Reader Responses to Separating Fat from Fiction

“We don’t need a ‘solution’ to ‘obesity,’ ­we need a solution to poverty and fat phobia.” While politically au courant, the statement is inaccurate. America is the wealthiest country on Earth and has the highest obesity rate of any major nation. While it may be uncomfortable to hear, we do need a solution to an enormous global problem. Obesity is one of the leading causes of preventable death, dramatically decreasing not just a people’s overall quality of life but also their life expectancy. 

For the minority who were born with the genetic disposition, such as one of my nieces, obesity is unusually complex. For everyone else, it is a result of too many calories in and not enough calories out. However, that is no justification for fat-shaming or blaming. Heavy folks deserve decency, kindness, and tolerance. But they also deserve the respect of the truth. 

One of my closest friends has been on the COVID-19 nursing floors since March 2020 and could speak volumes on the skewed survival rates, not to mention the complications to surgery, the degradation to general health, and the physical toll overweight patients cause for first responders and emergency room workers.

Human biology did not just suddenly change in the 1980s. At a certain point, no matter how many good intentions, body-positivity movements, or studies clinging to correlation over causation, the world will have to grapple with its billions of multi-decade experiments with hyper dosages of calories, glucose, frying, and starch. Objectivity must reign. Otherwise, fat-positivity will just need to queue with the anti-vax movement (a hysteria that sadly also first started amongst my political Left), anti-masking, and all the other anti-science refusals-to-accept-what-we-do-not-want-to-hear.

According to “Separating Fat from Fiction,” Nov.-Dec. ’21, “it is not fat people who are to be blamed for their fatness, research indicates, but the systems and structures that helped form their dietary habits.” But fatness is not evil, so why does the issue of blame arise at all? Moreover, as a former fat person, I am always amused to read yet another article about obesity that doesn’t even mention how good many fattening foods taste. It’s not just lack of “access to affordable fruits, vegetables, and whole grains” that makes children eat Snickers bars instead. It’s also that— let’s face it—Snickers bars taste a hell of a lot better to a lot of children (as well as to a lot of adults).

We don’t need a ‘solution’ to ‘obesity’—we need a solution to poverty and fat phobia.

Your article states that “A study with over 40,000 participants found…that metabolically healthy but obese people had no higher risk of death or illness than their ‘normal-weight’ peers.” The misleading phrase here is “metabolically healthy.” Yes, metabolically healthy obese people don’t have an increased risk of early death, but compared to their normal weight peers, the obese are between four and five time less likely to be metabolically healthy. As a primary care physician, my experience backs this up. I have thin patients who suffer from hypertension and diabetes, and obese ones who don’t, but there is no question that my obese patients are more likely to receive these diagnoses—and that they often improve dramatically with weight loss. I agree that obesity is a complex problem that is largely driven by social factors, and that overweight people need support and encouragement, not shame. But we owe the public and our patients the truth, namely that being overweight remains a risk factor for poor health. Suggesting otherwise is akin to claiming that since many smokers never develop lung disease, tobacco use is harmless.

Thank you for your article on fat phobia. I would be dead now if not for a caring, curious female doctor who looked at my symptoms and wanted to know why things were happening. I won’t go into all of the details, but there were enough symptoms that the male doctors I saw over the years could have explored further instead of telling me to eat fewer carbohydrates. I had periods that lasted two weeks with heavy bleeding, cramps that prevented me from standing up straight, monthly yeast infections, weight gain, and sugar cravings. It turned out that I had an extreme case of endometriosis that destroyed my ovaries. My body was producing estrogen all the time, with no counterbalancing progesterone. Estrogen is stored in one’s fat cells, which makes it very difficult to lose weight with constant estrogen production going on. And what grows in an estrogen-rich environment? Cancer. We don’t hear much about endometrial cancer, but the kind I had was slow-growing and potentially deadly. I lived with the misery of cramps, anemia, PMS, and being overweight for 20 years. I hope that your readers, especially your medical school graduates, all reflect on their own health and that of overweight people. Eating fewer carbohydrates may not be the answer.

I am happy to see that this topic is being studied. It sounds like they could have taken it even further. We don’t need a “solution” to “obesity”—we need a solution to poverty and fat phobia. Most, if not all, of the poor health associated with “obesity” can actually be accounted for by the effects of poverty, low education, and the poor medical care that fat people receive.