For the last week of December, we’re re-posting some of our favorite posts from 2012. Cross-posted at The Huffington Post.
If you live in the U.S. you are absolutely bombarded with the idea that being overweight is bad for your health. This repetition leaves one with the idea that being overweight is the same thing as being unhealthy, something that is simply not true. In fact, people of all weights can be either healthy or unhealthy; overweight people (defined by BMI) may actually have a lower risk of premature death than “normal” weight people. Being fat is simply not the same thing as being unhealthy.
The Health At Every Size (HAES) movement attempts to interrupt the conflation of health and thinness by arguing that, instead of using one’s girth as an indicator of one’s health, we should be focusing on eating/exercising habits and more direct health measures (like blood pressure and cholesterol).
A recent study offered the HAES movement some interesting ammunition in this battle. The study recruited almost 12,000 people of varying BMIs and followed them for 170 months as they adopted healthier habits. Their conclusion? ” Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.”
Take a look. The “hazard ratio” refers to the risk of dying early, with 1 being the baseline. The “habits” along the bottom count how many healthy habits a person reported. The shaded bars represent people of different BMIs from “healthy weight” (18.5-24.9) to “overweight” (25-29.9), to “obese” (over 30).
The three bars on the far left show the relative risk of premature death for people with zero healthy habits. It suggests that being overweight increases that risk, and being obese much more so. The three bars on the far right show the relative risk for people with four healthy habits; the differential risk among them is essentially zero; for people with healthy habits, then, being fatter is not correlated with an increased relative risk of premature death. For everyone else in between, we more-or-less see the expected reduction in mortality risk given those two poles.
This data doesn’t refute the idea that fat matters. In fact, it shows clearly that thinness is protective if people are doing absolutely nothing to enhance their health. It also suggests, though, that healthy habits can make all the difference. Overweight and obese people can have the same mortality risk as “normal” weight people; therefore, we should reject the idea that fat people are “killing themselves” with their extra pounds. It’s simply not true.
h/t to BigFatBlog.
Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.
Comments 169
Ohcoya — April 16, 2012
But how will a sexist culture know who to hate if we accept these "facts"?! Someone must be to blame for a woman not giving a man an erection! /sarcasm
Natalie — April 16, 2012
We need to remember, though, that greater BMI doesn't necessarily mean fatter. Athletes tend to be "obese" according to the BMI because of muscularity.
Umlud — April 16, 2012
There are only four habits that were measured (as opposed to having
up to four from a larger list). It would have helped to have mentioned this in the summary. Additionally, it helps to actually define the metrics of the paper, which the entry above did a poor job at (i.e., the author failed to define them at all). Therefore, this is the definition of the four healthy habits and how each of them were determined:
"Physical activity" was defined as:
"Being a nonsmoker" was determined by smoking status:
"Consuming ≥5 servings of fruit and vegetables a day" was determined by using an index:
"Drinking alcohol in moderation" was defined as:
(Yes, yes, yes, you could have gone on over and looked it up if you were interested, but did feel that the author could have at least added the definition of the 4 healthy habits - the first blockquote above - instead of using what could be interpreted as obfuscatory language.)
Andrew — April 16, 2012
I'd be curious to see if some of these people lost weight after adopting 'healthy habits' for the study.
Anonymous — April 16, 2012
BMI is useless -- it's just a ratio of height to weight and doesn't differentiate between muscle mass and fat mass, so very lean and muscular people have a high BMI. Likewise, "skinny" people may be carrying very little muscle mass ("skinny-fat"). It's just a stupid way to draw conclusions. Use body fat % instead, and the picture changes dramatically.
Medical professionals don't use BMI as a predictor of anything, it's simply one tool in a toolbox, typically given to patients to give them a number to make go down... again, the wrong number (people who are concerned with losing weight should rather be focused on losing FAT, not fat-and-muscle, and yes it is possible to achieve loss of only fat via diet and appropriate exercise -- that's my job, what I help people do, actually).
AHart — April 16, 2012
Anyone else notice that the hazard ratio increased for the lowest BMI group when they went from no habits to 1 habit? That seems counter intuitive.
Jamie — April 16, 2012
Because as we all know, as long as you're not dead, you're in perfect health.
We're better at stopping obese and overweight people from dying now, of the countless conditions they are at higher risk of. That's it.
Jamie — April 16, 2012
Also, of course, this study has nothing whatsoever to do with the statement "Overweight and obese people can have the same mortality risk as “normal” weight people". It says "exercise and reducing drinky etc is good for people of any size". Not "people of any size can be as healthy".
Anonymous — April 16, 2012
I'll just wait here for all the responses that say
"Yeah But! We all know that fat is unhealthy"
"I lost weight and so can you"
Hear it all the time whenever science is shown to NOT support the insane notion that fat=unhealthy and skinny=healthy
Anonymous — April 16, 2012
I'm not seeing that the linked study ("Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals") involved intervention or people changing their habits. It looks to me like they took data from an existing set (NHANES III) and analyzed it, rather than recruiting anyone. It's a relevant distinction because it changes the conclusions one can draw, at least slightly.
Celebdiur — April 16, 2012
I'm incredibly disappointed by the level of data analysis coming from sociological images. You've just regurgitated what this overweight lobby group (?) has presented you.
As many have already said BMI does not necessitate fat content, it works with weight and height, nothing else. Following this we don't actually recieve any support for the premise that fat people can be as healthy as 'skinny' people - and I'm sorry - I have a BMI of 23.5 and I am by no means skinny, nor particularly muscular, despite a regular workout regime.
It's almost as bad as claiming smokers revealed that generally healthly living habits helped provide a similar mortality rate to unhealthy non-smokers. We know smoking is bad for you and we know being fat is. People should avoid cigarretes and unhealthy eating habits.
I imagine the 'healthy' 'obese' have very different bodies (muscle-fat ratios) to the 'unhealthy' 'obese' bodies, and the same for the 'skinny' ones.
Anonymous — April 16, 2012
I read the full text expecting to
find yet another useless study, but the discussion actually focused on a completely different angle: namely that people who are not overweight shouldn't think they are not at risk if they don't engage in healthy lifestyle behaviours. It also recognized many limitations of the study with regards to self-reporting and causation vs. correlation. Fair enough. Look it up here:
http://www.jabfm.org/content/25/1/9.full#T2.
The kind of study I would have preferred to have read about is one that looks at morbidity, and not mortality, and its associations with weight, particularly as people age. (BTW only 14% of the study's sample were >65yo, which is relevant) It's perfectly feasible for large numbers of overweight teenagers to be perfectly healthy. What will happen to them as they age though? Will they develop ailments that affect their quality of life, or will they continue to be healthy?
James — April 16, 2012
I like that this study underscores the importance of a healthy lifestyle. However, this blogger's conclusion that "thinness is protective if people are doing absolutely nothing to enhance their health" is based on a complete misunderstanding of a hazard ratio. A hazard ratio is "a ratio of the hazard rates corresponding to the conditions described by two sets of explanatory variable" (wikipedia). In the graph of this study, the height of the bar corresponds to the ratio of the risk of dying early for the group of interest divided by the risk for equivalent reference group. The tallest bar in this graph represents the risk of dying early given that you are obese and have zero healthy habits divided by the risk of dying early given that you are obese and have 4 healthy habits. All three of the bars on the far right of the graph represent a similar ratio (risk for population of interest/risk for reference population). However, the population of interest and reference population are the same for any given bar. So the bar on the far right represents the risk of dying early given that you are obese and have 4 healthy habits divided by the risk of dying early given that you are obese and have 4 healthy habits. This is by definition 1 (any number divided by itself is one) and represents the standardization by which the rest of the graph can be understood. Similarly, the second bar from the right represents the risk of dying early given you are overweight and have 4 healthy habits divided by the risk of dying early given that you are overweight and have 4 healthy habits. The fact that the three bars on the right are the same reflects the definition of a hazard ratio and not the inherent equivalency of the groups. It could be true that obese people with healthy habits are just as likely to die early as their thinner yet similarly healthy peers, but this study does not provide any evidence for or against this contention. I appreciate the need to deal with obesity as a social issue. The stigma against obese and overweight people needs to be addressed. However, medical science should not be misused in this way to forward (even a very positive) social agend
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Dave K — April 17, 2012
"Overweight and obese people can have the same mortality risk as "normal" weight people; therefore, we should reject the idea that fat people are "killing themselves" with their extra pounds. It's simply not true."
This is a bad conclusion based on the information given.
I suspect, many fat people are "killing themselves" with their extra pounds AND lack of activity. Some fat people would not be fat if they had healthy habits. Other fat people are predisposed to being fat, but are they are not likely to have an early death due to their healthy habits.
Hinkiloi — April 17, 2012
Well, I'd make the presumption that if someone is 100 overweight, odds are good they don't do 2-4 of the healthy habits. What ratio of overweight people do 3-4 healthy habits? Critical question, too bad the author missed it in his rush to defend the stigma if being fat.
Doctors say fat people can live as long as thin ones | Miz Moe — April 18, 2012
[...] This data doesn’t refute the idea that fat matters. In fact, it shows clearly that thinness is protective if people are doing absolutely nothing to enhance their health. It also suggests, though, that healthy habits can make all the difference. Overweight and obese people can have the same mortality risk as “normal” weight people; therefore, we should reject the idea that fat people are “killing themselves” with their extra pounds. It’s simply not true. (via Sociological Images) [...]
David Moss — April 18, 2012
"overweight is the
same thing as being unhealthy" is a statement that would be
silly to treat as contestable. 'Overweight' clearly does not mean the
same thing as 'unhealthy'- there's no substantive argument here, one
can just consult a dictionary. The substantive issue that is at stake
is whether "being overweight is unhealthy”- does being
overweight cause negative health effects?
Similarly “people of
all weights can be either healthy or unhealthy” is trivially true.
But analogously people who smoke or drink too much can be healthy,
people who deliberately ingest small amounts of poisos can be
healthy, but smoking, drinking and unhealthy poisons are not healthy.
A person who has a cold can be healthy, but it is not healthy to have
a cold. The issue is whether being overweight is itself
healthy: is it conducive to health? To draw out the issue a little
more: would any given individual be more or less healthy if they were
to be overweight or not?
Now the graph shown
does show that, for people
with the 4 healthy habits being overweight is not associated with
worse health (and if you don't have the 4 healthy habits, being
overweight is associated with more than 3 times worse health, by that
measure). Naively inferring from this, we might conclude that in the
first case being overweight doesn't make you any unhealthier and in
the second case it does.
Tesslacoil — April 19, 2012
i think it's pretty obvious that the people with a bmi over 25 ("overweight") or 30 ("obese") who don't drink, don't smoke, eat fruits and vegetables, and exercise all the time are bodybuilders/athletes, for whom bmi does not apply well. no one who took care of themselves that well would ever be fat, and i think it's pretty obvious that no one who was actually obese (as opposed to just having a bmi over 30) could be as healthy as someone who was of normal weight
BethMit — April 19, 2012
I think there's a more satisfactory way to look at this data.
In
the study, they targeted 4 "healthy habits": not smoking, moderate
drinking, regular exercise, and eating 5 or more daily servings of
fruits and vegetables. Let's add "maintaining a healthy weight" to the
list - this is supported by their data, since people in the low-weight
set showed a lower health hazard rating in every category.
If
you choose only one thing to do for your health, maintaining a healthy
weight improves your health hazard rating more than following one other
healthy habit (it's really hard to say which is the most effective,
since the other four habits are all lumped together). People who smoke,
drink heavily, don't eat greens or exercise, but have lower body
weights fare better than people who are obese yet follow one other
healthy habit.
As you maintain more healthy habits, which four
or five you maintain seem to become less important - just as long as you
are doing something to support your health. So if you're eating well,
exercising, and not smoking or drinking, but just can't lose that weight
- you're fine.
This kind of trending would be much easier to see
if they'd presented their info as a scatter graph of which 1-5 healthy
habits (including weight management) their participants followed. That
would be interesting to see, especially to explain why the people with
low BMI fared worse with one of their four healthy habits and the same
as those with two healthy habits. That's an odd spike.
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[...] that the correlation between body size/weight and health is tenuous (recent research covered here, Big Liberty has a great collection of resources here, and I am working on my own list of resources [...]
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[...] that the correlation between body size/weight and health is tenuous (recent research covered here, Big Liberty has a great collection of resources here, and I am working on my own list of resources [...]
Ben333 — May 3, 2012
It is suspicious that the researchers who conducted the study do not draw the same conclusions from their data as does the author of the article above. For instance the study notes without disagreement that: "A large body of epidemiologic evidence suggests that obesity is an independent risk factor for early mortality...By even the most conservative estimates, obesity is responsible for more than 80,000 deaths annually."This would seem suggest that, rather than making the radical discovery that being fat is not bad for you so long as you have a healthy lifestyle, the study's authors are deliberately avoiding addressing the fact that their findings sit in stark contrast to the enormous weight of evidence on the subject, and are therefore probably wrong.
Veganism, Fat Shaming, and Why Vegan? | seitan is my motor — May 11, 2012
[...] too, especially those who diet all the time. (This is also addressed in the post I just linked to.) In fact fat people can be as healthy as thin people. And yes, there are overweight vegans. So what? Vegans come in all sizes, [...]
Remlapgirl — May 11, 2012
This Discussion if anyone else waste their time reading it is why us fat people (BMI index of 46 even though that is a useless number) yoyo diet and feel bad about themselves... no one took into account that maybe the fact that some of the higher BMIs got unhealthy trying to stick into society's idea of "sexy" thus resulting in bad health. doesn't matter if the study is a good one is a stupid argument. the point beyond the numbers is what i agree with... instead of telling people they are lazy, unhealthy, or their life span is shorter based on their weight (which all may or may not be true). it is stereotyping, hurtful, and mean. why not support fat people especially the younger generation instead of focusing on the fat content (which doesn't do any good anyway) to learn and love a healthy lifestyle. same with skinny and normal weights. this graph is pointless just like weight, it is a number and doesn't define who you are as an individual. everyone's health is relative to them self and not to the population. people making snap judgments on any form of demographic is because generations of raising children that way. unless you know that fatty personally, know their habits, and talk to their doctor you don't really know if they are healthy. me personally am morbidly Obese because of something called PCOS this means it is really difficult for me to loose weight. before someone says "you got that because you are fat" and "that means you aren't healthy" no... that means i have a chemical imbalance same idea of having bipolar disorder. and i'm fat because i have it. during the ripe old age of 11 i went through the "change of life" which didn't work the way it should and i ended up fat with a chemical imbalance. i take my medications, eat right, go to the gym, and sleep my full 8 hours a day... I AM FAT AND HEALTHY!
Matyze — May 21, 2012
It's almost as bad as claiming smokers revealed that generally healthly
living habits helped provide a similar mortality rate to unhealthy
non-smokers. We know smoking is bad for you and we know being fat is.
People should avoid cigarretes and unhealthy eating habits.
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Sergeant Pancakes — July 2, 2012
Evidence is not conclusive. Many of the most fit people I know are clinically "obese" but they have 8% body fat and tons of muscle. This study did not differentiate between people who are obese because of muscle and obese because of fat.
- — August 17, 2012
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Baiskeli — January 3, 2013
I'm so gonna agree with this.
Some perspective. I'm a road cyclist (hobby), last year I rode 4300 miles. Since we have winter here, I had months where I rode close to 600 miles, or close to 150 miles a week. I easily do 100+ mile rides. I also race road bikes (terribly, CAT 5). So I consider myself reasonably fit and relatively thin ( 6ft 167-175 lbs) compared to the average person.
Someone I used to ride with a few years ago was much shorter than I am, and significantly north of 225 lbs. By all measures, he would be considered overweight. But he rode about twice the distance I did per year, was a CAT 3, and was by far the fittest person I've ever known. He'd kill you on the flats, but wasn't too good on the hills (though good enough to be a CAT 3). His body type came from his family.
So the whole overweight people are unhealthy idea is incorrect. I know a lot of overweight people who are fine, I also know a lot of very thin people who eat crap, don't exercise and are one step away from a heart attack.
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[...] [...]
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[...] [...]
Jon — April 10, 2013
Having a heart chuckle while all the fat acceptance people argue while stuffing their faces with Twinkies.
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poor yorick — August 10, 2013
I can show you a population of healthy "fat" people... body builders who at the beginning of the study had put on weight to gain muscle, ending up just a smidgen above a BMI of 30. Of course, they probably don't look obese and wouldn't ever be called "obese" by onlookers ( http://www.firstclasssupplements.com/public_html/firstclasssupplements/site_articles/ckfinder/userfiles/images/394830_198911753533685_1188642150_n.jpg ... weight = 180, height = 5' 5", BMI = 30). If you look like that, I'll bet you're healthy and "obese" too!
In fact, it seems probable that the majority of people who adopt the healthy practices outlined in the article and end up being "fat" look like the person pictured above. If you look at the number of people originally in the CDC study (40,000) and at the number of people included in the paper (< 12,000), you can see the authors were hard pressed to find enough healthy, "obese" people to include in their study.
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TwoZeroOZ — March 12, 2014
Why did the author use a graph, instead of the actual numbers? According to this very study, "fat people" have a risk factor 15% higher than "thin people" even with all 4 habits(and let's be honest, this was a self-reported survey, how many obese people go to the gym 5 times a week? How do you stay fat when you're going to the gym essentially every day?)
Sizing Up Men’s Body Image - — September 15, 2014
[…] is one more societal idea that is completely wrong: weight as the barometer for health. A person’s weight does not determine how healthy they are. There are a plethora of other factors that play a role in a person’s health. Once that’s made […]
Nicholas Blonigen — June 7, 2015
News update from 2015:
"'Fat But Fit' Theory Mainly Flops in Long Term: Study
The notion that it's possible to be obese and healthy finally may have been debunked.
While some obese people show no signs of heart
disease, a new study suggests it's just a matter of time before the
consequences of carrying substantial, excess pounds ultimately take a
toll. "
http://www.nbcnews.com/health/diet-fitness/fat-fit-theory-mainly-flops-long-term-study-n278836
The_D_Man — March 11, 2016
Go to a retirement home for seniors, how many obese people over 70 do you see. Enough said.
Keep living in denial and delusion fatties, I really don't care if you eat yourselves to death.
run 3 — April 25, 2020
The Health At Every Size (HAES) movement attempts to interrupt the conflation of health and thinness by arguing that, instead of using one’s girth as an indicator of one’s health, we should be focusing on eating/exercising habits and more direct health measures (like blood pressure and cholesterol).
BMI — April 25, 2020
If you live in the U.S. you are absolutely bombarded with the idea that being overweight is bad for your health. This repetition leaves one with the idea that being overweight is the same thing as being unhealthy, something that is simply not true. In fact, people of all weights can be either healthy or unhealthy; overweight people (defined by BMI) may actually have a lower risk of premature death than “run 3” weight people. Being fat is simply not the same thing as being unhealthy.
Traffic — February 9, 2021
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