Up until not long ago it was considered a given, proven fact that obesity causes 300,000 deaths a year (this is still believed wholly by a good many people), and that by encouraging obese people to lose weight, exercise and eat healthy that those death rates could be slashed.
I agree that eating healthy and exercising are good for health, and I used to wholly agree that fighting obesity was a laudable goal. However I have been doing a lot of reading as of late and I have come to the conclusion that (in my view) treating fat as a bad thing may be doing more harm than good for our mental and physical health than the fat itself.
Sadly, because I am a minority voice in this debate I fear being insulted repeatedly and being expected to have flawless arguments (which is impossible), please try to keep the debate civil, fair (to me) and intelligent. I am willing to admit that fat can be, and actually is (according to the latest CDC report on obesity) damaging to health, I am just of the opinion that our attitudes towards fat (socially and medically) are far more damaging to us mentally and physically than the fat itself. I admit that obesity could be far more dangerous than I think, and that the attitudes towards obesity could be far less dangerous than I think, but I am right now of the opinion that it is not worth it.
Before I start the debate there are several studies I want you to read
Ok, having read those articles you may be wondering what any of that has to do with obesity. I will tell you. Assume there are two worlds, in one world obesity is considered disgusting, ugly, dangerously unhealthy and a sign of a weak will. In this world people are pressured hard to lose weight and keep it off, and treating obesity in and of itself is considered the smartest intervention when someone has health problems.
In the second world obesity is considered unattractive and somewhat unhealthy, but it is not a big deal in and of itself. Socially speaking obesity (especially morbid obesity) is considered somewhat unattractive, but no more ugly than having crooked teeth or being bald. Women believe that being fat is bad, but they do not base their worth as human beings based on how big their waist is.
In both worlds an individual is worried about developing a disease (cancer, diabetes, heart disease). This person has a BMI of 40 and wants to go to his doctor.
In version 1 this is what seems likely to happen. The person will say to her husband about her desire to get some preventative health advice “I want to see the doctor, but I’m afraid he’ll just insult me for being fat, maybe I shouldn’t go”. Her husband cajoles her into going, and when she does the doctor generally ignores all her complaints and simply tells her to lose weight. So she tries to lose weight. She eats healthy and exercises a bit, but after a month or two gives up. She (reluctantly) goes back to the same doctor after six months and after not losing weight the doctor subtly insults her and says ‘lose weight’ again, implying if she weren’t so weak willed she wouldn’t be fat. The same thing happens every six months for a few years.
In world two the same woman is less reluctant to see her doctor. When she sees her doctor and says ‘I’m worried about disease X’. The doctor may say ‘that’s understandable, but there are a myriad of interventions we can do to cut your risk’. She asks if she should try to lose weight and the doctor says ‘I guess it couldn’t hurt, but losing weight and keeping it off is very hard. We’d be better off focusing on other ways to prevent you from developing X’. So the doctor tells her to find a sport she enjoys playing, to go for walks with her friends, etc to improve her exercise habits. He tells her not to lead an overly restrictive diet, but to try to get in 20-30 grams a day of fiber, to try to eat 5 servings a day of fruits and vegetables and to switch some of her foods around to lower fat alternatives (to switch from ground beef to ground turkey, to switch from whole milk to 1% milk, etc). After he does that he fills her in on various things she can do to cut her risk of developing ‘disease X’. Assume ‘disease X’ is type II diabetes. I don’t know if the studies I’ll list below are proof in and of themselves that these interventions are a good idea, but my point is that in the first scenario these ideas wouldn’t even be considered by the physician, the physician in scenario one would be mainly/only concerned with weight loss.
When I made a post in MPSIMS about wanting to avoid getting type II diabetes much of the advice I got from medical professionals was to keep my BMI low and to eat a healthy diet and exercise. Although I am willing to admit that BMI in and of itself can be/is a predictor of type II diabetes it is one of several.
One study showed that not eating sugary drinks cuts the risk of type II diabetes by 83%. The study says half of the risk could be associated with weight gain, but the other half could be associated with the fact that sugary drinks are more readily absorbed.
Exercise is tied into cutting type II diabetes rates in many studies. Smoking almost doubles type II diabetes risks.
While the medical professionals did tell me to lose weight, eat healthy and exercise (all proven ways to cut the risk of diabetes, and I agree that having a high BMI is tied to type II diabetes, my mistake) the problem is that when eating healthy and exercising are seen as ways to lose weight instead of laudable goals in and of themselves compliance drops dramatically. According to the study I listed above, individuals who are taught that exercise and diet are tools for weight loss had a 42% dropout rate while individuals who were taught that healthy diet & exercise were good ideas in and of themselves only had an 8% dropout rate. By the end of the study (2 years later) exercise rates had quadrupled for the non-dieters but were back to baseline levels for the dieters. Considering the sixth study I listed that shows exercise can cut well over 400,000 deaths a year (it didn’t give total numbers it just said exercise can cut more deaths than smoking and smoking kills 400,000 a year) this is very relevant to the discussion of obesity. Not only that, but nobody really gave me advice other than eat healthy and lose weight. I am not a doctor and I don’t know their reasons (not giving advice based on a few studies may be a good idea for physicians) however, at the end of the day I received no advice other than to lose weight and exercise. All the studies I listed above which can cut risk factors for developing type II diabetes were not given to me as ways to decrease my risk factors, I was just told to lose weight and eat healthier and exercise. With heart disease, there are 246 risk factors and endless interventions to cut risk. However if a fat person goes into a doctors office the doctor will probably treat ‘losing weight’ as the first, best and main intervention he/she wants the patient to follow, ignoring the other 245 risk factors. As I said, the problem is that when eating healthy and exercising are tied into weight loss people associate these activities with restrictive living and the loss of bodyweight, lowering compliance.
Based on the second study, girls who believe that being thin is very important are four times more likely to take up smoking than girls who feel that being thin is unimportant. The link is not really known, but it could be tied into the idea that smoking can encourage weight loss and the idea that girls obsessed with thinness may develop psychological problems (then again, maybe their interest in thinness is a sign of pre-existing problems instead, I do not know). In the nurses study, which is quoted a lot when supporting the fight against obesity, smoking nurses are disqualified. However thin nurses were twice as likely to smoke as obese nurses, this link can’t be totally ignored and should be factored into debates on obesity. You also have to take into account that individuals who feel that being thin are important are probably (I can’t find any studies that test this) less likely to want to quit since quitting smoking is associated with weight gain. In fact, if you look at sites on quitting many list ways to not gain weight early on, which
Back to the two worlds listed above. In world 1 the woman lives in a world where she is much more likely to take up smoking, she is less likely to want to quit, she can’t trust her doctor, her doctor doesn’t listen to her and offers no advice or medical help other than telling her to lose weight, her compliance rates for exercise and healthy diet are very low and she suffers from major psychological problems associated with her obesity. People have their value judged based on their weight, personal accomplishments, devotion to charitable causes or family are not as important as bodyweight.
In world two the woman is less likely to start to smoke, more likely to quit, she trusts her doctor, her doctor offers her various kinds of advice on how to cut her risk factors that have nothing to do with losing weight (meaning they promote interventions with a much higher compliance rate), her compliance with eating a healthy diet and exercising are higher and her psychological states are better than the woman in situation 1. In this world making a persons entire self worth based on their weight is as laughable as making their self worth based on how straight their teeth are or how much hair they have (bad teeth, no hair and obesity are all considered unattractive for biological reasons, so I’m lumping them together).
It is now 15 years in the future, woman 1 has done almost nothing for her health, while woman 2 is more likely to have done a variety of intelligent interventions to improve her health. Drugs are starting to hit the market that can cause people to lose weight without diet and exercise. In world 1 most people do not eat healthy or exercise, and those who do mainly only do it to lose weight either for vanity or health reasons. In world two more people (I have no idea how many more) are likely to try to eat somewhat healthy (not overly restrictive, just a diet with adequate fiber, adequate fruits & vegetables, etc) and more likely to exercise. Being fat is considered bad, but no more than being bald or having crooked teeth. Too much fat is shown to be unhealthy, but since making fat people thin is highly unlikely, physicians focus on other medical interventions instead. Losing weight isn’t frowned upon per se, its just not treated at the smartest or most effective intervention for a medical problem.
In world 1 when the drugs hit the market rates for diet and exercise drop dramatically. Most of the people who were working out and eating right were only doing it in an effort to look good and to maintain a weight loss, and now that motivation is gone for them.
In world 2, since people eat healthy and exercise for mental and physical benefits and not for vanity benefits, the pills are taken but people continue to eat reasonably healthy and exercise in higher amounts than the individuals in world 1. Smoking rates are also still lower in world 2 and the rates of psychological disorders are also lower.
Now back to reality. The latest CDC report shows that 111,909 deaths a year are due to being overweight (a much smaller number than the 300,000 figure, which was immensely flawed). However, of these 111,909 deaths 82,066 were among individuals with a BMI of 35 or higher. Also, individuals in the overweight range (25-30 BMI) received health protections from being overweight, 86,095 people who would’ve died had they had a regular BMI instead survived. When subtracting the 86,905 figure from 111,909 you end up with 25,814.
Consider that only about 10-15% of Americans have a BMI of 35 or higher, and that about 35% are in the 25-30 range. I do not know the exact number of individuals with a BMI of 35, but the percentage of individuals with a BMI of 40 or higher was 4.7% in 2000 so I’m guessing its about 10-15% for a BMI of 35. At the very least, shouldn’t we change the BMI standards so 18-30 is considered normal, 30-35 is overweight and only at a BMI of 35 does obesity start to pose major problems if being overweight actually improves health?
You may be asking what does this all mean. Well I assume I made several assumptions in my post, and I’m sure there are many interpretations of my views and that I’ve made several mistakes. However, if the CDC’s latest report is true and only 25,814 deaths a year are actually due to obesity, is it really worth it? 25,814 lives a year is alot of lives, but is what obsessing over obesity is doing to us as a culture worth it to help those 25,814 lives (actaully we don’t help those 25,814 since compliance for weight loss is about 5-15%, so we barely save a few thousand a year in america due to our obsession with weight) Is it worth this culture that encourages people to hate themselves and each other, a culture that encourages doctors to think of their patients as worthless, lazy and stupid? A culture that discourages exercise and healthy eating (by teaching people that these things are ‘just’ ways to lose weight which can cut compliance rates), a culture that encourages people to start smoking and discourages them from stopping, a culture where medical interventions with a higher compliance rate are ignored in favor of interventions based on controversial studies with a 5-10% compliance rate? A culture that teaches a destructive value system that women’s worth is based on how fat/thin they are? Do women base their worth on how pretty their faces are or how straight their teeth are (if they do, its news to me)?
Many cancer deaths are due to poor decisions on the part of the sufferer (not getting screened, poor diet, lack of exercise, smoking) however cancer patients are treated differently than the obese in the sense that they are treated humanely. AIDS is due in large part to poor lifestyle decisions too but AIDS sufferers get treated well. In fact most diseases and illnesses are due largely or partly due to poor decisions on the part of the sufferer. Not getting regular checkups, poor diet, poor lifestyle, smoking, unprotected sex, living in a high crime area, working a dangerous job, etc. However these people are not treated as stupid, lazy & worthless by doctors & society.
People who live in the ghetto don’t want to be victimized by crime. If a politician said ‘we have the ultimate cure for crime in the ghetto, you’ll never be victimized again’. The people would say ‘what is that’ and the politican would say ‘move. Move out of the ghetto’. This is common sense advice and it would save lives but even though most people in the ghetto want to move, only a small percentage are able to move out. By focusing on telling people to move and dismissing the inhabitants as lazy, stupid or worthless if they don’t leave the ghetto this promotes a very destructive attitude. Luckily police are more concerned with criminal intelligence, community policing and stopping gangs (instead of telling the people there to move and calling them idiots when a year later they still live there) and as a result crime has gone down a bit.
At the very least there needs to be a debate on this subject, and people should look at the situation from all sides. People like Sandy Schwartz (who has articles available at tech central station) Paul Campos and Glenn Gaesser are good writers on the subject.
I am not saying this is an either/or debate that we have to be 100% in world 1 or 100% in world 2, I am saying our attitudes encourage the behaviors listed in world 1. I am not saying doctors are not allowed to factor in other interventions, or they are not allowed to be humane with patients, just that it is less likely to occur with our current views on obesity. Considering that only 25,814 lives are lost due to obesity a year in the US, and that we barely know how to make fat people thin (meaning I bet only a few thousand lives are actually saved by weight loss annually since most people who lose weight gain it back), and that obsessing over obesity is tied into endless medical problems (doctors hating their patients, higher smoking rates, lower exercise rates, lower dietary rates) and psychological problems (people hating themselves, people hating each other) maybe we should rethink this thing.