Wednesday, September 15, 2010

Fat and health

I'm still thinking about fat. The intense responses to the idea of fat acceptance are often justified in terms of health. The more I think about this, the more, intertwined reasons there are for calling bullshit on it.

Firstly, there's the science. All the research on obesity. Lots and lots of it is sponsored by the diet industry. Oddly, this doesn't seem to bother the medicos citing it. Also, more transparently, the premise of obesity research is to treat obese people as a uniform group of people. To look at obese people and compare them with not obese people. In many respects, health outcomes are worse for obese people. However, as well all know, correlation is not causation. Just as the strong correlation between the population of storks and number of babies born in Hamburg fails as evidence against babies being born via their mamas' vaginas, this correlation on its own doesn't mean obesity is the root cause of all evils.

I'm completely down with diet and lifestyle being correlated with good health - in fact I also believe that it is partially causative. (Many people know perfectly well that their ill-health has nothing whatever to do with diet and lifestyle, so it can't be more than a partial causation.) Also, because weight loss is sold as the goal for everything, and the marker of health, there is a correlation between obesity and poor diet and lifestyle. The direction of causation is not so clear though. Once you are fat, if eating healthy and exercising sensibly don't produce weight loss, why would you bother? It's clearly not working anyway, since weight is health. I can't help wondering if body fat was ignored completely by everyone, how much healthier many fat people would be. Still, here I am focussing on fat people. Just like the research. No-one seems to round up all the people with similar diet and lifestyle, irrespective of weight, and look at health outcomes. Plenty of not fat people have crappy lifestyles and crappy health outcomes, but no-one glares at them when they eat in public. So I call bullshit on fat = unhealthy.

Also, the only lifestyle that's really been looked at independent of the starting weight of the people is the Dieting lifestyle. (I use big D "Diet" to refer to weight loss regimes, rather than the stuff you eat.) That's been shown to be really bad for you - with increased risk of stroke and heart disease. It's really bad for you, because it produces yo-yo weight gain and loss, and that's definitely worse than constantly being fat or thin. So I call bullshit on being told to go on a Diet for health reasons.

Moving on to practical matters. The public shaming of fat people causes bad health. It stops fat people going to the doctor, because they know they're just going to be told that whatever is wrong with them is because they are fat. They are far less likely to have preventative health checks, because they know the doctor is going to tell them they're fat (in case they'd managed to forget this fact for a millisecond). It means that doctors treat people with less respect, and with less actual medicine, as it happens. 95% of people can't lose weight and keep it off, so doctors prescribing that as a cure-all is simply bad practice. So I call bullshit on the idea that making people feel bad about being fat will lead them to be healthier.

From the practical to the moral. Who said healthy was the be all and end all to all arguments anyway? Everyone has the right to decide what priority they want to assign to what degree of health. Apparently one is a hard working moral citizen if one gets a stress induced illness (even if the source of stress is a result of choosing high income over low stress occupations) but totally devoid of morals if one chooses to focus on other aspects of lifestyle at the expense of one's health. Sports people are allowed to destroy their joints requiring surgery and more, and are hailed as heroes. I call bullshit on lack of health being viewed as a moral failing.

Finally, I've heard more than one person point out that the upside of cancer (or other life threatening illnesses) is weight loss. I can't think of better evidence that the claim that fat hatred is all about health is utter, utter bullshit.

And when I say "fat people" as though they are other, it's because I'm an in-betweeny. I'm well and truly obese by medical definitions, but I can still sometimes buy clothes in mainstream shops. So some of the fat hatred (and all the body shame) come my way, but I realise I don't cop it as bad as lots of other people.

Also, if you want to change your diet (with a little "d") to improve your health or make other lifestyle changes because they make you feel better, that's cool. If you lose weight as a result, that's also cool. If you don't lose weight as a result, that's exactly as good as if you do. For a fabulous piece on how talking about Diets affects other people, have a read of this Spilt Milk article.


  1. Ariane,
    While I agree with a lot of what you have said I can still think of a lot of
    reasons to be concerned with the increase in obesity in the UK (and other western societies where there is a growing problem). And I have a
    major objection to your post in that you mostly assume that people have a choice about their lifestyle and food options which is sadly not always
    true since in the UK and elsewhere obesity is very strongly linked to poverty.

    At least in the UK it costs significantly more to eat a healthy diet with lots of fresh fruit and veg. Which means that the poorer you are the more likely you are to be overweight and this is particularly worrying for kids who do not have a choice in what they are feed. This is due for any number of reasons such as the cheaper supermarkets are located out of town and impossible to get to via public transport etc. Hence one of the major causes of obesity is poverty and we should be doing more to ensure that everyone is able to afford a healthy diet.

    The other major concern is that the food industry have realised that the
    more fat/sugar/salt they put into processed food the more the pleasure
    centres of our brains are activated and we desired such foods. Hence they are designing foods that put profit before health. They also object to proper labelling of the food so that it is very hard to make an informed choice about what you are eating.

    There are also very real health risks associated with being overweight. This then raises the cost to the NHS and so everyone's taxes go up to pay for the increases medical bills. The same is true of any unhealthy
    activity like smoking or excessive drinking and so think the government has a (limited) right to be concerned about public health.

    Ideally we as a society need to design a food production system that ensures everyone can make informed choices about what they eat and what the effects of that will be. Also ideally everyone should have access to a wide range of fresh fruit and vegetables that they can afford and know how to prepare.

    Personally I would recommend you read Michael Pollen's book 'In defense of food'. He has a much more sensible approach towards
    food than almost anyone else who I have read. The book contains
    a list of things to eat and not to eat which include 'do not eat anything
    your grandmother would not recognise as food' and 'do not eat
    anything that makes health claims'.


  2. Neil, I completely accept your points about food, but I don't see why obesity needs to be brought into it. As I said, I accept that bad diet and lifestyle can cause health problems. Therefore, poverty removing anyone's choices about diet and lifestyle (as well as any other restrictions doing the same thing) is definitely a cause for public concern and something that needs to be addressed. Why bring fat into it? What does that have to do with it? Surely it's the shit food that's the problem, not whether or not those who eat it get fat?

    I also agree that there should be more regulation of food, the way it's labelled, and just how much it can be turned into poison and still called food. I still don't see what this has to do with fat. This kind of food is just as dangerous to thin people as fat people.

    A large part of the point of this post is that I don't accept at face value that obesity itself causes health problems. There is increasing evidence that it's about diet and lifestyle, not weight. So I think the government has a limited right to be concerned about diet and lifestyle, not to be concerned about weight. And while they're being concerned about bad eating, they should be equally concerned about excessive playing of sport. So yeah, *extremely* limited right.

    So I really agree with you about food, in many, many ways. I just fail to see why only fat people who eat badly (not to mention all the fat people who don't eat badly) get judged, abused, discriminated against and taught to hate themselves while skinny people who eat badly are given a free pass.

    In other words, you were no more bloody healthy than I was in 1993. :)

  3. Oh, and yes, I do apologise for not making it clear that there are people who don't have a choice regarding good food. You're dead right that I shouldn't have ignored that entirely.

  4. Ariane,
    I am nowhere close to having any sort of specialised knowledge about health and weight but my impression is that there are some health risks
    that are directly related to weight rather than diet/lifestyle. The risk of heart attacks and diabetes seem to be directly related to weight at least
    for those classified as 'morbidly obese' with an explanation being that the heart comes under increasing strain as you weight increases. Similarly the more you weight the more work your other organs have to do which increases the risk of failure. But most of the studies only really relate to people who are extremely obese. There was a study earlier this year suggesting that people who where currently classified as slightly obese actually had a longer life expectancy than others.

    But you are I suspect correct in suggesting much of the increased health risks comes from diet and lifestyle rather than actual increase in weight. There is also a lot of evidence that is starting to suggest that where you put on weight is more important than how much you actually weight. If you put on weight close to your internal organs that is much worse than if you put in on close to the skin. But that is determined by your genes and you don't get much choice on that.

    And of course it goes without saying that no-one should be abused or discriminated against or taught to hate themselves. But that is true no matter what and certainly doesn't depend on any health risks associated with obesity.


  5. Even if we accept that there are cases in which weight is actually causative of health problems on its own (and I by no means accept that), what good does it do to harp on about it? Firstly, there are no successful ways to lose weight for 95% of the population. Gastric banding has better success rates, but the risks are significant, and at least comparable with the risk associated with the weight.

    Also, lots of other states of being are high risk - being tall and skinny puts you at massively elevated risk of a spontaneous pneumothorax, but I haven't noticed a panic about feeding children too much protein and thereby making them tall and at risk.

    By singling out fat the way the media and the medical profession do, people are discriminated against. Study after study has shown that fat people get inferior treatment in emergency departments and at GPs. This is because doctors (and the population at large) think they know something about someone on the basis of their weight, and they don't.

    The massive damage done by the OMG OBESITY EPIDEMIC campaign so far outweighs any benefit from thinking about whatever casuality there may be, I don't think there's much doubt that fat people would be healthier (and therefore cheaper) if everyone paid no attention whatsoever to their weight. The lack of preventative medicine in their lives alone makes this true.

    And yes, all people get the same claim to equality and liking themselves. One of the pieces at the thing on Friday night was a woman talking about living with a skinny body with no boobs or hips. There's no more justification for her treatment than there is for fat hatred. Still, fat hatred is much more vicious than skinny hatred in general.

  6. I'm not sure that my grandmother would have recognised rocket or mizuna as salad vegetables that a person would eat. Her diet was pretty much meat and three veg, meat cooked in it's own fat and then gravy made with the 1cm or more of fat in the pan. I don't eat like that and I'm still fat.

    "more than one person point out that the upside of cancer (or other life threatening illnesses) is weight loss." the downside of course being death which I think is worse than being fat.

  7. Which is why I've always loved you, Matt. :)

  8. And yes, Mindy, that argument has always kind of left me speechless. People have used it to describe their mothers. I know that they don't actually mean that they think that the person in question is better off dead than fat, but they do actually mean that being thin, irrespective of health, rates a mention in the case of life threatening illness. It shouldn't. Ever.

  9. Some people actually do believe that fat is far worse than death. It not only leaves me speechless, but saddens me deeply.

    Great post Ariane, I'll do some sharing.