Around and Around

So I found out this morning–from Dances With Fat–that there is this thing called the National Weight Control Registry. Ragen does her usual thing using those all-too-rare tools, Math & Logic, dismantling the claims the NWCR makes about the sustainability of large-scale weight loss over time, and points out the clear connections between the work done by the founders and their ability to generate income from pushing weight loss.  So there’s no need for me to go over what she says. But I would like to stop for a sec and think about the existence of this thing in the first place. I can’t quite decide whether it sounds more akin to a  bridal registry (stuff I believe I need) or a criminal registry for sex offenders (people no one believes they need in their neighborhood). Somewhere in between, probably. It purports to be a research tool whose aim is providing support for the idea that large-scale weight loss is sustainable over time. For which there is pretty much no evidence. But mostly, I’m just grossed out that there is a National Registry. I know that every thing from Facebook to my banks have bucketloads of info on me in their records, and I’m properly offended on the one hand and lazily complacent about it on the other. But the idea that, should I at some point lose a ton of flesh, I should feel compelled to become part of a registry of some sort is seriously skeezy.

One of the things that’s frustrating about trying to do research on any number of things is, indeed, the paucity of available research–especially if the research needs human subjects. And that’s for about a zillion profoundly important ethical reasons. AA, for instance, makes kind of a point out of not collecting data on who stays sober and who doesn’t, and this is because AA has a profoundly ethical commitment to  its members’ privacy. So they, and the rest of us, noodle along, making the best use possible of whatever anecdotal evidence we can collect along with whatever we can gather from anonymous surveys.

Typically, scientific ethics require specific  and informed consent before people become part of some research project. Since the people who’d be likely to sign up for the NWCR are people who are still in the first flush of elated success with big losses, they are not altogether capable of informed consent, I suspect. They’re converts, true believers.  So the whole thing turns into a registry of self-reported successes, and self-reporting is a notoriously fallible research method.

It all reminds me of the self-reported successes of sexual identity reparative therapy (Homo-No-Mo’ Camp, as a friend calls it). Nobody respectable, no-one with any sense of scientific or moral accountability believes this crap. Even the otherwise distinguished academic psychiatrist (Robert L. Spitzer) who spawned the idea that reparative therapy worked and was worthwhile has spent the past couple of decades apologizing for the article and acknowledging the damage it did.  It would be nice to think that the folks behind the NWCR would get to that point, but I doubt it’ll happen.

The Spitzer issue made Forbes Magazine‘s annual list of “The Top 10 Brain Science & Psychology Stories of 2012,” (http://www.forbes.com/sites/daviddisalvo/2012/12/23/the-top-10-brain-science-and-psychology-stories-of-2012/) along with stories about midlife crises in species other than ours, the positive neurological effects of compliments, the possibility that scientists have actually found a “switch” in the brain that can turn off bad habits, Dr. Spitzer’s detailed analysis of why his initial research on homo-no-no therapy was critically flawed, the personality traits shared by presidents and psychopaths–“fearless dominance,” a study of why jerks and their repugnant over-confidence tend to be so successful, work that maps the actual neurological damage caused by stress, studies proving that group-thinking is not necessarily any more reliable than single-brain-analysis and decision-making, research indicating that sleeplessness basically overheats our brains, and a study from Johns Hopkins about the relationship between a newly mapped part of the brain’s capacity for neurogenesis and weight gain. It’s obviously that last study that is most interesting here, though the list, as a whole, is in and of itself an interesting essay on what the culture, especially the top-of-the-heap types who read Forbes, are interested in. The studies about compliments and jerkiness and fearless dominance have fairly obvious implications for management practices. But they also have implications for a lot of other areas of life.

One of the things I find interesting about business-oriented journalism is that business is one of those places where you can watch much of what’s going on in the whole culture play out, sometimes with brutal honesty. Church communities and the military are other places to watch, too. It’s one of the reasons that “Marketplace” is one of my favorite NPR shows and that I enjoy the occasional romp through Forbes or one of the other biz-mags, in spite of my habitual tendency to autonomically demonize corporations. So I was delighted to see Forbes list the Spitzer stuff in their top 10, and intrigued to see the issues of stress, sleeplessness, and mid-life crises there as well. Those are all issues with which businesses have to deal (and to which they often contribute not inconsequentially)–so it’s good to see acknowledgement that these are not matters of weakness or character flaws, but are organic and authentic and sometimes fixable problems.

The bad habits switch thing is a little scary. As attractive as it must be to smokers to contemplate the idea of a simple switch that could free them from their addictions (assuming a simple relationship between habit s and addictions, which is a pretty flimsy assumption, of course), it’s also pretty easy to write the science-fiction scenario in which those switches come to be used to manipulate whole populations. But the looming threat of Behavior Control has been looming for a long time and has yet to manifest much in larger terms. Mostly, it seems to me that it would offer (the switch, I mean) actual choice. A person could actually choose to smoke or not to smoke with some security that his or her brain would be able to sustain the choice. Not a bad thing. As long as it was only used for that sort of fairly straightforward business.

And I’m fairly sure that I’d be willing to have somebody switch off my “feeling emptied by talking to too many people today, must fill back up with pasta” button. Provided that I had some other “habit” in in the background waiting to replace it. And that’s an awfully big proviso there. Because all the neuroscience in the world won’t override the complexities of genetics, environment, individuality, and who-knows-what-else goes into the big soup of Who We Are–though having the neurological/structural part mapped more or less reliably would certainly be useful. Medicine, psychology, and education are all likely to become more individualized and therefore more precise as we map the brain more accurately, but all the non-neurological factors will still be powerful.

Still, if someone came up with a shot or a surgery that would make my brain less inclined to…to what, precisely? To seek to comfort/heal itself from short term and long-lived stresses and/or sleeplessness by seeking another sort of nourishment? What precisely is it that makes the activities of newly discovered pathways and nodes/modes and switches in my things that need to be changed? And to what extent does this sort of research foster the continuation of the mind/body split even as it deals with a part of the body–the brain. Granted, the brain, though it’s an organ just like the liver, is a more complex organ. It’s different in lots of ways, not the least of which is its peculiar isolation up there at the top of the body in its very own spiffy bone-box. All the other organs are fairly specific machines with well-defined, largely mechanical purposes and not a lot of protection from the vicissitudes of bumpy lives. But if the below-the-neck organs are all machines–carburators and pumps and filters and pistons–then the brain’s a big computer whizzing around in that bone-box thinking a zillion things a minute and telling all those other machines what to do. It is different. And mucking about with it as if it were like the other organs has tended to produce results with much larger implications. So I’m not sure I’d let them turn my neurogenesis off even if it meant I could lose weight autonomically. I certainly wouldn’t want to be in the first cohort they tried it on. Or maybe not the first 3 cohorts.

If, in fact, the Johns Hopkins study provides the missing piece, or a missing piece of the puzzle of weight and individual responses to diet and environment, then it’ll certainly be useful somehow. I guess I find myself thinking, though, that the research could probably find a different and ultimately more useful direction to follow. Weight–research on weight in humans–seems somehow less worthwhile as a subject than, say, delivery systems for the dozens of efficacious-but-undeliverable cancer drugs out there, or new antibiotics, or new painkillers. It would be all too easy to rehash theories about why drug companies only spend money on research that is likely to make them rich (which they to tend to do–they’re capitalist entities, so no-duh), and to note yet again that there is a great deal of money in continuing to sell false hope to fat people (not so much $ in an actual cure/solution…), but the issues are probably more complex than that, and undoubtedly include the simple-but-troublesome fact that research is terribly expensive, and research that involves human subjects is even more expensive. Still, some new painkillers would be awfully useful (says the woman who did her 2nd knee replacement on acetaminophen because she really can’t handle opiates other than oxy-contin, which her *$@^()%$ surgeon wouldn’t give her in spite of her demonstrable safe-handling of opiates and having promised her she could have it after the first one, the bastard…). And new antibiotics are way beyond being a “good” thing and well into an emergency necessity. But, no, we need to spend zillions figuring out how we get and stay fat…  And yes, I know it’s more complex than that, but like many very complex things, it’s also just plain simple. Where you put your time and money are fairly clear reflections of what you care about, on a corporate level just as much as on personal or cultural or social levels.

Still, in so far as the JHU study makes it clear that weight gain is a matter, at least partially, of a physical set of genetically determined neurological responses, then it may go some way toward quieting some of the puritanical judgementism that dominates the larger discussion of weight and its relationship to character or intelligence or rights and human worth or the environment. Except that we already privilege the genetically gifted, so this may just be another place for us to rank human worth based on impossible-to-control-for factors.

Gosh, it’d be nice if one of these days I could manage a discussion that didn’t circle around on itself. I suppose it comes down, in many ways, to being able to figure out whether the ability to either prevent or control/cure obesity would make either the individual lives of humans better (unless something changes radically, I fear the answer there will remain yes, no matter how logically the Size Acceptance folks argue against it) and benefit any given society as a whole (now there, I would ague that the answer is no, since there is no actual evidence that fat people are killing the planet or inflating the medical-care crisis–unless we start trying for some sort of totalitarian-aesthetic-standard, in which case we’d have bigger problems than not liking fat people to deal with).

So the Johns Hopkins study is nice. Fat is a bit of a mystery, and I’m all for brainy types figuring out mysteries. And it’s good to remove the issue of weight gain from character-based blame-systems (although if you give your child sugary sodas instead of water or milk, you either have some character issues or some information issues–and there is a lot of that around–on many more fronts than What We Feed Our Children). It’s good to acknowledge that it’s a complex issue with many factors, many of which, in turn, are not controllable by the will of the fat person. It’s good. But it’s not necessarily good to keep treating obesity as a pathology and pouring endless dollars into it. It’s kind of a waste at some point.

Random not-unamusing picture:

round cat

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