A U.K.-based comedian tells a joke about a man who makes an insulting remark to a fat woman. “That’s an insult against me just because I’m overweight. You’re ‘fattist’,’’ she rebukes him.
           
“No,” he replies. “I think you’ll find that you’re fattest.”

And here is one of the latest web postings by a U.K. doctor in the ongoing debate about withholding treatments from obese people, a subject I covered recently.

I have been following a story, and the fallout from that story, about denying obese individuals various operations in one region of the U.K. — primarily knee and hip operations. While it is based in the U.K., the general points would apply to most other health systems.

To my mind, what this story has exposed is a powerful judgmental streak amongst doctors. Before getting into that, here is a précis of the story from a web site called doctors.net. You have to be a registered U.K. doctor to gain access.

If there is one thing that I really enjoy, it is a study that can be waved in the faces of the “food fascists,” as I call them. Those puritanical control freaks who are forever telling us how unhealthy our diets are, how McDonald’s Inc. is creating a race of hyper-blobs, and how we should eat this or that tasteless muck because it is “good and healthy.”

My own view has always been that the rise in people who weigh more than we consider “aesthetically pleasing” — I have decided to remove the word obese from my vocabulary — is mainly due to the fact that no one exercises any more. Correction, a large majority of people do not exercise.

(It might help you lose weight)

I seem to recall that there was a film called Outbreak, based on a book of the same name. Just shows how lazy I’m feeling today, I can’t be bothered searching the Internet. Anyway, sometimes it’s best to remember things rather than look them up all the time. Even if you’re wrong.

In the film Outbreak, the one that I remember anyway, a sadistic General played by Donald Sutherland wanted to hit an infected small town with a daisy-cutter bomb, thus evaporating it, plus virus. Meanwhile, Dustin Hoffman, playing a hero (bad casting in my view – Dustin just isn’t the hero type), heroically saved the day and got a kiss from Helen Hunt – or maybe it was that actress from What Women Want - or maybe Helen Hunt was in What Women Want, and I’m thinking of someone else whose name I cannot remember. The one who was in Tin Cup with what’s his name – you know Waterworld (what a stinker). Kevin Costner – of course. But blast – what was her name….

I suppose most of you will be aware of the research published in JAMA which showed that being ‘overweight’ helps you live longer. It seems to have caused a stir on this side of the pond, although I have to admit that I stifled a bit of a yawn. This ‘amazing fact’ has been proven many times before, most clearly in Norway, where a Body Mass Index (BMI) of twenty seven was associated with the greatest longevity.

Yesterday, I did some people-watching as I stood in line at the cash at Costco. Sometimes the goods in people’s shopping carts tell interesting stories, as was the case with the young family in the cash line next to me.

Both parents were slightly overweight, the mother more so than the father, and their three children were morbidly obese. The youngest boy may have been five-years-old at the most. His cheeks were the size of grapefruits that made his eyes, nose and mouth look more sunken in than they ought to have been. His double chin covered his neck. The girl had to be the middle child. She looked about 12, and slightly younger than her teenage brother who must have weighed at least 250 pounds. She weighed more than her brother, and I could imagine how hard it must be for her to get up in the morning to go to school where she probably felt ostracized by the more popular skinny girls.   

Part Three here
Part Two here
Part One here

Goodness me, it’s all getting a bit complicated. I feel like one of those jugglers who tries to spin fifty plates at the same time. Instead I am trying to keep fifty strands of thought spinning. I am beginning to understand Lenin, who said (sic) ‘everything is connected to everything else.’

Part two here
Part one here

A lot of people have asked when I was going to write this follow-up article, and why has it taken so long? The answer is that I have been trying to write it for months, but my lack of skill as a writer has driven me mad, as I have been unable to get my thoughts down on paper. Anyway, here is my attempt to make what is clear in my mind, clear in yours.

first article of the series here

For those of you who read my last article, ‘A sugary tale’, and who didn’t agree with a word that I said, which could well be almost everybody. I would like to introduce you to a fact that you may find surprising – to say the least.

Just to rewind for a moment. Basically I said that obesity probably wasn’t the underlying cause of type II diabetes. (I also said that there was no such disease as type II diabetes, but we’ll get to that later). In order to prove my first point I thought it would be interesting to try and find out if there is a population with zero adipose tissue to see what happens to their insulin resistance, levels of blood sugar, and rate of type II diabetes.

(First article in a series on ‘type II diabetes’)

part two here

For the past 30 years, give or take, people with type-II diabetes have been instructed to eat a low-fat, high-carbohydrate diet. Why? Because it is “known” that a high-fat diet causes heart disease. It is also known that people with type-II diabetes have a greatly increased chance of dying of heart disease (true). Ergo, type-II diabetics should not eat fat.

I’m sorry to see that Malcolm Kendrick has fallen into the ’First Law’ trap. Let me see if I can clarify the apparent paradox whereby people eating a high-calorie diet lose weight more easily than those eating a low-calorie diet.

By Fred Ottoboni, PhD, MPH and Alice Ottoboni, PhD

We learned a long time ago that when our data cast doubt on the First Law of Thermodynamics , the reason (always for sure) was that our data were somehow wrong.

Not Easy but Doable

I gained a whopping 60 pounds on hormone replacement therapy, and I didn’t like it one bit. Following a hysterectomy and ovary removal procedure in 1991, the gynecologist promptly prescribed Premarin, saying it would help to keep me in a good mood now that my ovaries were gone. What he didn’t say was that it could cause weight gain, and lots of it. Don’t you just hate it when doctors forget to tell you about ALL the risks associated with the drugs they push on you? 

(Ye cannae change the laws of physics, Cap'n)

‘The change in internal energy of a system is equal to the heat added to a system minus the work done by the system.'

Please don't get me wrong. I am a great supporter of the Atkins diet. Anything that helps to demolish the myth that eating animal fat, or saturated fat, causes health problems gets my vote every time. And I do believe that many people who try the Atkins diet do lose weight – when no other diet has worked.

I was idly watching a programme on the Atkins diet last night which, to my surprise, was reasonably balanced. Yes folks, the Atkins diet has crossed the pond to reach the United Kingdom. Although, in reality, all it is doing is returning. After all we invented it nearly one hundred and fifty years ago.

A man called Banting promoted a diet pretty much indistinguishable from that of Atkins in 1863. In fact, the verb to ‘bant’ is used in Sweden as a term for going on a diet

I am a great fan of the science philosopher Karl Popper, that is whenever I can manage to understand what it is that he is saying. I get through one paragraph at a time, very slowly, then I have to go and lie down until my brain stops hurting.

Popper has much to say on the theme of science, scientific progress and the like. He was highly pro-science and the proper use of the scientific method. But he was also acutely aware of the danger that science, and scientists, could become so entranced by a hypothesis that it became the answer, the truth, a belief. And those who dared to question such a fundamental belief were metaphorically burned at the stake.

Obesity is an established risk factor for hypertension, stroke, heart attacks, heart failure and a host of other things ranging from lung and kidney disease to diabetes, insulin resistance and certain cancers. It's easy to comprehend how a lot of excess weight can elevate blood pressure and put a strain on the heart, lungs and kidneys or that increased caloric intake can boost blood sugar to trigger repeated releases of insulin that eventually exhaust the pancreas and cause diabetes. But it's not that simple. All obesity is not created equal and where that extra fat is deposited may be more important than how much of it there is.

A number of people have written, asking me to comment on the Gary Taubes-Michael Fumento battle. What do I think, what is true?

Over on this side of the pond, most people have never heard of Taubes or Fumento, or Dr Aktins. But the pro and anti-fat battle seems to be raging in the colonies, with people hurling data of mass destruction at each other with great vigour. As usual, I find that ‘truth is the first victim in any war.’

I admit it: I can be seduced by food. And why stick to one dish when there’s a buffet?

At a recent wedding I was served enough portions of finger food, entrees, roast beef, roast chicken to end starvation in a third-world country.

Complementing this preliminary feast were Italian, Chinese, Greek and Deli food stations placed at strategic points throughout the hall. All of this with a free bar was available before the main course. Guests had the choice of steak, beef, ribs, fish, and a variety of salads for the MAIN EVENT.

WOMEN OVER THE AGE OF 40 UNDER ASSAULT

The face of people suffering from eating disorders has changed. Anorexia (starvation dieting) was once seen as a young woman’s problem, but more and more women in their 40’s and 50’s are calling doctors who specialize in eating disorders to talk about their own horror stories.

A recent article in the New York Times quotes one doctor in this field saying: "For the longest time, experts said there were no reported cases of eating disorders developing over the age of 40. People are not saying that anymore."

I received an overwhelming response to my little primer on lipoproteins, so I thought I should explain a little more about fats. Excuse my diagrams, I got them all from the internet, so they have no overall design template, but I hope that I can keep things clear.

A fat has the basic structure shown below (Fig 1).

(Fig 1) My nameless fat

Dogs and Cats, Carbs and Fats, and the Evolution of the Human Race

Why does obesity not afflict any other animal species? Why does obesity not affect primitive humans?

RELUCTANT THERAPIST SPEAKS OUT ON THE NIGHTMARE OF ANOREXIA NERVOSA

The most celebrated name connected with the topic of Anorexia Nervosa is the late singer Karen Carpenter. Mention eating disorders and twenty years after her passing she remains the person most people associate with dieting to death.