Doesn't Being Higher Weight Create Higher Risk for Health Issues?
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I’ve written about this before, I’m writing about it today, I’ll write about it again in the future because it is a core mistake/misunderstanding that is made by the healthcare system and then used to justify harming fat people.
It happens when the belief that higher weight people ARE AT higher risk for health issues gets interpreted (often by those who should absolutely know better) as “being higher weight CAUSES health issues” which is then followed by the assumption that weight loss would lower risk/incidence of health issues.
It’s also one of the most common questions I get when I give talks. The question goes something like: there is such a strong correlation between being higher weight and having health issues, how can you just dismiss that?
It’s not about just dismissing the correlational relationship between weight and health out of hand, it’s about examining the evidence around that correlation to test its strength.
To start, the relationship between correlation and causation is at the foundation of research methods (my first research methods teacher made us repeat “correlation never ever, never ever, never ever implies causation” in every class!). If two things are correlated, it means that they happen at the same time. What it doesn’t mean is that one of those things definitely causes the other.
For example, there is a very strong correlation between cis-male pattern baldness and cardiac incidents. If we assumed that baldness caused heart attacks that would be a faulty assumption. If we then assumed that making affected people grow hair would reduce cardiac incidents (creating, perhaps, a government-sponsored “War on Baldness,” blaming people for not growing hair, etc.) that would be another faulty assumption. In fact, other factors cause both the baldness, and the higher rates of cardiac incidents. That’s a common finding when analyzing correlations.
So, when we see a correlational relationship between weight and health, but without known a causal mechanism, the first question we have to ask is – what is the quality of the evidence?
We have to examine the research that finds this correlation for quality, and when we do, we find it lacking in some of the most basic principles of research methods. For example, if fat people are tested early and often for a health condition and thin people are almost never tested unless they have advanced symptoms, it’s spurious to assume that the health condition occurs more often in fat people. In another example, since too-tight blood pressure cuffs give too-high readings, and often fat people’s blood pressure is tested using a too-tight cuff, we have to ask ourselves how accurate that correlation is.
The next question we have to ask is: Could something else be causing this relationship?
In this case, there are at least three major candidates – weight stigma, weight cycling, and inequalities in healthcare (examined in Lee and Pausé’s Stigma in Practice: Barriers to Health for Fat Women for example.)
So again, it’s not about simply dismissing the correlation out of hand. It’s about the reality that until we can account for the possible impacts of the research issues and confounding variables, the correlation between weight and health has to be held in serious question.
This is especially important considering that the fallout from the extremely questionable acceptance of the correlation of weight and health as a causal relationship (and the follow-up extremely questionable assumption that weight loss is the “solution” despite about a century of data to the contrary) drives massive additional harm (looking at you Weight Loss Industry.).
That’s even more significant considering that studies like Wei et. al., Matheson et. al., Gaesser and Angadi, etc. show that (understanding that health is not an obligation, barometer of worthiness, or entirely within our control) there are plenty of ways to support the health of people of any size that have nothing to do with body size manipulation (you can find diagnosis-specific weight neutral practice guides and a resource and research bank at www.HAESHealthSheets.com)
Finally, while I think it’s worth having these discussions since so much of fat people’s treatment, including in healthcare, is driven by this, we must never lose sight of the fact that fat people have the right to live without shame, stigma, bullying or oppression no matter why we are fat, no matter what the “health impacts” might be, and whether or not we could, or even want to, become thin. That includes the right to equal accommodation, including in healthcare.
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Thanks for this. There's also the point that EVEN IF the correlation between higher weight and health issues is robust, that still does not demonstrate that causation exists, or the direction of the causation if it does exist. You touch on this with your example of baldness and cardiac events, but I think it's worth repeating!
For instance: according to my endocrinologist, there is growing evidence that insulin resistance causes weight gain, NOT vice versa. In other words, higher weight may well be a SYMPTOM of Type 2 diabetes, not a CAUSE of diabetes. If that is the case, then blaming fat people for "causing" their diabetes is as nonsensical as it would be to blame my swollen knuckles for "causing" my osteoarthritis.
Thank you so much for this post!
One thing I think about a lot is the stress-health relationship and how damn hypocritical it is for a doctor to be shaming us for our size while simultaneously saying we need to lower our stress levels. They’re the cause of much of my stress! I’m just flabbergasted that these supposedly educated professionals can’t put two and two together here.