Health At “Every” Size

Fallacy…or Fact?

I don’t remember where I first encountered this claim; the notion that one can be ‘healthy’ no matter what the scale read. My initial thought was, ‘well, that is some horseshit.’ That has been my experience. Everyone in my family who was obese, was also diabetic, on blood pressure medication, on cholesterol medication, and looked unhappy and somehow, frail. So how could someone be huge and healthy?

I seem to have remembered finding out about a normal-looking Ashley Graham who was a plus-sized model, followed by my cousin’s wife publishing a book about how Jesus just loves fat women. Of course He does. He loves everyone. So, I didn’t purchase that book because I thought it was a pretty intense cope, not to mention blasphemous, to claim that the God of the Universe wanted anyone to be unhealthy. It sounded about as theologically credible as postulating that God wanted someone to be an axe murderer. Whatever helps you sleep at night, my people.

As someone who’s fought, bled, sweat, cried, exercised, and attempted a variety of diets with the intentions of becoming a more healthful, attractive, and svelte version of myself to no avail - the idea that what I weigh has little to no effect on my all-cause mortality intrigued me. As ever, I wondered if what I were reading were true. I intuitively didn’t believe it to be true. But I didn’t want to dismiss it altogether. Perhaps there would be some nuance included in this theory, but I haven’t seen it yet. The only people I’ve witnessed pushing this concept are plus-sized influencers on social media. I am not sure I find their ideas as credible as I’d like. There is a whole body positivity movement, a crusade to stop fat-shaming in society-at-large.

Pun intended.

Everyone knows skinny, thin folks who seem to have hit the genetic lottery. People whose bodies don’t seem to acknowledge just how much food they take in - they can eat whatever they like, how much of it they desire, and whenever the mood strikes - and the bliss of never having to worry about gaining an ounce. No consequences for their gluttony, so it would seem. I won’t lie, I cannot stand these people. I have such difficulty empathizing with people who have never tried on clothes that didn’t fit right. Looking physically fit and outwardly healthy without putting in any real effort to do so for your entire life? Luck like that should be a quality that’s frowned upon, but nobody said life was fair.

Then there are the fit people who have become obsessed over their physical appearance, and so they track every calorie. Every macro, every morsel is accounted for by the ledger they have trained to permanently reside in their brains. They don’t always trust that, and so they buy food scales, ration their food for the week, and rarely if ever take a chance on takeout. If they do, they call it a “cheat” meal, after which they flog themselves again with more training. They already look flawless, but they will somehow find an imperfection and focus in on that. They will spend hours in the gym fatiguing their muscles, ramping up their heart rates on the treadmills, clad in sweatpants and hoodies. Chugging protein powder, measuring out electrolytes into their water so they don’t become dehydrated during their punishing sessions. We all know of someone like this, and despite how happy and fulfilled they say they are - the enthusiasm and satisfaction spilling from their mouths never quite reaches their eyes.

So where is this mysterious happy medium? Where does the enigmatic fulcrum settle itself of the scale between vibrant health and imminent danger?

Photo by Kelvin T on Unsplash

Let’s find out.

What qualifies someone as healthy or not healthy? You probably want to answer with a multitude of widely variable factors, and I’d agree with that. It isn’t simple to just look at a single set of numbers to determine whether or not someone is truly healthy. But that’s what we are reduced to when it comes to our health insurance companies. Everyone uses the Body Mass Index, which is a misleading acronym. They don’t qualify what makes up the body mass - they average out your height against your weight. That’s all. There is no attention paid to activity levels, smoking status, drinking habits, drug habits, diet habits, muscle mass, ApoB, VO2 max, or your A1C. Now, your physician might care about those numbers, but your insurance company doesn’t - and they determine how much you get to pay them based on your “risk” levels. Let’s assume you’re familiar enough with health insurance companies to know how they have to operate and keep moving forward. They aren’t in business to ensure your health, they’re there to get paid and to pay out as infrequently as they can. This means even if you’re an active, clean eating, tax paying, law-abiding citizen who’s a solid block of muscle… if your BMI puts you at a Grade 3 of Obesity, you get to pay as much as if you smoked four packs a day, mainlined heroin and engaged in unprotected intercourse with HIV+ male prostitutes each and every weekend.

To be fair, as of this date, most people in the Western first world countries - particularly the U.S., must be classified as overweight. Look around you. Go to the local fair. Watch the folks waddling around. Never mind that - you could go to any Costco on the weekend and see what I am talking about. Maybe like me, you only need to look in the mirror to see an overweight American. I am not being hard on myself, now. I am simply identifying which class I am in, and I know I am far from alone when it comes to my size.

Knowing there are different classifications of obesity helps me judge people (including myself) much more specifically and accurately, which is great for statistical science -and that’s about all. There doesn’t need to be any emotion attached to these levels. In case you’re curious, here is a key to how the authors of one of the studies classifies the levels of weight classes. This seems to be the industry standard, so keep these numbers in mind.

…overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25)…

My suspicions about where the needle starts to dip on the ‘Health At Every Size’ claim is on the folks who hang around the grade 3 obesity level. Now, being that I can appreciate what muscle mass does as opposed to adipose tissue, I don’t automatically assume that thicker, sturdier people are more prone to cardiovascular or any other disease, no matter what the BMI charts and studies are saying.

However -If you are a person with little to no muscle mass and your BMI is over 35, my assumptions and suspicions are going to lean more toward the fact that you have cardiovascular disease, diabetes, arthritis, bowel issues, and a host of symptoms that might lead you to believe you’ve got post viral syndrome, fibromyalgia, chronic fatigue syndrome, or some autoimmune issues. I’m not your doctor, I’m not a doctor at all - and thank goodness for that or I’d have some self hatred for being the third leading cause of preventable death in the United States. But, I am one who notices patterns. And I have also thought a pattern of no muscle and lots of fat doesn’t add up to anything healthy in my book.

Multiple studies agree with what nobody paid me to find out: Muscles lower mortality risks by neutralizing the diseases ordinarily associated with obesity. The more muscle you have, the better off you are - to an extent. Too much of anything isn’t good for you, so I suspect. And yet, I see so few people these days with any muscle structure out here in this world. This is one of the best arguments for building muscle I can find.

Muscle mass mediates associations of BMI with adiposity and mortality and is inversely associated with the risk of death. After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range. These results provide a concrete explanation for the obesity paradox.

Low muscle strength was independently associated with elevated risk of all-cause mortality, regardless of muscle mass, metabolic syndrome, sedentary time, or LTPA among US older adults, indicating the importance of muscle strength in predicting aging-related health outcomes in older adults. https://pubmed.ncbi.nlm.nih.gov/29641540/

In other words, even if you’re a little bit chunky - as long as you’re strong - your obesity doesn’t contribute to an elevated risk of early death. You are on par with those with a normal range of BMI. There are even studies proving that people with normal to lower BMI having a worse risk for mortality than those with a higher BMI. The notable factor in making the difference? Muscle mass.

Photo by Tejj on Unsplash

Movement, muscle, nutrition, and mental health- these factors are also important as we all know. Muscle is not what’s being included in the discussion when it comes to the Health At Every Size. Not even a whisper of it. Most of the Body Positivity advocates simply push the posterior of some large, immodest female of indiscernible ethnicity in your face, tell you that this is what’s being called “healthy” now, and basically you can’t criticize, question, or mock this message or you’re a racist bigot.

I don’t know about you, but I never remember spending much time mocking fat people. Most of us are fat. Most Americans are huge. The average woman in the US is now a size 14. Just a decade ago, the average size for a woman was a 10. This isn’t cause for celebration. This isn’t something we should quietly accept. We just came out of a three-year operation in which we saw obese people struggle the most with a virus. Much more than the elderly, and way more than the children we were all allegedly “protecting.” Obese people were hit hardest, but not by the people on the social medias. They were hit hardest by their lifestyle, which includes isolation, eating, drinking alcohol, and being unable to get through a flu without complications. Don’t bother coming at me about this. It’s being widely admitted at this point. I just can’t stop with these puns today.

This doesn’t change the fact that most people have a weight problem. Nobody is harder on most fat people than themselves. We have tried hating and depriving ourselves to a normal weight, because most of us are uncomfortable with how we feel and especially how we look. We aren’t out there making fun of any other fat people, we certainly aren’t afraid of them, but we are concerned about the effects of being obese has on our own health and the health of those we love. The body positivity movement seems to be more preoccupied with turning even more people into villains, just because we don’t want to be lied to about what’s truly healthy.

The facts remain that fat people are not healthy. Our bodies are miraculous at trying to keep us alive, heal us, and stave off illness and disease. And yet, our attempts seem to be thwarted by everything from the minerals being depleted from the soils we grow our food in, to industrial chemicals being leaked into our water supply. Food has never been more available, but most people are truly not bingeing and overeating themselves into obesity. There are ingredients used liberally here in everything from bread to milk to cereal to meat that are banned in every other country. There are ingredients known to induce cancer and diabetes that are subsidized by our own government. Not that these are excuses, but it makes an uphill battle even more arduous.

Fat people do not want to be fat. But so few people understand that it is much easier on us to just stay fat than it is to work twice as hard as a thin person to be healthy. When you’re a certain grade of obese, you are more depressed. You are hopeless. Your hormones don’t work efficiently, and you don’t absorb nutrition, let alone use the necessary vitamins and minerals and proteins and fats you take in. And let’s not get too deep into the lack of intimacy that often accompanies being a large person. It’s not that you can’t find someone to keep you company - it’s that your intimate parts simply don’t work well enough. https://pubmed.ncbi.nlm.nih.gov/37454073/

(Side note: I believe there are some seriously sinister reasons for this increase in obesity, especially since we are watching fertility rates plummet and the story of a couple who is having trouble conceiving isn’t rare at all. But that’s a story for another day.)

From what I’ve read, listened to, and witnessed firsthand, it is impossible and a lie to tell people that you can be healthy at “every size.” But it is entirely possible to become healthy and start a journey towards health at any size. We need far fewer influencers telling us to accept that we are fat, and perhaps more influencers telling us why it is vital, and why we can build muscle even if we are already fat.

But their answer is - stay hugely fat, or get surgery. I am not a fan of gastric bypass, gastric sleeves, or any drastic surgeries despite how they are often the only way many morbidly obese people can resolve their weight problem. I would much rather these people move, build muscle, and track their caloric intake, and make sure their bodies get and absorb the nutrients they are lacking. Once you permanently remove your body’s ability to absorb nutrients (by removing the sections of intestine and stomach that perform this job for the body), you render the patient to be forever dependent on pharmaceutical sustenance. This takes away their freedom of choice, autonomy and independence, and I find that reprehensible. They tend to regain their weight. They heal much more slowly, if at all, from infection. They’re astronomically more vulnerable to sepsis, and the numerous risks associated with any invasive surgery.

I have watched the vitality fade from people after getting the gastric bypass. I have seen them destroy relationships, never fully recover from slight scrapes and bruising, develop blood clots, and never let themselves be too far from a clinic or hospital “just in case.” But all this was okay by them and their provider, because at least their BMI was finally “normal.”

BMI was never supposed to be the final say-so on the health of a person. It was never supposed to be the metric by which you judge a person’s vitality, longevity, and mortality risk. How could it be? It is a number that tells you how tall you are, and how much you weigh. Not what that body mass is comprised of. Granted a lot of people with higher body mass are mostly made up of adipose tissue. And yet, there is a stark contrast with those who share that same body mass index, but their mass is a much higher percentage of muscle. And there are over 3500 search results on PubMed that will show you how much better you will fare if your muscle mass makes up a significant portion of your body mass as a whole.

The fulcrum between health and imminent danger is ultimately how well you are able to move, and to keep a decent slab of muscle on you. Build that buffer of protection any way you can, and move. If you can’t move, you die. Eat whole food, get as much of it locally grown as you can, and prioritize protein. Building muscle takes protein, preferably animal protein. A lot of “body positive’ influencers are vegan or vegetarian, and they claim you can utilize protein from plant sources as well or better than animal protein. This, like their claim being healthy at every size, is unsurprisingly a lie. The best protein you can get is from a ruminant animal (cows, deer, elk, bison, goat, lamb) that’s processed your food for you already - so you absorb much more of that protein than you would otherwise. I didn’t mean to turn this into a diet post. But I cannot under emphasize how important getting enough protein into your diet on the daily will improve your life.

That should be the message of the “Body Positive” influencers, but it isn’t. They are there to peddle the same load of horseshit as everyone else on the socials. “Be vapid, be vain, be a consumer, engage in meaningless behavior, YOU DESERVE IT!”

I am here to ask you to question the messages that you’re consuming on these platforms. That’s what I do. And once there is more of that, I think we will see a return to rational behavior and accountability.

Thank you again, for stopping by.

Photo by ian dooley on Unsplash