obese may not mean I’m unhealthy. I came to the conclusion a while ago that the best I can do is to try to eat right and exercise regularly. Like most people, I could do better on both these counts, but I also eat better and exercise more than plenty of thin people. Focusing on health rather than weight (which is tremendously difficult to do in today’s culture) actually helps me feel better and overeat less. Whether I lose weight as a result is not even relevant.

If you’re interested in more critique of dieting culture and the rhetoric behind the obesity crisis, check out these blogs: Dances with Fat, The Fat Nutritionist, and the Health at Every Size Blog. These blogs have been incredibly helpful to me as I’ve tried to let go of dieting and focus on health.

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26 Responses to Rethinking Thin

  1. This sounds like such a thoughtful book – there’s so much misinformation about how ‘easy’ weight loss is. (In passing, I like to mark all those dodgy weight loss adverts on facebook (etc.) as “Against My Beliefs”.)

  2. This sounds like a really informative book that I’d like to read. Thanks for blogging about this book and serious issue.

  3. Deb says:

    Coincidently, I just finished this book a few weeks ago and agree that it is wonderfully thought-provoking. The experiments with the mice who either had or did not have the “stop eating” gene and what happened when one of each were spliced together were very eye-opening because I sometimes think I don’t have that “stop eating” gene! But possibly the single most interesting and informative aspect of the book was the section about how pre-conceived notions of “overweight = unhealthy” has skewed so much scientific “research”–that when studies showed that, in general, overweight people are no less healthy that people of “normal” weight, the people who run those studies were “swiftboated” (there’s no other word for it) in the scientific community and press. We are constantly being fed (pardon the pun) the notion that being overweight means you cannot be healthy, but it turns out most of those studies were based on cultural preconceptions and not on scientific fact at all.

    Have you read Kolata’s book about the influenza pandemic of 1918? It too is a really good book, also blending science and history in an entertaining, informative way.

    • Teresa says:

      That whole chapter about the fat wars was shocking. I just can’t understand why those researchers would want to make people feel bad about their weight when it isn’t necessarily even a threat to our health. No, wait, there’s money in weight loss. The most horrible example was the Harvard group that wrote a press release saying people weren’t convinced by the study indicating you could be overweight and healthy. As if the fact that people aren’t convinced is evidence on its own!

      I’ve not read her flu book, but I’m glad to hear it’s good. She’s also written a book on exercise and health, which I’m very interested in.

  4. Jennifer says:

    Oh! Another book to put on my tbr pile..though this will be very near the top! Thank you for the review!!!

  5. Gavin says:

    Thanks for this thoughtful review. I am adding this book to my TBR list.

  6. gaskella says:

    I like the focus on health rather than weight too. Having said that, the other year, I lost 5.5 stone on the Atkins diet, but found I couldn’t enjoy life without some carbs – and the weight went back on instantly – I couldn’t find that balance. I did feel healthier in body after losing the weight, but my mind was obsessed with food which wasn’t so good!

    There has been an interesting series on the BBC recently called ‘The Men Who Made You Fat’ which examined the effects of substituting cheap high fructose corn syrup instead of sucrose in foods, supersizing and food promotional tactics, and claims about healthy foods – low fat – but high in sugar etc – all the ways the food industry manipulates us. Although I can accept that there are genetic links, programmes like these do make me think that it’s a multi-sided very complex issue. The book sounds fascinating though.

    • Teresa says:

      I lost a fair bit of weight a few years ago with Weight Watchers, but I never got out of the overweight range (and barely out of obesity), but I couldn’t keep it off. Most people can’t! For me, it just got to be too much work to track every calorie/point, and I hated thinking about it all the time. It didn’t feel mentally healthy, even if my bodily health improved.

      I agree with you that it’s a complex issue. Kolata acknowledges that for sure. Genetics are a bigger slice than is often acknowledged, but it doesn’t explain everything, I don’t think.

  7. This book sounds awesome Teresa, I just put it on hold at my library. While I do think there’s some truth to the “eat less, move more” mentality, at some point those simple rules don’t work anymore — your body gets to a comfortable place and then it’s better to be healthy than it is to struggle to lose more weight. I’m really interested in reading this one.

    • Teresa says:

      I hope you enjoy it.

      I agree that “eat less, move more” is a good guideline for improving health for a lot of people. It’s just that it doesn’t necessarily lead to significant weight loss. So many other factors are involved, and starvation and overuse injuries are no good for anyone.

  8. Juxtabook says:

    I agree with a lot of this. It is all far more complex than the simple calories in and calories out equation they’d have us believe. Another fascinating book on food is Queen of Fats: Why Omega-3s Were Removed from the Western Diet and What We Can Do to Replace Them by Susan Allport. I am sure that eating the wrong sort of fat is a massively underestimated problem.

    • Teresa says:

      I’m sure that where we’re getting our calories makes a difference. I’ve found I need some healthy fat in my diet to feel full so I don’t overeat, and I try to choose foods high in Omega-3s. (Salmon was my dinner tonight. Yum!)

  9. Jeanne says:

    As a yo-yo dieter, I’ve read lots of the books out there. This one doesn’t sound like it would be news to me, although there might be parts I’d like to look at. The most helpful book for me has always been Fat is a Feminist Issue.

    • Teresa says:

      It was a pretty good mix of new to me and not so new–and she gave more detailed explanations of a few studies I was only slightly familiar with. I’m going to look into Fat Is a Feminist Issue!

  10. rebeccareid says:

    How fascinating. I must say I feel I must read this just because the comment you make about weight issues “not being your fault” causes me to pause and wonder. Not that I’m personally blaming you, and please don’t take this the wrong way, but it disturbs me to think that people in general could dismiss responsibility for their own obesity issues. Sounds like I must read the book to see what brought you to that conclusion.

    • Teresa says:

      The whole question of personal responsibility is tricky because there are lots of obese people who do eat right and exercise, yet the scale doesn’t budge. They may have had terrible habits in the past and although healthy eating and exercise can get them to a much better place health-wise, they’ll remain obese. Yet people assume that all obese people are routinely sitting on their couches eating Big Macs, milkshakes, and whole buckets of KFC. In some cases, that may be true, but not for everyone. And plenty of thin people have terrible eating habits, so it goes both ways. What this book makes clear is that we might be able to have some control over our weight, but there’s a limit to how much control we have.

  11. boardinginmyforties says:

    This sounds like a must read for me and nice to hear another side to this story. I think that society demonizes overweight people instead of trying to understand what is really going on.

    • Teresa says:

      I agree. And I think too that a lot of people don’t recognize that what’s going on with one person might be completely different from what’s going on with another.

  12. I have been considered at least “overweight” from the time I was a teenager by my mom, who based her initial judgement on my being 5 lbs overweight (and never more than 10, true story) and a lot taller and bigger boned than she was. She nagged me constantly, and I was going through adolescent rebellion, so I deliberately defied her, until I weighed (in a self-prophesying manner) 30 pounds too much. After that, I went through my young adult life mostly thinner than that, but a few years I yo-yo’d (though most of the time I still didn’t have to diet) and went back up from my recommended healthy weight by about 25 lbs. Now that I’m in middle-age and older, I’m having serious problems with my weight (mostly losing it; I haven’t gotten diabetes yet, though I’ve been warned to watch my sugar and carb intake). Though an initial struggle with my mother caused this problem, I would not blame her at all for the rest of it–we have to take what comes to us in life and grow up and make our own standards–except that even today she still nags about every bite I put in my mouth that she doesn’t personally approve of. And it infuriates me. I tell her off constantly about it, but it doesn’t change much. I don’t know how much of it is or isn’t my fault by some impossible-to-achieve impartial scale, but I know that she would never believe (because even now I prefer to sit and read rather than engage in active exercise) that it isn’t my fault for what I eat and for being largely sedentary. I do make an effort to get exercise every day, but I don’t always do so; one tends to lose enthusiasm for it when it doesn’t achieve the advertized effects. And I want quality of life too, so sure, every now and then I eat something I shouldn’t eat. But I just started a new pattern of healthier eating two days ago, so we’ll see; it was nice, anyway, to hear of a sympathetic voice from the other side of the divide.

    • Teresa says:

      I’ve been so lucky that I haven’t had people nagging me about my weight (aside from one doctor who never bothered to check my cholesterol or blood sugar, which are fine, but told me that I shouldn’t be having raisins in the house when I told her a bit about my eating habits). I’m sorry you’ve had to deal with that.

      And I hear you about losing enthusiasm. I do too sometimes, but the thing that really changed my perspective was realizing that exercise and healthy eating are good for me even if I don’t lose weight. I just don’t care about the weight any more; I think more about my energy level and how I’m feeling.

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