Rethinking Thin - Book Summary
Here’s a quick synopsis of Rethinking Thin for anyone who hasn’t had a chance to read it yet. We’d like to have everyone join in the discussions, so orient yourself here with our 3FC Cliff Notes and jump in!
The book weaves together the story of a weight loss study conducted at the University of Pennsylvania with chapters about the history of dieting and the evolution of the science of weight and obesity. It then ends with the author’s controversial conclusions about where science leaves us in the battle against obesity. Chapter by chapter, it looks like this:
The prologue introduces us to the key questions to be explored in the book:
The book opens with an introduction to Carmen Pirollo, one of a group of dieters enrolled in a two-year study at the University of Pennsylvania comparing Atkins with a traditional low-calorie diet. The study began at the height of the Atkins/low-carb mania and all the participants hoped to be randomly assigned to the Atkins group.
The chapter is a rundown on the specifics of the two diet plans. Atkins is straight Atkins and the low-calorie plan used was LEARN, a diet and behavioral modification plan written by Kelly Brownell of Yale’s Rudd Center for Food Policy and Obesity. As we all know, Atkins is most nutritionist’s nightmare and in contrast, LEARN represents the traditional, mainstream approach to dieting. So this was a two-year, head to head study of low-carb versus traditional weight loss.
We’d all probably recognize ourselves in Carmen. The book reviews Carmen’s history of trying every diet and regaining all lost weight. He is the classic yo-yo dieter. His wish comes true and he’s assigned to the Atkins diet group. And we’re off.
Chapter 2: Epiphanies and Hucksters
It turns out that nothing in the diet world is new; everything is rediscovered. This chapter traces the history of diets from the ancient Greeks, focusing on the 19th century onward. It covers the first low-carb trend, drinking vinegar for weight loss, ‘Fletcherizing’ (chewing excessively) your food, low-protein and low-calorie plans, weight loss contests a la The Biggest Loser, diet pills and even weight loss surgery. It’s a fascinating chapter if you’re intrigued by dieting through the ages. And it’s somewhat depressing given as we seem to keep doing the same things over and over again without very much in terms of long-term results.
We now jump back to the group of Penn dieters. They’re one month into their diets and it’s the honeymoon period. The group discusses how to avoid temptations – it sounds like 3FC!
Chapter 3: Oh, to Be as Thin as Jennifer Aniston (or Brad Pitt)
As the different diets came and went, our body weight ideals got smaller and smaller. What was the epitome of female attractiveness in the late 1800s was considered positively chunky by the Flapper Era of the 1920s and that ideal is considered to be downright chubby today. The trend has undeniably been toward thinner and thinner as the ideal at the same time as we as a society are getting larger and larger. "By the 1960s … the ideal female body was once again that of a preadolescent girl". (p 78)
Three technologies enabled us to make dieting our obsession: the bathroom scale, the full-length mirror, and photography. All three give us objective evidence of our size and contribute to our national weight preoccupation.
We meet two more Penn dieters: Jerry Gordon (227 pounds at 5’ 4”) and Graziella Mann (223 pounds). They’ve both been assigned to the low-calorie study group. The book reviews their personal lifetime diet struggles, sounding just like most of us here at 3FC.
Chapter 4: A Voice in the Wilderness
Now that the book has reviewed the history of dieting and the evolution of social weight ideals, we move on to the science of obesity and weight loss.
This chapter focuses on the question of whether people become fat due to emotional eating. It concludes, after reviewing numerous studies, that fat people are not more emotionally disturbed and do not suffer more emotional problems than thin people do:
We’re left with the question:
We’re three months into the Penn study and just about everyone has lost 10% of their starting weight. This becomes an opportunity to discuss goal weights. The Penn researchers tell the study participants that a 10% loss would be a resounding success, yet all of the dieters have much greater weight loss goals. They would all consider a mere 10% loss to be a failure.
Chapter 5: A Drive to Eat
Chapter 5 begins the meat and potatoes of the book: an overview of the scientific studies concerning obesity, appetite, and weight determination. It begins with the famous World War 2 Keys starvation studies. Healthy volunteers (conscientious objectors) cut their calories in half and added in walking exercise (just like dieters do). The men lost 25% of their weight over six months time. But the consequences of the diet were -– as the book puts it –- shocking. The men became obsessed with food; thinking, dreaming, and talking about it nonstop. They began binging. They suffered psychological problems. And their metabolisms slowed to 40% of normal.
The next study discussed was conducted at Rockefeller University to determine what happened to fat cells when obese people lose weight. Four men lived at the University and lost an average of 100 pounds each over a six month period on a 600-calorie per day diet. What shocked the researchers was the fact that all regained their lost weight when they left the hospital setting.
From these studies, the book concludes:
The Penn dieters are discussing temptations and willpower. The big question is how to maintain motivation and resist temptation forever.
Chapter 6: Insatiable, Voracious Appetites
Chapter 5 rounded up the studies proving that obesity is a genetically linked trait and that it’s extremely difficult to manipulate your weight outside of a preset range. Chapter 6 moves into the world of hormones, receptors, and genes. Why do we get hungry? What makes us feel full? Is this system faulty in some people?
The chapter tells the story of the ob mice (ob for obese) -- genetic mutants who ate more than other mice and grew enormous – and the search for the ob gene.
Ob mice seemed to lack a satiety signal – an off switch. Other mice -- called db mice (for diabetes) – apparently produce a satiety signal but can’t respond to it:
We’re only six months into the two-year study but the diet honeymoon is over. Most of our study participants have stopped losing and started regaining.
Chapter 7 focuses on hormones that regulate hunger and satiety, primarily leptin, though others such as ghrelin, PYY, and AgRP are also discussed. The chapter opens with the story of a child born without leptin, who had an insatiable appetite. She grew tremendously obese until she was given leptin injections, after which her appetite and size returned to normal. Researchers drew hope from her experience that leptin injections would become the key to weight control for the obese.
Unfortunately, experiments didn’t bear this simple solution out and it now appears that the leptin pathway is a complicated system with potential for disruption at many steps along the chain.
The intriguing findings about leptin are that it also seems to have the potential to reshape and rewire the brain, permanently changing a person’s weight and appetite. Perhaps there are critical times in a person’s life – perhaps in infancy? – when the brain is wired for obesity? There are tremendous implications to the ongoing research:
Ron Krauss, one of the study participants, hits his lowest weight ten months into the study and promptly begins to regain. He blames himself for getting sloppy with portion sizes, eating at night, and failing to journal.
Jerry Gordon reaches his low weight after six months and then stalled. He blames himself for not having sufficient self-discipline.
Graziella Mann reached her low weight after six months. She’s rededicating herself to the program.
Carmen Pirollo lost his willower (as he put it) after six months and started to regain.
But none of the participants is giving up; all are sticking to the study for the full two years.
Chapter 8: The Fat Wars
Chapter 8 of Rethinking Thin challenges many popular beliefs about the health hazards of excess weight. It asks why we as a nation are fixated on weight as a health crisis? Why is obesity considered to one of the top health risks, right up there with smoking? It disputes the notion that being overweight is unhealthy and can lead to premature death. It challenges the idea that we can intervene in children’s lives to reduce the incidence of obesity. And it even suggests that being overweight may confer positive and protective health benefits and lead to a longer life span:
We jump from ten months into the Penn study to its conclusion at the end of two years. Few of the study dieters show up for the last meeting. The Atkins mania has turned into a bust and diet trends have moved on to whole grains, low GI, low sugar, and no trans fats.
Of our four spotlight dieters, Graziella has lost 11 pounds in the two years. Jerry is still fat and says he expects to stay that way. Carmen is still obese. Ron lost a total of 30 pounds. None has come even close to reaching their dream weights. All the dieters say they’ve learned better habits that they will continue for a lifetime.
The book’s epilogue begins with the notion of the psychology of false hope – a belief in something despite all evidence to the contrary. The author says that she experienced it herself in writing the book:
The author then concludes the book with an her suggestion of how we might "rethink" the issues of thinness and obesity:
I think the diet science is not developed. People come up with different theories and try to brainwash others.
I have seen different diatitians telling different theories.
But, you are succe ssful in keeping your excess weight off from 2011.
So, tell us your experience, rather than telling us disappointing theories of half baked brainy diatitians.
Parden me, but these theories really discorage people.
Having read your long post here, Meg, all I can say is that this book doesn't really shed any new information on this subject. I am inclined to believe that the reason why the population of the United States is now at 60% obese has more to do with the fact of our lifestyle choices.
Seven and a half years ago, I moved to Atlanta, Georgia from a small "walk-friendly" Midwestern town. There is a local saying here that "Atlanta is the city where you drive somewhere to go for a walk." My husband and I have found this to be true. When I lived in the aforementioned smaller college town, after our evening meal, we would put our athletic shoes on and go for an evening walk almost every night. It helped us digest our meal, relaxed us after a day at work and helped to put us to sleep. It was easy. We just stepped outside our front door. Within a year of moving here, I can gained 35 lbs and went up one size in clothing. Ditto with my former thin husband.
Although I had been diagnosed with arthritis in 1994, I never had any symptoms (ie, pain, stiffness, lack of mobility) UNTIL I moved here and stopped my regular exercise. Within 4 years, I was even bed ridden for a period of several months; due to the fact that I was inactive. I had no idea that I had kept the more serious complications of my arthritis at bay all of those previous years by doing something as simple as a nightly walk with my partner.
I stopped dieting long ago. However, what I have done is learn to make food choices that support a healthier body. As a result, the weight is coming off slowly but it is coming off. I "discovered" in January 2010 that my morning blood glucose was 174 mg/dl (diabetic is 146 mg/dl and normal is 90 mg/dl). By simply changing my food choices I have had a normal fasting blood glucose for nearly a year and my eye doctor, who was the one who first pointed out to me about the changes in my vision, now claims I have the vision of someone nearly 20 years younger! He was amazed! It goes without saying that you are what you eat.
I followed your personal history, Meg, long ago and I do know that you lost over 100 lbs in less than a year. I think that is what everyone here wishes they could do. However, after reading such books as the one you reviewed, and seeing how people here have struggled so much and feel they have gotten so little out of all their efforts; I have recently decided that I would instead focus on having good (if not great) health.
Since the affects of my RA and osteo-arthritis have really thwarted my desire to be as active as I once was, I have learned a more important lesson (for me): health and wellness is not a number on the scale nor a certain physical body image that may or may not conform to societal standards. What is to me today is to have "normal" numbers like blood glucose, blood pressure and blood cholesterol (all of mine are "normal"). The other part is that I am able to be as active as my arthritis will allow me to be. I am being more pro-active about regaining some of the muscle I lost when I moved here and with that strength and flexibility. I do set weight lose goals for myself but I don't "stress out" about not reaching a particular goal at a particular time. I do think that the obsessing that often accompanies weight lose efforts is counter-productive and can even contribute to a lack of overall well being. Will I end up seeing my goal weight? I honestly don't know at this point but, in the meantime, I am learning that optimal health is more subjective than being able to do 100 ab crunches or walking 10,000 steps a day. To me, that is real hope and one I am willing to bank on.;)
I imagine the rethinking thin info is accurate if our expectations are unrealistic and you expect to go back to relying on your genes to eat high tech food. But we know thousands of people can and do lose weight and keep it off.
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