Is Our Obsession with Weight Misguided? Here's What Really Matters When It Comes to Good Health

"Lay off the fat people!" says author and professor Linda Bacon. With a PhD in physiology (specializing in weight regulation) and graduate degrees in psychology (specializing in eating disorders and body image) and kinesiology (specializing in exercise metabolism), Bacon knows more than a little about the impact obesity on health. Bacon's message -- that health is more important than weight -- goes against the grain of our country's current obsession with the "obesity epidemic." Yet her work is extremely popular, and the second edition of her book, Health at Every Size: The Surprising Truth About Your Weight, was recently released.

According to Bacon (who is aware of the irony of her last name), being overweight or obese does not put people at significant health risk. Rather, factors like fitness, activity, nutrient intake, weight cycling, or socioeconomic status are far more important in determining disease risk. Often these same factors increase disease risk and risk of weight gain simultaneously. However, when epidemiological studies control for the aforementioned factors and then examine correlation between weight and disease, increased risk of disease from being overweight or obese is significantly reduced or nonexistent. In other words, while Bacon encourages acceptance of people of all sizes, she's not giving us a free pass to spend our lives in front of the TV eating junk food. A healthy lifestyle is important, even if it's okay that most of us don't have figures resembling the cast of "Bay Watch."

Given these findings, Bacon calls on Americans to join what she calls "the new peace movement" by refusing to fight the "unjust war" against body sizes that are larger than what our culture deems acceptable. Bacon points out that humans have internal systems designed to keep us healthy, and to maintain a healthy weight. These systems include signals of hunger, fullness and appetite. If you can follow your body's signals, your body will in turn find the healthy weight for you. This is, of course, easier said than done. A recent study asked both French and American people how they knew they were done eating; the French said it was when they felt full, while the Americans said they were done when their plates were empty. This is just one of many examples showing how we fail to pay attention to our body's hunger and fullness signals and instead use external cues to determine what, when and how much we eat.

Despite Bacon's impressive resume and her findings -- and the findings of countless studies she cites -- that obesity is not our problem, the war on obesity is only gaining steam with First Lady Michelle Obama's "Let's Move" campaign and celebrity chef Jamie Oliver's "Food Revolution." Obama's campaign specifically states its goal as solving "the epidemic of childhood obesity within a generation." With the program comes a new foundation, Partnership for a Healthier America (with a mission of tackling childhood obesity) and a Task Force on Childhood Obesity. Using this frame, the problem is entirely defined as one of body size and success will be determined by weight loss.

Jamie Oliver's Web site and his petition to start an American food revolution focus more on providing kids with fresh, healthy foods and cooking skills, but his Web site still notes obesity as a problem (for example, offering "facts and figures about how obesity and diet is affecting America's health"). The same can be said of the first few episodes of his show. Mostly they emphasize eating healthy food and preventing problems like type 2 diabetes, but many feel that the show contains a strong fat-shaming element as well. Rather than blaming obesity itself as the main problem, there is an implicit (and sometimes stated) message that obesity is part of the problem. In fact, the city chosen as the site for Oliver's show, Huntington, West Virginia, was selected because it was named the "fattest and unhealthiest" city in America (implying the two terms are synonymous).

Aside from the stark differences in their views on obesity, Linda Bacon, the First Lady and Jamie Oliver agree on quite a lot. Healthy diets are important, and healthy diets consist of fresh, wholesome food, preferably cooked from scratch. School lunches of corn dogs, tater tots and canned fruit in heavy syrup, washed down with flavored milk, are not good. Exercise is an important part of a healthy lifestyle. So, given that efforts like Let's Move and the "Food Revolution" are intended to move America toward healthier diets and less sedentary lifestyles, what's the harm in framing their work in terms of fighting obesity?

Bacon points out a few problems. First of all, research shows that people of all sizes have similar diets, but it only manifests as weight gain in some of us. People today eat more calorie-dense, nutrient-poor convenience foods than Americans did in the past. How we eat also plays a role, as eating while focusing on something else like driving, or eating while in a stressful situation affects our digestive processes. As the average American diet has gone downhill for people of all sizes, weight gain occurred for some -- contributing to the high rate of obesity in America today -- but Bacon says that "assuming fat people are eating worse than thin people is wrong." For this reason, focusing efforts on obesity sends the message to thin people that they do not need to make any changes in their lifestyles when in fact they may also engage in unhealthy behaviors that put them at risk for disease.

Second, focusing on obesity stigmatizes larger people and imbues everyone with a fear of fat. Instead of encouraging people to adopt healthy behaviors, an anti-obesity message encourages the development of eating disorders and the adoption of dangerous, restrictive eating habits. In fact, dieters readily admit they are willing to engage in unhealthy eating patterns in order to lose weight. Bacon encourages focusing on health instead of weight and promoting acceptance of people of all body shapes and sizes. While ending discrimination against fat people is one of her goals, she also notes that people who love their bodies will be more encouraged to take better care of them. "You take good care of things you like," she says. "Self-hatred is not good motivation to make change."

All in all, while inspiring individuals to improve their diet and exercise habits in order to promote public health is laudable, the number one issue we should address on a societal level to decrease the rate of chronic diseases like diabetes is poverty. Lower-income people are more prone to obesity as well as the health problems associated with weight gain. Major risk factors for obesity and disease are in place for each of us before we are born: our parents' income level, educational level and ethnicity, to name a few.

The AP article that declared Huntington, West Virginia the fattest and unhealthiest town in America also says the town's economy "has withered." The piece describes a high poverty rate and an unemployment problem teamed with the problem of low-paying jobs with poor benefits for those who have work. In fact, when the mayor was confronted about his city's health problems, he replied that he was too busy worrying about the economy to think about public health. The best way to accomplish Michelle Obama and Jamie Oliver's goals is to address social injustice and to reduce poverty in America. Why aren't either of them talking about that?

Jill Richardson is the founder of the blog La Vida Locavore and a member of the Organic Consumers Association policy advisory board. She is the author of Recipe for America: Why Our Food System Is Broken and What We Can Do to Fix It..

Poop Is the Most Important Indicator of Your Health

Like it or not, our bowels are the ID cards of our bodies, charting our recent histories with terrifying accuracy. So, how do we ensure a healthy gut?

According to a lawsuit filed this month, Ron and Sarah Bowers bought their son a Subway sandwich in Lombard, Illinois on February 27. After eating it, he had agonizing cramps and diarrhea. According to the suit, what the couple really bought was a shit sandwich. It had been contaminated with Shigella sonnei, a bacteria transmitted via the fecal-oral route and can cause vomiting, dysentery and death. Over 100 people claim to have been sickened at Lombard's Subway, according to attorney Drew Falkenstein, whose firm has filed suit on behalf of Ron and Sarah Bowers and two other customers. We don't want to think about excrement. We don't want to see it, smell it or touch it. We definitely don't want to eat it with chicken teriyaki, on toast. Yet intestinal goings-on are in our faces everywhere these days, whether the news is about probiotics and prebiotics appearing in new food products or yet another outbreak of norovirus -- the painful gastroenteritis that is spread via fecally contaminated food, water and surfaces and has sickened thousands of cruise-ship passengers in eight unprecedentedly massive outbreaks so far this year. And "poopular culture" is upon us: Witness Slumdog Millionaire's outhouse-plunge scene. Witness Oprah's "Everybody Poops" episode, in which Dr. Mehmet Oz avows that excrement should enter the toilet with not a plop but a swoosh "like a diver from Acapulco." In a scene from the forthcoming film Life As We Know It, a young mom portrayed by Katherine Heigl is interrupted by visitors while changing a diaper. "Sweetie," one of the visitors tells her, "you have shit on your face." In a dirty, crowded world where germs are outsmarting drugs by leaps and bounds and our health care options may or may not be mired in red tape for years, we're being forced to face feces. Which is kind of a good thing. They're the ID cards our bodies issue, charting with terrifying accuracy where we've been and what we've done. The bowel knows.

Good Bugs vs. Bad Bugs

"A gram of feces can contain 10 million viruses, one million bacteria, 1,000 parasite cysts and 100 worm eggs," asserts Rose George, author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters (Metropolitan, 2008). She despairs over the fact that 2.6 billion people "have no access to any latrine, toilet bucket or box. ... They do it in plastic bags and fling them through the air in narrow slum alleyways." Four out of every 10 human beings, George laments, "live in situations where they are surrounded by human excrement." In the developed world, our relationship with our bowels mostly entails controlling the flora that live in them. Lactobacillus. Peptococcus. Streptococcus. A hundred trillion microbes belonging to as many as 1,000 different species coexist at any given time in a single gut, which measures over three yards. What are they doing down there? Battling it out, rendering us well or ill.

Over 70 percent of the human body's immune cells are found in the gut's mucosal lining. A healthy gut means more immunity, and a healthy gut is a gut in which good bacteria outnumber bad. And they're all hitchhikers that rushed in from outside, mounting an invasion that began the instant our placentas broke. "We're all bacteria-free until then," says Emory University School of Medicine associate professor Andrew Gewirtz, the senior author of a study released this month on the effects of imbalanced gut flora. Once the placenta breaks, Gewirtz says, "the colonization begins." Garnering such headlines in the mainstream media as "You can blame bacteria in your stomach for those unwanted pounds" and "Germs are making you fat," his study found that mice whose guts contained too many of the class of bacteria known as Firmicutes ate much more than other mice, experienced metabolic changes and became obese. This finding undermines the assumption that obesity is driven by laziness and easy access to cheap fattening foods.

"You can't ask the mice" why they ate more, "but how much they ate was clearly not affected by price or marketing schemes," Gewirtz says. Instead, bad bugs can promote excessive appetite and fat storage. They can also make us sick in a million other ways.

The Business of the Gut

"Good bugs form an invisible barrier preventing pathogenic bugs to take root and multiply," says Ann Louise Gittleman, a doctor of holistic nutrition who has appeared on "Dr. Phil" and authored over 30 books including Fat Flush for Life (Da Capo, 2009). She urges us to wage "the new germ warfare" that optimizes "the balance of power in what amounts to a huge fungi kingdom. We have to, because in our bodies we have more bacteria than we have cells." Because of their crucial role in immune function, the bad ones "can turn into a source of bad health that can affect us from head to toe," creating not just irritable bowel syndrome, colitis and Crohn's disease but conditions such as nasal congestion, itchy skin, bleeding gums, acne and depression that we might not think had anything to do with our bowels, Gittleman says. Online, she sells stool-sample testing kits that come with vials and a discreet white box printed with the address of the lab that does the analysis. "The intestine is an unappreciated organ. It's a beautiful membrane," asserts vegan physician Michael Klaper, who appeared in the PBS documentaries Diet for a New America and Food for Thought and has served as an adviser to NASA. "Think of all the intestine does while supporting a population of alien organisms. Miraculous things happen on our gut linings."

At True North Health Education and Fasting Center in Santa Rosa, California, Klaper and his fellow doctors supervise patients undergoing water-only fasts that can last up to 40 days. "Like other organs, the gut could use a rest. We're talking about 22 feet of small intestine. Its lining is a very active membrane and it needs a holiday sometimes, too. "The body is perfectly capable of going for weeks without food as you burn off your fat stores. Of course, it's no picnic. In the first few days, people are very energetic, as all the energy that would have been used to digest food is put to other purposes. At the end of the second week, they get very quiet, meditative. They're in a different space," said Klaper. When it's over, "they're very light and clean, and we very gently re-feed them on highly diluted fruit juices and steamed vegetables." However long the fast lasted, refeeding takes half that long. "There's an art to it, of course," Klaper says.

How did we get so messed-up?

"In the old days, our ancestors drank water out of streams and wells. They ate fruit and vegetables harvested in gardens. They lived in close connection with the natural world, and part of the natural world would set up housekeeping in their intestines," he said. Traditional diets lacking chemical additives kept their gut bugs in balance, "but modern life is an assault on our normal bacterial flora. We put five or six majorly disruptive substances down there every day." The first of these is chlorine, found in tap water. "Okay, so we don't get cholera or typhoid. That's great. But every time you drink this water, you're drinking a chlorine-dilute solution," he said. That kills good bugs along with bad. Ditto phosphoric acid, a key soft-drink ingredient. "We're a nation of tea and coffee drinkers. What happens in your gut when you're constantly sloshing down a known bactericide?" Sugar is yet another villain, as are antibiotics, which wipe out nearly every bug in sight -- which saves lives but leaves guts thinking What the hell?

And they do think, insists Chicago colon therapist Alyce Sorokie, the author of Gut Wisdom: Understanding and Improving Your Digestive Health (Career, 2004). "The gut is always speaking to us. It has more emotional receptor sites than anywhere else in the body. The gut is filled with neurons and neuropeptides, the same things that are in our brains, so it can take in information. It can learn. It can respond to events even more rapidly that our brain does," says Sorokie. "You feel something in the gut, and the vagus nerve brings that 'gut feeling' up the spinal cord to the brain, and the brain makes up a story about it. The brain can always rationalize, but when we feel something in the gut, it's unedited. It's very primal. That's the gut's voice, and the more we don't listen, the louder it gets." And that is why Sorokie says her clients get emotional during colonics, as filtered water flowing through a hose inserted into the anus bathes the colon, bringing out with it accumulated fecal matter that can be viewed through a clear portion of the mechanism, foot by wiggly, rubbery, slippery, corn-kernel-studded foot.

Releasing stored material from digestive tracts releases stored material from hearts and minds as well, Sorokie says. "It lets everything come out. These clients say they wish they could bring the hose along with them to their psychotherapy appointments. Nobody wants to think, 'I harbor toxic thoughts and toxic waste within me,' but then there's a liberation: Here it is and there it goes. This was part of me, and now it's not," she said. Short of anal hoses and doctor-supervised starvation, we can give our bowels a break by eating prebiotics. Found in dandelion greens, Jerusalem artichokes, chicory, milk and a few other natural sources, these are soluble fibers that we can't digest, but our beneficial flora can. In other words, prebiotics (which aren't alive) fuel probiotics (which are), making them more active and fighting-fit. So, eating prebiotics is like sprinkling fish-food into a tank full of hungry fish.

"Most people are already comfortable with the idea of fiber in their diets," says microbiologist Mary Ellen Sanders, who belongs to the International Scientific Association of Probiotics and Prebiotics. "Now you can start to think of eating fiber not just for the traditional fiber effects, but to feed beneficial members of your bacterial community," she explained. These communities, which are unique to each of us, remained almost a total mystery until recently. Only in the last few years has DNA research brought the identities and functions of much of this flora to light. Up to 80 percent of the various types of human bacterial microbes have still never been grown outside the body under laboratory conditions, Sanders says. "It will be very interesting to see how all this develops in the next five years." In the meantime, she says eating probiotics and prebiotics "lets us feed the right microbes in the right way." As it would be difficult to eat enough chicory and dandelion greens to get the recommended five to eight daily grams of prebiotics, we can start looking for prebiotic-fortified food products and supplements, often identified by the presence of oligofructose and/or inulin on their labels.

We'll be seeing those words more and more, as products containing prebiotics are among the food industry's fastest-growing sectors. New ones keep popping up, such as the Jamba Juice frozen sorbet and yogurt bars that hit stores this month. The bars' marketing material promises that Coconut-Pineapple Passion Smashin' and its fellow treats-on-sticks "contain prebiotic fiber, allowing customers to satisfy their sweet tooth without feeling guilty." One hundred trillion microbes are too many to kill, so we're never out of bugs. But when they go way out of balance, a new kind of therapy lets doctors recolonize patients' bowels with what Emory University's Andrew Gewirtz calls "cocktails of good bacteria." As seen on "Grey's Anatomy" and in real life, the treatment is an extreme measure for people suffering from Clostridium difficile, a bad bacteria whose overpopulation causes debilitating intestinal infections when antibiotics wipe out the good bacteria that would normally quell it. (Clostridium difficile rates are skyrocketing in American hospitals these days.) Known as fecal bacteriotherapy, fecal transfusion or fecal transplant, the treatment entails inserting a healthy person's feces into the sick person.

Rich in good bacteria, these feces enter the patient's intestine from either end: via enemas or orally, through a tube. "These patients are at the ends of their ropes," says Gewirtz. "They're willing to try something that isn't very pleasant." So: Bad gut bacteria stay bad when Subway workers don't wash their hands after doing you-know-what. Good gut bacteria stay good even after they exit one body in feces and are more or less fed to another. And in this brave new world, eating shit might save lives.

Anneli Rufus is the author of several books, most recently The Scavenger's Manifesto (Tarcher Press, 2009). Read more of Anneli's writings on scavenging at scavenging.wordpress.com.