Fat and happy

The World Health Organization defines “overweight” as someone with a body mass index (BMI) of 25 or higher. BMI is calculated by weight in kilograms, divided by height in meters, squared. You’re considered obese if your BMI is 30 or higher and morbidly obese if it’s 40 or higher. But in case you haven’t heard the griping coming from the size-acceptance camp—backed up by books like Fat! So? by Marilyn Wann, The Diet Myth by Paul Campos, Dispensing with the Truth by Alicia Mundy, Fat Politics by J. Eric Oliver—BMI isn’t really a good determinant of unhealthy weight, and maybe, just maybe, this whole so-called “obesity epidemic” is a bit out of control. Just not in the way most people think.

BMI critics like to use Tom Cruise as the unwitting spokesperson—the short yet muscled man has a BMI of 31, which makes him technically obese. Using BMI as the standard, according to the National Health and Nutrition Examination Survey (NHANES) 2001 to 2004, about two-thirds of U.S. adults are overweight or obese and the estimated total cost of obesity in the United States in 2000 was about $117 billion. The point authors like Campos, who’s also a law professor at the University of Colorado in Boulder, want to make is that the numbers you typically hear associated with the obesity epidemic are inflated. What the numbers suggest is that overweight and obese individuals are likely unhealthy and therefore causing a strain on the medical system.

“It’s not that there’s no health risks involved with being overweight or obese,” Campos says. “It’s not that it’s 100-percent false—it’s just 97-percent false, and the risks are widely exaggerated and manipulated for all kinds of purposes. You know, the pharmaceutical industry is just behind so much of this propaganda so they can get the next generation of diet pills through the pipeline…. It’s estimated that the weight-loss industry pulls in 40 to 50 billion [dollars] a year—double the money people spend on book purchases a year, just to put things in perspective.”

According to the American Heart Association, the American Diabetes Association and the Centers for Disease Control and Prevention (CDC), all of which rely on BMI to cull their statistics, overweight and obese individuals are at increased risk for numerous diseases and health conditions, including hypertension, type 2 diabetes and strokes.

Campos isn’t saying that’s not true. He’s simply arguing that it’s only people who are in the highest weight ranges who are at risk for health problems. “BMI is set at a ridiculously low level so we can pretend there’s this epidemic going on.”

But why?

Once something is called an “epidemic,” says Abigail Saguy, an assistant professor of sociology at UCLA, who’s written extensively on obesity and society, media pay attention, the Food and Drug Administration approves drugs quicker, researchers get funding and private health organizations get their good-intentioned messages about proper nutrition and exercise heard. If something’s an epidemic, it gets priority.

Saguy traced the origin of the term “obesity epidemic” to the mid-’90s, after a publication by CDC researchers noticed the increasing number of people who are overweight or obese according to the BMI. Soon after the report was released, Xavier Pi-Sunyer wrote an editorial published in the Journal of the American Medical Association. In it, he said, “If this were tuberculosis, we’d call it an epidemic.”

“So it was metaphorical at first,” Saguy explains, “but then the metaphor was dropped and people just use it. Some people know that epidemic can mean ‘more than to be expected,’ but that’s so subjective, because what sort of numbers are we supposed to expect? Most lay readers still hear ‘wild,’ ‘uncontained,’ ‘spread’ and ‘contagion’ when they hear the word ‘epidemic.’”

And more than just finding a nicer, politically correct term, Saguy suggests rethinking or reframing the entire campaign. In a way, she’s saying we should leave fat people alone—it’s the unhealthy people we should be targeting with get-healthy messages. There are plenty of people, she says, who are overweight and healthy.
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Take Rachel Richardson for example. A journalist and graduate student in Cincinnati, Ohio, Richardson writes The-F-Word.org—a blog about food, fat and feminism—and studies the history of eating disorders. She’s also a survivor of bulimia and anorexia—she lost 175 pounds and eventually got down to 125, which was considered an average BMI for her height. “But it required an anorexic lifestyle to maintain,” she says, “and now that I have the healthiest relationship I’ve ever had with food, I’m back to being considered as fat again.”

Richardson is a vegetarian and tries to eat organic and locally grown foods as often as possible, but her picture on her blog shows a full-figured woman most would consider chubby.

Basically, the losers in the war on obesity, according to Saguy, are people like Richardson who are visibly overweight but technically healthy. The huge number of people who fit in that category are continually stigmatized because of a public-health policy that says being fat is inherently bad.

“The commonsense wisdom is that fat is a choice,” Saguy says. “That a lot of people are able to justify their bigotry by blaming fat people for their predicament—you know, I’ve actually heard people say this: ‘I’m doing them a justice by making them feel bad.’ That by stigmatizing fat people you provide an incentive for them to lose weight in the same way you stigmatize smokers to get them to stop smoking. And I have no idea if it works with smoking, but what I know is that it’s rarely effective and it has all sorts of negative effects with weight, often leading people to binge or stay indoors and not go out. In general, I just don’t think social stigma’s a good policy.”

In a study published this month in the American Journal of Public Health, researchers found that the difference between actual and desired body weight is a stronger predictor than BMI of mental and physical health. In other words, the results raise the possibility that some of the health effects of the obesity epidemic are related to the way people see their bodies, and the way people see their bodies is the way society sees their bodies—fat, disgusting and unhealthy.

“It’s a big mistake to assume that because someone is fat, they have a bad lifestyle,” Campos says. “You know, that they compulsively eat or never exercise, because there are lots of fat people who have perfectly healthy lifestyles. And there are plenty of thin people who have quite unhealthy lifestyles. It’s very dangerous to generalize about that stuff and it’s very socially corrosive to use body mass as a proxy for healthy lifestyles. And it’s also very false to tell fat people that they’ll be better off if they try to make themselves into thin people.

“The fact is,” Campos says, “most diets fail. What we should be doing is recognizing that healthy people come in all sizes and especially that pathologizing heavier bodies doesn’t help anybody. It hurts. The attitude of our public-health authorities is literally that the reason there are fat people is that they have not been informed of the social desirability of thinness, which is just about as crazy as thinking that there are poor people because they just aren’t getting the message that it’s desirable to have money in this country. And, to me, I don’t think it’s a coincidence that the population has gotten heavier as the obsession with thinness has gotten more intense.”

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