Would A Person Who Cares About Thinness Think I Look Good in this Swimsuit?
Would A Person Who Cares About Thinness Think I Look Good in this Swimsuit?
Plus some thoughts on intermittent fasting and people you can yell at.
Disclaimer: You’re reading this column because you value my input as a journalist who reports on these issues and therefore has a lot of informed opinions. I’m not a healthcare provider and these responses are not meant to substitute for medical or therapeutic advice.
REMINDER: We're recording a special AMA episode of the podcast today! (You’ll hear it in a few weeks.) So you’ve got a few more hours to submit your questions via this Google Form. Everything is fair game!
Q: I would love to hear some solid research behind intermittent fasting. You see it proposed as a cure for literally every condition: Diabetes, cancer, aging, etc. And I know tons of people who subscribe to it.
I also know tons of people who subscribe to intermittent fasting. And, every time I ask folks which diets we should debunk on the podcast’s bonus episodes, a bunch of you ask me to talk about it. It kind of blows my mind that we need to talk about it, because, I don’t know…this one doesn’t seem that hard? Yes, any “lifestyle plan” that requires you not to eat for significant portions of your waking day is a diet. See also any plan that requires you to periodically fast for several days. Not eating is a kind of dieting and a pretty intense one at that.
But intermittent fasting proponents have long worked to separate what they do from “dieting” by applying a thick veneer of It’s Just Science. We gloss right over the part where they tell you not to eat, because the advice is coming from doctors and researchers, using lots of jargon and gadgets. See Peter Attia, MD,1 who measures his blood glucose, lactate and ketone levels fastidiously on three or four different devices during his monthly three-day fasts, and shares pictures of the results with his 301,000 Instagram followers. Intermittent fasting is the diet—nay, the life optimization regimen!—of tech bros, of innovators and disruptors, of Real Men.
Well. It’s looking like all those dudes got the data wrong. Intermittent fasting has no benefit, according to a randomized one-year trial published last week in the New England Journal of Medicine. The researchers put 139 people (all of whom had BMIs in the ob*se range) to eat low-calorie diets and randomly assigned half of them to also only eat between 8am and 4pm. They also had to photograph everything they ate and keep food diaries. By the end of 12 months, the researchers concluded that the group only eating during business hours had done no better on their diet than the group eating the low calorie diet at any time of day. The intermittent fasters didn’t lose more weight and they also didn’t improve various markers of health any more than the control group—which suggests this diet is probably not a miracle cure for your future diabetes or cancer.
This is not the first study to show that intermittent fasting doesn’t work, though it is the longest run trial to date. And the diet’s disciples are not okay. “I was a devotee,” Dr. Ethan Weiss, a diet researcher at the University of California, San Francisco told Gina Kolata for the New York Times. “This was a hard thing to accept.” For seven years, Dr. Weiss had only eaten between noon and 7pm but his own research has shown similarly dismal outcomes for intermittent fasting. He is now eating breakfast again.
Here’s the frustrating part: This new data is not inspiring Weiss or any other diet researcher to question the fundamental premise of their work. That’s because everyone in the trial did lose some weight in the year they were studied (they just didn’t lose any more weight than the folks following the regular low-calorie approach). This is not surprising. Restricting caloric intake will induce weight loss in most people for as long as you continue to restrict caloric intake. The study didn’t follow people long enough to see what happens when restriction inevitably stops.
We know that most people regain the weight they lose on a diet within two to five years. We also know that this yo-yo pattern of gaining and losing weight increases your risk for a disordered relationship with food. (Indeed, some of us would argue that restricting your calories or having times of day when you aren’t allowed to eat is disordered right on the face of it.) Yo-yo dieting, also known as weight cycling, is associated with many of the health risks we normally attribute to higher body weights. The fact that people lost a small amount of weight after a year of dieting is in no way an endorsement of either diet as a long-term strategy for health.
And there is no reason to think that intermittent fasting will work better for people in the long-term than any other diet. For starters, it’s already not working better in the short-term, as this new research shows. But it’s also a patently unsustainable concept. Which is why it almost doesn’t matter if intermittent fasting can reduce your future risk of disease—even if it did, you’re really unlikely to do it long enough to accrue that kind of benefit. That’s because fasting is restriction, which is the basis of almost every eating disorder. If your timed eating plan lets you eat whatever you want during approved eating hours, you’re living in a restrict/binge cycle. If your plan makes you continue to show restraint by eating only very specific foods or a low number of calories during your feeding periods, you’re living with several different kinds of restriction.
Whatever version of fasting we’re talking about: Humans are not designed to do well with restriction. We’re designed to survive famines, which means our bodies have all kinds of physiological processes on board to fight starvation. Our metabolism slows down (in order to stave off weight loss so your body can tap into the energy stored in your fat). Production of our hunger hormones ramps up, to remind us to find food and stop starving. The reason diets fail for most people is because our bodies want to save us from ourselves.
But getting weight loss scientists to acknowledge this is like asking the sun not to shine. “We just need to do larger studies,” another researcher told Kolata, apparently unconvinced by this new round of data, let alone the past 50 years of diet research. Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston, said she “would still recommend intermittent fasting to patients, even though ‘we don’t have proof.’” That’s how I like my medical advice—footloose and evidence-free!
Don’t get me wrong. I’m glad to have this new study demonstrating so clearly that intermittent fasting is not the diet industry’s silver bullet. Only data defeats pseudoscience. But the real progress will come when we stop spending money on research comparing one shitty diet to another shitty diet, and instead start studying how to support people’s health.
Q: My daughter is almost 12, regular size, and she talks the talk on body-shaming, but she struggles with the concept when it comes to her own body. Some context: She was extremely skinny and small as a toddler, then not so much ages 9-11, hit puberty. In short, her body's been all sorts of shapes and sizes in a dizzyingly short period of time. I gave up dieting 3.5 years ago and our household is generally “eat what you want when you want to eat it.” I am regular size, as is her dad. I'm pretty consistent in my messaging to her; her dad struggles more, sometimes speaking of his own diets and characterizing certain eating behaviors as "good" and "bad." (Sigh.)
So last night, she was modeling a new bathing suit, worrying about every possible detail -- is it too baggy in the butt? Does it highlight her breasts too much or is it just that she's never had breasts before and they feel weird? -- when she said: "I think I'm getting thinner. Do I look thin in this?"
Me: "You know we don't think, talk like that. That's a beautiful color on you and you look wonderful in it."
Daughter: "But would the kind of person who does care about thinness think that I look good in this suit?"
My brain still hurts.