An article on BBC.com stirred up controversy this week, publishing the finding that:
…those who were overweight had an 18% reduction in dementia – and the figure was 24% for the obese.
“Yes, it is a surprise,” said lead researcher Dr Nawab Qizilbash.
He told the BBC News website: “The controversial side is the observation that overweight and obese people have a lower risk of dementia than people with a normal, healthy body mass index.
“That’s contrary to most if not all studies that have been done, but if you collect them all together our study overwhelms them in terms of size and precision.”
As you might imagine I’ve received a number of requests for comment (we’re way over The 100 Rule) and I’m glad that people are asking because there is a lot of questionable stuff here. According to the study’s authors, they undertook the study because “Obesity in middle age has been proposed to lead to dementia in old age. We investigated the association between BMI and risk of dementia.” I’m aware of this belief because it is often quoted at me as if 1. it were truth and 2. the natural conclusion is that fat people should lose weight to reduce dementia risk, but we’ll get back to that in a minute. The authors concluded that:
Being underweight in middle age and old age carries an increased risk of dementia over two decades. Our results contradict the hypothesis that obesity in middle age could increase the risk of dementia in old age. The reasons for and public health consequences of these findings need further investigation.
This study has all the same limitations of any study that produces results based on correlation. Basically, it’s just finding how often that things happen at the same time, not what, if anything, causes them to happen at the same time. Hence the researchers correctly explaining that these findings need further investigation.
What I do think is interesting is the way that the media is treating this study – that shows health benefits correlated with being fat – as opposed to how it treats studies that show health benefits correlated with being thin. To demonstrate, I thought that we might compare and contrast this article with one the BBC.com published in 2013 about some studies that showed that obesity might increase the risk of dementia.
Let’s start with the titles:
2015: Being overweight ‘reduces dementia risk’ which I’ll call RDR for short
vs
2013: Rise in obesity poses ‘dementia time bomb’ which I’ll call DTB for short (trigger warning, obviously.)
Hmmm… “reduces demetia risk” vs “poses demtia time bomb” I would call that, at least, an interesting difference in word choice. Moving on…
Mentions of the purported cost to society of people who are at a higher risk of contracting dementia based on their size:
DTB: 3 mentions, including a large font section header
RDR: 0 mentions. Also, no mentions that they may have been wrong when they blamed fat people for costing the world 1.4 billion dollars
Mentions of the lack of a causal relationship/limitations of the studies
DTB: None. Instead: “This study highlights the impact obesity will have on the numbers of people with the condition in the future.” (emphasis mine)
RDR: One: “Any explanation for the protective effect is distinctly lacking” (also see below re: “Analysis” section
Mentions of other health issues correlated with being the size that has a higher correlation to contracting dementia:
DTB: 6 mentions
RDR: 0 mentions (though they do mention 5 times that being in the lower risk group for dementia is correlated to higher risk for other diseases)
Mentions of changing body size as a way to reduce dementia risk
DTR: “maintaining a health weight [is] hugely important in reducing your risk”
RDR: “not an excuse to pile on the pounds” (points for alliteration if not for content)
RDR also contains an additional component – an “Analysis” section wherein the BBC Health Editor discusses, including quotes from other scientists, the limitation of the study and also says “These results do not seem to be an excuse to eye up an evening on the couch with an extra slice of cake.” I guess I must have missed the class that explained that “analysis” means “conflate body size with behaviors in the most unscientific way possible.” Although the exact same limitations (and some additional limitations because of size and scope) exist for the studies discussed in DTR, absolutely no analysis is given to clarify that.
When you read a lot of articles like this it becomes very difficult not to notice that any report that suggests that there are correlations between being healthy and being fat contain admonishments that it’s not a good reason to stay or become fat, but any reports that suggest that there are correlations between being healthy and being thin insist that it’s an excellent reason to stay or try to become thin.
The thing about correlations is that one thing might cause the other, or it could simply be coincidence, or they could be caused by a third unknown factor. When we look at correlations between larger body size and health issues it’s important to realize that negative health issues could be caused by a third factor – whether that’s the psychological stress of constant stigma and oppression (the kind that reporting like DTR contributes to), the physical realities of living in a world (including a healthcare system) this is not built to accommodate you, the physical stress of going on repeated diets and spending a good part of your life feeding your body less food than it needs to survive in the hopes that it will consume itself and become smaller, or something else. Especially in the case of dementia, where nutritional deficiencies are one of the possible causes being investigated, it is does not exactly smack of rigorous science to not consider and study the affects of intentional weight loss attempts, or purposeful under-eating to maintain a body with a certain height/weight ratio.
Another dangerous incidence of poor reporting is the constant conflation of body size with habits:
There is no cure or treatment, and the mainstay of advice has been to reduce risk by maintaining a healthy lifestyle. Yet it might be misguided.
WT actual F? You cannot substitute “maintain a healthy lifestyle” for a body size. You just can’t, at least not while calling yourself a scientist or a science writer. First of all, because what actually constitute a “healthy lifestyle” is widely debated, and even if it wasn’t there are thin and fat people who maintain the exact same behaviors around their health and have vastly different body sizes. NONE of the studies that are being talked about in these articles took lifestyle into account – they just look at body size which is not the same thing as behavior. It is completely ridiculous to suggest that if being fat reduces the risk of obesity, that means that advice to maintain a healthy lifestyle is misguided.
Or how about this gem:
But Dr Qizilbash said the findings were not an excuse to pile on the pounds or binge on Easter eggs. “You can’t walk away and think it’s OK to be overweight or obese. Even if there is a protective effect, you may not live long enough to get the benefits,” he added.
Let’s be clear about what’s happening here. Dr. Qizilbash, whose study just showed why we should be careful when we make assumptions based on correlational findings about body size and health, is now making declarations based on correlational findings about body size and health. Also fat is not the same as “binges on Easter eggs” (and “binge” has a real definition when it comes to eating disorders) so, while I understand that the media can be problematic when it comes to reporting science, can actual scientists please, for fuck’s sake, refrain from spouting bullshit stereotypes to science reporters or, you know, at all.
I think that a big part of the problem is that the media is either ignorant to the basic tenets of research, or they just don’t care as long as they get eyeballs, and so they report these things in ways that are massively misleading. That gives people misinformation about their own health and health risks, it also serves to fuel the fire of the anti-fat-people mob.
This type of reporting also contributes to healthism, ableism, and the misconception that health is completely understood, an obligation, barometer of worthiness and within our control, as well as the misconception that public health is about making the individual’s body the public’s business rather than about giving good information (including talking about the limitations of that information) and reducing barriers to accessing the food people want to eat, the activities in which they might want to participate, a world in which they do not face stigmatizing, bullying, or oppression, and appropriate evidence-based healthcare. At worst the so-called science and health reporting that we get is grossly misleading and at best it’s reader beware.
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