I don't worry about the health of others...it's their business,  not mine. As for me...yes, I weigh more than my cardiologist is happy about...but it's my life, not his.

While they do discuss not being able to zip up their pants, most of the time in this song is spent on the problems you talk about: eating healthily, exercising, and quitting smoking. Apart from two of the people in the cigarette part and one of the people in the buffet part, these people were also all about the same size; there was no obvious physical difference between those making healthy and less healthy choices.

None of them seemed larger than average. Perhaps the real problem here is that the only time we see the average American in advertising is when they're in PSAs, not selling aspirational products, distorting what we see as 'thin' and what we see as 'fat'.  

As a 41-year-old man starting to cultivate a spare tire, my doctor tells me I need to lose weight, or be at risk of diabetes and high blood pressure. That is not fat shaming. It is just good advice.

I work at a university with one of the highest rates of eating disorders in the country.  Every single one of the people in this advertisement, with the exception of the children with the taco night lady, are 'fat' by the standards I see around me on a daily basis. I know (rationally) that the women around me aren't healthy.  But I am always amazed at how my environment manages to radically distort my perceptions of 'what counts as fat.'

I'm starting to feel like a total jerk when I post in the comment section...because I don't see what's so offensive about this ad.  I use to be overweight too (and yes, these people are overweight) and I resolved to do something about it.  And it took conversations from my loved ones for me to start working out and exercising to lose the weight.  I didn't think that there was a problem really, and I felt fine.  However, once I decided to go for it, I went all in and ended up losing about 60 pounds over five months. 

I'm glad I lost the weight because I fit in clothes better and I have more energy.  There are a few negatives that I associate with my weight loss, but the positives far outweigh (no pun intended) the negatives. 

I don't see anything wrong with encouraging people to eat healthier and EXERCISE.  The exercise is much more important than eating healthy.  I actually don't eat much healthier than I use to eat.  Only now, I'm in the gym five to six days a week doing an hour of aerobic exercise.  It's fun, most of the time. 

I agree that there is a fair amount of fat shaming in society...and that the relationship between weight gain and health is a complex one, open for deep, reflexive re-examiniation....

but let's not kid ourselves the link between obesity and negative health outcomes is fairly strong to simply dismiss as a myth ...in fact even the study that you mentioned in the post that challenges this myth, in fact reaffirms that obesity was related to early death even in their study...As the study states..."In this large prospective study, obesity was strongly associated with the risk of death in both men and women in all racial and ethnic groups and at all age"....The unique issue that the study raised was the fact that moderate weight-gain in terms of BMI (overweight as opposed to obese) was not shown to have incremental risks for subjects.  That is, moderate weight gain was not a significant risk factor.  Indeed, low BMI is at times associated early death, in part because some diseases cause people to lose weight dramatically, which is what the study attempts to control.This is all to say, that I think we can be critical of public health discourses surrounding the appropriate weight/shape that people should have, without dismissing the fact that many of us eat far too many calories to be healthy.  Sorry, but there's nothing to deconstruct that the buffet is anything but an American obsession with excess, and an obsession that we should curb.   As your study states, "Excess body fat has long been recognized as a harbinger of disease and early death.14 Nearly a half-century ago, insurance records showed that life expectancy was diminished in obese persons.15 Epidemiologic studies subsequently confirmed the link between obesity and an increased risk of death.1

Health is definitely the key, though being overweight, and especially being obese, is associated with ill-health.

Food for Thought---and Action
www.brook.com/food

Smoking compounds the problem. Smoking is also clearly bad for health, but also really bad for our environment.

No Smoking?
www.brook.com/smoke

It really doesn't seem like these people are intentionally meant to be seen as abnormally fat. The smoking people, the one girl at the buffet, and the girl talking about salad all seem fairly normal-sized. Also, If I remember correctly, Minnesota is one of the heavier states, so this may have been a fairly representative sample.

I don't find this video to be too problematic over all.  But I know that "fat" and "unhealthy" are, in fact, not interchangeable.  The moments where I do feel the video relies on a common negative stereotype are the ones featuring the man lounging on the couch with the remote control.  Equating "fat" with "lazy" is an even greater injustice. 

As an exercise physiologist and a public health professional I need to call the B.S. flag.  Our country in particular is facing an obesity epidemic that has catastrophic consequences in terms of health, health care costs, productivity and serious implications from an economics perspective. While the obese and smokers are not the only offenders of unhealthy behaviors, they make up the largest piece of the health care utilization pie.

Further, it is not acceptable to discriminate or judge these individuals, but traditional health promotion efforts used in the past have been largely ineffective. It needs to be beaten in to peoples heads that lack of exercise and poor eating choices result in costly chronic health conditions. It's true not everyone that exercises and eats well looks like a tri-athlete and supermodel. The issue of obesity is extremely complex, being tied to race, socioeconomic status, policy, genetics, etc. But as a nation we do need to stop making excuses and some of the onus must be placed on the individual.

Also the "studies" people are citing on here aren't necessarily peered reviewed and may not have been subjected to rigorous methodology. Crack pot "scientists" to offer their counter "obesity isn't really bad" arguments are a dime a dozen. It's one thing to find information to support your argument, it's another to find FACTUAL information. Facts matter, but it's obvious we don't care about facts in our society, just as long as we can find some hack-job to support or go along with what believe. The literature is pretty consistent on the effects of obesity and very much so on the consequences of smoking.

Isn't there a difference between being heavy because 1) you choose to do the wrong thing for the sake of pleasure even while your health declines, 2) being heavy because you choose to take pleasure in food and socializing with food, and because it hasn't hurt your health or well-being, or because the benefits outweigh the costs, 3) being heavy because your life has put you in a position where healthy choices aren't terribly easy or affordable, and 4) being heavy because your ancestry has predisposed you to have a starvation-ready body that doesn't know how to turn its fat-storing survival mechanism off when faced with adequate food supplies? This commercial only addresses the first group, and assumes that fat is always a bad thing and always within the control of an individual. Inequality, social conditions, and ancestry are also strongly implicated. And arguing that "I lost this much weight through hard work and discipline, so fat people are just making excuses" is the same as arguing that "Oprah made good, so all the other poor black children who don't grow up to succeed are bad and lazy."

This isn't at all surprising, coming from BlueCross BlueShield. I used to work there in the underwriting department and saw first-hand how discriminatory they are towards overweight people. I remember one dispute in particular, where they denied a teenage boy health insurance because of his weight and the mother wrote in to dispute, sending a picture of him... He was a tall, muscular football player. He still got denied for health insurance.

....and there's no such thing as global climate change, AIDS can best be treated with vitamin therapy and masturbation will make you (not me) go blind!!!!

GOD HOW REFRESHING. More ammunition for the "if you're fat, you're gonna die! So you'd better beat yourself up about it!" state of mind. 

I have been a fat rights activist since the mid-90s. I've been glad to see the growth of the Health At Every Size community, which I'm aware started in the mid-80s. This community is made up of professionals from nutrition, physical fitness, psychology, research, and even medicine (a traditional bastion of weight bias). More recently, an interdisciplinary academic discussion has developed called fat studies. I hope that people who feel a commitment to data and to social justice will explore literature of fat pride, Health At Every Size, and fat studies. Good intro books include my book, "FAT!SO?," Linda Bacon, PhD's book, "Health At Every Size," and the "Fat Studies Reader," co-edited by Esther Rothblum, PhD, and Sondra Solovay, JD.
 
I notice, as always, that there is a kind of emotion involved in criticism of fat people that feels nothing like genuine concern for other people's health or wellbeing. The vibe is more like anger and vindictiveness. And, sadly, I notice such emotion especially in comments where opinions claim to be based on science, yet fail to distinguish carefully between correlation and causation.

Lisa: I wonder how much you've struggled with weight loss?

Maybe it depends on the environment you're around. Me, I've struggled with obesity & weight loss all my life. Attitudes have shifted so far in the other direction that, in my experience, the problem is the fat accepters, not the fat criticizers.

I've always been unhappy with the fat acceptance movement, and the counter-reactions that line of thinking produces whenever I tell people I'm trying to cut back. (In other words: PLEASE stop offering me food, I'm struggling with an addiction.) Yes, to me it's like you're telling me "you shouldn't worry about that!" whenever I try to turn down a cigarette.

It IS important for health reasons -- and some of these effects are subtle and manifest only in certain conditions. I recently made another dent in my years-long effort at weight loss and pushed my BMI from 30 to 28.3. Why? Because I'd been trying to conceive and I went six months without a period. That last push finally tipped the balance: my periods returned and I've finally managed to conceive. Here's to hoping I don't suffer one of the many complications that are strongly correlated to maternal weight.

If I hadn't been trying to conceive it would have been easy to dismiss me as "fat but healthy": my blood pressure & blood tests were absolutely fine, and I exercised regularly. But I did have a problem that became apparent in the last year, and it was caused in part by obesity.

I need more support for my weight loss, not mistaken efforts to boost my self esteem by dismissing the importance of my struggle.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041737/
Quote:
Assumption: Adiposity poses significant mortality riskEvidence: Except at statistical extremes, body mass index (BMI) - or amount of body fat - only weakly predicts longevity [32]. Most epidemiological studies find that people who are overweight or moderately obese live at least as long as normal weight people, and often longer [32-35]. Analysis of the National Health and Nutrition Examination Surveys I, II, and III, which followed the largest nationally representative cohort of United States adults, determined that greatest longevity was in the overweight category [32]. As per the report, published in the Journal of the American Medical Association and reviewed and approved by the Centers for Disease Control and Prevention and the National Cancer Institute, "[this] finding is consistent with other results reported in the literature." Indeed, the most comprehensive review of the research pooled data for over 350,000 subjects from 26 studies and found overweight to be associated with greater longevity than normal weight [36]. More recently, Janssen analyzed data in the elderly (among whom more than 70 percent of all deaths occur) - also from 26 published studies - and similarly found no evidence of excess mortality associated with overweight [37]. The Americans' Changing Lives study came to a similar conclusion, indicating that "when socioeconomic and other risk factors are controlled for, obesity is not a significant risk factor for mortality; and... for those 55 or older, both overweight and obesity confer a significant decreased risk of mortality." [38] The most recent analysis, published in the New England Journal of Medicine, concluded that overweight was associated with increased risk, but only arrived at this conclusion after restricting the analysis by excluding 78 percent of the deaths [39]. They also used a reference category much narrower than the entire "normal weight" category used by most other studies, which also contributed to making the relative risk for overweight higher. 
There is a robust pattern in the epidemiological literature that has been named the "obesity paradox" [40,41]: obesity is associated with longer survival in many diseases. For example, obese persons with type 2 diabetes [42], hypertension [43,44], cardiovascular disease[41,45], and chronic kidney disease [46] all have greater longevity than thinner people with these conditions [47-49]. Also, obese people who have had heart attacks, coronary bypass[50], angioplasty[51] or hemodialysis [52] live longer than thinner people with these histories [49]. In addition, obese senior citizens live longer than thinner senior citizens [53].
The idea that "this is the first generation of children that may have a shorter life expectancy than their parents" is commonly expressed in scientific journals [54] and popular press articles [55], even appearing in Congressional testimony by former Surgeon General Richard Carmona [56] and a 2010 report from the White House Task Force on Childhood Obesity[57]. When citation is provided, it refers to an opinion paper published in the New England Journal of Medicine [54], which offered no statistical evidence to support the claim. Life expectancy increased dramatically during the same time period in which weight rose (from 70.8 years in 1970 to 77.8 years in 2005) [58]. Both the World Health Organization and the Social Security Administration project life expectancy will continue to rise in coming decades [59,60].Assumption: Adiposity poses significant morbidity risk
Evidence: While it is well established that obesity is associated with increased risk for many diseases, causation is less well-established. Epidemiological studies rarely acknowledge factors like fitness, activity, nutrient intake, weight cycling or socioeconomic status when considering connections between weight and disease. Yet all play a role in determining health risk. When studies do control for these factors, increased risk of disease disappears or is significantly reduced [61]. (This is less true at statistical extremes.) It is likely that these other factors increase disease risk at the same time they increase the risk of weight gain.
Consider weight cycling as an example. Attempts to lose weight typically result in weight cycling, and such attempts are more common among obese individuals [62]. Weight cycling results in increased inflammation, which in turn is known to increase risk for many obesity-associated diseases [63]. Other potential mechanisms by which weight cycling contributes to morbidity include hypertension, insulin resistance and dyslipidemia [64]. Research also indicates that weight fluctuation is associated with poorer cardiovascular outcomes and increased mortality risk [64-68]. Weight cycling can account for all of the excess mortality associated with obesity in both the Framingham Heart Study [69] and the National Health and Nutrition Examination Survey (NHANES) [70]. It may be, therefore, that the association between weight and health risk can be better attributed to weight cycling than adiposity itself [63].
As another example, consider type 2 diabetes, the disease most highly associated with weight and fat distribution. There is increasing evidence that poverty and marginalization are more strongly associated with type 2 diabetes than conventionally-accepted risk factors such as weight, diet or activity habits [30,71-73]. A large Canadian report produced in 2010, for example, found that low income was strongly associated with diabetes even when BMI (and physical activity) was accounted for [73]. Also, much evidence suggests that insulin resistance is a product of an underlying metabolic disturbance that predisposes the individual to increased fat storage due to compensatory insulin secretion [61,74-78]. In other words, obesity may be an early symptom of diabetes as opposed to its primary underlying cause.
Hypertension provides another example of a condition highly associated with weight; research suggests that it is two to three times more common among obese people than lean people [79]. To what extent hypertension is caused by adiposity, however, is unclear. That BMI correlates more strongly with blood pressure than percent body fat [80] indicates that the association between BMI and blood pressure results from higher lean mass as opposed to fat mass. Also, the association may have more to do with the weight cycling that results from trying to control weight than the actual weight itself [48,81,82]. One study conducted with obese individuals determined that weight cycling was strongly positively associated with incident hypertension [82]. Another study showed that obese women who had dieted had high blood pressure, while those who had never been on a diet had normal blood pressure [67]. Rat studies also show that obese rats that have weight cycled have very high blood pressures compared to obese rats that have not weight cycled [83,84]. This finding could also explain the weak association between obesity and hypertension in cultures where dieting is uncommon[48,85]. Additionally, it is well documented that obese people with hypertension live significantly longer than thinner people with hypertension [43,86-88] and have a lower risk of heart attack, stroke, or early death [45]. Rather than identifying health risk, as it does in thinner people, hypertension in heavier people may simply be a requirement for pumping blood through their larger bodies [89].
It is also notable that the prevalence of hypertension dropped by half between 1960 and 2000, a time when average weight sharply increased, declining much more steeply among those deemed overweight and obese than among thinner individuals [90]. Incidence of cardiovascular disease also plummeted during this time period and many common diseases now emerge at older ages and are less severe [90]. (The notable exception is diabetes, which showed a small, non-significant increase during this time period [90].) While the decreased morbidity can at least in part be attributed to improvements in medical care, the point remains that we are simply not seeing the catastrophic disease consequences predicted to result from the "obesity epidemic."Assumption: Weight loss will prolong life
Evidence: Most prospective observational studies suggest that weight lossincreases the risk of premature death among obese individuals, even when the weight loss is intentional and the studies are well controlled with regard to known confounding factors, including hazardous behavior and underlying diseases [91-96]. Recent review of NHANES, for example, a nationally representative sample of ethnically diverse people over the age of fifty, shows that mortality increased among those who lost weight [97].
While many short-term weight loss intervention studies do indicate improvements in health measures, because the weight loss is always accompanied by a change in behavior, it is not known whether or to what extent the improvements can be attributed to the weight loss itself. Liposuction studies that control for behavior change provide additional information about the effects of weight (fat) loss itself. One study which explicitly monitored that there were no changes in diet and activity for 10-12 weeks post abdominal liposuction is a case in point. Participants lost an average of 10.5 kgs but saw no improvements in obesity-associated metabolic abnormalities, including blood pressure, triglycerides, cholesterol, or insulin sensitivity [98]. (Note that liposuction removes subcutaneous fat, not the visceral fat that is more highly associated with disease, and these results should be interpreted carefully.)
In most studies on type 2 diabetes, the improvement in glycemic control is seen within days, before significant weight or fat is lost. Evidence also challenges the assumption that weight loss is associated with improvement in long-term glycemic control, as reflected in HbA1c values [99,100]. One review of controlled weight-loss studies for people with type 2 diabetes showed that initial improvements were followed by a deterioration back to starting values six to eighteen months after treatment, even when the weight loss was maintained [101].
Furthermore, health benefits associated with weight loss rarely show a dose response (in other words, people who lose small amounts of weight generally get as much health benefit from the intervention as those who lose larger amounts).
These data suggest that the behavior change as opposed to the weight loss itself may play a greater role in health improvement.Assumption: Anyone who is determined can lose weight and keep it off through appropriate diet and exercise
Evidence: Long-term follow-up studies document that the majority of individuals regain virtually all of the weight that was lost during treatment, regardless of whether they maintain their diet or exercise program [5,27]. Consider the Women's Health Initiative, the largest and longest randomized, controlled dietary intervention clinical trial, designed to test the current recommendations. More than 20,000 women maintained a low-fat diet, reportedly reducing their calorie intake by an average of 360 calories per day [102] and significantly increasing their activity [103]. After almost eight years on this diet, there was almost no change in weight from starting point (a loss of 0.1 kg), and average waist circumference, which is a measure of abdominal fat, had increased (0.3 cm) [102].
A panel of experts convened by the National Institutes of Health determined that "one third to two thirds of the weight is regained within one year [after weight loss], and almost all is regained within five years." [28] More recent review finds one-third to two-thirds of dieters regain more weight than was lost on their diets; "In sum," the authors report, "there is little support for the notion that diets lead to lasting weight loss or health benefits [5]." Other reviews demonstrate the unreliability of conventional claims of sustained weight loss [104,105]. There is a paucity of long term data regarding surgical studies, but emerging data indicates gradual post-surgery weight regain as well [106,107]. Weight loss peaks about one year postoperative, after which gradual weight regain is the norm.Assumption: The pursuit of weight loss is a practical and positive goal
Evidence: As discussed earlier, weight cycling is the most common result of engaging in conventional dieting practices and is known to increase morbidity and mortality risk. Research identifies many other contraindications to the pursuit of weight loss. For example, dieting is known to reduce bone mass, increasing risk for osteoporosis [108-111]; this is true even in an obese population, though obesity is typically associated with reduced risk for osteoporosis[108]. Research also suggests that dieting is associated with increased chronic psychological stress and cortisol production, two factors known to increase disease risk [112]. Also, there is emerging evidence that persistent organic pollutants (POPs), which bioaccumulate in adipose tissue and are released during its breakdown, can increase risk of various chronic diseases including type 2 diabetes [113,114], cardiovascular disease [115] and rheumatoid arthritis [116]; two studies document that people who have lost weight have higher concentration of POPs in their blood [117,118]. One review of the diabetes literature indicates "that obese persons that (sic) do not have elevated POPs are not at elevated risk of diabetes, suggesting that the POPs rather than the obesity per se is responsible for the association" [114].
Positing the value of weight loss also supports widespread anxiety about weight [119,120]. Evidence from the eating disorder literature indicates an emphasis on weight control can promote eating disordered behaviors [7]. Prospective studies show that body dissatisfaction is associated with binge eating and other eating disordered behaviors, lower levels of physical activity and increased weight gain over time [121,122]. Many studies also show that dieting is a strong predictor of future weight gain [66,123-128].
Another unintended consequence of the weight loss imperative is an increase in stigmatization and discrimination against fat individuals. Discrimination based on weight now equals or exceeds that based on race or gender [129]. Extensive research indicates that stigmatizing fat demotivates, rather than encourages, health behavior change [130]. Adults who face weight stigmatization and discrimination report consuming increased quantities of food [131-134], avoiding exercise [133,135-137], and postponing or avoiding medical care (for fear of experiencing stigmatization) [138]. Stigmatization and bias on the part of health care practitioners is well-documented, resulting in lower quality care [139,140].Assumption: The only way for overweight and obese people to improve health is to lose weight
Evidence: That weight loss will improve health over the long-term for obese people is, in fact, an untested hypothesis. One reason the hypothesis is untested is because no methods have proven to reduce weight long-term for a significant number of people. Also, while normal weight people have lower disease incidence than obese individuals, it is unknown if weight loss in individuals already obese reduces disease risk to the same level as that observed in those who were never obese [91,93].
As indicated by research conducted by one of the authors and many other investigators, most health indicators can be improved through changing health behaviors, regardless of whether weight is lost [11]. For example, lifestyle changes can reduce blood pressure, largely or completely independent of changes in body weight [11,141-143]. The same can be said for blood lipids [11,143-145]. Improvements in insulin sensitivity and blood lipids as a result of aerobic exercise training have been documented even in individuals who gained body fat during the intervention [145,146].Assumption: Obesity-related costs place a large burden on the economy, and this can be corrected by focused attention to obesity treatment and preventionEvidence: The health cost attributed to obesity in the United States is currently estimated to be $147 billion annually [147] and this cost estimate has been used to justify efforts at obesity treatment and prevention. Although this estimate has been granted credence by health experts, the word "estimate" is important to note: as the authors state, most of the cost changes are not "statistically different from zero." Also, the estimate fails to account for many potentially confounding variables, among them physical activity, nutrient intake, history of weight cycling, degree of discrimination, access to (quality) medical care, etc. All are independently correlated with both weight and health and could play a role in explaining the costs associated with having a BMI over 30. Nor does it account for costs associated with unintended consequences of positing the value of a weight focus, which may include eating disorders, diet attempts, weight cycling, reduced self-esteem, depression, and discrimination.Because BMI is considered a risk factor for many diseases, obese persons are automatically relegated to greater testing and treatment, which means that positing BMI as a risk factor results in increased costs, regardless of whether BMI itself is problematic. Yet using BMI as a proxy for health may be more costly than addressing health directly. Consider, for example, the findings of a study which examined the "healthy obese" and the "unhealthy normal weight" populations [148]. The study identified six different risk factors for cardiometabolic health and included subjects in the "unhealthy" group if they had two or more risk factors, making it a more stringent threshold of health than that used in categorizing metabolic syndrome or diabetes. The study found a substantial proportion of the overweight and obese population, at every age, who were healthy and a substantial proportion of the "normal weight" group who were unhealthy. Psychologist Deb Burgard examined the costs of overlooking the normal weight people who need treatment and over-treating the obese people who do not (personal communication, March 2010). She found that BMI profiling overlooks 16.3 million "normal weight" individuals who are not healthy and identifies 55.4 million overweight and obese people who are not ill as being in need of treatment (see Table ​Table2).2). When the total population is considered, this means that 31 percent of the population is mis-identified when BMI is used as a proxy for health.