# Tuesday 150324

Our guess this week is for Box Jump Overs…

Workout
20/15/10
135/95 lbs Cleans
Ring Push-ups (Subs…Ring PU on knees, 50% more…H.R. PU, 100% more…H.R. PU on knees, 150% more!)
20 inch Box Jump Overs

Strength
BSquats
3x 70%
3×80%
3×90%
3×80%
3+ x70%

Compare to: Monday 140804

From The Atlantic

# How Obesity Became a Disease

And, as a consequence, how weight loss became an industry

Weight loss is a big business, and, since it’s rarely successful in the long term, it comes with a built-in supply of repeat customers. And doctors have been involved in the business one way or another for a long time. Some 2,000 years ago, the Greek physician and philosopher Galen diagnosed “bad humors” as the cause of obesity, and prescribed massage, baths, and “slimming foods” like greens, garlic, and wild game for his overweight patients. More recently, in the early 20th century, as scales became more accurate and affordable, doctors began routinely recording patients’ height and weight at every visit. Weight-loss drugs hit the mainstream in the 1920s, when doctors started prescribing thyroid medications to healthy people to make them slimmer. In the 1930s, the weight-loss chemical 2,4-dinitrophenol (DNP) came along, followed by amphetamines, diuretics, laxatives, and diet pills like fen-phen, all of which worked only in the short term and caused side effects ranging from the annoying to the fatal.

The national obsession with weight got a big boost in 1942, when a life-insurance company created a set of tables that became the most widely referenced standard for weight in North America. The Metropolitan Life Insurance Company crunched age, weight, and mortality numbers from nearly 5 million policies in the United States and Canada to create “desirable” height and weight charts. For the first time, people (and their doctors) could compare themselves to a standardized notion of what they “should” weigh.

And compare they did, using increasingly clinical-sounding terms like adipose, overweight, andobese. The new terminology reinforced the idea that only doctors should and could treat weight issues. The word overweight, for example, implies excess; to be overweight suggests you’re over the “right” weight. The word obese, from the Latinobesus, or “having eaten until fat,” handily conveys both a clinical atmosphere and that oh-so-familiar sense of moral judgment.

By the 1950s, even as Hollywood glamorized voluptuous actresses like Marilyn Monroe and Elizabeth Taylor, medicine was taking a different stance. In 1952, Norman Jolliffe, the director of New York’s Bureau of Nutrition, warned doctors at the annual meeting of the American Public Health Association that “a new plague, although an old disease, has arisen to smite us.” He estimated that 25 to 30 percent of the American population at the time was overweight or obese, a number he essentially made up. “No one loves a fat girl except possibly a fat boy, and together they waddle through life with a roly-poly family,” wrote Paul Craig, a physician from Tulsa, Oklahoma, in 1955. Craig was enthusing over a 1907 study that claimed “gratifying results … on the problem of obesity” by putting people on 800-calories-a-day diets and dosing them liberally with amphetamines, phenobarbital, and methylcellulose. (Craig concluded, in a comment that fails to inspire confidence in his methods of scientific inquiry, “Not all people who eat gluttonously grow fat, but no fat man or woman eats, as they claim, like a bird, unless they refer to a turkey buzzard.”)

In 1949, a small group of doctors created the National Obesity Society, the first of many professional associations meant to take obesity treatment from the margins to the mainstream. Through annual conferences like the first International Congress on Obesity, held in Bethesda, Maryland, in 1973, doctors helped propagate the idea that dealing with weight was a job for highly trained experts. “Medical professionals intentionally made a case that fatness was a medical problem, and therefore the people best equipped to intervene and express opinions about it were people with M.D.s,” says Abigail Saguy, a sociologist at the University of California, Los Angeles.

Those medical experts believed that “any level of thinness was healthier than being fat,” writes Nita Mary McKinley, a professor of psychology at the University of Washington, Tacoma. This attitude inspired a number of new treatments for obesity, including stereotactic surgery, also known as psychosurgery, which involved burning lesions into the hypothalamuses of people with “gross obesity.” Jaw wiring was another invasive procedure that gained traction in the 1970s and 1980s. It quickly fell out of favor, maybe because it stopped working the minute people started eating again. (At least one dentist in Brooklyn still promotes it.)

On a cool June afternoon in 2013, hundreds of doctors from around the country streamed into the grand ballroom of the Hyatt Regency Chicago. They were there, on day three of the American Medical Association’s annual meeting, to vote on a list of organization policies—boring but necessary stuff, for the most part. But one item on the ballot that day would prove contentious, and not just within the paneled walls of the ballroom. Resolution 420 was short and to the point: “That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.”

The question—whether to classify obesity as a disease in and of itself, or continue to consider it a risk factor for diseases like type 2 diabetes—had been under discussion for years, both within the organization and outside it. Months earlier, the AMA asked its own Committee on Science and Public Health to explore the issue; the committee came up with a five-page opinion suggesting that obesity should not be officially labeled as a disease, for several reasons.

For one thing, the committee said, obesity doesn’t fit the definition of a medical disease. It has no symptoms, and it’s not always harmful—in fact, for some people in some circumstances, it’s been known to be protective rather than destructive.

For another, a disease, by definition, involves the body’s normal functioning gone wrong. But many experts think obesity—the body efficiently storing calories as fat—is a normal adaptation to a set of circumstances (periods of famine) that’s held true for much of human history. In that case, the bodies that tend toward obesity aren’t diseased; they’re actually more efficient than naturally lean bodies. True, we live in a time when food is more abundant for most people and life is more sedentary than it used to be, and we don’t have the same need to store fat. But that simply means the environment has changed faster than we can adapt.

Finally, the committee worried that medicalizing obesity could potentially hurt patients, creating even more stigma around weight and pushing people into unnecessary—and ultimately useless—“treatments.”

The AMA membership didn’t agree with the committee; they passed Resolution 420 in an overwhelming voice vote. I asked the organization’s president, Ardis Hoven, an internist who specializes in infectious diseases, to help me understand why the membership voted that way despite the committee’s recommendation. She wouldn’t talk to me directly, instead writing through a spokesperson, “The AMA has long recognized obesity as a major public-health concern, but the recent policy adopted in June marks the first time we’ve recognized obesity as a disease due to the prevalence and seriousness of obesity.”

There are, of course, other possible explanations for the AMA’s decision. As James Hill, the director of the Anschutz Health and Wellness Center at the University of Colorado, told ABC, “Now we start getting some standardization for reimbursement and treatments.”

In other words, follow the money. Doctors want to be paid for delivering weight-loss treatments to patients. Coding office visits for Medicare, for instance, is a complex process that involves counting the number of bodily systems reviewed and the number of diseases counseled for. If Medicare goes along with the AMA and designates obesity as a disease, doctors who even mention weight to their patients could charge more for the same visit than doctors who don’t.

But that’s trivial compared with the sorts of financial conflicts of interest defended by some in the field. It’s rare to find an obesity researcher who hasn’t taken money from industry, whether it’s pharmaceutical companies, medical-device manufacturers, bariatric-surgery practices, or weight-loss programs. The practice isn’t limited to lesser-known luminaries, either. In 1997, a panel of nine medical experts tapped by the National Institutes of Health voted to lower the BMI cutoff for overweight from 27 (28 for men) to 25. Overnight, millions of people became overweight, at least according to the NIH. The panel argued that the change brought BMI cutoffs in line with World Health Organization Criteria, and that a “round” number like 25 would be easy for people to remember.

What they didn’t say, because they didn’t have to, is that lowering BMI cutoffs, and putting more people into the overweight and obese categories, also made more people eligible for treatment.

# Monday 140804

Workout

20/15/10
135/95 lbs Cleans
Ring Push-ups (Subs…Ring PU on knees, 50% more…H.R. PU, 100% more…H.R. PU on knees, NO!)
Box Jumps

Strength

BSquats
3x 70%
3×80%
3×90%
3×80%
3+ x70%

Ahhh…a thorn between roses

# Tuesday 140401

### Workout

For time:
30, 20, 10 reps of
95 lbs – OHS*
Ring Push-ups
Pull-ups

Compare to: Wednesday 071226

From NPR

Nutrition researchers are reaching a new consensus: Cut back on all those refined carbs. And remember that some fat is good.

Remember the fat-free boom that swept the country in the 1990s? Yes, we know from the Salt readers who took our informal survey that lots of you tried to follow it. And gave up.

“I definitely remember eating fat-free cookies, fat–free pudding, fat-free cheese, which was awful,” Elizabeth Stafford, an attorney from North Carolina, told us in the survey.

Back then, she avoided all kinds of foods with fat: cheese, eggs, meat, even nuts and avocados. Most of the experts were recommending a low-fat diet to prevent heart disease.

And, as a result, her diet was full of sugar (lots of fat-free, sugary yogurt) and carbohydrates, like bagels.

“Fat was really the villain,” says Walter Willett, who is chairman of the department of nutrition at the Harvard School of Public Health. And, by default, people “had to load up on carbohydrates.”

But, by the mid-1990s, Willett says, there were already signs that the high-carb, low-fat approach might not lead to fewer heart attacks and strokes. He had a long-term study underway that was aimed at evaluating the effects of diet and lifestyle on health.

“We were finding that if people seemed to replace saturated fat — the kind of fat found in cheese, eggs, meat, butter — with carbohydrate, there was no reduction in heart disease,” Willett says.

Willett submitted his data to a top medical journal, but he says the editors would not publish his findings. His paper was turned down.

“There was a lot of resistance to anything that would question the low-fat guidelines,” Willett says, especially the guidelines on saturated fat.

Willett’s paper was eventually published by a British medical journal, the BMJ, in 1996.

Now, nearly two decades later, a more complicated picture has emerged of how fats and carbohydrates contribute to heart disease.

For instance, it’s clearer that some fats, namely plant-based fats found in nuts and olive oil, as well as those found in fatty fish, are beneficial. Willett says there’s strong evidence that they help reduce the risk of heart disease.

But here’s where it gets interesting: “We’ve learned that carbohydrates aren’t neutral,” explainsDariush Mozaffarian, an epidemiologist at Harvard Medical School.

“[Carbs] were the base of the pyramid,” says Mozaffarian. The message was “eat all carbohydrates you want.”

Americans took this as a green light to eat more refined grains such as breads, processed snack foods and white pasta.

“But carbohydrates worsen glucose and insulin — they have negative effects on blood cholesterol levels,” he says. The thinking that it’s OK to swap saturated fats for these refined carbs “has not been useful advice.”

He says it’s clear that saturated fats can raise LDL cholesterol, the bad cholesterol. But that’s only one risk factor for heart disease.

There’s now evidence that — compared with carbs — saturated fat can raise HDL cholesterol (the good cholesterol) and lower trigylcerides in the blood, which are both countering effects to heart disease, he says.

“When you put all of this together,” says Mozaffarian, what you see is that saturated fat has a relatively neutral effect compared with carbs. He says it’s “not a beneficial effect but not a harmful effect. And I think that’s what the recent studies show.” He points to a review of studies published in 2010.

He also points to a highly publicized recent meta-analysis that concludes there’s no convincing evidence to support the dietary recommendations to limit saturated fat.

The findings in that paper have created quite a bit of controversy. For instance, the American Heart Association says it stands by its recommendations to limit saturated fat.

“This research simply means that we lack the data from controlled clinical trials that truly test this question of how much saturated fat is acceptable,” writes Linda Van Horn, a spokesperson for the American Heart Association.

But what’s the message that’s getting out?

A few days ago, Mark Bittman, an author and op-ed contributor to the New York Times, wrote acolumn titled “Butter is Back” based on the findings of the recent meta-analysis. “When you’re looking for a few chunks of pork for a stew, you can resume searching for the best pieces — the ones with the most fat,” he wrote.

This didn’t sit well with Alice Lichtenstein, a nutrition science and policy researcher at Tufts University, who wrote a letter to the editor arguing that green-lighting the return to butter and fatty pork was off.

She pointed to an AHA guideline review supporting the recommendation to limit saturated fats.

So, given the kerfuffle, is there some consensus? Yes, it turns out.

In an email to us, Lichtenstein explained that, “There are strong data to suggest substituting carbohydrate for saturated fat is not associated with a [cardiovascular risk] benefit.”

Like Willett and Mozafarrian, she makes the case that “substituting polyunsaturated fatty acids [which are found in nuts, seeds, fish and leafy greens] for saturated fat is associated with a benefit.”

So, the message here seems to be: Cut back on all those refined carbs, and remember that some fat is good.

After all, the heart-healthy Mediterranean diet, which includes lots of nuts, olive oil, fish, fruits, vegetables and legumes, and small amounts of cheese and meat, turns out to be a pattern of eating that includes 40 percent to 45 percent of calories from fat. That’s hardly low-fat!

Now, of course, in an age when people are avoiding animal products for many reasons, including animal welfare and environmental concerns, new studies that conclude meat is OK, compared with all the refined grains we eat, is bound to raise criticism from vegetarians.

Neal Barnard, a physician and vegetarian activist who leads the Physicians Committee for Responsible Medicine, writes, “Before you fry up that bacon, hold the fork.” His conclusion about the recent meta-analysis is this: “The study had some interesting statistical quirks that made [saturated fat] look safer than it really is.”

The debates about fat will likely go on. And the new studies have been like lighter fluid on the charcoal grill.

So, stay tuned. But what’s clear is this: Gone are the days of experts calling for ultra-low-fat diets.

Elizabeth Stafford, who told The Salt about how she struggled with her weight on a low-fat diet, says there’s a good reason why.

“I was always starving, and I never felt satisfied,” she says, thinking back to her low-fat, high-carb days. Eating carbs seems to make you quickly hungrier for more carbs. And ditto for sugar.

“It took me a long time not to be scared of fat,” Stafford says. But, she says, she now enjoys scrambled eggs and the occasional burger.

# Monday 130506

Workout

1Press + 1Push-Press – Start at 50% of your 1 RM and add 5-10 lbs after each successful set.

Met Con

EMOM for twenty minutes…

Odd – 10 Ring Push-ups
Even – 10-KB swings + 10-Sit-ups

From The Atlantic

# Look How Quickly the U.S. Got Fat (1985-2010 Animated Map)

25 brief, delicious years
More
This shows the percentages of the U.S. population medically defined as obese, which means a body mass index of 30 or greater. BMI isn’t an ideal metric to evaluate obesity, but it’s still what the U.S. standardly uses.

By now everyone knows obesity is a serious issue, but it always helps me to see things moving and in color, and makes the “epidemic” terminology make sense. Meanwhile, through 2012, no state has met the CDC’s nationwide goal to reduce obesity to 15 percent. According to a Gallup poll out this morning, here are the least and most obese metropolitan areas:

So if we all just move to Colorado we should be fine.

# Saturday 110423

Workout

OK…the 2nd Throwdown WOD has been completed.  Wher do you stand?

FOR TIME:
750m Row
Ring Push Ups (30 men / 30 women);
Ring Push Ups (25 men / 20 women);
Ring Push Ups (20 men / 10 women);
750m Row

# Monday 110314

Workout

5 x75%
5 x80%
AMRAP x85%
…Complete 15 Ring Push-ups between each set of DL

### On the Left Hand, There Are No Easy Answers

###### By PERRI KLASS, M.D.

Humans are asymmetric animals. Early in our embryonic development, the heart turns to the left. The liver develops on the right. The left and right lungs have distinct structure.

From left: United Press International; Gary Cameron/Reuters; Jonathan Ernst/Reuters

Recent left-handed presidents include, from left, Gerald R. Ford, Bill Clinton and Barack Obama.

There are certain rare syndromes in which the usual asymmetry of organs is reversed — I remember how disconcerting it was the first time I examined a child with dextrocardia, a heart on the right side, and heard the heart sounds in unexpected places. But when it comes to handedness, another basic human asymmetry, which reflects the structure and function of the brain, the reversed pattern is relatively common, and for all that, not easily understood.

Over the centuries, left-handers have been accused of criminality and dealings with the devil, and children have been subjected to “re-education.” In recent years the stigma has largely vanished; among other things, four of our last seven presidents — Ford, the elder Bush, Clinton, Obama — have been left-handed. (Reagan is sometimes cited as ambidextrous, and in his autobiography, Gerald Ford said he wrote with his right hand while standing.)

But the riddle of what underlies handedness remains. Its proportions — roughly 90 percent of people are right-handed and 10 percent left-handed — stay consistent over time.

“This is really still mysterious,” Read more Monday 110314

# Wednesday 110309

Workout

2000m Row or 1M Run
30-Box Jumps
30-Ring Push-ups
1000m Row or .5M Run

TitanFit Trainers WOD
PART 1 (for time):

50 Wallballs (20#/14#) plus
3 ROUNDS:
30 Double Unders;
15 Toes to Bar;
10 Front Squats (135#/95#)

PLUS (IMMEDIATELY FOLLOWING)

PART 2 (max weight):

1 Rep Max Clean (3 MINUTE TIME LIMIT)

My from obese to “normal”…OK it was not a journey, just a new measure of body adiposity recently developed.  Give the following a read and see where you fall.

### New measure of obesity – body adiposity index (BAI)

Scientists have proposed a new method for determining body fat, called the Body Adiposity Index.

### Background

Obesity affects 500 million people world-wide (which is crazy when one billion people are starving, but we’ll leave that issue for another time.)

There are several methods for measuring body fat (including hydrodensitometry, calipers, DEXA – Dual Energy X-ray Absorptiometry, infrared, MRI, and so on. See Body Fat Analyzing for more information.)

But is there an easy, low-tech way to measure whether somebody has a healthy amount of body fat, or is overweight?

For almost 200 years, the Body Mass Index (BMI) has been used to give a measure of body fat. The calculation for BMI is as follows.

$\text{BMI}=\frac{\text{height in m}}{\text{(weight in kg)}^2}$

BMI is useful in that you only need to know the person’s height and weight.

The problem with the BMI is that it often fails as a measure of how much unhealthy fat you are carrying. There are broad ranges in the BMI for “healthy” and “obese” to allow for athletes (who tend to be muscular, and muscles are more dense than fat) and women (who tend to have more body fat). The BMI overestimates body fat in lean people.

Also, you need a reliable set of scales to use the BMI.

In short, we need a new way to measure obesity.

### The Body Adiposity Index (BAI)

Ressearcher Richard Bergman of the University of Southern California measured 1700 Mexican-Americans for their fat levels and has recently proposed a new index – Body Adiposity Index (BAI). The formula is as follows:

$\text{BAI}=\frac{\text{hip (in cm)}}{\text{height (in m)}\times\sqrt{\text{height (in m)}}}-18$

The “hip” measurement is actually around your belly button level (which is usually a maximum).

Applying some basic index laws (fractional exponents), we can express this as:

$\text{BAI}=\frac{\text{hip in cm}}{\text{(height in m)}^{1.5}}-18$

Bergmean’s team settled on this formula after cross-checking the subjects’ body weight using Dual Energy X-ray Absorptiometry, mentioned earlier.

One advantage of the BAI is it doesn’t depend on weight – just 2 simple length measurements.

More research needs to be done (it has not been extended to caucasians yet) before it will be considered a valid measure of body fat.

I developed a new online calculator where you can find your own BAI and compare it to your BMI.

Try it out and let me know what you think. Go to:

Comparison calculator: BMI – BAI

### Final note – is it really complex?

The reporter from Reuters appears to have been a math phobe. At one point the article said:

BAI is a complex ratio of hip circumference to height that can be calculated by doctors or nurses with a computer or calculator.

Complex? Really? It’s rather sad when grade 8 index laws are considered “complex”. And I imagine most people would use a calculator (or an online tool, or a chart) to calculate their BMI. I don’t regard the BAI as all that more difficult in this respect.