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Authors: Linda Bacon
Health At Every Size: The Surprising Truth About Your Weight (23 page)
BOOK: Health At Every Size: The Surprising Truth About Your Weight
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Most striking is that the CDC did not publicize the new results, nor change their public health message. After all, they used the original study to justify their war on obesity. Why not stop the war now that the evidence has disappeared? And if they are so concerned about the health of “overweight” people, why isn’t this news cause for celebration? Interestingly, the study found slightly more total annual U.S. deaths in the “Underweight” category than in the two heaviest categories (“Overweight” and “Obese”), suggesting a stronger case for shifting public health attention to the dangers of thinner weights.
The CDC didn’t just overhype a crisis, they helped invent it. With only 26,000 victims, we don’t have an obesity/overweight epidemic; our epidemic is one of fearmongering and ignorance. Consider the following statements:
1. Overweight and obesity lead to early death.
2. Overweight and obesity lead to disease.
3. We are gaining weight at epidemic rates.
4. Weight loss improves health and longevity.
5. You control what you weigh.
6. Anyone can keep lost weight off if she or he tries hard enough.
7. Thinner is more attractive.
8. We can trust the experts to provide accurate information.
For most of us, these statements seem like basic truisms. However, much of what we believe to be true about weight—
including all of the statements above
—is in fact myth, fueled by the power of money and cultural bias. Public health officials, health advocates, and scientists are complicit (often unintentionally) in supporting and encouraging the lies. The campaign against obesity is not about science or health; its misconceptions about the most basic research are astounding. If you suspend your preconceptions and open yourself to the scientific evidence, a very different picture emerges.
including all of the statements above
—is in fact myth, fueled by the power of money and cultural bias. Public health officials, health advocates, and scientists are complicit (often unintentionally) in supporting and encouraging the lies. The campaign against obesity is not about science or health; its misconceptions about the most basic research are astounding. If you suspend your preconceptions and open yourself to the scientific evidence, a very different picture emerges.
No obesity myth is more potent than the one that says obesity kills. It gives us permission to call our fear of fat a health concern, rather than naming it as the cultural oppression it is.
That “obesity kills” has been the backbone of the federal public health campaign. Yet that is not supported by evidence examined by federal employees. Their research found that “even severe obesity failed to show up as a statistically significant mortality risk”
236
and suggested that overweight may actually be protective.
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and suggested that overweight may actually be protective.
235
About TerminologyNowadays, you don’t have love handles, puppy fat, curves, or a spare tire—you’re overweight or obese. Throughout this chapter, I use the terms “overweight” and “obese” because they are commonly understood medical terms, and I am describing research and attitudes that rely on these terms. However, these categories are meaningless in determining someone’s health status, and the terms “overweight” and “obese” miss the mark. Over what weight? There is no precise weight beyond which you will definitely be unhealthy! And the etymology of the word “obesity” mistakenly implies that a large appetite is the cause.Using these terms medicalizes and pathologizes having a certain body, which is why these words are rarely found elsewhere in this book. Instead, I use a more appropriate term: fat. There is a growing movement that seeks to reclaim the term “fat” as a descriptive term, stripped of its pejorative implications. This change is supported by many fat-acceptance activists and the National Association to Advance Fat Acceptance (NAAFA), a “human rights organization dedicated to improving the quality of life for fat people.” NAAFA argues, rightfully so, that fatness is a form of body diversity that should be respected, much like diversity based on skin color or sexual preference.
This finding is not new news, but entirely consistent with the bulk of the literature.
237
All of these well-respected studies cited below, for instance, determined that overweight people were living at least as long as, and frequently longer than, normal weight people:
237
All of these well-respected studies cited below, for instance, determined that overweight people were living at least as long as, and frequently longer than, normal weight people:
• The Established Populations for the Epidemiological Studies of the Elderly investigation (included more than 8,000 senior citizens)
238
• The Study of Osteoporotic Fractures investigation (included more than 8,000 women)
239
• The Cardiovascular Health Study (included almost 5,000 individuals)
240
• Women’s Health Initiative Observational Study (included 90,000 women)
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• An investigation of almost 170,000 adults in China
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• An investigation of 20,000 German construction workers
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• An investigation of 12,000 Finnish women
244
• An investigation of 1.7 million Norwegians
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(Yes, you read that right: 1.7 million people! In this, the largest epidemiological study ever conducted, the highest life expectancy is among individuals who are overweight by our current standards and the lowest life expectancy is among those defined as underweight. What’s more, individuals who fit into what is deemed the ideal weight range had a lower life expectancy than some of those who were obese.)
These are not a few errant investigations, but representative of conclusions that dominate the research. The most comprehensive review, for instance, pooled data from 26 studies and concluded that overweight individuals were living slightly longer than those of normal weight.
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Even the definitive National Institute of Health Clinical Guidelines on Identification, Evaluation and Treatment of Overweight and Obesity in Adults concludes that the weight associated with the
lowest
death rate is considerably
above
a BMI of 25.
247
(Yet that doesn’t stop them from recommending weight loss for overweight individuals—nor from defining their mandate as “evidence-based.”)
lowest
death rate is considerably
above
a BMI of 25.
247
(Yet that doesn’t stop them from recommending weight loss for overweight individuals—nor from defining their mandate as “evidence-based.”)
The scientific evidence is clear:
Body fat is not the killer it’s portrayed as.
Body fat is not the killer it’s portrayed as.
The idea that weight plays a large causal role in disease is also unproven. Little evidence supports that weight is the primary cause of many diseases for which it is routinely blamed, except osteoarthritis, sleep apnea, and possibly a few cancers. In contrast, there are several diseases for which high levels of body fat provide a distinct, though rarely acknowledged, advantage.
“The current generation of children is the first generation in modern American history projected to have a shorter life span than their parents.”This proclamation was drawn from an opinion piece
248
published in the prestigious New England Journal of Medicine and offered
no
statistical evidence to support its claim, though you would never know it from the authority it has been granted in the media. Consider this before you buy into the hype: Life expectancy has increased dramatically during the same time period in which our weight rose (from 70.8 years in 1970 to 77.8 years in 2005) and continues to hit record highs.
249
That’s right, government statistics predict that the average kid can now expect to live seven years longer than his or her parents! Not only are we living longer than ever before, but we’re healthier than ever and chronic disease is appearing much later in life.
249
Death rates attributed to heart disease have steadily declined throughout the entire spike in obesity.
250
Both the World Health Organization
251
and the Social Security Administration
252
project life expectancy to continue to rise in coming decades.
Many “obese” people are healthy and don’t suffer from the diseases that we tend to blame on weight, and a considerable proportion of “normal weight” people are prone to the cardiac and metabolic abnormalities that we blame on obesity.
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Epidemiologic Studies Cause Statistical DeathsThe majority of knowledge regarding the relationship between health and weight is drawn from epidemiological research. Epidemiological obesity research compares groups of overweight and obese individuals with a control group of normal weight individuals. It is intended to uncover associations which then need further examination. It cannot tell us whether a variable causes or even influences another.Consider this: It is well established through epidemiological research that bald men have a higher incidence of heart disease than men with a full head of hair.
255
However, this doesn’t mean that baldness promotes heart disease or that hair protects against heart disease. Nor is it recommended that bald men try to grow hair or buy toupees in order to lessen their disease risk.Instead, further research indicates that high levels of testosterone may promote both baldness and heart disease. “Confounding factors” can often serve to confuse the interpretation of epidemiologic research.
It is clear that weight is
associated
with increased risk for some diseases, but causation is an entirely different matter. In some cases, the causality may travel in the opposite direction, as in the case of diabetes (to be discussed shortly). Some of the medications intended to treat weight-associated diseases may also encourage weight gain, such as the insulin, sulfonylureas, and thiazolidinediones used to treat diabetes.
associated
with increased risk for some diseases, but causation is an entirely different matter. In some cases, the causality may travel in the opposite direction, as in the case of diabetes (to be discussed shortly). Some of the medications intended to treat weight-associated diseases may also encourage weight gain, such as the insulin, sulfonylureas, and thiazolidinediones used to treat diabetes.
Lifestyle habits can also confuse the picture. A sedentary lifestyle, for example, may predispose someone to weight gain
and
make them more vulnerable to many diseases. It is well established that the relationship between activity and longevity is stronger than the relationship between weight and longevity.
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Consider the research conducted as part of the Aerobics Center Longitudinal Study in Texas, which found that obese men who are classified as “fit” based on a treadmill test have death rates just as low as “fit” lean men.
257
Moreover, the fit obese men had death rates one-half those of the lean but unfit men, indicating that fitness is more important than weight in longevity. Similar results were demonstrated for women.
258
and
make them more vulnerable to many diseases. It is well established that the relationship between activity and longevity is stronger than the relationship between weight and longevity.
256
257
258
259
260
261
262
Consider the research conducted as part of the Aerobics Center Longitudinal Study in Texas, which found that obese men who are classified as “fit” based on a treadmill test have death rates just as low as “fit” lean men.
257
Moreover, the fit obese men had death rates one-half those of the lean but unfit men, indicating that fitness is more important than weight in longevity. Similar results were demonstrated for women.
258
Larger people may be more likely to have tried dangerous weight-loss methods, which may also be reflected in higher incidence of disease. For instance, in 1970, 8 percent of all U.S. prescriptions were for amphetamines intended to treat obesity
263
that are now known to increase heart disease risk.
264
Heavier people may also have gone through damaging cycles of losing and regaining weight, making them more prone to certain diseases. For instance, even a single cycle of losing and regaining weight may damage blood vessels and increase risk for cardiovascular disease.
265
263
that are now known to increase heart disease risk.
264
Heavier people may also have gone through damaging cycles of losing and regaining weight, making them more prone to certain diseases. For instance, even a single cycle of losing and regaining weight may damage blood vessels and increase risk for cardiovascular disease.
265
Reduced access to health care and poor quality health care may also confuse the picture.
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Weight bias among health care practitioners is well-documented
269
270
and life-threatening. As an example, several research studies indicate that fatter women with cancer may not get the appropriate dose of chemotherapy for their weight, which adversely affects survival.
271
Studies also indicate that fat women may delay or avoid seeking health care for fear of discrimination and receiving an unsolicited weight loss lecture.
267
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266
267
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Weight bias among health care practitioners is well-documented
269
270
and life-threatening. As an example, several research studies indicate that fatter women with cancer may not get the appropriate dose of chemotherapy for their weight, which adversely affects survival.
271
Studies also indicate that fat women may delay or avoid seeking health care for fear of discrimination and receiving an unsolicited weight loss lecture.
267
268
Also, it is well established that obesity is higher among ethnic minorities and people of lower socioeconomic status,
272
both of which are also highly associated with disease risk. The higher pollution levels in poorer neighborhoods
273
may play a role, and the increased discrimination to which ethnic minorities and people of lower socioeconomic status are subject may be a factor as well.
272
both of which are also highly associated with disease risk. The higher pollution levels in poorer neighborhoods
273
may play a role, and the increased discrimination to which ethnic minorities and people of lower socioeconomic status are subject may be a factor as well.
And of course, stress from the discrimination and widespread hostility directed at larger people may also be a significant contributor to the risks currently blamed on body fat alone. Researchers find larger people experience more cynical mistrust, which is highly associated with inflammation, a major risk for heart disease.
274
There is extensive research documenting the role of chronic stress in conditions conventionally described as obesity-associated, such as hypertension, diabetes and coronary heart disease.
275
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Stress itself alters metabolism independent of changes in BMI.
277
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There is extensive research documenting the role of chronic stress in conditions conventionally described as obesity-associated, such as hypertension, diabetes and coronary heart disease.
275
276
Stress itself alters metabolism independent of changes in BMI.
277
BOOK: Health At Every Size: The Surprising Truth About Your Weight
10.1Mb size Format: txt, pdf, ePub
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