This week the mainstream news media rushed to publicize a conference paper given at the European Congress on Obesity that argued that there’s no such thing as “fit but fat”. I posted Wednesday night with some immediate reactions and questions– you can see them here. Many of my questions were about the details of the study, for which we must wait until an article is published.
However, since then, I’ve been thinking more generally: What does this mean, the idea that there’s no such thing as fit if you’re fat? Is this right? And how does all this affect people with a BMI >30 (like me)? So let me address each of these questions, and you can tell me what you think about my answers.
First, questions about meaning (sorry, it’s the first place philosophers tend to go, but I’ll keep it short): What does “fit but fat” mean?
When medical professionals say this, they’re generally talking about people with BMIs over 30 (or even over 25), who don’t have any problems like high blood pressure, cholesterol or blood sugar readings, or various markers of potential future heart disease or potential future diabetes. That is, fit but fat people are healthy people who weigh more than the BMI scale says they should.
Just for fun, when I looked up google images for “fit but fat”, I got this gorgeous picture of two sumo wrestlers locked in a lovely balletic grapple. Wow. Don’t they look great?
But there’s the “but” to deal with in the “fit but fat” message. Why the “but”? Why not “and”? “But” is signalling that someone is fit, BUT all is not well– that person is also fat (which is not normal or good or healthy or… fill in the blank here). Even we we say it about ourselves, we are putting ourselves down, as “fat” is often associated with being unhealthy or defective or sub-optimal in some way. So being fit but fat is not exactly a position of great positivity to begin with. And now it’s being challenged by this study (to be fair, there are other studies with similar results– BUT there’s not medical consensus on the issue).
And it gets worse. Saying that it’s not possible to be both fit and fat seems to mean that BMI trumps ALL other factors (genetic, environmental, psychological, etc.) when it comes to determining health and risk for (weight-related) disease. Is this right? No– not as stated there.
What medical researchers say holds for a population or group overall does not necessarily hold for particular individuals. As we say, your mileage may vary. A lot. Here’s what the researchers said (this is from Pub Med Health, which doesn’t make money from splashy headlines; for a clear and undramatic account, check it out):
Of the 3.5 million people in the study, 766,900 (21.9%) were obese – of whom 518,000 (14.8%) were obese with no additional risk factors (metabolically healthy).
The researchers found that, compared to people of recommended weight, metabolically-healthy obese people were:
- 50% more likely to get heart disease
- 7% more likely to get cerebrovascular disease
- twice as likely to get heart failure
Metabolic risk factors raised the chances of getting any of these conditions, in addition to obesity.
Compared to recommended weight, metabolically-healthy people, those who were obese and had all three risk factors (diabetes, high blood pressure or abnormal blood fats) were:
- 2.6 times more likely to get heart disease
- 58% more likely to get cerebrovascular disease
- 3.8 times more likely to get heart failure
- 2.2 times more likely to get peripheral vascular disease
We don’t know if this research is largely correct. I have a whole bunch of technical questions about the study (all of which have to wait for the data and the article to be published). Their work coheres with some studies and conflicts with others. As always, we will have to wait to see how things go. Science is complicated.
Now to my last question: how does this result affect people with BMI > 25 and > 30?
In my view, there may be good news and bad news in answer to this question. Shall I go with the bad news first? Okay.
Uptake of the message that you can’t be fit if you’re fat could lead to more weight stigmatization, more fat shaming of people who seem larger than some idealized notion of a person. This could lead to eroded relationships with healthcare providers and more money spent on useless diets and weight loss programs. But most importantly: it could mean less physical activity in the population, which translates into generally lower levels of standard health markers and lower levels of all sorts of features of well-being.
That’s my biggest problem with the news so far. We don’t know if these researchers got the details right, and we don’t know how to interpret them if they did. But what we do know is this: studies consistently show that physical activity is a great predictor of health and a great mechanism for achieving and maintaining lots of features of well-being (e.g. less depression, better sleep). And unlike body weight, physical activity (which isn’t the same as fitness, but hear me out) is something that a lot of us have some modicum of control over. Becoming fit (in the various ways we understand that word) has a lot of benefits. It’s not the only useful life goal, and it’s not of interest to everyone; fair enough. You do you. But I don’t want to see its value drowned out amidst the shouts of studies trumpeting the importance of having a lower body weight. Especially since medicine offers no remotely effective tools for lowering and maintaining body weight over time (except gastric bypass, which as I’ve said many times isn’t designed or an option for most people).
Now to the good news: if it turns out that scientific consensus develops around this idea– that the main thing that matters to my health (at least some features of it) is my body weight, then this might put pressure on governments to do something about our obesogenic food systems and infrastructure. They could, for instance:
stop subsidizing corn production;
fund and promote public transportation;
tax sugar-sweetened beverages;
restrict food advertising targeted at children (or anyone, for that matter);
to name a few.
Are any of the actions above going to happen because of one research article? No. But it’s worth noting that as we learn more about the science of body weight and its relation to our health, we may find that more players are involved, giving us more options for promoting health and wellness in many ways. Hey, an aspiring to be fit feminist can dream, can’t she?