Now skinny people can be obese too! (Wait, what?)

Turns out you don’t actually need to be fat to be fat-shamed by your doctor. Maybe you knew that. (Christine wrote about BMI this week. See On doctors, BMI, and other bullshit.)

But wait. It gets worse. Now it seems you can actually be skinny and obese, not just skinny fat but skinny-obese. Who knew?

See Skinny patients can show signs of obesity.

The article talks about skinny patients who have undiagnosed metabolic disorders.

At the heart of all these conditions and what is known as “metabolic syndrome,” or having at least three of the conditions associated with obesity, is an inadequate ability to store fat. (Dr. C. Ronald Kahn, chief academic officer of the Joslin Diabetes Clinic, said two German physicians called the syndrome “metabolic” nearly 40 years ago. Conditions such as elevated cholesterol, diabetes and even high blood pressure appear to be linked through disruptions in metabolism, in this case the abnormal storage of calories.)

The body turns excess food into fat and tries to store it in fat tissue. If there is not enough fat tissue, the fat is stuffed into other organs, like the liver and the heart, as well as the muscles and the pancreas. There it poisons the body, causing metabolic syndrome.

Fat people develop metabolic disorders because their brain is driving them to eat more food than their bodies can store as fat. Their fat tissue has reached its limit. People with lipodystrophy have so little fat tissue that they, too, cannot store the fat their body makes to store extra calories from the food they eat.

It’s a theme I’ve worried about before. While fat people may get too much unneeded medical attention from doctors who assume that fat=unhealthy, thin poeple often get too little attention. See How equating being fat with being out of shape hurts thin people too.

But I’m also worried, as a philosopher, that the words we use are starting to lose their meaning, if skinny people can be obese. What we really mean is that thin people can be metabolically unhealthy. So why not just say that?

In my post asking questions about weight loss I wrote, “Is all obesity alike? Catherine Womack and I have chatted about whether there are medically significant different kinds of obesity (her suggestion). You know that there’s conceptual cleaning up to be done, of the sorts philosophers love, when medical researchers start talking about “thin fat” people and metabolically healthy obese people. It seems clear that these weight categories aren’t doing the work we need them to do. “Thin fat person?” What the heck is that? Oh you mean a metabolically unhealthy thin person. Then why not say so and leave weight out of the picture?”

Also, I know there’s a larger critique here about the medicalization of body sizes. “You’re too skinny!” “You’re too fat!” “You’re the right weight of skinny but oh, no, it’s skinny fat!”

And suppose it were true that being a certain number on the scale meant you had a certain healthy risk, then that might be something you’d like to know when planning your life. My son has a pretty benign genetic condition but one upshot is that he might have arthritis early in life. He’s known that since he was a younger teen but the point is no one expects him to do anything about it.

That’s the issue with medical talk about body size, the assumption that you can fix it. Even if my weight poses certain health risks, sharing that information (if and when it’s right) isn’t the issue, it’s the assumption that it’s my fault, that I can fix it if I only I tried hard enough. (And believe me, I’ve tried. Not quite Oprah-tried, but close. I’m not as wealthy as Oprah.)

So lots of questions here about size and health, but I’m just asking for one simple thing, stop saying “thin-fat” or  “skinny-obese” when what you mean is thin and unhealthy. I hope for all of our sakes, that’s not too much to ask. Thanks!