Sunday, March 24, 2013

7 Problems With the "Obesity Epidemic"

Here are 7 reasons why I cringe every time I hear someone talking about "the obesity epidemic"

1. "Obesity" is not contagious.

Consciously or unconsciously, when most of us hear the word epidemic we think of a virus rapidly spreading through a population.   And consciously or unconsciously we tend to think of its "carriers" as a threat.   Speaking of "obesity" as an epidemic thus further stigmatizes fat people who are already having to deal with discrimination in a society that privileges thinness

2. "Obesity" is not a disease.

The idea that high body weight or high percentages of body fat correlate to poor health are based on just that -- correlation.    Most studies that suggest a link between a high BMI or high body fat percentage fail to account for confounding factors such as behavioural patterns around diet, exercise, and yo-yo dieting.   When those factors are taken into account, differences in mortality between "overweight" or "obese" people and people whose body weights or health percentages are considered "healthy" begin to disappear.   People at the extreme high end of the spectrum for BMI or body fat do have higher mortality rates -- but the same is true for people at the extreme low end of either spectrum.    A disease is a physiological disorder that causes impairments in biological function.  Hence obesity is not a disease. 

3. BMI, the primary measurement of "obesity" is a virtually meaningless indicator.

The much vaunted "Body Mass Index,"  used to "measure" obesity by many physicians, and increasingly, educators and public health workers, is a crude ratio of weight to height that does nothing to take into account even obvious factors like bone density and muscle mass, not to mention the wide diversity of body types that exist around the world.   Its definitions of "overweight" and "underweight" are also pegged to already dubious assumptions about the "proper" weight of people of European descent that are even less applicable to people of non-European ancestry.

4. Public education campaigns about "obesity" tend to focus on giving people information about better food choices, while glossing over the real problem of malnutrition in North America rooted in a broken food system that denies many people access to good food.

 There is a real public health crisis in North America related to food -- malnutrition, which can express itself in weight gain, in weight loss, and in chronic disease.   At issue is the accessibility of food that provides people with their nutritional needs.   The nutrient poor "Standard American Diet" is the result not of poor education about nutrition, but of the fact that a carbohydrate and sugar rich diet is the most affordable diet for many people  a) because of agricultural subsidies for corn, wheat, and sugar and b) because carbohydrates and sugars are sources of quick energy that can more easily satisfy cravings when people haven't had enough to eat.   The problem isn't that people don't know that Kale is healthier than Kraft Dinner.   The problem is that people are trying to feed their families on wages too low to pay the escalating costs of food, housing, transportation, clothing, and medical care.    As a brilliant post at the Fat Nutritionist blog points out:

"You want people to eat better? Give them enough money, a place for cooking and storage, and access to a decent variety of food. "

5. The pathologization of fatness tends to lead health care practitioners to pay less attention to other causes of health problems in fat people.

Over the years I have had many doctors simply chalk chronic health problems I was dealing with up to weight while ignoring other factors.   The expectation that fat people will be less healthy tends to lead many healthcare practitioners to accept a lower quality of life as normal for fat people.   As I have dealt with many of my own chronic health issues, addressing them through diet and exercise, I have lost weight.   But some problems doctors previously chalked up to weight have remained.   And the underlying problem was not that I was fat, the underlying problem was that shaming about my body had made me believe my health was hopeless.   If instead of just telling me I was too fat my doctors had encouraged me to see how I could make changes in my life that would make me feel better regardless of my weight, I probably would have started making those changes at least 10 years earlier than I did.    And I also would have sought guidance from health care practitioners earlier and more often I had expected something other than shaming.

6.  Defining weight or body fat as the problem tends to encourage people to take drastic measures to lose weight rather than focusing on health.

There are lots of ways to lose weight -- and most of them are taxing on the body and difficult to sustain.   Pressuring people to lose weight makes them more likely to focus on whatever will bring off the pounds rather than on finding sustainable practices to integrate into their lives that can make them healthier in the long run.

7.  The campaign against "obesity" is rooted in a puritanical ethic.

Anti-obesity campaigns judge, criticize, and shame people not only based on their body size, but also based on the often erroneous assumption that fat people lack discipline and just need to say "no" to immediate gratification in order to lose weight.   The underlying ideology is one of denying pleasure in order to achieve virtue -- a repressive ideology that cuts people off further from their bodies.  And its in truly learning to find comfort and pleasure in their own bodies that people can best find their way to health.

There are dozens of other reasons I could give, but these are just a few thoughts to further questioning and discussion  . .


23 comments:

Micheal Clark said...
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Anonymous said...

Wow, so we'll said. #5 in particular, every fat person has lived this personally and you're are so right about how much more we'd all care for ourselves if given health information at the doctors office instead of a heaping dose of destructive shame.

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