Bill Maher is Wrong About Fat Shaming
This past Friday night, Bill Maher used his popular HBO show to declare that "fat shaming needs to make a comeback." During his closing "New Rule," Maher mixed snarky fat jokes with concern (trolling) that American's eating habits are leading to expanding waistlines and poor health. "Being fat is a bad thing," he says. "We’ve gone to this weird place where fat is good. It’s pointing out that fat is unhealthy that’s what’s bad." His solution is to bring back the social acceptability of fat shaming.
Maher is right about one thing - Americans tend to eat poorly, and it is affecting our health. But Maher whiffs on the solution. Fat shaming will never help the county get healthier, and it's nearly guaranteed to make us less healthy.
There Is Very Little Evidence That Being Fat, On Its Own, Is Unhealthy
Fat-haters like Maher claim that obesity leads to health issues like diabetes, heart disease, cancer, and autoimmune diseases. The primary evidence for this claim is that there is a correlation between weight and health issues. I've covered this before, and the actual evidence for this is mixed. In fact, some studies show that fat people live longer than thin people and are more likely to survive heart attacks.
While many may be incredulous, the largest body of evidence has found that fatness is not a risk factor for heart disease or premature death, even controlling for the effects of smoking. Ancel Keys and colleagues confirmed this nearly half a century ago upon examining 16 prospective studies in seven countries, as well as actual angiographic and autopsy examinations of 23,000 sets of coronary arteries which found no relationship between body fatness and the degree or progression of atherosclerotic build-up. And the most careful studies ever since have continued to support these findings.
Dr. Paul Ernsberger, of Case Western Reserve School of Medicine in Cleveland, Ohio led a review of nearly 400 studies that was published in the Journal of Obesity and Weight Regulation in 1987 which corroborated these results. “The idea that fat strains the heart has no scientific basis,” he said. “As far as I can tell, the idea comes from diet books, not scientific books. Unfortunately, some doctors read diet books.”
Other studies have found some of the correlations that Maher references. However, any scientist knows, correlation is not causation. Even if there is a correlation between poor health and large body size, further evidence is needed to prove that large body size causes poor health. One explanation of a correlation can be that both factors are caused by a third factor. Fat acceptance advocate Harriet Brown explains:
So how bad is it, health-wise, to be overweight or obese? The answer depends in part on what you mean by “health.” Right now, we know obesity is linked with certain diseases, most strongly type 2 diabetes, but as scientists are fond of saying, correlation does not equal causation. Maybe weight gain is an early symptom of type 2 diabetes. Maybe some underlying mechanism causes both weight gain and diabetes. Maybe weight gain causes diabetes in some people but not others. People who lose weight often see their blood sugar improve, but that’s likely an effect of calorie reduction rather than weight loss. Type 2 diabetics who have bariatric surgery go into complete remission after only seven days, long before they lose much weight, because they’re eating only a few hundred calories a day.
Disease is also attributed to what we eat (or don’t), and here, too, the connections are often assumed to relate to weight. For instance, eating fast food once a week has been linked to high blood pressure, especially for teens. And eating fruits and vegetables every day is associated with lower risk of heart disease. But it’s a mistake to simply assume weight is the mechanism linking food and disease. We have yet to fully untangle the relationship.
Poor Lifestyle Choices, Not Obesity, Cause Poor Health
Overeating and lack of exercise are bad for you regardless of your body size. Fat people who exercise and eat well tend to be healthier than thin people who don't. The fact that fat may be correlated with poor health could simply be a derivative of the fact that overeating and lack of exercise often lead to weight gain.
The problem with the simplistic "fat = poor health" conclusion is that, while making poor lifestyle choices will sometimes lead to weight gain, weight gain can be caused by numerous factors and even lab animals are getting fatter for reasons that nobody understands. Contrary to Maher's claims that "being fat isn't a birth defect," genetics play a large factor in body size. In fact, fat adolescents tend to eat less than their thin peers. So while overeating and lack of exercise can lead to weight gain, it's far from certain that most fat people got that way through poor lifestyle choices. There are two discrete group: (a) fat people who gained weight due to overeating and lack of exercise; and (b) fat people who live a healthy lifestyle, and there is no way to tell the two groups apart just from knowing their body size.
The corollary is true also. Many thin people stay thin regardless of their poor lifestyle choices, needing to eat up to 10,000 calories per day to maintain weight gain. Maher is right to worry that Americans are eating poorly, but he is wrong to demonize fatties as the problem.
Losing Weight Is Bad For You
Most studies that deal with the issue simply take a snapshot of a person's weight and health and compare the correlation. However, one study by researcher Andrew Stokes use an additional variable called "maximum BMI" to separate out people whose BMI's had formerly been higher. Stokes found that the healthiest subset were people whose weight was normal throughout their lives, but also found that over all categories, losing weight was associated with worse health outcomes. The more weight lost, the less healthy people were. Other studies have also found that losing weight does not result in improvements in biomarkers like blood pressure, fasting glucose, or triglyceride levels for most people.
Fat Shaming Will Only Make the Problem Worse
Maher's suggestion is that bringing back fat shaming will help America to be healthier. Maher is wrong. The link between fat and poor health is tenuous at best. Even if more fat shaming would motivate people to try to lose weight, 97% of people who try to lose weight fail to achieve any weight loss over three years, and 83% end up gaining weight. Maher's proposed "solution" would actually result in a fatter America. Further, as shown above, even if people are able to lose weight, it will result in worse health, not better health. Maher even has the audacity to cite obesity as a cause of depression, as if fat stigma isn't the main cause. Maher seems to believe, counterfactually, that heaping shame upon fat people who already suffer from our society's rabid fat hatred will somehow result in less depression.
When Maher says that "America eats like shit," he's not wrong. Poor diet is linked with all kinds of health problems. But he's wrong to equate poor diet with obesity. Fat people aren't the problem, and blaming them will only make the problem worse.