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NYT Article on the "Fat Pack"

http://www.nytimes.com/2008/03/19/din...

Really made me a little sick to my stomach. Is it finally over? This obsession with fat?

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  1. I don't think it's an obsession with fat, but more the obsession with delicious food.

    I also think that the people interviewed were arguing that everyone's favorite foods have a place in a generally balanced diet, and also "foodies" need to find the flavor in alternative ways besides the traditional ways.

    It didn't make me sick at all - I was pleased to see the people take matters into their own hands vs. just say "screw it, this food tastes good so who cares!"

    3 Replies
    1. re: Jeserf

      IMHO, Perlow wasn't troubled by obesity. He WAS troubled when a doctor told him he'd be dead in 5 years if he didn't change his ways. It doesn't surprise me that his wake-up call came in Denver, which is one of America's fittest, most health-conscious cities -- despite its growing reputation for good food.

      1. re: ClaireWalter

        if he didn't care about how he looked, who cares? But ultimately being told "you'll die within 5 years" is admitting you're too obese to not change. Which in turn means he was troubled by the obesity - the cause of pending death and doom.

        His wake up call might have come in Denver because of the altitude, moreso than thinking "gosh I'm a fat butt compared to these people!"

        heh

        1. re: ClaireWalter

          Well, thats a big assumption on your part. :) I've been troubled by obesity all my life, but when a doctor puts a mortality number on it, it becomes a bit more of a priority to resolve.

      2. I'm glad that this article came out. Some people eat only with their taste buds and give absolutely no thought to the health ramifications. This article is reminiscent of the die at 68 /86 thread floating around here.

        It seems that the fat pack who say that genes are more important than lifestyle are those who don't want to take any personal responsibility. Both play a role in one's health.

        5 Replies
        1. re: Miss Needle

          I think that people who truly eat with their taste buds are able to enjoy a wide variety of foods, including really healthy foods that are not necessarily prepared with lots of fat, especially not with butter, but (small amounts of) healthy oils.

          People who only consider fatty foods and red meat as delicious food, are not eating "with their taste buds". At least not with very many of them.

          1. re: FoodWine

            Believe me, I'm the poster child for tasty food doesn't have to be full of fat and salt. I didn't mean the statement to be taken so literally.

            Just want to add that I wholeheartedly agree with you that people who can only appreciate meat and fat probably do have impaired taste buds.

            1. re: Miss Needle

              "Just want to add that I wholeheartedly agree with you that people who can only appreciate meat and fat probably do have impaired taste buds."

              I think it's less about impaired taste buds and more about overcoming fear, whether that be fear of trying something new, fear of not "keeping it real", fear of ridicule from dining companions, fear of violating some ingrained brainwashing from mom... or other neurosis.

              Rarely have I encountered an over-the-top carnivore who couldn't appreciate a well-conceived meatless dish when confronted with one and no avenue for escape ;-)

            2. re: FoodWine

              fatty foods are not nearly as "unhealthy" as are highly processed, sugar laden foods. I eat plenty of fat. It's good for me. And I'm pretty fit.

              1. re: luniz

                The article was talking about fatty foods and people who obviously do not eat vegetables, fruit or whole grain.
                ("Fat is my meat and meat is by vegetable" = disgusting!)

                I also nowhere in my post claimed that sugary and processed foods are good for anyone. On the contrary, I pretty much think of them as poison.

                But splitting hairs, by claiming that something is "less unhealthy" than something else that also is very unhealthy (i.e. pigging on fatty food) -is plainly denial. Eating a diet of mostly meats and fat from meat, lard and butter and cream is not healthy, no matter how much you try to convince yourself.

                And no, I am not a vegetarian. I eat red meat -in moderation, and only lean cuts. But not butter and not margarine, if I can help it.

          2. <b>Really made me a little sick to my stomach. Is it finally over? This obsession with fat?</b>

            Why would it make you sick to your stomach? The whole point of this article is that calls for balance in diet and in exercise. Are you saying this a "bad" thing? If so, why?

            31 Replies
            1. re: jwoodcanyon

              Of course not. It was the gluttony that made me a little queasy.

              "Although his father died from heart disease, he thinks that the state of medical knowledge on the relationship of diet to health changes so frequently that it can’t be trusted." It's that attitude. How frequently does it change?

              1. re: southernitalian

                Not to endorse Shaw's overall attitude, but I do think he's using a reasonable observation to make an unreasonable point.

                From 2000 to 2005 I was a writer at a company that publishes patient education materials -- you know, the kind of thing the doctor gives you if you've been diagnosed with galloping whatsis or you're going to have some sort of invasive test. We had to keep up with the latest standards as defined by the major medical organizations so that we could update our publications -- and for a while there, it did seem to me that the AHA, the ADA, the NHLBI, and the NIDDK were in the process of defining a healthy cardiovascular system out of existence. The threshholds for what was considered healthy blood sugar, blood pressure, blood cholesterol, and triglyceride levels were all being lowered (or, in the case of "good cholesterol," raised). And it's certainly true that nutritional advice, especially concerning fats and cholesterol, has gone through several metamorphoses over the last couple of decades. Fat is bad? No, just saturated fat. Oh, and transfats -- turns out it would have been better to eat butter instead of margarine after all. Sorry about that! And now it's possible that even saturated fats may not be as bad as we thought. As for dietary cholesterol, it's probably less of a factor in blood cholesterol than was once thought. And if you're one of those poeple whose liver likes to make cholesterol, you can't do a lot about it with dietary changes. Cutting salt will lower your blood pressure -- if you're salt sensitive (not everybody is). Plus, cutting salt is less important to controlling blood pressure than overall dietary patterns, especially consumption of fruits and vegetables.

                Nutritional studies are notoriously difficult to do well, due to problems with study design (how to you isolate the factors you're looking for? how to you control for things like childhood nutrition? how do you get people to stick with the parameters of the study for months or years?) and data collection (people are bad at remembering and estimating what they eat, and they also lie about it).

                And even the CDC goofed a few years ago in its statistics on death rates due to obesity and had to issue a correction saying that they had overestimated them. Oops.

                But that doesn't mean that it's a good idea to eat and drink to excess, because there's plenty of evidence that eating a lot of meat increases risk of heart disease and (possibly more significantly) some cancers. Obesity may not be quite as deadly as the CDC said it was, but it's still a primary risk factor for type 2 diabetes. It also puts stress on your musculoskeletal system, which is very bad if you have arthritis in your knees or hips, it can cause sleep apnea, and in extreme cases it makes exercise difficult or impossible. This is, as far as I know, undisputed.

                My personal opinion is that the main foundations of healthy eating are (1) eating a wide variety of fresh (or frozen) minimally processed foods, with an emphasis on vegetables and fruits, (2) avoiding junk (foods that are heavily processed, loaded with sugar or salt, and/or contain chemicals not found in nature), and (3) eschewing binging, grazing, and skipping meals. But this is primarily common sense, or used to be.

                1. re: jlafler

                  Oh, I totally agree with you about the medical knowledge bit. So many people jump on the bandwagon when a news article comes out about such and such food helping with such and such condition and how this mineral can help with this ailment, etc. People neglect to use their common sense.

                  That said, I believe that everybody has a right to stuff him or herself to oblivion if they would like to. I don't agree with it, but it's their choice.

                  1. re: Miss Needle

                    Believe me, I'm 100% with you on the stuffing your face to oblivion. Have at it. I was just encouraged when I read the article because it seems like the pendulum may be swinging back in the other direction.

                    1. re: southernitalian

                      I understand. While it seems like the rest of the country is dieting (I'm speaking hyperbolically), the foodie circle is one where the "health nuts" may feel ostracized, as if they just don't REALLY live to eat. I mean, I've seen all these threads about whether vegetarians can really be chowhounds. Of course they can. Some people have a very narrow definition of what a chowhound/foodie is.

                      I found this article great because it may encourage some foodies to rethink their position on food. If foodie heroes like Batali are willing to take the plunge, others may follow suit.

                      1. re: Miss Needle

                        And the bit about overdiagnosing diabetes? I'm not a doctor but that's a disease that you either have or you don't, right?

                        1. re: southernitalian

                          I'm not an MD, but I think the borderline diabetes diagnosis is being replaced by the term "pre-diabetes" where the condition can manifest as diabetes in the future. A problem that the CDC has with getting an accurate number for the diabetes is that there are so many people that are not diagnosed with the condition because they don't see a physician. What's really scary is that Type II diabetes used to be referred to as "adult-onset." We're seeing increasing obesity and increasing numbers of children diagnosed with Type II.

                          Any doctors care to comment? Moh?

                          1. re: southernitalian

                            With type 1 diabetes, yes, either you have it or you don't. Your body doesn't make insulin, and you have to replace it with injected insulin or you die, usually within a matter of days or weeks (depending on various factors).

                            With type 2 diabetes (the more common form of the disease, and the one associated with overweight and a sedantary lifestyle), there is a continuum, because the main thing that causes the disease is insulin resistance -- your body makes insulin, but can't use it effectively to metabolize glucose. Insulin resistance can vary a lot from person to person. Some type 2's only have mild insulin resistance that can be easily controlled with minor lifestyle changes and no drugs, and these are people who, a generation ago, might never have been diagnosed with the disease. The cut-off used to be a fasting blood sugar of 140 mg/dl or above for diabetes, 126 - 140 for borderline diabetes (aka "insulin resistance" or pre-diabetes). Now it's 110 - 126 for pre-diabetes and 126 and up for diabetes. Or it was last I checked.

                            The other thing about type 2 diabetes that makes it a "softer" diagnosis is that for most people there are no near-term consequences to the disease. Unlike type 1, it doesn't kill you quickly if untreated. The issue, rather, is the long-term complications -- damage to the large and small blood vessels, which can lead to heart, kidney, eye, neurological and other problems. And these complications are also very variable. They're associated with poor control of the disease, as well as other factors. One of the most tragic things is people who have the disease for decades without knowing it and only find out about it when they develop complications.

                            A lot of people would disagree with me about the continuum, but I say that when you have a situation where diagnosing someone with the disease depends on which standard you use, by definition you have something that is not an absolute.

                            This is not to say that type 2 diabetes is the "better" or "milder" form of the disease. Type 1 diabetes (what used to be called "juvenile") is much better understood and much more straightforward. It's a terrible disease, but at least we have a good idea of how to control it and reduce the risk of complications. Type 2 occurs due to various factors surrounding glucose metabolism and can vary a lot from person to person, so it can sometimes be extremely difficult to treat.

                            Not a doctor, just a diabetic (type 1).

                            1. re: jlafler

                              Actually, by US federal standards, pre-diabetes is now considered a fasting blood glucose of 100-125 mg/dL....but I agree with everything else you said, jlafler. :) Reason it was lowered is because research shows that those troubling complications can begin to develop even at 100-110 mg/dL FBG.

                              Working in public health, I am often in the cross-fire when these standards are change, and I can completely understand the frustration that can come from changing advice. People may believe that these lowered standards are the result of greedy pharmaceutical companies, healthcare systems, etc. But in my estimation, the lowering of standards is meant to be prophylactic. Instead of allowing complications to slowly creep up, why not bring the risk to someone's attention early enough so that they can make some behavior tweaks (e.g. with moderate diet change and exercise) instead of being faced with major complications down the line that require surgery, lifelong drug treatment, being on an extremely restricted renal diet, etc.?

                              1. re: 4Snisl

                                Yes, but it also means stigmatising someone as a sick person for the rest of his or her life. I most certainly support exercise and healthy diet, but it is important to realise the negative psychological impact of such labels.

                                1. re: lagatta

                                  I agree that there can be stigmatization and psychological effects with labeling an illness- good point.

                                  However, it's important to recognize that pre-diabetes is a REVERSIBLE condition- a person can "repair" their impaired glucose tolerance if early action is taken. Pre-diabetes is not an inevitable road to developing diabetes (permanently impaired glucose tolerance).

                                2. re: 4Snisl

                                  The problem I have with all these constant downward revisions of these standards is that it's similar to size 0 models: it completely redefines "normal" to a state that's almost impossible for most people to attain and thus, cannot really be considered "normal." People who last week were considered normal and healthy are this week considered to be unhealthy and in need of treatment (for which the drug companies are more than willing to sell a quick fix), even though the only thing that's changed about their health status is that some people sitting a room somewhere changed a couple of numbers on a chart.

                                  It also seems to presume that if one can somehow attain the perfect numbers on this chart, then we'll all be perfectly healthy and live forever, which of course we won't. You can't eliminate the top ten causes of death, because people will always die, and they have to die of something. I think it may even have been my sister jlafler who once said "There's always going to be a leading cause of death -- what would you prefer that it be?" More people die of heart disease in and cancer in their 70 now because fewer people die of measels and smallpox in their youth. Isn't that a *good* thing?

                                  1. re: Ruth Lafler

                                    I completely agree with this. And I'm sure no size 0. For me, the presence of these causes of morbidity and mortality are a strong argument against calling diseases associated with diet a hoax -- as per the article, not referring to anything said by people on this board. I think that your point illustrates that either extreme position will not help us actually improve health outcomes or quality of life.

                                3. re: jlafler

                                  Thats a very good explanation of Diabetes. By the way, it was not explicitly said in the article, but the type of Diabetes I have is Type II, and since I have altered my diet its asymptomatic according to my doctor and my latest bloodwork.I dont take insulin nor do I have the need to do glucose monitoring. My cholesterol is at 100-110 and my blood pressure is within normal ranges.

                                  1. re: jlafler

                                    I'm coming in very late on this thread, but Jlafler's summary on diabetes is excellent. I particularly like the discussion on Type 1 vs. Type 2 diabetes. Type 1 is easier to diagnose, and diagnosed earlier on in the disease. The biggest problem with Type 2 is that you can live so long without symptoms. Then you only get diagnosed when you start suffering from the long-term complications, which can be terrible.

                                    I am trying to align myself with the moderation camp. Eat a good variety of fresh, minimally processed foods. Try not to overeat. Reduce portion size. Exercise. But occasionally give into your love of fat or sugar, just try not to overdo it. As someone else calls it, listen to common sense. BUT sometimes we need to learn what common sense is. The great thing about this article is that it addresses the need to discuss issues like obesity, illness, perceptions about food and taste. Hopefully this article will open the eyes of a few food-obsessed people, and help them modify their choices before they have problems. Information is our friend.

                                    Of course, after that sanctimonious little paragraph, I have to confess in the interest of full disclosure that I have just returned from a food-fest trip to Toronto. I shall soon be reporting on the Ontario board, and if you read that report, some of you will be horrified. And of course, I have been reporting on various Montreal food quests, one which involved eating zeppole in 4 different Italian pastry shops on one morning. "Did she really eat all that?" you might ask, somewhat disgustedly. Interestingly enough, I found myself having to employ many of the techniques noted in some of these other posts. Many friends were dragged along, many doggy bags were utilized, many gifts were given ("Hey! How are you! I've bought you half a dozen zeppole! Eat them while they are fresh! Share with your friends!"). But I still feel dietarily-overwhelmed, and have planned out a menu of salads and light soups this week. Listening to your body when you overeat is a newly acquired skill that I am trying to cultivate. I am looking forward to going to bed hungry tonight. (I am so very grateful to be in the situation where I can make that statement. Support your local food banks!)

                                    1. re: moh

                                      Sometimes, after an indulgent restaurant meal, my husband and I look at each other and say "Okay, nothing but thin gruel for the next week." We don't actually eat gruel (I'm not even sure what gruel is -- some sort of porridge, I assume), but, as you say, lighter foods.

                                      I like what you say about listening to your body. I think that's something a lot of people need to do more of -- it's amazing how often people (and I include myself) eat in ways that don't feel good. It seems like something that would be self-correcting -- oh, that made me feel bad, I won't do it again. But often it's not.

                                      And thanks for mentioning food banks. Whenever we donate food I try to give mostly solidly healthy stuff, but I also always include something fun, like a tin of cocoa or a jar of good jam.

                                      I hope you had fun on your food fest trip!

                                  2. re: southernitalian

                                    He didn't just say it was being overdiagnosed, he called it "a major hoax." Its one of the more idiotic statements I've read on any topic. That doesn't "border on the extreme" as the author put it; that's all the way into totally nuts territory.

                                    Certainly any number of conditions may have people who are inappropriately diagnosed and we do not understand all of the mechanics of diabetes but it is decidedly not a hoax and, in fact, is very often underdiagnosed leading to disastrous problems for those individuals who have it but don't know it.

                                    1. re: ccbweb

                                      Absolutely. I don't think anyone here is endorsing Shaw's statement.

                                      1. re: ccbweb

                                        ccbweb -- I totally agree with you. I am a medical student (soon ffinishing year 3 out of 4; I'm almost there...) in Louisiana and I've seen so many horrible results of diabetes... the idea of people believing it is a hoax is so scary...

                                        Here are some stats. Keep in mind that although Diabetes is famously a Sugar-disease, it also completely messes up your cholesterol (bad cholesterol high AND good cholesterol low)

                                        Top 10 causes of death in America:
                                        1. Heart Disease - caused by genetics, obesity and diabetes
                                        2. Cancer - probably not related, other than female cancers (breast, endometrial) which are associated with unopposed estrogen -- which can come from fat cells... oh, and the fact that when you're really fat it's totally impossible to feel small lumps, so people get diagnosed later in their disease, reducing the probability of being able to be cured.
                                        3. Stroke - related to clogged arteries, again associated with obesity and diabetes
                                        4. Chronic obstructive pulmonary disease
                                        5. Accidents
                                        6. Diabetes, straight up.
                                        7. Flu/Pneumonia
                                        8. Alzheimer's
                                        9. Kidney disease -- can be congenital, but the most common cause is diabetes again
                                        10. Septicemia (blood infection) -- infections are way more common in diabetics

                                        So 4 of the top 10 causes of death, including #1 and 2, are highly associated with obesity and diabetes, and 2 more are relatively associated but not direct results necessarily. And I've personally seen plenty of patients who have lost some or all of their vision or even a hand or foot because of uncontrolled diabetes. Oh yeah, and obese and diabetic women have a lot of trouble having babies. Their embryo/fetuses don't survive as well, or are born with birth defects.

                                        But ALL of this is preventable with appropriate managment -- and it doesn't have to mean losing hundreds of pounds, it can be as simple as keeping up with your meds and avoiding eating too much sugar and refined carbohydrate at a time. But that can only happen if we buy into the idea that obesity is a health risk.

                                        Stepping off my soapbox now.

                                        1. re: Adrienne

                                          You're conflating obesity and diabetes. They are not the same thing, even if you're talking about type 2 diabetes.

                                          Also, do you understand that statements such as "Oh yeah, and obese and diabetic women have a lot of trouble having babies. Their embryo/fetuses don't survive as well, or are born with birth defects" are belittling and objectifying?

                                          1. re: jlafler

                                            I am sorry if you feel that the way that I phrased this information was unfeeling; the point I was trying to make is that there are so many horrible things that can happen because of these conditions, that reading that someone was quoted as saying this is all a hoax is very disturbing. Obviously knowing that a given condition or disease state may cause other problems makes people feel bad, even when we say it gently, but not knowing -- or even hearing people try to mitigate these problems -- is why so many patients I've seen had no idea they were setting themselves up for health problems -sadly, including problems with fertility- with which they are now struggling to deal.

                                            As far as the difference between obesity and diabetes, of course they are completely different pathological states, but that doesn't change the fact that the two predispose for many of the same diseases. But anyhow, I think I did specify where I meant obesity vs. diabetes, both of which have been mentioned in the above thread. The entire passage I wrote after the top causes of death was intended to refer specifically to diabetes as opposed to obesity, which may not have been clear.

                                            1. re: Adrienne

                                              You wrote: "So 4 of the top 10 causes of death, including #1 and 2, are highly associated with obesity and diabetes." That doesn't sound to me like it's intended to "refer specifically to diabetes." It would be odd if it did, since as far as I know there's no causal relationship between diabetes and cancer. Maybe you have a cite for that.

                                              As for the fertility issue, being patronizing isn't a good remedy for insensitivity.

                                              1. re: jlafler

                                                I'm sorry you are completely right about that, that was a typo -- I meant to write # 1 and 3, not 2.

                                                Obviously we still disagree about some elements of communication.

                                                1. re: Adrienne

                                                  Ah, I see what you meant.

                                                  Yes, we do disagree about some elements of communication. But, if you'll forgive some unsolicited advice from someone who has a lot of experience as a patient, you will be a better doctor, and have better relationships with your patients, if you keep in mind the possibility that the root of a communication problem may be your error.

                                            2. re: jlafler

                                              That one made me laugh out loud: I live in a city/state that routinely hit the top of America's "fattest" lists, and statistics show that our birth rates aren't super-low & defect rates aren't excessively high.

                                              1. re: Hungry Celeste

                                                Lots of things can affect fertility rates, so that's not a counter-example. I've never heard of a link between diabetes and infertility, but unfortunately, women with diabetes do have a greater risk of stillbirth or of having a baby with neural tube defects (e.g. spina bifida), heart defects, high birth weight, and other problems. The risk of pre-eclamspia is greater, c-sections are more likely, and poor control during pregnancy can worsen diabetes complications in the morther. The good news is that with good control and good medical care, these risks can be reduced to a level that is virtually the same as a non-diabetic woman's.

                                                My objection to the comment was the tone and the sweeping generalization that babies of diabetic mothers "don't survive as well, or are born with birth defects." We're talking about risks here, not certainties. Even in the days before doctors figured out how to reduce the risks, there were some diabetic women who had healthy babies.

                                                1. re: jlafler

                                                  My diabetic sister is too modest to mention that with her good control and good medical care she had a practically textbook perfect pregnancy and as you can see a perfectly healthy baby girl.

                                                  Although I've heard that obesity can affect fertility (as can being underweight), I've never heard that it causes birth defects, and I'm trying to imagine what exactly the mechanism for that would be.

                                                  1. re: jlafler

                                                    Jlafler -- I have to say, the way you have phrased this issue now is much clearer to me, and I do now see how what I wrote could be read that way, and I am really sorry if anyone read my post and believed, for example, that the norm for women who have diabetes is the inability to have babies -- that is absolutely not the case at all. I think because it is part of my every day life to talk about risk factors, it just didn't cross my mind to specify that I was talking about risk. It was definitely not my intention at all to suggest that these are problems facing ALL diabetic or obese people, rather to show how many real and sad results can be part of the "hoax."

                                                    I would like to think that in the context of counselling an actual patient, I am clearer in identifying things that will happen versus things that we worry could happen if things don't go well; I will certainly have this issue on my radar now.

                                        2. re: Miss Needle

                                          MN - I'd take a vegetarian as a charter CH member any day over a Cheesecake Factory lover ;-)

                                          C'mon, you knew in a fattie thread somebody would find a way to work in CF, lol.

                                          1. re: Panini Guy

                                            A good rule of thumb: never eat in a restaurant with the word "factory" in its name.

                                            1. re: jlafler

                                              Oooh...hey now, one of my all-time favorites is a one-off joint called The Tortilla Factory! But, generally speaking, still good advice.

                              2. All of jfood's paws are clapping on the outcome of this article. Finally brains are beating bellies in some people.

                                You can eat great food, eat fatty food, eat healthy food, eat whatever you want as long as you are smart about it. Cheeseburger for lunch, fish for dinner. Lugers for dinner, salad for lunch. Then the next day plan a lighter, healthier menu.

                                Jfood was subjected to numerous chicago pizzas for lunch meetings yesterday, so he ordered sushi/sashimi for dinner. All about balance.

                                1. I totally understand why it made you sick to your stomach.
                                  I felt quite grossed out when I read about the eating habits of these fat fatty food lovers, a la: "fat is my meat and meat is my vegetable". = Gross. And really, really foolish.
                                  Some of the silly statements that these fat lovers made were so over the top idiotic, that I had to read some of them out loud for my husband, and we bot just laughed. Talk about huge denial.
                                  By the way, even if one has to eat many meals a day (for their fat praising food blogs), they do not have to eat huge amounts of it!

                                  Also, after reading this, one cannot help but ask, where are the taste buds of these people? If they cannot taste and appreciate the deliciousness of anything else than meat and other fatty foods, then they do not have well functioning taste buds.