Obesity: You'll know it when you see it...or will you?

We need to be careful with how we throw labels around — psychologists are particularly prone to this, and sometimes we don’t consider the repercussions from careless diagnoses, official or not. Some of these terms are derived in ways other than how you’d expect. A perfect example of this is the term “obese”. Interestingly enough, while we imagine an obese individual to be someone who is very fat, it’s possible for an individual with low body fat and a LOT of muscle (think Mr. Olympia) to end up in the same category. That’s because the official designation of “obese” is based not on fat, but on height and weight, using the Body Mass Index. But once you label someone as “obese”, our imaginations run off with what else that means…

In health terms, an individual is described as obese when he/she has a BodyMass Index (BMI) of 30 or higher. BMI is calculated as:

weight (kg)/[height (m)]2.

That’s all. It simply means that the person has attained a certain, greater degree of overweight that has knocked them into a certain category. Note that there is no direct measurement of fat involved, and in fact, the correlation of BMI with body fat is rough and imperfect, but “kinda, sorta good enough”. However, in the realm of public health, collecting reliable data is critical to making accurate assessments about populations, and it’s easier to measure height and weight (which are fairly straightforward measurements) than to try to gather body fat data (generally more time consuming and fraught with user-errors). And because of that “kinda, sorta good enough” correlation, the BMI is used to determine whether a person gets knocked into the “obese” category. The BMI was never designed to diagnose individuals, as has begun happening. If you’ve ever played “Wii Fit” and wanted to throw the balance board at your TV screen, you probably know what I mean — BMI is all over the place and being misused regularly. Wikipedia does an unusually good job of describing the problems with overinterpreting BMI here.

So the BMI, the measure by which we determine whether someone is, or isn’t, overweight/obese, is simply a number that doesn’t have anything to do with body fat, really. HOWEVER, Merriam-Webster’s dictionary defines “obese” as “having excessive body fat”. Doesn’t that seem wrong? “Fat percentage” is not a variable in the BMI formula (have I stated that enough times in one post?), but the word “obese” by definition is based on body fat. And the designation of “obese” as it’s used in our daily lives becomes painfully emotional to many people.

I came across an interesting article (via Twitter, thanks to @AliciaMarieBODY) about an obese woman who managed to avoid looking at herself as she gradually put on fat, thereby ignoring the changes to her body, only to be confronted by her physician with the reality of her physical state. She knew she was heavy, but grossly underestimated her actual weight. When her doctor told her she was obese, her response was,

“It may sound unlikely, but I was genuinely shocked. In my mind I was far from obese. To me, obese was beyond fat  –  with connotations of someone who was greedy, lazy and uneducated and that wasn’t me.”

Wow! To her, it wasn’t simply excess weight or even fat, it was something much worse than that. It was a character judgment. How frightening that a simple measurement (BMI), calculated from two very objective measurements (height and weight), would be interpreted so subjectively.

Even the word itself — “OH-BEEEESE” — sounds unpleasant and bears a resemblance to ‘obscene’, so it’s not surprising that there are several levels of negative connotations wrapped around it. Obese suggests extremely fat to the point of being a circus sideshow. It sounds hideous and evil.

So, we’ve transitioned from simple body measurements to their interpretation as body fat to something that’s nasty. The issue is no longer a number, but rather a reflection of who the person is as a human being. That’s a heavy emotional hit for someone who sees themselves as merely “carrying extra pounds”…and then is confronted with the loaded label of “obese”.

Taking all these things into consideration, it’s not surprising that the woman’s quote above reveals something more insidious that merits consideration: even the obese are prejudiced against the obese.

While I’m not recommending that we take “obese” out of the English language, I hope that people understand how that designation arose. And even more importantly, that it’s not an immutable life sentence. It doesn’t mean you’re bad, lazy, gluttonous, stupid or anything else negative that some people ascribe to that label. It does mean that you should take stock of your habits and see if you’re one of those who needs to reduce their body fat levels to get themselves out of a high-risk category for a number of diseases.

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