The Fat Discussion

An article in today’s New York Times discusses why America is so obsessed with fat. The author tries to tell us that in several large studies there has not been a correlation between fat and mortality. The author is correct. Just because you’re fat, that doesn’t mean you’re going to die early. Unfortunately, the author does not take this far enough. He’s arguing that several studies show that just because you are fat does not mean that you have a higher risk of dying early.

I think the author misses the point. What many Americans are looking for is a quality of life. Can we have a good, healthy life? So, the question becomes whether you have a good, healthy life while being fat. The answer is clearly a murky maybe. We’ve all seen pictures and heard tales of people who live into their 60s, 70s and even 80s who’ve been overweight most, if not all, of their lives. On the other hand, we’ve also seen people who died at an early age who were morbidly obese. As with almost every question in medicine, the answer is not simple black and white. Things like cholesterol level, history of heart disease, diabetes and other things play into mortality. A recent article in the American Journal of Surgery revealed that obesity increases wound infections and respiratory complications after abdominal surgery, yet mortality rate was not affected.

The question also is how fat is fat? Just because you are not “runway model” thin doesn’t mean you’re fat. Or, how fat do you have to be in order to increase your mortality rate? I don’t think that this has been adequately studied. Some people can be just a little overweight and have terrible trouble with diabetes mellitus. Other people can be 50-75 pounds over their “ideal” body weight and have absolutely no trouble with diabetes, hypertension or hypercholesterolemia. Genetics plays a huge part.

So, I think it is important for us, like Goldilocks, to find a spot where our weight is just right. We do need to exercise. We do need to manage our blood sugars, cholesterol and our blood pressure. Eating healthy and maintaining a healthy weight will help you, yes, but it will not guarantee a good quality of life.

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Errington C. Thompson, MD

Dr. Thompson is a surgeon, scholar, full-time sports fan and part-time political activist. He is active in a number of community projects and initiatives. Through medicine, he strives to improve the physical health of all he treats.


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