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.

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