Obesity is Not a Stunt Double

This post is not about my desire to do work as a plus-size stunt person when I move to LA (although I do and I am so if you need that kind of thing…call me :)

No, this post is about the way that people say “obesity” when they mean general or specific health problems.  Obesity is a poorly cast stunt double who gets called on set to stand in for diabetes, high blood pressure, high cholesterol, heart  disease, eating  disorders and whatever other thing we’re confusing correlation and causation about this week.

Yesterday’s post about Planned Parenthood is a really good example of how this happens. They were trying to list three “critical health care issues” and they listed obesity, children’s healthcare, and suicide.  Unfortunately that’s actually 2 critical health issues and one body size. It’s the same as if they said “critical health issues like tallness, children’s healthcare, and suicide.”.

Tallness, you see, is also associated with a shorter lifespan and a higher risk for health issues, but that doesn’t mean we try to make tall people shorter (and remember that we the chances of making someone thin are less than 5% better than making them shorter).

Part of this is a massive correlation vs. causation error.  Correlation means that we can observe two things happening at the same time, causation means that we know that one actually causes the other and how that happens. If all we have is correlation, even if the two things ALWAYS happen at the same time, we still can’t prove causation until we know how one causes the other.  This is the most basic pillar of research.  If all we know is correlation, then we have to leave room for the possibility that the two things are caused by a third factor, or that they are unrelated.  If we fail to do that, we are incompetent researchers.

So, even if every August has the most murders and the most ice cream eaten, we have no reason to believe that if we stop selling ice cream in August the murder rate will go down.  Nor can we accurately state that we want to work serious crime issues like home break-ins, grand theft auto, and ice cream eating.  Ice cream is not a stand in for murder no matter how much they may be correlated. But that’s exactly the mistake we make when we call obesity a “health care issue”.

Obesity is correlated with diseases, but causation isn’t proven.  It’s possible that both things are caused by a third factor (for example the stress of constant stigma has also been correlated to many of the same diseases as obesity in Peter Muennig’s work).  There are some chemicals that are in food that are correlated to both obesity and the disease that are commonly correlated with obesity.  The point is that nobody has solid research about why bodies are the size that they are (and it doesn’t matter what “everybody knows”), nobody has a shred of evidence proving that they can make fat people thin for the long term, and so calling fat bodies a health care crisis is not an evidence based claim, and focusing on things that we could “cure” if we could make people thin is like focusing on things that we could cure if we could make people fly.  Even if it would work, we don’t know how to get it done.

Not only does it create a second class of citizens who are shamed and stigmatized because of their body size and can’t get evidence-based healthcare because doctors are too busy prescribing behaviors for us that they diagnose as unhealthy in thin people.  It also harms thin people, who get all of the same diseases as fat people but often can’t get a diagnosis because their physicians believe that these diseases only happen to fat people, and are sold a dangerously false sense of security because they are told that their weight makes them healthy, regardless of their habits.

I sometimes wonder if the focus on obesity instead of disease is on purpose since obesity is seen as something that the obese person is “responsible for” and has to deal with, but diseases are seen as something that deserves healthcare (although  I notice some people, especially in the United States, are desperately trying to make disease an issue of blame and fear as well.)

Regardless of why it’s done, obesity is not the stunt double for diseases with which it is correlated. Obesity is a ratio of height and weight and we need to stop confusing the two.

This blog is supported by its readers rather than corporate ads.  If you get value out of the blog, can afford it, and want to support my work and activism, please consider a paid subscription or a one-time contribution.  The regular e-mail subscription (available at the top right hand side of this page) is still completely free.   Thanks for reading! ~Ragen

Published in: on March 23, 2012 at 7:18 am  Comments (25)  

25 CommentsLeave a comment

  1. I’ve just read your post as I do every morning (it is 8am here in the UK. Some people start their day with coffee – I start it with you)

    Then I switched to the bbc to read the news. Read a piece on very thin fashion models and who did they quote? You! Spelt your name wrong of course, but I love the fact that you are now the ‘go to’ size acceptance spokesperson (for ALL sizes) for the bbc. I think things are slowly starting to begin to change.

    Thank you for being a voice of reason.

  2. I agree with Lisa on starting my day with you. :-)

    Maybe I am missing the mark here, but I’m just not sure than tallness is the same as weight since height is always predetermined at birth, and weight is not always.

    • Actually height can be affected by childhood nutrition (or malnutrition).

    • Weight has about the same heritability as height, between 70-80%. Someone correct me if I’m wrong but I’m pretty sure this is true even in adopted twin situations where environment isn’t a factor.

      • Correct: great example would be the Koreas. A more or less homogenous population separated only 50 years ago, yet the average South Korean is something like 10 inches taller than the average North Korean.

  3. Hi Ragen, Just to let you know that I did a presentation last night to 18 of my peers (all health care professionals) in which I brought up fat stigma and quoted you several times (I was channeling ‘Danceswithfat’) and though I was sweating bullets, it went very well. This is the first time that I have publicly stood up and made a stand on being fat/fat stigma and it was very freeing-thank-you.

    • Elvie that’s fantastic, congratulations and thank you for getting in there, taking a stand, and educating. You totally rock!

      ~Ragen

      ________________________________

  4. Ashley- Height actually is ~70% genetic and ~30% environmental, about the same as weight. I forget which paper I read that from, but I think it was based on a twin study.

  5. Your blog teaches me so much everyday. Thank you. I joined a gym today (Curves), and confused the owner so much when I said I wasn’t interested in losing weight, because weight isn’t a good measure of health (my number especially seems to move or not move at random). She kept starting to testify to me how much weight she had lost, and how I can lose weight, and then stopping herself. I kinda wish I had told her my real motivation – to increase my libido! It’s so great to be eating and moving in order to make myself feel good, instead of to make my mother and society approve of me. Thanks again!

    • Whitney,

      That is an awesome story – I’ll bet the Curves director is still thinking about it – and it’s cool that she responded and stopped herself from selling weight loss when you asked! Rock on :)

      ~Ragen

  6. RAGEN YOU DO NOT KNOW HOW MUCH OF A DIFFERENCE YOU MAKE IN MY LIFE!!!! And yes I had to write that in all caps for extra emphasis! lol Honestly if it wasn’t for you and Ms. Wann I don’t know what I would do. Thank God for you two, please continue doing what your doing! Your fabulous!!

    • Thank you so much Alisa, you do not know how much this lifted me up for a really rough few days. Seriously, thank you.

      ~Ragen

  7. Statistically, women live longer than men, and no one tries corrective surgery to “fix” the men. Also, I recommend _Normal at Any Cost_ by Christine Cosgrove and Susan Cohen to read what children have been put through to manipulate their height.

  8. You know that I love you Ragen, but if obesity were actually “a ratio of height and weight,” the BMI wouldn’t be a BS number. Obesity is a presence of a certain amount of adipose tissue. This amount will vary depending on skeletal size, height, muscle mass, etc, but without adipose tissue deposits, one is not obese.

    All bodies need a certain amount of fat to maintain proper organ function, which is why anorexia and bulimia are so dangerous, but at a certain point, the mere amount of adipose tissue meets the definition of “obese,” regardless of the height/weight ratio.

    • I appreciate the love! The clinical definition of obesity is, in fact, a height weight ratio. That is precisely why BMI is a BS number, because it doesn’t take body composition into account at all – The Rock is considered obese because of his height/weight ratio, while a woman can have over 40% body fat but still considered “normal weight” because BMI only takes into account her height and weight. The idea that a certain amount of adipose tissue makes one meet the criteria for obesity is only true in so much as, at some point, an amount of adipose tissue will put the person in the height weight ratio to be defined as obese.

      Also, just to clarify, although low body fat certain can be dangerous, anorexia and bulimia are dangerous for a multitude of reasons beyond just low body fat.

      ~Ragen

      • I hear you. My point was that the clinical definition of obesity doesn’t actually define obesity.

        I know that lack of fat is not the only danger to anorexia/bulimia. I should have been clearer in my statement. Thanks for the correction.

        • Thanks, I appreciate the discussion :)

          ~Ragen

          ________________________________

  9. saw you quoted on bbc news/magazine report too! so great to see you become a go-to expert as previous commenter said, and the bbc is a really trusted source of info in britain, go you!
    p.s.did you see that obese people between 60 and 70 are more likely to get alzheimers, but obese people over 70 are LESS likely to get alzheimers,but this means according to the medics it’s obesity causing the problem? what happened to their reasoning abilities ;)?

  10. go you! on the bbc news website as a voice of reason! makes you so mainstream ;) (in the greatest possible way!)

    ps did you see that obese people between 60 and 70 are more likely to get alzheimers, but obese people OVER 70 are LESS likely to get alzheimers, but the medics say obesity is the problem. what happened to their reasoning powers? ;)

  11. Raegan, I’d be really interested to hear your thoughts on the criticisms from FA POC community of the Stand4Kids campaign. (You can find some of it here, for anyone not aware of it.)

  12. Love your analogy Ragen! Right on the mark, as usual

  13. Incidentally “children’s health care” also sounds like a broad stand-in and is not a specific health issue at all. I don’t know enough about suicide to comment if it is also too broad. It sounds like this article was poorly written in general.

  14. This is such a great analogy, because people go berserk about the whole “obesity epidemic” whenever the average body mass rises, but nobody ever complains about the “height epidemic” even though heights generally rise pretty dramatically from generation to generation in high-technology, high-food-availability societies.

  15. Hi Ragan, firstly may I thank you sincerely for your intelligent and inspirational blog. (I have been devouring your posts while nodding my head and muttering “yes… exactly… so true…”) I have just bought your e-book and am greatly looking forward to reading it.

    I know this post is an old one, but I did feel compelled to point out a small error in your comment about tallness. People did (and still do) undergo treatment to alter their height. I am one of those people. At age 12, I was ‘diagnosed’ as likely to grow to 6’1″ or 6’2″, and put on artificial hormones with the goal of keeping me under 6′. This was not a rare occurrence (here is an interesting book about it http://www.amazon.com/Normal-Any-Cost-Industrys-toManipulate/dp/1585426830 in case you are interested). The main reason was that girls/women who are “too tall” are freaks, can’t possibly look good in clothes, and will find it difficult to get a husband/partner (heaven forbid that you date anyone shorter than you lol)!

    Now I do realize that tall and fat aren’t exactly comparable. While there are many difficulties/inconveniences and some stigma associated with being “too tall” (it’s only OK if you are a model or a basketball player, and goddess help you if you happen to be slightly uncoordinated), there is certainly not the same degree of moralizing and shaming involved: while random strangers feel entitled to make comments about my height (random person: “Wow, you’re so tall! How tall are you?” me: “Really? I never noticed! Thanks for pointing it out.”) and identify me as a tall woman rather than as a mom, businesswoman, singer, etc, but at least they don’t assume that my unacceptable height is a result of some gross moral turpitude.

    • Thanks so much for this, the point is well taken. Also, I’m super sorry that you’ve had to deal with bs becasue of your height!

      ~Ragen


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