On Fatness, Health, & Causality

Here at MH Blog we've tried to problematize the discourse on fatness and obesity, suggesting in various ways, that the evidence connecting fatness to illness does not come close to justifying the tone and certainty often adduced by professional healers, policymakers, laypersons, and media alike.

Though it is hardly the first of its kind -- which itself is interesting because the attention it is receiving suggests it is a bombshell -- a study just published in Archives reports a number of interesting findings regarding obesity, the general conclusion being that there does exist metabolically benign obesity.  Or, you cannot tell just by looking at someone who is fat their health status.

This, however, is most assuredly not a revelation, though it seems to be regarded as such.  Kate Harding titles her post on this study "The Duh Truck Rides Again."

She notes:

you can be normal weight and far less healthy than old tubby. You can be normal weight and just as badly off as your normal weight neighbor. You can be old tubby herself and be better — or worse — off than another old tubby across the street. You can be any weight and healthy, or any weight and sick. You can’t tell how healthy someone is just by looking.

This is exactly right, IMO, and again, enjoys ample support beyond this study.  (The best source for this latter claim is Gard and Wright's 2005 book, in which they review over 1100 food science and obesity studies and illustrate the uncertainty that surrounds the evidence connecting fatness to poor health).  Harding continues,

So yes, there is still a correlation between higher weights and metabolic abnormality. But as we’ve been saying all along, this does not apply to all fat people or let thin people off the hook — which is why there’s so much pants-shitting going on in the media over this.

I am guilty of this myself from time to time, but I recently read -- I cannot remember where -- that those who note that correlation is not causation often proceed to flout this admonition in the following sentences.  And, as usual when discussing health and illness, it is the issue of epidemiologic and disease causality that is crucial.  For a nice introduction to the social aspects of disease causality -- i.e., the social and cultural forces that influence our causal attributions -- Sylvia Tesh's work is an excellent place to start (I work on this area myself).  And in context of fatness, the best evidence, IMO, suggests quite strongly that we know orders of magnitude less about the causal connections between fatness and poor health than is reflected in the relevant public and professional discourses.

The study did find a significant correlation between waist circumference, visceral fat, and poor health, but Harding observes that

Sumo wrestlers tend to have low levels of visceral fat. And it’s usually sedentary thin people who have high levels of it. The evidence suggests that exercise is protective against visceral fat, even if it doesn’t make you thin — so if you’re able to exercise, there is something you “can do about it,” which doesn’t involve starving yourself or getting a tummy tuck.

Indeed.  Harding's take is, like virtually anything she writes on fatness, worth reading.  So is the study.  The key, from a medical humanities perspective, is to reflect critically on the evidence connecting fatness to poor health, and to assess what social and cultural beliefs, attitudes, and practices are also at work in shaping attitudes towards fatness in the West.   

Comments

[Frank]

Fascinating work here. When I think about individuals' insistence on thinking that we can assess health by appearance, I want to make a connection to James A. Scott's Seeing Like a State....a tyrannical insistence on the "legibility" of the population. It might also reflect our deep discomfort at how mysterious any individual's health status truly is.