General

I often think about how silly it is that overweight people are berated for being a supposed drain on the health system yet athletes who are constantly breaking bones and being treated in hospitals never get the same treatment. It's because its not really about health, they just dont like fat people.

What I mean more is there are so many other different lifestyle factors that people do knowing that there can be injuries or illnesses associated with them like in athletics, extreme sports, drinking or even things like tanning with a solarium and yet they are never chastised for being a drain on the health care system like fat people are.

That is true that athletes dont need cranes or super super reinforced beds but either do most fat people, the majority that make up the obesity 'epidemic' are not above 220 kilos and Ive seen a very basic hospital bed in the emergency department here with that weight limit, when people need cranes to be lifted out of their houses we usually hear about it because its a novelty, doesnt happen all the time.

The reason they say fat people are a drain on the health care system isnt because of the supposed extra costs to accomadate the actual girth, its because instead of taking into account the actual risks associated with having extra adipose tissue which are mostly minimal and not fatal and probably dont even make a dent in the system, they use the risks that come with unhealthy eating and not exercising like high cholesterol, blood pressure, heart attacks etc. When you read the graphs they put out about the cost of obesity its actually the cost of living unhealthily, not having lots of fat tissue.

This is quite a can of worms! It runs into a lot of "nanny state" and "welfare state" issues as well as social stigmas and stereotypes.

You should write a book!

I like that you ask what "health" is! I never really thought about it much, but it is complex. E.g., Who was healthier: the person who was never sick, never in the hospital, always had full mobility and full possession of his faculties until dropping dead at 70 or the miserable, sickly, bed-bound, dementia patient who hangs on until 75?

I like this topic. It's a point of discussion that is of great social relevance. It's very much influenced by how people look at life, and how much important it seems to be to live as long as possible.

A wile back there was this documentary about smokers. Not exactly the same thing as obese people, but it was about people leading an unhealthy life. The docu showed that while it might appear that they cost society a lot of money for the special medical care they receive, the documentary concluded that smokers actually save us a lot of money. Because of their shortened life expectancy society saves a lot of money on the nursing home costs. I'm sure the same can be said for obese people.

So why should we live as long as possible? I'm not saying it's a bad thing, but it's a costly thing, that you might not enjoy much. Personally if i ever get that old, they can put me down the moment i lose my mind. I don't want to drool by the window until my body fails.

1. As to quality of life, who really wants to live a life of misery and regret. Besides being fat really doesn't mean that you are going to shorten your life by such extreme amounts, that it makes very little sense.

2. Wish I could find my copy of "Being Fat is not a Sin" by Shelley Bovey. In it she quotes a long term health study (from Norway I think), where the life expectancy was longest amongst the slightly overweight group (longer than so called normal) and the extremely obese group had a longer life expectancy than the underweight group. Maybe overweight people are costing the NHS more because they do live longer.

3. Indeed what is normal? What is considered beautiful? There are so many cultures where fat is prized as the most beautiful, that there is no such thing as normal.

From what I can see there is a pious attitude amongst fat haters, much like the safety police, that they know best. God forbid anyone should actually want to enjoy themselves, isn't everything we like/want to do, bad for us. It's as if they insist we all become clockwork oranges and women, in particular, to become Stepford Wives.

Ooooh, interesting topic!

OK, a few random thoughts:

Morbidity vs mortality

It's important to distinguish between these two. I have no desire to live past 80 if I have very poor quality of life beyond this point. However, I try to lead a healthy life so that I compress morbidity as much as possible. Dying in a surfing accident at 105 years old would be fine by me! (note to self: learn to surf)

"Natural" life expectancy

An interesting question... why do women live beyond reproductive age? For much of our evolutionary history this was probably a rarity so it didn't confer an evolutionary advantage, but having grandmothers around is likely to increase the survival of their grandchildren. Clearly there is some sort of limit to how long people can live, but we may not in fact be all that close to it yet. Average life expectancy is still rising.

Sport and health

People often hold up athletes as paragons of health, but they aren't - they are paragons of performance. Ignoring the issue of performance enhancing drugs, there comes a point where there is a trade-off between performance and health. Yes, exercise is good for you but you can have too much of a good thing.

It is also important to remember that all sports are an abstraction of proper human movement. We are all inherently capable of a huge diversity of movement, and each sport taps into just a small subsection of that. This is the source of a lot of injuries, from over-use, muscle imbalances, over- or under-joint mobility etc.

I think exercise is hugely important for the health of people of all sizes, but not all exercise is created equal and doing too much or operating in too narrow a field can be detrimental.

Natural weight

I'm going to stoke a little controversy and say that it's not natural to be very overweight... but that's because our bodies are responding to a very unnatural stimulus. Processed foods are designed to be over-consumed by companies seeking bigger profits. They are made hyper-palatable and moreish as this is good business. To get fat on real food (meat, fish, vegetables, tubers, fruit, nuts, good fats etc.) is not easy as our bodies are very good at telling us when we've had enough of these foods. Junk food short-circuits these hormonal mechanisms so we don't feel full. They break us, and that's not natural.

Weight and health

There are many diseases that are associated with being overweight - heart disease, diabetes etc. However, these aren't necessarily caused by being overweight per se. I'd argue that both being overweight and having these diseases is symptomatic of the kind of poor diet I outline above. This leaves room for being overweight and being healthy. Eat right (real foods, not packaged stuff with "Low fat" or "Healthy" written on it) and move around. You aren't likely to be huge if you do this, but you can certainly be overweight and healthy.

Sociological issues

Yup, I believe these play a big part. Poverty is an issue as the poor fall victim to the poor quality food pushed by the food industry, partly through means (i.e. it's cheap), partly through culture (e.g. peer pressure) and partly through lack of education. As pointed out above, stressors such as financial uncertainty, poor housing and low relative social standing also have a negative effect on health. In the US in particular, a lack of access to healthcare is a big (and frankly appalling) issue.

I agree with Lancila that emotional health is important too. In fact, I'd argue that both physical and emotional health are intertwined far more than most people would think.

Cheers

I'm sure others have more to add, though. At least I hope they do as this is an interesting area!

Such a good thread.

Like Gary I remember the study that said that being (moderately) fat actually doesn't shorten your lifespan.

I'm also trying to remember the literature on management of so-called obesity-related diseases such as diabetes, and arguments over whether or not certain diseases such as diabetes are really caused by obesity or whether the link is more sophisticated/complex than a causal link.

I recall reading that whilst there is an apparent correlation between being overweight and contracting adult-onset (Type II) diabetes, actually it also depends what you ate to get overweight. If you eat fast and sugary food to excess, you increase your risk of becoming diabetic. If you eat sensible food (ie. stuff that doesn't send your blood sugar up and down crazily, like protein and green vegetables and pulses) to excess, you might well be fat but you won't get diabetes because your blood sugar level has always been normal.

Further the expense to the health service caused by people with diabetes has a closer link to education than to being overweight. You are far less likely to require medical resources if you manage your diabetes well (type II diabetes can often be managed by food choices alone) than if you have poor control over your blood sugar. Because that control is tricky to achieve if you're confused about how to do it, a thin but cognitively challenged person is going to present much more of a problem to the GP and hospital than a very fat but bright or well-informed person who is dealing well with their diabetes.

Obviously there is a correlation between poverty and poor management of diabetes because of the education issue. Which links back to what Gingersnaps was saying about the real issue being fat = poor and also now fat = poor = drain on resources because of poor ability to manage a (usually) controllable health condition.

Can someone who has a more organised brain than me or proper medical knowledge summarise it/confirm or deny the above?

Does this apparent link to being overweight, which actually breaks down if you look at it carefully, apply to other health conditions as well as diabetes?

I seem to recall that there are certain cancers that fat people are allegedly more prone to, but again I wonder if that is actually fat people who eat a certain type of food or who don't take exercise (etc), not fat people per se. I also recall there are certain cancers that overweight people are LESS likely to get.

I agree that being overweight tends to be seen as a general evil when in fact it might be more specific, eg. eating certain foods (which you don't have to be fat to do) or behaving in a certain way (not managing a health condition). Sure, more fat people are likely to suffer those health conditions but it's not actually BEING FAT that causes them.

That wouldn't be me, but I think the word you're looking for is "cofactor"!