This is one of the most common questions I get. The question goes something like: there is such a strong correlation between being higher weight and having health issues, how can you just dismiss that? Especially when so much of the research you point to is correlational in itself.
The thing is, tt’s not about just dismissing the correlational relationship between weight and health out of hand, it’s about examining the evidence around that correlation to test the strength of it.
Before I get too far into it, the relationship between correlation and causation is at the foundation of research methods (my first research methods teacher made us repeat “correlation never ever, never ever, never ever implies causation in every class!). If two things are correlated, it means that they happen at the same time. What it doesn’t mean is that one of those things causes the other. For example there is a strong correlation between cis male pattern baldness and cardiac incidents. If we assumed that baldness caused heart attacks that would be a faulty assumption. If we then assumed that making affected people grow hair would reduce cardiac incidents (creating a government sponsored “War on Baldness” blaming people for not growing hair, etc.) that would be another faulty assumption. In fact a third factor causes both the baldness, and the higher rates of cardiac incidents.
So, when we see a correlational relationship between weight and health, but without a causal mechanism, the first question we have to ask is – what is the quality of the evidence?
We have to examine the research that finds this correlation for quality, and when we do, we find it lacking in some of the most basic principles of research. For example, if fat people are tested early and often for a health condition and thin people are almost never tested unless they have advanced symptoms, it’s spurious to assume that the health condition occurs more often in fat people. In another example, since too-tight blood pressure cuffs give too-high readings, and often fat people’s blood pressure is tested using a too-tight cuff, we have to ask ourselves how accurate that correlation is.
The next question we have to ask is – could something else be causing this relationship?
In this case there are at least three major candidates – weight stigma (as examined in Muennig’s studies for example), weight cycling (for example, in their paper Weight Science: Evaluating the Evidence for a Paradigm Shift, Bacon and Aphramor found that the health impacts of weight cycling could explain all of the excess mortality that was attributed to “ob*sity” in both Framingham and the NHANES), and inequalities in healthcare (examined in Lee and Pausé’s Stigma in Practice: Barriers to Health for Fat Women for example.)
So again, it’s not about simply dismissing the correlation out of hand. It’s about the reality that until we can account for the possible impacts of the research issues and confounding variables, the correlation between weight and health has to be held in serious question.
Not to mention, the fallout from the extremely questionable acceptance of the correlation of weight and health as a causal relationship (and the follow up extremely questionable assumption that weight loss is the “solution”) drives massive additional harm (looking at you Weight Loss Industry.). That’s even more significant considering that studies like Wei et. al., Matheson et. al., etc. show that (understanding that health is not an obligation, barometer of worthiness, or entirely within our control) there are plenty of ways to support the health of people of any size that have nothing to do with body size manipulation (you can find diagnosis-specific weight neutral practice guides and a resource and research bank at www.HAESHealthSheets.com)
Finally, while I think it’s worth having these discussions since so much of fat people’s treatment, including in healthcare, is driven by this, we can never lose sight of the fact that fat people have the right to live without shame, stigma, bullying or oppression no matter why we are fat, no matter what the “health impacts” might be, and whether or not we could, or even want to, become thin. That includes the rights to equal accommodation, including in healthcare.
UPCOMING ONLINE WORKSHOP:
In this talk I’ll share realistic strategies, tools, tips, and tricks I’ve learned for dealing with weight stigma – including our own internalized body issues, and the fatphobia that the world throws at us. This talk will focus on ways that we can stop making ourselves small to satisfy our bullies and the weight stigma that drives them, and start living life large.
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