Health at any size?

With tomorrow as the start of Vegan MoFo, I have one last health topic for you! The next 30 days are all about the food. 🙂

I just read an article about a study which concludes (among other things) that parents don’t like it when doctors refer to their children as “fat.”

Duh?

As the study’s lead author explains, fat is a pejorative term. It’s also quite subjective. It’s about a perception, not an exact definition. It’s just not nice to say that, so why would someone? Is that supposed to be helpful?

Me, circa 1990.

Look at the picture on the left. That’s me, circa 1989-1990 (can’t remember if it’s 7th or 8th grade. I was 12 or 13). Would you call that girl “fat?” I was clinically overweight, with a BMI* that fell around the 80th-85th percentile. My height was below the 5th percentile (still is). BMI wasn’t really used in health records back then, but I have a copy of my school health record, so I did the calculations. That put me in the “overweight” category.

My pediatrician was always clear with me that I needed to lose weight, but I don’t ever remember her calling me fat. Kudos to her. I’m saddened that there are apparently pediatric health care providers out there calling kids fat.

If you were to compare me to other kids at the time, statistically, there would have been kids that had a higher BMI than I, but there weren’t many at my school. Fast forward to today, where I routinely see kids that are well above the 100th percentile for BMI. I do see a major difference between now and then.

While at Vida Vegan Conference, I had the good fortune to meet many people. One of those was Jen of That Pain in the Ass Vegan. You should check her out!

After we had talked about what we do for a living, she asked me what I, as a healthcare provider, think of the idea of “health at any size.” There had been some hot debate the previous day on the “war on obesity,” the gist of which was one side being that we must end obesity at all costs, and the other that it’s a way for the diet industry to make a lot of money.

I don’t want anyone to feel ashamed of being not at a healthy weight. I don’t want to promote poor body image. I don’t want people to have to feel badly about obesity. On the other hand:

Obesity is an independent risk factor for cardiovascular disease (CVD).

A common argument in the fat acceptance movement is that just because you’re obese doesn’t mean you’re at more risk than someone who is thin, but has hypertension or high cholesterol. In my observation, that is usually followed with a statement about the thin person with hypertension being at more risk.

That’s not true.

Both obesity and high blood pressure are independent risk factors for CVD. So are high cholesterol, high triglycerides, high blood sugar and family history (not an exhaustive list). There seems to be a myth that obesity is only a problem when it leads to one of those other risk factors, which just isn’t true.

So my answer to the question is that I’m uncomfortable with part of the fat acceptance movement. I want people at any size to be as healthy as possible. I also want people to understand that they DO have a risk factor if they are obese (there’s no good evidence right now that shows that being in the overweight BMI category independently increases risk, though it may increase risk of developing other risk factors). I don’t want for people to become complacent in their health.

I also don’t want people to feel badly about themselves because of obesity. Would you feel badly about yourself if you were thin with hypertension? Would you feel like that made you a bad person?

I believing in striving for health at every size. If you were a thin person with no risk factors except high blood pressure, would you just say to yourself, “well, that’s okay. I don’t have to do anything because it’s just one risk factor.” I don’t think most people even think that way; they see a problem with their health, and they do their best to correct that.

That doesn’t mean that they’ll be able to control it on their own. But I think we would all hope that they wouldn’t stop trying.

That’s what I hope for all people with obesity- that we don’t stop trying to strive for health. And I’m one of them. A truth I know about myself is that I will likely never be “thin.” That’s okay- and that’s not what I’m striving for. But I can have a BMI below 30 and lower my risk factors.

Thoughts?

*I realize that BMI is a tool that is based on outdated information collected on only one race, but it is the tool used in virtually all studies on obesity, so there is some validity to that connection with risk factors. If you’re a really athletic person with a BMI of 30 or 31, you probably don’t have to worry so much, but it does give you something to consider.