Lies They Told Me About Health

Bad DoctorOne of the things that completely floored me when I started looking into the research on weight and health was that there wasn’t a single study of people who had maintained weight loss that showed that it led to greater health.

Studies that look at body size and health (but don’t factor in or control for  behavior) find that there is a correlation with higher body weights and higher disease incidence.  (Note that it is a correlation, not causation.) So the hypothesis is that if you can make fat people look like thin people, then they will have the same health outcomes, and hence manipulating body size becomes a recommendation for increasing health.

Let’s look at a quick comparison.

Male pattern baldness is strongly correlated with heart disease.  So, following the weight loss for health logic, if we can get bald guys to grow hair, we can decrease their risk of heart disease.  Imagine if we had a war on baldness, if we told those guys (despite all the evidence) that baldness is their fault and that  if they really cared about their health they would grow hair and that any man who tries hard enough can grow hair.  What if instead of doing the actual research to find out that it’s actually another factor that causes both the baldness and the higher rates of heart disease, medicine and science instead got stuck on the idea that if we could make bald guys look like guys with hair then they would have the same health outcomes?  Study after study about how to grow hair, just assuming that if they can just get that hair grown, these men will have better health outcomes.

That’s exactly the position that fat people are in.  Most researchers aren’t interested in looking at the correlation between higher body size and disease incidence and asking why the correlation exists and if it’s possible that other factors are involved.  But some have. When Peter Muennig from Columbia studied it he found that the stress of the constant stigma that fat people face is correlated with the same diseases to which being fat is correlated, and that women who were concerned about their weight had more physical and mental illness than women who were fine with their size, regardless of their size.  When Lindo Bacon and Lucy Aphramor studied the literature they found more than  ample evidence to support a paradigm shift.

Studies like Wei et. al, and Matheson et. al. found that behaviors are a much better predictor of future health than body size.

Wei et al found that when fitness was taken into account the differences in health outcomes became negligible.
Matheson et. al found that habits, not body size, were the best predictors of future health.

To be clear, health is not an obligation or a barometer of worthiness.  Health is not entirely within our control or guaranteed regardless  of habits or anything else. There is no such thing as a healthy weight – there is no weight that you can achieve at which you will be immortal unless and until you get hit by a bus, there are healthy and unhealthy people of all sizes.  People with health issues should be given options and treatment in accordance with their desires, not asked whether or not their health issue is their fault or could have been prevented.  Health care should be blame free, shame free, and future oriented. How highly people prioritize their health, and the path they choose to get there is an intensely person decision.

The reason I discuss weight and health is not because I want to tell people how to live or contribute to our society’s completely screwed up ideas around health, it’s because I believe that people are being misinformed and/or not given all of the information or all of their options and we should all have the opportunity to make decisions for ourselves

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26 thoughts on “Lies They Told Me About Health

  1. Just saw a couple typos in the “To be clear” paragraph — “hit by a bus, there are health[Y] and unhealthy people of all size[S]” and at the end of that paragraph, “an intensely person[AL] decision.”

    (Feel free to delete this comment.)

  2. The ‘maintain a healthy weight’ thing is making me want to scream. Everybody hears it said every day dozens of times on the TV and the radio and the internet, so a ‘healthy weight’ must be a thing, mustn’t it? Of course it is!

    The only problem is that nobody can tell you what it is, how to achieve it, or how to maintain it once it’s achieved.

    But they all know it exists and they all know it’s easy to reach and it’s even easier to stay that way if only you will.


    If it worked that way, you could actually tell whether or not someone is sick just by looking at their waistline, which you absolutely cannot no matter how many people are convinced they can.

    I’m fat and I’m pretty darn healthy. Mr. Twistie is fat and he has a plethora of health issues. I know thin people who are the very picture of health people assume they are for being thin, and I know thin people who are every bit as plagued with ill health as my husband is.

    Weight is one thing. Health is another. It’s time we stopped trying to make them the same thing when they aren’t.

  3. Another amazing blog post today (lol I’m fat AND bald–so I guess the fat shamers would say I have no hope to live! LOL). I so wish I had your time and energy to get into the facts and research to help me out with conversations with my friends.

    The post today will certainly help…one of my longest friends named Roger is very prone to fat shaming. I know most people would say I shouldn’t be friends with him but we were the only two openly gay kids growing up around Navy bases in the 80s…for that reason we will always have a very close bond. But he absolutely does not understand that health and weight show ZERO signs of being mutually happening at the same time. Of course he wouldn’t, he has model looks, still maintains a six-pack at 46 and can get just about any guy he sets his sights on. Looks privilege to the extreme.

    Here’s the thing, he does all these endurance activities including triathlons and these INSANE 100 mile run races (yes 100 miles at a time). I went to see him finish one in a little town called Auburn, CA and when he came around the corner after being on his feet for 18 hours he was literally peeing and defecating all over himself from sheer exhaustion. He did not have an strength in his legs for over a week. And what did he do? He started training for some world triathlon in October.

    So any doctor is going to stand up in MY face and tell me that because of some imaginary number of BMI, maybe my blood pressure is high enough to be on medication and my cholesterol fluctuates wildly that I am less healthy that my good friend who tortures himself with activity to point where he can’t control his bowels? I may be on some meds but at the very least I can control my own body.

    And thats not even getting into the psychology of how society has convinced him that his looks and muscle tone are so important that he has to literally run himself to near death.

    Go run Roger, if thats what you desire but I’ll be here in a warm house. Pass me the Buche de Noel if you please, in fact make it a double.

    1. Jessica, I don’t know if it’s just me, but your blog is unreadable. The text disappears into the trees/leaves background.

  4. Any health issues I have are genetic in nature and are improved by exercise, not necessarily weight loss. Although for me, exercise does cause some weight loss, so I suppose people would point to that and tell me I just need to do MORE exercise.

    On the other hand, reading this and other blogs have made me feel so much better about my appearance I can’t even explain it. Sure I wish I had bigger hips and a more narrow waist, but that’s genetics at work again.

    So thank you Ragen and everyone who posts here. *HUGS*

  5. I was told that a healthy weight is the weight at which you can move comfortably, not exhaust yourself just going up a flight of stairs and at which you did not gain or loose while eating a ‘normal’ way. I know now that there are SO many ‘conditional’ things in that statement… but based on this description, I was at a healthy weight at 270.. I was hiking, dancing, bellydancing, keeping up with my children and had flexibility.. I also just ate what felt good and was yummy to my body (fresh foods, grilled meats and yes, desserts. But since adding insulin to my health routine, the pounds have packed on. Also I have limited mobility with foot issues and have reduced my physicality to being wheelchair bound and very little exercise… can’t get in the pool til the feet heal.

    Great post… it is one I need to print and sprinkle around the teacher workroom.

    1. Yes, when. I was put on insulin I was warned by the “diabetic educator” that it would cause weight gain. She really pushed hard for me to have bariatric surgery. When I told her no way she basically threw her hands up in the air and gave up.

      My weight didn’t stabilize until I quit trying to lose and just ate whatever I wanted, with the exception of sugar, which I eat once a week. My physician, on the other hand is totally supportive. He even told me “If you’re going to sin, sin boldly!” Also gave me some short acting insulin to keep the blood sugar stable when I do eat dessert. I find I rarely need it.

      1. Maybe “diabetic educators” should just say, “well you’ll gain with insulin, so we’re going to withhold that because the scale number is more important than reducing your risks”. Nice.

      2. I would report that ‘educator’ to whoever is in charge. There is no need for such dramatics (throwing up of her hands). That is unprofessional and not treating the patient with respect. Shame on her! Certainly there are other courses of action beyond simply pushing bariatric surgery. And, if recommending bariatric surgery is the only course of action she is able to recommend, then is she to be the responsible party should the bariatric procedure cause you injury or death? No? Thought not. I question the ethics of the doctors in charge of the practice.

  6. I had pneumonia three times this year. The first time, I pretty much didn’t eat for about a month. Had I been skinny, I would have been f***ed. People don’t realize that’s what the fat is for. It has a protective purpose, and gives those who are able to store it an evolutionary advantage. I just focus on putting quality fuel into my body when I eat, and not worrying about the pounds. My weight doesn’t really vary anyway. The only thing I needed to lose was the worry and the shame.

    1. I’ve brought up the necessity of fat many times in discussions with thin-obsessed people. Women especially needed a decent store of fat through history, as they had the additional draw on their nutritional reserves of either pregnancy or nursing a child. Without a good store of fat, mother and child would both suffer.

      Our culture wants to promote the idea that fat kills. What they forget is that the reason the human race survived is that fat saves, literally in more than one way.

      1. I am now required to purchase only skim or 1-percent-fat milk for my preschooler using my WIC vouchers, because he might otherwise become “obese.” IME 1-percent milk does not quell hunger and skim doesn’t even quench thirst.* And of course there are the fat-soluble vitamins to consider, but oh noez, can’t have those, because faaaat.

        Meanwhile I am still allowed to purchase whole eggs, not fat-free egg-like product, as well as full-fat cheese instead of those low-fat abominations made with soybean oil. Anyone want to bet that the difference isn’t that milk already lists the fat percentage on the front label?

        *I purchased them anyway because I can use them in custards, butter rolls, white sauce casseroles, and pancakes, where the fat is added back in from other sources. Take that, diet-pushers!

        1. I’ve read a couple places that some groups of doctors (or many individuals) consider fat restriction before age 18 (or even age 25) to be extremely detrimental to the child. This also applies to calorie restriction: improper food abundance before age 25 leads to delayed puberty, less IQ/general brain power, shorter adult height, and more “chronic diseases of aging” (eg. osteoporosis).

          1. Already used up most of one of the gallons! Big pan of homemade mac’n’cheese, 2 loaves of sandwich bread, cup custards, and something else I forget what.

            Meanwhile the full-fat milk in the top of the fridge is what the kids are drinking. They think 1-percent tastes weird–“flat” or “plasticky.”

            1. Oh, right, forgot! Double recipe of French toast. With whole eggs and butter. Make it with whole-grain bread and add fruit on the side and it’s a square meal that will keep you going all afternoon. We eat it for lunch around here.

  7. I went to see my new doc on monday to discuss test results and have a physical. This was my second visit. The only thing she discussed the entire time was “what are you doing about your weight” “have you considered bariatric surgery”. Um yeah, I have, I was going to do it myself as part of a suicide attempt years before.

    I’m going to report her to the province and tell the office that I’m going to look for another doctor. Not worth it.

    This in Canada.

    1. This is the kind of thing that worries me greatly — doctors who are not only uneducated but misinformed, and (at least here in the U.S.) the insurance companies and government standards backing up their harmful recommendations. Yes, we can look for doctors who either don’t subscribe to this stuff or who are tolerant, but the bottom line is that the system has been rigged. And I feel we should do something about it — but what?

      How many people are being set up for years of misery by doctors telling them to lose (x amount of weight)? I know in my own case that I am far, far better off staying as I am than trying to lose weight. The thought of going through all that again — reliving the 20-pound yo-yo struggles of my teens (which would now be a 40-pound struggle if I went by BMI guidelines) — makes me shudder.

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