Comprehending

The two studies from yesterday (iron absorption with unfamiliar foods and nutrient absorption with stress) I found only in Health At Every Size. The two studies for today come up in almost all of the books. 

The primary study is "Actual Causes of Death in the United States” (McGinnis and Foege, 1993):

 https://www.frontiersin.org/articles/10.3389/fpubh.2020.00279/full

It is often mentioned in relation to another "study" (I have to use the term more loosely here) by David Allison. This gave a number of 400,000 deaths per year from obesity. That number had to keep going down, because even if you trusted all of the data, the math seemed to require a lot of extrapolation and some rounding.

(Allison was highly subsidized by various companies that had a vested interest in there being an obesity crisis.)

However, Allison was not the only one to use McGinnis and Foege's work incorrectly. They fought back on a regular basis, but even hearing about that before, this time around reading Happy Fat, I understood it better.

The substance of the study was that after lots of research and data, what largely determined health outcomes was nutrition and activity. People cited that as proof of the danger of obesity, but that's not what the researchers said.

What I realized this time was that the people citing it as proof of the danger of obesity had obesity so firmly in mind as the result of low activity and poor nutrition that they could not imagine those factors not meaning obesity.

That correlation is not a given.

This is why there are terms like metabolically healthy obesity as opposed to "metabolically obese, normal weight", sometimes delightfully called "skinny fat".

I was once in a diabetes education class with a lean and muscly guy who worked on roofs all day. His typical lunch was a big bag of potato chips.

He dropped out of the class because he could not believe that he had diabetes. The diagnosis was obviously a mistake; look at him!

Equating body size with health sabotages health. 

It allows the assumption of health for people who are not healthy but are thin. 

It discourages people who are trying to become healthier (which should be possible), making them more likely to give up when they fail to become skinnier (which may not be possible). 

It makes people choose pathways that are less likely to result in good health by setting the wrong priorities.

And it allows fat-phobia to feel justified. People who take sneaky photos at the gym or cat call people out for a walk can respond to any requests for dignity by righteously making it all about health. 

Because that fat-phobia has so much reinforcement -- socially, intellectually, and financially -- it allows doctors to feel an aversion to their fat patients, where they leave tumors undiscovered or withhold care until the patient can earn that care by losing weight. Not all doctors, but too many.

Mentally, we seem to have married the idea of a slim body size with health, and that seems to have reinforced the perceived relationship between a slim body size and the worth of the individual.

All of those ideas need to get divorced.