Myth One: Fat is Unhealthy

Dr. Pattie Thomas wrote a book called Taking Up Space: How Eating Well and Exercising Regularly Changed My Life that is just really awesome. If you haven’t read it, it’s well worth investing in.

The first chapter of the book has 10 fat myths. As I read them, I had so many ideas and thoughts and things I wanted to say about each one. I contacted Dr. Thomas and she said that it would be okay for me to use her list to talk about each of the myths here. So–welcome to a 10-week Thursday series.

Myth number one on Dr. Thomas’ list: Fat is unhealthy.

To my mind, fat is unhealthy goes beyond myth. It’s become part of our social identity. Fat is unhealthy is a statement that is so wildly and widely accepted in Western culture that, as I talked about in another post, to say that it isn’t is tantamount to being counter-cultural.

Fat is unhealthy is so deeply ingrained that doctors will recommend, encourage, sign-off on and even give you a hard time if you refuse invasive abdominal surgery even if you are currently healthy.

This happened to me. A doctor recommended weight loss surgery to me as she held my blood tests in her hand: 125 cholesterol and perfect blood sugar. I don’t have high blood pressure or a family history of heart disease. I don’t have sore joints. I have no mobility issues. I am healthy. In fact, many of my fat brethren are.

But I am fat.

And my doctor could not (and probably still cannot) reconcile health with fat. I would be willing to bet that she felt she was being responsible by referring me to a surgeon. In fact, she probably would have considered herself remiss if she didn’t mention that I needed to do something drastic about my weight, even in the absence of any health crisis.

What kind of doctor would have a patient who weighs over 300 pounds and not offer every possible solution to that little problem?

Never mind that I am currently healthy, and that there is no guarantee that I would be after weight loss surgery.

Never mind that I would have something implanted in my belly and while I had insurance at the time of the recommendation, it was certainly not guaranteed that I would have access to adequate health care in the aftermath of the surgery, much less for the rest of my life (the length of time I’d have a foreign object inside of me.)

Are some fat people unhealthy? Clearly. How ridiculous if they weren’t. Fat isn’t the fountain of youth or some sort of magic elixir for God’s sake. But, when you try to talk to many people about the idea that fat people are not necessarily unhealthy, you often hear something like, “well, what about your heart/a stroke/diabetes? Do you want to die?”

Here’s the thing: everyone dies. Fat people, thin people and in-betweenie people. All people. All animals. All plants. All living things. It’s the trade off for living.  There are bristle cone pine trees where I live. These suckers live forever–except they don’t. Eventually even they die.

It happens to all of us. It is the great equalizer.

The US Center for Disease Control (CDC) says that it happens to people with overweight BMIs at a slightly older age than those with normal BMIs and that when taken as a whole, people who are underweight or very very obese die slightly younger. There is no giant leap in early death that correlates with a person’s weight.

Let me repeat that: there is no giant leap in early death that correlates with a person’s weight.

Some people don’t exercise and/or they eat beyond past the point of being full. These things, not moving enough and eating too much (of any foods), sometimes result in health issues. They also sometimes cause people to weigh somewhat above their natural set point.

Sometimes people eat too much and don’t exercise, but have a combination of genetics that allows these behaviors to not cause weight gain. These people are still at risk for so-called obesity-related health problems.

Some people lose and gain and lose and gain themselves right into health problems, when they would have been healthier if they left good enough alone.

There are real, serious dangers in equating fat with health.

Almost any fat person has a story of going to see a doctor for a health problem, and leaving with a photocopy of a low-carb/low-fat/low-protein diet of some kind, or a brochure for a weight loss clinic, or a referral to Weight Watchers. This is wrong on so many levels, not the least of which is that it discourages doctors from listening to their patients with an open mind and it discourages fat people from being patients when they really should be.

Equating fat with health also puts some fat people in the position of believing that they have no hope of health. If they won’t ever be thin and therefore can’t ever feel good, what’s the point of learning to eat intuitively or getting any exercise?

Another problem is that while some of us are so busy turning fat into a moral failing that makes fat people use up too much of the health care, it is sometimes a symptom of a serious health problem that goes undiagnosed because the fat person is too scared to go to yet another doctor or the doctor can’t see the forest for the fat.

The flip side of equating fat with unhealthy is equating thinness with health. This results in some people believing that they don’t have to move or eat intuitively for their health, because they are not fat, when really these things are healthful for every single body.

I recently had a dear and very slender friend spend several weeks with us. We talked about this, and I was surprised to find that her experience has not been totally unlike mine. Medical doctors have failed to diagnose her or have misdiagnosed her because outwardly she appears healthy, just like the same has happened to me because doctors can’t or won’t see past my fat.

Sometimes fat people are unhealthy. Sometimes skinny people are, too. It happens. It is unfortunate that if you happen to be both fat and sick, you have a good chance of being blamed for your health problem in a way a thin person almost never will. It is also unfortunate that if you are a slender person, this may cause your doctor to mistake your body type for health that isn’t there.

Equating correlation with causation isn’t good for anybody.

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14 Comments

Filed under body, mind, spirit

14 responses to “Myth One: Fat is Unhealthy

  1. Not only is correlation not causation, but precursor is not causation, and sequela is not causation either. I could give a rat’s whiz if anyone thinks I’m in perfect health; I know I’m not. What I don’t buy is that I did it to myself, that I made myself ill, that if only I ate and exercised according to a specified formula, I’d have ideal weight and perfect health, and that I “blew it” by not doing so. That’s ridiculous, I’m sorry. I’ve seen too many people do everything “right” and still wind up desperately ill at a shockingly young age. And like you (and Pattie Thomas), dieting probably made me a lot sicker than I ever needed to be.

    Thin smokers and alcoholics and drug addicts DO get blamed for their illnesses, too, BTW. But I can’t believe that anyone is that surprised when someone who has been a total goody-two-shoes forever has health problems. I think it was Deb Burgard who said something like, “Eating right has the same relationship to weight and health that working hard has to being rich.”

    • Yes. It is ridiculous. I think there is some responsibility we can take for trying to shore up our health–but there is no way to guarantee that it will work. I also think health is a very individual thing. It is silly to say blanketly that if everyone ate right and exercised more they would be in good health. Some might be, like the woman at the gym I spoke to yesterday who brought her blood pressure down by exercising. Others might not. For instance, nearly every health complaint I have is tied to gluten intolerance. I had the same issues when I was smaller. They have gone away (mostly) with diet change (no gluten), despite the fact that I’m at my highest weight ever.

      As a former drug and alcohol counselor, I have maybe a different perspective on smoking, alcohol and drugs and the illnesses that go along with them. I personally don’t like to be compared to an addict by virtue of being fat (I know you didn’t to that, I just mean in general. I dislike the food is an addiction argument.) While I do believe that people who choose to smoke, drink to excess or use certain drugs are choosing to be at a higher risk for some health issues, I don’t believe that for all or even most of them becoming an addict is as much of a choice as we think. I hate when I hear someone who comes from a stable family, has no family history of addiction, has always had enough, etc. say they have no sympathy because “that person chose to use. They should have just said no.”

      • While I do believe that people who choose to smoke, drink to excess or use certain drugs are choosing to be at a higher risk for some health issues, I don’t believe that for all or even most of them becoming an addict is as much of a choice as we think.

        I think that’s probably true. I remember my dad saying it was EASY for him to quit smoking, he just threw the pack in the trash one day and that was it, whereas it took my mom multiple quitting attempts over 20 years, and then finally some nicotine gum, in order to do so. What he didn’t realize was that he was one of the lucky ones who wasn’t physically addicted to nicotine, and that among regular smokers, he was an outlier. A genetic outlier. It’s not like he was made of greater moral fiber than my mom!

        And the reason *I* never smoked is that my body has total disagreement with tobacco, even though I grew up at a time when half of adults were regular smokers, and indoor smoking was the order of the day until I was in my 20s. Again, that’s from stuff in my gene pool that probably skipped my parents’ generation. And getting drunk or high never made me feel better, either — usually worse. I didn’t try to feel that way, I just did. In fact, I wished I could “party hearty” like the other kids, but it wasn’t to be. And now they say I was “smart” not to do so. Ha.

  2. Patsy Nevins

    I am from an abusive alcoholic family, a survivor of very abusive parents, & I still believe that they could have chosen not to abuse substances. I choose not to drink, smoke, or use illegal drugs, it isn’t something anyone needs to live. Of course, my parents were so emotionally & psychologically messed up that they were abusive drunk or sober, my father in particular. He was a monster & I am afraid that I have no sympathy for him & very little for other addicts.

    Overall, fat people are no more or less healthy than anyone else, we do often tend to live longer than a lot of thin people, not shorter, & indeed no one is immortal. As for the ‘eat right & exercise’ trope, I am SOOO tired with all the damn nannying. I have known (I live in Maine, with a high rate of poverty/alcoholism/domestic violence/unemployment) so many people who did everything ‘wrong’, yet lived to be very old, & others who did everything ‘right’ but dropped dead early. Here in Maine we also have a high percentage of fat people; ironically, many live so long here that in many small towns, if you die before you are 100, the obituary is likely to say that you died ‘unexpectedly’. My own mother & grandmother both cooked with lard, salt pork, real butter (my mother made butter when I was small), both loved sweets, Nana loved chocolate as much as I ever have, put 4 tsps of sugar in her coffee, etc. My mother inherited kidney disease from her father & grandfather, neither of whom was fat, both of whom died from it. The fat was from my grandmother’s side. Mother had one kidney for over 40 years & lived to be 85; her mother lived to 90. Mother decided a couple of times that she should try walking with me, went about 100 yards, doubled over with a stitch in her side, & went back home. Could she have added a few months or a year or two to her life if she had walked as I do? Maybe, but how does anyone know? And whose business is it how anyone else lives?

    Anyway, my point is that this claim that fat is unhealthy is rooted in ignorance for some, greed for most, & an overwhelming need in our culture to mind other people’s business & try to control others’ lives. I saw a headline in yahoo this morning while checking my email…that Michelle Obama didn’t realize how ‘dangerous’ it was for her thin daughters to be able to eat like normal kids or that their health was at risk if they gained another 5 pounds or whatever until her pediatrician pointed it out to her. That led to this whole campaign to control everyone’s life & destroy the life of every fat kid in this country.

    I KNOW that fat people are not necessarily unhealthy or moreso than thin people. However, after well over 31 years of trying to dispel this attitude, I am getting a bit worn out. I often believe that we are all preaching to the choir & not convincing anyone except each other.

    • Patsy, until I started working with addicts that I wasn’t related to, I felt very much the same as you do. There was no abuse in my family, but lots of neglect. I am the only person in my family (I have eight siblings) that is completely sober. I’m sometimes made fun of for not not drinking beer at family barbeques or whatever. It is possible to choose to be sober–but for many people it’s not as easy as it is for others. For instance, my husband grew up as an only child in a home where neither of his parents drank or used drugs. Me choosing to be sober and him choosing to be sober are too different animals.

      I sometimes feel like I’m preaching to the choir, too. The hope, I guess is that our preaching gets loud enough that other people outside the choir can’t help but hear.

      XOXOX

  3. blessed

    Totally ridiculous. I know of so many women I have known over the years who would be considered fat but who were way stronger and more fit than me. Oh, and one of them worked alongside me daily slaving in the Illinois corn fields (we worked for a research company making hybrids–but were glorified fieldhands and it was hard physical labor most of the time, all day long) and at the end of every summer she looked exactly the same as she did at the beginning, only really tanned. She was the first person I knew who I realized was completely healthy and exactly the size she was supposed to be.

    The odd medical bias goes the other way too: for years now–years–I have been struggling with blood sugar issues, knowing something is wrong, but every single doctor I spoke with (ok, 3, but still) just shrugged it off. If I had been a larger woman I think they would have taken me more seriously.

    • If you were a larger woman, they would have been concerned about your blood sugar, even if there was nothing wrong with it. Have you found a doctor who listened?

      • blessed

        Well, the last Dr. listened and when I requested blood work she did make up the paperwork, but then also told me it essentially would not help, because the way blood sugar works some people can start to feel a physical reaction at a way different level than other people, so there is no “normal” level, you have to somehow find out what your own personal normal is. . . ? At least that made sense, and was the first time a dr listened and actually talked to me about it. But then I have not done the blood work after all–her response made me feel like I would not be h elpful, and we don’t have $ to throw away on unnecessary medical tests! Oh, and that Dr. has moved to the town next door, so I have not decided if I will follow her or not. . .

        So actually, I decided to forget the medical opinion for the moment and do what I KNOW will help–change my eating. You were one of my inspirations for going gluten free, and I am also adding low-carb to that, since I know carbs are problematic for me (just after listening to my own body for the past couple of years). It has been harder than I thought it would be, esp. since we used to be mainly vegetarian.

        The real reason I wanted help from a Dr. was because I don’t quite have a good grip on what is happening in my blood system to give me these responses. The least little bit of sugar seems to spike my insulin, but yet I have also had horrible sleepiness after eating pretty much nothing but protein and veggies (non starches), which makes me wonder if I need some carbs or otherwise there is too much insulin just floating around waiting to be used. . . oddly enough, the documentary “FatHead” (a rebuttle to “Super Size Me”) was the first thing that helped me get some idea of what might be going on inside me–inspiration can come from odd places at times!

        ANYWAY your blog is one of the things that helps me keep getting perspective about food, eating, moving, etc. And motivation to keep doing what I know is good for me, nevermind what anyone else says. So glad you are enjoying writing about all this!

      • I’m pretty sure everyone needs some carbs. (I’m not a doctor, though. There might be some people who have a medical reason to totally avoid them?) I’m glad you’re starting to feel better. That sleepiness is the worst. I’ll have to look up Fathead.

  4. In the Bacon/Aphramor paper, there was a chart that illustrated the “health care costs” involved in over-treating fat people with no actual health problems (ordering extra labs, medications, etc.) versus under-treating thin people with health problems. Recently my thin (BMI 20-21) partner had some labs, and his random glucose was a little elevated, but no one was especially concerned about it because it was a nonfasting sample. If my fat ass had an elevated random glucose (and on labs done just a couple of weeks ago, I didn’t), I would have been in there for fasting labs, a GTT, etc., faster than you could say “insulin pump.” The insurance company would have insisted on it!

  5. Patsy Nevins

    My husband had similar experiences, being tested multiple times to be certain he was not diabetic because they were assuming that one cannot be past 60 & fat & not be diabetic. They also tried to prescribe blood pressure medication even though his BP was 125/67.

  6. Matt

    At one point in your post you said “Almost any fat person has a story of going to see a doctor for a health problem, and leaving with a photocopy of a low-carb/low-fat/low-protein diet of some kind, or a brochure for a weight loss clinic, or a referral to Weight Watchers. ” Here’s mine. I actually wanted one of those list. Other people I knew came back with them and I thought that was the answer for me. “I need one of those list to tell me what to eat and then I can lose weight” I thought. I had just gotten a new job with healthcare and found a doctor nearby and set up an appointment to do a getting to know you/ general health exam. Well the doctor I signed up with was not there so another doctor at the same office filled in for him. I thought that was kind of strange, how could my doctor get to know me if there not even here? Anyway we went through the exam and every question I asked seemed to be an annoyance to the doctor. He obvoulsly just wanted to get the exam over with. The last thing I asked him as he was walking out was if I could have a list or something for a diet or food I should avoid. He said “Sure” pulled out a post it pad wrote something on it and handed it to me and walked away. I looked at the note and it said “Eat Less”. It was all I could do to keep from punching him in the face. I never went back to that office. I actually didn’t go to a doctor again for a couple of years.

    • Matt–thanks for posting this. I had a similar experience once with a chiropractor. I didn’t want a diet from him, I wanted him to make my back and legs stop hurting after I had Ruby. He was the single most awful doctor I’ve ever had to interact with. He wanted me to lay some certain way, and I wasn’t understanding what he wanted–and he actually said “I know it’s hard to move when you’re the size of a whale.” A doctor. He said it under his breath, and I said, “What did you say?” And he played it off and I let him, because I was humiliated and I didn’t know what to do. You’re so vulnerable when you’re at a doctor’s office, right? It obviously disgusted this man to have to do body work on a fat woman. I never did go back to any chiropractor. And my back and legs are still messed up from my pregnancy with Ruby.

  7. Sarah

    And this is why I love my doctor. She has NEVER treated me like I’m unhealthy because I’m fat. Granted, she wanted to check my liver and blood sugar, but was nonjudgmental and even said “you’ll probably be fine with your family history”–which I was. And when I mentioned that I was working out and would like to learn to eat “better” (which I now realize I wanted to learn to eat intuitively), she gave me information and told me that she highly recommends WW because it gives you tools to learn and emphasizes healthy nutrition. Fast forward 6 months on WW and my blood pressure (which was OK to begin with) is lower, I’m walking more and eating intuitively, yay! Not to mention that as a bonus, my clothes fit better and I have more energy.

    BTW–when I was 12 I had a young doctor absolutely eviscerate me for being 20 pounds overweight. Really worked wonders on me; I gained 100 pounds over the next 5 years and developed an unhealthy fear of doctors. Honestly, which approach worked better?

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