Rethinking Thin: The new science of weight loss – and the myths and realities of dieting by Gina Kolata.
As someone who once believed in the ‘calories in = calories out’ maxim I found Rethinking Thin to be a fascinating read. Logically, the math makes sense: the more you eat the more you should exercise to counteract your consumption. However, this idea is also heavily premised on the idea that fat is both medically and socially bad. As a sociological researcher I tend to give social factors a large portion of the pie when it comes to, well, everything but while reading this book I realized how often we (especially in a technology age) fail to give nature credit where credit is due. In this book we are reminded that our body was designed for survival rather than fashion or social acceptance; therefore, as much as we would like to believe that we have control over what our body does and how it looks we must concede some responsibilities to Mother Nature.
This book chronicles a two year study comparing the Atkins diet versus the standard low-calorie, low-fat diet. The study was a combined effort between the medical centers at the University of Pennsylvania, University of Colorado, and Washington University in St. Louis and involved several hundred obese participants. Study subjects were provided with intensive counseling and support over those two years. They all began with the hope of losing the weight, and more importantly, keeping it off. At the time, the Atkins diet was all the rage despite many medical practitioners fearing that it would create more health problems than it would solve with weight-loss. I will return to the study outcomes later on but here are some highlights about weight and weight-loss from the book that resonated with me:
1.) The author pinpoints the bathroom scale as one invention that was influential in creating our weight obsessed society. Kolata explains the personal bathroom scale as an “enabling technology…necessary for most people to live their lives with the nagging worry that they are not thin enough and for some to make dieting their obsession.” (p.74). She argues that with the scale everyone knows their weight within five pounds but how many people can recite their blood pressure or cholesterol levels (which are better measures of physical health)? The bathroom scale facilitates the conflation of thinness as equal to health. The first bathroom scales were created in the early 1900’s. They were heavy and expensive “but as demand grew, manufacturers started selling smaller, cheaper, more attractive scales, and began advertising that weighing yourself, knowing your weight, became almost an obligation.” (p.76). Hence, weight became one of the easiest measures of one’s health (and social worth) while not necessarily being an accurate measure of health. Fast forward to 2013 and the bathroom scale remains a household staple despite the fact that technology has advanced to the point where doctors can check pacemakers remotely through smart phones. Kolata also names full length mirrors and photography as two other major contributors to our social obsession with weight and appearance.
2.) There is also a persistent notion that psychological problems lead to obesity (e.g. fat people eat to suppress their pain, fat people eat late at night, fat people eat when they are anxious). Evidently, there is no research to support that psychological issues cause obesity. Study after study have consistently observed that obese people have no unique psychiatric abnormalities, and although some had problems, such as anxiety, depression, and mood disorders these psychiatric problems were just as prevalent in people of normal weight. Thus, there is no behaviour that is typical of the obese.
3.) Fat people have more fat cells. Kolata explains that the cellular make-up of obese people is distinctly different from that of non-obese people. When slim people gain weight their fat cells grow larger; however, in obese people when they lose weight their fat cells may become smaller but they still have a considerably larger number of fat cells. Therefore “because [slender people] always [have] fewer fat cells than people who [are] naturally fat, [slender people are] fundamentally different from naturally fat people” (p.118). Part and parcel with this research was the observation that our body will regulate our metabolism to help keep our weight as close to our ‘happy’ range as possible (happy range as in what our body deems happy, not what our mind deems happy). “Gain weight and the metabolism can as much as double; lose weight and the metabolism can slow down to half its original speed” (p.118). In other words, those people who seem to be able to eat whatever they want and not exercise but stay the same weight have their metabolism working quickly to keep them in their body’s happy state. Conversely, when naturally heavier people start to lose weight they have a difficult time keeping it off because their metabolism will ramp down so that it makes it harder for them to lose and maintain weight loss. It would seem that the body works harder to keep us in its happy state than we can consciously work to attain our ‘goal’ weight.
4.) Hunger is not experienced the same by everyone. It is often assumed that the ability to skip a meal or abstain from eating is merely mind over matter; however, some researchers argue that hunger, as a survival mechanism, can be thought of as a spectrum whereby some can easily fight the urge to eat and while others feel it like it overpowers them. One particular researcher argues that “Fat people are fat because their drive to eat is very different from the drive in thin people” which is “something thin people never understand” (p.168).
5.) We are bigger now than ever because the abundance of food we have enables us to reach our full weight potential. Kolata explains that with our abundance of food our body has reacted with a similar gain in weight. “The genes that make people fat need an environment in which food is cheap and plentiful, the same way that genes that make people tall need an environment in which children are well nourished” (p.178). It was pointed out that people today are at least 3 inches taller on average than they were in the Civil War era and it was not our genes that changed during that time, but our environment. Today’s children (in North America) almost always get enough food for their genes to reach their height potential and it is hypothesized that our genes react the same way with weight.
6.) Kolata contends that “the genetic study of obesity is in its infancy. It’s twenty years behind cancer, ten years behind diabetes.” (p.178). Similarly, just as cancer research focuses heavily on a cure without fully understanding the causes, obesity research works in a similar vein. It appears that no one really cares what causes obesity
but everyone knows that there is big money for whoever finds the silver bullet.
7.) Maybe getting healthy food into schools and increasing physical education isn’t as important as we think it is. In an eight year $20 million project sponsored by the National Heart, Lung, and Blood Institute (part of the National Institutes of Health) researchers followed 1,704 third graders in 41 elementary schools in the Southwest, United States. Most of the study participants were Native Americans who are generally at a greater risk for obesity. The study wanted to know if the schools made a grand effort to increase physical activity and facilitate healthy eating, by grade 5 would these children be thinner than the control schools? The school’s cafeteria adhered to a healthy and low fat school menu, teachers taught students about healthy choices, students (because they were low income) ate breakfast and lunch at school (which constituted half of their daily calories), families were included in healthy eating education, children learned how to prepare healthy snacks and cook for their families, the school enforced exercise at least 3 hours per week (at a minimum) but the goal was an hour a day, and teachers incorporated exercise breaks into class time. After everything was said and done the children learned a lot about nutrition and the amount of fat in their diets was reduced but on the whole the schools did not lose any weight. Furthermore, the control schools did not appear to gain any weight either. These findings should make us think twice about pointing the finger at unhealthy cafeteria food and a lack of physical education classes as the culprit behind increased body weights.
8.) Weight loss research centers conduct weight loss study after weight loss study with the same results. The goal of these obesity research centers is to find that magic bullet that says “eat this and you will be skinny” or “do this and you will be skinny” but rarely, if ever, do they ask what causes obesity. Gary Foster, who was the Clinical Director at The University of Pennsylvania Center for Weight and Eating Disorders during the Atkins versus low-calorie study, has admitted that every study pretty much ends the same way – people lose weight during the study and once it’s over they gain the weight back.
If you don’t want to know how the book ends then perhaps you should stop reading now…but I hope it is not surprising to learn that neither the low-calorie nor Atkins diets were all that successful or sustainable. Most of the participants left with more knowledge about calories and diets but were still ‘overweight’ and dejected. The underlying theme that runs throughout Rethinking Thin is questioning where our privileging of thinness comes from and why it continues to hold power over people despite the fact that the science has yet to prove that being outwardly thin is healthy or that being outwardly fat is unhealthy.