Health and fitness

In any society, certain needs have to be catered for, either socially or privately. At a minumum, those unable to work, because they are too young, too old, or too sick have to be cared for. Of course, they can be cared for in ways that are better or worse for them, but caring there must be, and that is going to take someone’s time, labour, and money.

I’ve been thinking about these rather obvious facts over the past few days partly because a report came out showing how many people – mainly women – are being driven out of the the UK workforce by the need to care for relatives, given that the social care system is broken. At present, there are also a lot of people out of the UK labour market either because they can’t work due to COVID and its after-effects, or because the underfunded National Health Service has been shattered by the pandemic and they can’t get the treatment they need in a timely fashion for other health problems they have. If left languishing, the skills these people have will atrophy. Many of them will never work again.

At the same time, our soon-to-be-former Prime Minister has been pushing her “pro-growth” agenda, which largely consisted of tax cuts, and her now-former Home Secretary mocked the anti-growth coalition of “Guardian-reading, tofu-eating, wokerati”, of which I am proud to consider myself a member.

Their central assumption is that growth is best served by a low-tax economy and that public spending needs radical reduction, with the fat-cutting exercise of the last twelve years now to be extended to the bones. Well, I hope readers can see the problem. You don’t get growth by pursuing policies that effectively force people to give up productive work either through their own sickness, or in order to care for other people. If these needs are not met socially, they will be met privately, and, again, because it bears repeating, in ways that are disproportionately damaging to women.
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I’m in the UK now, having spent the last (lovely) six weeks in France, an EU member-state with a much more functional government than we have. When we left for France in mid-June, it was on the UK government’s “amber list” and had just started admitting visitors from the UK with proof of full vaccination and a negative COVID test. To get such a test in the UK we had to pay £80 to a private provider. We also had to pay for additional travel insurance to travel to a country that the UK’s Foreign and Commonwealth Office advises against travel to, the advice having rendered our existing travel insurance inapplicable. All went swimmingly on the journey out apart from a 30-second hiccup when a French border guard thought a different set of rules applied to us, requiring urgent reasons for travel, but a colleague set him right.

Our plan had been to stay in France until the UK government moved it to an easier category not requiring quarantine. But the opposite happened. Ostensibly because of a surge in the Beta variant in France, the UK moved the country to an enhanced “amber plus” category, requiring 10 day quarantine even for the fully vaccinated. This measure against France was quite inexplicable, since there were other European countries with higher incidences of Beta, and becauce the French cases were actually overwhelmingly on French islands in the Indian Ocean. Perhaps there were other, more political, reasons behind the change, or perhaps the British government is bad at geography but couldn’t lose face by backing down once the error had been pointed out? Who knows? Rumour has it that France will be taken out of “amber plus” this week, and that the fully-vaccinated will be allowed quarantine-free admission to the UK from France this week, as visitors from the US and most of the EU are. That’s no good to us. (And note this is at a moment when nearly all internal restrictions have been lifted in the UK.)
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As Eszter said in her post on health living,, everyone has their own story and their own health. That’s true, but we are all subject to the same physical laws. So, here’s my story and some thoughts on the physics.

I managed to lose about 12 Kg over a couple of years, almost entirely through exercise.

The basic physics is simple
(1) weight loss = (kilojoules burnt – kilojoules consumed)*k,
(2) kilojoules burnt = base metabolism + work done

where k ≃ 0.025 is a constant reflecting the rate at which your body converts kilojoules of food energy into kilograms of fat. If you can alter the right hand side of (1) through any combination of diet and exercise then you will lose weight.

The problem is that altering either of these, or even altering while holding the other constant is really hard. Dieting makes you tired and slows your metabolism. Exercise increases your appetite, and also encourages you to flop once you stop exercising. All that’s because your body isn’t evolved to lose weight easily. Hunger and fatigue are both adaptations to stop you doing that. And, even if you can shift (1) enough to lose some weight, (2) puts a limit on how much you can lose. Balance is restored by the fact that your lighter body takes less energy to maintain and move around.

The crucial thing is to find some change for which you have both the willpower to adopt it initially and the willingness to maintain it indefinitely. For me, as I said, that’s been exercise. I aim to burn 4000 kj (about 1000 calories) a day in addition to base metabolism, which implies about 100 minutes of vigorous aerobic exercise. That’s logistically feasible for someone with flexible working hours and no kids at home, but very difficult otherwise. And it takes a long while to get to the point where you really enjoy it. That’s why the experts mostly recommend working on diet. But, if you can manage it, I think exercise is the better way to go.

This post is about health, weight management in particular. Friends have been asking me to write up my experiences so here it is. It is a personal story and offers no social analysis other than to acknowledge that living healthy is by far not the cheapest option out there, which is of course a problem.

A little over a year ago, my doctor told me that I was pre-diabetic. I had been steadily gaining weight for several years. I didn’t feel good in my body anymore, but wasn’t managing to do much about it. Knowing that my weight gain was having medical repercussions was the final push I needed to start making significant changes. I set out to lose 25* lbs (~11 kg) in three months and eventually lost 30 in four (for illustrative purposes, the books on the right equal that weight). I know many people struggle with similar issues and several friends have asked me to tell them how I did it so I decided to write up some details. I purposefully waited a year to do so as I only wanted to report back if I managed sustained change. I did. I started on June 21, 2019 and I’m 28 lbs below what I was then consistently hovering between that and 30 lbs down (such fluctuation or even a bit more is common).

As a caveat to this post, I want to say that this is not meant as weight-shaming or body-shaming. Everyone has their own story and their own health, this is mine.

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Everyone always says that forgiveness a worthwhile life strategy, and is for you, not for the other person who wronged you. This seems obviously true in some cases–in principle if you are nursing a rather trivial grudge which is bothering you, it would be better to let it go. In severe cases there is evidence that anger or misery can dampen your immune system, shave years off your life, give you heart disease, etc. The NYT has recently advocated both the somewhat paradoxical advice to hold on to grudges under certain circumstances, and the more traditional suggestion to let go of them. (At the former link there is a kind of fun quiz you can take to see how serious the grudge is, and whether you should allow yourself the petty pleasure of nursing it. Also, it’s clearly meant to apply to that girl in fourth grade who said that you used crayons and colored pencils on your poster of the solar system, and it didn’t match, and she didn’t want to sit with you at lunch for three days.) The latter is the advice most often given by psychologists and 12-step programs and self-help books.

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Early last year, I began to experience some pains in my hands. I associated them with bringing a large turkey back from the butchers. Hadn’t taken the car, because parking, but it was heavier than I appreciated and I struggled with the bird as the handles of the plastic bad tore on my fingers. I went to the doctor. Tendons, probably, he said. Most likely be better in a few months.

Then in September, back from a touring holiday in France which had involved a lot of lugging of boxes and cases up and down stairs, the pain was back, worse. I lacked the strength to open cans and bottles. Some movements were fine but turning a knob or using a key sometimes — ouch!
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Today’s art post inspiration comes from an unlikely source: JAMA Opthamalogy. The article “Evidence That Leonardo da Vinci Had Strabismus” makes the case that the artist’s exceptional rendering of 3-D in 2-D was in part thanks to his eye condition sometimes referred to as wandering eye. The author, opthomologist Christopher Tyler of City, University of London, examined six pieces thought to be depicting Leonardo da Vinci: “David (Andrea del Verrocchio); Young Warrior (Andrea del Verrocchio); Salvator Mundi (da Vinci); Young John the Baptist (da Vinci); Vitruvian Man (da Vinci) and another possible da Vinci self-portrait.” (quoted from the university’s press release). Ars Technica’s coverage of the piece has helpful visuals. There seems to be disagreement in the art community about whether all of those art pieces depict Leonardo da Vinci, but this is a topic Tyler had already researched earlier. His argument seems convincing to me and is an interesting revelation about the condition under which some artists did that work. Apparently other famous artists also had strabismus (e.g., Rembrandt) or other vision impairments (e.g., Monet, O’Keeffe). I appreciate the angle the Washington Post’s coverage takes on this at the end noting that this should give people with eye-alignment disorders some boost in confidence to counter the discrimination they sometimes face both on the job market and in social situations.

This week’s picture is quite an old one, of the sculpture outside the then-new Bristol Children’s Hospital which is directly adjacent to the Bristol Royal Infirmary, where I spent a good past of the last week following an acute gallstone attack (with associated pancreatitis) last weekend. On the Thursday I had my gall bladder removed (which turned out to be slightly more complicated than anticipated) and by Friday I was home. I’m now resting and recuperating, but basically feeling fine. Some reflections on the experience below the fold.
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What I am curious about in the Singer/infanticide/ending the life of the disabled vein is, what do those who are totally opposed to every form of infanticide think about anencephalic babies (and babies who have similarly non-survivable, severe birth defects)? I don’t think that, as a formerly pregnant person who has given birth to healthy children, my opinions on these questions have any extra merit, but I do think others not so situated may share my opinions without feeling so strongly about them, or in the same way. Perhaps the situation calls for some epistemic humility? The terrifying prospect to me, and to many mothers, of “late-term” abortion bans, is that pregnancies which are terminated after 20 weeks are almost all wanted pregnancies in which something horrible has occurred or been discovered. (And, in those cases where the baby is unwanted, there are almost certainly serious problems in the woman’s life that have led to the delay in getting an abortion sooner.) So, in a situation of supreme horror, the fetus might die, but the mother might be forced to carry the dead fetus inside her and have labor induced, to struggle in pain and blood to bring her dead baby into the world. She would feel the liquid inside her, and the lax ligaments, and all the other things she felt in pregnancy, but she would know the baby was dead. I have heard of mothers knowing right away. So close to you then, infinitely close, but infinitely far, and a rotting thing now, a poison for the rest of your body. So awful.

My first pregnancy was easy and wonderful. I felt and looked glowing, and although I was in labor for more than 40 hours (remind me not to do that again) I gave birth vaginally to a healthy girl who latched onto the breast just a few minutes after she was born, and fed well and naturally. In my second pregnancy I had unexplained bleeding starting at 19 weeks. Bright pink fresh blood in the toilet bowl. I thought my heart would stop. I thought her heart had stopped. They couldn’t figure out what was wrong. I was in terrible pain (I often am; but it seemed like she was tap-dancing on the worst bit of me.) I kept bleeding on and off. I knew how many movements she was supposed to make in an hour and I counted, and counted, and counted, hour after hour, so scared, and then another hour. The doctors were determined to deliver her surgically as soon as they felt she was cooked up right, so, 37 weeks. It turned out to be nothing serious, placenta previa (the organ grew over the cervical os, the opening to the birth canal, blocking the baby’s egress.) She was fine.

But sometimes when the doctors check, they find that the fetus, which has appeared to be developing fine, has no brain at all, that the blackness inside her skull on the scans is only water. This is not even a fetus, really–certainly not a future infant. It will never feel pleasure at a mother’s touch, or pain from being pinched by a crib mattress, or see anything, or hear anything. It is empty. Laws that would force a woman to stay pregnant and nourish and grow that wrongly-made creature inside her, and to suffer the agonies of childbirth, and to bring forth this…not-baby–laws like that are torture. I would go mad. I would try to abort the fetus myself. I would try to kill myself. I would want to be put to sleep then, there, in the doctor’s office, and wake up, not pregnant, and with a little coffin to bury my hope and love inside. With ashes inside, only, because I would want not to look, but I would look, and I would always wish I had not.

But let us say an unjust, oppressive, Christian regime forces me to endure, and to deliver this severely deformed baby. Does anyone think we should use artificial life support to keep the baby alive? Almost all fetuses of this type are stillborn, and those that are not usually die on the first day of ‘life.’ Even the Catholic Church has some hand-waving about letting God’s will take its course. That is, they are not insistent on providing hydration and nutrition–no one even considers artificial respiration. Reading on it, three children have lived a year or so. There are pictures of course, and now I wish I hadn’t looked at them, and I am so sorry, the poor little things, and so sorry for the parents. For the mothers! When I think of those oscillations inside you, feeling movements you didn’t make, the mysterious gliding of blood-wet surfaces over each other in the absolute black, the not-you inside you…what if you knew in the end there was nothing? Some kind of seasickness of death? At the last you would be holding a newly hatched chick, naked and grey and dead, grey and jerking with dying? But back to the matter at hand, we all think a form of infanticide is appropriate here, right? No one’s on team ‘drastic measures for resuscitation?’ Artificial respiration for 80 years, for something that can never feel you hold his hand? A rough golem on whose forehead no glyph has been inscribed? So isn’t there a small number of real-world, continuously-occurring cases in which we are all pro-infanticide?

UPDATE: so misinterpreted! Obviously my fault also. I didn’t jump in to give Singer crucial moral support. I’m not totally sure how I did…I guess I’m implying all his critics are disingenuous and have parked themselves at the top of a slippery slope with some dubious wedge. I apologize to sincere Singer-critics for insulting their position in this way. That wasn’t actually what I was trying to do at all. I was genuinely curious. There was a case maybe eight years ago now, but I can no longer find it in the welter of anti-abortion and pro-abortion articles, in which a woman’s 24 or even 26-week-old fetus died, and the laws of her state required a waiting period before you could get a late term abortion (Texas IIRC?). The removal of a dead fetus is done via dilation and curettage, i.e., via abortion. So she had to go talk to some doctor, and then go stay by herself in a motel with her dead baby inside her for two days. She wrote about her experience and I remember thinking, I don’t know if I could live through two days of that. A responsible, thoughtful doctor would have deemed the dead fetus a threat to her health and her ability to have future children and had it removed on those grounds, but in this particular case, it was a Catholic hospital and none of these things happened. So I did mean to say, I think there are a number of infants born each year whose lives everyone agrees cannot go on in any way. That doesn’t mean that–HAHA! now everyone is obliged to accept all Singer’s positions; I was honestly curious, not mock-curious, and I honestly don’t know what all Singer’s positions are. But I also meant to describe to people who haven’t been pregnant the terror of something going wrong, and how you hope you would be a good enough person to accept your baby any way she came, but you fear you’re not brave enough, not really, not truly brave enough. And that as long as she was inside maybe you could pretend it would be alright somehow? But even then there is only one feeling that is ever like this, of having something inside you that is alive, that isn’t you, that you are waiting for, and how would it be if you were waiting for nothing? That’s all. I really don’t know enough about Singer’s positions to arbitrate on any of these questions; I was just thinking, we need to hear from severely handicapped people who were written off as a total loss before we know whether he can be right. We might also be interested to hear from mothers. And I’m only the mother of perfectly healthy babies! That’s it. I’m not laying down my life for in-group sacrifice.

Last Thursday I went to the launch party for Katie Green’s Lighter Than My Shadow (just published by Jonathan Cape) a graphic memoir in which she tells the story of her descent into and recovery from anorexia (and quite a bit besides). It is a big book, 524 pages in all, which somewhat belies its title, yet I read the whole thing in one sitting. I know I’m not alone in having done this: once you start, it is very hard to stop. It is compelling but a hard book to read: I felt the tears welling up several times. It is also a great book. The graphic format works perfectly for the story and Katie – a terrific illustrator – has managed to convey very vividly some little part of what it felt like from the inside. The black cloud of despair, the screaming monsters in the head, the desperate urge to control, control, control and the sense of alienation from those closest to her, the pain she knows she’s inflicting on them but can’t help doing so.

When she spoke at the book launch Katie said that she hadn’t written the book to help anyone. Nevertheless, I’m sure it will help one very large group of people, the people who can’t imagine what it is like for someone in her position, who can’t understand the sense of compulsion, and why the sick person can’t just “pull themselves together”. In giving voice to this inside, Katie has pulled off something comparable to what William Styron did for depression in Darkness Visible. That’s a pretty high standard of comparison, I know, and I’m feeling swayed by the immediate experience of just having read Lighter Than My Shadow, but I don’t think it an unfitting one.

I should disclose a slight interest. I know Katie slightly (she’s a friend of one of my children) and a photo I took is on the cover flap. So I’m not entirely impartial. Still, I think this is, objectively, a very great achievement. And I don’t mean to relativise in a way that suggests that it is great for someone who has gone through her experience to have produced something this good. I mean that it would be great for anyone to have created this, even though her experience is a condition of having done so. Anyway, people out there, this is a book that most of you ought to read. You can get it at Amazon of course, but better to buy from somewhere else. (The Guardian had a feature on the book last week.)

I see lots of stories made up of handwringing over the “obesity paradox”, normally presented as saying that even though obesity is a risk factor for all kinds of diseases, obese people appear to have lower mortality than others. A typical finding is the one reported here

being overweight or slightly obese was linked to about a 6 percent lower risk of dying, compared to people considered “normal weight. Being severely obese, however, was still tied to an almost 30 percent higher risk of death.

People are tying themselves in knots over this, but it doesn’t seem to me that there is any paradox to be explained. The obvious reading of the data is that the Body Mass Index.[^1] ranges used for the various categories (20-25 Normal, 25-30 Overweight etc) were set a bit too low when they were originally estimated, or rather, guessed. From my quick look at the data, if you bumped the ranges up by a couple of points, the paradox would disappear. People at the bottom of the current normal range, who tend to have high mortality, would be classed as underweight, while those currently classed as slightly overweight would be reclassified as normal, and so on.

Am I missing something?

[^1]: This point is logically separate from the general problems of the BMI, regarding muscle mass and so on.

Via Ta-Nehisi Coates, a couple months back, I found this gallery of classic images of Venus – downsized courtesy of Anna Utopia Giordano and Photoshop. (The gallery was down for a while, so I didn’t post about it at the time. But now I see it’s up again.) Coates also linked to this post by Bob Duggan, responding to the Photoshopped images. I disagree with almost everything Duggan says. The grotesque results do not in any way shape or form show that there is anything grotesque about the thin, modern beauty standards the artist means to critique (I assume this is the intent.) It’s like trying to prove that moustaches are funny by drawing moustaches on famous paintings. You could also perform the exercise in reverse. Take some reasonably iconic superthin female image and give it the Titian treatment – or the full Rubens – and I’m sure the results would be incongruous and funny. It wouldn’t prove hips and stomachs are themselves inherently hilarious.

Which is not to deny that the superthin standard is grotesque, in a technical sense: it’s extreme and unrealistic to the point of caricature. Duh. But it seems to me that what is objectionable here, if anything, is not the extremity but the standardization. It’s also quite puzzling. Why is beauty culture (per the specs of the fashion industry) such a stable, monolithic body-type monoculture? Feel free to pipe up about how you like ’em with more meat on the bone, so you must be a feminist! (So do I!) But that’s not really what I’m asking. People – men and women – in fact find a wide variety of female body-types attractive. Fashion is all about variety and the new. It seems natural enough to me that the fashion world should gravitate to extremes, and that power-law-type distributions should tend to apply. But fashion is way more than 80-20 in favor of a very particular flavor of thinness. (Or am I wrong?) And thin has been in for a long time. Setting aside whether/to what degree this is to be condemned and/or something done about it, why is it this way? In your expert opinion.

Why don’t we get more change and multi-polarity in ‘ideal’ body-types from the fashion world?

Is it just that fashion designers like to draw nine-heads tall stick figures. And it all flows from that?

I’m sympathetic to a number of points made here (via Andrew Sullivan). I have been trying to institute anti-distraction mechanisms in my own life. Forced offline time. I have little doubt pretty much everyone ought to, these days. At the same time, I’m a big believer in effective multitasking. My philosophy is: peripatetic philosophy is healthy. [click to continue…]

I’ve already gone over my looking at words limit today, so this will be brief. I thought this odd problem was caused by watching a bad TV show in which some of the characters have Southern accents. Nope. In wending my way through the various neuroscience labs and so forth I have learned that they basically don’t know jack about migraines. But in any case migraines are exhausting. So I am strongly inclined to make curious mistakes, wrong words, spoonerisms, aphasia, whatever. (I couldn’t remember the word “tesseract” the other day. My doctor laughed at me when I brought this up as a complaint.) And to regress. But regress to what, when I was 6? I never have had a Southern accent as an adult. I speak overly quickly, but with a normal East Coast accent. Except under the strain of continual pain and electric storms in the brain I…have a Southern accent now? My daughter said “ain’t” the other day? What in the everlovin’ blue-eyed world is that, I ask you. My family is going to give me constant hell from the minute I see them till moment I leave. I’m afraid to go home to DC! I’ll go to S.C. sure, no one will notice.

My Chinese business partner loves it, she thinks Southern accents are the cutest things in the world, and it also means I talk at about…2/3 the speed of my previous rate. Maybe even 1/2. It’s just, really weird. I can feel it; I can actively fight it with concentration. It varies throughout the day, depending on pain and so forth. The funny thing is that I used to be unable to produce a Southern accent on demand. If she asked me to do it, I couldn’t, I would just freeze up somehow, it felt like I was pretending something. Oh well, ain’t is a perfectly fine word.