There certainly seems to be a lot of evidence to support the conclusion that we are, or at least to show associations between high body weight and poor health.
But I’m wondering, what’s really the most important question here? Whether fat people are unhealthy? Or why fat people might be unhealthy, if they are?
I think you know my bias is going to tend toward the latter.
This is not just an academic question for me: I am a fat person. And not just a little fat; I’m the highest caliber of fat there is — Class III Morbidly Obese. For me, this is an intensely personal question.
Am I unhealthy? Are people who look like me unhealthy? Are we unhealthy in similar ways, and can any of those ways be blamed on our bodies? Can our bodies, subsequently, be blamed on our habits, or our morals, or our characters?
And I think you might also know that my tendency is to answer these questions with yet another question:
What is health, anyway?
The World Health Organization says:
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Which, you have to admit, seems rather noble and inspiring.
My only problem is, according to this definition, who on earth has ever been completely healthy?
I would answer, no one.
I don’t believe anyone living now, or anyone in the past, has ever enjoyed such a rarified state of ideal physical, mental and social perfection. At least not for longer than, say, about ten minutes. On the most perfect day of their entire lives. Which also happened to be their sixteenth birthday. And the first day of spring. And the day when Kevin Garnett of the Boston Celtics professed his undying love for them . . .
. . . with an ice-cream cake.
And while I understand the rationale behind putting forth lofty mission statements for organizations, such as the WHO, whose reason for existence actually is the attempt to eradicate all threats to well-being, and to optimize all people’s health, I don’t believe such mission statements make appropriate aphorisms for the individual to live by.
We are, after all, individuals. So this matters.
And this is why, in my second or third year of university, I proposed another definition of health, based on the work of John Kabat-Zinn, who pioneered the mindfulness-based stress reduction approach, which has subsequently been applied to all sorts of therapies for mental, as well as physical, illness.
I sense a flaw within [the WHO's] definition of ideal health. It’s the silent assumption that anyone experiencing less than ‘ideal’ health is not only possibly to blame for their predicament, but that their lives are tainted, somehow broken, and possibly less meaningful than the lives of the ‘healthy.’
I propose that our definition of health should have less to do with how sick or well we are, and more to do with how we live inside and with our unique physical condition.
A person’s state of health is what it is, and the thing to strive for is not less disease, or even longer life, but the ability to inhabit, accept, and cope with what is.
We can focus on using our skills [as healthcare practitioners] to help individuals live meaningful and worthwhile lives, no matter what their physical condition, alongside treatment and our search for cures.
And we can revise our definition of health to mean having the skills to face and live with challenges, and call people ‘healthy’ who manage to enjoy meaningful lives in the face of pain, illness, and mortality.
See, the thing is, health and illness, as concepts, are socially constructed.
Meaning — reality is messy. There are no clear lines of demarcation between healthy and sick. We decide — humans decide — how to label each other. And in that deciding, we reveal our biases and our unspoken assumptions about how other people live, and how worthwhile their lives are.
This is not all just pretty talk. The definition of health is at the base of how we structure not only our healthcare system, but also how we structure our society with regard to impairment, illness, and death — all of which are inescapable facts of human existence.
And while I would never propose that we stop treating illness, or ending suffering, or curing actual diseases, I would like to see these things happen within a conscious awareness of where our ideas of illness come from, in the first place.
Who gets treated, and to what end?
Are we banishing disease and improving quality of life, or are we blindly, almost compulsively, seeking to bring people in line with powerful, if latent, cultural ideals?
Why must everyone’s BMI fall within a certain, narrow range in order for us to feel comfortable?
Is this truly a risk-reduction strategy, predicated on the notion that the associations between weight and health are purely causal in nature, as well as reversible if we could just figure out how to turn down the goddamn dial on weight?
For health practitioners, particularly those enamoured with biochemical indices and relative-risk reduction strategies, the notion of one, simple solution to a myriad of chronic diseases — and possibly to mortality itself — is eminently seductive.
Sadly, I also think it’s wrong.
Next, I’ll talk more about why. In the meantime, click on comments, and let ‘er rip.