Category Archives: fatness

Fatness Is Strongly Influenced By Genetics, But How?

An image from twin studies featured in the talk by Jeffrey Friedman posted after the jump, or click on the image for the YouTube link

A reader e-mailed me a good question about weight loss that’s outside my area of academic expertise but within the realm of stuff I’ve read enough about that I can offer some speculations and references. I am continually amazed at how complicated nutrition is and how much disagreement there is even among people who study it for a living. The only thing I can say with complete confidence is that anyone who tells you weight loss is simple and anyone can do it is (A) lying, (B) misinformed, (C) trying to sell you something, or (D) all of the above.

Here’s the e-mail I got:

If you have the time to answer a question…

I recently came across these articles claiming, more or less, that metabolism does not account for why some people are fatter or thinner than others. 

Article 1 [BBC Health]

Article 2 [Mayo Clinic]

I remember your posts on Sour Salty Bitter Sweet about dieting not being an effective solution to weight loss [here], and it sounded like you thought someone’s weight had more to do with genetic factors than lifestyle factors. Do I have that right? Would you disagree with the articles? Or point to non-metabolic genetic factors?

-Anna Macdonald

simple! right? that's why everyone is precisely the weight they want to be! Image Credit: CDC.govBoth articles essentially argue that it’s a myth that fatter people have “slow metabolisms” and burn fewer calories than thinner people. Basal metabolic rates vary based on age, gender, and body composition (or maybe just body composition, but that tends to vary based on age and gender), but as far as researchers can tell, fat people have at least roughly the same metabolic rate as thin people. They just eat more.

I think they neglect or dismiss a few complications too easily—in both diet studies and over-feeding studies, subjects lose/gain less weight than they should based on caloric arithmetic, usually by a significant margin. That’s usually attributed to shifts in thermogenesis, or how much heat you generate, and unconscious motions like fidgeting. If you eat more than you’re used to, your body may respond by getting slightly warmer and engaging in more restless activity. Eat less, and your body may respond by getting cooler and engaging in less activity. There’s some evidence that even for the very rare individuals who lose weight and keep it off long-term, basal metabolic rate remains depressed compared to people with the same relevant characteristics (weight, age, gender, and body composition) who were not previously fat (see NYTimes “The Fat Trap”). Incidentally, there’s research from as early as 1980 suggesting that people who maintain weight loss long-term are frequently monomaniacal about food and exercise, engaging in behaviors that might be seen as evidence of an eating disorder in thinner people.

But in general, the articles seem pretty accurate up to the point where they claim that people can lose weight if they eat fewer calories and exercise. The BBC article even claims that “people not only manage to lose weight but are able to keep control of it in the long term,” which is technically true—a small percentage of the people who lose weight by dieting do—but certainly isn’t the norm. Both articles make an unsubstantiated leap from the idea that basal metabolic rate is at least relatively stable and consistent to the idea that therefore, anyone can be thin if they only eat as many calories as a thin person burns. The key question they fail to address is why fat people eat more calories than thin people in the first place.

I suspect that’s because most people think they know the answer: they assume fat people have less willpower, knowledge, or motivation than thin people and therefore make bad choices about what and how much they eat. There’s a widespread assumption that if fat people knew better or tried harder, they could be thin. Many people, whatever their weight, believe that they themselves would be probably thinner if they ate better and exercised more and would be fatter if they ate whatever they wanted all the time and exercised less (which is actually probably true, but only within a small range). A lot of people even have personal experiences with weight loss or gain that they may be able to attribute to conscious choices or lifestyle changes. However, for most people, those changes prove to be temporary and I think they overestimate how much control they actually have.

Fat people are not fat because they’re weak or lazy or unmotivated or unaware of the supposedly-dire medical consequences and actually-dire social consequences of being fat. Body size is strongly genetically determined and biologically-regulated. It may be sensitive to some environmental conditions, but that doesn’t mean it’s within individuals’ conscious control. If the tendency towards weight homeostasis doesn’t work by regulating how many calories people tend to burn, which I agree that it probably doesn’t, it must work by influencing how much people eat.

How Heritable Is Fatness? 

Also from the Friedman lecture below.Very. Perhaps less than eye color, but more than other conditions widely seen as having a significant genetic component, like schizophrenia or alcoholism. Based on twin studies, one of the classic ways of evaluating the genetic component of all kinds of conditions, weight consistently appears to be approximately as heritable as height—most studies conclude that just under 80% of variation in weight and height is attributable to genetics. Furthermore, genetic influence consistently trumps environmental effects by a wide margin. In adoption studies, another way of evaluating genetic influence, children’s weights are strongly correlated with their biological parents’ and not at all with their adoptive parents. 

In Stunkard et al 1986, which compared approximately 4000 sets of male twins, the “concordance rates for different degrees of overweight were twice as high for monozygotic twins as for dizygotic twins.” In other words, the “identical” twins who share nearly 100% of their genetic material were twice as likely to have similar body types than “fraternal” twins who share only 50% of the same genes. At age 20, comparisons of height, weight, and BMI for both sets of twins yielded heritability estimates of .80, .78, and .77, respectively (1.0 would be perfectly heritable, .00 would be not heritable at all). At a 25-year follow-up, the heritability estimates for the same traits were .80, .81, and .84.

In another Stunkard et al 1986, which divided a sample of 540 adult Danish adoptees into four weight classes: thin, median, overweight and obese, there were strong correlations between the weight class of the adoptees and their biological parents (p<.0001 for mothers, p<.02 for fathers). There was no correlation between the weight class of the adoptees and their adoptive parents.

In Stunkard et al 1990, the researchers used a Swedish database of twins separated early in life versus those reared together collected between 1886 and 1958. They ended up with 93 pairs of identical twins reared apart, 154 pairs of identical twins reared together, 218 pairs of fraternal twins reared apart, and 208 pairs of fraternal twins reared together. The mean age of comparison was 58.6 years old. The heritability estimates (shown in the chart below) are similar to those in the 1986 study. Notably, twins reared together were no more similar than twins reared apart.

"The fourth estimate of heritability, the intrapair correlation for the monozygotic twins reared apart, was the most direct and perhaps the best estimate of the heritability of the body-mass index. It was 0.70 for men and 0.66 for women."

A review study done in 1997 by Maes et al looked at the data from 25,000 twin pairs and 50,000 biological and adoptive family members, finding BMI correlations of .74 for monozygotic twins, .32 for dizygotic twins, .25 for siblings, .19 for parent-offspring pairs, .06 for adoptive relatives, and .12 for spouses.

Researchers have also been curious to see if the “obesity epidemic” has changed anything. Have environmental changes in the last few decades trumped genetic factors? Not really. In Wardle et al 2008, they evaluated 5092 sets of twins between the ages of 8 and 11 whose body measurements were taken in 2005. The heritability estimate for BMI was .77. In comparison, the shared-environment effect in the same study was estimated at .10.

As a 2008 review study of research on the heritability of fatness by Stephen O’Rahilly and I. Sadaf Farooqi concluded:

Hereditary influences on adiposity [fatness] are profound and continuing…. There is little serious doubt that the single most powerful determinant of inter-individual differences in adiposity is heredity.

Okay, But How Does It Work? Part I: Epigenetics

Genetics isn’t the whole story. We have known for a long time that children without access to adequate nutrition may have their growth "stunted," meaning they may never achieve the same height or weight as adults as they would have if they had been able to eat more as children. Dietary composition also seems to have an effect: populations with access to more protein (or calcium?) may grow taller or fatter than genetically-similar populations who consume less protein. The availability of highly-palatable, calorie dense, high-sugar and high-fat food in countries like the U.S. may create the conditions for some people (though clearly not all) to become fatter than they would in another environment. However, how fat they get in that environment  is still determined largely by genetics, just like how tall people get in the presence of ample protein is still largely determined by genetics.

There’s a lot of research being done right now on what are sometimes called "epigenetic" effects, which are factors that influence whether or not (and how) genes get expressed, without any changes happening in the genome itself. This is the idea that genes can get turned “on” or “off.”  Some epigenetic effects are trans-generational, meaning something that affects a particular individual or population may only show up in their offspring. So, for example, population that experienced a famine may have offspring who are more inclined to store fat when it’s available than a genetically similar population that didn’t live through a famine.

See: This Nature article or Herrera et al 2011

Okay, But How Does It Work? Part II: Leptin

Leptin-deficient child before and after leptin therapyThe expression of genes that affect body size probably involves changes in the endocrine system, and particularly the release or suppression of the hormones leptin and gherlin, which control appetite and satiety. Leptin in particular seems to be crucial to the regulation of body fat. It was only discovered in the mid-1990s, so scientists are still trying to understand how it works and what the implications are.

Some extremely fat children, like the kid pictured on the right, have been found to be deficient in leptin. They have seemingly insatiable appetites—when presented with meals in excess of 2,000 calories, they’ll eat the whole thing and still be hungry. After receiving leptin injections, they eat age-appropriate portion sizes and lose weight rapidly without dieting or engaging in any formal exercise program.

One of the major differences between people who’ve lost weight through dieting and people who weigh the same without having dieted is in their leptin levels. Most of what I know about leptin (and most of images in this post) are taken by the following talk by the biologist who discovered the hormone, Dr. Jeffrey Friedman:

In the very beginning of the talk, he makes some causal claims about high BMI/adiposity and mortality that I disagree with, because I’m not sure the correlations are actually caused by fatness, rather than social stigma, racism, poverty, lack of health insurance, etc. (all of which are also correlated with BMI). If fatness caused mortality, why would “overweight” people live longer on average than “normal” weight and “underweight” people and “obese” people who are active live longer than “normal” people who are sedentary? He also says that even modest weight loss is associated with significant health improvements, and I wonder if that claim isn’t based on studies where participants begin eating more vegetables and exercising, lose something like 5 pounds, and get healthier overall and researchers conclude that weight loss improves health when really the weight loss is totally meaningless. But once you get past that bit, he makes a pretty strong case for the genetic basis of body size and the role of leptin in the regulation of body fat.

Okay, But How Does it Work? Part III: Endocrine Disruptors

Just to complicate things even further, it turns out that a lot of the chemicals we’re exposed to can affect the endocrine system. Bisphenol A, the now-vilified chemical used primarily in plastics and also in the lining of aluminum cans, turns out to be an endocrine disruptor. Fluoride is also an endocrine disruptor. So are brominated fire retardants and many pesticides (even organic-certified ones, like copper sulfate).

Some of these may only affect people if they’re exposed at a particular point in their development—in utero, pre-adolescence, etc.—or at a particular dosage. So if your mom ate a lot of highly-acidic canned foods while she was pregnant with you, that might affect your thyroid function from birth. Or if you spent a lot of time on a rug treated with flame retardant chemicals as an infant, that might affect you, but maybe if you’d been 5 or 6 years old, it wouldn’t. Those are just hypothetical scenarios, the actual effects and doses of endocrine disruptors are not yet well understood or documented. So I’m not saying you should stop getting fluoride treatments. I suspect (and hope) that in another decade or so, we’ll have a better sense of how chemical exposure affects weight gain.

For more on endocrine disruptors and obesity, see Julie Guthman, Weighing In especially Chapter 5.

When Metabolism Matters: The Evidence From Overfeeding

If body weight is genetic, it should probably be nearly as difficult to gain weight as it is to lose it. Although it does seem to be possible to gain weight deliberately—some athletes and actors do this—it takes a lot of work. The results of overfeeding studies suggest that people who deliberately eat more than they would normally have to suppress their desire to stop eating and lose any weight they gain very easily as soon as they stop “overeating.”

BBC made an hour-long documentary about one of these studies, called “Why Are Thin People Not Fat,” which I first saw posted on Tom Naughton’s blog FatHead:

If you don’t want to watch it (spoiler if you do): ten thin people were told to eat twice as much as they normally do (the target caloric intake for men was approximately 5000 kcal/day) and refrain from exercise for four weeks. There was a lot of variation in the results—some gained more weight than others, some gained more fat than others. One of the participants gained muscle. None of them gain as much weight as they “should” based on caloric arithmetic, meaning there must have been changes in their metabolism. Additionally, the subjects report feeling pretty miserable: the amount of food they have to eat makes them feel sick. At least one of them mentions throwing up some of what he ate. They all get tired of milkshakes and chocolate and pork pies. And month after the experiment was over, the participants had all lost most or all of the weight they gained during the experiment without engaging in any deliberate weight-loss strategies.

The documentary mentions another overfeeding study known as the Vermont Prison Experiment. Researchers at the University of Vermont led by Ethan Sims initially tried to use students as subjects. They were told to eat 2-3x their normal caloric intake, but even after 5 months, most had increased their weight by only 10-12%. Sims’ goal was 25%, so he turned to inmates at the Vermont State Prison, who he describes as “equally dedicated volunteers.” After 200 days of eating up to 9-10,000 kcal/day, some of the participants were still not able to gain 25% of their starting weight. For the few who were able to gain 25% or more, in order to maintain the goal weight for any length of time, they had to continue eating on average ten times the number of calories that should have been necessary based on simple caloric arithmetic. This is also explained by metabolic changes—whether through thermogenesis or unconscious activity, the men were burning vastly more calories than before despite being prevented from exercising. Again, after the study was over, the prisoners easily lost most or all of the weight they had gained.

In Conclusion

The genetic influence on weight seems to work primarily by affecting how much people eat, not how many calories they burn. Fat people burn more calories than thin people, but they also eat more than thin people. That doesn’t mean that fat people “overeat.” Most people, fat or thin, maintain a relatively stable weight over long periods of time. If fat people were eating more calories than they typically burn, presumably they would be constantly gaining weight. Appetite and satiety are governed by biology, not willpower. Most people seem to be capable of consciously and deliberately reducing or increasing their caloric intake temporarily, but that’s difficult and unpleasant and virtually impossible to maintain long-term.

Diet Soda Follow-up: Are Diet Sodas Better For You Than Regular Soda?

Artificial sweeteners definitely pre-dated the "obesity epidemic." Saccharin was being used commercially in the early 20th C. and diet sodas were widely available by the 1960s For more on the history of artificial sweeteners, see Carolyn de la Pena's brilliant book _Empty Pleasures_

Soda cans from the 1970s from Found in Mom’s Basement

In response to the recent entry about the association between diet soda and fatness, Jim asked:

Has anyone proved that drinking Diet Soda is better for you than drinking Regular Soda? Does Diet Soda have the same impact on the body as drinking say a glass of water? I haven’t done any research on it and I don’t know if any is out there. I’d really like to see a study of what happens to obese people who stop drinking diet soda and switch to regular.

There’s a ton of research on artificial sweeteners, but I can’t find any studies in which obese people who habitually consume artificially sweetened-drinks were made to switch to sugar-sweetened drinks. That might partially due to ethical/IRB concerns—it’s possible that asking people to consume more sugar than they were previously would be considered a significant health risk. On the other hand, there are studies in which subjects are randomly assigned to consume either artificial or caloric sweeteners, so maybe consuming regular soda falls into the realm of acceptable risk with informed consent.

In those kinds of studies, both “overweight” and “healthy”* individuals who consume regular sweeteners (usually sucrose or high-fructose corn syrup, which are nutritionally equivalent as far as we know) end up eating more calories overall than people who consume “diet,” artificially sweetened foods and drinks. The sugar/hfcs groups also gain weight and fat mass and have negative health indicators like increased blood pressure. I don’t think fatness is bad or that being thin is better, but based on the current available evidence, regular soda appears to be both more likely to make you fat and also worse for your health than diet soda.

*Stupid current labels for BMI categories that don’t correspond at all to actual health outcomes.(1)

A Closer Look at the Studies

This is apparently what Diet Coke looks like in Denmark. Or did in 2009. Pretty! In a 2002 study from Denmark, 41 “overweight” men and women between 21 and 50 years old were assigned to two groups, matched for sex, age, weight, height, BMI, fat mass, fat-free mass and usual amount of physical activity. One group was given sucrose-sweetened dietary supplements (2 g/kg of body weight daily; 70% from drinks and 30% from solid foods) and the other was given artificially-sweetened dietary supplements (an equivalent amount of food and drink by weight sweetened with a combination of aspartame, acesulfame, cyclamate, and saccharin, collectively and individually far below intake levels generally regarded as safe). All the supplements were commercially-available foods and included soft drinks, flavored fruit juices, yogurt, marmalade, and stewed fruits. The researchers note that “great efforts were made before the intervention to find the most palatable artificially sweetened food products on the market for which a matching sucrose-containing product existed.” As some of the artificially-sweetened foods were also fat-reduced, subjects in the sweetener group were given additional butter or corn oil every week.

The study lasted 10 weeks. In addition to the supplements, subjects were free to consume whatever they wanted and as much as they wanted. The subjects visited the lab weekly to pick up the supplements and have urine samples taken (which were used to validate their dietary records). Their height, weight, and fat mass were measured every two weeks. They also kept food diaries that included ratings of their  hunger, fullness, the palatability of the food they ate, and their sense of well-being over the course of each day in the week before the study began, the fifth week, and the tenth week.

Results: The sucrose group ate more calories overall than the sweetener group and got more of their calories from carbohydrates (58% compared to 44%). Both groups decreased how many carbohydrates they were eating in addition to the supplements, but the sugar in the supplements more than made up for the decrease in the sucrose group. The sucrose group gained an average of 3.5 pounds—which was, interestingly, only about half the weight gain that would have been predicted based on how many more calories they were eating. Their activity levels didn’t increase, so the most likely explanation is thermogenesis—i.e. their metabolism changed in response to the increased caloric intake. The group eating artificial sweeteners lost an average of two pounds. In the sucrose group, systolic and diastolic blood pressure increased; in the sweetener group, it decreased. There were no differences in appetite sensations, hunger, or satiety.

Similarly, in a 1990 study done at the Monnell Chemical Sense Center, a group of 30 subjects gained weight during a three-week period when they were given regular soda (sweetened with HFCS) and lost or maintained their weight during the two three-week periods when they were given diet soda (aspartame-sweetened) or no soda. In the regular and diet soda periods of the experiment, they were given 40 oz. of soda to drink every day. In the no soda period, they were told they could consume any beverages as they normally would. They also kept detailed dietary records for the duration of the experiment. The order of the 3-week periods was counterbalanced so some of them got regular soda first, some of them got the artificial stuff first, some of them had no soda for the first three weeks, etc. Here’s what the aggregate changes in their body weight looked like: 

Tordoff and Alleva 1990 in the American Journal of Clinical Nutrition 51: 963-9 (graph appears on 965)

During both the regular and diet soda weeks, they decreased their dietary sugar consumption by an average of 33% (i.e. aside from the sugar in the soda).

Studies like these also point to what I suspect is the more likely explanation why there’s never been a study like the one Jim describes: there’s just not much debate about whether consuming calorically-sweetened drinks leads to weight gain and possible health risks (which shouldn’t be conflated—weight gain is primarily an aesthetic issue, and high levels of sugar consumption may lead to negative health outcomes whether or not they make you fat). What is up for debate is whether artificial sweeteners are a good substitute and likely to promote weight loss or also bad and contributing somehow to weight gain. And if they’re contributing to weight gain, how and how much?

There appear to be three types of theories about why artificial sweeteners might cause weight gain and/or other undesirable outcomes.

Theory #1: Artificial sweeteners might have direct metabolic effects

I don't know what this has to do with anything, I just thought the entry needed more picturesIt’s possible that although they have no caloric value, artificial sweeteners could affect blood sugar or insulin in ways that cause the body to store fat. This is the theory being tested in the study described in the previous entry in which mice consuming aspartame in amounts comparable to an average-sized woman drinking 20 oz of aspartame-sweetened soda per day had higher fasting glucose levels than mice on the same diet minus the aspartame. The effect could be chemical, but seems more likely to be an effect of the sweet taste—i.e. the perception of sweetness might affect the hormones that govern appetite and metabolic rate.

Evidence for this is still extremely scant. Not only is it unclear whether or not the effect is reliable, biologically significant, or occurs in humans; it’s also unclear if it’s specific to aspartame or an effect of all artificial sweeteners, if it scales such that a small amount of aspartame causes a smaller increase in fasting glucose or only occurs at a certain critical level of aspartame consumption, if it only occurs after regular daily consumption over a long period of time or after a single dose, if it affects all people in the same way or only “overweight” people, if it interacts with other dietary conditions (i.e. does it only happen in conjunction with diets high in corn oil, like the ones the mice in the study were fed?), etc.

There are studies involving rats that suggest some kind of metabolic effect of artificial sweeteners might promote weight gain. Rats fed artificially-sweetened yogurt consume more calories than those fed sugar-sweetened yogurt.

However, it seems like it might not work the same in people—or at least that the effect might be smaller. Note that in both of the studies described above, subjects given artificial sweeteners decreased both their overall carbohydrate and dietary sugar intake. Additionally, in a 2001 study done at the Pennington Biomedical Research Center in Baton Rouge, 31 subjects (19 lean, 12 obese) were given sucrose (493 kcal), aspartame (290 kcal), or stevia-sweetened (290 kcal) "preloads" before lunch and dinner on three separate days. Their food intake, satiety (how full they felt), and postprandial (after-meal) glucose and insulin levels were measured. When they had the lower-calorie, artificially-sweetened preloads, they did not compensate by eating more at either the subsequent meals and reported similar levels of satiety as they did on the day they consumed the higher-calorie, sucrose preload.

Theory #2: Artificial sweeteners might have a psychological effect.

Another possibility is that drinking “diet” soda might make people believe that they can afford to eat more or nutritionally worse foods. This is similar to the “health halo” research being done by Brian Wansink and others, which has shown that people are more likely to underestimate the caloric content of foods they perceive as “healthy,” like a turkey sandwich from Subway, than they are with foods they perceive as unhealthy, like a Big Mac. They’re also more likely to order sides with the “healthy” choice that ultimately push the calorie content of the meals higher. Organic and “trans-fat free” labels or even just having calorie counts posted on a menu can have similar effects—triggering people’s dietary conscientiousness seems to cause many people to “treat” themselves to something extra.

However, it’s not clear that the “halo” affect actually influences total or long-term consumption. Thinking they’re getting the “healthier” sandwich may make people more likely to eat a bag of chips at that meal than they would have if they’d eaten a burger, but if that means they’re less likely to have an afternoon snack or they eat less at dinner, it might not affect their weight. I can’t find any studies that measure that.

Theory #3: Artificial sweeteners might change people’s palates

Artificial sweeteners might make people more accustomed to sweetness, which might cause them to eat more sweet things or sweeter things than they would otherwise. Since sweet things and the taste for them are seen as a kind of indulgence and not liking or eating sweet things is often constructed as proof of maturity, masculinity, or self-control, this is often described in morally judgmental terms like “infantilizing our taste sense” or “corrupting the palate.” But it’s not a theory entirely confined to blowhards. In an opinion piece in JAMA published in 2009, David S. Ludwig writes:

Individuals who habitually consume artificial sweeteners may find more satiating but less intensely sweet foods (eg, fruit) less appealing and unsweet foods (eg, vegetables, legumes) less palatable, reducing overall diet quality in ways that might contribute to excessive weight gain.

However, he admits that there’s no research showing this to be true. On the contrary, at least one study has found that people who consume artificial sweeteners regularly are more likely to eat foods generally considered to be healthy and less likely to consume foods generally considered to be fattening. According to a 2006 study done by the American Cancer Society as part of a larger project involving 1-2 million men and women who weigh 40% or more above average for their age and height, those who reported using artificial sweeteners also ate chicken, fish and vegetables significantly more often than non-users and consumed beef, butter, white bread, potatoes, ice cream and chocolate significantly less often. That study also found that artificial sweeteners were associated with weight gain. Given that their diets were apparently “healthier,” the authors conclude: “our weight change results are not explicable by differences in food consumption patterns,” perhaps implying that artificial sweetener might indeed be the culprit.

I think their data suggest something different entirely: people who drink diet soda are more likely to be dieters. They’re eating more of the stuff everyone tells them they ought to be eating to lose weight, and less of the stuff they’re supposed to avoid. It’s not working, and they’re getting fatter anyway, but that doesn’t mean diet soda makes you fat, it could simply mean that dieting doesn’t work.

Not Implausible, Just Not Supported By the Evidence

My suspicion is that if diet soda has any affect on weight, it’s a small one. I think it might be possible that in large amounts (probably 16 oz or more of diet soda per day), some artificial sweeteners might affect the metabolism slightly and lead to people being slightly fatter than they would be if they consumed less or no artificial sweeteners at all. However, I don’t think you’d see the results you see in studies like the ones from Denmark or the Monnell Chemical Sense Center if artificial sweeteners really have a dramatic, immediate effect on weight gain or fat storage.

Of course, that doesn’t mean artificial sweeteners are healthy, just that they probably don’t make you fat. Jury’s still out on the relationships between aspartame and cancer, sucralose (Splenda) and intestinal bacteria, saccharine and neurological function (especially in children), and stevia & its derivatives and DNA mutation. But for what it’s worth, most of the review articles I came across and Ludwig’s JAMA article claimed that concerns about cancer have basically been put to rest.

Of course, there’s still the problem of how they all taste

(1) Broken record footnote: Weight is a poor indicator of health. People in the BMI categories labeled “overweight” and “obese” people are often as healthy or healthier than people in the “healthy” or “normal” BMI category. People in the “overweight” category live longer on average than people in the “normal” or “healthy” category. People who are “overweight” or “obese” who engage in regular physical activity are healthier on basically every measure than sedentary “normal” or “healthy” weight people. The people who are really (statistically) screwed are the “underweight.”

A Food Policy & Politics Christmas Wish List

Santa baby, just slip sustainable aquaculture
under the tree, for me.
Been an awful good girl, Santa baby,
So hurry down the chimney tonight.

I wonder if she's asking for a garbage-fed pig, too. Also, I love that it looks like she's saying, "Santa, how could you? Why, I've never heard of such a thing!"From flickr user duluoz cats

Dear Santa,

I know I can be a bit of a “negative Nancy.” I spend a lot more time criticizing existing policy and reform efforts than offering alternatives or solutions. Of course, that’s partially due to the fact that not all policies need alternatives—the flip side of a lot of my apparent negativity is that I have a much sunnier outlook on the U.S. food system than many self-identified foodies and people associated with the “food revolution.”

For example, I’m down on most anti-obesity initiatives because I don’t think obesity causes serious diseases or death. I’m open to evidence to the contrary, but in all the epidemiological studies I’ve seen (including the ones cited by the WHO and NIH when they redefined “obesity” to a lower BMI range) BMI isn’t even significantly correlated with an increased risk of mortality until you get into the territory of severe or morbid obesity (BMI 35+). The number of Americans in that category has been growing since 1980, but it still amounts to less than 5% of the U.S. population, far less than the 30-60% of overweight or obese Americans usually cited as the evidence that we’re in the midst of an obesity “epidemic.” Americans on average aren’t much fatter than they were 50 or 100 years ago. The “typical American diet” high in refined grains and sugar probably isn’t optimal for human health (for reasons other than that it makes most people fatter), but it nonetheless enables many people to live long, relatively healthy lives.

What with the kids in laps and such, I'd think Santa might be more concerned about keeping his Ginger *down*, but what do I know?From Found in Mom’s Basement.

I think we’re doing somewhere between okay and great on several other fronts, too. Although imperfect in many ways, the industrial food production and distribution systems are sometimes more efficient in terms of total inputs and carbon emissions per calorie or pound than small, local farms—environmentalists should celebrate the spread of no-till farming and possibility of safe GMO crops that increase yields with reduced water, nitrogen, or phosphorus needs. Illnesses caused by food-borne pathogens are probably less common now than at any point in our country’s history (and new estimates about the incidence of food-borne illness are even lower). For anyone who’s interested in novel foods, there’s probably never been a better time or place to be an eater. The ever-increasing flows of people, goods, and information around the world have made everything from far-flung regional specialties to ancient recipes to innovative taste experiences more available to more consumers than ever.

Of course, that doesn’t mean things couldn’t be better. So here’s a list of seven changes I would like to see in how people produce, consume, regulate, and talk about food in the U.S. It’s a bit of a motley assortment—if there’s one thing people in the “food movement” seem to agree on it’s that food is implicated in our lives in a myriad of interconnected ways. I think there’s room for improvement in multiple realms. 

Is it just me or does this look like 1950s-era photoshopping? I'm skeptical that that dude's cheeks were actually that rosy, and wonder if maybe he wasn't really wearing that hat or holidng that magic kit. From flickr user HA! Designs

1. More Garbage-fed Pigs. This might be impractical, or ultimately less efficient than just feeding them  corn, but it certainly seems like it would make sense to feed more restaurant and/or home kitchen waste food to pigs. That might require revisiting some recent changes in state and local laws—according to the Institute of Food and Agricultural Sciences at the University of Florida, the practice of feeding pigs garbage in the U.S. has “declined in recent years because of stricter federal, state, and local laws regulating animal health, transportation, and the feed usage of food waste.”

1940s wartime poster from the UK, from the Mary Evans Picture Library, which will sell it to you as a mousepad or jigsaw puzzle. Click.According to George Monbiot, similar changes in the UK have caused the percentage of edible grain in pig feed to double from 33% in the early 1990s to over 60% today, replacing crop residues and food waste. He claims that was largely an overreaction to fears about mad cow disease, even though there’s no danger in letting pigs eat meat and bone meal. Given that it’s now apparently against English law to feed kitchen scraps—even vegetable matter—to pet pigs, I’m inclined to believe him.

I’m all for food safety, but perhaps we could re-examine whether recent laws about the feed usage of food waste are really protecting pigs and people from disease, or just preventing us from making good use of garbage. Anyone who’s ever worked in a restaurant knows how much food gets thrown out. Legal or not, I’ve heard about some people buying kitchen slops from restaurants to feed their pigs, and that sounds like a win-win: the restaurant profits from their garbage, and the hobby farmer gets cheap, high-quality pig food. I’m imagining something like that, but on a grander scale. Could we increase the amount of food waste in pig feed to 60-70% nationwide? Get on it, Santa.

2. More funding for food stamps. Not only do they prevent poor people from having to choose between buying food and paying the rent, they also provide the best stimulus “bang for the buck.” The biggest disappointment of the new school lunch bill is that it’s partially funded by cuts in federal funding for SNAP. If you’re the type to get your panties in a bunch over the possibility that a handful of underemployed college graduates might use them at Whole Foods, just remember 1) that’s probably not hurting anyone and 2) it’s not how the vast majority of food stamps get used. From Economix, click for link

3. More sustainable aquaculture. I love fish, but it’s getting hard to keep track of what kinds are safe and ethical and I’m worried about declining ocean stocks and the ecological impact of farmed salmon. Some promising developments I’ve heard about in the last year are aquaponics and farmed barramundi. More please?

4. Living wages for farm and food industry workers. Congrats to the Coalition of Immokalee Workers, who finally won the $0.01/lb raise they’ve been fighting for since 2001, which may raise their average annual income from $10,000 to $17,000. But that’s still pretty terrible. The low cost of fast food that people like Pollan complain about is almost certainly due more to the declining cost of labor in the last three decades than to farm subsidies. Thirty years ago, most meatpacking jobs were unionized and paid decent wages. I want that back.

Of course, it’s possible that if that happened, everyone else ( at least in the bottom 80% of income earners) would need help paying for the increased cost of food. So I guess this is a two-part request, and it’s probably the “big ticket” item on the list: I want more equitable income distribution. As Ezra Klein argued on the Washington Post site recently, there’s no reason to take our current rates of income inequality for granted.

In 1969, for instance, the average CEO made 26 times what the average worker made. Today, it’s closer to 500 times.

Not so in Japan, where “it’s indecent for rich people to make too much money because, after all, these are collaborative endeavors.” I’m not saying everyone needs to take home an identical paycheck, but I have a hard time believing the work and expertise of the average CEO is worth 500 times the work and expertise of their average employee. Or that the bankers who made deals with Magnetar deserve exponentially greater compensation than the people who spend all day every day picking vegetables or disemboweling beef carcasses. If that’s too much to ask, how about this for starters: everyone who works full time should be paid enough that they don’t qualify for food stamps.

5. Less “local,” more “low-impact.” I think the locavore movement has good intentions, but proximity is a poor proxy for things like the carbon footprint of food, largely because transportation only accounts for approximately 11% of the energy used in the food system—most of the rest is used up in water delivery, fertilizer production and application, harvesting, processing, packaging, heated barns and refrigeration, and the gas or electricity you use in your own kitchen.

Photo by Carbon Trust, featured in G-Online, click for storyJames Williams suggests that watchdog groups should calculate “life cycle carbon counts,” and the European Union has introduced “carbon labels.” I’m in favor of that, even though I’m not sure how practical it is. Perhaps some of your local farmers drive their produce to a single market in a new, energy-efficient vehicle while others drive old trucks, half-full, to a dozen markets every week. Despite the complications, someone might be able to come up with some ballpark regionally-specific estimates for commonly-purchased produce, and develop a “rating” system similar to the Seafood Watch guides you can print or download.

More broadly, I’d like to see the popular discourse shift away from the obsessive focus on locality, which corporations have already successfully co-opted. Are farmers in California or sub-Saharan Africa really any less deserving of your support than some guy who happens to live 50 miles away, especially if the former can get you a greener product? Sometimes thinking “global” may require buying “global,” not local.

6. Less condescension, more compassion. No more telling people they should be buying local, organic  heirloom beets instead of sneakers and cell phones. No more sneering at people who shop at “Whole Paycheck.” For the rich and the poor and everyone in between, I just want a cease-fire. I’m tired of people scolding other people or claiming the moral high ground because of where they shop, what they buy, how they cook, or what they feed their kids. This cuts both ways—it’s as annoying when people berate vegetarians for being stupid hypocrites or sneer at insufficiently-adventurous eaters as it is when people criticize fast food eaters and get smug about having a CSA share (or even having a particular CSA—I’m looking at you, Tantre shareholders).

No more of this passive-aggressive crap either. No one lectures people about how they ought to make their own clothes, but surely most of the same arguments people make about homemade food apply. Homemade clothes would probably be better-quality (at least once the maker has some practice and skill). They could be made with local, organic textiles free from chemical dyes and designed to suit individual tastes and needs instead of being made in factories and shipped halfway around the world. Wearing them instead of ready-made clothes would reduce your dependence on and support for unethical labor conditions and the culture of cheap, disposable wearables. And yet people are much more willing to accept that some people just don’t have the time to make their own clothes.

I’ve heard people say things to the effect of “it’s about priorities” in response to those who claim that some people don’t have time to cook. Well, duh, it’s about priorities. What is “I don’t have time,” if not a different way of saying, “It is less important to me than the other things I have to do”? No one saying “I don’t have time” is claiming they’ve got fewer hours in a day than anyone else, just that more important things are occupying those hours. What “it’s about priorities” doesn’t explain is why anyone thinks they should be the one to tell someone else what their priorities should be. If you have time to cook, or make your own clothes, bully for you. What I’m asking for is that people stop assuming the same is true of anyone else. Better to assume that most people are doing the best they can with what they’ve got. The fact that someone else’s life looks different than yours doesn’t make theirs inferior—nor does it make yours inferior, which is the fear that I suspect drives most of that kind of condescension anyway.

TeacherPatti wrote about a similar issue last week in the fabulous post titled “A Different Life.”

7. “Public health” policy that focuses on health instead of thinness. Thinness is a really poor proxy for health, for reasons I’ve already mentioned above. Policies that focus on calories, BMI, and weight-loss are all designed to make people thinner—not that they’re likely to succeed at that either. If we really wanted to make people healthier, we’d stop advocating calorie-restriction dieting, which is more likely to make people fatter and less healthy in the long-term. Instead, we could devote resources to encouraging physical activity and decreasing sugar consumption. And maybe in the process we could start promoting acceptance of a wider range of body shapes and sizes, which might in turn help people develop healthier relationships with food. More on this topic before and I’m sure, again in the New Year.

I know that’’s a lot to ask for, Santa, and I know you’re a busy guy. I don’t actually expect to get any of these things, and perhaps it’s better that way—as multiple fairy tales and clichés warn us, wishes can be dangerous, volatile things, prone to tragic backfiring. In the realm of food, that seems especially true. Policies that might be better for the environment often seem to be worse for animal welfare or human health; reforms that might be better for nutrition might be bad for the environment or leave some people hungry. The food system and its effects are so far-reaching and complicated that change is never going to be simple. I’m prepared to be happy with whatever you can swing this year.

Best regards to you and Mrs. Claus,

Margot

p.s. Happy Holidays.

nomnomnomFrom Roar of the Tigers

When What I Want Isn’t What I Want: On Temptation and Disordered Thinking/Eating

Note: I try to avoid writing overly confessional, navel-gazing posts, but I’m making an exception today because I think personal narratives can be useful in attempting to understand the complexities and challenges of trying to eat “well.”  

I have never been diagnosed with an eating disorder, but I think it's hard for most people to reach this state--disordered or not. I thought I had reached it, but now I'm starting to think it's not a destination that I can "arrive" at but something that requires continuous work, like a balancing act or relationship.

All images in this entry from PostSecret 

When I work from home, I almost never eat out. That doesn’t mean I don’t eat prepared or processed foods—the freezer is almost always full of things from Trader Joes and the local Asian market (I know I could make tamales and pot stickers myself, and that that would probably be cheaper and perhaps better-tasting, but at least for now, other priorities win out over eating 100% cooked-from-scratch meals). But even if you don’t count TJ’s prepared foods and the occasional package of instant pho or ramen, I still eat mostly “homemade” food most of the time, even when I’m working under deadline pressure. A lot of that has to do with the fact that it’s usually quicker, easier, and cheaper to cook an egg, cut up some fruit or vegetables, or throw together a salad or sandwich than it is to go somewhere or get delivery.

Having to be at an office everyday, which I’ve been doing for the last six weeks due to a dissertation writing institute, has disrupted my eat-at-home habits. I’ve tried to pack lunches every night and keep “healthy” convenience foods like nuts and apples in my office to minimize the extent to which I end up eating out, but I haven’t been entirely successful. The availability of outside food has basically exposed me to a whole array of temptations that I don’t normally encounter, and I’ve found myself engaging in some of the patterns of impulsive or emotional eating, negative self-talk, and general anxiety about food that I thought I was mostly “over.”

"Disordered" eating (which may be a misnomer that implies there's such a thing as "ordered" eating) can manifest in many ways; starving and purging are only symptoms, the underlying "disorder" may exist or persist without those symptoms.

Bad Day Part 1: Pizza and Self-loathing

Here’s how last Friday went:

While getting ready in the morning in the bathroom, I weigh myself for the first time in about a week. I used to weigh myself multiple times a day, taking perverse pleasure in every decrease, no matter how small, even if it was clearly due to excretion or being dehydrated from drinking too much the night before. Now I’m not nearly as obsessive, but when I see that the number is over 110—the highest it’s been in at least two years—I feel disappointed and ashamed. I tell myself the number doesn’t matter, and even if it did matter, 110.4 is a perfectly acceptable number for my height and build. And even if it wasn’t a totally acceptable number, obsessing about it wouldn’t do any good. But the best I can do is repress the emotions. I can’t un-feel them. 

It's so hard to internalize the fact that restricting food actually represents a *lack* of control or self-restraint. Even when it takes the form of "restraint," it is unrestrained restraint. I mean, obviously, right, someone in control of their restraint doesn't let it kill them.  In the kitchen, I look at the last container of leftover nettle soup in the refrigerator and sigh. The factors in favor of taking it are many and obvious: it is tasty, relatively healthy, easy, and will prevent me from even having to think about leaving the office to get food. There was even a handful of oyster crackers left at my office from the day before, when I had made the “right” choice and taken the soup. But I tell myself I’m “sick” of it, since I had it yesterday. I briefly contemplate grabbing one of the packages of tamales from the freezer, but then I’d have to find something to transport salsa in. Also, I don’t really have the eating implements at the office for that, and it doesn’t even sound that good in the first place. I am conscious of and unhappy about the fact that I’m making excuses. I throw some cherries in a tupperware container to eat for breakfast, feeling like that’s a reasonably healthy “trade-off” for the potentially less-healthy lunch I’m setting myself up for.

It hasn’t been a good week for dissertation writing. I keep revising instead of adding new material—or, worse, writing blog entries and playing games online. I feel lazy and ashamed, and I know that what would make me feel better is to actually do the work. But I just keep not doing it—willpower failing on multiple fronts. However, this particular morning goes pretty well. I spend an hour or so on the egg post, but then I finish revising a section of the chapter that’s been frustrating me for a while. Around noon, when I start to get hungry and distracted, I decide that the best way to keep my momentum going is to take a break and go to lunch to try to circumvent the pit of despair that I seem to slip into around 1pm.

I wander outside contemplating my options and decide to get pizza. I know this is probably among the worst of the options available to me no matter what criteria you’re using—carbs, calories, fat, pizza has it all in abundance. My justification is that I have been vaguely wanting pizza for days, so perhaps if I just have it, I will stop thinking about it and possibly compensating for not having it by “splurging” on other foods.

It tastes good, but as with most foods I have ever craved or idealized, it’s not nearly good enough to warrant either “craving” or feeling guilty about. The idea that it’s a “bad” food only makes me want it more, it doesn’t make it taste better. I probably would have gotten more pleasure from the nettle soup. I make a note of this but endeavor not to mentally castigate myself. working to change my perceptions about what is pretty--on myself and other people--is a related challenge, and also one that takes continuous effort.

Perhaps because I can tell I’m on a sort of dangerous track, while I’m eating the pizza, I start thinking about a moment a few years ago that has become somewhat totemic for me as an example of my “disordered” past tendencies. I was looking at a friend’s stomach—she’s slender, but has a tiny rounded belly—and I thought something along the lines of: ugh, if my stomach ever looked like that, I’d start seriously starving myself. It was less…concrete than that because I didn’t put it into words, but it was something between that kind of thought and more general feeling of disgust and dread that seemed like it was directed outward (towards the friend) but was actually just a projected form of self-hatred. At the time, I took the comparative flatness of my stomach as evidence of my superior self-control. But I wasn’t in control—I was terrified of getting fat and ashamed of my hunger and hypercritical of my body. When I did feel beautiful back then, it was entirely dependent on feeling thin (not being thin, because it was entirely about perception, not reality) and it was a hollow, imperious sort of self-love that required other people to be fat and inferior. And most of the time, I didn’t feel beautiful at all.

Thinking about that moment and how completely insane I had to be to think this woman was fat seems to help. I say to myself: So I had pizza for lunch, so what? Eating two pieces of pizza is not some major “transgression.” It’s not going to make me fat or sick, it doesn’t make me morally weak, and it definitely does not make me less beautiful or deserving of love.

Bad Day Part 2: The Unscratchable Itch

After lunch, still feeling vaguely hungry but suspecting that I’m really just thirsty since I didn’t get a drink with my slices, I stop in a small market/deli and contemplate the bottled drinks. I know VitaminWater is basically just sugar-water—that the antioxidants and “superfruits” advertised on the label are classic appeals to what Michael Pollan calls “nutritionism,” that it is not going to make me healthier, that I won’t even like the taste that much. But for some reason, some part of me wants it—VitaminWater is now the thing I hope will scratch this itch I can’t seem to locate, which is probably the same itch I was trying to scratch with the pizza. Deciding not to agonize over it, I pick up a bottle of XXX vitaminwater ZERO (acai-blueberry-pomegranate flavored), without even checking to see what the “natural” zero-calorie sweetener is (it turns out to be stevia). I also grab an apple in case it turns out that I am actually still hungry or want a snack later that afternoon. And then, remembering that I have a 5 hr drive ahead of me that evening, and in anticipation of that or perhaps to offset the “virtue” of the apple and calorie-free vitamin water, I grab a bag of Werther’s Originals Chewy Caramels. Even though I clearly also have and succumb to cravings, I find myself being snarkily judgemental about people who talk about cravings, which I think results partially from popular representations of women as basically crave-beasts made utterly irrational by things like chocolate and low-fat/low-calorie yogurt.

As I put them on the counter at the register, I feel like this is unlike me. I feel like I ought to be above these things: eating “junk food” for lunch, impulse-buying VitaminWater and candy. I’m not even entirely sure why I’m doing it. It certainly doesn’t make me happy.

Back at the office, I look at the nutritional information for the caramels, even though I don’t want to care. I used to count calories obsessively. I don’t anymore, and not just because caloric algebra is imprecise and restricting calories just prevents you from having enough energy and slows your metabolism. What concerns me more are the psychological effects: it causes me to moralize my hunger and food choices, making calorie-dense foods “bad,” and that causes me to crave them. Even when I resist the cravings, I feel ashamed for having them, and become more inclined to indulge in other self-destructive behaviors, either to “treat” myself for being good (resisting cravings) or to punish myself for my unruly appetite. Basically, it makes me want to eat more and enjoy the food I do eat less. Even people who lose weight the "healthy" way through diet and exercise almost always gain it all back, or more. 60% within a year, 97% within three years. 23% gain back more than they lost. Attaching moral significance to weight is a recipe for self-loathing.

Also, it’s unsustainable. My pattern for years was basically: for 2-6 months, I’d restrict myself to 1100-1700 calories/day (usually trying to alternate low and high days). I’d lose a few pounds, feel superior in a hollow way and make pejorative judgments about the moral character of everyone fatter than me (and given that my BMI was between 17.2-18.0, almost everyone I knew or met was fatter than me). But eventually, I’d run out of steam and I’d start “cheating” more, although most of the “cheating” seems pretty ludicrous now—I remember considering a small skim latte a big indulgence. Eventually, I’d stop weighing everything I ate and looking up nutritional values online and for maybe 6 months, I’d eat basically whatever I wanted (although I was always still following some form of restricted diet that usually had ethical/medical rationalizations, i.e. veganism, but was also at least partially motivated by the desire to stay thin). At some point, I’d notice that I had gained a few lbs, and that would inspire me to start counting/restricting again. Many dieters know this cycle well.  Of course, not all vegans are disordered eaters, but I think part of the gender imbalance in vegetarianism/veganism is related to the same factors that cause the gender imbalance in diagnosed eating disorders. More women than men use/abuse food as a form of self-control. Because I really don't think women are generally more "ethical" than men.

Even though calorie counting or “dieting” is often difficult and unpleasant and takes a lot of mental energy, it’s also incredibly difficult to resist because of the short-term weight loss and the illusion of control. The thing I still can’t seem to shake, no matter how much I try and want to, is the desire to be thin—or at least, to not be fat. Given that I know how to be (temporarily, unhappily) very thin by restricting how many calories I eat, it’s hard not to see calories, especially in sugary or starchy foods, as a measure of how bad the “bad’ things I eat are. The caramels turn out to be approximately 40 calories/caramel bad, which I immediately compare to the 20-calorie sugar-free popsicles in our freezer at home (another sin against the Church of Real Food, like the VitaminWater). Each one of these caramels = two popsicles. I eat three of them and ignore the apple, and then struggle to tell myself that that’s okay and that letting this become a matter of guilt/desire will only make me want more and feel worse, etc.

People also derive a lot of pleasure from monitoring their diet, weight, and body shape, too. But if it causes you more anxiety than pleasure, try stopping for a while. I know that's easier said than done, but deciding you don't want to worry or obsess anymore is the first step.

Saying “Enough!” and Giving Myself Permission to Eat What I Want

The rest of that day was better and this week has been fine. I really can’t emphasize this enough: last Friday was an exception, not the norm. However, that kind of lapse—and I’m referring to the thought patterns I indulged in, not the act of eating the pizza or caramels—has been happening way more frequently since the institute started. It’s been an unpleasant reminder that the balance I thought I had achieved—where I generally don’t make impulsive, emotional decisions about what to eat, don’t count calories, don’t feel bad about what I want, and just plain don’t worry so much about getting fat (and by the way, don’t gain weight: I was stable at ~105 lbs for almost 3 years after breaking the calorie-counting cycle)—is still really fragile.

I try to speak up when people make pejorative comments about fatness, I try not to make or think complimentary things about thinness or congratulate people on weight loss. But the idealization of thinness is pretty pervasive. It's difficult to resist. At first—hell, even when I started writing this entry—I thought the problem was the sudden exposure to all kinds of temptations I normally don’t have to deal with. But that’s not quite right. The kind of food that I want when I’m on campus is not the kind of food I actually find all that desirable. The reason it’s not tempting when I work from home is not just because it’s far away, but because there’s nothing inherently tempting about it. I made it into a temptation by constructing “food from home” as the virtuous alternative, which inevitably made it seem boring and oppressive and made me desire restaurant food as the “bad” other. And then, rather than choosing restaurant food that might have been nutritionally equivalent to something I’d eat at home, I was looking for a “treat” so I chose things that violated my beliefs about what is “healthy”…and still felt dissatisfied. Thus the itch I couldn’t scratch.

What I should have done from the start of the institute, and what I will do if I’m ever in this kind of situation again, is reject the impulse to moralize my lunch. I hereby give myself permission to eat as much restaurant food as I want, from whatever restaurants I want. I will eat pizza every day for a week if I want to. And the funny thing is that already, just by giving myself permission to do it, I find that I don’t want to. I only want it when I think I shouldn’t.

That’s basically the same strategy that a lot of proponents of “intuitive eating” recommend to people who want to break patterns of emotional or compulsive eating. It’s hard to listen to the cues your body supplies about hunger and satiety if the reasons you’re eating have more to do with being sad or angry or feeling deprived or wanting to be comforted or thinking you deserve a “treat” than they do with whether you physically need food. If you reject the idea that some foods are virtuous and others “bad” but therefore very desirable and rewarding, you rob food of the moral and emotional significance it has acquired due largely to contemporary anxieties about fat (which are not medically justified—see Paul Campos The Obesity Myth, J. Eric Oliver Fat Politics, Glen Gaesser Big Fat Lies or Michael Gard and Jan Wright The Obesity Epidemic: Science, Morality, and Ideology).

If you decide that you are going to eat what you want without judging yourself—without feeling shame or guilt or self-hatred or the culturally-constructed fear of fatness—a crazy thing happens: you will probably eat mostly “healthy” things in moderate amounts. I don't think most people do have to pick, but if I ever do, I hope I have the strength to choose fat and then try to learn to be happy.Here’s how another Margot, who writes the blog ReelGirl describes her experience of learning to “eat when you’re hungry, eat whatever you want, stop when you are full” (basically the intuitive eating mantra):

I was ready to stop dieting. I’d had enough. It bored me to tears. I was sick of it and bulimia too and thinking about calories or fat grams. I read a book called Overcoming Overeating and When Women Stop Hating Their Bodies (both by Jane Hirschmann), and I did exactly what the books said. I filled my house with an abundance of every food I wanted, and if I binged, I’d go out the next day and buy lots more. That action helped me like nothing else.

Keeping my house stocked with all the food I loved no matter what showed me that I was sticking with myself no matter what, even if I gained 300 pounds, I didn’t care, dieting was over for me. I didn’t gain much weight, by the way, maybe five pounds– going from extreme dieting, calorie counting, and throwing up to eating whatever I wanted hardly made a physical difference. (from an interview she did with A Weight Lifted)

The hardest part is really convincing yourself it’s okay to eat what you want. I’m actually not sure if she—or I—would stick with it if we did gain weight. Despite the fact that I believe that fatness is not a moral or medical concern, despite the fact that I think the idealization of thinness is destructive—especially to women, who are subject to far more scrutiny of their bodies and food choices and held to a much more restrictive standard—the desire to be thin is hard to shake. And as long as I care about being thin, I will probably still sometimes feel ashamed of my body or my desires or my food choices. I feel better and happier about my body and food choices than I did three years ago, in part because giving myself permission to eat what I want broke the negative thought patterns that used to really dominate how I thought about food. But it’s clearly still—and may always be—a work in progress. 

Most days, I am. All is probably too much to ask for.