Saturday, March 5, 2016

Review: What is Fat For?: Rethinking Obesity Science

Next up in my parade of non-fiction books is What is Fat For? Ignatius Brady, a science writer and weight loss clinician, has synthesized what I think can officially be called a "boat load" of research and his experience as a medical professional working with what we term the "morbidly obese" into an intriguing, eminently readable, and compassionate book.

I've voiced my skepticism of, and exasperation with, the diet mythos before. If you just started following me (like, I don't know, through the #sciart or the recent Book Blogger Appreciation Week Twitter events...!), you can watch me lose my mind at diet culture and at BMI as a meaningful metric. These things touch a nerve with me because I was a fat kid, and now I'm definitely a fat adult. (Haters to the left!) I won't get into my life story here; that's fodder for a Talky Tuesday post, maybe. But I think it's important to know where I was coming from in reading this book, and what I was hoping to get out of it.

To the point: Brady is a skilled and readable science writer, so the book is a breeze. I've read a lot of non-fiction in my day, and I've found that the science-related ones fall into two camps: they either cite specific studies and sources and work to interpret and explain the results and how they fit into the author's larger thesis (Cure was really good at this) or they simply state an opinion/trend with a vague "studies have shown" and then fail to specifically name or explain the studies (except in the bibliography). Brady manages to make ideas clear and easy to understand and treats you like a reasonably intelligent adult who lacks the specific knowledge (or access) to interpret data and medical studies.

Brady is also extremely careful about the implications of much of his research. One of the building blocks in his argument is the protein leverage hypothesis: that obesity rates are connected with a deficiency in protein in the modern diet.

See, you read something like that, and you think: "Wow, there's the silver bullet! I'll just eat nothing but protein and I'll be wearing a size 2 by Christmas!"

Brady knows exactly how this will come off, and so he carefully (and responsibly, IMO) mitigates it with the warning that we still don't know what happens when we eat too much protein (preliminary data seem to suggest that, among other things, excessive protein might be damaging for the kidneys), that adipose tissue (fat) serves a protective and necessary role, and that given humans' universal tendency to gain weight over time (about a pound per year), almost anything that causes prolonged, effortless weight loss probably has some kind of scary side effect or cause (illnesses such as cancer or thyroid dysfunction). Also, many of the health conditions we associate with obesity turn out not to have much of a correlation with weight at all. Smoking is still worse for you than being a fatty, turns out!

That is what sets this book apart from fad diet and "nutrition" books. Brady doesn't assume that you want to go on a diet or lose weight, but rather that you have a genuine curiosity about the body and how it works. He emphasizes again and again that we should not only stop seeing obesity as a problem of will power, but as a problem at all. He's not selling you a miracle diet, a meal plan, or a training regimen. He's just a guy who's found a lot of interesting research and wants to share it with you, which makes it the best kind of science reading.

That said, at the end of the day you're still relying on the author to be correctly interpreting this data for us. Brady is the one with access to the papers: not me, and not you. All of my gut (haha) instincts point to him being knowledgeable in the field, familiar enough with the terminology and the requisite background information, and just generally clear-eyed (and honest) enough to see the data for what they are (more or less) and not for what he wants them to be (more or less) or for what will sell a book (more or less). But then, I went into this book pretty much agreeing with Brady from the get-go, so I'll admit I didn't come at this one with a critical, defensive edge.

And it would be hard for me to do that, anyway, since I'm not a doctor! But I also finished this right after a much more irritating book that had me side-eyeing at every turn; with What is Fat For? I just wanted to sit back, relax, and learn.

The only moment the book made me stop and go "hmmmm =/" for a moment was just one or two parts on the topic of exercise that seemed to understate what its effects on health (unrelated to getting smaller). Yes, exercise alone certainly won't make you smaller, but it still seems to have demonstrably (and dramatically) good effects on health otherwise. While life is too short to waste time on things you hate (why I'll never run a marathon), there are probably appropriate and fun ways to move for almost every body (and everybody). Even if I'll never run a marathon, I love going on walks, yoga, and weight lifting. (And back in the day, running regularly did make a significant dent in my blood pressure. But I also hated running.) Naturally, everyone gets to decide for themselves if they're going to move and how much, but we can still admit that it's a good thing.

This is certainly the highest-quality self-published book I've read yet, bar none. The more I think about it, though, the more I'm wondering: why self-publish? The topic is popular enough, and the writing is good enough, that any publisher would have picked it up in a heartbeat. Considering that legacy publishers put out victim-blaming woo garbage like The Secret without a second thought, I doubt the means of What is Fat For?'s release into the book wilds indicate anything about the veracity of the claims therein. But it's enough to nag.

Content aside, there are a few formatting problems. Of course, I'd rather read excellent, focused writing with formatting issues than mediocre writing that's perfectly formatted, so this is a small complaint, but it's worth noting.

NetGalley sent me the eBook version, and the formatting on this is a mess. A hot mess. I don't know if it was some kind of XML error or just the difference between how something looks on a Kindle versus on the Kindle app on a smartphone, but on about half of the pages there would be bizarre word smashes.

It's easier if I show you:

At first glance it looks fine, but look carefully at that black space between the last two "paragraphs": those aren't different paragraphs, but just one with some weirdness in it, thanks to a misplaced block of empty space:

"While there may be a way to present an argument in either field using just logic and pure reason, math becomes complex necessary as the questions become more and better defined."

If you don't read carefully, that might still sound okay. But look closer: "math becomes complex necessary..."

From the best I can gather, it should read:

"While there may be a way to present an argument in either field using just logic and pure reason, as the questions become more and better defined complex math becomes necessary."

Or maybe something similar. There was something like this on every page. Sometimes I could sort it, but other times it was impossible to make out.

"His by recognizing this: Hunger is we modern, complicated, guilty, mouth dries; he can barely swallow, but manages."

I don't even know what to make of that. And I can't check it on any of my other eBook reading apps (I have Google Play Books, UB Reader, and GooteBooks), so I don't know if it's a Kindle thing or a this file thing or my phone thing or what.

Likewise, there are a few charts and graphs in the book, and most of them are essentially non-existent. Many of the graphs turn up as a list of their Y-axis values. Charts are squashed into incoherence.

Both of these problems seem to be an inherent issue with dealing with the eBook format. Maybe this is where the budget ran out? The author info also mentions something about a website ( or some such) but as of this writing it seems to be defunct, without even a trace on Archive.Org. The book isn't old by any means, so: has the website just not launched yet? is it just temporarily down? Did Brady decide to pull it?

All in all, I enjoyed What is Fat For? and I'd recommend it for your own reading (fun facts!) and as a part of a Health At Every Size/Fat Acceptance library/GP toolkit.

As this was a free book from NetGalley, I'm obligated to let you know that I received it  in exchange for an honest review. 


  1. This sounds good! That is weird it had to be self-published, though.

    1. It definitely feels odd. I get that there are reasons to pursue self-publishing instead of legacy publishing (since he's been writing over at Science 2.0, maybe he figured he'd have no problem getting the book visible), but I still side-eye, you know? Especially because it's science/non-fiction. Like I said, his insight surrounding the data seems reasonable, but I also know that confirmation bias is a thing, so I hesitate to completely endorse his authority.

      That said, this is the first self-published book I've read that's been competently edited, both in terms of content and copy editing. Even if he's totally wrong, it's still a pleasant read!

  2. Hi Katherine, Thanks for the review and kind words. I thought I'd chime in about the questions you raised on how I published.
    First of all, so sorry about the formatting problems. I haven't heard of others having these issues, but perhaps if one doesn't read close, you can gloss over them, like you mentioned. You maybe are catching glitches that a less careful reader just plows through. I haven't gotten complaints from anyone who bought it on Amazon and it looks good on my devices. Happy to send you a paperback for your troubles!
    Why self-publish? Well...I live in Iowa City, which is a town of writers (because of the workshops). As a doc and former English major, I run in a crowd full of people complaining about their agents and publishers: delays in going to press, demands for revisions, difficulty getting a book accepted, battles over title, battles over the cover. Writers give a lot of control to the publishers who are interested in making a buck, not making a statement. I thought (arrogantly) "like hell I'm going to work this hard on something and have them put some six pack abs or tape measure on my cover..."
    So, I decided that in this wonderful modern world, I could forgo all the trouble. Who needs these publishers, slowing the process down, rejecting manuscripts without reading them, etc? I also figured, in the year or two it would take to get a book published, I could learn how to prepare a manuscript myself for Amazon, createspace, netgalley. All of this required new learning and I thought it was a better use of time than sending letters to publishers and agents.
    In short, I self-published because I was cocky and impatient.
    I did show this to many clinicians and researchers along the way. I have met a lot of the researchers whose work I cover in the book. I made sure that I wasn't totally off base, and I made 20-30 rounds of revisions to the manuscript (wish that was exaggeration) over a year or so. I also had the benefit of all the science-y people who find my stuff on blogs. Most of this has been critiqued, at least in bits and pieces. I think that made the book what it is. In addition, after a writer friend found five mistakes of small grammar issues in the introductory paragraph, I hired two separate copy editors, who found countless errors. So that is why it is perhaps more put together than most self-published books you run into.
    Did it work? Yes and no. I have a book I like. Those who read it say positive things, like you did. But nobody is exposed to it. So it can't reach an audience without a publisher. I couldn't have found that out without trying it my way. If you wrote a song you were proud of or painted a picture you liked, would it matter if you sold it? I'm not sure.

    1. Ahh! Hi Dr. Brady! It's always a shock to find that one isn't just screaming out into the void. ;)

      I wish I had a good explanation for the formatting errors; I don't know how the process of working a manuscript into an ebook goes, exactly, so it's not like I can make an educated guess about what went wrong. I can tell you that my particular version was the protected PDF format delivered by Amazon (which is, if I understand things correctly, the .mobi file type).

      I just sat and fiddled with things now, and the protected EPUB version (.acsw) I can download straight from NetGalley works (at least in another reader). So: time to go back and look at all the graphs! If you've had multiple people open the Kindle one fine on their devices, the error is probably a fluke on my end. Because while it would be flattering to think I have a better eye than most, the truth is that a lot of those jumps were noticeable and disconcerting. I think if it were a widespread problem on multiple versions and platforms, someone would have mentioned it. (I *hope* so!)

      The legacy publishing model is a shitshow. (Little known fact: "shitshow" is a technical term.) I suppose I give publishers too much credit -- the covers you're describing would be 1) a nightmare and 2) exactly the kind of thing they'd want to push, probably *especially* on the debut book from a relative newcomer. Never mind potential editing to the actual content (e.g. trying to get you to frame it as a diet book). Anything else would just be a hassle, arguably, but reshaping your entire message to sell better crosses the line into compromising integrity. From that perspective: thank you for maintaining your integrity.

      And also, THANK YOU for seeing the value in good copy editing. I say this as someone who periodically gets paid money to, well, copy-edit (so a grain of salt is maybe needed) but also as someone who prefers to read well-written books. Good editing and solid revisions seem to be overlooked often, especially in the self-publishing world, and it kills me. The scientific rigor is good and important too (you did more than your due diligence and it shows), but focused, clear, and organized writing is just as important (and harder than people think! but you know that).

      I have already been talking up your book offline. Hopefully NetGalley and the like will get some momentum going on this. All the best in this and in your future endeavors!

  3. As much as you enjoy bumping into a writer who did his homework, I feel the same hearing from a careful thoughtful reader...I swear, are people asleep or something?
    In any case, thanks. It's good encouragement. I will keep your name for editing the next one (2-3 years from now, anorexia is the new topic I'm obsessing over). Thanks again!