obesity

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

Posted by Margot | Filed under:
Jun 16 2010

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. Read more

HFCS Follow-up: What the Rats at Princeton Can and Can’t Tell Us

Posted by Margot | Filed under:
Mar 29 2010

Ed called my attention to last week’s press release about the study at Princeton currently getting some mass media attention. The press release claims:

Rats with access to high-fructose corn syrup gained significantly more weight than those with access to table sugar, even when their overall caloric intake was the same. 

i know it's a squirrel, not a rat. apparently no one's gotten a rat to do this and then circulated it with the right keywords to match my google search. this image likely not original to: http://ybfat101.com/notyourfault.shtmlThat’s pretty surprising, given that other studies have suggested that there is no difference between HFCS and sucrose. The Princeton study doesn’t offer a definitive explanation for the difference they found, but they suggest that it may have something to do with the slightly greater proportion of fructose in the HFCS.

As I noted in the first post on high-fructose corn syrup, HFCS-55, which is the kind used in soft drinks and the Princeton study, has roughly the same proportions of fructose and glucose as table sugar. Table sugar, or sucrose, is composed of fructose bonded to glucose so it’s a perfect 50-50 split. HFCS-55 contains 55% fructose, 42% glucose, and 3% larger sugar molecules. There’s a lot of evidence that fructose is metabolized differently than glucose, and may promote the accumulation of fat, especially in the liver and abdomen. Indeed, that’s why I believe that agave nectar is probably nutritionally worse than table sugar. Still, I’d be pretty shocked if a 5% increase in fructose could produce a statistically significant difference in weight gain, unless the rats were eating nothing but sugar-water. And they weren’t—in both of the experiments reported in the original study, the rats had access to unlimited “standard rat chow,”

Experiment 1: Rats Who Binge?

In the first experiment, 40 male rats were divided into four groups of ten. All of them had 24-hour access to rat chow and water. Group 1 was the control, so they just had chow and water. Group 2 had 24-access to an 8% solution of HFCS (.24 kcal/mL), which the press release claims is “half as concentrated as most sodas”. Group 3 had 12-hr access to the same HFCS solution. And Group 4 had 12-hr access to a 10% solution of sugar dissolved in water (.4 kcal/mL), which the press release claims is “the same as is found in some commercial soft drinks.” The two things of note so far are that none of the rats had 24-hr access to sucrose-sweetened water, and that the concentration of the sucrose was nearly 2x that of the HFCS syrup.*

Why the 24 hr vs 12 hr groups? According to the study:

We selected these schedules to allow comparison of intermittent and continuous access, as our previous publications show limited (12 h) access to sucrose precipitates binge-eating behavior (Avena et al., 2006).

In other words, they fed the sucrose group on a schedule that they already knew would cause binging. And they didn’t include a 24-hr sucrose group to control for that.

That helps to explain the results: the rats that had 24-hr access to HFCS-water gained less weight than either the rats who had 12-hr access to sucrose-water or the rats that had 12-hr access to HFCS-water. So according to the experiment, it’s better to consume some HFCS than it is to binge on sugar (not, obviously, how they chose to frame it in either the formal write-up or the press release).

Princeton rats

The only difference between the four groups in the first experiment that was statistically significant at a p<0.05 was between the rats who got chow only and the rats who got 12-hr HFCS. There was no statistically significant difference between the rats who had 12-hr access to sucrose-water and the rats who had 12-hr access to HFCS-water. There wasn’t even a significant difference between the rats who had 24-hr access to HFCS-water and the chow-only rats. So the only basis for the claim in the press release that HFCS is worse than sucrose is the fact that the rats with 12-hr HFCS got a “significant” amount fatter while the 12-hr sucrose rats didn’t. Even though the 24-hr HFCS rats didn’t either.

I am not the only one who’s picked up on this—both Marion Nestle (a vocal critic of the food industry) and Karen Kaplan (not, as far as I can tell, a shill for the Corn Refiners Association) also dispute the claim that this research demonstrates anything conclusive about HFCS vs. sucrose. The lead researcher replied to Nestle’s post, and rather than addressing the discrepancy between the 12-hr and 24-hr HFCS groups, he merely corrects her assumption that the 24-hr rats should be fatter:

There have been several studies showing that when rats are offered a palatable food on a limited basis, they consume as much or more of it than rats offered the same diet ad libitum, and in some cases this can produce an increase in body weight. So, it is incorrect to expect that just because the rats have a food available ad libitum, they should gain more weight than rats with food available on a limited basis. –Bart Hoebel

Which just makes it all the more baffling why they didn’t include a 24-hr sucrose group. Additionally, according to their results, binging or “consuming more” doesn’t explain the results, because:

There was no overall difference in total caloric intake (sugar plus chow) among the sucrose group and two HFCS groups. Further, no difference was found in HFCS intake and total overall caloric intake in the groups given 12-h access versus 24-h access. Both groups consumed the same amount of HFCS on average (21.3±2.0 kcal HFCS in 12-h versus 20.1±1.6 kcal HFCS in 24 h), even though only the 12-h group showed a significant difference in body weight when compared with the control groups.

The only explanation they offer for these results is the slight difference in the amount of fructose the rats in the HFCS and sucrose groups consumed. But even that relies on the idea that the HFCS rats did not feel as satisfied by their sugar water and compensated by eating more:

…fructose intake might not result in the degree of satiety that would normally ensue with a meal of glucose or sucrose, and this could contribute to increased body weight.

Unless satisfaction itself makes rats thinner. Read more

Things That Won't Kill You Volume 3: MSG

Posted by Margot | Filed under:
Oct 14 2009

From Flickr user "The Other Dan" taken in Corktown, Toronto 

Unlike juice, which has sort of a mixed reputation even among contemporary nutritionists and doctors, MSG has been consistently demonized. Most people can't tell you why, they just know that it's bad. If pressed, they might tell you that it's "unnatural," that food manufacturers put it in processed foods to con people into eating "junk," that it's basically salt (which I'll address in a future post in this series), or that it gives some people headaches. Or they might just gesture to the fact that it's common knowledge that MSG is basically some kind of poison—after all, why would Chinese restaurants be so eager to reassure you that they don't use it if it were completely benign?

A recent commercial for Campbell's New Select Harvest Light (which is the sort of self-satirizing product name I'd expect to find in David Foster Wallace's fiction) suggests that even if people don't know what MSG stands for, they know that it's bad—potentially bad enough to deter people from buying a particular brand. Reading from a Progresso Light can, blonde #1 gets through "monosodium" but stumbles on "glutamate"—fortunately, the rainbow coalition includes an Asian woman who can translate that jargon into something we all understand: "That's MSG."

Although people may still associate it primarily with Chinese restaurant cooking, the Campbell's ad hints at its broader prevalence—MSG and other forms of glutamic acid are omnipresent in processed foods. They're especially likely to be found in foods designed to taste like things that have a lot of naturally-occurring glutamate (or similar molecules like inosinate or guanylate). Stock, broth, and bouillon often contain MSG, as does anything cheese-flavored or ranch-flavored, like Doritos, which actually contain five different forms of glutamate. I taste it the most in instant ramen and Chex Mix, but even though I know what it tastes like on its own, I can't always tell when something contains it or not. When used sparingly, it may not even be possible to discern because whether the glutamate in a dish comes from a mushroom or a salt, once it's dissolved in liquid or on your tongue, it's the exact same molecule:

from Wikipedia, showing up weirdly gray here

So even people who think it's "bad" and expect to feel bad after eating it probably eat MSG, at least from time to time, without even knowing it, and without suffering any negative effects.Read more

Against the Soda Tax

Posted by Margot | Filed under:
Oct 6 2009

awesome depth of field courtesy of Stephane Pompougnac http://www.flickr.com/photos/vox_efx/3063389109/

Although many states already tax soda (usually a fraction of a penny per ounce), a recent article in the New England Journal of Medicine on the potential benefits of a $0.01 per ounce tax on "soft drinks, energy drinks, sports beverages, and many juices and ice teas" has re-ignited the debate about whether or not we need a national soda tax. Back in July, Obama said a sin tax on soda was "an idea we should be exploring" in an interview with Men's Health although in the recent panic about industry profits and personal liberties, the White House has been quick to note that they haven't yet and have no plans to propose anything like it. 

Most people probably already know how the two sides shake out: promoters argue that soda makes people fat (which allegedly makes people sick and thus incurs social costs) so the tax would have the dual benefit of reducing the costs associated with obesity and generating money that would help cover health care costs (or balance state budgets). Opponents argue that soda isn't morally distinct from many other elective behaviors that sometimes (but not always) contribute to disease and health care costs, and as soda consumption is inversely correlated with income, taxing it would disproportionately burden those least able to pay.

All of those are actually pretty complicated claims, some of which I'll try to unpack below the jump but here's the short version: even promoters admit that the tax isn't likely to meaningfully reduce obesity or the diseases associated with it (note: not caused by it, as there's still no reliable evidence that fatness causes any disease besides osteoarthritis, and anyone who wants to hear more about that should consult Paul Campos' The Obesity Myth, J. Eric Oliver's Fat Politics, Glen Gaesser's Big Fat Lies, and/or Michael Gard and Jan Wright's The Obesity Epidemic). That means the only real argument in favor of the tax is that it would raise money. But everyone agrees that it would be a regressive tax. So unless you think that collective costs like state budget deficits and health care reform should be disproportionately shouldered by the poorest citizens, there is no good reason to support the soda tax (and this goes double for ill-considered suggestions that we just axe corn subsidies instead—also after the jump).Read more

Things that won't kill you Vol. 2: Fruit juice

Posted by Margot | Filed under:
Sep 17 2009

This may seem like a strange thing to argue about, because the popular consensus still seems to be that juice is healthy. Jamba Juice markets itself as "the category-defining leader in healthy blended beverages, juices, and good-for-you snacks." They even use Jamba as an adjective to mean the opposite of high fructose corn syrup and trans-fats (adding those things to juice ""just wouldn't be Jamba"), which again, constructs the brand as healthy vs. the demon poisons that make people fat. Even if it's foolish to go looking for truths in advertising, I don't think Jamba Juice's branding generally occurs to people as a massive irony or lie. Advocates of banning or restricting soda vending machines in schools often claim that the soda should be replaced with 100% fruit juice with no added sugars, and for many people, a glass of orange juice still represents "part of a nutritious breakfast" strongly with desirable nutrients like Vitamin C.

The Case Against Juice

But a number of health trends have begun cast suspicion on juice, especially the (impartial and incomplete) shift from primarily low-fat to primarily low-calorie and low-carb dieting in mainstream weight-loss culture, and the growing concern about the role sugars (especially fructose) play in personal and national obesity.

On the low-calorie front, people who believe that losing weight or maintaining a healthy weight is all about the basic algebra of calories-in vs. calories-out often end up axing all caloric beverages from their diets because they have a bad satiety-to-calorie ratio—I mean, obviously, right? Fruit juice is just fruit with some or all of the filling fiber removed. If the goal is maximum satiety on minimum calories, you're better off eating whole fruit and drinking water or artificially sweetened beverages.

On the low-carb front, people who believe that what's important is not how many calories you eat but what kind are also going to see juice (and sometimes most fruits and vegetables as well) as "unhealthy." It does seem to be true that diets high in carbohydrates drive up insulin levels, slowing metabolism and encouraging the body to store fat. And the overwhelming majority of the calories in most fruit juices are in the form of carbohydrates. Some green vegetable juices have protein content approaching 50% of the carbohydrate content, but that just makes it 75% bad rather than 100% bad, at least as true carbophobes are concerned.

And finally, there are some non-carbophobes who might avoid juice because they're wary of sugar qua sugar, rather than sugar qua carbohydrate. The carbohydrates in fruit juice primarily take the form of fructose—wikipedia has a handy chart of the kinds of sugars in common plant foods. It doesn't seem like there's a true consensus yet about whether or not fructose is especially bad—despite recent studies linking fructose to obesity, even within the medical community, some people still advocate fructose as a "low glycemic" sugar that's better for diabetics. It basically all comes down to whether you think the fact that fructose is digested in the liver and doesn't trigger insulin production is a good thing or a bad thing. To link it to other sugar purveyors: pro-agave nectar people should also think that fruit juice is healthy and people who think hfcs is bad because they think it's "high fructose" compared to other sugars are, well, a) wrong, but b) should also be advocating hfcs-sweetened sodas over fruit juices, which are even richer in sugar.

Personally, I think the evidence that fructose in large amounts causes equivalent blood sugar spikes to other sugar, increased "bad" cholesterol and triglycerides and signs of insulin resistance compared to glucose, and can cause non-alcoholic fatty liver disease consumed in vast quantities suggests that it is certainly no better and possibly much worse for human health than glucose or sucrose. But "worse for human health" is relative, not absolute, and depends a lot on amount, kind, and context.  Read more