Study: Fat People Can Be Healthy

You may have heard of the study by  Kuk et. al. on the Edmonton Obesity Staging System. I’ll give you the background first and then get to the interesting stuff and the swearing:

They characterized fat people’s health on a 4 point scale: “stage 0, no risk factors or comorbidities; stage 1, mild conditions; and stages 2 and 3, moderate to severe conditions”.

They found that:

Compared with normal-weight individuals, obese individuals in stage 2 or 3 had a greater risk of all-cause mortality and cardiovascular-related mortality. Stage 0/1 was not associated with higher mortality risk (emphasis mine)

The study has limitations in terms of statistical significance (the sample was mostly middle class white people for example), much of the data was self-reported and the authors are clear that further research is necessary.  Interestingly, in the conflict of interest section it states that two of the authors sit on Jenny Craig’s advisory board (although maybe not for long?) and one of those authors has research grants from coca-cola and Body Media (a weight loss product).

Some interesting tidbits:

Stage 0 or 1 participants were less likely to die from cardiovascular disease than “normal weight” individuals.

Stage 0 and 1 individuals were more likely to be physically active and eat more fruits and vegetables. Stage 0 or 1 participants were also less likely to report engaging in weight loss practices.

Hey isn’t there a name for engaging in healthy habits and not engaging in weight loss practices?  Wait a minute it will come to me…ah yes, it’s a Health at Every Size (R)* perspective!!!  I knew that sounded familiar!

According to this article, Dr. Pieter Cohen, assistant professor of medicine at Harvard Medical School and a general internist at Cambridge Health Alliance said:  It’s “absolutely” possible for people to be overweight or obese and healthy.

Harvard doctors making sense?  I may have to play the lottery today!

Dr. Sharma, chair for obesity research and management at the University of Alberta (who often makes sense) said: “The key message is I can’t tell you how healthy someone is if you tell me height or weight on a scale.  I have to do additional tests for other health problems.”

Then there are some things that I almost can’t believe about this:

They list the health issues as “co-morbidities”, thereby making the unsupported assumption that obesity is a primary disease or disorder  when it’s really just a height/weight ratio.

The study says

Nevertheless, these factors, together, indicate that obese patients, particularly in EOSS stages 0 and 1, may be better served if physicians promoted weight maintenance, as opposed to weight loss, as it remains to be seen whether individuals in EOSS stages 2 and 3 will benefit from weight loss.

Yet the articles that I read are still recommending weight loss for patients who are at stage 2 or 3. This is problematic because:

1.  They JUST SAID  that weight loss attempts may well worsen health.

2.  They don’t know if losing weight will  help these people.  There is no solid proof.

3.  Even if they did have proof that weight loss would help, they have no idea how to get it done.  Prescribing something with an efficacy rate of 5%, especially knowing that the 95% who fail will likely end up less healthy than when they started, isn’t just dumb – it’s medically unethical.

4. I don’t know whether to make study author Jennifer Kuk the blue ribbon loser or winner for this quote: “the ranking system helps to identify who should actually lose weight and who are we torturing for no reason”

Ok Dr. Kuk. In addition to saying that you don’t know if weight loss will help, in your study you said

For the vast majority of obese individuals, lifestyle-based weight loss is not maintained over the long term (Wing et al. 1995).” This is particularly concerning, given that weight cycling is associated with greater weight gain over time (Van Wye et al. 2007) and potentially worse health outcomes, compared with individuals who may have maintained a stable body weight (Blair et al. 1993; Wannamethee et al.2002).

If you are:

  • ruining people’s current quality of life by self-describedly torturing them
  • under the auspices of possibly giving them better quality of life later
  • all the while knowing that the most likely outcome is actually worse health

may I gently suggest that Ur Doin it Wrong.

Dr. Howard Eisenson (executive director of the Duke Diet & Fitness Center) totally doesn’t get it, but gets quoted in the CNN article on the subject anyway: “If we don’t intervene now [when someone is healthy, 25 and obese], by the time the person is 35 … maybe some damage has been done and the unhealthy habits are more established.”

Okay Dr. Einsenson, I need you to stay with me here, I’ll type slowly: Not all obese people practice unhealthy habits, you’re just making that up in your head. In fact the very  study upon which you are commenting showed that people who practice healthy habits and don’t attempt to lose weight (thereby ignoring the advice of the Duke Diet and Fitness Center) have better health outcomes. Also, see above on your complete inability to effectively create long-term weight loss.

(And not for nothing but why does every article about this study have at least three doctors offering a counter-opinion but Jess Weiner gets to mischaracterize the entire Health at Every Size(R)* movement to sell her new diet program, and nobody bothers to call any of us for a counter opinion? I’m just curious.)

Several articles suggest that the stigma that fat people face may be a worthy reason to lose weight even if their health is fine.

Oh, how can I put this delicately?

YOU HAVE GOT TO BE  FU#%ING KIDDING ME! The cure for social stigma is not weight loss, it’s ending social stigma.

Finally, there are the comments.  If I could give you a piece of advice, it would be not to read the comments.  All kinds of people who think that “personal responsibility” means that I am personally responsible for looking how they want me to look.  So many people who can bite me. But the message I’m taking away is that, as I’ve long suspected, these people don’t care about my health.  If they did there would be a zillion comments saying “wow, I really need to question my assumptions about weight and health”.  Alas, none that I saw, and perhaps that’s because they only actually care about having someone to whom they can feel superior.  But that’s just a guess.

It bears repeating that prioritizing one’s health is not a moral, social or personal obligation (you do not get to choose what is important for me and I don’t get to choose what’s important to you – that’s why we each have our own underpants to be the boss of).  Also, health is multi-dimensional, not all aspects are within our control, and it should never ever be used as a barometer for worthiness.  Knowing those things, I’ve said it before and I’ll say it again (today backed by research):  while health is never guaranteed, if being healthy is what we want, then healthy habits are our best chance for healthy bodies.

*You’re probably wondering why I’m putting at (R) after every use of Health at Every Size (R).  It’s because the awesome organization ASDAH has successfully put a copyright on the term so that it can’t be misused, and now there are a bunch of rules to follow. And you know that I think this is important because normally I reject rules.  That being said, if anyone knows how to actually make the trademark symbol in WordPress I’m all ears, or fingers, or whatever.

25 thoughts on “Study: Fat People Can Be Healthy

    1. Oh, very convenient! I’ve often considered making up a file of characters to keep on my own computer to copypaste from (something about my current system – Linux OS? the antiquity of said OS [to be rectified shortly]? something about the keyboard? dunno – doesn’t always play nicely with alt codes), but have never taken the time/trouble to do anything about it. I should have thought to see if anyone’d made a website!

      Thanks for linking that, Wendy!


  1. Alternatively, you can use the HTML © when using a HTML editor, or the ASCII number 0169 (that’s Alt + 0169 on your numpad).

    Also, this study is awesome. As an unhealthy fatty who’s undergoing surgery for the third time in three years, though, it’s very difficult to defend fat acceptance and HAES. People just need to point at me and go “but YOU are unhealthy, and it’s because you’re fat!” Even though I don’t want to believe that that’s true, it’s also difficult not to believe it when all of society is trying to convince you.

    Even within the fat-o-sphere, you often find that fat people are trying to defend themselves with “but I’m healthy! Look at my numbers!” Well, I’m not healthy. And I still deserve to love myself, to have a happy life, to not torture my body with diets when it’s already in pain. I try to have healthy habits within the limits of my own energy capacity, but that means I can’t really exercise because I’m already at my limit at the end of the day, and it means I can’t eat less simple carbs because I need them to get energy back.

    I’m a bit tired of not only being judged on my health by society, but also within fat acceptance circles. Even unhealthy fatties who can’t do all the habits and don’t have all the good numbers still deserve love and respect. Health *shouldn’t* be a barometer for our self-worth. Thank you.

  2. I heart this post for so many reasons. It is so wonderful to see HAES discussed more broadly and supported by science. I only wish my father in law who actually teaches nutrition to med students was willing to consider the possibility of this science being not only valid, but worth seriously exploring. (He teaches calories in / calories out despite being surrounded by evidence that it’s just not true within his own family.)

    Also, on my MacBook I can click the funny little box (I think it’s been a flag in the past too) next to my charger icon on the top of the screen, select View Character Viewer, find the character I want and click insert to get this → ®

    1. I saw something on one of the morning shows about the calories in and calories out thing. This was an author who has a book out and yeah, it was about weight loss BUT, some of what she was saying was good because she was totally going after the whole idea of calories in and calories out saying that it does depend on the food, it does depend on the person, the calories listed on something can be up to 20% off, and she advises to eat food as close to its natural state as possible and not count calories because it’s not the best way to lose weight (yeah, that whole weight loss thing came up, I KNOW but other than that, she made some good points).

  3. Press and hold the ALT key on your keyboard
    Use your number pad to type 0174, while holding down the alt key
    Let go of the alt key and the ® symbol will appear

    You can also get the ™ symbol by doing the same thing but using the numbers 0153, and the © by doing the same thing with the numbers 0169.

    Neat factoid learned because of one of my cats… her name is Èclair and I got REALLY tired of having to find someplace to copy the È from every time I wanted to talk about her, but I didn’t want to just type her name as Eclair either LOL. È is easy, it’s alt-0200

      1. Mac is simple, though it requires a bit of guessing sometimes. Press the ‘option’ key and a letter or number that seems to fit. ® Hey, that was opt-r 🙂 ™ is opt-2…

    1. Hi, Erin–Love that your cat is named Èclair, but isn’t the French way of spelling it Éclair? Or maybe you just wanted her to to have her own special spelling, since, as we all know, every cat knows he or she is completely unique.

  4. Established paradigms take a very long time to change. It’s great that researchers are standing back and taking a good hard look at something that the whole world thinks is common sense.

    What stunned me when I started reading fat studies is how little researchers actually know. A lot of health assumptions are going to turn out to be wrong. Even when they do, it will take more time before that knowledge gets filtered through the general medical community and then into the population.

    One of the things that’s not yet established that fat is completely health neutral, or whether a certain amount of fat becomes a co-morbidity in some circumstances. Adipose tissue seems to have a role to play in oestrogen regulation, particularly post-menopause, so the presence of lots of fat cells may have implications for oestrogen dependent diseases like some forms of breast cancer.

    It’s why I read Dr Sharma’s blog every day – I like the way he makes it clear what he’s uncertain about, and what he knows.

  5. I too read the article, and then read the comments. I felt like a sack of crap after being told repeatedly how I just don’t care about myself, I am selfish, lazy, gross, stupid…etc. I am obese, I am strong, have excellent medical numbers. I am active and healthy. A few years ago I was a fitness coach in a ladies gym and could outperform lots of thin people. Why doesn’t that count for something? Why does the fact that I wear a size 20 make me some kind of a pariah?

    1. Hi Andrea,

      It does count for something. I think it’s important to realize that these people can be mean spirited idiots who spend their time trashing fat people on the internet, but we do not have to buy what they are selling at the convenience store of crap.


      1. I don’t want to shop at the convenience store of crap, btw, I may use that phrase. Thanks Ragen for your amazing outlook. I look forward to reading your blog every day.

    2. If anything it’s worse sometimes when you aren’t perfectly healthy… I’ve been reduced to tears on more than one occasion because I got sucked in and read the comments. Because you can never really escape the idea that maybe you DID do it to yourself, no matter how many times you’re later told you couldn’t have. Or even if you know that what’s broken is the result of damage from an *accident* and the same accident would have caused the same damage regardless of if you weighed 100 or 400. What’s the saying, if stigma could ‘cure’ fat, there wouldn’t be a fat person on earth?

  6. I keep saying that if your doctor offered you any other treatment with a 5% long-term success rate and a 33% chance of getting worse, you’d tell him to take a hike. Yet, people faithfully take home their 1500 calorie (or less) a day diets and rearrange their lives to follow them.

    And I, too, get irritated at those citing “quality of life” in terms of stigma. It’s like blaming the kids who get bullied instead of the bullies.

  7. Platform independent way: use the HTML code ®

    On a Mac: option-R

    Also, generally you only need to attribute the trademark in the first mention on a page. So the first time you mention HAES use the registered trademark symbol, but every time after that on the same page you should be fine without.

  8. I read the article yesterday and was overwhelmed by the bizarre mixture of things I agree with, things I don’t agree with, weird self-contradictory assumptions, and the tiny, tentative, newly-hatched willingness to acknowledge that maybe, just maybe one can be healthy and obese. Thanks for your analysis. I didn’t have the energy to parse it out, but you did so beautifully. The article and study show clearly that even when the evidence lines up in support of HAES (as it so often does!) we still have a long way to go in getting the message safely through the gauntlet of the “weight-loss is the only solution” cohorts. Lately I’ve been reassuring myself that probably most of us in the HAES community were once advocates of weight loss ourselves (at least in our own minds), and that every weight loss advocate is potentially a future HAES activist waiting to emerge into the light.

  9. Alas, modern science seems to have forgotten the tenets of good science, in which the observed data continues to refine the theory, until all the data results in an inescapable conclusion that can be considered fact. Today, science tends to force the data to fit the theory, or to disregard any data that might refute the theory. It seems science has become more about the scientist proving himself right, than about finding the truth.

  10. I composed (most of) a really long comment picking apart exactly why centring obesity in a list of this kind is getting ahead of the evidence (all correlation, no supporting causality), then deleted it, because it’s really simpler than that. All they’ve really said here is, “People with more chronic health conditions are unhealthier than people with fewer chronic health conditions! And since the people we studied were all fat, this is not a tautology but Breaking News About Obesity!!!”

    It’s nice that they’ve discovered that fat people are – imagine that! – just like non-fat people in having a variety of health statuses.

    About the only thing new seems to be organizing it into a staging system – which is deeply problematic, because it implies that not only is obesity a disease, it’s a progressive disease. When we talk about Stage 3 cancer, we’re talking about a verifiable progression – talking about Stage 3 Obesity is just VFHT clothed in *!Science!* (think Magnus Pike’s soundbite in Thomas Dolby’s “She Blinded Me with Science” to get the proper effect). No real science to see here, move along, pay no attention to the man behind the curtain.

    So the only “win” here is that they’ve decided to stop torturing some of us. This doesn’t even get them a cookie in my books, much less a blue ribbon.


  11. I have a problem with the whole “obesity is a disease” model too, but I also think the EOSS system marks a great advance in de-medicalizing obesity and (I hope) de-stigmatizing fat people when we seek medical treatment. Keep in mind that EOSS was devised because Dr. Sharma realized that BMI alone was a very poor indicator of health, and what the EOSS basically tells doctors to do is to check before assuming that a person’s weight is the source of health problems. I know – duh!! but we also know there are still a lot of doctors out there operating under the old assumptions and this shows they’re not true.

    I’ve started reading Dr. Sharma’s blog recently and he very clearly understands that telling people to lose weight for their health is mostly an exercise in futility and will likely cause more harm than good. Now, whether the media coverage about weight issues will ever stop giving the OMG FAT=DEATH!! alarmists so much air time is a whole other question — and I doubt any amount of evidence will stop trolls from posting hateful sh*t on news stories about it. Lots of people say things online that they’d never have the nerve to say to someone’s face. Let them stew in their smug little puddles of self-righteousness.

  12. I met someone at a chronic pain support group that is in WAY worse health because of weight loss– surgery-induced weight loss at that. The surgery went as the surgery was expected to go. The problem is that her body freaked out b/c its fat was gone. Yeah, weight loss isn’t always good.

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