Monday, November 12, 2012
Why I can't quite be okay with 'Okay at Any Size'
There has long been a movement to defend the overweight from a prevailing lack of understanding. And, alas, that defense seems to be needed.
The evidence of obesity bias in our culture is abundant and pervasive, and can be found from playground to boardroom. We have historically done a poor job of attacking the problem of obesity without attacking those burdened by the problem of obesity.
The defense has come in the form of professionals who highlight the pernicious effects of bias. It has come in the form of organizations, such as NAAFA, the National Association to Advance Fat Acceptance. In my own case, it comes in the form of the National Exchange for Weight Loss Resistance, which I launched to help spread the word that some people can eat well, be active, and still never get too thin.
There has long been some okay-at-any-size support from Hollywood and Madison Avenue, as well. The Dove ads for women with "normal" curves are already classics. Oprah has emoted on the topic. Plus-size models can do quite well. And Queen Latifah has brought her inimitable "what you see is what you get, if you're lucky" brand of gumption to the issue.
Apparently, though, we've entered a new stage of evolution on the topic. The New York Times recently reported that a whole new cadre of celebrities prone to the same obesigenic influences as the rest of us are simply shrugging their shoulders, and letting it all hang out. In some cases, quite literally, by exposing the expanding epidermis in question.
So "okay at any size" seems to be gathering pop culture momentum. And I regret to say, I can't be entirely okay with that. It's not the size I'm not okay with, it's the consequences.
Epidemic obesity is not just a reason we have epidemic diabetes, it is the reason. It is the reason why the CDC is projecting that as many as 1 in 3 of us may be diabetic by mid-century, at a cost the nation is unlikely to find manageable.
It is the reason why what used to be "adult onset" diabetes is now a disease of children as well, and called "Type 2." It is the known reason for a proliferation of ever more cardiac risk factors in ever younger people. It is the reason behind a triple coronary bypass in a 17-year-old boy whose case I know. And it is the likely reason for a 35 percent increase in the rate of stroke among 5-to 14-year-olds.
And the toll of this menace continues to rise. Not so much now because of more people becoming overweight, although that continues to happen. Rather, since most of us vulnerable to becoming overweight or obese are already there, the relevant trend at present is the degree of overweight, which is worsening fast. A recent report indicates that the prevalence of severe obesity has "skyrocketed" in the past decade. We can probably no longer gauge this epidemic by noting how many are overweight; we now need to monitor how overweight the many are.
These, then, are the stakes in play. It's true that people can be fat and fit, but few of us are. More and more of us are fat to one degree or another, and most of us are unfit as well. These can be unbundled, but in the real world they seldom are. And when they are unbundled, it's because thin people can be unfit, too. In general, the behaviors that cultivate genuine fitness offer the best defense we have against fatness.
And this points to a message residing more than skin deep. Whether fat or thin, what we eat matters. Food is the fuel that powers the human machine. It is the one and only construction material for the growing body of a child. It is the construction material on which adults rely to replace spent cells and enzymes and hormones every day. Junk is a poor choice all around, no matter your size.
And exercise matters. It is the vital, conditioning work of the body, whatever its proportions. The "okay at any size" message does not explicitly say that junk food and lounging on the couch are fine, but it doesn't tend to say explicitly that they aren't, either. We could be more okay at any size if we took good care of ourselves, large or small. But if one of the reasons for larger size is lesser attention to health, that's not really okay. And frankly, what we know about prevailing dietary and physical activity patterns suggests that's just what's going on.
Along with helping many patients lose weight over the past 20 years, I have talked some out of the enterprise. I have told them they were healthy, and as far as I was concerned, looked great as well. I encouraged them to love the skin they were in, and not obsess for the rest of their lives with themselves 10 pounds lighter, or a size or two smaller. Sometimes they listened to this advice, sometimes not. Those that didn't listen might well have benefited from a bit more cultural emphasis on the "okay at any size" message.
So I am not only okay with "okay at any size" up to a point, but an active proponent. I oppose obesity bias, and reject the notion that widespread obesity among children and adults alike is somehow due to an inexplicable, global outbreak of personal responsibility deficiency syndrome. If you have evidence of such an outbreak, it would be the first I've heard of it.
I am more than okay with the notion that weight and waist circumference do not measure human worth. I will gladly stand shoulder-to-shoulder with others inclined to fight in defense of this proposition.
I am not just okay, but adamant, that we should be able to attack the problem of obesity without attacking those dealing with the problem of obesity.
And I can be okay with "okay at any size" if it includes a proviso: okay at any size as long as health is not adversely affected.
But when weight imperils health, as it clearly does all too often, I am not okay with it. In this context, bold displays of burgeoning flesh, and "flab is fab" bravado may do more harm than good. We do not, as a society, want to normalize ill health or the factors that impose it. Fewer years in life, and less life in years is not an acceptable endowment to the next generation.
We could choose to give our children a future in which 80 percent of all chronic disease goes away, because we commit to making tobacco avoidance, eating well, and being active our cultural standard. Or we can be okay with the trajectory we are on, and give them ever more serious illness starting at ever younger age.
When the bigger we are on average, the harder and younger we fall victim to serious chronic disease, I am not okay with it, and don't think anybody else should be, either. It's not the size that inspires my opposition; it's the consequences.
David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.
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