Health at Any Size: Science Based or Wishful Thinking?

I have taken an unpopular stance amongst my peers that “health at any size” is simply a fantasy. We are in agreement on a few points, however: we need to focus more on achieving health and not about reaching a certain number on a scale. And regardless of size, everyone deserves to be treated with respect and dignity. That said, to think that you can be 350+ pounds and still be “healthy” is the exception, NOT the rule. In my nearly 30 years as a clinician, rarely do I see someone of “size” who has a healthy percent body fat, is absent of joint pain or metabolic health challenges and so on. By the way, I don’t see NBA/NFL players – that might be the exception to the rule though a great many x-athletes who maintain their size but not their activity are prone to the same aforementioned concerns.

This article featured in the Huffington Post, by David Katz, MD, does a great job in pointing out the flaws in the “Health at any size” philosophy. Of course, I would welcome your thoughts and comments!

Why I Can’t Quite Be Okay With ‘Okay at Any Size’
by David Katz, MD

There has long been a movement to defend the overweight from a prevailing lack of understanding. And, alas, that defense seems to be needed.

The evidence of obesity bias in our culture is abundant and pervasive, and can be found from playground to boardroom. We have historically done a poor job of attacking the problem of obesity without attacking those burdened by the problem of obesity.

The defense has come in the form of professionals who highlight the pernicious effects of bias. It has come in the form of organizations, such as NAAFA, the National Association to Advance Fat Acceptance. In my own case, it comes in the form of the National Exchange for Weight Loss Resistance, which I launched to help spread the word that some people can eat well, be active, and still never get to thin.

There has long been some okay-at-any-size support from Hollywood and Madison Avenue, as well. The Dove ads for women with “normal” curves are already classics. Oprah has emoted on the topic. Plus-size models can do quite well. And Queen Latifah has brought her inimitable “what you see is what you get, if you’re lucky” brand of gumption to the issue.

Apparently, though, we’ve entered a new stage of evolution on the topic. The New York Times recently reported that a whole new cadre of celebrities prone to the same obesigenic influences as the rest of us are simply shrugging their shoulders, and letting it all hang out. In some cases, quite literally — by exposing the expanding epidermis in question.

So “okay at any size” seems to be gathering pop culture momentum. And I regret to say, I can’t be entirely okay with that. It’s not the size I’m not okay with — it’s the consequences.

Epidemic obesity is not just a reason we have epidemic diabetes — it is the reason. It is the reason why the CDC is projecting that as many as 1 in 3 of us may be diabetic by mid-century, at a cost the nation is unlikely to find manageable.

It is the reason why what used to be “adult onset” diabetes is now a disease of children as well, and called “Type 2.” It is the known reason for a proliferation of ever more cardiac risk factors in ever younger people. It is the reason behind a triple coronary bypass in a 17-year-old boy whose case I know. And it is the likely reason for a 35 percent increase in the rate of stroke among 5-to 14-year-olds.

And the toll of this menace continues to rise. Not so much now because of more people becoming overweight, although that continues to happen. Rather, since most of us vulnerable to becoming overweight or obese are already there, the relevant trend at present is the degree of overweight, which is worsening fast. A recent report indicates that the prevalence of severe obesity has “skyrocketed” in the past decade. We can probably no longer gauge this epidemic by noting how many are overweight; we now need to monitor how overweight the many are.

These, then, are the stakes in play. It’s true that people can be fat and fit, but few of us are. More and more of us are fat to one degree or another, and most of us are unfit as well. These can be unbundled, but in the real world they seldom are. And when they are unbundled, it’s because thin people can be unfit, too. In general, the behaviors that cultivate genuine fitness offer the best defense we have against fatness.

And this points to a message residing more than skin deep. Whether fat or thin, what we eat matters. Food is the fuel that powers the human machine. It is the one and only construction material for the growing body of a child. It is the construction material on which adults rely to replace spent cells and enzymes and hormones every day. Junk is a poor choice all around, no matter your size.

And exercise matters. It is the vital, conditioning work of the body, whatever its proportions. The “okay at any size” message does not explicitly say that junk food and lounging on the couch are fine, but it doesn’t tend to say explicitly that they aren’t, either. We could be more okay at any size if we took good care of ourselves, large or small. But if one of the reasons for larger size is lesser attention to health, that’s not really okay. And frankly, what we know about prevailing dietary and physical activity patterns suggests that’s just what’s going on.

Along with helping many patients lose weight over the past 20 years, I have talked some out of the enterprise. I have told them they were healthy — and as far as I was concerned, looked great as well. I encouraged them to love the skin they were in, and not obsess for the rest of their lives with themselves 10 pounds lighter, or a size or two smaller. Sometimes they listened to this advice, sometimes not. Those that didn’t listen might well have benefited from a bit more cultural emphasis on the “okay at any size” message.

So I am not only okay with “okay at any size” up to a point, but an active proponent. I oppose obesity bias, and reject the notion that widespread obesity among children and adults alike is somehow due to an inexplicable, global outbreak of personal responsibility deficiency syndrome. If you have evidence of such an outbreak, it would be the first I’ve heard of it.

I am more than okay with the notion that weight and waist circumference do not measure human worth. I will gladly stand shoulder-to-shoulder with others inclined to fight in defense of this proposition.

I am not just okay, but adamant, that we should be able to attack the problem of obesity without attacking those dealing with the problem of obesity.

And I can be okay with “okay at any size” if it includes a proviso: okay at any size as long as health is not adversely affected.

But when weight imperils health, as it clearly does all too often, I am not okay with it. In this context, bold displays of burgeoning flesh, and “flab is fab” bravado may do more harm than good. We do not, as a society, want to normalize ill health or the factors that impose it. Fewer years in life, and less life in years is not an acceptable endowment to the next generation.

We could choose to give our children a future in which 80 percent of all chronic disease goes away, because we commit to making tobacco avoidance, eating well, and being active our cultural standard. Or we can be okay with the trajectory we are on, and give them ever more serious illness starting at ever younger age.

When the bigger we are on average, the harder and younger we fall victim to serious chronic disease, I am not okay with it — and don’t think anybody else should be, either. It’s not the size that inspires my opposition; it’s the consequences.

Type 2 Diabetes and Pre-Diabetes: The Real Deal

 

The Centers for Disease Control and Prevention recently released stats that are downright scary!
· 26 million Americans have diabetes (90%+ have type 2)
· 79 million (35% of American adults) have pre-diabetes (

What is true in both scenarios is that many don’t even know they have it: seven million who have diabetes don’t yet know it and only eight percent of people with pre-diabetes know they have it. The good news is if pre-diabetes is diagnosed and managed from the outset, the progression to type 2 diabetes can be greatly reduced if not prevented entirely.

Research shows the keys are: losing five to seven percent of your body weight (10 – 20 pounds for someone starting at 200) and getting in 150 minutes of activity at least five days a week. People with type 2 diabetes can also lead a very healthy life (if they take their diabetes seriously starting day one, follow a healthful eating plan, get and stay physically active and, work with their health care provider to take the appropriate medications as their type 2 progresses over time. But unfortunately, there’s lots of misinformation out there and many don’t know where to turn to get the straight scoop on diabetes.

To help me sort out the myriad of information and get the “un-sugar-coated” facts about diabetes, I turned to expert Hope Warshaw, registered dietitian, certified diabetes educator and author of several books about healthy eating for diabetes.

Tell us Hope why you have dedicated your career to diabetes management?

Thanks for asking! Diabetes actually found me. My first job, way back (ouch, I hate to say it) in 1979, was in a unique diabetes program at Grady Hospital in Atlanta. I have stayed engaged in the diabetes field over these 30 years. Unfortunately over time, diabetes, especially type 2, has grown exponentially world-wide. Because food choices and eating habits are so integral to managing diabetes, it’s a great place for an RD to do good work. I am hopefully reaching people far and wide indirectly as the author of several books for American Diabetes Association and author of articles in Diabetic Living.

What are the most common misunderstandings about Type 2 diabetes?

Many assume that type 2 diabetes isn’t the “serious” type and that it’s typically diagnosed later on in life. Many also assume that people who are diagnosed with type 2 diabetes just need to follow a healthy eating plan, lose a few pounds and perhaps over the years, they’ll need a “diabetes” pill.

Research, which has been accumulating over the last two decades, underscores that type 2 is a progressive disease and the progression is typically kicked off nearly a decade before diagnosis. Insulin resistance, due to excess weight mixed with a positive family history, are common culprits. Type 2 diabetes is now being diagnosed in younger adults and even children. By the time of diagnosis, most people have already lost half to three-quarters of their insulin making pancreatic beta cells. Expert guidelines now recommend starting individuals on a blood glucose lowering medication to treat the insulin resistance right out of the starting gate, most commonly metformin. It’s now known that insulin production will dwindle further over time. Most people will need a progression of blood glucose lowering medicines over the years. The good news: research shows early and aggressive management to control blood glucose can slow this progression. Healthy eating, losing a few pounds, and being physically active will always offer an assist.

Is controlling blood glucose goal number one?

Having type 2 diabetes carries a risk factor equivalent to having had a heart attack or stroke. The most common complication of type 2 is heart and blood vessel diseases, not eye or kidney disease, as is often thought. Research has shown that to get and stay healthy over time, people with type 2 need to focus squarely on their ABCs: A for glucose control (both the daily glucose numbers and the two to three month A1C result), B for blood pressure and C for cholesterol (more correctly blood lipids – LDL, HDL, triglycerides). Studies show that when people think diabetes, they think glucose. They don’t make the link between diabetes and circulatory problems. Yet, three-quarters of people with diabetes have high blood pressure.

Isn’t losing weight the key to controlling blood glucose?

Research shows that the greatest impact of weight loss on blood glucose is in the first few years after diagnosis – as early on as possible. In fact, the biggest bang per pound is in the pre-diabetes phase. With a loss of 5-7% of body weight and 150 minutes of physical activity, research has shown people can prevent or delay the progression to type 2. Once insulin production is on a dwindling course, weight loss will have less impact on glucose control. So, five, ten years after diagnosis, losing weight is unlikely to correct high glucose numbers. Reality is if blood glucose is out of control, it’s time for medication.

What about carbohydrate? Is it best to eat a low carbohydrate diet?

Nutrition recommendations for people with type 2 diabetes from the American Diabetes Association and other health authorities echo the recently unveiled U.S. 2010 Dietary Guidelines for carbohydrate consumption: about 45 to 65% of our daily calories should come from carbohydrates. (Americans currently eat about 45- 50% of their calories as carbohydrates.) Countless research studies do not show long term benefit of low carb diets on blood glucose, weight control or blood fats. People with type 2 diabetes, like the general public, should lighten up on added sugars and sweets (they’re mainly carbohydrate with minimal nutrition). They should eat sufficient amounts of fruits, vegetables, whole grains and low fat dairy foods — all healthy, nutrient-packed sources of carbohydrate.

What do people with type 2 diabetes need to do to get and stay healthy?

First is facing the diagnosis promptly and taking action immediately and continuously tracking and controlling blood glucose, blood pressure and blood cholesterol – those ABCs. Type 2 diabetes is such an easy disease to deny because nothing typically hurts. And what we’re learning is that it doesn’t take years to develop the diabetes complications, most commonly for type 2 heart and blood vessel disease. These can predate the diagnosis or occur shortly thereafter. But don’t let anyone tell you this is all easy….losing weight, eating healthfully, being active is tough to do in our culture. Find yourself some support. It will come in handy!

What resources do you recommend that are credible and the most help to those with either pre-diabetes or Type 2 diabetes?

Well, of course, my books which can be found wherever books are sold and conveniently at www.hopewarshaw.com. If people want to get straight facts all about type 2 diabetes in bite size snippets, I recommend Real Life Guide to Diabetes. If they want to dig into what to eat, how to frame in a healthy eating pattern for themselves and how to address making those challenging lifestyle changes, I recommend Diabetes Meal Planning Made Easy. Both books are published by American Diabetes Association and can be easily purchased via my website www.hopewarshaw.com or ADA’s www.shopdiabetes.org.