Maggie's Farm

How a ‘fatally, tragically flawed’ paradigm has derailed the science of obesity

Yes, it is about carbs and not so much about calories.

That is the wrong question but James Q. Wilson's 2004 essay (re-posted at City Journal for 9-11) is good.

Why is it the wrong question? Because it makes it sound as if terrorism were some sort of pathology rather than a form of war for those without large armies and weapons.  

The Truth about Autogynephilia

After having spoken with many people, over decades, about their lives and sometimes their wildest sexual fantasies, I still find the gender identity issue sort of strange. I suppose I have heard it all, but have never seen a patient who was worried about their gender expression. I have seen plenty of gay men who were afraid to come out of the closet though. That was usually prompted by wives who wondered about their husbands' lack of sex drive.

Wild fantasies are normal, at least in people lacking in the usual sorts of repression of taboos. Perhaps the political climate is making way for the overcoming of sex and gender taboos. 

From Marilyn Simon's The Language of Sex, at Quillette:

 My students, for instance, are surprised to learn that of the 154 love sonnets that Shakespeare wrote, the first 126 of them are to a young man. (The final 28, give or take, are love sonnets to the “dark lady,” who is characterized as both sexually experienced and sexually active, with desires and a will of her own. A woman adored and respected, deserving of admiration and love. So much for repressive patriarchy.) The question students invariably ask, then, is: “So… Shakespeare was bi?” To which I reply, “I think Shakespeare would have simply characterized himself as a man, a husband, and a father, though he clearly had an attraction to the beautiful young man of the sonnets, to say nothing of his many characters who demonstrate sexual flexibility in identity and desire.” “But then he’s bi!” they insist. To which I reply, “I think Shakespeare would have found our need for precise labels strange. Why do we have the need to define and to categorize human desire? Why this compulsion to attach precise labels to attraction, lust, and pleasure? If what Oscar Wilde says is true, ‘To define is to limit,’ then is it really Shakespeare and his contemporaries who are more repressed than us moderns because they didn’t self-identify as a category? Or is it us who try to contain our sexuality by itemizing every possible iteration of lust and attraction? Are we ready to assume that because we attach a label to human sexuality, we somehow understand better than Shakespeare did? Are we in a cultural position to say that Shakespeare’s insight into human nature is limited compared to the average 19-year-old student’s today?”

Is Obesity A Lack Of Will, A Poor Lifestyle Choice, Or A Disease?

I term being overweight (aka fat) simply as a physical condition regardless of how it came to be. Many people seem to be quite content with being heavy even though it is not fashionable or entirely functional.

When people I see want to lose weight, I offer simple nutritional advice. Once in a while, they take it. 

How What Was Good Became Ugly and Then Bad

In history, being fat was a sign of prosperity. In this world of food abundance, it is the opposite: "You can't be too rich or too thin."

Money is great but it can't buy happiness, and you can be too thin but that is another issue. 

There is "cardio", and then there is real Cardio exercise.  What many people, especially women, do for cardio is actually endurance work: Swimming a mile, fast walking, stairmaster, treadmill, elliptical. An hour or four of endurance work per week will keep you moving, but it's not really Cardio for a relatively healthy person.

Real Cardio means training the heart muscle (the invisible muscle) and stressing the cardio-pulmonary system. For the Cardio component of our Fitness For Life program, we recommend some endurance cardio but, more importantly, HIIT cardio training. 

What does it do? Primarily, it builds cardiac muscle and cardiac vessels. We need those for life exertions (eg mountain hikes), for endurance, for energy, for our sports, and, sadly, to help us survive our first or second heart attacks. Since most of us will die from cancer or heart disease, why not postpone the latter if we can, and have more energy and life vigor in the process? There's some evidence that it might help postpone dementia too.

HIIT entails maximum sprints, 30-45 seconds, integrated in a regular cardio program. You want your heart rate near you max output, 90% or more. This can be done with swimming, treadmill, stairmaster, Jacob's Ladder, rower - whatever.  Best not to undertake this without a stress echocardiogram and your doc to clear you first to make sure you do not drop dead in the gym. That would be embarassing for you and for them.

Customizing your HIIT workout. 

If you do 5-10 fully-intense, max effort cardio sprints on your cardio days, you will feel it. A bit of dizziness means you've done your best. Good calis classes offer this too, and you can, of course, exert yourself to your own best level.

Reminder: Whether you do "long-slow" exercises, or do HIIT, or jus take walks or swims, none of these will offer you any meaningful loss of abdominal fat. Fat is nutritional unless you workout 6 hours/day.

Not "social science". Real science. Dr. Ioannidis is on the video panel.

Immune system “clock” predicts illness and mortality

As researchers unravel the molecular machinery that links exercise and cognition, working out is emerging as a promising neurotherapy.

Part 1 is here 

Now to the related topic of Satiety. 

It was not long ago that being pudgy or having a bit of a gut signaled prosperity, and leanness signaled lower class. Now it's the opposite. With incredible food abundance, and with obesity always in the news, funding for nutrition-related studies has grown.  So now we know a lot more about how insulin works and about how the three food categories (fats and oils, carbs, and protein) are handled by the body. We are also learning about how hunger and satiety work. It's quite interesting but complicated.

These are "First World issues."  In our world of nutritional abundance, recreational, social, and emotional eating, and the constant temptation of food porn, "hunger" often does not denote a need for nutrition except for the skinny, and satiety is often over-ridden by habit, speed-eating, stomach-stretching, delicious foods, sugar-and-carb dosing, and insulin-resistance.  That is what it means when overweight people, who have no pressing energy needs at all other than water, vitamins, and minerals, eat hungrily two or three times a day. We term that appetite "false hunger" not because the appetite is not subjectively experienced but because appetite has, for them, disconnected from nutritional need and satiety signals (which are very slow to go into effect). That luxury used to be only for the wealthy.

It's like the flip side of anorexia. Anorexia nervosa is famously difficult to ameliorate, but it is not too difficult for most pudgy or fat people to re-set their bio-psycho-social food-o-stat if they want to. For starters, that entails small portions, plenty of protein to satisfy the hormones, and very slow eating so as not to short-circuit the awareness of the moment at which "That's enough to sustain me, because I don't feel hunger anymore." That way, the "Eat 'til I'm filled or stuffed...now I'm stuffed" effect never has to happen.

In the Western world, "sufficient" can be the stopping point, not "filled." Except Thanksgiving, when feeling ill from getting stuffed with stuffing is expected.

Being too scrawny, with underdeveloped muscle and bone, is life-limiting and unhealthy, but not as life-limiting as carrying excess fat around with its lengthy list of associated ailments. There's no need to carry it on your body, because there's a pizza joint on every corner to prevent sudden death from starvation.  Most people, fortunately, make themselves sensitive to satiety signals most of the time so most active adults are neither significantly under- or over-weight. 

Obviously, little of this applies to most children and adolescents. 

Where did the cultural habit of three square meals per day come from?

 It's quite recent, actually, and really a European cultural concept. More specifically, a British aristocratic concept because even today an Italian breakfast (except for the tourists) is an espresso or latte and a biscotti, and a typical French breakfast is a cafe au lait and a croissant. Typical Italian supper?  Soup and bread, or cheese and leftovers.

"Eating between meals"? I suspect people might feel better with 5 mini-meals - balanced snacks, really, because stuffed and lazy after supper is not an effective life plan. Stuffed and lazy after any meal is not a good plan except on Thanksgiving. Serious exercisers and athletes tend to discipline themselves to a 5 meal program to keep the nutrients flowing. They have to eat when they aren't hungry to maintain their level of fitness and power, and to keep their weight up.

A mini-meal for many can be something like a couple of slices of chicken and a handful of olives, or an apple and some cheese slices, maybe a slice of pizza or a cup of yoghurt or oatmeal with berries. Volume and details depending, of course, on total muscle mass, body frame, daily physical demands, physical goals, etc.  Body-builders need 4-5 full meals daily to put on muscle mass, while the old-fashioned three squares/day will make most adults flabby if not obese.

To understand what your body needs, look at it nude in the mirror. One look will tell you what it needs in fitness and nutrition in terms of muscular development, leanness or fatness, posture, etc. When it comes to food, we can't listen to our body too much. It's a liar because it was programmed for scarcity a long time ago, before agriculture. Humans seem to have the instinctive inclinations (eat, nap, fight, play, sex, and repeat until dark when the predators come out) of monkeys, chimps, and gorillas but we have some added higher capacities, or so the scientists claim.

A brief history of the origin of three meals/day.

Part 2 tomorrow will deal with hunger, appetite, and satiety. 

From Mate Selection for Modernity:

This mathematical model offers key insight into our unbalanced sexual marketplace. The number and weight of a woman’s mate preferences is negatively correlated with the number of eligible mates that are available to her. Thus, the distance of a prospective mate to a woman increases with each new preference she adds. Put simply, the more you demand, the less you receive.

More generally, there’s a disconnect between what women want and what is actually available to them. Whereas greater male attainment increases the number of romantic options a man has, greater female attainment reduces the number of options a woman has.

I quit them years ago when they were hijacked by lefty functionaries. 

This new AMA position paper is crazy, illiterate, and only comprehensible in tone: AMA Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity.

It sounds like the Babylon Bee. 

More evidence is emerging

A friend sent me this 2019 piece by New Yorker art critic Peter Schjeldahl. I always said that when my time came I’d want to go fast. But where’s the fun in that?

It's about his life.

Ozempic (semaglutide) had been approved by the FDA for Type 2 diabetes, but now it has also been approved for treatment of overweight and obesity provided you have 1 weight-related problem (which could include arthritis, etc.).

It comes as a (tiny) weekly injection, done at home. 

It is mainly an appetite-suppressant, and a highly-effective one according to a couple of patients. It can have some GI side-effects, but is usually tolerated.

It is something to consider for those who have too much trouble with food. As we have often said, it's impossible to burn off dangerous deep fat with exercise.

A notice from my Department of Psychiatry today:

Topics for the Black Wellness and Healing course include "misogynoir, engaging Black youth, survivors of intimate partner violence and sexual violence, protecting yourself as an academic/ organizer doing Black liberation work, financial wellness, Afrocentric healing and spirituality, and celebrating the diversity of Blackness."

People give me random books to read.

The most entertaining way to get some sense of Chinese 19th C history: Flashman and the Dragon.

You can see where Mao came from. His horrors were just historically normal. Of course, this is historical fiction but Frazer tried to make it realistic. Sir Harry, I feel, was the original James Bond. 

From Amazon:

 Lusting after a clergyman’s wife, smuggling opium to Hong Kong, coupling with an Amazonian woman river pirate, groveling before a ruthless warlord, and becoming the sexual plaything of the most beautiful and evil woman in the world, Sir Harry Flashman, the supreme antihero of the Victorian era, is ready to rise to the occasion to matter what depths of dishonor he must plumb. In this uninhibited and uproarious adventure, Flashman is once again at his irascible best.

Maps in the head - How animals navigate their way around provides clues to how the brain forms, stores and retrieves memories

Transplanting solitary land animals to a new habitat can be a death sentence.

Loneliness is a sad human condition. Misanthropists, socially-phobic, and the overly-narcissistic might see it differently, but I feel that having a solid group of pals is an essential ingredient in my life. A few close friends, a bunch of lunch and couples pals, and plenty of enjoyable social friendlies. There are many things best talked about with friends instead of with spouses.

In tribal societies, everybody is, by necessity, connected but most Western people do not live that way now. Still, humans are social creatures. Humans also need support systems.

I once wrote a post about thinking about concentric social circles, from intimate confidantes to casual social aquaintances to work colleagues.  It was a good post, but I can not find it.

Scott Adams did a brief chat about how to make friends, at the 42-minute point.

Many people could use such advice. He hints that one thing to do is to join groups, and he is right about that. You also need to have something positive, pleasant, fun, or interesting to bring to the table. Having things in common helps a lot. Alas, some people are just not very likeable, and that is a handicap.

I know people who still have friends from grammar school, high school, and college.  Lifetime friends are a blessing.

At Mises

Right or wrong, family structures matter. 

Thank you, reader.

The Case Against Stretching: Scientists are increasingly skeptical of the benefits of flexibility, but the fitness world doesn’t want to hear it

 Stretching science has shown that this extremely popular form of exercise has almost no measurable benefits

Of course, these articles do not apply to physical rehab and physical therapy. 

NYT: Editor of JAMA Leaves After Outcry Over Colleague’s Remarks on Racism

If you do not get the NYT, here's the story:  Top editor at JAMA to step down following outrage over colleague's comments about racism in medicine