a closer look at "the diseases of obesity"

image credit: samuel ramos; unsplash

taking a deeper dive into what the evidence says about the connection between weight & health.

Last week we talked about the ‘obesity epidemic‘ which we uncovered is, by and large, over-blown. In name alone it’s inherently misleading. The definition of “epidemic” is: a widespread occurrence of an infectious disease in a community at a particular time. While it’s true that the majority of Americans fall into the ‘overweight’ and ‘obese’ BMI categories (~60%), referring to ‘obesity’ as an epidemic implies that being at a higher weight and ‘fatness’ itself a disease.

This completely disregards the notion that there’s natural diversity in size and infers that there’s a specific weight or BMI at which health is achieved (there’s not).

There’s a pervasive message in our society (promoted in large part by our public health officials) that higher weight or fatness itself the cause of increased disease risk. According to the WHO: “Obesity is one of today’s most blatantly visible – yet most neglected – public health problems…obesity poses a major risk for serious diet-related noncommunicable diseases including diabetes mellitus, cardiovascular disease, hypertension and stroke, and certain forms of cancer. Its health consequences range from increased risk of premature death to serious chronic conditions that reduce the overall quality of life.”

I mean. That statement is downright terrifying to read. When this is the type of information being disseminated by public health officials, it’s no WONDER everyone is constantly dieting and trying to lose weight. As we talked about last week – that statement puts us into 2 buckets (neither of which of good): those who ‘need to lose weight’ because they meet that criteria and those who ‘don’t,’ but suffer constant anxiety of ever letting their weight get to that point.

As I’m sure you gathered from the last newsletter, there’s much more to the story here than what you’re being lead to believe.

‘Diseases of Obesity’

Let’s take a closer look at the ‘diseases of obesity’ that the WHO so gravely warns against.

First off, referring to them as ‘diseases of obesity’ is in and of itself untrue. Everyone gets these conditions. These are not diseases specific to higher weight or fatness.

While it is true that many of these conditions are more commonly found in individuals in larger bodies, that doesn’t mean that higher weight itself is the cause. So much of the evidence our society has come to accept as ‘fact’ is based off research that shows association, not causation (these are two very different things, as we’ll explore below).

There are many independent factors that could explain the increased incidence of these conditions in larger bodies versus smaller bodies. Here are just a few to consider:

Stigma & discrimination: Weight stigma and (all forms of) discrimination are stressful. Individuals in larger bodies are subject to this on a daily basis in our fatphobic society. Increased stress is an independent risk factor (meaning that no matter someone’s weight, elevated stress negatively impacts health) for most of the conditions our society blames on higher weight (including cardiovascular diseases & diabetes).
Dieting & Weight Cycling: Energy restricted diets and weight cycling (repeatedly gaining & losing weight) increase inflammation in the body. Inflammation is an independent risk factor for most of the conditions our society blames on higher weight (including heart disease and diabetes).
Body Dissatisfaction: One study showed that body dissatisfaction or simply feeling fat actually had a stronger negative impact on health than actually being fat.
Fitness: The death rate for individuals who are thin but unfit is at least 2x that for individuals who are at a higher weight but are fit thereby making fitness an independent risk factor.
Dieting & Weight Cycling: Energy restricted diets and weight cycling (repeatedly gaining & losing weight) increase inflammation in the body. Again, inflammation is an independent risk factor for most of the diseases our society blames on higher weight (including heart disease and diabetes).

So it’s clear that the research with regards to the weight/disease connection is muddled with all kinds of confounding factors, making it impossible to draw definitive conclusions from it. When independent risk factors (those factors that can impact a situation on their own) are not separated out from other factors that may play a role, we cannot draw a sure-fire conclusion about the connection (because again, it may be increased weight, it may be increased stress due to discrimination, it may be one’s body dissatisfaction or it could be everything together!). A great deal more research needs to be done in this area in order to understand the role higher weight actually plays (if any) in risk for these conditions.

With regards to the WHO‘s statement that “Its health consequences range from increased risk of premature death to serious chronic conditions that reduce the overall quality of life.” We already discussed last week how there’s a large body of research indicating that individuals in the ‘overweight’ category live longer than people in the “normal” category and that individuals deemed “obese” live at least as long as individuals in the “normal” category.

In addition, in Body Respect (aff. link) the co-authors state, “Several epidemiological studies have evaluated weight loss and health long term; they have consistently found that weight loss is associated with increased mortality, even when the weight loss is intentional and the studies are well controlled with regard to known confounding factors, including hazardous behavior and underlying disease” (Bacon, L & Aphramor, L, 2014).

If you’re into the research side of things, I highly recommend reading Linda Bacon & Lucy Aphramor’s 2011 review: “Weight Science: Evaluating the Evidence for a Paradigm Shift” in the Nutrition Journal [PDF linked].

Reference:

Bacon, L. & Aphramor, L. (2014). Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand About Weight. Dallas, TX. BenBella Books, p. 8-10.

disclaimer: the content that I share in this space should be used for informational and educational purposes only. It should not be used as a substitute for medical or mental health advice and does not constitute a client/practitioner relationship.