SCIENCE! New Obesity Research Demonstrates That Health and Weight Are a Billion Times More Complicated Than You Thought

Why am I fat? Why do you care?
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Lesley Kinzel
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Why am I fat? Why do you care?

This week the Wall Street Journal reported on a recent study published in the American Journal of Clinical Nutrition. The study analyzed data following over 300,000 Europeans for 12 years and discovered that there were twice as many deaths due to lack of physical activity as obesity. The study’s authors therefore concluded that exercise is of critical importance to health and longevity, and can help overweight and obese individuals live longer lives, even if it doesn’t result in weight loss.

After accounting for other factors that could affect life expectancy, the researchers found that life expectancy was 3.4 years longer for people who reported they got the recommend level of physical activity. People who reported leisure-time physical activity at twice the recommended level gained 4.2 years of life. In general, more physical activity corresponded to longer life expectancy.   

The researchers even saw benefit at low levels of activity. For example, people who said they got half of the recommended amount of physical activity still added 1.8 years to their life.

These results are not entirely new. Prior research has also found that regular exercise has positive benefits even when weight loss is not a factor. Of course, science hasn’t had much of an impact on the widely held presumption that the only reason a fat person should exercise is to lose weight. And a lot of people still buy into the idea that exercise is only “working” if they lose weight.

This study is followed up by a paper published in The Lancet today, in which a group of medical experts from U.S. universities suggest that exhorting fat people to lose weight via diet and exercise is largely pointless. In a direct response to the persistent ideology that overweight and obesity are products of individual laziness and gluttony — and easily remedied by lifestyle change — the paper explains that obesity causes a series of biological and metabolic changes that make it almost impossible for many fat people to lose weight and keep it off.

“Few individuals ever truly recover from obesity; rather they suffer from ‘obesity in remission’,” [Dr Christopher Ochner, assistant professor of pediatrics and psychiatry at the Icahn School of Medicine in New York] said. “They are biologically very different from individuals of the same age, sex, and bodyweight who never had obesity.” [...]

Dr Rachel Batterham, head of University College London Hospital’s Centre for Weight Loss, said she saw hundreds of patients “nearly every one” of whom had successfully lost weight, only to put it back on again.

“That’s because their biology wants them to return to the maximum weight they had achieved,” she said. “Once people have become overweight, then biology changes. An understanding of how difficult it is to lose that weight and keep it off needs to be communicated.”

If this sounds familiar, it’s probably because a similar concept was originally developed in 1982 to explain the tremendous rate (80 to 95 percent, depending on the research) at which diets fail. It's called Set Point Theory, and it argues that each unique human body, through a combination of biological and environmental factors, has a “set” weight, a sort of equilibrium that it prefers to maintain, and that it is with this Set Point that so many dieters are waging a doomed war.

The Lancet paper comes on the heels of two more new studies, both also published in Nature today, that looked at genetic factors behind both body weight and fat distribution.

In both studies, researchers recorded the physical characteristics of over 220,000 study participants of all shapes and sizes. Then, they correlated these data with genetic regions in their DNA. "We found 97 different regions of the genome that are associated with BMI," [Elizabeth Speliotes, a geneticist at the University of Michigan and a co-author of the study] says — 56 of which were completely novel. The researchers involved in the second study found 33 new genetic regions associated with waist and hip circumference. [...]

The BMI team also put numbers to the impact of the 97 genetic regions they identified. Speliotes explains this by using an ordinary person as an example. "Take a human of average height," she says. Each human carries two alleles — a specific region on a chromosome — for each of the 97 BMI-related regions they identified, and these alleles may or may not increase a person’s BMI relative to the average. Now, if that normal-sized individual carries more than 104 BMI-increasing alleles, they will be 20 to 24 pounds heavier on average than someone of similar height carrying less than 78 BMI-increasing alleles — "a medically significant difference," she says.

So, science! Look at all the science! Big oily globs of obesing science, all over your screen! This is why you’re fat! It's scientific! Don’t you feel better?

In truth, I am struggling to muster up a single fuck to give. I have none. I am empty-handed of fucks to offer. (Oh, wait, is that a giveable fuck? No, no, it's just the cat.)

I mean, it’s interesting, in that way that it’s interesting to read about how the pancreas works or that your whole body-wide epidermis recycles itself every two weeks. It’s interesting in that it is a thing that is evidently real and true and proven by research, but the knowledge of it doesn’t actually change anything about my experience of my body, or my experience of living in my body in a culture that seems to give even less of a toss about science than I do, because sometimes it just wants to yell at me to eat a celery or murder myself on a treadmill or whatever. 

Regardless, my pancreas keeps chugging, my skin cells keep overturning, and I keep being fat, no matter the processes behind it all. While I get that this kind of research is about tracking obeseology across huge populations of people, I have long ago given up on the idea that the secret science-y long-ago individual origins of my or anyone else's fatness matter in favor of focusing on my life in the here and now. Why am I fat? Why do you care?

Let's do an experiment: If I post one picture of myself eating a churro online, how long will it take for someone to suggest I literally subsist 100 percent on churros all the time and THAT is why I'm fat?

Let's do an experiment: If I post one picture of myself eating a churro online, how long will it take for someone to suggest I literally subsist 100 percent on churros all the time and THAT is why I'm fat?

Too often detractors presume that fat positivity and body acceptance are making a case that all fat people are perfectly healthy, no fat people are sick, and fat itself never causes, contributes to, or worsens health problems. It's a convenient misunderstanding to cling to. By erroneously placing this specious argument at the center of the body acceptance movement, critics can send the whole concept tumbling to the ground, because it’s so easily disproven, and therefore all fat-positive folks can be dismissed as arguing in favor of an obvious falsehood. Even if this is not what most of us are actually arguing.

The reality is more complicated, like reality often is. Of course fat people get sick. Some fat people get sick, and some fat people do not. Some fat people are extraordinarily fit and others are sedentary. Some fat people love a Quarter Pounder value meal and some fat people are lentil-chewing vegans. It’s way weird, but fat people are just as varied in their behaviors as thin and average-size people are. I know! Bombshell.

Health is just as diverse. Health does not come in one universally recognized format. Health is as flexible and manifold as people with bodies; a person with fibromyalgia may clock "healthy" as "I was able to walk two blocks today with manageable pain" or even just “I was able to empty the dishwasher in one go,” things that people without chronic pain take for granted. A person with asthma may feel “healthy” for wheezing less than usual on a brisk hike, while people without asthma don’t even think twice about being able to take a deep breath at the top of a hill. A person with diabetes might rank their health by how well their blood sugar is managed. A person with a long-ago sports injury might judge their health by whether their knee is acting up lately. None of these people are wrong to feel "healthy" within their individual parameters, even if those circumstances are dramatically different from a concept of one-size-fits-all “health” in which the only “healthy” people are the golden, highly moral ones with no health problems to manage at all.

Further, health is not a finite resource. People do not all receive the same pile of health when they’re born, and subsequently spend the rest of their lives jealously guarding it or using it all up. Thus, people who are less "healthy" didn't squander what nature generously gave them. Health changes as we age and as life happens to us. Some of it is because of the choices we make, some of it is locked into our biological makeup, and some of it is pure dumb luck.

Regardless, no one should be shamed, harassed, or pressured about their health or their weight because it's none of your business. There are a very narrow range of situations in which it is acceptable to assert your feelings about a person’s weight or health, and exactly 0 percent of them happen with strangers, and all of them begin when said person point-blank raises the subject and asks for your input. Most polite humans, I think, can agree on this.

But here’s the unpopular bit: Fat people, like anyone else, are allowed to be unhealthy.* They are! It’s not against the law, at least not yet. Some fat people are unhealthy, and that’s okay. Just being fat doesn’t place a person at an increased responsibility for their health over someone who has a lot of “bad” health habits but happens to be thinner. The cultural and social connection between morality and health is toxic and inaccurate; getting sick or developing chronic health problems doesn’t make you a person less worthy of dignity and respect— not even if you could have averted those problems had you just made “healthier choices” earlier in your life.

This is not the conversation most people want to have. Because frankly, in the face of social perceptions about fatness, it's even more perplexing than the fallacious suggestion that all fat people are magical paragons of perfect health. 

It's normal and understandable that many fat people feel validated by large-scale studies like those cited above — they lend legitimacy and confidence to the things many of us have known in our individual lives to be true, like that simply eating less and exercising more doesn't always result in instantaneous weight loss, or that our health does feel improved when we're more active even if our size doesn't seem to be changing, or that sometimes trying not to be fat feels like fighting a futile battle with every single cell of our bodies. But in the end, like the BMI, these results are not meant to be applied to us as individuals, and as interesting as they may be, we don't benefit from relying on them overmuch to bolster our right to exist.

And we do have a right to exist, whether science backs us up or not.

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*And just because someone is bound to bring it up: Yes, fat people are also allowed to be healthy, and are also allowed to lose weight. Although if you needed me to tell you that, I really wonder what kind of world you’re living in where that is not a constant and inescapable message.