Can You Be Fat and Healthy?

We are told over and over that people in larger bodies are unhealthy. It’s the underlying assumption that drives the so-called “obesity epidemic” that everyone from doctors to Michelle Obama to Susan on Facebook are ranting about. This assumption about weight and health is so pervasive that most people don’t even stop to question it.

So is it true? Does being fat automatically mean that you’re unhealthy? Or put another way, is it possible to be fat and be healthy?

Believe it or not (and most don’t at first), there’s empirical support for the idea that you can be fat and healthy. Let’s take a look.

What the “Evidence” Leaves Out

First, we have to realize that all the evidence we hear on this topic is selected specifically to support the fat=unhealthy assumption that already exists. It’s human nature to ignore or reject information that doesn’t fit with our preconceived beliefs. So much of the evidence that supports the idea that people can be healthy at all sizes (e.g. Health At Every Size, or HAES®) is not even discussed.

Here is a summary of just some of the data supporting HAES®, as stated by Dr. Arya M. Sharma, MD, DSc (hon), FRCPC. Dr. Sharma is a Professor of Medicine & Past-Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada, and he writes:

“For one, as reviewed by the authors, a comprehensive search of the literature reveals at least six randomised controlled trials indicating that a HAES approach (focussing on promoting health behaviours and size acceptance rather than weight loss) is associated with statistically and clinically relevant improvements in physiological measures (e.g. blood pressure, blood lipids), health behaviors (e.g. physical activity, eating disorder pathology), and psychosocial outcomes (e.g, mood, self-esteem, body image). None of these studies found adverse changes in any variables.”

Additionally, a government survey indicated that over half the “overweight” adults (51.3%) being targeted were metabolically healthy. There are studies showing that weight and BMI are poor predictors of disease and longevity (see the sources listed at the bottom), and the bulk of epidemiological evidence suggests that five pounds “underweight” is more dangerous than 75 pounds “overweight.”

In another study comparing the HAES® model to a diet approach, though only dieters lost weight, both groups initially had similar improvements in metabolic fitness, activity levels, psychological measures, and eating behaviors.  After two years, dieters had regained their weight and lost the health improvements, while the HAES® group sustained their health improvements.

This is just some of the research behind HAES®, but truthfully, there’s way too much for me to cover it fully here in just a blog post. Please consider additional reading on the topic, which can be found on my Resources page.

What the “Evidence” Gets Wrong

The fact that contradictory evidence gets left out or dismissed is not the only issue. The other problem is that the evidence to support the claim that being fat is unhealthy is just not as cut and dry as we’ve been told. There is literally NO study that has proven being fat causes illness or disease. Some studies show an association between being fat and having certain conditions, but as anyone who has ever studied research and statistics will tell you, correlation does not equal causation. (Say it again with me: correlation does not equal causation!)

For instance, what if I told you that the more ice cream is consumed, the more murders there are. Crazy, but yes, it’s an actual correlation. However, I doubt anyone would claim that eating ice cream causes people to commit murder. You would probably assume it’s either a coincidence or that there is another factor driving both increases. Maybe the heat? People are more likely to buy ice cream in summer months when it’s hot, and perhaps people are also more likely to murder someone because hot weather can make people irritable and temperamental. We don’t really know, but the point is, that in examples like this, we see pretty easily that it would be erroneous to assume correlation equals causation.

Yet that’s what we do all the time with “obesity” studies linking higher weights to certain conditions. We don’t really know that weight causes those conditions, only that they correlate to higher weights. Perhaps there are underlying factors driving both? A very real possibility for that is the emotional stress involved with being in a larger body, especially for those who suffer bullying, discrimination, or even abuse. (It’s well documented that discrimination is a chronic stressor and can increase people’s vulnerability to physical illness.) Another possibility is there’s an underlying physical condition that causes both. Still another possibility is that larger-bodied people are less likely to seek healthcare due to negative experiences with fatphobic medical professionals, and therefore, conditions aren’t caught and treated as early or effectively.

Do you see what I’m getting at? We JUST DON’T KNOW but we sure like to pretend that we do. The truth is that weight, genetics, nutrition, medicine, mental health… all work together somehow and we don’t have it figured out yet (if we ever really will). It’s incredibly complicated! I’m not saying we should stop trying to figure it out, but we definitely should stop blaming everything on weight. A mistaken belief that we’ve already discovered the truth prevents us from searching for the real truth. And our mistaken assumptions end up hurting people of all shapes and sizes in many, many ways, but mostly, of course, those in larger bodies.

Want to Know More?

Check out my Resources page for recommended reading and podcasts related to HAES® and anti-dieting (start with Christy Harrison’s Anti-Diet book or Food Psych podcast if you’re not sure where to start). Or if you’d like to talk with me or someone on my team, please contact us.

Sources

http://www.drsharma.ca/obesity-the-science-behind-health-at-every-size-haes

https://www.buzzfeednews.com/article/kjh2110/the-10-most-bizarre-correlations

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/discrimination

Gaesser, G. (2002) Big Fat Lies: The Truth About Your Weight & Your Health. Carlsbad, CA: Gurze.

Flegal, KM et al. (2005). Excess deaths associated with underweight, overweight, and obesity.JAMA, 293(15) 1861-1867.

Flegal, KM, Graubard, BI, Williamson, DF, Gail, MF (2007). Cause-specific excess deaths associated with underweight, overweight, and  obesity. JAMA, 298(17), 2028-3037.

Orpan HM, et al.(2009).  BMI and mortality: Results from a national longitudinal study of Canadian adults. Obesity, doi:10.1038/oby.2009.191

Tamakoshi1 A, et al. (2009). BMI and all-cause mortality among Japanese older adults: Findings from the Japan collaborative cohort study. Obesity, doi:10.1038/oby.2009.190

Campos P (2004).The Obesity Myth. New York: Gotham Books.

Bacon, L, VanLoan M , Stern JS, Keim N. Size acceptance and intuitive eating improve health for obese Female chronic dieters. J of Amer Dietetic Assoc 2005;105:929-936.

Wildman RP, et al. (2008). The obese without cardiometabolic risk factor clustering and normal weight with cardiometabolic risk factor clustering: Prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Archives of Internal Medicine, Aug 11, 168(15):1617-24.

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