Pas de HAES en France

Published 10.22.2017

There is no HAES (health at every size) movement in France, yet. Obesity is not accepted nor acceptable in France, and the French are not subtle about it (the French in my experience are subtle about little). An obese French woman has written a memoir about her experiences, which the New York Times reviews— sort of.

The comments on the article are typical, obesity is complicated, obese people are victims, it’s all about bigotry… blah blah blah. Of course, people being rude based on appearance should be discouraged— but the French are a rude people (to be more direct than calling them "unsubtle" above.

The causes of obesity are known, the energy balance rules. I have a hard time thinking that French society would be accepting of the notion that fat people are "helpless victims" or that they haven't caused their own issue. The title of the book acknowledges that, "On ne nait pas grosse" or "One is not born fat."

Is it easy to lose weight? Not if you don’t want to change how you live, move and eat. That’s the reality, which I have written about too many times to count.

Why is there confusion as to whether being overweight is healthy or not? Statistics are massaged and associations are touted as definitive. Naturally Katherine Flegal gets a mention, but so does Andrew Stokes.

Flegal is the researcher whose statistical butchery is endlessly cited by HAES fans as "proof" that obesity can be healthy. Stokes is the researcher that went back through Flegal's mess and pointed out just how deceptive her conclusions were.

Andrew Stokes, the demographer at Boston University, says some of most vocal supporters of the “obesity paradox” are activists and people with vested interests. He’s found that the paradox disappears when “normal weight” is defined as only those people who have remained thin over time, as opposed to those who entered the normal-weight category after losing weight due to an illness. In a paper published this April, Stokes, Willett, and others found being overweight was associated with mortality—but only if you looked at a person’s maximum weight over the past 16 years. According to their findings, it’s having ever been overweight that’s risky.

Flegal’s work does not take into account the weight history of the person, and context matters. If you’re think when you die because you’ve wasted away while sick, that doesn’t make being thin unhealthy. Flegal pushes back on Stokes, claiming that the illness effect isn’t that large. Well then, prove that.

In the end, it’s a bunch of researchers arguing about associations. Flegal won’t recommend that someone with a BMI of 22 gain weight to increase health, suggesting that she herself recognizes that the association she’s found doesn’t mean what she thinks it does.

What happens when outsiders stumble across HAES or “fat studies”? I can’t disagree with a single point made in this article. In particular, I agree that it’s extremely dangerous to convince obese young people that they have no way to be anything else but obese.

The body compensates until it cannot, and the earlier that your exceed your body’s ability to compensate for the various stresses you place on it, the sooner serious health issues will manifest.

Is there a link between obesity and depression? Many people who look for help with depression also happen to be “heavy.”

The relationship between obesity and depression is what researchers call "bidirectional." Being obese or overweight ups the odds of depression, and vice versa.

For example, about 43% of people with depression are obese, according to the CDC, compared with a third of the general population. People who are obese are 55% more likely to be depressed, and people with depression 58% more likely to develop obesity, according to one 2010 study. "This is a massive public health issue when you have numbers that large," Donato said.

“Bidirectional” sounds like a fancy term for “chicken or the egg?” In other words, are you fat because you’re depressed and eating your feelings, or are you depressed because you’re fat?

The HAES followers would assert that the becoming depressed while fat is a direct result of society’s “fatphobia” and the oppression of fat people that results from it. And I’m certainly not going to argue that fat people don’t suffer insults and worse. The elimination of that abuse is the part of fat activism that I can wholeheartedly support.

But, (and you knew there was going to be a ‘but’ right?) I think it’s equally likely that fat people may become depressed as their excess weight begins to affect their health, mobility and quality of life. Of course, this entire argument is hinged on the acceptance of obesity as a disease— something that I do not accept. Unlike depression, the cause of obesity is not in doubt, nor is the treatment.

Both obesity and depression cost the healthcare system incredible amounts of money.

Obesity already costs the medical system almost $150 billion per year in direct costs, and the nonprofit Robert Wood Johnson Foundation estimates that by 2030, obesity will sap the U.S. economy of an additional $390 billion to $520 billion in lost worker productivity.

Depression makes the price tag worse. Its most severe variant, major depressive disorder, costs the country more than $200 billion per year in direct costs such as psych visits, medication and other treatments, as well as the hours and days in which people afflicted aren't able to work.

The federal government foots much of this bill.

The other cause of linkage might be the fact that many of the drugs used to treat depression cause obesity (cause people to overeat).