That Questionable “Fit and Fat” Study

fat people have the right to existA blog reader asked me to take a look at this study.  It’s another one of those studies that headlines claim prove that you can’t be fat and “fit” (we’ve been here before and it was crap then as well.)  Let’s talk about this:

First, they are making an extremely basic correlation vs causation mistake – the fact that two things happen at the same time doesn’t indicate that one causes the other.  (Short example – they are suggesting that if people with fatter bodies have higher rates of cardiac incidents than thinner people, then making fat people look like thin people will give them the same health outcomes. That’s not good science. For comparison: men with male pattern baldness have higher rates of cardiac incidents than men without male pattern baldness.  Imagine if, upon finding out that information, researchers did as these researchers have done and suggested that in order to reduce the cardiac incidents, we need those bald men to grow hair – then the government started a “war on baldness,” studies calculated the cost of “baldness” on society etc. In this case while there is a correlation, there is no causation – both the baldness and the cardiac incidents are caused by a third factor, but if researchers had treated baldness like they treat body size we wouldn’t know that.)

One of the measures of “unhealthiness” that they are using is “increased waist circumference,” so they are studying whether it’s unhealthy to live in a larger body and they are using having a larger body as a measure of  “unhealthiness.” You can do that I guess, but you probably shouldn’t call it credible research.

They don’t control for the negative health effects of dieting and/or weight cycling (aka yo-yo dieting) which the larger bodied participants can be much more likely to have engaged in. Let’s not forget that in a diet culture, whenever anyone studies the effects of having a larger body, they are also studying the effects of dieting since that’s what is encouraged for fat people in our culture.

They don’t control for the negative health effects of living in a society where larger people are shamed, stigmatized, bullied, and oppressed in a number of ways including a lack of evidence based healthcare (because of systemic fat bias as well as doctor’s individual bias and the tendency to prescribe diets to fat people when they would have given a thin patient an evidence-based intervention), being hired less and paid less than thin people and, as Peter Muennig from Columbia found in his research, just living in a society where one is stigmatized is correlated with many of the same health issues that this study used to judge “unhealthiness.”

One of the quotes in the article my reader sent says that “information on physical activity, smoking, diet and social status could be adjusted for.” Looking at the study while they claim to have “adjusted the data” it does not appear that they actually had this information from the study participants. This is important because studies that do include behaviors (including Wei et. al; Matheson et. al; and The Cooper Institute Longitudinal Studies) have found that behaviors are a much better predictor of long term health than is body size, so studies that don’t include participant’s actual behaviors aren’t really relevant and are either poorly designed, or specifically designed to get exactly the results that this study did. (For an exhaustive list of evidence around this, check this out.)

The conclusion that if fat people are in more danger of cardiac incidents then it’s “not ok to be fat” or that one should attempt weight loss is problematic on a number of levels. First, they are acting as if body size is something that we can control, but provide absolutely no evidence for that. (Hint: it’s because there is none. The research shows that the most common outcome of weight loss attempts is weight gain, and there isn’t a single study where more than a tiny fraction of people achieve long term weight loss and even among those the weight loss is often just a few pounds.)

Again, saying that if fat people have more cardiac incidents than thin people then we should try to make them thin, is like suggesting that if men have more cardiac incidents than women we should recommend that they go through sex reassignment surgery (note that this is not be the same thing as correctly recommending gender confirmation surgery that a trans person might choose.)

People are at higher risk for health incidents based on everything from genetics, to race, to height and more, so suggesting that we try to make some people look like other people to make them healthier is seriously questionable. (Speaking of race, I think we should stop funding studies that under sample and/or ignore People of Color.  For far too long studies like this have been allowed to act as if white people are the only people worthy of study, and that’s bullshit.)

I also noticed that many of the doctors quoted in this article and others seem absolutely giddy that fat people might die sooner. I think that this is part of a (fatphobic) process by which scientists, healthcare professionals, and public health professionals are shirking their responsibilities to tackle the difficult things that would actually improve health – access to non-biased physical and mental healthcare for everyone, a good wage for everyone, enough vacation and down time for everyone, a world without oppression and more (these are often referred to as Social Determinants of Health.) Instead, these “professionals” shift the conversation to suggest that the “problem” is that fat people exist, and then they claim that fat people could be thin if we wanted, so they conclude that all the world needs to be healthier is just a little more fat-shaming and weight loss culture, which isn’t just lazy, it’s dangerous and wrong. We have to start calling them on this behavior.

More important than any statistical analysis is that health is a complicated, multifaced concept. Health is not an obligation, a barometer of worthiness, entirely within our control, or guaranteed under any circumstances. Nobody owes anybody else “health” or “healthy behaviors” by any definition. Fat people have the right to exist in fat bodies without shame, stigma, bullying, or oppression and it doesn’t matter why we are fat, what being fat “means” for our health, if we could become thin, or if doing so would make us “healthier” by some definitions. The right to life, liberty, and the pursuit of happiness are not size (or health) dependent.

The conclusions being drawn here (that if fat people have higher rates of cardiac incidents then fat people should be eradicated – yes, eradicated is the right word) are sizeist and healthist and add to the stigma that negatively effects fat people’s health, includingthe suggestion of dangerous so-called “weight loss interventions” that include things like drugs, stomach amputation surgeries, and balloon swallowing, that end up killing fat people. So the most important takeaway needs to be that, regardless of what any study finds, it’s ok to be fat no matter what.

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24 thoughts on “That Questionable “Fit and Fat” Study

  1. This kind of reminds me of the last study that was trumpeted all over the universe, “proving” that fat people couldn’t be fit over the long term.

    IIRC, that study took a bunch of fat people with healthy metabolic markers and followed them, finding that those markers tended to degrade over time.

    …Which is pretty predictable in “sedentary” people (I put that in quotes because a whole lot of people, myself included, would get a lot more healthy movement in if we weren’t overworked, stressed, exhausted, and/or ashamed or afraid of being seen in public). They did not control in any way for what a physiotherapist would consider “fitness”–muscle mass, stamina, oxygen use efficiency, etc.

    The definition of “fit” in both cases doesn’t seem to be what a layperson thinks of as fitness at all, and doesn’t really answer any questions.

    Who funded this study? Are they interested in persuading fat people to swallow balloons or taking beyond-questionable drugs at any cost?


    Wait, wait, wait… they defined unhealthiness as “having a large waist”… and then did research to discover whether or not people with large waists were unhealthy by that definition?

    They spent money to find out if people with large waists have large waists?

    Okay, now that’s moving the goalposts so far below the bottom of the barrel you’re about to hit the Mohorovicic discontinuity.

  3. I just “love” how all these “people” tell us that they want to make us thin “to save our lives,” and so we have to do “whatever it takes” even if it kills us, because “Better dead than fat,” “For your health’s sake!”

    Seriously, they CLAIM it’s all about our health, but they don’t care if it kills us? At least dead fatties aren’t sick fatties? I suppose they think if they cut off all the fat-weight (dead-weight?), then whoever is left will be healthier, by default?

    Or will they finally care then?

  4. As a person on the thin side I am kind of confused on the treatment of other people for those on the bigger side. My 2 bestfriends are plus size women who are, as I can see, being together for 16 years, healthier and more agile than me. I just can’t see the “unhealthy” side of it.

    1. Fat people became unhealthy in 1959, when MetLife Insurance was imploding and needed a quick and significant cash infusion. They dug up Adolphe Quetelet’s old census charts, retooled them into the Body Mass Index, used them to determine their customers’ average size, and then came up with a tiered payment system that charged customers more the further they deviated from that mean. Knowing they needed some excuse for this price gouging, they claimed BMI outliers were less healthy and therefore riskier to insure. They had no quantifiable evidence for this claim, and the doctors of the era were quick to point that out, but MetLife found other avenues to deliver their BMI charts to the public, making up for their lack of science by appealing to the era’s pop culture love affairs with fashion, bio-purity, nuclear efficiency, and moral improvement through self-denial. Eventually that generation of doctors died off. The new generation had grown up seeing the BMI charts spread to omnipresence (erroneously) presented as tested fact, so they treated them like it. Thus, fat = unhealthy was woven into the social and cultural consciousness much in the same way that story about Richard Gere needing a gerbil surgically removed from his ass has been.

      Although I’m kinda curious about this, young’uns. Does Richard Gere still need a gerbil surgically removed from his ass, or does he get swapped out for a more currently trendy celebrity these days? Like, is it Benedict Cumberbatch needing Twilight Sparkle surgically removed from his ass now?

      Anyway, if you’re interested in the history of modern health-based systematic fatphobia, Paul Campos’s The Obesity Myth has a pretty good summary with a nice bibliography. Although it’s important to note fatphobia was around before that. MetLife and their BMI charts are just who and what made it about “UR HEALTH!!!1”

      1. I have seen references to fat=unhealthy from a women’s army hygiene film from the early forties and a health textbook from the 1920’s, so this idea is deeply ingrained. (In the fil this was put forth in a “ladies should watch their figures” kind of way, mentioning that fat people had more chronic health problems as an aside. In the text it was “How ten fat men and ten thin men walk through life” and showed twenty men at a starting line, with about six thin men and three fat men making it to the “finish” at some old age.)

        Which does not automatically make it true as stated. It does, however, suggest that weight and morality have been conflated forever, and that morally-upstanding people will not “let themselves get fat,” an idea still with us today.

        Fat=gluttony=moral lassitude is a very old idea and can’t die fast enough.

        1. Fat= moral lassitude was present (for women, at least) in Victorian times. A woman HAD to wear a corset, or she was wanton, and loose, and obviously a whore (whether that be an actual prostitute, or just someone to whom they wanted to address the slur). A man was supposed to be able to wrap his hands (not arms – hands) around his woman’s waist. If you don’t wear a corset, because you actually need to breathe to do your work, well, obviously you’re too low-class to even be moral, because a true lady would never stoop to work that required any form of physical exertion and excessive use of air.

          This, at the same time that fathers of young women would send their daughters to the dentist just before marriage, and have ALL of their teeth pulled and replaced with dentures, as a gift to their future sons-in-law, so they’d never have to fuss with paying for their wives’ dental care.

          I believe that the leg-shaving came in the early 20th century, when some brilliant marketer came up with a plan to boost safety-razor sales. Men were still using folding flat razors, and “real men” still do today (it takes real skill and courage, after all), but the safety razor needed someone to buy it, so let’s tell women that they must shave their legs. Last year, I actually saw a commenter online, on one of the many shaving debates, who said, I kid you not – “Body hair on women is not natural.” He was questioned on it, and truly believed that women evolved to be hairless, except for on their head. But, if that were the case, they wouldn’t NEED to shave! “Well, modern women are so decadent, immoral, and unhealthy, that they are deviating from their evolution, and growing men’s hair, because of all the testosterone they consume in their fast-food diet” (or words to that effect). Gobsmacked. He probably believes that women can control their periods, like they control their bladders, too.

          In other words, it seems to go back to class issues, patriarchal power plays, and greed.

          1. What I’m trying to figure out is when fat = immoral turned specifically into fat = unhealthy, because while you can find instances of the former as far as you go back, the latter seems to be a far more modern concept. Sure, the greedy rich fat man was as much a stock character of 1800’s literature as he is today, but other books from the same era (for example, A Secret Garden and Heidi) treated thin characters gaining weight and becoming fat a sign of their *improving* health, and the go-to way for food companies (think Campbells) to insinuate their product was nutritious was to show rosy-cheeked fat kids eating it. I mean, MetLife and their BMI system was definitely a landmark of some sort, and I’ve heard the industrial revolution’s improving logistics making it easier for poor people to get food (thus robbing the wealthy of food as a status symbol) and size standardization shifting fashion attitudes from “clothes fit you” to “here are the clothes, now YOU fit THEM” also contributed. Now that Ziggy’s mentioned it, I also remember reading an exercise manual from the early 1900’s that tried to convince skeptical fathers to let their little girl enroll in a “manly” fitness program by suggesting she might experience “reduction of flesh” and by it become more marriageable, so maybe it was a gradual shift with a lot of little pieces as opposed to there being any one Patient Zero?

              1. Well, this is going to be on readable on my phone, but what the heck. I think we’d have to look at what point in history morality was subsumed or replaced by the concept of health. I think that currently “health” house the same place in society that “morality”used to. There has been a decline of other markers of “respectability” such as “modest clothing,” whether or not a lady wears rouge;-), and whether her front steps are whitewashed daily. Now we define a good person (and people are always more concerned with women, right?) by “health.” Denying yourself delicious food, mortifying the flesh with constant cleanses and exercise, being visibly thin or athletic are now the things that say “good girl.” It’s very weird, very complicated, very interesting, and just as much bullshit as whitewashing your front steps ever day.

  5. Hi I’m an exercise physiologist with a specialization in clinical populations, which means the group of people I work with are people with heart disease, lung disease, and diabetes. I can tell you that all of these people have body types across the board! The most common risk factor I see among my patients has actually been smoking, not weight. For me (and for many people in the exercise field, so please don’t think we are all trying to tell you to be skinny and expecting that to solve all the world’s health problems) “fitness” means strong and cardiovascularly fit, which doesn’t always equate to thin. People who are bigger, but lead physically active lifestyles are healthier than genetically thin but otherwise sedentary people.

    1. Color me so surprised that a behavior has more effect on health than a simple state of existence.

      Thank you! I hope you educate a lot of people, and help stamp out the ridiculous myths out there.

      Also, interesting thing about smoking – it is a risk factor for glaucoma, which is a leading cause of blindness. Which basically means that smoking *can* cause you to go blind. Not that it will, and the numbers aren’t as high as lung cancer, and the like, but yeah. It’s just another thing where a controllable behavior has a whole lot more effects than people might think.

      And you know what? Smokers still deserve our care, even if they lose their voices, while stumbling blindly and coughing up their lungs. Because they are people! So thank you so much for giving them that care! Evidenced based care, FTW!

      They also deserve a safe place to smoke, because kicking the habit is HARD, and some people just can’t do it, and others can, but at a really high price, and darn it, they should not be forced, nor tortured all day long on a “smoke free campus” (because going all day without a fix IS torture for them). This means they will find unsafe places to get that fix, and that’s not good for anyone. (I say this as a life-long non-smoker, btw.)

      I once worked in a great company (for two weeks, as a temp), and they had an indoor smoker’s lounge with a separate air system, so that the second-hand smoke didn’t get into the rest of the building, and the smokers could take quick breaks (it was close to their desks), and be safe and comfortable, regardless of weather or season. They also had an outdoor smoker’s area, where non-smokers could comfortably join their friends, by simply standing or sitting up-wind. This company did not in any way encourage smoking, any more than accommodating fat people’s need for large and sturdy furniture encourages obesity. They simply accommodated people who had a real biological need, so that they could work most effectively, rather than fight their cravings all day. If an employee wanted to quit, and chose to quit, they supported that, as well. Nicotine gum, for example, was encouraged, with no ugly comments about “chewing your cud,” or “it’s rude to chew in public,” or anything like that. The bosses realized that their employees were human BEINGS, not “human resources.” As I recall, they had a “Personnel” department. It wasn’t a fancy place to work, but it was a comfortable place to work, and the employees I met were happy and satisfied, and highly productive.

      1. totally agreed. I married a smoker, knowing he was a smoker, I didn’t marry a smoker with the intention he would become a non-smoker. Smoking is an addiction that is very hard to quit. I am also a non-smoker and I get people all the time wondering when my husband is going to quit and why I haven’t made him quit yet, as if he doesn’t get to make his own decisions… A few years ago he switched to vapor cigarettes, and I think the jury is still out on how that measures up health-wise to regular cigarettes but every time it comes up, whether someone tells me “good its healthier” or “oh no, you know those are synthetic chemicals and its even worse than cigarettes” [really? you think cigarettes are all natural?] I just tell them that it doesn’t really matter to me, I like that he switched because it is cheaper, it doesn’t stink, and it’s not messy.

  6. Forever. I am still waiting for the call back from the pharmacy for my prescription refill. I had my update prescription visit in August. The doctor got so involved telling me the benefits of weight loss and weight loss surgery that he forgot to update my prescription… First do no harm. Unless the client falls into the high end on the BMI. Then disregard all concerns and queries and focus on weight loss. Ta.

  7. Thinking Fat became unhealthy when it became and medicalized/prescibe-able disease. It became a “WAR” when it reached monetary values in the billions.

  8. (Continuing down here to keep it readable) That actually makes a lot of sense, Ziggy! So it’s sort of recursive. Fat people are bad, so when society’s idea of what made someone bad changed, so did the stereotypes about fat people.

    1. …”Fat people are bad, according to society”… you think I’d have learned to proofread before I hit post by now. XD

      1. I finally reread my post on the computer, where it isn’t a vertical string of single layers, and I’m impressed that it made sense to you at all! That’ll teach me to dictate when I can’t proofread!

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