HBO Documentary The Weight of the Nation: A Critique

So the world is abuzz about this weeks documentary from HBO The Weight of the Nation. No matter its views, TheFatNurse was eagerly anticipating it due to the public influence it would have since it’s sponsored partly by the institute of medicine and other important medical establishments. It also featured prominent figures such as Dr. Lustig encouraging parents that fruit juice is just as bad if not worse than soda. However, there were some glaring things that didn’t strike TheFatNurse as productive in the battle against obesity:

*Quotes are mostly paraphrased and descriptions are based off what TheFatNurse remembers while watching the movie.

1) So right off the bat they show how the weight of the nation is increasing due to BMI without even touching on the controversy of using BMI. 

They used one portly looking fellow! However, you can have a BMI of 25-29.9 and be perfectly healthy and fit looking especially if you are an athlete. Shouldn’t they at least acknowledge this?

2) TheFatNurse already covered this in a previous post but here you can see them combining the percentages of “overweight” and “obese” to the audience.

 

Over two thirds of Americans are over weight or obese (according to controversial BMI)! Combining both categories here into one percentage just makes it seem overly dramatic.

3) An obese individual makes the statement:

“Because of my high blood pressure and risk of diabetes my doctor told me to go brown. No white bread, just wheat.”

There is a lot of controversy with this since some wheat and whole grain products can actually increase an individuals blood sugar faster than processed or refined white carbs can. Additionally, there has been a lot of studies coming out where diabetics have responded very well on Low Carb High Fat diets in decreasing their blood sugars.

4) They had an interesting experiment that looked at the metabolic effects of a 5% weight gain in already obese people. They showed an individual who was already fat and informed her to add 1000 more calories from five different fast food joints over the course of the experiment. She pointed out the fat and calories of the fast foods she ate:

However, this individual kept a food journal of what she ate before she started so they would know what her normal diet was like before the 1000 calorie intervention. Granted, this is only a one day sample, but this was the only data flashed on the screen. Look at some of these foods:

Kellog’s Special K – Hey isn’t this a “low fat heart healthy cereal?”
Banana – Heathy fruit!
Fat Free Milk – healthy milk that is fat free!
Baby carrots – nice!
Apple – More fruit!
Roasted Chicken Breast – low fat white meat!
Broccoli – OoOo healthy vegetable!
Olive Oil – healthy fat right?
Brown rice – No white rice! Yay!
French Bread – Eh…well it has no fat on it at least I suppose!
Berries – More healthy fruit!

So those foods on her daily meal log are typically portrayed as the “healthy” foods one should eat. However, for the exact same day it also includes these foods which are generally regarded as bad:

Pizza Hut Pepperoni Pizza – Blah…TheFatNurse says go round table if you gonna order junk pizza!
Rice Crispy Treat – refined processed sugary junk!
Pepsi can – More sugar!
Ketchup – more Sugar!
Angel Food Cake – TheFatNurse has actually never had angel food cake interestingly enough

So this was the amount of food in her normal diet; isn’t it also the diet that is keeping her at her baseline obesity before the 1000 calories added experiment? Notice something?  It’s an extremely high carb diet! The only foods here with high fat content is the pizza!!! And even then, the pizza has about the same amount of calories in fat as carbs! So why the need to point out how much fat you’re eating!? By the way, just looking at the amount of calories and calories from fat from the entire day…one might even be able to say this is a low fat diet based off the % of fat from calories (TheFatNurse is just estimating this)!

So now she is going around adding 1000 more calories from fast food places eating things like Fried Chicken with biscuits or classic burger fries and sodas. Yes they are high fat, but they can actually be higher in carbs than fat!

The subject then informs the audience that she now has the liver of a french goose along with her cholesterol and triglycerides off the charts. Should this really be that surprising with the amount of calories and carbs she consumed? The doctor involved with the study then shows how an obese person’s liver cells become very fat but with weight reduction (while pointing at a picture that says after gastric bypass surgery) the liver cells can return to normal.

Hmm…speaking of gastric bypass and shrinking livers…before you go in for a gastric bypass guess what you are put on in an effort to shrink your liver…a low carb diet. And after? A low carb diet (this is a low carb high protein diet instead of a low carb high fat diet).

5) Okay, enough about that experiment (Interpretation was based on the way they portrayed it in the show. TheFatNurse hasn’t read the actual study to check out the methodology). Continuing on…A loving wife who’s husband has severe diabetes says:

“You don’t have to have roast beef and steak.”
Is she implying that these foods lead to her husband’s diabetes? TheFatNurse doesn’t remember, maybe she was just giving the anti-saturated fat message in hopes to avoid heart disease since diabetics are prone to heart disease (of course the link between saturated fat and heart disease is controversial itself).

6) A scientist says:

“Obesity is the driving force behind insulin resistance…”

Oh yay! But what is the driving force behind Obesity?

7) While addressing an obese individual a doctor says:

Patient: “I’ll work on exercise for my blood pressure.”
Doctors response: “I don’t care you need to be on medication.”

Granted, who knows what this individual’s pathologies are (he may indeed have needed more than just exercise), but the doctor’s response struck TheFatNurse as non patient centered and unnecessarily dramatized things for the audience.

8) Statement from some public health government person:

“How many people are able to maintain a healthy weight in this soceity?” “A third or less”

Healthy weight based off what? BMI’s 68% mentioned earlier? Is that really a good way to define “health?” It’s the cheapest way for sure since you can just use height and weight but TheFatNurse recalls studies showing skinnier people to not always having the healthier outcome than people who may be a bit fatter.

9) Another statement made:

“Being wealthy is no longer the protective factor against obesity as it use to be.”

Well duh! The notion that wealthyness can protect against obesity like some sort of prophylaxis is nonsense! It may use to be associated with lower obesity, which means it deserves exploration but to call it a protective factor?

10) A pediatrician says:

“We as pediatricians never had to worry about learning a lot about hypertension, that was a specialist disease we sent to the cardiologist…”

I’m guessing what the doctor was trying to say was she rarely dealt with hypertension in kids. However, her statements just sound very dramatized.

11) A statement made during the film:
“The diet industry has no reason to solve the problem. It puts them out of business.”
Technically…solving the obesity dilemma would put a lot of medical establishments out of business as well. The FatNurse doesn’t mean that the medical industry wants us to be obese, but just pointing out a potential flaw in that statement.

12) Extreme emphasis on the failure of Atkins diet

TheFatNurse is not trying to say that the Atkins diet is correct or failure free, but Atkins is associated with lower carb intake which flies against traditional low fat advice (TheFatNurse is not trying to say that Low Carb is the end all be all solution either; just that it’s worked for some and might be worth looking into for some people). During a segment of obese people talking about the different diets that failed them, Atkins was emphasized with the most failure through the documentaries presentation than any other diet.

13) They show two ladies who are able to lose 100+ pounds and maintain that weight loss. They show them replacing rice with a salad instead, but no mention of carb reduction?

At this point, TheFatNurse decided to stop taking notes since it required constant stopping and made watching the documentary too long! Therefore this critique really only extends to part 1 and the beginnings of part 2. 

The Good: However there are many good things about the film as well such as Dr. Lustig’s part about sugar and they briefly touched on insulin resistance. TheFatNurse liked the advice on stopping sugar sweetened drinks for instance. Additionally, they also covered processed foods a lot and over eating which was good as well. The documentary also emphasized eating real foods instead of the processed junk that is out there. Additionally they also cover how corn subsidies from the government lead to increased processed foods.

The Bottom Line: Even with all the critiques, TheFatNurse thought the documentary was well produced and highlighted a growing problem. TheFatNurse only wishes that documentaries like this would interview and touch upon different schools of thought on what causes obesity in the first place and to critique current conventional wisdom on treatment. Lots of the information conveyed to the audience is implied to be uncontroversial “facts” when there are many controversies and competing hypotheses out there on what causes obesity and what is the best treatment.

To be clear, based off the critique, TheFatNurse feels people may think TheFatNurse is pushing a low carb high fat diet, but this is not the case. Since LCHF is often neglected in the media, TheFatNurse just chooses to bring it up often as a competing theory. There are also other great theories out there like the food reward theory (future post!). Hell, there is even controversy to the mechanism behind LCHF! Does it work for some people because of the insulin carbohydrate response? Does it work because low carbohydrate diets reduce appetite throughout the day leading to calorie deficit? Of course this doesn’t mean the traditional low fat diet doesn’t work – plenty of people lose weight with it! But for those who don’t, it may be worth exploring other avenues and documentaries such as this one would have been perfect for introducing different ideas for people to go over with their doctors.

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4 thoughts on “HBO Documentary The Weight of the Nation: A Critique

  1. I don’t have HBO, but I watched part 3 last night online. For the most part I think they did a pretty good job pointing out that the proliferation of grain (mostly corn) and soy crops (spurred by government subsidies) leading to cheap, highly available junk food (almost all full of CARBS and soy oils) is a large part of the problem. One thing that particularly struck me is the statistic (not sure how accurate this is) that only 3% of America’s farm land grows fruits and vegetables. That’s stunning! And they pointed out that if every American followed the supposedly healthy diet recommended by the USDA (which is fairly modest in recommendations for vegetables since it is so grain dependent), our agriculture could not sustain it because there are not enough fruits and vegetables grown in the US to fill the need.

    OTOH, one of their “experts” pointed out that “our bodies don’t know how to stop eating fat because when our ancestors were lucky enough to kill an animal we had to eat as much fat as possible whenever it was available to prevent starvation between hunts.” HUH??? Has this woman ever eaten any fat??? I’d like to see her sit down and try to eat an entire stick of butter! There are plenty of peer reviewed studies on the satiety factor in foods with a high percentage of fat. Talk about getting things entirely backwards! Were their fact checkers asleep???

    Reply
  2. Yea the 3% farm fact was pretty shocking as well. If demand increases for veggies and fruits somehow I don’t see why farmers wouldn’t want to come in to earn a profit from that. Growing grains is just so much cheaper with subsidies and storage. Sometimes I wonder what our farms would be like without subsidies altering the price of things.

    YES! I had the same thought about the woman who said we can’t stop eating fat once we start. Literally was screaming at my screen!

    Reply
  3. Yes, I wanted to reach inside my laptop screen when the woman and her adorable husband (with diabetes) stated how they didn’t “have to have” roasts. I believe that was in direct reference to his diabetes. No doubt, some “diabetes educator” was responsible for this belief. That poor fellow looked so sad. I wanted to scream, “yes, have your roast!”

    Reply

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