Perhaps the biggest lie that the medical establishment continues to tell fat folks is that our body size is solely (or at least primarily) our own fault; and further, that we could all permanently change our body size to a “healthy” one, if only we would make better lifestyle choices.
The second big lie is that even if we’re fat and healthy today, we will definitely be dropping dead as a direct result of our fat someday soon, just you wait!
It’s a familiar story for many of us, being judged as inherently diseased based only on a cursory glance, and being prescribed the old “treatment” of “eat less, move more” by doctors regardless of the purpose of the visit. All this in spite of ample research indicating that not only is weight loss an incredibly ineffective “treatment,” it actually does more harm than good; and that thinner is not necessarily healthier.
In this environment, when someone with M.D. after his or her name starts questioning harmful assumptions, the Fatosphere is soon abuzz with the good news. Today’s video is one example. It has been widely circulated with comments like, “How wonderful!” and “This gives me hope!”
So I clicked, and initially was taken in. Then I listened carefully a couple more times, and did some research about this physician’s work. This time, fellow fatties, I’m sorry to report that this video did not give me hope; in fact, it had rather the opposite effect.
Trigger warning: This doctor speaks frankly and graphically about his contempt for a patient he was called upon to consult with in the emergency room. He says ugly things, in an ugly way, about the body of another human being who happens to be fat.
Summary: A young doctor tells the story of how he treated a fat patient abysmally in the ER, making a moral judgment that she brought her illness (diabetes) upon herself. He then says he realized the error of his ways years later when he began to gain weight in spite of his own “healthy” lifestyle. His own weight gain apparently caused him to finally question the conventional wisdom on weight and health, and to consider a different hypothesis: that weight gain is a symptom, rather than a cause, of metabolic dysfunction. Then he tearfully shares the epiphany that fat patients are actually (sniffle) worthy of empathy and compassion because (sniffle) when they get ill, it might not even be their fault!
He talks about our humanity as if the idea were something new and absolutely fucking revolutionary. To thunderous applause.
This is the part where I get angry.
We’ve heard this song before though, haven’t we? Dr. Attia is not the first thin, conventionally attractive doctor to make a big show of magnanimously acknowledging the humanity of fat folks, but only after pretending to walk a mile in their extra-wide shoes:
“I could no longer afford the luxury of arrogance,” Attia says in his speech, just before comparing himself to Abraham Lincoln. In his new work, he says, he is leading a “team of rivals” to develop evidence-based treatment for metabolic disorders such as insulin resistance and diabetes. “I’m putting my career on the line,” he says.
So what has Dr. Attia done with his newfound empathy, compassion, and enthusiasm for challenging the conventional wisdom?
He has stopped practicing medicine and has partnered with journalist Gary Taubes, author of “Good Calories, Bad Calories” to form the Nutrition Science Initiative, also known as NuSI. There’s not much new at NuSI. So far it’s just another institution promoting the same old, tired, debunked obesi-panic. If you’re a glutton for punishment, click on over to their website. (I’ll do a more thorough commentary on NuSI in another blog post if I can accumulate sufficient Sanity Points, but I make no promises in this regard.)
Dr. Attia also has a personal blog called “The Eating Academy” where he recounts his “weight-loss journey,” a narrative which sounds like it might be yet another backwards chicken-and-egg scenario.
Dr. Attia claims to have been 40 pounds overweight at one time, and that he was experiencing insulin resistance. At this point in his life, however, he was also training 3 to 4 hours a day for elite open-water swimming events including the Maui Channel swim (about 20 miles roundtrip), and the 20-mile Catalina Channel swim, twice! Despite his training regimen and “following the Food Pyramid to the letter,” his weight “ballooned” to 200 pounds and he was beginning to accumulate some fat in his midsection. (No, seriously he BALLOONED! to a waist measurement of 36 inches!)
After completing these near-superhuman feats of open-water swimming, the doctor’s loving wife told him not that he was a superhero and amazing in every way, but that he should “try to be a little less not thin.” Bless her heart.
Dr. Attia then embarks on a “weight loss journey” consisting of 1) going on a ketogenic diet, which eliminates nearly all carbs and in the doctor’s case sourced 88% of caloric intake from fat; 2) changing his sport of choice from open-water swimming to bicycling; and 3) exercising less (down to 2 to 2 1/2 hours per day from 3 to 4 hours). Yet he credits only diet with reducing his weight and waist circumference, and improving his metabolic health. Then he posts some pretty pictures of steak and salad. Yay dieting!
WAIT. Baaaaack up.
Let’s take another look at the good doctor’s self-reported lifestyle pre-weight-loss for a minute. He was engaging in an extreme sport (open-water swimming) and training for 3 to 4 hours a day in frigid water.
And yet …
Even after he had “ballooned,” I must point out that Dr. Attia did not look like any elite open-water swimming champion I’d ever seen.
Let us feast our eyes on some photos of elite open-water swimmers, shall we?
Dear readers, you will have no doubt noticed that these swimmers have something in common.
They are not thin.
In fact, some of them are VERY not thin.
Coincidence? Apparently not. Irish open-water swimmer Nuala Moore (she’s at the far right of the Irish team photo) gives this fascinating account of what happened to her and her teammates’ bodies in the course of the 56-day Round Ireland swim:
Over 56 days around Ireland while swimming 4-6 hours a day including being 16 hours a day at sea on open Zodiacs in the wind while getting soaked in the rain, we never saw a pizza or a soft drink. On most days, we gave up food in lieu of catching a tide. We pushed into the abyss. But we didn’t have anyone guiding our nutrition, except we faced the blind need to finish. We had breakfast in the morning and sometimes dinner in the evening and after 56 days we were all up 1-2 stones weight. UP! All [of] us gathered huge fat around our backs, arms and bellies despite being lean. For we were all wet and cold for 16 hours a day, but we survived. [emphasis mine]
Could Dr. Attia’s “ballooning” process have been nothing more than his body’s way of staying alive through hours of arduous swim training in the frigid Pacific?
It’s just a hypothesis, but I think it’s worthy of consideration.
Now, just for giggles, let’s take a look at some photos of elite bicycle racers.
It would appear that athletes vary greatly in size and body composition, and that elite athletes’ bodes are especially well-suited to their respective sports:
I’m no doctor, I’m just a personal trainer. But based on the observations I’ve presented here, I think it’s worth investigating the hypothesis that if a person has a drastic change in physical activity (such as quitting an extreme sport like open-water swimming, and taking up a land-based sport such as cycling), the weight loss that follows might be primarily due to the change in activity rather than any dietary restriction.
Dr. Attia, though, is still mired in old assumptions. To him, the only thing he can see is that he got fat, he went on a diet, and that’s why he lost weight.
Chicken or egg?