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Forget about looking good, forget about thin privilege, forget about fat privilege, forget about your personal rights and civic obligations, forget about your abs and your guns and your lats and whatever other laundry-list of nonsense is now used to describe your various bodyparts. Forget about all the normal scares?—?atherosclerosis, and arterial plaque, and cardiac arrest, and pulmonary hypertension, and stroke, and a laundry list of cancers, and diabetes, and metabolic syndrome.
Specifically, let’s discuss 5 areas of research in the health and medical sciences which provide good reasons not to be fat. These reasons are alarmingly neglected in the public debate about obesity, nutrition, dietetics and exercise.
They are less alarming than arguments about whether or not you’re going to die.Or, for that matter, be diagnosed with something horrible.
This doesn’t make them inconsequential, just less consequential than getting a horrible illness or dropping dead.
So, as might be expected, they broadly concern conditions which are mainlyquality of life issues. It’s very common, because one of the primary risk factors is age, and the fact that everyone’s grandma has a twinge of it hides the degree to which it can be very unpleasant and debilitating. We used to think obesity was just a matter of loading?—?more weight, more force over the knee joint, right? In English, this says the increase in properly diagnosed osteoarthritis of the knee between obese and normal people is more that 6-fold. Adipose tissue, once considered a passive storage portal of energy, is now recognized as a highly metabolic endocrine organ with the capacity to secrete active agents including adipocytokines, such as leptin, resistin, and adiponectin.
There are a few straightforward mechanisms connecting body fat to the development of sleep apnoea. This is a prospective cohort study?—?they followed a large group of people over time to see the interrelationship between different bodily changes. I can find an even scarier number for children though, albeit from a small study?—?46% of obese children had sleep apnoea. This is the issue here which is most seriously under-recognised, probably because we have to make the step from neuroscience research to human behaviour. The results from the present study support this proposition as individuals who were orally hypersensitive to C18 : 1 consumed less habitual fat and tended to consume less fat as a percentage of total energy intake. Facial expression results were consistent with our hypothesis, showing that bittertasting stimuli (grapefruit and chocolate) elicited significantly more intense disgust reactions and less neutral state reactions in the high BMI than in the low BMI condition. But for our purposes here, there seems to be an association between body fat and the sensitivity to both pleasant and unpleasant flavours.
Now, those of you who have sharp eyes will have noticed that I haven’t framed this as a reason not to be fat.

From the simple perspective of wanting to maintain your normal interest and pleasure in food, I’d argue yes. I’m not an endocrinologist, so I found approaching this topic a bit more challenging than the others. But as luck would have it there are two excellent and recent review papers on this?—?I shall now quote heavily from them, look clever by association and give my poor fingers a rest.
Adipose tissue in general and adipocytes in particular secrete a great number of bioactive molecules of different nature, collectively termed adipokines, many of which have immuno-modulatory actions.
Obesity clearly interferes with protection against infectious agents, and therefore increased research for a better understanding of the interactions between excess adipose-related metabolic abnormalities and immune cell activity is needed. As it says above, the link between excess bodyfat and the immune system is the fat itself?—?it isn’t just a passive storage unit, it’s an active endocrine organ. If I ever need surgery, I’m going to carve whatever spare bodyfat I’ve got off as soon as possible. Seriously, pop any related search terms through PubMed and see the wonderful array of horrors you can find. And not only are post-operative outcomes worse, but put this together with the need for more operations in the first place.
Narrative analysis of the 22 reviews included show gestational diabetes, pre-eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight.
Let’s not pretend I’ve scoured the world looking for negative information, and I’ve cherry-picked the few precious bits available.
This is something of a shame, because I seriously doubt that either side of the acerbic public debate over body size and morality is contributing anything towards solving the problem of keeping people alive and happy. Maybe sore knees and pesky infections and bad sleep should see a little more attention, if we’re actually trying to help this problem along.
Forget about Fat Wars, and shame, and size oppression, and the fact that you’re beautiful just the way you are (which is thin, or fat, or self-identifying as a mollusk, or whatever other wretchedness the internet has spawned this week). Or if that’s impossible, let’s corral those feels as much as possible so we can discuss just tissue.
When we talk about public health outcomes, there’s a lot of focus on overall mortality from heart attack, stroke, cancer, etc.?—?things which don’t impair your health as much as take away your ability to have any.
One thing that has been (usually correctly) noted about associations between obesity and disease in studies of hundreds of thousands of people is that big increases in proportional disease risks are tempered by the fact that they are very minor risks in the first place. Most of these issues are clear and present dangers?—?if you are fat, one or more of them are borderline guaranteed to directly affect you. This is a degenerative joint disease characterised by the loss of cartilage and the destruction of bone joints.

Over the past decade, interest in these adipocytokines has quickly become an area of intense study with respect to osteoarthritis based on evidence that they may play an important role in cartilage homeostasis and because of their emerging potential as therapeutic targets.
It would be more true to say that gaining significant weight seems to result in flavour perception which is fundamentally altered. This observation is confirmatory to animal models, and strongly suggests that in human subjects, oral sensitivity to fats may be a determining factor in fat consumption. The next question is causality?—?is this something that you ‘learn’ if you gain weight, or is there a predisposition at work which means that certain types of ‘tasters’ are more likely to acquire different dietary habits? Especially considering the most obesogenic foods just accidentally-on-purpose happen to pander directly to this dysfunction by having aggressively over-sweet, over-salty, over-fatty, etc. Maternal obesity is also linked to greater risk of preterm birth, large-for-gestational-age babies, foetal defects, congenital anomalies and perinatal death.
Looking for academic sources for everything I wanted to say was extremely straightforward?—?I’ve just picked the most summarisable bits out of the towering mound of available evidence.
And certainly, the collective recognition of the very serious health problems concomitant to the obesity epidemic doesn’t seem to affect behaviour a great deal. In the absence of some deeper psychological problem (which may well get WORSE, not better, with your waistline), I’ve heard or read a thousand stories of people who lost weight, and people always seem just a titchy bit better off.
Let’s make up an example: if the risk of bladder cancer in normal weight people is 15 out of 10,000 and that goes up sharply by a WHOLE 60% (which sounds like a great deal!), that risk increases to 24 out of 10,000. Moving less means less joint loading and tissue turnover and muscle weakness (which means force doesn’t get cushioned correctly), which means the condition worsens… which means more pain. While the neurological evidence seems to quite robustly support the idea that normal taste processing is disordered in obesity, does thistechnically constitute a dysfunction?
For a start, macrophages and lymphocytes can be normally found in the non-adipose fraction of the tissue. For instance, Caesarean birth rates are much higher… in the normal population it’s about 1 in 5, increasing to 1 in 2 in the morbidly obese.
These feelings make them upset and insane and hurtful, and they validate their feelings by battering others about the head and neck with them. They’re very well established, as we shall soon see, they just seem to be less well established in the public consciousness. In other words, the inflammatory environment created by excess fat seems to be provoking osteoarthritis over and above the effects of increased joint loading.

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