One of the things that completely floored me when I started looking into the research on weight and health was that there wasn’t a single study of people who had maintained weight loss that showed that it led to greater health.
Studies that look at body size and health (but don’t factor in or control for behavior) find that there is a correlation with higher body weights and higher disease incidence. (Note that it is a correlation, not causation.) So the hypothesis is that if you can make fat people look like thin people, then they will have the same health outcomes, and hence manipulating body size becomes a recommendation for increasing health.
Let’s look at a quick comparison.
Male pattern baldness is strongly correlated with heart disease. So, following the weight loss for health logic, if we can get bald guys to grow hair, we can decrease their risk of heart disease. Imagine if we had a war on baldness, if we told those guys (despite all the evidence) that baldness is their fault and that if they really cared about their health they would grow hair and that any man who tries hard enough can grow hair. What if instead of doing the actual research to find out that it’s actually another factor that causes both the baldness and the higher rates of heart disease, medicine and science instead got stuck on the idea that if we could make bald guys look like guys with hair then they would have the same health outcomes? Study after study about how to grow hair, just assuming that if they can just get that hair grown, these men will have better health outcomes.
That’s exactly the position that fat people are in. Most researchers aren’t interested in looking at the correlation between higher body size and disease incidence and asking why the correlation exists and if it’s possible that other factors are involved. But some have. When Peter Muennig from Columbia studied it he found that the stress of the constant stigma that fat people face is correlated with the same diseases to which being fat is correlated, and that women who were concerned about their weight had more physical and mental illness than women who were fine with their size, regardless of their size. When Linda Bacon and Lucy Aphramor studied the literature they found more than ample evidence to support a paradigm shift.
Studies like Wei et. al, and Matheson et. al. found that behaviors are a much better predictor of future health than body size.
Wei et al found that when fitness was taken into account the differences in health outcomes became negligible.
Matheson et. al found that habits, not body size, were the best predictors of future health.
To be clear, health is not an obligation or a barometer of worthiness. Health is not entirely within our control or guaranteed regardless of habits or anything else. There is no such thing as a healthy weight – there is no weight that you can achieve at which you will be immortal unless and until you get hit by a bus, there are health and unhealthy people of all size. People with health issues should be given options and treatment in accordance with their desires, not asked whether or not their health issue is their fault or could have been prevented. Health care should be blame free, shame free, and future oriented. How highly people prioritize their health, and the path they choose to get there is an intensely person decision.
The reason I discuss weight and health is not because I want to tell people how to live or contribute to our society’s completely screwed up ideas around health, it’s because I believe that people are being misinformed and/or not given all of the information or all of their options and we should all have the opportunity to make decisions for ourselves
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