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The pursuit of thinness | Financial Times

The pursuit of thinness | Financial Times

October 06
05:22 2018

It was one of the pointless cruelties that are a speciality of childhood. One morning at my primary school in Glasgow, the teacher asked us to suggest examples of metaphors and similes. Another child stuck up his hand and shouted out: “As fat as a Robert!” The incident, when I was nine, helped to shape how I’ve viewed myself in the succeeding 39 years. While I wasn’t the chubbiest in the class, I certainly carried what my mother called “puppy fat”. Even in subsequent periods when I was less heavy, I thought of myself as overweight and physically incompetent. At secondary school, I’d lumber in last, alongside the wheezing asthmatics, from cross-country runs.

I gravitated towards non-physical pursuits. A PE teacher once growled: “Don’t waste your own and others’ time, Wright,” when I suggested he give me one more chance to get the hang of throwing the discus. My voice, however, was welcome in the school choir and the annual musical, my wit in the debating society and my memory in the general knowledge team. I nurtured a healthy mind. But I assumed it would forever inhabit a body typifying some of the weight problems of western countries.

To my surprise, that assumption has proved false. From about July 2016 — when I moved back to London after four years in New York — my weight has declined, steadily, from 17st 4lb (242 pounds,110kg) to about 12st 8lb (176 pounds, 80kg). Measured by Body Mass Index — which assesses if you are a healthy weight for your height — I started at 29.2, solidly in the “overweight” category for someone who is 6ft 4in (1.94m). I now have a BMI of 21.2, solidly in the middle of the “healthy weight” range. I may not be, like the narrator of The Beatles’ “Yesterday”, “half the man I used to be”. But I am three-quarters of him.

I pursued thinness, however, the way a dog pursues its tail — I barely expected to succeed and had no plan of what to do when I did. Accustomed to thinking a desirable weight is “less than I weigh now”, I realise now that I have little idea what a healthy weight might be. I’m still more clueless about how to manage my weight when I’m no longer targeting a lower number on my bathroom scales.

But there has been an unmistakable increase in expressions of concern about my appearance. Some kind colleagues have sounded worried and warned me not to get any thinner. Another, more bluntly, told me I look “like a scarecrow, man”. Most depressingly, a couple of people I’ve met for the first time have assumed, based on my gaunt features, that I am about 15 years older than my actual 48. It is time to consider how far further weight loss will do me good.

It marks me out as part of a privileged elite that I am even contemplating such a question. When I visit Professor Susan Jebb, of the Nuffield Department of Primary Care Health Sciences at the University of Oxford, she points out that, for hundreds of millions of people worldwide, many of whom lack my income, knowledge, access to healthy food and opportunities to exercise, obesity remains on the rise. “What we’re seeing is that the rate of increase is really worrying,” Jebb says. “It’s hard to think of countries in the world where it isn’t increasing.”

As for the UK, she says that, when she started her career in nutrition in the 1980s, the prevalence of obesity in the population was 7 per cent. “We thought that was really frightening,” she recalls. “It’s now 25, 26 per cent.”

© Sergiy Maidukov

Doctors offer intensive support to patients who have conditions such as high blood pressure, Jebb says. But many seem to think people who are overweight should simply pull themselves together. “My impression is that it’s because obesity is seen as some kind of moral failing,” she adds.

Jebb’s most resonant observation, from my perspective, is that periods of upheaval can be propitious times for people to start weight loss programmes. It is the first convincing explanation I’ve heard for why my ineffectual efforts to control my weight started succeeding just as I moved from New York to London. “We see transition times in people’s lives as times when people’s weight can change significantly,” Jebb tells me. People undergoing big life changes are forced to make choices about their behaviour, instead of following routines, she says.

There is no doubt those routines have changed substantially. Instead of hiring cars or travelling by taxi on work trips, as I often did in the US, I now mostly put my bike on a train and reach my destination that way. While I have got about by bicycle most of my adult life, the change in travel habits and the UK’s less hostile winters have combined to push up my annual bike mileage from about 3,900 when I was in the US to about 5,400 now.

On the diet side, meanwhile, the changes included my wife’s decision, shortly before we left New York, to cut down on carbohydrates in our diet. Then, when I moved to London, my usual lunch became a small vegetarian pie, rather than the $4 chicken gyro sandwich I used to buy near the FT’s New York office. It must have made a difference that I no longer spend long periods on the road in areas that often have poor food options, such as large parts of the American Midwest.

“Half the time, we’re not making choices at all,” Jebb says. “We’re not making reflective, rational, carefully considered choices. We’re just going with the flow.”

Another expert, Adam Collins, senior tutor in nutrition at the University of Surrey, tells me when I visit him in Guildford that the increased exercise and diet changes have created a “calorie deficit” — a shortfall in daily food energy intake compared with the amount of energy I am expending. The deficit has forced my body to eat into its fat reserves to fill the gap. A typical weight loss plan will aim to create a daily deficit of between 400 and 500 calories.

Collins explains my sudden physical change by saying different people follow different “weight loss trajectories”. “That weight loss trajectory can be very steep and then shallow or it can be slow and steady over that long period of time,” he says. “It really depends on the means by which you’re losing that weight and the other things that are driving it.”

For most of the time I’ve been losing weight, however, I’ve only dimly understood what was happening, making the process a little frightening at points. Remembering that rapid weight loss was an early symptom of the small bowel cancer that killed my father, I went to the doctor in spring last year. A battery of blood tests and a CT scan found nothing sinister.

© Sergiy Maidukov

Jebb acknowledges that, while healthy in many circumstances, rapid, unintentional weight loss can be a “prognostic indicator” of disease. “It’s absolutely right to get it checked out,” she says. Yet, while it’s reassuring that I’m probably not currently dying, it is strange to be shrinking. I feel energetic and healthy and enjoy the benefits of being lighter — most notably, that I get around faster on my bike. But it’s spooky when the numbers on the scales record a new low. I was particularly taken aback when I realised recently that my feet, whose substantial proportions I’ve always taken for granted, had gone down a shoe size.

It is a process that both Collins and Jebb insist will stop of its own accord. Collins says my weight will find a “plateau” when my food intake and energy expenditure are aligned for my new, lighter body. There is certainly no concern yet that I am so thin as to endanger my health. Jebb recommends I maintain a BMI of above 20; for my height, that correlates to just over 11st 11lb (165 pounds, 75kg) — although Collins puts the lower end of the healthy range at about 18.5 — or 11st (154 pounds, 70kg) — the point below which the National Health Service classes people as “underweight”. He puts the high end of the potentially healthy range at 27. “There’s quite a lot of leeway if you think of it from a health perspective in terms of a healthy weight,” Collins says.

Collins’ view of potentially healthy weights reflects a caution about BMI as a measure that is widespread among nutrition experts. The measure was developed by US insurance companies as a broad guide to the health risk a person faces as a result of excess adiposity — carrying too much fat. It takes no account of variations between different body types or whether the weight is composed of fat or muscle.

“The key message is that it’s about fatness and excess adiposity,” Collins says. “That’s what is really causing the health risk. You can have a rugby player who has a BMI that’s classed as obese when it’s mainly muscle mass that’s contributing to that.”

Jebb, meanwhile, points out that, while obesity is an important and growing risk to health, it is only one of a series of risk factors — alongside others such as smoking or drinking — that are driving growing health inequalities between rich and poor in many developed countries. “It’s not just about obesity,” she says.

For me, however, the most telling realisation dawns when Jebb talks about what I should do next. The key to improving my health now, she explains, is no longer to chase a falling weight but to round out my diet. Among other things, she suggests, I should be reintroducing more carbohydrates that provide dietary fibre.

It is a conversation that I notice I avoid pursuing. That is partly to head off what I fear may be a looming recommendation to eat brown rice. But I also feel a sudden pang. The period since I moved back from New York has, I realise, been chaotic and stressful. My family have been readjusting to life in the UK while I have coped with a succession of different, temporary jobs. It comes home to me that my weight is a rare area in which I have had the reassuring comfort of complete autonomy.

The nutritionists’ advice must be right, nevertheless. I have far less scope to keep losing weight than I have already lost. I leave Jebb’s office and, before mounting my bicycle to return to the station, buy a falafel salad. The chickpea content feels aligned with her instruction that I eat more hummus. A few days later, for lunch I buy another falafel salad, this time with big dollops of the approved Middle Eastern paste. The next stage of wrestling with my humiliated inner nine-year-old has begun.

Robert Wright is an FT correspondent in London

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