In Apologetics, Dryasdust on 25 June 2010 at 15:15

I haven’t thought a lot about the epidemiology of fat lately, and I’ll tell you why: you will nowhere find a more fruitless endeavor. Life expectancy’s up; cardiac disease, down. Honestly, the fifteen-odd pounds we have on our forebears seems, if not the cause, then certainly a benign-enough byproduct of our national condition. Of course that’s incompatible with mainline discussion of the obesity crisis, which is a moral panic, and the opposite of science, at any rate indistinguishable from the pseudoscience patter that has underwritten just about every other kind of bigotry at one point or another.

And yet.

So-called overweight’s protective effects are exhaustively documented, often in studies designed to prove the opposite. But what do we know, really, about the deleterious effects of adiposity? Besides being hell of rough on your triglycerides, I mean. As it turns out, beyond the realm of speculation, not a whole lot.

There is exactly one clinical problem directly implicated with fatness: osteoporosis, which is indeed aggravated in very fat persons. It’s not a causal relationship, mind, but assuming the coincidence of porous bones and fatness, what might be prescribed?

Oddly, it’s conditional. Within certain limits, fat actually mitigates osteoporosis, and both are indifferent to aerobic exercise. Restricted calorie diets may engender nutritional deficiencies that accelerate bone loss in the genetically predisposed, irrespective of weight, and chronic dieting has been observed to decrease bone density in fat premenopausal women. And it’s still, overwhelmingly, a disease of the very thin. Fatties can’t even win at their own epidemic.

So it is, all the way down the risk factor checklist, with the tiniest amount of time and attention paid.

It occurred to me the other day that fat – considered, in excess, a prima facie pathogen – has come to occupy the place of the medieval humours, and diet and exercise regimens, to make no mention of actual invasive surgery, are absolutely modern bloodletting. The parallels are actually kind of spooky: near-universal support from the medical establishment, temporary and perceptual gains in health, and, on the unlikely realization of its stated goal, mortality.

Physician, heal thyself.


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