In reference to the president’s hydroxychloroquine-consumption controversy, House speaker Nancy Pelosi told Anderson Cooper that the president’s “age group and [his], shall we say, weight group” were particularly concerning. Shall we say? Trump is “morbidly obese, they say,” she said. They say? Why such qualifiers? American reticence on the subject of weight remains a mystery.
A person’s Body Mass Index (BMI) is their “weight in kilograms” divided “by the square of height in meters.” According to the CDC, a BMI of 30 or higher constitutes obesity. At his last physical, in 2019, Trump’s BMI was 30.4, thus Trump is — by this metric — obese. For stating this fact, however, Pelosi incurred the wrath of the positivity movement. Epidemiologist Abdul El-Sayed, a CNN commentator, tweeted in response that “fat-shaming drives obesity stigma. It’s not cool or funny.” Another commentator called for recognizing “fat positivity” as a “complex issue.”
Actually, it’s quite simple. Though the CDC prefers to say that a person “has” obesity, rather than is obese, it nevertheless informs us that “people who have obesity, compared to those with a normal or heavy weight, are at increased risk for many serious diseases and health conditions.” These include:
All-causes of death (mortality)
High blood pressure (Hypertension)
High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
Type 2 diabetes
Coronary heart disease
Osteoarthritis (a breakdown of cartilage and bone within a joint)
Sleep apnea and breathing problems
Low quality of life
Mental illness such as clinical depression, anxiety, and other mental disorders
Body pain and difficulty with physical functioning
All causes of death, as well as, according to at least one study, the coronavirus.
A few weeks ago, there was a similarly bizarre episode when singer-songwriter Adele — who has been overweight for all of her career — revealed she’d shed upwards of 50 pounds. Prior to this, Adele had consciously incorporated her size into her brand. “Fans are encouraged that I’m not size 0 — that you don’t have to look a certain way to do well,” she said to Vogue in 2007. “I represent the majority of women and I’m very proud of that,” she told People magazine in 2012. But while she’s right that, with a healthy BMI (anything between 18.4 and 24.9) there is plenty of variety to be had in terms of body shapes and sizes; that one needn’t look like a Victoria’s Secret model to have a healthy body — being overweight is still objectively unhealthy. Presumably, this is something Adele eventually recognized, having put in considerable effort to get in shape, for which she surely deserves congratulations.
Yet self-help gurus and so-called “fat-studies” scholars promote denial of the health risks associated with being overweight. Dawn Serra, a “fat positivity” coach, complained: “We are exposed over and over again from a very young age to very specific messages about who is worthy and who’s not, who is desirable and who is not.” And in their 2017 study on “weight discrimination,” Maya Vadiveloo and Josiemer Mattei concluded: “Eliminating weight stigma may reduce physiological dysregulation, improving obesity-related morbidity and mortality.” [emphasis added] Um. You know what might also work? Losing weight.
One reason Pelosi has come under heavy fire is that she said the president was “morbidly” obese, a term the CDC does not use. But morbid, which comes from the Latin morbidus, simply means “disease.” Obesity comes with stigma, in part because it is self-inflicted, but also because of its visibility. Unlike other vices — e.g. difficulty controlling one’s sexual urges, temper, alcohol intake, finances etc., — the effects of overeating and under-exercising are constantly on show to others. That must be humiliating. But it must also be a motivation to change. Especially, one would have thought, for public figures.
The United Kingdom may be about to get tougher on obesity. James Forsyth recently reported for the Times of London that “the [U.K.] government is rapidly coming to the conclusion that one of the main reasons why the UK has been so hard hit by this virus is how obese the population is. Obesity is the second biggest risk factor, after age, and more than a quarter of Brits are obese. In South Korea, the country that has handled the disease best, only 6 percent of people are.” According to Forsyth, the prime minister, who had previously opposed a sugar tax on libertarian grounds, believes that one of the reasons he ended up in intensive care was because he is overweight. “I’ve changed my mind on [how to tackle obesity]. We need to be much more interventionist,” Boris Johnson is reported to have told his senior ministers and advisers last week.
Policy aside, if length and quality of life is our aim, then it helps to be more straight-talking in fighting obesity. To that end, as was the case with smoking, a certain amount of stigma can be helpful. At the very least, we ought to be able to state the facts without embarrassment.