Feeling fat may be worse for you than actually being fat

News broke in the UK this week that prescriptions for obesity drugs topped 1 million in 2006 ” an eight-fold increase in just seven years. No doubt some of this increase has come about as a result of the increasing dire statistics about the burgeoning rates of obesity. However, as I revealed here and here, anti-obesity medications have generally limited effectiveness, and clearly not the answer to the obesity ‘epidemic’ we are told we are in the grips of.

Another reason for not putting too much faith in such medication is that there is compelling evidence to suggest that the health risks of excess weight have been distorted. Basically, the bulk of the evidence suggests that individuals in the ‘overweight’ body mass index (BMI) category enjoy health at least as good, if not better, than those in the ‘healthy’ category.

One factor that may be driving the somewhat distorted messages about obesity and the ‘need’ to lose weight is commercial in nature: pharmaceutical companies, food companies selling foodstuffs with a weight loss angle, and the fitness industry, for instance, will all do a bit better out of having individuals have an exaggerated sense of what they might lose by not losing weight. However, if the results of a new study are to be believed, there is some suspicion that just feeling like there’s weight to be lost might be contributing to the our physical and mental disease burden.

The study in question was published on-line in the American Journal of Public Health [1]. The research involved analysis of data gained from over 170,000 US adults.
Data on these individuals included their actual weight, as well as their perceived ideal weight. Together, these give some measure of an individual’s belief about whether they are overweight or not. Other information gained on the study participants was the number of days in the last month when they felt either their physical or mental health was not good.

The results of this study showed that the more weight an individual felt they had to lose, the more likely they were to experience ‘bad’ days in terms of their health. For example, compared to those who thought their weight was ideal, women who felt they needed to 10 percent of their body weight reported an additional 1.6 healthy days a month. For women who assessed themselves to be 20 percent overweight, additional unhealthy days amounted to 4.3 per month.

The results in men were not as stark: additional unhealthy days for men rating themselves as 10 and 20 per cent overweight were 0.9 and 2.7 days a month, respectively.

The suggestion here is that feeling as though you are overweight may be worse for health than actually being overweight.

Now such associations could be as a result of age (older individuals may be bigger and more likely to be sick). And obviously, those who are bigger may actually be at risk of ill health. However, the associations between perceived weight status and self-ratings of health stated above were calculated after these factors had been taken into account. In fact, overall, an individual’s beliefs about how much weight they have to lose had a stronger correlation with self-reported health than weight (BMI) itself.

I saw Dr Peter Muennig, the lead author of this study, quoted as saying: “There needs to be a realization among public health officials and medical professionals that the messages we are giving the public could be doing more harm than good”. There’s a familiar ring to that sentiment: only a week ago scientists were claiming that conventional ‘low-fat’ nutritional paradigm might be doing more harm than good too.

It wouldn’t be right, I think, to infer too much from this single study. However, my experience in practice is that weight issues can be a considerable source of stress and unhappiness in people’s lives. And let’s not imagine for one moment that stress cannot translate into not just emotional upset, but physical illness too (because it can). What this means is that there is a plausible reason for how feeling there is weight to lose could increase sickness.

Personally, I’m glad that the traditional concept of what a desirable weight is being challenged here in the UK. There is much more work to be done in terms of reframing public perception in this regard, but it’s a start.

I also think health professionals would do well to embrace the data which demonstrates excess weight to be not as much of a risk of health and longevity as we have been led to believe. I’ll leave you with another quote from Dr Muennig: “It has long been recognized that “fat” does not necessarily equal unhealthy. Nonetheless, we doctors often have a very visceral reaction when we see an obese person in our office. This visceral reaction sets off a red light that says, ‘tell this person to lose weight.’ That is not the right way to approach obesity.”


1. Muennig P. et al. I Think Therefore I Am: Perceived Ideal Weight as a Determinant of Health. American Journal of Public Health 2009 [epub 30th January]

3 Responses to Feeling fat may be worse for you than actually being fat

  1. Fiona 1 February 2008 at 4:02 pm #

    I think that this is very interesting – there is no doubt that feeling bad about weight is a national obsession. The issue of the health risks of overweight sells many magazines and newspapers, and weight seems to be the last non-taboo – anything may be said about people who are overweight in the guise of ‘concern’ for their health. And of course, if someone does want to lose weight, starting from the position of feeling negative about themselves is very bad – we all know it is easier to achieve something when in a positive frame of mind.

    Thank you, Dr Briffa, for continuing to inject a sense of reality into the often baffling world of medical advice!

  2. nina patel 3 February 2008 at 7:32 pm #

    I agree with everything you say and strongly believe that there is another agenda behind public health cries of populations being overweight. However, why do you have a range of hyperlinks promoting ‘weight loss programmes and pills’? Just an observation but I would love to know


  3. Dr John Briffa 3 February 2008 at 7:43 pm #

    Please read ‘A word about the adverts that appear on this site’ on the home page for more information on the links to which you refer.

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