On Fatness

22Oct08

It is impossible if one is at all associated with public health, or indeed owns a TV, to have missed the news that obesity is on the rise, and as far as your health is concerned, doubleplusbad. And that’s true…obesity is associated will all manner of negative outcomes.

What’s frustrating is how that gets translated. There are people who just are overweight. I’m one of them. I’ve been told my entire life that if I just ate better and exercised more, I’d be skinnier, and thus healthier. I’ve heard the Calories In, Calories Out mantra. And right now, I am admittedly out of shape – stressful graduate school will do that to you.

But there was a time when I wasn’t. There was a time when I lived on a good deal of rice, swam long distance freestyle on a varsity team 5 days a week for 2 hours, and was a competitive ski racer on the weekends. And, if you calculated my BMI, I was also obese.

 

I think how we, as a society, approach weight is fundamentally unhealthy. First, BMI is a very, very poor measure. It’s a somewhat accurate measure of body fat, which in turn is a somewhat accurate measure of your nutritional status. It’s subject to the same measurement and misclassification bias that plagues other epidemiological studies, but is rarely covered as such – even in methodologically rigorous graduate level courses in epidemiology. BMI is not a measure of health. You can be heavy and healthy, or skinny and on the verge of a cardiac arrest. What BMI is is a measure of skinniness (or fatness) and thus societal desirability. There’s studies talking about the impact of the stress of being fat, of whether or not people stop seeking care because their fat (because the judgement of the medical community when your obese is never a positive one, even when – as mentioned above- you’re exercising more than most). 

 

Obesity, nutritional status and the like are all important measures and determinants of health. But right now, it’s also a moral status to the public and much of the medical community. That if people would just shut their mouths, they’d lose weight and start living the way we want them to. For some it is, for others, it isn’t. That needs to stop carrying a moral weight to it. It especially needs to happen if we as a society don’t want to create a class of people who, because of a flawed, judgmental and dogmatic view of weight and health, are denied the quality of care to which they should be entitled. People who need it. Getting people the care they need without judging it as a moral state (just as poverty was and still is viewed as a moral failing) should be the overarching concern of the medical community. And that we don’t always do it, or even sometimes try, should disturb us.

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