Monday, November 23, 2009

Omg panic: only 92% of "obese" people think they need to lose weight!

This is not an Onion article, but it's so depressingly hilarious that you'd think it might be.

The article starts with a statistic: in the Dallas Heart study, of the 2056 "obese" people surveyed, 8% "said they were satisfied with their body size or felt they could gain weight."

Well, it's really a shame that only 8% of "obese" people are satisfied with their body size, but I guess that figure is not surprising. Maybe the article will go on to suggest ways we can help fat people to overcome their feelings of inadequacy in a culture that places such intense pressure on people to conform to an arbitrary and very small body norm? Oh... wait... I'm being told that wasn't the point of the article. No, it turns out that the "story" here, according to Tiffany Powell MD, is that those 8% are suffering from a "misperception" and "don't understand they are overweight," and so doctors need to hassle them about it more to get it through their fat skulls that they need to lose weight. Yes, Tiffany, I'm sure that's it: "obese" people are so stupid that they just "don't understand" that they're fat.

Of course, every article about "obesity" has to contain at least one gigantic and utterly unfounded leap of logic, and here it is: "Those with a misperception of body size believed they were healthy. But 35 percent of them had high blood pressure, 15 percent had high cholesterol, 14 percent had diabetes and 27 percent were current smokers. These risk factors are similar to obese individuals who acknowledged they had a weight problem and needed to lose weight, Powell said."

So did they also ask people if they "believed they were healthy," and it turned out that the exact same fat people who were satisfied with their bodies were the ones who said they believed they were healthy? Gee, that would be an interesting finding... but I have a sneaking suspicion that the author of this article is simply asserting that if a person said they were satisfied with their body size then that means they think they are healthy. Earth to mind-bogglingly stupid author of article: those two things are not the same at all. Maybe you should go back to reporting school. Or, like, preschool.

Another teeny problem is the inclusion of smoking as a risk factor that is supposed to have something to do with being "obese". Here's the logic as far as I can see: this person doesn't think she needs to lose weight, and therefore I will assume she thinks she is healthy even though she didn't say that. But really, this person is not healthy, which we know from the fact that she is a smoker. Therefore she needs to lose weight. And therefore she is an idiot for not knowing that she needs to lose weight, because all she needed to do was think about the fact that she is a smoker and therefore obviously unhealthy, and that there could only be one solution to this problem: lose weight!

So, OK, let's just set aside the smoking category (we'll assume the author was smoking something him/herself when he/she decided to include smoking) and look at those other "risk factors". Even if we simply add up all the percentages, we come to 77% of the "obese" people who thought they didn't need to lose weight as having some kind of health problem. Which means that at the very minimum, 23% of the "obese" people who supposedly thought they were "healthy" were absolutely right according to the health measures mentioned in the article! And let us remember that there is likely to be significant overlap between the people who had high blood pressure and high cholesterol, and possibly diabetes too. So possibly up to 65% of the stupid fatties in this study who think they're healthy are totally right.

But hey, let's not get bogged down with the facts -- or even the version of "facts" reported in the article. Let's just continue to assume that all fat people are unhealthy and that our goal should be to make sure that 100% of fat people (not a measly 92%) are fully aware that they are fat and therefore unhealthy and that they have to lose weight. Even if we grant all that, there are some other really questionable conclusions here. For example, "Those who misperceived their body size were less likely to go to a physician. In fact, 44 percent didn't visit a physician during the past year, compared to 26 percent of obese participants who correctly perceived they needed to lose weight." The idea is apparently that it's bad if you don't think you need to lose weight because then you won't go to the doctor. But I have some other ideas that would explain these correlations. How about this: if you are unhealthy you are more likely than a healthy person to go to the doctor. And if you are fat and unhealthy, given all the messages you hear about fat being unhealthy, you are probably somewhat likely to blame your poor health on being fat, and therefore to think that you need to lose weight. Even if not, if you are fat and unhealthy you are likely to be told by your doctor that you need to lose weight. So there, I've just explained the correlation, and notice how my explanation doesn't rely on the idea that a fat person who is stupid enough to be satisfied with his/her body is also too stupid to go to a doctor. Or here's another, more depressing possibility: people who are fat but don't think they need to lose weight avoid going to the doctor even when they get sick because the doctor is likely to tell them that they need to lose weight rather than actually bothering to diagnose their real health problem.

My friend who sent me the link pointed out a similarity between this and our cultural attitude towards "depression": if you're a sensitive, introspective person who feels saddened by the state of the world, rather than being able to glibly go through life thinking everything is hunky dory the way that most people apparently do without getting bummed out by things like war and global warming, then clearly you are the pathological one and you must have a medical problem that needs to be treated in order to bring your worldview into alignment with everyone else's.


meerkat said...

Spot on!

I particularly like the bit about depression at the end.

Jay said...

Fat people should always be working towards correcting their obesity.

Mary said...

Totally!!! LOL

Jen said...

Oh my! That is very close to the stupidest article I've ever read! What is it with people? When it comes to discussing fat, it's like logic goes right out the window! How many of the people who thought they needed to lose weight were actually healthy? Did they bother finding out so maybe those folks could relax and feel better about themselves? And can we compare it to a group of "normal" people to see how many of them are unhealthy? Oh...wait. They probably couldn't find enough "normal" people to make a group.

Anonymous said...

I mean this comment with total respect. I've just come across your blog but I don't get it - what exactly is your message? It seems like you take a sarcastic tone against anything that condems obesity or being overweight.


I don't understand why there is a "fat acceptance" movement. Why cant people accept that there is something wrong (USUALLY) with being fat? Listen, I'm not saying that every person who is of "normal" weight or is "under weight" is healthy. But if being overweight or obese were the norm, if they were what nature intended, then why is this a recent phenomenom?

Yes, people have been overweight and obese since a long, long, long time ago. But the percentage of people becoming this way is increasing. THIS is not natural.

How can i make this claim?

Because if you eat vegetables, fruits and a wide variety of other healthy foods, if you do this slowly and mindfully and if you are decently active throughout the day, then MOST people won't become overweight or obese.

I'm not saying some of this isn't genetic. I'm not saying its fair that some "normal" weight or underweight people can eat badly and have dangerous amounts of visceral fat but it doesn't show on them (thus appearing "healthy")

But why take aim at studies that are trying to pound into the heads of americans and other citizens around the world that you should EAT LESS! If they were saying, "Hey! Be like a model and weigh only 120 pounds even though you are 5'10!", well then I'd be all on your side.

But why hide from the facts: People shouldn't be fat. Why? Its not natural. Humans are animals, right? If it were natural, we'd see it across the animal kingdom, but we don't. (well, accept domesticated animals that are made obese by their owners - now THAT is abuse!) If people are fat or obese, they should want to lose weight. NOT only for aesthetic reasons (though I won't act that this isn't a reason I believe in) but for HEALTH reasons.

I understand trying to move the direction away from villanizing the overweight and obese. But to nitpick at articles like this is doing the population a disservice.

You can still be PRO HEALTH, against villanzing the overweight and obese but still have a message that people really should take care of themselves.

Mary said...

I appreciate your politeness, Anonymous. The problem is that you are making a lot of assumptions that are not true, or at least are not supported in the scientific literature. It's not your fault; they are mainstream ideas that you hear every day from very authoritative-sounding people.

For example, take the idea that being fat in itself is unhealthy. There are large-scale morbidity/mortality studies that show this claim to be incorrect; when you control for diet and lifestyle, fat people actually live longer than thin people and have better health outcomes with respect to certain diseases. Paul Campos has written a lot on this topic, and I think if you took the time to look at some of the studies he reports on, you would be quite surprised at the disconnect between what the media says about the relationship between fat and health and what the actual studies say (especially those studies that are not directly funded by the diet industry).

You also asserted that if a person eats well and exercises, he/she will not be fat. This is simply an assumption that you are making; I can tell you from personal experience that it is false. You did temper the claim by saying that it applies to "MOST" people. But even that is simply speculation.

You might be interested in the literature on Health at Every Size (HAES -- you can find it by Googling). There is a growing scientific literature showing that when people start engaging in the healthy lifestyle activities you mentioned (eating veggies, eating mindfully, being active, etc.), their health indicators improve -- blood pressure, cholesterol, blood sugar, etc., but they do not necessarily lose weight, and the health benefits seem to be totally independent from the weight that some people do end up losing. Everyone seems to think that weight loss makes fat people healthier, but in every study that seems to show this, the people in the study were engaging in healthy *activities* that would be obvious causes for both improved health and weight loss. There is no credible study showing that weight loss itself without improved health habits leads to better health.

I am all for good health. I try to live a healthy lifestyle and I think it's great when others do, too. But I don't think it's my place (or yours or anyone else's) to tell people that they "should take care of themselves" -- it's a matter of personal choice. I also believe we actually harm people's health when we say things like "being fat is unhealthy" -- because not only is it not true, but it encourages people to think that if they are thin they are automatically healthy and shouldn't concern themselves with eating well or exercising (you acknowledged this problem already). It also causes fat people to think that all they have to do is get thin and they will be healthy; in fact, there is a study on liposuction patients that shows that if you artificially make a fat person thin through liposuction, they do not get any health benefit at all. And not only does this false belief cause fat people to harm themselves (e.g., by undergoing dangerous surgery) to become thin, but it also discourages fat people from exercising and eating well. If you've tried every diet known to man and you're still fat, and if you believe that the only way to be healthy is to be thin, then why bother eating well or exercising if you know you're never going to get thin? I know many people who have this attitude, and I think it's sad and wrong, and I don't want to contribute to that.

One last point about the "it's unnatural" claim. I don't find that type of argumentation to be persuasive. People say it about homosexuality, too. In fact there is homosexuality elsewhere in the animal kingdom. But even if there weren't, who cares? There are a lot of characteristics that make human beings unique -- they shouldn't be declared "wrong" or "unnatural" just because other animals don't exhibit them.

Anonymous said...

Mary, thank you for your thoughtful response (i'm annonymous - i really should get a username, i'll do it soon!).

I read what you wrote and find it to be great. I think what you are saying probably does apply to a percentage of the population. I too agree that you can be healthy at many sizes. I am open to reading articles that support the assertion that having a little extra body fat can be beneficial.

But what bothers me (and maybe its not my business to be bothered) is that it seems like there are certain facts that are being ignored. For example, my "natural" argument (btw, I didn't mean it to sound rude. Reading over my first post makes my argument sound ridiculous, so I'll try and do a better job here). Look at all animals in nature. Have they, within one generation, dramtically increased the percentage of their population that has more fat on their bodies? I think its safe to say we can all see people getting bigger and having more fat on their bodies. If some people can claim that this isn't necessarily harming anyone then I just can't agree with them. Diabetes, heart disease, cancer- everything is on the rise. We are seeing diabetes in higher rates in children. I know there are other culprits and that its not a simple blame game. But the fact still stands that there are more people who are overweight now, this was never found in the human race before (at such porportions) and we are incidentally seeing a rise in certain diseases.

So lets say that being moderately overweight may not be such a bad health risk for some people. Would you still argue, though, that there shouldn't be a push in getting people thinner? Not to be "thin", mind you, but to shed exccess fat? This is what bothers me about posts like this. I feel like you shouldn't nitpick.

Yes, 100 % people shouldn't discriminate. There shouldn't be others being rude or unjust to someone because of their size. But i truly believe that the answer doesn't lie in accepting it either.

Mary said...

It's possible that rates of diabetes, etc. are on the rise. I don't know the numbers, and I don't know to what extent the numbers are increasing due to these diseases simply being diagnosed more, or the thresholds being lowered (for instance, 120/80 used to be the "normal" blood pressure but now I think they say 120/70; I think the blood sugar level cutoffs for diabetes/pre-diabetes also have been lowered), but I could believe that those diseases are on the rise.

However, over the last 40-50 years, the weight of the average person has increased only by something like 8-12 pounds. This small increase (combined with a lowering of the BMI cutoffs for overweight/obese in the mid 1990's) was enough to push a whole lot more people in the middle weight range into the "overweight" or "obese" category, but in terms of individual health it likely made very little difference. On multiple occasions I have lost or gained more than 8 pounds in a single week. You barely even notice 8 lbs. in the fit of your clothes. And if you have a "normal" BMI, even the most anal-retentive doctor is not going to hassle you if you are 8 lbs. over the exact statistical middle of the "normal" BMI range. People's weights are not really ballooning the way you think they are; as in any witch hunt, the more witches you think there are, the more likely you are to spot them everywhere you go.

In any case, weight and health are two completely separate things, and there is no study that shows that being fat *causes* any of the diseases you identified. If those diseases are truly reaching epidemic proportions and a public health campaign is needed to reverse those trends, I feel strongly that this should be kept strictly separate from any discussion about weight. So yes, to answer your question, I feel that there should absolutely not be "a push in getting people thinner". Such efforts are not only orthogonal to efforts to improve health, but in fact they actually *harm* peoples' health in a variety of ways.