Healthy at any size?

What involves the exposure of government health conspiracies, the realization that exercise doesn't make you thin, restricting calories doesn't work very well, and a take-down of low-fat diet foods?

If you are thinking Good Calories, Bad Calories you are right, but there is another community that accepts these things that's not really on the low-carb/paleo radar.

Because it's the fat acceptance community, sometimes known as Health At Every Size. Yes, you read that right. I bought Linda Bacon's book Health at Every Size because I was curious about the fat acceptance community's views. I heard about the movement because yes, I googled my own name, which I share minus one letter with fat acceptance blogger (among other things) Melissa McEwAn.

Now that NYC Paleo is doing beginner's workshops, I'll be fielding more questions than ever and dealing face-to-face with people interested in the diet. Besides that, I'm interested in overall compassionate approaches to human problems.

Some of those people inevitably will be interested in weight loss. Which is interesting for me because that's not how I got into evolutionary eating. I was really sick and looking to feel better. I was also pretty chubby, but that wasn't a huge priority for me.

Three years later I weigh thirty pounds less. But that's not why I'm happy with paleo. I'm happy with paleo because I don't have chronic pain, my digestion is good, my blood sugar is stable, and my inflammatory markers are low. For me, paleo is an overall health strategy, not a weight-loss gimmick. I think this is the philosophy of most successful long-term paleo dieters.

I would like the paleo community be about overall health and not about weight. So many skinny sedentary computer nerds have told me that they are glad they don't have to do anything like paleo because they aren't "fat."

I wonder if they'd feel this way if I told them that studies show that "overweight" people who are in shape have death rates lower than skinny unfit people and actually quite similar to "normal" fit people? In fact, some "fat" people are metabolically healthy, while some "skinny fat" people aren't. Appearances aren't everything.

What if paleo was the opposite of the vegan low fat movement which shames people into eating nutritionally bankrupt foods by calling them "fatties" in rude books like Skinny Bitch? Apparently they are so busy thinking themselves so compassionate to animals that they forgot about people.

The more I study weight the more I think we need this approach. Why do people weigh more than they used to? Why do people find it so hard to loose weight? We ain't in the paleolithic anymore and this is more complex than people not exercising enough or eating too much. Epigenetics, gut flora, pollution, and the complexity of metabolic set-points messed up early in life or with yo-yo dieting make weight a difficult issue.

And in the end…are we sure we know how much people in the paleolithic weighed? Pictures of tribal women show many with modestly round bellies. Is not being svelte a health risk? Consider that, on average, "overweight" people live longer than "normal" weight people. A study of angiograms shouldn't that for every 11 pound increase in weight there was an associated 10-40 lower chance of atherosclerosis.

I don't want people setting unrealistic goals. When people come up to me and tell me they are having a tough time meeting their weight goals on paleo, I look at them and think how great they look. They can run for miles, have glowing skin, feel awesome, and certainly aren't "obese". I tell them that it might be worth trying to adjust their diet, but that they should think about having more health-based goals like higher energy and vitamin-D levels.

I think emphasis on weight often leads people to nutritionally bankrupt diets like low-fat veganism, but also to excessive calorie restriction in general. This can be dangerous for most Americans, who are already pretty low in many nutrients. Lots of the studies on weight loss are also as flawed as those that show how saturated fat is evil. The evidence is that just losing weight doesn't fix many of the problems that doctors say it does.

So how does this effect my approach to paleo? What if you gave me 30 women who wanted to get healthier? They weigh more than they want to, but most importantly they have high inflammation, autoimmune conditions, and impaired insulin sensitivity.

The first step I recommend is ditching processed foods and adding nutrient-rich foods into their diet. I think calorie restriction should come only after people are nourished. And most Americans, even if they look "over nourished," are vitamin, essential fatty acid, and mineral deficient.

It's possible that many of the studies cited in this book that show how bad calorie restriction can be have been done mostly on malnourished individuals. Because studies done on nutrient-emphasizing diets like intermittent fasting and CRON (link) show exactly the opposite.

Then I would target specific goals like improving insulin sensitivity and decreasing inflammation. I would do this by altering the quality of their diet, not the quantity. Once their systems aren't completely deranged I would recommend occasional intermittent fasting.

So about this book. There is a lot of useful information, particularly about the exercise myth and whether being "overweight" is really unhealthy. Some might find her self-esteem building chapters useful. But I find her dietary recommendations to be problematic. She basically says enjoy your food, don't feel guilty, but increase fiber intake dramatically and lower your meat/saturated fat intake. First part is good, but the rest is what happens when you drink only half the government-sponsored health recommendation Kool-Aid.

She says fiber is what makes you feel full and will prevent digestive difficulties. Which actually flies in the face of what scientists now know about digestion. It's not the fiber per-se that matters, but the bacteria in the gut. Where is the recommendation for probiotics? It's not there despite a few paragraphs on how "fat" people have different gut flora. Instead she recommends things like whole-grain toast. Maybe she hasn't seen the evidence that gluten is harmful for everyone because of its inflammatory effects. Not to mention the fact that wheat basically strips minerals from women's bodies.

As for fat it seems odd that she says the government scare-mongering about OMGFATPEOPLERUININGTHECOUNTRY is wrong, but their fat recommendations are right…hmmm. At one point she says weight and hunger are more complex than just leptin and then at another she warns that high-fat diets can reduce leptin. That study she cites used a low-carb diet of WHOLE WHEAT BREAD, commercial mayo (vegetable oil redux), margarine, and canola oil. She also fails to mention that high leptin levels might be bad.

The paleo diet gets a shoutout when she mentions that the wild game meat our paleolithic ancestors ate was different, but uses that fact to say eat less meat instead of eating the meat that's available that IS like what our ancestors ate. In fact, she doesn't mention the nutritional differences between wild/grass-fed meat/fish and factory-farmed crap at all!

I also agree the exercise is not the key to losing weight, particularly chronic cardio, which is unfortunately the method that most people use. I know lots of people who have lost weight with chronic cardio and none of them have kept it off. The benefits of exercise are far beyond weight loss, but it's important to do something that's a source of fun activity rather than a slog. I remember getting up at 5:30 AM as a freshman in college to run the treadmill. My weight never budged and I felt stressed and miserable all the time.

I agree with her that hate-mongering against "fat" people is bad. It leads to justification for ineffective government problems as well as dehumanization of human beings. She also exposes the tragic facts of bariatric surgery, a practice that kills people (7.5% of men who have the procedure!) or leaves them malnourished for life. It typifies the approach to weight in this country: malnourishment is AOK as long as you lose weight! I think in the future bariatric surgery will be considered similar to corsets and foot-binding.

I also don't like the idea of food consumption being a moral issue. I don't think some foods are good and others evil. Even high-fructose corn syrup is not evil. Inanimate objects cannot be evil. Demonizing, guilting, and self-punishment should not be part of a rational paleo diet. Some foods ARE bad for you. You should educate yourself about them and avoid them as best as you can. You should acknowledge that it will be hard and might take time to learn how to exclude things like gluten and processed sugar. In the end, you shouldn't be afraid to love food and enjoy it often. Luckily, unlike the low-fat diet, the paleo diet actually includes foods that are delicious and not just as "sometimes foods."

But according to some, the paleo diet excludes "normal" food. I guess it depends on your perspective, but in my view the paleo perspective is refreshing in that it's about foods, not numbers. There has also been a collective quashing on things that might lead to disordered eating like fat-restriction or quasi-religious food guidelines. One of the only problems I see is that some people try fasting before their bodies might be ready... and then they feel sick and post about it on paleohacks. Fasting should never make you feel unwell.

When I think about how we treat people who aren't thin, I think of my grandmother who is healthy at over 90 despite not being thin according to government guidelines (by the way, the BMI system is pretty messed up). Would she feel comfortable at a paleo meetup? This book was part of a study where they took one group of "overweight" women and had them read a copy of this book and have consultations with the author. The other group followed conventional diet advice. The HAES women showed decreases in bad cholesterol, lower blood pressure, higher activity levels, and greater self-esteem.

What if a paleo-type program were included in that study? I think we'd do even better. Most paleo books are positive about health and don't spend much or any time on emphasizing weight loss. I think paleo wins hands down because it targets actual health problems (and let's be honest, most people who follow is DO lose weight). Linda Bacon falls into exactly the trap of conventional diet gurus when she doesn't look outside the box and see that specific foods might be more important than macro-nutrient ratios or calories.

This series of interesting blog posts about the paradox of metabolically healthy "fat" people highlights an important point:

As a important caveat, there are countless other health issues brought on by carrying excess weight that are not always metabolic (i.e. joint problems due to excess load, skin infections, etc.). Thus, it is often argued that despite being metabolically-healthy these individuals may still be far from optimal health.

My own opinion is that overemphasis on weight is a problem and that many people can't lose weight very easily, but that there really are real disadvantages associated with weight that have nothing to do with stigma. Unfortunately, weight is also more complex than "eat less, move more." In fact, it's even more complex than just "eat paleo, lose weight." YES, there are long-term paleo dieters that are "fat" by BMI standards. Their health has improved, but it's possible they might never be "thin." This new Taubes interview discusses how metabolic damage might not be completely reversible. It might be similar to crooked teeth. Yes, such problems are not present in societies eating traditional diets, but once they are there they are there. You could go 100% paleo for years and it's not going to make your teeth straight.

I think the obesity set point posts on Whole Health Source are a great starting point for exploring this topic. I'm not saying to give up. I'm saying that this is hard stuff and it's more productive to focus on holistic health. There are too many women and men out there waiting to lose weight to buy nice clothes or to enjoy life. Enjoy life now, eat some paleo foods, and enjoy the overall benefits of being outside.