MythBusters: Weight and Health
If this year has taught us anything, it’s that science, a discipline rooted in evidence and carefully backed hypotheses, and the tangible and visible, can unfortunately be very easily ignored, misconstrued, or even inaccurately reported. COVID-19 has had close to a year to exploit the pathways of misinformation that can infect this country, yet misconceptions and myths about the correlation between weight and health have had centuries to propagate this infrastructure. Below, we debunk some of the most toxic ones.
Myth: The BMI is an accurate and current way to measure health based on weight.
The BMI is a measure of health in which one’s body weight is divided by the square of their height. According to Aubrey Gordon, a body-positive activist and writer, the BMI traces its roots to an 18th century astronomer who developed the classifications of underweight, “normal”, overweight, and obese based on white men in Scotland. The persistence of this measure of health is not only numb to how the average human body has evolved from the 18th century but it ignores the variety in body size that ethnicity provides (with Asians on average having 4% higher body fat) and age. From a scientific view, the number one critique of the BMI is its inability to distinguish between muscle and fat. On average, muscle weighs around 18% more than fat and yet the BMI categories muscle as a contributor to poor health simply based on its weight.
Myth: Weight is more strongly correlated to mentality than to medical conditions.
Poverty and weight have a direct correlation. In today's world with rising access to desserts and fast food chains, it is often cheaper to buy the higher fat and higher calorie food option from the local McDonalds than a salad or fresh vegetables from a Whole Foods that could be 40 minutes away. Rather than individual goodwill, poverty is much more likely to be a determinant of obesity. Additionally, weight-based discrimination is currently only outlawed in 2 states and 1 city meaning that everywhere else, it is unfortunately legal to deny jobs and services to individuals simply based on their weight. According to sociologist Katherine Mason, when controlling for all other likely causes of income inequality, women who are obese had lower socioeconomic statuses than women who weren’t, not to mention the fact that income equality affects two times more women than it does men. In other words, poverty is not only likely to increase the probability that an individual is overweight, but being overweight increases the probability that someone will be denied a job or advancement in a current job, especially for women. In addition to poverty, stress (including the stress originating from body shaming and weight-based discrimination) can increase cortisol levels which in turn spikes insulin levels in the blood and contributes to weight gain.
Myth: A person’s weight is based on their choices.
Studies have shown that a fat person (a term we are using in its recent reclaim as a descriptive term, not one with a stigma attached) seen by a doctor is 50% more likely to experience implicit bias and thoughts that they are lazy and simply don't care about their health. The fact of the matter is 95-98% of individuals who attempt to lose weight will not achieve this goal according to Gordon. This is partly due to the fact that higher body weight is caused by a multitude of different factors. Apart from social factors such as poverty, high sugar foods and factors we have discussed above, genetics, hydration, medications, and medical conditions such as hypothyroidism can also cause weight gain. Genetics have been found to control 30%-70% of weight - including where fat is stored and distributed.
Myth: Being obese or overweight translates to poor health.
It is true that increases in weight can correlate with increased risk factors for chronic conditions such as heart disease and Type 2 Diabetes. However, the whole picture is much more complex than this. A 2012 study from The European Heart Journal found that overweight and obese people were found to be at no greater risk for chronic health conditions as long as they were metabolically fit (categorized as not having insulin resistance, diabetes, low levels of good cholesterol, high triglycerides and high blood pressure). This same study found obese indviduals who were metabolically fit were 38% less likely to die an early death and when compared to some metabolically unhealthy, “normal” weight people. Thus leading to the question - could it be that some bodies are just made differently (wide, narrow, tall, short, etc.), that perhaps there is not just one mold for all bodies? And do medical professionals know the metabolic health of every patient before assuming the answer for their current concern is to lose weight? This correlation may relate to the fact that muscle, though heavier than fat, also consumes much higher levels of energy and sugar than fat leading to healthier blood glucose levels and less risk for insulin resistance. Additionally, where an individual’s fat is concentrated can play a big role in their health. If the fat is visceral (concentrated in their belly), the individual is much more likely to have increased risk of death than if the fat is distributed as subcutaneous fat around the body.
The media has long peddled unhealthy and inaccurate ideals of what a healthy body size and body weight is and individuals with higher body weight have suffered for it. As it turns out, medical providers haven’t always had it right either. Often, when patients who happened to have higher weights came into offices with health conditions, the first solution many providers suggest would be weight loss. In some cases, providers’ primary focus on a patient’s weight has made patients’ PCOS, endometriosis, and thyroid diseases go undiagnosed for unnecessarily longer periods of time. Weight is one measure of health. However, it is not the only measure of health and using BMI is a fairly inaccurate way to measure weight. Though systems may take a while to catch up to this fundamental truth, it’s time we stop assumptions and discrimination - explicitly or implicitly - based on weight. Because along with making the problems individuals with higher weights face, it is harmful and frankly unacceptable.
By Akansha Das