You may have heard of the study by Kuk et. al. on the Edmonton Obesity Staging System. I’ll give you the background first and then get to the interesting stuff and the swearing:

They characterized fat people’s health on a 4 point scale: “stage 0, no risk factors or comorbidities; stage 1, mild conditions; and stages 2 and 3, moderate to severe conditions”.

They found that:

Compared with normal-weight individuals, obese individuals in stage 2 or 3 had a greater risk of all-cause mortality and cardiovascular-related mortality. Stage 0/1 was not associated with higher mortality risk (emphasis mine)

The study has limitations in terms of statistical significance (the sample was mostly middle class white people for example), much of the data was self-reported and the authors are clear that further research is necessary. Interestingly, in the conflict of interest section it states that two of the authors sit on Jenny Craig’s advisory board (although maybe not for long?) and one of those authors has research grants from coca-cola and Body Media (a weight loss product).

Some interesting tidbits:

Stage 0 or 1 participants were less likely to die from cardiovascular disease than “normal weight” individuals.

Stage 0 and 1 individuals were more likely to be physically active and eat more fruits and vegetables. Stage 0 or 1 participants were also less likely to report engaging in weight loss practices.

Hey isn’t there a name for engaging in healthy habits and not engaging in weight loss practices? Wait a minute it will come to me…ah yes, it’s a Health at Every Size (R)* perspective!!! I knew that sounded familiar!

According to this article, Dr. Pieter Cohen, assistant professor of medicine at Harvard Medical School and a general internist at Cambridge Health Alliance said: It’s “absolutely” possible for people to be overweight or obese and healthy.

Harvard doctors making sense? I may have to play the lottery today!

Dr. Sharma, chair for obesity research and management at the University of Alberta (who often makes sense) said: “The key message is I can’t tell you how healthy someone is if you tell me height or weight on a scale. I have to do additional tests for other health problems.”

Then there are some things that I almost can’t believe about this:

They list the health issues as “co-morbidities”, thereby making the unsupported assumption that obesity is a primary disease or disorder when it’s really just a height/weight ratio.

The study says

Nevertheless, these factors, together, indicate that obese patients, particularly in EOSS stages 0 and 1, may be better served if physicians promoted weight maintenance, as opposed to weight loss, as it remains to be seen whether individuals in EOSS stages 2 and 3 will benefit from weight loss.

Yet the articles that I read are still recommending weight loss for patients who are at stage 2 or 3. This is problematic because:

1. They JUST SAID that weight loss attempts may well worsen health.

2. They don’t know if losing weight will help these people. There is no solid proof.

3. Even if they did have proof that weight loss would help, they have no idea how to get it done. Prescribing something with an efficacy rate of 5%, especially knowing that the 95% who fail will likely end up less healthy than when they started, isn’t just dumb – it’s medically unethical.

4. I don’t know whether to make study author Jennifer Kuk the blue ribbon loser or winner for this quote: “the ranking system helps to identify who should actually lose weight and who are we torturing for no reason”

Ok Dr. Kuk. In addition to saying that you don’t know if weight loss will help, in your study you said

For the vast majority of obese individuals, lifestyle-based weight loss is not maintained over the long term (Wing et al. 1995).” This is particularly concerning, given that weight cycling is associated with greater weight gain over time (Van Wye et al. 2007) and potentially worse health outcomes, compared with individuals who may have maintained a stable body weight (Blair et al. 1993; Wannamethee et al.2002).

If you are:

ruining people’s current quality of life by self-describedly torturing them

under the auspices of possibly giving them better quality of life later

all the while knowing that the most likely outcome is actually worse health

may I gently suggest that Ur Doin it Wrong.

Dr. Howard Eisenson (executive director of the Duke Diet & Fitness Center) totally doesn’t get it, but gets quoted in the CNN article on the subject anyway: “If we don’t intervene now [when someone is healthy, 25 and obese], by the time the person is 35 … maybe some damage has been done and the unhealthy habits are more established.”

Okay Dr. Einsenson, I need you to stay with me here, I’ll type slowly: Not all obese people practice unhealthy habits, you’re just making that up in your head. In fact the very study upon which you are commenting showed that people who practice healthy habits and don’t attempt to lose weight (thereby ignoring the advice of the Duke Diet and Fitness Center) have better health outcomes. Also, see above on your complete inability to effectively create long-term weight loss.

(And not for nothing but why does every article about this study have at least three doctors offering a counter-opinion but Jess Weiner gets to mischaracterize the entire Health at Every Size(R)* movement to sell her new diet program, and nobody bothers to call any of us for a counter opinion? I’m just curious.)

Several articles suggest that the stigma that fat people face may be a worthy reason to lose weight even if their health is fine.

Oh, how can I put this delicately?

YOU HAVE GOT TO BE FU#%ING KIDDING ME! The cure for social stigma is not weight loss, it’s ending social stigma.

Finally, there are the comments. If I could give you a piece of advice, it would be not to read the comments. All kinds of people who think that “personal responsibility” means that I am personally responsible for looking how they want me to look. So many people who can bite me. But the message I’m taking away is that, as I’ve long suspected, these people don’t care about my health. If they did there would be a zillion comments saying “wow, I really need to question my assumptions about weight and health”. Alas, none that I saw, and perhaps that’s because they only actually care about having someone to whom they can feel superior. But that’s just a guess.

It bears repeating that prioritizing one’s health is not a moral, social or personal obligation (you do not get to choose what is important for me and I don’t get to choose what’s important to you – that’s why we each have our own underpants to be the boss of). Also, health is multi-dimensional, not all aspects are within our control, and it should never ever be used as a barometer for worthiness. Knowing those things, I’ve said it before and I’ll say it again (today backed by research): while health is never guaranteed, if being healthy is what we want, then healthy habits are our best chance for healthy bodies.

*You’re probably wondering why I’m putting at (R) after every use of Health at Every Size (R). It’s because the awesome organization ASDAH has successfully put a copyright on the term so that it can’t be misused, and now there are a bunch of rules to follow. And you know that I think this is important because normally I reject rules. That being said, if anyone knows how to actually make the trademark symbol in WordPress I’m all ears, or fingers, or whatever.