Obese does not necessarily mean unhealthyOli Williams, University of Bath; Kevin Deighton, Leeds Beckett University, and Michelle Swainson, Leeds Beckett University
Self-proclaimed “weight loss hypnosis master” Steve Miller has announced a campaign to see all overweight NHS staff wearing badges that read “I’m fat, but I’m losing it”. He also wants all restaurant menus to carry the warning that “if you’re fat, think before ordering”.
It would be easy to discount Miller’s campaign as a publicity stunt, but doing so would ignore the damaging consequences it is likely to have. Scientific evidence overwhelmingly demonstrates that this sort of obesity stigma is an ineffective way to reduce the incidence of obesity, and in fact perpetuates it. If this strategy supported losing weight, the obesity “epidemic” would already be over, because obese people are frequently framed as lazy, gluttonous and targets for ridicule as it is.
Obesity stigma, guilt, and shame reinforce high body weights and can even promote weight gain. Experiencing obesity stigma often leads people to adopt coping strategies that undermine physical health – such as comfort eating, or avoiding exercise in case they are made to feel embarrassed about their bodies. Obesity stigma has also been strongly linked with depression and compromised mental health .
Simplistic promotion of individual weight loss also fails to consider scientific evidence which shows that hunger is elevated in obese populations, and that it takes more effort for an obese person to exercise, as they have a greater amount of body weight than a lighter person doing the same activity. In many cases weight loss is not simple or easy.
The way obesity is currently addressed – though it may be with the best of intentions – does not generally support overweight/obese people to lose weight, or indeed promote the health of those who are most in need. Obesity and associated health behaviours – for example eating fruit and vegetables, and being physically active – are linked with social inequality. So even where someone may want to lose weight, their circumstances may make it difficult for them to do so.
At present obesity campaigns tend to focus on this idea of individual “choice”, but the evidence suggests that making it easier for everyone to access healthy food and to be physically active would do far more.
Fat but fit
Focusing on obesity and individual weight loss also ignores another key issue: that a person may be obese and yet healthy at the same time. Indeed, there is growing research that questions whether being overweight/obese is always detrimental to a person’s health.
Many people use BMI to measure their own weight and health, but this indicator is inaccurate, and cannot portray a true picture of physical health. For instance, someone with a “healthy” BMI, or who looks slim, may not actually be in good health (think about regular smokers, for example). Likewise more muscular people, like rugby players, are often categorised as having an “obese” BMI but are in good health.
It has been scientifically proven that some obese people with high levels of fat can also be in good physical health. In 2012, a US study with over 40,000 participants found that the difference between healthy and unhealthy obese people was fitness levels: the people who were metabolically healthy but obese were fitter. What’s more, this “fat but fit” group had no higher risk of death or illness than their “normal-fat” fit peers.
Similarly, a British study found that an overweight or obese person is more likely to be “metabolically healthy” when they lead an active lifestyle and have moderate-to-high levels of fitness. This remains the case irrespective of age, smoking status, alcohol consumption and waist measurement. Furthermore, despite 78% of the men studied being classified as either overweight or obese according to BMI, the vast majority – around 84% – of them were actually metabolically healthy. In fact, only 3.7% were classified “metabolically unhealthy obese”, which was comparable to the prevalence of metabolically unhealthy people within the “normal weight” group (3.4%).
Support not stigma
What these findings reveal is that whether or not someone is regularly physically active is more important than if they are overweight or obese. In terms of promoting health, the cultural obsession with weight loss is unnecessary and ineffective. Additionally, the continued focus on individual willpower and responsibility disguises the impact of social inequality and to this extent blames the victim.
Miller’s idea latches onto the trend of treating obesity as an individual health issue, but it would be far more constructive to deal with the social factors that stop people being physically active, and also to recognise that being overweight/obese does not necessarily mean that someone is unhealthy or indeed lazy.
It is those who continue to ignore scientific evidence and the long established link between inequality and health who should be obliged to wear badges proclaiming that they are “losing it”. Continuing to stigmatise obesity and to treat it as an individual issue is unhelpful and ineffective. The focus needs to be on creating social conditions that make healthy living the easy choice for all.
Oli Williams, Postdoctoral Research Fellow, University of Bath; Kevin Deighton, Senior Lecturer, Leeds Beckett University, and Michelle Swainson, Senior Lecturer in Exercise Physiology, Leeds Beckett University