Today in Fat

[Content Note: Fat hatred; medical malfeasance.]

The Good News: Our old friend Paul Campos is in the New York Times talking about "Our Absurd Fear of Fat." And, as per usual, he is saying very smart things.

In other words, there is no reason to believe that the trivial variations in mortality risk observed across an enormous weight range actually have anything to do with weight or that intentional weight gain or loss would affect that risk in a predictable way.

How did we get into this absurd situation? That is a long and complex story. Over the past century, Americans have become increasingly obsessed with the supposed desirability of thinness, as thinness has become both a marker for upper-class status and a reflection of beauty ideals that bring a kind of privilege.

In addition, baselessly categorizing at least 130 million Americans — and hundreds of millions in the rest of the world — as people in need of "treatment" for their "condition" serves the economic interests of, among others, the multibillion-dollar weight-loss industry and large pharmaceutical companies, which have invested a great deal of money in winning the good will of those who will determine the regulatory fate of the next generation of diet drugs.

Anyone familiar with history will not be surprised to learn that "facts" have been enlisted before to confirm the legitimacy of a cultural obsession and to advance the economic interests of those who profit from that obsession.

Don't expect those who have made their careers on fomenting panic to understand that our current definition of "normal weight" makes absolutely no sense.

I encourage you to read the whole thing. It's very good.

The Bad News: Will Saletan, professional concern troll, is in Slate, saying, ahem, slightly less good things. He's essentially looking at the same evidence that Campos is, but, unlike Campos, he hasn't spent years immersed in this subject, so he ends up saying some truly absurd (and unhelpful) things. Like:

10. Overweight gets you more medical attention and intervention. Doctors' belief that fat signals a health risk makes them more likely to scrutinize heavier patients for disease symptoms or risk factors. Lots of evidence suggests doctors treat these patients more aggressively, thereby reducing mortality. In this way, the medical profession's assumption that weight correlates with illness makes that correlation less visible in mortality data.

LOL no. There are a lot of fat people who die, or nearly die, because doctors can't see past their fat to find illness unrelated to fat. Shaker Azzy, as you may recall, was continually diagnosed as "fat" and "depressed," even though: "I actually had cancer. Of the thyroid. Which had metastasized to my lymphatic system. OOPS!!"

What minimal reduction in mortality there may (or may not) be by doctors associating fat with illness is almost certainly outpaced by the increase in mortality because of misdiagnoses as a result of doctors associating fat with (specific) illness, treating weight loss as a cure-all for fatties, and the routine discouragement of careseeking by fat people because of endemic fat-shaming by health practitioners.

Which is to say nothing of the increasing emphasis on weight loss to access health insurance, and the still ever-present insistence of many surgeons that fat patients need to lose weight before they earn surgery, even to fix disabilities that limit movement. (Good luck losing weight for your hip replacement surgery when your hip doesn't work!)

Fat hatred kills people all the time.

The suggestion that we get "more medical attention and intervention" is indecent, in the face of the reality we experience. Sure, we get more doctors telling us we're dangerously fat (attention) and that we need to lose weight (intervention), but when you're at the doctor for difficulty breathing and it turns out to be a blood clot in your lung that kills you, the attention and intervention for your fat isn't meaningful medical attention. It's harmful.

And so is publicly eliding the harm done to fat people, to assert something about our lives that is flatly not true.

[H/Ts to Shakers Jacksonandlola and mal black for the Campos piece, and to Shaker Nicole for the Saletan piece.]