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A few considerations about health and body size

by Sam Killermann · 10 comments

in Op-Ed

I wrote an article and apology yesterday about a poorly-thought-out graphic I posted to IPM’s Facebook page.  One of the things I mentioned was how I don’t know nearly enough about this whole health and body size thing to be dabbling around in these waters, and there was one thing in particular that concerned me.  Before I get to that, I want to reiterate something:

I do not condone or support fat-shaming.  I think that we should be loving and supportive of one another regardless of body size or type, as well as all the other identities one possesses, because I believe that the one of the greatest sources of health comes from loving oneself.

However, one of the comments on the errant image I posted troubled me.  It was something along the lines of “some people are naturally overweight, which is healthy for them” (unfortunately, I can’t get the actual quote because I deleted the image).  This statement struck me as suspicious, because everything I know about health says otherwise.  The commenter also provided a link to a book, Health at Every Size, by Dr. Bacon (no joke, her actual last name), which supports the claims that being “overweight” is okay as well as a few other new-to-me concepts regarding weight and health.  As I mentioned, I’m not that well-versed on this stuff, so I wanted to run this by someone who was.

In an effort to understand this better, I asked Eric Teske, an old classmate and friend from grad school who knows a lot and more about health, fitness, and nutrition, to the point of earning a master’s (sport behavior and performance) and a bachelor’s (exercise science) studying the stuff, what his thoughts were on the book.  Below is Eric’s response:

The fact is, being fat is an independent risk factor for morbidity. That means, controlling for things like diet, family history, occupation, sex, age, gender, race, level of stress, cholesterol levels, whether or not you smoke, etc. Whether or not you do/have or do not do/have any of those things, you are still more likely to acquire a debilitating medical condition if you are carrying fat.

Or, as the National Institutes of Health says: “The presence of excess fat in the abdomen out of proportion to total body fat is an independent predictor of risk factors and morbidity.”

“Higher morbidity in association with overweight and obesity has been observed for hypertension, type 2 diabetes, coronary heart disease (CHD), stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems and some types of cancer (endometrial, breast, prostate, and colon).”

How much is genetic?

“Recent studies of individuals with a wide range of BMIs,
together with information obtained on their parents, siblings, and spouses, suggest that about 25 to 40 percent of the individual differences in body mass or body fat may depend on genetic factors.”

However, the fact that up to 40% (or even as high as 70% in a few studies) is genetic predisposition doesn’t mean that the health risks go away. It just means it especially sucks for those people and they have all the more reason to watch their calorie intake. (Not your fault [not equal to] not a problem).

If someone has a BMI of 30 they are 50-100% more likely to die “from all causes, and especially from cardiovascular disease” than someone with a BMI of 20-25. So basically if you are obese, you are twice as likely to die.


Now while I wholeheartedly disagree with the notion of “health at every size” I support the themes of loving yourself, gradually changing your behavior rather than crash dieting, and learning to love moving rather than starting and failing at a specific workout program.

People will always buy a book that tells them they can eat what they want and that it’s not their fault and not a problem that they are obese and out of shape — but frankly this can create more problems if people are told to not believe what scientists say and that they don’t need to lose weight, when losing weight might just save their life.

The reason I’m sharing this is because I absolutely do not want to support any type of socially or emotionally harmful behavior on this site, but I also don’t want to encourage anything that is physically harmful either.  While I do not think we should target folks, ridicule them and judge them for their weight, I also think we should be careful about believing things like Dr. Bacon’s Health at Every Size, as it might also do far more damage than good to our physical bodies.

I guess the biggest lesson learned from all of this is the age-old measure twice cut once.  Before you do something, or believe something, you might want to give it a second thought or investigate it further.  I will be sure to do so.

Written by Sam Killermann

Sam is a writer and performer who uses those skills as an ally to advance progress in the realms of LGBT equality and social justice. He tours the country speaking to college students about stereotypes, prejudice, and oppression, and writes for this site when he's at home in Austin, TX.

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  • switcher

    Thanks for this article! I love the idea of “love yourself no matter what”, but I want to be alive long enough to love myself. I have a genetic predisposition to being overweight. Not a medical condition, but I have a slower metabolism than other people. So while my best friend can eat six slices of pizza and not gain a pound I eat 1 slice and gain six pounds! I’m glad your friend pointed out that just because its not your fault doesn’t mean you get to ignore it. 
    But I want to add something. I think sometimes we get so caught up on wanting to to be “skinny” we forget about healthy. My brother is super thin, looks muscular enough, and dresses nice so when he drinks beer and eats pizza and nachos nobody thinks twice about it. I’m heavier, so when I eat nachos, i get the judgement like “ugh get a salad!”. Well, we both had our cholesterol tested and because I’ve been aware of my food intake because of my weight I am actually a hell of a lot healthier than him. He has high cholesterol. 

    My point: don’t be obese. But even if you’re skinny, don’t be unhealthy.  

  • Megan Vermillion Kean

    Let’s just pretend for a moment that there was no weight bigotry in our society; all shapes and sizes were treated equally and nobody was shamed for their body size.  (Wouldn’t that be nice?)  If that was the world we lived in, then wouldn’t the health of the person be of the utmost importance?  

    The heart of the matter is, it’s really not just a weight issue.  People at every size and at every weight category are at risk for heart disease, high cholesterol, diabetes, etc. Everyone dies, not just fat people – skinny people die of these illnesses too.  And everyone has morbidity risks that are unrelated to weight – some genetically defined, some defined by behavior.  Why, then, is it the public’s concern to regulate and judge people who carry more fat?  Why aren’t we regulating and ridiculing all people who eat badly, or have other risk factors that increase their morbidity?  The answer is, it’s because weight is something that is easily recognizable on first glance.  Things we can determine about a person at first glance are often the features that get the most scrutiny and discrimination – i.e., race, gender expression, height, age, physical dis/ability, etc.

    Eating unhealthy and lacking physical exercise does not always lead to obesity.  Some people can eat fatty, greasy foods every day and not become obese…but they ARE unhealthy, so why aren’t they shamed?  What about a person who is obese but has eaten only fruits and vegetables for many years, exercises daily, and has no known health complications?  They still get shamed because people assume that they are unhealthy and therefore deserving of ridicule.  

    If your friend concedes that 40-70% of weight factors are determined genetically, then that also means a large percentage (perhaps even a majority) of people can eat things that are bad for their body, not exercise, and STILL maintain a ‘healthy’ weight.  The obvious answer to me is to stop focusing so much on weight and start looking at the real, underlying health of the person which cannot be instantly determined by stepping on the scale.  In other words, health at every size.

    • Samuel Killermann


      The big gist of what you’re saying here is something I’ve always been frustrated by: the idea that a certain “weight” is healthy, objective, and should be aimed for.  I think it’s somewhat frivolous because, like you, I know plenty of folks who eat absolute garbage and never gain a pound, while I eat incredibly healthy and still have to exercise to fit in my pants.  Further, I know plenty of gym-jockies who weigh FAR more than they are supposed to based on their height, but are exceedingly healthy.
      The bigotry comes in when, like switcher mentioned, you have two people eating the same thing (one thin and one large) and you watch the judgment roll in.  If a large person orders a double cheeseburger with large fries and a large soda, eyes will roll, but a thin person can do the same and likely not provoke a response.  That’s not cool.  They are both wreaking the same amount of havoc on their body with that meal.

      However, trying to navigate this issue is like driving a ship through a rocky lagoon in the dark.  According the an article I was reading in the Economist, the CDC put the cost of obesity in America at $147 billion in 2008, a huge strain on the health-care system.  To mitigate that, we have two major politicians arguing for two distinctly different political approaches, Bloomberg in NYC criminalizing large sodas and Michelle Obama in the White House pushing organic farming and vegetables/exercise for children, and both have been meet with mockery and labeled as sizeist by many bloggers.

      We clearly have a very real issue with health in the US (and several other developed nations).  I wonder if there’s an inclusive way to approach it.

      Thanks again for commenting, here, the other article, and on Facebook!


  • Blair Bear

    As a followup, thank you for your apology, you’re doing good work here.

    The idea of Health At Every Size isn’t that you can eat whatever you want– I was skeptical too, when I made my first public Sizeist Internet Gaffe and was called out on it, so I know what it’s like!– but that some people can eat healthy, exercise regularly, have healthy cholesterol, etc. and still be fat… and that *this is okay*. The dieting industry would not be worth billions of dollars if it was easy for everyone to lose weight and be a “normal” size. Some people have an equilibrium weight that BMI would consider overweight or even obese but to get into “normal” range, these people would literally have to be on a starvation diet, forever.

    Medical studies tell us that being overweight is a risk factor for health complications, as your friend says. Totally not in dispute. But there are two things to consider here– a risk factor is not a death sentence; it’s a probability, not a certainty. This means that for a lot of people, being overweight leads to serious health problems– but for the other portion, it does not. The second thing is, how is being “overweight” defined? The common method, BMI, is actually fairly flawed and was originally devised as a *statistical* measurement; even today, it is still fairly arbitrary and is defined in different ways in different countries. For many people, the case might be simple: their equilibrium weight is in the “normal” range, they gain weight due to inactivity and go into the “overweight” range, they develop health problems. But anecdotally, I have been exposed to the testimony of many people who have been fat all their lives, physically fit and testably healthy– and continuously bullied, shamed, body-policed and food-policed because of their large bodies. Weight changes are a normal part of life and it’s time we stopped
    ascribing specific, damaging motivations to different body states.

    Basically our thesis is that there’s a difference between being fat and being overweight. Consider the olympic weightlifter, Cheryl Haworth– I’m sure she would be considered “obese” if someone just saw her on the street. And I’m sure there are more like her.

    But leaving all that aside– let’s say that the science is rock-solid and incontrovertible and all fat people could lose the weight and being fat is completely unhealthy and you will always die from it. It’s still *none of our business*. We have lost the privilege of commenting on other peoples’ body size and eating habits due to the utter insanity and saturation of the media– the constant bullying of fat people, the constant fad diets that don’t work, the shaming, etc. etc. etc. It’s time to stop. Humans engage in all kinds of risky behaviors; we can comment on and attempt to regulate the behavior of people whose habits (drinking, smoking, etc.) affect others, but your average overweight person *does not affect my life*. It’s none of my business. Real psychological damage is being done, not just to fat people, but to everyone, by this obsession with weight that pervades our society. So I, and others, have stopped participating.

    It is more important that everyone feels good about themselves and their bodies (and therefore *empowering* them to make changes to their lifestyle if needed) than upholding the toxic, shaming atmosphere that has arisen that hurts everyone.

    • Samuel Killermann

      Thanks, Blair, I think you bring up a lot of really great points here.  The science side is one that I barely want to touch, because I’m not qualified to talk about it, and the more I read about nutrition science the more I begin to believe that nobody really is.  It’s amazing how little we actually *know* about this stuff, and how controversial even that all is.

      Up to this point, I only have a couple of things that are still bugging me, so perhaps you can help me sort through them.  I’d really like to find a way to reconcile all of this with my internal value structure (

      I completely agree with the people live risky lives in so many other areas, and it’s not for us to stop them (I’m not in favor of illegalizing sky diving, or, a sport that actually causes more injuries every year: golf).  It’s not affecting us; it only affects them.  It’s not our place to intervene.

      But there are two areas where the obesity thing isn’t just a “their” thing thing. 

      One example of this is childhood obesity.  I feel a compelling urge to care about that, and to want to intervene, because I don’t believe kids should be expected to be able to understand the implications of unhealthy eating habits, the possible long-term effects, and then weigh those decisions when they are deciding between an apple and a side of fries.  And in many cases from my childhood, the options just didn’t exist for kids in some homes.  I remember loving going over to certain friends houses because snacks were catered by Hostess and dinner was always fried and covered with cheese.

      And the other example, and one that I’m still trying to get a good bead on, is the impact of obesity on the health-care system and economy.  Read this for an idea of what I’m talking about:

      • FloraJL

        First let me tell you how much I appreciate trying to get a true understanding of the issue. This is something I’ve been trying to learn about also.

        Like the above commenter, I follow Dances With Fat blog. The following is a cut-and-paste from her “Things Obesity Is Not” blog post which helps to answer your question. She may have a more in depth post that I haven’t come across yet.

        Obesity is correlated to a number of diseases so it is considered a “risk factor” although the term is used loosely since there is no proof of causality of risk, it’s as if they found out that short people get a certain disease more often but they have no idea why so they say that shortness is a “risk factor”. At any rate, a family history of heart disease is also considered a risk factor. The calculations that are commonly used to show the “cost of obesity” are often based on the assumption that obese people will get every disease for which they have a risk factor, or that every disease they get is caused by their fat. This is exactly the same as if we calculated the cost of people with a family history of heart disease based on the assumption that they are all going to get heart disease, or that any heart disease they get is caused by their family history. It’s just poor research.
        Besides which, an attempt to calculate the cost of a group of people based on how they look in order to make a decision to eradicate that population because they’ve been deemed to expensive is clearly dangerous and wrong.

  • Korena

    You should check out Dances With Fat. She has a lot of posts about studies about weight and health, including one that showed that people who have healthy habits (eating fruits and vegetables, exercising, not smoking, drinking minimal alcohol) have equal risk factors, regardless of their weight.

  • MooBoo22

    I would say pound-for-pound, it is better to be overweight than underweight.  For example, it is far better to be 30 pounds overweight than 30 pounds underweight.  Also, most people can be more than 100 pounds overweight and still be alive, but people start dying quickly once you reach 100 pounds underweight.

    However, the best thing to be is your ideal weight.  This varies for people’s height, but an ideal body should have a small amount of body fat and a reasonable amount of muscle.  I have a very fast metabolism and have always been very skinny.  I eat a high protein vegetarian diet and work out enough to keep myself from becoming too underweight.  It is a constant struggle and I was routinely made fun of by other guys for being so thin.

    I agree body shaming is not fair and can be very dangerous, but pretending your body weight (in either direction) is in no way connected to your health is an absolute lie.  It is like folks who believe smoking is not bad for you.  Just because some folks who smoke never get lung cancer does not mean it is a danger-free activity.  Similarly, some folks can be overweight their whole lives and never suffer consqeunces, but they are the exception to the rule.

    Everyone should want to be a healthy weight because they love themselves and want to live long lives, not out of vanity.  Likewise, we should always encourage people to be a healthy weight because we care about the quality and length of their lives, not because we care about how they look.

  • Matthew Huntington

    I disagree with your friend.
    It’s not that fat people tend to get sick. It’s that sick people tend to get fat. Heart disease is a big one for that. If you have a bad heart, you’re not going to get any exercise, and you’ll gain weight. I know, shocking, isn’t it?
    If you exercise and eat right, it won’t matter what your weight is. Your body will find its own happy medium.