3 Reasons Objectivity Is Scarce on “Healthy Obesity”

The response to a pair of publications in Annals of Internal Medicine about “healthy obesity” reminds us that objectivity on this subject is scarce. Jim Hill and Holly Wyatt this week declared “healthy obesity is a myth.” Their editorial accompanies an analysis of risks associated with metabolically healthy obesity and overweight.

Arya Sharma takes strong exception to these sweeping conclusions. He pointed out a flawed approach to defining what is metabolically healthy in the analysis, and said:

This of course is nonsense. The term “healthy” should mean just that – “healthy.”

The notion of good health at a high BMI seldom fails to get people riled up. Objectivity goes out the window, largely because of three problems:

  1. Schismogenesis. The anthropologists have our eternal gratitude for this concept of how nasty disputes erupt between groups of people who stop listening and reasoning with each other. At one extreme we have folks who are committed to the notion that obesity is a myth or a conspiracy perpetrated by people who are intolerant of diversity in body size. At the other extreme we have folks who harbor strong bias against people with obesity and advocate for shaming as a strategy to reduce the impact of obesity on public health.
  2. Defining normal. As a statistical concept, defining a norm is an objective process. As a social concept, defining expected patterns of behavior and lifestyle is hardly objective. Some people who advocate — implicitly or explicitly — for shaming cite concern about “normalizing obesity” as a reason. Here they sow the seeds of conflict.
  3. Defining health. Good health is a subjective, elusive, moving target. Perhaps it’s glib, but the assertion that life is a sexually-transmitted, fatal condition is worth thinking about. Health goals are inherently individual and subjective.

Sharma concludes that this “meta-analysis adds to meta-confusion.” Perpetuating this dispute is not helpful. “Healthy obesity” is a straw-man concept that misses the point. Says Sharma:

Unfortunately, studies such as this, by mislabeling unhealthy obese individuals as supposedly “healthy,” do little more than further confuse the literature and promote weight bias while reinforcing the widespread misconception that you can measure health by simply stepping on a scale.

We agree.

Click here to read the meta-analysis, click here to read the editorial by Hill and Wyatt, and click here to read the commentaries by Sharma.

Objectivity Glasses, primitive pinta sketch © Robert Nunnally / flickr

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