The big FAT problem: My thoughts on Obesity

These are just my own opinions, likely highly flawed.  In fact, I'm looking for flaws in my logic so I ask you to share your own opinions or stats.  

First of all, how are we diagnosing this “obesity epidemic" and what are the implications of said epidemic?  The BMI charts have been used to classify “overweight" and “obese."  One need not look far for the criticisms over the BMI.  The BMI falls short by failing to distinguish between lean body mass and fat, or in body fat distribution.  Body fat and its distribution is, arguably, a much greater indicator of overall health than weight or a height-weight-age ratio alone. 

 

So the measure by which we determine obesity faces its own issues.  But let us, for the sake of argument, suppose that the BMI is a good tool is diagnosing obesity.  And by this tool we find a painstaking obesity statistics in the U.S.  After all that, why is obesity something to be avoided?  Most, if not all, journal articles point to obesity as a link to cancer, heart disease, and other links to preventable death.  Aren’t we all just looking to cheat death?  So let’s consider this:  Average life expectancy in the U.S. from 49.2 in 1902 to 77.3 in 2002 (Life Expectancy http://aging.senate.gov/crs/aging1.pdf).  It is in that same time that the American diet has grown to include processed foods, and exercise has drastically decreased.  Additionally, the U.S. lifespan comes into 36^th place at 78.3 years, however still much higher than the world life expectancy of 67.2 years from birth. 

 

I find it very difficult to indict our society’s abundance of food when 13.6% of the world population, 925 million people, are “undernourished" according to the UN’s Food and Agriculture Organization’s 2010 report.  McDonald’s and their less-infamous counterparts is an easy target for frivolous lawsuits and media scrutiny.  But one cannot deny that McDonald’s can offer calories for a very small fraction of our income.  Indeed, cheap abundant food is what has gotten many of us into trouble.  And while wealthy countries may see this as a hindrance to their health, cheap food could drastically enhance the health of poor countries.    

One would be correct to argue that health, and lifespan, have increased INSPITE of the increasingly processed U.S. diet.  There are many, many factors that could be responsible for the dramatic increase in U.S. life expectancy in the past century, and the dietary habits of Americans could have had a positive effect, negative effect, or no effect at all.  And I'm sure that the statistical models must show some kind of positive association between America's expanding waistline and premature death, but the argument is grossly over-simplified IMHO.  Eric Oliver, Associate Professor at the University of Chicago puts it nicely:   “There are only a few medical conditions that have been shown convincingly to be caused by excess body fat, such as osteoarthritis of weight bearing joints and uterine cancer that comes from higher estrogen levels in heavier women, although this can be treated medically without weight loss.  For most medical conditions, it is diet, exercise, and genetics that are the real causes. Weight is merely an associated symptom."  I understand many of us had surgery for health-related reasons and can point to comorbidities that we either experienced personally or know a loved one who suffered through these.  I simply want to introduce an alternative explanation.

I have questions over the rigorousness of the obesity-classification system, and the causation between obesity and premature or preventable death.  

For the purpose of debate, let's say that the BMI is a good measure of obesity which is positively linked with premature/preventable death.  There is an obesity epidemic.  

The problem seems to be that every attempt to treat obesity serves only to worsen the problem (save for surgery hurrah!).  Americans spend more money on the billion-dollar weightloss industry each year, and each year the obesity statistics seem to only become more dismal.  I have to agree wholeheartedly with the aforementioned Professor Eric Oliver when he advocates a stop in "making body weight an indicator of a person's help."  He also suggests a reworking of the classification of obesity to better fit the real criteria of the disease.  

I completely agree with this because I find that too often healthy eating and exercise habits are viewed as only a means of arriving at a lower weight.  I have many average-weight friends who see no need to cut out sodas and fast food or increase cardio activity by virtue of the fact that they believe themselves to be in good health due to their normal-weight classification.  On the other end of the spectrum I know overweight people who abandon any and all attempts at healthy eating and exercise in a bout of frustration over their failed weightloss attempts.  This is a very serious and costly side effect of our weight-obsessed nation.

Now I want to just throw out some random thoughts...

I heard a tv-personality doctor call Paula Deen's concealment of her type II diabetes as "egregious."  Are you freaking kidding me?!!!  This is about as ridiculous as that stupid lawsuit blaming McDonald's for making them fat.  It is counterproductive to keep looking outward.  What happened to the idea of self-responsibility?  If we are really at a point where Paula Deen of all people is contributing to obesity and type 2 diabetes, I have absolutely no hope for our society!  These are serious issues and silly solutions like "take the butter outta Paula Deen's hands" only diminish the real issues at stake.  Does it come as a shock to anyone that a recipe with two sticks of butter may not be best for every day consumption?!

Second of all, I think we need to RUNNNNNNNNNN fast away from this notion that weight tells us anything more than the correlation between the calories that someone ingests IN COMPARISON to how their body metabolizes calories.  Someone's weight does not even tell us how much they eat, or the quality of the food.  And it certainly doesn't tell us anything about a person's self-discipline with regard to food or in any other aspect of life.  Nothing makes me more furious than when someone tries to deduct something about a person's personality based on their weight.  I've even heard heavy people use this poor logic.  "Discipline" is the most common refrain.  And it sounds like a nice idea--someon needs to cut back on their eating, pure and simple.  They need to exercise discipline at the table.  But even such a simple suggestion includes in it the assumption that I can snap my fingers and eat less.  The only difference between  my weight and a thinner person's weight is that the thinner person has greater mastery of their self discipline.  There can be no difference in the way our bodies metabolize calories, or in the way our brains tell us we are full or hungry.  Nope, it all comes down to good ol' hunger.  And once people mistakenly use this logic, it's easy to expand this to all areas of life--heavy people are, by this logic, simply lazy and undisciplined.  Therefore it is understadable to discriminate on the basis of weight because, after all, is there any fault in "laziness" discrimination?

Ok, I think I've said all I have to say.  I've been thinking about this for awhile.  Weight-based discrimination just gets me so mad

 Just to clarify:  I do think weight is linked with premature/preventable death via illnesses such as cancer, heart disease, asthma, and other many other illnesses that contribute to a loss in quality of life.  The issue I have is the classification of obesity for the purposes of preventing and treating above illnesses, the over simplification of the issue and the irresponsiblity of drawing causation conclusion, and worst of all the fact that all the "solutions" seem only to worsen the problem

I like your thought provoking thoughts here. But, just like BMI can really misconstrue true obesity so can the statistics of the average life span. The truth is infants that die at birth are included in life expectancy. In the past there were more infant deaths ( addding zero when averaging lowers the final results dramatically) and also some medical conditions that are easily treated with medication now, were not available in the 1940's. I once learned in a class that if a person in the past lived beyond the of age 5, they actually lived just as long or longer than people do now. What we eat is definately reflects our health. I am not knocking anything you said, just adding my own info.

 You are quite right.  Something I should have included in the statistics.  There are endless charts that delineate life expectancy based on age.  For example, from birth statistics may show, say, 67 year life expectancy.  But if you are 60 your life expectancy may be another 22 years, making your life expectancy 82.  And these differences in early-childhood deaths can also make up some of the differences in life expectancy in developed and developing countries.  But not entirely.  In 1850 the life expectancy at 20 was 40.1 years for white males (if we imagine a 20 year old has survived all childhood illnesses)--60.1 year life expectancy.  In 2000 the life expectancy for a 20 year old white male was 55.7 years, meaning 75.7 years.  So while that shrinks the gap, you can still see that life expectancy is still greater now.  This was from Massachusetts census bureau information

When looking at things like life expectency, it's often more useful to look at the median rather than the mean (average).  For example, if you look at the average life expectancy of a breed of dogs the mean (average) will generally be lower than the median (point where 50% live longer/50% shorter) because of infant mortality. 

Also, the rise in average life expectancy in the 20th century has a lot to do with vacination for and elimination of infections diseases and life sustaining therapies for others.  Back in the day, diseases like measles killed up to 25% of the childeren infected.  Juvenile Diabetes was a death sentence before insulin.  My family has a detailed geneology that goes back 10+ generations.  There were a lot of children who did not survive whereas there has not been a single infant lost in my or my parent's lifetime.  My husband's burst appendix which almost killed him in 1993 would have killed him in 1923.  Trauma surgery, heart surgery, organ transplants, etc., all help 'boost' the statistics. 

I don't agree with discrimination in any form; however, There are good and serious reasons to deal with obesity from a public policy standpoint.  BMI may be a rough measure, but across the population, lower BMI's generally are indicative of lower risk for a variety of problems.

I also think that the science is not complete in the area of obesity. Just as the discovery of Ghrelin and Leptin have brought an entirely new light onto the issue, I have long believed that we know less now about obesity than there is to know. It is not a simple math equation. It is a highly complex physiological process that results in obesity. Just my HO