As longtime readers know, I have spent years -- more than a decade, in fact -- attempting to calmly suggest that sometimes, some fat people can be healthier staying fat than they would be by continuing failed efforts to be thinner.
For the response I’ve frequently received, you would think I was arguing for the benefits of a diet of human fetuses stolen from the wombs of pregnant women via witchcraft. But I maintain that it’s not really that radical an idea: If you find yourself among the many people for whom repeated weight loss efforts fail to “take,” if weight regain is always an inevitable happening, or if successful weight loss requires you to go to measures that cross into disordered eating or compulsive exercising, or other methods that cause intrusive thoughts and interfere with your ability to be fully present in your life, then in most cases I’m inclined to gently suggest that you might be better off just learning to deal with being fat.
Weight cycling -- that’s what they call it when you lose and re-gain weight over and over -- is incredibly hard on a body, especially your heart, which is kind of important. Whether these weight-cycling-induced possible negative health effects outweigh any possible negative health effects as a result of simply being fat is not a subject that has been extensively studied. This does not surprise me in the least, unfortunately, as it’s tough to fund research that attempts to derail the multibillion-dollar weight loss industry.
More than that, the disordered eating patterns a dieting person might develop can also be psychologically damaging, causing problems that might not show up on a routine physical but which can be just as dangerous.
Is this inevitably true of every person who diets to lose weight? Certainly not. Lots of people diet and intentionally lose weight without injuring their health or their mental well-being, and come out better for it. But for those individuals for whom these negative effects seem to be inevitable and life-ruining, continuing such self-destructive behaviors in the name of one’s health seems awfully misguided.
So I, unlike lots of folks, continue to be really unsurprised when studies like this most recent offering published in the Journal of the American Board of Family Medicine come out seeming to indicate that most of what we assume about body weight having a direct and incontrovertible connection to individual health may be a little skewed.
The purpose of the study, its authors say, is to bring to account any discrepancies in the current statistics about how Body Mass Index (BMI) affects mortality, as most of our current knowledge is based on decades-old information, and public health, as many things, is not a static object but a statistical organism constantly in flux. They looked at the Medical Expenditure Panel Surveys from 2000 to 2005; these surveys are administered by a sub-agency of the US Department of Health and Human Services for the purpose of tracking the usage and cost of health services in the United States. The data pool consisted of nearly 51,000 respondents from 18 to 90 years of age.
It’s pretty extensive, is my point.
Their discoveries were, to some extent, predictable: people with low BMIs, specifically, BMIs of less than 18.5, had mortality rates roughly twice as high as people falling into the “normal” BMI range between 18.5 and 24.9. Mortality measurements assess the risk of death associated with a certain group, so essentially this means underweight individuals are twice as likely to die than normal weight individuals. (I realize the use of mortality -- which, after all, eventually reaches 100% for everyone -- is sort of curious, but this is how public health statistics work.)
However, the study finding that will probably blow the minds of many is that on the mortality risk associated with obesity. I’m just going to directly quote their results here:
In analyses not adjusted for diabetes or hypertension, only severe obesity was associated with mortality (adjusted hazard ratio, 1.26; 95% confidence interval, 1.00–1.59). After adjusting for diabetes and hypertension, severe obesity was no longer associated with mortality, and milder obesity (BMI 30-<35) was associated with decreased mortality (adjusted hazard ratio, 0.81; 95% confidence interval, 0.68–0.97). There was a significant interaction between diabetes (but not hypertension) and BMI (F [4, 235] = 2.71; P = .03), such that the mortality risk of diabetes was lower among mildly and severely obese persons than among those in lower BMI categories.
So, to break it down:
- In people who qualified as “severely obese” -- that’s having a BMI of over 35 -- the mortality rate is 26% higher than it is for people with “normal” BMIs.
- When we remove diabetes and hypertension as influencing factors from the "severely obese" group, their risk of death is the same as “normal” weight folks. The increased mortality vanishes completely.
- Also, when controlled for diabetes and hypertension, people with BMIs in the "mildly obese" range -- 30 to 35 -- actually have a LOWER mortality risk than people in the "normal" range.
- Finally, if you have diabetes, your risk of dying from it is lower if your BMI is above 25.
WAIT, WHAT? That can’t be right, can it? I mean, that would go against everything we think we understand about the health of fat people (AND this here obesery epidemic flabbily terrorizing the nation), namely that they are all going to die of hugeitude, their lives choked from their corpulent bodies by the encroaching adipose as a strangling vine suffocates a mighty tree. Like any minute now. Death by obesification is imminent.
The obvious catch here is whether diabetes and hypertension are in play, and whether obesity contributes to or causes the development of both. But even if they are, the increased mortality risk is hardly earth-shattering, and fat individuals of any size who have neither of these conditions are not statistically any more likely to die than normal weight people. Also, to be fair, these results are hardly conclusive and final until the end of time, but at the least they might foster a more critical conversation than "Fat people are going to DIE DIE DIE EVERYBODY PANIC," which is what we usually tend to hear, and believe, on this subject.
Anyway, my point in bringing this up is not to argue that all lardasses worldwide are universally bursting with good health like plump little cake-eating Buddhas of stereotype-subverting longevity, but simply to make the point that much our conventional wisdom on weight and health -- those cultural assumptions that we cling to and argue in favor of nigh irrationally, even in the face of conflicting information -- is inherently flawed. And also, as I’ve explained at length just a few months ago, that the BMI is a useless load of crap that tells us little of value about an individual’s overall health or risk of death.
Of course, this study probably won’t be covered by CNN anytime soon; in general, we don’t really want to hear that the obesity epidemic we all know and love is not a great lumbering Doomsday Machine hewn from wobbly folds of human flesh, firmly marching us to the end of our great (?) civilization. As an editor friend at a giant national news magazine once told me years ago, people don’t like to be challenged, rather they like to hear things that reinforce what they already think they know. That idea disgusts me, but it’s often true. Revising our cultural understanding of weight and health to account for the often dizzying real-life diversity of bodies and wellness is going to take a very long time, but at least by drawing attention to studies like the above, the conversation can begin to happen.
I can hope, anyway.