Thinsplaining the Ease of Calorie Restriction

Easy peasy. That’s how a thinsplaining cardiology professor describes long-term calorie restriction. He did it in one of JAMA‘s most popular articles this week. That article is a news report on a study of calorie reduction and cardiometabolic health. The treatment group in this RCT cut about 300 calories from their diet for two years. The professor, William Kraus, explained to JAMA how easy this is:

Ninety five percent of people will be able to do that if they just do not eat after dinner. It’s not hard to do. It just takes a little intention and discipline.

But The Data Disagree

In fact, it’s not hard to figure out that Kraus’s statement is false. For one thing, about 40 percent of the people Kraus et al recruited for the study refused to participate. “Because of concerns about their ability to adhere to the protocol,” the study says.

Another pesky fact is the dropout rate. More than three times as many people (18%) dropped out of the calorie restriction arm, compared to the control arm of the study. And remember, those were people who thought they could stick with it.

So no. That 95 percent figure has no basis in fact.

Thinsplaining Fueled by Implicit Bias

Implicit weight bias is everywhere we turn. Unfortunately. Even though explicit bias – outright fat shaming – is going down, more subtle implicit bias is rising. That’s how an otherwise brilliant scientist could say something so demonstrably false. After all, the American Heart association says having a BMI under 25 is one of “Life’s Simple 7” ideal health behaviors. Easy peasy.

Of course BMI isn’t a behavior. It’s a physical characteristic. And 70 percent of a person’s risk for having a high BMI comes from their genes. Much of the rest comes from environmental triggers. Genes set the table for obesity. The environment serves it up.

Dietitian and researcher Michelle Cardel also reminds us that voluntary calorie restriction is not a real option for many people. Circumstances get in the way.

But that doesn’t sit well with a conviction that people should control their own destiny. So we hear people murmur that “genes are not destiny” to encourage people to buck up and get their weight under control. When this cliché serves to describe the interactions of genes and environment, that’s fair. However, it’s a false argument for obesity as a matter of personal choice.

Self-Awareness and Humility

Living in a body that’s slender and fit confers well-documented privileges in our culture. It’s not right, but it’s true. People who enjoy those privileges would do well to be more self-aware. They should think twice before  thinsplaining the ease of restricting calories and maintaining a low BMI. For starters, it’s false. More important, though, it’s arrogant and offensive.

Some privileges are earned. Others are inherited. In either case, humility is wise.

Click here for JAMA‘s news report and here for the study. For a commentary by Frank Hu, explaining the practical problems of that study, click here.

The Thin Man, public domain movie poster art from WikiMedia Commons

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September 1, 2019