Someone on a fat acceptance blog has written another post about the excoriating unfairness of the Body-Mass Index. (For those who have been trapped under a rock for fifteen or so years, the BMI — calculated by dividing mass in kilograms by the square of height in meters — is a metric clinicians use to define people as overweight [BMI greater than 25.0], obese [over 30.0] and “morbidly obese” [over 40.0].) This post, however, doesn’t attack the legitimacy of the BMI itself by contesting the established correlation between higher BMI and higher risk of certain medical conditions. Instead it targets those who use it without saying exactly who these people are, although from the context it seems to be a loose cabal of epidemiologists, doctors, health insurers, climate scientists, social workers and others. Her argument seems to be that using 30 as a a cut-off for obese ends up classifying a lot of healthy people as unhealthily fat:
I am way over on the heavy side of the US BMI bell curve; according to this calculator, I’m in the heaviest 15% for an American woman of my age and height. That’s right. They say that 30% of Americans (…23% of Brits… 22% of Aussies) are obese, and I’m smack dab in the middle of the obese category by percentile. I’m not an average sized American woman. I’m an average obese American woman.
Obesity is defined by BMI. It isn’t defined by ‘Damn, she’s big!’ or ‘look at the moobs on that guy!’ and ‘look at those people huff and puff walking up those stairs!’ When they talk about ‘the obese’ in the news, they are talking about everyone with a BMI over 30, not just the ones who are exceptionally large, who are proportioned in a different way than smaller people, who have a low muscle percentage, or who are in poor physical condition. Hello, other large-side-of-average-looking people whose BMIs are over 30! I am not an exception, and neither are you. When they talk about ‘the obese’ they’re talking about us.
And if they’re going to go around constantly talking shit about the people they’ve put into the obese category by the use of BMI, then hell yes, obese people with BMIs between 30 and 40 – the vast majority of obese people – should be speaking out. And hell yes, our experiences are the legitimate experiences of obese people. They don’t get to say that 30% of Americans are obese and then pat people who are smack dab in the middle of their “obese” BMI category on the head and say “Oh, you’re fine. We weren’t talking about you.”
The medical studies are about us, so if the results don’t make sense, we should take a closer look. We are the ones being charged higher insurance rates. We’re the ones being blamed for everything from global warming to the collapse of the US health care system. We’re the ones that the good, upstanding thin folk are being discouraged from befriending or even gazing upon, lest they become like us (newest piece of dog dirt from BBC radio, and I can’t find a link for it). We’re the ones who are being accused of abusing our children if they (shock! horror! surprise!) come out looking like us.
The writer has a point in that the boundaries of BMI-based category delineation are arbitrary in the same sense that a lot of data-driven boundaries are arbitrary, especially when it comes to biometrics (a person with an IQ of 99 is “below average” in intelligence; someone scoring 101 is “above average”). These categories represent an attempt to pin exact numbers on physical states that in the real world don’t admit of such conveniences, like the vaunted 10 percent rule. But having such categories is really the only way that researchers can attempt to determine, on a population level, the effects of being heavier or lighter by some given baseline amount. It’s not an exact science, though not for technical lack of precision. Studies that account for adiposity would be much more useful, but more on that in a second.
The writer is also doing what a lot of polemicists do and trying to combat hyperbole — i.e., society’s exaggerating the negative impact of a mostly overweight or unfit citizenry — with hyperbole of her own. At least that’s the sense I get, since the last paragraph is nothing more than inane saber-rattling; few people argue that fat people aren’t treated unfairly in out society in conscious and (worse) unconscious ways, so there’s no reason I can see to make it worse by accusing “them” of especially grotesque solecisms. The problem is that most people with a BMI over 30 (you can pick another number if you want to) are not physically active. (Most people who are “merely” overweight or considered “normal” aren’t either, but that’s another matter.) While it is unquestionably true that some people’s frames and musculature make it ludicrous to consider them “overweight” or “obese” per BMI, the majority of people classified as obese are simply fat, with, on average, the attendant risk of higher medical conditions. In a similar light, while there are a fair number of people out there with BMIs of around 17.5, such as U.S. 10,000-meter record holder and Olympic bronze medalist Shalane Flanagan, most people at or below that number are probably sick with a chronic wasting disease or courting illness in some behaviorally relevant way. (For those who know what I look like, picture me 15 pounds lighter; that’s your 17.5.)
I think that when a sensitive issue like this arises, when fat people read that those with BMIs higher than whatever are at greater risk of diabetes, heart disease, arthritis, sleep apnea, gout, certain malignancies, etc., they naturally feel as if “they” are saying that all of those possibilities apply to them. Clearly this is not the case and no sound physician treats people as numbers. The mass media does, however — it loves controversy and, as we’ve noted repeatedly here over the years, loves misrepresenting medical studies in such a way as to skirt the bounds of fiction. Most writers for decent newspapers become very good at misleading readers without actually lying, and since more and more Americans are becoming fat, articles about just how bad it is for you or (much less frequently) how it just might actually be good for you are turned out in a never-ending stream. Few people have the scientific sophistication to understand what these studies actually imply, and that’s just how the media likes it.
The post continues:
Do you have a BMI over 30, no chronic health problems, use less health care than average, and seldom get sick? They’re still talking about you. Do you suspect that no one at work knows you’re obese, think you look good for your size, and feel like you shouldn’t rock the boat when you’re asked to shoulder more than your share of the health insurance burden? You’re definitely not an exception. Is your lifestyle average or healthier than average, yet your BMI is still in the obese category? Yeah, that’s not unusual. Are you well educated and reasonably successful in your career, and sure that you’re not one of those junk food eating, lazy, smelly fat people that are out there someplace – possibly at WalMart – and it’s that type of obese person, not you, that they’re talking about? No, you’re wrong. It’s you. Are you athletic, with a high muscle percentage? People with high muscle percentages aren’t excluded from the medical studies and obesity is defined by BMI. You’re one of us, too.
The moral panic doesn’t work without a high percentage of the population being defined as obese, and the high percentage of the population that is obese is made up mostly of people with BMIs between 30 and 40 who, thanks to the use of headless fatties, don’t register as obese, visually, to most people. But you know what? Rather than hiding behind the fact that most people can’t tell we’re obese, we should speak out. Because they’re talking about us.
One more thing. The people who do register as obese visually; people with 40+ BMIs, people who do look quite fat because of how they’re proportioned or for whatever reason? You can’t judge their worth, their intelligence, or their strength by their size. You can’t judge their health or habits by their size (and we have no business judging people on that basis, in any case). They don’t deserve discrimination. They don’t deserve social exclusion. They don’t deserve to be laughed at. They don’t deserve pity or a patronizing attitude. Size discrimination and the moral panic over obesity is impacting them harder than it impacts us, and we should do everything in our power to support them and not to add to the crap that they’re already dealing with. In our groups of friends, in our jobs, and in our families, we should be the last people to judge, show prejudice, or discriminate against other fat people.
On balance I agree with the writer’s basic point, which is that not all fat people are the same and shouldn’t all be regarded as shiftless, sedentary Wal-Martians. I consider this a given, but that doesn’t mean that “they” don’t think that way, so the perception is out there to some degree. But I disagree with her simply re-defining arbitrary for purposes of her argument. She essentially claims that people who are merely fat are as stigmatized as others even though they’re not (viz. the “no one at work” comment), and that while no fat people deserve to be treated poorly, it’s especially wrong to mistreat the less-fat faction of obese people because those people are actually behaving more like “normal” people, not that they should have to. This in a nutshell is what I’ve seen the extremely cranky Paul Campos try to argue — he concedes that really obese people, say 40 and above, are at very high risk for certain illnesses, but below that level the term “obese” is medically irrelevant. This is a very convenient argument for people who happen to have a BMI of over 30 but less than 40. They are trying to have it both ways, sort of like climate-change deniers who insist that climatologists are incompetent, dissembling whores of liberalism until they turn up the 1 in 1,000 who agrees with the anti-AGW crowd, at which point the science suddenly appears trustworthy.
It also doesn’t say much to proclaim “I’m technically overweight but I’m as healthy as anyone I know.” Most smokers under the age of 30 or even 40 don’t yet outwardly manifest the consequences of their habit, either. But if anyone thinks that the rise in markers of diabetes mellitus in preteen Americans is a benign state simply because its effects have yet to become fully realized, that person ought to pay more attention to what “they” say.
This is getting far too long and off-topic, but what it again boils down to is the conflation of a purposeful and worthy aim (not being regarded as weak or second-class on account of being fat) with a more difficult and nuanced one (the health issues). And since you’ve read this far, I’ll tell you that this post was indirectly inspired by this story, as I expected to see discussion of it at BFB.