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Why an Alabama professor claims it's OK and sometimes even healthy to be fat
Seeing all fat people as unhealthy is outdated and causes 'rampant discrimination', according to a new book.
Rekha Nath, an Associate Professor of Philosophy at the University of Alabama, says there is enough evidence that shows that being fat is not always bad for someone's health and that the issue is not black and white.
She draws on a wave of new research over the past decade suggesting that our current methods for addressing obesity are not working, and that a more nuanced approach is necessary if we want to create a healthier public.
Professor Nath also argues that these standards contribute to a 'collective aversion' to overweight people that actually makes them more likely to gain weight and become depressed.
A 2023 study found that the distribution of someone's fat was more important to their overall fat than just their body weight. Fat around the midsection, which stresses crucial organs, led to increased risk of diseases that could lead to premature death
She argued that changing how society thinks about fat people will help create better healthcare practices for them that make them more likely to lead healthy lives.
'It is OK to be fat because there’s nothing wrong with being fat. There’s nothing wrong with being fat, of course, except for all that our society does to make it bad to be fat,' she said.
In her new book, entitled 'Why it's OK To Be Fat', Professor Nath pointed to a 2010 review of 36 older studies which found that overweight people who exercise were less likely to die prematurely than unfit people at a 'healthy' body weight.
She argues that lifestyle factors, in this case exercise, may be a better predictor of health than their waistline alone.
Professor Nath and published different papers on obesity and global social political philosophy, and earned a PhD from the University of Melbourne
That study and the American Healthcare system uses Body Mass Index (BMI) which sorts people into one of three categories - healthy weight, overweight and obese - depending on their height and weight.
For example, someone who is 5 foot 2 inches tall and 153 pounds would be considered over weight and someone who is 5 foot 2 inches tall and 175 pounds would be considered obese.
But physicians have increasingly become critical of this measurement. Fatima Cody Stanford, an obesity physician at Massachusetts General Hospital and Harvard Medical School in Boston, said that BMI doesn't paint a full picture of someone's health.
Not everyone with a high BMI has bad health - things like fat distribution and activity level might be more important than your weight alone, she said.
For example, increasingly studies showing where your fat sits is more important than how much of it you have overall.
Studies have shown that fat that's located deep in your mid section - padding the stomach, liver and kidneys - contributes more to some of the factors associated with obesity than fat that lies just beneath your skin on your legs and bum.
This is because your deep stomach fat, called visceral fat, releases more molecules that inflame your body, contributing to a host of health conditions, than surface-level, subcutaneous fat, according to Dr Howard E LeWine, an internist at Brigham and Women’s Hospital.
This association is so clear that a 2023 study found that people who stored the majority of their fat away from their bellies were healthy - making 15 percent of the obese people included in the study healthy overall.
'When we look at just height and weight, we don’t know anything about the health status of the individual,' Dr Stanford told Nature.
Some doctors will scoff at the idea being fat is healthy, especially given the current situation.
Researchers from six countries, including the US and UK, found people who were 'generally obese,' as well as those who were taller with increased belly fat, were at the highest risk of colorectal cancer
Roughly seven in ten Americans are obese or overweight, according to the NIH, a number which has been steadily rising since the 1970's.
The annual cost of treating obesity and obesity-related conditions in the US likely exceeds $1.4trillion, a 2020 report from the Milken Institute, a nonprofit think tank, found.
This includes spending from private insurers, public insurers and individual costs for bariatric surgeries, medications, diagnostic testing, preventive services and medical treatment.
Though no one dies directly of obesity, Harvard researchers estimated that obesity -related conditions caused nearly 500,000 deaths in America per year.
Obesity causes Type 2 diabetes, high blood pressure, stroke, heart disease, liver disease and many kinds of cancers.
Professor Nath's book was published by the Taylor & Francis group, a large academic publisher
It also makes people lose, on average, two to four years of life, making it more linked to premature death than smoking, the Harvard researchers said.
Dr Nath acknowledged this, but said the methods for treating obesity don't always work well, and instead make fat people feel worse.
Until the arrival of Ozempic, the common advice for overweight people was to eat less and move more. This sometimes works.
But Professor Nath cited a study that showed that 41 percent of people who try to lose weight by dieting end up heavier than their original weight four to five years later.
Though dieting isn't always effective, when people don't see results from it, they're seen as a failure, Professor Nath said.
'Being fat is seen as unattractive, as gross even. We view fat as a sign of weakness, of greediness, of laziness,' Professor Nath said.
This creates a system wherein being thin makes people good, and being fat makes people bad, she said, adding: 'Many, if not most, of us are not quite sure whether it is genuinely OK to be fat.'
However much fat someone has does depend on the number of calories they consume, regardless of who they are.
If you consistently eat more calories than your body uses to power itself, your body will begin to store those excess calories as fat.
However, genetics, stress, medication and health conditions can all make it harder to lose fat, by causing inflammation, creating a slower metabolism and affecting body-fat distribution.
Regardless of the cause, it's clear across society that people fear getting fat, and associate it with failure, Professor Nath said.
One in three college students said that becoming obese would be 'one of the worst things that could happen to a person,' a 2014 study from Dickinson College and Yale University School of Medicine found.
Almost half of 4,000 respondents to a global online survey said that they would prefer to give up one year of their life than be obese, Professor Nath cited.
This creates a bias that means that fat people get poorer medical care, less job opportunities and are more likely to be shamed in public.
This makes them less likely to be able to lose weight and more likely to develop conditions like depression and anxiety, which harm them.
'Not only does subjecting fat people to weight stigma seem to make it less likely that they will become thin, but, moreover, weight stigma appears to seriously harm their physical and mental health in many ways,' Professor Nath said.
This is most common in Western cultures like the United States, United Kingdom and Australia, Professor Nath said. But other cultures actually prefer fatness over thinness.
For example, fatness is seen as a sign of beauty in communities in Nigeria’s southeastern Cross River state.
The solution to the problem isn't ignoring someone's weight when they come into the doctor's office, Dr Stanford said. BMI still gives providers, 'a sense of how much weight you’re carrying,' Dr Stanford said.
They key is that after taking into account someone's weight, you still have to look at all the other factors in their life to determine their health, she said.