Last week, the European Society of Cardiology published a clinical research journal on the link between obesity and metabolic syndrome, and coronary heart disease (CHD). Its findings are definitely worth considering, however it’s important to consider both mental and physical health when defining what makes a person ‘healthy’.

Because we’re not all cardiology doctors, before we get started I’d like to break down the definitions, aims and conclusions in this study. If you would like to read the report in full you can download it here.

The report discusses both metabolically health obesity (MHO) and metabolic disorders.

Metabolically healthy obesity is a condition characterised as obesity which does not produce metabolic complications – in other words, the idea that people can be fat and physically healthy at the same time.

Metabolic disorders are genetic conditions that result in metabolism problems. Most people with inherited metabolic disorders have a defective gene that results in an enzyme deficiency. There are hundreds of different genetic metabolic disorders, and their symptoms, treatments, and prognoses vary widely.

The study’s aims:

“The hypothesis of ‘metabolically healthy obesity’ implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study.”

In plain English: To test the theory that a person can be fat and healthy – i.e. if someone is fat and doesn’t have an existing metabolic disorder, they are not at greater risk of heart problems.

The study’s conclusion:

Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of ‘metabolically healthy obesity’, encouraging population-wide strategies to tackle obesity.”

In plain English: Regardless of a person’s BMI, people with existing metabolic disorders had a higher risk of CHD than healthy people. Also, regardless of metabolic health, fat people also had a higher risk of CHD than thinner people. This challenges the idea that a person can be both fat and healthy.

So. Let’s begin to unpack this.

“BMI is used to estimate the amount of body fat a person carries based on height and weight. It’s also largely bullsh*t.”

The study says that they “defined obesity and overweight using body mass index (BMI)”, which is used to estimate the amount of body fat a person carries based on height and weight, and categorizes people based on what is appropriate for their size. It’s also largely bullsh*t. The BMI was introduced by a mathematician (not a doctor) in the early 19th century, and he explicitly said that it should not be used to measure someone’s level of fatness. It doesn’t take into account the relative proportions of bone, muscle and fat, and is widely considered to be poor as a sole measure of a person’s health.

Straight away then, we can’t really be sure that those defined as ‘obese and overweight’ by the study truly are, in terms of body fat.

“You cannot judge a person’s health just from the size of their waistband.”

The conclusion reached by the report is, essentially, that you cannot be fat and healthy at the same time. I’m not about to argue with the findings of an institution dedicated to researching our health, and undeniably there is a link between obesity and health. I would however point out that you cannot take these findings and apply them to every single fat person you meet – not only will there are always those that will buck a trend, but you cannot judge a person’s health just from the size of their waistband. To consider all people of a similar body shape or size as one is both unhelpful and incorrect. I would also point out that, as an organisation dedicated to researching heart conditions, their definition of ‘healthy’ stretches only as far as the physical.

“Mental health and obesity is a swings and roundabout issue, with no clear solution for the individual,” says Hayley Smith, a PR executive working with PRCA to combat stigma in the PR industry. “The connection between the two is more of a jagged curve than a straight conclusion. Depression can lead to comfort eating, and lack of exercise or looking after yourself, and then putting on weight or bad body image can lead to depression and anxiety. It is a difficult cycle to get out of, and for many it leads to further eating, and sinking into further depression. Then this can lead to even further health issues.”

“Sacrificing your mental health for the sake of your physical health is no better a lifestyle.”

When you start to weigh up a person’s physical health against their mental health, the balance is extremely tricky to get right. Making people aware of the health risks of being overweight or obese is the responsibility of health organisations, and it’s important to take their findings onboard. But it’s so important to remember that sacrificing your mental health for the sake of your physical health is no better a lifestyle.

“If someone already suffers from fragile self-esteem, I do think that reading this kind of report can trigger negative feelings, and possibly cause them to obsess and perform unhealthy behaviours,” says Alexandra Schlotterbeck, a psychotherapist at Psymplicity Healthcare. “It’s also possible for eating disorders such as anorexia, bulimia or body dysmorphia to develop as a result of these feelings and behaviours.”

“Messages that link ‘fat’ and ‘unhealthy’ are unavoidable in today’s society, often using the findings of health research to shame larger people for the way they live.”

Unfortunately it can be the stigma surrounding obesity and fatness, and the fear of being judged, that can deter people from seeking medical advice when they truly need it. Fat people both know they are fat, and know that this can be detrimental to their health; while ongoing research into the link between obesity and health is important, their conclusions are not exactly breaking news. Messages that link ‘fat’ and ‘unhealthy’ are unavoidable in today’s society, from body-shaming advertisements to sensationalist newspaper headlines, often using the findings of health research to shame larger people for the way they live.

“The negative stigma of obesity in both society and the media creates a notion that if you are over a certain amount of weight, you are worth less than others,” says Hayley. “This can lead to several mental health issues, and causes a lot of pressure to be perfect. Not only do obese people have to face themselves, they have to face isolation and bullying from the outside.”

Staying healthy in mind is just as important as in body, so while listening to information provided by researchers is important, you also need to be thinking about how this information will affect your mental health.

“Problems arise when people take this information and use it as a tool with which to shame or belittle fat people.”

“It’s important to know the difference between taking on board information such as that given in this report, being curious about health and using it to better your life, and using it to be critical and punish yourself for it,” says Alexandra. “It’s important to practice self-care, look after yourself in a compassionate way, and be in touch with what you need both physically and mentally.”

In an ideal world, this kind of information linking obesity to ill health would always be presented clinically and without emotive language as it is in the report. The problems arise when people take this information and use it as a tool with which to shame or belittle fat people, with sensationalist headlines and blanket statements about all people with a bigger waistline.

While we still live in an imperfect world, in light of medical studies such as this, it’s important to reiterate the importance of valuing your mental health, as well as physical health. Ultimately, partaking in a healthy lifestyle means both a balanced diet and exercise, but also self-care and acceptance of yourself as more than just a body. Whilst your weight may have an impact on your health, it does not have an impact on your worth.

Quotes kindly provided by:

Alexandra Schlotterbeck, psychotherapist at Psymplicity Healthcare.

Hayley Smith, Director of Boxed out PR working on removing mental health stigma in the PR industry.

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