Here is a curious article called What Happens To Your Body If You Drink A Coke Right Now? The descriptions of metabolic processes lack context, so it’s unclear how normal or abnormal the body’s reaction to Coke is. Since I lack expertise in this area, I can’t offer an informed opinion on the effects of Coke vs. a Krispy Kreme donut or a spoonful of peanut butter. However, I don’t believe that the effects of any Coke-like beverage are any too good.

I pretty much stopped drinking the stuff a few years ago. When asked why, I usually respond that what amounts to sugar water no longer appeals to me. (It still tastes good to me, but it doesn’t help me to eat healthily.) And as the article says, buried down in the footnote:

Coke itself is not the enemy, here. It’s the dynamic combo of massive sugar doses combined with caffeine and phosphoric acid — things found in almost all soda.

I admit, though, that it’s hard to escape soft drinks in one’s diet. They’re bundled with meals, mixed with alcohol, and closely associated with a variety of activities and behaviors. For instance, I can hardly bring myself to see a movie in a theater without also getting a popcorn/soft drink combo. Those combos usually come with 32 oz. drinks and free refills. No wonder why everyone queues outside the restrooms after the movie lets out.

From the Disability Law Blog (thanks to Blue for emailing me the link!):

This morning, the Sixth Circuit issued its decision in EEOC v. Watkins Motor Lines, Inc. The EEOC had brought suit on behalf of a worker who claimed he had been fired because of his morbid obesity (he weighed up to 450 pounds). The Sixth Circuit held that the worker did not have a “disability” for purposes of the ADA, because he did not show that his obesity had a “physiological cause” and therefore qualified as a “physiological disorder.” Although the EEOC had shown that the worker’s weight was more than 100% greater than the norm (sufficient for a diagnosis of morbid obesity under the traditional definition), they failed to show that the weight was “the result of a physiological condition.”

This decision seems to me quite confused, though it’s a confusing area so I cut the court some slack. What does it mean to say that morbid obesity has a “physiological cause”? All of our behavior has some physiological cause, if only from hormones and brain activity. And there’s lots of reason to believe that brain proteins that alter appetite and activity levels, not to mention genetics, are substantial contributors to morbid obesity. More broadly, every fact about our body is by definition physiological. And morbid obesity, being a condition of one’s physiology, is by definition a “physiological condition.”

So the problem can’t be that the worker’s morbid obesity had no “physiological cause” or was not a “physiological condition.” The problem has to be that he had no physiological “disorder.” But what does that mean? The theory of “disorder” can’t be a condition that has some identifiable organic etiology, or most “syndrome”-type conditions would be ruled out. We often just don’t know what the etiology of a particular condition is, even when doctors diagnose it, recognize that it calls for treatment, and treat it. For it to make any sense, I think “impairment” has to be defined medically — according to what are the conditions that are the basis for recognized medical (and psychological, since the statute includes both physical and mental impairments) diagnoses. On that score, morbid obesity that meets clinical criteria should always be an “impairment” — which doesn’t mean it will always be a “disability,” as the plaintiff will still have to show actual or perceived substantial limitation of a major life activity.

The Court’s decision can be read here (pdf link). I think they made the wrong decision, but maybe making the wrong decision is the right thing to do at this time. Basically, they argued that for an obese person to qualify for ADA protection, the obesity must have a “physiological cause.” But it’s a little tricky to support that interpretation based on the text of the ADA itself. The relevant section of the ADA reads:

Any physiological disorder, or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genito-urinary, hemic and lymphatic, skin, and endocrine.

So the court is in the position of arguing that obesity has to be shown to be a physiological “disorder” and not a “condition” to qualify for ADA protection – even though the ADA’s own definition clearly includes physiological conditions. To see how finely they had to chop their arguments, consider this: Judge Gibbons, in her concurrence, concedes that a “literal” reading does not support the Court’s position, but argues that a missing comma which existed in an earlier piece of legislation the ADA took its language from should be the controlling authority.

I think that fat acceptance and disabled rights, while not identical, have significant areas of overlap – both literally, in the bodies of people who are both disabled and fat, and philosophically. In the end, both movements are about the idea that there is no one correct form that all human beings are obliged to fit into, or to work to become; and that all human beings, regardless of how their bodies differ from the average, are deserving of equal dignity and equal rights.

Perhaps the biggest difference between anti-disabled bigotry and anti-fat bigotry is that disabled people are not seen as responsible for their “condition,” whereas fat people are by and large blamed for being fat. I think this underlying prejudice is the unstated logic driving the Sixth Circuit’s decision. While obese people who can prove that their obesity is not their fault may be covered by the ADA, obese people in general are to blame, and thus must not be covered by the ADA.

So why did I say “but maybe making the wrong decision is the right thing to do at this time”? Because I think that when Congress passed the ADA, they probably didn’t intend for it to apply to most “morbidly obese” people, because the Representatives and Senators probably share the idea that most obese people have only themselves to blame and can reasonably be discriminated against by employers. I worry that if the Courts found that the ADA covered all “morbidly obese” people, the result would be a backlash against the ADA and the Courts, at a time when the ADA itself is still very controversial and not totally secure. Probably more work needs to be done to change the “hearts and minds” of the American population about obesity; court victories based on the ADA might not be sustainable until the fat acceptance movement has achieved at least a small degree of mainstream acceptance.

Late last month, a National Cancer Institute study published in the New England Journal of Medicine was given a lot of unskeptical press coverage.

This report, from the AP’s Alicia Chang, is typical in its gloom-and-doom prognosis:

Being a little overweight can kill you, according to new research that leaves little room for denial that a few extra pounds is harmful. Baby boomers who were even just a tad pudgy were more likely to die prematurely than those who were at a healthy weight, U.S. researchers reported Tuesday.

Fortunately for overweight people, the NEJM study is pretty awful, combining bad methodology with dishonest interpretation. The results of this NEJM study, if honestly reported, show that overweight people on average live as long or longer as “normal” weight people; and that the one group of overweight people who did seem to have a significantly elevated risk of mortality, were overweight 50-year-olds who lost weight.

Expect multiple “Alas” posts criticizing this NEJM study. Starting us off is a commentary by Linda Bacon, quoted here with her kind permission.

New Weight Scare Based on Faulty Analysis

by Linda Bacon, PhD, Nutrition Researcher and Professor, NAAFA member

At least 400,000 Americans die of overweight and obesity every year, making it soon to surpass smoking as the leading cause of preventable death [1]. At least that’s what the Centers for Disease Control (CDC) told us.

But an updated federal report, published last year in the Journal of the American Medical Association (and reported in the Late Spring 2005 NAAFA Newsletter), acknowledged that the previous analysis suffered from computational errors [2]. In fact, obesity and overweight only result in an excess of 26,000 annual deaths, far fewer than guns, alcohol or car crashes. And separating overweight from obesity reveals further interesting information: “overweight” people live longer than “normal” weight people.

The data weren’t surprising to those of us who study these issues. This is not an anomaly, but consistent with many other investigations. That it came from the CDC and got published in JAMA were the real astonishing facts.

We waited for the backlash. Fear-mongering about weight is worth billions to industry and is consistent with government policy. Few stand to gain from the news that overweight is benign, if not beneficial. The backlash has been slowly building, and recently came out full force in a highly publicized study published in the August issue of the New England Journal of Medicine [3].

The front page leader in my local paper loudly proclaimed: “Just a few extra pounds is bad for you” and the article title reinforced the message: “Study finds risks for the barely overweight.” Turn to the original report, and you find a consistent conclusion in the abstract: “excess body weight during midlife, including overweight, is associated with an increased risk of death.”

But before you dust off those diet books, let’s take a look at the data itself. The authors worked hard for their conclusion. They examined records from over a half million AARP members that had been surveyed over a ten year period. What they found was entirely consistent with the earlier JAMA report: “overweight” people had the lowest mortality risk. But that wouldn’t serve their purposes. NEJM’s press release wouldn’t look nearly as attractive with that headline.

So they subjected their data to numerous manipulations before finally arriving at a suitable conclusion. First they threw out data on people who were smokers or former smokers. Nope, still shows overweight as benign. They hid this with a sleazy method: using only the top (BMIs of 23 to 24.9) of the “normal weight” group compared to the whole of the “overweight” group.

Then they found an even more creative trick. When they asked participants – some of whom were in their 70s – what they had weighed at the age of 50, they hit paydirt: at last, overweight – at midlife – was associated with increased risk, albeit modest. This will grab the headlines. No need to highlight that we had to whittle our data down to about 5% of the original sample to get this result! (That 40% of the participants chose to leave the question on recalled weight blank should give some indication of the ability of people to accurately report this information.)

Their paper is weak for many other reasons: they had a very low response rate (18%) from a sample that is not nationally representative; their data is based on self-report, which is known to be inaccurate; adjustments for potential confounders were weakly conducted; the list goes on. And they neglected to note another important conclusion: weight loss is associated with a significant increased risk of death for middle-aged “overweight” people.

Come on, New England Journal of Medicine. We expect scholarship, not propaganda.

References

1. Mokdad, A.H., et al., Actual causes of death in the United States, 2000. Journal of the American Medical Association, 2004. 291: p. 1238-45.
2. Flegal, K.M., et al., Excess deaths associated with underweight, overweight, and obesity. Journal of the American Medical Association, 2005. 293(15): p. 1861-7.
3. Adams, K., et al., Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old. New England Journal of Medicine, 2006. 355(8): p. 763-8.

(By the way, my usual email addresses have been broken for the last few days, and will probably remain broken for another week or so. Anyone wishing to contact me in the meanwhile should use “barryishere (at) gmail (dot) com”.)

I found myself watching an episode of “Hell’s Kitchen,” which was reasonably entertaining. But I hated that a fat kitchen staffer was berated for being fat by the host, Gordon Ramsay: i.e., “get your lazy fat ass in gear,” “you fat jerk,” etc. (I’m paraphrasing, but the gist is right). I tried to imagine the popular revulsion if the host had berated a Jewish worker in the same way – “get your lazy Jewish ass in gear” and so forth. Is there any question that the host would have been fired?

Looking online a bit, I find that Ramsey also constantly referred to contestant Sara Horowitz (pictured) as “a fat cow,” “a bloody cow,” “a stupid mouthy cow,” etc. (Ramsay did this so often that another contestant bought Sara a toy cow as a gag gift). Unlike the fat man Ramsay berated, Sara isn’t fat. But she’s not skinny, and on TV all non-skinny women are considered fat.

(The final two contestants were both model-thin. If Ramsay had called Sara “a Jewish cow,” and if all Jewish contestants were cut before the final round, wouldn’t people be questioning whether or not Ramsay’s judgements were unbiased?)

Anyway, what the hell, at least fat people appeared. On TV, that’s a pretty rare thing.

In other news, I took this “Rate Your Life” quiz (via Melancholy Revolutionary). I understand that quizzes like this are just fluffy entertainment, not to be taken seriously. Nonetheless, I was struck by the fact that three of the opening questions asked me to put myself into categories that I just don’t fit clearly into.

Am I overweight, or healthy weight? The question implies a contradiction between being “overweight” and being “healthy.” And the answer to this one question made a very large difference in the results (see below).

Am I straight, or undecided? Nowadays I self-identify as a straight-leaning asexual, but that option isn’t included. There’s not even an “other” option – I’m either straight, gay, bi or undecided.

Am I married? Not legally, and not in the sense that the author intends. But I have two people I share lives with; we’ve lived together since the late 80s, and it’s a lifetime commitment. In terms of rating the quality of my life, my relationship with my life partners is as relevant as another person’s relationship with their legal spouse.

(There are other implicit assumptions in the quiz as well – for instance, the only choices for “sex” are male and female. But the above three were the ones that applied – or, rather, failed to apply – to me).

(Click below to see how my results changed depending on the above assumptions.)

Here’s the results when I describe myself as straight, single, and very overweight:

This Is My Life, Rated
Life:	6.5
Mind:	7
Body:	4.7
Spirit:	6
Friends/Family:	4.6
Love:	0.8
Finance:	6.9
Take the Rate My Life Quiz

And here are the results when I describe myself as undecided, married and of a healthy weight, but otherwise answered everything the same (insofar as the quiz allowed – a few of the follow-up questions change based on how you describe your marital situation and sexual orientation):

This Is My Life, Rated
Life:	7.2
Mind:	7.1
Body:	7.1
Spirit:	6.2
Friends/Family:	6
Love:	6.7
Finance:	6.7
Take the Rate My Life Quiz

What puzzles me is the slight change in my finance score. (It’s possible that I made a typo – answering “4″ instead of “5″ for a single item could have caused such a small change).