The thin paradox

A few months ago, fat rights agitator Marilyn Wann stated on an e-mailing list that, in addition to an “obesity paradox”, there is a “thin paradox”, which she defined as thin people having diseases that supposedly only fat people get. Some diseases or conditions occur more frequently in fat people, such as high blood pressure, high cholesterol, and diabetes. When a fat person has these, he or she is told to become thin. But if thinness cured these, then thin people would never get them. And yet, they do.

Of course, healthier behaviors such as more varied food intake and more physical activity can have a positive effect on these conditions, and can sometimes lead to some weight loss, but as we’ve said before on this blog, the evidence shows that it’s the healthier behaviors that cause the improvements in health, not the weight loss.

Then we come to the fact that fatness seems to have health benefits, in that (for example) among people who have heart attacks or strokes, fatties have higher rates of survival than thin people. That’s the “obesity paradox” that is mentioned in journal papers and even in the popular press. To the medical establishment, anything like this is a paradox because fat is supposed to be 100% bad.

But the “obesity paradox” has a corollary: the “thin paradox”. It should be just as paradoxical to the medical community that thin people get “obesity-related” diseases as the fact that fatness has benefits. The fat-o-sphere has much discussion (and rightly so) of the harm done to fat people by the assumptions that fat people (a) are never healthy, (b) are unhealthy because of their fatness, and (c) it’s their fault for being fat.

But what about the harm done to the thin people by the assumptions that they are always healthy, and that their thinness is in any case unrelated to any illness they may have? (Or if it is they must be anorexic: http://fathealth.wordpress.com/2009/09/23/thin-and-losing-weight-youre-not-sick-youre-anorexic-or-bulemic/) It seems to me that thin people are poorly served by these assumptions. The real paradox is, how can doctors hold on to a belief that harms both fat and thin patients while at the same time telling themselves that they are doing what’s best?

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13 thoughts on “The thin paradox

  1. I often wonder about this myself, as these assumptions really hurt both fat and thin people alike. How about thin people who don’t get tested and develop diabetes without any care? it makes me so sad.

  2. I believe it to be true, my bff was an incredibly fit and muscular, active man. Then a horrible genetic disease completely devastated him. Almost lost his eyesight to incompetence of diagnosis… as just the tip of how harmed he was by being viewed as “healthy.”

  3. “But what about the harm done to the thin people by the assumptions that they are always healthy, and that their thinness is in any case unrelated to any illness they may have?”
    That is a really good point!

  4. Something that hurt me when I was younger was the assumption that I was healthier while being both fat and anorexic. Doctors ignored the signs and gave me positive feedback for effectively starving myself. When doctors believe these stereotypes about fat and thin people make it difficult for people struggling to get the help they need.

    I am thankful my current doctors ask when they notice a weight shift (I go in frequently for a separate condition) “Brittany, what’s going on in your life. Are you exercising? Are you eating healthily?” instead of “Congrats on the weightloss”. For some people it means the same thing but for me, it makes all the difference when someone I respect shows appreciation for healthy living verses weightloss at any cost.

  5. My grandmother was naturally slim, at first glance she would have been considered very healthy. She walked twice a day, ate garden fresh veg etc. She also had a tumor growing in her colon that eventually killed her. Her doc. never gave her the right tests cause he assumed she was fine. My aunt was on the otherside, and also died of cancer due to her fear of doctors, (and how they would treat her due to her weight. Stereotyping your patients is not a good plan.

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