Fat OR fit? Fat AND fit? Part 1: Fatness as a proxy

“Some girls are bigger than others / Some girls’ mothers are bigger than other girls’ mothers.”

–Morrisey

Over the last several months, I have turned the twin elements of fatness and fitness over in my mind. I even thought about not writing this article because it might piss people off. But this is my site, so what the hell. I have some rather conflicting feelings and thoughts about these issues, based on my experiences with them. I have numerous points of entry into this discussion.

First, I have spent over twelve years directly studying women’s and feminist issues. I did volunteer lectures on body image and media images of women for both high school and university students. In art school I examined historical images of women and looked at both traditional and feminist critiques of how women are represented. I speak to young women both as colleagues and as students, about their self-perceptions, about their ideas around fatness and body image. I had the privilege of knowing an amazing, sexy, and cool fat activist and discussing her work with her.

Second, I have worked for several years as a personal trainer, helping diverse people meet diverse goals. In these interactions I have also had the chance to observe how people perceive their bodies and the bodies of others around them. I have surveyed the clinical literature in fields like physiology and nutrition.

The third point of entry is personal, and has two elements. The first element is the experience of watching my father cope with his heart attack. We have a family history of heart disease but it was quite clear that lifestyle factors of activity and nutrition made a significant contribution to his risk. As we sat in the cardiac ICU one night, my father enumerated his sins to me, like a penitent making a last confession to a priest. He talked about all the chances he had to care for his body, that he did not take. He painstakingly catalogued every piece of pizza, every pound gained over his ideal weight, every run around the track he did not do because he had too much seated paperwork to finish. In the moment of staring death in the face, as the medical team fought to save him, my father decided that if he made it, he was going to make different decisions (by the way, he made it through, and he’s currently the proud owner of two new stents).

The second personal element is my own experience of being both leaner and fatter than my ideal bodyfat range. I thought a lot about whether to mention this. In a way it feels like kind of a copout to presume that my ideas should have merit just because I spent some time in a fat body. On the other hand, it has been an excellent learning experience to learn how to manipulate my body composition in a productive fashion. This has been particularly instructive to observe in the context of my family. We are all short and stocky, and our genetics predispose us to obesity and overfatness. Family photos look like Weeble conventions. It has been most interesting to consider what role genetics does in fact play in determining my own body shape. It has also been very illuminating for me to observe the changes in my self-perception.

So, given my multiple perspectives on this issue, I have chosen to struggle with how to best understand the complex questions of fitness and fatness.

fat as a proxy

In my line of work as an academic dweeb, a key concept is that of a proxy. A proxy is something that stands in for something else. In terms of empirical, numbers-based research, proxies are things which express complex ideas using the limited tools of statistics. It’s understood by researchers that a proxy is not a perfect measure of something, but is good enough to use as a means to express an idea.

A proxy doesn’t necessarily cause something, though it can. For example, a study might be released which shows that people who don’t eat breakfast are much more likely to suffer heart attacks. This doesn’t necessarily mean that the presence or absence of breakfast causes heart attacks. Breakfast can be a proxy for lifestyle here. Perhaps people who don’t eat breakfast have other problematic lifestyle habits. Or, perhaps breakfast is meant to be used as a proxy for people’s rushed lives. Maybe people who are too busy do not have time to eat breakfast, and it’s the level of time stress that leads to increased heart disease. Or, maybe, who knows, the absence of breakfast, or the absence of nourishment at a critical time in the body’s morning chronology, may cause a rise in stress hormones which do indeed cause heart attacks!

An ongoing conceptual struggle exists between fatness and fitness. It is quite confusing to sort out fact from fiction and relevant from misleading or inappropriate information in the mainstream media. Even apparently sympathetic media such as feminist magazines can interpret the results of scientific study in problematic ways.

For instance, a Canadian feminist magazine recently reported the results of a clinical study on heart disease, which showed rates of heart disease in women correlated with bodyfat levels. The magazine concluded that the study showed that fatness was good for us. Reading the study closely, however, it actually showed that bodyfat within a certain range had positive health effects, possibly because having sufficient bodyfat resulted in a healthy supply of circulating estrogens. It didn’t mean that more bodyfat meant more protection from heart disease; in fact, quite the opposite; past a certain point, risk of heart disease is greatly increased.

Fatness is used, both in clinical literature as well as mainstream media, as a proxy for fitness and health. There are advantages to using fatness as a proxy, as well as disadvantages.

Fatness is a useful proxy for fitness and health because:

• in general, fatness is fairly well correlated with nutritional status and activity levels. Despite the role of genetics in body composition, is quite clear from cross-national lifestyle and nutrition data that good quality nutrition and high levels of regular physical activity are the primary determinants of bodyfat levels.
• there are health conditions which are directly caused by fatness (e.g. joint problems because of increased bodyweight loading on connective tissue, or hormonal disorders related to the amount of bodyfat, which is a hormonally active tissue)
• there are health conditions indirectly associated with fatness, usually because of the correlated poor nutrition and low activity levels

On the other hand, using fatness as a proxy:

• does not address people who are overfat but nevertheless participate in regular exercise and good nutrition
• does not always show the problematic health status directly and indirectly associated with underfatness (such as lower bone density)
• does not address people who are at normal or lean bodyfat levels but who are unfit and poorly nourished

So, how do we make sense of the question of whether it is possible to be fat and fit, and or fat and healthy?

the facts

Fatness in excess of, as well as below, ideal ranges has clearly been shown to increase mortality and morbidity. In other words, being over-fat and under-fat can make you sicker and more likely to die early. To say it a fancy way, having a level of bodyfat which is significantly greater or lesser than an ideal range can increase both the risk of premature death as well as the incidence of a poor quality of life. (Don’t get all uptight, lean bodybuilders. I’ll explain this more below.) This is, as I have noted, due to both indirect as well as direct factors. This relationship has been unambigously demonstrated.

Excess as well as inadequate body fat changes the chemical environment of the body. Above a certain level of body fat, your cells make more of the stuff you don’t want (such as inflammatory proteins) and less of the stuff you do want. Your organs don’t respond properly to the chemical signals that the cells send (such as in the case of insulin resistance) — or they respond too much. Below a certain level of body fat, same thing, except some of the actual substances are different. For example, in a very lean person, leptin levels may drop; in an overfat person, leptin levels may be high. In an overfat person, circulating sex hormone levels may be too high; in a very lean person, sex hormone levels may not be high enough. Etc. Some of this can be offset with nutrition and activity. Some of it can’t.

Bodyfat levels are not absolutes, but are expressed as a range. There is a range of variation in optimal bodyfat levels. Some women can be very healthy at 15%, while others can be very healthy at 25%, a significant difference of 10%! Additionally, while bodyfat is correlated to some degree with bodyweight, it plays a much greater role in health status than bodyweight per se. A 150 lb. woman can be very lean and muscular, or she can be inactive and overfat (or perhaps even muscular yet overfat). The scale alone does not reveal the nuances of health and fitness status.

Nutrition, lifestyle choices (such as smoking), and activity levels are far, far greater determinants of fitness and health than bodyfat levels alone. Indeed, a growing problem among young women is the constant maintenance of an underweight body through self-starvation or excessive dieting, consumption of caffeine or other stimulants, and/or smoking. Inactivity and poor nutrition among young people is also at shockingly high rates, and even young children are showing signs of pre-diabetes, insulin resistance, and atherosclerosis (arterial plaque, a major factor in cardiovascular disease).

A body that is under-fat from starvation or malnutrition, drug use, illness etc is different than a body that is under-fat from good nutrition and regular activity. Likewise, a body that is over-fat from poor nutrition, sedentary living, chronic illness such as polycystic ovary syndrom or hypothyroidism is different than a body that is extremely fit, active and healthy but carrying a little extra squish.