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Of Course You Can Be Fit And Fat
Undeniably fit ultra-marathoner Mirna Valerio (from a 2015 Runner's World story (am quoted))
How about I pose a different question.

Can you be fit and have diabetes?

Of course you can. It'd be ridiculous to suggest otherwise.

So why doesn't the question of whether or not a person can be fit and fat sound equally ridiculous?

Why instead do we regularly see articles like this recent one from the New York Times that cover the "controversy" of the fit fat person?

In part it's because these stories conflate fitness with being free from other chronic diseases and/or from the risk of developing other chronic diseases.

But is that the average person's definition of fitness?

I don't think so.

I think most people think of fitness as the thing one gains as a consequence of regular exercise. That's why when it comes to the question of can you be fit and have diabetes, it sounds ridiculous as of course you can exercise and have diabetes.

Well guess what, you can also exercise and have obesity.

And in fact, that same study on which the New York Times based their article, didn't even try to quantify whether or not exercise provided health and/or quality of life benefits to people with obesity (of course exercise does). It simply looked at the heart disease risk of people with obesity, who didn't have other chronic medical conditions.

So basically the study concluded that obesity ups cardiovascular disease risk, not that those with obesity couldn't be fit.

And exercise mitigates, to varying degrees, the risks associated with virtually all chronic diseases, and obesity is no different.

Coming back to why we see stories in even the world's most reputable newspapers framing fitness and fatness as a controversy, well I think it just comes down to weight bias - specifically the trope that assumes that anyone with obesity must be lazy, because without that bias as a backdrop, there really isn't much of a story.
Saturday Stories: Gene Drives x 2, and The Uncounted
By Mariuswalter (Own work) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons
Ed Yong, in The Atlantic, on how New Zealand's war on rats might change the world (and not necessarily for the best).

Carl Zimmer, in The New York Times, on why scientists believe gene drives (like the one discussed in Ed Yong's article) are too risky to employ.

Azmat Khan and Anand Gopal, also in The New York Times, with an incredible piece of journalism on the accuracy, or lack thereof, of America's bombing of ISIS.

And lastly, if you enjoy my blog, please consider a donation to my Movember fundraising for men's health initiatives. Thanks to the generosity of friends, family and readers, I'm 91% of the way to my $3,500 goal. You can give anonymously and it's fully tax deductible. Just click here! No donation is too small.

Physicians Best To Have Practiced What They Preach Regarding Lifestyle
A few days ago I put out a tweet that stated that physicians (and with more characters here I'll say other allied health professionals as well) shouldn't give lifestyle advice unless they've followed it themselves. Given it led to a varied discussion, thought I'd expand more here.

First, I'm talking primarily about diet and fitness advice which pertain to any diet/fitness responsive condition or simply on healthy living as its own aim.

Second, while I think it'd be terrific if all physicians continually walked their talks, this isn't a reasonable expectation. What is however reasonable, at least in my opinion, is that a physician providing lifestyle advice has spent at least some time following their own advice (barring of course any physical or medical limitations that might preclude same).

Living the whys, wherefores, real-life challenges, and logistics, of their own lifestyle advice provides physicians with insights and empathy that in turn will help in their understandings of their patients' struggles and barriers. That understanding is likely to improve the counselling and support those physicians provide.

Whether it's keeping a food diary, following a particular diet, cooking the majority of meals from fresh whole ingredients, exercising a particular amount each week or day, mindfully meditating, etc - spending a real amount of time doing so (my non-evidence based suggestion would be for a month at least) will make you a better clinician.

[And to be clear, as there were those online who wanted to extrapolate my statement into one that suggested physicians must themselves all live incredibly healthful lives and maintain certain weights - that's definitely not what I'm saying, nor of course does weight provide real insight into the health of a person's lifestyle (as plenty of people with obesity live healthy lives, and plenty of people without don't).]
        
Early Childhood Physical Activity Does Not Vaccinate Against Obesity
By Pete (originally posted to Flickr as determination_0970) [CC BY-SA 2.0], via Wikimedia Commons
It's not uncommon when I meet parents of children with obesity for them to tell me either that it doesn't make sense because their child is extremely active, or that inactivity is to blame for their child's struggles.

And while my confirmation bias is that weight leads to inactivity in kids rather than inactivity to weight, data is somewhat mixed, with some studies finding total daily energy expenditure in very young children is associated with lesser weight gain, and others, not.

One of the shortcomings of prior studies were that they focused primarily on energy expenditure measured during a child's first year of life, and didn't cover the period known as adiposity rebound whereby BMI typically decreases until the age of 4-7 years before beginning to increase through late childhood.

A recent small study, High energy expenditure is not protective against increased adiposity in chldren, included that time period.

Briefly, 81 subjects who were classified as either at low risk of developing obesity (in that they had lean mothers with an average BMI of 19.5), or at high risk (mothers with an average BMI of 30.3), were recruited, and 53 remained through to the study's conclusion of 8 years. Three measures of adiposity at 8 years were collected - BMI percentile, BMI Z-score, and percent body fat. Total energy expenditure was measured using doubly labelled water at 4 months, 2, 4, 6, and 8 years of age (though only 58% of all total measurements were collected). Body composition was measured by way of bio-impedance analysis at ages 0.25 and 2 years, and by way of DEXA at ages 4 and 6.

What was found was that total daily energy expenditure increased with body size, but,
"there was no evidence supporting the hypothesis that a low habitual TEE for that body size leads to subsequent increase in BMI or % body fat"
Nor was there an association between measures of adiposity at age 8 and total energy expenditure between the ages of 0.25 and 6 years.

The authors overarching conclusion is that when it comes to the genesis of childhood obesity, it's energy in, not energy out.

I can't help but wonder, were that to be the prevailing belief, would parents with concerns about their children's weights be more conscious of their children's diets (especially liquid calories and purchased meals) as energy-in is something that many parents deemphasize during our initial discussions.
Saturday Stories: Trump's USDA, ORBITA, and 'Woman, Black',
Michael Lewis in Vanity Fair on Trump's USDA.

James Hamblin in The Atlantic covers the ORBITA trial and wonders how much of heart disease is a state of mind?

Future physician Chika Oriuwa with her spoken word poetry slam 'Woman, Black'

More Evidence That More Exercise Doesn't Up Total Daily Calorie Burn
Why is it that exercise doesn't seem to help appreciably with weight loss (and for those who enjoy building strawmen out there, note I'm talking about weight loss, not fat loss, nor fitness, nor health)?

One possible reason is that many people eat back their exercise in the form of a reward for doing it, or because they have been taught by savvy marketers that they need to refuel or recover something or other.

Another possible reason is that upping intentional exercise may lead bodies to decrease unintentional calorie burn (decreased fidgeting/NEAT, decreased autonomic tone, etc.) and also by way of improved exercise efficiency.

Overarchingly the latter theory is called constrained energy expenditure, and the evidence on all of this is early, and somewhat mixed.

Well a few months ago another block was added to the pile (at least for older women without obesity) suggesting constrained energy expenditure is a real phenomenon. It was a study published in Physiological Reports and it detailed the impact that a 4 month long moderate-intensity walking program had on the total daily energy expenditures of older women without obesity.

The study's 87 included participants reported being physically inactive, and weren't found to have any significant medical issues. The group was randomized into either receiving one of 2 doses of moderate intensity exercise for 4 months. Importantly, the exercise itself was supervised. Before and after measurements included resting energy expenditure (via indirect calorimeter), total daily energy expenditure (via doubly labeled water), body composition (via DEXA), graded exercise test (via treadmill VO2 max), physical energy expenditure (TDEE*0.9-RMR (to account for thermic effect of food reduced by 10%), and NEAT (by subtracting exercise energy expenditure - physical activity energy expenditure).

When it was all said and done, the lesser group added an average of 105 minutes of walking to their weeks, while the higher group added 160 minutes to their weeks.

There was a teeny tiny bit of weight lost in both groups (1.7lbs), and a tiny change to body fat percentage (-0.7%), but there were no between group differences. Expectedly, V02max improved more in the larger amount of exercise group.

What didn't change?

Everything else.

Despite marked increases in intentional exercise, and marked differences in adhered to doses of exercise, there were no differences found for participants' total daily energy expenditures, resting metabolic rates, NEAT, non-exercise physical activity or even total physical activity.

These results changed some when they further analyzed the data as they determined that those patients with higher baseline levels of physical activity showed lower levels of NEAT (important to note, difference did not reach statistical significance) post 4 months of exercise, whereas those with lower levels of baseline activity experienced decreases to resting metabolism with exercise (authors suggested latter might be due to weight loss, but given how small weight loss was, I find this confusing as the RMR drops were not small).

All this to say when it comes to exercise and its impact on calories burned, it's clearly far from a simple math formula. It's also incredibly unfair to weight. But as always, when it comes to improving health, nothing beats it.

[Thanks to Matt Woodward for sharing this study with me]
Guest Post: Special K Nourish Ad Perpetuates Supermom Nonsense
I've never been a fan of Kellogg's Special K's pretending to give a crap advertising, and so when I received an email from longtime reader Rosemary, who was unimpressed to say the least with one of their latest ads (embedded at the end of this post), I asked her if I could share her thoughts. She kindly agreed. Raw to say the least, and though I don't fully agree with every sentiment expressed herein, I'm betting they'll resonate with many.
I know soooo many women (and men!) that eat these products - thinking they are a whole / healthy choice.

This ad is so much ugh. Of course they had to throw in the shot of the well-endowed woman in the bra. "Casually getting dressed" ... while literally stuffing her face. Geneen Roth would not approve! Lol.

The whole "I am woman hear me roar - I can do anything - I am fierce - around food / being in charge of the food / feeding the kids - this media trope is so such nonsense. I dont know any women that work / live / eat the way this ad depicts.

Just perpetuating that myth -women- no, we don't deserve time carved aside to eat calmly - we are just too damn busy being everything to everyone. Just perpetuates this super mom woman role nonsense.

Most women I know / especially those with young school age children LOATHE grocery shopping / planning meals / making lunches / cleaning up (cuz let's face it, cooking proper whole foods is more work) / and just generally feeling the societal pressure to excel to be creative (and inspired! (Oh shut up Jamie Oliver))- about feeding their families. (And isn't this just code for "if you love your family you should be obsessing about this too like every other delusional Martha Stewart wannbe? Most of us are just so exhausted from overwork / we lose the motivation. In secret, we all admit how much we hate it and what drudgery it is.)

And there Kellogg's is trying dutifully to hit all their "diversity notes" - woman motorcycle mechanic / buzzcut lgbt-ish rainbow wristband girl - / It is all so contrived.

They are depicting the overworked woman - and they are the solution, when in fact, eating their crap that masquerades as "breakfast" and "food" probably actually contributes to feeling exhausted - re unstable blood sugar - carby weight gain - making one less energized to shop and prepare. It's a cycle.

I know when I eat next to no processed food - my energy levels are great. After about 4 days of not eating any crap.

The cereal is 10g's of sugar per 3/4 cup serving. That would maybe cover the bottom of the cereal bowl. No one eats only 3/4 cup of cereal when they pour a bowl.

And the granola bars are even worse - palm oil - and many different forms of sugar. Cane in the chocolate and corn syrup.

No reply necessary - yer bizzy - just wanted to pass it along.

Saturday Stories: Global Trolling, Pain Empires, and Fake News Towns
A non-bylined piece (at least not that I could see) in The Economist explaining how the world has been trolled and why social media is to blame.

Patrick Radden Keefe in The New Yorker on the Sackler family and their empire of pain.

Caitlin Dickerson in the New York Times on what fake news did to Twin Falls, Idaho

[If you find this blog entertaining, interesting, and/or valuable, know I'll never ask you for money to read it, nor will I subject you to ads, but I will, once a year, ask you for donations to support my #Movember efforts. Please to report I'm nearly halfway to my $3,500 fundraising goal! Click here to give. No amount is too small, you'll get a tax receipt, and if you don't want it known by me or anyone else that you hang out here from time to time, you can give wholly anonymously as well.]