Can You Be Fat & Healthy? For the last time…

Hey guys!

Happy New Year! There’s been a LOT of talk via various media outlets about a recent meta-analysis conducted of studies related to BMI and published in JAMA titled, “Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories.” Basically, the researchers studied studies (hence why it’s called a meta analysis) to draw generalizations about mortality related to BMI.

The results: “Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.”

Of course, this study stirred up a shit-storm of controversy because it supposedly counters the mainstream belief that you cannot be overweight or obese and not be at higher risk for death than say someone who is not fat. We all know that’s bullshit. Or do we? Based on how people reacted to this study, it’s clear that so many of us still have our heads up our collective arses.

Anyhow, here’s a sampling of the responses:

• “Big Deal: You Can Be Fat & Fit” by Marilyn Wann (fat activist & author of FAT!SO?) on CNN.com here. Marilyn discusses fat discrimination, the idea that we can be fit and fat (Health at Every Size(R)), and the medical hindrances that people of size face. We rarely ask whether fat stigma is itself to blame for many of our health issues, so I’m so happy to see she got this on the map (again).
• Dr. Sharma blogged about the study here noting that in a similar meta-analysis of data compiled in Canada (of US data), they found that “when it comes to mortality, what matters most is how ‘sick’ you are, not how ‘big’ you are.” And: “Neither BMI nor waist circumference were much use in predicting mortality – but whether or not you had hypertension, diabetes, or sleep apnea was.” Don’t we all know that BMI is a useless tool by now? So why are we using it as if it were a valuable piece of information? Did you know kids are now getting sent home with BMI report cards?!
• Paul Campos – author of one of my favorite books on obesity politics, The Obesity Myth- wrote a New York Times op-ed called, “Our Absurd Fear of Fat” here. He does a great job, per usual, describing the vested interests the govt and Big Pharma (et al) have in perpetuating this fear of fat.
• Dr. David Katz responded to Paul Campos in the Huffington Post here. Some great points by Dr. Katz on the limitations of the study: “A meta-analysis is never any better than the studies it is aggregating. In this case, those studies merely looked at the population-level association between the body mass index, itself a rather crude measure of body fat — which is what really matters — and death rate. The first, obvious limitation of this study is that it examined mortality (death) but not morbidity (illness).” And then the rest of his piece goes to hell because while he does say that BMI is bogus and that we should focus more on health than weight he ends with your typical alarmist obesity-crisis rally cry. I’ve always felt conflicted about everything he’s ever written for this very reason. It’s like saying, “don’t focus on weight! here’s my diet plan…”

So what do I think?

I think more of us should be asking questions than taking a position. Why does the government, for example, think obesity is its #1 health concern, but not, say, stress or the depressed economy? What is health to you and how intricate and complex is it really? If you lost 10 pounds, would that better your station in life? Why? Etc.

I know it’s big in the Health At Every Size(R) community to demand, “show me the evidence” when it comes to the supposed perils of obesity, but I honestly care less about obesity from a medical and evidentiary standpoint and more about it as a social issue – as a representation of how we, as a society, can manufacture the “look” of health and then hold everyone accountable to these standards. Worse, we can – and do – discriminate against those who do not meet them in HUGE ways – for example with health benefits, jobs (i.e. the essentials to life, if we’re talking about it from a Maslowian perspective). Whether you are poor, rich, white, black, woman, man, you are expected to make the look of health your responsibility. If you do not, you are considered morally reprehensible and a drain on society.

The idea that health is a moral imperative is tricky in and of itself because, clearly, “health” is very subjective and personal. Worse – if health is an imperative for access to civil rights and basic human services, where do we stand as a society? And, yes, let’s be real – most of the research does show that there is a correlation between higher body mass and type II diabetes (I am being specific here because higher body mass does not yield higher correlation to ALL disease and, as we’ve seen, it can be protective in many populations!), but correlation is not the same as causation. We should ask then, what other correlations do we know about and how do we treat those? There is a correlation between people with yellow teeth and lung disease. Does this mean that all people who have yellow teeth should be taxed higher? Denied health care?

And, yet, the very government that gives us these standards for “health” (i.e. health = BMI) is the same govt that is endangering our health (FDA’s lackadaisical approval process; USDA’s grain & dairy love and fruit/veg “equivalencies” are bologna (many people cannot tolerate our drought-resistant wheat varieties; why is a fruit-juice equivalent to a fruit? Why are farmers’ interests and lobbyists determining our dietary standards?), our health care system is horrendous and many of us do not have insurance – or a job -etc.; you get the picture. Why should we trust them? What are other options? Question. Question. Question.

And, many of us, blinded and dying to fit in (and/or to access society’s resources reserved for those who fit in), internalize the message that if we do not look thin (whatever that looks like; this is problematic in and of itself) there is something wrong with us. What happens to our health when we believe we are bad? This is why I am happy to see more and more activists asking “what is the price of fat stigma?”

Any of us who believe we are not a part of the obesity crisis because our BMIs do not fall on the overweight or obese categories should just recall that the NIH/CDC can change the definition and overnight we can become one of “them.” And if it’s not your body weight today, perhaps it will be your height tomorrow. If we do not respect the civil rights of all people, none of us are free.

To get back to the question then, can you be fat and healthy? Yes, of course you can. But it sure is hard – not necessarily because it may increase risk of certain diseases (“may” being the key here), but because you have to deal with the added weight of stigma and the potential hindrances that places on access to proper healthcare.

I’ll be posting a book review tomorrow of Dr. Abigail Saguy’s new book What’s Wrong with Fat?  You can get a glimpse of her beliefs in this op-ed she recently had published in the Los Angeles Times called, “Why We Diet” here. It’s a perfect introduction to her writing style and the issues she covers in her book. My favorite part is her call to action: “…if you are trying to change your body to shield against discrimination and stigma, consider making a different kind of New Year’s resolution: to stand up to intolerance and bigotry in all its various forms, whether racism, sexism or fatphobia.” YES! 100x YES!

<3,

The Cranky One

Tags: abigail saguy, david katz, Fat Acceptance, health at every size, marilyn wann, obesity politics, paul campos