Skeptical Inquirer and Fatties, Part 2

[Part 1 is here.]

Kenneth W. Krause has a column in Skeptical Inquirer magazine in which, lately, he has been taking on fat activists. By comparison of this page and this page, he appears to be the same guy who tried to shame fat newscaster Jennifer Livingston into losing weight for the good of society. (I’m not trying to imply that Skeptical Inquirer is hiding Mr. Krause’s other activities, just that identifying people can be tricky because different people can have the same name. Note also that the Skeptical Inquirer articles I am discussing here are not available online.)

That was in 2012. In 2013, he took his anti-fat crusade to the pages of Skeptical Inquirer. Now, before Mr. Krause gets mad at me (assuming he ever reads this) for saying that he is on an anti-fat crusade, let me state that the first of this series, in the May/June issue, is relatively even-handed about the science of fatness. He starts off discussing why the energy balance concept (calories in = calories out) is an oversimplification, and that we need a better approach to fatness. He then discusses other hypotheses for fatness (hormonal imbalance, carbohydrates, lack of will power), and shows that they are all oversimplifications. But he can’t resist a “PS we hate you” at the end, stating the usual alarmist stuff about the “obesity epidemic” and how we must do something. (I agree, if that something starts with acceptance of fat people.)

But in the Sept/Oct issue, Krause tackles head-on the idea that fat could be a good thing. He starts with the most recent Flegal study, which confirmed that people in the “overweight” BMI category (between “normal” and “obese”) have the lowest risk of death (by a small margin), and that even the biggest fatties have only a modestly elevated risk of death (29% higher). Krause latches on to Flegal’s list of potential explanations, specifically the idea that the lower risk is because “heavier patients” (Flegal’s words) get better health care because they go to the doctor earlier. That actually sounds like an argument for Health at Every Size: “overweight” people can improve their health without losing weight. (And while this may be true for those in the “overweight” category, we larger fatties have had a different experience with the medical profession.) Even better, Krause himself admits that, among those with many chronic illnesses, fatties have better outcomes than thinner people (the “obesity paradox“). But he says that these people benefit from “a little, though never a lot, of extra weight.” (Then why is it called the “obesity paradox” and not the “overweight paradox”?) He concludes this part of the column with the following:

We should of course remain open to all potential subtleties regarding adiposity and health. But given the depth and breadth of the evidence associating extreme overweight with all manner of affliction, the primary public health objective must be to prevent both obesity and pre-obesity.

First of all: “pre-obesity”? Gimme a break. Second, more research is fine, but given that today we don’t know how to prevent or get rid of fatness in a way that works over the long term for most people, and since you (Mr. Krause) believe that better health care has given “overweight” folks longer lives, why not work toward better health care for the “obese” patients as well?

The next part of his Sept/Oct column looks at various diets (Paleo, Mediterranean, and vegetarian), showing that they all have flaws and none of them is for everyone. On that we can agree. But, you guessed it, he finishes by returning to the idea that we need to keep trying to lose weight, phrasing it as a way to give fat children “an opportunity for accomplishment and not . . . an excuse for regression to mediocrity.” Excuse me, pal: Fatness is not mediocrity; there are wonderful fat people who are exceptional musicians, writers, even (that’s right) dancers and athletes. Equating fatness with mediocrity is an opinion that is not based on science.

Finally we come to the latest (Jan/Feb 2014) issue of Skeptical Inquirer. This time he limits himself to a response to a letter, and here he takes off the gloves. He starts off with this gem:

Doctors tell people to lose weight because, by definition, that’s what obese and overweight people need to do.

Did we not just talk about this? Do you (Krause) not remember the paper that showed that the “overweight” had the lowest risk of death? Isn’t it clear that these definitions are unhelpful?

He then states, “And I don’t know of any doctor, dietician, or personal trainer who has ever advised a patient or client to go on a “yo-yo” diet.” Dude, look at the scientific evidence: weight-loss diets are yo-yo diets. He goes on to state that weight loss is “not impossible”. So you recommend an intervention that works 5% of the time because it is “not impossible” that it works?

He wraps it up by suggesting that we “frustrated and angry” fatties should have sympathy for health care professionals who are only trying to help. OK. But if they really want to help, they should stop using interventions that don’t work, and try the HAES approach, which has science behind it.

10 thoughts on “Skeptical Inquirer and Fatties, Part 2

  1. With any other condition, no doctor would dare prescribe a medical intervention that fails 95% of the time, usually makes the condition being treated worse, and for which there is no solid evidence that it helps the 5% it does work for.

    Why? Because that would be the dictionary definition of malpractice.

  2. Reminds me of the Star Trek: TNG ep with the genderless ppl, who had a society who “cared” about them to surgically alter them if they developed gendered thoughts. “They’re just trying to help.”

  3. It seems like Krause “saw the light” for a second and then rescinded everything good that he said and then some. Maybe he was suffering from momentary pangs of guilt for being a profligate liar and fat hater. Physicians as a whole are very prejudice against obese people, prejudice enough to harm them either consciously or unconsciously. What do you thing that bariatric surgery is about? People need to realize that there is a lot of evil out there that takes on the guise of being friendly and helpful. Everything comes down to the fact that obese people are simply hungrier. Yet the word hunger is conspicuously left out of the discourse. Recent studies on dieting, weight cycling, and changes in hormonal regulation have led me to conclude that excess adiposity is a biological adaptation to an environment that has a history of being deficient in calories. I have not seen anyone else conclude this, but if I am correct the entire societal discourse on obesity would have to collapse.

    • Thanks for your comment. I think there’s a lot of truth in what you’re saying, especially about fatness being an adaptation. (I’ve said the same thing myself.) But, although this may be naive, I think Krause means well for the most part. (FYI, he’s not an MD.)

  4. Pingback: How can fat be good? | Fatties United!

  5. Pingback: Note about the Fatosphere | Fatties United!

  6. “he appears to be the same guy who tried to shame fat newscaster Jennifer Livingston into losing weight for the good of society” — I know this is over a year later, but in case you wanted to know, I confirmed this is the case. Krause himself admitted to being that same man in a comment thread on my Facebook page just today. I’ve screencapped it all just in case, although I don’t think anything ever really goes away on FB. Krause also acted like a childish d-ck in that thread. But relevant to your post, he stood by everything he said to Livingston and was just sorry it made her upset. He then faux apologized for hurting my feelings over it (even though I never brought up my feelings) so I’m not so sure he was sincere even to her. But at least now we have the factual record squared away.

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