Fat Australians have the nerve to think they’re healthy

Apparently, according to a survey by the Australian Heart Foundation. Kunoichi has a blog response here, and here’s my take. It was written as an email to send to friends who are not really into FA or sort of on the fence, so the framing is a little different to something I’d write to Advanced Fats.

The survey of 1200 people found one in four people who are considered obese using the body mass index (BMI) rate their health as being very good or excellent, and one in five believe their risk of getting heart disease is low to very low. The chief executive of the Heart Foundation, Lyn Roberts, said that despite years of public health messages, there was still an alarming lack of awareness about the cardiovascular risks of being overweight or obese.

Considering that the BMI is, frankly, a terrible indicator of one’s health, why is the Heart Foundation still using it? The man who invented it in the early 1800s, Belgian Adolphe Quetelet, never intended for it to be used as a measure of health, and a great many medical researchers agree that it is a poor way to measure overweight, obesity, and health risks, especially as epidemiological studies on the relationship between some health risks and BMI show only a correlation, not a causation, and that some health risks decrease with increasing BMI, such as osteoporosis and lung cancer. The same epidemiology continually shows that ‘overweight’ people have the highest life expectancy, ‘obese’ and ‘normal’ people the next best expectancy, ‘morbidly obese’ people rank third, and ‘underweight’ people, independent of illness which causes weight loss, have the worst life expectancy.

Thin people who are sedentary show just as much cardiovascular disease risk as fat people who are sedentary, and fat people who are active share the same reduced cardiac risk as slim people who are active. This was conclusively demonstrated by Drs Stephen Cooper and Glenn Gaesser in a comprehensive study, and has been shown further in yet more studies. How about we have a campaign encouraging healthy activity for all, not singling people out based on the flimsy BMI?

There is not one study that proves a causation between cardiovascular disease and larger amounts of adipose tissue on a body. There are, however, studies which show stress, stigma, discrimination, imposed low self-esteem, poor treatment by health professionals, low socio-economic status, repeated dieting and eating disorders are strongly correlated with and have some direct causation of obesity, all of which are known to contribute to poor cardiovascular health. There are well-known “obesity paradoxes” also, one of which is that obese people survive heart attacks far better than ‘normal weight’ people.

”As our waistlines expand, it appears that our perception of what is a healthy weight has also expanded, so many people who are overweight or obese do not actually see themselves in this way,” Dr Roberts said.

No, it’s that the BMI is rubbish and people know it. Have a look at Kate Harding’s BMI Project sometime and you can see photographs of what the various BMI categories actually look like. The vast majority of the ‘obese’ population are BMI 30-35, which, as photographs show, makes one look chubby at best. The headless fatties, unflatteringly photographed and used to illustrate obesity scare stories in the news, are of extremely fat people who represent about three percent of the Australian population. Surveys such as this one by the Heart Foundation also make no exception for people who are muscular and have solid frames. There’s no section after height and weight for people to write in their body composition and if they’re an athlete or not. A quick look at NRL player stats finds that Joel Clinton has a BMI of 29.1, Nathan Hindmarsh is BMI 28.3, and Wendell Sailor is obviously cause for concern at BMI 31, and most other players are Officially Overweight or Obese. One could claim that such people are not representative of everyone else with a BMI of more than 25, but I can’t seem to find any surveys of this kind which measure body composition and actual fitness levels as opposed to assuming that someone with a BMI of 31 is a couch potato. Assuming isn’t very scientific but it does get you good publicity! …And plenty of grant money, if I might be so cynical.

One in six who had a BMI of 30 or more believed their weight met health guidelines, compared to one in nine last year. The proportion of overweight people (those with a BMI between 25 and 29) who thought they were in the healthy range also increased,, from 51 to 57 per cent in 12 months.

Surely this should be taken as a measure of success, not despair. While “almost half of obese Australians had made no changes to their behaviour to reduce their risk of heart disease” this implies that the other half have, and have thus seen real measures of their health improve, such as decreased cholesterol and glucose levels, better mental health and exercise capacity. They may have lost a little weight (just 1%-5% of bodyweight lost is pushed by health authorities as improving health) but still remain in the ‘obese’ or ‘overweight’ BMI category, or remained the same weight but had body composition change to more muscle, less fat, or even not at all and just improved various actual health measures. There’s also some tricky wording here: believing one is in the official healthy weight ranges when you’re not and believing you’re healthy when you’re not are in fact different things.

The survey, which was jointly funded by the life insurance company Zurich,

Well, of course. Who better to fund a study proving fat people are walking time bombs, ignorant that they are about to die any moment now, than a company which has a vested interest in denying overweight and obese people insurance based on tenuous claims.

…found one in four obese people smoked, with most smoking daily, a proportion 70 per cent higher than people of ideal weight range.

Could it possibly be that they’re that desperate to lose weight that they’ll smoke to keep appetite down? Surveys have shown that young women would rather be blinded or lose two limbs than become fat. Hey, at least chemotherapy’s good for weight loss!

The tendency to judge ourselves against other people, rather than scientifically based weight guidelines, was ”normalising” obesity, said the Heart Foundation, which commissioned the survey.”

Oh yes, obesity is so normalised! Fat people can walk down the street and not have people sneer at them, small children point and stare, groups of teenagers snicker and throw things; fat kids can go to the beach and wear swimmers without their photographs being taken and exploited for anti-obesity articles; plus-size fashions are available at every designer boutique; Kyle Sandilands is telling Magda Szubanski to put those kilos right back on so she’ll be hot again; of course! Apparently Dr Roberts is living in a special magical fantasy world where fat people are not treated like a mysterious brown smear on the bottom of one’s shoe, and the BMI is a scientific measure. (Let’s remember high school maths: human bodies are three dimensional, and volume increases by the cube, not the square. BMI measured by the square: fail number one.)

What, exactly, is wrong with allowing fat people a little self-esteem? Psychiatrists and dieticians who work in the eating disorder wards know that good self-esteem and mental health is the foundation of good health. When Dr Roberts comes along and gets in a flap that even though you have taken to eating better and exercising you’re still a fatty and therefore all your positive health gains amount to nowt, and of course you must be completely ignorant of any of the anti-obesity messages which saturate our society, then it’s enough to make one feel like giving up. Perhaps that’s what they want. There are a lot of people whose entire careers depend on the moral panic that is obesity, and frankly it seems like some of these people get a sick little thrill about how they’re paid to bully fat people in public.