2018 Goals

Happy New Year! I had a great New Year's Eve, attending a party with friends, and have been taking it easy today. But I've been thinking about my goals for the year, and wanted to share for accountability purposes.

First off, I want to add one quick update to my 2017 Year in Review - I finished book 53 before heading out to the party last night, making my page count 17194. I'm sure I had many years as a kid where I read more than that, but this is my highest count since I started tracking.

And now for my goals!

1. Read at least 48 books - this is the same goal I set last year. I commute by train now, and I always have a book with me in case of unexpected downtime, so this seems to be an easy goal for me.
2. Relatedly, I have a huge stack of to-read books, so I'm making a resolution that I can't buy any books this year. Instead, I need to read all of the books on my to-read shelves (yes, there are multiple). I am allowed to borrow books, from the library or friends, and I can receive books as gifts, but no purchases. I have a feeling this one is going to be very hard.
3. Write at least 12 short stories - Ray Bradbury recommends writing one per week, but with a full-time job, multiple hobbies, and a social life, that's going to be difficult. I think one per month is a good goal, and I can always exceed it if I'm feeling particularly inspired.
4. Make sure I always post my weekly statistics posts: Statistics Sunday and Statistical Sins. For that reason, I'm not going to make the goal of writing 1 post per day. I'm happy with 3-4 posts per week, and once again, I can exceed that if I'm feeling particularly inspired.
5. Build up more of an online presence for Deeply Trivial, including Twitter and Facebook. I just need to finish something up first - stay tuned!
6. Visit a new state - I've visited 35 of them, so I want to bring that total to 36 by the end of 2018! Most of the states I have left are on the East Coast or Northern Midwest, so I have some easy ones I can hit on a road trip. But who knows? Maybe I'll spoil myself with a trip to Hawaii this year instead.
7. I always make a goal to eat healthier and get in better shape, but I plan on really putting some effort into it this year. (My weight has been creeping up and I'm not happy about it.) I already go to a dance class once a week, so I think I can add a goal of getting a workout in 1-2 more times per week.
8. Finish my book! I've been working on the book I wrote for 2016 NaNoWriMo - I still have one subplot to wrap up, and a few more scenes to write.

You'll notice I'm calling them goals rather than resolutions (well, except #2). I've blogged previously about the problem with resolutions. I called them resolutions last year, but after putting more thought into the idea recently, I think goals is more true to my approach to making New Year's resolutions. But if you insist...

More Evidence for Why We Should Care About Climate Change

A new study has found a potential connection between climate change and type 2 diabetes:

Diabetes data were collected from the CDC. The team also did a worldwide analysis based on rising rates of glucose intolerance and mean annual temperature.

The analysis showed that, on average, for every 1-degree Celsius increase in temperature, age-adjusted diabetes incidence rose 0.314%. A country-by-country analysis of glucose intolerance found an association of 0.170% for every 1-degree rise in temperature. These rates held up after an adjustment for obesity.

[T]he researchers concluded, “This association between temperature and raised fasting blood glucose cannot merely be due to international differences in age, sex, income, or obesity prevalence, as our analyses adjusted for these variables.”

Fat Shaming and Bullying: Why It's All About (Mis)Attribution

Over the weekend, the New York Times published an article on fat shaming, and the bullying people experience for being overweight or obese. Though - as with many articles recently - they tied it to comments from a certain presidential candidate, fat shaming and bullying have been issues for much longer. In fact, I've blogged about weight management and similar topics before, since this was one of my research interests.

The problem with fat shaming is that it is widespread, and the bullying and negative comments about weight begin early and continue even among adults:

Rebecca Puhl, the deputy director of the University of Connecticut’s Rudd Center for Food Policy and Obesity, and her colleagues find that weight is the most common reason children are bullied in school. In one study, nearly 85 percent of adolescents reported seeing overweight classmates teased in gym class.

Dr. Puhl and her colleagues asked fat kids who was doing the bullying. It turned out that it was not just friends and classmates but also teachers and — for more than a third of the bullied — parents.

“If these kids are not safe at school or at home, where are they going to be supported?” Dr. Puhl asked.

How can parents - who (hopefully) would reprimand their children for being bullies - also participate in this behavior? The issue, I suspect, comes down to attribution: is the person "to blame" for the condition? Though children may tease others simply for being different, as we grow older, we are taught that difference is not always bad. Further, we learn (again, hopefully) not to judge others who are different for reasons beyond their own control. That is, we shouldn't make fun of someone who has a disease that is not their fault.

The issue with overweight and obesity is that many people do not consider it to be a disease, even if the medical community for the most part does. Instead, they view it as a lifestyle choice, and see no issue with judging others they perceive have made bad choices. It's all about attribution. If I believe a person is overweight or obese because they lack the willpower to eat healthy portions and/or engage in physical activity (that is, I attribute the cause of their condition to their own behavior), what's the issue with denigrating them? Attribution theorists would argue that we engage in this kind of thinking regularly - determining whether someone is at fault for their situation - and that our conclusions impact a variety of behaviors.

Errors in attribution lead a variety of negative behaviors, like blaming the victim. There's an additional level here, though, in that people perceive the shaming and bullying as potentially helpful to the individual being shamed. That is, they think it will help motivate the individual to change:

“There tends to be this public perception that maybe fat shaming is O.K. because it will provide motivation to lose weight,” Dr. Puhl said. Instead, she adds, “it is very harmful to health.”

Research suggests that even people who overweight or obese (which amounts to about two-thirds of the general population) share many of these same beliefs. And of course, when we judge our own behavior, we all think of things we should be doing differently to be more healthy. I know I should exercise more, eat healthier, and drink less beer. Would making these changes help me lose weight? Probably, but then there's more to it that. In fact, anyone who has made these lifestyle changes knows (myself included) it is still very difficult to lose weight and even more difficult to maintain weight loss. For many years, I was 20-25 pounds overweight, and despite trying everything I could, was not able to lose much. What finally worked was a complete accident - I was prescribed a medication for a different purpose that had a side effect of weight loss. But as with other treatments for overweight and obesity, like bypass surgery, it's perceived by many to be "cheating." I didn't work to lose that weight.

What we need to do is to change perceptions about overweight and obesity. If the key is attribution, that's where we need to focus our efforts.

City Planning, Healthy Habits, and the Broad Field of Public Health

To improve health, we need to be thoughtful about city design, a series of articles published in the Lancet says. This may seem like a strange juxtaposition, but in fact, city planning has been an important aspect of public health since the beginning. A press release about the series, published by the American Journal of Managed Care, explains:

"With the world’s population estimated to reach 10 billion people by 2050, and three quarters of this population living in cities, city planning must be part of a comprehensive solution to tackling adverse health outcomes," series author Professor Billie Giles-Corti, University of Melbourne, Australia, said in a statement. "City planning was key to cutting infectious disease outbreaks in the 19th century through improved sanitation, housing and separating residential and industrial areas. Today, there is a real opportunity for city planning to reduce non-communicable diseases and road trauma and to promote health and wellbeing more broadly."

Thanks to my time at VA, I've gotten to learn more about this broad field known as public health. This field covers many aspects of understanding and improving health - everything from how diseases spread to understanding health habits to interventions that improve health. And the diseases they study also range from communicable - diseases you can "catch" from others - to noncommunicable - a broad category that includes lifestyle diseases (like Type II diabetes and cardiovascular disease) and accidental injuries (car accidents). City planning has the potential to prevent these noncommunicable diseases, by encouraging physical activity, promoting healthy eating, and creating a safe environment that minimizes traffic accidents. Even pollution and noise levels need to be considered, as these also contribute to physical and mental health.

In fact, city planning is immensely important when considering lower income housing sections, which historically have had limited green space, poor (or no) walking paths, and other safety concerns that keep people from spending time outside and/or engaging in physical activity, as well as limitations in healthy food choices. This only serves to increase health disparities between high and low income individuals. Just as in the past, public health efforts improved living conditions especially for individuals living in low income sections, thoughtful planning is needed today.

The important thing to keep in mind in terms of public health is that improving population health has far-reaching benefits, like increased productivity and decreased disability. Obviously, it's difficult to put a price on the quality-of-life benefits, but for those who think more in terms of tax dollars spent, spending money to improve living conditions actually does pay for itself.

Weight Management and Reality TV

Weight management is one of the topics I study at my job, so it's unsurprisingly something I've blogged about before. Yesterday, the NY Times featured a story about The Biggest Loser, a reality TV weight-loss competition, and a scientific study performed using previous contestants on the show.

The study was done on 14 of the 16 contestants from Season 8 of the show, which aired about 6 years ago. Participants completed 3 days of testing at offices at the National Institutes of Health, where Kevin Hall, the principal investigator, works (at the National Institute of Diabetes and Digestive and Kidney Diseases, part of NIH). Additionally, researchers sent equipment beforehand to track participants' physical activity and weight prior to the visit (just in case participants tried to lose weight before testing began).

They found participants had drastically lower basal metabolic rates (BMR: the rate at which your body burns calories at rest). Over half of the participants now burn 400-800 fewer calories a day than the average person their size. For comparison, a pound equals 3500 calories. If these individuals used standard calculations to determine how many calories they could eat without gaining weight, they would gain between 0.8 and 1.6 pounds a week because of their slowed metabolism. Participants also had low levels of leptin, a hormone that controls hunger, which also explains weight gain; low leptin would make them feel hungry almost all the time.

Dr. Robert Huizenga, the physician for the show's contestants, sadly shows a complete lack of understanding that what contestants are being asked to do is unreasonable and unlikely to lead to long-term weight loss. In fact, his response to these findings, other than that he thought the measurements in the study were inaccurate was this:

But maintaining weight loss is difficult, he said, which is why he tells contestants that they should exercise at least nine hours a week and monitor their diets to keep the weight off.

“Unfortunately, many contestants are unable to find or afford adequate ongoing support with exercise doctors, psychologists, sleep specialists, and trainers — and that’s something we all need to work hard to change,” he said in an email.

That's right, 9 hours a week. Just for comparison, the recommendation from the American Heart Association is 40 minutes 3 to 4 times a week; that's less than 3 hours. And by the way, that number is actually for people at risk for heart disease, due to high blood pressure or cholesterol. If your BP and cholesterol are normal, you only need 2.5 hours a week of moderate exercise or 1 hour 15 minutes of vigorous exercise.

And don't even get me started on the fact that Dr. Huizenga thinks contestants need a team of weight management specialists after the show is over. Isn't the purpose of the show to demonstrate that regular people can lose weight and get healthy? Oh wait, it's reality TV, one of the most contrived, unrealistic situations you can find. Silly me.

Sure, Dr. Huizenga probably recommends this extreme amount of exercise because of the drastically reduced BMR. But it seems, for a medical professional, the better advice would be don't do The Biggest Loser. Just don't.

The problem with these shows and other fad diets, where people want to lose weight quickly, is that: the faster the weight is lost, the more drastic the changes needed to lose that weight. And drastic changes, which can include extreme calorie restriction or unreasonable amounts of exercise (or more likely, both) are 1) difficult to maintain long-term, and 2) trigger starvation mode, resulting in slower metabolism. What we didn't know is how long the body stays in starvation mode following extreme weight loss. This study tells us that, even 6 years later, BMR and leptin levels are significantly reduced.

Further, this study highlights the importance of weight maintenance - the things we do to keep the weight off. In so many cases, people participate in diet programs to lose the weight, and are essentially told, "Good job. Have a nice life." But it's not that easy. Ongoing support is needed. Not at the level Dr. Huizenga thinks, but keeping weight off can be just as challenging as losing the weight initially, perhaps even more challenging. There's still a lot we don't know, and more research is needed. But this study gives us some direction for the future of weight management research.

Dr. Pepper Ten: The Product is “Not for Women”, But the Commercials Are

No doubt, you’ve seen and heard about Dr. Pepper’s new soda, Dr. Pepper Ten, a low-calorie beverage that, unlike diet sodas, uses real sugar. And you’ve probably heard their commercials that feature manly men talking about action movies, duct tape, and bacon.

Mmmm, bacon…

Sorry, where was I? Oh, yes, the commercials. The purpose of the testosterone-infused advertising is in response to research showing that men are not interested in drinking diet sodas because they are perceived as being “girly” (find out more here). This soda was also developed to be a low-calorie option that didn’t taste like diet soda, because many people have issues with the taste of artificially sweetened beverages.

Word. There are few flavors in this world I dislike as much as artificial sweetener.

So in order to cater to men who want a diet beverage they can feel comfortable drinking with the guys, Dr. Pepper created Ten and created ads (likely spending millions of dollars on said ad campaign) that focus on men.

But they don't.

Listen to the ads. They’re always addressing women, without any statements toward men. Rather than saying, “Hey guys, want a beverage that recognizes your desire to be calorie conscious without all the estrogen? Try Dr. Pepper Ten.”, they start out the ads with, “Ladies…” and go on to explain to women why this beverage isn’t for them.

“Hey, ladies! This soda? Not for you…
 Wait, where are you going? I wasn’t finished explaining why this soda isn’t for you.”

Perhaps the aim is to remind guys of their days building clubhouses with their friends and putting up the “No girls allowed” sign (rather than a “Boys only” sign, which would have made a lot more sense). It’s also possible that the goal is to get women interested in trying the soda, because of the way people respond to being told not to do something. Specifically, they may be trying to elicit psychological reactance.

Humans are motivated to believe they have free will, as in control over their actions (whether you actually have free will – well, that’s something philosophers have been arguing about forever, so we won’t even go there right now). When someone tells you not to do something, your free will is threatened, and so you will behave in a way to reaffirm your sense of free will; the best way to do that is to do the thing you were just told not to do.

Parents are very familiar with this concept.

And I’ll admit, one thing that really drives me nuts is being told I am not allowed to do something or am even incapable of doing something (especially things that are learned) by virtue of my genitalia. Because apparently, the ability to change my oil, troubleshoot my computer, and hammer a nail are tied to the Y chromosome. “No point in teaching a woman to do any of those things. She’d never be able to learn it. So I’m going to avoid teaching her those things just to prove my point.” <sarcasm>Wow, your logic is infallible.</sarcasm… for now>

There’s a reason that social scientists insist on using the term “gender” in research. It’s not that we have an aversion to the word “sex”; it’s that we recognize “sex” is a biological term, whereas “gender” is a social term. Yes, because I am a woman, I have been shaped to behave in certain ways and believe certain things (and this perspective is also why I’m writing this blog entry and focusing on these issues). At the same time, I have my own unique set of traits, abilities, beliefs, and attitudes that were shaped by a variety of factors, not just the fact that I am a woman. The same is true for everyone; we were all shaped to be the way we are by our unique experiences, and throwing us all into one big category doesn’t make us all the same. Just like calling a calorie “manly” doesn’t make it so.

My point is that, perhaps they’re posting the “No Girls Allowed” sign while secretly hoping the girls will come around. And if that were my only reaction to Dr. Pepper Ten, I might just say, “What the heck, I’ll try it.”

After all, torque is a rather fascinating word.

There’s more to it than that, of course. Not only is Dr. Pepper Ten dragging out every gender stereotype possible, which has some documented effects on women’s performance in certain domains (see previous post), this issue of diet soda and gender has many more ramifications.

One of the reasons diet soda is so popular with women is because of our society’s focus on women’s bodies and the stigma associated with female overweight and obesity.

What stigma are men concerned about? Apparently, being seen drinking diet soda in public.

Forgive me if I’m not feeling too sympathetic, guys.

In all seriousness, I know that body image is also a serious concern for men, and have known more than one man who developed an eating disorder in response to pressures to look a certain way. Even so, women are constantly bombarded with messages to be thin, not just through the media, but in the fashion world overall. Clothing is often designed with thinner women in mind, and simply sized up to fit larger women; of course, the styles that look good on thinner women often differ from styles that look good on larger women, so this “sizing up” doesn’t necessarily allow women in larger sizes to look, and more importantly feel, good. And the messages come from our peers, too, even other women, who are often the worst offenders in making women feel bad about how they look.

I’d like to take a moment to thank those people who go out of their way to make me feel fat. At the very least, you’ve proven to me that being thin doesn’t make you happy or a good person.

And honestly, research has shown that no one really likes the word “diet”. In fact, some weight management programs are exploring new titles, like “wellness-focused”, and finding that people still have positive weight loss outcomes without needing to include words like “diet” and “weight”. Dr. Pepper Ten could probably still be a successful beverage because it doesn’t use words like diet, instead focusing on being a lower-calorie alternative that (presumably) tastes like a non-diet drink.

But at the end of the day, what Dr. Pepper Ten’s advertising makes me think of – besides, “Come on, aren’t we all smarter than this?” – is the Monty Python “Lumberjack” song, where the manly lumberjack suddenly discusses how much he enjoys wearing high heels and a bra. Yeah, the Dr. Pepper Ten commercials are just like that except, you know, not nearly as funny.

Men: I’m interested in hearing what you think about Ten, and what you think about an advertising campaign that is supposed to be all about you without actually addressing you directly. Does their need to preface words like “calories” with “manly” make any difference? Or do you find the commercials as idiotic and irritating as I?

Thoughtfully yours,
~Sara

Celebrities and Weight Management

I didn't think, when I started this blog, that I would even bother responding to celebrity quotes. True, I could probably blog forever and a day about the things celebrities utter in interviews, on their Twitter page, etc. - in fact, there are many successful blogs devoted to just that topic. In a recent interview, however, Mila Kunis talked about weight loss. Since weight management is one of my areas of research, I felt I needed to respond -- plus, I was looking for a good reason to talk about weight management research on here.

Essentially, Mila said that people who are “trying to lose weight” and are unsuccessful are simply not trying hard enough. What prompted her to reach this conclusion is the fact that she was able to lose 20 pounds for her role in Black Swan, a substantial amount, considering she normally is very thin. Of course, what Mila said is problematic for a few reasons.

Even when an individual is successful at losing weight through a program, weight gain in the time following the program is very common; most will gain back two-thirds of the weight within a year, and nearly all of it within 5 years. Why? Because sudden and drastic changes are difficult to maintain. That’s one reason you’ll find that, for many people, losing weight, especially with “fad diets”, is easy but maintaining weight loss is difficult. The approaches celebrities often take to lose weight for a role definitely work over the short-term, but are rarely sustainable. Look at celebrities who did not lose weight for a role, but who did so because their weight was unhealthy – for example, Oprah Winfrey (whose weight has often been the target of comedians) lost 67 pounds on the liquid diet, and unveiled her new look on her show while pulling a wagon of fat… only to regain much of that weight later. In fact, within a week of going off the diet, she had gained 10 pounds. Such low calorie diets cannot be maintained for very long, and there’s a good reason for that. In fact, even in cases where a doctor has prescribed a very low calorie diet (an approach taken only for patients who are very obese), the patient has to (or is supposed to) undergo intense medical supervision.

Whatever changes you make to lose weight, whether it is diet, exercise, or some combination of both, they have to be changes you’re willing to maintain over the long-term, or your chances of regaining the weight are high.

My predominant concern when I see celebrities losing large amounts of weight, and talking about how easy it is and “anyone can do this”, is that it creates unrealistic expectations. In fact, a lot of research shows that people entering weight loss programs come in with really unrealistic expectations.

Furthermore, telling people they’re going about weight loss in the “wrong way” and to “try harder” doesn’t instruct them on how to lose weight effectively and in a healthy way. This is probably one reason that media coverage of celebrity weight loss and the constant messages about what people are “supposed to look like” can lead to disordered eating and other maladaptive behaviors. Figuring out how to lose weight is pretty intuitive – cut down on calorie intake and/or increase physical activity – but the approaches one needs to take to lose weight healthily are definitely not intuitive. Even if someone decides to do some research into losing weight, there are many sources of information, some teaching really unhealthy approaches. A lot of people don’t even realize what disordered eating means, thinking that, as long as they aren’t starving themselves or forcing themselves to vomit after eating, their behaviors (like “fasting” after large meals or exercising to the point of exhaustion) are perfectly normal and even healthy.

I’m certainly not attacking celebrities. I know that Mila probably felt that by telling people “no, you can” was an attempt to boost people’s confidence in themselves and their ability to reach their goals (a concept psychologists call “self-efficacy”). It’s definitely a noble goal, because research suggests that people starting weight management programs often have low self-efficacy.

Even so, boosting confidence may lead people to try something to lose their weight, but not necessary the right thing, so increasing self-efficacy needs to be done in concert with teaching healthy weight management approaches. This is one of the many reasons that people trying to lose weight on their own are not very effective.

Just once, rather than hearing a celebrity go on and on about how much he loves to eat fast food or how she is able to keep thin simply by “playing with her kids”, I would love to hear a celebrity say, “You know what, keeping thin is hard work! Here are all the things I do…” Okay, not as a great a sound-bite, I know (and arguably not the celebrity's responsibility), but it might help to balance out some of the other celebrity sound-bites that I fear do more harm than good.

Of course, celebrities are not the only ones sending the wrong, or at least, incomplete messages. Proposed policy to outlaw Happy Meals or add additional taxes to “junk food” is just as bad as simply saying, “What you’re doing is wrong” – it doesn’t teach what people should be doing instead. Rather than punishing people for making the “wrong” choices, we need to incentivize them to make the “right” choices.

Thoughtfully yours,
Sara