Twin Views of Obesity in Conflict

“The way that fat people and thin people experience this conversation is worlds apart,” says Michael Hobbes on a recent episode of his Maintenance Phase podcast with Aubrey Gordon. He’s describing a heated debate about catastrophizing obesity that has been smoldering for almost two decades. This is a conflict between two views of obesity. One holds that obesity is a deadly scourge. The other says, hold on, mild obesity is not so deadly.

A Not-So-Scholarly Debate

Hobbes and Gordon spend 84 minutes addressing a seemingly simple question: “Is Being Fat Bad for You?”

But, in fact, they zoomed in on an even narrower question. Will it kill you?

So they wound up diving into the not-so-scholarly debate that Walter Willett has stirred about risk of mortality linked to overweight and mild (class 1) obesity. You may recall, that for the better part of two decades, he has been working on stomping out the finding by Katherine Flegal that overweight and mild obesity may not lead to premature deaths.

Indeed there are two elements of Willett’s “stomp it out” campaign that are unhelpful. First and most obvious is the invective language. Merely calling a body of research “rubbish” enlightens no one. But perhaps the more important thing is the drive to catastrophize obesity – blow it up into a problem that supersedes all other health issues.

This is a problem because hyperbole obscures the truth. It serves to promote stigma and make the problem seem overwhelming (falsely) to those who are living with it. Hobbes put it simply:

“Fat people experience this as ‘you are going to die!’”

False Dichotomy

The result is to drive the dialogue about the health effects to polarized extremes. Either any degree of obesity or overweight will surely kill you. Or there’s no harm in this and people need to shut up about it.

We have some sympathy for the idea that people need to put a lid on moralistic clucking about obesity. It does much harm and no good because it’s nothing more than a tool for promoting stigma. In the end, the only thing moralists accomplish is to harm the health of people they’re stigmatizing.

But the other side of this false dichotomy is to assert obesity is harmless. Obesity is not necessarily a disaster, but over time, it will most likely harm a person’s health through cardiovascular disease, diabetes, liver disease, certain cancers, and other conditions causally related to excess adiposity. None of this is inevitable, but the risks are real. They are also manageable, with the help of healthcare providers who actually understand the problem. Sad to say, such providers can be hard to find.

For an alternative to this false dichotomy, we really like the Retro Report segment that digs into the problem of catastrophizing obesity. Fatima Cody Stanford sums it up, saying:

“I think we need to take a more holistic approach. It’s not just the number on the scale. It’s about other risk factors that can contribute to worsened health outcomes. So we have to look at the whole picture. It’s not just one size fits all.”

Click here for the podcast with Hobbes and Aubrey and here for the Retro Report on biased ideas about health and body size. Note: listeners with delicate ears should be prepared for a lot of F-bombs from Hobbes and Aubrey.

Trees Mirrored in a Pond, painting by Egon Schiele / WikiArt

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November 23, 2021