Monday, August 21, 2006

I'm Worried About Your Health

In The Diet Myth, Paul Campos discusses the “disease” of obesity as a socio-cultural construction designed to underhandedly fuel bigotry against fat, as well as to potentiate racist and ethnocentric thought. How many times have we heard, “You see, it’s not that you don’t look good—it’s just your health that I’m concerned about”? In his journalistic account of the weight-loss research enterprise (and industry), Campos debunks this myth by presenting facts exposing that (exact quote):

1) The health risks associated with increasing weight are generally small, in comparison to those associated with, for example, being a man, or poor, or African American.
2) These risks tend to disappear altogether when factors other than weight are taken into account. For instance, fat active people have half the mortality rate of thin sedentary people and the same mortality rate as thin active people.
3) There is no good evidence that significant long-term weight loss is beneficial to health, and a great deal of evidence that short-term weight loss followed by weight regain (the pattern followed by almost all dieters) is medically harmful. Indeed, frequent dieting is perhaps the single best predictor of future weight gain.
4) Despite a century-long search for a “cure” for “overweight,” we still have no idea how to make fat people thin.
It’s interesting how often the “health” card is invoked, even amongst medical and psychological professionals. Truth is, there’s really no way to evaluate people’s health based on how they look. And yet, we do it all the time. So, now what? Without the “health” argument to back us up, how should we disguise our disgust with fat?


FatMom said...

Well, I kind of agree with that...I'm 36, 5'4" and weigh 210 pounds. I've weighed between 205 and 220 for about 7 years now, and I'm quite healthy. I do exercise. That all being said, there's a book called Fat Land that shows the exact opposite of those findings. Seems that one can find statistics and scientific studies to show whatever they want to show. Awesome blog, by the way! I really enjoy it!

Anonymous said...

But what about the strain on the body by being overweight? I am a personal trainer and one of my clients currently weighs in at 450lbs and is 5'6''. She is only 40 years old. She can't sleep in a bed anymore, has sleep apnia, both her hips and both her knees are in bad need of replacemmet (but her doc won't operate because her obesity is a major risk factor). She is in chronic pain and getting around is severely painful. She has rashes all over her body from being unable to wash properly. Travel is impossible, work is impossible. Standard of living as an obese person can be very poor.

PalmTreeChick said...

Kind of goes back to the BMI and body fat percentage thing. One may have a high BMI but a low body fat percentage because they are really muscular.

An person who is slightly overweight, maybe like 25 lbs or so (I'm not a doctor so I don't know) and works out on a regular basis could be in better shape than someone who is "normal" weight or "thin" and doesn't workout at all. Sometimes we have to look below the surface to see how one's insides (heart, etc) are doing. With that said, someone who is carrying an excess amount of weight does put a lot of strain on their body.

ps22 said...

All things aside about the research, I totally agree with the idea that we (meaning, society/culture) use these excuses about health and whatnot to discriminate unfairly against people of a certain weight. Anonymous - I see your point, but it seems that your client is an extreme case. My guess is whatever led this person to be 450 pounds goes far beyond food intake and exercise.

Haley-O said...

It is all a case of language. Obesity is called a "disease," something we want to cure, and also something we need to repudiate. Another case of "othering" what's less than desirable in our culture: turn it into an illness, abjectify it so that we can consolidate our own "healthy" ideal of beauty....Healthy? Our ideals of beauty healthy? What did she just say?

littlem said...

Haley-O said:
"Another case of "othering" what's less than desirable in our culture:"

Following up on that thought, there are people -- Professor Campos among them -- who unmask obesity as a proxy for race and class issues, as the latter are (theoretically) politically incorrect to assert in 21st-century America as an excuse not to want to associate with someone.

There's a whole conference about "healthism" at UMichigan going on in October; it covers birth control and related issues as well as obesity from that viewpoint. Read about it on Feministe. Never knew such stuff existed.

Dr. S., going to send you a note re: your "housekeeping" post. Stay tuned.

drstaceyny said...

fm--thanks. You're proof that we should look at these things on an individual level, instead of generalizing. Statistics can be an art, as you point out. Campos presents challenges to what's currently accepted as fact.

anon--I think even Campos would agree that 450 pounds is uncomfortable and can lead to health consequences. He's talking, in my words, mainly abt the 150-, 200-, 250-, pound ppl who society identifies as fat and therefore unhealthy. Again, I'd go back to the individual. Re: your client, her weight IS affecting her health, as well as her "standard of living," as you write.

ptc--exactly. In fact, the Lancet just came out and advised against using BMIs--I'll post abt it soon.


haley--I get it, and good point. It's interesting how the process of "othering" can create medical "diseases."

lm--that's exactly what Campos does. Thanks for telling us abt "healthism."

pinkcat said...

I feel like I have to post because I read Campos' book and it makes a lot of sense.

I am overweight by about 25 lbs. The last time I saw my Doctor he told me to lose weight or I might get diabetes and heart disease.

Well, my cholesterol levels were really excellent, both good and bad cholesterol (he asked if I was a vegetarian) My resting heart rate was 69 and my blood pressure was 100 over 70. He gave me the thumbs up for all of the good work I do like eating healthy and excercising daily but.....

My point is that despite being very healthy, my doctor looked at me and gave me advice based on my appearance alone. Do you diagnose cancer that way.

It's interesting that in Campos' book he cites statistics that show people whose BMI is less than 20 are more likely to die than people whose BMI is between 20 and 40.

Today I read in the times that if you are over age 75 BMI is not a good indicator of your health. The article went on to say that it is thought that BMI is a good indicator of health under age 75. Huh?

I think we as a culture look at fat people and think "OUT OF CONTROL", or "DOESN'T CARE ABOUT HERSELF"(we don't feel the same about fat men).I look at the ones who are bigger than myself and think "there but for the grace of god go I" because I got to tell you it sucks to be fat in America.

littlem said...

Pinkcat said:
"My point is that despite being very healthy, my doctor looked at me and gave me advice based on my appearance alone. Do you diagnose cancer that way."

Did you look him dead in the eye and ask him that?

Knowing what I know about how fatphobia is pounded into doctors in med school, I think I would have.

But then, I've been told I'm confrontational like that.

And apparently that's not ladylike.

drstaceyny said...

pc--another good example. Kinda calls into question the whole idea: You're healthy, but still "overweight." If the weight standards are in place for health purposes (as they say they are), then what do we do w/you? Why are you "overweight"?

Re: your last paragraph, well said.

lm--I'd love to be a fly on the wall in that exam room. . . .

littlem said...

"lm--I'd love to be a fly on the wall in that exam room. . . ."


Well, it does really serve as a method from separating the boys/girls from the men/women, as far as doctors go.

I stay with the docs that take questions from their patients (my dentist, dermatologist, and ENT all have national reps, and the bp is 112/74 (although not as low as Pinkcat's; I'm a little high strung, like you couldn't tell, haha)) -- they seem to be the most early-adopter-state-of-the-art types, and generally smarter too, at least to me -- the others gotta go.

'Cause after all, aren't those of us who have some clues about the issues supposed to be the ones leading the revolution, one doctor's visit at a time? If not us, who?

(Anyone on the board who lives in NYC and likes their GP, please let me know -- I luuurve my specialists, but most of the GPs I meet seem to be pompous windbags.)

Anonymous said...

On a sort of related side note, a study by Dr. Holloszy of Washington University brings up the theory that reducing caloric intake (to between 1,000 and 2,000 calories a day - depending on certain factors) actually lengthens life and quality of life. The theory goes that when the body is slightly stressed with the restriction of calories the body slows its aging and reproduction and reduces free radicals in the body. The goal isn't weight loss, but health and long life.

The study began in rats, and has continued in humans with pretty amazing results.

drstaceyny said...

lm--no leads on GPs (I only like my specialists, too). : (

anon--there are a few of these studies floating one. This one seems to be correlational (i.e., there's no evidence that the calorie restriction caused the increased lifespan). It seems there are other factors that may be at work--e.g., perhaps those who choose to restrict their diets also make healthy choices (lots of fiber, vitamins, etc.), exercise, don't smoke, etc. It's hard to weed these things out w/out a true experimental design.