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What's Wrong With Calling Obesity A Medical Problem?

Americans have gotten heavier since 1980 — this we know.

And most doctors would say that the extra weight has made us more prone to heart disease, diabetes, arthritis, hypertension and even cancer.

It's become a source of major national anxiety. The Robert Wood Johnson Foundation predicts that every state in the nation will have an obesity rate greater than 44 percent by 2030, and will be sicker for it.

But not everyone is convinced obesity in America warrants so much gloom and doom. Take Abigail Saguy, an associate professor of sociology at the University of California, Los Angeles and the author of a new book called What's Wrong With Fat? She argues we've gone too far in equating obesity with disease.

"People think that being obese means being sick, and there are some health risks, but risk is not the same thing as illness," Saguy tells Shots. That's a controversial view, given how many other researchers would argue the link between obesity and declining health is pretty clear. But she's skeptical about the strength of the data proving causality, with the exception of Type 2 diabetes, which she concedes is tied to excess weight.

One of her criticisms is the blunt tool with which doctors assess health and weight: body mass index, which doctors say is unhealthy when it hits 30 or higher. "It's a very arbitrary threshold — there are plenty of people with BMI well over 30 who are perfectly healthy," she says, "and plenty of people at 'normal' weight with metabolic issues."

She says that as bigger bodies have become framed as a medical problem, those bodies are increasingly seen as bad. "We are living in society in which is it so deeply ingrained that it is bad, immoral to be fat. Fat people are widely seen as lazy, selfish, and consuming too much resources."

This takes a toll, she argues, in the form of social problems like bullying, weight discrimination and eating disorders. And doctors can make the problem worse by turning their offices into what she says is a hostile environment. Obese women, Saguy says, are less likely to get Pap smears, and thus have higher rates of cervical cancer.

Instead, Saguy would like to see obesity framed as another form of human diversity – beautiful and healthy. And if she had her way, we'd do away with the word "obesity" entirely, trading it for "fatness."

The problem with assuming that the obesity epidemic has been overblown is that plenty of people are not even aware that their weight puts them at risk for disease, which means they're at even greater risk. Some observers, like Daniel Callahan, a bioethicist who specializes in health policy at the Hastings Center, argue that we need to apply more social pressure, not less, to help people lose weight.

People who are unaware they are overweight "need, to use an old phrase, a shock of recognition," Callahan wrote in a recent Hastings report. "Only a carefully calibrated effort of public social pressure is likely to awaken them to the reality of their condition. They have been lulled into obliviousness about their problem because they look no different from many others around them."

Though policymakers, like New York City Mayor Michael Bloomberg, also support nudging people publicly to eat less, with things like bans on supersized sodas, there are other signs that thinness as the ideal body shape may not rule anymore. One sign is the decline in dieting. A recent survey of 3,800 adults found that about 23 percent of women reported being on a diet in 2012. That's a significant drop from the 35 percent who said they were dieting back in 1992.

And a recent study also found that a little extra body weight may be associated with living longer. Saguy applauds those findings and calls them a reminder of the so-called obesity paradox that suggests some people who are overweight may be healthier in the long run.

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