Why you should care

Because nobody wants to be sick and fat. 

Benjamin Spoer is a Ph.D. student at NYU’s College of Global Public Health and is obsessed with urbanism, obesity, and community health.

When it comes to nutrition, public health professionals seem to agree on very little, from whether coffee is a vice or a virtue to if red wine is a life extender. Yet for decades, they could agree on one thing: Being fat is bad for you. Everyone seems to know that carrying too much weight can lead to diabetes and heart disease, as well as increase some potentially hazardous biomarkers.

But recent research suggests that being fat might, in fact, be good for you. In 2013, a massive scientific review found that being in the least-severe overweight category — above “normal weight” but not by much — actually reduces your chances of dying in the future, aka “all-cause mortality.” Meanwhile, being in the lowest obesity category seems to have no effect on risk of death whatsoever. So if being overweight lowers your risk of dying, then being overweight is good for you … right? Time for doctors to prescribe Oreos? (Please, God.)

Not so fast. That review had more than a few critics. For instance, some scientists say that the sick, who are at a higher risk of death, tend to lose weight — that might make it look like people who are heavier are staying alive, when really it’s that sick people lose a lot of weight before they die. Another theory that could explain the paradox is that obese patients get more attentive care from doctors. Also, that review was based on a huge group of people, including smokers, gym rats, and the elderly, so it’s hard to translate its findings into medical recommendations for any single person.

So if benefits of being heavier were limited to reducing the risk of all-cause mortality, we might be able to put this idea in the “interesting but inconclusive” category and move on. But it turns out it’s even more complicated than that. Beyond the potentially protective effects of a little belly, being obese can also help you survive certain health problems. For example, being very obese has been linked to higher survival rates for people who have heart failure and other cardiovascular problems.

The source of much of this confusion is this: When researchers talk about obesity, they are rarely talking only about fat. Studies that are allegedly about obesity tend to feature a host of other chronic health conditions, like type 2 diabetes and cardiovascular disease. This paper, for instance, claims to project the economic burden of obesity in the near future. It’s actually telling us how much it will cost to treat new cases of type 2 diabetes and cardiovascular disease if they continue to increase at present-day rates.

The problem here is that we are not distinguishing between symptom and cause. Obesity is caused by the same behaviors that cause cardiovascular disease and type 2 diabetes. This means that obesity is just the most visible and, to some, the most alarming symptom of unhealthy eating and sitting around too much. This is why some researchers think it’s possible to be fit and fat at the same time — obesity itself is not the problem, but the consequences of doing the things that make people obese, like diabetes and cardiovascular disease, are.

So is obesity actually good for you? Or is obesity a big fat villain? On the one hand, the mixed evidence is hard to parse. On the other hand, the answer to this question doesn’t actually matter. In fact, we shouldn’t even be talking about obesity. We need to focus on poor nutrition and inadequate exercise instead. Instead of worrying about our collective waistlines, we need to focus on making it possible, if not fun and easy, for everyone to eat well and move around. If we do that, obesity and its related health conditions should take care of themselves.

Comment

OZYPOV

Interviews, op-eds, and analysis to help you make sense of the news of the day and the news of the future.