Feminist Philosophers

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So you found the magic pill… January 2, 2013

Filed under: ageing,aging,appearance,autonomy — annejjacobson @ 7:41 pm

Let’s suppose you were given a prescription for a pill that will mean you lose 2-3 lbs a week, while you eat as much as you want of anything you want.

But it has some side effects.  One is getting seized by itching, which seems to move around your body at random.  (Cortisone cream helps.)  Another is that you can get tense and a bit bad tempered; your partner’s new and strange desire to help with dinner is irritating you a lot.  Digestion is not as simple as before, there may be mild hair loss(temporary), sleep can be disturbed easily and you have quite dry mouth.  And even with insurance, it is $10 a pill, one pill daily.

Of course, you strongly disapprove of the cultural obsession about women’s weight that is all around you.  But then you remember the recent remark on this blog that if you lose 20 lbs, your course evaluations will go up.  So it isn’t that you are endorsing these norms; you are trying to survive them.

Not everyone gets all the side effects.  How much would you tolerate to lose 15 lbs in 5 weeks?  Without ever being hungry, eating what you want, etc.

——————————

By the way, there really is such a pill.  Do you know which it is?

 

54 Responses to “So you found the magic pill…”

  1. Give it to me and NOW! If it’s available to everyone, what’s the problem? I disapprove of the cultural obsession about slimness but I’m not going to trash myself for a matter of principle. Gimme those pills!

    As far as “without every being hungry and eating whatever you want” this is where I balk. The assumption is that if you’re fat you’re pigging out. Not so. I spent most of my life agonizing an starving myself and still being fat. It’s a matter of physiology, not will power. Please recognize that most people who are overweight aren’t pigging out, but are trying their best to starve themselves, as I have for most of my life. It’s simply a matter of biology: if you’re set up to be fat it’s really, really difficult to avoid it, unless you really really starve yourself and torture yourself.

  2. What’s the pill? Where can I get it? I’d pay much more than $10 a pop for it.

  3. tarabound Says:

    I don’t find any of those tolerable. I would rather be slightly less angular than the norm and still be comfortable.

  4. Matt Says:

    I have a lot of those problems anyway (though I do like it if people want to help me cook. Perhaps I’m otherwise irritable, but I don’t mind help with these things.) But the money would be too much for me. I suppose it’s lucky I’m not interested in losing that much weight, and that if I were, I probably could.

  5. annejjacobson Says:

    Harriet, let’s wait to see if anyone can say what it is. Remind me, please, tomorrow if we haven’t had the big reveal.

    It is not a simple medication, by the way. I am dealing right now with a situation that I think is very, very bad. My doctor gave it to me to help with the stress. I was extremely surprise to see my weight take this nose dive, though plenty of others report that as a side-effect.

    I didn’t mean to equate ‘eating what you want” with pigging out. I think the pill lets one eat as much as one wants because it kills one’s appetite. I think I read somewhere that it has a chemical structure close to amphetamines, though it isn’t one of them.

  6. tarabound Says:

    Please be good to yourself.

    My spouse took something similar for smoking, but the side effects seemed more distressing than smoking dangers.

  7. It’s a matter of preference and trade-offs. I’d be prepared to up with lots of risk and discomforto to lose weight. that’s that. I’m waiting for the revelation about the pill–because I want it. There are other trade-offs I wouldn’t think worthwhile. I won’t dress up for classes, regardless of what it might do for my course evals. I wouldn’t get my hair done. but my desire to be thin in one of the primary ends of my life–so I want that pill!

  8. Bijan Parsia Says:

    I’m curious esp. as I expect there’s some funky twist in the answer. I expect any googling is going to be a disaster ;)

  9. annejjacobson Says:

    Tarabound is certainly on the right track. Thank you, T, for your kind advice.

  10. Oh, also by the way, I took pills to quit smoking. My quit date was April 13, 2010 and I haven’t had a cigarette since! Pills work! Willpower doesn’t! And yet there’s this enormous puritanical program to keep us from those magic pills that fill smoking–and obesity. The medical establishment has the pills, the chemicals, to fix smoking and obesity but they won’t give them to us because they’re moralizing puritans! Because they, like the general public, want to punish us. Pills work! Better living through chemicals! Let us adults decide whether we’re prepared to take on the risk.

  11. Bijan Parsia Says:

    Hmm. So the weight loss is a side effect (and a result of appetite surpression)…I’d be suspicious that it’s off label use for weight loss would be generally reliable or long term sustainable.

  12. Anonymous Says:

    I feel like you can’t say will power doesn’t work, when some people have it and do fine because of it. That’s not to say your situation (whether it be smoking or what I can only assume to be obesity by your posts) is due to a lack of will power, but it could be due to ignorance of causes. That is neither here nor there, but to boldly claim that will power doesn’t work, because it has yet to work for you, is lacking epistemic humility. The underlying issue is health, which should be the aim of anyone who has a weight issue, not because of some type of physical aesthetic. Running to something you don’t fully understand shows little regard for your health, which seems to promote a value in aesthetic more.

    That’s not to say that one has a moral obligation to either health or aesthetics, or should be morally vilified for valuing one over the other.

    I would never take such a pill for the goal of losing weight, because I’d be doing so in a manner which shows too much risk to my mental and physical health. I’d rather improve my health through regular means and hope my weight follows suit.

  13. Moralism! I have absolutely no interest in health. My only interest is aesthetics. I want to look good and I don’t give a damn about my health. So what. Give me some rational justification why it’s ok and edifying to be intersted in health but not appearance. I want to be thin. I don’t give a sh*t about health.

  14. Bijan Parsia Says:

    Hi Anonymous,

    I feel like you can’t say will power doesn’t work, when some people have it and do fine because of it.

    I feel it’s pretty safe to say that the current consensus (about weight loss) is that will power per se doesn’t work (esp. if you look at a 5 year timeline).

    Thus, I don’t think it’s a failing of epistemic humility for Harriet to claim that willpower doesn’t work.

  15. Bijan Parsia Says:

    Hi Harriet!

    I don’t think you are obligated to prefer health to aesthetics, but from a public health/regulatory perspective, I think it’s totally reasonable to weight health highly. I don’t think this is necessarily “moralism” either (though it could be driven by moralism) and more than mandating seat belts (and use thereof) is necessarily moralism either. Given that health and safety costs often are spread out, one needn’t even be paternalistically motivated to support such regulations.

  16. Anonymous Says:

    I’d like to see the studies your referencing in terms of will power not working. Specifically in how they control/take into account the fact that one may lose will power overtime, versus someone who keeps strong through tough circumstances. Though I don’t think will power is necessarily the key (or should be considered at all really), as I’m afraid I may have made it seem in my previous post. Will power may not actually be within any of our control, and without an understanding of how nutrition or bodily science works it’s useless. For those who are concerned with our health, understanding what makes one healthy should be the aim via the relevant science.

    In regards to those who don’t, cocaine may be a suitable option (I’m not an expert on such drugs). As you said previously, Bijan, this pill would probably stop working after a prolonged time just as meth has been shown to do.

  17. Matt Says:

    “Give me some rational justification why it’s ok and edifying to be intersted in health but not appearance.”

    Because health issues have externalities? Lots of people are mistaken about what is “healthy”, of course, but that doesn’t change the deeper issue. (These externalities may or may not justify regulatory intervention in a particular case. That’s obvious. But that there are these externalities is also both obvious and a rational justification for caring more about health than appearance.)

  18. Bijan Parsia Says:

    Hi anonymous,

    Well, start with intuition: People diet like crazy but obesity rates go up.

    Second, let’s be clear, I’m not saying that there isn’t some level/form of will power that would be insufficient to produce a life long decline in weight. I’m saying that diet/exercise regimes are ineffective in the general population thus “willpower” (typically what holds people to the unpleasantness of a diet/exercise regime) is generally insufficient for sustained weight loss. The precise etiology (i.e., whether it’s because people don’t have enough willpower or whether diet/exercise is itself ineffective) is irrelevant.

    Here’s a study. It’s not hard to find more.

    http://www.ncbi.nlm.nih.gov/pubmed/10449014

    A brief survey of the most popular dieting techniques used over the past 40 yr shows that most techniques cycle in and out of popularity and that many of these techniques may be hazardous to health. Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr.

    Ok, that’s from 1999, but I’ve seen that figure used currently even on diet science blogs. Ah! Here’s a paper citing the above:

    http://www.ncbi.nlm.nih.gov/pubmed/21261939

    which leads me to a more recent systematic review:

    http://www.ndwls.com/wp-content/uploads/2011/08/WEBformat-DIETING_MANN_DIETS-NOT-THE-ANSWER-2.pdf

    Findings are summarized below: The overall finding was that dieters were no better able to lose and maintain weight-loss than non-dieters.
    • Diets led to short-term weight loss that was not maintained over time.
    • The more time that elapsed between the end of a diet and the follow-up, the
    more weight was regained.
    • The largest weight loss occurred in the study with the shortest follow-up time.
    • It was difficult to retain all participants for follow-up. Possibly, dieters who were
    more successful remained in the studies longer.
    • Some studies did not include control groups of nondieting comparison
    participants.
    • Many studies reported the percentage of participants who have kept off some
    lost weight, but only some studies also reported on participants for whom the diet
    was counterproductive (typically a larger percentage than for whose who kept
    weight off).

    Alas, it’s only the summary, but hey, it’s something :)

  19. Bijan Parsia Says:

    Matt:

    Ah yes, I blanked on the term “externality” which is one of my favorites. Thanks!

  20. Matt Drabek Says:

    I sincerely hope there’s at least a wee bit of hyperbole in Harriet’s post. If you really don’t care at all about health and just want to lose weight, there are a number of chronic illnesses you could willingly contract that will cause you to lose weight. I mean, if you have absolutely no concern whatsoever for health. But I wouldn’t recommend going through with it.

  21. Anonymous Says:

    M. Drabek has made the point I was trying to with my cocaine comment.

    Bijan, I definitely think all those studies point to a major problem I agree with: wrong information. The diets cycle in and out of popularity because they don’t really work, which means the error is due to ignorance of what actually causes healthy weight loss.

  22. Bijan Parsia Says:

    Look, Harriet didn’t say anything about an absolute prioritization of aesthetics over health, but only implied that the list in the poll was very attractive. And frankly, the symptoms do seem comparatively mild. Given that my full head of hair is already a lost cause and I already have sleep and itching issues…these are fairly copable esp. compared to, say, ongoing dieting. (Hunger, you know, is fairly unpleasant.)

    Bijan, I definitely think all those studies point to a major problem I agree with: wrong information. The diets cycle in and out of popularity because they don’t really work, which means the error is due to ignorance of what actually causes healthy weight loss.

    But they do support that willpower is not a likely cause of sustained, much less healthy weight loss (the two are not identical). So, I reiterate my support for Harriet’s claim that “willpower doesn’t work” as not just an unwise generalization of her experience, but a consensus scientific view. Now, that doesn’t mean it’s the right view (my epistemic humility compels me to add), but it’s perfectly justifiable and I don’t think a crass sin against epistemic humility to use the loose formulation in a blog comment.

  23. Andy Says:

    I take it that Harriet doesn’t value looking good at the expense of health, but rather independently of health.

  24. Anonymous Says:

    I see your point, and still respectfully disagree. Willpower coupled with the proper thing to dedicate that willpower to could bring about sustained weight loss. Though, like I said, I don’t really think willpower has too much to play in this issue.

    I have absolutely no interest in health. My only interest is aesthetics. I want to look good and I don’t give a damn about my health. …I want to be thin. I don’t give a sh*t about health.

    That sounds like an absolute prioritization, but I’ve been wrong before. If it isn’t one, I’d like to know where the line is drawn and the rational justification for that.

  25. Bijan Parsia Says:

    I see your point, and still respectfully disagree. Willpower coupled with the proper thing to dedicate that willpower to could bring about sustained weight loss.

    But this is vacuous. It takes willpower to take a pill, esp. if there are side effects. Harriet (for example) is willing to take a pill. This clearly isn’t what’s being discussed, but rather a modality of weightloss that prioritizes the typical range of behavioral modification comprising dieting and exercise based on decision and encouragement (aka, willpower). Which generally don’t work (at least over the long term).

    Though, like I said, I don’t really think willpower has too much to play in this issue.

    Then I’m unclear why you stick to your claim that Harriet was speaking well beyond the evidence. In point of fact, she seems to have spoken quite reasonably in the content of her claim.

    That sounds like an absolute prioritization, but I’ve been wrong before. If it isn’t one, I’d like to know where the line is drawn and the rational justification for that.

    This just isn’t charitable. She spoke of quitting smoking (which often supports weight loss). An earlier comment:

    It’s a matter of preference and trade-offs. I’d be prepared to up with lots of risk and discomforto to lose weight. that’s that. I’m waiting for the revelation about the pill–because I want it. There are other trade-offs I wouldn’t think worthwhile. I won’t dress up for classes, regardless of what it might do for my course evals. I wouldn’t get my hair done. but my desire to be thin in one of the primary ends of my life–so I want that pill!

    She says “lots of risk and discomfort” not “arbitrary negatives”. The later comment you quote was a reactive one thus more likely to be rather hyperbolic.

    I don’t see how anyone could reasonably take those comments, collectively, as supportive of an absolute priority of aesthetics over health. C’mon!

  26. swallerstein Says:

    Bijan:

    I know lots of people who lose weight and keep their weight low for many years as a result of diet (changing their eating habits is a change in the diet) and increased exercise, so while for some people diet and exercise may not result in longterm weight loss, for lots of people they do.

    Now the people whom I speak of are not those who consult doctors, but rather those who decide on changing their diet and doing more exercise on their own and so they are less likely to appear in most studies.

    As for will power, some people have more will power than others, I guess, but
    using will power, I stopped smoking; others whom I know have left drugs or drinking, and still others whom I know have changed their eating habits.

    It’s not a moral question at all, and it undoubtedly depends on the individual genetic makeup and/or on very early childhood learning processes.

  27. annejjacobson Says:

    The reveal:

    Possible side effects of WELLBUTRIN XL®:

    The most common adverse reactions reported with WELLBUTRIN XL® are weight loss, dry mouth, nausea, difficulty sleeping, dizziness, and sore throat. Other common side effects include loss of appetite, skin rash, sweating, ringing in the ears, shakiness, stomach pain, agitation, anxiety, muscle pain, fast heartbeat, and more frequent urination.
    You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch, or call 1-800-FDA-1088.

    I’ve seen such lists for almost any meds I’ve taken, and this is the first time I’ve caught any significant number of them.

    The list is very odd, because the principle use is for major depression, but surely enough of these induce the problem it’s supposed to solve

  28. Bijan Parsia Says:

    Old Welbutrin. Harriet, I’m sorry to say that I was on that at one point and saw no associated weight loss. One of the few meds where I didn’t have some annoying subset of the adverse reactions.

    Maybe this is a different version though since it wasn’t no $10 a pop.

  29. annejjacobson Says:

    Actually without insurance, it would be $15 a pop.

    Loss of apetite is common, but not universal. I hate the side effects, but there are conditions that can make it impossible to lose weight. Not that that is why it was prescribed.

    It’s also the case that there are serious problems with whether the generics are really functionally equivalent. Perhaps that’s what you had, Bijan??

  30. Bijan Parsia Says:

    I know lots of people who lose weight and keep their weight low for many years as a result of diet (changing their eating habits is a change in the diet) and increased exercise, so while for some people diet and exercise may not result in longterm weight loss, for lots of people they do.

    I find it interesting that you would use anecdotes to slide the studied percentages to “some” and the unstudied percentages to “lots”. I’ve no idea what “lots” mean. I don’t know how you’ve tracked the weight loss over time. Etc. So, I don’t really know what to say. But:

    Evidence: Long-term follow-up studies document that the majority of individuals regain virtually all of the weight that was lost during treatment, regardless of whether they maintain their diet or exercise program [5,27]. [Emph added] Consider the Women’s Health Initiative, the largest and longest randomized, controlled dietary intervention clinical trial, designed to test the current recommendations. More than 20,000 women maintained a low-fat diet, reportedly reducing their calorie intake by an average of 360 calories per day [102] and significantly increasing their activity [103]. After almost eight years on this diet, there was almost no change in weight from starting point (a loss of 0.1 kg), and average waist circumference, which is a measure of abdominal fat, had increased (0.3 cm) [102].

    Other reviews demonstrate the unreliability of conventional claims of sustained weight loss [104,105]. There is a paucity of long term data regarding surgical studies, but emerging data indicates gradual post-surgery weight regain as well [106,107]. Weight loss peaks about one year postoperative, after which gradual weight regain is the norm.

    Hmmmmm.

    Now the people whom I speak of are not those who consult doctors, but rather those who decide on changing their diet and doing more exercise on their own and so they are less likely to appear in most studies.

    Hmm. Sorry, I’m not sure why I should find this even a little bit convincing. I get people who tell me similar stories about acupuncture.

    As for will power, some people have more will power than others, I guess, but
    using will power, I stopped smoking; others whom I know have left drugs or drinking, and still others whom I know have changed their eating habits.

    I like to keep my claims narrow, when possible, what I just looked up was whether the evidence supports diet and exercise as a reliable long term weight loss mechanism. The consensus as far as I can determine is that they do not. For me, this is sufficient to justify someone saying in a causal blog comment, “Willpower doesn’t work” as a reasonable generalization.

    The literature is complex and a lot isn’t known and undoubtably a lot will be learned, but I think I’m going to continue to rely on what I can glean from the literature rather than rely on my own (or other people’s) casual observations.

  31. Bijan Parsia Says:

    Hi Anne,

    I can’t remember the details (from the 1990s!), but I’m pretty sure it wasn’t a generic. It neither did much to or for me :)

    It looks like it has been prescribed for weight loss.

  32. Bijan Parsia Says:

    Eek! I hit before finishing: I hope your heath issues resolve favorable soon and your side effects, at least, diminish rapidly.

  33. swallerstein Says:

    Bijan:

    This is making me a bit angry.

    I can’t give you a list of people whom I know for obvious reasons, but most people lose weight and manage to keep their weight lower through changing their diets and exercising.

    I don’t have time to read tons of studies or to look for counter-studies or to argue for the sake of arguing, but I’ve lived 66 years, seen lots of people with weight problems and
    seen most of them deal with their weight problems through diet and exercise.

    Now, I fully admit that some people may not be able to lose weight through diet and exercise. No argument there.

    However, the fact is that many people can lose weight through diet and exercise, if they get up from their computers and make the effort and when you suggest that they cannot, you are making it harder for them to deal with a common problem.

    You are doing those people who can lose weight through diet and exercise a tremendous disservice by suggesting that they cannot and that makes me angry.

    Are you so intoxicated by “THE LITERATURE” that you are unable to accept the evidence that a person observes during his lifetime?

    If so, that’s sad and I’m no longer angry at you, but sad about the whole sad thing.

  34. swallerstein Says:

    Bijan:

    Let me say one more thing. It might get me banned from this blog or get me put in moderation, but the whole thing saddens me.

    I sense that you’re defending Harriet and Anne, and I can’t think of two more valuable people to defend. More power to you for that. It’s a sign of your nobility, which I’ve referred to previously.

    However, for hundreds of years the standard way to lose weight has been to decrease calories ingested and to increase calories consumed exercising. That works for most people. And if most people change their dietary habits and continue to exercise, they will not regain that weight lost. To insist otherwise is irresponsible, since lots of young people read this blog and can end up using pills to lose weight when exercise and diet would have done the trick, without the side effects (and costs) of pills.

    Now, I give up, will turn off the computer and go to sleep.

  35. Bijan Parsia Says:

    This is making me a bit angry.

    I’m not sure what to do about that.

    I can’t give you a list of people whom I know for obvious reasons, but most people lose weight and manage to keep their weight lower through changing their diets and exercising.

    I don’t know how you generalize to most people. This isn’t generally true as far as we know from the best available evidence.

    I don’t have time to read tons of studies or to look for counter-studies

    Then, with all due respect, you aren’t going to have much to offer to a discussion on weight loss which is focused on public health.

    or to argue for the sake of arguing,

    Are you sure? You are commenting on a blog! :)

    I don’t feel like I’m arguing for the sake of arguing. I’m arguing the evidence as I understand how to argue for evidence. I find it very interesting that Harriet’s bare word gets dismissed but even after I dig up citable evidence that view…still gets dissed. I’m not sure what else to do.

    but I’ve lived 66 years, seen lots of people with weight problems and
    seen most of them deal with their weight problems through diet and exercise.

    I…don’t know what to tell you that doesn’t sound snarky. I don’t believe in personal experience based medicine. I believe in science (more than evidence!) based medicine (though evidence based medicine is way better than personal experience based medicine). I don’t think your reports are particularly valuable evidentially. (Not because you are particularly unreliable, natch, but that such reports are not reliable or even really interpretable.)

    However, the fact is that many people can lose weight through diet and exercise,

    It might help if you quantified that “many”. Is it most? Some? 30%?

    if they get up from their computers and make the effort and when you suggest that they cannot, you are making it harder for them to deal with a common problem.

    I’ve not at all suggested that people cannot make such efforts. I’ve merely said that willpower based modalities are (thus far) ineffective in the long term. That can be due to unsustainability of the effort or the inefficacy of the effort. Recall from my prior comment this quote:

    Evidence: Long-term follow-up studies document that the majority of individuals regain virtually all of the weight that was lost during treatment, regardless of whether they maintain their diet or exercise program [5,27].

    The negative effects on people who do not maintain those programs are often profoundly negative. For example, it puts them off improving their health.

    If you look at the literature, I think you’ll find that the negative effects of the “lose weight, esp. by diet and exercise” to be quite nasty:

    There are serious ethical concerns regarding the continued use of a weight-centered paradigm in current practice in relation to beneficence and nonmaleficence. Beneficence concerns the requirement to effect treatment benefit. There is a paucity of literature to substantiate that the pursuit of weight control is beneficial, and a similar lack of evidence to support that weight loss is maintained over the long term or that programs aimed at prevention of weight gain are successful. Nonmaleficence refers to the requirement to do no harm. Much research suggests damage results from a weight-centered focus, such as weight cycling and stigmatization.

    I encourage you to at least skim the paper…it’s pretty accessible. I’m not 100% convinced by it all (it’s definitely not rigorously formulated enough for my tastes), but it certainly represents a fairly common scientific consensus.

    Are you so intoxicated by “THE LITERATURE” that you are unable to accept the evidence that a person observes during his lifetime?

    Yes, without a lick of shame or hesitation. I’m, indeed, sorta surprised that you would think I would think otherwise. We are terrible at making useful generalizations without fairly rigorous protocols, esp. in health related matters. There’s all sorts of problems with the medical literature (which is why it needs to be approached with a ton of care and, yes, epistemic humility), but I think I’ve been reasonably hedging (after all, I’m not an expert!).

    If so, that’s sad and I’m no longer angry at you, but sad about the whole sad thing.

    Don’t be sad! I’m not sure why you’re sad :)

  36. Bijan Parsia Says:

    However, for hundreds of years the standard way to lose weight has been to decrease calories ingested and to increase calories consumed exercising. That works for most people. And if most people change their dietary habits and continue to exercise, they will not regain that weight lost. To insist otherwise is irresponsible, since lots of young people read this blog and can end up using pills to lose weight when exercise and diet would have done the trick, without the side effects (and costs) of pills.

    Young people! Don’t do that! There’s little evidence that current diet pills (or surgical interventions!) result in long term weight loss either (afaict)! The tentative advice I’ve seen is to focus on weight stablization (if you’re concerned about health, along with focusing on improving health rather than losing weight). This is an interesting study:

    Participants who had tried pharmaceutical medications were generally happy with the amount of weight they lost on the medications, but were unhappy with the side effects of the medications. This was particularly true of participants’ experiences of Phentermine. Participants who had tried Orlistat were also dissatisfied with the cost of the drug, and found it difficult to afford over a long period of time.

    There’s no panacea at the moment.

    Just a quick comment about my noble defendingness. While I am touched by your personal regard, I dearly hope I’m not white knighting. That would be exceedingly annoying of me. I really am just arguing my understanding. I argued against Harriet when I thought she was wrong. I argued against anonymous and you when I thought y’all were wrong. I don’t think I’ve done any defending of Anne as…she hasn’t even made any disputable claims :)

    Apologies for my overcommenting!

  37. I get all nasty and perverse because I’m perennially irritated by the self-congratulatory moralism and plain snobbery that surrounds “health.” There’s probably more of this in the US than in the UK, and there’s certainly more in California than in most of the US. But I am sick of hearing people congratulate themselves for “eating healthy,” moralizing about organic products, condemning “chemicals” and complaining about fat people, especially working class fat people, for being “unhealthy.”

    Say “I’m doing x because I want to be healthy” and that’s edifying. Say “I’m doing x because I want to look good” and people sniff: you aren’t supposed to say or think such things. I’m really irritated by the hypocrisy, self-deception and plain snobbery.

  38. Matt Says:

    Say “I’m doing x because I want to look good” and people sniff: you aren’t supposed to say or think such things.

    In a coastal city in Southern California that surprises me. I guess times have changed. I’ll admit- one of the big reasons I go to the gym, when I do, is that I’d like to look a bit better. (I also feel better when I’m more active and in a bit better shape, but I like looking better, too.) I’d like to think the type of exercise I do, when I do it, makes me healthier, too, since it’s mostly fairly low-impact and cardio, but who knows. I do suspect that lots of exercise that people do (such as jogging, if they don’t have basically perfect form) is actually somewhat bad for them- hard on the joints, etc.

    When people talk about “will-power” for things like quitting drugs, smoking, or changing their eating habits, I think that a big part, and often the hardest part, is changing one’s life-style. For drugs, this usually means getting rid of most of one’s friends and changing one’s daily habits. That part, and some times all of that, is so for many people for quitting smoking, losing weight, etc., and that’s a big part of what makes it hard. (I lost about 20lb, which for me was a lot, almost entirely by moving from a job where I tended to eat big lunches and snack too much while sitting all day to one where I ate much smaller lunches, didn’t have such easy access to or habits of having snacks, and tended to walk around a bit more. It wasn’t that I had more or less will-power, but I was in a different situation.)

  39. annejjacobson Says:

    Let me clarify: i am not taking the pill to lose weight, and I really don’t know if I would. I thought it woul be interesting to discuss it.

  40. swallerstein Says:

    http://www.mayoclinic.com/health/obesity/DS00314

    Here’s a link to the mayo clinic website article on treating obesity. It stresses dietary change and increased physical activity.

    I’m sure that others can provide an avalanche of literature showing that the Mayo Clinic is biased or capitalist or patriarchal or has vested interests in pushing a certain line of conventional healthcare or whatever, but their website has been helpful to me on various occasions.

    What’s more, obesity is a serious health problem and I feel that I have a responsibility to provide an account of how many doctors treat this issue, given the number of readers, especially young students who may just be beginning to take responsibility for their own health issues, visiting this blog.

  41. Anonymous Says:

    I would love to lose 10 or 15 pounds without having to do anything, but it’s also a really good feeling when you feel your body working and moving to lose weight and be active. Excercise is hard for me because I’ve had trouble being motivated but it always feels good in the end and changing your whole lifestyle to be healthier feels great. This pill sounds like just another thing in our culture that is handed to us without having to do any work. Doesn’t seem like a good idea. We should connect with our bodies and feel the effects of our poor or good choices.

  42. annejjacobson Says:

    SW, your contributions have been so thoughtful and good, I can’t see your getting banned.

    I wonder if some of the difference you decribe is cultural. In the States, food is constently presented as getting one on a fast track to happiness, especially if it is full of empty calaries.

  43. shaslang Says:

    Gary Taubes’ work on the issue ow weight and willpower is excellent. Check out one of his lectures here:

    http://m.youtube.com/watch?v=KH9079LV4tY&desktop_uri=/watch?v=KH9079LV4tY

  44. swallerstein Says:

    Anne:

    Thank you very much for your words of encouragement.

  45. Here’s a nice piece from the NYTimes: http://www.nytimes.com/2013/01/03/opinion/our-imaginary-weight-problem.html?smid=pl-share

    As it notes, big metastudies strongly suggest that being mild to moderately overweight isn’t unhealthy and notes, as we all know, that thinness is a marker of upper class status as well as a beauty item that confers privilege. And that is why I want to be thin: I want as much social status and prestige as I can get. So there. That’s why we need those pills.

  46. annejjacobson Says:

    Thanks for the reference to Taubes, Sally. Here’s a summary of part of what he says:

    Taubes’ book is the ladtest blast in a decades-long battle over whether calories or carbohydrates are to blame for Americans’ bulging waistlines. Taubes targets the calories-in, calories-out paradigm – people get fat because they take in more calories than they expend – that has been the long-held belief of the American medical establishment and diet industry.
    “It has done incalculable harm,” Taubes writes. “”Not only is this thinking at least partly responsible for the ever-growing numbers of obese and overweight people in the world – while directing attention away from the real reasons we get fat – but it has served to reinforce the perception that those who are fat have no one to blame but themselves.”

    Read more: http://www.sfgate.com/entertainment/article/Gary-Taubes-on-ldquo-Why-We-Get-Fat-rdquo-2376593.php#ixzz2GvUusIq3

    As a fairly consistent reader of the NY Times, I think his negative points are widely shared by people doing research in the area. I’m less convinced that he’s got the right culprit.

    Another piece of evidence that calories and exercise are not the whole story is the fact that cancer preventing hormone pills can cause havoc with one’s weight, as indeed steroids seem to do.

  47. Anonymous Says:

    Could I just add that in a good nutrition/exercise regime you are not supposed to be hungry? And definitely not starve yourself… You just eat differently.

  48. Anonymous Says:

    I lost over 40 pounds this year, without trying to. This year, I tried a vegetable supplement called moringa, for the nutritional benefits, as it is a natural source of amino acids. It turns out it has lots of nutrients in it — I just found I ate less; I was satisfied with smaller and smaller portions. It’s just ground leaves of a tree, and can be purchased as capsules, or tea leaves. As for side effects: just good ones!

    What I learned about it is uplifting: I am wondering if early humans co-evolved with it. (It is thought to have originated in Africa.) It is one of the “Lost Crops of Africa” and the National Academies of Science have identified leaves of the moringa oliefera tree as one of the most hopeful ways to increase nutrition (the trees grow wild in Africa and parts of Asia), the other parts of the tree are wonderful, too: to address global health problems (other parts of the tree almost magically purify turbid water), address poverty and energy issues (the nut oil is a cash crop women can make in their own yards, as it makes the best biodiesel, cleanburning lamp oil & many other high quality products), make unpleasant places more liveable (shade, screens, living fences), and food for livestock (they love the leaves), etc. (It’s thought to have many health benefits, too, in terms of curing and preventing ailments.) This is all described in “Lost Crops of Africa: Volume II: Vegetables”

    http://www.nap.edu/openbook.php?record_id=11763&page=246

    I learned afterwards that many athletes take it. Some Pgh Steelers said they often recommend it to family members, too — and that the common experience is that family member feels better, too, wrt things like arthritis — and, by the way, they lose 30 or 40 pounds, at first.

    Oh, and the trees sequester carbon in the soil, so they are good for climate change issues (whereas Iowa corn is not.)

    I don’t like to hear preaching about “healthy” foods in general, as I think people’s bodies are so different, there is no such thing. But maybe moringa is an exception. At least, I felt I wanted to share my experience.

  49. ali Says:

    i think it somewhat short sighted to refer to ‘published literature’ as though it a golden record of best attainable facts. not even (good) scientists are that confident in the scientific method! what is needed is scientific humility (recognising the bounds of what can be known through such a method of knowledge acquisition) and good critical thinking when engaging the literature. admittedly, epistemology and the scientific method are not well taught areas … (we really need to fix this!)

    sure, there seems to be more at work than a simple equation of calories in/out, yet this new discourse seems to have emerged at a time when the soda industry and associated saturated fats and sugar foods have come under greater and greater scrutiny, with calls for improved labeling, controlled advertising and restricted access in certain environments (schools). coincidence? perhaps, but looks like it could be brilliant propaganda too. is this possible? sure. check the validity of some anti depression studies as exposed by a team of scientists. much like the science published in favour of gene maniuplation companies, there were interests at the center and so the data skewed in their favour. a little critical thinking, and digging into the grant history of those on research teams, seems the most effective approach with such queries, if one has time and interest. but the point is that what gets published represents ‘interests’ and not simply facts.

  50. ali Says:

    and what isn’t asked here in terms of costs is the ‘other’ lives traded for this ‘easy’ weight loss. what moral cost re vivisection when one forgoes the effort/will power option?

    further to this, the double speak of the word ‘diet’ is frustrating. i have a specific diet that i prefer to refer to as a lifestyle for this reason.

    a lot of people find they lose weight (or gain, if that is what they need) when they cease to ingest foods that they have an intolerance to. then there is gaining a healthy weight on a cruelty free diet (without soda drinks). yes, there is published data and the bonus is that you fall into the lowest category for the gastro intestinal cancers, diabetes and heart disease.

    the term diet is wrapped up in notions of restriction, limits and lack, yet those who engage a cruelty free diet with some knowledge gain a huge array of food choices. as for suggestions of privilege, which has been a legitimate association, it is cheaper. so this connection is not a financial one but rather a cultural one which i wont hash out here.

    Note – my ‘diet’ doesnt appear on the studies previously referred to as representing will power failure in weight loss, yet studies consistently refer to the weight loss and health benefits of a vegetarian and vegan diet. i wonder why its not included? perhaps i’m missing something …

    i know its capitalist blasphemy, but if there were a ban on marketing junk/gmo food and it werent so accessible to children, do we think this will power issue might be improved some? seems like people keep pointing the finger all over the place but rarely where responsibility for actual actions reside (in a fair manner). emphasis on that last bit :-)

  51. Bijan Parsia Says:

    A few quick comments:

    To swallerstein:

    It is, indeed, dominent clinical practice in many countries to stress weight loss and to propose diet and exercise as the primary modality. It was also the dominent clinical practice to require a vigorous prostate and breast cancer screening program. We’re in the midst of a revision of that clinical practice as the evidence continues to roll in and similarly with respect to weight loss as a health goal.

    There are negative effects of making weight control the focus of diet and exercise changes (see some of the articles I, and others, have linked to). So while I laud your concern for other people’s health, I do suggest that we need to take into account the best available evidence (with the knowledge that our conclusions may need to change as new evidence comes in).

    No one thinks, afaick, that eating well and exercising should not be strongly encouraged. (Though, recent evidence on the exercise front suggests that breaking sedandery behavior is more important: vigorous exercise doesn’t seem to compensate.)

    I am a mere interested layperson with a variety of health issues including struggles with eating, weight, and exercise. I try to delve into the actual literature when I can and follow some research blogs. But everything I write on this topic should be taken with even more qualifications than the fallibility of the underlying empirical science.

    To ali:

    i think it somewhat short sighted to refer to ‘published literature’ as though it a golden record of best attainable facts.

    I’ll take that as directed at me, given my exchange about the literature.

    I don’t think I, or anyone else in this thread, have referred to the literature as a golden record of best attainable facts. Indeed, my initial point was that Harriet’s comment about willpower is supported by an emergine scientific consensus and thus wasn’t a failure of epistemic humility. I also strongly prefer studies to reports of personal observation: It’s not that nothing can come from personal observation, but there’s generally no attempt to correct for known problems or even to document them.

    not even (good) scientists are that confident in the scientific method!

    If by “that confident” you mean “think it’s a golden record of fact” then sure. No one sensible thinks that. I’m not sure what that shows though. There’s lots of great metaresearch (Ioannidis is the obvious standard bearer). The mere fact that the consensus about obesity is shifting shows that one cannot just read the truth off what we currently believe. And yet, I strongly prefer looking at the literature than relying on my personal experience or casual observation of others, esp. for generalizations. Esp. in public health.

    That all human endeavor is modulated by the interests of the participants is obviously true, but I don’t see the relevant of the observation here. If you think I’ve been insufficiently careful in some way, I’d love to have some specifics.

  52. [...] great posts and articles on bodies and size and fat. On Feminist Philosophers, what say you found a magic pill for weightloss? Would you take it, even with all the nasty side effects? And via Feminist Philosophers, a link to a [...]

  53. JT Says:

    I think many commenters are right to point out that the literature being cited might be inconclusive, and that the ‘scientific method’ that is being applied in these studies is not a ‘golden record of fact,’ but this concern alone is not enough to discount the studies. Unless confounding evidence (such as some specific reason to discount these studies) is presented, we should trust them. Maybe personal experience can provide this confounding evidence, but I share Bijan’s mistrust of such reports.

    I haven’t been able to find the full studies (only the abstracts) in my very limited searching, but here is one potential reason to discount the studies – they are studying people who went to medical professionals for weight loss help. Those who do not need medical professionals for help with weight loss might have better results with diet and exercise. (Again, I don’t know if this is the case, I’m just speculating).

  54. Synaesthetik Says:

    Between hypothyroidism, sleep apnea, and fleas on my dog, I have most of those symptoms anyway…The cost is the only prohibitive thing on the list!


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