Does That Study Really Say You Can’t Be Fit And Fat?

CNN ran a recent headline “Fat but fit’ is a myth when it comes to heart health, new study shows” and since then I’ve received a lot of requests to write about it, asking if that’s really what the study shows.

The short answer is that the headline and article are deeply misleading. For reference, in my recent workshop on The Truth About Weight And Health I used this headline, article, and study as my example of nearly every research and common media issue and research mistake that I had just talked about for the last hour.

In the CNN article (which I’m not linking to, they don’t get clicks from me) the study’s author, Alejandro Lucia who is a professor of exercise physiology, was quoted as saying “One cannot be ‘fat but healthy.’ This was the first nationwide analysis to show that being regularly active is not likely to eliminate the detrimental health effects of excess body fat“

Except that’s not remotely what his study showed, and not just because it was in no way designed to draw that kind of conclusion.

Let’s start with what the study actually did. It looked at self-reported activity data from 527,662 adults from Spain. They grouped the subjects based on BMI (and we already know the use of BMI reflects a lack of scientific rigor but we’ll move past that for now.) Then they classified activity level into three groups. No activity was considered “inactive,” less than 150 minutes of moderate or 75 minutes of vigorous activity per week was labeled “insufficiently active,” (a label that is unnecessarily judgmental and ableist, and doesn’t reflect the fact that studies have shown that small amounts of activity confer health benefits) and finally, 150 minutes of moderate or 75 minutes of vigorous activity per week or more was labeled “regularly active.”

The study’s goal was to look at the impact of exercise on risk factors for cardiovascular issues, including diabetes, high blood pressure, and high cholesterol. Note that they didn’t look at actual cardiac incidents (like heart attacks or strokes,) they just looked at factors that may raise the risk for such incidents.

So what did they find? Well, to quote their own paper

In summary, increasing PA [physical activity] levels appear to provide benefits in an overall dose-response manner (regularly active > insufficiently active > inactive for the risk of hypertension or diabetes) across BMI categories and should be a priority of health policies

Wait…what? You read that correctly – What they found was that activity provided health benefits to people of all sizes. (which is consistent with the findings of Wei et. al. and Matheson et. al, and Barry et. al. which found “Therefore, fit individuals who are overw*ight or obe*e are not automatically at a higher risk for all-cause mortality.” (And as always, a reminder that health is an amorphous concept, is not an obligation, barometer of worthiness, or entirely within our control)

So why are they claiming that you can’t be fat and fit? Well, because they found that fatter people’s risk factors were not mitigated to an equal level with thin people’s risk factors. Their (unsolicited) recommendation? “weight loss per se should remain a primary target for health policies aimed at reducing CVD risk in people with overw*ight/ob*sity.” (With a reminder that those are terms that were literally invented to medicalize and pathologize fat bodies and that person first language for fat people is a terrible idea and also excuse me while I bang my head on my desk for a couple minutes.)

This is where we see perhaps the most common mistake that is made in this type of research. They assume that if fat people have higher risk, then it must be due to their body size, and that making fat people look like thin people is the solution. This is the kind of mistake that would get you failed in freshman research methods class, but it consistently makes it past peer review in articles around weight and health.

In order to avoid making a correlation vs causation error (one of the most basic concepts in research methods) we have to, at the very least, ask ourselves if there are other things that could cause these different outcomes in fat people. And, as it turns out, there are.. Peter Muennig’s research found that the stress of constant weight stigma is associated with risk factors, and Bacon and Aphramor found that weight cycling (aka yo-yo dieting which is, by far, the most common outcome of more than one intentional weight loss attempt) is also associated with risk factors.

That means that when the study authors (whose language, especially in their intro paragraph, suggests that they are coming from a deeply fatphobic place) claim that exercise can’t fully mitigate the risk of being fat, what they very well could have actually found is that exercise can’t fully mitigate the risk of being constantly stigmatized and/or encouraged to diet repeatedly.

That makes their recommendation that “weight loss per se should remain a primary target for health policies” even worse that it originally seemed (and it originally seemed pretty bad..) First of all, they did not in any way study whether or not weight loss 1. is achievable or 2. lowers risk factors for cardiovascular incidents, so they have no basis in their own research on which to make that claim, and no basis in other research either.

It’s important to understand that these are, in fact, two different things. So in order to recommend weight loss as a health intervention you would need:

1. Research that shows that weight loss is likely to be achievable and maintainable long-term (if not then there’s no point in making it a recommendation regardless, it’s like recommending levitation to solve knee pain, it might take the pressure off the joint, but since it’s not likely to work, it’s not an ethical, evidence-based intervention)

2. Research that shows that weight loss has positive health impacts, including when measured against any risk associated with weight loss attempts

Let’s start with #1. They don’t have that. What we know from other research is that by far the most common outcome of intentional weight loss attempts (about 95%) is short-term weight loss followed by long-term weight gain, with up to two-thirds of people gaining back more than they lost. So they are using the platform of this research to recommend something that has the opposite of the intended effect the majority of the time. Not a good look.

Onto #2. They don’t have that. There is no study that compares those who have maintained weight loss to those who are fat to see if there are health outcome differences. Their recommendation is based on the assumption that if you make fat people look like thin people, they will have the same health outcomes, which ignores the possible impacts of weight stigma and weight cycling, and is roughly like saying that, since cis male pattern baldness is correlated with a higher risk of cardiovascular incidents, the solution is to figure out how to get all the bald folks to grow hair.

So does that study really mean you can’t be fit and fat? No, it doesn’t. That study means that, yet again, research that would have earned me a well-deserve F in freshman Research Methods class is instead getting CNN headlines, because when it comes to weight and health research any fatphobic nonsense will do.

If you want more information about the weight/health relationship and research, my workshop talk is available as a video with a pay-what-you-can option here.


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18 thoughts on “Does That Study Really Say You Can’t Be Fit And Fat?

  1. How to bring real-world solutions to dream world problems. IE, How to get rid of people I don’t like. I’ve been telling them and telling them I don’t want them in MY WORLD and they just won’t go away. If Fat People won’t lose weight and become human, if I can’t scare tactic them to try dangerous/stupid/deadly weight loss programs, if I can’t shame them into suicide, if I can’t claim I am only interested in their well being… what can I do?! Where is my Final Solution to the Fat Problem, and how do I make it sound like it is in society’s best interest to sacrifice these people I don’t like….?
    If ridicule, harassment, ignoring, moral arguments, health and DEATH arguments, and 24/7 shaming don’t work. Jeeze, I don’t know Bud. Could you make it illegal to be fat and start rounding em up…?
    Germany almost got away with it…..

  2. I am shocked- shocked– to find that an ob*sity researcher spun their findings to make them sound like they supported weight loss more than they did, and that a reputable media outlet such as CNN would report said spun findings under a headline like “Fat but Fit Is A Myth.”

    Sarcasm aside, here’s the thing about the study the ob*sity pundits are hoping you won’t notice: they monitored a bunch of “regularly active” fat people, which means a statistically significant sample of “regularly active” fat people existed for them to monitor… which means the only thing they proved mythical is the fatphobic trope that fat people become fat people by being lazy and that “getting off our asses” will make us thin.

    1. Ah May, a vast country full of endless vistas and hidden depths. Every kind of landscape can be found here, the Damning With Faint Praise Valley, the Mount of Unrivaled Assumption, Bias Way, I Know Better Beach, S’all here in MAY. The word that works as a fill-in-the-blank in any essay. As good as might, as useful as could, better than maybe. Just bring your own opinion…
      Even better in papers suggesting “Scientific Rigor”.

    2. Double negatives? “Active Fat People” And statistics, scientific findings And opinions. Maybe befuddled is all you need. They only want to beat the deaf, fat horse. Nothing to see here, keep moving…?

  3. I am sick to death of the ‘may increase risk’ crap. Does it actually increase the risk or not? By how much? There are problems where we actually know what the risk is and how to take steps to decrease it. Why don’t we work on getting actual knowledge instead of this ‘may increase’ crap.

    1. It’s telling that the fatphobes are trying to hard-code the most insulting and inherently judgmental words for “fat” into the mainstream lexicon as the only acceptable words.

        1. Person-first language is dangerous. It allows fatphobes to separate the object of their hatred into two beings: the outer “obesity” that they view as an enemy and an inner “real” person they presumably view as thin. This allows them to target, dehumanize, oppress, and even physically harm the “obesity” while feeling like they aren’t doing the “real” person any damage.

          When the fact is- I have said this before, and I will repeat it until the end of time- you cannot do anything to “my obesity” without also doing that thing to me, and if your actions result in illness or death, I am the one who will suffer it, not some intellectual abstraction of “obesity.” A war on obesity is a war on fat people. Period.

          1. I am having trouble understanding what “person-first” language is. From the sounds of it, it is an oxymoron. It sounds very much like person last, or even other, to the lead descriptor. Why they feel they need descriptors is the next worry…

            Person WITH GAYNESS, Person WITH BLACKNESS, Person WITH NATIVE AMERICAN TENDENCIES… Am I missing something? Oh, can I bum a ride? Me and Obesity need a lift to the airport…

            1. And if I’m driving my ob*sity to the airport, am I at least allowed to use the carpool lane?

              The concept came out of disability community (as in someone is “person with a disability” rather that “disabled person”) it’s very controversial within that community but of course the weight loss industry just grabbed hold of it with absolutely no care about that and applied it to fat people creating problems on top of problems.
              I wrote about it here in relation to fat people:

              Here’s more info about the issues within disabled community:

      1. He who controls the language… Controls how we can ever TALK about things. No wonder thin people get so thrown by any stepping away from the mainline. Doesn’t just EVERYBODY KNOW…

        Watching third of a stupid Netflix cartoon. Something PD. wall to wall fat jokes thus far…Saw all of them coming. Maybe comedy is here to support the status quo and make people feel all is right with the world: at people and food, old people and sex, Asian women driving, pick a stereotype, sit back, enjoy the show.

  4. Watching CNN, MSNBC Angry White Men are coming out of their winter hibernation, rubbing the sleep out of their eyes and picking up military-grade weaponry to slaughter their fellow Americans and Brian Williams has somehow equated eating ice cream, or NOT eating ice cream, with getting murdered by a stranger at the grocery store.
    William’s lauded the ear witness to the shooting for his strong moral fiber and willpower for NOT going back to the freezer aisle to pick up a pint of ice cream. These millisecond choices could result in our life or death… Had he broken down, given in to temptation, had he let his childish desire for cream and sugar rule him HE MIGHT HAVE DIED!
    Oh My God! So, the people in frozen foods died because they were ice cream pigs? What if they were buying frozen peas? Would they be martyrs to Eat To Live Food Choices?
    A MAN got up today, loaded a high-powered assault rifle, drove to a grocery store to MURDER innocent people. Cut and Paste his background issues: life fails, hang-ups, political persuasion, sexual addictions, religious confusion, and/or mental aberration to “understand” why he would carry out this despicable act. Ice Cream had NOTHING to do with it. I mean really. Is that the best he can do?

  5. In other ways data can be twisted into fat phobia: I just recently saw a study blaming fat people for “driving” the pandemic because—wait for it—England and the US had so many deaths and also a large fat population, while “thinner” countries like Japan had fewer casualties. I think this is a correlation-vs-causation of the magnitude of blaming hot weather on number of bikinis worn to beaches. It has to be the fat people, right? I mean, nothing else in the pandemic response of UK and US could possibly be responsible, right? 🙄

    1. When DEATH is in play, it is human nature to look for someone to blame. Oh, all THOSE people are going to die, but I’M SAFE!… Yeah, right.

      Hey, there are more earthquakes in Cali…fat people? More tornadoes in the South, fat people. Global warming, fat people…

      My take, recalcitrance, and America’s claim of rugged individualism, along with the putrid political climate had more to do with it.

      In Asia, I don’t believe there are countries with large populations of people who “are gonna do their own thing”. Japan in particular is very insular and obedient, you don’t put yourself first. COVID is a disease that lives for the blatantly, determined who can’t be told ANYTHING.

      How dare you tell me to wear a mask, use turn signals, not spread a deadly virus! I’m an American!

      COVID is a dystopian dream for haters, a disease that kills fat people, minorities, old people, and the poor at higher numbers than The Chosen People, perfect! If only it would kill ugly people too. Be a movie in there…

    2. Oh, is that the one that bragged about how “politically incorrect” it was in its headline and chose a headless fatty pic to represent itself? I didn’t click on it for the obvious reason that either one of those things would have caused me to give it a pass, and seeing both at once had me pondering Poe’s Law as I scrolled past it to the next story. Like, are you seriously serious with that “We are the only ones Brave and Un-PC enough to tell you how it was actually fatties existing what caused the pandemic!” line, or is this some kind of avant garde parody of fatphobic desperation?

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