Fat police refuted?

Our posts on accepting women’s bodies of all shapes and sizes will sometimes inspire the fat police to appear to denounce any acceptance of being overweight. So I’m very happy to say that the idea that being overweight is unhealthy now has a huge question mark against it. Though we’ve heard this before, the idea is getting new attention from an August finding that even with diabetes II, being overweight can be a protection. From the NY Times:

In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments. The accumulation of evidence is inspiring some experts to re-examine long-held assumptions about the association between body fat and disease…

…. there were hints everywhere. One study found that heavier dialysis patients had a lower chance of dying than those whose were of normal weight or underweight. Overweight patients with coronary disease fared better than those who were thinner in another study; mild to severe obesity posed no additional mortality risks.

In 2007, a study of 11,000 Canadians over more than a decade found that those who were overweight had the lowest chance of dying from any cause.

To date, scientists have documented these findings in patients with heart failure, heart disease, stroke, kidney disease, high blood pressure — and now diabetes.

There are many possible explanations. One is that being overweight is often not studied independently of fitness:

The link between obesity and health derives in part from research like the Framingham Heart Study, which has followed thousands of men and women since the 1940s. But Paul McAuley, a professor of health education at Winston-Salem State University, has noted that Framingham and other longitudinal studies often fail to take into account physical activity and fitness.

Research that does tease apart weight and fitness — like a series of studies conducted by Steven Blair at the Cooper Institute in Dallas — shows that being fat and fit is better, healthwise, than being thin and unfit. Regular aerobic exercise may not lead to weight loss, but it does reduce fat in the liver, where it may do the most metabolic damage, according to a recent study at the University of Sydney.

The bottom line? This may be it:

In 2005, an epidemiologist, Katherine Flegal, analyzed data from the National Health and Nutrition Examination Survey and found that the biggest risks of death were associated with being at either end of the spectrum — underweight or severely obese. The lowest mortality risks were among those in the overweight category (B.M.I.s of 25 to 30), while moderate obesity (30 to 35) offered no more risk than being in the normal-weight category.

The article is interesting in another respect, as a comment on what happens to opinions that go against very established beliefs. An early article ran up against the critical review, “This cannot be true.” And as they say, it will take some time before you can expect an internist/general practitioner to accept it. It goes against the “paradigm”.

13 thoughts on “Fat police refuted?

  1. DRL, I think there were two comments from you with the same comment. Of course, I love receiving “thanks” twice, but once was enough. :)

  2. Many of what we deem disease risks are culturally determined. Next up: non-smokers get lung cancer too, too. Then: late menarche, not bearing children, and early menopause are not really dangerous at all, and not getting a mammogram does not mean you’ll die sooner.

  3. It’s remarkable, and outrageous, that “healthy” has now become a surrogate for “virtuous”–particularly in the US where we don’t pay for the National Health and can’t claim that all these “unhealthy” people are costing us money. You aren’t allowed to say you don’t like people because they’re ugly so you, piously, disapprove of them because they’re “unhealthy.”

  4. For godsake why can’t people get out of the punitive moralism–and of course this isn’t only or primarily about overweight. Why can”t reflective educated people get thous counterfactuals: If —— I’d be fat; If ———I’d be poor; If ———- I’d have some low status, despised characteristic and be one of the 47% that Romney has written off.

  5. I actually know someone involved in this particular study, and I can assure you, her main motivation is having grown up with diabetes, knowing how hard it is to live with and what the dangers are, and hoping to save others from what she has faced. While I am sure there are plenty of people out there with a moralistic motivation, don’t paint everyone with the same brush.

  6. I’m not getting the turn this discussion is taking. ‘Unhealthy’ in the article and in the quotes above is clearly linked to mortality rate. What is further claimed is that a heavily criticized/stigmatised group of people do not have a higher mortality rate.

    Quite how moralistic motivation gets in this picture is difficult for me to see.

  7. The knee-jerk rejection of the findings by the establishment is as interesting as the findings themselves.

    One thing the article doesn’t address (unless I missed it), was obesity as a potential cause of illness. The main focus was on people who have and illness, and the subsequent mortality rates given their obesity or lack thereof.

    If obesity causes things like diabetes and heart disease at significantly greater rates, that’s at least prima facie reason to discourage it, even if it’s better to be obese while ill.

    As to the moralistic issue, I think such judgments are motivated in part by the belief that many people’s obesity is something within their easy control (whereas their poverty or disability may not be). So, if being obese has negative effects and one decides not to take the easy steps to avoid those effects, then one possesses a character flaw or some other moral failing – or so the argument goes. This could of course be flawed for several reasons: that obesity isn’t bad, or that it’s not generally within one’s control even if it is, or that failing to avoid easily avoidable bad things isn’t a moral failing.

  8. ajk, yes, I worried about that too. However, in terms of mortality rate, which is how the relevant studies seem to be measuring health, nature seems to be on the side of the moderately fat.

    Of course, if they are living longer but generally in great pain and so on, then a very important factor is left out. Perhaps that factor is considered too hard to measure? Nonetheless, I’d like to know something about the rate of illness, amounts of meds, etc.

  9. I’m a bit late to the party (my RSS reader’s about three days behind), but I wanted to recommend Linda Bacon and Lucy Aphramor, “Weight Science: Evaluating the Evidence for a Paradigm Shift,” Nutrition Journal 10:9 (2009), doi:10.1186/1475-2891-10-9. Bacon is a physiologist by training, and teaches nutrition at the City College of San Francisco; she’s also a prominent proponent of Health At Every Size [HAES], and is quoted in the NYT piece linked above. This article is a nice summary of the evidence against the conventional approach to obesity and a brief explanation of HAES.

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