Welcome to my chapter-by-chapter review of Rethinking Thin, the 2007 book by science writer Gina Kolata. Rethinking Thin was written after the conclusion of a large study comparing a low-carb diet to a reduced-calorie diet. Tonight, I'll be continuing with the "Two Months" interlude between Chapters 3 and 4, followed by a review of Chapter 4 itself.
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Rethinking Thin, by Gina Kolata
The story so far:
In chapter one, Kolata introduced Mr. Carmen Pirollo, one of the participants in the large diet comparison study. She then discussed the two diets - the low-carb Atkins regimen, and the low-calorie LEARN lifestyle program. She followed that with an exploration of the phen-fen (a combination of phentermine and fenfluramine) fad of the 1990s, and finished the chapter by detailing Mr. Pirollo's experiences with phen-fen and his other diet successes and failures.
In chapter two, she showed how everything old is new again when it comes to diets. She started with the 19th-century origins of low-carb diets with Brillat-Savarin and Banting, and low-protein regimens from Sylvester Graham and Horace Fletcher. She also discussed the history of calorie counts on restaurant menus, and an early 20th-century weight-loss contest (very much like today's The Biggest Loser phenomenon, complete with post-contest weight regain).
In chapter three, Kolata looked at societal attitudes toward obesity. After looking at modern attitudes toward obesity, she traced the beginnings of the modern attitudes about obesity to the Gibson Girl and flapper eras of the early 20th century. Three then-new inventions helped democratize worrying about one's weight - the inexpensive bathroom scale, the inexpensive full-length mirror, and inexpensive photographic reproduction in magazines.
Interlude: Two Months
Previously, we've been introduced to several of the participants in the low-carb group of the Penn study, including Mr. Carmen Pirollo. Now, in the "Two Months" interlude, we meet Jerry Gordon and Graziella Mann, two people who drew the "low-calorie" straw in the Penn diet study. Like Mr. Pirollo, Graziella comes from an Italian family, and she's not the only family member who is putting on weight. Her mother has diabetes, and her sister, once slim and elegant, has gained as much weight as Graziella, and has been her partner in weight loss attempts, including Weight Watchers, Atkins, and amphetamines.
Graziella became aware of the first (one-year) Penn study comparing the Atkins diet to a low-calorie regimen when she saw a fellow church member wearing a good-looking red dress, who'd just completed the study and lost a lot of weight. Since Graziella works on the Penn campus, she was in a good position to watch for the two-year study, and signed up as soon as it was announced. Just before the new study started, she saw the woman in the red dress at church again - only she wasn't wearing the new fashion anymore. In fact, she'd put back on much of the weight she'd lost during the one-year study - but Graziella is determined that this won't happen to her too.
Jerry Gordon had hoped to be selected for the low-carb group in the diet study - the idea of eating all you want while still losing weight was appealing. And he'd seen other people lose weight successfully doing Atkins [this was back in 2004 - Ed]. At 52, his blood pressure has started to climb, and his weight is the highest it's ever been, so he's determined to stay the course with the study diet, even though he's wound up in the low-calorie group.
Chapter 4: A Voice in the Wilderness
Kolata starts the chapter by introducing Albert J. "Mickey" Stunkard, who started the Center for Weight and Eating Disorders at the University of Pennsylvania (which is where the two-year low-carb versus low-calorie diet study is being conducted). Stunkard has researched obesity for decades, but fell into obesity research by accident. He'd originally planned to become a Freudian psychiatrist when he finished training in the late 1940s, but became interested in obesity after encounters with psychoanalysis patients who had problems with out-of-control eating.
Stunkard's early work focused on the idea that obesity is caused by overindulgent mothers or other relatives, who teach children to associate food with affection. He first started in 1961 by examining a small group of men, half of whom were obese. He found no significant psychological differences between the obese men and the control subjects. He followed this small study by analyzing data from the large (1660 subjects) Midtown Manhattan study of mental illness from the 1950s, and at first found the only psychological difference between the obese and normal-weight subjects was that the obese men and women were slightly more neurotic. It wasn't until he thought to look at the relationship between social class and weight that he found a statistically significant relationship in the Midtown Manhattan study - obese people tended to be poor. Only five percent of upper class women in the Midtown study were obese, but fifteen percent of middle class women and thirty percent of lower class women were obese.
Subsequent research by Stunkard and others has failed to find a common psychological cause of obesity. Many obese people are clinically depressed, but many are not. Many obese people suffer from anxiety, but many do not. In Kolata's words, "If all you had was scores on psychological tests--if you could not actually see the people you were testing--you would not be able to decide who was fat and who was not...There is no behavior that is typical of the obese...There is no psychiatric pathology that spells obesity."
Kolata goes on to point out that despite the decades of non-results from studies of behavioral and psychological factors in obesity, the diet programs used in the Penn study (at the Center for Weight and Eating Disorders founded by Mickey Stunkard, no less) include a good deal of behavior modification tools.
The behavior modification information in the Penn study programs cautions the dieters that experts have found little support for the idea that obesity is caused by psychological issues, but the dieters themselves tend to feel that psychological issues have more impact than the research shows. Graziella Mann feels that her stressful afternoons cause her to want to eat more at that time of day. Jerry Gordon says that his overeating is caused (at least in part) in reaction to his wife's nagging. For Ron Krauss, another in the low-calorie group, it's his mother. At 5'2" and 105 pounds, her BMI is less than 20 - but she worries out loud that she needs to lose another five pounds, and he overeats in response.
Scheduled WHEE diaries:
March 11
Thur AM - WHEE Open
Thur PM - WHEE Open
March 12
Fri AM - WHEE Open
Fri PM - Wee Mama (weekly diary)
March 13
Sat AM - bloomin (weekly diary)
Sat PM - Edward Spurlock (Wansink, Ch. 2)
March 14
Sun AM - louisev (weekly diary)
Sun PM - WHEE Open
March 15
Mon AM - NC Dem
Mon PM - WHEE Open
March 16
Tues AM - WHEE Open
Tues PM - WHEE Open
March 17
Weds AM - WHEE Open
Weds PM - Edward Spurlock (Kolata, Ch. 5)