Am I normal? Yes, but you’re still overweight.
Spotting obesity is tricky, but labeling people may be unhelpful anyway.
Posted December 15, 2008
I get paid to find out why people get fat. I read statistics about the ever-growing numbers of obese people. I go into schools to weigh children and assess their eating habits. I even see obesity surgery patients as they prepare to get their stomachs stapled. So why is it that when I first look at someone I still have no idea if they're overweight or not?
It's true that you genuinely can't tell with a single sideways glance. If you want to know someone's weight status you have to measure their height and weight and calculate their BMI, or Body Mass Index. If it's over 25: you're overweight. If it's over 30: bad luck, you're obese. These proclamations may sound arbitrary - and many people have quibbles over the BMI's ability to diagnose fatness - but they're based on sound evidence that the risk of health problems goes up for most people at these values.
I would like to add at this juncture that it's not just me walking around with weight-blinkers on. Columbia University's Institute of Human Nutrition runs a specialist obesity course every spring. Last year Mary Horlick showed us three pictures of children and asked us which one was normal-weight. Nearly all of us picked the skinny looking chap on the left. Surprise - even he was clinically overweight according to national growth standards. The only person who got it right was a Brooklyn pediatrician with a simple rule of thumb: Can you see the child's ribs? If not, he's probably overweight.
But perhaps we needn't all throw tantrums and look for new careers just yet. Categorizing people's weight status might not be everything it's cracked up to be.
Despite the fact that most of us are heavier than we should be, being overweight is stigmatized. When tested by stealth, even health professionals treating obese patients betray an anti-fat bias. And sadly, obese children also get a rough deal. In 1961, obesity research veteran Mickey Stunkard showed kids drawings of healthy, disabled and obese children and asked how much they liked them. The obese drawings were liked least of all. This wasn't even a product of the times: when they repeated the experiment in 2001 the obese children were liked even less than before.
These findings make me think that on top of a genuine difficulty in identifying over-fatness, we're understandably reluctant to give people a negative label. When UK charity Weight Concern surveyed a panel of overweight people, they said that to be called ‘obese' or ‘fat' by their doctor was offensive and hurtful. Medical types talk about ‘obesity' in its medical sense, but everyone else thinks about unflattering media and movie portrayals of house-bound super-obese people eating themselves to death - so it's no surprise that we would rather not tar ourselves or others with the term.
This reluctance to acknowledge adult or child obesity could admittedly be a problem if it prevents action to lose weight. It's one thing for adults to advocate for more sensitive language and less obesity bias - but no-one would want a child's weight problem to burgeon due to a lack of recognition.
In my opinion, though, parents may be more aware than we think. When we asked mothers of overweight and obese preschoolers to classify their child's weight, only 6% of them said they were overweight. But when we asked if they were concerned their child may become overweight in the future, 66% said yes. It might just be that everyone would benefit from talking about weight in a more sensitive way.
As for my weight-blindness problem, I don't plan to get caught out again. My new plan is to assume everyone is overweight or obese until I can get them in the lab and run comprehensive and embarrassing testing procedures to prove otherwise. Any volunteers?