Call for an urgent rethink of the ‘health at every size’ concept • Hacker News Board

Re: Call for an urgent rethink of the ‘health at every size’ concept

#21

Post by mseebach » Tue, Nov 17, 2015, 8:03 PM UTC

atwebb wrote: post #8

steven777400 wrote: post #6

This is significant as well in that it points out that people can legitimately struggle with overweight eating issues as the brain adapts and makes people more hungry. I struggled a lot with losing weight and continue to struggle with keeping it off. It's frustrating when some folks (presumably, who have never struggled with weight and eating, and the psychology issues with eating, such as eating to feel good and the…

That goes for a lot of issues, it's hard to empathize. Addict? Just stop using Alcoholic? Just stop drinking Gambling issues? Just stop betting Depressed? Just cheer up Unmotivated? Just try harder There are underlying, complex factors to most of these and many other issues. It's easier to ignore them when you've never directly dealt with it.

Yes, absolutely -- but all of these ills, as with obesity, are possibly even more ill-served by an acceptance movement.

Re: Call for an urgent rethink of the ‘health at every size’ concept

#22

Post by rtl49 » Tue, Nov 17, 2015, 8:09 PM UTC

DanBC wrote: post #12

rtl49 wrote: post #7

Earlier quoted context omitted.

I agree. Earlier this year I read an article highlighting just how extraordinarily rare it is to overcome morbid obesity in adulthood and maintain this progress indefinitely without medical intervention. Ultimately, we need to accept that our bodies, including the organ which gives rise to our behavior, are physical systems subject to occurrences entirely beyond our conscious control. I've not dealt with obesity pers…

> and maintain this progress indefinitely without medical intervention And bariatric surgery comes with significantly increased risk of suicide. http://www.medscape.com/viewarticle/852616?nlid=89075_2052&s...

This is interesting to learn, though I believe this line is relevant:

Notably, 93% of the self-harm events occurred in patients diagnosed as having a mental health disorder during the 5 years preceding the surgery.

It would appear there's some positive association between incidence of mental health conditions and obesity, which could account for at least some of this difference from the general population. Ultimately, in absolute terms, the increase in self-harm is by 1.3 out of 1000 patients, which is statistically significant, but not so much at an individual level. Considering the much more significant, known health problems associated with obesity, I don't believe this finding changes the expected value of bariatric surgery by much.

Re: Call for an urgent rethink of the ‘health at every size’ concept

#23

Post by DHJSH » Tue, Nov 17, 2015, 8:10 PM UTC

Frondo wrote: post #10

rtl49 wrote: post #7

Earlier quoted context omitted.

I agree. Earlier this year I read an article highlighting just how extraordinarily rare it is to overcome morbid obesity in adulthood and maintain this progress indefinitely without medical intervention. Ultimately, we need to accept that our bodies, including the organ which gives rise to our behavior, are physical systems subject to occurrences entirely beyond our conscious control. I've not dealt with obesity pers…

I think you're touching on the heart of the tension behind the "health at every size" movement. I know a couple of people who are big advocates of it, and surprise surprise, they're all pretty fat. They're still wonderful people, and I of course don't respect them less because they're fat. You know, for me, it's like..who cares? It's not my body. I'm even pretty sympathetic to how much difficulty they have doing basi…

The HAES people don't seem to have a lot of respect for people at normal sizes. It's less "Healthy At Every Size" and more "Healthy at MY Size".

Re: Call for an urgent rethink of the ‘health at every size’ concept

#24

Post by [deleted] » Tue, Nov 17, 2015, 8:10 PM UTC

Frondo wrote: post #10

rtl49 wrote: post #7

Earlier quoted context omitted.

I agree. Earlier this year I read an article highlighting just how extraordinarily rare it is to overcome morbid obesity in adulthood and maintain this progress indefinitely without medical intervention. Ultimately, we need to accept that our bodies, including the organ which gives rise to our behavior, are physical systems subject to occurrences entirely beyond our conscious control. I've not dealt with obesity pers…

I think you're touching on the heart of the tension behind the "health at every size" movement. I know a couple of people who are big advocates of it, and surprise surprise, they're all pretty fat. They're still wonderful people, and I of course don't respect them less because they're fat. You know, for me, it's like..who cares? It's not my body. I'm even pretty sympathetic to how much difficulty they have doing basi…

[deleted]

Re: Call for an urgent rethink of the ‘health at every size’ concept

#25

Post by rtl49 » Tue, Nov 17, 2015, 8:13 PM UTC

MPSimmons wrote: post #16

rtl49 wrote: post #7

Earlier quoted context omitted.

I agree. Earlier this year I read an article highlighting just how extraordinarily rare it is to overcome morbid obesity in adulthood and maintain this progress indefinitely without medical intervention. Ultimately, we need to accept that our bodies, including the organ which gives rise to our behavior, are physical systems subject to occurrences entirely beyond our conscious control. I've not dealt with obesity pers…

It's hard to admit this, but I have found since I lost around 90 pounds (~41KG), I've found myself mentally judging overweight people pretty harshly. I don't mean to do it, it just happens. I think it may come from the, "if I can do it anyone can" line of thinking, but I'm not proud of it.

If we gave voice to every harsh judgment that comes to mind, we would never stop criticizing other people. There's a tension between the need to see oneself in a positive light and the desire to think positively of others.

If you manage to keep these feelings to yourself, I see no cause for shame.

Re: Call for an urgent rethink of the ‘health at every size’ concept

#26

Post by gmarx » Tue, Nov 17, 2015, 8:13 PM UTC

MPSimmons wrote: post #16

rtl49 wrote: post #7

Earlier quoted context omitted.

I agree. Earlier this year I read an article highlighting just how extraordinarily rare it is to overcome morbid obesity in adulthood and maintain this progress indefinitely without medical intervention. Ultimately, we need to accept that our bodies, including the organ which gives rise to our behavior, are physical systems subject to occurrences entirely beyond our conscious control. I've not dealt with obesity pers…

It's hard to admit this, but I have found since I lost around 90 pounds (~41KG), I've found myself mentally judging overweight people pretty harshly. I don't mean to do it, it just happens. I think it may come from the, "if I can do it anyone can" line of thinking, but I'm not proud of it.

I've been really fat most of my life, currently doing pretty well. When you have this problem most people, if they ever lose weight, experience a cycle- lose a lot of weight followed by cockiness/judginess (maybe, I never got that) followed by imperceptible creeping up back to and past original weight. I've done that at least 4 times

Re: Call for an urgent rethink of the ‘health at every size’ concept

#27

Post by DHJSH » Tue, Nov 17, 2015, 8:15 PM UTC

300,000 people die every year from Obesity. It's our #1 killer. And it can be solved by eating less.

See this study in the NEJM:

http://www.nejm.org/doi/full/10.1056/NEJM199212313272701

Discrepancy between Self-Reported and Actual Caloric Intake and Exercise in Obese Subjects

Of all the "diet resistant" subjects studied, ALL of them (100%) were grossly underreporting actual calories consumed and overexerting physical activity. Some of the people in this study were on medication because doctors had believed their self-reported numbers and believed they may have had thyroid or other metabolic problems.

Remember that "bariatric surgery" is just a way to get people to eat less by making it physically impossible to overeat. (Of course, people still manage.)

Re: Call for an urgent rethink of the ‘health at every size’ concept

#28

Post by rtl49 » Tue, Nov 17, 2015, 8:18 PM UTC

Frondo wrote: post #10

rtl49 wrote: post #7

Earlier quoted context omitted.

I agree. Earlier this year I read an article highlighting just how extraordinarily rare it is to overcome morbid obesity in adulthood and maintain this progress indefinitely without medical intervention. Ultimately, we need to accept that our bodies, including the organ which gives rise to our behavior, are physical systems subject to occurrences entirely beyond our conscious control. I've not dealt with obesity pers…

I think you're touching on the heart of the tension behind the "health at every size" movement. I know a couple of people who are big advocates of it, and surprise surprise, they're all pretty fat. They're still wonderful people, and I of course don't respect them less because they're fat. You know, for me, it's like..who cares? It's not my body. I'm even pretty sympathetic to how much difficulty they have doing basi…

The gem in the mud of "Healthy at Every Size" is indeed the encouragement of emotional resilience. Perhaps someone is a large person with an unhealthy appetite. This is unfortunate, but it doesn't mean he or she must be resigned to consuming unhealthy foods. Certainly it's better to consume 4,000 kcal per day of vegetables than the same amount in cake.

So often, in a state of despair, we indulge the sunk-cost fallacy by giving up simply because our conditions are not absolutely ideal. This is the emotional phenomenon the HAES seems to have been intended to address.

Re: Call for an urgent rethink of the ‘health at every size’ concept

#29

Post by atwebb » Tue, Nov 17, 2015, 8:19 PM UTC

mseebach wrote: post #21

atwebb wrote: post #8

Earlier quoted context omitted.

That goes for a lot of issues, it's hard to empathize. Addict? Just stop using Alcoholic? Just stop drinking Gambling issues? Just stop betting Depressed? Just cheer up Unmotivated? Just try harder There are underlying, complex factors to most of these and many other issues. It's easier to ignore them when you've never directly dealt with it.

Yes, absolutely -- but all of these ills, as with obesity, are possibly even more ill-served by an acceptance movement.

We agree though I'd phrase it as, acceptance being the most important part. The individual accepting their status/issue/persona and not society acquiescing. It's all very specific and personal.

Re: Call for an urgent rethink of the ‘health at every size’ concept

#30

Post by gmarx » Tue, Nov 17, 2015, 8:19 PM UTC

vox_mollis wrote: post #3

In modernity, hurt feelings are the ultimate sin, public health be damned.

Hurting peoples feelings does not improve their health. My guess is (I don't know you) looking down on fat people is one of the mechanisms by which you make yourself feel worthy. You are not doing it from their benefit. Believe me, it is a vanishingly rare person who is fat and doesn't mind it. The fat acceptance movement is about feeling helpless and just wishing people would stop giving you a hard time on top of it