O*****y: A new dirty word
Cancer research UK launched a series of adverts around the second leading preventable cause of cancer. With over half of the UK adult population overweight or obese the medical implications of excess body fat are only going to grow.
Obesity is excessive body fat but not all body fat is created equal. The distribution of body fat and the ratio of fat to muscle is also important. Your body is an incredible balancing act of energetic processes. The human body is also naturally conservative, in that is will err on the cautious side. You can survive being 20% overweight much more comfortably than you can being 20% underweight.
There is a hard floor with weight in that there is a minimum below which life is very difficult to sustain but there doesn’t really exist a hard ceiling. When doctors say that being overweight will shorten your lifespan they are talking statistics. Increasing your risk of various diseases year on year with a factor, weight, that is modifiable by lifestyle.
What’s Your Number?
How we measure body weight, which should technically be called body mass, defines your weight ‘label’. The easiest method; BMI is almost useless. Actually it is not it is just widely misused. BMI is good but too sensitive, it catches too many people in its higher weight categories. This oversensitive nature leads to false positives which people fixate on. A 6 foot 4 fellow weighing in 16 stone would be overweight, almost obese, on the BMI scale but their body fat percentage of 9.5%, waist circumference of 34 inches means they aren’t overweight in the intended manner. Indeed you would probably be in awe of the athleticism of these individuals.
If you have a BMI that reads as overweight, obese or higher than more numbers are necessary, numbers such as body fat percentage and waist circumference. The BMI fails to take into account whether the mass in its calculation is muscle, fat or other. It also doesn’t take into account where that mass is distributed on the body. Body fat percentage is another useful tool especially when combined with BMI. Two women, with the same BMI, from the same height and weight, but different body fat percentages have completely different risk profiles related to obesity. Body fat percentages vary as the same percentage on one individual could look very lean but on another look less so.
So we go another number. Waist measurements are more sensitive indicators not only of total body fat but the high risk body fat. The fat that clings to your belly encasing your internal organs is part cause and also warning bellof metabolic dysfunction. The waist figures are more absolute. The NHS says 34 inches for women and 40 inches for men is obese and steps should be taken to reduce those measurements.
The BMI should not be dropped, it serves as a quick way to identify individuals at risk of being overweight. There are better tools for those who are trying to get fit or lose weight. Note that these are not the same thing. If you want to lose weight the BMI and body fat are likely the ideal tools for you. If you want to get fit the waist measurement will be more sensitive to improving fitness.
Cancer(s)?
There are two hundred different cell types in the body. Each one of these in theory can become a cancer. Certain cells types are more susceptible to cancer than others. Usually these are the cells that are either exposed to environmental damage the most such as skin, lungs and the bowel or those which are sensitive to the hormone profile of the body such as breast and prostate.
There are many things that can increase your risk of developing cancer. Many of these are non modifiable such as sex, ethnicity and family history. These have a variable contribution to the risk of any given cancer. However certain lifestyle (i.e modifiable) factors are also contributors. The most important thing is that these are the factors we can change. You can’t change your sex linked risk of endometrial cancer, you can make contraceptive and weight choices based on that. You can’t change your family history of bowel cancer, you can avoid alcohol and attend regular screenings. Mitigating risk is what much of modern medicine has become.
Smoking is the biggest modifiable risk with obesity is next, drinking is also somewhere in there. This is a rigorously proven relationship. Seriously smart people have studied the damage that smoking, obesity and drinking to your health. Stating rigorously proven science shouldn’t be problematic. Body fat is an endocrinologically active organ. It sends out hormonal signals throughout the body, and it does so in a volume based manner. The cells that respond to these hormones are sensitive to the volume of signalling they receive from the fat organ. The hormones produced by fat are similar to Insulin and oestrogen. This is evidenced in the cancers most susceptible to obesity.
Blah Blah Blah: Free speech is the right to offend
This is the tricky part of good science; effectively communicating findings. Modern society is a dynamic state and previously marginalised voices are now speaking up. This is good. However the right to speak doesn’t guarantee that what you say is worth listening to. Being offended is not enough to silence others. Being threatened and being offended are different things.
Very few people feel that smoking is a healthy activity with no risks to health. People still smoke but do so knowing that their habits are damaging their health. Drinking enjoys spells where people try and briefly delude themselves that a little alcohol is beneficial, seriously it really isn’t. We can talk about reducing people’s drinking, we encourage smokers to quit. Why is fat different?
There are many possible answers, perhaps the simplest is we are very sensitive about how we look. An obese individual is pre-labelled with negative stereotypes by simple virtue of being fat. Fat shaming on society is a real and damaging thing. Being fat, black and a woman is a heavy burden. Defensive behaviours and language around public consumption of food pop up unbidden but triggered. Fat people get mocked for eating, mocked for dancing and mocked for simply existing.
Glandular. Big boned. Thicc. Fluffy. Curvaceous. Rubenesque. Those are some of the more polite terms used to describe being overweight. Modern culture is still enthralled with thin and has a narrow accepted view of what the ideal human should look like. This isn’t helping. Getting real bodies into media is helping and the Body Positive brigade is doing good work in that regard.
Being fat also demonstrably increases the risk of several diseases, including a range of cancers. Yet the question of how to tackle this problem is prickly. That poster with the simple sentence “Obesity causes cancer” is blunt, but is it offensive? There is no blame in that sentence; yet people are all bent out of shape about the adverts. Would being the sentence “Ginger hair increases your risk of skin cancer 20 fold” be as offensive? Is describing an individual as tall and dark-skinned or another as small and overweight problematic? None of these words should cause offence in this context.
This is not a problem the medical community, and the world, can ignore. Obesity, by whatever metric you measure it is rising, and the implications are being felt on almost every healthcare specialty in the world. So how to treat the noisy dissenters, those who scream FAT SHAMER! and use body positivity as a shield?
Radical thought: You don’t have to listen to someone’s opinion.
Everyone is entitled to an opinion, regardless of how dumb and nonsensical it is. Facts do not care about your opinion, they will continue and persist whether you believe in them or not.
There will always be dissenters. Ignore them. Talk to the curious,those who want to change their lifestyle. Educate, always, with an honesty that may be uncomfortable but without judgement.
With patience, facts and dogged determination good science will persevere. This will require embracing the negatives. Don’t panic that simply because someone said something it must be true. Think and evaluate, calm your monkey brain and think logically. Calling someone overweight should be a factual statement, not a value judgement. We should be comfortable with people of all shapes in all spaces. Overweight women should feel comfortable in the gym exercising or simply changing. Obese men busting the prime moves on the dancefloor should be celebrated for the pure joy of dancing. Everyone gets hungry. If we cover our eyes and say that fat people don’t exist, and shun them from public spaces, then we make educating people about obesity risks even more difficult.
Emotions are a powerful and facts can be dry and dull. Scientists have a difficult job communicating their research. The obesity conversation is an emotion laden debate which cold facts alone will not win, so change the platform. Embrace the body positivity movement; get people moving more, eating better, socialising and interacting with nature. Show people the benefit of reducing the risks of obesity rather than hit them over the heads with the negatives, more carrots fewer sticks. We have seen this work with smoking and drinking.
Media that latches on to the extreme emotions of outrage doesn’t help. Much of the coverage of the Cancer Research’s advert has focussed on one outspoken outraged individual. Just because the conversation is difficult doesn’t mean we should have it. Obesity is a growing problem and any solution is going to take work and time. Regardless society will have to adjust to accept this bigger perspective of human existence and scientists will have to be thorough and steadfast in their conclusions.
Obesity is a cancer risk, a modifiable one.