We can’t seem to resolve questions of fat and health because we’re emotional beings
Back in the late 60s and early 70s, I was captivated by attempts to breed giant pandas in captivity. Pandas were so rare and the difficulties of getting them to breed made it a big deal. Every move made to try to get a couple of pandas to mate made the news. Like a lot of children, I even knew the names of some of the pandas. Blue Peter and Newsround reported every collaboration between zoos world wide to get the pandas to get it on. In a U certificate kind of way.
Back then, the biggest problem was getting the pandas to mate at all. Then there was the wait to see if the pregnancy was successful. That again was rare - and it was a long wait to find out. In the 1960s, only around 30% of the babies that were actually born survived.
We kids were all on tenterhooks. It was a life lesson in patience and how to cope with disappointment. It was the biggest soap opera in town. Well, in our house because my dad refused to watch ITV and he certainly wasn’t going to have Emmerdale Farm or Coronation Street on over his dead body.
Nowadays, around 90% of pandas born in captivity survive. The knowledge of how, what and why pandas conceive, give birth and survive the first few days and weeks has increased by trial and error, by exchange of information, observation and analysis of data.
One of the breakthroughs from this process for example, was the discovery that baby pandas can’t poo on their own. A lot of newborns were dying of constipation. I can’t help but see myself back in my childhood home (with the avocado bathroom suite), hearing the latest sad news of a baby panda death, and being completely oblivious to the fact that the poor thing might be constipated to death.
No public arguments, name-calling or vitriol flew around while panda-breeding mistakes were made. Just communication - quite often across the Iron Curtain, observation, analysis, move forward.
So why isn’t it always like this? In particular, why can’t we get a consensus on how fat affects health?
Because it is as much a life or death question for us humans as it would be for giant pandas. And if we were asking how fat affects the health of giant pandas, I’m pretty sure we’d have some answers by now.
If you don’t believe me, I enter into evidence these 5 questions about the role fat plays in health which we still haven’t put to bed a fifth of the way through the 21st century.
Is dietary fat good or bad?
This is a debate that has been going on for decades. If you’d asked that question during the 1980s, the answer would have pretty much been: yes, it’s bad for you.
Now this one is winding us up all over again.
The view that the role fat plays in health is not good was very strongly influenced by US public policy (in particular by the American Heart Association), which in turn was influenced by Ancel Keys. Keys argued that a diet which included large amounts of animal fat would lead to coronary heart disease. Essentially eating fat created body fat and heart problems.
Keys had also concluded that unsaturated fat from vegetable oil had beneficial effects.
Keys won the political argument and his views became policy in the US. Much of the west followed suit to a greater or lesser extent.
To cut a very long story short, this lead to a clear message that animal fat is bad for you and a resulting change in food manufacturers’ strategies. Foods that were low in fat became widely available. But the loss of taste caused by reducing fat content had to be replaced somehow to make food palatable. Most often, this meant that sugar was added to food to bring taste to it.
It also resulted in fats like butter and lard being replaced by manufactured polyunsaturated fat products.
During the same period, though, obesity also became a lot more commonplace, which lead to a lot of headscratching. Some of that headscratching lead to the opposite extreme (dietary fat is good for you, carbohydrates are bad for you), yet more of it sparked long term health studies which haven’t reported full results yet.
The debate in this arena is very heated, as opinions and vested interests from all sides fly around.
Public health advice has been slow to react as the debate has fired up, so every kind of source has been filling the vacuum it has left.
And therein lies the irony in the Ancel Keys story. Usually, changes in public health advice have to be well-grounded in exhaustive studies and agreed by medical and other health bodies.
Keys managed to get his opinions fast-tracked through the political process and they have been influencing public policy ever since. Re-evaluating that policy is a long, hard, emotional process.
The fact that this question still hasn’t been resolved shows how much politics and public policy can make us uncertain about how fat affects health.
Can body fat play a positive role in our lives?
Quite often, when I read about new breakthroughs in nutritional research, it turns out that a lot of things that are only just coming to our attention have been floating around since Victorian times. Now and again I find out that even the ancient Greeks might have been on the right path with something that is just coming back into view.
So when I start looking into something which seems to have been discovered in the 21st century, I always expect to read that some Victorian gentleman doctor had published on it in the 19th century but his ideas never gained traction, or even to unearth a pithy quote from Hippocrates on the subject.
Imagine my surprise when I started researching brown fat and health and found that it was only discovered in adults in 2009! Apparently it was known that babies carried it before then, but not adults.
That 2009 research also showed that people with lower BMIs tend to have more brown fat. The researchers concluded that brown fat might play a role in adult metabolism. It seems to be activated by cold to help us keep our body temperature stable. And it could turn out to help prevent obesity and diabetes because it consumes energy.
Brown fat apparently also supplies essential fatty acids and ferries vitamins A, D, E and K into and around the body as well as helping keep skin, eyesight and brains healthy.
The jury isn’t quite ready to reach its full verdict, but clearly there’s more to body fat than meets the eye. Pun absolutely intended.
This is a good example of a question about how fat affects health that’s been hiding from us in plain sight, because we weren’t asking the right questions. Probably a bit like they panda poo.
Why is (female) body fat still up for debate?
In June 2018, the Guardian newspaper marked the 40th anniversary of the publication of Fat Is A Feminist Issue with an article by its author, Susie Orbach. Susie’s conclusion is that yes, fat is still a feminist issue. Girls and women are still profoundly dissatisfied with their bodies, just as they were in the 60s and 70s. We’re desperate for approval as diet culture tells us we should be. 40 years on and this desperation is still holding us back. Here we have a clear example of a question about fat and health which affects both mental health and public health.
While the parameters in the fight may have changed - we’re not so much burning bras as trying to take on the porn industry and make #metoo stick - bodies, especially female bodies, are still up for auction.
Anyone - male and female - can comment publicly on a woman’s body shape and we still haven’t really got round to condemning it as morally unacceptable.
This is an example of a behaviour that was already so ingrained before the age of social media that it just carried on and embedded itself even more deeply once Facebook and Instagram were properly up and running.
We are so used to this behaviour that we just can’t seem to collectively call it out for what it is. Opposition is still only really coming from lone calls in the wilderness.
This is a clear example of herd mentality getting in the way of answering the question of how fat affects health and it shows how embedded cultural norms can guide our behaviour - even when they are not in our best interests.
Can you be fat but fit?
I’m taking a deep breath for this one, because I think it’s the most contentious issue in this list of questions about how fat affects health.
On the one hand, you’ve got the “obesity is a drain on the NHS, eat less and move more, simples!” crowd (anyone else hate that word “simples”, or is it just me?)
On the other hand you have body positive advocates insisting that they are perfectly healthy. A large number of people in this group are reclaiming the word “fat.
Now, I’m going to say that most people, myself included, recognise that the first of those two views is at best immature and at worst just nasty.
The ground moves a lot more under the second one, though. I’m of the view personally that it is not for me to tell someone else that they are healthy or unhealthy by just looking at them. What do I know about their lives that gives me the right to judge?
However, I also think that all other things being equal, less strain on joints and vital organs is healthier than more strain on joints and vital organs. But here’s the thing: I can never know that all things are equal and what’s more the chances of all things being equal are pretty much nil. Here’s a little scenario to try to explain what I mean.
Let’s say we have two parallel universes. A woman - let’s call her Debra - lives on universe 1 and has a parallel - let’s call her Deborah - in universe 2. Everything in Debra and Deborah’s lives is identical, except for 2 things.
1. The difference in the spelling of their names and (because writing Debra 1 and Debra 2 all the time is clumsy) and 2. The amount of body fat they carry; Debra weighs 65kg, while Deborah weighs 130kg. Other than this, they are identical: they have the same family , the same medical history, the same education, same DNA, live in the same environment and do the same work and have the same mental health history.
Now, let’s say I’ve got some kind of superpower that allows me to know everything about Debra and Deborah. Kind of like the Christian God knows everything about everyone. So I know that they have identical lives apart from the weight difference. Now someone asks me who is more likely to be in better physical health and have a better prognosis for quality of life. In this scenario, and this scenario only, I’m saying Debra does.
Of course this is a really silly story, because life doesn’t work like this. And in my world it’s just as silly to make judgements about what the state of someone’s health should or could be just by looking at them.
The dilemma is that it’s not for me to say whether or not any person can get healthier by having less (or more) body fat, but at the same time I know that carrying around a lot of excess body fat (or too little body fat) can have health consequences over time that affect quality of life.
Have I made myself perfectly unclear? Good!
One of the reasons this aspect of how fat affects health is so contentious is because it touches on aspects of personal physical health, mental health and public health. That’s a heavy burden to carry.
Why is it even possible to weaponise the word “fat”?
When someone calls you “fat”, it’s guaranteed to hit home, because thanks to our diet culture it’s one of the things we’re most afraid of or most ashamed of.
It’s an insult that might trigger an eating disorder at worst and at best hangs around in or memories for years and years. No one forgets being called fat.
It seems to be the number one go-to insult for bullies everywhere. But why is that? Is that because instinctively know it’s actually what most people are most afraid of; being seen as overweight and, by extension, lazy and stupid and clumsy?
I think deep down we all recognise that this the word fat gets used because it hurts universally - and unfairly.
We can actually use that one word to manipulate another person’s mental health! The goodies are afraid to talk about it for fear of upsetting anyone, the baddies are happy to use it as a weapon.
That we can do so much damage with the word shows how important it really is to understand how fat affects health.
Science alone can’t answer all the questions of how fat affects health
These open questions show that all aspects of the human condition can hinder progress towards better knowledge of the role fat plays in health in a way that can benefit us all.
We’re hampered by policy, by political power games, by fear, by herd mentality and by the Patriarchy (yes, I mean it). It doesn’t help that we have only really just started to explore the relationship between body image and mental health.
Fat is a physical health issue, a mental health issue, a political issue, a feminist issue and also a public health issue. It’s also an economic issue, which I haven’t even touched on here.
It’s no wonder that it’s easier to work out how to send someone to the moon or raise the survival rate for pandas in captivity.
To move forward, we need to accept that the conversation will be difficult, but embrace it anyway. Let’s hope we can make progress by 2030.