Monday, November 11, 2013

When fat things happen to good people. On being thin, fat, and your false assumptions.

"Such crazy thoughts in that Aussie article!"
Do you think that if only you do the right thing—eat a healthy diet, exercise, get enough sleep—then you will achieve your dreamed of weight, live free of disease and live happily ever after? This, dear readers, is a fairy tale. 

If you believe that eating nutrient packed, low calorie foods is solely responsible for whether or not you get cancer, or arthritis or MS, think again. And don’t be fooled by the preaching of Dr. Fuhrman in his book, Eat for Health, that health equals nutrition divided by calories, period. Health is not such a simple equation. And no, eating whole grain, veggie packed meals won’t protect you from an eating disorder either. 

If you think that eating 'right' ensures thinness, as was recently emphatically suggested in a popular newspaper article in Australia, it is yet another fantasy.

And if you torture your overweight self with the belief that you must lose weight--at all costs, and that your inability to reach target goals based on BMI charts is your personal failure, you’re wrong again.

“What is she thinking?” you’re thinking? Let’s start from the top. 

Eating healthy equals health

Yes, diet can impact many, many health measures. And I certainly encourage a balanced, varied diet filled with a complement of vitamins, minerals, antioxidants, and an appropriate level of fiber, to name a few. Yes, there are correlations in populations that have higher intakes of alcohol and saturated fat, for instance, with increased rates of cancer and high cholesterol, respectively. And a nutrient-rich diet chock full of antioxidants and lycopenes, like those found in tomato-based products, may help stave off such conditions as Alzheimer’s, cancer, and other diseases. But eating a proscribed diet will not guarantee your health. Nor will it ensure happiness, which is not to say I don’t encourage making healthy choices—I surely do. But do not, for a moment, think that if you are fortunate enough to stay healthy (or unfortunate enough to become ill) that it is solely by your hand. Credit your parents for their genes, to start.

Fallacies about thin

And do you know what? Eating well does not ensure thinness either. I see my share of patients who choose the most wholesome foods, but eat in excess—even those nutrient rich, heart healthy foods, like avocado and almonds, lean protein and kale. By excess I mean frequently eating without regard for hunger, and eating past a point of comfortable fullness. And eating well—high quality, nutrient-rich foods—even eaten mindfully and intuitively—may not keep you slim. Yup, it’s a sad truth that many of you don’t want to hear. And in fact, the very act of pushing your body to be a weight it is not meant to be, may put you in worse shape—both physically and psychologically. Just wait until you hear about these studies!
Stay tuned. That’s my next post, based on fascinating research presented at the Renfrew Conference I attended last weekend.

And those who are thin do not necessarily eat well and are often hardly fit by any standard. Do be careful about equating weight with health because they do not always pair up as you’d expect. Individuals may be thin because they are genetically predisposed to be, or they may be thin because, in contrast to what journalist and dietitian Susie Burrell believes—that they “know what to do to control their weight”—they may fall quite short in controlling it appropriately. They may be no better than someone who binge eats for emotional reasons at knowing “how to cope when things are tough”. Don’t be fooled into assuming that thinness is simply a lifestyle choice, a moral higher ground.

And I’d caution her, and you, not to overgeneralize about thin people’s skill at “assuming responsibility for self”. Just spend a few hours in my office; even those without eating disorders may allow anxiety or depression to stand in their way of eating enough. How responsible for self is the person who denies herself nourishment when low energy or headachy—hunger gone too far—or pushes herself to exercise even when she reports constant fatigue, or pain? 
Eat when they are hungry, stop when they are full? Some thin people may. But overgeneralizing about a segment of the population isn’t too intelligent. 

No, I didn't leave the rest over, for the record.
Thin people may self-regulate just fine. Or they may deny their hunger and fluid load or rely on high volume low calorie foods. They may eat nourishing foods, or a diet of junk—just not excessive in calories. Or they may compulsively exercise, hardly resulting in mental health, potentially leading to loss in muscle mass, heart problems and a range of symptoms if accompanied by undernourishment. Really, the only thing you can generalize about thin people is… that they are THIN. You can’t assume they are healthy, or happy, or good at self-care or self-regulation.

And of course the reverse is also true. The only thing you can tell by looking at a fat person is….? Yup. It’s that they are fat. You cannot predict their lipid levels or their blood pressure. You can’t tell whether they’ve never exercised or they exercise too much. And you can’t determine the quality of their diet.
My own parents are perfect examples of this, as I’ve written about previously. 

The mere suggestion that health is 100% in our hands I take offense to, as would the rest of the population which struggles with MS, and cancer, and ALS, and type 1 diabetes and arthritis and, and and… And I can say the same thing about a target weight or size. I hate to break it to you, but even if you do all the ‘right things’, you may not achieve your desirable, fantasized-about weight. And you know what? It’s not your fault.

Stay tuned for part two, (which I hope to get out within the week), which will address obesity, weight loss, and the risks and benefits of change.

Did this post push your buttons? Did it challenge your thinking? Did it offer some relief? Do let me know what you’re thinking! 

Thanks for reading, and if you liked this post, please share!


  1. This is a great post! I think most people want to know the why of things that happen. If everything has a cause, then negative things can be avoided. As you point out though that's not always true. In addition to that there is a prevailing mind set that if you want something bad enough you will push and work at it until you accomplish it. That's not always true. Sometimes no matter how much you want something, how much you work at it or how much you spend on it, it isn't going to happen.

  2. Lori, love your articles and site. I've been reading for years. I think your reaching a bit on this one. The article you refer to actually is pretty dang close to something you would typically write. Eating when hungry. Stopping when full. Not changing diet based on holidays. There are a few things that are a little off track but I appreciate this article a whole lot more than the typical article that lays on crazy diet rules.

    1. Here's the problem, Alice. IF she had structured her article with statements like:
      -it is best to: listen to your hunger and stop when you are full, self-regulate, avoid changing your diet regime..., use alternative coping when things get tough--that I would support. And as you point out, that is certainly in line with what I support in this blog.
      The problem is that her statements state that this is what thin people do. AND the assumption, then, that these are things fat people DON'T do.
      More on this in the next post!

  3. Thanks for addressing this! I see so many doctors pushing the low fat vegan diets lately, and I have allowed myself to be pulled into believing I should be eating that way. I'm trying to get back on track with listening to my body instead of these doctors. I've been doing well for many years after a period of restricting and binging, but some of that behavior has been triggered again by reading materials along these lines and looking for the "perfect" diet that will eliminate the chance of any health problem. Thanks for your blog that reminds me of what sane happy eating looks like!

  4. Point taken. The articles tone that if you do this then you will be slim no matter what is contrary to what you are trying to teach on this site.

  5. I was just discussing this with my nutritionist a couple of weeks ago. I'm very lucky that I was blessed with good genetics and it would actually take a concerted effort for me to be significantly above the lower end of a healthy weight range. When I bemoan the fact that my eating disorder took away my ability to exercise and that I'm now really out of shape people will just look at me and say "psh, you're so thin... you're not out of shape." And then I have to explain that yes, I might still be thin, but I lost most of my muscle mass and a great deal of my cardio vascular fitness. You're so right that because I'm thin, people assume I must be so healthy. Even doctors fall prey to that line of thinking. And with anorexia that can be a huge problem, especially when they believe that a low heart rate and blood pressure is enviable. There are people who are considered overweight and obese who are fitter and eat a more varied and nutrient rich diet than I do, but they must be unhealthy right?

    And when people ask me what I do to "stay so thin" it's awkward, when I'm painfully thin from being sick I want to be like "well I have an eating disorder... wanna hear the real price of this." And when I'm doing well and I eat lots of desserts and rich foods and consume a lot of calories in a day it's hard to be like "well I eat huge servings of dessert and umm... walk?"

    Then there's always the "how can you eat all that and stay so thin" comments, to which the answer is... GENETICS. The "unfortunate" part, I guess, is that for people who aren't as lucky to fit the absurd, rigid, narrow definition of what a woman should look like, and buy into the diet industry's sentiment that they can do it if they just have willpower etc. they have to live every day with a sense of failure. My nutritionist was saying one of the hardest conversations she has to have with some patients is the "you're never going to have that body type" conversation. That in order to set realistic health goals, they have to let go of the idea that they can have an entirely different build than they have.

    I once was having lunch with a bunch of people I work with and one person was eating pizza and enjoying it and another said, "I wish I could eat that." And I (idiotically and naively) said "what do you mean?" (thinking maybe she was lactose intolerant or had gluten intolerance or something) and she said "If I have one piece I'll gain a ton of weight." And I (again reallllllly stupidly) said "oh well if you can't even have one piece without gaining weight maybe your body needs to be at a higher weight, everyone has a different body type." I was genuinely trying to help, but being tall and thin generally means that a. I'm not "allowed" to have an opinion and b. that I must have absolutely no idea what the other person is experiencing. Anyways, that didn't go over well, and she got huffy and said "well that's not fair." I get it, I really do, no one wants to hear about food and weight from the woman who can eat basically whatever she wants and still be thin, but I just wish I could shake her and be like "IT'S ALL THIS DIET BS!" I hate how every new diet can somehow solve all of our weight problems, thus solving all of our worthiness issues and also how every diet can somehow solve every health problem ever. If you eat only these foods you'll be invincible. Unless someone learned how to make the Ambrosia of the Greek Gods, we're not living for ever.

    So in summary, that was a lot and I don't know if it makes sense, but there you have it. Keep doing what you're doing Lori :)

  6. Great post and great blog all in all! I love that you go against the mainstream ideas of weight and dieting. Your patients are really lucky to have you as their dietitian.

    I study clinical nutrition at the university myself and I get so mad at the attitudes our teachers and students have towards fat people. I so wish this would change as I think the current style of weight loss programs and the shame that overweight people feel just makes things worse and takes our patients further from intuitive and mindful eating. As you say, being fat doesn't equal lazy, unhealthy etc. and being thin isn't a proof of fitness and healthy eating.

    I have heard far too many times from patients already that they aren't honest with their dietitian when telling about their eating or filling a food diary cause they are so ashamed. I think this won't change as long as we have these attitudes that fat people shouldn't eat this and that and that they are gluttonous etc. Although we wouldn't say it loud, I'm sure the patient can feel, if the dietitian has negative attitudes towards them. There should be more dietitians like you, who understand that being fat certainly is not a choice that is made of free will or lack of self-discipline.

    Okay, end of rant...This just makes me so frustrated cause I have to deal with it every single week at uni.