Understanding Obesity and Art

Obesity, like art, is something that most people think they understand on sight. Not so. Obesity is not a simple matter of body size. It’s a metabolic disease of excess adiposity (fat tissue). Understanding obesity takes far more than a visual assessment.

But that hardly deters smug observers from offering advice based on a superficial visual diagnosis. And naive policymakers readily proclaim simple solutions to end the problem of obesity.

When someone says “he really should do something about his weight,” that casual advisor has no idea what the person has or has not already done. Someone with a BMI of 32 might have worked very hard to achieve their best health in years. Or they might be on a dangerous upward trend. Like any other health concern, it’s a very personal matter.

Policymakers who enthusiastically say all we need to do is get people moving more and eating healthier food are either ignorant of the complexity of this disease or find it inconvenient. The fact is, booming sales of healthy foods, ever-growing health club memberships, and two-thirds of the population trying to do something about their weight has done nothing to reverse the inflated prevalence of obesity.

That’s not to say that healthy diet and exercise are unimportant. For an individual, it’s the best first step one can take. It’s just that ignorant finger-waving about diet and exercise is unlikely to fix the problem our population suffers.

Roughly 30% of people with a BMI in the range associated with obesity are in good health. And 24% of people with a healthy BMI have cardiometabolic health problems. This is why BMI — as useful as it is to epidemiologists — has very limited value for personal health decisions. Wise professionals use something like the Edmonton Obesity Staging System, which accounts for the medical, mental, and functional impact of obesity to assess a person’s health needs.

Unfortunately, simplistic finger pointing prompts another opposite and extreme reaction — denial that obesity is a disease or even a problem. Neither extreme is helpful.

In a recent essay, David Berreby, author of The Tribal Mind, offers a wise caution:

Today’s priests of obesity prevention proclaim with confidence and authority that they have the answer. So did Bruno Bettelheim in the 1950s, when he blamed autism on mothers with cold personalities. So, for that matter, did the clerics of 18th-century Lisbon, who blamed earthquakes on people’s sinful ways. History is not kind to authorities whose mistaken dogmas cause unnecessary suffering and pointless effort, while ignoring the real causes of trouble. And the history of the obesity era has yet to be written.

Remember, if they don’t ask for it, it’s not advice.

Click here to read Berreby’s essay, click here and here to read about the prevalence of good cardiometabolic health despite a high BMI, and click here to read about the Edmonton Obesity Staging System.

Portrait of Daniel Lambert, 19th century, British artist unknown; public domain image from Wikimedia

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