Keep Yer Flab On

By Lakshmi Chaudhry, AlterNet. Posted July 15, 2004.

We're at war and the enemy is obesity – or so warn the doctors. U.S. Surgeon General Richard Carmona has declared obesity "the terror within because it is every bit as devastating as terrorism." It allegedly affects nine million children and two out of three adults, and claims the lives of 400,000 Americans every year.

It takes a brave man to speak out in favor of flab today – and that man is Paul Campos.

The Obesity Wars are nothing but a big lie about fat, says the author of a provocative new book titled "The Obesity Myth: Why America's Obsession With Health is Hazardous to Your Health." Campos argues that Americans are in fact only a mere 15 pounds heavier than we were 20 years ago. What have become more stringent in that duration are public health standards for ideal weight, which now define the vast majority of us as "overweight" or "obese" – and that includes Hollywood icons like Brad Pitt and George Clooney.

What's more, according to Campos, there is no documented relationship between weight loss and health. He claims that medical studies that link obesity to wide range of diseases, including heart disease and cancer, are misleading and often self-serving. The result is a cultural hysteria that uses a dangerous and pervasive myth to demonize all – especially poor people of color – who do not fit the shrinking standards of the ideal body weight.

Campos talked to AlterNet from his office at the University of Colorado, Boulder.

Your central claim is that major epidemiological studies show little or no link between weight and health, be it risk for cancer or heart disease. That sounds kind of kooky to a lay person.

For the vast majority of people in the United States, their weight does not give you any meaningful information about their likely overall health. You can look at the roughly 75 percent of the population that has a Body Mass Index (a measure of your weight relative to your height) between 18.5 and 32 or so. That entire range, which represents about 80 pounds for an average height woman (5 ft. 4 in.), you will not see any significant variation in terms of risk (of contracting a disease).

So you're saying that there is no difference in terms of overall health between someone who would be considered "obese" with a BMI of 32 and someone who has the "normal" BMI of 20.

There are two points here. One is that for the vast majority of people, weight simply isn't going to tell you anything relevant about their health in and of itself. And second that among those groups that do show some meaningful correlations with health, we need to unpack the extent to which the weight is causal or merely a marker for other things, such as poor nutrition, socio-economic status, weight cycling brought on by dieting etc.

If a person with a BMI of 32 has a significantly increased health risk but is far less likely to have health insurance than someone with a BMI of 25, what is really relevant here? The BMI or health insurance?

So you do make a distinction between weight and a healthy lifestyle. Eating well and exercising is important to good health but it is not necessarily connected to weight loss.

Absolutely. The war on fat is based on the assumption that if people have a healthy lifestyle they'll be thin. Now we know that's not true. Now we don't know the extent to which it's not true – i.e. what percent of the population would be "overweight" or "obese" if they had a healthy lifestyle – but we know it's a very significant percent.

One of the things I've found exasperating about this issue is that many of the people who are making these claims are themselves "overweight" or "obese." So their own bodies literally embody a contradiction of their own claims.

Have we always made this connection between being thin and being healthy?

There is a long and complicated cultural history here, but here's the short version. In the first two decades of the twentieth century there was a strong aesthetic swing toward an ideal of thinness. The notion was first pushed forward by Christian Dior, the French fashion designer. It caught on and in the United States you saw the flapper phenomenon of the 1920s.

What happened essentially is that this cosmetic preference became transformed into a medical judgment through a complex process, where doctors began giving credence to this new cultural preference for thin-ness. The guy who played the biggest role is Louis Dublin, the head of actuarial statistics for Metropolitan Life Insurance in the 30s and 40s. He became absolutely convinced that people who were thin would have the best health, even though he had no data to back this up at all. But he constructed these height/weight tables and gave countless speeches to medical groups advocating that idea. The medical establishment then picked up on this notion and ran with it.

What happens in these kind of cultural processes is that cosmetic preferences get medicalized and then moralized. So it's not only that we like thinness because it is fashionable but it becomes that thinness is actually good for health. And what's more, if we're not thin, it's our fault and we're bad people. It becomes a moral good.

Lakshmi Chaudhry is senior editor of Alternet.

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