Synopsis: The cultural bias against obesity is often justified on health grounds. But recent studies show that people classified in the “overweight” BMI category actually have less mortality than normal weight people. Experts discuss how culture drives our obsession with weight and what science really has to say about it.
Host: Reed Pence. Guests: Harriet Brown, Associate Professor of Magazine Journalism, Newhouse School of Public Communication, Syracuse University and author, Body of Truth: How Science, History, and Culture Drive Our Obsession With Weight and What We Can Do About It; Dr. Carl Lavie, Medical Director of Preventive Cardiology, John Ochsner Heart & Vascular Institute, New Orleans and author, The Obesity Paradox: When Thinner Means Sicker and Heavier Means Healthier
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Weight, Culture and Science
Reed Pence: Just about everybody has heard the basics about obesity: that two thirds of Americans are at least overweight, and a third of us are obese. It’s an obesity epidemic, we’re told, that threatens to make our children’s life expectancies shorter than our own. And it drives millions of us to try to lose weight. It’s for our health, we say. But is it really? Or is our bias against anyone carrying around a few extra pounds–ourselves included–strictly cultural, using health science as an excuse?
Harriet Brown: That cultural bias runs deep, and it’s been with us for over a hundred years, and really interestingly, some of the groups that are most deeply invested in that bias that show the most prejudice, are doctors.
Reed Pence: Harriet Brown is Associate Professor of Magazine Journalism at the Newhouse School of Public Communication at Syracuse University. She’s also author of the book, Body of Truth: How Science, History And Culture Drive Our Obsession With Weight And What We Can Do About It.
Harriet Brown: We don’t make a distinction between fat is unhealthy for you and fat is unattractive, and I think you’re right, that a lot of times what we’re really saying is, I don’t like fat, that’s ugly. I’m being told all the time that’s unattractive and unsexy and unappealing. So, when you separate out what do we actually know about health and weight, it turns out very different?
Carl Lavie: My colleagues and I, I think we have been involved in some groundbreaking research during the last fifteen years or so that has been quite controversial and in many ways has yielded some surprising results to me, even as a doctor, and in many ways, I think has turned conventional wisdom on its head.
Reed Pence: Dr. Carl Lavie is Medical Director of Preventive Cardiology at the John Ochsner Heart and Vascular Institute in New Orleans and author of the book, The Obesity Paradox: When Thinner Means Sicker And Heavier Means Healthier.
Carl Lavie: I am not in any way trying to promote obesity or to any way suggest that normal weight people try to gain weight. But I think our research really has indicated that fat is not always the devil. You know, patients who come to us with hypertension, coronary disease, heart failure, atrial fibrillation we’ve been finding in study after study that the overweight and obese are actually doing better, having better survival sometimes thirty to fifty percent lower mortality rates, than do the patients with the same diseases who are a normal weight.
Reed Pence: But everybody knows that people who are obese have more high blood pressure, diabetes and heart attacks. True? Well, yes and no. It depends on how obese. But Brown says our fat-phobic culture has distorted the facts, to the point that a lot of us think a few extra pounds will make us much more likely to drop dead.
Harriet Brown: That is exactly what we believe and that’s exactly what we say to each other and to ourselves. And what’s interesting about that is that if you look at the data if you look at the correlation between BMI’s that’s the measure that we use and mortality or you know your risk of dropping dead prematurely, the people who are the least likely to drop dead are actually the people in the category that we would call overweight to mildly obese. So, we think of it as a linear equation, right, so like the heavier you are the higher your risk of dropping dead. Think of it as a U-shaped curve your risk of dropping dead lets say, is highest at either end of the curve but the bottom of that curve is in the overweight to mildly obese range.
Carl Lavie: It was a major study in January 2013 by Catherine Flagel in the Center of Disease Control, of ninety-seven studies 2.9 million people quite statistically powered because it had over 270,000 deaths. And in that study the obese had higher mortality, but that was all because of Class 2 obesity and Class 3 obesity and that it’s BMI class 2 is above 35 and class 3 is sometimes called morbid obesity although that sounds like a mean term and so it’s probably better to say Class 3 or severe obesity that’s above 40 BMI. But the overweight and the mildly obese BMI’s in the 30, 35 range did not have higher mortality. In fact the mildly obese had a five percent lower mortality that wasn’t quite statistically significant but the best survival was in the overweight BMI between 25 and 30, and they actually had six percent better survival then did the normal BMI patients.
Reed Pence: But then, BMI itself is an issue as well. Medicine has used BMI for only a few decades to measure ourselves against the ideal, and Brown says it’s used at all only because it’s easy. Not because it’s necessarily accurate.
Harriet Brown: It was never intended to be a way to characterize anybody’s health it was developed by a Belgian mathematician in 1832 as a way of talking about populations in a sort of broad scale, and he specifically said this shouldn’t be used to talk about individual people’s health. And yet that’s what we do.
Reed Pence: What’s more, to say even that there are far more obese people than there used to be ignores the fact that BMI has had a changing definition.
Harriet Brown: We used to have different categories on that BMI chart. So, before 1998 you were considered overweight if your BMI was over like twenty-seven point something if you were a woman and there was no category for obesity. And then in 1998, those categories all changed and so part of what we’re talking about when we’re talking about the obesity epidemic and the huge rise in obesity in this country is the fact that the category shifted downward. And so overnight a lot of people suddenly were classified as overweight or obese who never had been before. So, it’s so interesting we have this like drum beat of rhetoric around this the obesity epidemic it’s killing us, it’s killing our children, our children aren’t gonna live a s long as we do and so much of it is simply not based on reality.
Reed Pence: But if that’s true, where did the idea come from that the obesity epidemic threatens the health of, well, just about everyone? What doctors tell us is supposed to be based on impartial studies. But Brown says not when sixty-one billion dollars is at stake. And that’s the money spent on the weight-loss industry last year.
Harriet Brown: One of the things I learned researching this book is all of the ways that private industry can influence research. Everything from buying doctors prescribing habits, to subtly influencing them, to suppressing research that doesn’t exactly find what they want it to find. So there’s a lot of money at stake in people who want to market weight loss, and it’s a sort of built in clientele because ninety-seven percent of people who lose weight regain it you’ve kind of got this built in customer base.
Reed Pence: Brown says 130 years ago, it wouldn’t have been that way. American culture admired overweight people. It was even something to be aspired to.
Harriet Brown: Plumpness was considered a status symbol because if you had enough money, if you had enough to eat that you could get plump, then that meant you had a certain amount of money. And so, in our culture I think part of what happened is, as we went through the industrial revolution, as food became more accessible as more and more people had enough to eat and so weren’t necessarily facing starvation a lot of the time, then suddenly there wasn’t so much status associated with plumpness then all of a sudden oh the thing that was actually harder to do was be thin, and so that acquired the higher status.
Reed Pence: That’s bolstered by societal power dynamics. Brown has noticed when the culture pushes hardest for women to be thin.
Harriet Brown: They coincide with periods of time when women were gaining more power in the culture. So like, right around 1910 to 1920 with the flappers, if you think about what was happening then the suffragettes were pushing for a woman’s right to vote, which of course we won in 1920. Twiggy came about in you know the early sixties what was happening then–the women’s liberation movement and the invention of the birth control pill, which made women feel more sexually free. And what’s happening now in our culture, at this moment women are half the work force, still aren’t paid as much as men, but we’ve definitely been knocking on those glass ceilings more and more. And I think it’s really, really interesting that the ideals you know what you’re supposed to look like as a woman they’ve never been more punishingly rigid and thin.
Reed Pence: Today, nearly 50 years after Twiggy, the cultural pressure to be thin is everywhere. Unrelenting. And often cruel. Brown says our ideal of body size is so warped that her daughter was heaped with praise of beauty when she suffered from anorexia.
Harriet Brown: Literally strangers would walk up to us in the street and praise her when she looked like a concentration camp victim. When she was, to my eyes, certainly like scarily gaunt and clearly did not look well. And as she recovered and gained weight and became healthy in every sense of the word, people just stopped doing that no one came up to her, no one praised her I mean it’s mind boggling.
Reed Pence: Brown says she’s gotten a considerable amount of pushback from people who seem to resent claims that obesity is anything less than a reflection of personal responsibility. Brown says she has a friend, a sociologist, who’s written on obesity and culture.
Harriet Brown: She would get comments from people saying your just a fat slob, you just want to rationalize your own laziness. It’s kind of amazing the level of hate and vitriol this brings out. No matter how reasonably you try to talk to people about it no matter how you try to look at the research, the evidence, gather information, people go ballistic over this topic.
Reed Pence: But why? Why is it so threatening?
Harriet Brown: There’s a huge issue around the idea of thin privilege. You know, in other words. If I’m a thin person and I’m used to feeling good about myself I feel healthy I feel attractive. Lets say I work at that lets say I deprive myself you know I diet all the time, as a lot of women do. I go to the gym for an hour a day, even when I don’t feel like it even when I don’t enjoy it you know there’s things I just do because I feel like I am working hard. And then someone comes along and says, well, you know, it’s okay if you don’t do that and it’s okay you can be considered attractive and healthy, you don’t have to be a size two. Well, suddenly that’s very threatening where does that leave me the person with all this thin privilege. It leaves me wondering if I’ve spent a lot of time and energy for nothing really. And so we now know that people who experience some kind of privilege will defend it to the death.
Reed Pence: Brown also believes there’s something uniquely American about our obsession with weight.
Harriet Brown: In this country we also have sort of rigid ideas of right and wrong, you know good and bad and they’ve gotten overlaid onto all these body and food dishes. So like we talk about being good when we’re only eating salad without dressing and being bad if your eating a piece of cake. And that sense of moral virtue and moral transgression. I also think is we’re deeply wedded to it for some reason we, it’s black or white we sort of like that even though the world is very gray.
Reed Pence: Brown says she’s not very hopeful that American culture will turn around anytime soon. But she says the process has to start somewhere. If we can’t change others, we have to change how we think of ourselves.
Harriet Brown: The first thing is we have to just understand the facts. We have to sort of peek behind the curtain of all of these halftruths that we’re fed all the time and we have to educate ourselves right? So we have to understand for example that being fat is not necessarily bad for you at all. That health and weight are not the same thing you know that you can be healthy and fat, unhealthy and thin and everything in between. So, sort of the cognitive knowledge we have to educate ourselves and we have to also understand that like ninety-seven percent of people who diet regain the weight and then some. So that if we try to lose weight and we regain it we’re not stuck feeling like this is your personal failure. No, it means that you’re a human being and that you’re like in the ninety-seven percent of the rest of the human race.
Reed Pence: You can find out more about Harriet Brown’s book, body of truth, on her website, harriet-brown-dot-com. You can find more about Dr. Carl Lavie’s book at obesity-paradox-dot.com. You can always find our shows in our archives at radiohealthjournal.net, or on Stitcher and ITunes. I’m Reed Pence.