The story goes, a woman (of clothing size unknown) answered the following way:
"Dear people, whales are always surrounded by friends (dolphins, seals, curious humans), they are sexually active and raise their children with great tenderness.
They entertain like crazy with dolphins and eat lots of prawns. They swim all day and travel to fantastic places like Patagonia, the Barents Sea or the coral reefs of Polynesia.
They sing incredibly well and sometimes even are on cds. They are impressive and dearly loved animals, which everyone defend and admires.
Mermaids do not exist.
But if they existed, they would line up to see a psychologist because of a problem of split personality: woman or fish?
They would have no sex life and could not bear children.
Yes, they would be lovely, but lonely and sad.
And, who wants a girl that smells like fish by his side?
Without a doubt, I'd rather be a whale.
At a time when the media tells us that only thin is beautiful, I prefer to eat ice cream with my kids, to have dinner with my husband, to eat and drink and have fun with my friends.
We women, we gain weight because we accumulate so much wisdom and knowledge that there isn't enough space in our heads, and it spreads all over our bodies.
We are not fat, we are greatly cultivated.
Every time I see my curves in the mirror, I tell myself: "How amazing am I ?! "
(The girl on the picture is French model Tara Lynn)
Lizzie Miller, the 20-year-old model in question, agrees that it's astonishing that, at 5ft 11in and 12.5 stone she's considered a "plus size" model. "It's sad," she says. "In the industry anything over size six is considered a plus-size." Miller, who is around a US size 12-14 (that is, either average or slightly below average) lost about 60lb when she was 13 but today she is considered too large to model for plus-size lines Marina Rinaldi (she says, "they like girls who are an 8-10") or Elena Miro. She says that the overwhelming reaction to the tiny photograph, buried on page 194 of Glamour magazine "shows that the world is hungry to see pictures of normal women."
One wouldn't have thought this would be news. As Miller says, "pretty much every picture in a magazine or ad is airbrushed . . . I don't think the public understands how much smoke and mirrors are involved in making women look like that."
So does the reaction to this picture mean that the tide is turning? Hardly. Even after the deluge of emails, Leive hasn't made a commitment to using average-sized women in fashion shoots, saying only that the magazine wants to celebrate "all kinds of beauty". The outcome for Miller, though, has been more positive. She has received more offers of work since the picture was published. And her model agency, Wilhelmina, has told her that she mustn't lose any weight.
That also reminded me of another recent article where author Jess Weiner talked about being fat and fit. And it begs the question...how do we love ourselves for who we are but still make sure we are healthy enough to stick around for years to come?
Jess Weiner: “Did Loving My Body Almost Kill Me?”
For years, Jess Weiner urged women to accept their weight as is. She, after all, was a happy, successful size 18. But when her doctor warned that her weight posed a health risk, she had to ask: Was her body acceptance making her sick? Could yours be?
My face flushed at her rudeness. I was shocked and embarrassed, but responded firmly: “My body is none of your business.” The audience erupted into cheers.
But the woman continued. “What about health?” she asked me. “How can you be healthy looking like that?”
Again I had an answer ready. “You can’t tell someone’s health just by looking at them,” I told her. “So don’t assume that just because someone is overweight that he or she is unhealthy.” And again the crowd cheered, and that was that. Friends asked the woman to leave, and I finished up my talk, forcing a phony smile.
It wasn’t the first time I’d been confronted about my work and my self-love messages. But that night I felt as though I had been exposed. The woman’s caustic question nagged at me: How healthy was I? My weight hadn’t stood in the way of my dating gorgeous men or succeeding in my career. But I couldn’t remember the last time I’d been to the doctor. And it had been 16 years since I weighed myself. In fact, I’d stopped completely when I began recovery from the eating disorder I’d suffered in my teens. So I didn’t know: Was I really obese? My body wasn’t anyone else’s business, but had I done everything I could to make it my business?
I realized I had to be honest with myself. I had to answer that woman’s question—not for her, but for me. I picked up the phone and made a doctor’s appointment.
My Big DecisionI’m not the only woman with weight issues to shun medical checkups—and the issue of health in general. Like me, many women recovering from eating disorders step away from the scale to focus on their value independent of numbers. And “some heavier women avoid the doctor completely for fear they’ll be shamed about their body,” says Cynthia Bulik, Ph.D., director of the University of North Carolina Eating Disorders Program. Their worries may be legitimate: Studies have found that many doctors have less respect for their overweight patients than for thinner ones, and some experts say that medical professionals have a history of recommending weight loss as a cure-all. “Sometimes it’s hard for physicians to see past a woman’s weight,” says Bulik. “No matter what problem she brings into the office, their immediate response is ‘Well, the first thing you need to do is take off some weight.’ This simplistic thinking is hurting women’s health.”
That kind of bias, along with the finger-wagging from our thinness-obsessed culture, has helped fuel what’s become known as the body-acceptance movement. “If society is saying, ‘Shame on you. You’re lazy. You’re not trying,’ we can expect a defensive reaction among women: ‘Shame on you—I’m heavy, and I’m proud,’” says David L. Katz, M.D., M.P.H., an obesity specialist and director of the Yale University Prevention Research Center.
I’d been a proud leader and a strong voice within that movement. I’d written books and magazine columns, appeared countless times on Oprah and other TV shows, and given hundreds of speeches telling women to love themselves no matter what their size. But now it was time to consider not just my self-esteem but also my well-being. After all, says Dr. Katz, “Women should be able to feel confident in their body image. But there’s a danger in the ‘OK at any size’ message. The fact is that obesity is a risk factor for heart disease, for cancer, for diabetes. It’s not OK to say ‘OK at any size’ if your size has implications for your health.”
I felt I’d be in good hands with Nadini Verma, M.D., the ob-gyn I also considered my primary care doctor. I loved her no-nonsense attitude and warm demeanor, and I knew she’d give me a fair assessment. After she ran a few tests, she sat me down.
“Jess,” she said, “your blood sugar numbers show me that you are almost in the prediabetic range. If you don’t lose some weight and watch your sugar intake, you will get diabetes.” It was a harsh truth: Diabetes is a disease you can’t easily undo. And then she showed me these stats—stats I never thought I’d share with anyone:
250: My weight at the time
99: My blood sugar—anything between 100 and 125 is prediabetic
146: My LDL, or “bad,” cholesterol—borderline high
40: My HDL, or “good,” cholesterol—that number should be 50 or higher for women
150: My triglycerides—borderline high
120/72: My blood pressure—the only figure in a healthy range
Dr. Verma had no pity or shame in her voice as she shared these findings with me. These were just numbers, after all. But these numbers told me that I wasn’t just overweight—I was unhealthily overweight. I wasn’t processing insulin properly. My arteries were quickly clogging. And I was in danger of becoming irreversibly sick.
It didn’t matter in that moment, sitting half dressed in a paper gown, how many books I had written or speeches I had given about loving your body and accepting yourself as you are. The cold, hard truth was that accepting myself as I was was putting my life in danger. But could I really call a public time-out and say, “I’m going to focus on losing some weight now”?
I was about to find out.
Prepping for the BacklashI knew dropping pounds or even talking about a diet could be career suicide for me. When Oprah slimmed down, some of her fans got angry; and after plus-size model Crystal Renn lost weight, some comments were vicious. One skeptic lashed out: “She’s a hypocrite, and her whole pseudo plight for plus-size models was a publicity stunt.” It’s like when celebs get a nose job and say it was because they had a deviated septum—you never believe them. Instead, you think, Now there’s one fewer of us who’s succeeding “as is,” one more woman who caved to the image machine that wants us all to be skinnier, prettier, more “perfect.”
When I confided to a colleague about my plans, she suspected that that exact pressure was getting to me. “Are you sure you want to do this?” she asked.
I wasn’t sure. I didn’t want to join the ranks of women who felt as though weight loss alone made them “healthier.” But when I thought about how I felt physically—weighted down and not as strong and vibrant as I would like—the realization hit me like a ton of bricks: I needed to go deeper than the mantras and speeches. To truly love my body, I had to treat it better.
I started doing just that. With Dr. Verma’s guidance, I sought out a nutritionist, who helped me understand how my body breaks down insulin and who tasked me with choosing foods that have at most 10 ingredients and 5 grams of sugar per serving. (I’ve come to appreciate fresh veggies and whole-grain wraps.) It was a blow to realize how many foods I liked had unhealthy chemicals and extra sugar in them—such as many cereals and yogurts—but she taught me to feed my body five times a day to keep my blood sugar steady. And slowly but surely, things got easier.
Knowing that I enjoy working out in a group, I joined a gym that offered dance and water-aerobics classes. I was one of the bigger women there (I do live in Los Angeles), but I powered through my negative inner voice and kept myself committed. I also started seeing a therapist to work on the emotional baggage I carry and how it plays a part in the way I turn to food for solace, not nutrition.
During those first months, it felt like a fog was lifting. I felt stronger, more in tune with my body. And after 18 months, how were my numbers?
225: My weight
88: My blood sugar—normal!
116: My LDL—out of danger
50: My HDL—up 10 points
129: My triglycerides—no longer a risk factor
110/80: My blood pressure—superhealthy
Here's one last article about the grey area that "fat but fit" creates:
The study contradicts an earlier finding that people who are obese and yet healthy may actually be worse off if they lose weight. What the new study can't do is explain why some people manage to be both obese and healthy ¾ or whether there's really such a thing.
"Right now, we are in a gray zone. Is it really protective to be metabolically healthy?" said Martin Brochu, an obesity researcher at the Université de Sherbrooke in Quebec. "There's a huge debate in the scientific literature right now."
Obese, but healthy?
Researchers have long known that excess weight doesn't affect everyone the same way. Obesity is defined as having a body mass index of 30 or over, a measure that includes height and weight but not other related measures like the ratio of muscle mass to fat. At the population-wide level, BMIs over 30 are associated with numerous health problems, including cardiovascular disease and diabetes. But the measurement is less sensitive when it comes to predicting individual health.
Starting in the 1960s, researchers noted that some obese individuals didn't have the hallmarks of weight-related illnesses. Some had normal blood cholesterol and normal insulin sensitivity, meaning they lacked risk factors for heart disease and diabetes.
In the last decade, research on these metabolically healthy obese individuals has ramped up. In 2001, Brochu and colleagues tested 43 obese, sedentary and post-menopausal women and found that 17 of them qualified as metabolically healthy. The key difference between the healthy and unhealthy groups? Where they stored their fat. Those who were healthy had half the visceral fat, or deep belly fat, of those who weren't. Other studies have shown that visceral fat, which packs around the organs in the abdomen, is more detrimental to the body than the subcutaneous fat found just beneath the skin.
There's no universal definition of metabolic health in obese people, but researchers estimate that between 25 percent and 30 percent of the obese have normal metabolic profiles. Now they're struggling to understand what that means. Why do some people resist packing on bad belly fat? And if they're already healthy, should they bother to lose weight?
A 2008 study published in the journal Diabetologica suggested the answer to that second question is "no." In that study, 20 metabolically healthy obese women and 24 metabolically at-risk women went on a six-month diet to lose weight. Results showed the women who were metabolically healthy actually experienced a 13 percent decrease in insulin sensitivity after losing about 6 percent of their body weight. Since decreased insulin sensitivity is a risk factor for heart disease and type 2 diabetes, the findings suggested that losing weight made the metabolically healthy obese women less healthy.
One study isn't cause to skip your the gym, however. Last month, Janiszewski and his Ph.D. adviser published a study attempting to replicate the 2008 study's results. They included other weight-loss methods, like exercise, and studied both men and women.
After six months, the researchers measured the participants' insulin sensitivity. The results failed to match the findings of the previous study: Regardless of how the metabolically healthy obese people lost weight, their insulin sensitivity improved by 18.5 percent. Metabolically unhealthy people improved more, perhaps because they had more to gain.
"There should be no fear, regardless of what your metabolic status is, of being active," Janiszewski told LiveScience. "You certainly won't get any worse with exercise and diet, and you have a likelihood of improving some metabolic risk factors."
Antony Karelis of the University of Quebec at Montreal, the author of the 2008 study, said that the two studies were hard to compare, because the two groups of researchers used different measurements and methods. But, he said, more studies are needed that take metabolic health into account.
"I think we should actually promote weight loss in these individuals, but we need to find out, what is the best way to do it?" Karelis said.
But how are we defining 'health'?
Obesity researchers are quick to note that this academic gray area is no excuse to pack on the pounds. Obesity is a major public health issue, responsible for 9 percent of total U.S. medical expenditures in 1998, including out-of-pocket, insurance and Medicare/Medicaid, according to the Centers for Disease Control and Prevention. And good metabolic indicators may not capture the full picture of what it means to be healthy. Even the metabolically healthy obese are at higher risk for health problems like joint pain, and obesity has been linked with depression.
There's also no guarantee that being obese but metabolically healthy reduces the risk of dying sooner than metabolically at-risk individuals. A study published last year in the journal Diabetes Care found there was no difference in the age of death between metabolically healthy and metabolically unhealthy obese people over a follow-up of nine years.
Part of the reason, said Jennifer Kuk, a professor at York University in Toronto who led the study, seems to be that obese people are more likely to die of cancer and trauma-related causes regardless of their metabolic status. Cancer may claim lives, because obese people are more reluctant to see their doctors, Kuk said, and trauma injuries may be more difficult to treat in people with greater body mass.
The bottom line: diet and exercise
Kuk's findings suggest weight loss might be beneficial no matter what your cholesterol levels tell you. But given research showing that most people fail to maintain weight loss (and findings that yo-yo weight loss and gain may be psychologically and physically harmful), the best message for the metabolically healthy subset is unclear.
"Whether we should be actively promoting weight loss knowing that over 90 percent of these individuals are going to fail is a question that I don't think anyone can answer at this point," Kuk said.
At least some clinicians are considering increasingly sophisticated screening procedures to separate metabolically healthy from metabolically unhealthy patients in the doctor's office. In 2009, researchers proposed a new scale in the International Journal of Obesity that would take into account metabolic risk factors. Under that scale, metabolically healthy obese patients would be counseled to maintain their weight by eating well and exercising.
Amid the debate over the benefits of weight loss, one thing is certain, Janiszewski said: The “eat well and exercise” message is good for everyone.
"Weight isn't maybe the most important thing you should look at," he said. With a healthy diet and exercise, "even if the scale says zero change, you're still getting a lot healthier and reducing your risk of disease."