Fat. Overweight. Obesity.
For some people it’s unhealthy. Or a disease. Or a symptom. Or a cause.
Or it’s actually health promoting. Or increases survival rate of certain diseases.
How can it do, or be, such conflicting things?
It’s called the ‘Obesity paradox’.
Technically, this paradox is that:
We think that obesity leads to an increase in the risk of coronary heart disease (among other things), but some researchers have found that obese patients actually have a higher survival rate and fewer treatment complications than normal weight people. (Note: the vast majority of this research is with elderly people, so it is even more complicated).
One study sums it up by saying that, “Despite the fact that obesity is recognized as a major risk factor in the development of cardiovascular diseases and diabetes, a higher BMI may be associated with a lower mortality and a better outcome in several chronic diseases and health circumstances”. This protective effect of obesity has been described as the “obesity paradox” or “reverse epidemiology.”
There’s also evidence from rat studies that obesity is protective against things like insulin resistance and other commonly known outcomes of a nutrient-poor high-processed-carb diet. These researchers found that the mice in their study who were lean developed metabolic illness twice as fast as those who became obese on the same diet. This suggests that there may have been something blunting the metabolic impact of the diet in the overweight mice. Was it the weight?
So yeah, there’s scientific evidence, compelling amounts of it, that suggest that overweight and obesity are not the all-out health demons we judge them to be.
Scientists are having a hard time explaining these kinds of findings – how can something be both disease causing AND protective at the same time? This is why it’s labelled a ‘paradox’. There are, of course, theories put forward, but they are in the baby stages and none are super convincing (see here for some good examples of this).
So, is there something else causing the heart disease, and the overweight is a bodily protection response? Or is it like sickle cell anaemia – an issue that is causes illness, but also provide protection for malaria. The reason that’s not a ‘paradox’ and obesity is, is that we are saying that obesity is the cause AND the protection against the same illnesses.
Interestingly, in many of the research studies and articles I read on this topic, the “fact” that obesity CAUSES disease was clearly stated, but was in no way backed up or questioned.
Which begs the question: Is it the cause?
Does excess body fat cause illness?
My personal, professional opinion is: Not necessarily.
Not being a scientist or medical doctor, I obviously can’t answer this, but the very fact that there is evidence that overweight and obesity can be helpful, protective, and indeed, lifesaving, has some important implications for the health and wellness realm, as well as our culture as a whole.
I believe that for some (many? most?) overweight individuals, overweight and obesity are symptoms of underlying problems, most often metabolic syndrome, but could also be other health issues, emotional problems, or something else. And like many of our bodily symptoms, it’s present both as a message (hey! There’s something wrong!) and as a protection mechanism (like when the skin around a cut swells to promote healing).
Why am I writing about this?
Because obesity and overweight often carry with them not only moral judgments, but the assumption that a person is unhealthy and at risk from disease. They are often blamed for rising health costs, and looked upon with scorn for ‘not taking better care of their health’. This story has so many sides and is not even partly well understood yet. We can’t decide if obesity is a cause, a risk factor, an outcome, a genetic predisposition, or something else entirely. It’s probably all of those things and more.
I’m writing this to add one more voice to the mix and to suggest in some small way that we can re-think some of our prejudices around weight, health, and judging people.
Do I think people can and should work to be their best selves, physically and mentally? Yes.
Do I think part of that is having a healthy weight? Yes.
Do I think that this healthy weight might vary for different individuals? Yes.
I also strongly believe that we would all be better if we could work towards these individual expressions of health without all the hate, fear, misinformation, and ostracism.
If we can believe that excess weight could be a symptom, like a runny nose or a fever, we can work to fix the underlying cause of that symptom. We don’t judge a person with a cold for having a blocked nose, so maybe we shouldn’t be judging people with more fat than we deem ‘correct’. We work to boost out immune system and have a healthy diet to protect and heal ourselves from a cold. We don’t beat ourselves up or hate ourselves for it. Maybe we can treat overweight the same – as something we can work on without all the blame and moral crap.
The Bottom Line:
We all want healthy, functional bodies. For many people, overweight or obesity is a sign that something is going wrong. Listen to that sign, really feel what it has to say, and then work in a loving way to fix the problems behind it.
This is what I believe we can learn from the ‘obesity paradox’: look deeper, listen carefully, judge less, and question more.
Tell me: Do you think there is a reason for this ‘paradox’? Is obesity a disease, a cause of disease, a symptom, or all three/something else?