The obesity "epidemic". The "Health At Every Size" campaign. The "war on obesity". The "fat acceptance" movement.
Depending on your exposure to these lenses through which the media discusses obesity, you may have different responses to the question, "Can an obese body be healthy?"
Media is a powerful tool that influences our perceptions of obesity. Unfortunately, discourse on obesity as a public health crisis has often been within a damaging framework of obesity as a failure of personal responsibility and has led to awful prejudice against overweight and obese people--in social settings, employment, and even healthcare. The "fat rights" movement is an attempt to remove such prejudice. Another helpful media campaign is "Health At Every Size", which calls for people to look at healthy habits and individual needs without a constrained focus on body weight, which, along with reducing social stigma of obesity, also helps individuals become their healthiest selves, accepting that this may be in a body with more fat than others.
Last week, Chapman University published an article in Science Daily on the results of their studies with UCLA and Stanford on participants' perceptions of BMI after reading news articles discussing obesity in the context of either "Health At Every Size" and fat rights (anti-prejudice) dialogue, or in the framework of obesity as a public health crisis and obesity as a personal responsibility issue.
Using these photos, participants, after reading their article, responded whether they thought the figure could be healthy, and you'll see that 69% responded "yes" to an obese body after reading Health At Every Size or anti-prejudice articles, compared to only 27% who read the other articles. That is a big difference!
What do you think about obesity and health? Or what about an overweight body and health? Is the "normal BMI"--the 18.5-25 BMI--the "healthiest" body?
What is the healthiest BMI? There isn't one! There are increased risks for various diseases with increasing BMI over 26, but these risks don't take into account the smattering of variation of body fat settling points we have without any health problems--the weight range our body naturally maintains when we practice gentle nutrition guidelines and regular body movement. These settling points are influenced by our genes, our prenatal and neonatal health, and a great many other uncontrollable variables.
For some, an "overweight" or "obese" settling point may require more attention to diet and exercise when chronic diseases are present. For others, though, additional body fat does not cause metabolic dysregulation. These healthy bodies, which include many in the "overweight" BMI of 26-29, have normal insulin sensitivity, normal cholesterol levels, and normal blood pressure.
Obese bodies can be healthy. But as BMI rises above 30, the odds of an obese body being free from chronic diseases decreases sharply. For most people, excess body fat--particularly abdominal fat--promotes chronic systemic inflammation, which causes increased oxidized LDL's & atherosclerosis, blunted insulin signaling pathways & diabetes, and increased free radical damage & cancers.
Why are some bodies apparently immune to these health problems associated with obesity? An important factor is how individuals store fat within fat cells. Those who have much body fat but are at lower risk for health problems tend to make plenty of new fat cells to accommodate extra fat to store (see "hyperplasia" in the photo). These people tend to have a difficult time losing weight, because it's easier to reduce the size of a fat cell than for existing fat cells to die and be removed. (This was a very desirable adaptive mechanism for energy storage before our food-abundant era!) Where obesity can be unhealthy is when it causes cell "hypertrophy"--when fat cells swell too large and an inflammatory cascade ensues.
How do you make sense of various media frames around obesity? Rejecting the restrictive and often unattainable standards of slimness that the media equates with health is a great start. Respecting everyone and celebrating our diversity in our bodies' shapes and sizes is an excellent aim for public health campaigns. Welcoming campaigns that focus on engaging positive self-esteem, like "Health At Every Size" is essential for promoting allied health improvements at the community level. And, while prejudice and "fat shaming" need to be eradicated, we also shouldn't throw the baby out with the bathwater in ignoring real systemic health problems that can occur in metabolic dysregulation with obesity. The various media frames around obesity tend to have some elements of truth, but being able to consider numerous factors that contribute to health will help us to recognize that BMI isn't a very representative picture.