I have a bad cold today; I feel like my head’s stuffed with cotton, and I have next-to-no ability to concentrate for more than a few minutes at a time. So rather than attempt to write an original post, I’m going to quote from an excellent article from The New Republic about fat, health, and weight-loss. It’s an excellent article, and I’d highly recommend reading the whole thing.
What accounts for the conflict between studies that claim being “overweight” is a significant health risk and those that suggest such weight levels might actually be optimal? The biggest factor is that researchers fail to point out that, in practical terms, the differences in risk they are measuring are usually so small as to be trivial. For example, suppose that Group A consists of 2,500 subjects and that over the course of a decade five of these people die from heart attacks. Now suppose that Group B consists of 4,000 subjects and that five members of this group also die from heart attacks over the same ten-year span. One way of characterizing these figures is to say that people in Group A are subject to a (implicitly terrifying) 60 percent greater risk of a fatal heart attack than those in Group B. But the practical reality is that the relevant risk for members of both groups is minuscule. Indeed, upon closer examination, almost all studies that claim “overweight” people run significantly increased health risks involve this sort of interpretation (or, less generously, distortion) of their data. […]
In a decided majority of studies, groups of people labeled “overweight” by current standards are found to have equal or lower mortality rates than groups of supposedly ideal-weight individuals. University of Virginia professor Glenn Gaesser has estimated that three-quarters of all medical studies on the effects of weight on health between 1945 and 1995 concluded either that “excess” weight had no effect on health or that it was actually beneficial. And again, this remains the case even before one begins to take into account complicating factors such as sedentary lifestyle, poor nutrition, dieting and diet drugs, etc. “As of 2002,” Gaesser points out in his book Big Fat Lies, “there has not been a single study that has truly evaluated the effects of weight alone on health, which means that ‘thinner is healthier’ is not a fact but an unsubstantiated hypothesis for which there is a wealth of evidence that suggests the reverse.”
And from later in the article….
If fat is ultimately irrelevant to health, our fear of fat, unfortunately, is not. Americans’ obsession with thinness feeds an institution that actually is a danger to Americans’ health: the diet industry.
Tens of millions of Americans are trying more or less constantly to lose 20 or 30 pounds. (Recent estimates are that, on any particular day, close to half the adult population is on some sort of diet.) Most say they are doing so for their health, often on the advice of their doctors. Yet numerous studies–two dozen in the last 20 years alone–have shown that weight loss of this magnitude (and indeed even of as little as ten pounds) leads to an increased risk of premature death, sometimes by an order of several hundred percent. By contrast, over this same time frame, only a handful of studies have indicated that weight loss leads to lower mortality rates–and one of these found an eleven-hour increase in life expectancy per pound lost (i.e., less than an extra month of life in return for a 50-pound weight loss). This pattern holds true even when studies take into account “occult wasting,” the weight loss that sometimes accompanies a serious but unrelated illness.
And here’s a point I wish Campos had developed further:
Americans… long to believe that medical experts can solve the problem of their expanding waistlines. The reason for this can be summed up in six words: Americans think being fat is disgusting. That psychological truth creates an enormous incentive to give our disgust a respectable motivation. In other words, being fat must be terrible for one’s health, because if it isn’t that means our increasing hatred of fat represents a social, psychological, and moral problem rather than a medical one.
Again, I recommend reading the whole article.
Pingback: Big Fat Blog | The fat acceptance weblog.
Pingback: a-blog馬鹿
Pingback: Asymmetrical Information
Pingback: Shakespeare's Sister
Thanks for pointing out this article. Too bad so many of the feedback comments on TNR are so awful.
Something is true with this. To be fat does not always mean to be a sick person and to be slim does not mean to be without health problems.
My father was never a slim man, but moving around a lot by feet and by bicycle, he is now 99 and soon he will be 100 years old. Still healthy.
People who told him, he will die soon because he is too heavy, are all dead since a long time ago. It is not possible to tell them now, that they were wrong.
About myself, I do not care much about my weight, same as my father, until I feel myself uncomfortable – If I really feel uncomfortable, I try to do more movement, like walking around or swimming. This helps.
I never missed a working day during the last 30 years unlike my slim co-workers.
For sure, UNDERWEIGHT is much more dangerous for your health than overweight. My daughter tried it out to be perfectly slim, against my objection. She spent 6 weeks in a hospital, as suddenly she could not eat anything anymore.
What some people are doing to remain slim cannot be seen as a healthy lifestyle.
If I see some models on stage, I ask myself how you feel, if your body is only skin and bones.
I dont think this is as black and white as people want to make it. Is being heavy unhealthy… Yes, probably in a lot of cases it is, more blood, more tissue, more strain on the heart. No in others. We want to say yes or no but I dont think that covers it at all. I think one of the dangers of saying yes or no to thin/fat people being healthy is that people then point to that and decide not to maintain a healthy bodyweight because they have proof that it isnt healthy to do so. If I believed BMI indexes and stuff like that I am morbidly obese myself. I was obese through my athletic phase as well. There are definately problems with the “rules” as everyone is an individual and the definition of healthy will vary. I don’t think saying too thin is unhealthy should end up defending being glued to a couch eating cheetos. I also don’t think things like BMI should define our body image.
Ed, there’s no evidence that “being heavy is unhealthy”, there is copious evidence that being a little over the ideal weight is healthiest, there is copious evidence that being whatever weight and active is healthy, whereas dieting to lose weight is unhealthy. Why do you not want to accept that “heavy is unhealthy” is completely bogus?
Mostly because accepting “being heavy is unhealthy is completely bogus” leads to people deciding not to control their weight at all. Excessive weight loss is unhealthy. The same is true of weight gain… Not crash dieting is not the same as not maintaining a healthy body weight and composition. And the “active” qualifier is great if it wasn’t so subjective. Some people think sleeping on the second story means they are active because they have to walk up and down stairs to get to bed. Why are you so desperate to be absolute in your statement? Saying body size or composition has absolutely no impact on health would be short-sighted to say the least.
The problem I see is that people see studies like this, then conclude “hey, I can eat all the junk food I want and gain all the weight I want and there will be no health impact!”. Which is not true. The morbidly obese have significant health impacts due to their weight, ranging from diabetes to heart disease to joint failures.
I’ve maintained a fairly stable weight for the past 15 years. This weight is about 20 pounds heavier than the “lean mean athletic machine” weight I had when younger, but my blood pressure is fine, I engage in strenuous outdoor activities just fine, etc. But a year or so ago, due to stress and the availability of lots of fattening junk foods at my then-job, I gained an additional 20 pounds. My blood pressure went through the roof, my belly spilled over my belt, my back ached all the time, I was uncomfortable doing outdoor activities, etc. I changed jobs to a lower-stress job and went on a restricted calorie diet (high protein to prevent significant muscle loss), lost the 20 pounds, when I reached my target weight exercised to regain the lost muscle, and now I’m fine again and eating normally again, just being careful to only eat junk food a couple of times a week to prevent putting the weight back on. Should I have gone ahead and lost the other 20 pounds? No. Because my adult history over the past 15 years shows that my current weight is healthy for me, so there’s no need to lose more. But just 20 pounds extra above that caused significant health problems for me, and we do nobody a favor when we imply “you don’t need to maintain a stable healthy weight.” It’s just that our body’s idea of a “stable healthy weight” and society’s idea of the “ideal weight” are often two different things, and we should listen to our body, not to society.
If our body likes the weight it’s currently at — if blood pressure is fine, pulse is fine, engaging in athletic activities is fine, back and joints aren’t complaining, etc. — then that should be that. But if additional weight causes health issues, we do nobody a favor by trying to paper over those health issues with studies that can be interpreted as “being overweight is fine.”
I forget where I read this, but there was an article that stated many thin people have a lot of invisible fat around their innards, which is very unhealthy. Yes, you can be fat and healthy or thin and unhealthy. Marilyn Wann has lots to say on the topic.
It’s plain that being sedentary is, however, extremely unhealthy. And, at the risk of dipping my toe into the cesspool that is evolutionary psychology, a sedentary existence is not what we are meant for. Twenty-first century humans in privileged societies are inactive to a degree incomprehensible to our ancestors – even the privileged ones. For instance, it is clear upon reading Pride and Prejudice, for instance, that the Bennet sisters, while not doing any farmwork or housework like their less privileged compatriots, led plenty active lives. They walked, they rode, they danced. The constant whirl of balls added up to a kind of step aerobics for the attendees.
It’s a pity that issues of physical activity and healthy eating have gotten all tied up in issues of “fat” vs. “thin” and how being fat is lazy, immoral, and disgusting. And that if only you’d eat right and exercise, you’d be thin. Which is patently untrue. Plenty of fat people exercise and eat healthy food, and plenty of thin people sit on their butts all day stuffing themselves with Cheetos.
>> “people see studies like this, then conclude “hey, I can eat all the junk food I want and gain all the weight I want and there will be no health impact!”.”
I really don’t think there are many people at all who think that. The message that fat is unhealthy is so pervasive that people in general have trouble believing that any fat person could be healthy at all, even fat people themselves – and despite plenty of solid evidence that it is possible.
What I, and many other people I know, see when we read articles like this is “Well, maybe I don’t have to spend my whole life starving and exercising like a fiend (to be slim) to be healthy.” It was articles like this, and the subsequent research I did, that made me healthier – instead of obsessing over “healthy eating” (which is the euphemism for dieting these days) and how many calories I burned at the gym, I learned to eat normally and do physical activity I actually enjoyed. I’m still fat but my chronic depression and anxiety have faded to a minimal, manageable level, I sleep better, I’m stronger and I rarely get sick.
I believe this is a far more common reaction to articles such as the one posted about – but that doesn’t fit with the myth that fat people are lazy and don’t care about their health.
>> “The morbidly obese have significant health impacts due to their weight, ranging from diabetes to heart disease to joint failures. ”
Still not nearly as much as you might imagine. I’m afraid my bookmarks with the source of this statistic are on my home PC, not this one, but even in people with a BMI of over 50 (which is less than 2% of all people in the “obese” category), the rate of type 2 diabetes is only 14%. And one *can* control their blood sugar levels *without losing weight*, believe it or not.
Heart disease is usually caused by one or a combination of genetics, environment, and activity levels, and possibly intake of certain kinds of fats, not the amount of adipose tissue in the body – even in very fat people. Multiple studies (most notably the work done by Ancel Keys) have shown no link between the level of atherosclerosis and fatness.
Joint failure is not inevitable, even in the very fattest people. For instance, Kelly Bliss, a well-known personal trainer who works with large people, tells on her web site the story of a woman who was 500lbs and had trouble getting out of bed. She gave her an exercise program that could be done in bed and in a chair, progressing from there, and in not too long the woman was able to *dance* on her feet – without joint pain and without losing a significant amount of weight. You can imagine the great rise in mental and physical health this woman had – all after she found someone to help her who didn’t lecture her about the perils of being fat and insist she lose weight.
Quite a lot of joint pain in people (even slim people get it quite a bit) can be improved or cured through physiotherapy, appropriate strengthening and stretching exercises, properly fitting shoes, etc. (My sore knee stopped hurting after I my personal trainer recommended shoes with proper arch support – I could have lost 100lbs and still had a painful knee if I didn’t.)
Now, my main point: I don’t beleive that nobody ever has problems contirubted to by their weight, just that it’s not nearly as widespread as claimed. That even though some people may have problems related to being very fat, it’s still not doom and gloom, as you might guess from reading most articles on “obesity”. It’s the articles that harp on about how unhealthy fat people are and how they’re going to keel over from a combination of diabetes, cancer, heart disease and arthritis any minute now that tend to make people depressed and likely to either “give up” or undertake unsafe eating and exercise habits. Articles from Campos, et al, are far more likely to encourage people to see the health benefits of physical activity even if they don’t lose any weight.
(I’m not even going to get into healthism here. Not everyone wants to make it their life’s work to be “healthy”. And that’s their business. I even live in a country with socialised health care – and I don’t mind that my taxes contribute to treatment of others’ medical problems, self-inflicted or not.)
From the first part of the article: “For example, suppose that Group A consists of 2,500 subjects and that over the course of a decade five of these people die from heart attacks. Now suppose that Group B consists of 4,000 subjects and that five members of this group also die from heart attacks over the same ten-year span. One way of characterizing these figures is to say that people in Group A are subject to a (implicitly terrifying) 60 percent greater risk of a fatal heart attack than those in Group B. But the practical reality is that the relevant risk for members of both groups is minuscule.”
From the second part of the article: “Yet numerous studies–two dozen in the last 20 years alone–have shown that weight loss of this magnitude (and indeed even of as little as ten pounds) leads to an increased risk of premature death, sometimes by an order of several hundred percent.”
I have a hard time taking articles seriously when they blast one statistical reporting method and then proceed to use it to back up their claims. Like the first part of the article said: the relative difference might be huge, even though the absolute difference is miniscule. Where are the numbers? And don’t ask me to read the whole article. I’d have to register with that website to do so.
In any case, great post, and great convo afterwards. From my simplistic point of view the knowledge that can be gained here is: lifestyle is most important in determining if someone is healthy. We (North Americans) should stop assuming that fat people have unhealthy lifestyles, and that skinny people have healthy lifestyles. I’m game.
What’s unfortunate about this, is that in North America the reason for obesity is far too often a direct result of the unhealthy life style. So we associate fatness with unhealthiness. As always, being informed is the key.
In fact, there is plenty of evidence that obesity is an indendepent risk factor from a sedentary lifestyle and may in fact be MORE of a risk factor
See this for instance
http://www.medpagetoday.com/PrimaryCare/ExerciseFitness/tb/2588
Obesity is heavily correlated with caloric excess and lack of exercise, so it is difficult to separate it out, but there is evidence indicating it is an independent factor.
Fat stored internally within the body (so called visceral fat) is now known to be not just a passive reservoir, but practically an endocrine organ in its own right, secreting various hormones, including inflammatory cytokines. These inflammatory hormones are believed to cause oxidative stress within the body, that can contribute to artheroclerosis, heart disease etc.
Fat within the body is known to interfere with glucose metabolism. Free Fatty acids are also believed to damage the pancreatic beta cells ( liptoxicity), helping to cause diabetes. It is also believed to contribute to “fatty liver”
In experimental mice with diabetes, removal of the visceral fat surgically sent diabetes into remission. And surgery that removed part of the omental fat in a surgical experiment did greatly improve blood glucose control in a patient. Ditto for laproscopic surgery.
So, yes obesity is an independent risk factor.
Yes, I would like to see a reference for that. Is the stat on people with BMI over 50 adjusted for age ? It could well be the case that sadly, most people with that BMI die of other complications before they get diabetes.
And speaking as someone who was obese and developed diabetes (I’ve since lost enough weight to fall beneath the obese definition), I used to be as blase about it. Not since my diagnosis. If someone thinks that society makes them miserable by mentioning their weight or doesn’t like diet and exercise (I know I didn’t), think how miserable they will be when they have to diet & exercise and take their blood a few times each day and await further complications ?
Practically all of the methods for controlling blood sugar without meds or insulin involve diet, exercise and fat loss.
“For sure, UNDERWEIGHT is much more dangerous for your health than overweight”
Yes, and being hypoglycemic (low blood sugar) is much more dangerous for your health than hyperglycemic (high blood sugar). That, of course means that hyperglycemia is not harmful at all because the only alternative MUST be hypoglycemia.
Short version: The valid points Campos raises not only don’t support his main ideas, they don’t even relate to them meaningfully.
Lobg version:
“Americans… long to believe that medical experts can solve the problem of their expanding waistlines. The reason for this can be summed up in six words: Americans think being fat is disgusting. That psychological truth creates an enormous incentive to give our disgust a respectable motivation. In other words, being fat must be terrible for one’s health, because if it isn’t that means our increasing hatred of fat represents a social, psychological, and moral problem rather than a medical one.”
I don’t know what “point” Amp thinks the writer should have developed further. Anyone not already invested in the idea that being overweight is without medical consequence recognizes this goofy rhetoric as simply a long-winded false dichotomy and a play on people’s easily tapped emotions regarding a hot-button issue.
It’s one thing to write about high-society and entertainment-industry America’s fascination with leanness and its potentially destructive consequences. It’s necessary to report examples of genuine discrimination and root out injustices perpetrated against people for the non-infraction of being large.
However, these issues are psychosocial, not medical. In the TNR piece, the author tries to bash to dust the health-related realities of excess weight by using a pumped-up, dumbed-down version of society’s regard for obese people as a club. It doesn’t work.
That some people (few to none that I know of, at least among adults) see fat people as sexually unappealing, lazy, or otherwise corrupt of character has nothing to do with the statistics linking obesity to Type II diabetes (one has to be cloaked in a whole tinfoil suit of armor to accept this one these days), pregnancy complications, gout, connective-tissue and orthopaedic problems, and a variety of other morbid conditions. It’s cruel and wrong for schoolchildren to make fun of peers who are short and underdeveloped thanks to pituitary derangements or, much worse, those who cannot run or even walk owing to neuromuscular disorders abnd the like. But this doesn’t mean such people aren’t unquestionably, and unfortunately, affected by of medical diseases.
Creationsists sometimes point out that evolution has to be wrong because it indirectly rejects gods and therefore represents a cold, uncaring world view. This is moot, but the point is that facts are independent of human wishes and desires, meaning that what we see is often not a bad of roses — unless we insist on pretending it is.
Atheists could indeed be the most bitter, hopeless people alive, but this wouldn’t change any biological realiities. Similarly, doctors and politicians could be the most judgmental creeps in the world, with nothing but contempt for the overweight and their supposedly slipshod self-control mechanisms. Diet-pushing companies might not care one way or the other whether there services work worth a damn. We could all be hysterical wannabe anorexics on the inside, striving for some untenable physical ideal. Fortunately things aren’t that bad. But the point is that they could be and none of it would matter if the scientific data are valid — and they are. We aren’t talking about a few scattershot, small-scale, unreproduced propositions about health and weight, were talking about millions pof subject-years’ worth of careful analysis.
That being fat is as bad for you as health professionals claim is no more open to scientific debate than evolution, the germ theory of disease, or the general age of the universe. Now, if your response is that activity is more important, I support that 100 per cent. But I also don’t know a whole lot of overweight, sedentary people who take up regular exercise and stay at the same weight as before, and I’ve seen a great deal of people involve themselves in just this sort of undertaking. That doesn’t mean everyone needs to have a BMI of 20 or become eligible to ride in the Tour de France, by the way. I’d rather spend my life in the company of active people of any size than skinny ones who need a steady supply of cigarettes and Diet Cokes to shepherd them through their days, because I know what exercise — even “just” walking — does for people’s moods and states of mind, regardless of how significantly it affects their waistlines.
Paul Campos does everyone a tremendous disservice with these articles. Sadly, he probably knows it even if few of his acolytes can or will recognize it, preferring the easy route of maligning Campos’ critics on the basis of their own purported special interests and personal biases even where none exist or are irrelevant to the central message.