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Making it Through the Minefield

by Miriam Berg

Dear Reader,

Open up your local paper and read about the Harvard Nurses' Study, Olestra, dexfenfluramine, the "ob" gene, yo-yo dieting, etc. What are we to make of all this news? We decided that our column should be devoted to an understanding of the latest information which besieges us. To this end, we've asked Miriam Berg, friend, activist and director of the Council on Size and Weight Discrimination, to take over our column and give us a view from another window. Thank you, Miriam. – Jane and Carol

For those who are larger than average, the world is full of land mines. We are constantly bombarded with ads for diet products, pictures of slim, happy women who "owe it all" to some pill or packaged pseudo-food. Fashion magazines tell us in no uncertain terms that we don't belong in their world. Even some catalogs that sell only large size clothing continue to use slender models. Television offers very few role models of healthy, lively, attractive fat women. With each step we take, we are at risk of having society's scorn of our size explode in our faces.

The most dangerous land mines are located in the field of science. One group of researchers recently studied a hundred thousand nurses and concluded that the fat ones were less healthy and died sooner than the thin ones. Another concluded that yo-yo dieting does not in fact cause weight gain, as previously proven by a different study. A third laboratory claimed to have discovered "the gene that causes obesity," and a fourth found that when a lab rat lacks the hormone leptin, the rat gets fat. Losing weight, they concluded, might be simply a matter of adding more leptin to our systems. Meanwhile, drug companies are coming out with a barrage of new appetite suppressants, and our former surgeon general, C. Everett Koop, has declared war on fat.

To negotiate such a mine field, we need to educate ourselves, maintain a healthy skepticism, and have faith in our personal experience. We need to read the reports in reliable sources, and to ask the tough questions. When we do, for instance, we find out that the 100,000 nurses were classified according to current weight. Some might have just had a large weight loss or gain, but that was not considered significant. Some might be chronic dieters, or binge eaters, or anorexics. None of those questions were asked, even though women who smoked were excluded from the study because smoking was considered another risk factor that might skew the results.

Why didn't the researchers consider dieting an independent risk factor? The health risks of dieting have been well documented (Frances Berg, "Health Risks of Weight Loss," Healthy Weight Journal, 1992). The failure to consider dieting history is the fatal flaw in this and other population studies on weight, and this omission is not consistent with sound research practices.

We also find out, when we investigate this study further, that Dr. Joann Manson, the scientist whose name appears as the head researcher, works as a consultant to two pharmaceutical companies, and that one of those companies is about to market a new weight-loss drug. How can a scientist maintain impartiality, objectivity, and professional credibility if some of her funding comes from companies with a vested interest in proving the need for new weight-loss methods?

As for the genetic research being reported in the media, most scientists believe a single gene could not possibly determine body weight, and that many genes and many other factors must work together to establish any one person's size. Several years ago, there was talk of genetically eliminating Tay-Sachs disease, which affects some people of Eastern European Jewish descent. When they studied it further, however, they found that the genetic predisposition to Tay Sachs also protected people from tuberculosis. Any attempt to eliminate the one disorder through genetic manipulation would have interfered with this ethnic group's ability to stave off another deadly disease.

Genetic manipulation is a dangerous prospect until we reach the point where the body's mechanisms are fully understood. Aside from the cultural advantage of living in a world where people come in all shapes and sizes, it may well be that there are physical and medical advantages for some people to carry more weight than average.

To keep our skepticism healthy, we need to look at the big picture and remember history. A few days after the news of the "magic" hormone leptin, a much less publicized report told us that fat people already have more leptin than average. The rat studies, it turns out, are probably not applicable to humans. Over the past few decades, we have seen the recommendations for the "best weight-loss diet" change from low carbohydrate, to low calorie, to high protein, to high fiber, to low fat (with a few bizarre detours along the way). We need to be suspicious when so many researchers say that they and they alone understand the cause and "cure" of obesity, but each of them says something entirely different.

It is also necessary to determine who funds these studies. Weight Watchers™ and Heinz™ (its parent company) each pledged a million dollars to Dr. Koop's "Shape Up America" campaign. As long as the main source of funding for weight-loss research and anti-obesity campaigns is large pharmaceutical corporations and diet product manufacturers, we must be extremely cautious in interpreting the results of such research and the goals of such campaigns.

Finally, we have to believe in ourselves. The readers of this newsletter, I suspect, have some experience with yo-yo dieting. Most of us have lost and regained weight, and most of us have had the experience of regaining more than we lost. Now a new study says that yo-yo dieting does not cause weight gain. The regain, they say, must have been due to our lack of will power and our voracious appetites.

A large number of studies have shown that, in both laboratory animals and in humans, weight loss results in greater "metabolic efficiency." This means that after a diet, the body requires less food to maintain weight, and weight will be gained on a smaller number of calories than the pre-weight loss eating pattern [eg, R. Keesey, "The Body-Weight Set Point" Postgraduate Medicine 83 (1988) and D. Garner and S. Wooley, "Confronting the Failure of Behavioral and Dietary Treatments for Obesity," Clinical Psychological Review 11 (1991): 729-80.] It has also been shown that blood pressure rises as a result of weight cycling ["Dietary Obesity and Weight Cycling: Effects on Blood Pressure and Heart Rate in Rats," American Journal of Physiology 256 (1989): 1209-10, and the article by David Levitsky to be published in the International Journal of Obesity (Jan. 1996).]

Many people have figured out for themselves, after yo-yo dieting their way down and up the scale many times, that they had to stop dieting for the sake of their physical and mental health. And for most people, binge eating behavior ends when they stop dieting. Our internal body wisdom confirms the earlier research on the dangers of weight cycling. Scientific research is not immune to social bias, and must not be considered conclusive until there is a consensus in the scientific community. We are nowhere near that point in the area of weight loss research.

Why are we seeing such fierce attacks on weight, and so much scientific support for dieting at this moment? Perhaps the reason is that the multi-billion dollar diet industry is hurting, and that the funding for scientific research is becoming more competitive. The size acceptance movement has become much more active. Anti-dieting workshops are springing up all over; books encouraging women to feel good about themselves are proliferating; people of all sizes are refusing to take the abuse any more. As a result, those whose livelihood depends on women's dissatisfaction with their bodies are fighting to get us back. In order to keep research money flowing, scientists are overstating the risks of obesity and understating the risks of their particular weight-loss methods.

I see these attacks as a hopeful sign, a sign that the anti-diet, size-acceptance movement is having an effect. Perhaps someday we will see more independent research on weight issues. Perhaps scientists will acknowledge the overwhelming evidence, and reach the consensus that doctors should not be prescribing weight-loss diets. And perhaps our society will come to understand that size diversity, like other forms of diversity, has a positive effect on our culture.

Miriam Berg is a free-lance writer and the president of the Council on Size & Weight Discrimination. For more than two decades, she has worked to improve women's health care and access to services, and has been an activist in the size acceptance movement since 1980.

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