Abigail Saguy on obesity

A couple of months ago I read an interesting interview with Abigail Saguy, PhD, the author of an interesting sounding book, “What’s Wrong with Fat?

Most books you see about obesity relate to the physiology or mental issues relating to them (diet books, blog posts about body acceptance, etc.), but her take is sociological: how does society view and treat people who are obese. I very interested to read her thoughts because, as a fat person, I’m bombarded with societies judgement of me based on my body size on a daily basis and, frankly, it’s meant that for at least the past decade I’ve never truly believed anyone who’s said that I’m pretty/etc. because all I can think is, “that’s one person’s opinion, but society/media tells me otherwise.”

So, what is society telling us, where did it come from, and is it valid (spoiler: the answer to the last question is “no!”).

Saguy points out that society looked at weight as a fashion issue before it become a health issue:

It’s important to see this happening within a context. Before obesity became a public health crisis, it became a medical problem, and before it became a medical problem, it became a social problem. So before doctors started talking about obesity as medical problem, middle-class white women began begging doctors to help them lose weight. And they were doing so not because of health, but because of fashion.

This isn’t to say that obesity isn’t potentially a medical problem, but that it was first flagged as a problem because of social pressures to conform to a specific “look.” So, our view of obesity is fogged with layers of filters that may not be fair or even relevant.

Now it’s become a major marketing tool. And, not just for diet books, weight loss clinics and fitness magazines – organizations like the World Obesity Federation (formerly IOFT, the International Obesity Task Force) are funded by pharmaceutical companies who benefit from people pursuing weight loss. Saguy notes: “The greater the perceived risks associated with obesity, the greater the need for weight loss drugs and the greater the tolerance for potential negative side effects.

Here’s the problem: there’s a lot of science (good quality science) that shows that the obesity-to-health correlation is a lot more complicated and that you can be fit and fat. But, people only want to hear what fits in their belief system:

We tend to be more sceptical of evidence that challenges our deeply held beliefs and to uncritically accept information that is consistent with them. This is called “confirmation bias” and it affects how journalists—and the general public—interpret medical studies related to body weight.

I’ll be honest: this is true for me, too. It takes effort, even for a science nerdy librarian looking for the closest thing we have to the truth, to make time to properly digest and (when necessary) accept information that may be counter to what I thought was the truth. A couple weeks (months?) ago there were some articles claiming that it wasn’t possible to be fat and fit, and I had a really hard time making myself read them and look at the science they based their claims on because it not only went against what I believed, it also meant that I was no better off than every other fat person, despite my hours and hours at the gym. Fortunately, it turned out that they were wrong and based on misinterpreted research.

The thing is, there are health risks with being overweight, even if you do eat well and stay active, but there are also health risks with being thin if you don’t eat well or stay active. The correlation isn’t 1:1 (thin ≠ fit/healthy, fat ≠ unfit/unhealthy) and someone’s health can only be accurately measured through running test and making measurements of things like blood pressure, etc.

When I was at my least fit and most overweight, I almost definitely had much higher risks for things like diabetes and heart disease, but now I go to the gym at least 5 hours a week, walk everywhere and eat well – my disease risk is very low compared to someone who’s thin, lazy, and has a crummy diet. In fact, I would argue that I’m one of the fitter people in my office, despite being one of the largest. And, as Saguy points out in an article about her book, risk isn’t the same as being sick – it’s just an indication of the likelihood or possibility of getting sick later, assuming you continue on the same path you’re on at the time of risk assessment.

Further to this: body size isn’t as important as things like body fat percentage. Here’s a real life example: we get our body fat percentage measured at my gym on a monthly basis. It’s done using the caliper method, which isn’t perfect (there’s about a 5% range of error), but can be used to see trends. My body fat percentage is quite high, but the thinnest person in the lunch class isn’t too far behind me. She’s skinny fat: super thin, but very little lean body mass. Her body fat percentage puts her in the same range of risks as I am, which shocked and upset her because she and everyone else always assumed she was relatively healthy because of her small size.

But, like I keep saying, size is not a good indicator of health risk. Saguy points out that there is a relationship between weight and Type 2 diabetes, but that the relationship doesn’t necessarily indicate causation:

First of all, genetics play the most important role in determining who gets Type 2 diabetes. And secondly, we do not know what the causal mechanism is. It may be that heavier weight or more body fat causes Type 2 diabetes, but it is also possible that Type 2 diabetes causes weight gain. And it may be that some third factor, such as poor nutrition, a sedentary lifestyle, poverty or stress, causes both weight gain and Type 2 diabetes.

She also points out some research indicates some benefits to being overweight:

There is a large and growing body of literature that is referred to among researchers as the ‘obesity paradox’ literature that shows that, among clinical populations of people who have cardiovascular disease or Type 2 diabetes, those in the obese category are less likely to die than those in the normal weight category. We don’t know what is causing this association, but the association is very robust. It’s a big mistake to assume that people who are normal weight are healthy and people who are overweight or obese are unhealthy. The relationship is much more complex than that.

Saguy concludes with some important thoughts that I won’t try to paraphrase:

We use the fear of becoming fat as a way of scaring people into adopting healthy practices. I think that’s very dangerous. It makes fat kids and adults the victims of bullying, it leads to eating disorders for others, it reinforces this idea that it’s bad to be fat and that fat people are lazy, and it worsens weight-based discrimination. We should avoid scare tactics and instead emphasize the positive: that everyone deserves the opportunity to be able to nurture their bodies.

It’s not just how others perceive and treat fat people that becomes a problem, as mentioned in a previous post, using negative messages doesn’t work.

In her book, Saguy looks at the messages we get from media and others (our parents, our peers, …):

That obsession is only fueled by attention seeking politicians and the media. A large portion of the book is devoted to a study of the media and its thirst for sensational headlines about an impending epidemic. Saguy asserts that the headlines may be dramatic but offer little to the discourse about healthy living.

She also points out that when health messages, like Michelle Obama’s Let’s Move campaign, link nutrition and physical activity to obesity, it could have a negative effect on how children view their own bodies:

Here they are being told by adults, adults in position of authority, that their bodies are not okay. Is this going to have a positive effect on them? Is this going to make them take better care of themselves, probably not.

Instead of being able to look at weight as simply a health issue, weight has become a moral issue.

We are living in society in which is it so deeply ingrained that it is bad, immoral to be fat. Fat people are widely seen as lazy, selfish, and consuming too much resources. [source]

The one thing I would argue against is her assertion that we should look at weight simply a form of human diversity. I think that would also over simplify the issues. Much in the same way that we can’t assume that fat = unhealthy, as also can’t assume that, because it’s possible to be fit and fat, all fat people are probably healthy enough. I know that’s not true because I’ve been there and I know plenty of people who have been or are still there (and many of them are still fooling themselves into thinking that they’re fine). I think what we need is to shift the focus from body size as a measurement and recognize that what we eat and our activity level is a better measure. This shift will not only benefit fat people by (slowly) removing the vilification they suffer through, regardless of their level of health, but it will also help thin people to understand that they may not be as fit as they think they are.

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