What we eat still matters

Obesity is a complex disease. I have come to appreciate this even more over the last 5 years, and what I am about to say in this post is NOT a refutation of that complexity. Instead, I want to make a point that though obesity [whether becoming obese in the first place or remaining obese after an effort to lose weight] is an intricate mess of bad decisions, bad environment, genes, social pressure, family customs (not traditions, but the every day way of preparing foods or eating that we learn from our families), lack of physical activity, metabolism, gut microbes, infections, injury and things we haven't even discovered yet - even though this is true, on its own, what we eat still matters.

Yesterday, I  was waiting for my train to arrive at 30th St Station in Philadelphia PA. I had been traveling over the weekend. I had an hour wait and was standing - standing - at a table, eating a salad that I had prepared and carried with me. I am a small person, slight of build, low weight. I am this way purposefully, not genetically; I share the same food environment, social pressures, and family cooking practices as most of you - some of whom are normal weight, and if the CDC is to be trusted, most of whom are not. As I ate my salad (which I found delicious with its ample amount of lean protein), I looked across the room and saw a person who was not slight of build and they were also eating. Eating from a box. A box of dunkin donuts. This is not a judgement, several of the things I listed in the first paragraph factor into the decision for that person to buy donuts. My point is, the food we eat still matters and even if it is not that simple in the grand scheme, it certainly is at some level. The small person was eating the salad. Maybe the small person routinely eats low calorie foods and doesn't exceed the calorie requirements to maintain a normal weight - and the large person routinely eats calorically dense foods and does exceed the amount they need.

NB: I didn't post this right away, its been a week since I was at the train station. So I have another observation to add. I was at dinner with friends the other night where I ordered a beautiful steamed seafood and vegetable entree. The man to my left, who is somewhat overweight (we had to trade seats at the movies recently because he was too large to sit comfortably unless in the aisle seat) was the first to request and be disappointed that the restaurant did not serve dessert. Not a judgment, an observation.

What keeps us healthy doesn't involve self loathing.

There are several diseases and poor health outcomes that may be related to weight gain and having excess adipose tissue (fat).  Research suggests an association among weight gain, diabetes, heart disease, and some cancers (see e.g., The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity.)  There is reason to believe that the increase risk in heart disease is related to inflammation caused by fat tissue (Berg & Scherer, 2005) and that belly fat specifically, increases the risk for diabetes (Chan, Rimm, Colditz, Stampfer, & Willett, 1994).  Being overweight is also associated with joint problems (Anderson & Felson, 1988) .  The studies that I have referenced here do not show cause and effect, but many scientists, myself included, agree that excess body fat is detrimental to health.

Disease and poor health may also be the result of sitting around too much, of being still. Researchers have found that people who spend continuous hours of time doing sedentary activities, like sitting at one’s desk, sitting and playing cards, sitting and watching TV, sitting and reading, etc, regardless of how physically active they are at other times, are at risk of premature death from any cause (Katzmarzyk, Church, Craig, & Bouchard, 2009).  Sedentary activity also increases the risk of metabolic syndrome (Bankoski et al., 2011), which is often seen as a precursor to diabetes or heart disease.

A lack of regular, consistent physical activity (exercise) is another risk factor for disease and early death. The Physical Activity Guidelines for Americans and several independent research studies have shown numerous health benefits of daily exercise.  For example, men and women who spend more time engaging in leisure time physical activity have less heart attacks and less heart attack deaths than men and women who engage in little or no leisure time physical activity, i.e., exercise (Leon, Connett, Jacobs, & Rauramaa, 1987; Oguma & Shinoda-Tagawa, 2004).   Lack of exercise is also related to incidence of diabetes, cancer, hypertension, obesity, depression and osteoporosis (Warburton, Nicol, & Bredin, 2006).

So, these things are clear to me and maybe to you as well:
· achieving and maintaining a weight that is considered low risk by waist to hip ratio, waist circumference and/or BMI -indicating normal levels of fat tissue, especially in the abdomen- is smart (i.e., it promotes health and reduces risk of disease and early death);
· limiting the amount of time spent in activities that require you to be still is also smart; and,
· engaging in physical activity for prolonged bouts - 20 to 60 minutes at a time, at least once a day is again, smart.

All of these lifestyle behaviors, which we have some or total control over, are good for us.  We are wise to be mindful of our dietary intake (what and how much), wise to sit for only short periods of time (< 1 hour), and wise to exercise every day.  We should do what we have the power to do to keep our bodies from becoming overfat and deconditioned.  I believe this and I promote it, but I believe something else just as vehemently.

I believe we have weight stigma in the USA and this stigma may be responsible for adverse health outcomes (Puhl & Heuer, 2010).  I find that the worst part of the stigma and the discrimination it promotes is its internalization: people turn the stigma onto themselves and become self-loathing. 

Please click on this link to read a story and watch a video about the hatred many women feel about their own bodies.  Being overfat is bad for health.  I will continue to say it, and continue to push back against body acceptance when body acceptance is a justification for poor dietary habits and a lack of exercise.  But let me be clear, hating oneself is more than bad for health; it is bad for the soul. Obesity researchers, myself included, must be ever mindful of the very difficult and complex process of weight loss and not let our work imply that obesity is a chosen disease, it is not. Weight loss is not easy, if it were easy, two out of three US adults wouldn't be overweight.  Please watch that video.

Anderson, J. J., & Felson, D. T. (1988). Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I) evidence for an association with overweight, race, and physical demands of work. American journal of epidemiology, 128(1), 179-189.

Bankoski, A., Harris, T. B., McClain, J. J., Brychta, R. J., Caserotti, P., Chen, K. Y., . . . Koster, A. (2011). Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes care, 34(2), 497-503.

Berg, A. H., & Scherer, P. E. (2005). Adipose tissue, inflammation, and cardiovascular disease. Circulation research, 96(9), 939-949.

Chan, J. M., Rimm, E. B., Colditz, G. A., Stampfer, M. J., & Willett, W. C. (1994). Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes care, 17(9), 961-969.

Katzmarzyk, P. T., Church, T. S., Craig, C. L., & Bouchard, C. (2009). Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise, 41(5), 998-1005. doi: 10.1249/MSS.0b013e3181930355

Leon, A. S., Connett, J., Jacobs, D. R., &; Rauramaa, R. (1987). Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. Jama, 258(17), 2388-2395.

Oguma, Y., & Shinoda-Tagawa, T. (2004). Physical activity decreases cardiovascular disease risk in women: review and meta-analysis. American journal of preventive medicine, 26(5), 407-418.

Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6).

Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Canadian medical association journal, 174(6), 801-809.