“No Longer Defensible”
I don’t think there is a person who is connected to the wider world somehow (e.g., internet, evening news, newspapers) who doesn’t know that the AMA declared obesity a disease this week. Many Fat Acceptance bloggers have written about it.
In the same week that this is happening, Time Magazine posted an online article about, well, about a sort of Fat Acceptance. Oh, they didn’t call it that, but that’s what it was.
Yes, there are certain health risks associated with having an elevated BMI, such as Type II diabetes and heart disease. More broadly, a higher BMI is associated with a greater risk of cardiometabolic abnormalities, as measured by blood pressure, triglycerides, cholesterol, glucose, insulin resistance and inflammation. Nonetheless, almost one quarter of “normal weight” people also have metabolic abnormalities, and more than half of “overweight” and almost one third of “obese” people have normal profiles, according to a 2008 study. That’s 16 million normal weight Americans who have metabolic abnormalities and 20 million obese (or 56 million overweight and obese) Americans who have no such abnormalities.
One explanation for this discrepancy is that physical fitness and/or nutrition – rather than weight per se – may be what really matters. Several studies have shown that physically fit “obese” individuals have lower incidence of heart disease and mortality from all causes than do sedentary people of “normal” weight. A recent clinical trial published in the New England Journal of Medicine showed that adopting a Mediterranean diet reduced cardiovascular risk independent of weight loss.
Let’s read that again. Exercise and good eating habits reduced cardiovascular risk independent of weight loss.
This is from Time. You know, Time, with its series of five articles it ran under the heading of “Overcoming Obesity.” Time, with pages telling us that “smaller dishes could cut childhood obesity” and that “ADHD may prime boys for obesity.” (No, I’m not going to link to those articles, they are easy enough to Google, and I don’t want to give those articles free clicks.)
And then, across my Facebook feed tonight, I saw a link to this article called “The Obesity Era.” The article basically shows just how complex an issue weight and weight gain is, and how the thermodynamic module (basically, “calories in/calories out”) is too simplified a concept to address the issue. This article systematically dismantles the idea that “a calorie is a calorie is a calorie, and if you’d just eat less and exercise more, you’d be thin and presumably healthy.” And, of course, for all the good it does, it also does the whole “we shouldn’t stop trying to forestall a major public-health menace” thing.
However, it has a lot of good things in it:
And so we appear to have a public consensus that excess body weight (defined as a Body Mass Index of 25 or above) and obesity (BMI of 30 or above) are consequences of individual choice. It is undoubtedly true that societies are spending vast amounts of time and money on this idea. It is also true that the masters of the universe in business and government seem attracted to it, perhaps because stern self-discipline is how many of them attained their status. What we don’t know is whether the theory is actually correct.
Of course, that’s not the impression you will get from the admonishments of public-health agencies and wellness businesses. They are quick to assure us that ‘science says’ obesity is caused by individual choices about food and exercise. As the Mayor of New York, Michael Bloomberg, recently put it, defending his proposed ban on large cups for sugary drinks: ‘If you want to lose weight, don’t eat. This is not medicine, it’s thermodynamics. If you take in more than you use, you store it.’ (Got that? It’s not complicated medicine, it’s simple physics, the most sciencey science of all.)
Yet the scientists who study the biochemistry of fat and the epidemiologists who track weight trends are not nearly as unanimous as Bloomberg makes out. In fact, many researchers believe that personal gluttony and laziness cannot be the entire explanation for humanity’s global weight gain. Which means, of course, that they think at least some of the official focus on personal conduct is a waste of time and money. As Richard L Atkinson, Emeritus Professor of Medicine and Nutritional Sciences at the University of Wisconsin and editor of the International Journal of Obesity, put it in 2005: ‘The previous belief of many lay people and health professionals that obesity is simply the result of a lack of willpower and an inability to discipline eating habits is no longer defensible.’ (Emphasis mine.)
The quote was written in 2005. This has been known for a while, and it has taken mass media this long to catch up. (And yes, I know that the International Journal of Obesity is problematic, as it addresses the development and treatment of obesity. However, that just makes the quote that much more remarkable.)
This article really states that obesity is so complex that the “cause” of it can be laid everywhere, including on the fact that we live in modern times with lights and central heating and air conditioning, as well as the chemicals we ingest every day that leaches out of our packaging, in addition to stress and lack of sleep and whether our mothers were malnourished during their pregnancy with us and …
And. And. And.
‘The previous belief of many lay people and health professionals that obesity is simply the result of a lack of willpower and an inability to discipline eating habits is no longer defensible.’
Honestly, it never was. It’s about time they figured this out.