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3 Problems with Equating Weight and Health

I’ve written before about how a low or “normal” weight doesn’t mean good health, just as a high weight doesn’t mean poor health. Thin people may be sick, and fat people may be quite healthy.

But Aubrey Gordon highlighted a few other important points about this correlation in “You Just Need to Lose Weight”: And 19 Other Myths About Fat People (Myths Made in America) that I wanted to share and comment on.

Mortality rates attributed to obesity

Myth #6 in Gordon’s book is: “Obesity is the leading cause of death in the United States.” Perhaps you’ve heard that myth before, and you might have even believed it, considering how widely it’s used.

You might have also heard the statistic: “Obesity kills four hundred thousand Americans every year.” (loc 953)

Those phrases are certainly alarming, but that doesn’t make them true. And once you start looking into it, you can find plenty to question about these assertions.

As Gordon points out, it’s extremely complicated to sort out what deaths might actually be caused by people being overweight. After all, thin people can also have health conditions that are often associated with obesity, like type 2 diabetes, hypertension, and heart disease. And plenty of other factors can contribute to poor health:

“[Fat] people could have other health issues or life experiences that complicate their condition: living in poverty, dealing with addiction, handling the stress of living with racism, and facing discrimination in healthcare can all complicate diagnosis, treatment, and mortality. How could one know that those same deaths wouldn’t have occurred had those same people been thin?” (loc 969)

That’s an excellent question, and while it can’t be truly answered, it should be considered carefully, to avoid assigning an inaccurate cause of mortality. Unfortunately, that’s not how things happened.

It seems that studies in both 1999 and 2004 assumed that any difference in mortality rates between thin and fat people was simply because of added weight. “Thin people can die of all manner of things, but in the logic used by these studies, any fat person who passed away when a thin counterpart didn’t would have died because of their fatness.” (loc 1012)

Meanwhile, a different study done by Katherine Flegal got a vastly different estimate. Instead of hundreds of thousands of deaths attributed to obesity, she estimated 25,815 excess deaths in 2000, for those with BMI >= 25. She also estimated that 33,746 deaths were related to people with an “underweight” BMI. (loc 1024)

The reality is, no one dies from being fat. They may have a health condition commonly associated with a higher BMI, but that doesn’t make obesity the cause of death. So, if you hear those high statistics about obesity deaths in the future, take a closer look before believing them.

BMI as a measure of health

I don’t know about you, but I’ve become very disillusioned with the Body Mass Index (BMI) chart. It makes me angry to have this chart dictate how I’m treated by doctors, especially after learning about the history of the BMI.

I don’t remember ever being told about how the BMI came about, but I assumed that it must have been created by a doctor and had some medical basis to back it up. But I was wrong.

The BMI was created in the 1800s by Adolph Quetelet, an academic who was interested in finding averages in all kinds of things, hoping to find new ways to understand people. He didn’t have access to a lot of data, though, so he worked with what he had: data gathered about white Western European men in the military. For Quetelet, who lived in a time when racism was the norm and women couldn’t vote, it wasn’t a concern that he didn’t have data about women or people of color.

As problematic as that is, it’s also important to note that Quetelet “was clear about one aspect of the BMI: it was never intended as a measure of individual body fat, build, or health. To its inventor, the BMI was a way of measuring populations, not individuals, designed for the purposes of statistics, not individual health.” (loc 1129)

Additionally, the definitions of obesity and overweight have changed over time. In 1995, the World Health Organization (WHO) formed an International Obesity Task Force, many of whom had a clear conflict of interest because they worked for weight-loss clinics.

The task forced ignored the researchers who advised that the BMI was too restrictive and that a wider range of weights could be considered healthy. Instead, the task force made the BMI more restrictive.

Then in 1998, the National Health Institute followed suit by aligning its definition of “overweight” and “obese” with the more restrictive guidance from WHO. Suddenly, people who had been a normal weight became “overweight.”

All this means that the BMI may not even be accurate for the white men it was originally based on, and it’s certainly not accurate for people of color, women, or trans or nonbinary people. It seems like it’s high time to find a better and more accurate measure of health.

Weight bias in doctors

And yet another major problem with equating weight and health is that it reinforces weight bias in doctors.

Apparently, some people don’t think that doctors are biased against those who are overweight. I’m guessing this applies to “normal” weight or thin people who’ve never experienced disdain from a doctor because of their size.

That disdain is one big reason why so many fat people – including myself in my younger years – avoid going to the doctor. It can feel humiliating to be lectured by someone about your size (which, by the way, you already knew about) and it can feel futile to try getting an actual diagnosis instead of, “You just need to lose weight.”

And this treatment isn’t something we’re imagining. As Gordon wrote: “For twenty years, studies that set out to examine anti-fat bias in medical settings have confirmed not only that it exists, but that it is incredibly prevalent among healthcare providers of all stripes. In 2001, the International Journal of Obesity published a study that found those anti-fat judgments caused material differences in the outcomes of care received by fatter patients.” (loc 1324)

Doctors’ notes also reveal that they think heavy patients are lazy, weak-willed, ugly, non-compliant, and must lead miserable lives. And the situation is even worse for people of color and LGTBQ people.

With all this research, plus plenty of anecdotal evidence, is it any wonder those who are heavy put off going to the doctor? But if they do, then their health may get worse, increasing the perception that fat people are unhealthy because of their weight. It can become a vicious cycle.

It doesn’t have to be this way, though. Doctors could receive training to help them become aware of their weight biases and work to overcome them. They could be encouraged to treat fat people with the same care and compassion as those who aren’t fat. But until and unless this happens, the anti-fat bias in medicine will continue to negatively impact too many.

Weight is not health

Our society tries very hard to convince us that weight is the same thing as health, and it succeeds all too well, as you can see from how many people believe the idea that obesity kills, and how doctors treat those who are heavy.

But the prized tool used by the medical field, the BMI, is something that was never meant to indicate individual health, and it excludes so many people. And health and weight are not the same thing. This is important for all of us to remember so we can try to combat this perception in our society and work to ensure that everyone gets good treatment, no matter their size.


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