A friend of mine recently visited her GP for advice about a suspected allergy. She exercises at least twice a week, barely ever gets a cold, has never smoked in her life and rarely drinks more than a couple of gins on the odd Friday night. Yet, the GP seemed to disregard all of the above and instead decided to focus on an element of her health for which he could produce a number: her weight. What resulted was anxiety, stress and low self esteem which – according to all the scientific studies – can make you LESS healthy. Also, it’s just a hunch, but I’m pretty sure you’d be less keen to go to your doctor for any potentially serious health problem (i.e a worrying lump) if that same doctor had embarrassed you the week before by calling you fat.
This got me thinking. Why is it okay to vilify, blame or insight general nastiness on someone all in the name of “health”? The amount of times I’ve overheard colleagues, friends and fellow Sainsbury’s customers spouting hateful poison about a woman’s body and excusing it as, “genuine concern for their health”, is somewhere in the thousands. When the conversation is regarding a total stranger, it’s pretty justifiable to conclude that said poison-spouter is nothing more than a bitter bitch. However, when it comes to friends, family and loved-ones, are we right to be concerned about a heavier person’s health? Or have we consumed so many Daily Mail headlines, that we’re now unable to detect blatant fat bias? Or could it be the case that being a bit bigger isn’t actually that ‘bad’ for you?
It’s a pretty controversial issue which sparks strong emotions in many so as always, I enlisted the help of the up-most experts to help me assess the real health implications of carrying extra weight. According to NHS England, if your BMI is classed in the overweight, obese or very obese category then you’re, “heavier than is healthy”. I don’t usually like getting into BMI territory, but in this case, I feel as though it’s pretty necessary. A BMI of 18-25 is considered “healthy”; 25-30 overweight and 30+ obese. Needless to say that anything lower than 18 is technically classed as “underweight”. Although the NHS website does point out that the BMI chart, “may not be suitable for you if you have a muscular build”, it also states that such circumstances, “will not apply to most people” and instructs you to download the NHS weight loss plan.
There is, of course, a wealth of research to support the significant risks to your health that come about from moderate to severe obesity. According to obesity experts, More Life, obesity reduces your life expectancy by at least nine years, and dramatically increases one’s risk of coronary heart disease, high blood pressure, strokes, Type 2 diabetes, liver disease and some cancers. Having said that, the statistics quoted by the research papers don’t necessarily represent the whole story. Not only will not ALL obese patients end up with such negative outcomes, but the direct causal link is up for debate – as some argue that the stress generated by social stigma may contribute to cardiovascular disease.
Rebecca Pearlman and her research team at the University of Pennsylvania revealed that exposure to, and internalisation of anti-fat rhetoric made participants three times more likely to develop metabolic syndrome and six times more likely to have high triglycerides, or blood fats – all of which are symptoms associated with obesity. It’s not the first time such a correlation has been stumbled upon. Countless studies of the past thirty years have found that exposure to weight-bias creates further physical and mental health problems including inflammation, production of cortisol (the stress hormone), cardio-metabolic disease and makes individuals less likely to exercise and more likely to engage in binge eating behaviours. Even more concerning is that these damaging attitudes may actually be perpetuated by the healthcare professionals who are tasked with making them ‘healthier’.
“WEIGHT BIAS CREATES FURTHER PHYSICAL AND MENTAL HEALTH PROBLEMS”
“I regularly hear from people who are overweight who feel their doctors (and often their friends too) blame them for their excess weight,” says Dr Susan Jebb, a government advisor on obesity and population health. “Society in general treats people who are overweight, especially those who are seriously obese, very badly – it is much harder to change views in wider society, but this has to be the goal.” Research published in the British Journal of Obesity refutes Susan’s observations. Studies involving doctors, nurses, dietitians and even medical students have shown the widespread weight-bias that exists within the healthcare world, as well as the resulting health implications for patients.
Another controversial line of thought is that, perhaps carrying extra weight could actually be good for your health. Bear with me on this.
Carl Lavie is the Medical Director of Cardiac Rehabilitation and Preventive Cardiology at the University of Queensland’s School of Medicine. He’s also Associate Editor and Cardiovascular Section Editor of big cheese scientific journal, Mayo Clinic Proceedings. Quite the title, huh? According to this uber-smart scientist, being obese – in some cases – may actually help you to live longer. “Despite the fact that obesity worsens all of the cardiovascular disease (CVD) risk factors and leads to more cardiovascular disease,” he says, “numerous studies and large meta-analyses repeatedly show that overweight and obese people with cardiovascular disease have a better survival, at least short-term and medium-term.” In other words, if you’re unlucky enough to have heart disease (which can also be caused by genetic factors; smoking and excessive alcohol consumption e.t.c) having a heavier body may protect you against death – at least for a while. And it’s not just heart disease; “carrying extra weight can be protective against some cancers and other serious chronic diseases,” he says. According to Carl and his colleague Tamara Horwich at the University of California who has produced similar findings, there are predictors other than weight that may be a better indicator of overall health.
“Whilst it’s true that weight gain increases blood pressure and worsens lipids & blood sugar,” he says, “it’s a myth that being overweight dooms people to poor survival. Low fitness is a much greater threat to health than carrying a few extra pounds. Overweight and obese people who maintain decent fitness have a much better prognosis than those who are lean, but unfit.” And while a recent study did make headlines with data supposedly outlining that “fat but fit” is a myth – a) the study hasn’t even been officially published in a scientific journal; b) other factors such as smoking and/or diet weren’t accounted for and c) single measurements of blood pressure and cholesterol is too simplistic to determine whether a person is healthy or not. Otherwise, there’s significant evidence to suggest that being a little overweight can prolong your life slightly, although according to Dr Susan Jebb, “it depends how large you are and how long you’ve carried the weight for”.
Aside from weight, diet, smoking and fitness, there’s a whole host of factors which have also been proven to predict health outcomes – none of which are likely to feature on a leaflet you might pick up in the GP’s surgery. Dietitian Lucy Aphramor highlights one detail in particular which she only discovered once she rejected common practice in favour of her own, “ethical” approach. “I used to work in Coventry,” she says, “and we had community meetings about the number of South Asian men with heart disease as in the UK as they have about double the rate of heart disease than the general population.
“I started reading around it and I learnt that there’s a big link between heart disease and racism. It was the one piece of the puzzle that was missing. There’s links that cannot be explained by lifestyle or genetics and stigma is a social determinant of ill health.” Lucy struggled to justify the approach that was expected of her during NHS training. “I found no evidence to support intentional weight correction,” she says, “but I found lots of evidence to suggest that it was harmful. Listening to people’s stories of how badly they’ve been treated in and beyond healthcare made me realise that our current approach was part of the problem. I couldn’t carry on with it because it was oppressive.”
These days, Lucy works according the the principle that; “eating and activity are only one part of the picture of health” and health is gained by helping people to find ways to be kind and understanding when looking after themselves. Lucy incorporates every single aspect of a person’s life when analysing the best way to advise them. From body image issues, to childhood traumas, to troubled eating; everything is relevant and weight is not the thing that she “aims to fix”. In fact, every time I refer to ‘BMI’ or use the term, “overweight”, she responds disapprovingly. “We have to let go of a whole load of assumptions,” she instructs, “BMI assumes that there is a particular weight that I know this person will be well at and that is simply not true. It over- amplifies the role of weight itself. For the vast majority of people, there are lifestyle factors that are a much bigger determinant of health.” She may be right, but does that mean the correlation between large body size and overall poor health is simply coincidence?
“Of course there is a link between so-called ‘fatness’ and health,” she admits, “but it doesn’t then follow that fatness causes poor health, or that anybody wants to change their body.” According to Lucy, it’s this desire to change our body mass that is causing the health complications in the first place. ” Weight fluctuation is an indication of cardiac mortality,” Lucy points out, “and yes, fatter people are more likely to die than thinner people but the assumption is that they’re that way because the pathology is within the individual – which simply isn’t true.” The self-proclaimed “radical” dietitian must be onto something – just ask her long list of clients, most of whom are healthier and happier for being treated by her.
“WE’RE TAUGHT TO THINK THAT ONE BODY IS BETTER THAN ANOTHER”
The message pushed by most health authorities; “eat less, move more” is, as far as Lucy is concerned, the easy option for politicians and government advisors. “We can blame the individual and don’t need to look at the big structures, such as inequality and privilege,” she says. What about the onslaught of enticing adverts for sweet treats that are constantly thrown at British kids – don’t they play a part in our overconsumption? Lucy isn’t sure it’s as simple as that.
“The child who has structured eating will learn that they’re not going to starve,” she says, “they’re not the children who walk past the sweet shop and want to buy everything in it. It’s about making sure all children have access to food.” Given that poorer children are statistically way more likely to become obese, Lucy’s theory has some serious grounding. According to figures from January this year, 40 per-cent of children in the most deprived areas of the UK are obese, compared to 27 per-cent in the most affluent parts of the country. Add to those percentages an increased risk of asthma, dying in a car accident; tooth decay; access to healthcare; breathing in second-hand smoke; and dying before the age of five – perhaps being poor is much worse for your health than being big…
Why then, despite the knowledge of other health indicators, are we so hung-up on weight? “We’re taught to judge and think in competitive categories,” Lucy says, “we’re taught to think one body is better than another, so we end up in a binary way of thinking. “One is always deemed better or worse than the other and that thrives in a culture of body shaming – but there’s a deeper structure at work than just appearance.” Such a comment leads me to consider my own weight conundrum. At my current weight, and given my history of anorexia, I am at significantly more risk of developing osteoporosis, becoming infertile and having a sudden cardiac arrest than your average person. Yet, appearances would have you believe that I am slim and healthy. Last time I visited my GP, she didn’t ask about my weight, let alone ask me to jump on the scales. My friend on the other hand, was required to justify her lifestyle and left feeling humiliated. Funny that, seeing as I’m the one with a greater chance of sudden death.
IMAGE: Lucy Harding
After delving into the ever-confusing world of weight, it’s taken a while to reach a cohesive conclusion about whether being overweight is bad for our health. In summary, here’s what I’ve decided:
- Being severely obese may indeed be “bad” for your health and increase your risk of developing certain illnesses, but the chances are you’ll probably know you’re heading that way before you get there.
- That doesn’t necessarily mean you will be healthier if you attempt to lose weight. There are a whole load of other factors which may or may not effect your health regardless of weight.
- On the whole, being a bit ‘overweight’ won’t affect your health that much – so long as you are looking after yourself.
- There are some instances in which having a heavier body is protective and better for your overall health
- BMI isn’t really ‘a thing’
- We live in a fucked up, image-obsessed society whereby even those in a professional position of care make judgements based on the way you look.
- Poverty and inequality is much more terrifying and threatening to any civilised society than the size of our waist-bands.