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
The researchers say their figures were statistically significant; however they were unable to supply the full data with confidence intervals, so we can’t check this.
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?
I have a good friend for the past 6 years here in town.
She has gained weight..meaning well over 15-20 lbs. during same period.
When I first knew her, she was merely sturdy but strong.
I still think she is sturdy, strong but has sustained several injuries from various sports related accidents which has taken longer for her to recover. (skiing when someone slammed into her, snowshoeing when she fell and had mild concussion..)
She has never eaten at her own home. She doesn’t cook her own meals. She is single and no children at all. She is quite dismissive about the idea of cooking for herself.
So it’s restaurants and cafes for her meals.
I have gently sometimes turned down her invitations to join her for a restaurant meal and instead, suggest I cook for both of us at my home. About 90% of the time she takes up on my suggestion. Other time, we eat out for dinner somewhere. I try limiting this with her up to 3-4 times per month. It’s not good…..for myself.
The reason why I turn her down: The only way I can control what I eat and is best, by cooking at home.
I can, like her, afford to eat out. I too don’t have children and have a freer schedule like her.
Her latest injury as of 2 wks. ago, was the whole of her shoulder-neck area which will seriously prevent her from playing her favourite sport: golfing in a few wks. She was sitting twisted on my couch to rest her arm but rest of body was misaligned..which means, if you know anything from doing yoga: you must align your body properly when you sit, lift, etc. or you may easily cause unnecessary muscle sprain, pain.
There have been the odd occasion where we go into a food store and she’s looking on body detoxs on the alternative health medicine shelves.
Seriously….it’s bothersome as a friend to witness all this and say ..nothing. And this a woman raised by a mother who herself a gentle soul, cooked healthy for 7children and was in fitness classes regularily in her 70’s. She admires her mother a lot for her health and fitness.
The latest article highlights in this blog post might help her..or not. It might confuse her.
I don’t know you and I don’t know your friend, so I’d take this thought with a grain of salt, but I would like to gently say that 1) injury is incredibly hard to adjust to mentally and physically and body changes during that time are normal; 2) your friend is probably getting a lot of messages right now about how she should take care of herself from all sorts of sources, and a lot of them are probably not sources she asked advice from. I know that since I’ve been injured and gained weight I’ve really appreciated my friends who will meet me at the activity level I’m capable of without giving me their opinion about what I should be doing, even if it’s something that has really helped them. Honestly, I feel that health advice is strictly between me and my many doctors. I can tell you are a good friend because you care about how your friend is taking care of herself, so I just wanted to offer my perspective. It may not apply to your situation, but I hope it’s a little helpful.
Appreciate your comment. She suggested a short hike in a place where I’ve never been yesterday. I let her drive the exercise activity when we are together.
I’m actually in the same spot in terms of injury, since I had a concussion which has affected my sleep although other parts of me have recovered (which took 6 months).
Yes, most likely #2 she is getting enough messages from her..own family. I do nothing on the food front except offer to eat at my place at times, and try to do interesting simple dishes I normally would eat anyway. I know once she cleary wanted to be babied because of her shoulder problem….because she orchestrated a visit to my place with some healthy made bought tomato sauce and dried spelt pasta. ..which I happily prepared for us. 🙂
There’s so much confusion in this area. Clearly football players and sumo wrestlers are fat and fit. Their bodies match the sports they play. They’re fit for that thing. So that’s fat and fit. Really what they mean is fat and healthy. But what’s the comparison? Fat people who exercise are healthier, generally, than fat people who don’t. We’re also generally healthier than thin people who don’t exercise. Are we healthier than thin people who exercise? Maybe. Maybe not. It depends. But if thinness isn’t possible, why should we care? I mean suppose being 5’7 were unhealthy. Would people tell me not to exercise because I’m 5’7? Would they tell me to try to change my height? No, no, no. I find all of this incredibly frustrating. Yes, I’m fat. Yes, I exercise a lot. Yes, right now, I’m healthy. I’ve decided that’s all that really matters. Argh!!!!
I have to say I’m not sure about that “good news” point you had near the end… the government has been convinced that obesity is the leading cause of disease for decades now. And all that means is that money is funneled into public health campaigns that are mostly just fat shaming in disguise.
I think we need the government to be convinced that there is more to health than individuals being fat. Social determinants of health play a much larger role in health. So little about health is about individual choice (and how that leads to fatness), so much as the larger system at work (food system, the physical environment and whether it promotes activity….. time availability, food security, income level, capacity… SO MUCH). I’d love to see the government do what you suggest, but that won’t happen if the conclusion is that weight is the issue. Weight is what they will focus on, not health behaviours.