Greta Christina's fat positive manifesto

[ciphergoth]

I froze the discussion here because I thought it deserved a top-level post of its own, rather than being under a general discussion of Greta Christina. A few weeks ago she posted a very interesting series of articles on the fat-positive movement and her own beliefs; I'd be very interested to read more about what people think of them.

"I was frankly shocked at how callous most of the fat-positive advocates were about my bad knee. I was shocked at how quick they were to ignore or dismiss it. They were passionately concerned about the quality of life I might lose if I counted calories or stopped eating chocolate bars every day. But when it came to the quality of life I might lose if I could no longer dance, climb hills, climb stairs, take long walks, walk at all? Eh. Whatever. I should try exercise or physical therapy or something. Oh, I'd tried those things already? Well, whatever."

• The Fat-Positive Diet
• The Fat-Positive Skeptic
• An Open Letter to the Fat-Positive Movement

Comments

[djm4]

Good idea, and it deserves a better (and more measured) response than the somewhat snarky one I gave on the previous post, but I don't honestly know when I'll find time to write one. Not in the next couple of weeks, certainly.

[wildeabandon.livejournal.com]

I'm largely in agreement. The vast majority of what the fat-positive movement stands for should be uncontroversial, but to quote your response to the third post:

"I agree that unless you are an expert - and by expert, I mean on the level where your research is published in peer-reviewed journals - you are crazy to bet against the scientific consensus."

I haven't done enough reading of the literature to be confident in what the scientific consensus is, and to what extent it is scare-stories in the media, but I've certainly seen more papers arguing that there is a negative correlation link between weight (above a certain level, obviously) and a variety of health measures than I've seen arguing the opposite.

[djm4]

Actually, who am I kidding? I'll never have the time, and am officially bowing out of this debate.

[purplerabbits.livejournal.com]

Hmm. I find "The Fat-Positive Diet" kinda depressing because it's so exactly where I was a few years ago, including the unintended boost you get from people telling you you look better, the mixed messages you get, the everything.

And I am now heavier than I have ever been. Which might mean I can't participate in a debate like this as objectively as I feel it deserves.

I think her Fat Positive Manifesto is *almost* right and that her depiction of the Fat Positive message she's been getting is neccessarily cherry picked and a reaction to a range of annoying comments she is bound to have recieved. I'm not sure any real person believes all of that, so it's in danger of being a bit of a straw man argument.

I wish I knew what to think about the science, I really do, but I don't know of *anyone* who is doing a balanced job on this.

[djm4]

I'm utterly in agreement with the paragraph you quote here, by the way, whatever else I might think.

[ciphergoth.livejournal.com]

I'd be willing to take a bet on what answer I'd get if we asked the head of a randomly chosen University medical department - and if I'm wrong about this I'd like to know very much.

[valkyriekaren.livejournal.com]

Certainly the learning objectives here at St George's are keyed towards an understanding of BMI and the importance of lifestyle changes (including activity level, dietary restrictions and weight loss as appropriate) in controlling conditions such as high blood pressure, high cholesterol and heart disease.

(I still think BMI is unreliable and shouldn't be the be-all and end-all, and that the lines for 'healthy' and 'overweight' are drawn in completely the wrong places. But that doesn't mean it's not an OK place to start when looking at overall physical health.)

[ladycat.livejournal.com]

I think maybe bodystat is a beter measure than BMI because it gives you a clearer overall picture of the composition of your body.

[valkyriekaren.livejournal.com]

Indeed, but at the moment not all GP surgeries, hospitals, clinics and health centres have bodystat machines (which are quite new and expensive), whereas they do all have scales and height charts (old and cheap).

[altamira16.livejournal.com]

I think that people shouldn't be mean to fat people just because they are fat, but I think the whole notion of a fat-positive movement really depressing.

[valkyriekaren.livejournal.com]

Can you explain in more detail why you find it depressing? I'm not sure I understand your position.

[wildeabandon.livejournal.com]

One thing that I have a suspicion is supported by the science, but is a long way from permeating through to the popular consensus, including medics, is the fact that diets usually don't work.

[lizw.livejournal.com]

In this particular case, I think there are strong reasons to bet against the scientific consensus, starting with the fact that almost all of the science in question is of appallingly poor quality and skewed by a combination of politics and big money. I'd recommend picking out some specific studies and looking to see whether junkfoodscience has commented on them, or reading her obesity paradox series.

[djpsyche.livejournal.com]

But thinking, "I can never have another donut again as long as I live" would make this intolerable. Thinking, "I can have a donut today if I have a light dinner" makes this do-able.

And this is the nutshell of my argument of why Quitting Smoking Is Harder Than Dieting.

[purplerabbits.livejournal.com]

I think some of it has permeated, but most individual GPs seem to feel that the *reason* most diets don't work is that eithyer they are crash diets or the dieters aren't doing it right. Hence their tendency to just harangue people harder into following what they consider to be a sensible diet.

What I think they fail to take into account is the cognitive bias which can happily accept that 90% of something is crap and just assume that the thinker falls into the 10%, plus that even if they're right, pushing people harder also doesn't work.

[purplerabbits.livejournal.com]

I don't think I agree, because dieting, or even just healthy eating, isn't a case of saying "I can never have another donut again as long as I live" it's saying "I can never eat without having to think about it again". Just giving something up cold can be way easier.

[ciphergoth.livejournal.com]

Interesting. Ainslie's Breakdown of Will makes exactly the opposite argument - that dieting is harder than quitting smoking exactly because it's easier to make a clear and simple rule and stick to it than navigate the maze of making choices that keep total calorie intake at about the right amount.

[valkyriekaren.livejournal.com]

I'm going to come over all Ben Goldacre here (ooh matron) and suggest that it's probably a bit more complicated than that. Maybe for some people it's easier to go 'cold turkey' and say, "I'm never going to have a cigarette/drink alcohol/eat a Curly Wurly again!", and for others it's easier to cut down gradually and allow oneself the occasional indulgence balanced against other, healthier/safer behaviours?

And actually, if what we're talking about is harm reduction, isn't it still good for people to cut down to 'every once in a while' even if they never get to the point of completely cutting out?

Food, I think, is more difficult to break the 'addiction' to than many drugs, because you need to eat to live - it's policing what you eat that's the difficult part (and let's not get into all the misinformation and misdirection about what's 'good food').

[lizw.livejournal.com]

Okay, some quick comments because we're ridiculously busy at work and that's all I have time for:

The Fat-Positive Diet uses the wrong definition of success, in my view. A 10% one-year "success" rate is already appalling - a drug or surgical intervention with this rate of success and the same physical mental health side effects as dieting would not be licensed - but the rate drops to 2% after another year. Statistics beyond that don't exist, because it's not even possible to recruit a large enough pool of "successful" dieters to do that study. My source for this is Paul Campos in The Obesity Myth.

The Fat-Positive Skeptic and the Open Letter are wrong about the science, and for that I repeat my suggestion to wildeabandon earlier in this thread. I would also add that even if I am wrong (and so is Paul Campos, and so is Sandy Swarcz) on (a) whether or not being fat is unhealthy and (b) whether or not diets "work", there is still AFAIK not a shred of evidence as to (c) whether someone for whom a diet has "worked" thereby acquires the same health benefits that someone who maintains the same weight, BMI etc without dieting ex hypothesi enjoys (and, given the problem with recruiting "successful" dieters, it is difficult to see any such evidence emerging any time soon.)

I do feel sympathy for her knee pain, having had similar problems myself in the past (at a much lower weight than I am now), and she is of course entitled to take whatever gambles she wishes to try to resolve it - just as she is entitled to try homeopathy, reiki, animal sacrifice or anything else that does no harm to anyone else. Perhaps the sense of taking charge of the problem will even produce a placebo effect that will do her some good, and I'm all in favour of that where medicine can't come up with anything better. But I believe it will be just that - a placebo, and one bought at the price of considerably more health risks than drinking water that may or may not have come into contact with a minuscule drop of herbal extract at some point in its history.

Edited for clarification of my view on placebos.

[djm4]

Aside: I got a slight kick out of quoting 'I think you'll find it's a bit more complicated than that' back at Ben Goldacre at the Lib Dem fringe event on keeping libel laws out of science. I was, basically, agreeing with him, though, so I hope he forgave me - at any rate, I didn't spot any tweets about 'the annoying smug git with the beard who quotes my own catchphrases back at me'.

[rosenkavalier.livejournal.com]

'Abstinence is easier than temperance' (Seneca, if memory serves)

[purplerabbits.livejournal.com]

Yes, though if memory serves the book mostly uses quitting alcohol as an example, which may be wise given how notoriously hard smoking is to give up...

[ciphergoth.livejournal.com]

I'd recommend picking out some specific studies and looking to see whether [info]junkfoodscience has commented on them

This is a good recommendation. I can't find anything on any of the studies referenced here on junkfoodscience, though that's not to say they're not discussed.

Edit: I note they have a post specifically about junkfoodscience.

Edit: and she links with approval to global warming denialist Steven Milloy's junkscience.com. Top link on her list of recommended links. Last is noted nut Bjorn Lomborg. Um.

[djpsyche.livejournal.com]

Quitting smoking is quite easy when you give up alcohol. :/

Actually, the more I think about it (and I've given up drinking, too, which was a walk in the park compared to quitting smoking), quitting drinking is more like dieting than it is like quitting smoking. Because with both dieting and giving up alcohol, there are substitutes. With dieting, instead of that donut you eat an apple, but at least you have the option of eating SOMETHING. With alcohol, instead of a beer you order a soft drink. With smoking... well, there is no substitute. There's nothing else you can smoke instead when you get a craving for a cigarette. You just have to suffer.

[valkyriekaren.livejournal.com]

Edit: and she links with approval to global warming denialist Steven Milloy's junkscience.com. Top link on her list of recommended links. Last is noted nut Bjorn Lomborg. Um.

I'm not sure damning someone for the company they keep is much of an argument.