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The Delectable Myths of Healthy and Healthier Obesity

Kenneth W. Krause is a contributing editor and “Science Watch” columnist for the Skeptical Inquirer. He may be contacted at krausekc@msn.com.

Why, sometimes I’ve believed as many as six impossible things before breakfast.

—The Queen to Alice in Through the Looking Glass

Wouldn’t it be splendid to have our cakes and eat them too? Arguably, both ideology and popular culture allow their followers to do just that. Until they don’t, of course. At that point, when facts and logic can no longer be denied, the rudely awakened find themselves confronted with difficult choices.

The concept of healthy obesity, for example, has gained much traction during the past fifteen years. At one end of the continuum, members of the popular but clearly flawed “Healthy at Every Size (HAES)” movement profess the nonexistence of excess adiposity and suggest that even the most obese people can lead perfectly healthy lives (“Every size”—really?). On the other end, and somewhat more credibly, others allege the existence of an “obesity paradox” and a “metabolically healthy obesity.” Such are the tantalizing subjects of this column.

Cardiologist and obesity researcher Carl J. Lavie has described the paradox as follows: “Overweight and moderately obese patients with certain chronic diseases . . . often live longer and fare better than normal-weight patients with the same ailments” (Lavie 2014). In addition to his own research, Lavie’s conclusions are based on a revolutionary (and, in some circles, much-celebrated) Journal of the American Medical Association study led by Katherine Flegal at the U.S. Centers for Disease Control and Prevention, who reviewed ninety-seven studies of more than 2.88 million individuals to calculate all-cause mortality hazard ratios for standard body mass index (BMI) classifications (Flegal et al. 2013).

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