Posts by Peter Ashby
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@Dyan
Great post.
I liked your pointing out that we need more than doctors to set health priorities. This is largely because when all you see are sick people (yes, okay and the worried well), you get a warped view of how prevalent ill health is. Which is why we have epidemiologists, to measure the incidence and run the stats. Etc, etc. It's why those who work in A&E are the most vocal against alcohol, because they see all the problems (and their drinking is never problematic). But they don't see all the alcohol use that doesn't cause problems, so they are not good people to get to determine the whole policy.
I agree with your point from Road to Wigan Pier too. Allotments have been an antidote in part for those bad diets. Giving people who don't have anything even approximating a garden somewhere to grow a few vegetables. In NZ it is assumed everyone has a quarter acre paradise for that, but many don't.
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@Islander
What you describe is all part and parcel of Type 2 diabetes, and you are right having Polynesian ancestry makes you highly prone to developing it. When exposed to a modern western diet. The two are inextricably linked.
Jared Diamond reckons that the fact that non European peoples are like that is not the issue. The issue is why Europeans have significantly lower levels of Type 2 diabetes when exposed to the same diet.
He thinks it is because, due in part to Feudalism, Europeans have had food security for a long time. Sure there have been famines, but they are remembered because of their rarity. If you were genetically predisposed to develop Type 2 in that milieu then you will likely be insulin dependant before you turn 20. Which is a death sentence. So susceptibility has been bred out of Europeans.
For the rest of the world the normal situation was much more precarious. In the Islands cyclone season hits before the staple crops are ripe, so when one hits, every few years or so you need what is called a thrifty phenotype, the ability to pack away the calories efficiently. But what is good in the Islands traditionally is not good in Mangere or Porirua or anywhere else with a MacDonalds and supermarkets packed with cheap white bread, packets of chips and cheap nasty sausages.
Life is too easy for most of us, so unless you have the drive and enjoyment that I have it is hard to keep your weight under control. It takes some determination to come home after work, in the dark here and make yourself go out into the rain and exercise. I do it by reminding myself of how I will feel if I wimp out and because experience has taught me that once I'm warmed up I don't care about the weather. I grew up running in West Auckland and when it rains like it does in Auckland you are soaked inside of 30s. My philosophy was firstly that I am not soluble and secondly that it was better than sweating buckets in high heat and humidity.
The weather forecast says it will be raining, lightly then heavily and 5C on my run tonight. I will not wear any water proof gear, it won't be cold enough for that. Experience tells me that, provided I keep moving at a good rate, I will generate enough heat that being wet won't be a problem. I am not soluble.
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I am well aware of the hormonal cross talk adipose tissue sets up with hunger signals from the stomach and squashing satiety signals. However none of that makes it biologically impossible to lose significant amounts of weight once you are obese. People do it all the time without even a stomach stapling. Which doesn't make it easy for everyone of course, but it does mean it is not biologically impossible as some have claimed.
I agree that it is more than about food, that even basic activity levels are part of the problem. Activity monitors show that those who are not fat are so in part because they fidget, they pace, they are unable to sit for hours in a chair.
The thing is we know all this stuff, we are just not good yet at working out how to build all that into programs people can follow. And even if we get that good there is the problem I have described earlier that the signals from advertising, from the specials in the supermarket and from what tastes good conspire against such programs and they are all pervasive.
It is why people get morbidly obese in the first place, if empty calories were taxed heavily only the rich could afford to be fat. Which is how things were in the past. It's why in China the Buddha is fat and happy and why being fat is a proxy for wealth.
Our society is inverted from that, being slim, tanned and groomed are signs of wealth and being morbidly obese is a sign of being poor.
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Much the same way people who exercise <b>too much</b> become addicted to the endorphins.
Ahem, I get my endorphin hit after a mere 30min of running, and it doesn't have to be hard. I dont' call that 'too much'. It only seems so to people who exercise inadequate amounts.
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Anyway, fascinating as this is. It's nearly half past midnight here. Good night, see you in the morning.
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Peter, not everyone is able to lose weight, for a variety of reasons.
I will be first in the queue to argue that you cannot blame people for their obesity. However it is not true that not everyone can lose weight. Even without exercise, an awful lot of it is down to modern diets and its way, way too many empty calories.
Prof Colin Palmer here in Dundee, a former boss of mine did a study on obesity in 9-10 yo primary kids analysed by socio-economic status. They found that obese poor kids are 1cm shorter on average than obese middle class kids. That may not sound like much but its more than the difference between girls and boys at that age and is very highly statistically significant. They are 'malnourished in the face of plenty' as the paper put it.
That is true of much of our modern diets. Good food is expensive. The supermarkets discount stuff that is bad for you, two for one on bags of chips. Cheap ready meals packed with fat and salt are lots cheaper than the healthier alternative. Look next time you are in the supermarket at the sort of foods that are on special.
If people ate properly, ate good calories, which are also low GI and so fill you up and keep you full by dribbling glucose into your bloodstream instead of in one big splurge then they would eat less and so lose weight. It is not rocket science.
The hard part is that society is filled with inducements to do the opposite and we are opposed by our biology. Food high in sugar and fat are high value when you are a hunter gatherer. Peoples who still are will do a lot and risk a lot for honey for eg. So our tastebuds are evolved to favour those foods. That is why a chocolate eclair tastes so good.
So when we live in a society where it is cheap to produce food laced with sugar, salt and high in fat and fesh vegetables and wholegrain bread are expensive eating right becomes hard, especially on a budget. When supermarkets in low decile areas are both few and far between and don't even bother stocking decent food then people don't even have a practical choice.
Those are the reasons it is hard to lose weight, because we are conspired against by powerful interests which make the solutions hard to achieve for many. Not because in the absence of all those it would be hard, or for some basic biomedical reason.
Obesity is a modern phenomenon, people have not changed in the last 30 years (I remember the '70s when everyone was thin). So it cannot by some ineluctable biological barrier that prevents weight loss or prevention of weight gain.
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Actually Giovanni, I wouldn't worry about my knees. That recent paper didn't actually measure osteo-arthitis, it measured damage. I bet if you looked in my knees you would see damage. That is because last night I ran up, and down, a very steep hill (1 in 9 gradient 450m long) 10 times. But I heal as well. None of which means My joints are prone to either osteo-arthritis (I also have no family history, at all) or need joint replacement (you should see the size of my thigh muscles, well able to hold my knees together).
Actually I have no knee pain at all, not in the joint that is, my problem is those muscles. My vastus medialis accessorius muscles keep playing up. not enough to be a problem, just an annoying niggle. My rule is if it hurts at the bottom of the hill I keep going, if it stops I forget it. If I listened to my knee muscles I would never run, but they are all mouth and no trousers.
The joys of the ageing athlete.
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And I don't know about NZ, but over here they offer everyone over 50 statins routinely. Which is as big an admission as you are ever going to get that govt has given up on the idea that people can be persuaded to look after themselves properly. I do not intend to take them since I am persuaded about the benefits of looking after myself and I prefer the side effects of running to the side effects of taking statins every day.
Actually I should modify my reasons to run. I started to run again in middle age (I ran a LOT in my youth) after the GP gave me pills to take every day to deal with my heartburn. I was a bit taken aback that he did not even mention I could do with losing a bit of weight. The pills worked but I didn't want to be someone who took a pill every day for the rest of my life, first one then two, then even more. So when I finished the course, instead of going back for more I strapped on my running shoes, hit the road and watched what I ate. The weight dropped off, the heartburn stopped and I got hooked again. The list above is why I run now. This was why I started to run again.
It's cold and WET here in Eastern Scotland, but that only determines what I wear when I run and whether or not I wear my glasses (no point in the rain). Only really icy conditions will stop me, frost won't, that crunchy frost is fine to run on. Dry snow is great to run on and I am not soluble so rain is no problem.
if you see in the news 'runner dies of exposure on city street in Scotland', that will be me ;-)
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If only we had some sort of Health Credit Trading Scheme.
hmm, a discount on my tax (or over here, National Insurance) would be welcome. The problem is of course that while on average, doing what I'm doing will reduce my ill health burden on society, that doesn't mean it will be the case in my particular case.
Instead govt taxes those things that are known to be very bad for us, ciggies and alcohol. Of course they should also be doing it for overly sweet or fatty foods too and using the income to subsidise healthy food.
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You're planning to be one of those people who lives forever and breaks our superannuation bank, aren't you? For shame!
Nope. With my familial inheritance I intend to be a bright burning comet, to be fit enough so that when the decline comes it comes swiftly and decisively. I am pessimistic about drawing a pension at all, let alone for a long time.
The real reasons I run are:
1. I enjoy it (no really, I just love it)
2. I'm addicted to my own endorphins (I have to restrain myself from running on my rest days)
3. I feel absolutely fantastic
4. I like the challengeBeing fit and not being sick don't really factor. Though when I had swine flu recently it took me a while, in fact after the peak, until I realised what I had. My main symptom was a complete and utter loss of energy and that is about it. Though at its peak I didn't have the energy to sit in a chair. According to New Scientist people who exercise regularly experience the mildest symptoms. So I'm not complaining about the health benefits either.
My only visit to the doctor in the last year was for a new inhaler, I get a bit wheezy on those dry, really cold winter days. Hard to run like that. Reminds me, must check the one I have is still in date.