Amy Schumer said in her humorous acceptance speech at the Glamour Women of the Year Awards: "I'm like 160 pounds right now, and I can catch a dick whenever I want, and that's the truth."
The line, like many in her speech, is obviously very funny. But the humor is directed at a misperception that is not so funny. With our society's superficial focus on youth and appearance, we have emphasized all the wrong reasons for maintaining a healthy body weight, which has nothing to do with "catching dick." We are sold the idea that remaining slim is primarily important as a means of attracting the opposite sex, rather than as a path to good health and longevity. That inherent and unquestioned assumption about our motivations for weight loss is why Schumer's line is in fact so humorous. But being overweight, even by a little, is no laughing matter.
I have written much in the past that fat is not fit; any claim in that direction is just wishful and dangerous thinking. But such thinking remains common. Here is a typical claim we see in the media, in this case the June 4, 2015, Daily Mail: "...even if you are fat, the key to prolonging your life seems to be how fit you are." Wrong.
This misleading media play goes on even though the theory that a person can be overweight but healthy has been disproven repeatedly. Some confusion arises because in 1998, the National Institute of Health claimed a person could be overweight and be considered healthy; but the report has been fully repudiated by more recent studies.
Last year, New Jersey Governor Chris Christie told former White House physician Connie Mariano to "shut up" about his weight when she expressed concern that he might die in office if he were elected president. Christie openly acknowledges that he struggles with his weight, but claimed that he is "remarkably healthy." Well, no. The Governor said that unless Mariano gave him a physical exam or learned his family history, she could make no judgment about his health. He is wrong, because any casual observer can see that Christie is obese, as he would himself admit -- and the reality is that obesity is known to lead to an increased risk for premature death. Here is an easy bottom line worth remembering: one in five deaths is linked to excess weight. Most Americans die sooner than necessary by stroke, heart attack or cancer -- and obesity increases the risk for all of these. Christie should remember that the Titanic was a healthy ship just before hitting the iceberg.
We know absolutely that obesity creates an increased risk of diabetes. In 1990 about 11 million Americans had type 2 adult onset diabetes, a disease of insulin resistance that commonly coexists with obesity; just nine years later the number was 16 million, or about 6% of all Americans. Then from 1999 to 2003 we saw a 41% increase in diagnosed diabetes. Since then obesity has ballooned to an astounding 64% of all Americans and the number of diabetics continues to explode. The insulin resistance syndrome associated with obesity has other dire consequences, including hypertension and the increased risk of atherosclerotic cardiovascular disease.
If you are not yet convinced of the fallacy that fat can be fit, consider the following realities:
• About 300,000 deaths per year are attributed to obesity; in spite of the deep flaws in BMI, we know that individuals with a body mass index (BMI) over 30 have a 50% to 100% increased risk of premature death from all causes compared to lean people with lower BMIs.
• High blood pressure is twice as common in obese adults compared to those with a healthy weight; obesity is associated with elevated blood fat (triglycerides) and decreased good cholesterol (HDL).
• A weight gain of only 11 to 18 pounds increases the risk of developing type 2 diabetes; over 80% of people with type 2 diabetes are overweight or obese at the time of diagnosis.
• Obesity is associated with an increased risk of cancer of the uterus, colon, gall bladder, prostate, kidney, and postmenopausal breast cancer.
• Sleep apnea is more common in obese people. And some recent studies have indicated that a lack of sleep might impact hormone levels to a degree that could, indeed, cause weight gain.
• Obesity during pregnancy is associated with a greater risk of birth defects, including spina bifida.
• Every increase in weight of two pounds increases the risk of arthritis by 9% to 13%. This fact should eliminate any questions about the limits and deficiencies in using BMI as a health indicator; it does not matter much. Yes, BMI misses more than half of people with excess body fat. Inversely, because BMI is deeply flawed, some people are incorrectly labelled as overweight. But that limitation is no excuse when we know that even a small increase in weight has negative health consequences.
Another problem with "fat but fit" is simple mechanics. The human body evolved from a period of deprivation where food was scarce and difficult to obtain. Our ancestors were almost certainly lean. In any case, we are not engineered to bear excess weight on our joints. Obesity leads to arthritis -- and often to joint replacement not only because of the mechanical stress it can cause but because fat produces chemicals that attack cartilage. Think of it this way: If you stuff 20 people into a VW Bug, the suspension will wear out faster and the engine will have to work harder, ultimately reducing its useful life.
One final consideration on the idea of being fat but fit: obesity affects quality of life through limited mobility, decreased physical endurance, and social, academic and job discrimination. Right or wrong, that is the current reality.
Amy Schumer looks good and can catch dick at her current weight; but she would live a longer healthier live if she shed a few pounds. That is the lesson we should all take home.
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