According to a report released this week, an obesity researcher has seriously proposed that the solution to America's weight problem is to shame fat people into losing weight. No, that isn't brilliant satire from The Onion. That's according to a story published earlier this week in the Atlantic:
“People don't hate being fat enough, basically, according to Hastings Center bioethicist Daniel Callahan … he argues that nothing … is working, and goes on to make the case for fat-shaming people until they start eating more salad.”
The proposal is based on two comical assumptions, each enough to sink the idea before it gains any traction as a serious policy. So, let's take a look at why shaming fat people into losing weight is the stuff of good satire, not science.
The assumption that a bigger number on the bathroom scale is always a cause of poor health has gone unquestioned for decades, but the evidence clearly shows that it's possible to be overweight and perfectly healthy. One study, published last year in the Journal of Clinical Endocrinology and Metabolism, found that obese people are at no greater risk for cardiovascular disease than their slimmer neighbors, provided they don't have high cholesterol or diabetes. Or as one of the authors of the study put it, "People with good metabolic health are not at risk of future heart disease — even if they are obese."
Two previous studies, published in 2009 and 2010 respectively, found that exercise habits are a better indicator of overall health than body weight. Overweight participants in both studies actually outlived those who were considered to be within the “normal” weight range according to the Body Mass Index (BMI). And to solidify this point, a study published in the Journal of the American Medical Association (JAMA) just two weeks ago found that people with a higher BMI may outlive the rest of the population.
These results are certainly odd if carrying around extra weight is really the threat it's made out to be, and several obesity experts have made an effort to discount the counter-intuitive findings. But there's a better way to explain the possibility that fat people can be healthy: it's real. Or if you prefer a more authoritative summary, the “Simplistic messaging that body fat is 'bad' and weight loss is 'good' for our health can be misleading...” as a pair of researchers argued last year.
In a recent interview, University of San Francisco endocrinologist Robert Lustig pointed out why this simplistic approach to obesity is so problematic. Weight gain, Lustig says, is merely a marker for poor metabolic health, not the cause. The evidence backs him up, too, as many people in the developed world, though they never get fat, are still at risk for metabolic syndrome. It's for this reason that our efforts to address obesity really need to be efforts to address unhealthy eating and the poor metabolic health that almost always results from it.
The science is pretty clear that our emphasis on weight loss is misguided, but what makes the proposal to shame fat people into getting skinnier even more ridiculous is that it's been acceptable to ridicule fat people for a century in America. Moreover, a 2003 study published in Obesity Research found that doctors “view obesity as largely a behavioral problem and share our broader society's negative stereotypes about the personal attributes of obese persons.” What we have, then, is evidence that obesity has long been thought of as a character defect, even by the experts we charge with treating it, and this disdain for fatness has done absolutely nothing to makes us slimmer.
On this point there's a strange contradiction in the argument for making shame an official response to obesity. Callahan acknowledges society's dislike of fat people, which they are obviously aware of as the recipients of the discrimination. Yet his argument is based on the assumption that fat people really don't know how fat they are, thus we should tell them in a polite but pointed way how fat they are. It's really a little too absurd for anybody to take seriously, I hope.