New Research Says There Is No Such Thing as “Healthy Obese”? [Women are supposed to have fat! Busting the flat abs myth.]

If we’re sincere in our desire to “just be healthy” that may mean embracing more fat – both in our diets and on our bodies. Psst, Adele – LOVE you. Lose the cigs!!

Yes Virginia, There is a Santa Claus! Or at least there was until he died from having a belly like a bowl full of jelly. Yeah, yeah, he got lots of exercise making toys and flying them around the world in nanoseconds but apparently even being “metabolically healthy” wasn’t enough to save the old guy. Or maybe he just died because he was like 900 years old. Whatever. You still have the Easter Bunny, so stop crying.

Ever since a new meta study examining the life expectancy of “healthy obese” people came out there have been some big headlines making waves through the health and fitness communities. For years now scientists have acknowledged the existence of people who are obese but also have healthy metabolic markers like blood pressure, cholesterol and blood sugar. However, the study published in the Annals of Internal Medicine last week, said that while these obese people may look healthy on paper, they’re still dying younger – by about ten years. That’s a lot of life. Since then I’ve seen a lot of responses to the study. Jezebel posted an interesting takedown of it. While most other news organizations ranged from “I guess that makes sense” to “I TOLD YOU FATTIE McFATTERSONS SO!!!” It’s been ugly. And I wasn’t going to comment on it until a dear friend, who happens to be one of the most genuinely kind people on the planet and works in community health, posted about it on Facebook and tagged me in it:

“Not the news I wanted to hear. Now I’m pondering how we can counter the effects of individual, societal, and clinical “fat shaming” while helping each other achieve a healthy weight? I hope to dig into these articles to see if the authors discuss mental health and health body image as crucial aspects of “health,” along with other nuances. Sigh…. How about we just dance and have fun?”

Good question. Really good question. My first instinct was to try to pick apart the study and find out what’s wrong with it. For one, it’s a meta analysis, meaning that they simply looked at data from previously conducted research rather than doing their own research to directly investigate the question. But then, no research is perfect and meta analyses have a lot of strong points. Numbers, for example. The new study evaluated eight previously published studies of 61,386 people. That’s a huge (no pun intended) sample size. The researchers found that “people of any weight who had metabolic abnormalities were more likely to die earlier from all causes. They also were more likely to have cardiovascular disease. The risk increased as the amount of excess weight increased. And the more risk factors someone had, the higher the likelihood of early death and disease. People who were obese without having metabolic syndrome also had a higher risk of death, so they weren’t protected by being healthier.”

Honestly I think they’re probably right. First, everyone should take note that people who had high blood pressure, high cholesterol and insulin resistance died younger no matter what they weighed. (For some reason that’s not getting reported quite as loudly. Go figure.) Second, it always seems to be the extremes that are unhealthy. People who are extremely overweight have complications. As do people who are extremely underweight. The trick is in finding that healthy sweet spot – and I still maintain that that isn’t as small as most of us think it is.

“Get ripped in the new year!” “Have the lean body of your dreams!” “Six-pack abs in 6 weeks!” “Burn fat up to 400 times faster!” Thanks to the advent of Resolution-Making Season (also known as the fitness industry’s Santa) and an e-mail address that seems to be on every marketer’s PR list, I’ve been getting a slew of “get shredded” pitches every day. The products are wildly variable – everything from mushroom pills to different exercise equipment to books – but the end goal is always the same: to help women get as lean as possible. Inevitably these pitches are all illustrated with pictures of 18-year-olds with perfectly sculpted abs. I don’t even need to describe them further because you already know exactly what I’m talking about. They’re in every magazine and on every website, everywhere.

But these photo (-shopped?) beauties with amazing muscle definition distract us from a very important fact: women are supposed to be fat. I’m not knocking these girls, especially because I give them mad props for putting in the work required to get those muscles but while there is a nod to health with most fitness experts acknowledging that women shouldn’t go “too low” (although that varies wildly as fitness competitors are often under 10% while most medical professionals will tell you not to go below 16-18%), people completely forget that getting as close to the minimum of the healthy range as possible is not the same when it comes to health as being a few percentage points higher. And of course there is such a thing as too fat although if you need me to explain that to you then clearly you don’t have enough lady mags in your life. Body fat is integral to a woman’s health and there is no on/off health switch; it’s more a of a sliding scale with risk of death a disease increasing rapidly at both ends of the spectrum.

So if too low and too high are too bad then what’s a Goldilocks girl in our weight-obsessed world to do? Where is the sweet spot when it comes to fat? According to science, it’s more than we think. Gina Kolata, a science writer for the New York Times who predominantly covers health and fitness research, blew my mind a few years ago with her book Rethinking Thin: The New Science of Weight Loss—and the Myths and Realities of Dieting. Her basic premise is that we suffer from a bizarre dichotomy wherein we are told that the ideal standard for both health and beauty is as lean as possible while many Americans carry an unhealthy amount of fat. Both are as ubiquitous as they are unhealthy. While many of us can easily point out what is unhealthy, very few can identify what is healthy because it turns out that healthy is what many of us think of as “fat”.

Research published in Why Women Need Fat: How “Healthy” Food Makes Us Gain Excess Weight and the Surprising Solution to Losing It Forever (aff) written by an evolutionary biologist and a doctor adds more evidence to the debate. In an interview with Salon.com, co-author Steven Gaulin, explains how “evolution shows that women’s dieting beliefs aren’t just unrealistic — they’re unnatural.” One of the main points of the book (which I haven’t read but hope to) is to show polyunsaturated omega-6 fats like canola and corn oils for the public health hazards they are. Gaulin says their research shows that processed omega-6 fatty acids are the precursors to endocannabinoids, making them a food that acts like marijuana in the brain “telling the body, “Store the fat you have.” And “Eat more, I’m hungry!” ” He adds, “Many studies in the U.S. and other countries show that the single best predictor of how much a woman will weigh is how much omega-6 is in her diet.” But the part of the interview that most fascinated me was this gem:

“Many M.D.s have bought this fallacious line that the optimal weight for women in terms of their health is what M.D.s call normal weight, a BMI between 18.5 and 25. And they have thought this to be true because women with higher BMIs exhibit a series of physiological measures that are indeed risk factors for disease in men. But they are not systematically risk factors for disease in women. If you actually look at the data from the National Health and Nutrition Examination Survey and data from studies done in other countries, the optimal weight for women who have had a kid is what doctors currently call “overweight.” I’m not saying that obesity is optimal, but all the findings show that overweight women survive better than “normal” weight women. We walk a fine line in the book because we argue that being overweight is not nearly as bad as your doctor has been telling you, but on the other hand, Americans are heavier than they need to be. There are diseases that still correlate with heavier weights, like diabetes. But if we ate a more natural diet, by that I simply mean the diet that we evolved to eat, we would all weigh less.” (emphasis mine)

There seems to be a paranoia in our society that if we tell women it’s okay to be fatter then suddenly all women are going to balloon up into obesity. This is especially true for women who have had children as we are told that if we don’t get back to what we weighed before we grew an entire human being inside us then we’re a failure. And a lot of women have internalized this thinking that the best way, both from an aesthetic and health standpoint, is therefore to get as low as possible and stay there. Which means we are fighting our bodies for the rest of our lives.

So to answer Grant’s question. Think for a moment what it would be like if we gave women permission to carry fat in places other than their boobs and butts and to still be seen as beautiful – not just because adult women should not have to be shaped like teenage boys but also because it’s better for our health? I think that perhaps we would see less obesity because there wouldn’t be such a huge gap between the ideal and the reality and there would be less shame associated with having body fat. According to science there is a reason that for centuries the female ideal was closer to this:

Check out that beneath-the-bellybutton pooch on Venus! The full cheeks! Her fleshy thighs and arms (what’s left of them anyhow – they got blown off at such an unflattering angle)! And not a clavicle in sight! She was the standard of beauty for centuries. Even 50 years ago it was this:

Sophia Loren was considered not only one of the most beautiful women of her time but of all time. Today she’d be doing plus-sized modeling and working with a trainer 5 days a week to tone up. But then we swung this direction, which most of us now recognize as unhealthy (I’m not commenting on this woman in particular, I don’t know her from Kate Moss):

And now we have this:

The flat-as-a-board tummy.

It may be healthier but does it still represent an unrealistic and unhealthy standard? I’ll admit it: I still wish my abs looked like this. Some women are born with a 6-pack but for me, I know what it would take to get my body fat low enough to get a tummy like this and it would not be good for me. I’ve been into single-digit body fat percentage and even though I’d lost my period, was depressed, suppressed my own thyroid and was losing handfuls of hair I still didn’t have a tummy like this.

Selling women this standard isn’t telling women that “strong is the new skinny” it’s telling us that now we have to be strong and skinny to be attractive. But the problem isn’t just that we may be driving ourselves crazy with this shift, even worse we may also be hurting our health. So what’s the magic number for optimal health, happiness and beauty? 42! (Well it is the answer to life, the universe and everything!) Kidding. I have no idea. And I may be overthinking this. Certainly there are women who are naturally very thin and are healthy just as there are women who are considered “large” who are also very healthy. I am not condemning anyone for their natural shape. What I do know is that if we put half the energy into being good as we do looking good, we would have cured cancer by now. And I say that as much as a personal indictment as I do a societal one. I freely admit that I struggle with this concept.

I’m not sure what the end is but I think it starts by recognizing that the extremes – whether that’s obesity, catwalk thin or the ultra-ripped standard – are detrimental to our health.

Help me figure this out – What are your thoughts on this meta analysis? Did it confirm what you already thought or was it surprising? How would you answer my friend’s question of “How we can counter the effects of individual, societal, and clinical “fat shaming” while helping each other achieve a healthy weight?”

23 Comments

  1. This is fascinating Charlotte, the meta-analysis does confirm what I suspected, and what you bring up at the end- about achieving these ideal goals such as the washboard abs is something that I have been trying to figure out. Even the guys worry about the six pack and the back fat… I’ve been limiting my carb intake (around 40g a day) to try and get rid of the little bit of fat back there- and when I do it works- but I feel terrible physically and my peripheral neuropathy gets worse. Its a catch 22- do I just accept that I have a bit of back fat or do I do what I’ve been told will get rid of that fat and just feel terrible?
    I’m thinking that there needs to be more discussion about body differences, because these studies are always looking at the standard measure and truly there is much more variance among the population that can’t be accounted for in these studies…

  2. I think it’s one of those things that we’re making harder than it needs to be. Is it THAT hard to talk about a healthy lifestyle without fat shaming or pushing diet products? It seems to be but it honestly shouldn’t be. I think health educators/doctors/societ/etc can start with encouraging healthy habits — What are you eating? Are you active? How’s your mental health? — instead of looking at a woman and making assumptions about her health. And as a society, I think we can stop making fat people the target of our anti-obesity efforts. Not only does fat-shaming NOT HELP, it also ignores the fact that certain foods and habits are unhealthy even when done by thin people. If you eat McDonalds all day every day, you’re probably going to have health problems, whether or not you have weight problems.

  3. Whatever weight you are is a consequence, a symptom, if you will, of whatever it is we’re doing with our life, combined with genetics. Therefore, there is a high correlation with other health issues, but I don’t think it should be looked at as a “disease” in and of itself. Does that make any sense? (Somehow, I don’t think this is going to turn into a famous internet meme.)

    In other words: Don’t focus on your weight. Focus on eating and exercising in a healthful manner and let the weight fall where it may.

  4. I think spending time thinking about what you eat, and how it makes you look is unhealthy. Almost ALL the guys I know don’t do this. They eat. They eat “healthy” food, try to eat leaner meats, try to remember to eat their veggies (which are always a challenge for many) and limit the portion sizes of desserts (which means…they don’t eat the WHOLE cake). And…they exercise doing something they like.

    Women on the other hand, worry about their size. They worry about if their butts look big, if their bellies look as good now as they did before their kids. If breastfeeding has made their boobs look like empty sacs. Wrinkles. Hair. All…such a waste of time. And food! Eating salads when they really want a burger. Eating carrot sticks for breakfast. Starving. Just to LOOK good.

    All this looking and worrying is unhealthy. And, it makes you a boring and superficial person. Spend all that time learning french. Or, teaching your children french. Eat when you are hungry, stop when you are full. Let yourself be. It is the obsession with bodies that make us “fat”. And, it makes women mean to each other…Men (who are over the age of 30, and are not jerks) don’t go around judging women for looking like the mom’s they are. It is women who say “Boy, she should not be wearing those yoga pants!”. Go to a yoga class, and quit worrying about how other people (and yourself) look.

    That’s what I think anyway. And, when I quit worrying about it…I stopped feeling bad. And, as it turns out, I learned to eat when I was hungry, and quit when I was full. And, I no longer feel panic about food. The years of food obsession are over, and my weight has stabilized at a nice, happy (although not ab-a-riffic) weight.

    I am raising a daughter, and want her to feel good about food, and herself. That starts with setting a good example.

  5. Yay for having the underweight comments! I have a pretty strong genetic skinny disposition, but I feel like I can’t comment on any weight/health related topics because of my size. I like this post because it allows freedom on both sides to speak. I do have a bit and of a …weight disorder if you will, where I judge if I have gained weight and feel pudgy but won’t turn to diet to “fix” it. I see others bigger than me and simply see them for who they are with no weight judgement. I would love to see myself that way. However, I have found describing women (and even men) to my husband is difficult. ‘They are a healthy weight.’ Then I have to try and proportionalize that to people I know he would recognize. I hope that some day, sooner than later, I can just see myself as being what I am meant to be with no judgement.

  6. If the girl in the picture with the body of a teenage boy put on some fat she would look like . . . a fat teenage boy; not like Sophia Loren. Why? Because she has the bone structure of a teenage boy; not one of an adult woman.

    Bone structure fills out at exactly the time today’s young women are most likely to be on extreme diets. They are thin through malnutrition and grow like a stalky weed, rather than as a sturdy tree. They never develop the full breadth of shoulder and pelvis necessary to have a classic hour glass figure.

    We have become so culturally fixated on fat that we often don’t even see the real damage done by extreme diets.

    And even though it is true that women don’t have the same risk factors as men, it isn’t just a women’s problem. There is a famous scene of Sean Connery, mirroring the one of Ursula Andress, where he walks out of the water in a bathing suit. Mr. Connery, in his youth, was a body builder of sufficient advancement that he placed third in the Mr. Universe contest.

    But what do you not see in that scene? Abs.

    Mr. Connery gave up body building specifically because to be competitively muscular and lean it would have hurt his level of athleticism. A certain amount of fat is necessay for power and endurance. It is a critical element in maintaining hormonal balance, it is fuel and it is even structure; especially of that organ know as the “brain.”

    Although the cynic might note that in many people the latter is a largely useless appendage, so, like, whatever.

    • What?! Really? I never knew all that about developing bone structure. I thought it was just predetermined. Is there somewhere I can learn more about this topic?

      • http://en.wikibooks.org/wiki/Human_Physiology/Development:_birth_through_death#Female

        I’ll bet you aren’t as unaware of it as you think, that you have, in fact, observed it yourself, but in men where the effect is more dramatic, and thus more obvious. A teenage boy hitting his growth spurt and “growing like a weed” is a stereotype. They grow straight up and become “lanky” and even “gawky.”

        By the time they hit 16 to 18 years old they have attained all the height they ever will, yet physical growth does not end until early to mid 20s. If they aren’t growing up where are they growing?

        They grow “out.” That is they fill out their breadth. In men this happens mostly in the shoulders and they lose the lanky look, which is why it is so obvious.

        Women, on the other hand, fill out their pelvic girdle.

        This filling out takes just as much energy and raw material as growing up. In the days of Sophia Loren, and nearly all the days before as well, the “ideal” hip measurement was held to be around 36 inches. Sometime in the 80s and 90s that changed to 32″.

        If, during those critical years between 16 and 25 or so you are living on an 800 calorie a day diet, instead of the thousands you need to grow – growth will halt.

        And that is how, in most women (yes, there is a genetic factor), achieve that 32″ hip, teenage boy look. Starving themselves so much that they never develop their full structure. And this is damage that once done, cannot be fixed. Once those growth hormones shut down, that’s it.

        • That’s fascinating! I was severely anorexic in my teens but recovered in late teens–I then proceeded to grow (up) an inch and a half. I don’t know about hips, but the growth plates in my hips were not fully closed, so perhaps I grew out (bones) as well; I actually have normal-width shoulders and hips now as a healthy adult, so maybe I still had a window of opportunity for growth?

        • Interesting. Makes me think of Audrey Hepburn saying several times when interviewers would comment on her lithe frame that it was a product of starving during WW 2 as a teen.

  7. It’s sad to me that so many women (and some men) seem to be brainwashed into believing they should look like men.That’s right. I said too many female fitness models look like a man with boobs (often fake ones – all that dieting withers the natural breast).

    If you are a woman and you have 6-pack abs, sorry, then you look like a guy. To a red-blooded heterosexual man like me, frankly it’s a turn off. It’s gross!! And no, I don’t want to see veins bulging on your biceps or cuts and striations either.

    How ’bout some soft curves? Leave all the chiseled, hard angles to males who are genetically more likely to achieve this. I certainly am not one of them, although I did try – for decades – and it ruined my health both physical and mental in doing so.

    Stop ruining your health, which is what diet and exercise have become, DESTROYERS of health and well-being, both physical and mental.

    I am 51, and an exercise and diet fiend since my teens. It has been a long journey for me to learn to enjoy eating in a balance healthy way – plenty of fat, protein and complex carbs please. And I am finally learning to exercise to feel good and maintain health, not appearance. Exercise is also for the fun of it or to develop skills, not to “sculpt and tone” or “burn off those Holiday calories”

    May you all learn to love and accept yourselves for who and what you are and enjoy healthy eating and exercise. Life is so much better this way!

  8. I do quite a bit of aerial acrobatics and it is a *constant* struggle to not come down really hard on myself for not having the typical “dancer” body. I’ve come across these two photo collections in my wanderings, I am blown away by the body difference between acrobats and dancers now and even 50 years ago. I’m not sure if I’m supposed to post links, but if you are ok with it, people should definitely take a look. The concept of what a healthy athlete looks like has changed soooo much.

    http://www.messynessychic.com/2013/11/27/dancing-in-the-attic-of-the-paris-opera-house/
    http://www.retronaut.com/2011/10/colour-photographs-of-circus-performers-1940s-1950s/

  9. Have you seen this one?

    http://healthyurbankitchen.com/blog/obesity-how-the-media-misleads-you/

    This person analysed the reports that news media made- they totally skewed the idea behind the report- over simplification and altering the findings to fit things that they want to portray! It is an interesting take on it and how we should be taking the whole study thing- AS REPORTED ON MAINSTREAM MEDIA – with gigantic grain of salt.

    But you bring up very interesting points! Thanks for adding to the conversation- a sane conversation.

  10. I think the problem with ‘strong is the new skinny’, is that what people REALLY mean by it is, ‘strong AND skinny is the new skinny!’. I’m certainly strong, I lift heavy, I build muscle like crazy, and if you want to move furniture at my house, you ask me, not my boyfriend. But I’m not cut and defined and six-pack-abs like the photos. I’ve got curves and squish on top of the muscle. But having gone through the seven-mental-layers of hell of thinking, “It’s not fair! I can pull a dang car! I should look like those pictures!”, I’m slowly and quietly reaching the point where I can say, strong is good enough. I like my body, I like what it can do, and comparison is doing me no favors. My body is my body, it’s ridiculous to fight it tooth and nail.

    • I love this comment. And I strongly dislike the phrase “strong is the new skinny” because of exactly your reasoning.

  11. Jsut a quick comment abot hte 6-pack; I notice that for most, to get that 6-pack you ahve to put on a lot of mass, therefore gain a few inches on your waist… which most women are not willin to do… gorgeous though! I also want that…

  12. Such a fascinating and important topic Charlotte! There is little representation of ‘normal’ in the media. Obesity has become a serious issue in the western world and we are all being told we need to get to the unachievable and unhealthy opposite extreme. Women are under so much pressure. It’s like we’ve all missed the point. No focus on moderate exercise and a balanced diet – all of it is get skinny quick with whatever crazy method will get you there.

  13. I think the biggest issue when it comes to living well, being healthy, exercise, nutrition, and all the rest of that stuff is where (and whom) the focus is on. The intention is all about the individual in our present culture, but the problem is that individuals are so, well, individual. There are thousands of standards of fitness, wellness, health, and beauty out there, but they don’t even begin to categorize the individual make-up of the billions of people on the planet. The nutrition and exercise sciences are extremely young in the grand scheme of things, but people cling to the plans and guidelines for fitness like they are absolutes. My quandary always comes down to why I should follow one set of guidelines over another. Should I go Paleo (yes fat, boo carbs) or MyPyramid (eat lots of grains, you farm animals!) or Intuitive (eat whatever I want…as long as it’s totally natural)? Should I stick to CrossFit, or become a yogi, or power up like a triathlete, or just run around the block a couple times and count it as enough?

    The question I have is, what is my mooring for making these decisions, since the reasons and supporters of all of the above are numerous for all (and probably equal too) with wildly varying results? My answer has very little to do it seems with the subject matter itself. The way I make these decisions is a little more philosophical and this is it; I choose, in almost all circumstances, to do those things that bring me into the best relationship with others and with God and to let the results be what they are. A large part of this requires personal, spiritual, and material poverty, not in the sense that I try to necessarily be poor and get rid of things or shun material goods and pleasures, but rather that I work with whatever is provided most readily for me, whatever does not go above and beyond and out of my means. Right now, as I am a daughter and student who does not pay for her own food, my “diet plan” is whatever my mom makes when I am home (with some necessary gluten-free provisions) and at school, the allergen free meal option they provide. Basically, I choose the best that is offered and then trust that the outcome will be exactly what I need. This puts God in charge, and He truly does want the best for each of us. It also puts me into better relationship with my family members; food brings people together, so part of the diet plan problem is that it makes the food about what is best for the individual again, regardless of what everyone else is eating. I’ve seen it in my own family a lot lately; this mentality drives people apart When (and, yes, I am very excited for this ‘when’ to happen) I am able to choose for myself what to eat, this is how I plan on choosing; the foods that are grown, sourced, processed, delivered, and paid for in a way that is kindly towards nature and neighbor are the ones that I will buy. As far as I can tell, this will mostly mean finding community supported agriculture and other local sources of food and produce. Why? It is kindest to nature, by treating and raising the animals I eat humanely, as well as reducing the nasty by-products from the industrial food industry. It is also the most charitable because I would avoid eating foods harvested, grown, processed, or packaged by those who are little more than underpaid slaves working in sweat houses in South America and elsewhere.

    In terms of fitness, I ran track for my whole life up until I went to college so that was fitness made pretty darn easy. I LOVE exercise, so of course I wanted a way (or ways) to stay in shape, again by using what was provided to me; regular (and free!) CrossFit practice at the gym at school. I have developed an AWESOME relationship with the trainer. She has been a source of body-image healing for me, as well as new fitness opportunities throughout the past year. When the gym on campus closed for construction, I kept up with the workouts in a little closet-turned-aerobics room, until this same trainer happened to get a new job at new gym down the hill, and invited me to come…ohh and did I mention it’s a CrossFit gym too? Coincidence? Or something more? I had resisted joining the CrossFit box out-right because I did not want to over-step my means; after all I had a great friend for a trainer, and was doing just fine. The decision almost seemed to be made for me, given to me even, when she moved. Like I was being given permission to go for the next best thing too.

    If we are willing to change our lifestyle for the sake of well-being, I think it should be motivated by the factors of simplicity, compassion, and trustful poverty, not by some arbitrary standard that doesn’t have a true ultimate anyway. Because of the faith and trust it takes to choose in this way, giving up much of our “rational” control in situations, I believe we will be greatly blessed with health and a body that looks the way it is supposed to. More importantly, we will have the relationships we are supposed to have, which contribute just as much to overall health. So take a look at what is being presented most basically and fundamentally in your life, including being open to new opportunities, particularly ones that build relationships, instead of chasing that “just right” health plan which always seems to evade the best efforts.

  14. I can’t help but notice that the six-pack-abs woman appears to have implants. (I can’t be sure, but they look suspiciously round and firm.) That picture right there shows me how messed up body image has gotten. Women have to diet down so extremely to show off a six pack that we lose one of our most feminizing features, our breasts. But NO WORRIES! Just cut yourself open and stuff some silicon in there. What!? Messed up.