Fatty and Skinny went to the beach...

The ABC is reporting a study on thigh circumference and its relation to heart disease. The gist of the conclusion is this (from the ABC article):

The research, published in today's edition of the British Medical Journal, reveals that thigh circumference is linked to the risk of heart disease and premature death.

The study looked at more than 2,800 men and women with an average age of around 50.

It found that the risk of heart disease more than doubled for both men and women who had a thigh circumference of less than 55 centimetres.

Those participants with thighs between 55 and 60 centimetres received a protective effect against heart disease, the study reports.

But that protective effect reduced for people with thighs above 60 centimetres in circumference.

I read that and thought, "Yeah, clearly everyone understands exactly how weight and disease are related." Then I wandered over to Feministe and read this post about the Pro-food movement and its lack of skepticism with respect to the "obesity epidemic", and so I started wondering again about cause and effect.

If you think that measuring thighs and concluding anything about future health prospects is silly, you'd be right. It's about as silly as measuring BMI and concluding anything useful about future health prospects. The problem here is that for a very long time, people have been measuring convenient things, and then correlating them with actual health outcomes. That'd be fine if they then spent lots of time trying to work out what those convenient measures were actually proxies for. Obesity correlates well with lots of stuff. The number of storks in Hamburg also correlates really well with the number of babies born.

Still, I very much doubt that there would be too many people arguing that terrible diet and no exercise is a good option. If you read Shapely Prose, the main message is that your weight doesn't matter because there is no demonstrated way to reduce it in the long term anyway. And the vast majority of studies focus on weight, not lifestyle, in predicting health outcomes.

It is not surprising that you find that fat correlates with health problems, there is a correlation between bad eating and insufficient activity and fat. I'd even go so far as to say that far less people would be fat if everyone ate well, exercised regularly and never, ever dieted for their entire lives. However, once you get fat, all the evidence suggests that trying to get thin again is probably pointless, and more importantly, if you fail, worse for you than being fat in the first place. Don't get me wrong, this hasn't stopped me wishing I could just lose 5kg...

Still, the problem here, from a health point of view, is that by obsessing about the weight, we are ignoring the health. The fundamental argument between the two sides of this debate is whether, given that someone follows a good diet and exercise, they will lose weight and keep it off. Kate Harding and others would tell you the answer is an unequivocal "No". Others (and not just the diet industry) will say "Yes". But ultimately, who gives a shit? If the focus is health, and most people are agreed that good diet and exercise are the better predictors of health, why do we discuss weight at all? If the "No" camp are right, focussing on weight completely defeats the purpose. If a healthy lifestyle doesn't result in weight loss, and weight loss is the only thing that is valued, why bother with the healthy lifestyle? Hands up if you or someone you know has or does say "Fuck it, I'm fat when I eat well, and I'm fat when I don't, may as well eat whatever the hell I want." Under those conditions, you will see an excellent correlation between BMI and bad health.

If the "yes" camp are right, taking the body image issues out of the equation and encouraging people to be healthy irrespective of their weight will result in weight loss anyway. And if they are right, why do they care about weight? It's just one of the side effects of unhealthy living. Surely we want to be thin because it's healthy, not healthy because it will make us thin? So focus on the healthy and forget about the weight.

My personal anecdata is that on the CSIRO diet, I feel better. Sometimes I lose weight, sometimes I don't. Sometimes I put it on. But following a menu plan is good for me, I can feel it. It results in a much broader range of food in my diet, and apparently I do have a body that prefers it when I don't eat carbs at night. When I am eating badly and not exercising, I feel crappy. But I can't find a correlation between well-being and weight, personally. I'm not saying others can't, just that at least one person doesn't*.

The only really positive thing I took out of this report about thighs, is that the authors focussed on the fact that muscle mass was the most important thing - in other words being fit is important, and more so than the amount of fat sitting over the muscle. They did imply that more fat reduces the bonus from muscle, but lack of muscle was clearly the big risk indicator. It's still just another dodgy proxy indicator, and I won't be measuring my thighs to calculate my risk, but pointing out that lifestyle is what matters, not measurements is definitely a Good Thing.

*I have lost lots of weight deliberately, and kept it off for more than 5 years, but it was crazy making getting there, and I'm fairly convinced that living on a salad roll whilst riding a bike 10km each day is not good for me.

Can of worms

Apparently Mim's "Stop putting life on hold" post opened a can of worms, at least in my mind. Toni and I were discussing various aspects of what she wrote and the related issues, and I still couldn't seem to get my thoughts clear on it. So whilst listening to the wind valiantly attempt to blow in the balcony doors last night, I tried to work out my own issues with this subject. (Sleep, after all, was definitely not an option.)

I think in my world, there are three separate issues associated with weight, diet etc. The first one is the question of what constitutes a healthy, sustainable diet and lifestyle for me. This is the one I think I've cracked - even if by accident. My body doesn't like carbohydrate rich food at night, and needs much less of it in general than I previously thought. The CSIRO diet works for me, even if I did only discover this because I was too lazy to do my own meal planning. On the exercise side of things, resistance training is very good. One Pump class a week is better than 3 aerobic classes. If I add a belly dance class and one decent walk or something similar a week, that is enough. Once I do this much, my energy levels go up and my incidental activity is greater. This is a pattern than I can sustain, or at least get close to (exercise is harder, just due to logistics, but this is at least an exercise regime I enjoy.) So it has worked, and my weight is in the normal range (ignoring pregnancy). So why is this not done and dusted?

Toni pointed out that I still "diet" a lot. She is right, in that I am always still trying to lose weight. What does that mean and why?

If I've sorted the global food issues, I definitely haven't sorted the acute, right there in front of me issues. While I have found an eating pattern that I enjoy and is healthy for me, when sitting in front of food, I eat whatever is there, irrespective of ... well anything really. I eat it even if I don't especially like it. I remember when I was seeing a dietician and I was writing down everything I ate. She noted a large quantity of chocolate eaten and said "This is too much chocolate (pure genius!), if you want chocolate just have two squares." I looked at her expression of bewilderment that I couldn't grasp this simple concept, and considered my sense of bewilderment that she thought that all I needed was to be told not to eat an entire family block of chocolate and realised this woman was never going to help me.

I truly have no clue why I have no brake, there is no signal that I can identify that tells me my body doesn't need this. I have enough impulse control to manage alcohol, a budget and so on. This is what I have the greatest concern about passing on to my kids. If I have no handle on it, how do I avoid recreating it in them?

And then there is the body image thing. I have all the normal female body hangups, no doubt with all the normal factors that created it. (I remember my mother telling me that it didn't matter that I would never be beautiful because I was smart.) I don't feel much better about myself in the normal weight range than I did when I was obese. I think this may be where the school of thought that says you must learn to love how you look now, and not be losing weight because of how you look, comes from. If you are only losing weight to feel better about how you look, there is a reasonable chance that when you lose the necessary amount of weight, you will still not be happy with how you look. I don't know about a hard line approach to this philosophy, but I can certainly see that if we could just appreciate the beauty of how we are now and combine this with the healthy lifestyle that works for us, we could all enjoy the smaller body when it comes along a hell of a lot more and be much happier along the way.

We all need to look more sensibly at the female population of the planet, and realise that all bodies have good points and bad points. Make the most of the good ones, ignore the bad ones and get out there and enjoy our bodies. I have not mastered this problem, but I can see what I need to do. I hope I can avoid passing this on to the next generation. I want my kids to have realistic ideas of what bodies look like, both their own and other people's. I am going to try, despite the media's concerted efforts to do the opposite. Maybe I should record "How to Look Good Naked" and make them watch it every week until they are 25... :) That show has normal women and lots of them.

The other thing I've realised from watching these kinds of shows, is that basically the world's attention is grabbed by boobs, waists, butts and legs. Everyone has at least one of these features in spades. If you flaunt the one you've got and don't accentuate the failures in another department, you'll look great. Mim's bustier and Susie's infamous Melbourne Cup dress (sadly no photos, but anyone who was there remembers!) are proof positive. So the point is, we are all stunning in our own way, if only we could convince ourselves of it. Our bodies change shape our whole lives even if we are perfectly healthy, we will never be happy if we have one image of how we should look.

Anyway, enough babble. I needed to clear this is my head. Now if I could only resolve the issues rather than identifying them...