The Obesity Epidemic’s Dirty Underwear

I went to Prof. Kelly’s office hours to talk to her about the so-called “obesity epidemic.” She had stick-straight blonde hair and an overall appearance that said, I used to be a hippie. When I asked her about the “obesity epidemic” she rolled her eyes. 

“I bet if you look at death certificates, they never have ‘obesity’ listed as a cause of death.” She said. Then she added,

“I’ll bet there’s not nearly as much research to support these claims as you would think.”

That was all I needed. An intelligent, compassionate, and political woman had given me the green light to take seriously the idea that the medical paradigm surrounding fat people might just be completely bogus. Up until to that point, most of the people guiding my research had suggested mostly helpful things, such as poverty being the real issue, not weight. Or food insecurity being the underlying problem. But there were also people trying to convince me that we should treat obesity as existing on the disease pathway, meditating or moderating chronic illnesses.

Prof. Kelly’s view skirted that last consideration. What if this entire thing is bullshit? Was her underlying message. I had to find out if that wasn’t the right way to look at things after all.

I had to know if the veneer of certainty about the ill-effects of so-called obesity wasn’t hiding a dark secret. That is, did the obesity epidemic have dirty underwear? We are all familiar with the saying, and with actual people and situations fitting the bill. The idea of “dirty underwear” speaks to hiding imperfections. Keeping skeletons closeted. Ugly truths about a person or a thing that are hidden from plain view, as its polished presentation leads us to believe it is perfectly good, true, and reliable.

After speaking with Dr. Kelly, I began my research into the history of the medicalization of fatness in earnest.

* * *

In Fearing the Black Body, I shine a light on the completely haphazard way BMI (or Body Mass Index, the only tool regularly used to assess obesity), entered the medical conversation. It began with a 19th century Belgian astronomer.  Yes, an astronomer.  You know, the people who study stars and galaxies, and other effects beyond the Earth’s atmosphere? This is our guy.

His name was Adolphe Quetelet.  Quetelet realized there wasn’t a whole lot of money in his chosen field. People were more interested in what was going on with themselves and others on this planet. So, needing an occupation that would actually give him enough money for food, in the 1830s he switched to a career in the new “sciences of men.” 

He took an interest in understanding the size and shape of the “average man” in a population such as his. So, he gathered data on the average height and weight of (mostly) men in Belgium. But whaddya gonna do with raw data like that? He needed something manipulable. He was trying to establish an average man. A physical norm.

Quetelet then realized that by dividing weight (in kg) by height (in m2), he could fasten the data onto a normal curve. This became known as the “Quetelet Index.” The normal curve had, incidentally, been getting a lot of play since renowned German astronomer Carl Gauss had been using it for astronomical measurements. You might have even heard of the “Gaussian curve.”

You may be asking yourself: Wait a minute. Everybody involved is an astronomer. Does this have anything to do with health outcomes?  

The answer is no. According to one of Quetelet’s biographers, the astronomer-cum-statistician, “had no interest in obesity.” Health was not his concern. He was only interested in quantifying the “average man” which he considered an idealized human form. A representative of every man. Again, this was mostly for, and relying on data about, men. Curiously, when he and his followers did concern themselves with women—which was rare—they often found women weighed more at the same height than men. They considered that normal, too.

Quetelet became recognized as one of the founders of modern statistics. A little under a century later, sciences based on idealized humans, on  “norms,” would be put to work for nefarious ends with the eugenics movement. In the 1920s, a eugenicist named Charles Davenport pulled the Quetelet Index into American medicine. He thought racial Others—anybody not claiming Anglo or Saxon identities—were fatter than those elite whites. He also thought that these fat racial Others were bringing down America’s prime stock. He used the Quetelet Index to make these claims about "racial build," or what he liked to refer to as "racial obesity." He renamed it the “Index of Build.”

Nearly 50 years later, eugenics had been firmly repudiated. But that doesn’t mean all of its scientific endeavors were discarded. In the 1970s, a man named Ancel Keys—who showed his disdain for fat people openly—renamed the Index of Build, Body Mass Index, or BMI. He himself admitted BMI was a crappy tool, but shrugged those concerns off by claiming, it was no worse than the insurance industry standard weight tables they had been using. Translation: It sucks, but, whaddya gonna do?

And voilà! Just like that, a new health standard was born from a tool that did not start out having anything to do with health. It was introduced into American medicine by a known eugenicist. It was later promoted to the status of an indispensable tool for assessing the relationship between size and health by a known a fat phobe.

 

A man with a round belly celebrating himself.

* * *

 

There you have it. The obesity epidemic’s shady history. And here I go, exposing these dirty drawers. 

Prof. Kelly’s hunch was right on the money. It was ultimately confirmed by my research. BMI as a tool is bogus. And obesity designations are based almost entirely on it.

You may be thinking, “So its history is weird. That doesn’t change the negative effects of ‘obesity,’ does it? I mean, doesn’t modern research show high BMIs are correlated with a bunch of health conditions? Doesn’t that make fatness a recipe for illness and death?” I’ll do a post about that in the future. For now, just remember: correlation isn’t causation. All kinds of things have misleading correlations, like the correlation between ice cream consumption and criminal behavior.

There was one thing Prof. Kelly had gotten wrong, though. Sometimes, death certificates do list “obesity” as a cause of death. Can you guess when this became popular? It tripled between 1999, when obesity was declared an “epidemic,” and 2015, which was two years after the AMA labeled obesity a “disease” in its own right.

But the story doesn’t end there. There are two more things I want to tell you about one day in the future: The first is the likely reason the AMA chose to label obesity a disease when it did. The second is the relationship between “obesity” and illness for Black women. For both of them, the story takes plenty of unexpected twists and turns.