Ampersand at Alas, a Blog takes on some recent research about obesity and dieting, shredding to pieces some of the myths that persist about the health effects of being fat. Despite all the efforts of the diet industry — a $30 billion a year industry according to NAAFA (the National Association to Advance Fat Acceptance), making it bigger than Hollywood, pro sports, even porn — clinical research repeatedly shows no benefit from dieting (except in specific cases such as diabetes). What’s more, losing weight — any amount of weight, at any time in your life — significantly increases the likelihood of death. In fact, it appears that “healthy” people actually have a higher mortality rate than “unhealthy” fat people — that is, people with lower BMIs (body mass indexes) are more likely to die than even people who are significantly overweight!
This all goes directly against the grain of our cultural preference for thinness and our notions of what “healthy” is. Look at the mortality rate chart in Ampersand’s post — at virtually every age, people with a BMI in the mid-30s to 40 range have about 60% lower mortality than those determined to be “healthy” by life insurance company charts. This is an almost stunning example of a worldview filtering perceptions — after all, insurance companies make their living on being able to guess more or less accurately which people are more likely to die. The chart here suggests that insurance companies could boost profits by lowering the rates of people currently considered clinically obese and raising the rates of skinny people — which is probably something akin to public relations suicide for the company that tried it!
Fat in Western societies is not, however, primarily a health issue — “unhealthiness” is merely a justification for attitudes like those expressed in response to an experiment described at fatty mcblog. The author, fatty mcgee, put an ad in the personals section at Craigslist New York asking men if they would date a woman who was ideal in every way but was significantly overweight. This is not a particularly scientific study, but the responses are interesting nonetheless. Although a few men responded positively to the scenario fatty mcgee outlined, most respondents described fatness in moralistic, negative terms, with health being raised only as part of an overall point along the lines of “a woman who doesn’t take care of her own body doesn’t respect herself and therefore won’t respect me”. Fat women were described as messy, selfish, childish, unable to take care of themselves, lacking in confidence and self-esteem, lazy, and neurotic (almost all exact quotes). What a bind, then, for fat people — to have their social standing depend on their willingness and ability to lose weight, while research suggests that for most people, losing weight in any meaningful way is not a possibility even if it were medically desirable.
One line in Ampersand’s post strikes me as particularly interesting (from the first block quote in section 2):
[I]n a study of mortality risks among 16,936 Harvard alumni, Paffenbager at al. not only found that the highest mortality occurred in those with the lowest body mass index (below 32), but also that those who had gained weight since college had a significantly lower mortality risk compared to those who had minimal weight gain since college.
Apparently, not only is losing weight unhealthy, but even not gaining weight as one gets older is unhealthy! I think it’s fairly well-established that metabolism slows as we get older; it would seem almost common sense that to maintain the same weight in the face of a slowing metabolism means not simply maintaining dietary practices but steadily and gradually reducing our intake of calories as we get older — in effect, multiplying the overall reduction of capability due to aging.
Now, most Americans have some vague sense that “in the past” fatness was prized as a sign of affluence. In several societies, including our own European forebears, a large body was a powerful body — leading those not blessed with girth to pad themselves to appear more regal, as for instance Louis XIV did. Now it seems that the equation of fat with power may not have been simply about access to more and richer foods — if the well-functioning body is the body that grows larger with time, it would make sense to find privilege associated with size, and thinness a sign not of healthfulness but of an inability to maintain healthiness, an inability related not to willpower or self-discipline but to disempowerment. Which is to say that if fat people are more likely to live longer, than the people we expect to live longer — the rich and powerful — are more likely to be fat.
The American reversal of what seems to be a deeply-embedded biological tendency takes on a different character in light of the research presented by Ampersand. While it is still curious that working- and middle-class Americans have become significantly heavier over the last several decades, this may not be the sign of impending epidemic unhealthiness that it’s often made out as. Americans have long been bigger than their Old World counterparts — immigrants are quite often dwarfed by their American-bred progeny. Perhaps American fatness is simply the further elaboration of the same trend — the body achieving its ideal form in an environment characterized by abundance, both natural and political. The thinness of American elites, then, may not be so much a matter of being better able to afford to be healthier, but rather the reverse — being more able to afford being less healthy. Poor health as conspicuous consumption of the self. It will be interesting to see, as our conception of the ideal physical form is challenged by the weight of accumulating research, how and if obesity comes to be regarded as a norm rather than a deviation. In a society where the norm is already at odds with its own conception of normality — well over half of us are clinically overweight — it is hard to imagine that a continued belief in the immorality of fat is sustainable.
13 thoughts on “A Thin Hypothesis About Fat People”
From what I’ve read, the so-called BMI indicies used to determine who is overweight are out-of-whack and people can be comfortably much fatter than what their BMI should be. But I’m not sure this contradicts other research, such as that from the UN (PDF) which states that increased obesity is a major risk factor in the developing world. In other words, if your arteries are all clogged up it doesn’t matter how skinny you might be.
I’d also like to throw in some pure speculation based on what I learned when I studied Physical Anthropology, which is that environmental factors can have a different effect upon us depending on our age. For instance, people who grow up at high altitutdes develop larger lungs and process oxygen better than thier brothers and sisters who move down below before hitting puberty. Moving back up to the mountains after you are already a teenager won’t make much difference. I’ve always assumed that dieting is very similar, in that if you are a fat teenager it will be very hard, if not impossible, to become a skinny adult. Although (the linked post makes clear) the changes in our body continue throughout our life – so perhaps puberty is not the only transition we should look at.
That seems to be the point — exercise is good, balanced eating is good, but neither seems to have much to do with long-term weight-loss. On the other hand, diet plans intended to cause weight-loss seem pretty universally to raise mortality, as well as being almost never sustainable. I doubt Americans are doing themselves any favors eating diets high in fat and processed starches — but that seems to be because these foods are unhealthy, not because the weight that they sustain is.
I think it’s becoming fairly standard knowledge that the body shape we attain when we enter adulthood will pretty much remain throughout our lives. End your teen years skinny, chances are you’ll stay that way, and vice versa. As you note, this speaks to body weight as a developmental process, one that, as adults, we have little control over — as the Andean mountain dweller cannot make the choice to lose the barrel chest s/he attained in his/her adolescence.
One thing that isn’t addressed in the above post (or for that matter any of the links) is definitions of fatness. I think that there is much variation in how people define fat. For some 150 poinds might be fat while for others someone must have higher weights to be considered fat. I think that this is important to keep in mind when discussing peoples’ perceptions of the unhealthiness of others. While the people responding to the fatty mcblog entry may have been unwilling to date an “overweight” girl, what they consider to be “overweight” might vary.
Anthro Grad Student Guy: THat’s an important point, although the chart I refer to several times actually does mark off both the insurance company “healthy weight” (about 21 BMI) and the point where “overwieght” begins (about 25 BMI). But insurance standards don’t necessarily reflect “civilian” perceptions — I recall my surprise at finding that my family health insurance premium would be higher if I were married than if I were married *and* had children; it’s actually cheaper to insure 4 people than 2. I also recall Elizabeth Hurley saying that if she were as fat as Marilyn Monroe, she’d kill herself — clearly notions of “fatness” are both fluid and subjective. Two things stand out for me, though: a) that it’s healthier to remain at whatever your body weight is, or even gain weight over the course of your adulthood, than to lose weight even if you are among the lucky 5% that keeps it off, and 2) that perceptions of fatness obviously have little to do with health and everything to do with morality. In this light, I think it’s telling that the issue for anorexics is usually not health at all — in fact, both their unrealistic weight and the practices used to achieve it are often dangerous, even life-threatening — but rather their ability to *control* their bodies (in a society in which women’s bodies, especially, and perceptions of women’s bodies are subject to dozens of external controls, ranging from the media to the legal structure to passersby on the street).
That graph is kind of being used out of context. If you look at the original article, it was specifically looking at the relationship between mortality and obesity among though who are ill (hence why the study is done on hospital patients). It seems the point of the graph (originally) was:
Not a generic:
I’d be interested in what oneman says about the perception of especially (us american) fat men, if I may ask. Like are there differences or similarities in regards of moral or cultural shaped perception in comparison to those of fat (us american) women over there?
Let me add a couple of things to Maniaku’s comment. First, enormous amounts of medical effort have been thrown at the problems associated with obesity, thus advances in drug therapy for diabetes, hypertension, and high cholesterol allow the obese to live healthier lives. On the other hand people who fall too far below the ‘safe’ BMI range risk severely damaging their internal organs permanently (mostly because the body consumes itself). It is obvious that starvation is more fatal than putting on weight. Ernsberger and Koletsky (from whom the graph comes) argue that we need a more nuanced approach to the health of the obese – rather than simply say ‘lose weight’ we should treat the specific health problems associated with individuals who are obese (i.e. give them drugs for hypertension, diabetes etc.). Their evidence should absolutely not be read as “Aha, Fat people are healthy! Everyone was wrong!” Rather it is about risk management and damage limitation – they argue that it is safer to treat the diseases associated with obesity and prevent further weight gain than it is to put bodies under more stress with weight fluctuation caused by dieting.
As such their evidence mostly refers to rapid changes in weight rather than fatness per se. In studies weight cycling has been shown to be the real killer: it increases blood pressure, enlarges the heart, ruins the kidney, increases abdominal fat deposits, and leads to further weight gain. Our bodies are put under stress by fluctuations. Again this is about risk management rather than any absolutes or equations of particular weights vs particular mortalities. All else being equal (and it never is) a person who is within the safe BMI range (a problematic measure as others have mentioned, because of muscle weight, height etc) and stays there all their lives will generally be healthier. People who start off above or below and remain the same may also be quite healthy. But people who decrease or increase are at more risk, and those who fluctuate constantly are even more at risk. At the extremes however, much of this goes out the window – if you are morbidly obese you will die quickly if you don’t lose weight. For such people losing weight is risky because of the bodily stress involved, but that risk is often worth it given the alternative.
The message that we should focus more on healthy living than idealised measures of body image or weight is very sound. But I worry that there is too much simplification and glossing over going on in these posts.
So perhaps it does make sense to worry about the diets of teens? If you’ve watched “Supersize Me” you’ll see what kind of crap most schools feed kids, and other studies have shown that large numbers of people think that French Fries are suitable for very young kids. I think these are things we should continue to be worried about… even as we de-emphasize adult weight loss programs.
I think you are perfectly correct Kerim. Preventing people from getting fat in the first place would be ideal – especially among kids.
Finally, to fill my Savage Minds Comment Quota for the week (which has barely started), and to give some context to the Harvard Alumni Studies that Oneman has quoted from Ampersand’s post, I post below the results as published. Basically I think Oneman’s conclusions are untenable. Note that what they are saying is that it is weight gain and loss that is damaging. Note the weight gain ranges too – 1-5kg is ok (though worse than staying the same weight) but if you gain over 5kg you are a goner!
“Lowest mortality was among alumni maintaining stable weight (+/- 1 kg). With this category as referent (relative risk = 1.00), relative risks of death associated with losing more than 5 kg, losing between 1 and 5 kg, gaining between 1 and 5 kg, and gaining more than 5 kg, were 1.57, 1.26, 1.06, and 1.36 respectively. For coronary heart disease mortality, relative risks were 1.75, 1.43, 1.28, and 2.01, respectively. Findings were not explained by cigarette habit, physical activity, or body mass index. Those losing or gaining more weight also reported greater total lifetime weight loss, which may indicate weight cycling. CONCLUSIONS–Both body weight loss and weight gain are associated with significantly increased mortality from all causes and from coronary heart disease but not from cancer.”
I understand that BMI is used to determine who is overweight
Check out this introduction article on Body_mass_index:
5.Guidelines for health
These gains (or losses) is that over one’s entire adult life or, say, per year?
Looking at my own body I tend to gain about 1kg per year. I’m 36 now, and gained 15kg since turning 21. I’m now about 95kg. Add another 50 years, and thus another 50kg, and they’ll need a forklift to carry my dead 145kg body to my grave. And I cycle 40km per day to/from work, eat moderately, and don’t drink or smoke.
As much as I’d like to believe that a slight increase in weight over the years could be/is beneficial and is natural, I doubt whether an increase of 1kg+ per year can be considered such. The use medicin and other medical procedures will add their own side effects, as will one’s personal lifestyle.
It doesn’t mention the peoples lifestyles. In my opinion fat people (I’m fat) are more likely to have healthier lifestyles, like having nights in, being friendly to people and (since fatness is discriminated against) having a less stressful job due to not climbing the career ladder as high. Skinny people are more confident, probably go out partying more, drinking, climbing high on the career ladder and suffering stress – skinny people sometimes (in my experience) are egotistical, and can aggravate people, and cause arguments. They are more likely to pursue fitness and extreme lifestyles like skiing, mountain climbing, biking and motorbiking all of which can be dangerous. I know this all sounds very stereotypical and like I’m opinionated – I’m not, I just wanted to point out that lifestyle choices can be linked to BMI’s and therefore taking the BMI as the sole cause of mortality is not an accurate picture.
Personally, I don’t think “skiing, mountain climbing, biking, and motorbiking” are “extreme lifestyles”. Yes, they can be dangerous, but not because “skinny” people do them. Nor do I think “skinny” people are any more “egotistical and argumentative” than fat people. Some skinny people are this way, and they sometimes get into “extreme” obsessions about being a certain weight. I knew a lady who was a member of Weight WAtchers, who was nowhere near being fat. She was, in fact, a pretty good shape, and I told her so. But she kept insisting(which often interfered with her presence at a certain writers’ group I then belonged to), that she had to keep up with these Weight Watchers’ sessions, because she had to lose “those last ten pounds”. Huh? Weight Watchers certainly made some money off her, and from what I’ve heard of their methods, they kind of “suck people in” to keep them coming. But I wonder if a lot of these studies are not themselves perhaps generated by the diet industry. As are the attitudes that prevail these days about “fat”. I see “moral panic” written all over them.
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