From the Mailbag: Good News, Bad News

A Shapeling writes:

I am a biologist attending a large, well respected conference on insulin resistance, metabolic syndrome, and heart disease.

All the experiments were well designed, good solid data, and a lot of it correlates EXACTLY with the message of your blog, like the factoid I gleaned that fully 25% of Coronary Artery Disease cases diagnosed have no known risk factors- not high cholesterol, not obesity, not smoking, not type II diabetes. The fact that exercise and activity level is a better predictor of long term health than fat. That pear-shape fat (subcutaneous fat) releases adipocytokines that protect against metabolic disease, improve lipid and glucose metabolism, and positively correlate with increased longevity and quality of life.

The problem is the huge disconnect. It made me want to curl up into a ball and cry- which is what I did as soon as my husband joined me at the conference.

  • The slide that had a picture of an obese man with the caption “homo stupidus.”
  • The news that the AHA reclassified anyone over 27* (me!! me!!) on the BMI scale obese with the attendant scare-the-crap-out-of-you warnings.
  • The obese diabetic (ob/ob db/db) mouse model- google for images if you’re curious- which is considered a great way to model the metabolisms of healthy fat people like you and me and then tell us we’re all going to die and its ALL OUR OWN DAMN FAULT.

Sigh.

Sigh, indeed. Also, as I said to the Shapeling, HOLY CRAP, are they seriously moving the cut-off for obesity down to 27?!? Ten years ago, that was the cut-off for overweight! If this is true, people with a BMI of 26 have now gone from being a healthy weight to overweight to just shy of obese, without ever gaining an ounce.

You’d think things like that would make people wake the fuck up. You’d think.

And seriously, “Homo Stupidus”? Charming.

Anyway, Shapelings, have at it. And thanks to the sender-inner, as they say over at CO.

*Update: The Shapeling who says this in now says she thinks she must have misheard or misinterpreted this — or the presenter might have been from a different country. The Wikipedia page on BMI notes international variations in keeping with what she heard, but as far as we know, the AHA hasn’t changed anything recently. So if you’re American, you can exhale. A little.

47 thoughts on “From the Mailbag: Good News, Bad News

  1. The slide that had a picture of an obese man with the caption “homo stupidus.”

    But remember, they’re just doing this for our own good!

    *sigh*

  2. The slide that had a picture of an obese man with the caption “homo stupidus.”

    So, was everyone in the room of “normal” weight? Doubtful. It angers me to no end that there were probably overweight, even obese, people in that very room, seeing that awful image up there, who are just expected to suck it up and take the “joke”. Even laugh along with it. Doesn’t matter that they may be doctors and scientists…nope, must be stupid if they are obese.

    Either that or they get the “Oh, it’s totally not a comment on you! You’re totally different!” commentary. Nice.

    Grumble, grumble….

  3. OK, that slide offends me on two levels. Not only is it the obvious “fatties could be skinny if they wanted to” myth, but the ableism inherent in the label. Intelligence is highly heritable. Granted that there are environmental factors like good pre-natal care, sufficient childhood nutrition/freedom from poisons, mental stimulation, etc. that can affect how much of one’s potential intelligence one develops, but like height and weight, the number one predictor of intelligence is family history.

    Unlike the willful ignorance of those who cling to the fat == stupid/lazy/slovenly meme, true stupidity (as in low intelligence) is not something that one has much control over.

  4. huzzah, that means i can go around telling people that i’m obese and watch their eyes boggle at the thought.

    also, how, HOW can they have such a massive disconnect? and not stop and think? and be so fucking offensive?

    Theyre the homo stupiduses. *stamps foot*

  5. WTF at that slide? Seriously? HUMOR AT THE EXPENSE OF OTHERS WHO ARE NOT LAUGHING IS NOT FUNNY. That slide is offensive on so many levels and is coming from someone who *should* know better.

    *WTF IMPLOSION OF WTFness*

    If this is true, people with a BMI of 26 have now gone from being a healthy weight to overweight to just shy of obese, without ever gaining an ounce.

    HEY, that’s my BMI! I also have low cholesterol overall cholesterol with high HDL, perfect blood sugar, and I have run multiple marathons and in addition to running, swim, bike, and lift weights on a regular basis. I’m a vegetarian. I wear a size 8 jeans. Yes, I wear a single-digit size and with these changes I would be near the borderline of “obese.” BUT OH NOES I AM GOING TO DIE OF TEH OBESEETY.

  6. The local vet clinic is having a “competition” to get dogs and their owners fit. What’s the measure for this fitness?
    Weight.
    I know people aren’t rats, but my cats, who are allowed to eat more or less whatever they want whenever they want it (except they don’t really like meat – regular cat food really is all they want) are slim and lithe. My neighbor’s cat is on severe calorie restriction, and exercises *way* more, and is roly-poly.
    Good luck with that competition! (Yes, you *can* have more luck with dogs, since they’re a little more exercise-happy than cats, but seriously, couldn’t they use minutes of exercise or something?)

  7. Wow. If they’ve moved “obese” down to 27, then what’s the new cut off for “overweight” going to be? And how can people not be suspicious about the changing of these criteria? How???

  8. Yes, you *can* have more luck with dogs, since they’re a little more exercise-happy than cats, but seriously, couldn’t they use minutes of exercise or something?

    You haven’t met my dogs. :) But yeah, measuring minutes of exercise would make a lot more sense, except for TEH FATTIES WOULD LIE LIKE ALWAYS.

  9. Just want to throw in a supportive “ugh” and to say I know where this shapeling is coming from. I’m a scientist too, and I’ve now embarked on a career as a medical student. Personally I experience a special brand of frustration from all the misinformation among scientists and health professionals on the state of science surrounding body size and dieting. In my kind of professional culture it’s especially hard to assess when to let other people’s ignorance go, and when to have a conversation about evidence-based medicine and the utility of counseling patients on their weight. Cause maybe? I could make a difference to somebody’s patients?

    I’m currently skipping a lecture on how to take “non-judgmental nutrition histories” because, well, I just wasn’t up to arguing with a lecture hall full of 160 people today or patting anybody on the back for their extraordinary powers of medical empathy.

  10. I thought 26 was already overweight. Isn’t “overweight” BMI 25-30? I mean, it’s easy to forget because of how dumb it is, but I’m pretty sure that’s the cutoff. I’d love to see confirmation/more info on the change. Can’t imagine how they’ll revise the “overweight” definition.

  11. I thought 26 was already overweight. Isn’t “overweight” BMI 25-30?

    Yes, but until 1998, 27 was the “overweight” cutoff, so 26 was “normal.”

    I’d love to see confirmation/more info on the change. Can’t imagine how they’ll revise the “overweight” definition.

    I’d love to see confirmation on the change, too. But sadly, I can imagine how they’d revise the “overweight” definition. I’ve heard lots of people say we should all really be aiming for a BMI of 21-22ish, even if up to 25 is currently “normal” (and up to 27 was 10 years ago).

  12. Anita – I hear you on the kitties.

    Mine went to the vet yesterday. The vet told us that they need to be put on a diet (they are grazers) of only a half a cup a day each (they are supposed to eat 3/4 to 1 C at their size). I measured how much they ate for two weeks. They average less than a half a cup a day normally, eating as much as they want. The vet moved the goal posts down to a third of a cup a day.

    Wait – they are obviously not over eating, but the solution is still to make them be hungry all the time just so they can be smaller? These have never been and never will be small cats. Their bodies are not structured for it and one of them has a massive amount of muscle on her. But no, we need to focus on her being three pounds overweight. I think he’s pulling these numbers out of thin (ha) air. We’ll try to make sure they are active, but other than that I think I’m going to let the vet lecture me.

    And how lovely – what was once just barely obsese is now solidly in that area. Good for me.

  13. Oh, and just to add to the “preponderance of evidence,” my supposed BMI, according to the old scale, is 18.4. Which is underweight, I guess. Which is Hee-freaking-larious, because I’ve been this goddamn weight since I stopped growing in my freshman year of high school. I don’t do much exercise outside of walking to class and having sex, and I eat as much pizza and soda as I can get my hands on, so… Fuck you, BMI.

    *pumps fist in support of FA*

  14. 27!? Seriously? That’s ridiculous. Well, shapelings, we have a lot more company now, since a whole lot more people are suddenly “obese.” I guess those of us already classified as obese before the arbitrary number change are now classified as “Holy Crap! You’re not dead yet?”

  15. I’m waiting for them to create another high-end category. Overweight — obese— extremly obese– BABY-FLAVORED DONUT EATER.

    Or maybe just FATTY.

    Or UNDESERVING OF LOVE.

    Heh.

  16. Anita and Ailea: I was actually concerned about my cats’ weight since they gained it so quickly after being spayed at age 2 (long story), but I think they are training vets in feline weight control now, because my vet seriously wrote down the calorie math for me. He recommended 1/4 cup dry food a day with 1 small can of wet. I said, “I thought kitties were supposed to have food out at all times so they get free choice?”
    He said, “That is what you do for cats at a healthy weight.”
    BURN!

    Cats can’t talk and tell me if they are comfortable being a little overweight, so I did take his advice – in moderation. Turns out (as Ailea found out) they don’t eat much more than that anyway. And they are fat and happy.

  17. …Wow.

    I looked at the pictures SM linked to, and holy crap. Those people are in no way overweight, or anywhere near obese.

    What the fuck.

  18. @ emmy: I guess those of us already classified as obese before the arbitrary number change are now classified as “Holy Crap! You’re not dead yet?”

    And what about those of us who were already morbidly overweight (you know, unable to chase my kids around, leave my bed, and so on…)? What do we get to be now? I’m not clever enough to come up with a good one right now.

  19. I thought 26 was already overweight. Isn’t “overweight” BMI 25-30?

    Yes, but until 1998, 27 was the “overweight” cutoff, so 26 was “normal.”

    Oh right, duh, gotcha. Yeah, “normal” to “pratically obese” in ten years without gaining an ounce… impressive!

  20. I recently took Fang to the vet. He weighs 18 lbs. Believe me, when he jumps on my ROD while I’m lying in bed, I’m aware that he’s a big cat. Anywho . . . The vet asked me what kind of food he was on. Told her (grazing dry, usually Iams). She said, “Well, he is big-boned, but you should switch him to the light food, because he’s got a little extra weight.” I just love telling people that my cat is big-boned. HA!

  21. I have not heard about the AHA reclassifying their standards yet, so I’d like some confirmation of that before I jump the gun in reaction……but if it’s true, gees.

    I do know that some in the medical community have been advocating that the “normal” standards be ratcheted down to 22 or 23. I believe WHO has discussed doing this for Asians, and there was a study that found that risk for diabetes and related problems began at a BMI of 23 (iirc).

    So while I haven’t heard anything about revising down those BMI cutoffs for non-Asians, some *have* been suggesting that people aim for a BMI of no more than 22 for optimal health. It’s not a universal recommendation yet, but I’ve certainly seen it.

    I wouldn’t be surprised if some medicos eventually suggest changing the guidelines so that “normal” BMI ends at 22….but it hasn’t happened yet. Still, the fact that they keep lowering all these “goals” for people every few years makes me seriously ill.

    And of course, the other thing they did in 1998 was revise down the bottom of the BMI to 18.5. I know there are indeed plenty of people in that area who *are* naturally slender and perfectly healthy (they revised the cutoffs down because they didn’t want to “stigmatize” these people, how ironic considering they are not afraid to stigmatize people on the upper side of the cutoffs), but I also bet they are shrugging off some who are not healthy in the lower part of the range, simply because they are “average” now.

    I REALLY hate how they’ve politicized the whole BMI thing and used it as a weapon against so many people. UGH.

  22. And what about those of us who were already morbidly overweight (you know, unable to chase my kids around, leave my bed, and so on…)? What do we get to be now? I’m not clever enough to come up with a good one right now.

    Lilah, how about, “Pack your bags, the Grim Reaper is on his way to send you to the big donut stand in the sky.” Because according to some medical experts, we should already have croaked thanks to all our fat.

  23. …I’m obese now?
    Shenanigans. What’s the fucking point of that? Ooga booga!
    And way to throw TONS of people with ED into a downward spiral. I can’t fucking imagine what would of happened if someone would have told me that 5 years ago.
    Why can’t people just be? Why does there have to be a stupid arbitrary scale to classify people into rigid categories? Everyone is so different and beautiful. Shouldn’t pretty much everyone fall into the Normal category?

  24. Carleigh wrote: Why does there have to be a stupid arbitrary scale to classify people into rigid categories? Everyone is so different and beautiful. Shouldn’t pretty much everyone fall into the Normal category?

    Goodness, if everybody was normal, then the media and big business and big medicine couldn’t manipulate people into feeling horrible about themselves and then promise them instant eternal happiness by selling them more diets and pills and tell them how to run their lives for the benefit of big business.. And then when those diets and pills don’t work, they couldn’t blame the consumer for “doin’ it wrong” and sell them more and newer diets and pills. My goodness, if we were all ok and and normal, that endless money train might actually have to stop! Then where would we they be?

    (Need I even say that this has the sarcasm stamp all over it?)

  25. wellroundedmama, I just googled and also discovered I couldn’t find this story online. Oh well, I’m obese or I’m not. Good grief, don’t people have better ways to help people be healthy than categorizing people and then telling them they’re BAAAAD.

    In other news, I just got three job applications off today. And, Interfolio is a money-sucking racket. HATE!! I can’t believe they fucking charged me $6 to send a three-page confidential recommendation somewhere at domestic rates. This is AFTER I paid their stinking joining fee. Hey, geniuses at Interfolio: if it costs me MORE to send a document through you all than it would to do it on my own, AND it’s on uglier paper, then WHAT THE HELL AM I PAYING YOU TO DO?

  26. Oh, sorry Kate, was commenting at the same time as you… yes, I now realize that we’re awaiting confirmation.

    Also sorry for bad punctuation. And for following up a comment with an apology, which I’ve said I wouldn’t do. In my own defense I’m frazzled and I have a 4-year-old next to me saying “Mommy. Does this look like a good face? Does this one? Mommy. Mommy. Mommy. Look. Mommy. Is this an angry face? I don’t want an angry face.”

  27. You know, I comment sparingly here because while I consider myself fat, at the moment, I wear a 14. (I’m gaining weight and will probably be in a 16 shortly.) But my BMI should be about a 27 so I guess I’m obese if they go to the new standards! Cool! Maybe if they actually do this there will be a huge backlash as people realize how ridiculous the BMI is.

    I wonder how much of the “obesity epidemic” is to take our minds off everything that’s going on with the government and the economy? If all we worry about is dieting (and who can really think straight when they’re starving) we aren’t going to question what’s going on around us. Yes, yes I am a little paranoid? Why do you ask?

  28. @LilahCello – Maybe we are Deathly Obese? Maybe in a Halloween red-blood-dripping-type font?

    Obviously my doing aerobics and lifting weights and walking are all a total LIE, since I can’t get out of bed and will soon die ;)

  29. *Snort*

    I have an ongoing debate over HAES with my martial arts instructor. I think I’ll tell him tonight that at 6’2″ and 220 lbs., he’s now obese. That’s pretty funny.

  30. Hmm, it seems that I am now potentially obese. They really should make some sort of announcement soon, so I’ll know whether to drop dead in a pool of baby donuts or not.

    Deathly obese…*snort*

  31. This may be deleted, I realise, but there isn’t anywhere appropriate for it. Had thin person moment of fat-hate backlash recently. Cried after explaining that thinness isn’t be all and end all of universe. 4yo daughter asked if I keep getting thinner will I be as small as a baby and how will I lift her? Also, she’s now worried she will stop growing and get smaller and vanish.

  32. ((((((Alibhe))))))

    I have a 4 y.o. and I can imagine that conversation. Recently my son said, “But thin bodies are okay too, right?” I think I had been pushing the point a little too hard. It’s amazing what they pick up from us, and what they make of it in their active little minds. Amazing, and daunting. I wish we could get our kiddos together; they sound similarly precocious.

  33. The American Heart Association isn’t one of the organizations that makes the widely quoted and followed BMI standards anyway. That would be the National Heart, Lung, and Blood Institute and the CDC (who at some points have shifted their standards to comport with the World Health Organization). Which is not to say that the AHA and research they conducted/funded didn’t play a role in the setting and re-setting of the BMI cutoffs, but whether anything they say unilaterally will have a major effect on people who practice medicine and public health is uncertain. I wouldn’t worry about it.

    Frankly, looking at the papers and reports of the agencies that have made the current BMI standards and trying to follow the references back to find out where they come from, I don’t understand why they didn’t put the “ideal” cutoff at 22 in the first place. The claim in these reports is that the cutoffs are based on the association between increasing BMI and increasing mortality risk (which, of course, more current research has brought into question, but this apparently is what they were looking at 10+ years ago). But if you look at their references, they show a fairly flat line of BMI vs. mortality risk for BMIs up to 22 and a continuous upward slope from 22 on up. So what’s magical about the 25 point on that upward slope? No idea.

    I don’t think it’s in any way *reasonable* to expect or encourage everyone to have a BMI under 22, nor is it reasonable to expect or encourage everyone to have a BMI under 25. But I can see why one might want to be able to say “people who happen to have this characteristic have a significantly lower probability of XYZ than people who happen to have this other characteristic” (e.g. people who happen to be men have a significantly lower probability of developing breast cancer than people who happen to be women. Doesn’t mean we should try to make everyone men, but might influence our behavior in other ways). But I don’t understand how the current cutoffs meaningfully accomplish even that much.

  34. I’m so glad to read all your comments right now, and it’s sadly funny that this post came up today, because TODAY I went to a new primary care doctor – the first time I’ve been to a GP in more than a year. It was a hard day.

    My size 20 butt just barely fit into the waiting room chairs. That’s a pretty small chair.

    There were a bunch of different brochures out, supposedly talking about treating disease but really advertising medicine, and there was one for that weight loss drug, Alli.

    I got weighed for the first time in years and tried to have a FA attitude about it, but I have to say I didn’t completely succeed. I’d gained about 50 lbs since the last time. Also, my BP was a little high, which is hereditary in my family, both from my thin father and fat mother. I was trying to tell myself it was not from gaining the weight, and that I am beautiful at this weight, but that awful little I-hate-my-fat-self voice would not shut up.

    When the doctor was ready to see me, it was NOT the one I had made an appointment with; instead, it was his partner. I had spent hours this morning doing research and reading reviews about drs in my area and I had chosen the other guy, NOT the partner. But whatever, I was there and I was sick so I saw the guy.

    Since it was an initial visit, I had filled out a bunch of forms with medical/family history and I told the Dr. about my other health issues (as well as the ear infection I went in for). I let him know that I had gained weight and wasn’t thrilled about it – I guess it was a defensive measure to say it first before he mentioned it. Anyway, I should have just shut up because once he started talking he was very negative about my weight, and I felt like my comment which was supposed to fend him off just gave him justification for harping on it.

    One of my health issues is that I get VERY crabby and unable to focus when I get hungry, and if I wait too long to eat I can start acting weird and cry and refuse to eat anything. But if my husband gets me to eat something, I get better quickly. I think it might be hypoglycemia, so I told the Dr I wanted my blood sugar tested. His response was that it isn’t good if I need to eat frequently, because of my weight. WTF!!!! I said very sharply, “Just because I’m fat doesn’t mean I don’t have to eat!” Admittedly, he ordered me a fasting blood test to test my sugar, but it seemed like he was more worried about me getting fatter than about my blood sugar!

    Another issue is that I started having knee and foot problems about 5 years ago, back when I was a very trim size 12 and dieting (and unhappy) and going running. These problems have made it harder to find exercise I can do but still like. But I stay pretty active – I walk my dogs as much as I can with my bad feet, and do exercises and stuff. Anyway, I’ve started getting plantar fasciitis in combination with my other crap and guess what? The Dr thinks it is my weight that’s causing it. And I believed him.

    Thank God for this website, because now I’m revisiting it and realizing that maybe it’s because I’m on my feet all day at work, and that most of my problems STARTED when I was at my thinnest. I know professional athletes have a lot of plantar fasciitis. Except maybe for some linebackers, I don’t know of a lot of them who would have a dr attribute their injury to their WEIGHT.

    Anyway, a lot of other things made me uncomfortable in there (like the fact that when I mentioned my hubby and I are thinking of having a baby, he said that at 33 years old I didn’t have a lot of time to decide). But I’ll leave it at this.

    Thanks for the opportunity to vent and for some catharsis! And thanks to those few but wonderful doctors and scientists who don’t believe the fat = homo stupidus and death CRAP.

  35. Wow, guess I was super late to the party, there’s been like three updates. ^_^

    I love how the mice “prove” that “it’s all our fault.” Obviously, mice share human Puritanical views and morals about how to “take care of themselves” and “choose” to overeat, which causes their problems. Because anthropomorphism is only a mortal sin when it means we might have to consider the ethical implications of torturing animals for money, er I mean science. Genes only predict, you know, everything else about you. Not your health. That’s ALL you. You unhealthy slob. Because there are moral values implicit in your health.

    Wow. My brain hurts.

  36. I see that it’s been disproven, but I am totally obese if this change ever happens. 27.1, baby! Ten years ago, that would have barely squeaked over the “normal” line. Oy.

  37. wellroundedmama said:

    I do know that some in the medical community have been advocating that the “normal” standards be ratcheted down to 22 or 23. I believe WHO has discussed doing this for Asians, and there was a study that found that risk for diabetes and related problems began at a BMI of 23 (iirc).

    As if the BMI wasn’t offensive enough, now it’s going to be racist too? Yikes.

    Since I’m half White and half Asian, would I take an average of Asian “normal” and White “normal”? *eye roll*

    Also, I can’t get over the “homo stupidus” slide. Coming from people who are supposed to be some of the smart ones…

  38. @Epiphenomena:
    “I’m currently skipping a lecture on how to take “non-judgmental nutrition histories” because, well, I just wasn’t up to arguing with a lecture hall full of 160 people today or patting anybody on the back for their extraordinary powers of medical empathy.”

    I think it’s quite telling that they’d have to offer a class in non-judgmental methodology, which assumes that the default is judgmental.
    Also, you have my unconditional support and praise for just … even … dealing with med school and I hope someday to have you as a doctor.

    @Carleigh:
    No. Because then no one could feel superior, and also, economic skies would fall. Dogs and cats, living together, mass hysteria. You know the drill.

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