Obsession with obesity hides unhealthy thin
Amid the panic about rising obesity levels, there’s growing evidence that being fat may not be as unhealthy as feared, writes Eilis O’Hanlon
HERE’S a stark little factlet. No country in the world in the past 40 years has managed to reduce obesity levels, not even fractionally. Still politicians keep up the charade that this time they can slay the fat dragon.
Fianna Fail’s spokesperson for Children and Youth Affairs is the latest to have a go, suggesting that all Irish children should be weighed in school as a way of tackling rising obesity levels. What’s the thinking here? That the best way to tackle the bullying of overweight kids is to draw more attention to them?
If so, perhaps they should also have to do it publicly in their vests and pants, in some quasi-Operation Transformation ritual of shame just to make the strategy even effective? Of course, that’s not what Fianna Fail is advocating, but the road to hell is paved with good intentions, and there’s no doubt that the panic about obesity has reached such a fever pitch in the ranks of Those Who Must Be Obeyed that they’re probably not ruling anything out.
Think tanks have even seriously debated whether fat people should pay more taxes in order to compensate for all the money they’re supposedly costing thin people in terms of medical treatment. Naturally, everyone is expected to support these regular Two Minute Hates on the overweight because obesity is the great bogeyman of our age.
News bulletins are dominated by experts with furrowed brows insisting that we’re eating ourselves into an early grave, all illustrated by ubiquitous footage of the large waistlines of random people in town, filmed from the midriff down so they can’t be identified, but with an obvious underlying message: Just look at all these disgusting crea- tures cluttering up our nice streets. Let’s humiliate them into shedding the pounds.
There are a couple of things wrong with this approach. Firstly, it’s gratuitously cruel to constantly draw attention to people’s imperfect body shape, and telling them you’re doing it for their own good just adds insult to injury. People overeat for a range of complex emotional and psychological reasons. Understanding why they do it, rather than nagging them to stop, as if their eating is a sign of moral weakness, should be the starting point.
Secondly, it might not be based on as much evidence as the medical gurus insist.
If there really was an urgent need to shame the nation into action, it should be because of a clear-cut connection between weight and ill health, and increasingly it seems that there’s not. Instead there’s a growing understanding that there may be something called “healthy obesity” — that is, people who on the outside may look larger than they should be, but who are physically in fine shape, and certainly much healthier than many thin people whose health is supposed not to be a problem because they conform to a stereotype of what a healthy person should look like. Thinness can mask an abundance of health problems, because we’ve all been habituated into thinking of it as normal, even doctors.
Healthy obesity is a controversial subject. Some doctors deny that it can exist at all, whilst, in studies of the phenomenon, estimates of the proportion of overweight people who are deemed to be healthy vary widely, from one in 10 to one in two. Women also seem more capable of carrying those extra pounds and remaining healthy than men.
What seems undeniable is that the official definition of obesity is too rigid and too extreme. Doctors categorise any Body Mass Index (BMI) between 25 and 29.9 as “overweight”, and anything over 30 as “obese”. It’s surprisingly easy to stray into either category, which is probably why 89pc of Irish men and 85pc of women are predicted to be overweight or obese by 2030. It’s quite a kick in the teeth for people who may be carrying a few extra pounds to suddenly discover they are so far outside what is generally considered ideal.
It just encourages people to give up. What’s the point? Even if they lose a few pounds, their BMI only drops fractionally, and most people on diets don’t keep the weight off long term anyway. They yo-yo, and feel worse about themselves as a result, comfort eating more to cope with feeling low.
That doesn’t mean everyone should be encouraged to add more cakes to their diet. Being overweight is associated with certain health risks, and every study shows that eating more fruit and vegetables and taking regular exercise increases your chances of living longer and in better condition.
But it does mean the way in which obesity is discussed and regulated needs to be finessed to get rid of the lazy correlation that thinner is good and fatter is bad. Some studies have found that, counter-intuitively, overweight people actually have a significantly lower mortality risk.
There are a number of possible reasons for this. People who smoke tend to have lower BMI, because tobacco suppresses appetite, and is indeed used for that purpose by many smokers, and smokers tend to die younger, so they skew the figures. Those at the lower end of the BMI scale also includes people with underlying health conditions that may limit their life spans. Again, the figures may therefore be misleading. But it must still come as a shock to thin people to discover that being smug about their weight doesn’t mean they’ll live any longer than the chubbier people to whom they feel so superior.
The concept of “healthy obesity” has come under challenge by the medical establishment, which fiercely resists any suggestion its standard, one size fits all approach may be misguided. Earlier this year, a different study challenging the idea that there was any such thing as healthy fatness was unveiled to a blare of trumpets. Its central finding was that women who are overweight but otherwise healthy still have a much higher risk of developing cardiovascular disease, meaning they’re more likely to have strokes or heart attacks, than healthy women of “normal” weight.
The study was heavily reported in the international media as confirming that the official approach to eradicating obesity had been right all along. Even the authors admitted, however, that their study showed association rather than cause and effect. It still remains very difficult to say that A directly causes B.
Following women in the US over a 30-year period, the same study also found that healthy women of a normal weight developed conditions such as high blood pressure, excess cholesterol and diabetes as they got older anyway, so even being good is no guarantee of optimal health.
Furthermore, supporters of the concept of “healthy obesity” quickly pointed out that they’d never said everyone should be stuffing their faces with pies, simply that the link between weight and health was more complicated than the official approach suggests. As Professor Carl Lavie of the School of Medicine in New Orleans put it, “fitness is more important than fatness”, and he noted that the study which was being hailed as the final word in obesity research hadn’t even collected data on participants’ physical activity and cardio fitness, which, when you think about it, is quite the omission.
The real culprit in all this is processed food. It’s not how much we eat, but what we’re eating, that’s the key to living healthier. A century ago, people ate more calories, but they had higher levels of activity and, crucially, got their calories from real recognisable food. They didn’t pepper their diet with sugary drinks, snacks and instant meals. Thin people are consuming all this additive-rich rubbish too, which is why
they might not be as healthy as they think. Doctors don’t spot the problem because they too have been conditioned to look at thinner people and superficially presume they must be doing the right thing.
Instead of tackling the root cause of poor health, we’re constantly bashed over the head with simplistic scaremongering about obesity, as if being fat was itself the problem. Obesity only seems to be seriously life-limiting at the very upper end of the weight spectrum, where no one in their right mind denies that there’s a problem, and the greatest risk factor of all is being poor. Politicians should turn their minds to tackling that instead of worrying about waistlines.
The good news remains that we’re all living longer than ever, in every corner of the world, even as the message “we’re all doomed” grows ever more shrill and insistent. Perhaps that’s because there’s a whole medical and political industry devoted to telling us what to do every single minute of the day, and admitting that the situation is far too complex to reduce to a slogan would limit their opportunities for round the clock self-righteous nagging.