This weekend I came across a disappointing article from Washington Post columnist Eugene Robsinson. The article was discussing New Jersey governor and possible presidential candidate Chris Christie. And as happens so frequently with public officials who happen to be obese, the article focused entirely on Christie’s weight. While the article is awash in obesity-related tropes, there are a few especially grievous (and common) misconceptions that I’d like to highlight.
From the Post:
Whether or not he lets himself be persuaded to run for president, Chris Christie needs to find some way to lose weight. Like everyone else, elected officials perform best when they are in optimal health. Christie obviously is not.
We’ve said it before, but it’s worth repeating: weight ≠ health. Obesity (as defined by body weight) is associated with increased health risks, but by no means are all obese individuals unhealthy. Much of Peter’s PhD thesis centred on this issue, and he has written about metabolically healthy obesity at length both here and elsewhere. By the same token, not all lean people are healthy.
Robinson goes on to quote Christie, who recently stated that he is:
“relatively healthy by all objective indicators,” but added that “if I weighed less, I’d be healthier.”
That may be the case, at least hypothetically – all else being equal, lean individuals tend to be healthier than individuals with obesity. But if a person is already healthy, then there is little or no medical reason for them to attempt to lose weight, especially given that many attempts at weight loss actually result in weight gain. For example, prominent bariatric physician and researcher Arya Sharma (who likes to joke that “the easiest way to gain 25 lbs is to lose 20!“) has recently argued:
that, given the rather loose relationship between health and weight, continuing to promote the notion of ‘healthy weights’ may do more harm than good, as such messaging would simply continue to promote obesity related stereotypes and can potentially set people off on paths of unhealthy weight loss in the firm belief that losing weight is equivalent to improving health.
Robinson goes on to point out the obvious:
You could argue that this is none of my business, but I disagree. Christie’s problem with weight ceased being a private matter when he stepped into the public arena — and it’s not something you can fail to notice. Obesity is a national epidemic whose costs are measured not just in dollars and cents but also in lives. Christie’s weight is as legitimate an issue as the smoking habit that President Obama says he has finally kicked.
This is something that comes up a lot, and it’s strange that otherwise smart people make such a horrible leap in logic. Smoking is a behaviour. Obesity is an outcome. It really is that simple.
Aside from obesity, we don’t typically demonize people for health outcomes. We don’t tend to look down upon people with high blood pressure, or diabetes, or cancer, because we realize that these things are complicated and not completely under an individual’s control (For example, we probably all know someone who, despite their best efforts, has been unable to lower their cholesterol of blood pressure).
Similarly, we would not see articles pondering whether a person with type 2 diabetes or peripheral vascular disease should be president. But because we can tell if a person is obese simply by looking at them, and because of the incredible amount of stigma around the issue of obesity, it is a health outcome which is treated as if it were simply a behaviour. Which may explain why articles like Robinson’s are all too common whenever an individual with obesity runs for office (you can find links to several articles of this ilk in a Slate piece taking apart Robinson’s essay).
Oddly, later in the article Robinson does a 180 and says some things that actually make sense. Mostly.
My intention is not to blame Christie… for his own obesity. Blame is not the point. Christie is just 49 and has four young children; politics aside, I’m sure he wants to be around to share the milestones in their lives. He prides himself on bullheaded determination and speaks often about the need for officials to display leadership. Well, Gov. Christie, lead thyself.
“I weigh too much because I eat too much,” [Christie] said after his hospitalization this summer, “and I eat some bad things, too.”
If only it were that simple. Yes, the basic arithmetic of calories ingested vs. calories expended is inescapable. But the science of weight control now takes into account the role that genetics might play, along with psychological factors that lie outside our conscious control. There are new options, including gastric surgery, beyond the dieting roller coaster — lose 40 pounds, gain it all back — that Christie says he has been riding for years.
So Robinson seems to understand that obesity is not simply a matter of eating less and moving more, and that it’s a complex health outcome which is only partially under a person’s control. And yet somehow, he still ends his article thusly:
Today, I’d just like to offer [Christie] a bit of unsolicited, nonpartisan, sincere advice: Eat a salad and take a walk.
So obesity is the result of a complex interaction of multiple factors, and yet it can be cured simply by the odd salad and a leisurely walk? Robinson might want to patent that idea, I’m sure no one has tried it yet…
[Update: The Obesity Society has put out a statement on this recent debate, which I have embedded below. Thanks to Atif Kukaswadia for pointing it out in the comments]