If Obesity is a Risk Factor…So What?

This weekend I took my course and test to be re-certified by the Aerobics and Fitness Association of America (and I passed Yay!).  It was exactly as super fun as you can imagine (which is to say, not very super fun at all) but I was pleasantly surprised to find out that there was much more talk about healthy lifestyle than about weight loss.  One of the tools that I was tested on is the American Society of Sports Medicine’s Risk Factor Stratification.  This tool looks at the risk factors for Cardiovascular and Pulmonary Disease.

One of the risk factors is “obesity”.  I have an issue with this since I think that they are trying to use weight as a proxy for behaviors (specifically behaviors that are already covered by the tool).  But, for the sake of argument, let’s say that obesity is a risk factor.  Some of the other factors include age and heredity.  But unlike obesity, there isn’t a sixty billion dollar a year industry that tries to change our age or genetics because we know that, even if it would help, it’s not possible.  Intentional weight loss, and the diet industry as a whole, only make sense as a way to lower risk if they in fact succeed in changing the risk factor, in this case obesity.

That means that, for weight loss to be advisable as a way to lower the risk for cardio/pulmonary disease, the average obese person who attempts to lose weight would have to become and stay non-obese.  The problem, of course, is that the research doesn’t bear that out. Based on all of the science, only 5% of people will be successful at long term weight loss,  and let’s not forget that many of those people did not start off as obese, or lose an amount of weight that would change their BMI category at all.  So a 5% success rate does not indicate that even 5% of obese people can become and maintain a BMI-defined “normal weight” that would, in theory, lower their risk.  In fact most obese people who attempt to lose weight end up as heavy or heavier than when they started which means that their risk is as high or higher than it was to begin with, and now they have the added risks that come with weight cycling.  That does not sound like an advisable treatment plan.

Personal trainers are not instructed to give up on health just because someone’s age or heredity is a risk factor that can’t be changed.  By the same token, if health is a goal for you, there is no reason to give up just because body size is a risk factor that can’t be changed.  The good news is there are still a lot of risk factors that we may be able to control:

My point here is that obesity may be a risk factor for cardio/pulmonary issues but even if it is, evidence points to the fact that it is an unchangeable risk factor – like age or heredity. The fact that healthy habits are unable to change our age, heredity, or body size, doesn’t mean that they aren’t making us healthier or lowering our risk for disease. Indeed, the available science suggests that healthy habits are where it’s at if you choose health:

“Groundbreaking work on fitness and weight has been done by [epidemiologist Steven] Blair and colleagues at the Cooper Institute. They have shown that the advantages of being fit are striking and that people can be fit even if they are fat … and thus have lowered risk of disease. A remarkable finding is that heavy people who are fit have lower risk than thin people who are unfit.” -Dr. Kelly Brownell, Director of the Yale Center for Eating and Weight Disorder

“We’ve studied this from many perspectives in women and in men and we get the same answer: It’s not the obesity—it’s the fitness.” -Steven Blair, P.E.D., Cooper Institute for Aerobics Research

“Consistently, physical inactivity was a better predictor of all-cause mortality than being overweight or obese.” -Annals of Epidemiology

So it’s time to stop pretending  that if obesity is present than health cannot be, or that there is no point in healthy habits if they don’t make us thin.  It’s simply not so. Health is multi-dimensional and not entirely within our control, so all we can do is work on the things that we can control and then do our best to deal with whatever happens.

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12 thoughts on “If Obesity is a Risk Factor…So What?

  1. Fantastic post! Thank you for wading through the misinformation, hysteria and misconceptions that are used as ammo used by bigots, some of whom don’t even try to thinly disguise their fat shaming as ‘concern for health’. Having recently been bombarded by ‘health professionals’ over a repost of a blog article empowering fat women, I could not get through to them that their fear and panic-inducing ‘facts’ about heart disease did little for the people that they claimed they wished to help.

  2. It took forever to get it through to my PT that I’m not about losing weight anymore, not since I started reading about HAES. I mean, I was never going to be skinny anyway by virtue of actually having a large frame. He still mentions jumping on the scales every now and then, but I’ve managed to divert him each time 😉

  3. I think if ones obesity is controllable and they want to lose weight to lower their risks for diseases, then more power to them. That goes for any other health risks too. Some people will not be able to change their weight. Some will be able to be, but it will not be easy, and some are easily able to do. Just do what you can and rest assured that you are doing everything in your power to keep your body healthy.

  4. I love your list of some of the things we can do to lower our risk of disease. The best part is that I am already doing some of them! Last year I had begun to exercise and eat better (lots of freshly prepared foods, fruits, vegetables, lean meat), and I felt so good physically–lots more energy, and I slept better too. This post was a great reminder that the things I can do to improve my health are not that difficult (they may be more so for some people depending on physical, economic, and other factors; but for me, they are very doable).

    This does bring me to one question that I’ve been too embarrassed to ask until now (and thank you for making this a safe space in which I feel comfortable asking!). Does anyone know of any exercise garments that will keep my big tummy from bouncing and jiggling so much when I exercise? I try to do no-impact workouts to minimize the movement, but even then it can be pretty uncomfortable.

    1. This might sound silly, but have you tried a swimsuit with a “tummy panel”? (GOD, I hate that stupid effing euphemism. We call it a “tummy” when you’re 5 years old, not a damned grown woman. But I digress….) Or have you tried wearing a leotard or something that’s a teeny bit too small? It might help to minimize the bounce.

      Or maybe some Spanx or something?

  5. Every time I read a post here, I either learn something new or am reminded of something really important. Yes, obesity is a “risk factor”, but that doesn’t mean people can do anything about it. It’s so easy to let the weight-health-talkers wear me down. I hear “risk factor”, “risk factor”, “risk factor,” and I’m not sure how to reply. I need to remember “age”, “age”, “age”. Ha!

  6. That you for covering this topic. I was dealing with a really annoying person commenting on my blog about obesity being a risk factor in itself, and you did such a good job of answering it, now I’ll just send her to your blog. I have been speaking up for health at every size and respect for every body for a long time now and connect with all that you say. Appreciate your voice!

  7. it is amusing how I get a lot more flak for being omgfat!!!! than I get for smoking like a chimney… One of these being jsut a part of how I am and out of my control, and the other being a full on flat out choice to go out of my way and behave in a harmful way.

  8. If obesity is a risk factor, so what?

    Prezactly. This is at the heart of it for me, no matter how bad fatness is or isn’t using that to justify the crusade in its present form is a total non sequitur.

  9. Another excellent article, and I appreciate the direct quotes from your sources.

    I disagree on one minor point: “But unlike obesity, there isn’t a sixty billion dollar a year industry that tries to change our age or genetics because we know that, even if it would help, it’s not possible.”

    One of the primary focuses of the multi-billion dollar cosmetics industry IS to convince us that we can change our age! “Look younger!” “Decrease the 7 signs of aging!” A massive amount of advertising rhetoric is designed to convince us that we shouldn’t age either. And we don’t have to, if we just buy their products!

    I suppose one could argue that cosmetics are aimed at changing our genetic appearance as well, but I think one could argue about ornamentation vs. camoflauge. Anywhoo, cosmetics industry; secret bedmate of the diet industry?

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