by Deb Burgard, PhD
“Oh yippee, a new research study to re-ignite the debate over fatness and mortality.” Said no fat person, ever.
Now we get to see another round of appeals for our prevention, in order to prevent our early demise, although presumably our early deaths would prevent the predicted economic disaster of our failing to die. Um, what was it again that we wanted to prevent?
Researcher Masters may be tipping his hand with his opening line in a companion paper published earlier this year: “There is now ample evidence and widespread agreement that a massive epidemic of obesity has spread across the United States.” Overstating consensus and the size of the “problem” both serve the interests of the study’s funder, the Robert Wood Johnson Foundation. In both papers the author is clearly arguing against “framing the obesity epidemic as a ‘moral panic'” [shoutout to Campos, Saguy, Ernsberger, Oliver, & Gaesser, 2005!] and instead insists that “major public health consequences will track with the epidemic and . . . efforts to stem its growth are probably well worth the investment.” So this is about preventing premature death of funding?
Masters’ central argument seems to be that even though the repeated findings for decades of rigorous research (reviewed by Flegal, 2013) has found that BMI and mortality are only weakly correlated, and that higher BMI may actually correlate with longevity in old age, this set of findings must be wrong, because 1) fat elderly people are more likely to be unable to participate in the surveys due to being “institutionalized” more than thin elderly people (no citation), and 2) there are apparently going to be major differences in longevity between people who were fat in their 60’s in 1995 and people who will be fat in their 60’s in 2030 because of the latter group’s “longer exposure to the obesogenic environment.” I guess that is an interesting thought experiment, but if you look at current trends it would seem that fat people are more likely to be healthier in the future if we continue to improve access to healthcare and continue the progress in managing hypertension and diabetes.
I do not pretend to understand the complex equations and “controls” the author performed to arrive at his neat trick of flipping the graphs showing the percentage of deaths attributable to obesity growing rather than diminishing over the lifespan. While the computations left me bewildered, what I found striking was the amount of dismayed language about the prospect of “not investing” in anti-obesity programs:
“the obesity epidemic is worthy of its status as a leading public health concern,”
“the cohort dimension of the obesity epidemic will likely carry forward the health and mortality implications of the epidemic for many years to come,”
“it is imperative for . . those who construct policy . .to recognize that . . more than a century of steady gains in life expectancy are being jeopardized by the obesity epidemic.”
Whatever the details turn out to be in this specific analysis, I think we need to think about the big picture. Every time someone comes up with a “years lost to obesity” or “obesity kills” claim, they have to be comparing it to something. When researchers say that x% of Black women are dying prematurely due to obesity, they are comparing fat and thin Black women, presumably, and that conveniently takes the focus off of all the health disparities from poverty, sexism, violence, racism, stigma, etc., that all Black women face. Look at how low Masters’ rate of death-attributable-to-obesity is for Black men – that’s not because Black men are living so long in “obesity-free” bodies, it’s because so many Black men are killed or die young from all the other assaults they face all their lives so that by the time we consider obesity it is at the end of a long line of much clearer causes of early death.
These sorts of claims make the structural threats to the health of people of color invisible. Why are efforts to police the weight of the bodies of people of color getting so much more traction, and yes, funding, than efforts to address racism, poverty, unequal access to education and healthcare, the school-to-prison pipeline, wage discrimination, unequal sentencing, death penalty decisions, etc.?
And of course the other big problem is the suggestion that we have some set of decisions, some “policies,” that will prevent weight diversity. The weight cycling industry is licking its chops over the expansion of markets into communities of color, and even if it were absolutely clear that higher BMI caused earlier death, pursuing weight loss and whipping up anti-obesity hysteria is not a solution, it’s a corporate windfall.
We need a national discussion about death threats, death anxiety, and dying while fat. Fat people are the target of so much of the cultural baggage around our collective frozen denial about the actual life cycle of humans that I believe it is in itself a risk factor for our health. Every study like this is an invitation to participate in the illusion that we have evidence for a right way of eating or a right kind of body to prevent death. Most of us have been told by a healthcare provider, “Well you may be healthy now but at some point you are going to get sick and die.” Right. And your point is? The Boomers are at their peak of social power and death anxiety right now, and I don’t think it’s an accident that we are beset with so much magical thinking around the mortality horizon coming into view. And magical thinking is fertile ground for selling us stuff, all kinds of stuff to prevent whatever we find terrifying.
What I find terrifying is the way my body gets reduced to a formula in the eyes of people who have the power to help or hurt me. My body is not a number. It is not a cautionary tale, a ticking timebomb, or a battleground for corporate adversaries trying to make money on marketing to fat people (weight cycling industry! workplace wellness programs! Big Pharma!) or trying to save money by hoping fat people die (health insurers! HMOs! Cost-of-obesity policy wonks!).
My death will not be a point for one side or the other. I am opting out of the illusion of immortality as a solution to this terror of not being seen. Instead, I am going to struggle to be seen, and still know that I will die anyway. I am going to live as well and as long as I can, and then I have to get off the bus. It is not different for any of us, and the best use of my time is to make this world a place that gives every one of us the maximum chance at happiness and well-being. My body allows me to do that work for now, and I am grateful for every day.
References:
Flegal, KM et al. (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA Jan 2;309(1):71-82. DOI: 10.1001/jama.2012.113905.
Masters, Ryan, et al., (2013). “Obesity and US Mortality Risk Over the Adult Life Course.” American Journal of Epidemiology,178 (2): 320.
DOI: 10.1093/aje/kws325
Masters, Ryan, et al., (2013). “The Impact of Obesity on US Mortality Levels: The Importance of Age and Cohort Factors in Population Estimates.” American Journal of Public Health, published online ahead of print August 15, 2013: e1-e7. DOI:10.2105/AJPH.2013.301379