I’ve had health on the brain this week, so I decided to watch “Weight of a Nation” because I’m a masochist. I wonder if it’s a documentary like “Game Change” was a documentary.
This is a pretty basic break down of what is wrong with the documentary, but let me elaborate.

The first episode is called “Consequences.” The first minute is people talking about how they crave big macs, but they do drop in the fact that we rely on cheap foods. The idea that we need to fix the American diet with collective action is solid, but we don’t need to go on a national weight watchers program.

And then, they open the thing with the BMI. There are so many loopholes in the BMI, and it has been proven to NOT be the best correlation between weight and health. The BMI is a measurement of weight to height, not weight to blood pressure or weight to insulin levels secreted from your beta cells in your pancreas. Maybe the biggest indication that BMI isn’t a solid indicator of health is that we can set the cut offs arbitrarily. The Body-Mass-Index is an equation — a chart — and the cut offs are arbitrary. Not ‘flipped a coin’ arbitrary, but this study, and others like it, found that people who are over weight can live longer and have health risks similar to those in the average range. The two categories with the highest correlation to mortality are underweight and obese II (BMI under 18 and BMI over 35). If you looked at a bell curve of the population’s weight, it should be encouraging if the average weight has the highest rate mortality. If underweight people or obese II had the highest mortality, we would be screwed, too, because it’s really hard to hit those tiny, little corners of a bell curve. In addition, we’ve changed the BMI markers since the 1960s. Our definition of overweight and obese have changed. If you shift your parameters, change how you’re filtering information, then your data and the results it gives you will change.

During the videos of the Bulagusa study, you see them measuring people’s waist and using calipers to measure body fat. There is a stronger correlation between percentage body fat and waist:hip ratio and waist:height ratio, but correlation doesn’t equal causation. That’s statistics 101, so tuck it away in your brain the next time you read about something being linked with something else. The best example: ice cream sales and murders are at an all time high in the summer. Is ice cream making people commit homicide? (Hint: Nope.)

I support that people contributed to the Bulagusa study, and the one woman did mention her mother and grandmother had a history of heart disease. I don’t want to harp on this too much, but genetics plays a huge role in how much you weigh. I’m not going to fight out nature-nurture in this post (and those studies and any studies with humans can be notoriously difficult), but we should under estimate our biology. This is why fat and extreme diets (I’m talking to you, master cleanse) don’t work; our bodies want what they want, and to quote Jurassic Park, “Life will find a way.”

Even your rich kids aren’t protected from THE FAT. Poor children, by the way, were never ever protected to begin with.

And now, onto heritability! I promised I wouldn’t talk about genetics, but I lied. Did you catch that number? Obesity is a composite of genes, it’s heritable, and 60-70% of your risk for obesity is already with you when you’re born. Wait, Mr. CDC man, how did we jump from this to “but it has a small effect on obesity in the population.” Your individual people (data points) make up a bell curve. If obesity is mostly heritable, we can control about a third of our weight on the population level. They’re paying a lot of lip service to genetics in a documentary that wants to be about the environmental factors of obesity. I would prefer 70% of this documentary to be about genetics, and then we can talk about the aspects of environment that actually contribute to that last fluctuation in weight.

But onwards! To Brooklyn! And we get another salient fact about obesity rates: the poorest counties in cities are the most obese. And then we get the dreaded “1 in 3 children are overweight or obese”. Also, see what they’re doing: they’re grouping together at least 2 groups of the BMI scale. If they grouped together average and underweight, would the data say “2 in 3 children are average or underweight”?

“Is Bogalusa special, or do we just have 35 years of data on this city?”

This is what I would call a statistical rhetorical question. To logic this one out, they said the study was one of a kind, and then they implied that study could be extrapolated to the entire country. As a bonus, a concerned school nurse is worried about “the obesity.” They refocus it with blood pressure, but damn, I feel bad for that child. There’s nothing worse than getting shamed by a school nurse. And then we get the quality line of “They’ll be on dialysis when they’re in their 30s.” The jumps in logic are amazing. Okay, if you’re looking at obesity in one of your most obese states, the data will be anomalous. Bogalusa’s rates diverged in the 1960s, but look at the national levels. They’re rising, but they’re leveling off, and there was a fall in the levels of childhood obesity between 2000 and 2005. In this period, Bogalusa’s rate of obesity continued going up.

At 30 minutes into part 1, we get some dissections. I love dissections, but the two hearts they compare are interesting, but they’re comparing two very different specimens. Hypertrophy is the thickening of the heart muscles. This does lead to heart failure, by the way. Even in the healthy specimen, you develop fatty streaks in your arteries.

We get pictures of fat people while a man talks about how we need fat for metabolic purposes. Then, we get talk about men as hunters and women as providers. Can we not use the words “elegantly designed?” Also, the most appalling moment in part 1 goes to the comparison of beautiful paintings with photos of modern fat people. The context is that the way we used to store fat was elegant, but now, it’s just gross.

“I’ve battled my weight my entire life.”

That is the sentence of doom. She’s been trying dieting her entire life, which is maybe why it hasn’t worked. When you fight your body and refuse to eat, you’re fighting your very physical existence. It’s damn painful, by the way, but we’re talking about the NIH study now. The woman admits she yo-yo diets, but she doesn’t want to stay obese because her cholesterol and body fat increased. Also, to get obese, she ate an extra 1000 calories from fast food. Yes, if you do it that way, I can see how you’re health would go to shit. Now, we get to the hitch: two people who have the same BMI and weight can have drastically different levels of health because they’ve got more fat on their liver. This is the most important point that Health at Every Size makes, and your health vitals are more important than your weight.

Maybe I was wrong. Handing that woman, who already seems to have issues around her weight, a blob of ‘fat’ was the most appalling part of this documentary. The study then put this woman on another diet. As a scientist, I think an interesting control group would have been to get a person to gain 10% of their body weight through eating healthy but calorie dense foods. I wonder what those results would have looked like, but that hypothetical study doesn’t seem to exist.

Oh good, we get ‘fat people are stupid’ and can’t perform ‘important cognitive operations’. It’s hidden amid a long list of diseases correlated to obesity. Let’s be clear: Type II diabetes is the one associated with obesity, and it works in a feedback loop, which is partially explained in the documentary. Type I diabetes is associated with people being underweight or with no weight difference. They explain the basic mechanisms of diabetes well. I don’t appreciate how they parse every pound the older man with diabetes gained throughout his life. It comes across as extremely condescending when you’re introduced to his current health condition. But their wedding picture is super cute.

I’m just going to quote HAES for the part about the costs in health care.

“If everyone was thin, would we still have this social problem?”

* There are problems with the way we produce food, and inequities in how we distribute food.
* We are living in an environmentally unsustainable way.
* We don’t have a functional healthcare system.
* The baby boomers are a big demographic group who are living longer and will cost more in their final phase of life.
* Our schools are struggling to feed, educate, and exercise our children with too few resources.
* The demands of making a living leave little time for caring for ourselves and each other.

Hedgehog break! Little hedgehog, big hedgehog! Love them both!

I’m done with consequences, which had more science than I thought it would have. Onto part 2: CHOICES!

People are filming the intro, which sounds like a diet add. Shit, they just asked the one man “Why are you fat?” And now, we get into diet pills. I like how they show the vintage weight lose add (RDX magic pills!), and then, have a fat man ask if there is a magical pill because he’s fat and lazy, get it? I’m only 5 minutes in. At least they brought back the MRI machines. They’re showing fat people pictures of burgers and cake. Good job, science, for proving ‘fat people like cake.’

Dr. Brownell speaks some truth: there is no miracle diet. Also, who doesn’t want to hear ‘eat more fruits and vegetables?’ Maybe it’s still the juice diet talking, but there are lots of fat people who eat fruits and vegetables. The chef they feature tells her story, and it’s full of how people (her mother, mainly) fat shamed her into buying a scale. She gets asked, “How were you able to do it?” I’m having flashbacks of “SuperSize Me.” I like Yolanda, and she seems awesome and loving herself, but it’s sad that she has to be in a weight loss group that mimics AA because I want her to be doing more awesome things with her time. I like how they’re talking about how Yolanda ‘tricks’ herself with KitKats. It’s also depressing how she describes eating the second half of a KitKat as ‘an accident.’

I understand why Yolanda is in this documentary. She’s amazing and likable, and she does say some sensible things. She notes she didn’t realize how much food she was eating. I’ve been there because it’s so easy, for people at every size and athletic level, to slip into eating mindlessly. She’s right that it does take thought to plan meals, and if you’re stressed and rushed, you just don’t put the time into it. This is where poverty and working link up with obesity; we don’t promote a culture where you can eat well easily. I can bet my entire fridge they’re going to cover school lunches later, but I think back to early in the year when the Congress defined pizza as a vegetable. We need to meet facts and make real vegetables and good food available to the people who need it most and not just ‘foodies’. I think of college culture and the ‘freshmen 15′ because the life style in cafeterias is to eat and eat more. Get pizza with your friends, fill your tray in the cafeteria, only the boring people diet, and everything goes when you’re drinking. Classes are stressful, and the culture is ‘fast and cheap’ writ large. Your individual choices only happen within that framework.

Back to the diet commercials; everyone admits to trying all of these diets. OH GOD, THE MASTER CLEANSE REARS ITS HEAD! We get the line, “Just eat a little bit less and move a little bit more.” How condescendingly obvious.

Macro-nutrients! I love them, they are the best. While calories are the base line, our bodies interpret eating these molecules differently. Yes, you can subsist on twinkies and lose weight because ‘calories’, but you’ll be malnourished. Even if they don’t want it, a brownie goes them for killing the idea that you need to cut one nutrient from your diet. You don’t! You need all of them, so eat them all, even the dreaded carbs and fats.

I feel for the woman who says she feels her body is fighting her weight lose. Well, yes it is because your body doesn’t like to starve. And yes, you can lose or gain 10 lbs or a certain percentage of your body weight ‘in a weekend’ or over a few months and then drop it just as easily. Us humans aren’t divorced from annual cycles and normal fluctuations. They do acknowledge that you have to eat about 20% less to stay at a lower body weight that someone who never had to lose weight. They acknowledge these eating habits, eating 20% less, have to be maintained FOREVER because this phenomena doesn’t go away.

A woman blames herself for being fat, and it’s sad. I would hate to be filmed for this documentary. They’re talking about fat people like they’re another species, and then, these people are asked to talk about how terrible their lives are. That’s a shit deal right there.

Dinosaurs never dieted because life finds a way.

What is bothering me the most is the condescension is wrapped in moments that really humanize people. Vivya’s story about being teased in school is heart breaking. She expresses the torture of growing up fat and dating while fat. She says she feels like she’s limited because she’s obese. While there were really terrible parts of this documentary, I would have watched the entire thing about Yolanda and Vivya become happy and more fulfilled humans. I liked them, and I wanted to see them living happy and amazing lives.

The vintage exercise adds are amazing. I loved the man lifting barbells in a suit. So many 80s jumpsuits! Can we stop equating every minute you exercise with the amount of food you eat? “I ate a cookie, now I must run 3 miles!” is a guaranteed way to hate your run. “I cringe when I see the biggest loser.” Me too, Only Sane Man! It’s brutal to watch people crash diet and hate every minute of their exercise.

The diet adds are back, and the people are talking about snacking and the extreme constraints during work. I said it earlier, but I’m going to say it again: we don’t have a culture where the average person is encouraged to eat well. It’s not easy for your average worker to work 40-60 hours a week and lose weight. You could say it’s almost impossible, really. The one woman said she only got a half an hour for lunch and bathroom breaks. One way to fix this would be to prioritize workers health, but in the first episode (CONSEQUENCES!) we’re shown that people are more likely punished for BMI by employers and government by being charged more in health care premiums.

The link between stress, poverty, and obesity is explored. The problem is not fat, but it’s the fact that we’re stressed. Yes, when we were hunters and gathers, we needed to replenish our fat, but getting mauled by tigers or getting hurt in a world with no medicine meant death was on its way. I can’t say I’m looking back with nostalgia on the good old days when I could eat pizza in exchange for having to hunt down my own mammoth. Instead of focusing on fat and weight loss, how about stress reduction as the focus? I would watch the follow up documentary, “Strung Out.”

Words not not use: stress soup, fat growing machine.

The man who owns a brick of how much weight he’s lost has a ticking count down clock play while he sits at the table and weights to eat. While the man was a little wonky, his story was the perfect example of how to screw up a documentary on people learning to enjoy food. They could have showed him sitting there, meditating over his food, but they added a ticking clock. That clock says, “You must wait X minutes before eating!” It puts the moment back into one of those ‘fad diet’ feels. “Wait 5 minutes and just sniff your food, and you’ll magically lose weight!”

“I sat down on a toilet seat and it broke,” one woman says at the beginning of the bariatric surgery part. I don’t know how I feel about this part, but it’s those peoples choices weather to undertake this surgery. It’s a serious choice and thankfully one I’ll probably never have to make. The judge who opts for bariatric surgery says why he’s doing it. He also mentions that, because it’s a surgery, he had to sign a last will and testament. It’s a small drop, and they site the statistic as a 1 in 300 fatality. If you’re not squeamish, watch the surgery because you get the idea how major it is. He’s in there for over 3 hours, and as I said, that’s not a light choice to make. They don’t half-ass this part, and to have this procedure, I imagine there would have to be very serious medical problems associated with someone’s weight. The man says he went through 6 months of discomfort, and the surgeon recommends “radical, behavioral change” after the surgery.

In the end, CHOICES had some very high points. There are points about people living better lives and connecting with friends and being amazing people. At the same time, the documentary undermines some of these moments by being condescending, and then, you get to really see how the fear of fat and fat shaming impact people’s daily life. These people are ashamed to look back on how fat they were, and it’s difficult to watch because so many of these people are so amazing. One idea that keeps coming up is that people under estimated how much they were eating, and it’s such a cliched idea, but the documentary wanted to hammer home the point that fat people must be stuffing their faces. I wish they would have included fat people who were healthy while they were fat and who were just fine with their weight. That said, there were fat people in this documentary who were living healthy lives, but this is — of course — after they lost some weight. This part suffered from a lack of fat, happy people who weren’t obsessed with weight lose, but were living a healthy life at their set point. The fact that many of these people didn’t get fat by stuffing their faces with pizza and donuts is apparent, and they go into the science and reasons why it’s difficult to keep weight off, but I think they hit the wrong conclusion. They jump from ‘stress’ to ‘mind less eating’ too quickly, and I wanted an entire section on how we, as a society, don’t value the average person’s health. Maybe that’s coming up, but you can only make an individual choice as far as the framework of your world and society allows you to.

AT the very end, the Only Sane Man breaks my heart by saying “You never know what attempt will keep it [weight] off.” That’s right, keep yo-yo dieting and one day, you’ll lose weight. This is a terrible message. There are parts where actual changes in health are mentioned, but the focus on weight does drive me nuts. The weight obsession comes from weight being something easily accessible for everyone to see. You can’t measure cholesterol easily, and not everyone is going to prick their fingers to test daily blood sugars, so weight is the barometer we use to eye ball someone’s health. But that’s just what we’re doing, eye balling it.

I’m taking a break, but I want to watch parts 3 and 4 later. Go read the first link from Health at Every Size. They’re more coherent about the problems in this piece, but I bet they quoted Jurassic Park less.

I hope we get a moment where they discuss how many calories you burn running away from dinosaurs.