We’ve been here before, people.
Now the American Medical Association has decided that obesity is a “disease”.
some doctors and obesity advocates said that having the nation’s largest physician group make the declaration would focus more attention on obesity.
Because you know, we as a society spend no time at all on the topic of weight and health and how disgusting and evil fat people are.
The first technical problem is that there’s no single definition of what a “disease” is – so sorry, fat-haters, you don’t really get “but SCIENCE!” free rein to keep hating on people whose bodies you dislike. From the article linked above:
To some extent, the question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed upon definition of what constitutes a disease. And the A.M.A.’s decision has no legal authority.
The second is that the AMA contradicted its own committee of experts on public health:
The report panned body mass index as a proxy for obesity, saying it’s limited as a stand-alone. Furthermore, calling obesity a disease may undermine prevention efforts and will do little to impact its treatment, the report said.
“Without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state,” the council told the AMA’s policy-making House of Delegates. “Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive.”
The third is all about following the money, because the initial report above clearly states:
And [the declaration] could help improve reimbursement for obesity drugs, surgery and counseling.
i.e. could make it a lot easier for fat people to pay for drugs which don’t work, undergo dangerous surgery which doesn’t work, and be convinced they need therapy for their existence.
The weight cycling industry in the US alone is worth $66 billion a year. And yet it has not delivered a significant decrease in fatness in the US population. If someone were making $66 billion a year and only returning illusory results to its investors, we’d call it a Ponzi scheme and throw people in jail for it.
But the overwhelming issue is, of course, that my body is not a disease. Being fat is a characteristic of my body, like my eye colour, like my hair colour, like my skin tone. It is strongly influenced by genetics, just like my foot size (not a disease) and the shape of my ass (way too awesome to be a disease).
People always want to say “but I’m not talking about you, it’s just that obesity is linked blah blah blah”.
You’re lying, people. Maybe you’re lying to yourself, too, and do honestly believe that you’re a judgement-free snowflake whose only flaw is caring too much. But you’re lying nevertheless.
As has already been covered on far too many occasions, height is “linked” with plenty of health issues. Different ethnic and geographic backgrounds are linked with health issues – and we don’t say “let’s declare “spending your childhood in New Zealand” a disease” in order to “focus more attention” on iodine deficiencies.
We are, in many (but not all) other spheres, quite able to treat health issues on their own without demonizing the associated characteristics of the people who have those health issues. We do it for fat because we’ve accepted the idea that (a) fatness is controllable (despite reams and decades of scientific research to the contrary) and thus blameable, and (b) the “links” between weight and certain health issues is rock-hard and invariable, as opposed to the “links” between height and Alzheimer’s disease, which are just random, blameless flukes of nature.
When you talk about “obesity”, you’re talking about my entire life. Because the only way I will ever be not-fat, ironically, is if I am sick and that sickness, or the cure-or-kill-you treatment for it, causes unnatural, damaging weightloss which will reverse itself once I’m not sick – yep, being healthy would make me gain weight again.
You don’t “cure” obesity without killing me, and everyone else who’s fat. You don’t call obesity “a disease” without labelling every single fat person as inherently sick. And we’re not.
At some point in this saga, I used the phrase “eliminationist”, and was promptly told off because the person I was arguing with never used that word.
I suppose it’s a bit like how someone can’t be misogynist just because they refer to all women as bitches, because, um, unless they use the word “misogynist” their behaviour can’t be described as misogynist.
Anyway, for people genuinely interested in the concept, the canonical post on it is at Shakesville. I paraphrase:
When you talk about eliminating obesity, stopping people getting fat, waving a magic wand and making everyone a “normal” weight, you are talking about eliminating me. Because I’m a fat person. I’m never going to be a thin person – because diets don’t work. Because there is no scientific evidence to support the idea you can make a fat person eternally thin.
To actually attain your dream world where no one is fat? You need to find a way to get rid of me.
And given how we know – from PEER REVIEWED SCIENCE!!! – that weight cycling damages people’s health, that “weight loss surgery” damages your life expectancy if you survive in, and that the medical profession will let you die because they’d rather diagnose all your health problems as being about your weight and not your ovarian cysts or your depression or your multiple sclerosis?
I think we can take a good, informed guess as to how that magical fat-free world is meant to come about.
I’m sorry, everyone.
I’ve been spreading misinformation on Twitter. Dangerous, subversive misinformation.
I started off with the radical notion that obesity isn’t a health problem. In the same way that being red-headed or having A+ blood isn’t a health problem. Those things may be “linked” statistically with certain conditions or illnesses or levels of mortality … that doesn’t make them illnesses in their own right.
Of course, people may say “oh, I didn’t mean individual health, I meant overall health”. Obesity is still not an illness. It doesn’t have a diagnosis, it doesn’t have a cure. It has some incredibly vague and imprecise alleged measurements, and a hell of a lot of
very profitable yet completely unreliable suggested treatments. But I choose not to see that as the same thing.
Also? BMI or amount of body fat are weak predictors of longevity, and being “overweight” is associated with greater longevity, especially for the 55+ age group; obesity may have a protective factor for people with type 2 diabetes, hypertension, cardiovascular disease and chronic kidney disease; obese people are more likely to survive a coronary bypass.
But clearly, I was wrong. My ass is an epidemic. My boobs are the plague. Despite my lack of actual health conditions like high blood pressure or heart disease or diabetes, I am fat, and ergo sick.
I pointed out that height is more affected by environment than weight.
Okay, okay, you got me. I was wrong. Because weight is 70-80% heritable, and height is 60-80% heritable. Or it’s 75-85% versus 90-95%. Either way, the lesson is clearly that I was wrong, and weight is totally something individuals can control, unlike their height, which is fixed by God.
I was basing this statement on studies which show things like activity-based programmes to reduce children’s BMI consistently fail.
I read Junkfood Science, and learned:
Professors and clinicians David Garner, Ph.D., and Susan Wooley, Ph.D., reviewed 500 studies on the long-term treatment efficacy, the biology of weight regulation, and health outcomes of weight loss, and confirmed that multiple researchers, using a variety of methodologies, have continued to fail to find any meaningful or replicable differences in the caloric intake or eating patterns of the obese compared to the non-obese to explain obesity.
And I discovered this study shows that there’s fuck-all difference between “metabolically healthy” obese people and thin people.
But look, it just makes sense that fat people are lazy gluttons. Science said so. Just not here.
I am at least smart enough to know that individual studies can be flawed, but I was truly taken in when my research found that meta-study after meta-study after meta-study shows weight loss programmes failing. If they bothered to follow the subjects for longer than a year. A lot didn’t. Probably for totally innocuous reasons.
See the “Also?” link above?
Long-term follow-up studies document that the majority of individuals regain virtually all of the weight that was lost during treatment, regardless of whether they maintain their diet or exercise program. Consider the Women’s Health Initiative, the largest and longest randomized, controlled dietary intervention clinical trial, designed to test the current recommendations. More than 20,000 women maintained a low-fat diet, reportedly reducing their calorie intake by an average of 360 calories per day and significantly increasing their activity. After almost eight years on this diet, there was almost no change in weight from starting point (a loss of 0.1 kg), and average waist circumference, which is a measure of abdominal fat, had increased (0.3 cm).
You know what does work to actually improve people’s health? The Health At Every Size approach. Which doesn’t result in weightloss. (It’s even been … PEER REVIEWED!!! More on that in a later post.)
But it’s probably all just a scheme so fatties can feel good about themselves and justify eating more doughnuts.
I said that successive generations are getting taller, that height is correlated with some illnesses, and that it thus surprises me (note: it doesn’t really) that no one runs around panicking about a tallness epidemic.
This was then presented as me actually arguing that height is a health problem. At this point I probably should’ve stopped, because I was clearly arguing with someone who had no intention of engaging honestly, but I am a glutton for
doughnuts punishment sometimes..
What I tried to clarify – and of course, Twitter is a bad medium for anything more complex than one full sentence – is that fatness is not sickness, and our social responses to sickness are ineffective and oppressive.
Like diets. Oh, said the other person, I never mentioned diets. Nope, he just talked about “controlling” body weight. Because there are totally safe predictable sustainable ways to do that which aren’t “diets”, right?
What there actually are are a lot of studies (PEER REVIEWED! SCIENCE!!!) which show that it’s seriously, seriously hard to permanently alter people’s weight. In either direction. And despite the constant panic-mongering over THE OBESITY EPIDEMIC, life expectancy continues to rise and the population is getting healthier – in actual measurable things.
There’s the way that messages about THE OBESITY EPIDEMIC have led to increased discrimination against fat people – including discrimination in the medical professional which has almost certainly killed people.
The 70-80% heritable link above? Also notes that stress has a major impact on body weight. Gosh, I wonder if underprivileged, poor, oppressed minorities, who are so often the Scary Fat People Who Will Eat Your Babies, might be under some stress that Good White People From Nice Schools don’t experience?
The “Also?” link above? Notes that:
Most prospective observational studies suggest that weight loss increases the risk of premature death among obese individuals, even when the weight loss is intentional and the studies are well controlled with regard to known confounding factors, including hazardous behavior and underlying diseases
So clearly the answer is to be born thin, to thin parents. But not too thin, obviously.
I apologise, people. I’ve been wilfully leading you all down a garden path to obesity. I will not rest until we all look like that fucking creepy vampire Pearl from Blade. Probably because I’m a jealous bitch, or something. (Well, I’m sure the more kindly fathaters will pretend to look on me with pity.)
I’ll stop worrying my little fat ladybrain about this now.
Until tomorrow’s post.
Hat tips (and seriously recommended reading): the Redefining Body Image resources page; Shapely Prose’s immortal FAQ; Dr Linda Bacon, the appropriately-named goddess of HAES; Big Liberty’s Truth Behind Fat: References; Junkfood Science.