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Sat, 01 Feb 2003 Hi, My Name is FAT

OK. Let's face it. I'm fat.

Not "mature." I'm fat.

Not "muscular." Not "beefy." I'm fat.

How many of ideas do you believe in?

The above are all, basically, lies. We as Americans are, truly, the fattest people in the world. We're seeing something quite new and disturbing: not just fat adults, but grossly obese children; rap stars dying of obesity at a young age, carrying hundreds of extra pounds; two- and three-hundred pound sixteen-year-old children who can't walk without canes. We can pretend that the problem is scrawny supermodels and their negative effect on our self-esteem, but the truth has more to do with the 90% of American children who eat at McDonald's at least once a week, the servings of fries that have gone from 200 calories to over 600 calories, and people who have time to watch four hours of television a day but apparently no time for exercise. I know the reason I don't exercise; these days I don't even walk to work. It has nothing to do with negative role models or low self-esteem; I'm lazy. I wasn't quite this lazy a few years ago, but paradoxically, when I was working out four days a week at a gym and biking, I weighed more. The body is a confusing thing, and getting it to do what we want is difficult.

Anyway, what brought on this rant? I've just been reading the book Fat Land: How Americans Became the Fattest People in the World, by Greg Critser. Think of it as a companion volume to Fast Food Nation by Eric Schlosser, which I read last week. Whereas FFN focused specifically on the history and consequences of the fast food industry, Fat Land covers, literally, what its subtitle indicates, in a series of chapters on where the calories came from, how we came to eat them, why they stayed with us. The book is short and sweet; obviously a highly biased and antagonistic treatment of the subject, and Critser is not quite the investigative reporter that Schlosser is. But we don't necessarily need every detail of his argument to be correct; we need to get off our asses and stop believing that it is OK to be obese.

Critser is not quite a scientist, and this shows; some of what he says about saturated fats and carbohydrates will be disputed and is still controversial. Sometimes he is glib; it's a short book, and he breezes by his discussion of (for example) the Atkins diet. He can be taken to task for some of his elisions and omissions. A reviewer on Amazon, Joel M. Kauffman, notes, in a comment about glycemic index, "One of the things that creates high (bad) insulin levels is high blood glucose levels. Since all the common complex carbohydrates (starches) in foods are polymers of glucose, and some of them are metabolized very rapidly, and we eat more of them by weight, the contribution of wheat, corn, potato and other forms of high-GI starches to poor health is greater than that of the simple sugars."

It's true; Critser's brief analysis focuses primarily on high-fructose corn syrup as a factor in causing the development of Type II diabetes. Perhaps in looking for a smoking gun here he should have been focusing a bit more on the french fries as well. But to Critser's credit, the pronouncements made by health "authorities" can be endlessly confusing; researchers with advanced degrees do not necessarily agree, and apparently we are still discovering fundamental issues in the way humans metabolize fats and sugars. The general public hears that that best way to lose weight is by following the Atkins diet, eating minimal carbohydrate, and all the protein and fat we want, without reducing our overall calorie intake. Or they hear that we should follow the Ornish model, a very low-fat vegetarian diet with lots of carbs. My doctor told me my LDL was a bit high. Is it all about the carbs? The protein? Or all about the fats? How many servings of whole grains are we supposed to eat? Is pasta bad for you? Over the course of my lifetime I've heard that the best fat is polyunsaturated, unsaturated, monosaturated, or just plain saturated. Is saturated fat the antichrist, or is hydrogenated fat the great Satan? Weren't trans-fatty acids the problem? What about non-hydrogenated saturated fats like coconut oil? Should you ban butter from your diet? Can you eat avocado? Should you cook with olive oil, safflower oil, peanut oil, rapeseed oil, grapeseed oil, or bacon grease?

I grew up eating skim milk and skinless chicken breasts; my wife was raised on greens, heavy cream and bacon fat. She was an athlete in college; I was a sedentary computer geek, for the most part. I believe our diet is generally pretty good these days, and I've been losing weight, but she's continued to gain weight while eating considerably less than I do. Should my diet be very different from my wife's diet?

It's all very confusing: but to debate endlessly the metabolic pathway taken by high-fructose corn syrup, the glycemic index of french fries, our fat-gram count, our resting heart rate, our VO2 max, or the merits of eliminating carbohydrates is, quite possibly, to miss the forest for the trees: we're eating too damned much, given our level of physical activity. One side, or preferably, both sides, of the equation desperately need to change. And yes, it is hard. Especially hard for people who have grown up thinking life should be quick, clean, and convenient, but above all, that we should be able to have it all, our way, and quickly. Hard enough that we start to believe our bodies are not on our side -- and they may not be, given our various genetic predispositions to store calories rather than burn them, and after the various ways we've damaged ourselves with gluttony and sloth -- or that there is a magic bullet that represents "the secret" of why we got this way and how to fix it. There isn't. There are a number of key insights, but we ate all those fries, and no one else can sweat for us to burn them off.

Particularly disturbing is the chapter on what obesity does to the body; the relationship between class and obesity is the fascinating subtext here, especially when it comes to the vast differential in the deployment of medical intervention. It used to be that the rich were fat; now the poor whites, but especially Blacks and Latinos, are the fat ones, and they aren't being helped. It doesn't take a Faith Popcorn to predict that as the costs of health care and the increasing lack of access to involved and concerned physicians hits people in the upper classes, rich white males like me also won't be hearing much in the way of useful health information over the din of food advertising and the self-serving infomercial telling us how we can eat all we want as long as we also purchase product X.

Of great interest to me was the history of how American guidelines and standards for physical fitness have been eased, and eased, and eased, and eased again. I grew up with the dreaded President's Council of Physical Fitness tests, and flunked the pull-up in grade school; I was the kid, not fat but weak, who couldn't climb the rope. (These days I could probably do the pull-up, but the rope climb will likely forever elude me). Yes, PhysEd class did turn me off exercise for many years, and I was humiliated at dodge ball; but in no sense can this be a justification for throwing the fat baby out with the bathwater; children must be encouraged to earn their self-esteem by gaining strength and endurance. Myself, I learned later in life the fitness activities I enjoy: weightlifting, biking, and hiking, instead of competitive team sports. These are things I can do my whole life, but (thank god) the dodge ball days are long-gone.

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