The Fat Police
For instance, being overweight, defined as having a body mass index (BMI) over twenty-five, may not be inherently bad. It is possible to be fit, eat well, and be overweight, just as it is possible to be thin and unhealthy. But at the upper ends of the spectrum, health risks seem more clear. When someone’s BMI goes above thirty, they’re considered obese, and are at greater risk for heart disease, cancer, osteoarthritis, diabetes, and stroke. Increased mortality is associated with both the underweight (a BMI less than 18.5) and the obese, but despite what some blogs say, the majority of excess deaths (relative to normal weight) are associated with obesity. And obesity-related diseases means having to spend more time with the people you’d rather just see once a year: doctors. According to the Centers for Disease Control, about 10 percent of U.S. medical expenditures went to treating weight-related medical conditions, to the tune of almost $100 billion dollars.
Sugar-Coated
Positive body image is something women should strive for, but putting themselves at risk for real medical and quality of life issues isn’t. Unfortunately, when cosmetic issues overlap with medical concerns, the discernment becomes muddled. Clinically, the terms overweight and obese are objective measures with defined numerical measurements. (Whether or not BMI is the best way to measure these things is also up for debate.) Though the definitions are straightforward, broaching the subject is not. The problem, for doctors trying to alert patients to potential ailments, is as much semantic as it is medical. For those people who have not embraced the word fat, clinical information is distorted as an insult. A study by the University of Pennsylvania school of medicine found that obese women rated the phrases “fatness, excess fat, obesity, and large size” as offensive terms, instead preferring the more generic terms like “weight,” “heaviness,” “BMI,” and “unhealthy body weight.”
Realistically, weight often comes down to an issue of perception. You’re only as thin as the person next to you is fat. Surrounded by obese people, overweight doesn’t look so bad anymore; surrounded by fashion magazines, even thin women are large. Skewed perceptions can make one unaware of what is healthy, or where she would normally fall in the spectrum. Recently, researchers from the University of Michigan surveyed more than 2,000 parents about their children’s weight. While 25 percent of children were overweight or obese, more than 40 percent of the parents were unaware of this. Would labeling these kids be better? Only if their weight was a proxy for unhealthy behavior that could result in long-term problems. Otherwise, the label could do more harm than good.
One Size Does Not Fit All
What does seem clear is that our current cultural climate makes it hard for people to develop a healthy sense of self. The diet, food, and pharmaceutical industries all have a stake in keeping people on the weight roller coaster, and spend massive amounts to market this objective. I don’t think we should support their cause. I’ve argued that prevention is the best way to ditch dieting, and that our environment, not the individual, is what really needs to change.
But just as we should not celebrate the excessively thin, I’m not so sure celebrating the obese outlier is any healthier. Size acceptance should be served with a side of medical reality. Rather than numbers or labels, perhaps we should be discussing healthy lifestyles and happiness, where size doesn’t matter.
Updated August 20, 2008
