Fatness and Health: What Does the Research Say?
We live in a world of unexamined fat prejudice and size prejudice, especially against women. This results in a bias that influences researchers, impacting how research is carried out and interpreted. We end up with questionable research that few people question.
Even health professionals are biased. Rebecca M. Puhl and Chelsea A. Heuer report that, “In a study of over 620 primary care physicians, over 50% viewed “obese” patients as awkward, unattractive, ugly, and noncompliant. One-third of the sample further characterized obese patients as weak-willed, sloppy, and lazy.” Other research show similar attitudes amongst nurses and dietitians.
Most people believe that fat people are unhealthy. And that weight loss will improve health.
There is research challenging these ideas. Unfortunately, it rarely makes it to mainstream media and is largely ignored. I gather it when I have time, and present it here. I wonder what you will think after reviewing it. Make sure to pay attention to the “Obesity Paradox.
(Also, check out resources at the bottom of this page.)
What You Don’t Hear About “Obesity” Research
When research shows that fat people can be healthy, rather than concluding that fatness may not be the problem most think it is, they put their research in a category called the “obesity paradox.” In other words, “we don’t like the findings, and don’t want to believe them, so now we don’t have to.” The bias against fatness is that strong.
“Paradox - a statement or proposition that, despite sound (or apparently sound) reasoning from acceptable premises, leads to a conclusion that seems senseless, logically unacceptable, or self-contradictory.”
For a short article looking at the obesity paradox: “In Obesity Research, Fatphobia Is Always the X Factor.”
Maintained Weight Loss Has No Effect On Cardiovascular Health. The Look AHEAD study, which included fat people with Type 2 Diabetes (and possibly the only study to get participants to maintain a 5% weight loss for four years) was cancelled due to lack of cardiovascular health improvements. Xavier Pi-Sunyer, MD, MPH stated, “While there was a differential effect on weight loss and fitness between the two groups, there was no effect on cardiovascular outcomes.” I’ve met this doctor, and he is very against “obesity,” so his conclusions are significant.
Mann and Tomiyma’s 2013 study also failed to find a causal link between weight loss and health improvements.
But professionals keep saying that “if you just lose 3% (or 5% or 20%) of your weight, you will be healthier.” Where did this come from? As Mann and Tomiyama point out, the claim started with very specific height weight ratio, but when research showed people were not able to sustain the weight loss, researchers changed the definition of success.
The new standard was to lose 20 percent of one’s starting weight. However, a review of diets from that era found that only 5 percent of obese dieters succeeded even by that definition, and often were not able to sustain it so the definition was changed again.
Eventually, the medical community decided that losing 5% of starting weight would result in health benefits. Unfortunately, there is no scientifically-supported medical reason for doing so. But it looks good for the weight loss industry, because dieters can be deemed successful without having to lose much weight, or, as in the Look AHEAD trial, said to have meaningful improvements in cardiovascular health.
Let’s look at this logically. If a 300 pound person lost 5% of their body weight, and was now a 285# person, would you assume that health improvements were do to a loss of 5% as most researchers do?
Or, would you note that the sedentary subjects who ate a diet low in fiber, and then they became more active and began to eat more nutrient dense foods with more fiber. Perhaps they connected with others for walks, and became more connected socially (in part because they felt they were “doing something” about themselves. Maybe they even joined a support group, or sought out counseling to improve emotional health.
So, was their improved health because they now weigh 291 pounds? Or because of lifestyle changes?
We need to stop confusing body size with health. We need to quit pretending that anyone can lose weigh if they just tried. And we need to take our blinders off. Sure, people can lose some weight, but it is almost always regained (which is why people have to keep repeating that “successful” diet). We need to also read the research that is out there, but that is unpopular because it challenges long-held beliefs about “obesity,” which we do below, but first, let’s look at that idea that is is lifestyle factors and not weight loss that will improve the health of a fat person.
Do Not Need Weight Loss to Improve Health Even If You Are Fat-Bodied
Following is a quick listing of studies that have found that the health of “obese” individuals can be improved with NO focus on weight or weight loss.
Matheson, et al: Healthy, Lifestyle Habits and Mortality in Overweight and Obese Individuals. “Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.”
Steven Blair – Cooper Institute, who has done multiple studies of health and weight concludes, “We’ve studied this from many perspectives in women and in men, and we get the same answer: It’s not the obesity, it’s the fitness.”
Glenn Gaesser – Obesity, Health, and Metabolic Fitness, who wrote an excellent book called Big Fat Lies: The Truth About Your Health and Your Weight, where he methodically examines “obesity” research. I had the privilege of presenting at conferences with him multiple times, and I analyzed his book, and the 100s and 100s of research articles quoted during my PhD studies, leaving more convinced that ever that we need to quit focusing on weight.
Gaesser states that:
“No measure of body weight or body fat was related to the degree of coronary vessel disease. The obesity-heart disease link is just not well supported by the scientific and medical literature…Body weight, and even body fat for that matter, do not tell us nearly as much about our health as lifestyle factors, such as exercise and the foods we eat…total cholesterol levels returned to their original levels–despite absolutely no change in body weight–requiring the researchers to conclude that the fat content of the diet, not weight change, was responsible for the changes in cholesterol levels.”
Paffenbarger et. al. Physical Mortality: All Cause Mortality, and Longevity of College Alumni. “With or without consideration of …extremes or gains in body weight…alumni mortality rates were significantly lower among the physically active.”
Wei et. al. Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men. The health of normal weight / unfit individuals is worse that the health of fat and fit individuals. T
Challenging Long-Held Beliefs About “Obesity”
The following are articles that usually do not make it to mainstream media. How often have you heard of the “obesity paradox”? Or of the study showing subjects with a BMI of 27 are healthier than those at lower BMI of 23.7. This means that a 5'8" person would be healthy at 180 pounds. Read on to find out just how commonly held views of obesity are built on very shakey ground.
Losing Weight Before Knee Replacement Surgery Doesn’t Lead to Better Outcomes for Patients. Not only does using BMI as a determinant limit surgical access, but it can risk patients’ health
How To Leave Toxic Diet Culture Behind And Pursue Actual Health - Similar to this author, I (Karin) also analyzed obesity research during 8 years of pursuing a PhD in Cognitive Anthropology. And I found exactly what she found (and which others have found such as Gaesser, author of Big Fat Lies). 7/20
What is Weight Descrimination? Interview with A. Janet Tomiyama, Ph.D., is an associate professor at UCLA, who studies health psychology and social psychology.
A Tale of Advocacy: Two Knees and a Surgeon - On being fat and having knee replacement surgery. One woman’s efforts, and success.
Fat Is Not the Problem—Fat Stigma Is - “Health experts” are sending incorrect and destructive messages about the relationship between weight and wellness, and this does far greater damage to public health than fat tissue itself.
Weight Loss in Overweight Patients with Type 2 Diabetes - Long term weight loss did not reduce the chances of death or complications such as cardiovascular disease during the succeeding 13 years.
Obesity Won't Affect Joint Surgery Safety: Study - Heavy patients needed fewer blood transfusions, did not have more complications.
Overweight Who Lose Weight Have Increased Risk of Death - Weight loss of 15% or more associated with increased risk of death among overweight. (You can see how the research is NOT as clear cut as the media and our doctors report!)
Why is Weight Regained? - Study shows how food restriction is rarely effective, doesn’t reliably improve health and does more harm than good. The root of the problem is not willpower but neuroscience. (Looks at the TV program The Biggest Loser.)
Metabolic Adaptations with Weight Loss - These adaptations continued even 6 years later - participants were still burning 500 calories less each day!
Underweight Have Greater Risk of Death than “Obese” - The study also found that increased risk of death occurred in the extremely obese, which is only 8 percent of Americans, and that being very thin caused a slight increase in the risk of death. This research, from the National Cancer Institute and the Centers for Disease Control and Prevention is considered by many to be the most rigorous yet on the effects of weight.
Lowest Risk of Death in Overweight - Subjects at BMI of 27 healthier than those at lower BMI of 23.7. (For instance, a 5'8" person would be healthy at 180 pounds.)
Defying Conventional Wisdom - Excess fat is not, by itself, a serious health risk for the vast majority of people who are overweight or obese. Recommendations to cut calories and lose weight may do more harm than good in overweight or mildly obese individuals.
Decreased Risk of Death in Overweight - This 12 year study of BMI and mortality in 11,326 adult Canadians showed increased risk of death in the thin (BMI <18.5) and 'obese' (BMI >35). However, there was a decreased risk of death for the overweight (BMI 25 to <30). Researchers stated, "Overweight appears to be protective against mortality." 6/09
Overweight Lower Risk of Death - Eleven year study of BMI and mortality in 26,747 Japanese. The underweight group had higher risk of mortality, even among those with a lower normal BMI range. Lowest risk occurred at BMI between 20.0 and 29.9. 6/09
The Obesity Paradox - Researchers show that "...obesity appears to be protective in a number of cardiovascular disorders...", but continue to recommend weight loss. 5/09
Is Fatness to Blame? - In this New York Times article, "Losing the Weight Stigma." 10/08
Research that Overweight Live Longer - It looks like a BMI of 25 to 30, the so-called overweight range, may be the optimal range. 11/07 ....but the experts refuse to believe it.
Obesity is Unhealthy Claims Challenged - Is body weight really a barometer of health? It turns out…..not a very good one. International Journal of Epidemiology (IJE), 2006
Obesity Officials Funded by Weight Loss Industry - World Health Organization "independent" obesity stays afloat with "millions" from weight loss drug industry. Original article in British Medical Journal. 6/06
400, 000 Deaths Grossly Exaggerated - CDC needs to disclose how flawed research was cleared within the agency. 4/05
Obesity: An Overblown Epidemic? - An increasing number of scholars have begun accusing obesity experts, public health officials and the media of exaggerating the health effects of overweight and obesity. 5/05
CDC Study Exposed - Obesity causes 400,000 deaths annually, right? In little more than a year, the CDC's much-touted study has come unraveled. Here is a timeline of the study's incremental demise. 11/04
Fatness Not Necessarily Unhealthy, But Thinness Can Be - After decades of dire warnings to lose weight, it turns out that a modest amount of "excess" weight may be good for you! And being too thin is dangerous. See CDC: Save Our Statistics, They're Sinking Fast - informative article with links, and You Can Be Too Thin, After All - a NYTimes editorial. 4/05
Life Expectancy: Another Obesity Myth Debunked - Experts say that kids are getting so fat that they will not live as long as their parents. Obesity scaremongers have repeated this in countless articles, editorials, and even Congressional testimony - all without so much as a shred of credible research to back it up. This "deeply flawed study" was in the New England Journal of Medicine (NEJM). 3/05
CDC Study Overstated Obesity as Cause of Death - Apparently the Centers for Disease Control and Prevention overstated the number of obesity-related deaths. 11/04
CDC Must Retract Obesity Deaths Study - Just a year after its extremely controversial announcement that excess weight kills 400,000 American each year, the agency is rumbling, bumbling, stumbling toward an explanation for the new results that says the real figure is just 26,000. 4/05
Obesity Not Necessarily a Risk Factor - A “fat” body cannot possibly be fit and healthy, right? Wrong, see this report on the scientific evidence that challenges these views.
The Fat Epidemic is An Illusion - Contrary to popular opinion, national data do not show Americans growing uniformly fatter. Instead statistics demonstrate clearly that while the very fat are getting fatter, thinner people have remained pretty much the same. 6/04
Public Enemy Number One: Tobacco or Obesity? - The evidence on tobacco is well tested, but " the new numbers on obesity are weak--or as one critic in CDC says, "loosey-goosey."" CDC authors use inconsistent methods for calculating relative risks associated with tobacco and bad diet. Several epidemiologists at CDC and the National Institutes of Health (NIH) echoed these concerns but declined to speak on the record. "I don't want to lose my job," said one CDC staffer who does research in this area. Science, 5/04
"Obesity" Expert Calls for Nationwide Effort to Diet - Obesity researcher Xavier Pi-Sunyer makes claims that others call ludicrous.
Health Benefits With Fatness - According to U.S. and Swedish studies, "fatness is not associated with increased doctor visits, medical procedures or hospitalizations - fat men took no more days of sick leave, and were no more likely to have work-limiting health conditions.” “‘Obese’ men and women over age 60 are no more likely to suffer from chronic diseases than ‘average-weight’” persons.” But they are more likely to survive longer. 12/06
Women Get Heavier, and Healthier, as they Age - Women are getting healthier at the same time they’re getting heavier. Yet more proof that experts fighting obesity are not seeing things clearly. 5/00
About Eating Wisdom and Drs Karin and Hannah
We are two PhD level Registered and Licensed Nutritionists whose passion is to help others escape diet culture and to learn to use their natural, innate Eating Wisdom to, finally, find peace with food, eating and weight.
Check out our course, Intuitive Eating: How to Escape Diet Culture and Become an Empowered Eater,. plus we have lots of info and handouts (including the original Hunger Fullness Scale) at our website, www.EatingWisdom.com. We also offer 1:1 nutrition therapy. Take advantage of our combined 40+ years of experience and reach out today!
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