Alan Cleaver/Wikimedia Commons

Foolish to be fat and proud of it

Here, according to the latest research in the peer-reviewed New England Journal of Medicine, is what the Fat Acceptance/Body Positive movement is helping to deliver in America:

• Cardiovascular–kidney–metabolic syndrome
• Hypertension (ie, high blood pressure)
• Type 2 diabetes
• Hyperlipidemia/dyslipidemia (ie, high cholesterol)
• Heart failure
• Atrial fibrillation (ie, heart rhythm disorders)
• Cardiovascular disease
• Chronic kidney disease
• Pulmonary embolism (ie, blood clots in the lungs)
• Deep vein thrombosis (ie, blood clots in the legs)
• Gout
• Metabolic dysfunction–associated liver disease
• Biliary calculus (ie, gallstones)
• Obstructive sleep apnea (ie, breathing stops during sleep)
• Asthma
• Gastroesophageal reflux disease
• And osteoarthritis.

You can now add these diseases to the well-documented cancers and deaths from Covid-19 linked to obesity.

But let’s be clear about one thing. These are not medical observations meant to shame fat people. Many, if not most, Americans now struggle with weight issues in these sedentary times.

And it’s not wholly clear whether the diseases reported in the New England Journal are linked solely to obesity, or to the country’s now pervasive sedentarty lifestyle tied to obesity, or to some combination of the two.

The best evidence for the role of sedentary activity in this situation arguably comes from The Transitions and Activity Changes in Kids (TRACK) study initiated in South Carolina. It closely monitored the diets and physical activity of 658 children as they progressed through 21 elementary schools for years in the 2010s.

What they found was “that children with higher levels of moderate-to-vigorous physical activity had lower levels of adiposity (ie. body fat) at each grade,” despite how much time they spent sitting when they weren’t active or what they ate.

Adult studies have found similar links between lack of physical activity and obesity, so one can not discount the physical activity link in a country where people drive to the supermarket and then take a seat on a motorized cart to drive around the story to shop for their groceries and otherwise avoid physical activity at any opportunity.

Fatlandia

These are simply facts Americans need to wake up to in what has become a modern Fatlandia.

“Over the past several decades, the overweight and obesity epidemic in the USA” has exploded, researchers reported in The Lancet, a peer-reviewed medical journal, last year, and they projected, given current trendlines, that the nation is going to get fatter and fatter unless something is done to change how Americans behave.

“By 2050,” they warned, “the prevalence of overweight and obesity in children (aged 5–14 years) is projected to reach 45.1 percent, and the prevalence of obesity is projected to reach 22.6 percent. For adolescents (aged 15–24 years), the prevalence of overweight and obesity is projected to reach 57.3 percent, with obesity alone projected to reach 34.2 percent.”

Obesity in early life, and especially in adolescence, dooms most people to obesity throughout life.

As the Georgetown University Health Policy Institute notes, “obese children younger than age three are generally at low risk for obesity in adulthood. But more than one-half of obese children over age 6 become obese adults. Obese children ages 12 to 17 are even more likely to be obese in adulthood. Between 70 and 80 percent of obese adolescents remain obese in adulthood.”

Along with their obesity comes the heightened risks of all of the diseases listed above. Many end up suffering from one or more of these diseases, but they are not the only ones suffering.

The nation, too, pays a huge price for their obesity.

The Milken Institute – a nonprofit, nonpartisan, national think tank – in 2020 calculated that the cost of obesity in the U.S. had reached $1.4 trillion. The Institute’s “Weighing Down America” report warned that “the economic and social impact of obesity is at an all-time high. The estimated cost of obesity is roughly 6.76 percent of gross domestic product in 2018 compared to 5.57 percent in 2014.”

The costs have only gone up since with some Americans proclaiming themselves fat and proud of it and some academics pushing fatness as a “social justice issue.”

“Fat communities, such as the National Association to Advance Fat Acceptance (NAAFA), have contested society’s stubborn generalizations that associate fatness with disease and poor health outcomes, and push back against the assumption that fat people have little regard for themselves or their own well-being,” sociologist Deborah McPhail and political scientist Michael Orsini argued in the Canadian Medical Assocation Journal in 2021. “Thinking about obesity as a disease or medical risk (such as for severe COVID-19) contributes to stigma because it positions larger bodies as drains on an already-taxed health care system.”

The duo went on to argue that being fat is too often coupled to “moral weakness and failed citizenship, and can fuel stigma in various settings, even health care,” and that this relationship needs to be uncoupled because “people who are labelled obese are not necessarily unhealthy.”

They were right about the need to uncouple obesity and “moral weakness” or “failed citizenship.” Fat people need help, not stigmatization. Almost no one tries to get fat.

Unfortunately, the authors of the Canadian Journal opinion piece on obesity were badly, badly wrong about ill health. Obesity is not just a “label.” It is a measure of health based on height, weight, or, more recently, height, weight and body shape.

There are some obese people who qualify as “healthy,” but the majority of them aren’t. The medical community has for years talked about “metabolically healthy obesity,” but it has never come up with a good definition of what constitutes a fat-but-fit individual.

A study in The Journal of Clinical Investigation, a peer-reviewed publication, estimated that “about 50 percent of people with obesity are metabolically healthy when healthy is defined as the absence of the metabolic syndrome, whereas only approximately 5 percent  are metabolically healthy when healthy is defined as the absence of any metabolic syndrome components and normal insulin sensitivity.”

The latest research in the New England Journal, which involved an examination of medical records of 270,657 people, quantified the consequences of the size of this obesity to some extent by noting a “graded association” of disease as obesity increased from Class I to Class III or what used to be known as “morbid obesity.”

To reach Class III,  the average American woman standing 5-feet, 3.5 inches tall has to attain a weight of 225 pounds or more, and the average American man standing 5-feet, 9 inches tall has to weigh 270 pounds or more.

Almost one in 10 adult Americans have now reached this category, according to the National Insitute of Diabetes and Digestive and Kidney Diseases. None of them are healthy.

The Institute says they are among the 42.4 percent of Americans who now qualify as obese within all classes. Some of those less that morbidly obese – 5 percent to 50 percent – could be considered healthy, but even if that is the case, the number of unhealthy obese people in the U.S. is huge.

The 9.2 percent of American adults the Institute classed as severely (ie. morbidly) obese works out to 24 million people sick due their obesity. Half of the remaining 33.2 percent of less obese Americans works out to just shy of another 43.5 million people sick due to their obesity.

If you use the 5 percent estimate for health among those suffering from less than morbid obesity, the number works out to nearly 83 million people, but let’s be optimistic and use the 43.5 million sick because of Class 1 and Class 2 obesity plus the 24 million sick due to Class 3 obesity.

This works out to about 67.5 million Americans sick because they are obese. This is a number that adds up to just slightly more than the combined populations of California and Texas, the nation’s two most populous states, at 66.5 million people.

America clearly has a big, fat problem, and it can’t be fixed by pretending it doesn’t exist or lobbying for acceptance of the idea that society should embrace the obese. What society should do is try to help the obese in the same way it tries to help alcoholics and drug addicts.

Nobody- well almost nobody- accepts alcoholism or drug addiction as OK. There is no Alcoholics Acceptance organization or Drug Addict Positive movement.

Why?

Because American society long ago accepted there are societal costs to alcoholism and drug addiction, and there are now societal costs to obesity. Those costs are estimated at about four times the estimated $300 billion that smokers cost the economy, and the country has for years now been trying to stomp out smokers.

They’re largely banned from offices and restaurants everywhere. In some cities, there are even places where they are banned from smoking outside even though the pollution from their secondhand smoke pales compared to the pollution caused by motor vehicles.

Still, the broad, societal view is that smokers should be stigmatized in this way for their own good. It would be wrong to take the same approach to the obese.   Obesity is a much harder issue to deal with than smoking, given that humans need to eat to survive.

But society shouldn’t be pushing the idea that it’s fine to be fat either because the now overwhelming scientific evidence is that it isn’t good to be fat. It’s unhealthy to be fat. It diminishes quality of life, shortens lifespans, reduces worker productivity and costs the economy more than $1 trillion per year.

It’s almost enough to make one think that the American medical community should quit fretting so much about Health and Social Services Director Robert F. Kennedy Jr.’s issues with vaccines, swallow hard, and embrace his proposal to Make America Healthy Again even if it is hard for the country’s upper class to stomach a pitch that echoes President Donald Trump’s Make America Great Again pitch to the country’s blue-collar, working class.