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Is Fat the New Normal?

A rise in average body weight may be changing how we see ourselves.

Obesity Hotspots

Jana Gordon Bunsic, DO, has seen evidence of this first-hand in her practice. She's a board-certified family physician and clinical nutritionist in Morristown, Tenn. – a town in a state with one of America's highest obesity rates.

"Upon moving my family and my medical practice to east Tennessee, I was immediately surprised by the prevalence of obesity in the area," says Bunsic, who used to live in south Florida. She cites a culture that's fond of "biscuits and gravy," as well as too little exercise. "The society is quite rural, and few people walk or ride bikes from place to place."

With obesity being so common, Bunsic finds her patients have a skewed idea of what's normal. "A 16-year-old patient came in with his mother the other day," she recalls. "By following my recommendation, he had lost 45 pounds… His mother was very concerned he was starting to become too thin" even though he was still overweight by medical standards.

Changing Perceptions

Skewed perceptions are not confined to Tennessee.

"It's taking more and more weight as time goes by for people to judge themselves heavy," Christakis says. In a study using government data, he found that obese people generally knew they were obese 20 years ago. That's not necessarily the case anymore. In 2007, a National Consumers League survey showed that although 34% of adult survey participants were obese, only 12% said they had ever been told that by a health care professional.

Contributing to these changing perceptions is a fashion trend known as vanity sizing. Manufacturers have made clothing sizes more forgiving over the years. "This is making women feel good about themselves," Kushner says, "but the bad thing is it's supporting the weight increase in the population."

Pros and Cons of a New Normal

Kushner sees two positives in society's changing views of weight. One is that overweight people "don't tag so much of their self-esteem to weight," Kushner says. The other is that women of a healthy weight are less likely to see themselves as fat. With so much more of the population being truly overweight, those in the healthy category may feel slim by comparison.

But Kushner cautions that there is a downside, particularly for the obese. If people don't recognize that they have a problem, they'll be less motivated to lose weight, he says. And although the social norms may be changing, the health risks of obesity are not.

Health Risks of Obesity

"It's clear that being overweight is bad for your health," Christakis says. This does not mean that everyone who is overweight will develop health problems, but the risks are well documented. Excess weight has been linked to diabetes, arthritis, heart disease, and some forms of cancer. And last year, a study found that weighing a third more than your ideal weight could take three years off your life.

"Many [patients] intuitively know their weight is a big part of their diabetes, hypertension, lower extremity swelling, and feeling poorly," Bunsic says, "but they have never had a doctor tell them that their weight was a root cause."  To turn the situation around, she says doctors should counsel patients about the dangers of being overweight and help them develop accurate perceptions of what is normal.

Christakis agrees, but he says health professionals must handle the issue of weight delicately. "People could tell their patients, ‘When you make an effort to lose weight, it doesn't just benefit you.'" The bottom line: Healthy habits tend to spread among social contacts. So when you make a positive change in your life, it may also affect the people you care about.

Reviewed on January 26, 2010

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