The point he’s making is that killer conditions have given way to chronic disabilities. These diseases get worse as you get older and just because you can survive them doesn’t make them any less miserable. Living at 70 with diabetes is no joke.

Obesity and diabetes have a strong statistical correlation – between 80% and 90%  of adult Type II diabetes sufferers are obese. Just why this is isn’t completely understood, but enough is understood to make a compelling case that there is a very strong relationship between the two. To dismiss this is ‘correlation is not causation, silly’ is to show a total lack of understanding of medical risk.

Here’s the BUPA report that the ABC piece David linked to mentions:
http://www.bupa.com/media/284419/bupa_health_pulse_2011_interactive.pdf

The exact quote from the report is “Worldwide, almost half of people survey (49%) are overweight (BMI > 25 or more). Yet only a third of people (36%) think they are overweight.”

So it’s not, as Dr Bert Boffa puts it that “half of the Australians who are overweight don’t realise they are”. It’s that half of the Australians who have a BMI > 25 reject that definition of overweight. This is actually far more interesting than Dr Boffa’s analysis. It opens the discussion about what are sensible measures of the health of the general population. 

By your logic, you could say ‘it’s hard to know which comes first – the smoking or the lung cancer’. Correlation does not tell you which is cause and which is effect, yes, but the statistical relationship is not used in isolation. Enough is known for doctors to be able to state, with some certainty, that gaining tremendous amounts of weight will put you at risk of diabetes.

The mantra ‘correlation is not causation’ is a piece of scientific wisdom that is being abused. It does not mean ‘correlation is merely a statistical artefact that has no value’.

“By your logic, you could say ‘it’s hard to know which comes first – the smoking or the lung cancer’”

Er no, lung cancer definitely doesn’t cause smoking. And its not “logic” its fact, we do not know whether, insulin resistance=fat or vice versa, nor whether a tendency toward type 2 makes you more likely to gain weight or gaining weight makes you diabetic. The overwhelming majority of fat people do not have diabetes. 

Some slim people have IR, some fat people don’t. Why do people start playing stupid when they’re losing arguments about fatness?

Not every fat woman is going to get post-menopausal breast cancer. Many women who are not fat will get post-menopausal breast cancer. Guess what? Doesn’t change the fact that being fat puts you in the high risk category for post-menopausal breast cancer.

Being obese at a young age sucks, and it sucks that there may not be much that the kid – or adult – can do about it. It equally sucks that the health consequences are independent of whether that kid could intentionally lose weight or not.

You’re right. Being overweight by itself does not guarantee that you are going to have diabetes.

Unfortunately, it does mean you have a raised risk of having diabetes.

Thin people can indeed be very unhealthy and you are right that thin people should not be complacent about their health. There are also fat people who are very healthy.

Unfortunately, it still remains the case that the more excessively overweight someone is, the higher their health risks become, including for diabetes. And, unfortunately, it doesn’t work the other way round – that lots of normal weight people get diabetes and suddenly become overweight. There will always be exceptions, but the fat tends to come first.

Fat rights are important. I can’t see, however, that it does fat activism any good to claim that fat doesn’t bring problems with it, including diabetes and other metabolic disorders. The health risks and consequences are too well documented.

The overwhelming majority of fat people may not have diabetes, but the overwhelming majority of diabetes patients are fat.

The older you get, though, the more the association with body weight diminishes.  (IOW, the younger you are at diagnosis, the stronger the genetic link.)  As Paul Ernsberger once put it, if you live long enough, you WILL get t2d.  One of your internal organs has to start crapping out on you first, and since we’re doing a much better job of preserving hearts and brains than we used to, more people are going to see the pancreas start to go first.  It’s also being diagnosed at much, much earlier stages than it used to be — at lower levels of fasting glucose, and without any of the later stage symptomatology like fainting, gangrene, etc.  (And don’t think they won’t lower the qualifying FG again if the drug companies insist on it.)

So plenty of people with the diagnosis live perfectly normal and beyond-normal life spans now, even with an early diagnosis; it’s only people who got a very late diagnosis or don’t have any kind of treatment at all who die from it anymore.  (I know this; I have examined close to 150,000 medical records during the course of my working life, and I know what people actually die from.)

Also, risk factor =/= death sentence.  Sleeping less than 7 hours a night is a risk factor for many illnesses (and injuries) too, but people seem to do that every chance they get, and they don’t get shunned for it.  In fact, it’s considered a badge of honor to do with as little sleep as possible.

But think the whole point of this post is to ask how two-thirds of the population a country with tens of millions (or in the case of the U.S., hundreds of millions) of people can have bodies that are said to be deviant or abnormal.  How does that even make any sense?  Even ONE-third is an awful lot of “deviants” in a population that size.  And shaming people for their supposed deviance has done precisely squat-all to make them not “deviant”; in fact, it has arguably the opposite effect.

There are two separate issues here. One is fat shaming and discrimination and so on. That is obviously a human rights issue and is something that shouldn’t happen.

That doesn’t change the biological reality that diabetes is a miserable disease that is being diagnosed at a younger and younger age. It’s no consolation to a child of 12 to know that they won’t die from it any more. I’m sure most kids would have preferred not to get it in the first place.

People are also better off sleeping properly. Culturally, people may feel a sense of reward for running on adrenaline, but the body doesn’t know or care about ‘everybody does it’. It just feels awful. Diabetes – or breast cancer, colorectal cancer, sleep apnea, bladder leakage, weight-related arthritis – also feel awful, even if they don’t kill you and if more and more people have them.

As to bodies being considered deviant – bodies are certainly culturally constructed. They’re also biologically constructed. There is a biological range of ‘normal’ for humans. This can shift radically depending on the nutrition available – you can see it in the way height changes rapidly depending on local conditions. Some of it is also genetic and we’re seeing genetic expressions that we’ve never seen before, because of a new food environment (new in evolutionary terms). Even taking all of that into account, there is only so far the human body can change before it becomes extremely unhealthy. Once it’s got into that range, you can say it’s not longer within normal range. Everybody seems to complain about the BMI, but even with all its faults, it still remains a consistent predictor of certain types of medical risk.

The question about all of this, of course, is what you can do about it. Once the body is fat, there’s no point fat shaming, exhorting people to become thin when they can’t, etc etc.

But that doesn’t change the fact that higher fat IS associated with a heightened risk for a number of disease processes, diabetes among them. For health, it really is better not to get obese in the first place.

I’ll give it up at this point. I just wish that people who are abusing the  ‘correlation is not causation’ argument would also give it up.

Disqus isn’t letting me edit, but the first two sentences were a little murky, so let me restate:  In elderly populations, the association with body weight diminishes.  (And the younger you are at diagnosis, the stronger the genetic link.)

When you compare a direction of causation that is unknown, with one that is, you’re throwing in the towel on that point. I did not mention any prognosis on fatness, so if you wish to respond to me, stick to what I actually say.

But as you raised it, the weight and health graph is U Shaped, meaning that either ends of the spectrum are more likely to be showing some difference in function from the mean, obvious.

The difference between the thin and fat ends is that with the former, the ‘obesity scientists’ attempt to excuse it away. Saying if you are thin you’re more likely to be dying (yup) so its not what it seems on the face of it etc.,  by this ‘obesity’ experts undermine their own thesis of taking fatness at face value and soft soaping one end of the curve. It is refusing to think that anyone who isn’t fat is always honourable and fat people sneaky, that “undermines fat rights” whatever they are.

Thanks!