The Q&A we published earlier this week with authors Kate Harding and Marianne Kirby attracted a lot of attention and debate. Understandably so: their book, "Lessons From the Fat-o-Sphere: Stop Dieting and Declare a Truce With Your Body," (Perigee Books, 2009) flies in the face of everything we've been taught about weight, health, and the root causes of obesity. To write "fat can be healthy" reads almost like libel. But is true?
This post isn't meant as the definitive fact-checked rebuttal to all the arguments made in the book. It will, however, give a little perspective and context to the debate.
It's been pretty well established that BMI is not the best way to measure health - or even to measure body composition. Everyone has heard stories of muscle-laden athletes with crazy high BMI scores, and the simple, one-size-fits all calculation doesn't do a great job of assessing all the different types of bodies out there. But you don't need to measure someone's BMI to tell if they're fat, just like you don't need a Pantone chart to tell if someone has brown hair. The question remains, is fat unhealthy?
That depends. "If the fat is on the hips or arms or back or under the neck, we believe that its main risk is its weight-causing problem," says Michael Roizen, MD, chair of the Cleveland Clinic Wellness Institute. "It can cause an increase in arthritis [from bearing extra weight on your joints] but that's much different than the medical problems that come with an increased waist."
It's the fat that forms in the abdomen area - fat that increases your waist size - is that can cause insulin resistance, inflammation associated with heart attack and stroke, and increase your risk for certain cancers.
It is possible, says Dr. Roizen, to be healthy and heavy, as long as that weight accumulates on your hips, not your waist (most women tend to "wear" their weight here, while men are more likely to gain abdominal fat. However, heavy men are better able to fit into narrow airplane seats...it's always something.)
In their book, Harding and Kirby claim that the real health hazard is not being overweight may not be the weight itself, but repeatedly trying to lose that weight.* There have been several studies indicating that yo-yo dieting that people who lose and gain weight over time have a higher mortality due to cardiac problems. However, some researchers claim that because these studies include people who drop weight due to an underlying medical condition, the results are less clear. Their research shows that people who lose weight intentionally, even if they gain the weight back, aren't at as much risk.
The other health hazard associated with being overweight is what Dr. Roizen calls social problems. "That's depression, suicide, and other forms of stress-induced mental problems," he says. These problems, of course, are not causes by fatness in and of itself, but with the shame and guilt that can result from living as an overweight person. There are two ways to treat that: either by losing the weight or, as Harding and Kirby suggest, embracing your body and tuning out the societal messages that say being fat makes one unhealthy -- and unworthy.
* Post amended after Kate Harding responds: "We do point to some evidence that yo-yo dieting can be more harmful than staying fat, but we don't claim it's conclusive -- only "a clear source of concern," as Traci Mann, et al., put it in 2007... At this point, I just don't think it's responsible to make a definitive statement either way. Obviously, I'm inclined to believe that yo-yo dieting is problematic, if only for the damage it does to people's self-esteem and mental well-being. But like many of the health issues we discuss in Lessons from the Fat-o-Sphere, it's one on which medical opinion is divided. That's why we devote an entire chapter to encouraging people to read everything -- including our book -- with their critical thinking caps on."
