The Obesity Fallacy

By Mica Lemire

There is a significant problem with the way the public looks at obesity, especially as it relates to health.

There are many reading this article, possibly even you, who may hold that obesity is necessarily damaging to a person’s health. But how could you not? Modern medicine operates within a similar weight-pathology mindset, that obesity is a disease– a narrative that propagates out of the hospital and into the public’s rolodex of health axioms. In addition, it’s almost ubiquitously understood that obesity is associated with many diseases, including diabetes, hypertension, and cancer.

So what’s the problem? Obesity is bad for your health and every overweight person should strive to lose weight.

But it’s not that simple. A significant problem with conventional research, however, is that few have taken into account the role of habitual– and especially incidental– physical activity.

One study by Carl J. Lavie, medical director of cardiac rehabilitation and preventive cardiology at the John Ochsner Heart and Vascular Institute in New Orleans, found that diminishing occupational activity levels accounted almost perfectly for reduced metabolism, and thus increased weight gain, in the last 50 years.

The same study went on to demonstrate that individuals who regularly participated in physical activity lived almost identical lifespans, irrespective of weight status. Astoundingly, physically active obese people were at a lower risk of all-cause mortality than sedentary lean people. More to the point, if you are skinny and don’t exercise, a large physically active person will almost certainly outlive you.

Another study by Steven N. Blair, Professor of Exercise Science, Epidemiology, and Biostatistics at the Arnold School of Public Health, USC, found that the negative outcomes of obesity are attenuated or completely eliminated when treated with exercise, even when no weight was lost.

“So what?” You ask. “Fat people still need to exercise.”

Well, yes. To be clear, the problem isn’t about weight. Too little does the current conversation on health focus, instead, on physical activity levels. The more that shame becomes a part of the weight loss narrative, the more weight stigma becomes internalized in those who are overweight, making overweight persons less likely to adhere to exercise in the long run. Gym avoidance is exceedingly common among obese people for fear of facing ostracism at the gym. To make matters, this same stigma can promote harmful perfectionistic behaviors, such as eating disorders with deleterious consequences for short term health.

Like it or not, to indict overweight people of laziness, even under the veil of care is more likely to cause damage, and not inspire and overweight person to become healthy. Additionally, irrespective of “obesity” as a disease state, a sensible person would not apply the same scrutiny of health and lifestyle to a person with a different chronic illness (e.g. cancer). While this is purely an assumption, I should hope that any person with a chronic illness should be treated with respect, compassion, and a means to cure or manage their disease.

I hope I've sufficiently made two points clear: people who are obese, when undertaking structured physical activity, are nearly as healthy as those who don't. Regardless, the fixation on obesity as a disease state, I feel, does more harm than good. A better explainer of poor health, and also a burgeoning epidemic in the States, is poor physical activity levels, regardless of weight status. I can do little with a call to action, but let's try to fixate on exercise as a promoter of long-term health, instead of weight loss. And while the socioeconomic aspects of diet are an important albeit incredibly complicated piece of the puzzle (which I'll address in a later article), obesity could very well become less of a problem if everyone were just a little more physically active from day one.