American tourist at Dauchau
A type of activism called fat acceptance activism – or in the words of all the isms we’re now afflicted with: Sizeism – is currently on the move. Overweight people who are the movers and shakers of the various fat acceptance groups are trying to make the point that it’s okay to be overweight and that one should revel in one’s fatness and not try to deal with it. I don’t really have a problem with this way of thinking as long as people are willing to accept the risks that ride along on obesity’s coattails.
I think it’s fine that overweight people are trying to gain acceptance. I don’t believe that they should be discriminated against anymore than I believe people with leukemia or high blood pressure should be discriminated against. But, obese people need to realize that in the vast majority of cases their obesity is self inflicted.
I can’t tell you how many patients I’ve seen in practice who say these very words: Doctor, I just can’t understand it. I almost don’t eat anything at all and I can’t lose weight. My husband (it’s usually a female patient that says this) eats everything and he never gains weight. As we’ve seen self deception is an easy task.
I’ve made it a hobby to watch people at all-you-can-eat buffets, and what I see is obese people piling the food on their plates- mainly high-carb food – and going back for more. Thin people go back to their tables with small plates of food. I often wonder how many of these people with the huge plates of food are telling their doctors that they don’t eat much of anything at all yet still can’t lose.
People who tell me that they almost never eat and still can’t lose weight drive me nuts because I know it doesn’t work that way. It puts me in a bad position because I know they’re either fooling themselves or trying to fool me and I either have to nod my head in understanding or basically call them liars. It’s a tough spot.
On our recent trip to Europe MD and I spent a day at Dauchau, the first Nazi concentration camp and the model for all the others. It was a sobering but incredibly interesting experience. Throughout the facility there are photos of the camp inmates during the years the camp was in operation (1933-1945), and I didn’t see a single fat person. These were truly people who “almost ate nothing at all” and they were all thin, very thin.
Most readers of this blog know that there are other ways to lose a lot of weigh without resorting to concentration-camp-style starvation, namely the low-carb diet. But I had to vent a little because I get so annoyed when people tell me that they don’t eat yet can’t lose weight.
The fat acceptance movement – which is what this post started out to be about – is nothing new. Way back in the early 1900s obesity in women was becoming accepted in this country as a positive thing. From the February 1919 Atlantic Monthly:

The fat woman has been so long accustomed to commiseration that it may be difficult for her to realize her new dignity; we have all pitied her, been sorry for the bursting glove-clasp, the exuberant girth, the sweets desired but denied, the chin whose apparent hauteur was so unjust to the kindly heart beneath it; and above all for that plump palm laid upon our arm with its accompanying tremulous whisper, ‘Am I as fat as she, or she, or she?’ [my italics]
But now all that evil time is forgotten. The anti-fat nostrum, the recipes for rolling, the panting mountain climb, all the many-doctored advice, all the beauty-parlor pummeling—all this is obsolete, for obesity has come into its own. The corpulent dame now has dresses made to exhibit, not to conceal, her shapeliness; these throng authentic fashion-sheets. She has her own clothes, not the adapted ‘line’ of the lean and lovely sylph. The fat woman is no longer done out of her inheritance by a cruel and carping world. She has become a ‘stylish stout.’

So sizeism -at least for women – is nothing new. But the country wasn’t yet so accepting of male obesity:

It is a curious fact that in neither East nor West has the stylishness of stouts been extended to the male sex. The norm for man is to be long and limber. As the hero of romance, a man may be brawny; but except in farce, he may not yet be fat. In America this ideal of masculine slimness is explained by our fondness for thinking of our men as lean wrestlers with frontier conditions, for the fact of a frontier is still a pleasant figment of our fancy. As a matter of brutal truth, both our men and our women have swelled perceptibly during a long period of plenty and of ease. Not all our Hooverizing has notably reduced the tendency of both sexes toward an opulent maturity. The pitiful point is that our men are not yet allowed by fashion to grow fat with dignity. Of course, it has never been so hard for a man to be voluminous as for a woman, because he thinks only of how uncomfortable he feels, and not, concomitantly, of how ungainly he looks. And yet the fat man has had pain enough in being the butt of the papers and of his pals; and from this anguish he cannot be relieved until fashion lifts its ban from his person as it has lifted it from that of the lady. No shop is as yet exhibiting styles for the stout man. He is still forced to squeeze himself into clothes designed for the stripling.


  1. This post reminds me of an interview with Gina Kolata that was on the radio in May. It was a discussion of her latest book and during the interview she kept bringing up the story of a 200+ pound woman who was “extremely healthy” and was unable to lose any weight. What frustrated me was that she insisted that this was the woman’s natural set weight and that a 5’3″ woman who was over 200 pounds was perfectly fine. I’m that height and was close to that weight zone before starting the low carb diet. Never once did it cross my mind that there was anything natural about being that size. Here is the link to the interview – from npr’s OnPoint.
    Hi Mary–
    Thanks for the link.  I can guarantee you that if this ‘normal’ 5’3″ 200+ pound woman had spent a few months in Dauchau she wouldn’t have had any trouble losing some weight.

  2. Phuqing Hell the irony of that picture.
    You know i’ve just had the most awful work experience of my adult life at the hands of a First Nation. Awful by a million miles given have worked in France, the USA, Australia, Sub Saharan Africa and Canada.
    My point being relevant to your point vis fat folks who wanna revel in their fatitudes is similar to FN who seem to want to revel/ be complacent about their rampant bio-psychological ill health and all the horrible behaviours that perpetuates.
    Do it but don’t come crying to whomever, as invariably human beings do,when the manifestation of living in a particular fashion yield really unpleasant long term results.
    Don’t waste yr time Sir.
    Incidentally i tried last week to do an Olestra-induced POP reduction and after 60 odd olestra crisps(or chips as you Colonials call em) nowt happened.
    Mrs on the other hand became quite regular for many hours..me nowt
    Hi Simon–
    Sorry to read that you have suffered mightily at the hands of a First Nation.  Nothing sucks worse than a bad job.
    If you got no relief – so to speak – from the Olestra in your POP purging efforts, give escolar a try.  Escolar is a fatty fish that contains a type of indigestible fat that works the same way Olestra does.  Let me know how it works for you. 

  3. For your scrutinizing eye ?

    Cancer cases spiralling – modern living to blame
    Smoking, overeating, drinking and sunbathing takes its toll
    By DANIEL MARTIN – More by this author » Last updated at 23:57pm on 8th August 2007
    Binge drinking, reckless sunbathing and overeating are fuelling a massive rise in cancer, experts warn.
    In a shocking report, they have laid bare the deadly consequences of increasingly hedonistic modern lifestyles.
    Cases of mouth cancer, which is associated with smoking and drinking, have increased by almost a quarter.
    Malignant melanoma – the most dangerous form of skin cancer – is up by 43 per cent in ten years as warnings to stay out of the sun are ignored.
    Kidney cancer, which is much more common in smokers and the overweight, is also on the rise, the report shows.
    Rates of another disease linked to obesity, womb cancer, went up by a fifth.
    Cancer Research UK, which compiled the figures, said up to half of all deaths from the disease could be avoided by the use of common sense.
    Lucy Morrish, of the charity, said: “While incidence rates for some cancers have fallen over the past decade, others are rising and many of these cases could be prevented if people avoided excessive sun exposure, smoking and obesity and limited their alcohol intake.”
    Malignant melanoma is now the seventh most common cancer and the fastest growing form of the disease.
    In 2004, 8,939 Britons developed the condition, compared with 5,783 in 1995.
    Although more common among women, the skin disease is now affecting large numbers of both sexes.
    Since the mid-1980s, rates among men have tripled while they have doubled among women.
    Sara Hiom, also of Cancer Research UK, said: “We’re very concerned that cases of malignant melanoma are spiralling.
    “Exposure to ultraviolet radiation in sunlight is the main cause of skin cancer.
    “Most cases of this disease could be prevented if people protected themselves in the sun and took care not to burn.”
    Middle-class women are 2.5 times more likely to get malignant melanoma than their working-class counterparts.
    For mouth cancer, most cases occur in those who smoke or chew tobacco and regularly drink alcohol.
    And, although the number of smokers is falling, binge drinking is on the rise.
    Mouth cancer rates have increased by 23 per cent in the past decade, up from 3,696 in 1995 to 4,769 in 2004.
    The charity highlighted as especially worrying the 21 per cent rise in womb cancer from 5,018 cases ten years ago to 6,438 today.
    Obese and overweight women are twice as likely to develop the disease as those of healthy weight.
    This is blamed on higher than normal levels of the female hormone oestrogen in the bodies of postmenopausal women who are overweight.
    Obesity and smoking also increase the risk of kidney cancer, which was found to be up 14 per cent.
    Colin Waine, of the National Obesity Forum, said: “These figures just go to show the wide-reaching ramifications of obesity, which go way beyond diabetes, heart disease and stroke to several sitespecific cancers.
    “As well as womb cancer, obesity has been linked to postmenopausal breast cancer, colonic cancer, bile duct cancer and pancreatic cancer.
    “These figures can only get worse if we fail to halt the obesity epidemic.”
    Frank Soodeed, of Alcohol Concern, said: “The Government estimates that 5,000 people a year die from cancers attributable to alcohol.
    “It’s another reminder to stay within safe drinking limits if at all possible to minimise health risks.”
    Liberal Democrat health spokesman Norman Lamb said the report was a call to action.
    “This is further evidence that a failure to deal with pressing public health issues now can have serious consequences later on,” he added.
    “This must be a priority in the NHS of the 21st century.
    “We are seeing a whole generation of young people grow up with weight and alcohol problems.
    “The Government must act now to tackle the enormous human and financial cost that this will bring.”
    Tory health spokesman Andrew Lansley said: “Labour have raided public health budgets and Government efforts are disjointed.
    “It is a false economy to fail on public health when we know that being healthy is the best way to curb disease.”
    Overall, the number developing all forms of cancer rose slightly, up 2.1 per cent to 284,560 in 2004.
    However, mortality rates are declining and the proportion of cancer patients living for more than five years after diagnosis rose from 40 to 50 per cent. The top four types of cancer – breast, lung, bowel and prostate – account for more than half of all cases of the disease.
    Prostate cancer saw the second biggest rise in cases after malignant melanoma.
    But the 39 per cent increase over a decade is not thought to be caused by preventable risk factors and is blamed instead on better detection through prostate specific antigen testing.
    The third biggest rise – of 33.5 per cent – was in mesothelioma cases. This cancer of the tissue lining is linked to industrial exposure to asbestos, the use of which is now banned in the UK.
    Experts predict the mesothelioma epidemic will peak between 2010 and 2015 before declining rapidly.
    There was a similar rise – of 33.4 per cent – in liver cancer. This is partially linked to alcohol intake and also to the hepatitis B and hepatitis C viruses.
    Breast cancer rates went up by 11 per cent with obesity raising the risk of the disease in post-menopausal women by 40 per cent.
    The figures did, however, contain some good news. Rates of cervical cancer fell by 24 per cent thanks to a national screening programme.
    And lung cancer rates are continuing to decrease, especially in men, as more and more smokers kick the habit.

    I would hardly call it a “massive rise in cancer.”  Most of the statistics I’ve seen are that deaths from cancer have fallen over the past few years.  I don’t know what the change in incidence has been, but I don’t think it is anything on the “massive” scale this author seems to imply.

  4. Very interesting article which got me to wondering just exactly what was it about the style of the day that allowed stout women to be able to dress to flatter for a change? And just what was considered stout? A quick search and I had my answers. Prior to the war years, the Gibson girl look was all the rage and women wore corsets that forced their figures into the s-curve (bosom thrust forward) with a very small waist. The corsets that women wore during the Victorian times were bad enough, but the s-curve had to be particularly hellish to wear. This is a classic example of the look:
    During the years of WWI, fashion changed with women’s skirts starting to raise and a less rigidly corseted body started to appear to facilitate natural body movement as women became more active and athletic. Here’s a dress from 1919, the year the article was written. One can easily see why stout women felt they could at last be fashionable.
    And as an added bonus, this suit from 1914 was for stout figures:
    I’m sure that this is all more than you possibly wanted to know about women’s fashion trends.
    I agree with you about folks saying they don’t eat a thing but still can’t lose weight. I also watch people at buffets and I am amazed how much food they can pile on their plates.
    Hi Esther–
    Thanks for the additional info and for the links.  One of them was duplicated; if you’ll send me the correct link, I’ll put it up.

  5. Thank you for an excellent blog! I’m reading your book right now, losing weight, and truly appreciate the time you take to keep your readers informed about everything. Your site is one of my most frequently-used Blackberry favorites.
    I know my question is unrelated to the blog topic of fat people deceiving themselves about their food consumption, but I’m hoping you might be kind enough to answer it.
    I notice that when I drink lots of water in a day (80 oz or so), I weigh 1-2 pounds less the next day. I suppose this may be the body’s way of “assuming” the drinking will continue, and trying to avoid over-hydration. Is this correct?
    Also, the original Protein Power book seems to suggest that drinking lots of water help a person excrete (via urine) caloric ketone bodies that are circulating in the blood. But in one of your posts on this site, you suggested that ketones are absorbed/utilized quickly, and thus there probably wouldn’t be many calories lost through urination if a person drinks lots of water.
    Do you know of any studies (or do you have any educated quess) about how many extra calories a person in ketosis would lose per day by drinking lots of water? I know that drinking lots of water likely reduces appetite (and thus calorie consumption). But aside from that indirect benefit, is there a way of measuring the caloric value of ketones in the urine?
    Irvine, CA
    Hi Brian–
    I’m glad you’re enjoying the book.
    In answer to your question, I don’t know why you would lose 1-2 pounds the day after consuming a huge amount of water.  I’ve never had a patient relate this kind of incident to me, and I really don’t have a clue as to why it happens to you.  I’ll think about it, though.
    Drinking water does help excrete ketones minimally, but drinking huge amounts of water simply dilutes the urine.  I don’t know of any studies showing how many ketone calories a person would lose daily by drinking a lot of water, but I would guess that it wouldn’t be much more than from drinking a normal amount of water because of the urine dilution effect.

  6. People used to eating a lot carbohydrates have difficulty finding anything else appetizing. Researchers say appetite is very complex with many factors, but each factor–based on personal experience, and what I’m inclined to think from reading Descartes’ Error–is a different feeling. Each physiological state evokes a different feeling. Though they may result in the same behavior, they have a different sensation due to the fact that they’re different metabolic pathways. The drive to eat carbs is a serotonin thing and it’s very different from the type of hunger that involves having an empty-stomach feeling or feeling light-headed.
    When obese people say they hardly eat, I’d say it’s because they’re eating below what their hunger is telling them to. If hunger is defined as the desire to eat, and not further specified as to what type of symptoms they have, there’s a huge miscommunication in what’s happening to the body. Skinny people tell fat people that starvation crash diets are bad. To fat people, denying a craving for carbohydrates is the same as denying hunger, which may be equated with starving themselves.
    Hi Carly–
    I understand what you’re saying.  If overweight people will fight through the carb cravings long enough to stabilize on a low-carb diet, hunger tends to go away – even carb hunger.  I’m sure there are exceptions as there are for everything in medicine, but my years of practice make me believe that most will rid themselves of hunger if they go low-carb for just a day or two.

  7. I deal with this daily as well – clients who swear to me they’re eating next to nothing but simply cannot lose weight. I assure them they’re wonderful, unique individuals, but that their bodies absolutely do not defy the basic laws of physics–namely creating matter from nothing.
    Invariably these same folks 1) refuse to keep a food log and 2) when finally persuaded to do so are dumbfounded by what they’re actually eating. Some will simply not be honest (I had a client hide voracious wine consumption from me while supplying me with excellent food journal entries–she “forgot” to add it).
    Point being, some folks are trying to fool themselves; some are trying to fool you; and others genuinely have no sense of quantity and need to see the numbers in black and white.
    Hi Greg–
    This is pretty much the same picture I’ve seen in my many years of practice.

  8. Dr. Mike:
    I am reading this one with mixed feelings.
    On the one hand, yes I agree with you that by and large, people do not eat “almost nothing” and gain weight. It is almost always self-inflicted. When I see a kid walking through a mall who looks to be 150 lbs at the age of 7 and he is carrying what can only be called a BUCKET of high fructose corn syrup and phosphoric acid, I am absolutely guilty of the same cringing behavior.
    Then I remember my mother. I was her one advocate with the doctors…I saw what she ate all day because I cooked for her. It was not denial. It was the most astonishing sort of ideopathic weight gain. In one month she was on a broth fast. She would drink a broth for lunch and breakfast (nothing weird, I assure you–just chicken or beef broth) and then for dinner she ate a small serving of very low starch, largely raw, vegetables (whenever she tried to diet, she would automatically ditch breads and starches because this is what she was taught to do in the 50s). No sugars, no cookies or chips or pretzels. I watched her in that month gain roughly 25 lbs. In her adult life, she went to hypnotists, shrinks, chiropractors, and all manner of voodoo. She tried (heaven help her) that Dick Gregory Bahamian fiasco. Still she gained or maintained. No one could explain it without talking to her as if she was a naughty child and was secretly hoodwinking everyone in the house, including me (who bought the groceries). She didn’t even go the market herself because she couldn’t drive. She was so obese that we had to buy a special medical scale just to know how bad it was.
    [Now, in hindsight I know why. I happen to share many of her medical problems. It first started showing up at a time when I was in my 20s, living in Alaska, eating local fish and my home-grown produce and climbing mountains on a near-daily basis. (In one month: 25 lbs. of fat out of nowhere.) Much of what I go through is still not well-understood, but I have better tools to work with now than I did then. I am not without hope. In the meantime I have the intervention phase of Protein Power and it has gone a long way (with a daily workout) toward keeping me from gaining, but every pound lost is hard won indeed.]
    My point is only this: it happens. It might be rare as hen’s teeth, but it happens and when it is it is a total smackdown with the kind of dogmatic thinking we tend to expect. I can’t even go to a doctor (for a cold) without being told about the benefits of weight loss surgery.
    I don’t for a moment accept my own fat as normal, healthful or useful, but I do not allow it to stand in the way of living a life which is purposeful and of value. It would be nice if I could receive repect from everyone, but the realist in me does not believe it possible or even necessary. I fully expect people to honk and shout when I go out for a jog or a brisk walk (and I also have learned to recognize that the same people who tell me to go out and exercise and “just run around the block” are the ones who will point and jeer when I am out doing just that). I live in fear of recognizing my own headless/legless torso on the evening news during a spot about “America’s Obesity Epidemic.”
    As for Dachau, I somehow doubt obese people would have made the cut to be kept alive as workers even if there had been many entering the camp. 😉
    Hi Anne–
    You’re definitely right in that the condition you describe is scarce as hen’s teeth.  In all my years of practice seeing thousands of patients I never saw a single case such as you describe.  I’ve only seen a handful of cases in which there was a medical problem causing the weight gain – in virtually all of these a type of benign tumor – a pituitary adenoma – was the cause.  Perhaps you should be checked for such.
    If you think about the thermodynamics of the situation it seems virtually impossible to gain 25 pounds in a month on a regular diet.  Let’s say the regular diet was in the 3000 calories per day range, which is high for a female.  If the 3000 calories came from one third fat, a third carbs and a third protein it would weigh about 0.3 pounds.  Wait, you say, my daily food intake weighs more than a third of a pound.  It does, but the main component of most foods is water.  The one third pound is the weight of the non-water fat, protein and carbohydrate that are the only substances that can add to body mass.  So, I third of a pound per day times 30 days gives 10 pounds that could be added to one’s weight, and that’s only if none of these calories went towards the energy needed for life.  Which obviously can’t be the case.  Thermodynamically it is impossible.  If the caloric intake were sky high and there was an underlying metabolic problem, I could see it, but not with a regular diet.
    If this is the case with you, I can’t believe your doctor hasn’t had you written up in a medical journal as a case report.  I certainly would have.

  9. I was interested in your comment that fat women are better accepted than fat men. That has not been my experience. All the “fat people” jokes are about fat women. Somehow, if the joke is told with a male figure, it is not funny. In addition, most of the negative appelations are given to overweight women while a man would be called “big” rather than “fat.” There are ads for the TV show “Trailer Park Boys” that show a shirtless man who looks pregnant as all his weight is in his belly so that he look like he has a basketball just below his ribs. I doubt seriously that anyone would label him as “fat” or “gross,” rather he would be described as “having a paunch” since his arms and legs are normal sized.
    A second point, women who are starved in concentrations camps for a period of years simply do not look as skeleton-like as the men do in the same camp over the same period of time. I refer you to the photographs of the Navy Nurses when they were rescued from the Los Banos prison camp in the Philippines during WWII in February 1945. See Monahan, Evelyn M. & Rosemary Neidel-Greenlee. 2000. All this Hell: US Nurses Imprisoned by the Japanese. The University Press of Kentucky. These nurses did not look starved, yet they had been. The author gave the names of all the nurses, listing their weights before and after imprisonment. The heaviest among them lost the most weight but for the most part the weight loss was about 20 pounds. What the nurses described was that they simply moved slower, climbed the stairs in the hospital very slowly as they had less and less food. Yet they managed, with the physicians, to care for patients throughout their imprisonment. North American women who look emaciated are frequently long distance runners. There are, of course, women who are genetically predisposed to leanness and do not eat much either. I have just not experienced that overweight men have had the same degree of discrimination against them as the women have. (Speaking, of course, of my experience and that of my 2 brothers, as well as my observations of other fat people like my brothers and me.)
    There are big amd tall shops for men and Lane Bryants for “oversized” women. Note the difference in connotation.
    Sorry for my rant. Just ignore it but thanks for your patience.
    Hi Pam–
    I didn’t make the point that fat women are better accepted than fat men.  That was the point made by the article written in 1917.
    I read about the amounts of food that made up the daily rations at Dauchau, and I can tell you that women would have starved.  I’ve seen pictures of female corpses from the surrounding camps -Dauchau was the mail camp, but there were many satellite camps in the area, some of which housed women – and they were skin and bones.

  10. There’s also the matter of just what a “fat person” looks like — in other words, how fat is fat?
    Every now and then I watch reruns of “The Mary Tyler Moore Show” from the early and mid-70s. During the first couple of seasons of that show, Ed Asner (Lou Grant) was overweight. Everybody thought so. Pretty obese, we thought.
    But if you look at the show now, he looks positively… well, not skinny, but certainly not so fat that you would call him obese, comparatively speaking.
    In the pictures that accompany Esther’s comment above, the “stout” person looks pretty thin to me… comparatively speaking.
    I see lots of high school and college girls (way too many) who would never have got a date, ever, when I was in high school or college, because of their weight, and yet there they are walking around wearing skimpy, tight tops that reveal all their rolling fat, with boyfriends on their arms. It bothers me, mainly because of the health problems I know they’re setting themselves up for that will affect the rest of their lives, unless they change their eating habits, and the more fat acceptance there is, the less likely they will feel any particular motivation to change.
    Thanks for another great post. –Anne
    Hi Anne–
    Same with Jackie Gleason aka The Fat Man.  He looks positively normal by today’s standards.  He actually looks a little overweight, but no one would give him a second look now.

  11. I have been fighting weight almost all my life. For several years I tried to follow the low fat dogma. However, that just fueled insatiable cravings, which I tried to satisfy with “healthy,” “complex” carbs. I could go through a half a box of whole grain crackers or cereal in no time. I could lose weight, but I would just gain it all back. I knew I was eating too much and not really sticking to my Weight Watcher points, but I found it impossible to do so. Being brainwashed that low fat was the only “healthy” way to go, I finally gave up on trying to lose weight and just accept myself as fat.
    A few months after that, I was diagnosed with type 2 diabetes. At diabetes education, I got the standard dietary advice, eat low fat and follow the food pyramid. I tried to continue with that, but found I still had the cravings, which weren’t good for weight or glucose control. My blood sugar did improve, mostly due to cutting way back on sugar and taking meds. I finally realized that the diabetes educator and the medical establishment were telling me to keep doing what I was doing before — which just made me fatter & diabetic. One definition of insanity is doing the same thing over & over and expecting different results, so I switched to low carb. I’ve been able to cut back on my meds. My cholesterol went down, so I’m not under pressure to take statins. My blood pressure is lower and I’m 100 lbs lighter. I also feel better overall. I’m not down where I want to be weight wise, but I’m getting there.
    I agree that we shouldn’t discriminate against fat people and it’s good for fat people to love themselves as they are, while trying to improve. I view heavier people with sympathy in that I’ve been there myself and I know the standard dietary advice is the problem. Many of them, like me are probably trying to eat a “healty diet,” but it isn’t the right approach for them. Their high carb lifestlye is only causing them to overeat. I know the dangers of being overweight as I wrecked my own health. Fat people need the message of hope that there is a better way, rather than hatred & discrimination.
    I couldn’t have said it better myself.  I’m glad you’re now on your way.
    Thanks for the great story. 

  12. Someone once pointed out to me that no one questions what a skinny person eats. They could eat truly horrific diets, one that would send me way into obesity land, and no one ever questions that they should cut back, eat healthier or change their lifestyle. Well, they might if they get cancer or heart disease, but until then, no one criticizes them or says they’re unhealthy.
    True.  And just because someone is skinny is no guarantee that he/she is healthy. 

  13. “But, obese people need to realize that in the vast majority of cases their obesity is self inflicted”
    Sigh. Well, at least you used a qualifier.
    I think I’ve mentioned this before here, but it seems relevant to share it again.
    I have PCOS with a history of Cushings (I am very sensitive to prednisone). The PCOS went undiagnosed for 10 years.
    Despite a history of previous weight loss and maintenance prior to the Cushings/onset of PCOS, my complaints were ignored by my docs. For 10 years. I was told to go to TOPS, to join Overeaters Anonymous because clearly I was lying/fooling myself.
    At 244lbs, I taught Kickboxing and the thin chicks couldn’t keep up with me. In fact some of them quit because I made them too sore from all the squats.
    I starved. I exercised. I never lost a damn pound. And my doctors continued to believe I was just some closet binging idiot who couldn’t keep her face out of the cookie jar.
    At least 10% of women have PCOS. (I personally think it’s probably higher.) And they aren’t getting diagnosed. Instead they are lumped in with the ‘majority’ you mentioned and receive substandard care based on stereotypes of what obesity is.
    I think we’ve spent enough time on the majority and maybe it’s time for us to be more sensitive regarding the minority, the people who truly do have medical conditions that affect their weight. PCOS isn’t stamped on my forehead. Going by physical appearance alone, I look like a majority and all too often, I’m treated like one. Which, as a patient, is a disservice to my health.
    Unfortunately, this post just feeds all the negative stereotypes about fat people that too many doctors use to judge their patients by.
    Hi Michelle–
    I probably didn’t say what I was trying to say as well as I could.  What I mean by self inflicted is that there is a way to treat the vast majority of obesity out there – it’s called a low-carb diet.  Most people don’t explore the options they have available to them.  They try a low-fat, starvation diet, are hungry all the time, and quit.  They don’t bother to look for something that might work better.  They admit defeat without trying something different. 
    It’s clear that the eat-less, exercise-more strategy is a dismal failure.  There is no body of medical literature that shows that drastically restricting calories (unless done with a low-carb diet) or greatly increasing exercise work to help people lose for the long term.  Yet these strategies are what probably 90+ percent of doctors and dieticians recommend.
    There are definitely underlying problems that drive obesity.  People don’t become fat because they overeat; they overeat because they’re fat.  People don’t become fat because they’re lethargic’ they’re lethargic because they’re fat.  Their obesity is driving their behavior, not the other way around.  Obesity is a symptom of a host of metabobilic problems that have to be dealt with by more than simply advising the obese to eat less and exercise more.  Obesity is a true disease.  No one knows this better than I.
    It’s just that there is a solution that, for whatever reason, many overweight people won’t even try.  That’s what I find annoying.

  14. Hi Doc–I agree completely. People eat so much high-carb food these days and it’s all very calorically dense–they have no idea how many carbs and calories they are getting with a big bowl of cereal, pasta, etc. The other day I saw some “natural granola” in the grocery store and just for fun I read the label. A serving had 150 cals and 30-some grams of carbs. Guess the serving size–1/4 cup! Barely enough to cover the bottom of a bowl. A full bowl would equal 5-6 servings.
    And a full bowl would wreck absolute havoc with your insulin/blood sugar system.  The food industry has managed to persuade people that it’s okay to eat all this because it’s ‘natural.’  Jesus wept.

  15. Interesting.
    So, one of my favorite things in all of TV journalism (from an ironic/nihilistic point of view) is B-roll footage of various local fat people from the shoulders down. You get a lot of butts walking away from the camera and guts walking towards it. It must be the easiest footage to shoot, too. This is apropos of nothing, except that your picture made me think of it. Except you got her head.
    Oh yeah, fat acceptance. I have no problem with fat acceptance. Except that everytime someone talks to a fat acceptor, they talk about the futility of dieting, about yo-yoing their weight being worse than being morbidly obese (I suppose this could be true, but weight loss in not futile unless you are approaching it in a futile way). They will bag on Weight Watchers (fine) and Dr. Atkins (less cool), and Dr. Sears (even less cool since he wrote such nice stuff about your books). They will suggest that they are healthy (perhaps relative to dead people, diabetics, and coronary stroke victims). I have even seen one suggest that fat in men leads to greater testosterone production, less ED, etc (I know from my personal experience, this is the opposite of true). In the newsgroups, some of them will attack people who diet or exercise (granted, some people go trolling, but what are you gonna do).
    I should wrap. I think it’s great that there is a civil rights movement for the very big. They should not face discrimination (even though there’s a body of research suggesting they are less productive). But, I think it’s out of line when it becomes essentially an apologist activist campaign discouraging people from trying to better their situation.
    PS- I don’t say it often enough, but thanks for the tools to better my situation. I’m coming up on my first year of protein power (August 20th) and it’s over 50 lbs gone, and something like 5-10 lbs of LBM built. Thanks.
    Hi Max–
    Glad to hear you’ve done so well on the program.  It’s extremely gratifying to hear.
    I pretty much agree with you on the fat acceptance issue: the obese shouldn’t be discriminated against.  But many of them should be more proactive in trying to solve their problem instead of just saying ‘Hey, it’s me. I’m fat and proud of it.’

  16. In general, I tend to come down on the side of the fat acceptance folks on many of these issues. The anti-obesity crowd is getting really shrill and out of hand and the portrayal of all fat people as lazy gluttons that need to be forced to comply with the standards of the “lifestyle police” are scarier to me than their so-called obesity epidemic. It seems to me that the rise in obesity correlates quite nicely with the rise in bad advice about “healthy” lifestyles. It’s quite clear that weight loss dieting is a big fat failure. Perhaps the pressure to force “overweight” people to lose weight has had the opposite effect? How many folks do you know that have been dieting all their life trying to attain an ideal weight they will never attain.
    Comparisons to camps where people who were starved were skin and bones is a very bad one I think. All those people in the camps were skinny – but you wouldn’t call them healthy would you? Many of them died of malnutrition.
    I can’t for the life of me understand the rationale of those folks who want us all to have BMI’s under 25 when it’s those in the 25-30 range that have the best mortality rates. Skinny doesn’t equal healthy and overweight doesn’t equal unhealthy. Sure the morbidly obese have a lot of health problems – but that doesn’t mean everyone has to be a size 6 to be healthy.
    I agree that the rise in obesity correlates with the rise in bad dietary advice, i.e., to follow low-fat, high-carb diets, which have never been shown to bring about permanent weight loss. 
    The concentration camp example was to show that if people don’t eat, they lose weight.  The inmates of Dauchau certainly weren’t healthy, but they did lose weight.
    I’m not sure there is reliable evidence that those in the BMI range you cited had the best mortality rates.  And since BMI is such a lousy way to measure anything, I wouldn’t believe anything using that as a standard anyway.

  17. >If this is the case with you, I can’t believe your doctor hasn’t had you written up in a medical journal as a case report. I certainly would have.
    I don’t know why her doctor would be any different than most of them.
    “You’re a liar, you just eat too much and lie about it.”
    Diabetics hear that all the time, even the ones that _can_ manage to stick to the high carb, low cal, low fat ADA exchange diet. They hear it if they are still gaining weight and they hear it if their BG is still out of control. They must be lying, it couldn’t be the diet, after all, calories in, calories out. . . No wonder some diabetics say, “The hell with it, f ’em all, I’ll eat what I want.” The local diabetic educator here, an RN, has been labeled noncompliant. God forbid somebody recommend one of those ‘dangerous high protein diets’ that she warned me against in her class.
    Yeah, I’m bitter. The last hundred pounds I gained could have been avoided if a doctor would have just explained to me why I was so hungry all the time, and I did ask.
    For the last half century or so the medical profession has been in the grip of the eat-less, exercise-more mentality, which does not work.  People trying to lose weight on low-fat, high-carb diets are doomed to failure, yet medical professionals continue to put their patients on these diets despite the vast literature that they don’t work.
    Low-carb diets reduce hunger in the majority of people who follow them.  There is no doubt that there exists individual variability in how much carb reduction is required to reach the no-hunger state.  I’ve had some patients who got their with a fairly modest reduction, and I’ve also had some who had to cut carbs to the absolute bone (so to speak) to reach the non-hunger state.  It can be a tricky business, and it’s a real shame that most practicing physicians are so woefully ill informed as to how to successfully treat the overweight.

  18. I have a question that might not relate 100% to this post, but wanted to share with you after reading this.
    Being a semi-pro cyclist, I am extremely lean (2.5 ~ 4.5% fat) and have defined muscles, but small in size, so I rely a lot on eating consistently since I cant store much glycogen in my small muscles.
    I have noticed that for the last couple of years I have adopted a very high carb diet; making sure I get my protein and fats (as well)from “healthy” sources, yet still focusing on plenty of carbs everyday.
    I am 125-128 lbs but have an average daily intake of about 5800 calories. Hard to believe but as a nutrition student I have done plenty of homework where I record my diet for several days.
    the point being. If I eat so many calories, most of which come from carbs (~70%) how come I cant seem to gain 1 single pound?…
    Also, Ive had 2 blood tests in the past year, both of which looked great in every aspect.
    what do you think? wouldnt carbs affect me in a more visible way?
    I would like to hear an opinion from someone like you. ill take anything as constructive criticism.
    Hi Pablo–
    My thoughts…
    You are young and you are extremely active.  Both of these situations allow one to eat much more carbs than one who is old and sedentary.  I was the same way when I was young and active, but, believe me, it catches up with you.  I always had trouble gaining weight despite how ever much I ate.  Now I have just the opposite problem.  If I’m on my normal low-carb diet, I’m great; if I go on a carb debauch for a long weekend or during vacation, here come the pounds.  What I don’t know is if I hadn’t eaten so many carbs when I was young, would I still have the difficulty I have today?
    Hope this helps.

  19. The thing I can not figure out is why people on a low fat diet that isn’t working continue to believe it’s just them and not the diet. I tried losing weight the low fat way without success. I finally went to a doctor who put me on Dr. Atkins’ low carb diet. The pounds fell off. My blood profile improved. I feel great.

  20. I was amused by the part about “the shops (retailers) not carrying the styles for the stout.” Boy, have times changed. Now that I’ve gotten beneath my goal weight, I have a 30-inch waist. When I go to the store, I can rarely find my size, and when I do, there are very few. A salesperson told me, “when we get a shipment, it contains only one 30-inch waist.” Even looking for suits at a reputable store, it was very difficult to find slim styles.
    Interesting.  I never really thought about how retailers would stock clothes today. Must be a real pain to be ‘normal’ sized. 

  21. I understand the eat less weigh less theory…yes, it makes sense when you think of it in terms of Dachau. But is a calorie always just a calorie though? as i understand it, some folks are more sensitive to carbs than others? Is Taubes’ book about how all calories are same?
    It seems I can gain pretty quickly when I eat a diet low in protein and high in carbs. Even if it is just a few sugary items each day I grow. I always gain on a low fat high carb diet. My doctor put me on Phentermine and I gained 10lbs. I ate less but all I craved was carbohydrate. Of course I stopped taking that crap.
    Since then I have had a terrible time “staying on track” and feel I’ve lost my way a bit and have gained an additional 10 lbs in 2 months. Mostly from having a muffin with my coffee, some rice or corn with my dinner, skipping lunches, having flax cereal for dinner. Very random eating. But it has been low protein high carb. And it is a downward spiral for me. 🙁
    I know if I eat more calories, albeit adequate protein and fats, I lose weight rather quickly. Why is this? It seems hard to eat the quantity of food required to get my protein requirement in. I know this will work. I have lost 50 lbs this way and felt wonderful. I ate a tremendous amount while losing it.
    I am certain if i ceased to eat completely I would lose weight, but that is something that i am afraid to consider. As a young woman it is a tempting thought. It is terribly painful being overweight sometimes.
    Hi Marcella–
    No a calorie isn’t a calorie isn’t a calorie.  The idea that it is is nonsense.  A calorie represents a precise amount of energy contained in a food but doesn’t tell anything about the hormonal consequences of eating that food.  Carbohydrate calories are much more fat inducing that fat and/or protein calories, which is why you did so well on a higher protein, higher fat diet, and is why you’re having so much difficulty when you consume the carbs that you’re now consuming.
    I hope you switch back to the protein and fat.

  22. A question…
    If you are insulin dependant diabetic type 2 does the process of adding more insulin to your body make it even more difficult to lose weight? Or is the use of the insulin to keep numbers in a more normal range, which helps one to feel better and be more active, a good solution.
    In my opinion the best solution is to follow a low-carb diet with the help of a physician who understands how low-carb diets work.  If the low-carb diet doesn’t almost immediately solve the blood sugar problems a little insulin isn’t problematic.  I like insulin in very small doses better than any of the oral drugs that are available. 

  23. I think we’re missing a step here. It’s not so much that people are amazingly unaware of how much they eat and are so good at fooling themselves, but that what they are truly aware of is that their bodies are getting NO satisfaction from the food they eat and somehow their mind knows it and feels it. They may be putting large quantities of substance into their mouths, but their body is not getting large quantities of immediate energy-making use out of it. So in this case “I eat almost nothing” defines eating not as what enters into the mouth, but what gets healthfully utilized.
    I don’t know if the Protein Power program ever actually goes so far as to say that carbohydrates aren’t really a food (certainly high fructose corn syrup isn’t!), but my determination is that essentially that’s the gist of it. I am trying to get myself to look at substances like sugar and white flour, not as a food, but more like something akin to cocaine–it can go into your body but what does it do when it gets in there? The people you speak about here may as well be eating mounds of dirt, or sand, or sawdust; they’re eating and eating and eating and their body is sitting there waiting and waiting and waiting for some real food to come in. It’s not getting it, so it keeps signaling “I’m empty!” Unfortunately, the “non-food” that they are eating is one that the body can store as adipose tissue. But give them some real food that the body craves and they will won’t have to ingest so much and suddenly even a rather small portion will feel like a lot.
    You’ve hit the nail on the head.  It’s hunger at the cellular level that is important and that drives the body to seek food and decrease the metabolic rate.  If the cells are starved – even in the face of a lot of food calories – the hunger signals go out.  And you’re right that carbs tend to feed the fat and not the non-adipose cells creating a hunger even in the face of plenty of ‘food.’ 

  24. Thanks for the answer! I realize it was a bit off the topic but I appreciate your takeing the time to speak to it.
    I agree that I’d much rather use Insulin than other drugs if I need it…and doing low carb helps me to take as little as I can.
    My doc is totally supportive of low carb diets for diabetics, which is not the norm for this area.
    I lost about 55 pounds when I first discovered the diabetes using Protein Power…got my AC1 down to 5.5 but after my compulsary visits to dieticians who were horrified about my diet…I added in more carbs…which added in more weight. Which added in more Insulin…which added in more weight.
    Now we have decided I can skip the dietician classes and do what works for me!
    Sorry for the ramble…just some pent up frustration with the dieticians I guess.
    You’ve learned a valuable lesson: avoid dietitians like death.  In all my years of practice I’ve come across only a couple who appeared to have good sense.  Their training totally fills their heads with idiocy.

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